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Song B, Boulware A, Wong ZJ, Huang I, Whitaker AK, Hasselbacher L, Stulberg D. "This has definitely opened the doors": Provider perceptions of patient experiences with telemedicine for contraception in Illinois. Perspect Sex Reprod Health 2022; 54:80-89. [PMID: 36071608 PMCID: PMC9826464 DOI: 10.1363/psrh.12207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT The COVID-19 pandemic increased the provision of contraception through telemedicine. This qualitative study describes provider perceptions of how telemedicine provision of contraception has impacted patient care. METHODS We interviewed 40 obstetrics-gynecology and family medicine physicians, midwives, nurse practitioners, and support staff providing contraception via telemedicine in practices across Illinois, including Planned Parenthood of Illinois (PPIL) health centers. We analyzed interview content to identify themes around the perceived impact of telemedicine implementation on contraception access, contraceptive counseling, patient privacy, and provision of long-acting reversible contraception (LARC). RESULTS Participants perceived that telemedicine implementation improved care by increasing contraception access, increasing focus on counseling while reducing bias, and allowing easier method switching. Participants thought disparities in telemedicine usage and limitations to the technological interface presented barriers to patient care. Participants' perceptions of how telemedicine implementation impacts patient privacy and LARC provision were mixed. Some participants found telemedicine implementation enhanced privacy, while others felt unable to ensure privacy in a virtual space. Participants found telemedicine modalities useful for counseling patients considering methods of LARC, but they sometimes presented an unnecessary extra step for those sure about receiving one at a practice offering same day insertion. CONCLUSION Providers felt telemedicine provision of contraception positively impacted patient care. Improvements to counseling and easier access to method switching suggest that telemedicine implementation may help reduce contraceptive coercion. Our findings highlight the need to integrate LARC care with telemedicine workflows, improve patient privacy protections, and promote equitable access to all telemedicine modalities.
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Affiliation(s)
- Bonnie Song
- Department of Obstetrics and GynecologyUniversity of Southern California/LAC+USC Medical CenterLos AngelesCaliforniaUSA
| | - Angel Boulware
- Department of Comparative Human DevelopmentUniversity of ChicagoChicagoIllinoisUSA
| | | | - Iris Huang
- Pritzker School of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | | | - Lee Hasselbacher
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3)University of ChicagoChicagoIllinoisUSA
| | - Debra Stulberg
- Department of Family MedicineUniversity of ChicagoChicagoIllinoisUSA
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Brown BP, Chor J, Hebert LE, Webb ME, Whitaker AK. Shared negative experiences of long-acting reversible contraception and their influence on contraceptive decision-making: a multi-methods study. Contraception 2019; 99:228-232. [PMID: 30685284 DOI: 10.1016/j.contraception.2019.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We explored how negative stories about long-acting reversible contraception (LARC) - defined as a firsthand negative experience with LARC shared directly with the study participant - were involved in participants' decisions about whether to use LARC following abortion, and how counseling affected the influence of negative LARC stories on contraceptive choices. STUDY DESIGN We performed a multi-methods study, embedded within a trial examining the impact of a theory-based counseling intervention on LARC uptake post-abortion. Participants completed a baseline survey to determine the influence of negative LARC stories. We subsequently invited respondents who reported having heard negative LARC stories to participate in a semi-structured qualitative interview. We analyzed quantitative data with univariate statistics. We analyzed qualitative data using thematic content analysis. RESULTS Among the 60 participants, 16 (27%) reported having heard negative LARC stories. Two of the 16 (13%) planned to initiate LARC prior to counseling, compared to 18 of 44 women (41%) who had not heard negative LARC stories (p=0.06). Prior to counseling, 69% of participants with negative LARC stories reported that these stories made them less likely to use LARC. In qualitative interviews with 9 women, we identified several key themes: (1) negative LARC stories deterred LARC use; (2) friends and family were valued informants; (3) potential side effects were important to LARC decision-making; and (4) positive and negative features of the counseling encounter influenced the effect of negative LARC stories. CONCLUSIONS Negative LARC stories are common among women presenting for abortion at our institution and may influence patient uptake of these methods. Implications This study uses a multi-methods approach to examine the influence of negative stories about long-acting reversible contraception (LARC) on decision-making about LARC. These findings can help providers elicit patients' needs in contraception counseling and generate hypotheses for future counseling research.
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Affiliation(s)
- Benjamin P Brown
- University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. - MC2050, Chicago, IL 60637..
| | - Julie Chor
- University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. - MC2050, Chicago, IL 60637..
| | - Luciana E Hebert
- University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. - MC2050, Chicago, IL 60637..
| | - M Elizabeth Webb
- University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. - MC2050, Chicago, IL 60637..
| | - Amy K Whitaker
- University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. - MC2050, Chicago, IL 60637..
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Hebert LE, Hill BJ, Quinn M, Holl JL, Whitaker AK, Gilliam ML. Mobile contraceptive application use in a clinical setting in addition to standard contraceptive counseling: A randomized controlled trial. Contraception 2018; 98:281-287. [DOI: 10.1016/j.contraception.2018.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 11/16/2022]
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Akinola M, Hebert LE, Hill BJ, Quinn M, Holl JL, Whitaker AK, Gilliam ML. Development of a Mobile App on Contraceptive Options for Young African American and Latina Women. Health Educ Behav 2018; 46:89-96. [PMID: 29896969 DOI: 10.1177/1090198118775476] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Young African American and Latina women aged 15 to 24 are more likely to adopt short-acting forms of contraception over long-acting reversible contraception. Mobile applications and other forms of digital media may be useful for providing adolescents with information about sexual and reproductive health both inside and outside of the health care setting. The miPlan app was designed in accordance with principles of user experience design, and its content was informed by the theory of planned behavior and the transtheoretical model of behavior change. A university-based design team engaged young African American and Latina women to inform app development and provide input on app design, conducting multiple rounds of usability testing. Researchers then evaluated the acceptability of the miPlan app in family planning clinics among African American and Latina women aged 15 to 24. Participants rated the app highly acceptable, finding it both easy to use and highly informative. We demonstrate that mobile applications designed in conjunction with user populations may be effective at providing health information due to users' ability to identify with them and their accessibility.
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Whitaker AK, Chen BA. Society of Family Planning Guidelines: Postplacental insertion of intrauterine devices. Contraception 2018; 97:2-13. [DOI: 10.1016/j.contraception.2017.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 01/09/2023]
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Whitaker AK, Quinn MT, Munroe E, Martins SL, Mistretta SQ, Gilliam ML. A motivational interviewing-based counseling intervention to increase postabortion uptake of contraception: A pilot randomized controlled trial. Patient Educ Couns 2016; 99:1663-9. [PMID: 27211225 PMCID: PMC5028248 DOI: 10.1016/j.pec.2016.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/04/2016] [Accepted: 05/08/2016] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To determine if a counseling intervention using the principles of motivational interviewing (MI) would impact uptake of long-acting reversible contraception (LARC) after abortion. METHODS We conducted a pilot randomized controlled trial comparing an MI-based contraception counseling intervention to only non-standardized counseling. Sixty women 15-29 years-old were randomized. PRIMARY OUTCOME uptake of LARC within four weeks of abortion. SECONDARY OUTCOMES uptake of any effective contraceptive, contraceptive use three months after abortion and satisfaction with counseling. Bivariate analysis was used to compare outcomes. RESULTS In the intervention arm, 65.5% of participants received a long-acting method within four weeks compared to 32.3% in the control arm (p=0.01). Three months after the abortion, differences in LARC use endured (60.0% vs. 30.8%, p=0.05). Uptake and use of any effective method were not statistically different. More women in the intervention arm reported satisfaction with their counseling than women in the control arm (92.0% vs. 65.4%, p=0.04). CONCLUSION Twice as many women in the MI-based contraception counseling intervention initiated and continued to use LARC compared to women who received only non-standardized counseling. PRACTICE IMPLICATIONS A contraception counseling session using the principles and skills of motivational interviewing has the potential to impact LARC use after abortion.
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Affiliation(s)
- Amy K Whitaker
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, Chicago, IL, USA.
| | - Michael T Quinn
- The University of Chicago Medicine, Department of Medicine, Section of General Internal Medicine, Chicago, IL, USA
| | - Elizabeth Munroe
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, Chicago, IL, USA
| | - Summer L Martins
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, Chicago, IL, USA
| | - Stephanie Q Mistretta
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, Chicago, IL, USA
| | - Melissa L Gilliam
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, Chicago, IL, USA
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Benson LS, Martins SL, Whitaker AK. Correlates of Heterosexual Anal Intercourse among Women in the 2006-2010 National Survey of Family Growth. J Sex Med 2016; 12:1746-52. [PMID: 26289541 DOI: 10.1111/jsm.12961] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Heterosexual anal intercourse (HAI) is common among U.S. women. Receptive anal intercourse is a known risk factor for HIV, yet there is a paucity of data on HAI frequency and distribution in the United States. Condom use is lower with HAI vs. vaginal intercourse, but little is known regarding of correlates of HAI with and without condoms. AIMS The aims of this study were to describe recent (past 12 months) and lifetime HAI among sexually active reproductive-aged U.S. women, and to characterize women who engage in HAI with and without condoms. METHODS We analyzed a sample of 10,463 heterosexually active women aged 15-44 years for whom anal intercourse data were available in the 2006-2010 National Survey of Family Growth. MAIN OUTCOME MEASURES Weighted bivariate and multivariable analyses were used to determine HAI prevalence and correlates. Primary outcomes were lifetime HAI, recent (last 12 months) HAI, and condom use at last HAI. RESULTS In our sample, 13.2% of women had engaged in recent HAI and 36.3% in lifetime HAI. Women of all racial and ethnic backgrounds and religions reported recent anal intercourse. Condom use was more common at last vaginal intercourse than at last anal intercourse (28% vs. 16.4%, P < 0.001). In multivariable analysis, correlates of recent HAI included: less frequent church attendance, younger age at first intercourse, multiple sexual partners, history of oral intercourse, history of unintended pregnancy, and treatment for sexually transmitted infections (all P < 0.05). Correlates of lifetime HAI were similar, with the addition of older age, higher education, higher income, and history of drug use (all P < 0.05). CONCLUSION Women of all ages and ethnicities engage in HAI, at rates higher than providers might realize. Condom use is significantly lower for HAI vs. vaginal intercourse, putting these women at risk for acquisition of sexually transmitted infections.
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Affiliation(s)
- Lyndsey S Benson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.,Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, University of Chicago, Chicago, IL, USA
| | - Summer L Martins
- Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, University of Chicago, Chicago, IL, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Amy K Whitaker
- Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, University of Chicago, Chicago, IL, USA
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Whitaker AK, Quinn MT, Martins SL, Tomlinson AN, Woodhams EJ, Gilliam M. Motivational interviewing to improve postabortion contraceptive uptake by young women: development and feasibility of a counseling intervention. Contraception 2015; 92:323-9. [PMID: 26093191 DOI: 10.1016/j.contraception.2015.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective was to develop and test a postabortal contraception counseling intervention using motivational interviewing (MI) and to determine the feasibility, impact and patient acceptability of the intervention when integrated into an urban academic abortion clinic. STUDY DESIGN A single-session postabortal contraception counseling intervention for young women aged 15-24 years incorporating principles, skills and style of MI was developed. Medical and social work professionals were trained to deliver the intervention, their competency was assessed, and the intervention was integrated into the clinical setting. Feasibility was determined by assessing ability to approach and recruit participants, ability to complete the full intervention without interruption and participant satisfaction with the counseling. RESULTS We approached 90% of eligible patients and 71% agreed to participate (n=20). All participants received the full counseling intervention. The median duration of the intervention was 29 min. Immediately after the intervention and at the 1-month follow-up contact, 95% and 77% of participants reported that the session was helpful, respectively. CONCLUSIONS MI counseling can be tailored to the abortion setting. It is feasible to train professionals to use MI principles, skills and style and to implement an MI-based contraception counseling intervention in an urban academic abortion clinic. The sessions are acceptable to participants. IMPLICATIONS The use of motivational interviewing in contraception counseling may be an appropriate and effective strategy for increasing use of contraception after abortion. This study demonstrates that this patient-centered, directive and collaborative approach can be developed into a counseling intervention that can be integrated into an abortion clinic.
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Affiliation(s)
- A K Whitaker
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. MC 2050, Chicago, IL, 60637.
| | - M T Quinn
- The University of Chicago Medicine, Department of Medicine, Section of General Internal Medicine, 5841 S. Maryland Ave. MC 6092, Chicago, IL, 60637
| | - S L Martins
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. MC 2050, Chicago, IL, 60637
| | - A N Tomlinson
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. MC 2050, Chicago, IL, 60637
| | - E J Woodhams
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. MC 2050, Chicago, IL, 60637
| | - M Gilliam
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. MC 2050, Chicago, IL, 60637
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Davidson AS, Whitaker AK, Martins SL, Hill B, Kuhn C, Hagbom-Ma C, Gilliam M. Impact of a theory-based video on initiation of long-acting reversible contraception after abortion. Am J Obstet Gynecol 2015; 212:310.e1-7. [PMID: 25265403 DOI: 10.1016/j.ajog.2014.09.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/27/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Adoption of long-acting reversible contraception (LARC) (ie, the intrauterine device or the contraceptive implant) immediately after abortion is associated with high contraceptive satisfaction and reduced rates of repeat abortion. Theory-based counseling interventions have been demonstrated to improve a variety of health behaviors; data on theory-based counseling interventions for postabortion contraception are lacking. STUDY DESIGN Informed by the transtheoretical model of behavioral change, a video intervention was developed to increase awareness of, and dispel misconceptions about, LARC methods. The intervention was evaluated in a randomized controlled trial among women aged 18-29 years undergoing surgical abortion at a clinic in Chicago, IL. Participants were randomized 1:1 to watch the intervention video or to watch a stress management video (control), both 7 minutes in duration. Contraceptive methods were supplied to all participants free of charge. Rates of LARC initiation immediately after abortion were compared. RESULTS Rates of LARC initiation immediately after abortion were not significantly different between the 2 study arms; 59.6% in the intervention and 51.6% in the control arm chose a LARC method (P = .27). CONCLUSION This study resulted in an unexpectedly high rate of LARC initiation immediately after abortion. High rates of LARC initiation could not be attributed to a theory-based counseling intervention.
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Whitaker AK, Endres LK, Mistretta SQ, Gilliam ML. Postplacental insertion of the levonorgestrel intrauterine device after cesarean delivery vs. delayed insertion: a randomized controlled trial. Contraception 2013; 89:534-9. [PMID: 24457061 DOI: 10.1016/j.contraception.2013.12.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 12/06/2013] [Accepted: 12/14/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This trial was designed to compare levonorgestrel intrauterine device (LNG-IUD) use at 1 year after delivery between women randomized to postplacental insertion at the time of cesarean delivery and delayed insertion 4-8 weeks after delivery. STUDY DESIGN This randomized controlled trial was conducted at two urban medical centers. Eligible pregnant women with planned cesarean deliveries were randomized to immediate postplacental insertion during cesarean or delayed insertion after 4-8 weeks. We used intention-to-treat analysis for the primary outcome of LNG-IUD use 12 months after delivery. RESULTS Forty-two women were randomized, 20 into the postplacental group and 22 in the delayed group. Although confirmed use of the LNG-IUD 12 months after delivery was higher in the postplacental group (60.0% vs. 40.9%, p=.35), this difference was not statistically significance. Expulsion was significantly more common in the postplacental group (20.0% vs. 0%, p=.04). There were significant differences between the two sites in baseline population characteristics, follow-up and expulsion. The trial did not answer the intended question as it was halted early due to slow enrollment. CONCLUSIONS Our results show higher expulsion after postplacental insertion compared to delayed insertion but suggest similar IUD use at 12 months. Moreover, it provides valuable lessons regarding a randomized controlled trial of postplacental LNG-IUD placement due to the challenges of estimating effect size and the nature of the population who might benefit from immediate insertion. IMPLICATIONS Postplacental insertion of an IUD may improve use of highly effective contraception during the postpartum period. While our results suggest higher expulsion after postplacental insertion compared to delayed insertion and similar IUD use at 12 months, our trial was insufficient to definitively test our hypothesis.
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Affiliation(s)
- Amy K Whitaker
- Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, The University of Chicago, Chicago, IL 60637.
| | - Loraine K Endres
- Department of Obstetrics and Gynecology, The NorthShore University HealthSystem Evanston Hospital, Evanston, IL 60201
| | - Stephanie Q Mistretta
- Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, The University of Chicago, Chicago, IL 60637
| | - Melissa L Gilliam
- Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, The University of Chicago, Chicago, IL 60637
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Whitaker AK, Sisco KM, Tomlinson AN, Dude AM, Martins SL. Use of the intrauterine device among adolescent and young adult women in the United States from 2002 to 2010. J Adolesc Health 2013; 53:401-6. [PMID: 23763968 DOI: 10.1016/j.jadohealth.2013.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 04/18/2013] [Accepted: 04/19/2013] [Indexed: 01/21/2023]
Abstract
PURPOSE Long-acting contraceptives, such as the intrauterine device (IUD), show potential for decreasing the incidence of unintended pregnancy. However, use among adolescent and young adult women remains low. We determined factors associated with IUD use among young women. METHODS We conducted an analysis of nationally representative, cross-sectional data from the 2002 and 2006-2010 National Surveys of Family Growth. We included sexually active women 15-24 years old. We used bivariate analysis to compare proportions of ever-use of any type of IUD in 2002 and in 2006-2010 and multivariable logistic regression to identify correlates of ever-use in 2006-2010. RESULTS We found an increase in IUD use in teens 15-19 years old, from .2% to 2.5% (p < .001), and among women 20-24 years old, 2.0% to 5.4% (p < .001). Use increased among nearly all subgroups of respondents. Compared with nulliparous young women, those with one prior delivery and with two or more deliveries were substantially more likely to have used an IUD (adjusted OR 11.43, 95% CI 3.61-36.16, and adjusted OR 13.60, 95% CI 4-46.48, respectively). Young black women were less likely to report IUD use (adjusted OR .32, 95% CI .16-.66), and women whose mothers received at least a high school education were more likely to report use (adjusted OR 2.56, 95% CI 1.22-5.43). CONCLUSIONS IUD use is increasing among adolescent and young adult women overall and among almost all sociodemographic subgroups. Nonetheless, use remains low, and nulliparous young women are highly unlikely to use the IUD.
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Affiliation(s)
- Amy K Whitaker
- Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, The University of Chicago, Chicago, IL 60637, USA.
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Bergin A, Tristan S, Terplan M, Gilliam ML, Whitaker AK. A missed opportunity for care: two-visit IUD insertion protocols inhibit placement. Contraception 2012; 86:694-7. [DOI: 10.1016/j.contraception.2012.05.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 05/14/2012] [Accepted: 05/16/2012] [Indexed: 10/28/2022]
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Barrett M, Soon R, Whitaker AK, Takekawa S, Kaneshiro B. Awareness and knowledge of the intrauterine device in adolescents. J Pediatr Adolesc Gynecol 2012; 25:39-42. [PMID: 22051791 DOI: 10.1016/j.jpag.2011.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 08/15/2011] [Accepted: 08/24/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to explore intrauterine device (IUD) awareness and knowledge in a diverse, multiethnic population. METHODS We conducted a self-administered, anonymous survey addressing awareness of the IUD as a contraceptive method and knowledge about aspects of IUD use in a group of women aged 14 to 19 years. Demographic and medical information was obtained to compare awareness and knowledge between demographic groups. Chi-square, Fisher exact test, and t tests were used for analysis. Multiple logistic regression was utilized to confirm relationships. RESULTS Of the 106 respondents, 76.4% (81/106) were sexually active and 56.6% (60/106) reported a history of ever being pregnant. There were 21.1% (33/106) of respondents who had heard of the IUD as a contraceptive method. Of the subjects who had heard of the IUD, 39.4 % (13/33) were able to identify key features of the IUD. Although a history of pregnancy was predictive of having heard of the IUD, age, insurance status, education, and all other demographic factors were not associated with IUD awareness. CONCLUSION Over 70% of the adolescents had not heard of the IUD and less than half of adolescents who had heard of the IUD were able to identify key features about this contraceptive method. The lack of knowledge of this effective and safe contraceptive option is concerning given that most participants were at high risk for unintended pregnancy.
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Affiliation(s)
- Maria Barrett
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii, Honolulu, Hawaii, USA.
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Webster RD, Neustadt AN, Whitaker AK, Gilliam ML. Parental involvement laws and parent-daughter communication: policy without proof. Contraception 2010; 82:310-3. [PMID: 20851223 DOI: 10.1016/j.contraception.2010.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 07/05/2010] [Indexed: 11/24/2022]
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Whitaker AK, Terplan M, Gold MA, Johnson LM, Creinin MD, Harwood B. Effect of a brief educational intervention on the attitudes of young women toward the intrauterine device. J Pediatr Adolesc Gynecol 2010; 23:116-20. [PMID: 19896397 DOI: 10.1016/j.jpag.2009.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 09/23/2009] [Accepted: 09/30/2009] [Indexed: 12/30/2022]
Abstract
STUDY OBJECTIVE The intrauterine device (IUD) is underused by young women, who are at high risk for unintended pregnancy. We aimed to assess the impact of a brief educational intervention on the attitudes of young women toward intrauterine contraception and to assess characteristics associated with a change in attitude. DESIGN, SETTING, AND PARTICIPANTS This is a planned secondary analysis of a survey of 144 women, aged 14-24 years, which assessed attitudes toward the IUD. INTERVENTION The analysis was planned to fully examine the impact of a 3-minute educational intervention about the IUD given during administration of the survey, which included risks and benefits of IUD use, costs, side effects, and a demonstration of the IUD insertion and removal process. MAIN OUTCOME MEASURE Proportions of participants with a positive attitude toward the IUD before and after the intervention were compared using McNemar's chi-square test for paired proportions. Factors associated with a change in attitude toward the IUD were evaluated using multivariable analysis. RESULTS Before the educational intervention, 14.7% (21/143) had both heard of the IUD and expressed a positive attitude toward it. After the intervention, this proportion increased to 53.8% (77/143) (P < .01). The increase in proportion with a positive attitude was consistent for all subpopulations. In multivariable analysis, the only significant predictor of a positive change in attitude toward the IUD was a history of voluntary sexual activity (adjusted odds ratio 10.3, 95% confidence interval 2.0-53.1). CONCLUSIONS A brief educational intervention significantly improves the attitude of young sexually active women toward the IUD.
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Affiliation(s)
- Amy K Whitaker
- Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL 60637, USA.
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Whitaker AK, Johnson LM, Harwood B, Chiappetta L, Creinin MD, Gold MA. Adolescent and young adult women's knowledge of and attitudes toward the intrauterine device. Contraception 2008; 78:211-7. [PMID: 18692611 DOI: 10.1016/j.contraception.2008.04.119] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 04/24/2008] [Accepted: 04/28/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to assess adolescent (aged 14-18 years) and young adult (aged 19-24 years) women's knowledge of and attitudes toward intrauterine devices (IUDs) before and after a brief educational intervention. STUDY DESIGN We administered a 43-item survey to 144 women aged 14-24 years, with half in each age category. The survey assessed knowledge of and attitudes toward IUDs, and incorporated a 3-min educational intervention about IUDs. Predictors for knowledge of and attitudes toward the IUD were examined using logistic regression. RESULTS Forty percent of participants had heard of the IUD. Having ever heard of the IUD was associated with age >18 years [adjusted odds ratio (OR)=5.7; 95% confidence interval (95% CI)=2.1-15.7], a higher level of maternal education (adjusted OR=4.5; 95% CI=1.5-13.3) and a history of voluntary sexual intercourse (adjusted OR=4.9; 95% CI=1.0-23.5). Of those who had heard of the IUD previously, 37.5% reported a positive attitude toward the IUD before the intervention. After the educational intervention, 53.5% of all participants reported a positive attitude toward the IUD, with both adolescent and young adult women having similarly positive attitudes (51.4% vs. 55.6%, p=.62). This positive attitude was associated only with a history of voluntary sexual intercourse (adjusted OR=5.2; 95% CI=1.3-21.1). The characteristics of the IUD that the participants strongly liked and disliked were rated similarly by the two age groups. However, more adolescent women considered the privacy of the IUD and the ability to use the copper IUD for 10 years as positive characteristics. CONCLUSION Most young women were unaware of IUDs but were likely to think positively about IUDs after being educated about them. Demographic and reproductive health history did not predict attitude; thus, all young women should be offered education about IUDs.
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Affiliation(s)
- Amy K Whitaker
- Department of Obstetrics and Gynecology, University of Chicago Hospitals, Chicago, IL 60637, USA
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Abstract
OBJECTIVE To quantify and compare serum levels and uterine effects following vaginal (dry), vaginal (moistened), buccal, and rectal misoprostol administration. METHODS Forty women seeking elective abortion between 6 and 12 6/7 weeks were randomly assigned to receive 400 mug of misoprostol by one of four routes. A 2.5-mm pressure monitoring catheter was placed through the cervix to the uterine fundus to record uterine tone and activity during the 5-hour observation period. Serum levels of misoprostol acid were measured at 15 and 30 minutes, then every 30 minutes. RESULTS The four groups were similar in age, race or ethnicity, body mass index, parity, and gestation. Serum levels after vaginal, vaginal moistened and buccal administration rose gradually, peaked between 15 and 120 minutes and fell slowly. Vaginal and vaginal moistened routes produced higher peak serum levels than buccal and rectal (445.9 and 427.1 compared with 264.8 and 202.2 pg/mL; P = .03) and higher serum concentration area under the curve at 5 hours (1,025.0 and 1279.4 compared with 519.6 and 312.5 pg-hr/mL; P < .001). Uterine tone and activity, however, were similar for buccal and the two vaginal routes. After rectal administration, serum levels peaked earlier (P < .001) then dropped more abruptly, and peak uterine tone (P < .001) and total activity (P = .04) were lower than after the other routes. CONCLUSION Although serum levels were lower for buccal compared with the vaginal routes, the three routes produced similar uterine tone and activity. Rectal administration produced lower uterine tone and activity. Vaginal serum levels were two to three and a half times higher than those observed in prior misoprostol pharmacokinetic studies.
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Affiliation(s)
- Karen R Meckstroth
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA.
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Drey EA, Darney PD, Louie B, Kellogg TA, Kang MS, Prabhu R, Whitaker AK, Chin J, Molina A, McFarland W. HIV sentinel surveillance among women seeking elective pregnancy termination, San Francisco. Sex Transm Dis 2005; 32:590-2. [PMID: 16118609 DOI: 10.1097/01.olq.0000175420.35851.6b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to measure HIV prevalence, HIV incidence, and risk factors for infection among women seeking elective pregnancy termination in San Francisco. STUDY The authors conducted a cross-sectional survey comprising a consecutive sample of women seeking elective pregnancy termination in San Francisco's county hospital from August 2002 to July 2003. Demographic and risk behavior information was abstracted from routine clinic records. HIV testing was conducted on blood specimens collected for other purposes after removing identifying information. RESULTS Based on 11 HIV-positives among 1,992 tested, HIV prevalence among women seeking pregnancy termination was 0.55% (95% confidence interval [CI], 0.28-0.99). One recent HIV seroconversion was detected for an annual incidence of 0.11% per year (95% CI, 0.23-0.88). In addition, risk factors significantly associated with HIV infection included sex with a known HIV-positive man, history of an abnormal Pap smear, history of genital herpes infection, history of trichomoniasis, and age 25 to 29 years. CONCLUSIONS Women electing pregnancy termination can serve as a sentinel population to track trends in the HIV epidemic. However, barriers remain to wider implementation of the approach as a surveillance tool.
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Affiliation(s)
- Eleanor A Drey
- Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco General Hospital, University of California San Francisco, CA 94102, USA
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Goldberg AB, Drey EA, Whitaker AK, Kang MS, Meckstroth KR, Darney PD. Misoprostol compared with laminaria before early second-trimester surgical abortion: a randomized trial. Obstet Gynecol 2005; 106:234-41. [PMID: 16055570 DOI: 10.1097/01.aog.0000168629.17326.00] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the efficacy and acceptability of same-day misoprostol and overnight laminaria for cervical ripening before early second-trimester surgical abortion. METHODS We performed a randomized, double-blinded, controlled trial comparing 400 microg of vaginal misoprostol, given 3-4 hours preoperatively, with overnight laminaria before early second-trimester surgical abortion among women at 13.0-16.0 weeks of gestation (n = 84). The primary outcome was procedure time, and the sample size was based on 95% power to detect a difference of 4.5 minutes between groups. Secondary outcomes included completion of the procedure on the first attempt, procedural difficulty, and patients' pain scores and preferences. RESULTS The average gestational duration was 14 weeks 6 days. Procedures performed after laminaria were significantly faster than those after misoprostol (median 3.4 versus 7.2 minutes, respectively, P = .01). Laminaria patients had significantly greater dilation than misoprostol patients at abortion (mean 43 versus 33 French, P < .001), and more misoprostol patients required additional dilation (85% versus 21%, P < .001). Physicians rated 27% of the misoprostol procedures as moderate-markedly difficult versus 5% of laminaria procedures (P = .01). Differences in efficacy were pronounced among nulliparous patients. There were no significant differences in ability to complete the procedure on the first attempt or patients' intraoperative pain scores. More women in the misoprostol group would choose their assigned method again (93% versus 62%, P < .01), and 82% of all subjects preferred a 1-day procedure. CONCLUSION Early second-trimester abortions take longer and are technically more challenging after cervical ripening with same-day misoprostol than with overnight laminaria, but patients prefer same-day misoprostol.
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Affiliation(s)
- Alisa B Goldberg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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