University of California, San Francisco
Obstetrics, Gynecology and Reproductive Sciences
Introduction: In 2000, approximately 1.31 million abortions were performed in the US, making abortion one of the most common procedures experienced by women of reproductive age. However, since 1982 the number of abortion providers has... more
Introduction: In 2000, approximately 1.31 million abortions were performed in the US, making abortion one of the most common procedures experienced by women of reproductive age. However, since 1982 the number of abortion providers has declined by 37% due, in part, to the lack of routine educational and training opportunities for health service professionals. Our study examines the ways in which Ob/Gyn residency programs describe, discuss and highlight abortion training opportunities on their institutional websites.
Objective. To inform an intervention integrating family planning into HIV care, family planning (FP) knowledge, attitudes and practices, and perspectives on integrating FP into HIV care were assessed among healthcare providers in Nyanza... more
Objective. To inform an intervention integrating family planning into HIV care, family planning (FP) knowledge, attitudes and practices, and perspectives on integrating FP into HIV care were assessed among healthcare providers in Nyanza Province, Kenya. Methods. Thirty-one mixed-method, structured interviews were conducted among a purposive sample of healthcare workers (HCWs) from 13 government HIV care facilities in Nyanza Province. Structured questions and case scenarios assessed contraceptive knowledge, training, and FP provision experience. Open-ended questions explored perspectives on integration. Data were analyzed descriptively and qualitatively. Results. Of the 31 HCWs interviewed, 45% reported previous FP training. Few providers thought long-acting methods were safe for HIV-positive women (19% viewed depot medroxyprogesterone acetate as safe and 36% viewed implants and intrauterine contraceptives as safe); fewer felt comfortable recommending them to HIV-positive women. Over...
- by Sara Newmann and +1
- •
- HIV / AIDS treatment
This study was undertaken to describe demographics and contraceptive familiarity and use among postpartum adolescents in El Salvador. Questionnaire-guided interviews were conducted in Spanish with 50 postpartum adolescents at an urban,... more
This study was undertaken to describe demographics and contraceptive familiarity and use among postpartum adolescents in El Salvador. Questionnaire-guided interviews were conducted in Spanish with 50 postpartum adolescents at an urban, public hospital in El Salvador. Open-ended questions included assessments of education, partnership status, and contraceptive knowledge and use patterns. The median age of subjects was 17 years, 84% were nulliparous, 80% had partners, and 6% were married. Eighty-four percent of the women reported contraception knowledge and 18% reported contraception use. Educational experience and literacy predicted contraceptive knowledge (P = .008 and .001, respectively), but not use. After delivery and postpartum contraception education, 58% of the subjects stated intention to use contraception. Having a partner and living with him were predictors of intent to use contraception (P = .001 and .002, respectively). Being single negatively predicted intention to use c...
Objective Assessed the feasibility, acceptability, and sustainability of Planet Health, an interdisciplinary, integrated health education curriculum implemented in six public middle schools. Methods Workshops on Planet Health... more
Objective Assessed the feasibility, acceptability, and sustainability of Planet Health, an interdisciplinary, integrated health education curriculum implemented in six public middle schools. Methods Workshops on Planet Health implementation were attended by 129 teachers (language arts, math, science, and social studies) over three school years (). Questionnaires were administered post-implementation and in the fall and spring of each year. Outcomes were dose, acceptability, feasibility, and intent to continue use. Results The average number of lessons taught per teacher per year was 1.7 to 3.1, compared to a goal of 2 to 3. Each year, teachers reported high acceptability and perceived feasibility of the intervention, and the majority indicated they intended to continue using the curriculum. Conclusions Planet Health was feasible and acceptable in a participatory research model involving a public school-university partnership, and it was also sustainable independent of the research effort.
Underage alcohol use remains a significant public health problem throughout the United States and has important consequences for the health of individuals and communities. The objective of this study was to assess the impact of... more
Underage alcohol use remains a significant public health problem throughout the United States and has important consequences for the health of individuals and communities. The objective of this study was to assess the impact of distributing an alcohol retailer toolkit via direct mail on increasing positive alcohol retailer attitudes towards checking IDs, encouraging retail managers to formalize ID checking procedures with their employees, and promoting consumers to be prepared to show ID when purchasing alcohol. This community randomized study included five matched Massachusetts community pairs. Our analysis sample consisted of 209 retailers (77 intervention; 132 control). In models adjusted for baseline response and matching community and establishment characteristics, intervention communities reported posting, on average, one additional sign or wall decal in their establishments (β = 0.937, P = 0.0069), and a twofold higher odds of handing out written materials on ID checking to staff (OR: 2.074, 95%CI: 1.003–4.288) compared to control establishments. However, the intervention was not found to have an effect on changing establishment policies, retailer attitudes, or other establishment practices. Intervention retailers perceived all components of the toolkit to be very useful for their establishments, and nearly all reported having shared materials with their employees and customers. These results suggest that some significant changes in alcohol retailer establishment practices can be achieved among motivated owners or managers through the distribution of a toolkit targeting best retailer practices. We do, however, recommend that future program planners consider alternative dissemination and marketing strategies beyond direct mail to encourage greater utilization.
This multi-national study hypothesized that higher levels of country-level gender equality would predict smaller differences in the frequency of women's compared to men's drinking in public (like bars and restaurants) settings and... more
This multi-national study hypothesized that higher levels of country-level gender equality would predict smaller differences in the frequency of women's compared to men's drinking in public (like bars and restaurants) settings and possibly private (home or party) settings. GENACIS project survey data with drinking contexts included 22 countries in Europe (8); the Americas (7); Asia (3); Australasia (2), and Africa (2), analyzed using hierarchical linear models (individuals nested within country). Age, gender and marital status were individual predictors; country-level gender equality as well as equality in economic participation, education, and political participation, and reproductive autonomy and context of violence against women measures were country-level variables. In separate models, more reproductive autonomy, economic participation, and educational attainment and less violence against women predicted smaller differences in drinking in public settings. Once controlling for country-level economic status, only equality in economic participation predicted the size of the gender difference. Most country-level variables did not explain the gender difference in frequency of drinking in private settings. Where gender OPEN ACCESS Int. J. Environ. Res. Public Health 2010, 7 2137 equality predicted this difference, the direction of the findings was opposite from the direction in public settings, with more equality predicting a larger gender difference, although this relationship was no longer significant after controlling for country-level economic status. Findings suggest that country-level gender equality may influence gender differences in drinking. However, the effects of gender equality on drinking may depend on the specific alcohol measure, in this case drinking context, as well as on the aspect of gender equality considered. Similar studies that use only global measures of gender equality may miss key relationships. We consider potential implications for alcohol related consequences, policy and public health.
Pregnant women who use drugs are more likely to receive little or no prenatal care. This study sought to understand how drug use and factors associated with drug use influence women's prenatal care use. A total of 20 semi-structured... more
Pregnant women who use drugs are more likely to receive little or no prenatal care. This study sought to understand how drug use and factors associated with drug use influence women's prenatal care use. A total of 20 semi-structured interviews and 2 focus groups were conducted with a racially/ethnically diverse sample of lowincome women using alcohol and drugs in a California county. Women using drugs attend and avoid prenatal care for reasons not connected to their drug use: concern for the health of their baby, social support, and extrinsic barriers such as health insurance and transportation. Drug use itself is a barrier for a few women. In addition to drug use, women experience multiple simultaneous risk factors. Both the drug use and the multiple simultaneous risk factors make resolving extrinsic barriers more difficult. Women also fear the effects of drug use on their baby's health and fear being reported to Child Protective Services, each of which influence women's prenatal care use. Increasing the number of pregnant women who use drugs who receive prenatal care requires systems-level rather than only individual-level changes. These changes require a paradigm shift to viewing drug use in context of the person and society and acceptance of responsibility for unintended consequences of public health bureaucratic procedures and messages about effects of drug use during pregnancy.
- by Sarah Roberts and +1
- •
- Fear, Focus Groups, Social Support, Health insurance
j Abstract Background We investigated the contributions of individual, family, and community-level factors for explaining anxiety symptoms among rural adolescents in Mexico. Method As part of a largescale survey, 3,553 adolescents and... more
j Abstract Background We investigated the contributions of individual, family, and community-level factors for explaining anxiety symptoms among rural adolescents in Mexico. Method As part of a largescale survey, 3,553 adolescents and their mothers from 333 poor, rural communities in seven Mexican states provided cross-sectional data on family level, socio-economic and psychosocial factors, and individual-level data on anxiety symptoms. Community standard of living indicators were also gathered. Results Linear regressions adjusted for sampling design indicated that adolescents' anxiety symptoms were uniquely predicted by mothers' depressive symptoms, maternal perceived stress, larger family size, and lower maternal and adolescent educational attainment. Family income and community standard of living were not directly associated with adolescent symptoms. Adolescent females reported more symptoms than males, but gender did not moderate the relationship between the predictors and adolescents' symptoms. Conclusions We found that maternal mental health was a key factor in adolescent children's psychological wellbeing; this finding extends prior research in economically developed countries that emphasizes the importance of maternal functioning for child mental health. Family size, gender, and the educational attainment of mothers and adolescents also uniquely contributed to adolescents' anxiety symptoms in these rural Mexican communities.
Background: The prevalence of obesity among women of reproductive age calls for research focused on strategies that ensure obese women receive high-quality reproductive health care. This study adds to this literature on service delivery... more
Background: The prevalence of obesity among women of reproductive age calls for research focused on strategies that ensure obese women receive high-quality reproductive health care. This study adds to this literature on service delivery by exploring obese women's experiences receiving or avoiding family planning care. Methods: We included 651 women seeking abortion care who completed iPad surveys about their previous family planning experiences. Findings: One quarter were classified as obese, with almost 5% morbidly obese. Only 1% of obese women reported avoiding family planning care. More than 12% of morbidly obese women reported not having their family planning needs met (pap smears, sexually transmitted infection testing, or ultrasonography). This is compared with only 2% among overweight and obese women and 0% among normal and underweight women. Almost 10% of obese and morbidly obese women reported that at least one of the previous family planning clinics they had visited was not prepared to provide care for heavier women and around 25% of obese women reported at least one item in the clinic (such as blood pressure cuffs and examination gowns) was not adequate for their size. Results: Contrary to expectations, we did not find that obese women avoided family planning care. However, morbidly obese women reported not having all of their family planning needs met when they attended care. Family planning providers should ensure that their facilities have the capacity to meet the family planning needs of obese women and that they have adequate equipment to care for this population of women.
Background: In 2014, Louisiana passed a law requiring abortion providers to have hospital admitting privileges. This law is temporarily on hold while a court case challenging it continues. We aimed to describe the population who would be... more
Background: In 2014, Louisiana passed a law requiring abortion providers to have hospital admitting privileges. This law is temporarily on hold while a court case challenging it continues. We aimed to describe the population who would be affected if the law goes into effect and how closures of between three and five Louisiana abortion facilities would affect the distance Louisiana women would need to travel for an abortion. Study design: We abstracted patient data from three of the five Louisiana abortion care facilities in the year before the law was scheduled to take effect. We then estimated distance traveled and distances women would need to travel if clinics close. Findings: Half (53%) of women who had an abortion had no education beyond high school, most were black (62%) or white (30%), three fourths (73%) had a previous live birth, and most (89%) were having a first-trimester abortion. Seventy-nine percent resided in Louisiana and 15% in Texas. The parishes in which abortion patients resided had lower median income and higher percentage poverty than the Louisiana average. Abortion patients residing in Louisiana traveled a mean distance of 58 miles each way for an abortion. If all Louisiana facilities close, the mean distance women would need to travel would more than triple to 208 miles, and the proportion of Louisiana women of reproductive age who live more than 150 miles from an abortion facility would increase from 1% to 72%. Conclusion: The admitting privileges law will likely significantly increase the distance Louisiana women need to travel for an abortion. This burden is likely to disproportionately affect Louisiana's more vulnerable residents. Implications: If all Louisiana abortion facilities close due to Louisiana's hospital admitting privileges law, the mean distance women would need to travel for an abortion would more than triple from 58 to 208 miles. Louisiana's law would thus present a considerable burden on many Louisiana women, particularly those who are more vulnerable.
Agencies and organizations promoting universal screening for alcohol and drug use in prenatal care argue that universal screening will reduce White versus Black racial disparities in reporting to Child Protective Services (CPS) at... more
Agencies and organizations promoting universal screening for alcohol and drug use in prenatal care argue that universal screening will reduce White versus Black racial disparities in reporting to Child Protective Services (CPS) at delivery. Yet, no published research has assessed the impact of universal screening on reporting disparities or explored plausible mechanisms. This review defines two potential mechanisms: Equitable Surveillance and Effective Treatment and identifies assumptions underlying each mechanism. It reviews published literature relating to each assumption. Research relating to assumptions underlying each mechanism is primarily inconclusive or contradictory. Thus, available research does not support the claim that universal screening for alcohol and drug use in prenatal care reduces racial disparities in CPS reporting at delivery. Reducing these reporting disparities requires more than universal screening.
Introduction: In 2000, approximately 1.31 million abortions were performed in the US, making abortion one of the most common procedures experienced by women of reproductive age. However, since 1982 the number of abortion providers has... more
Introduction: In 2000, approximately 1.31 million abortions were performed in the US, making abortion one of the most common procedures experienced by women of reproductive age. However, since 1982 the number of abortion providers has declined by 37% due, in part, to the lack of routine educational and training opportunities for health service professionals. Our study examines the ways in which Ob/Gyn residency programs describe, discuss and highlight abortion training opportunities on their institutional websites.
Soft tubing Norplant contraceptive implants were studied in 1210 women for 7 years to measure the duration of effectiveness and the magnitude of the pregnancy rates over that time. Mean age at enrollment was 27.4 years. Of the enrollees,... more
Soft tubing Norplant contraceptive implants were studied in 1210 women for 7 years to measure the duration of effectiveness and the magnitude of the pregnancy rates over that time. Mean age at enrollment was 27.4 years. Of the enrollees, 42% were US residents. weighed Ն70 kg at the time of implant placement. At the end of 5 years, the cumulative pregnancy rate was 1.1/100; at the end of 7 years, it was 1.9/100. No pregnancies occurred to any of the 400 women who enrolled in the study at age Ն30 years and who weighed Ͻ100 kg. Among women aged 18 -33 years, the 7-year Norplant pregnancy rates are comparable to the median pregnancy rates of tubal sterilization methods for women of the same age and duration of use. For women aged Ն34 years, without regard to weight at admission, the 7-year effectiveness of soft tubing Norplant equals or surpasses that of tubal sterilization. For continuing implant users, annual pregnancy rates Ͻ1.0/100 in years 6 and 7, together with low cumulative pregnancy rates, testify that Norplant capsule implants remain highly effective for 7 years. CONTRACEPTION 2000; 61:187-194
In a three-year randomized trial that included 398 women, blood samples were collected for the purpose of assaying levonorgestrel concentrations in women using a new tworod contraceptive implant system or an earlier implant formulation,... more
In a three-year randomized trial that included 398 women, blood samples were collected for the purpose of assaying levonorgestrel concentrations in women using a new tworod contraceptive implant system or an earlier implant formulation, NorplanF-2 implants. Sample collection was at 1, 3, 6, 9, and 12 months after placement and semiannually thereafter through three years. Resulting assays and analyses showed that levonorgestrel concentrations of each implant formulation decreased significantly with time after placement, with increasing body weight, and with ponderal index. In the third year, several measures indicated that concentrations of the contraceptive drug were higher in women using the LNG ROD implants than in users of the original formulation.
- by Livia Wan and +1
- •
- Contraception, Adolescent, Pregnancy, Blood sampling
A 5-year trial of a two-rod contraceptive implant, which releases the progestin levonorgestrel (LNG rod), was conducted at four clinics with 594 women. Mean age and weight at admission were 25.5 years and 62.4 kg, respectively. Consent to... more
A 5-year trial of a two-rod contraceptive implant, which releases the progestin levonorgestrel (LNG rod), was conducted at four clinics with 594 women. Mean age and weight at admission were 25.5 years and 62.4 kg, respectively. Consent to continue through 5 years was sought and obtained when the 3-year cumulative pregnancy rate proved to be 0.8 per 100. No pregnancies occurred in the fourth or fifth years. The 5-year cumulative pregnancy rate was, therefore, 0.8 per 100 with an annual average pregnancy rate below 2 per 1000 women. Prolonged bleeding/ spotting (8.2 % of subjects) and irregular bleeding (5.6 %) were the most frequently cited medical reasons for removal. Removals for headache (4.7%) and weight change (4.0%) were the next most frequent medical reasons. Between 1% and 2% of subjects during the 5-year trial sought removals for each of the following conditions: mood changes, lower abdominal pain, depression, or pain at the implant site. The mean annual continuation rate during the study was 77 per 100. Use per woman averaged 2.96 years. Mean removal time was 5.9 Ϯ 0.6 min. These data indicate that, for a 5-year period, the two LNG rod implants are equivalent to the six Norplant capsule implants with respect to safety and efficacy parameters, but permit easier and more rapid implant removal. CONTRACEPTION 1998;58:275-282
- by Livia Wan and +1
- •
- Contraception, Adolescent, Dominican Republic, Pregnancy
Objective: To measure effectiveness, adverse event experience, and acceptability of the Food and Drug Administration-approved variant of levonorgestrel capsule implants in the United States through 5 years and to examine determinants of... more
Objective: To measure effectiveness, adverse event experience, and acceptability of the Food and Drug Administration-approved variant of levonorgestrel capsule implants in the United States through 5 years and to examine determinants of these outcomes. Methods: In a prospective, multicenter study, 511 sexually active women selecting contraceptive implants were monitored four times in the 1st year, then semiannually through 5 years. Adverse events were elicited by query and physical examination, and their incidence was measured. Lifetable analyses computed pregnancy and other discontinuation rates. Cox regression models examined effects of age, parity, and preadmission desire for more children on continuation. Removal times were analyzed by analysis of variance. Results: Three pregnancies occurred, yielding a 5-year cumulative rate of 1.3 ؎ ؎ ؎ 0.8 per 100 users, an average annual rate of three per 1000 women, and an ectopic pregnancy rate of 0.6 per 1000 woman years. No pregnancies occurred to women weighing less than 79 kg. Prolonged or irregular menstrual bleeding, followed distantly by headache, weight gain, and mood changes, was the most frequent medical conditions leading to removal. Weight gain averaged 1 kg per year. Each annual continuation rate was above 80 per 100, for a cumulative 5-year rate of 39 per 100. Continuation was age-dependent, with younger women (younger than 25 years at entry) having lower 5-year continuation rates than older subjects (P < < < .01). Tissue trauma from deeply placed or poorly aligned implants or severe reactions to local anesthetic affected subjects in 3.1% of removals (nine cases). As measured by annual continuation rates of 80 per 100 or higher and annual pregnancy rates below one per 100, implant contraception in the United States was found to be highly acceptable and effective, year after year, regardless of the woman's age or family formation status. The cumulative 5-year pregnancy rate, 1.3 per 100, is comparable to that of tubal ligation. (Obstet Gynecol 1998;92:337-44.
- by Livia Wan and +2
- •
- Prospective studies, Pregnancy, Cox Regression, United States
Objective: We evaluated the tolerability of emergency contraception in adolescents. Study design: In this descriptive study, 1 0.75 mg levonorgestrel tablet was administered to 52 females aged 13-16 with instructions to take the second... more
Objective: We evaluated the tolerability of emergency contraception in adolescents. Study design: In this descriptive study, 1 0.75 mg levonorgestrel tablet was administered to 52 females aged 13-16 with instructions to take the second tablet 12 hours later (unprotected intercourse was not an entry requirement). Participants kept diaries of side effects and menstrual patterns. We assessed correct use, side effects caused by treatment, and impact on menstrual cycle. Results: Virtually all participants used the drug correctly, with no serious adverse events. Minor expected side effects occurred, including nausea, fatigue, and vomiting. There was no difference in reporting of side effects by age. Adolescents' mean duration of menses was comparable pre-and post-treatment (5.3 vs 5.0 days; P= .146), and onset of menses was within the expected range. Ninety percent of participants reported they would recommend emergency contraception to a friend or relative if needed. Conclusion: Adolescents tolerated the medication well, experiencing transient side effects.