Missed Opportunities to Address Pregnancy Prevention With Young Men in Primary Care

Associations between sexual and reproductive health knowledge, attitude and practice of partners and the occurrence of unintended pregnancy

Background

Although global contraceptive coverage has increased significantly, high rates of unintended pregnancy remain the current global status quo. A comparative analysis of the differences and correlations of knowledge, attitude and practice (KAP) of sexual and reproductive health (SRH) of both partners will help guide public health work according to gender characteristics and needs, and reduce the occurrence of unintended pregnancy.

Methods

A questionnaire survey of people with unintended pregnancies including women and their male partners (n = 1,275 pairs) who sought help from the Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from October 2017 to October 2021. Data were collected on sexual and reproductive health knowledge, attitudes, and practices in both partners who had unintended pregnancies. Chi-square test and Logistic regression were used to analyze the relationship between the occurrence of unintended pregnancy and KAP and its influencing factors. Paired odds ratio and McNemar's test were used to estimate the difference and concordance of KAP between partners.

Results

This study included 1,275 partners with a mean age of 30.0 years. The partner's overall level of KAP is good. Compared with women, men had better knowledge (χ2 = 3.93, p = 0.047) and more active contraceptive practices (χ2 = 19.44, p < 0.001). In the analysis of partner concordance, male contraceptive intention was found to be better than female [matched pairs odds ratio (ORMP) = 2.56, p < 0.001], and the concordance of positive contraceptive practice between partners increased with male education [adjusted odds ratio (aOR) = 1.556, 95% confidence interval (CI) = 1.185-2.044, p = 0.001]. In partner-paired regression analysis, compared with good contraceptive knowledge in both men and women in the partner, the risk of negative contraceptive practice was 1.7 times (aOR = 1.721, 95% CI = 1.234-2.400, p = 0.001) higher with good contraceptive knowledge in women but negative in men, while women with poor contraceptive knowledge but men with good knowledge are 1.3 times (aOR = 1.349, 95% CI = 1.000-1.819, p = 0.05) more likely to have negative contraceptive practices. In addition, compared with partners with positive contraceptive attitudes, women with positive attitudes but negative men and women with negative attitudes but positive men had 1.7 and 1.4 times the risk of negative contraceptive practices, respectively.

Conclusion

The study found that unintended pregnancy occurs mainly in young people, and the younger age of first sexual intercourse, the low education background and the lack of discussion of contraception between partners are risk factors for not taking contraceptive measures. Men's better knowledge and contraceptive practices compared with female partners, and poor male contraceptive knowledge and attitudes may lead to a higher risk of negative contraceptive practices, the results suggest that male KAP plays an important role in promoting contraceptive use and reducing unintended pregnancy.

Understanding the Sexual and Reproductive Health Needs of Hospitalized Adolescent Males

OBJECTIVES

To describe sexual behaviors and acceptability of receiving sexual and reproductive health (SRH) services among hospitalized adolescent males.

METHODS

We performed a cross-sectional survey of hospitalized adolescents. Eligible participants were males aged 14 to 20 years admitted at 2 academic medical centers. Outcome measures included reported healthcare utilization, sexual health behaviors (eg, sexual activity), contraception use, and acceptability of SRH discussions during a hospitalization.

RESULTS

Among 145 participants, 42% reported a history of vaginal sex, 27% current sexual activity, 12% early sexual debut, and 22% 4 or more prior sexual partners. At last sex, condom use was reported by 63% and use of reversible contraception by 36%. Nearly half (45%) agreed that hospital-based SRH discussions were acceptable, particularly among those with history of sexual activity (P < .01). Some (12%) reported they had not accessed care in the past year when they felt they should.

CONCLUSIONS

Hospitalized males in our study had similar rates of sexual activity as compared with the general population but had higher rates of early sexual debut and number of prior partners, which are independently linked with negative sexual health outcomes (eg, sexually transmitted infections). Our participants found SRH discussions to be generally acceptable. These findings reveal opportunities to screen for unmet SRH needs and provide SRH education and services for adolescent males in the hospital.

Quality Initiative to Increase Delivery of Adolescent Hospital-Based Reproductive Health Care

OBJECTIVES

Hospitals are an important nontraditional setting in which to address adolescent reproductive health. However, opportunities for intervention are frequently missed, especially for boys and patients hospitalized for noningestion complaints. Our global aim was to increase delivery of reproductive health care to adolescents hospitalized through our children's hospital Pediatric Hospital Medicine service.

METHODS

We performed 2 quality improvement intervention cycles: (1) provider education and monthly reminder e-mails and (2) an automated electronic health record (EHR) adolescent history and physical note template with social history prompts while discontinuing reminder e-mails. The primary outcome measure was sexual history documentation (SHD). Secondary measures were sexually transmitted infection (STI) testing and contraception provision. Statistical process control charts were used to analyze effectiveness of interventions.

RESULTS

From July 2018 through June 2019, 528 Primary Hospital Medicine encounters were included in this study and compared with published baseline data on 150 encounters. Control charts revealed a special cause increase in SHD from 60% to 82% overall, along with 37% to 73% for boys and 57% to 80% for noningestion hospitalizations. Increased SHD correlated with cycle 1 and was maintained through cycle 2. Percent STI testing significantly increased but did not shift or trend toward special cause variation. Contraception provision, length of stay, and patient relations consultations were not affected.

CONCLUSIONS

The interventions were successful in increasing SHD, including among boys and noningestion hospitalizations. The EHR enhancement maintained these increases after reminder emails were discontinued. Future interventions should specifically address STI testing and provision of contraception.

Young Men's Communication With Partners and Contraception Use: A Systematic Review

PURPOSE

The rate of adolescent unintended pregnancy in the U.S. is high compared with that in other developed countries. While past research and interventions have focused on young women, the role of young men in pregnancy prevention has increasingly been recognized. Studies have assessed young men's knowledge and attitudes toward pregnancy prevention as well as their role in male-controlled methods of birth control such as condoms or withdrawal. However, less is known about how young men contribute to decision-making about contraceptive methods other than condoms with female partners. The purpose of this systematic review was to explore how young men communicate with their female partners and the effect of such communication on contraception use to prevent pregnancy.

METHODS

We conducted a systematic review of six databases to identify English language articles published from January 1, 2002, through March 24, 2019. The review specifically explored how young men aged 11-24 years communicate with and affect their female partner (noncondom) contraceptive use. The systematic review explored additional questions, including those pertaining to the timing of partner communication in a relationship, communication strategies used by young men, and which dynamics of partner communication were measured in studies.

RESULTS

Of the 12 articles identified as exploring male partner communication, five of the articles used quantitative analysis to measure any association between partner communication and contraception use, three of which produced statistically significant findings suggesting that communication increases the use of contraception other than condoms. Seven qualitative studies provided supporting narratives from young men describing communication with partners and how they influence contraception use by female partners. The articles also explored timing and strategies of communication, as well as topics, prompts, and communication cues used by young men. Measurements of both communication and contraception varied across studies.

CONCLUSIONS

With the small number of studies identified in this systematic review, we conclude that future research needs to corroborate the relationship between partner communication and contraception use with more robust and precise measurements of both communication and contraception.

Hispanic Male Cancer Survivors’ Coping Strategies

Cancer survivors manage their new status using a multitude of coping mechanisms. Coping strategies vary by individual, but are also socioculturally mediated. Scarce evidence on coping strategies adopted by Hispanic male cancer survivors (HMCS) is available to date. The purpose of this study was to explore the reaction to diagnosis and subsequent coping strategies employed by HMCS. Data were gathered through focus groups ( n = 18), cognitive interviews ( n = 12), and phone interviews ( n = 84). Coping strategies included positive attitudes, humor, optimism and social support, use of home remedies, lifestyle changes, and faith. Findings are consistent with research on non-cancer-related coping showing that HMCS use active coping strategies, such as religion and support from family and friends. The analysis of existing strategies and needs points to the need to develop evidence-based psychosocial services that build on strengths and coping behaviors already employed by HMCS.