TxPEP Related Publications
Permanent URI for this collectionhttps://hdl.handle.net/2152/41693
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Item Recent Advances in Contraception(2014) Aiken, Abigail R.A.; Trussell, JamesFocusing on intrauterine contraceptives (IUC), contraceptive implants, and emergency contraceptives, we review recent advances in contraceptive development and discuss progress in policies to improve access to the most effective methods. We report on the shift in practice towards routinely providing IUCs and implants to young and nulliparous women, prompted in part by the reduced diameter of the insertion tube for the Mirena IUC and the development of a smaller IUC called Skyla. Additionally, we describe the new SCu300A intrauterine ball and the development of an implant called Nexplanon, which comes with a preloaded inserter. We also discuss the efficacy of ulipristal acetate versus levonorgestrel for emergency contraception, especially for women who weigh more than 75 kg. Finally, in light of the increasing interest in providing IUCs and implants to women in the immediate postpartum and post-abortion periods, we consider the rationale for this change in practice and review the progress that has been made so far in the United States.Item Rethinking the Pregnancy Planning Paradigm: Unintended Conceptions or Unrepresentative Concepts?(2016) Aiken, Abigail R.A.; Borrero, Sonya; Callegari, Lisa S.; Dehlendorf, ChristineApproximately half of pregnancies occurring each year in the United States are unintended: They either occurred too soon or were not intended at any time. This commonly cited statistic is testament to the dominance of unintended pregnancy as a public health benchmark for measuring and improving women's reproductive health. In addition to its use as a public health metric, this timing-based definition of unintended pregnancy is reflected in pregnancy planning paradigms in clinical practice. According to these paradigms, women are expected to map out their intentions regarding whether and when to conceive, and to formulate specific plans to follow through on their intentions. What can researchers, public health practitioners and clinicians engaged in efforts to reduce unintended pregnancy and improve pregnancy outcomes do in response to these limitations? As a first step, we propose a conceptual model that integrates insights from recent research and provides a framework for informing women-centered approaches to preventing undesired pregnancies and improving outcomesItem Medicaid Policy on Sterilization — Anachronistic or Still Relevant?(2014) Borrero, Sonya; Zite, Nikki; Potter, Joseph E.; Trussell, JamesFemale sterilization, typically accomplished by means of tubal ligation, is a widely used method of contraception that is highly effective at preventing unintended pregnancy. Yet there appears to be unmet demand for the procedure in certain segments of the U.S. population. Specifically, low-income women and women from minority racial and ethnic groups may face substantial system-level barriers to obtaining a desired sterilization procedure. One such barrier is the federal policy regarding Medicaid-funded sterilizations. Although this policy was designed to protect vulnerable populations, we believe that it does not effectively fulfill that intention — in fact, it restricts the reproductive autonomy of the women it intends to serve. With the upcoming Medicaid expansions, the number of women affected by these barriers could increase substantially.Item Requests for Abortion in Latin America Related to Concern about Zika Virus Exposure(2016-07-28) Aiken, Abigail R.A.; Scott, James G.; Gomperts, Rebecca; Trussell, James; Worrell, Marc; Aiken, Catherine E.With the rapid emergence of Zika virus throughout Latin America and its association with microcephaly, requests for access to abortion medications through online telemedicine have increased in countries where access to safe abortion is not universally available. On November 17, 2015, the Pan American Health Organization (PAHO) issued an epidemiologic alert regarding Zika virus in Latin America. Several countries subsequently issued health advisories, including cautions about microcephaly, declarations of national emergency, and unprecedented warnings urging women to avoid pregnancy. Yet in most Latin American countries, abortion is illegal or highly restricted, leaving pregnant women with few options.Item Changes in Use of County Public Health Services Following Implementation of Alabama’s Immigration Law(2014) White, Kari; Blackburn, Justin; Manzella, Bryn; Welty, Elisabeth; Menachemi, NirSeveral states have enacted legislation restricting undocumented immigrants' access to publicly funded health benefits not protected by federal law. Using electronic health records from 140,856 county health department visits, we assessed the monthly change in Latino patients' visits compared to non-Latinos 12 months before and after implementation of Alabama's immigration law. We used ICD-9 diagnosis codes to determine whether visits included services exempt under the law: immunizations, testing and treatment for sexually transmitted infections (STIs) and communicable diseases, and family planning. Differences between groups in the mean percent change were assessed with t-tests. Among children younger than 18 years, there were no significant differences by ethnicity. Visits among Latino adults decreased by 28% for communicable diseases, 25% for STIs, and 13% for family planning; this was significantly different from changes among non-Latino adults (p <.05). State-level legislation may reduce immigrants' access to protected benefits, which could adversely affect the broader public's health.Item Hypertension among Oral Contraceptive Users in El Paso, Texas(2013) White, Kari; Potter, Joseph E.; Amastae, Jon; Grossman, DanielOn the U.S.-Mexico border, residents frequently cross into Mexico to obtain medications or medical care. We previously reported relatively high prevalence of hypertension among Latina oral contraceptive users in El Paso, particularly those obtaining pills over the counter (OTC) in Mexico. Here, we examine factors associated with having hypertension among 411 OTC users and 399 clinic users. We also assess hypertension awareness and interest in using blood pressure kiosks. Women age 35 to 44 and who had BMI ≥ 30 kg/m2 had higher odds of having hypertension. 59% of hypertensive women had unrecognized hypertension, and 77% of all participants would use a blood pressure kiosk; there were no significant differences between clinic and OTC users. Alternative approaches to increase access to health screenings are needed in this setting, where OTC pill use among women with unrecognized hypertension confers unique health risksItem Perceived Interest in Vasectomy among Mexican-Origin Women and Their Partners in a Community with Limited Access to Female Sterilization(2016) Hubert, Celia; White, Kari; Hopkins, Kristine; Grossman, Daniel; Potter, Joseph E.The low prevalence of vasectomy among Latino men in the United States is often attributed to cultural characteristics despite limited evidence supporting this hypothesis. We assessed male partners’ perceived willingness to undergo vasectomy through surveys with 470 Mexican-origin women who did not want more children in El Paso, Texas. Overall, 32% of women reported that their partner would be interested in getting a vasectomy. In multivariable analysis, completing high school (OR=2.03 [1.05, 3.95]), having some college education (OR=2.97 [1.36, 6.48]) or receiving US government assistance (OR=1.95 [1.1, 3.45]) was associated with partners’ perceived interest. Additionally, we conducted two focus groups on men’s knowledge and attitudes about vasectomy with partners of a subsample of these women. Despite some misperceptions, male partners were willing to get a vasectomy, but were concerned about cost and taking time off work to recover. Health education and affordable vasectomy services could increase vasectomy use among Mexican-origin men.Item Attitudes Surrounding Contraceptive Responsibility: Do Latino Youth Differ from Other Groups?(2013) White, Kari; Hopkins, Kristine; Schiefelbein, EmilyRecent estimates demonstrate that more than 75% of young women and men ages 15 to 19 used contraception at first sex and their most recent intercourse. However, there are notable disparities in contraceptive use by race/ethnicity. Female and male Latino adolescents are less likely than African American and white teens to report contraceptive use at first sex. In addition, Latino adolescents are less likely to report using condoms at last intercourse (54.9%) compared to African Americans (62.4%) and whites (63.3%) and were also less likely than whites to state they used hormonal methods (14.0% compared to 29.3% among whites). These lower rates of contraceptive use may be due, in part, to differences in attitudes about contraceptive decision-making. Several studies have noted that Latinos report that women are primarily responsible for contraception and preventing pregnancy, which is associated with less effective method use compared to when both partners are responsible for deciding on contraception. However, it is not clear whether attitudes placing responsibility for contraceptive use on women are more widely endorsed among Latinos compared to other racial/ethnic groups. Some of these studies have only included Latinos, and others that assessed attitudes across racial/ethnic groups found few differences. Additionally, little is known about the underlying beliefs and values that shape ideas about which partner or partners have responsibility for contraception and how these might vary by race/ethnicity. Such information is important in order to identify target areas for interventions that promote shared decision-making, and therefore increase effective use of contraception. In this study, we explore youths’ attitudes toward contraceptive responsibility. The specific questions we address are: Which partner is usually responsible for contraception and why? How do these attitudes and beliefs vary, if at all, across racial/ethnic groups and gender? To answer these questions we used data collected from focus groups with Latino, African American and white young women and men. Focus groups are particularly well-suited for the study of this topic because they highlight values and norms within groups sharing similar characteristics, as well as identify beliefs underlying attitudes and behaviors.Item DEMOGRAPHIC RESEARCH(2013-06-11) White, Kari L.; Potter, Joseph E.Background: Mexican women in the United States (US) have higher rates of fertility compared to other ethnic groups and women in Mexico. Whether variation in women’s access to family planning services or patterns of contraceptive use contributes to this higher fertility has received little attention. Objective: We explore Mexican women’s contraceptive use, taking into account women’s place in the reproductive life course. Methods: Using nationally representative samples from the US (National Survey of Family Growth) and Mexico (Encuesta National de la Dinámica Demográfica), we compared the parity-specific frequency of contraceptive use and fertility intentions for non-migrant women, foreign-born Mexicans in the US, US-born Mexicans, and whites. Results: Mexican women in the US were less likely to use IUDs and more likely to use hormonal contraception than women in Mexico. Female sterilization was the most common method among higher parity women in both the US and Mexico, however, foreign-born Mexicans were less likely to be sterilized, and the least likely to use any permanent contraceptive method. Although foreign-born Mexicans were slightly less likely to report that they did not want more children, differences in method use remained after controlling for women’s fertility intentions