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Hubacher D, Schreiber CA, Turok DK, Jensen JT, Creinin MD, Nanda K, White KO, Dayananda I, Teal SB, Chen PL, Chen BA, Goldberg AB, Kerns JL, Dart C, Nelson AL, Thomas MA, Archer DF, Brown JE, Castaño PM, Burke AE, Kaneshiro B, Blithe DL. Continuation rates of two different-sized copper intrauterine devices among nulliparous women: Interim 12-month results of a single-blind, randomised, multicentre trial. EClinicalMedicine 2022; 51:101554. [PMID: 35865736 PMCID: PMC9294241 DOI: 10.1016/j.eclinm.2022.101554] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/19/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The most widely used copper intrauterine device (IUD) in the world (the TCu380A), and the only product available in many countries, causes side effects and early removals for many users. These problems are exacerbated in nulliparous women, who have smaller uterine cavities compared to parous women. We compared first-year continuation rates and reasons/probabilities for early removal of the TCu380A versus a smaller Belgian copper IUD among nulliparous users. METHODS This 12-month interim report is derived from a pre-planned interim analysis of a sub population and focused on key secondary comparative endpoints. In this participant-blinded trial at 16 centres in the USA, we randomised participants aged 17-40 in a 4:1 ratio to the NT380-Mini or the TCu380A. In the first year, participants had follow-up visits at 6-weeks and 3, 6, and 12-months, and a phone contact at 9 months; we documented continued use, expulsions, and reasons for removal. Among participants with successful IUD placement, we compared probabilities of IUD continuation and specific reasons for discontinuation using log-rank tests. This trial is registered with ClinicalTrials.gov number NCT03124160 and is closed to recruitment. FINDINGS Between June 1, 2017, and February 25, 2019, we assigned 927 nulliparous women to either the NT380-Mini (n = 744) or the TCu380A (n = 183); the analysis population was 732 (NT380-Mini) and 176 (TCu380A). Participants using the NT380-Mini, compared to the TCu380A, had higher 12-month continuation rates (78·7% [95% CI: 72·9-84·5%] vs. 70·2% [95% CI: 59·7-80·7], p = 0·014), lower rates of removal for bleeding and/or pain (8·1% vs. 16·2%, p = 0·003) and lower IUD expulsion rates (4·8% vs. 8·9%, p = 0·023), respectively. INTERPRETATION The NT380-Mini offers important benefits for a nulliparous population compared to the TCu380A in the first twelve months, when pivotal experiences typically occur. Higher continuation rates with the NT380-Mini may avert disruptions in contraceptive use and help users avoid unintended pregnancy. FUNDING Bill & Melinda Gates Foundation, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Mona Lisa, N.V. (Belgium).
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Affiliation(s)
- David Hubacher
- FHI 360, Durham, NC, USA
- Corresponding author at: FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701 USA.
| | - Courtney A. Schreiber
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - David K. Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey T. Jensen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Mitchell D. Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | | | | | - Ila Dayananda
- Planned Parenthood Greater New York, New York, NY, USA
| | - Stephanie B. Teal
- Department of Obstetrics and Gynecology, University Hospitals Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | | | - Beatrice A. Chen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh and Magee-Womens Research Institute, Pittsburgh, PA, USA
| | | | - Jennifer L. Kerns
- Department of Obstetrics, Gynecology and Reproductive Sciences, Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Michael A. Thomas
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
| | - David F. Archer
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jill E. Brown
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Paula M. Castaño
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Anne E. Burke
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii, Honolulu, HI, USA
| | - Diana L. Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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2
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Fang NZ, Advaney SP, Castaño PM, Davis A, Westhoff CL. Female permanent contraception trends and updates. Am J Obstet Gynecol 2022; 226:773-780. [PMID: 34973178 DOI: 10.1016/j.ajog.2021.12.261] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022]
Abstract
Permanent contraception remains one of the most popular methods of contraception worldwide. This article has reviewed recent literature related to demographic characteristics of users, prevalence of use and trends over time, surgical techniques, and barriers to obtain the procedure. We have emphasized the patient's perspective as a key element of choosing permanent contraception. This review has incorporated sections on salpingectomy, hysteroscopy, unmet need, impact of policies at religiously affiliated institutions, and reproductive coercion.
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Affiliation(s)
- Nancy Z Fang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Center, Aurora, CO.
| | - Simone P Advaney
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Anne Davis
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
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3
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Hubacher D, Castaño PM, Goldberg AB, White KO, Chen BA, Nelson AL, Chen PL, Dayananda I, Kerns JL, Teal SB. ORAL ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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4
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Hellwinkel JE, Konigsberg MW, Oviedo J, Castaño PM, Kadiyala RK. Subfascial-located contraceptive devices requiring surgical removal. Contracept Reprod Med 2021; 6:13. [PMID: 33934717 PMCID: PMC8091535 DOI: 10.1186/s40834-021-00158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background Subdermal etonogestrel implants are highly effective contraceptive methods. Despite standardization of insertion technique by the manufacturer, some implants are inadvertently placed too deeply within or below the plane of the biceps brachii fascia. Placement of these implants in a deep tissue plane results in more difficult removal, which is not always possible in the office setting. In rare cases, surgical removal by an upper extremity surgeon is warranted. Case presentation Here we present 6 cases of etonogestrel implants located in a subfascial plane requiring removal by an upper extremity surgeon. Implants were all localized with plain radiography and ultrasound prior to surgical removal. All cases had implants located in the subfascial plane and one was identified intramuscularly. The average age was 28 years (19–33) and BMI was 24.0 kg/m^2 (19.1–36.5), with the most common reason for removal being irregular bleeding. The majority of cases (5/6) were performed under monitored anesthesia care with local anesthetic and one case utilized regional anesthesia. All implants were surgically removed without complication. Conclusions Insertion of etonogestrel contraceptive implants deep to the biceps brachii fascia is a rare, but dangerous complication. Removal of these implants is not always successful in the office setting and referral to an upper extremity surgeon is necessary to avoid damage to delicate neurovascular structures for safe removal.
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Affiliation(s)
- Justin E Hellwinkel
- Department of Orthopedics, Columbia University Irving Medical Center, 622 W 168th St PH 11 - Center, NY, 10032, New York, USA.
| | - Matthew W Konigsberg
- Department of Orthopedics, Columbia University Irving Medical Center, 622 W 168th St PH 11 - Center, NY, 10032, New York, USA
| | - Johana Oviedo
- Department of Obstetrics and Gynecology, New York University Langone Health, 550 First Avenue, NY, 10016, New York, USA
| | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 W 168th St, NY, 10032, New York, USA
| | - R Kumar Kadiyala
- Department of Orthopedics, Columbia University Irving Medical Center, 622 W 168th St PH 11 - Center, NY, 10032, New York, USA
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5
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Nelson AL, Kaunitz AM, Kroll R, Simon JA, Poindexter AN, Castaño PM, Ackerman RT, Flood L, Chiodo JA, Garner EI. Efficacy, safety, and tolerability of a levonorgestrel/ethinyl estradiol transdermal delivery system: Phase 3 clinical trial results. Contraception 2020; 103:137-143. [PMID: 33259782 DOI: 10.1016/j.contraception.2020.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the contraceptive efficacy, safety, and tolerability of a contraceptive transdermal delivery system, (TDS; TWIRLAⓇ) containing levonorgestrel (LNG) and ethinyl estradiol (EE). STUDY DESIGN This single-arm, open-label, multicenter, 1-year (13 cycle), phase 3 study enrolled sexually active women ≥18 years old at risk for pregnancy irrespective of body mass index (BMI). Women used patches in 28-day cycles (3 consecutive administrations of 7-day patches followed by 7 days off-treatment/patch-free week). We assessed contraceptive efficacy by the Pearl Index (PI) in women 18 to 35 years, excluding cycles without intercourse or when other contraceptive methods were used. RESULTS The study enrolled 2032 demographically diverse women in the US, of which 35.3% had a BMI ≥30 kg/m2. In the primary efficacy analysis, the PI (95% confidence interval) was 5.8 (4.5-7.2) pregnancies per 100 woman-years. PIs trended higher as BMI increased; the PI was 4.3 (2.9-5.8) in women with BMI <30 kg/m2 and 8.6 (5.8-11.5) in women with BMI ≥30 kg/m2. Hormone-related treatment-emergent adverse events included nausea (4.1%) and headache (3.6%); 11% of women discontinued due to adverse events. Four women (all with BMIs ≥30 kg/m2) reported thromboembolic events considered related to treatment. CONCLUSIONS The low-dose LNG/EE TDS was effective in preventing pregnancy in a population of women representative of US demographics. Efficacy was reduced in women with BMI ≥30 kg/m2. The TDS safety and tolerability profile was consistent with other similar dose combined hormonal contraceptives. Results of this phase 3 study supported the US Food and Drug Administration approval of TWIRLAⓇ for prevention of pregnancy in women with BMI <30 kg/m2. IMPLICATIONS TDS (120 µg/day levonorgestrel and 30 µg/day ethinyl estradiol) is an effective, low-dose transdermal contraceptive patch with favorable tolerability profile approved for prevention of pregnancy in women with BMI <30 kg/m2. TDS has reduced effectiveness in women with BMI ≥30 kg/m2.
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Affiliation(s)
| | - Andrew M Kaunitz
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Robin Kroll
- University of Washington, Seattle Women's Health, Research, Gynecology, Seattle, WA, USA
| | - James A Simon
- George Washington University School of Medicine, Washington, DC, USA
| | | | - Paula M Castaño
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Lisa Flood
- ALK-Abello, Inc. Pharmaceuticals, Bedminster, NJ, USA
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Palomares KT, Parobchak N, Ithier MC, Aleksunes LM, Castaño PM, So M, Faro R, Heller D, Wang B, Rosen T. Fetal Exosomal Platelet-activating Factor Triggers Functional Progesterone Withdrawal in Human Placenta. Reprod Sci 2020; 28:252-262. [PMID: 32780361 DOI: 10.1007/s43032-020-00283-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 07/31/2020] [Indexed: 11/27/2022]
Abstract
In most mammals, labor is heralded by the withdrawal of progesterone. In humans, circulating progesterone levels increase as gestation advances while placental expression of progesterone receptor A (PR-A) declines. As a result of PR-A downregulation, the non-canonical NF-κB pathway is activated, an event implicated in triggering labor. Here, we sought to identify fetal-derived mediator(s) that represses placental PR-A in human placenta leading to activation of pro-labor signaling. Lipidomic profiling demonstrated enrichment of platelet-activating factor (PAF) in exosomes originating from the human fetus. Exposure of primary cytotrophoblasts to fetal exosomes from term pregnancies reduced PR-A expression by > 50%, and PAF also reduced PR-A message levels in a dose-dependent manner. Notably, fetal exosomes from preterm pregnancies had lower PAF levels and no effect on PR-A expression. Synthetic PAF-induced DNA methylation increases by 20% at the PR-A promoter, leading to recruitment of corepressors and downregulation of PR-A in cytotrophoblast. Furthermore, suppression of PR-A by PAF-stimulated expression of the pro-labor genes, corticotropin-releasing hormone (CRH) and cyclooxygenase-2 (COX-2), which was reversed by disruption of the DNA methyltransferases 3B and 3L. Taken together, PAF represents a novel fetal-derived candidate for initiation of labor by stimulating methylation and repression of PR-A and activating pro-labor signaling in trophoblast.
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Affiliation(s)
- Kristy T Palomares
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
- Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, NJ, 08901, USA
| | - Nataliya Parobchak
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Mayra Cruz Ithier
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Lauren M Aleksunes
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, 08854, USA
| | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Melody So
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Revital Faro
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
- Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, NJ, 08901, USA
| | - Debra Heller
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, 07103, USA
| | - Bingbing Wang
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA.
| | - Todd Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA.
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Fang NZ, Castaño PM, Davis A. A hospital-based COVID-19 abortion case in the early phase of the pandemic. Contraception 2020; 102:137-138. [PMID: 32416144 PMCID: PMC7235605 DOI: 10.1016/j.contraception.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/03/2022]
Abstract
In this case report we discuss changes in hospital-based abortion care due to the COVID-19 pandemic. We highlight our experience with exposure to an asymptomatic COVID-19 positive patient. We hope early lessons from the United States epicenter will guide clinicians providing abortion care during this and future pandemics.
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Affiliation(s)
- Nancy Z Fang
- Columbia University Irving Medical Center, Department of Obstetrics and Gynecology, Division of Family Planning and Preventive Services, 622 West 168th St, PH 16-69, New York, NY 10032, United States.
| | - Paula M Castaño
- Columbia University Irving Medical Center, Department of Obstetrics and Gynecology, Division of Family Planning and Preventive Services, 622 West 168th St, PH 16-69, New York, NY 10032, United States
| | - Anne Davis
- Columbia University Irving Medical Center, Department of Obstetrics and Gynecology, Division of Family Planning and Preventive Services, 622 West 168th St, PH 16-69, New York, NY 10032, United States
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8
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Castaño PM, Westhoff CL. Experience with same-day placement of the 52 mg levonorgestrel-releasing intrauterine system. Am J Obstet Gynecol 2020; 222:S883.e1-S883.e6. [PMID: 31945336 DOI: 10.1016/j.ajog.2019.12.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prescribing information for the levonorgestrel-releasing intrauterine system allows placement when the clinician is reasonably certain the patient is not pregnant. A 6 item checklist aids clinicians in determining pregnancy risk but may be too restrictive, resulting in delaying placement for many women. Same-day placement, however, may risk placement during an unrecognized luteal-phase pregnancy, that is, a preimplantation fertilized ovum not yet detectable by urine pregnancy test. OBJECTIVE We assessed the applicability of pregnancy checklist criteria in 2 gynecology practices that routinely provide same-day placements following a negative urine pregnancy test. STUDY DESIGN In this retrospective cohort study, we reviewed electronic medical records of all women who underwent levonorgestrel-releasing intrauterine system placement from July 2009 to August 2012. We evaluated each record to identify whether the woman met any of the checklist criteria to exclude pregnancy. We ascertained luteal-phase pregnancies and other outcomes within 12 months following placement. RESULTS Of 885 placements, 293 (33%) were immediately after abortion. Of the remaining 592 placements, 353 (60%) met at least 1 pregnancy checklist criterion to rule out pregnancy but 239 (40%) met none. Two percent received levonorgestrel emergency contraception at the time of placement. One luteal-phase pregnancy occurred in the group not meeting pregnancy checklist criteria. Removals and expulsions were rare and similar whether or not patients met checklist criteria. CONCLUSION In 2 practices that provide same-day intrauterine system placements, strict adherence to pregnancy checklist criteria would have resulted in 239 patients (40%) not receiving a same-day intrauterine system. Twelve month outcomes were similar whether or not patients met pregnancy checklist criteria. Providers need not withhold intrauterine system placement based on the pregnancy checklist criteria.
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Affiliation(s)
- Paula M Castaño
- Division of Family Planning, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY.
| | - Carolyn L Westhoff
- Division of Family Planning, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY
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Shimoni N, Nippita S, Castaño PM. Best practices for collecting repeated measures data using text messages. BMC Med Res Methodol 2020; 20:2. [PMID: 31900108 PMCID: PMC6942258 DOI: 10.1186/s12874-019-0891-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background Researchers and clinicians use text messages to collect data with the advantage of real time capture when compared with standard data collection methods. This article reviews project setup and management for successfully collecting patient-reported data through text messages. Methods We review our experience enrolling over 2600 participants in six clinical trials that used text messages to relay information or collect data. We also reviewed the literature on text messages used for repeated data collection. We classify recommendations according to common themes: the text message, the data submitted and the phone used. Results We present lessons learned and discuss how to create text message content, select a data collection platform with practical features, manage the data thoughtfully and consistently, and work with patients, participants and their phones to protect privacy. Researchers and clinicians should design text messages to include short, simple prompts and answer choices. They should decide whether and when to send reminders if participants do not respond and set parameters regarding when and how often to contact patients for missing data. Data collection platforms send, receive, and store messages. They can validate responses and send error messages. Researchers should develop a protocol to append and correct data in order to improve consistency with data handling. At the time of enrollment, researchers should ensure that participants can receive and respond to messages. Researchers should address privacy concerns and plan for service interruptions by obtaining alternate participant contact information and providing participants with a backup data collection method. Conclusions Careful planning and execution can reward clinicians and investigators with complete, timely and accurate data sets.
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Affiliation(s)
- Noa'a Shimoni
- Department of Family Medicine, Rutgers New Jersey Medical School, 183 South Orange Avenue, E1562, Newark, NJ, 07103, USA.
| | - Siripanth Nippita
- Department of Obstetrics and Gynecology, New York University-Langone Medical Center, New York, USA
| | - Paula M Castaño
- Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, USA
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10
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Kimble TD, Poindexter A, Barnhart K, Castaño PM, Chen BA, Chiodo JA, Garner EIO. Body mass index and weight are predictors of pregnancy in a phase 3 multicenter contraceptive efficacy study of AG200-15, a low-dose combination hormonal contraceptive patch. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chernick LS, Stockwell MS, Wu M, Castaño PM, Schnall R, Westhoff CL, Santelli J, Dayan PS. Texting to Increase Contraceptive Initiation Among Adolescents in the Emergency Department. J Adolesc Health 2017; 61:786-790. [PMID: 29056437 PMCID: PMC5701840 DOI: 10.1016/j.jadohealth.2017.07.021] [Citation(s) in RCA: 24] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the feasibility and acceptability of a text messaging intervention to increase contraception among adolescent emergency department patients. METHODS A pilot randomized controlled trial of sexually active females aged 14-19 receiving 3 months of theory-based, unidirectional educational and motivational texts providing reproductive health information versus standardized discharge instructions. Blinded assessors measured contraception initiation via telephone follow-up and health record review at 3 months. RESULTS We randomized 100 eligible participants (predominantly aged 18-19, Hispanic, and with a primary provider); 88.0% had follow-up. In the intervention arm, 3/50 (6.0%) participants opted out, and 1,172/1,654 (70.9%) texts were successfully delivered; over 90% of message failures were from one mobile carrier. Most (36/41; 87.7%) in the intervention group liked and wanted future reproductive health messages. Contraception was initiated in 6/50 (12.0%) in the intervention arm and in 11/49 (22.4%) in the control arm. CONCLUSIONS A pregnancy prevention texting intervention was feasible and acceptable among adolescent females in the emergency department setting.
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Affiliation(s)
- Lauren S Chernick
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, New York, New York.
| | - Melissa S Stockwell
- Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York; Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Mengfei Wu
- Department of Biostatistics, Columbia University, New York, New York
| | - Paula M Castaño
- Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, New York
| | | | - Carolyn L Westhoff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York; Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, New York
| | - John Santelli
- Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York; Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Peter S Dayan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, New York, New York
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12
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Stockwell MS, Cano M, Jakob K, Broder KR, Gyamfi-Bannerman C, Castaño PM, Lewis P, Barrett A, Museru OI, Castellanos O, LaRussa PS. Feasibility of Text Message Influenza Vaccine Safety Monitoring During Pregnancy. Am J Prev Med 2017; 53:282-289. [PMID: 28495223 PMCID: PMC6675451 DOI: 10.1016/j.amepre.2017.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/20/2017] [Accepted: 03/16/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The feasibility and accuracy of text messaging to monitor events after influenza vaccination throughout pregnancy and the neonatal period has not been studied, but may be important for seasonal and pandemic influenza vaccines and future maternal vaccines. METHODS This prospective observational study was conducted during 2013-2014 and analyzed in 2015-2016. Enrolled pregnant women receiving inactivated influenza vaccination at a gestational age <20 weeks were sent text messages intermittently through participant-reported pregnancy end to request fever, health events, and neonatal outcomes. Text message response rates, Day 0-2 fever (≥100.4°F), health events, and birth/neonatal outcomes were assessed. RESULTS Most (80.2%, n=166) eligible women enrolled. Median gestational age was 8.9 (SD=3.9) weeks at vaccination. Response rates remained high (80.0%-95.2%). Only one Day 0-2 fever was reported. Women reported via text both pregnancy- and non-pregnancy-specific health events, not all associated with medical visits. Most pregnancy-specific events in the electronic medical record (EMR) were reported via text message. Of all enrollees, 84.9% completed the study (131 reported live birth, ten reported pregnancy loss). Two losses reported via text were not medically attended; there was one additional EMR-identified loss. Gestational age and weight at birth were similar between text message-reported and EMR-abstracted data and 95% CIs were overlapping for proportions of prematurity, low birth weight, small for gestational age, and major birth defects, as identified by text message-reported versus EMR-abstracted plus text message-reported versus EMR-abstracted data only. CONCLUSIONS This study demonstrated the feasibility of text messaging for influenza vaccine safety surveillance sustained throughout pregnancy. In these women receiving inactivated influenza vaccination during pregnancy, post-vaccination fever was infrequent and a typical pattern of maternal and neonatal health outcomes was observed.
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Affiliation(s)
- Melissa S Stockwell
- Department of Pediatrics, Columbia University, New York, New York; Mailman School Public Health, Columbia University, New York, New York; NewYork Presbyterian Hospital, New York, New York.
| | - Maria Cano
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen Jakob
- Department of Pediatrics, Columbia University, New York, New York
| | - Karen R Broder
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Paige Lewis
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela Barrett
- Department of Pediatrics, Columbia University, New York, New York
| | - Oidda I Museru
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Philip S LaRussa
- Department of Pediatrics, Columbia University, New York, New York
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Chernick LS, Schnall R, Stockwell MS, Castaño PM, Higgins T, Westhoff C, Santelli J, Dayan PS. Adolescent Female Text Messaging Preferences to Prevent Pregnancy After an Emergency Department Visit: A Qualitative Analysis. J Med Internet Res 2016; 18:e261. [PMID: 27687855 PMCID: PMC5064124 DOI: 10.2196/jmir.6324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/06/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022] Open
Abstract
Background Over 15 million adolescents use the emergency department (ED) each year in the United States. Adolescent females who use the ED for medical care have been found to be at high risk for unintended pregnancy. Given that adolescents represent the largest users of text messaging and are receptive to receiving text messages related to their sexual health, the ED visit represents an opportunity for intervention. Objective The aim of this qualitative study was to explore interest in and preferences for the content, frequency, and timing of an ED-based text message intervention to prevent pregnancy for adolescent females. Methods We conducted semistructured, open-ended interviews in one urban ED in the United States with adolescent females aged 14-19 years. Eligible subjects were adolescents who were sexually active in the past 3 months, presented to the ED for a reproductive health complaint, owned a mobile phone, and did not use effective contraception. Using an interview guide, enrollment continued until saturation of key themes. The investigators designed sample text messages using the Health Beliefs Model and participants viewed these on a mobile phone. The team recorded, transcribed, and coded interviews based on thematic analysis using the qualitative analysis software NVivo and Excel. Results Participants (n=14) were predominantly Hispanic (13/14; 93%), insured (13/14; 93%), ED users in the past year (12/14; 86%), and frequent text users (10/14; 71% had sent or received >30 texts per day). All were interested in receiving text messages from the ED about pregnancy prevention, favoring messages that were “brief,” “professional,” and “nonaccusatory.” Respondents favored texts with links to websites, repeated information regarding places to receive “confidential” care, and focused information on contraception options and misconceptions. Preferences for text message frequency varied from daily to monthly, with random hours of delivery to maintain “surprise.” No participant feared that text messages would violate her privacy. Conclusions Adolescent female patients at high pregnancy risk are interested in ED-based pregnancy prevention provided by texting. Understanding preferences for the content, frequency, and timing of messages can guide in designing future interventions in the ED.
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Affiliation(s)
- Lauren Stephanie Chernick
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, New York, NY, United States.
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14
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Aiken ARA, Westhoff CL, Trussell J, Castaño PM. Comparison of a Timing-Based Measure of Unintended Pregnancy and the London Measure of Unplanned Pregnancy. Perspect Sex Reprod Health 2016; 48:139-146. [PMID: 27574959 PMCID: PMC5028288 DOI: 10.1363/48e11316] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/07/2016] [Accepted: 07/07/2016] [Indexed: 06/01/2023]
Abstract
CONTEXT Unintended pregnancy is a universal benchmark for reproductive health, but whether variations reflect differences in measurement and how well measures predict pregnancy outcomes warrant further examination. U.S. and British measures of unintended and unplanned pregnancy offer a useful comparison. METHODS Some 220 women seeking pregnancy testing at the Columbia University Medical Center in 2005 responded to three pregnancy measures: a binary timing-based measure of unintended pregnancy (TMUP); a multi-item measure of timing-based intentions and planning behaviors, the London Measure of Unplanned Pregnancy (LMUP); and a measure combining intentions (from the TMUP) and how women would feel about a positive pregnancy test. Six-month pregnancy status was assessed among 159 respondents. Estimates of unintended and unplanned pregnancy were calculated using the TMUP and the LMUP, and receiver operating characteristic (ROC) curves were generated to assess congruence. RESULTS According to the TMUP, 76% of pregnancies were unintended; by contrast, LMUP scores categorized 39% as unplanned. The ROC curve indicated that expanding the range of scores for classifying pregnancies as unplanned on the LMUP would achieve greater congruence between these measures. At six months, the proportion of pregnancies that had ended in abortion was 42% of those classified as unintended using the TMUP, 60% of those classified as unplanned using the LMUP and 71% of those that women said they had not intended and were very upset about. CONCLUSIONS U.S. and British measures of unintended pregnancy are not directly comparable, and a measure combining intentions and feelings may better predict pregnancy outcomes.
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Affiliation(s)
- Abigail R A Aiken
- LBJ School of Public Affairs, University of Texas at Austin.
- Population Research Center, University of Texas at Austin.
| | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York
| | - James Trussell
- Office of Population Research, Princeton University, Princeton, NJ
| | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York
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15
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Horvath S, Castaño PM, Champer M, Davis AR. Decreasing gestational age at abortion for fetal aneuploidy, but not structural anomaly, 2004–2014. Contraception 2016. [DOI: 10.1016/j.contraception.2016.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Nippita S, Oviedo JD, Velasco MG, Westhoff CL, Davis AR, Castaño PM. A randomized controlled trial of daily text messages versus monthly paper diaries to collect bleeding data after intrauterine device insertion. Contraception 2015; 92:578-84. [PMID: 26363433 DOI: 10.1016/j.contraception.2015.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 03/06/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Bleeding data in contraceptive trials are often collected using daily diaries, but data quality may vary due to compliance and recall bias. Text messaging is a widespread and promising modality for data collection. STUDY DESIGN This trial randomized participants 1:1 to use text messages or paper diaries to report on bleeding experienced during the 90 days after intrauterine device (IUD) insertion. Participants chose either the copper T380A or the 52-mg levonorgestrel IUD. Our primary outcome was number of days of reported bleeding data. We hypothesized that data gathered with daily text messages would have fewer missing values than paper diaries. Intention to treat analyses used the rank-sum test to compare medians. RESULTS Two hundred thirty women enrolled, and randomization yielded groups similar in baseline characteristics. Twenty percent of participants provided no bleeding data; of these, 77% were assigned to paper diaries. With 90 days of reporting, approximately 20% in each group provided complete bleeding data. The text group reported a median of 82 days [interquartile range (IQR) 40-89] and the paper group reported a median of 36 days (IQR 0-88) (p≤.001). The number of responses received decreased gradually over the 90-day period but was always higher in the text group. Women who had attained higher levels of education did well regardless of data collection modality, while response rates of text messages were greater among those with a high school education or less (p<.01). CONCLUSIONS Participants reporting bleeding via text messages provided more complete data than women using paper diaries. IMPLICATIONS Depending on resources and population of interest, text messages may be a useful modality to improve data collection for patient-reported outcomes.
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Affiliation(s)
| | | | | | | | - Anne R Davis
- 622 West 168th Street, PH-16, New York, NY 10032, USA.
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17
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Chernick LS, Schnall R, Higgins T, Stockwell MS, Castaño PM, Santelli J, Dayan PS. Barriers to and enablers of contraceptive use among adolescent females and their interest in an emergency department based intervention. Contraception 2014; 91:217-25. [PMID: 25499588 DOI: 10.1016/j.contraception.2014.12.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 07/19/2014] [Revised: 12/02/2014] [Accepted: 12/08/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Over 15 million adolescents, many at high risk for pregnancy, use emergency departments (EDs) in the United States annually, but little is known regarding reasons for failure to use contraceptives in this population. The purpose of this study was to identify the barriers to and enablers of contraceptive use among adolescent females using the ED and determine their interest in an ED-based pregnancy prevention intervention. STUDY DESIGN We conducted semistructured, open-ended interviews with females in an urban ED. Eligible females were 14-19 years old, sexually active, presenting for reproductive health complaints and at risk for pregnancy, defined as nonuse of effective (per the World Health Organization) contraception. Interviews were recorded, transcribed and coded based on thematic analysis. Enrollment continued until no new themes emerged. A modified Health Belief Model guided the organization of the data. RESULTS Participants (n=14) were predominantly Hispanic (93%), insured (93%) and in a sexual relationship (86%). The primary barrier to contraceptive use was perceived health risk, including effects on menstruation, weight and future fertility. Other barriers consisted of mistrust in contraceptives, ambivalent pregnancy intentions, uncertainty about the future, partner's desire for pregnancy and limited access to contraceptives. Enablers of past contraceptive use included the presence of a school-based health clinic and clear plans for the future. All participants were receptive to ED-based pregnancy prevention interventions. CONCLUSIONS The identified barriers and enablers influencing hormonal contraceptive use can be used to inform the design of future ED-based adolescent pregnancy prevention interventions. IMPLICATIONS Adolescents who visit the emergency department (ED) identify contraceptive side effects, mistrust in contraceptives, limited access, pregnancy ambivalence and partner pregnancy desires as barriers to hormonal contraception use. They expressed interest in an ED-based intervention to prevent adolescent pregnancy; such an intervention could target these themes to maximize effectiveness.
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Affiliation(s)
- Lauren S Chernick
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States.
| | - Rebecca Schnall
- Department of Nursing, Columbia University Medical Center, NY, NY, United States
| | - Tracy Higgins
- Department of Nursing, Columbia University Medical Center, NY, NY, United States
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States; Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, NY, NY, United States
| | - Paula M Castaño
- Department of Obstetrics & Gynecology, Columbia University Medical Center, NY, NY, United States
| | - John Santelli
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States; Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, NY, NY, United States
| | - Peter S Dayan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States
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18
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Castaño PM, Aydemir A, Sampson-Landers C, Lynen R. The folate status of reproductive-aged women in a randomised trial of a folate-fortified oral contraceptive: dietary and blood assessments. Public Health Nutr 2014; 17:1375-83. [PMID: 23534865 PMCID: PMC10282410 DOI: 10.1017/s1368980013000864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 02/04/2013] [Accepted: 02/20/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the folate status of US women in a study of a folate-fortified oral contraceptive (OC) using the Short Folate Food Frequency Questionnaire and plasma and red blood cell (RBC) folate samples. DESIGN Sub-analysis from a multi-centre, randomised, double-blind, controlled contraceptive trial with assessments at baseline and 6 months. We calculated dietary folate equivalents (DFE) consumed and the proportion of participants meeting folate adequacy benchmarks. SETTING Eight centres in the USA. SUBJECTS Healthy women aged 18-40 years requesting contraception with no contraindications for OC use. RESULTS Overall, 385 participants were randomised to either a novel folate-fortified OC or a marketed OC. The 262 (68 %) participants compliant with the protocol were included in the analysis set. Baseline daily DFE consumption was 529·8 (sd 342·1) μg and similar in both groups. At follow-up, the fortified OC group had higher intake than the conventional OC group (1225·9 (sd 346·2) μg compared with 500·6 (sd 361·2) μg). Mean plasma folate level increased from 44·5 (sd 17·2) to 55·8 (sd 21·1) nmol/l. Mean RBC folate level increased from 996·7 (sd 369·8) to 1311·9 (sd 436·0) nmol/l. The proportion meeting selected folate adequacy benchmarks increased in the fortified OC group (P < 0·001). CONCLUSIONS Lack of adequate folate intake in reproductive-aged women from dietary sources or supplements alone suggests the need for novel approaches. Use of folate-fortified OC ensures adequate folate levels and meeting of folate benchmarks.
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Affiliation(s)
- Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, PH 16-69, New York, NY 10032, USA
| | - Aida Aydemir
- Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ, USA
| | | | - Richard Lynen
- Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ, USA
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19
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Hall KS, Castaño PM, Westhoff CL. The influence of oral contraceptive knowledge on oral contraceptive continuation among young women. J Womens Health (Larchmt) 2014; 23:596-601. [PMID: 24571282 DOI: 10.1089/jwh.2013.4574] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Using a multidimensional approach, we assessed young women's knowledge of oral contraceptives (OC) and its influence on OC continuation rates. METHODS We used data from 659 women aged 13-25 years participating in a randomized controlled trial of an educational text message OC continuation intervention. Women received 6 months of daily text messages or routine care. At baseline and 6 months, we administered a comprehensive 41-item questionnaire measuring knowledge of OC's mechanism, effectiveness, use, side effects, risks, and benefits. We ascertained OC continuation status and reasons for discontinuation at 6 months. We analyzed relationships between OC knowledge and continuation with multivariable logistic regression. RESULTS Young women scored, on average, 22.8 out of 41 points on the OC knowledge assessment at baseline and 24.7 points at 6 months. The 6-month OC continuation rate was 59%. OC continuers had >2-points-higher OC knowledge scores at 6 months than discontinuers (p<0.001). Those who reported discontinuing their OCs for side effects and forgetfulness scored >2 points lower than women who discontinued for other reasons (p-values<0.001). In multivariable regression models, each correct response on the baseline and 6-month knowledge assessments was associated with a 4% and 6% increased odds of OC continuation, respectively. Six-month OC knowledge scores were negatively associated with OC discontinuation due to side effects (odds ratio [OR] 0.94) and forgetfulness (OR 0.88). CONCLUSIONS OC knowledge, which was low among young women in our study, was associated with OC continuation and common reasons for discontinuation. Continued efforts to characterize relationships between OC knowledge and behavior and to test the effectiveness of different components of interventions aimed at increasing knowledge, addressing side effects, and improving use of OCs are warranted.
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Affiliation(s)
- Kelli Stidham Hall
- 1 Department of Obstetrics and Gynecology, Institute for Social Research, University of Michigan , Ann Arbor, Michigan
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20
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Stockwell MS, Westhoff C, Kharbanda EO, Vargas CY, Camargo S, Vawdrey DK, Castaño PM. Influenza vaccine text message reminders for urban, low-income pregnant women: a randomized controlled trial. Am J Public Health 2013; 104 Suppl 1:e7-12. [PMID: 24354839 DOI: 10.2105/ajph.2013.301620] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the impact of influenza vaccine text message reminders in a low-income obstetric population. METHODS We conducted a randomized controlled trial that enrolled 1187 obstetric patients from 5 community-based clinics in New York City. The intervention group received 5 weekly text messages regarding influenza vaccination starting mid-September 2011 and 2 text message appointment reminders. Both groups received standard automated telephone appointment reminders. The prespecified endpoints were receipt of either pre- or postpartum influenza vaccination calculated cumulatively at the end of each month (September-December 2011). RESULTS After adjusting for gestational age and number of clinic visits, women who received the intervention were 30% more likely to be vaccinated as of December 2011 (adjusted odds ratio [AOR] = 1.30; 95% confidence interval [CI] = 1.003, 1.69 end of September: AOR = 1.34; 95% CI = 0.98, 1.85; October: AOR = 1.35; 95% CI = 1.05, 1.75; November: AOR = 1.27; 95% CI = 0.98, 1.65). The subgroup of women early in the third trimester at randomization showed the greatest intervention effect (December 31: 61.9% intervention vs 49.0% control; AOR = 1.88; 95% CI = 1.12, 3.15). CONCLUSIONS In this low-income obstetric population, text messaging was associated with increased influenza vaccination, especially in those who received messages early in their third trimester.
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Affiliation(s)
- Melissa S Stockwell
- Melissa S. Stockwell is with the Departments of Pediatrics and Population and Family Health, Columbia University, and New York-Presbyterian Hospital, New York, NY. Carolyn Westhoff is with the Departments of Obstetrics and Gynecology and Epidemiology, Columbia University. Elyse Olshen Kharbanda is with HealthPartners Institute for Education and Research, Minneapolis, MN. Celibell Y. Vargas and Stewin Camargo are with the Department of Pediatrics, Columbia University. David K. Vawdrey is with the Department of Biomedical Informatics, Columbia University, and New York-Presbyterian Hospital. Paula M. Castaño is with the Department of Obstetrics and Gynecology, Columbia University
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21
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Castaño PM, White KO. Should we do more to improve oral contraceptive continuation? Womens Health (Lond) 2013; 9:145-156. [PMID: 23477321 DOI: 10.2217/whe.13.10] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Oral contraceptives are commonly chosen methods whose contraceptive effectiveness is very user-dependent. Approaches to significantly improving oral contraceptive continuation have been largely unsuccessful. Long-acting reversible methods are the most highly effective reversible contraceptives, with the highest continuation rates, and should be the first-line methods offered to reproductive-aged women.
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Affiliation(s)
- Paula M Castaño
- Columbia University Medical Center, New York, NY 10032, USA.
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22
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Guerrero JM, Castaño PM, Schmidt EO, Rosario L, Westhoff CL. Music as an auxiliary analgesic during first trimester surgical abortion: a randomized controlled trial. Contraception 2012; 86:157-62. [DOI: 10.1016/j.contraception.2011.11.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 11/20/2011] [Accepted: 11/23/2011] [Indexed: 02/03/2023]
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Kharbanda EO, Vargas CY, Castaño PM, Lara M, Andres R, Stockwell MS. Exploring pregnant women's views on influenza vaccination and educational text messages. Prev Med 2011; 52:75-7. [PMID: 21047526 DOI: 10.1016/j.ypmed.2010.10.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [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: 07/20/2010] [Revised: 10/07/2010] [Accepted: 10/24/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND The influenza vaccine has the potential to reduce morbidity among pregnant women and newborns but immunization coverage remains low. Effective interventions are needed to promote vaccine uptake in this population. PURPOSE The goal of this study was to explore attitudes toward influenza vaccination and interest in targeted educational text messages among urban pregnant women. METHODS English and Spanish language focus groups were conducted with pregnant women in New York City in April 2010. Transcripts were independently coded using content analysis. RESULTS The 40 participants ranged in age from 19-35 years (mean=26, SD=5). Their gestational age ranged from 8-40 weeks (mean=27, SD=8). Most were Latina (85%), had other children (70%), and were publicly insured (78%). Nearly half had received the seasonal influenza or influenza A (H1N1) 2009 monovalent vaccine. Barriers to vaccination included concerns regarding vaccine safety and efficacy, misperceptions regarding risks for influenza, and lack of provider recommendation. Pregnant women expressed interest in receiving educational text messages regarding influenza. Even women who had refused the influenza vaccine thought the text messages would encourage vaccine-related discussions during prenatal visits. CONCLUSION Among urban pregnant women, educational text messages regarding influenza would be well received and may effectively address current barriers to vaccination.
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Hall KS, Castaño PM, Stone PW, Westhoff C. Measuring oral contraceptive knowledge: a review of research findings and limitations. Patient Educ Couns 2010; 81:388-94. [PMID: 21084170 PMCID: PMC3785081 DOI: 10.1016/j.pec.2010.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 10/14/2010] [Accepted: 10/21/2010] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Poor oral contraceptive (OC) knowledge may contribute to premature OC discontinuation and unintended pregnancy. Yet, to understand relationships between OC knowledge and contraceptive behavior, knowledge must be adequately measured. This review evaluates the findings and methodological limitations of research in which OC knowledge has been measured. METHODS We performed a systematic review of primary research from January 1965 to January 2009. Studies were audited for study characteristics, purpose for measuring OC knowledge, key findings and measurement properties including administration method, knowledge domains, reliability, validity, health literacy and cultural sensitivity. RESULTS We reviewed 21 studies: 18 cohort studies, including one psychometric evaluation, and three randomized trials. Results on OC knowledge outcomes were variable. Measures were largely self-administered survey (n=15) and lacked assessment of all OC knowledge domains. Information on measures' characteristics, reliability, validity, health literacy and cultural sensitivity was limited. CONCLUSION Existing OC knowledge measures lack critical psychometric elements, leading to inconsistent and unreliable findings. PRACTICE IMPLICATIONS Poor OC knowledge measurement precludes identifying counseling needs and developing interventions for contraceptive behavior change. Future research considerations include: measurement information in publications, psychometric evaluations, formal reliability/validity techniques, and attention to all OC knowledge domains, health literacy and cultural sensitivity.
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Affiliation(s)
- Kelli Stidham Hall
- Office of Population Research, Princeton University, Princeton, NJ 08544, USA.
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Castaño PM, Martínez RA. Harnessing technology for adolescent health promotion. Adolesc Med State Art Rev 2007; 18:400-xiii. [PMID: 18605654] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Sexually active adolescents are at risk for unintended pregnancy. Teen pregnancies can be prevented by consistent use of birth control, such as oral contraceptives. However, many teens forget their daily doses and eventually stop using oral contraceptives altogether. Teen pregnancies are more likely to be medically complicated and can adversely impact the teen, her child, and their community. Cell-phone use is becoming widespread, and teen cell-phone users frequently use text messaging. We describe a study in which we use cell-phone text-messaging technology in a novel way: we provide daily oral contraceptive dosing reminders and educational messages and evaluate oral contraceptive continuation at 6 months. We will use the information we obtain to develop specific, practice-based interventions to improve reproductive health programs and policies.
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Affiliation(s)
- Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA.
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Abstract
Human immunodeficiency virus (HIV)-infected women have unique contraceptive needs. HIV infection is now considered a chronic disease and contraceptive options have widened for HIV-infected women. However, there are safety concerns regarding the use of intrauterine devices and systems in HIV-infected women. Although studies are limited, intrauterine devices appear to be safe for use by most HIV-infected women. This is a review of the available data and international recommendations.
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Affiliation(s)
- Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
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Stuart GS, Castaño PM, Sheffield JS, McElwee B, McIntire DD, Wendel GD. Postpartum sterilization choices made by HIV-infected women. Infect Dis Obstet Gynecol 2006; 13:217-22. [PMID: 16338782 PMCID: PMC1784575 DOI: 10.1080/10647440500147968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To assess if HIV-infected women made different choices for postpartum sterilization after implementation of the Pediatric AIDS Clinical Trials Group protocol 076 (November 1, 1994) compared to before implementation. STUDY DESIGN: A retrospective cohort study in which medical records were reviewed to obtain demographic, obstetric and HIV-related data from January 1993 through December 2002. HIV-infected women who completed a pregnancy by birth or abortion were divided into two comparison groups: "Pre-076" and "Post-076". The primary outcome was sterilization by postpartum tubal ligation.Results. Forty-two women (74%) in the Pre-076 group chose sterilization compared to 139 of 310 women (45%) in the Post-076 group (unadjusted OR 3.44, 95% CI 1.83, 6.47). Seventy-one percent of women younger than 21 years of age in the Pre-076 Group chose sterilization compared with only 35% of women younger than 21 years in the Post-076 group (p = 0.0136). Similarly, 78% of primiparous women chose sterilization after their first pregnancy in the Pre-076 group, compared to 14% in the Post-076 group (p < 0.001). CONCLUSIONS: Since the implementation of PACTG 076 protocol in November 1994, fewer HIV-infected women chose postpartum sterilization. The typical woman who now chooses postpartum sterilization is less likely to be young or primiparous than those who chose sterilization before PACTG Protocol 076 implementation.
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Affiliation(s)
- Gretchen S Stuart
- Department of Obstetrics & Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9032, USA.
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Abstract
Oral contraceptives (OCs) provide safe, effective, and reversible contraception and are widely used by women for fertility control. Little is known about the effects of OCs on sexual functioning. This paper critically examines the published literature addressing the impact of OCs on sexual desire or libido. We reviewed 30 original research studies. In the retrospective, uncontrolled studies (n = 17), it was found that most women reported an increase in libido during OC use. In the uncontrolled, prospective studies (n = 4), it was found that most women reported little change in libido during OC use. In the prospective and cross-sectional controlled studies (n = 4), women using OCs reported both increased and decreased libido compared to non-OC users. The findings from randomized, placebo-controlled studies (n = 5) were mixed: In the most recent and well-conducted trial, a decrease in libido in OC users compared to placebo users was found. Overall, women experience positive effects, negative effects, as well as no effect on libido during OC use. Better-designed studies are needed to establish the independent, causal effects of OCs on libido.
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Affiliation(s)
- Anne R Davis
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
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Davis AR, Castaño PM. Oral contraceptives and libido in women. Annu Rev Sex Res 2004; 15:297-320. [PMID: 16913282] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Oral contraceptives (OCs) provide safe, effective, and reversible contraception and are widely used by women for fertility control. Little is known about the effects of OCs on sexual functioning. This paper critically examines the published literature addressing the impact of OCs on sexual desire or libido. We reviewed 30 original research studies. In the retrospective, uncontrolled studies (n = 17), it was found that most women reported an increase in libido during OC use. In the uncontrolled, prospective studies (n = 4), it was found that most women reported little change in libido during OC use. In the prospective and cross-sectional controlled studies (n = 4), women using OCs reported both increased and decreased libido compared to non-OC users. The findings from randomized, placebo-controlled studies (n = 5) were mixed: In the most recent and well-conducted trial, a decrease in libido in OC users compared to placebo users was found. Overall, women experience positive effects, negative effects, as well as no effect on libido during OC use. Better-designed studies are needed to establish the independent, causal effects of OCs on libido.
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Affiliation(s)
- Anne R Davis
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
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Abstract
It is important to examine the successful completed research and use it to move forward in practice to halt the almost 50% unintended pregnancy rate in the United States and the continued worldwide epidemic of HIV and other STIs. A significant development has been the evidence supporting the IUD as a valuable contraceptive option available to many women, including women who are HIV infected, with no increased risks of infertility or PID. Evidence exists that OCPs may increase chlamydial infection acquisition and cervicitis, but it is unlikely that OCP use is associated with PID. The lack of female-controlled dual method protection remains a void, but with the introduction of products such as FemCap and Reality condom and the continuing progress of microbicides and spermicides, the future is brighter. Clearly research into the interactions of STIs and contraceptives must continue to discern how best to approach a resolution to these public health concerns that affect women and the global population.
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Affiliation(s)
- Gretchen S Stuart
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032, USA.
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