Lorraine Tiezzi

Quick Start: a novel oral contraceptive initiation method.

Conventional oral contraceptive (OC) starting instructions require waiting until menses to begin the OC. The conventional approach requires detailed patient education about when to begin and also may require the use of less effective or less acceptable interim contraceptive protection until menses. At our urban family planning clinic, we routinely offer patients starting the OC the option of taking the first tablet sooner. We prospectively evaluated predictors of short-term OC continuation among 250 OC requestors who were offered several approaches to OC initiation. Telephone follow-up of 91% of participants showed that women who swallowed the first OC in the clinic were more likely to continue the OC until the second package than women who planned to start the OC later (adjusted OR 2.8, 95% C.I. 1.1-7.3). Other factors associated with short-term continuation were: partners knowledge of planned OC use, older age, and participants agreement that she would be very unhappy about becoming pregnant in the next 6 months.

Carrying and using weapons: A survey of minority junior high school students in New York City

To explore weapon carrying among young, inner-city adolescents, a survey was administered in fall 1993 to 2005 predominately Hispanic students (mean age = 12.8 years) in three New York City junior high schools. The survey revealed that 21% of students reported personally carrying a weapon; guns and knives were the weapons most commonly carried. Most of those who carried guns reported that they bought them. Forty-two percent indicated that they had a family member or close friend who had been shot. Boys and older students were more likely to report carrying weapons. Preventive efforts may need to begin before or on entry into junior high school rather than high school.

Depression in users of depo-medroxyprogesterone acetate

Prevalence of depression is high among poor, young, Hispanic inner city women. Depot-medroxyprogesterone acetate (DMPA) is a popular contraceptive choice in this group. DMPA labelling suggests that depression may worsen with use. In order to identify any association of DMPA use with worsening depression, we surveyed an English-speaking subset of DMPA users in a Title-X funded family planning clinic. Eighty women completed the CES-D scale on two occasions: once about four weeks after a DMPA injection when the subject would have been exposed to the highest blood levels, and once immediately prior to an injection when recent blood levels of the drug would be somewhat lower (or absent preceding the first injection). The median CES-D score was 14. The scores were not related to timing of the test (pre- or post-injection). The depression scores were somewhat higher among those women receiving their first DMPA injection during the study period (i.e., unexposed women) and among those women who had received four or more injections. Scores were unrelated to age or parity, but were somewhat higher in women who reported fewer years of education or a recent adverse pregnancy outcome. These data provide little evidence of increasing depression with long-term use of DMPA and no evidence of a short-term effect of dose (within the contraceptive range) on mood. Women at risk of depression should not be denied DMPA as a contraceptive choice.

Characteristics of users and nonusers of health clinics in inner-city junior high schools.

PURPOSE To compare the demographic, behavioral, psychosocial, and academic characteristics of users versus nonusers of inner-city junior high school-based health clinics. METHODS Students who used (n = 1344) and did not use (n = 2394) the health clinics based in four junior high schools in an economically disadvantaged, medically underserved New York City school district were compared on their responses to a health risk survey administered at the end of the 1991/92 academic year. RESULTS Compared to students who did not use the clinics, students who used the clinics were more likely to have had unprotected sexual intercourse, to have had suicide intentions or attempts, to be suspended from school for fighting, to be exposed to violence and the illicit drug culture, to hold beliefs favoring involvement in sexual intercourse and suicidality, and to have failed subjects in school. CONCLUSIONS Users of these junior high school-based health clinics are engaging in behaviors and hold beliefs that place them at risk for serious adverse health outcomes. School-based clinics have the potential to provide early intervention for these high risk adolescents.

Pregnancy prevention among urban adolescents younger than 15: results of the 'In Your Face' program.

Data from a pregnancy prevention program operating through school-based clinics in four New York City junior high schools suggest that an intensive risk-identification and case-management approach may be effective among very young adolescents. Among students given a referral to a family planning clinic for contraception, the proportion who visited the clinic and obtained a method rose from 11% in the year before the program began to 76% in the programs third year. Pregnancy rates among teenagers younger than 15 decreased by 34% over four years in the program schools. In the fourth year of the program, the pregnancy rate in one school that was unable to continue the program was almost three times the average rate for the other three schools (16.5 pregnancies per 1,000 female students vs. 5.8 per 1,000).

A New School-based Program to Provide Eyeglasses-. ChildSight

OBJECTIVE To address the unmet need for glasses encountered in an urban school setting by developing and implementing a school-based, cost-effective program that provides appropriate spectacle correction to needy children. METHODS A total of 5851 students 9 to 15 years of age in 4 middle schools in northern Manhattan were screened for vision. Those with vision worse than 20/40 were examined, given glasses if appropriate, or referred for additional evaluation. RESULTS Of the 5851 children screened, 1614 (28%) had a failing result, with visual acuity less than 20/40 in the worse eye. Of this group, 1082 were given glasses that were assembled at the school within 1 hour of testing. Ten percent of the group that required glasses already had them, and the remaining were referred for a complete ophthalmic examination that was completed in 58 cases. Only 14 of these had vision loss unrelated to refractive error. CONCLUSIONS The program successfully treated 88.3% of the children within the school who needed glasses. Given that only 10% of children who needed glasses had them, it indicates a huge need to provide glasses to at least a million children in this age group in the United States.