Creinin, MD

Piazza, AJ

Schwirian, K

Scott, FJ

Zite, NB

Creinin

eScholarship - University of California

UC DavisUC Davis Previously Published WorksTitleWomen’s preferences for method of sterilization and willingness to be randomized for a theoretical trialPermalinkhttps://escholarship.org/uc/item/1rq4g5rnJournalContraception, 96(4)ISSN0010-7824AuthorsPiazza, AJSchwirian, KScott, FJet al.Publication Date2017-10-01DOI10.1016/j.contraception.2017.07.153 Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaResults: Nearly 65% of women experiencing an unintended pregnancy had adocumented clinical visit in the year prior to the pregnancy. Of 177 visits,primary care was the most common setting (46.5%). A total of 100.0% ofgynecologists, 97.1% of primary care providers and 40.0% of emergencydepartment providers documented reproductive topics. Women with social riskfactors (e.g., history of abuse, homelessness, or exchange of sex for drugs ormoney) were less likely than other women to have such documentation (70.0%vs. 96.3%, p=.02), and women who had psychiatric comorbidities were less likelythan women who did not to receive this counseling (47.4% vs. 77.4%, p=.03).Conclusions: We identified an HIV-positive population of women whoexperienced an unintended pregnancy. Emergency department visits mayrepresent an opportunity to offer more reproductive counseling, perhaps byintegrating an EMR tool or improving access to social workers. Providers wereless likely to document reproductive topics for patients with social risk factorsor psychiatric comorbidities, suggesting that these factors may contribute toreproductive counseling disparities.http://dx.doi.org/10.1016/j.contraception.2017.07.149P120“I think at this point of my life, I worry more about pregnancy and theeffects of that.” How young women perceive and manage risks related toanal and vaginal sexLE HebertThe University of Chicago, Chicago, IL, USASL Newton, ME WebbObjectives: This study explores howyoungwomen perceive andmanage risk relatedto STIs/HIV comparedwith pregnancy risk, and risk related to anal sex vs. vaginal sex.Methods: In-depth interviews were conducted with 29 young women aged18–24 who reported any lifetime experience of anal intercourse. Interviewslasted up to 90 min and were audio-recorded, transcribed, verified and coded inATLAS.ti. Themes related to reasons for anal sex, risk perceptions and riskmanagement related to anal sex vs. vaginal sex, risk prioritization betweenHIV/STIs and pregnancy, and contraceptive and condom use were explored.Results: Most young women reported engaging in anal sex in conjunction withother forms of sex (vaginal, oral). Several participants expressed having anal sex inlieu of vaginal sex due to religious-, health- or hygiene-related preferences; nonereported using anal sex for contraception. Despite using contraceptives and citingabortion as a backstop, many participants weighed pregnancy as a greater risk thanSTIs/HIV. Young women perceived risk related to STIs/HIV as more situational,minimized through limiting the number of one’s partners, using condoms ortrusting one’s partner. Many participants interpreted STI/HIV risk from anal sex asless than or equal to STI/HIV risk from vaginal sex.Conclusions: With a few exceptions related primarily to hygiene, young womenwho have engaged in anal sex do not distinguish risks related to anal sex fromthose related to vaginal sex. Young women may put themselves at greater risk forHIV and STIs due to misperceptions about anal sex and related behaviors.http://dx.doi.org/10.1016/j.contraception.2017.07.150P121“Never anything about anal sex whatsoever”: young women’s reflectionson sources of information about anal sexLE HebertThe University of Chicago, Chicago, IL, USASL Newton, ME WebbObjectives: This study explores how young women learn about anal sex andthe sources of information they use, with a particular focus on informationreceived from health care providers.Methods: In-depth interviews were conducted with 29 young women aged 18–24who reported any lifetime experience of anal intercourse. Interviews lasted up to90 min and were audio-recorded, transcribed, verified and coded in ATLAS.ti.Themes related to sources of information, sex education, and perceptions andconversations with health care providers about anal sex were explored.Results: Young women described a dearth of information about anal sexgained via formal avenues, such as school education or health care providers,and relied more on information accessed through informal channels. Theseinformation sources included those gained passively from friends, partners,pornography or erotica, or information they accessed through the internet (e.g.,health-related websites and web-video channels). Very few women reportedever having spoken with a health care provider about it; most said it had notcome up, and had perceptions that clinicians were not interested in orcomfortable with discussing matters related to sex beyond pregnancy risk.Conclusions: Anal sex is a common sexual practice among heterosexual womenbut remains a taboo topic for discussion or education even in arenas where suchdiscussion belongs. This leaves many young women unaware of the risksassociated with anal sex and of how to protect themselves. Both educational andhealth care settings should offer young women reliable information about anal sex.http://dx.doi.org/10.1016/j.contraception.2017.07.151P122The association between intrauterine device use and the risk of precancerouscervical lesions and cervical cancerSH AverbachUniversity of California, San Francisco, School ofMedicine, San Francisco, CA, USAMJ Silverberg, W Leyden, T Raine-Bennett, K Smith-McCune, GF SawayaObjectives: We aimed to evaluate the association between recent IUD use by type andcervical intraepithelial neoplasia 2, 3, adenocarcinoma in situ or cancer (CIN2+orCIN3+).Methods: We conducted a case–control study of 17,559 women aged 18–49with incident CIN2+ cases and 5:1 age-matched, incidence-density selectedcontrols (N=87,788) who were members of Kaiser Permanente between 2006and 2014. IUD use within 18 months of index was the exposure of interest.Results: There were 1707 IUD users among the cases and 8082 IUD users amongcontrols. After adjusting for STI testing, smoking, HPV vaccination, other hormonalcontraceptive use, parity, race and number of outpatient visits, IUD use wasassociated with an increased rate of CIN2+ [rate ratio (RR), 1.13 (1.05–1.18);pb.001] but not CIN3+ [RR, 1.02 (0.94–1.11); p=.63]. Levonorgestrel IUD use wasassociated with an increased rate of CIN2+ [RR, 1.19 (1.09–1.30); pb.001] but notCIN3+ [RR, 1.03 (0.90–1.18); p=.43]. Copper IUD use was not associated withCIN2+ [RR, 0.89 (0.76–1.04); p=.14] or CIN3+ [RR, 0.80 (0.64–1.02); p=.07].Conclusions: IUD use had variable associations with CIN2+ but was notassociated with increased risk of CIN3+. There may be a weak associationbetween IUD use, particularly levonorgestrel IUDs, and cervical precancer andcancer; IUD use, regardless of type, probably does not have a clinicallymeaningful effect on the incidence of cervical precancers or cancers.http://dx.doi.org/10.1016/j.contraception.2017.07.152P123Women’s preferences for method of sterilization and willingness to berandomized for a theoretical trialAJ PiazzaUniversity of California, Davis, Sacramento, CA, USAK Schwirian, FJ Scott, NB Zite, MD CreininObjectives: We aimed to understand women’s preference for laparoscopicsalpingectomy or tubal interruption following standardized sterilizationcounseling and evaluate the feasibility of a future randomized trial.Abstracts / Contraception 96 (2017) 263–306 303Methods: We invited pregnant and nonpregnant women planning sterilizationat the University of California, Davis, and University of Tennessee obstetricsand gynecology clinics to participate. We enrolled women the day theyreceived counseling and signed procedure consent. Participants received astandardized information sheet reviewing sterilization options based onpregnancy status. Participants then completed an anonymous survey withquestions about demographic characteristics, sterilization method preferenceand theoretical willingness to participate in a randomized trial comparinglaparoscopic salpingectomy and tubal interruption.Results: From July 2015 to October 2016, some 75 women at the Universityof California, Davis, and 63 women at the University of Tennessee enrolled.Women at the Tennessee site, compared with those at the California site,were more likely to be aged 30 or younger (73.0% vs. 28.0%, pb.0001),white (85.7% vs. 62.7%, p=.003) and non-Hispanic (98.4% vs. 69.3%,p=.003), and less likely to be college educated (0% vs. 41.3%, pb.0001) or tohave had an abortion (3.2% vs. 24.0%, p=.0005). Among the 47 women notcurrently pregnant at both sites, 40 (85.1%) preferred salpingectomy, mostcommonly because of higher efficacy. Thirteen (27.7%) subjects notcurrently pregnant and 54 (39.1%) of all subjects would be willing to berandomized to a theoretical trial comparing salpingectomy and tubalinterruption procedures.Conclusions: Among a diverse group of women from two areas in the UnitedStates given a choice of laparoscopic methods, salpingectomy was preferredover tubal interruption. Most women planning sterilization would not agree toparticipate in a randomized comparison of these methods.http://dx.doi.org/10.1016/j.contraception.2017.07.153P124Disparities in postpartum sterilization fulfillment for women covered byMedicaid vs. private insuranceKS AroraCaseWestern Reserve University–MetroHealthMedical Center, Cleveland, OH, USAB Wilkinson, E Verbus, M Montague, J Morris, M Ascha, B MercerObjectives: A health care system in which 37%–51% of women who desirepostpartum sterilization are unable to obtain one due to a lack of a validsigned Medicaid consent form is not delivering patient-centered, medicallyappropriate, ethically sound care. The Affordable Care Act has improvedaccess to contraceptive services and has increased the size of the populationcovered by Medicaid. The purpose of this study was to provide acontemporary and comprehensive analysis of the disparities in postpartumsterilization fulfillment rates and times between the Medicaid and privatelyinsured populations.Methods: All women who delivered from 2012 through 2014 at our urban,tertiary care, county hospital that serves primarily the underserved populationwere included in our retrospective chart review. Data were analyzed viaunivariate and multivariate logistic regression as well as survival analyses.Results: Of the 8655 women in the study, 1335 (15.4%) desired sterilizationfor postpartum contraception. Some 474/1018 women covered by Medicaid(46%) and 150/260 (57.7%) covered by private insurance received postpartumsterilization within 90 days of delivery (p=.0014). The number of outpatientprenatal visits, parity greater than two, gestational age and cesarean deliverywere significant predictors of sterilization fulfillment. Time to sterilizationfulfillment was significantly shorter for women with private vs. Medicaidinsurance (HR, 1.40; 95% CI, 1.17–1.69).Conclusions: These findings highlight the importance of revising thesterilization process given disparities in fulfillment rates and time topostpartum sterilization for the Medicaid population. Identification of patient-level, provider-level and systems-level barriers is necessary to achieveequitable access to autonomously desired postpartum sterilization services.http://dx.doi.org/10.1016/j.contraception.2017.07.154P125A retrospective review of women desiring immediate postpartum sterilizationand their subsequent contraceptive useMM UliRush University Medical Center, Chicago, IL, USAK Derby, SL YorkObjectives: We aimed to determine the proportion of women who desirepostpartum tubal ligation and undergo the procedure immediately postpartum.Secondary objectives included examining potential barriers for those who donot receive tubal ligation and determining other contraceptive methodsreceived, including long-acting reversible contraceptives.Methods: We conducted a retrospective chart review to identify patients whodelivered with hospital-affiliated groups between July 1, 2013, and June 30,2015, who expressed antenatal desire for postpartum tubal ligation. Wecompared women who did and did not undergo the procedure and the methodthey received by their postpartum visit.Results: Of the 1979 women who delivered during the study period, 705 wereexcluded. Antenatal assessment found 229 who desired postpartum tuballigation. By time of delivery, 21 had changed their mind. Sixty percent(n=125) received sterilization prior to discharge. Women were more likely toundergo the procedure if they were African American, were married, had threeor more living children, and delivered by cesarean section (all pb.05). Thosewithout a signed Medicaid sterilization consent form were less likely toundergo tubal ligation. By their postpartum visits, 8.4% of women desiringtubal ligation had received long-acting reversible contraceptives.Conclusions: Forty percent of women who wanted sterilization during theirpregnancy did not receive immediate postpartum tubal ligation. Most weredischarged from the hospital without contraception, and very few had received aneffective method like long-acting reversible contraceptives by their postpartumvisit. Knowing the high rate of unfulfilled postpartum sterilization requests,improved prenatal contraception counseling should be completed to ensure thatwomen have access to immediate and effective postpartum contraception.http://dx.doi.org/10.1016/j.contraception.2017.07.155P126Long-term effects of TeamSTEPPS® on patient satisfaction and perceptionsof teamwork at ambulatory reproductive health care facilitiesS NippitaBeth Israel Deaconess Medical Center, Boston, MA, USAL Dodge, M Hacker, G Ozcelik, EM Intondi, M PaulObjectives: While growing evidence suggests that team training has positiveeffects in the ambulatory care environment, long-term effects are unknown.We evaluated long-term effects of team training on patient satisfaction andperceptions of teamwork in this environment.Methods: Since 2014, we have conducted an annual TeamSTEPPS® mastertraining course for ambulatory reproductive health centers. Sixty-nine healthcenters from the first two cohorts trained their staff. We assessed patientperceptions of teamwork among the care team using a validated survey, andpatients reported satisfaction with their visit. We used generalized estimatingequations to compare differences in baseline, 1-year and 2-year responseswhile accounting for correlation between health centers.Results: Patients receiving care at 32 health centers completed baseline(n=2026) and 1-year surveys (n=1899); four centers distributed surveys at 2years (n=390). All of the 16 teamwork behaviors assessed improved at 1 year,with the team working together well, members being considerate of each otherand not hearing arguments between team members showing significantimprovement (all p≤.04). At 2 years, 15 of 16 behaviors improved fromAbstracts / Contraception 96 (2017) 263–306304

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Women’s preferences for method of sterilization and willingness to be randomized for a theoretical trial

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Women's preferences for method of sterilization and willingness to be randomized for a theoretical trial

Women's preferences for method of sterilization and willingness to be randomized for a theoretical trial

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