Bliss Kaneshiro

Body mass index and sexual behavior.

OBJECTIVE: To characterize the relationship between body mass index and sexual behavior, including sexual orientation, age at first intercourse, ever having had sex with a male partner, number of partners, and frequency of intercourse. METHODS: This study employed the 2002 National Survey of Family Growth, a cross-sectional, nationally representative database in which women between the ages of 15 years and 44 years were surveyed regarding reproductive health outcomes. Sexual behavior was compared between body mass index groups—normal (less than 25 m/kg2), overweight (25–30 m/kg2), and obese (greater than 30 m/kg2)—using self-reported height and weight. Multiple logistic regression with adjustment for the sampling design was used to measure associations of interest. RESULTS: Body mass index was not significantly associated with sexual orientation, age at first intercourse, frequency of heterosexual intercourse, and the number of lifetime or current male partners. Overweight women and obese women were more likely to report ever having male sexual intercourse (P<.001). This difference persisted when we adjusted for age as well as type of residence. CONCLUSION: With the exception of ever engaging in sexual intercourse with a man, sexual behavior differs little between women of different body mass indices. LEVEL OF EVIDENCE: II

The relationship between body mass index and unintended pregnancy : results from the 2002 National Survey of Family Growth

BACKGROUND The study was conducted to characterize the relationship between body mass index (BMI) and unintended pregnancy, contraceptive use patterns, and perceived fertility. METHODS This study employed a cross-sectional, nationally representative database (2002 National Survey of Family Growth). Unintended pregnancy was compared among BMI groups [normal (<25 m/kg(2)), overweight (25-30 m/kg(2)) and obese (>30 m/kg(2))]. Analyses also evaluated the association between demographic, socioeconomic, behavioral and health-related variables and BMI. Multiple logistic regression with adjustment for sampling design was used to measure associations of interest. RESULTS BMI data were available from 6690 nonpregnant women. Of these, 3600 (53.6%) were normal weight, 1643 (25%) were overweight and 1447 (21.4%) were obese. Compared to women with normal BMIs, the risk of unintended pregnancy in the last 5 years did not differ among overweight [adjusted OR 0.95 (95% CI 0.77-1.17)] or obese [adjusted OR 0.87 (95% CI 0.70-1.09)] women. There were no differences in contraceptive use patterns or perceived fertility among BMI groups. CONCLUSION Data from the 2002 NSFG do not support an association between obesity and unintended pregnancy.

Knowledge and Awareness of Emergency Contraception in Adolescents

STUDY OBJECTIVE The purpose of this study was to (1) describe the awareness of emergency contraception among adolescent females, (2) identify factors that are associated with accurate knowledge of emergency contraception and (3) describe prior use of emergency contraception among adolescent females. DESIGN Cross-sectional study. SETTING The study procedures were carried out at Kapiolani Medical Centers Teen Clinic in Honolulu, Hawaii, which is comprised of an ambulatory university-based resident clinic. PARTICIPANTS English-speaking females who were between the ages of 14 and 19 were invited to participate. INTERVENTIONS This study utilized a self-administered, anonymous survey that contained questions regarding emergency contraception as well as questions on reproductive and sexual health. MAIN OUTCOME MEASURE The primary outcome was percentage of adolescent women who were aware of emergency contraceptives. RESULTS A total of 100 surveys were distributed and collected. Fifty-six percent of respondents had an awareness of emergency contraception and 69.6% of these adolescents were able to correctly list an emergency contraceptive method. Older teens were more likely to have an awareness of emergency contraception but we did not find any other factors that were associated with accurate knowledge of emergency contraception. Adolescents who had used emergency contraception in the past found it to be acceptable. CONCLUSIONS Despite being at high risk for unintended pregnancy, adolescents in this population had lower rates of emergency contraceptive awareness in than has been reported in adults.

Awareness and Knowledge of the Intrauterine Device in Adolescents

BACKGROUND The purpose of this study was to explore intrauterine device (IUD) awareness and knowledge in a diverse, multiethnic population. METHODS We conducted a self-administered, anonymous survey addressing awareness of the IUD as a contraceptive method and knowledge about aspects of IUD use in a group of women aged 14 to 19 years. Demographic and medical information was obtained to compare awareness and knowledge between demographic groups. Chi-square, Fisher exact test, and t tests were used for analysis. Multiple logistic regression was utilized to confirm relationships. RESULTS Of the 106 respondents, 76.4% (81/106) were sexually active and 56.6% (60/106) reported a history of ever being pregnant. There were 21.1% (33/106) of respondents who had heard of the IUD as a contraceptive method. Of the subjects who had heard of the IUD, 39.4 % (13/33) were able to identify key features of the IUD. Although a history of pregnancy was predictive of having heard of the IUD, age, insurance status, education, and all other demographic factors were not associated with IUD awareness. CONCLUSION Over 70% of the adolescents had not heard of the IUD and less than half of adolescents who had heard of the IUD were able to identify key features about this contraceptive method. The lack of knowledge of this effective and safe contraceptive option is concerning given that most participants were at high risk for unintended pregnancy.

Sex education and contraceptive use at coital debut in the United States: Results from Cycle 6 of the National Survey of Family Growth

BACKGROUND The study was conducted to characterize the relationship between formal sex education and the use and type of contraceptive method used at coital debut among female adolescents. METHODS This study employed a cross-sectional, nationally representative database (2002 National Survey of Family Growth). Contraceptive use and type used were compared among sex education groups [abstinence only (AO), birth control methods only (MO) and comprehensive (AM)]. Analyses also evaluated the association between demographic, socioeconomic, behavioral variables and sex education. Multiple logistic regression with adjustment for sampling design was used to measure associations of interest. RESULTS Of 1150 adolescent females aged 15-19 years, 91% reported formal sex education (AO 20.4%, MO 4.9%, AM 65.1%). The overall use of contraception at coitarche did not differ between groups. Compared to the AO and AM groups, the proportion who used a reliable method in the MO group (37%) was significantly higher (p=.03) (vs. 15.8% and 14.8%, respectively). CONCLUSIONS Data from the 2002 NSFG do not support an association between type of formal sex education and contraceptive use at coitarche but do support an association between abstinence-only messaging and decreased reliable contraceptive method use at coitarche.

Treatment of unscheduled bleeding in continuous oral contraceptive users with doxycycline: a randomized controlled trial.

OBJECTIVE: To estimate whether doxycycline, a matrix metalloproteinase inhibitor, would decrease unscheduled bleeding associated with initiation of a continuous oral contraceptive pill. METHODS: Participants initiating a continuous oral contraceptive pill (20 micrograms of ethinyl estradiol/90 micrograms of levonorgestrel) were randomly assigned to receive either doxycycline (100 mg orally twice daily) or placebo taken for 5 days at the onset of each bleeding or spotting episode during the first 84 days of the study period. For the final 28 days of the study, participants were observed on the oral contraceptive pill alone. The primary outcome was the number of bleeding and spotting days. A sample size of 66 (33 in each arm) was calculated to detect a 50% reduction in bleeding (&bgr;=0.80, &agr;=0.05) and accounted for a 30% dropout rate. RESULTS: Sixty-six women were randomly assinged (33 in each study group). There were no significant differences during the 84-day treatment in bleeding or spotting days (doxycycline [mean {standard error}, placebo, P=.32) or the length of the longest bleeding or spotting episode (doxycycline, placebo, P=.70) between study groups. Similarly, no significant differences in bleeding patterns existed between groups during the final 28 days. CONCLUSION: Doxycycline, administered once bleeding has started, does not decrease unscheduled bleeding or shorten episodes of unscheduled bleeding in continuous oral contraceptive pill users. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00480532. LEVEL OF EVIDENCE: I

Assessment of internet-based information regarding pelvic organ prolapse and urinary incontinence.

Objective This study aimed to establish descriptive data on the content, accuracy, and relevance of Internet-based information regarding pelvic organ prolapse and urinary incontinence. Methods Using the search terms, urinary incontinence, uterine prolapse, dropped uterus, cystocele, and dropped bladder, the first 20 Web sites that appeared in each of 3 highly used search engines were identified. Two experienced reviewers independently evaluated each site for specific content, relevance, and accuracy. Results A total of 220 individual sites were identified: government-, university-, and/or society-sponsored sites represented 14.1% of the identified sites. Private parties, community groups, or unknown sponsors represented 73.2% of the sites. Industry represented 12.7% of the sites. The year the site was created was displayed in 45.9% of the sites, although 66.4% of the sites contained a year of update. Overall, 45% of the sites were rated as mostly/completely relevant to the search term and 44% of the sites were rated as mostly/completely accurate. Government-, university-, and/or society-sponsored sites were significantly more likely to be rated mostly/completely relevant and mostly/completely accurate compared with all other site sponsors with P = 0.05 and P = 0.0003, respectively. Conclusions Government, university, and/or medical societies sponsor a minority of Web sites compared with other sponsors but provide more comprehensive content that is more relevant and accurate to the topics of pelvic organ prolapse and urinary incontinence.

Factors Affecting Sex Education in the School System

STUDY OBJECTIVE To describe the current status of school based sex education and to determine predictors of providing a comprehensive sex education curriculum. DESIGN Cross-sectional mailed survey SETTING Hawaii PARTICIPANTS Seventh and eighth grade health teachers INTERVENTIONS Participants were surveyed regarding the content, quality, and influences on sex education for the 2007 to 2008 academic year. MAIN OUTCOME MEASURES Measures of association (chi-square, ANOVA) and multiple logistic regression were used to determine predictors for teaching comprehensive sex education topics including sexually transmitted infections and pregnancy prevention. RESULTS Approximately 80% of teachers incorporated some form of sex education into their curriculum and 54.4% of teachers incorporated a comprehensive education. Teachers indicated that personal values and the availability of curriculum had the greatest influence on the content of the curriculum. Specific factors which were associated with an increased likelihood of providing a comprehensive curriculum included teaching in a public school (public 66.7% versus private 34.6%, P = 0.01), receiving formal training in sex education (received training 77.8% versus did not receive training 50.0%, P = 0.03) and having contact with a student who became pregnant (contact 72.7% versus no contact 46.7%, P = 0.04). CONCLUSION Although most teachers incorporate some form of sex education, only half incorporate a comprehensive curriculum. Personal values as well as teacher resources play an important role in the content of the curriculum.

A randomized controlled trial of subantimicrobial-dose doxycycline to prevent unscheduled bleeding with continuous oral contraceptive pill use

BACKGROUND Unscheduled bleeding is the main side effect of continuous oral contraceptive pills (OCPs) and has been correlated with the up-regulation of matrix metalloprotineases (MMPs). The study objective was to determine if prophylactic administration of doxycycline (an MMP inhibitor at low subantimicrobial doses) would prevent unscheduled bleeding during the initiation of a continuous OCP. STUDY DESIGN Subjects using cyclic hormonal contraceptives (combined OCPs, patch or ring) without unscheduled bleeding were switched to continuous OCPs (20 mcg ethinyl estradiol/100 mcg levonorgestrel). They were randomized to receive daily doxycycline [sustained-release subantimicrobial dose (40 mg daily)] or placebo for the first 84 days and then observed for an additional 28 days on the continuous OCP alone. The number of bleeding/spotting days and the time in days it took to achieve amenorrhea were compared using a t test. RESULTS Sixty-five subjects were randomized. Although the use of doxycycline did not significantly decrease the number of mean bleeding/spotting days in the first 84 days of the study [doxycycline 14.75 (SE 2.30), placebo 17.78 (2.31), p=.36], women who received doxycycline had a significantly earlier onset of amenorrhea [mean last day of bleeding/spotting doxycycline 61.7 (7.7), placebo 85.2 (6.7), p=.03]. CONCLUSION The coadministration of subantimicrobial-dose doxycycline during initiation of continuous OCPs results in a significant reduction in the length of time needed to achieve amenorrhea.

Pharmacy access to ulipristal acetate in Hawaii: is a prescription enough?

OBJECTIVE To determine pharmacy availability of ulipristal acetate (UPA) and compare to availability of levonorgestrel-containing emergency contraceptive pills (LNG-ECPs). METHODS We conducted an observational population-based study utilizing a telephone-based secret shopper methodology. Researchers called all 198 unique retail pharmacies in Hawaii on December 2013-June 2014, representing themselves as patients and physicians. RESULTS Only 2.6% of pharmacies had UPA immediately available, though 22.8% reported ability to order UPA. In contrast, 82.4% reported immediate availability of LNG-ECPs. No significant difference in availability was reported to patients and physicians. CONCLUSIONS Availability of UPA is limited and significantly lower compared to LNG-ECPs. The study period did overlap with a change in distributor for UPA, likely capturing some disruption of the supply chain. IMPLICATIONS Systems-based interventions are needed to address barriers to obtaining UPA.