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Barbera JP, Cichon B, Ankam N, Schwartz BI. Equitable Care for Patients With Disabilities: Considerations for the Gynecologic Health Care Professional. Obstet Gynecol 2024; 143:475-483. [PMID: 38176014 PMCID: PMC10953678 DOI: 10.1097/aog.0000000000005493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/09/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024]
Abstract
All patients deserve high-quality health care. Patients with disabilities have historically experienced discrimination in health care and subsequently detrimental health outcomes. Health care professionals often lack confidence and preparedness in treating patients with disabilities effectively. Barriers such as communication difficulties, biased assumptions, and inadequate equipment hinder comprehensive care. These barriers to care lead to health inequalities and a diminished overall quality of life for individuals with disabilities. Existing clinical guidelines for care of this underserved population are lacking. This article establishes a comprehensive educational framework and accessible reference tools for gynecologic health care professionals to enhance their ability to offer inclusive and effective care to patients with disabilities. Insights in this article stem from expert consensus among clinicians experienced in this field and ongoing dialog with community-based disability care partners. We present actionable steps to cultivate an open, adaptable, and patient-centric method to actively engage patients and to provide suitable accommodations when needed.
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Affiliation(s)
- Julie P Barbera
- Sidney Kimmel Medical College, the Department of Rehabilitation Medicine, and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
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2
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Colarossi L, Collier KL, Dean R, Pérez S, Riquelme MO. Sexual and Reproductive Health Education for Youth with Intellectual Disabilities: a Mixed Methods Study of Professionals' Practices and Needs. Prev Sci 2023; 24:150-162. [PMID: 37289271 PMCID: PMC10764499 DOI: 10.1007/s11121-023-01522-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 06/09/2023]
Abstract
We conducted formative research to inform the creation of innovative new tools and strategies to engage professionals in communicating with youth with intellectual disabilities about sexual health. The research was guided by a multidisciplinary network of experts and an advisory board of self-advocates with intellectual disabilities and caregivers that make up Project SHINE: the Sexual Health Innovation Network for Equitable Education. A cross-sectional mixed-methods study utilized survey data from 632 disability support professionals who provide services to youth ages 16-24 with intellectual disabilities (ID). We then conducted focus groups with 36 professionals to obtain more in-depth information related to organizational support needs and suitable contexts, methods, and tools for sexuality education. Participants included licensed/credentialed direct service professionals (social workers, nurses, teachers), non-licensed direct service providers (case managers, supportive care specialists, residential care line staff), and program administrators. Quantitative and qualitative data analyses triangulated the findings across four content areas: attitudes about providing sexual health information to youth with ID, preparedness to communicate about sexuality, current communication practices, and professional needs in the field for new teaching tools and methods. We discuss how findings can be used to guide the creation and successful implementation of innovative new sexual health learning tools for youth with intellectual disabilities.
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Affiliation(s)
- Lisa Colarossi
- Planned Parenthood of Greater New York, New York, NY, USA
| | - Kate L Collier
- Planned Parenthood of Greater New York, New York, NY, USA.
| | - Randa Dean
- Planned Parenthood of Greater New York, New York, NY, USA
| | - Siana Pérez
- Planned Parenthood of Greater New York, New York, NY, USA
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3
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Parekh T, Gimm G, Kitsantas P. Sexually Transmitted Infections in Women of Reproductive Age by Disability Type. Am J Prev Med 2023; 64:393-404. [PMID: 36528453 DOI: 10.1016/j.amepre.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The objectives of this study were to estimate the prevalence of sexually transmitted infections in women of reproductive age by disability type and examine the association between disability types, participant characteristics, and the prevalence of sexually transmitted infections (STIs). METHODS Pooled data from 2015 to 2019 National Survey on Drug Use and Health were analyzed in 2022. The analytic sample included 90,233 women of reproductive age (18-49 years). Disability was defined as having any sensory, cognitive, physical, or ≥2 disabilities.. A total of 15% of women reported having a disability. Descriptive analyses were used to estimate the prevalence of STI, and logistic regression analyses were conducted to examine the association of disability type and other participant characteristics with the odds of having STIs. RESULTS The prevalence of STIs was more than twice as high for women of reproductive age with cognitive disabilities (6.8%) or ≥2 disabilities (6.7%) as for those without disabilities (2.7%). Women with sensory disabilities (AOR=1.47; 95% CI=1.17, 1.85), cognitive disabilities (AOR=1.89; 95% CI=1.65, 2.17), or ≥2 disabilities (AOR=1.78; 95% CI=1.49, 2.14) had greater odds of STIs than those without disabilities. Bisexual women had higher odds (AOR=1.31; 95% CI=1.14, 1.50) of STIs than straight women, whereas lesbian/gay women had lower odds (AOR=0.41; 95% CI=0.27, 0.63). The odds of STIs were higher among non-Hispanic Blacks (AOR=1.42; 95% CI=1.24, 1.63) and lower among Asian women (AOR=0.62; 95% CI=0.43, 0.90) than among non-Hispanic Whites. The odds of STIs were also greater among participants having any alcohol, cannabis, or illicit drug use. CONCLUSIONS Women of reproductive age with disabilities have a higher prevalence of sexually transmitted infections. In addition to disability type, the odds of sexually transmitted infections varied by race/ethnicity, sexual orientation, and substance use.
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Affiliation(s)
- Tarang Parekh
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia.
| | - Gilbert Gimm
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Panagiota Kitsantas
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
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Fletcher J, Yee H, Ong B, Roden RC. Centering disability visibility in reproductive health care: Dismantling barriers to achieve reproductive equity. Womens Health (Lond) 2023; 19:17455057231197166. [PMID: 37675891 PMCID: PMC10486212 DOI: 10.1177/17455057231197166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/21/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
Access to comprehensive and culturally competent reproductive health care is essential for individuals and communities to realize and achieve health and well-being, as one prefers. The disability community represents a diverse group of individuals with a wide spectrum of functional, physical, sensory, and/or neurodivergent abilities. Existing barriers to reproductive health care are a consequence of environmental and attitudinal barriers, not from the disabilities themselves. People with disabilities are also not frequently centered or included in discussions surrounding reproductive rights. This article reviews the intersection of the Disability Justice Movement and the history of discrimination in the United States against people with disabilities with a particular focus on reproductive oppression. We discuss the mechanisms of inequity and barriers to health care, including financial barriers, inaccessible medical facilities, provider discrimination and competency, and guardianship; as well as the importance of open access to contraception, menstrual health, and abortion for people with disabilities. Finally, we explore the intersection of the Disability Justice Movement and the Reproductive Justice Movement to better promote reproductive autonomy.
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Affiliation(s)
- Jordan Fletcher
- Department of Obstetrics and Gynecology, The Pennsylvania State University, Penn State College of Medicine, Hershey, PA, USA
| | - Halina Yee
- Department of Obstetrics and Gynecology, The Pennsylvania State University, Penn State College of Medicine, Hershey, PA, USA
| | - Bonnie Ong
- Department of Medical Anthropology, University College London, London, UK
| | - Rosemary Claire Roden
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, Hershey, PA, USA
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Kirkpatrick L, Collins A, Harrison E, Miller E, Patterson C, Sogawa Y, Van Cott AC, Kazmerski TM. Pediatric Neurologists' Perspectives on Sexual and Reproductive Health Care for Adolescent and Young Adult Women With Epilepsy and Intellectual Disability. J Child Neurol 2022; 37:56-63. [PMID: 34657501 DOI: 10.1177/08830738211041824] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore perspectives of pediatric neurologists regarding sexual and reproductive health care for adolescent women with epilepsy (WWE) and intellectual disability. METHODS We interviewed pediatric neurologists regarding sexual and reproductive health for WWE with intellectual disability. We audio-recorded and transcribed interviews and conducted qualitative analysis. RESULTS 16 pediatric neurologists participated. Themes included the following: (1) Pediatric neurologists have differing perspectives about how intellectual disability affects WWE's sexual and reproductive health needs, (2) pediatric neurologists provide sexual and reproductive health counseling variable in content and frequency to this population, (3) pediatric neurologists tend to recommend longer-term methods of contraception for this population, and (4) pediatric neurologists are asked to be involved in decision-making around sterilization, yet express ethico-legal reservations. CONCLUSION Our findings suggest pediatric neurologists provide variable, often suboptimal, sexual and reproductive health care for WWE and intellectual disability. Themes reveal ethical concerns among neurologists about sexual and reproductive health practices including sterilization. More tailored clinical guidelines and provider training on sexual and reproductive health for this population may be beneficial.
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Affiliation(s)
- Laura Kirkpatrick
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Collins
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Allegheny Reproductive Health Center, Pittsburgh, PA, USA
| | - Elizabeth Harrison
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Christina Patterson
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Yoshimi Sogawa
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Anne C Van Cott
- Department of Neurology, UPMC Presbyterian Hospital, Pittsburgh, PA, USA.,Veterans Affairs Neurology Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
BACKGROUND In the past 20 years, there has been an increase in the number of college students with disabilities (SWDs) in the United States. Students with disabilities may have not received relevant, or accessible, sexual health education from medical providers, parents, or school health educators. Because of the lack of this education, the college social environment, and developmental timing of traditional college aged students, SWDs are at risk of engaging in health compromising sexual behavior. METHODS We conducted a secondary data analysis of traditionally aged (18- to 24-year-olds) college students who completed the National College Health Assessment administered in Fall 2017 and Spring 2018 (N = 95,119). We use prevalence and generalized linear models to describe self-reported sexual health behavior and outcomes among college students without disabilities and SWDs, by disability category. RESULTS Findings indicate that college students with disabilities-particularly students with attention-deficient hyperactivity disorder, psychiatric conditions, and multiple disabilities-are at higher risk than students without disabilities to engage in health compromising sexual health behavior and that students with multiple disabilities have higher adjusted prevalence ratios of being diagnosed and/or treated for a sexually transmitted infection. CONCLUSIONS Students with disabilities are not a monolithic population and there is cross-disability variability of engaging in health compromising and health promoting behavior. These findings highlight the need for college health promotion specialists and clinicians to advocate for accessible, sex positive, disability inclusive sexual health education.
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Affiliation(s)
- Michael S Argenyi
- From the Department of Anesthesiology at Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Tyler G James
- Department of Health Education and Behavior, University of Florida, Gainesville, FL
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Horner-Johnson W, Senders A, Higgins Tejera C, McGee MG. Sexual Health Experiences Among High School Students With Disabilities. J Adolesc Health 2021; 69:255-262. [PMID: 33902994 DOI: 10.1016/j.jadohealth.2021.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study was to investigate the sexual experiences of adolescents with and without disabilities. METHODS Data were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. We compared teens with and without disabilities on whether or not they had ever had sexual intercourse (N = 20,812). Among those who had ever had intercourse (N = 8,311), we used multivariable Poisson regression to measure the association between disability status and the prevalence of five sexual experiences. RESULTS After adjusting for sociodemographic characteristics, the prevalence of ever having had intercourse was 25% higher among teens with disabilities than among those without (adjusted prevalence ratio [aPR] 1.25, 95% confidence interval [CI]: 1.20-1.30). Among students who had had intercourse, the prevalence of having had intercourse before the age of 15 years (aPR 1.25, 95% CI: 1.14-1.47), having ≥ 2 lifetime sexual partners (aPR 1.13, 95% CI 1.07-1.19), having ≥ 2 sexual partners in the previous three months (aPR 1.23, 95% CI: 1.00-1.52), having used alcohol and/or drugs at the last intercourse (aPR 1.28, 95% CI: 1.10-1.48), and having condomless sex at the last intercourse (aPR 1.17, 95% CI: 1.08-1.27) was higher among students with disabilities than among students without disabilities. After accounting for sexual abuse, each of these associations was attenuated and most were no longer significant. CONCLUSIONS Youth with disabilities are sexually active. Findings highlight the need for increased attention to sexual abuse prevention, sexual health promotion, and risk reduction efforts for this population.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon.
| | - Angela Senders
- Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon
| | - César Higgins Tejera
- Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon
| | - Marjorie G McGee
- Office of Equity and Inclusion, Oregon Health Authority, Portland, Oregon
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Kirkpatrick L, Harrison E, Khalil S, Miller E, Patterson C, Sogawa Y, Van Cott AC, Kazmerski TM. A survey of child neurologists about reproductive healthcare for adolescent women with epilepsy. Epilepsy Behav 2021; 120:108001. [PMID: 33964536 DOI: 10.1016/j.yebeh.2021.108001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate child neurologists' knowledge, attitudes, and practices regarding sexual and reproductive health (SRH) care for adolescent and young adult women with epilepsy (WWE). METHODS Child neurologists (including attending physicians, residents, fellows, and advanced practitioners) completed an online survey distributed through subspecialty listservs. We analyzed results using descriptive statistics, chi-square, and logistic regression. RESULTS Two hundred eight child neurologists completed the survey. Most believed that child neurologists should counsel young WWE on: teratogenesis (99%, n = 206/207), contraception-antiseizure medication interactions (96%, n = 194/202), pregnancy (95%, n = 198/206), contraception (89%, n = 184/206) and folic acid supplementation (70%, n = 144/205). Fewer respondents felt confident with such counseling (teratogenesis: 90%, n = 188/208, drug interactions: 65%, n = 133/208, pregnancy 75%, n = 156/208, contraception: 47-64%, n = 96-134/208, p < 0.05). Ninety-five percent (n = 172/181) reported ever discussing SRH with typically developing young WWE, compared to 78% (n = 141/181) for young WWE with mild intellectual disability (p < 0.01). One third (n = 56/170) who ever discussed SRH did not do so routinely. Respondents correctly answered 87% ± 5% of knowledge questions about SRH for WWE, 80% ± 4% of questions about teratogenic antiseizure medications, and 61% ± 7% of questions about contraception-antiseizure drug interactions. The greatest barrier to SRH care was time constraints (80%, n = 149/186). The majority (64%, n = 119/186) identified solutions including longer appointment times and co-managing SRH care with other specialties. CONCLUSIONS Findings reveal gaps in SRH care by child neurologists for adolescent and young adult WWE, especially those with mild intellectual disability. Provider-identified barriers and solutions may serve as targets to improve SRH care for this population.
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Affiliation(s)
- Laura Kirkpatrick
- UPMC Children's Hospital of Pittsburgh, Division of Child Neurology, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
| | - Elizabeth Harrison
- UPMC Children's Hospital of Pittsburgh, Division of Child Neurology, 4401 Penn Avenue, Pittsburgh, PA 15224, United States
| | - Suad Khalil
- Michigan State University College of Human Medicine, Department of Neurology, 965 Fee Road A110, East Lansing, MI 48824, United States
| | - Elizabeth Miller
- UPMC Children's Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, 4401 Penn Avenue, Pittsburgh, PA 15224, United States
| | - Christina Patterson
- UPMC Children's Hospital of Pittsburgh, Division of Child Neurology, 4401 Penn Avenue, Pittsburgh, PA 15224, United States
| | - Yoshimi Sogawa
- UPMC Children's Hospital of Pittsburgh, Division of Child Neurology, 4401 Penn Avenue, Pittsburgh, PA 15224, United States
| | - Anne C Van Cott
- UPMC Presbyterian Hospital, Department of Neurology, 200 Lothrop Street, Pittsburgh, PA 15213, United States; Veterans Affairs Pittsburgh Healthcare System, Department of Neurology, 4100 Allequippa Street, Pittsburgh, PA 15240, United States
| | - Traci M Kazmerski
- UPMC Children's Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, 4401 Penn Avenue, Pittsburgh, PA 15224, United States; Center for Women's Health Research and Innovation, University of Pittsburgh, 4200 Fifth Avenue, Pittsburgh, PA 15260, United States
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9
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Hartini S, Nur Chamidah A, Siti Herini E. Sexual Behavior Problems in Adolescents with Intellectual Disabilities: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Several studies conducted on adolescents with intellectual disabilities (ID) have reported various problems of sexual behavior that occurs in the group, including HIV-related risky sexual behavior and other health-related concerns.
AIM: This review aims to synthesize studies on the problems regarding sexual behavior in adolescents with ID to obtain data on the types of risky sexual behavior problems.
MATERIALS AND METHODS: Synthesis was conducted on nine studies of children aged 10–20 years old with intellectual disabilities as subjects who have no other psychiatric comorbidities and met the appraisal criteria based on the checklist for analytical cross-sectional studies of the Joanna Briggs Institute (JBI).
RESULTS: Several behaviors were found in the group of adolescents with ID. Masturbation is the type of solitary behavior that appears the most, besides other behaviors like touching genitals and getting naked in public places. Sexual intercourse is the most widely reported in the type of “involving other persons.” Sexual intercourse with more than 1 person without using contraception to protect against sexual transmitted disease (STD) is at risk for HIV infection or other infectious diseases.
CONCLUSIONS: The results of this review have indicated that adolescents with ID have sexual needs and experience sexual behavior problems similar to ordinary adolescents in general. They actually have a higher risk for having risky sexual behavior because they lack understanding of sexuality. These findings emphasize the need for sex education so that young people with disabilities can have healthy sexual behavior and a safe life.
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Schmidt EK, Beining A, Hand BN, Havercamp S, Darragh A. Healthcare providers' role in providing sexual and reproductive health information to people with intellectual and developmental disabilities: A qualitative study. J Appl Res Intellect Disabil 2021; 35:1019-1027. [PMID: 33527499 DOI: 10.1111/jar.12861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/21/2020] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Individuals with intellectual and developmental disabilities demonstrate disparities in sexual and reproductive health (SRH) compared to individuals without disabilities (e.g., lack of sexual education and knowledge, increased rates of abuse, unplanned pregnancies and sexually transmitted infections). Therefore, the purpose of this study was to identify topics healthcare providers address and perceived barriers and supports to SRH education. METHODS We conducted semi-structured interviews with healthcare providers (N = 12). RESULTS Providers address relationships, safety, protection and appropriate sexual behaviours with clients with intellectual and developmental disabilities. Parent education and client-centred care were identified as supports, while the patient's level of understanding, the provider's lack of knowledge or access to resources and to appropriate referrals were identified as barriers to SRH education. CONCLUSION Future studies are needed to link providers to resources they can use to provide comprehensive, accessible SRH education for clients with intellectual and developmental disabilities.
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Affiliation(s)
- Elizabeth K Schmidt
- Boston University, College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, USA
| | - April Beining
- Department of Occupational Therapy, The Ohio State University, Columbus, Ohio, USA
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Susan Havercamp
- College of Medicine, Nisonger Center, Ohio State University, Columbus, Ohio, USA
| | - Amy Darragh
- Department of Occupational Therapy, The Ohio State University, Columbus, Ohio, USA
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11
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Namkung EH, Valentine A, Warner L, Mitra M. Contraceptive use at first sexual intercourse among adolescent and young adult women with disabilities: The role of formal sex education. Contraception 2020; 103:178-184. [PMID: 33359508 DOI: 10.1016/j.contraception.2020.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study examines receipt of formal sex education as a potential mechanism that may explain the observed associations between disability status and contraceptive use among young women with disabilities. STUDY DESIGN Using the 2011-2017 National Survey of Family Growth, we analyzed data from 2861 women aged 18 to 24 years, who experienced voluntary first sexual intercourse with a male partner. Women whose first intercourse was involuntary (7% of all women reporting sexual intercourse) were excluded from the analytic sample. Mediation analysis was used to estimate the indirect effect of receipt of formal sex education before first sexual intercourse on the association between disability status and contraceptive use at first intercourse. RESULTS Compared to nondisabled women, women with cognitive disabilities were less likely to report receipt of instruction in each of 6 discrete formal sex education topics and received instruction on a fewer number of topics overall (B = -0.286, 95% CI = -0.426 to -0.147), prior to first voluntary intercourse. In turn, the greater number of topics received predicted an increased likelihood of contraceptive use at first voluntary intercourse among these women (B = 0.188, 95% CI = 0.055-0.321). No significant association between noncognitive disabilities and receipt of formal sex education or contraceptive use at first intercourse was observed. CONCLUSIONS Given the positive association between formal sex education and contraceptive use among young adult women with and without disabilities, ongoing efforts to increase access to formal sex education are needed. Special attention is needed for those women with cognitive disabilities.
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Affiliation(s)
- Eun Ha Namkung
- Lurie Institute for Disability Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA, United States.
| | - Anne Valentine
- Lurie Institute for Disability Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA, United States
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA, United States
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12
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Roden RC, Schmidt EK, Holland-hall C. Sexual health education for adolescents and young adults with intellectual and developmental disabilities: recommendations for accessible sexual and reproductive health information. The Lancet Child & Adolescent Health 2020; 4:699-708. [DOI: 10.1016/s2352-4642(20)30098-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/23/2022]
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13
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Verlenden JV, Bertolli J, Warner L. Contraceptive Practices and Reproductive Health Considerations for Adolescent and Adult Women with Intellectual and Developmental Disabilities: A Review of the Literature. Sex Disabil 2019; 37:541-557. [PMID: 33005065 PMCID: PMC7527256 DOI: 10.1007/s11195-019-09600-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Whereas progress has been made on increasing access to comprehensive healthcare for individuals with intellectual and developmental disabilities (I/DD), disparities continue in health outcomes, including those related to the reproductive health of adolescent and adult women with I/DD. This review summarizes reproductive care considerations for adolescent and adult women with I/DD and current practices regarding the delivery of contraceptive services to these women. Forty-seven (47) articles based on research conducted in the US between 1999 and 2019 were selected for inclusion in the review. Primary themes discussed include (1) common reproductive health concerns for adolescent and adult women with I/DD, other than pregnancy prevention; (2) contraceptive methods and disability-related concerns; (3) informed consent and reproductive decision-making; and (4) provider knowledge and education. The management of menses and hormonal dysregulation were identified as concerns that providers encounter among patients with I/DD and their families. Disability-related concerns with regard to use of contraception in general and considerations regarding certain methods in particular include challenges with prescription adherence, physical effects of hormonal therapies, drug interactions for individuals with additional health conditions, and legal and ethical concerns involved with decision-making and consent. The results of this review also suggest that focused efforts in partnership with health care providers may be needed to address barriers that adolescent and adult women with I/DD face when trying to obtain quality reproductive health services and contraceptive guidance.
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Affiliation(s)
- Jorge V. Verlenden
- Morehouse School of Medicine, Satcher Health Leadership Institute, Atlanta, USA
- Atlanta, USA
| | - Jeanne Bertolli
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, USA
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA
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14
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Schmidt EK, Brown C, Darragh A. Scoping Review of Sexual Health Education Interventions for Adolescents and Young Adults with Intellectual or Developmental Disabilities. Sex Disabil 2019. [DOI: 10.1007/s11195-019-09593-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Schmidt EK, Hand BN, Simpson KN, Darragh AR. Sexually transmitted infections in privately insured adults with intellectual and developmental disabilities. J Comp Eff Res 2019; 8:599-606. [PMID: 30838884 DOI: 10.2217/cer-2019-0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Individuals with intellectual and developmental disabilities (I/DD) may have an increased risk of sexually transmitted infections (STIs) due to limited sexual health education and higher rates of sexual abuse, yet little is known about the prevalence of STIs and STI testing in this population. Methods: This study compared national samples of privately insured individuals with (n = 25,193) and without I/DD (n = 25,193) on the prevalence of STIs and STI testing. Results: In multivariable models, individuals with I/DD were significantly less likely to have an STI diagnosis and no difference was found between groups on the odds of STI testing overall. Conclusion: Findings may, in part, be explained by fewer sexual experiences, increased supervision in social settings and delayed onset of sexual activity among those with I/DD.
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Affiliation(s)
- Elizabeth K Schmidt
- Department of Health & Rehabilitation Sciences & The Department of Occupational Therapy, The Ohio State University, OH 432102, USA
| | - Brittany N Hand
- Department of Health & Rehabilitation Sciences & The Department of Occupational Therapy, The Ohio State University, OH 432102, USA
| | - Kit N Simpson
- Healthcare Leadership & Management, Medical University of South Carolina, SC 29403, USA
| | - Amy R Darragh
- Department of Health & Rehabilitation Sciences & The Department of Occupational Therapy, The Ohio State University, OH 432102, USA
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Roden RC, Oholendt K, Lange H, Noritz G, Bonny AE. Primary care provider adherence to reproductive healthcare guidelines in adolescents and young adults with disabilities: A retrospective matched cohort study1. J Pediatr Rehabil Med 2019; 12:317-324. [PMID: 31476181 DOI: 10.3233/prm-180589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Assessing provider adherence to preventative sexual and reproductive healthcare guidelines in adolescents and young adults (AYA) patients with physical and intellectual disabilities (PWD). METHODS Records of PWD (N= 42) age 12-26 receiving health maintenance between 01/01/11-12/31/16 were reviewed for: (1) initiation and completion of human papilloma virus (HPV) vaccination series, (2) initiation and completion of meningococcal vaccination, (3) screening for human immunodeficiency virus (HIV), and documentation of (4) sexual, (5) menstrual, and (6) pregnancy histories. Unaffected age and gender-matched patients provided comparison data (Comparison Cohort, CC). RESULTS The mean age of both groups was 17.3 years ± 3.8 and 40.5% were female. There was no significant difference between groups regarding the completion of HPV or meningococcal vaccine series. Among those 15+ years of age, 7.1% of PWD and 28.6% of CC were screened for HIV (p= 0.04). Sexual history was documented in 19.0% of PWD versus 73.8% of CC (p< 0.001). Among females, menstrual regularity was recorded in 11.8% of PWD versus 47.1% of CC (p= 0.02) and pregnancy history in 0.0% of PWD versus 29.4% of CC (p= 0.04). CONCLUSIONS Adherence to sexual health guidelines was suboptimal, and lower among PWD. Vaccination rates did not differ between the two groups.
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Affiliation(s)
| | - Kyle Oholendt
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hannah Lange
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Garey Noritz
- The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Complex Care, Nationwide Children's Hospital, Columbus, OH, USA
| | - Andrea E Bonny
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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Grove L, Morrison-beedy D, Kirby R, Hess J. The Birds, Bees, and Special Needs: Making Evidence-Based Sex Education Accessible for Adolescents with Intellectual Disabilities. Sex Disabil 2018; 36:313-29. [DOI: 10.1007/s11195-018-9547-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
PURPOSE OF REVIEW This review provides support for promoting the sexual health of adolescents and young adults with developmental disabilities, and particularly those with intellectual disabilities. It offers guidance for pediatricians on incorporating counseling on sexuality and reproductive healthcare, socially appropriate behavior, and sexual abuse prevention for adolescents and young adults with developmental disabilities into healthcare visits. Additionally, it provides resources for developmentally appropriate sexuality education in the home and community to allow access to the comprehensive sexual and reproductive healthcare patients deserve. RECENT FINDINGS Adolescents and young adults with developmental disabilities often do not receive developmentally appropriate sexual health education, and this is associated with poor sexual health outcomes and increased rates of sexual abuse in this population. SUMMARY Pediatricians should discuss sexual health with all patients, including adolescents and young adults with developmental disabilities. They are well suited to provide sexual health education and inform families about appropriate sexual health resources.
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Affiliation(s)
| | - Susan Hayden Gray
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Durbin A, Brown HK, Bansal S, Antoniou T, Jung JKH, Lunsky Y. How HIV affects health and service use for adults with intellectual and developmental disabilities. J Intellect Disabil Res 2017; 61:682-696. [PMID: 28612475 DOI: 10.1111/jir.12381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/14/2017] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE(S) Although rates of human immunodeficiency virus (HIV) are similar for individuals with and without intellectual and developmental disabilities (IDD), very little is known about the health needs and service use of those with IDD and HIV. Among a population with IDD, we compared the physical and mental health profiles, as well as general and mental health service use for those with and without HIV. DESIGN Retrospective cohort study in Ontario, Canada using linked administrative health and social service databases. METHODS The prevalence of physical conditions and mental health disorders, and patterns of service use for any reason and service use for mental health issues were compared among Ontario adults with IDD and HIV (n = 107) and without HIV (n = 63 901) in log-binomial models adjusted for age, sex and neighbourhood income and rurality. RESULTS Adults with IDD and HIV were more likely than those without HIV to have three types of mental health disorders: non-psychotic disorders [aRR: adjusted rate ratio (aRR): 1.22 (95% confidence interval (CI): 1.01-1.47)], psychotic disorders [aRR: 1.57 (1.09, 2.28)] and substance use disorders [aRR: 3.52 (2.53, 4.91)]. Adults with IDD and HIV were also more likely to have emergency department visits [aRR: 1.68 (1.42, 1.98)] and hospital admissions [aRR: 2.55 (1.74, 3.73)] for any reason, and to have mental health emergency department visits and/or admissions [aRR: 2.82 (1.90, 4.18)]. DISCUSSION Adults with IDD and HIV have complex health profiles and greater health service use than HIV-negative adults with IDD. These findings call for closer integration of programs delivered by the HIV and disability sectors to optimise the health of this patient population.
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Affiliation(s)
- A Durbin
- Epidemiology Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Research and Evaluation, Canadian Mental Health Association - Toronto Branch (CMHA), Toronto, Ontario, Canada
| | - H K Brown
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Anthropology (Health Studies Program), University of Toronto Scarborough, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - S Bansal
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - T Antoniou
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J K H Jung
- Epidemiology Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Y Lunsky
- Epidemiology Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Ballan MS, Freyer MB. The sexuality of young women with intellectual and developmental disabilities: A neglected focus in the American foster care system. Disabil Health J 2017; 10:371-5. [PMID: 28408099 DOI: 10.1016/j.dhjo.2017.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/19/2017] [Indexed: 11/23/2022]
Abstract
Youths with intellectual and developmental disabilities (ID/DD) are overrepresented in the American foster care system and experience heightened rates of pregnancy compared to their nondisabled peers. Yet limited information is known about sexually active or pregnant young women with ID/DD in foster care. Consequently, important healthcare needs of this population are not adequately addressed. This article explores sexuality education and sexual healthcare for female adolescents in foster care with ID/DD and recommends practice guidelines to support and prepare their emergent sexual development.
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Lunsky Y, Durbin A, Brown HK, Bansal S, Heifetz M, Antoniou T. Health profiles and associated service use among adults with HIV and intellectual and developmental disabilities. AIDS 2017; 31:697-705. [PMID: 27922856 DOI: 10.1097/QAD.0000000000001361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE(S) Owing to the commonly held notion that individuals with intellectual and developmental disabilities (IDD) have low risk of HIV acquisition, we compared the prevalence of HIV infection among people with and without IDD. We also examined health status and health service use among the HIV-infected group. DESIGN Population-based cohort study using linked administrative health and social services databases. METHODS We compared HIV prevalence between Ontario adults with IDD (n = 64 008) and a 20% random sample of Ontario adults without IDD. Among the HIV-infected group, we compared adults with and without IDD in terms of comorbid chronic physical conditions and mental health disorders, as well as use of overall health services, mental health services, and HIV-specific services. RESULTS HIV prevalence per 100 000 population did not differ for adults with IDD [163.38 (95% confidence interval: 132.27, 199.6)] and without IDD [172.45 (95 confidence interval: 167.48, 177.53)]. Among the HIV-infected group, those with IDD had more comorbid chronic physical conditions and mental health disorders. They also had greater use of overall health services and mental health services. Likelihood of use of HIV-specific services also differed for those with and without IDD. DISCUSSION A similar prevalence of HIV among adults with and without IDD accentuates a need for strategies for individuals with IDD to be included in HIV prevention efforts. High prevalence of chronic physical and mental health comorbidity and health service use among the HIV-infected group with IDD highlight a need for comprehensive and coordinated treatment plans to optimize outcomes for this complex patient group.
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Dispenza F, Watson LB. Comparing Sexual Risk Behaviors Between Sexual Minority Men Living With and Without a Chronic Illness/Disability (CID). Sex Disabil 2015; 33:399-403. [DOI: 10.1007/s11195-014-9376-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Barnard-Brak L, Schmidt M, Chesnut S, Wei T, Richman D. Predictors of access to sex education for children with intellectual disabilities in public schools. Intellect Dev Disabil 2014; 52:85-97. [PMID: 24725108 DOI: 10.1352/1934-9556-52.2.85] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Data from the National Longitudinal Transition Study-2 ( SRI International, 2002 ) were analyzed to identify variables that predicted whether individuals with intellectual disability (ID) received sex education in public schools across the United States. Results suggested that individuals receiving special education services without ID were only slightly more likely to receive sex education than students with mild ID (47.5% and 44.1%, respectively), but the percentage of students with moderate to profound ID that received sex education was significantly lower (16.18%). Analysis of teacher opinions and perceptions of the likelihood of the students benefiting from sex education found that most teachers indicated that students without ID or with mild ID would benefit (60% and 68%, respectively), but the percentage dropped to 25% for students with moderate to profound ID. Finally, across all students, the only significant demographic variable that predicted receipt of sex education was more expressive communication skills. Results are discussed in terms of ensuring equal access to sex education for students with ID in public schools.
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Greenwood NW, Wilkinson J. Sexual and reproductive health care for women with intellectual disabilities: a primary care perspective. Int J Family Med 2013; 2013:642472. [PMID: 24455249 PMCID: PMC3876698 DOI: 10.1155/2013/642472] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/19/2013] [Accepted: 10/03/2013] [Indexed: 05/22/2023]
Abstract
Adults with intellectual disabilities (ID) face multiple health disparities and challenges to accessing health care. Little is known about sexual health care of this population and about how to optimize women's reproductive health care for women with intellectual disabilities. Women with ID face important barriers to care, including lack of provider training and experience, hesitancy to broach the topic of sexual health, a lack of sexual knowledge and limited opportunities for sex education, disability-related barriers, higher prevalence of sexual abuse and assault, often underreported, lack of dialogue around this population's human right to consensual sexual expression, undertreatment of menstrual disorders, and legal and systemic barriers. We conducted a limited literature review related to six aspects of sexual health care of women with ID, including barriers to sexual health care, sex education, sexual abuse and consensual sexuality, contraception, screening for sexually transmitted infections and cervical cancer, and pregnancy and parenting. After providing background information about each topic, we suggest practice recommendations for primary care clinicians, using a rights-based framework.
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Affiliation(s)
- Nechama W. Greenwood
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
- *Nechama W. Greenwood:
| | - Joanne Wilkinson
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th floor, Boston, MA 02118, USA
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Baker JL, Brawner B, Cederbaum JA, White S, Davis ZM, Brawner W, Jemmott LS. Barbershops as Venues to Assess and Intervene in HIV/STI Risk Among Young, Heterosexual African American Men. Am J Mens Health 2012; 6:368-82. [DOI: 10.1177/1557988312437239] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
African Americans, particularly men, are disproportionately affected by the HIV epidemic. Inconsistent condom use and concurrent sexual partnerships are risk factors; there is limited investigation on how these factors influence HIV risk engagement in young, heterosexual, African American men. To identify contextual risk factors that place young men (18-24 years) at risk for HIV infection, one focus group was conducted with 13 men, and questionnaires were administered to 48 men. Participants were 18 to 24 years old and were recruited from local barbershops. The majority engaged in noncondom use (83%) and had multiple sexual partners (64%). Qualitative themes revealed noncondom use “when in the moment” and enhanced condom use with casual partners. This study provided an understanding of participants’ attitudes, intentions, and behaviors as they related to HIV risk and revealed the need for culturally relevant, theory-based HIV prevention programs to reduce HIV transmission among this population.
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Affiliation(s)
| | | | | | - Shawn White
- University of Pennsylvania, Philadelphia, PA, USA
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