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Bøje RB, Bardou M, Mensah K, Rico Berrocal R, Giorgi Rossi P, Bonvicini L, Auzzi N, Taut D, Jiboc N, Tisler A, Reintamm K, Uusküla A, Teixeira M, Firmino-Machado J, Amorim M, Baia I, Lunet N, Michaylova R, Panayotova Y, Kotzeva T, Andersen B, Kirkegaard P. What are the barriers towards cervical cancer screening for vulnerable women? A qualitative comparative analysis of stakeholder perspectives in seven European countries. BMJ Open 2024; 14:e079921. [PMID: 38760040 PMCID: PMC11103196 DOI: 10.1136/bmjopen-2023-079921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/31/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES The aim of this study was to map and compare stakeholders' perceptions of barriers towards cervical cancer screening for vulnerable women in seven European countries. DESIGN In Collaborative User Boards, stakeholders were invited to participate to identify barriers towards participation in cervical cancer screening. SETTING The study is nested in the European Union-funded project CBIG-SCREEN which aims to tackle inequity in cervical cancer screening for vulnerable women (www.cbig-screen.eu). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania. PARTICIPANTS Participants represented micro-level stakeholders covering representatives of users, that is, vulnerable women, meso-level stakeholders covering healthcare professionals and social workers, and macro-level stakeholders covering programme managers and decision-makers. METHODS Across the seven countries, 25 meetings in Collaborative User Boards with a duration of 2 hours took place between October 2021 and June 2022. The meetings were video recorded or audio recorded, transcribed and translated into English for a qualitative framework analysis. RESULTS 120 participants took part in the Collaborative User Boards. Context-specific barriers were related to different healthcare systems and characteristics of vulnerable populations. In Romania and Bulgaria, the lack of a continuous screening effort and lack of ways to identify eligible women were identified as barriers for all women rather than being specific for women in vulnerable situations. The participants in Denmark, Estonia, France, Italy and Portugal identified providers' lack of cultural and social sensitivity towards vulnerable women as barriers. In all countries, vulnerable women's fear, shame and lack of priority to preventive healthcare were identified as psychological barriers. CONCLUSION The study provides an overview of stakeholders' perceived barriers towards vulnerable women's cervical cancer screening participation in seven European countries. The organisation of healthcare systems and the maturity of screening programmes differ between countries, while vulnerable women's psychological barriers had several similarities.
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Affiliation(s)
- Rikke Buus Bøje
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Marc Bardou
- CIC-P INSERM 1432, Institut national de la santé et de la recherche médicale, Paris, France
| | - Keitly Mensah
- Early Detection, Prevention and Infections Branch, IARC, Lyon, France
| | - Raquel Rico Berrocal
- Centre d'Etudes des Mouvements Sociaux, Ecole des Hautes Etudes en Sciences Sociales, Paris, France
| | - Paolo Giorgi Rossi
- Servizio Interaziendale Epidemiologia, Azienda Unita Sanitaria Locale della Romagna, Ravenna, Italy
| | - Laura Bonvicini
- Servizio Interaziendale Epidemiologia, Azienda Unita Sanitaria Locale della Romagna, Ravenna, Italy
| | - Noemi Auzzi
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Osservatorio Nazionale Screening, Florence, Italy
| | - Diana Taut
- Babes-Bolyai University, Cluj-Napoca, Romania
| | | | - Anna Tisler
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kerli Reintamm
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Margarida Teixeira
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | | | - Mariana Amorim
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Ines Baia
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Nuno Lunet
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | | | | | | | - Berit Andersen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Kirkegaard
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Andringa KR, Schott RM, Ellerson RM, Carroll S, Jones HE. Sex and Female Empowerment (SAFE): Learning from health care providers, men and women to design a sexual health intervention for women with substance use disorders. Drug Alcohol Depend 2023; 253:111010. [PMID: 37931327 PMCID: PMC10842687 DOI: 10.1016/j.drugalcdep.2023.111010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Substance Use Disorder (SUD) treatment is a promising setting to provide sexual health education to women. This study examined barriers and possible solutions to effectively providing sexual health education and services during SUD treatment. METHODS To obtain a full picture of the barriers and solutions, 29 cisgender women and 17 cisgender men in treatment for a SUD and four health care providers in North Carolina were interviewed regarding the domains of pregnancy-planning, barriers to reproductive health services and contraception, selecting a method of contraception and desired aspects and elements of a sexual health intervention. RESULTS Eight themes and 12 sub-themes emerged that included how addiction impacts pregnancy planning and pregnancy motivations, the stigma and fear regarding accessing health services, the lack of accurate knowledge of the human reproductive cycle and contraceptive methods and worries about contraception side-effects. Recommendations for interventions to reduce unintended pregnancy in this treatment population included the need for simple and focused information given by trusted communicators in a short time frame in accessible locations, and offering incentives for participation such as food and transportation. CONCLUSION As SUD treatment providers and programs look to improve access to sexual health and contraceptive options for women with SUD, these eight themes provide helpful guidance in crafting future interventions.
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Affiliation(s)
- Kimberly R Andringa
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA
| | - Rachel M Schott
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA
| | - Rachel Middlesteadt Ellerson
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA
| | - Senga Carroll
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA
| | - Hendrée E Jones
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA; Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA.
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Greenley R, Bell S, Rigby S, Legood R, Kirkby V, McKee M. Factors influencing the participation of groups identified as underserved in cervical cancer screening in Europe: a scoping review of the literature. Front Public Health 2023; 11:1144674. [PMID: 37304105 PMCID: PMC10247980 DOI: 10.3389/fpubh.2023.1144674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Background Cervical cancer is a preventable and inequitably distributed disease. Screening plays a vital role in prevention, but many women face barriers to participation. The aims of this scoping review, undertaken to inform the co-design of interventions to equitably increase screening uptake, were to: (1) identify barriers and facilitators to cervical cancer screening for underserved populations, and (2) identify and describe the effectiveness of interventions aimed at improving participation in cervical cancer screening among underserved groups in Europe. Methods Qualitative, quantitative, and mixed methods studies focusing on barriers and facilitators to cervical screening participation and interventions to improve uptake undertaken in Europe and published after 2000 were included. Four electronic databases were searched to identify relevant papers. Titles and abstracts were screened, full text reviewed, and key findings extracted. Data were extracted and analyzed according to different health system strata: system-wide (macro), service specific (meso) and individual/community specific (micro). Within these categories, themes were identified, and the population groups impacted were recorded. All findings are presented in accordance with (PRISMA) guidelines. Results 33 studies on barriers and facilitators and eight intervention studies met the inclusion criteria. Collectively, the findings of these studies presented a wide array of screening uptake barriers, facilitators, and interventions, predominantly related to screening service and individual/community factors. However, although diverse, certain core themes around information provision, prompts for participation and the need for inclusive spaces were apparent. Implementation of screening programs should focus on: (1) reducing identifiable barriers, (2) increasing public awareness, and (3) providing patient reminders and measures to promote engagement by healthcare providers. Conclusion There are many barriers to uptake of cervical cancer screening and this review, nested within a larger study, will inform work to devise a solution alongside groups identified in three European countries.
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Affiliation(s)
- Rachel Greenley
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sadie Bell
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Samuel Rigby
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosa Legood
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Victoria Kirkby
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Covshoff E, Blake L, Rose EM, Bolade A, Rathouse R, Wilson A, Cotterell A, Pittrof R, Sethi F. Sexual and reproductive health needs assessment and interventions in a female psychiatric intensive care unit. BJPsych Bull 2023; 47:4-10. [PMID: 34782026 PMCID: PMC10028536 DOI: 10.1192/bjb.2021.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS AND METHOD To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments and interventions in this setting. Within a quality improvement framework, staff were trained, a clinical protocol developed and clinical interventions made accessible. RESULTS Thirty per cent of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. Forty-two per cent of women were assessed, representing a 3.5-fold increase in uptake. Twenty-one per cent of women initiated SRH interventions, of which 14% had all their SRH needs met. Staff, patients and carers highlighted the acceptability and importance of SRH care, if interventions were appropriately timed and patients' individual risk profiles were considered. Barriers to access included lack of routine enquiry, illness acuity and impact of the COVID-19 pandemic. CLINICAL IMPLICATIONS SRH needs for PICU admissions are greater than previously realised. Providing a nurse-led SRH assessment is acceptable, feasible and beneficial for PICU patients.
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Affiliation(s)
| | - Lucy Blake
- South London and Maudsley NHS Foundation Trust, UK
| | | | | | | | | | | | | | - Faisil Sethi
- Dorset HealthCare University NHS Foundation Trust, UK
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Harmanci D, Edelman N, Richardson D, Lunt A, Llewellyn C. How are young people's mental health related to their sexual health and substance use? A systematic review of UK literature. Int J Adolesc Med Health 2023; 35:131-158. [PMID: 36636992 DOI: 10.1515/ijamh-2022-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The transition from childhood to adulthood is complex and presents challenges to young people's mental health. Mental health impacts and is impacted by a range of contextual and personal factors. Adolescence and young adulthood also coincide with increased experimentation with sex, sexuality and substance use. Addressing the mental health, sexual health and substance-use challenges experienced by young people therefore necessitates an understanding of how these elements relate to one another. By collecting and analysing existing literature, this review aims to identify associations between young people's mental health and sexual health, their mental health and substance use and any resulting gaps-in-knowledge. CONTENT Seven electronic databases were searched between March and May 2021 and updated in May 2022 with terms collated under the categories of "young people", "mental health", "sexual health" and "substance use". English-language articles, presenting data from the UK & Ireland, on young people aged 16-24 years inclusive were screened and subjected to a selection process in accordance with PRISMA guidelines (preregistered on PROSPERO, ref. number CRD42021245096). The quality of the resulting articles were assessed using the Mixed Methods Appraisal Tool (MMAT) and findings were tabulated through a data extraction process. SUMMARY 27 articles were included in the review. Various mental health indices such as depression, anxiety, self-harm, psychotic-like experiences, hypomanic symptoms and binge-purge type eating disorders were found to be associated with higher use of substances such as alcohol, cannabis, ecstasy and generalised drug use. Additionally, mental health indices such as depression, anxiety and self-harm were found to be associated with sex before age 16 and/or unprotected sex at age 16, positive Chlamydia infection and higher levels of sexual activity at a younger age. Overall, cross-sectional associations were stronger than the longitudinal associations presented in the articles. OUTLOOK This review into the specific relations between young people's mental health, sexual health and substance use has revealed the complex and bi-directional nature of these associations, with some conditions and substances having been more extensively investigated (e.g., alcohol and depression/anxiety) as opposed to the relations between young people's sexual health and mental health which is lacking in the UK and Irish context. The findings can help inform mental health related policies and service provisions targeted at young people in the UK and Ireland. Areas for future work are suggested.
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Affiliation(s)
- Damla Harmanci
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Natalie Edelman
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK.,School of Sport & Health Sciences, University of Brighton, Falmer, Brighton, UK
| | - Daniel Richardson
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK.,University Hospitals Sussex NHS foundation Trust, Brighton, UK
| | - Alexandria Lunt
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Carrie Llewellyn
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
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Motyka MA, Al-Imam A, Haligowska A, Michalak M. Helping Women Suffering from Drug Addiction: Needs, Barriers, and Challenges. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14039. [PMID: 36360917 PMCID: PMC9656705 DOI: 10.3390/ijerph192114039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Statistical data on the use of various psychoactive substances indicate a narrowing of previous differences in substance use between men and women. Data from studies conducted among women suffering from drug addiction are increasingly published, with the authors highlighting the specific needs of this group and the difficulties that women with addiction problems encounter. The current study aimed to identify the barriers and needs of this audience, both when seeking help and during treatment. The method used in the study was secondary content analysis. To identify publications describing the barriers and needs of women suffering from drug addiction, we searched the PubMed database to find publications that met the adopted research objective. We set the data search period to the last ten years to examine the timeliness of the issue under study. The search yielded 199 research reports. Twenty-three articles describing 21 studies were included in the final analysis. The selected publications dealt with the difficulties and challenges faced by women with addiction problems. Barriers to accessing treatment for this group, the needs, and the challenges of helping women suffering from addiction were identified. Results showed that the barriers are mainly stigma but also deficits in the therapeutic offerings for this group. The primary need was identified as the introduction of appropriate drug policies, and the challenges, unfortunately, are the still-reported gender inequalities. To improve the situation of women, regular attention to these issues and the need to include them in national health strategies is essential.
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Affiliation(s)
- Marek A. Motyka
- Institute of Sociological Sciences, University of Rzeszow, 35-959 Rzeszów, Poland
| | - Ahmed Al-Imam
- Department of Computer Science and Statistics, Doctoral School, Poznan University of Medical Sciences, 61-806 Poznan, Poland
- Department of Anatomy and Cellular Biology, College of Medicine, University of Baghdad, Baghdad 10001, Iraq
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
| | | | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Rokietnicka 7 St. (1st Floor), 61-806 Poznan, Poland
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Preconception Substance Use and Risk of Unintended Pregnancy: Pregnancy Risk Assessment Monitoring System 2016-17. J Addict Med 2022; 16:278-285. [PMID: 34334685 PMCID: PMC9444263 DOI: 10.1097/adm.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study examined the association between preconception substance use and unintended pregnancy in a large, nationally representative sample of women. METHODS In this cross-sectional study, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) comprising, 74,543women who had birth during 2016-17. Logistic regression was used to assess the independent association of unintended pregnancy overall and by subtypes to preconception substance use (smoking and other nicotine/tobacco use, alcohol consumption, and use of cannabis, illicit/recreational drugs) and specific medication including prescription opioids, antidepressants and over the counter pain relief. RESULTS Overall, 41% of pregnancies were unintended. Nearly 57% of participants reported alcohol consumption during the preconception period, with 32% indicating binge drinking, 17% reported preconception smoking, and 10% cannabis use. Unintended pregnancy was significantly associated with substance use, including smoking (adjusted odds ratio [AOR]:1.5, 95% confidence interval [CI]: 1.4-1.6); as well as the use of other nicotine/tobacco (AOR:1.4, 95% CI: 1.3-1.5); cannabis (AOR: 1.9, 95% CI: 1.5-2.3); illicit/recreational drugs (AOR:1.7, 95% CI: 1.2-2.4), prescription opioids (AOR:1.4, 95% CI: 1.02-1.9), and prescription antidepressants (AOR 1.8, 95% CI: 1.1-3.0). The likelihood of unintended pregnancy was significantly elevated with heavy smoking, heavy alcohol consumption, and binge drinking. Analyses by unintended pregnancy subtype yielded similar results. CONCLUSIONS Preconception substance use was significantly and positively associated with unintended pregnancy. Evidence-based interventions are needed addressing substance use behavior and effective contraceptive use to prevent unintended pregnancy and related adverse effects on maternal and child health.
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Stancil SL, Miller MK, Duello A, Finocchario-Kessler S, Goggin K, Winograd RP, Hurley EA. Long-acting reversible contraceptives (LARCs) as harm reduction: a qualitative study exploring views of women with histories of opioid misuse. Harm Reduct J 2021; 18:83. [PMID: 34348734 PMCID: PMC8335991 DOI: 10.1186/s12954-021-00532-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The sharp rise in opioid use disorder (OUD) among women coupled with disproportionally high rates of unintended pregnancy have led to a four-fold increase in the number of pregnant women with OUD in the United States over the past decade. Supporting intentional family planning can have multiple health benefits and reduce harms related to OUD but requires a comprehensive understanding of women's perspectives of preventing unintended pregnancies. The purpose of this study was to comprehensively evaluate the knowledge, attitudes and experiences as they relate to seeking contraception, particularly LARCs, among women with active or recovered opioid misuse. METHODS In-depth interviews and focus group discussions with 36 women with current or past opioid misuse were recorded and transcribed. Transcripts were coded by ≥ 2 investigators. Themes related to contraceptive care seeking were identified and contextualized within the Health Belief Model. RESULTS Our analysis revealed seven interwoven themes that describe individual level factors associated with contraceptive care seeking in women with current or past opioid misuse: relationship with drugs, reproductive experiences and self-perceptions, sexual partner dynamics, access, awareness of options, healthcare attitudes/experiences, and perceptions of contraception efficacy/ side effects. Overall, perceived susceptibility and severity to unintended pregnancy varied, but most women perceived high benefits of contraception, particularly LARC. However, perceived barriers were too high for most to obtain desired contraception to support family planning intentions. CONCLUSIONS The individual-level factors identified should inform the design of integrated services to promote patient-centered contraceptive counseling as a form of harm reduction. Interventions should reduce barriers to contraceptive access, particularly LARCs, and establish counseling strategies that use open, non-judgmental communication, acknowledge the continuum of reproductive needs, explore perceived susceptibility to pregnancy, and utilize peer educators.
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Affiliation(s)
- Stephani L Stancil
- Division of Adolescent Medicine, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, MO, USA.
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Melissa K Miller
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Alex Duello
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | | | - Kathy Goggin
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
- School of Pharmacy, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Emily A Hurley
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
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Edelman N, Whetham J, Cassell J, de Visser R, Mercer C, Jones C, Gersten A, Bremner S. Performance of a tool to identify different types of self-reported sexual risk among women attending a contraception and sexual health clinic: results of a cross-sectional survey. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:117-128. [PMID: 32499381 PMCID: PMC8053341 DOI: 10.1136/bmjsrh-2019-200482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION A clinical prediction rule (CPR) using psychosocial questions was previously derived to target sexual healthcare in general practice by identifying women at risk of unintended pregnancy (UIP) and sexually transmitted infections (STIs). This psychosocial CPR may help target resources within contraception and sexual health (CASH) services. This study investigated how well it predicted recent self-reported risk of UIP and STI acquisition among women attending a CASH clinic. METHODS Female patients aged 16-44 years attending a CASH clinic in South-East England were offered a questionnaire on arrival. This comprised psychosocial questions, and others addressing three sexual risks: (1) two or more male sexual partners in the last year (2+P), (2) risk of STI acquisition through most recent partner and (3) risk of UIP in the last 6 months. A CPR score was calculated for each participant and cross-tabulated against self-report of each sexual risk to estimate CPR sensitivity and specificity. RESULTS The psychosocial questions predicting 2+P had sensitivity 83.2% (95% CI 79.3% to 86.5%) and specificity 56.1% (95% CI 51.3%-60.6%). Those predicting combined 2+P and/or risk of STI acquisition through most recent partner had a sensitivity of 89.1% (95% CI 85.7%-91.8%) and specificity of 43.7% (95% CI 39.0%-48.5%). Questions predicting risk of UIP in the last 6 months had a sensitivity of 82.5% (95% CI 78.6%-86.0%) and specificity of 48.3% (95% CI 43.4%-53.1%). CONCLUSIONS The CPR demonstrated good sensitivity but low specificity, so may be suited to triaging or stratifying which interventions to offer CASH patients and by which mode (eg, online vs face-to-face). Further investigation of causal links between psychosocial factors and sexual risk is warranted to support development of psychosocial interventions for this patient group.
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Affiliation(s)
- Natalie Edelman
- School of Health Sciences, University of Brighton, Brighton & Hove, UK
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | - Jennifer Whetham
- Claude Nicol Centre, Brighton & Sussex University Hospitals Trust, Brighton and Hove, UK
| | - Jackie Cassell
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | | | - Catherine Mercer
- Centre for Population Research in Sexual Health and HIV, University College London, London, UK
| | - Christopher Jones
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | | | - Stephen Bremner
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
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Gilmartin CE, Milman O, Leung L. Postpartum contraceptive planning of women with substance abuse disorders. Int J Clin Pharm 2020; 43:1006-1014. [PMID: 33236276 DOI: 10.1007/s11096-020-01209-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Women with substance abuse disorders have lower use of contraception. Unplanned pregnancies increase risk of fetal exposure to addictive and teratogenic substances. Postpartum inpatient periods for these women can be challenging times to facilitate contraception planning. OBJECTIVE To explore postnatal contraceptive planning practices, patient preferences for contraception, and supply challenges, and to identify how clinical pharmacists may best provide care in this context. SETTING A tertiary maternity referral hospital in metropolitan Victoria, Australia (January 2015-December 2018). METHOD A retrospective cohort study was conducted on postnatal women with substance abuse disorders. Patients were excluded if they had delivered at another health service, had inadequate documented evidence of a substance abuse disorder, or had incomplete or unavailable medical records. Records were reviewed for demographic data, admission details, and documented contraceptive planning. MAIN OUTCOME MEASURES Documented contraceptive planning, patient contraception preferences and identified supply challenges. RESULTS Ninety-three women were included. Seventy-one (76.3%) had psychiatric disorders or impairments, and 92 (98.9%) had identifiable follow-up challenges (eg. Homelessness). Nine (9.7%) self-discharged/absconded. Eighty-seven (93.5%) had documented postnatal contraception discussions. Sixty-two of 87 (71.3%) considered a medicine/device, three (3.4%) preferred condoms, 10 (11.5%) considered sterilisation, 2 (2.3%) preferred no contraception, and 16 (18.4%) undecided. Etonogestral 68 mg implants were most commonly prescribed (28 of 42; 66.7%). CONCLUSION Inpatient postpartum periods for this cohort were characterised by psycho-social complexities, inconsistent contraceptive planning documentation, and patients seemingly unprepared to consider contraception. This study highlights a need for an earlier decision-making process and pragmatic counselling with antenatal pharmacists.
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Affiliation(s)
- Christine E Gilmartin
- The Royal Women's Hospital Pharmacy Department, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Oran Milman
- The Royal Women's Hospital Pharmacy Department, The Royal Women's Hospital, Parkville, Victoria, Australia.,Hawke's Bay Hospital, Hastings, New Zealand
| | - Laura Leung
- The Royal Women's Hospital Pharmacy Department, The Royal Women's Hospital, Parkville, Victoria, Australia
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Yermachenko A, Massari V, Azria E, Clergue-Duval V, Thurn M, El-Khoury Lesueur F, Jauffret-Roustide M, Melchior M. Unintended pregnancy prevention in women using psychoactive substances: A systematic review. Addict Behav 2020; 107:106393. [PMID: 32200197 DOI: 10.1016/j.addbeh.2020.106393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022]
Abstract
This systematic review seeks to evaluate the efficacy of interventions aimed at preventing unintended pregnancies in women using psychoactive substances. Seven electronic databases (Medline, EMBASE, CINAHL, Web of Science Core Collection, PsycINFO, Cochrane CENTRAL database) were searched in October 2017. Twenty-two articles met our inclusion criteria. Interventions based on behavior change theory yielded an increase in the initiation of effective contraception as compared with provision of written information materials. The effect was more pronounced when the intervention provided on-site contraceptive counseling and free access to birth control. Financial incentives also seemed to effectively increase women's contraception intake. Case management interventions including pregnant and postpartum women with heavy levels of substance use showed promising results in terms of initiation of contraception, but rates of unintended pregnancy over long-term follow-up were nevertheless elevated. Finally, some interventions integrated family planning services into specialized centers taking care of pregnant and postpartum women with substance abuse. However, most studies aimed at postpartum and post-abortion contraception used a non-comparative design and had a number of methodological flaws. The risk of bias in most studies is high. All interventions with a primary or secondary focus on the prevention of unintended pregnancy in women using psychoactive substances short-term improvements in contraception intake, but it is unclear if these effects last or have any impact on unintended pregnancy rates in the long-term.
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Affiliation(s)
- Anna Yermachenko
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France
| | - Véronique Massari
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France
| | - Elie Azria
- Université Sorbonne Paris Cité, INSERM, UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPe research team), DHU Risks in Pregnancy, Paris, France; Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Virgile Clergue-Duval
- APHP, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, 200 rue du Faubourg Saint-Denis, 75010 Paris, France; Université Sorbonne Paris Cité, Faculté de Médecine, Paris Diderot, Paris, France
| | - Marion Thurn
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France; Cermes 3 (Inserm U988/CNRS UMR 8211/EHESS/Université Paris Descartes), Paris, France
| | - Fabienne El-Khoury Lesueur
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France
| | | | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France.
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12
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Sexual and Reproductive Health Characteristics of Women in Substance Use Treatment in Michigan. Obstet Gynecol 2020; 135:361-369. [PMID: 31923070 DOI: 10.1097/aog.0000000000003666] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the sexual and reproductive health characteristics of women in treatment for opioid use disorder in Michigan and explore services provided and desired. METHODS We conducted a cross-sectional study of female patients aged 18-50 years who accessed opioid use disorder treatment at 22 randomly selected facilities in Michigan from December 2015 to May 2017. Computer-assisted self-interviews were completed using online survey management software to assess prior substance use and use disorder treatment, sexual and reproductive health history, and sexual and reproductive health services received in the previous 12 months through a treatment program, and desire for and barriers to sexual and reproductive health services within substance use disorder treatment. Descriptive statistics were calculated. RESULTS The final sample consisted of 260 participants. About half (51.5%) had ever had an abnormal Pap test result, and 57.3% had ever tested positive for a sexually transmitted infection. Unintended pregnancy was common (61.2%), as was substance use during pregnancy (74.2%). Nearly half (46.5%) were not currently using a method of contraception, and only 28.5% were using a highly effective method. Common barriers to accessing reproductive health services included fear of being treated poorly or judged because of substance use, fear of child protective services, and structural barriers such as cost and lack of transportation. Most participants (80.4%) indicated interest in receiving sexual and reproductive health services on site or by referral from their substance use disorder treatment programs. CONCLUSION Women in treatment for opioid use disorder in Michigan have high rates of adverse sexual and reproductive health experiences and face barriers to accessing care.
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Phillips C, Schulkind J, O'Sullivan M, Edelman N, Smith HE, Verma S, Jones CJ. Improving access to care for people who inject drugs: Qualitative evaluation of project ITTREAT-An integrated community hepatitis C service. J Viral Hepat 2020; 27:176-187. [PMID: 31566851 DOI: 10.1111/jvh.13214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/08/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022]
Abstract
Achieving hepatitis C virus (HCV) elimination by 2030 requires an increased linkage to care for people who inject drugs (PWID). Project ITTREAT was established to mitigate barriers to HCV care by providing an integrated service within a local drug and alcohol treatment centre. This study aimed to explore the experiences of clients and staff involved in Project ITTREAT and assess the facilitators and barriers to a community-based HCV service. Between October 2014 and April 2016, drug and alcohol treatment attendees were interviewed using one-to-one semi-structured interviews. Drug and alcohol treatment staff took part in focus groups. All data were recorded, transcribed verbatim and analysed using thematic content analysis. Fifteen drug and alcohol treatment attendees with current/previous HCV infection were interviewed, and 15 staff members contributed across two focus groups. Drug and alcohol treatment staff and attendees reported that Project ITTREAT facilitated access to HCV care by mitigating previous negative hospital-based experiences. Other key facilitators were positive narratives around HCV care, and drug and alcohol treatment attendees being well engaged in their drug/alcohol recovery. Barriers included a lack of stability in drug and alcohol treatment attendees, negative discourse around testing/treatment and stigma associated with attending the drug and alcohol treatment to access HCV treatment in some who had successfully achieved drug rehabilitation. Our findings indicate the positive impact of an integrated and personalized community-based service delivered by a dedicated hepatitis nurse. This played a crucial role in reducing barriers to HCV care for PWID. Our work also highlights areas for future investment including non-DAT-based community services and increasing awareness of new treatments amongst this cohort.
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Affiliation(s)
- Clare Phillips
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital NHS Trust, Brighton, UK
| | - Jasmine Schulkind
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Margaret O'Sullivan
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital NHS Trust, Brighton, UK
| | - Natalie Edelman
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, Brighton, UK
| | - Helen E Smith
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, Brighton, UK.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Sumita Verma
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital NHS Trust, Brighton, UK.,Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
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Edelman NL, Cassell JA, Mercer CH, Bremner SA, Jones CI, Gersten A, deVisser RO. Deriving a clinical prediction rule to target sexual healthcare to women attending British General Practices. Prev Med 2018; 112:185-192. [PMID: 29719219 DOI: 10.1016/j.ypmed.2018.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/24/2018] [Accepted: 04/28/2018] [Indexed: 10/17/2022]
Abstract
Some women attending General Practices (GPs) are at higher risk of unintended pregnancy (RUIP) and sexually transmitted infections (STI) than others. A clinical prediction rule (CPR) may help target resources using psychosocial questions as an acceptable, effective means of assessment. The aim was to derive a CPR that discriminates women who would benefit from sexual health discussion and intervention. Participants were recruited to a cross-sectional survey from six GPs in a city in South-East England in 2016. On arrival, female patients aged 16-44 years were invited to complete a questionnaire that addressed psychosocial factors, and the following self-reported outcomes: 2+ sexual partners in the last year (2PP) and RUIP. For each sexual risk, psychosocial questions were retained from logistic regression modelling which best discriminated women at risk using the C-statistic. Sensitivity and specificity were established in consultation with GP staff. The final sample comprised N = 1238 women. 2PP was predicted by 11 questions including age, binge-drinking weekly, ever having a partner who insulted you often, current smoking, and not cohabiting (C-statistic = 0.83, sensitivity = 73% and specificity = 77%). RUIP was predicted by 5 questions including sexual debut <16 years, and emergency contraception use in the last 6 months (C-statistic = 0.70, sensitivity = 69% and specificity = 57%). 2PP was better discriminated than RUIP but neither to a clinically-useful degree. The finding that different psychosocial factors predicted each outcome has implications for prevention strategies. Further research should investigate causal links between psychosocial factors and sexual risk.
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Affiliation(s)
- N L Edelman
- Brighton & Sussex Medical School, United Kingdom; University of Brighton, United Kingdom.
| | - J A Cassell
- Brighton & Sussex Medical School, United Kingdom
| | - C H Mercer
- University College London, United Kingdom
| | - S A Bremner
- Brighton & Sussex Medical School, United Kingdom
| | - C I Jones
- Brighton & Sussex Medical School, United Kingdom
| | - A Gersten
- Pavilion General Practice, United Kingdom
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15
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Edelman N. Towards a critical epidemiology approach for applied sexual health research. J Health Psychol 2017; 23:161-174. [DOI: 10.1177/1359105317743768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Critical approaches may benefit epidemiological studies of sexual health. This article proposes a critical approach, reconcilable with social epidemiological enquiry. Key aims of critical epidemiology for sexual health are identified, from which three criticisms of practice emerge: (1) lack of attention to socio-cultural contexts, (2) construction of ‘risk’ as residing in the individual and (3) enactment of public health agendas which privilege and pathologise certain behaviours. These reflect and construct an apolitical understanding of population health. This article proposes features of a critical epidemiology that represent a morally driven re-envisioning of the focus, analysis and interpretation of epidemiological studies of sexual health.
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Affiliation(s)
- Natalie Edelman
- University of Brighton, UK
- Brighton and Sussex Medical School, UK
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Pittrof R, Sauer U, Covshoff E. Austerity and sustainable sexual and reproductive health care. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2016; 42:232-4. [PMID: 27207851 DOI: 10.1136/jfprhc-2015-101400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rudiger Pittrof
- Consultant in Community Sexual Health and HIV, Department of Sexual and Reproductive Health, Guy's and St Thomas' NHS Foundation Trust, London, UK;
| | - Ulrike Sauer
- Consultant in Sexual and Reproductive Health, Lead for Brent Contraceptive Services, Brent Contraceptive Services, Central and North West London NHS Foundation Trust, London, UK;
| | - Elana Covshoff
- SHRINE Programme Manager, Guy's and St Thomas' NHS Foundation Trust, London, UK;
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17
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Black KI, Day CA. Improving Access to Long-Acting Contraceptive Methods and Reducing Unplanned Pregnancy Among Women with Substance Use Disorders. Subst Abuse 2016; 10:27-33. [PMID: 27199563 PMCID: PMC4869602 DOI: 10.4137/sart.s34555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/06/2016] [Accepted: 03/09/2016] [Indexed: 01/10/2023]
Abstract
Much has been written about the consequences of substance use in pregnancy, but there has been far less focus on the prevention of unintended pregnancies in women with substance use disorders (SUDs). We examine the literature on pregnancy incidence for women with SUDs, the clinical and economic benefits of increasing access to long-acting reversible contraceptive (LARC) methods in this population, and the current hurdles to increased access and uptake. High rates of unintended pregnancies and poor physical and psychosocial outcomes among women with SUDs underscore the need for increased access to, and uptake of, LARC methods among these women. A small number of studies that focused on improving access to contraception, especially LARC, via integrated contraception services predominantly provided in drug treatment programs were identified. However, a number of barriers remain, highlighting that much more research is needed in this area.
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Affiliation(s)
- Kirsten I. Black
- Central Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Carolyn A. Day
- Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia
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18
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Vanthuyne A, Mundt-Leach R, Boyd A, Broughton S, Pittrof R. Sexual and reproductive healthcare provided onsite in an inner-city community drug and alcohol service. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2016; 42:152-4. [PMID: 26769726 DOI: 10.1136/jfprhc-2014-101126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/14/2015] [Indexed: 11/04/2022]
Affiliation(s)
- An Vanthuyne
- ST6 in Sexual and Reproductive Health, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Rosie Mundt-Leach
- Head of Nursing, Addictions Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Alastair Boyd
- Associate Specialist in Addiction Psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephanie Broughton
- Blood Borne Viruses CNS, Health Inclusion Team, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Rudiger Pittrof
- Consultant in Sexual Health and HIV, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
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19
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Edelman NL, de Visser RO, Mercer CH, McCabe L, Cassell JA. Targeting sexual health services in primary care: A systematic review of the psychosocial correlates of adverse sexual health outcomes reported in probability surveys of women of reproductive age. Prev Med 2015; 81:345-56. [PMID: 26441301 DOI: 10.1016/j.ypmed.2015.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/24/2015] [Accepted: 09/26/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women using primary care vary in need for sexually transmitted infections (STIs) testing and contraception. Psychosocial correlates of these needs may be useful for targeting services. We undertook a systematic review to identify psychosocial correlates of STI acquisition, unplanned pregnancy (UP), abortion and risky sexual behaviours in general population samples of women of reproductive age. METHODS We searched bibliographic databases for probability surveys of women aged 16-44 years in the European Union, USA, Canada, Australia, UK or New Zealand undertaken January 1994-January 2014. RESULTS Eleven papers were included. Unplanned pregnancy was associated with smoking, depression, being single and sexual debut <16 years. Abortion was associated with lack of closeness to parents, leaving home at an early age, and relationship break-up. Multiple partnerships were associated with intensity of marijuana and alcohol use, and smoking. STI diagnosis was associated with relationship break-up and younger partners. Non-use of contraception was associated with smoking, obesity, relationship status, sedentary lifestyles, fatalistic pregnancy attitudes and lower alcohol use. Condom non-use was higher (at first sex) with partners 5+years older and lower (at last sex) in less stable partnerships. CONCLUSION Psychosocial variables, particularly relationship status and smoking, may help identify women in primary care for STI testing and contraception advice and supply.
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Affiliation(s)
- Natalie L Edelman
- Division of Primary Care and Public Health, Brighton & Sussex Medical School, Mayfield House, Village Way, Falmer, East Sussex BN1 9PH, UK; Centre for Health Research, University of Brighton, Mayfield House, Village Way, Falmer, East Sussex BN1 9PH, UK.
| | - Richard O de Visser
- School of Psychology, Pevensey 1, University of Sussex, Brighton BN1 9RH, UK
| | - Catherine H Mercer
- Centre for Sexual Health and HIV Research, University College London, 3rd Floor, Mortimer Market Centre, London WC1E 6JB, UK
| | - Lucy McCabe
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - Jackie A Cassell
- Division of Primary Care and Public Health, Brighton & Sussex Medical School, Mayfield House, Village Way, Falmer, East Sussex BN1 9PH, UK; Centre for Sexual Health and HIV Research, University College London, 3rd Floor, Mortimer Market Centre, London WC1E 6JB, UK
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Edelman NL, Patel H, Glasper A, Bogen-Johnston L. Sexual health risks and health-seeking behaviours among substance-misusing women. J Adv Nurs 2014; 70:2861-70. [DOI: 10.1111/jan.12442] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2014] [Indexed: 11/26/2022]
Affiliation(s)
| | - Harish Patel
- Hastings Sexual Health Clinic; Hastings & Rother Primary Care Trust; Hastings UK
| | - Anthony Glasper
- Hastings Substance Misuse Service; Sussex Partnership NHS Foundation Trust; Worthing UK
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