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Nguyen BT, Chapman NM, Johnson N, Stessman HAF, Tracy S, Drescher KM. Complete sequence of the closed circular extrachromosomal element of Naegleria pringsheimi De Jonckheere (strain Singh). Microbiol Resour Announc 2024; 13:e0080623. [PMID: 38509051 PMCID: PMC11008152 DOI: 10.1128/mra.00806-23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/09/2024] [Indexed: 03/22/2024] Open
Abstract
The DNA encoding the ribosomal RNA in Naegleria is encoded on closed circular extrachromosomal ribosomal DNA-containing elements (CERE) in the nucleolus. In this report, we describe the sequence of the CERE of Naegleria pringsheimi De Jonckheere (strain Singh).
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Affiliation(s)
- Brian T. Nguyen
- Department of Medical Microbiology and Immunology, Creighton University, Omaha, Nebraska, USA
| | - Nora M. Chapman
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Niklas Johnson
- Department of Medical Microbiology and Immunology, Creighton University, Omaha, Nebraska, USA
| | - Holly A. F. Stessman
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, Nebraska, USA
| | - Steven Tracy
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kristen M. Drescher
- Department of Medical Microbiology and Immunology, Creighton University, Omaha, Nebraska, USA
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Nguyen BT. The demand for male contraception: Estimating the potential market for users of novel male contraceptive methods using United States National Survey of Family Growth data. Contraception 2024:110438. [PMID: 38555051 DOI: 10.1016/j.contraception.2024.110438] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/07/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To estimate the potential market for novel male contraceptives (NMCs) using United States National Survey of Family Growth (NSFG) data, 2015-2017. STUDY DESIGN We described the market for NMCs via secondary analysis of the 2015-2017 NSFG's weighted male respondent data, utilizing surrogate markers for contraceptive switching (NSFG) and contraceptive discontinuation data from the Contraceptive CHOICE project. Potential NMC users included men relying on: (1) no methods or less effective methods but who reported that they would be "very upset" if they got someone pregnant, (2) permanent methods but who reported that they might still want more children, (3) a female partner's method that she might discontinue in the next year, (4) a male method even when his partner uses her own contraceptive. RESULTS Of 3340 respondents-representing 55,890,830 sexually active, reproductive-age men-23.2% used no contraception at last intercourse, 15.8% condoms, 5.1% withdrawal, and 5.1% vasectomy. Among respondents relying solely on condoms, withdrawal, or no method, 19.7%, 3.8%, and 4.4% would be "very upset" if they got someone pregnant. For permanent contraceptive users, 17.3%-20.5% wanted another child. For men reliant on their partner's long-acting reversible or combined hormonal contraceptive, 12-17% and 45-51% of partners might discontinue their method. These data conservatively suggest that 13% or more than 7 million men would potentially use NMCs, rising to 15.5 million with less restrictive contraceptive switching criteria. CONCLUSION Adjusting for pregnancy attitudes and likelihood of contraceptive switching, a substantial portion (between 7-15.5 million) of reproductive age men in the US are potential NMC users. IMPLICATIONS The population of potential novel male contraceptive users extends beyond just users of condoms, withdrawal and vasectomy and should include couples practicing dual-partner contraception and female partners using contraceptive methods that they may become dissatisfied with and discontinue.
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Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Department of Obstetrics and Gynecology, Los Angeles General Medical Center, Los Angeles, CA, United States.
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Nguyen BT, Heyrana K, Ohsfeldt R, Johnston A, Summers K. Descriptive study of the real-world, long-term cost estimates and duration of use for hormonal and nonhormonal intrauterine devices using US commercial insurance claims. J Manag Care Spec Pharm 2023; 29:1303-1311. [PMID: 38058139 PMCID: PMC10776262 DOI: 10.18553/jmcp.2023.29.12.1303] [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] [Indexed: 12/08/2023]
Abstract
BACKGROUND Intrauterine devices (IUDs) have comparable efficacy to permanent surgical contraceptive methods; however, long-term costs are infrequently considered. Existing estimates inconsistently account for costs outside of IUD insertion or removal, actual duration of use, or differences between hormonal and nonhormonal IUDs. OBJECTIVE To describe health care resource utilization and commercial payer costs that arise throughout hormonal and nonhormonal IUD use. METHODS In this retrospective cohort study, paid claims data (Merative, MarketScan) from a large US commercial claims database were evaluated between 2013 and 2019. Claims were included from individuals aged 12 to 45 years who had an IUD inserted in 2014, continuous insurance coverage for 1 year prior to insertion and throughout follow-up, and no insertion, removal, or reinsertion in the previous year. Procedures and services that could be IUD-related were identified using Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Edition codes. Duration of IUD use was evaluated by Kaplan-Meier analysis of time to IUD removal. Event rates were determined for identified procedures and services; costs were calculated as the sum of payer reimbursements per enrolled individual. All IUD types available during the study period were described: 2 hormonal IUDs (52-mg and 13.5-mg levonorgestrel-releasing [LNG]) and the nonhormonal (380-mm2 copper) IUD. RESULTS Of 195,009 individuals meeting the age requirement and receiving an IUD in 2014, 63,386 met the inclusion criteria and 53,744 had their IUD type on record-42,777 (67.5%) 52-mg LNG, 2,932 (4.6%) 13.5-mg LNG, and 8,035 (12.7%) nonhormonal IUD users. Despite differences in their indicated duration (13.5-mg LNG, 3 years; 52-mg LNG, 5 years; and nonhormonal, 10 years), most individuals had their IUD removed before its indicated full duration of use (13.5-mg LNG, 56.1%; 52-mg LNG, 61.3%; nonhormonal [at 5 years], 54.6%). The event rate per 100 individuals during the follow-up period was highest for abnormal uterine bleeding (16.2), ovarian cysts (9.3), and surgical management of uterine perforations (4.5). IUD insertion costs (mean ± SE) per enrolled individual for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $931 ± $9, $1,107 ± $4, and $897 ± $6, respectively. Cumulative mean ± SE 5-year postinsertion costs for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $2,892 ± $232, $1,514 ± $31, and $1,389 ± $97, respectively, among the remaining enrolled individuals. CONCLUSIONS In this descriptive study of commercially insured IUD users, at least half had their IUD removed before its indicated duration. IUD improvements that reduce the frequency of abnormal uterine bleeding, ovarian cysts, and uterine perforations may help reduce long-term IUD costs.
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Affiliation(s)
- Brian T. Nguyen
- Department of Clinical Obstetrics & Gynecology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Katrina Heyrana
- Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Robert Ohsfeldt
- Texas A&M School of Public Health, College Station
- Medical Decision Modeling, Inc., Indianapolis, IN
| | | | - Kent Summers
- AlphaScientia, a Red Nucleus company, King of Prussia, PA
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Nguyen BT, Chapman NM, Johnson N, Stessman HAF, Tracy S, Drescher KM. Complete sequence of the closed circular extrachromosomal element (CERE) of Naegleria australiensis De Jonckheere (strain PP 397). Microbiol Resour Announc 2023; 12:e0032123. [PMID: 37750728 PMCID: PMC10586121 DOI: 10.1128/mra.00321-23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
Ribosomal RNA is not encoded in chromosomal DNA in amoebae of the Naegleria genus but the rRNA genes are located on closed circular extrachromosomal ribosomal DNA (rDNA)-containing elements (CERE). In this report, we describe the sequence of the CERE of Naegleria australiensis De Jonckheere (strain PP397).
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Affiliation(s)
- Brian T. Nguyen
- Department of Medical Microbiology and Immunology, Creighton University, Omaha, Nebraska, USA
| | - Nora M. Chapman
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Niklas Johnson
- Department of Medical Microbiology and Immunology, Creighton University, Omaha, Nebraska, USA
| | - Holly A. F. Stessman
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, Nebraska, USA
| | - Steven Tracy
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kristen M. Drescher
- Department of Medical Microbiology and Immunology, Creighton University, Omaha, Nebraska, USA
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Wright SR, Gabby LC, Nguyen BT. Cerebrospinal fluid as vaginal discharge: ventriculoperitoneal shunt migration following Cesarean section. Minerva Obstet Gynecol 2023; 75:498-501. [PMID: 37768257 DOI: 10.23736/s2724-606x.22.05091-6] [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] [Indexed: 09/29/2023]
Abstract
Congenital hydrocephalus was once a permanently disabling and even fatal disease. With the advent of ventriculoperitoneal shunts, affected women are now surviving to their reproductive years and beyond. Pregnancy outcomes in this population are generally positive. However due to possible shunt complications, including infection, migration, and organ perforation, perinatal care for pregnant individuals with a ventriculoperitoneal shunt is complex and requires input from both obstetric and neurosurgical providers. We present the case of a 28-year-old G1P1 with a history of congenital hydrocephalus and ventriculoperitoneal shunt who presented to the emergency department at two months postpartum with clear fluid leaking from her vagina. The shunt's distal end had migrated and perforated the uterus causing cerebrospinal fluid to leak into the uterine cavity. Surgical repair was required of both the uterine hysterotomy and ventriculoperitoneal shunt, and the patient's symptoms ultimately resolved. Patients with a history of shunt placement who later undergo abdominal surgery, including cesarean section, are at risk for shunt complications. Shunt-dependent patients presenting in the post-partum period with new neurological or abdominopelvic complaints should undergo evaluation by a multidisciplinary team.
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Affiliation(s)
- Steffanie R Wright
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA -
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA -
| | - Lauryn C Gabby
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Department of Maternal Fetal Medicine, University of California, San Diego, CA, USA
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Heyrana KJ, Kaneshiro B, Soon R, Nguyen BT, Natavio MF. Data Equity for Asian American and Native Hawaiian and Other Pacific Islander People in Reproductive Health Research. Obstet Gynecol 2023; 142:787-794. [PMID: 37678914 PMCID: PMC10510826 DOI: 10.1097/aog.0000000000005340] [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: 01/31/2023] [Revised: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 09/09/2023]
Abstract
Though racial and ethnic disparities in sexual and reproductive health outcomes are receiving greater interest and research funding, the experiences of Asian American and Native Hawaiian and Other Pacific Islander (NHPI) people are often combined with those of other racial and ethnic minority groups or excluded from data collection altogether. Such treatment is often rationalized because Asian American and NHPI groups comprise a smaller demographic proportion than other racial or ethnic groups, and the model minority stereotype assumes that these groups have minimal sexual and reproductive health needs. However, Asian American and NHPI people represent the fastest-growing racial-ethnic groups in the United States, and they face disparities in sexual and reproductive health access, quality of care, and outcomes compared with those of other races and ethnicities. Disaggregating further by ethnicity, people from certain Asian American and NHPI subgroups face disproportionately poor reproductive health outcomes that suggest the need for culturally targeted exploration of the unique drivers of these inequities. This commentary highlights the evidence for sexual and reproductive health disparities both in and between Asian American and NHPI groups. We also examine the failures of national data sets and clinical studies to recruit Asian American and NHPI people in proportion to their share of the U.S. population or to consider how the cultural and experiential diversity of Asian American and NHPI people influence sexual and reproductive health. Lastly, we provide recommendations for the equitable inclusion of Asian American and NHPI people to promote and systematize the study and reporting of sexual and reproductive health behaviors and outcomes in these culturally, religiously, and historically diverse groups.
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Affiliation(s)
- Katrina J Heyrana
- Department of Obstetrics & Gynecology, Cedars Sinai Medical Center, and the Department of Obstetrics & Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California; and the Department of Obstetrics, Gynecology & Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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Thomas K, Quist S, Peprah S, Riley K, Mittal PC, Nguyen BT. The Experiences of Black Community-Based Doulas as They Mitigate Systems of Racism: A Qualitative Study. J Midwifery Womens Health 2023; 68:466-472. [PMID: 37057730 DOI: 10.1111/jmwh.13493] [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: 08/03/2022] [Revised: 02/01/2023] [Accepted: 02/19/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Black pregnant individuals endure a disproportionate burden of preventable morbidity and mortality due to persistent, racially mediated social and systemic inequities. As patient advocates, Black community-based doulas help address these disparities via unique services not provided by conventional doulas. However, Black doulas themselves may encounter obstacles when providing care to Black perinatal clients. We characterized the barriers encountered by Black community-based doulas in Los Angeles, California. METHODS We partnered with a Black community-based doula program to conduct semistructured interviews with its community doulas and program directors, covering the following topics: motivations for becoming a doula, services provided, and challenges faced as a Black doula in perinatal settings. Interview transcripts were reviewed via directed content analysis, with attention to the influence of systemic racism on service provision. Additionally, our research team used Camara Jones' Levels of Racism, which describes race-associated differences in health outcomes to code data. RESULTS We interviewed 5 Black community-based doulas and 2 program directors, who all shared experiences of inequitable care and bias against Black clients that could be addressed with the support and advocacy of culturally congruent doulas. The community doulas shared experiences of stigma as Black doulas, compounded by racial prejudice. Interviewees noted sources of structural racism affecting program development, instances of interpersonal racism as they interacted with the health care system, and internalized racism that was revealed during culturally based doula trainings. Additionally, the doulas emphasized the importance of cultural concordance, or a shared identity with clients, which they considered integral to providing equitable care. CONCLUSION Despite facing institutionalized, interpersonal, and internalized forms of racism, Black community-based doulas provide avenues for Black birthing individuals to navigate systemic racism experienced during the perinatal process. However, these forms of racism need to be addressed for Black community doulas to flourish.
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Affiliation(s)
- Kimeshia Thomas
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sasha Quist
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Sayida Peprah
- Frontline Doulas Centering the Community Program, Diversity Uplifts, Inc, Los Angeles, California
| | - Khefri Riley
- Frontline Doulas Centering the Community Program, Diversity Uplifts, Inc, Los Angeles, California
| | - Pooja C Mittal
- Department of Family and Community Medicine, University of California, San Francisco and HealthNet of California, San Francisco, California
| | - Brian T Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Violette CJ, Nguyen BT. Expectations for family building, assisted reproduction, and adoption among lesbians in the National Survey of Family Growth, 2017-2019. F S Rep 2023; 4:190-195. [PMID: 37398611 PMCID: PMC10310959 DOI: 10.1016/j.xfre.2023.04.003] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To characterize the family-building goals and experiences of lesbians compared with those of heterosexual females in the United States. Design Secondary analysis of nationally representative, cross-sectional survey data. Setting National Survey of Family Growth 2017-2019. Patients 159 reproductive-age lesbian respondents and 5,127 reproductive-age heterosexual respondents. Interventions We characterized family-building goals and the use of assisted reproduction and adoption among lesbians using nationally representative female respondent data from the 2017-2019 National Survey of Family Growth. We performed bivariate analyses examining variations in these outcomes between lesbian and heterosexual individuals. Main Outcome Measures Wantedness of children, use of assisted reproductive technology, and pursuit of adoption among reproductive-age lesbian and heterosexual participants. Results We identified 159 reproductive-age lesbian respondents of the National Survey of Family Growth, representing 2.3% or approximately 1.75 million US individuals of reproductive age. The lesbian respondents were younger, less religious, and less likely to have children than heterosexual respondents. These groups did not differ significantly by race/ethnicity, education, or income. More than half of the individuals reported wanting a child in the future, with proportions similar between the lesbian and heterosexual individuals (48% vs. 51%, respectively; P = .52). Accordingly, 18% of both the lesbian and heterosexual individuals reported that they would be greatly bothered if they were unable to have children. Nevertheless, health care providers reportedly asked the lesbians about their desire to get pregnant less frequently than they asked the heterosexual individuals (21% vs. 32%, respectively; P = .04). Only 26% of the lesbians had ever been pregnant compared with 64% of the heterosexual individuals (P<.01). Approximately one third (31%) of lesbians with medical insurance were seeking reproductive services compared with 10% of heterosexual individuals (P = .05). Lesbians were significantly more likely to be seeking adoption than heterosexual individuals (7.0% vs. 1.3%, respectively; P = .01), although they were more likely to report being turned down (17% vs. 10%, respectively; P = .03), not knowing why they were unable to adopt (19% vs. 1%, respectively; P = .02), and quitting because of the adoption process (100% vs. 45%, respectively; P = .04). Conclusions Approximately half of US females of reproductive age desire to have a child, a proportion that is not different between lesbian and heterosexual individuals. However, fewer lesbians are asked about their desires to get pregnant, and fewer ever become pregnant. Lesbians are significantly more likely to pursue assisted reproductive services when covered by insurance and more likely to seek adoption. Unfortunately, lesbians are more likely to face challenges with adoption.
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Affiliation(s)
- Caroline J. Violette
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Brian T. Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Amory JK, Blithe DL, Ware RS, Swerdloff RS, Bremner WJ, Dart C, Liu PY, Thirumalai A, Nguyen BT, Anawalt BD, Lee MS, Page ST, Wang C. Design of an International Male Contraceptive Efficacy Trial Using a Self-Administered Daily Transdermal Gel Containing Testosterone and Segesterone Acetate (Nestorone®). Contraception 2023:110064. [PMID: 37210024 DOI: 10.1016/j.contraception.2023.110064] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
Injectable male hormonal contraceptives are effective for preventing pregnancy in clinical trials; however, users may prefer to avoid medical appointments and injections. A self-administered transdermal contraceptive gel may be more acceptable for long-term contraception. Transdermal testosterone gels are widely used to treat hypogonadism and transdermal administration may have utility for male contraception; however, no efficacy data from transdermal male hormonal contraceptive gel are available. We designed and are currently conducting an international, multi-center, open-label study of self-administration of a daily combined testosterone and segesterone acetate (Nestorone®™) gel for male contraception. The transdermal approach to male contraception raises novel considerations regarding adherence with the daily gel, as well as concern about the potential transfer of the gel and the contraceptive hormones to the female partner. Enrolled couples are in committed relationships. Male partners have baseline normal spermatogenesis and are in good health; female partners are regularly menstruating and at risk for unintended pregnancy. The study's primary outcome is the rate of pregnancy in couples during the study's 52-week efficacy phase. Secondary endpoints include: the proportion of male participants suppressing sperm production and entering the efficacy phase, side effects, hormone concentrations in male participants and their female partners, sexual function and regimen acceptability. Enrollment concluded on November 1, 2022, with 462 couples and enrollment is now closed. This report outlines the strategy and design of the first study to examine the contraceptive efficacy of a self-administered male hormonal contraceptive gel. The results will be presented in future reports. IMPLICATIONS: The development of a safe, effective, reversible male contraceptive would improve contraceptive options and may decrease rates of unintended pregnancy. This manuscript outlines the study design and analysis plan for an ongoing large international trial of a novel transdermal hormone gel for male contraception. Successful completion of this and future studies of this formulation may lead to the approval of a male contraceptive.
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Affiliation(s)
- John K Amory
- Department of Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | | | - Ronald S Swerdloff
- The Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - William J Bremner
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - Peter Y Liu
- The Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bradley D Anawalt
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Min S Lee
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Stephanie T Page
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Christina Wang
- The Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
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Foster AM, Darney BG, Nguyen BT, Russo J, Arora KS, Westhoff C. Advancing diversity, equity, inclusion, and anti-racism in Contraception: A statement of commitment from the Editorial Board. Contraception 2023:110066. [PMID: 37207728 DOI: 10.1016/j.contraception.2023.110066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Angel M Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON Canada
| | - Blair G Darney
- Oregon Health & Science University, Portland, OR USA; OHSU-PSU School of Public Health, Portland, OR USA; National Institute of Public Health (INSP), Center for Population Health (CISP), Cuernavaca, Morelos, Mexico
| | - Brian T Nguyen
- Department of Clinical Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
| | - Jennefer Russo
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Los Angeles, CA USA; DuPont Clinic, Washington, DC USA
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, University of North Carolina - Chapel Hill, Chapel Hill, NC USA
| | - Carolyn Westhoff
- Department of Obstetrics and Gynecology and Mailman School of Public Health, Columbia University, New York, NY USA
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Nguyen MT, Nguyen BT, Campo-Engelstein L. In Reply. Obstet Gynecol 2023; 141:1027. [PMID: 37103542 DOI: 10.1097/aog.0000000000005164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Lisa Campo-Engelstein
- Bioethics and Health Humanities, University of Texas Medical Branch, Galveston, Texas
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Huynh TD, Nguyen HK, Inchingolo AM, Bao Tran HL, Dipalma G, Mancini A, Cao Diem Nguyen K, Balzanelli MG, Distratis P, Lazzaro R, Nguyen Ho TA, Serlenga EM, Hung Pham V, Romanos G, Nguyen BT, Rapone B, Inchingolo F, Isacco Gargiulo C, Cong Tran T. Soft tissue regeneration in animal models using grafts from adipose mesenchymal stem cells and peripheral blood fibrin gel. Eur Rev Med Pharmacol Sci 2023; 27:3670-3680. [PMID: 37140317 DOI: 10.26355/eurrev_202304_32161] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Our study aimed to evaluate the effect of soft tissue regeneration in nude mice using grafts made from the combination of adipocytes from fat tissue mesenchymal stem cells and fibrin gel from peripheral blood. MATERIALS AND METHODS Mesenchymal stem cells were isolated from adipose tissue and identified according to ISCT criteria. The scaffold used was fibrin obtained from peripheral blood. The grafts in this study were generated by transferring mesenchymal stem cells onto a fibrin scaffold. Two types of grafts, the research sample (fibrin scaffold containing adipocytes differentiated from mesenchymal stem cells) and the control sample (fibrin scaffold only), were grafted under the dorsal skin of the same mouse. After each research period, samples were collected and evaluated by histological methods to observe the existence and growth of cells inside the grafts. RESULTS The results showed that the study group's graft integrated better within the tissue when compared with the control group. In addition, the grafts in the study group showed the presence of cells with characteristic morphology of adipocytes one week after transplantation. In contrast, control samples showed dimorphous shapes and features mainly composed of non-homogenous fragments. CONCLUSIONS These initial conclusions might be considered a first step in generating safe bio-compatible engineered grafts specifically usable in post-traumatic tissue regeneration procedures.
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Affiliation(s)
- T D Huynh
- Department of Histology, Embryology, and Genetics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
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Nguyen BT, Chapman NM, Stessman HAF, Tracy S, Drescher KM. Complete Sequence of the Closed Circular Extrachromosomal Element of Naegleria jadini Willaert and Ray (Strain ITMAP400). Microbiol Resour Announc 2023; 12:e0006123. [PMID: 36995246 PMCID: PMC10112140 DOI: 10.1128/mra.00061-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Amoebae of the Naegleria genus carry all ribosome-encoding DNA on closed circular extrachromosomal elements (CERE). We report the sequence of the CERE of Naegleria jadini (strain Willaert and Ray).
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Affiliation(s)
- Brian T Nguyen
- Department of Medical Microbiology and Immunology, Creighton University, Omaha, Nebraska, USA
| | - Nora M Chapman
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Holly A F Stessman
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, Nebraska, USA
| | - Steven Tracy
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kristen M Drescher
- Department of Medical Microbiology and Immunology, Creighton University, Omaha, Nebraska, USA
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Nguyen BT, Jacobsohn TL. Men's willingness to use novel male contraception is linked to gender-equitable attitudes: results from an exploratory online survey. Contraception 2023:110001. [PMID: 36924819 DOI: 10.1016/j.contraception.2023.110001] [Citation(s) in RCA: 2] [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] [Received: 09/09/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To explore the association of men's willingness to use a novel male contraceptive method with their attitudes toward gender equity. METHODS We conducted an anonymous online survey examining willingness to use male contraception among reproductive age (18-50 years) cisgender men from the United States and Canada, recruited via online forums, social media ads, and male contraceptive mailing lists from April through July of 2022. The survey collected socio-demographics and reproductive histories and used a 20-item Gender Equitable Men Scale (GEMS) to examine men's gender role attitudes. We conducted bivariate analyses to inform a multivariable logistic regression isolating the independent influence of increasingly gender-equitable attitudes on cis-men's willingness to use novel male contraceptives. RESULTS We received 2,066 surveys from primarily white (n=1,192; 58%), heterosexual (n=1,816; 88%), married cis-men, (n=1,008; 49%), below the age of 30 (n=1,010; 49%), and who had not completed a bachelor's degree (n=1,173; 57%). The majority reported having sex multiple times per week (n=946; 46%), but had never gotten someone pregnant, (n=907; 44%); nearly half (n=994; 48%) identified as parents. Approximately three-quarters of respondents reported being willing to use a novel male contraceptive method (n=1,545; 75%); willingness was independently linked to having had an abortion (adjOR: 2.04; 95%CI: 1.37-3.02) and increasing total GEMS scores (adjOR: 1.05; 95%CI: 1.02-1.08), even after controlling for age, race/ethnicity, and education level. CONCLUSIONS About three-quarters of cis-men surveyed reported willingness to use new male contraceptives, which was correlated with increasingly gender-equitable attitudes. IMPLICATIONS As gender-equitable attitudes are linked to men's willingness to use novel male contraceptive methods, older population surveys may underestimate male contraceptive demand. Additionally, given the association of abortion experience with willingness to use novel male contraceptives, abortion-providing family planning clinics may be considered for future dissemination of male contraceptive methods.
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Affiliation(s)
- Brian T Nguyen
- The Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA; Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Tamar L Jacobsohn
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
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Bayard KE, Fabricant SP, White JD, Gordon B, Nguyen BT. Infectious outcomes following immediate postplacental intrauterine device placement in the setting of chorioamnionitis: An exploratory, retrospective study. Contraception 2023; 119:109913. [PMID: 36473509 DOI: 10.1016/j.contraception.2022.11.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To evaluate infectious outcomes following postplacental intrauterine device (PPIUD) placement in patients with suspected chorioamnionitis. STUDY DESIGN This retrospective cohort study identified individuals desiring PPIUD who subsequently developed suspected chorioamnionitis, treated with antibiotics. We followed 12-month infectious outcomes amongst two cohorts: (1) those who received PPIUD and (2) those with placement deferred. RESULTS Of 55 followed, 18 of 22 PPIUDs were placed before chorioamnionitis was suspected; 33 placements were deferred. Neither group experienced acute infectious complications. Notably, IUDs were more often deferred when chorioamnionitis was more clearly diagnosed (20/33, 60.6% vs 4/22, 18.2% p < 0.01). Overdiagnosis of chorioamnionitis prevented IUD uptake in 10 of 55 (18.2%) individuals in this sample. CONCLUSIONS PPIUD placement in individuals with early signs of chorioamnionitis may not result in severe morbidity, in a study limited by sample size. Larger, prospective studies are needed in well-defined cohorts. IMPLICATIONS Incidental, immediate postplacental IUD placement in individuals with treated, suspected chorioamnionitis was not associated with severe morbidity within 1-year postpartum. Larger-scale, prospective studies are needed to guide the management of incidentally-placed, postplacental IUDs in the setting of mild chorioamnionitis.
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Affiliation(s)
- Katherine E Bayard
- Keck School of Medicine of the University of Southern California; Los Angeles, CA, United States
| | - Sonya P Fabricant
- Department of Obstetrics and Gynecology, Los Angeles County + University of Southern California Medical Center; Los Angeles, CA, United States
| | - Jessica D White
- Keck School of Medicine of the University of Southern California; Los Angeles, CA, United States
| | - Brian Gordon
- Department of Obstetrics and Gynecology, Los Angeles County + University of Southern California Medical Center; Los Angeles, CA, United States
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Los Angeles County + University of Southern California Medical Center; Los Angeles, CA, United States.
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Latack KR, Nguyen BT. Trends in copper versus hormonal intrauterine device breakage reporting within the United States' Food and Drug Administration Adverse Event Reporting System. Contraception 2023; 118:109909. [PMID: 36328095 DOI: 10.1016/j.contraception.2022.10.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To examine trends in national reporting of broken intrauterine devices (IUDs). STUDY DESIGN We enumerated IUD device "breakage" reports in the Food and Drug Administration Adverse Event Reporting System from inception (1998) until February 2022. We explored associations of breakage with IUD type (copper versus hormonal), year reported, reporter (consumer versus clinician), and patient characteristics (age and weight). RESULTS We identified 4144 breakage reports for copper versus 2140 for hormonal IUDs. Among the 170,215 adverse events reported, breaks were disproportionately reported for copper (9.6%) versus hormonal (1.7%) IUDs. CONCLUSION National pharmacovigilance data suggests disproportionate breakage in copper versus hormonal IUDs though the true prevalence of breaks cannot be calculated from this dataset.
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Affiliation(s)
- Kyle R Latack
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States.
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Section of Family Planning, University of Southern California, Los Angeles, CA, United States
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Lue Y, Swerdloff R, Pak Y, Nguyen BT, Yuen F, Liu PY, Blithe DL, Wang C. Male contraception development: monitoring effective spermatogenesis suppression utilizing a user-controlled sperm concentration test compared with standard semen analysis. Fertil Steril 2023; 119:208-217. [PMID: 36347310 PMCID: PMC9898087 DOI: 10.1016/j.fertnstert.2022.11.002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether a user-controlled sperm concentration test compared with standard semen analysis can effectively monitor spermatogenesis suppression for male contraception. DESIGN Single center, prospective sub study of the ongoing clinical trial: "Study of daily application of Nestorone and testosterone combination gel for male contraception." SETTING Research institute at an academic medical center. PARTICIPANT(S) Couples participating in the male contraceptive clinical trial. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) The ability by participants to monitor sperm suppression to a threshold compatible with contraceptive efficacy utilizing a user-controlled test verified by sperm concentration determined by standard laboratory methods. RESULT(S) Thirty-eight men participating in a hormonal male contraceptive clinical trial provided multiple samples during spermatogenesis suppression for this substudy. Participants, employing a user-controlled test, correctly identified the absence of sperm (a negative test) in 100% of their laboratory-confirmed azoospermic samples (n = 122). Participants also identified 100% of samples (n = 73) with sperm >0.2 million/mL as positive. Sperm counts between 0.01 and 0.2 million/mL were identified as negative in 96% of samples. Trial participants noted the overall ease of using the test with respect to sample preparation, test timing, and result interpretation, and that they could accurately use this test at home without difficulty. CONCLUSION(S) Participants undergoing spermatogenesis suppression in a hormonal male contraceptive trial performed user-controlled test to determine whether their semen sperm concentration was ≤ or >0.2 million/mL. Compared with standard semen analyses, participants correctly identified 100% of samples with sperm counts >0.2 million/mL as positive (Sensitivity 100%). A positive result when the couple is using a male contraceptive method triggers the need for semen analysis by a laboratory while the couple uses another method of contraception. Participants correctly diagnosed samples ≤0.2 million sperm/mL as negative in 99% of samples (specificity 99%). A negative result indicates a sperm concentration ≤0.2 million/mL, well below the threshold of ≤1 million/mL offering contraceptive efficacy demonstrated by prior studies. At-home sperm concentration test would minimize the need for users to return to the clinic to monitor suppression of spermatogenesis, decreasing cost and burden of male contraception trials and increasing practicality of the method. CLINICAL TRIAL REGISTRATION NUMBER NCT: 03452111.
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Affiliation(s)
- Yanhe Lue
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Ronald Swerdloff
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Youngju Pak
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California; Clinical and Translational Science Institute, The Lundquist Institute at Harbor-University of California, Los Angeles, Medical Center, West Carson, California
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Fiona Yuen
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California; Clinical and Translational Science Institute, The Lundquist Institute at Harbor-University of California, Los Angeles, Medical Center, West Carson, California.
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Sweeney HE, Bainvoll L, Mandelbaum RS, Sangara RN, Violette CJ, Klar M, Matsushima K, Paulson RJ, Cahoon SS, Nguyen BT, Bender NM, Ouzounian JG, Matsuo K. Uptake of postplacental intrauterine device placement at cesarean delivery. AJOG Glob Rep 2023; 3:100157. [PMID: 36748028 PMCID: PMC9898742 DOI: 10.1016/j.xagr.2022.100157] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Several studies have investigated the effectiveness of intrauterine device placement at cesarean delivery as a contraceptive method. However, national-level use and outcomes of a postplacental intrauterine device at cesarean delivery are currently understudied in the United States. OBJECTIVE This study aimed to examine the trends, characteristics, and outcomes of patients who received a postplacental intrauterine device at cesarean delivery. STUDY DESIGN This retrospective cohort study used the National Inpatient Sample. The study cohort included patients who underwent cesarean delivery from October 2015 to December 2018. The exclusion criteria included hemorrhage, chorioamnionitis, uterine anomaly, hysterectomy, and permanent surgical sterilization. Eligible cases were grouped on the basis of the use of a postplacental intrauterine device at cesarean delivery. The primary outcome measures were temporal trends and characteristics associated with the use of a postplacental intrauterine device at cesarean delivery, assessed using the generalized estimating equation model in multivariable analysis. The secondary outcome measure was perioperative morbidity (leukocytosis, endometritis, myometritis, and sepsis). Propensity score matching was used to balance the baseline characteristics. RESULTS Among 2,983,978 patients who met the inclusion criteria, 10,145 patients (0.3%) received a postplacental intrauterine device at cesarean delivery. The use of a postplacental intrauterine device increased from 0.1% in the fourth quarter of 2015 to 0.6% in the fourth quarter of 2018 (P<.001). In a multivariable analysis, the use of a postplacental intrauterine device increased by 14% every quarter-year (adjusted odds ratio, 1.14; 95% confidence interval, 1.13-1.15). In addition, (1) patient characteristics of young age, non-White race, obesity, tobacco use, lowest quartile median household income, and insured with Medicaid; (2) hospital characteristics of large bed capacity and urban teaching setting in Northeast region; and (3) pregnancy characteristics of early gestational age at cesarean delivery, hypertensive disease, previous cesarean delivery, multifetal pregnancy, grand multiparity, placenta previa, and nonelective cesarean delivery represented the independent characteristics associated with the use of a postplacental intrauterine device (all P<.05). A regression tree model identified 35 discrete patterns of the use of a postplacental intrauterine device based on 8 factors (time, race or ethnicity, primary expected payer, obesity, hospital bed capacity, hospital teaching status, hospital region, and previous cesarean delivery). There were 9 patterns, representing 8.8% of the study population, exhibiting a use rate of ≥1.0%, whereas there were 7 patterns, representing 16.0% of the study population, exhibiting no use of a postplacental intrauterine device (absolute rate difference from the highest group to the lowest group, 4.7%). In a propensity score-matched model, postplacental intrauterine device placement at cesarean delivery was not associated with increased risk of measured morbidity (any, 1.8% vs 1.7%; odds ratio, 1.06; 95% confidence interval, 0.66-1.69; P=.812), including postpartum endometritis (1.2% vs 1.0%; odds ratio, 1.19; 95% confidence interval, 0.67-2.14; P=.554). CONCLUSION The use of a postplacental intrauterine device at cesarean delivery increased significantly in recent years in the United States.
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Affiliation(s)
- Heather E. Sweeney
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo)
| | - Liat Bainvoll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo),Keck School of Medicine, University of Southern California, Los Angeles, CA (Ms Bainvoll)
| | - Rachel S. Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo),Division of Reproductive Endocrinology and Infertility, University of Southern California, Los Angeles, CA (Drs Mandelbaum and Paulson)
| | - Rauvynne N. Sangara
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo)
| | - Caroline J. Violette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo)
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany (Dr Klar)
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA (Dr Matsushima)
| | - Richard J. Paulson
- Division of Reproductive Endocrinology and Infertility, University of Southern California, Los Angeles, CA (Drs Mandelbaum and Paulson)
| | - Sigita S. Cahoon
- Division of Obstetrics, Gynecology, and Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Cahoon)
| | - Brian T. Nguyen
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Nguyen and Bender)
| | - Nicole M. Bender
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Nguyen and Bender)
| | - Joseph G. Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Ouzounian)
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo),Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (Dr Matsuo),Corresponding author: Koji Matsuo, MD, PhD.
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Latack KR, Nguyen BT. O18Trends in copper versus hormonal intrauterine device breakage reporting within the us food and drug administration adverse event reporting system. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.023] [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: 11/19/2022]
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Jacobsohn T, Nguyen BT. P071Men's willingness to use novel male contraception is linked to gender equitable attitudes. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.095] [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: 11/19/2022]
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Heyrana K, Nguyen BT, Santiano C, Chun E. P015Acculturative processes in the generation and evolution of family planning stigma: Lessons from the los angeles filipinx/a/o family planning study. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.040] [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: 11/19/2022]
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Nguyen BT, Jacobsohn TL. Post-abortion contraception, an opportunity for male partners and male contraception. Contraception 2022; 115:69-74. [PMID: 35870483 PMCID: PMC9561074 DOI: 10.1016/j.contraception.2022.07.004] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Men who accompany their female partners at the time of an abortion represent a unique population who may be amenable to receiving postabortion contraceptive services. We sought to examine their interest in receiving both counseling and contraception when available. STUDY DESIGN We analyzed a subset of survey data on the experience of accompanying male partners at the time of an abortion at two urban family planning clinics. We examined their beliefs about shared contraceptive responsibility, attitudes towards participating in contraceptive counseling, and willingness to use novel male contraceptives. We conducted bivariate analyses and logistic regressions for sociodemographic and reproductive factors linked to these outcomes. RESULTS Of 210 male partners surveyed at the time of an abortion, nearly three-quarters characterized preventing unwanted pregnancy as a shared responsibility, believed in the importance of attending contraceptive counseling with their female partner, and reported willingness to use novel male contraceptives. Contraceptive method used when discovering the pregnancy was neither linked to men's attitudes towards counseling nor interest in using novel male contraceptives. Individuals between the ages of 25 to 34 (aOR: 2.69; 95%CI: 1.32-5.48), those with a college education (aOR: 5.49; 95%CI: 1.31-22.94), and those who had never experienced abortion (aOR: 2.21; 95%CI: 1.08-4.55) exhibited greater interest in using novel male contraceptives. Black respondents (aOR: 2.33; 95%CI: 1.01-5.38) exhibited greater interest in receiving contraceptive counseling with their partner and a counselor following the abortion. CONCLUSION For male partners, abortion may be an opportunity to engage men in contraceptive counseling and when available, offer new male contraceptives. IMPLICATIONS As few men receive comprehensive contraceptive counseling, engaging men when they accompany their female partners to family planning clinics may be an additional strategy to prevent unwanted pregnancy.
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Affiliation(s)
- Brian T Nguyen
- Section of Family Planning, Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States.
| | - Tamar L Jacobsohn
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
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Jacobsohn T, Nguyen BT, Brown JE, Thirumalai A, Massone M, Page ST, Wang C, Kroopnick J, Blithe DL. Male contraception is coming: Who do men want to prescribe their birth control? Contraception 2022; 115:44-48. [PMID: 35550379 PMCID: PMC9560967 DOI: 10.1016/j.contraception.2022.04.014] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/15/2022] [Accepted: 04/29/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess men's preferences for healthcare provider from whom they would obtain hormonal male contraceptive (HMC) methods. STUDY DESIGN We asked participants from 3 clinical trials of investigational HMC methods-an oral pill (11β-Methyl-19-nortestosterone-17β-dodecylcarbonate, 11β-MNTDC), intramuscular or subcutaneous injection (Dimethandrolone undecanoate), and transdermal gel (Nestorone and testosterone)-to rank their top 3 preferred HMC providers from a list including: men's health doctor (urologist/andrologist), hormonal doctor (endocrinologist), reproductive health doctor (OB/GYN), family planning clinician (community health worker, midwife, nurse practitioner), regular doctor (family medicine/internal medicine), and community pharmacist. We examined preferences based on their rankings and conducted bivariate analyses. Collapsing the various specialists (men's health doctor, hormonal doctor, reproductive health doctor, and family planning clinician) into a single provider type, we examined participant demographics against provider preference (regular doctor, pharmacist, or specialist). RESULTS Participants across the 3 trials (n = 124) ranked their regular doctor (44%) and community pharmacist (18%) as their most preferred HMC provider; these preferences did not differ significantly by trial and drug formulation. Specialists in family planning (13%), men's health (12%), reproductive health (10%), and hormones (4%) were least frequently ranked as their preferred provider. Older and higher educated participants more often preferred specialists over regular doctors and pharmacists (p = 0.02 and p = 0.01). CONCLUSIONS Despite receiving contraceptive steroid hormones and care from endocrinologists and family planning specialists in a clinical trial, participants would prefer to obtain contraception from their regular doctor. IMPLICATIONS As most men expect to obtain hormonal male contraceptives from their regular doctor when commercially available, primary care physicians should become familiar with HMCs and be prepared to provide counseling and options accordingly.
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Affiliation(s)
- Tamar Jacobsohn
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States.
| | - Jill E Brown
- Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Michael Massone
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Stephanie T Page
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Christina Wang
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Jeffrey Kroopnick
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
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Anderson Z, Agarwal R, Mandelbaum RS, Toner JP, Nguyen BT. LACK OF ACCESS TO MIFEPRISTONE LEADS TO SUBOPTIMAL MANAGEMENT OF EARLY PREGNANCY LOSS: SURVEY OF PROVIDERS. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.156] [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: 11/04/2022]
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Nguyen BT, Streeter LH. RE: 'Gender bias in the medical education of obstetrician-gynaecologists in the United States: A systematic review'. Aust N Z J Obstet Gynaecol 2022; 62:E13-E14. [PMID: 36004423 DOI: 10.1111/ajo.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics & Gynaecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Laer H Streeter
- Department of Obstetrics and Gynecology at Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Patel J, Nguyen BT, Shih G, Or M, Harper DM. Vasectomy Training in Family Medicine Residency Programs: A National Survey of Residency Program Directors. Fam Med 2022; 54:438-443. [DOI: 10.22454/fammed.2022.649054] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background and Objectives: Vasectomy is considered a permanent contraceptive method with fewer associated harms than bilateral tubal ligation. However, the number of vasectomy-trained providers may not be meeting the demand for vasectomy in the United States. We describe the vasectomy training landscape in family medicine residencies and factors related to increased procedural training.
Methods: Program-specific data were collected from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2019. Program characteristics, vasectomy training (eg, time spent, procedural numbers), as well as direct and specific faculty support are described, with bivariate analyses for factors related to procedural competency, defined as more than five vasectomy procedures per resident.
Results: We received responses from 250 program directors (response rate=39.8%), with representation across all US regions, and program types. Nearly half (47.5%) offered less than 1 day of vasectomy didactics and/or procedural training; 38.9% of programs reported having a family medicine faculty champion for vasectomy. Only 16 programs (6.8%) reported that their average graduating residents performed more than five vasectomies. Programs with a faculty champion (OR 28.1, CI 3.6-216.4) or family medicine faculty as primary trainer (OR 17.6, CI 2.2-138.2) were more likely to graduate residents who had performed more than five vasectomies.
Conclusions: Fewer than 10% of surveyed family medicine residency programs offer adequate vasectomy procedural training. Family medicine faculty who serve as primary trainers and act as faculty champions can increase vasectomy training opportunities for residents, and thereby increase the supply of vasectomy providers in the United States.
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Affiliation(s)
- Jasmine Patel
- Division of Family Planning, Department of Obstetrics and Gynecology, University of California Irvine
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Brian T. Nguyen
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - Maya Or
- Department of Obstetrics and Gynecology, George Washington University Hospital, Washington, DC
| | - Diane M. Harper
- Department of Family Medicine and Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI
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Ho VS, Cenzer IS, Nguyen BT, Lee SJ. Cover. J Am Geriatr Soc 2022. [DOI: 10.1111/jgs.16591] [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: 10/18/2022]
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Nguyen BT, Streeter LH, Reddy RA, Douglas CR. Gender bias in the medical education of obstetrician-gynaecologists in the United States: A systematic review. Aust N Z J Obstet Gynaecol 2022; 62:349-357. [PMID: 35293613 PMCID: PMC9310565 DOI: 10.1111/ajo.13511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The number of men entering obstetrics and gynaecology (Ob/Gyn) residencies and general Ob/Gyn practice is decreasing. Gender biases against their participation may affect career decisions. Objective This systematic review examines: (i) female patients’ gender preferences and perceptions of men as Ob/Gyns and/or medical students; and (ii) the influence of gender on students’ education and career decisions. Search strategy We identified relevant research via PubMed using variations of three concepts in combination: Ob/Gyn care, gender bias/preference, and medical education or career. We conducted the initial review in 2018 and repeated the search in March 2021, adding additional references via citation review of included research. Selection criteria We restricted the review to original research from the United States between 2000–2021. Data collection Fifteen studies met inclusion criteria, categorised into three groups: (i) patient’s gender preference for Ob/Gyns; (ii) patient’s gender preference for medical students during the Ob/Gyn clerkship; and (iii) influence of gender bias on Ob/Gyn career decisions. Main results Patients prioritised their physician’s care attributes (eg technical skill, compassion, experience) over gender when choosing Ob/Gyns; however, provider gender was prioritised for medical students. Male medical students more commonly reported exclusion from clinical opportunities, although objective clinical exposure was like that of female counterparts. Despite perceived gender bias, male medical students reported increased Ob/Gyn interest post‐clerkship; interest did not translate into residency applications. These findings are limited by study quality and heterogeneity. Conclusions Real and perceived gender bias among female patients and male medical students in Ob/Gyn may underlie declining numbers of men entering the field.
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Affiliation(s)
- Brian T Nguyen
- University of Southern California, Los Angeles, California, USA
| | - Laer H Streeter
- Department of Obstetrics and Gynecology at Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ravali A Reddy
- Department of Obstetrics and Gynecology at the Stanford University School of Medicine, Stanford, California, USA
| | - Christopher R Douglas
- Los Angeles Medical Center, Department of Obstetrics and Gynecology at the University of California, Los Angeles, California, USA
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Nguyen BT, Darney B. Re: "Impact of Stress on Menstrual Cyclicity During the COVID-19 Pandemic: A Survey Study" by Ozimek et al. J Womens Health (Larchmt) 2022; 31:299-300. [PMID: 35147469 DOI: 10.1089/jwh.2021.0587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Brian T Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Blair Darney
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Health Systems and Policy, OHSU/PSU School of Public Health, Portland, Oregon, USA.,Profesora Investigadora Honoraria en Ciencias Medicas "F," Instituto Nacional de Salud Pública (INSP), Centro de Investigación en Salud Poblacional (CISP), Cuernavaca, México
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Ho VS, Cenzer IS, Nguyen BT, Lee SJ. Time to benefit for stroke reduction after blood pressure treatment in older adults: A meta-analysis. J Am Geriatr Soc 2022; 70:1558-1568. [PMID: 35137952 PMCID: PMC9106841 DOI: 10.1111/jgs.17684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/24/2021] [Accepted: 01/09/2022] [Indexed: 12/19/2022]
Abstract
Background Hypertension treatment in older adults can decrease mortality, cardiovascular events, including heart failure, cognitive impairment, and stroke risk, but may also lead to harms such as syncope and falls. Guidelines recommend targeting preventive interventions with immediate harms and delayed benefits to patients whose life expectancy exceeds the intervention's time to benefit (TTB). Our objective was to estimate a meta‐analyzed TTB for stroke prevention after initiation of more intensive hypertension treatment in adults aged ≥65 years. Methods Studies were identified from two Cochrane systematic reviews and a search of MEDLINE and Google Scholar for subsequent publications until August 31, 2021. We abstracted data from randomized controlled trials comparing standard (untreated, placebo, or less intensive treatment) to more intensive treatment groups in older adults (mean age ≥ 65 years). We fit Weibull survival curves and used a random‐effects model to estimate the pooled annual absolute risk reduction (ARR) between control and intervention groups. We applied Markov chain Monte Carlo methods to determine the time to ARR thresholds (0.002, 0.005, and 0.01) for a first stroke. Results Nine trials (n = 38,779) were identified. The mean age ranged from 66 to 84 years and study follow‐up times ranged from 2.0 to 5.8 years. We determined that 1.7 (95%CI: 1.0–2.9) years were required to prevent 1 stroke for 200 persons (ARR = 0.005) receiving more intensive hypertensive treatment. Heterogeneity was found across studies, with those focusing on tighter systolic blood pressure control (SBP < 150 mmHg) showing longer TTB. For example, in the SPRINT study (baseline SBP = 140 mmHg, achieved SBP = 121 mmHg), the TTB to avoid 1 stroke for 200 patients treated was 5.9 years (95%CI: 2.2–13.0). Conclusions More intensive hypertension treatment in 200 older adults prevents 1 stroke after 1.7 years. Given the heterogeneity across studies, the TTB estimates from individual studies may be more relevant for clinical decision‐making than our summary estimate. See related Editorial by Mark A. Supiano in this issue.
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Affiliation(s)
- Vanessa S Ho
- College of Medicine, California Northstate University, Elk Grove, California, USA.,Medical Student Training in Aging Research (MSTAR) Program, Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Irena S Cenzer
- Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Brian T Nguyen
- Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Northern California Institute for Research and Education, San Francisco, California, USA
| | - Sei J Lee
- Medical Student Training in Aging Research (MSTAR) Program, Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Li VM, Heyrana KJ, Nguyen BT. Discrepant abortion reporting by interview methodology among men from the United States National Survey of Family Growth (2015-2017). Contraception 2022; 112:111-115. [PMID: 35122730 DOI: 10.1016/j.contraception.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/07/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine discrepancies in men's abortion reporting when queried via face-to-face interview versus audio computer-assisted self-interviewing (ACASI) in the National Survey of Family Growth (NSFG). STUDY DESIGN The NSFG collects nationally representative data on family life, sexual behavior, and reproductive health in the United States. The questionnaire is administered to participants via face-to-face interview (FTF), with selected items also asked of the same participant via ACASI for direct comparison. As the 2015-2017 NSFG queried individuals' abortion history via both methods, we examined discrepant reporting among respondents. We additionally explored sociodemographic and reproductive characteristics associated with discrepant abortion reporting in a multivariable logistic regression model. RESULTS Of 4,540 male respondents ages 15-49, 45.3% reported a pregnancy. Via FTF, 12.3% reported an abortion, compared to 19.9% via ACASI (p<0.01). With respect to discrepancies in the number of reported abortions, 8.5% of respondents reported more abortions via ACASI versus FTF. Multivariable logistic regression modeling noted independently greater odds of abortion reporting in ACASI among non-Hispanic Black men (aOR 2.31, 95% CI 1.19-4.45), men living below the Federal Poverty Level (less than 100% FPL: aOR 3.65, 95% CI 1.93-6.89; 100-400% FPL: aOR 2.04, 95% CI 1.20-3.45), and those desiring more children in the future (aOR 1.91, 95% CI 1.20-3.04). CONCLUSION Men were more likely to disclose their abortions in ACASI compared to FTF interview. Disproportionate, discrepant abortion reporting among low-income, minority men who report desiring more children in the future warrants further research. IMPLICATIONS Surveys utilizing ACASI as an adjunct to FTF interviews may more accurately capture men's abortion experience.
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Affiliation(s)
- Victoria M Li
- Keck School of Medicine of the University of Southern California, Los Angeles CA
| | - Katrina J Heyrana
- Section of Family Planning, Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA
| | - Brian T Nguyen
- Section of Family Planning, Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA.
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Nguyen BT, Violette C. Condom Use at Coitarche Among Men in Non-Steady Relationships in the United States, 2006-2013. J Adolesc Health 2022; 70:127-132. [PMID: 34362645 DOI: 10.1016/j.jadohealth.2021.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE Using U.S. National Survey of Family Growth (NSFG) data from 2006 to 2013, we characterized men aged 15-44 years who reported not using a condom at their first vaginal intercourse (coitarche), while in a non-steady relationship with a female partner. METHODS Men who reported ever having intercourse were asked about male and female contraceptives used at coitarche. Analysis was restricted to respondents whose first sexual relationship was reported as non-steady, thereby comprising a population for whom condoms are recommended for preventing both pregnancy and sexually transmitted infections. Demographic and behavioral factors were examined against condom use, with significant associations included in multivariable logistic regression. We additionally describe young men's receipt of various components of sex education prior to coitarche. RESULTS Nearly half (43%) of men aged 15-44 in the U.S. reported not using a condom at coitarche during a non-steady relationship. Among these men, coitarche was reported on average at 16 years old; more than one third (37%) endorsed mixed feelings or not wanting to have sex at the time. Older men (adjusted odds ratio [adjOR] 1.07, 95% confidence interval [CI] 1.06-1.08), as with men from earlier National Survey of Family Growth cycles, were increasingly likely to have reported unprotected coitarche. Similarly, men reporting coitarche before the age of 15 (adjOR 2.39, 95% CI 1.99-2.87) or having a younger sex partner at coitarche (adjOR 1.73, 95% CI 1.11-2.69) were more likely to have not used condoms. About three quarters of men received at least some form of sex education prior to coitarche. CONCLUSIONS Condomless coitarche is commonly reported among men in non-steady adolescent relationships and with mixed feelings about having sex. Condomless coitarche among these men is independently associated with initiating sex before the age of 15 and having sex with a younger female partner. These findings may guide how to structure young men's sexual education programing.
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Affiliation(s)
- Brian T Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California.
| | - Caroline Violette
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Whittum M, Schickler R, Fanarjian N, Rapkin R, Nguyen BT. The History of Female Surgical Sterilization. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2021.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michelle Whittum
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Robyn Schickler
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Planned Parenthood of Southwest and Central Florida, Sarasota, Florida, USA
| | - Nicole Fanarjian
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Rachel Rapkin
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Brian T. Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
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Schickler R, Whittum M, Fanarjian N, Rapkin R, Nguyen BT. The History of Female Surgical Sterilization: A Social and Ethics Perspective. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2021.0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robyn Schickler
- Planned Parenthood of Southwest and Central Florida, Sarasota, Florida, USA
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Michelle Whittum
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Nicole Fanarjian
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Rachel Rapkin
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Brian T. Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
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Nguyen BT, Yuen F, Farrant M, Thirumalai A, Fernando F, Amory JK, Swerdloff RS, Anawalt BD, Blithe DL, Long JE, Liu PY, Page ST, Wang C. Acceptability of the oral hormonal male contraceptive prototype, 11β-methyl-19-nortestosterone dodecylcarbonate (11β-MNTDC), in a 28-day placebo-controlled trial. Contraception 2021; 104:531-537. [PMID: 34153318 PMCID: PMC8995005 DOI: 10.1016/j.contraception.2021.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 03/10/2021] [Revised: 05/24/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine men's satisfaction with and the potential acceptability of 11β-methyl-19-nortestosterone dodecylcarbonate (11β-MNTDC) when used for 28 days as an experimental, once-daily, oral hormonal male contraceptive (HMC). STUDY DESIGN We surveyed participants from a double-blind, randomized, placebo-controlled, phase 1 clinical trial, examining their experience with and willingness to use daily oral 11β-MNTDC for male contraception. RESULTS Of 42 trial participants, 40 (30 11β-MNTDC, 10 placebo) completed baseline and end-of-treatment surveys. Based on a 28-day experience, few cited any baseline concerns about safety and drug adherence. Following treatment, nearly three-quarters (72.5%) of participants reported satisfaction with the study drug and nearly all (92.5%) would recommend the method to others. More than half of participants would be willing to pay for the study drug (62.5%) and indicated that the method exceeded initial expectations (53.9%). Nearly 90% reported that taking the pill was easy to remember and did not interfere with their daily routines. Approximately one-third of participants reported bothersome side effects (37% 11β-MNTDC vs. 20% placebo, p = 0.45). Given the option, 42% of participants would prefer a daily HMC pill over injectable regimens or a daily topical gel. CONCLUSION A majority of participants in this short-term trial of daily oral 11β-MNTDC reported satisfaction with the regimen, would recommend it to others, and would pay to use the drug as HMC despite some bothersome side effects. IMPLICATIONS Oral 11β-MNTDC would be an acceptable and preferable method among men desiring reversible hormonal male contraception (HMC). These data support further trials of novel oral HMCs such as 11β-MNTDC.
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Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States.
| | - Fiona Yuen
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
| | - Maritza Farrant
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Frances Fernando
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - John K Amory
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
| | - Bradley D Anawalt
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Diana L Blithe
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Jill E Long
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
| | - Stephanie T Page
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
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Nguyen BT, Pang RD, Nelson AL, Pearson JT, Benhar Noccioli E, Reissner HR, Kraker von Schwarzenfeld A, Acuna J. Detecting variations in ovulation and menstruation during the COVID-19 pandemic, using real-world mobile app data. PLoS One 2021; 16:e0258314. [PMID: 34669726 PMCID: PMC8528316 DOI: 10.1371/journal.pone.0258314] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As war and famine are population level stressors that have been historically linked to menstrual cycle abnormalities, we hypothesized that the COVID-19 pandemic could similarly affect ovulation and menstruation among women. METHODOLOGY We conducted a retrospective cohort study examining changes in ovulation and menstruation among women using the Natural Cycles mobile tracking app. We compared de-identified cycle data from March-September 2019 (pre-pandemic) versus March-September 2020 (during pandemic) to determine differences in the proportion of users experiencing anovulation, abnormal cycle length, and prolonged menses, as well as population level changes in these parameters, while controlling for user-reported stress during the pandemic. FINDINGS We analyzed data from 214,426 cycles from 18,076 app users, primarily from Great Britain (29.3%) and the United States (22.6%). The average user was 33 years of age; most held at least a university degree (79.9%). Nearly half (45.4%) reported more pandemic-related stress. Changes in average cycle and menstruation lengths were not clinically significant, remaining at 29 and 4 days, respectively. Approximately 7.7% and 19.5% of users recorded more anovulatory cycles and abnormal cycle lengths during the pandemic, respectively. Contrary to expectation, 9.6% and 19.6% recorded fewer anovulatory cycles and abnormal cycle lengths, respectively. Women self-reporting more (32.0%) and markedly more (13.6%) stress during the pandemic were not more likely to experience cycle abnormalities. CONCLUSIONS The COVD-19 pandemic did not induce population-level changes to ovulation and menstruation among women using a mobile app to track menstrual cycles and predict ovulation. While some women experienced abnormalities during the pandemic, this proportion was smaller than that observed prior to the pandemic. As most app users in this study were well-educated women over the age of 30 years, and from high-income countries, their experience of the COVID-19 pandemic might differ in ways that limit the generalizability of these findings.
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Affiliation(s)
- Brian T. Nguyen
- Department of Obstetrics and Gynecology, Section of Family Planning, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
- * E-mail:
| | - Raina D. Pang
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Anita L. Nelson
- Department of Obstetrics and Gynecology, Western University of Health Sciences, Pomona, CA, United States of America
| | | | | | - Hana R. Reissner
- Department of Obstetrics and Gynecology, Section of Family Planning, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | | | - Juan Acuna
- Department of Epidemiology and Public Health, Khalifa University, Abu Dhabi, United Arab Emirates
- Research and Data Intelligence Support Center, Khalifa University, Abu Dhabi, United Arab Emirates
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Affiliation(s)
- Brian T. Nguyen
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Katharine M. Ciesielski
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Robyn Schickler
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
- Department of Family Planning, Planned Parenthood of Southwest and Central Florida, Tampa, Florida, USA
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Wright SR, Reid J, Cortessis V, Natavio M, Nguyen BT, Bender N. ORAL ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.010] [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: 10/20/2022]
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Reissner HR, McGough A, Ponzio M, Cawley A, Nguyen BT. POSTER ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.034] [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: 11/28/2022]
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Nguyen BT, Brown AL, Jones F, Jones L, Withers M, Ciesielski KM, Franks JM, Wang C. "I'm not going to be a guinea pig:" Medical mistrust as a barrier to male contraception for Black American men in Los Angeles, CA. Contraception 2021; 104:361-366. [PMID: 34118271 DOI: 10.1016/j.contraception.2021.06.001] [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: 07/10/2020] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Racial disparities in unintended pregnancy and contraceptive use in the United States are not mediated by access to family planning services alone. Rather, a history of medical mistrust underlies Black Americans' adoption of new medical technologies, inclusive of contraception. Efforts to develop hormonal male contraceptives need to incorporate Black Americans' experiences and perspectives so that new contraceptives enable their reproductive goals and promote gender equity. STUDY DESIGN Working with our community-based partner, Healthy African American Families in Los Angeles, California, we conducted six 60-minute focus group discussions with 39 Black men over age 18, in ongoing heterosexual relationships, to explore attitudes towards and willingness to use hormonal male contraceptives. RESULTS Just over one-third (35%) of respondents reported willingness to use or rely on hormonal male contraceptives. The majority held negative attitudes about hormonal male contraceptives, citing concerns about side effects and safety. Several respondents expressed mistrust of the medical community and medical research, noting that hormonal male contraceptives could be used against Black communities; several expressed unwillingness to trial hormonal male contraceptives without years of testing. However, all groups described scenarios where they would use them despite stated concerns. CONCLUSIONS Black men's hypothetical willingness to use hormonal male contraceptives is limited by medical mistrust, which may be overcome by their concerns about the unreliability of current options or the contraceptive behaviors of female partners. Nevertheless, addressing Black Americans' history of medical mistreatment and exploitation will be essential for hormonal male contraceptives to positively contribute to Black men's reproductive options and agency. IMPLICATIONS While the development of reversible, hormonal male contraception intends to fulfill unmet global needs for contraception, the utility of these hormonal male contraceptive methods among Black men living on low incomes in Los Angeles, California cannot be fully realized until developers address and overcome historical and ongoing medical mistrust.
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Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA.
| | | | - Felica Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Loretta Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Mellissa Withers
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles CA
| | - Katharine M Ciesielski
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA
| | - Jennifer M Franks
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA; Department of Obstetrics & Gynecology, Kern Medical Center, Bakersfield, CA
| | - Christina Wang
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
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Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Nicole Mitchell-Chadwick
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Katrina J Heyrana
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles
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Nguyen BT, Long M, Petrosyan N, Grundy D, Mahoney B, Heyrana KJ. Access to male sexual and reproductive health services in publicly funded California clinics in 2018. Contraception 2021; 104:165-169. [PMID: 33857484 DOI: 10.1016/j.contraception.2021.04.004] [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: 10/30/2020] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To characterize the sexual and reproductive health (SRH) services available to men from publicly funded family planning clinics in California. STUDY DESIGN We conducted a cross-sectional telephone survey in 2018 to compare the accessibility of SRH services for male clients at Planned Parenthood clinics in California to those visiting a random sample of 200 other publicly funded family planning clinics, selected from a California Department of Health Care Services list of 773 that had served at least 15 male clients in the prior year. A representative at each clinic answered questions about provision of 20 clinical services. We examined differences in individual service provision by clinic affiliation using χ2 tests. RESULTS Only one-third (773/2348) of publicly funded clinics in California served more than 15 male clients each year, with rural clinics less likely than urban counties to do so. We were able to contact 62 of 107 Planned parenthood clinics and 81 of the 200 other publicly-funded family planning clinics that we attempted to reach. Most (95%) offered HIV and STI screening; 65% offered vasectomy consultation, but only 5% provided vasectomy services. Planned Parenthood clinics were more likely than other publicly funded clinics to provide condom demonstrations, emergency contraception, STI testing, HPV vaccination, penile/testicular exams, and infertility testing (p < 0.05 for all comparisons). CONCLUSIONS Male family planning services are less frequently offered by rural clinics and by publicly funded clinics in California that are not affiliated with Planned Parenthood. IMPLICATIONS Men's underutilization of family planning may be partially explained by a lack of access to clinical services.
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Affiliation(s)
- Brian T Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.
| | - Minica Long
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Nina Petrosyan
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Dayna Grundy
- David Geffen School of Medicine of UCLA, Los Angeles, CA, United States
| | | | - Katrina J Heyrana
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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Latack KR, Patel J, Moog D, Spencer D, Nguyen BT. Withdrawal method inquiries and user experiences: An analysis of content posted on 4 gendered forums on Reddit. Contraception 2021; 104:170-175. [PMID: 33852898 DOI: 10.1016/j.contraception.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/02/2020] [Revised: 04/03/2021] [Accepted: 04/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Limited research and guidance on the use of "withdrawal" or coitus interruptus for contraception lead to inconsistent or even inaccurate physician recommendations regarding its use. Consequently, patients rely on online communities to learn about this commonly used contraceptive method. To identify knowledge gaps and concerns between men and women, as well as explore how they use withdrawal, we examined withdrawal-related posts on the popular internet discussion forum, Reddit. STUDY DESIGN To explore gendered variations in withdrawal-related Reddit posts, we extracted posts from the gendered forums: "TwoXChromosomes," "Askwomen," "Askmen," and "OneY" between 2010 and 2019 that contained the search terms: "coitus interruptus," "withdrawal," "pull out," "preejaculate," or "precum." We developed an initial codebook with expected codes and augmented it with emerging findings from a random sampling of 10% of posts. We revised iteratively for interrater agreement, after which researchers coded the remaining posts independently. RESULTS Of 269 withdrawal-related queries, 19% were submitted by men; 81% referenced the contributor's own withdrawal use. Salient domains included: concerns about pregnancy risk (59%), how to effectively use withdrawal (13%), benefits/pleasure from using withdrawal (12%), impact on personal life/relationship (9%), and problems encountered, inclusive of consent (7%). Posts to female-focused forums more frequently inquired about pregnancy risk, while those on male forums more frequently inquired about withdrawal-related logistics (p < 0.001); domains were not associated with contributor gender. CONCLUSION Withdrawal-related queries within this Reddit sample are frequently posted by women, the majority of whom want to understand their risk of pregnancy with withdrawal. Research operationalizing withdrawal and more accurately estimating withdrawal-related pregnancy risk is warranted. IMPLICATIONS Reddit users discuss their personal experiences with withdrawal as contraception, as well as seek advice regarding its use from the online community. Pregnancy risk, logistics of use, and ongoing stigma are salient topics. Further research on pregnancy risk, operationalizing success, and approaches for discussing this behavioral method is warranted.
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Affiliation(s)
- Kyle R Latack
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Jasmine Patel
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Division of Family Planning, Department of Obstetrics and Gynecology, University of California Irvine School of Medicine, Irvine, CA, United States
| | - Dominic Moog
- University of Southern California, Los Angeles, CA, United States
| | - Donovan Spencer
- University of Southern California, Los Angeles, CA, United States
| | - Brian T Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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Latack KR, Yuen F, Wang C, Nguyen BT. Online community queries on hormonal male contraception: An analysis of the Reddit "Ask Me Anything" experience. Contraception 2021; 104:159-164. [PMID: 33617839 DOI: 10.1016/j.contraception.2021.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Reddit is one of the most popular websites in the United States because of its user-driven aggregation and community-based curation of online content. We describe the use and impact of Reddit's Ask Me Anything platform, for public engagement and education about developments in hormonal male contraception (HMC). METHODS We analyzed the content from and user engagement with 2 Reddit Ask Me Anything events that answered user queries about HMC in June 2018 and March 2019. Clinical trial investigators provided real-time responses throughout the events. We examined the 25 most popular posts from each event, analyzing content for salient themes via an inductive approach. To quantify event impact, we examined Google Trends data and subsequent traffic to the investigator website. RESULTS Over 18,000 registered Reddit users interacted with each of the 2 Ask Me Anything events, with each generating over 1600 comments. The most popular posts of each Ask Me Anything event expressed interest in off-target effects associated with the use of HMCs. Additional themes included queries about previous and ongoing clinical trials, HMC physiology, and market analyses and projections of public willingness to use HMCs. The events coincided with a spike in both Google searches for "male birth control" and first-time visits to the study's website where users could express interest in participating in clinical trials. CONCLUSION Reddit Ask Me Anything events conducted by HMC investigators revealed wide public interest in HMCs. The events prompted further searches for more information on male contraception, while driving traffic to the investigator website for trial recruitment purposes. IMPLICATIONS Reddit Ask Me Anything events are a popular, cost-free online platform for publicly responding to a range of HMC-related queries, while providing investigators with insight into stakeholder priorities and preoccupations.
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Affiliation(s)
- Kyle R Latack
- University of Southern California, Department of Obstetrics and Gynecology, Section of Family Planning, Los Angeles, CA, United States
| | - Fiona Yuen
- Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Christina Wang
- Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Brian T Nguyen
- University of Southern California, Department of Obstetrics and Gynecology, Section of Family Planning, Los Angeles, CA, United States.
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Yourman LC, Cenzer IS, Boscardin WJ, Nguyen BT, Smith AK, Schonberg MA, Schoenborn NL, Widera EW, Orkaby A, Rodriguez A, Lee SJ. Evaluation of Time to Benefit of Statins for the Primary Prevention of Cardiovascular Events in Adults Aged 50 to 75 Years: A Meta-analysis. JAMA Intern Med 2021; 181:179-185. [PMID: 33196766 PMCID: PMC7670393 DOI: 10.1001/jamainternmed.2020.6084] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/06/2020] [Indexed: 12/22/2022]
Abstract
Importance Guidelines recommend targeting preventive interventions toward older adults whose life expectancy is greater than the intervention's time to benefit (TTB). The TTB for statin therapy is unknown. Objective To conduct a survival meta-analysis of randomized clinical trials of statins to determine the TTB for prevention of a first major adverse cardiovascular event (MACE) in adults aged 50 to 75 years. Data Sources Studies were identified from previously published systematic reviews (Cochrane Database of Systematic Reviews and US Preventive Services Task Force) and a search of MEDLINE and Google Scholar for subsequently published studies until February 1, 2020. Study Selection Randomized clinical trials of statins for primary prevention focusing on older adults (mean age >55 years). Data Extraction and Synthesis Two authors independently abstracted survival data for the control and intervention groups. Weibull survival curves were fit, and a random-effects model was used to estimate pooled absolute risk reductions (ARRs) between control and intervention groups each year. Markov chain Monte Carlo methods were applied to determine time to ARR thresholds. Main Outcomes and Measures The primary outcome was time to ARR thresholds (0.002, 0.005, and 0.010) for a first MACE, as defined by each trial. There were broad similarities in the definition of MACE across trials, with all trials including myocardial infarction and cardiovascular mortality. Results Eight trials randomizing 65 383 adults (66.3% men) were identified. The mean age ranged from 55 to 69 years old and the mean length of follow-up ranged from 2 to 6 years. Only 1 of 8 studies showed that statins decreased all-cause mortality. The meta-analysis results suggested that 2.5 (95% CI, 1.7-3.4) years were needed to avoid 1 MACE for 100 patients treated with a statin. To prevent 1 MACE for 200 patients treated (ARR = 0.005), the TTB was 1.3 (95% CI, 1.0-1.7) years, whereas the TTB to avoid 1 MACE for 500 patients treated (ARR = 0.002) was 0.8 (95% CI, 0.5-1.0) years. Conclusions and Relevance These findings suggest that treating 100 adults (aged 50-75 years) without known cardiovascular disease with a statin for 2.5 years prevented 1 MACE in 1 adult. Statins may help to prevent a first MACE in adults aged 50 to 75 years old if they have a life expectancy of at least 2.5 years. There is no evidence of a mortality benefit.
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Affiliation(s)
- Lindsey C. Yourman
- Division of Geriatrics and Gerontology, School of Medicine, University of California, San Diego
| | - Irena S. Cenzer
- Geriatrics, Palliative and Extended Care Service Line, San Francisco VA (Veterans Affairs) Health Care System, San Francisco, California
| | - W. John Boscardin
- Geriatrics, Palliative and Extended Care Service Line, San Francisco VA (Veterans Affairs) Health Care System, San Francisco, California
- Division of Geriatrics, School of Medicine, University of California, San Francisco
| | - Brian T. Nguyen
- Geriatrics, Palliative and Extended Care Service Line, San Francisco VA (Veterans Affairs) Health Care System, San Francisco, California
- Division of Geriatrics, School of Medicine, University of California, San Francisco
- Northern California Institute for Research and Education, San Francisco
| | - Alexander K. Smith
- Geriatrics, Palliative and Extended Care Service Line, San Francisco VA (Veterans Affairs) Health Care System, San Francisco, California
- Division of Geriatrics, School of Medicine, University of California, San Francisco
| | - Mara A. Schonberg
- Department of Medicine, Harvard Medical School, Cambridge, Massachusetts
- Department of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nancy L. Schoenborn
- Division of Geriatric Medicine and Gerontology, School of Medicine, John Hopkins University, Baltimore, Maryland
| | - Eric W. Widera
- Geriatrics, Palliative and Extended Care Service Line, San Francisco VA (Veterans Affairs) Health Care System, San Francisco, California
- Division of Geriatrics, School of Medicine, University of California, San Francisco
| | - Ariela Orkaby
- Division of Geriatric Medicine and Gerontology, School of Medicine, John Hopkins University, Baltimore, Maryland
- New England GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, Boston, Massachusetts
- Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Annette Rodriguez
- Geriatrics, Palliative and Extended Care Service Line, San Francisco VA (Veterans Affairs) Health Care System, San Francisco, California
- Division of Geriatrics, School of Medicine, University of California, San Francisco
- Northern California Institute for Research and Education, San Francisco
| | - Sei J. Lee
- Geriatrics, Palliative and Extended Care Service Line, San Francisco VA (Veterans Affairs) Health Care System, San Francisco, California
- Division of Geriatrics, School of Medicine, University of California, San Francisco
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Yuen F, Nguyen BT, Swerdloff RS, Wang C. Continuing the search for a hormonal male contraceptive. Best Pract Res Clin Obstet Gynaecol 2020; 66:83-94. [PMID: 32197832 PMCID: PMC7375909 DOI: 10.1016/j.bpobgyn.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 12/31/2019] [Revised: 01/28/2020] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
Abstract
This chapter discusses the mechanisms of action of hormonal male contraception, which suppresses the hypothalamic-pituitary-testis axis. When the intratesticular concentration of testosterone is subsequently suppressed to adequately low concentrations, spermatogenesis is arrested. Androgens are a necessary hormonal male contraceptive component because they not only suppress the hypothalamic-pituitary-testis axis, but also provide the male hormone necessary to maintain peripheral androgen functions. Past studies using testosterone alone and testosterone combined with progestins demonstrated contraceptive efficacy in the female partner at rates similar to combined hormonal female methods. Newer hormonal male contraceptive formulations and the alternative routes of administration are discussed, along with potential barriers, challenges, and opportunities for hormonal male contraceptive development. Novel methods that are safe, effective, reversible, user-friendly, and coitus-independent are intrinsic to equitably meet the various needs and limitations of an increasingly diverse population.
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Affiliation(s)
- Fiona Yuen
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA.
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90007, USA.
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA.
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Nguyen BT, Yuen F, Farrant MT, Thirumalai A, Pham C, Amory JK, Swerdloff RS, Anawalt BD, Blithe DL, Long JE, Liu PY, Page ST, Wang CCL. SAT-LB7 Acceptability of Oral 11β-Methyl-19-Nortestosterone Dodecylcarbonate (11β-MNTDC) as a Potential Hormonal Male Contraceptive Pill: Results From a Randomized, Placebo-Controlled Trial. J Endocr Soc 2020. [PMCID: PMC7208864 DOI: 10.1210/jendso/bvaa046.2161] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Injectable hormonal male contraceptives (HMC) injectables appear safe and are effective in clinical trials, but global surveys suggest men would prefer an oral pill. 11β-methyl-19-nortestosterone dodecylcarbonate (11β-MNTDC) is orally bioavailable and well-tolerated. When taken daily with food for 28 days, the drug decreases serum gonadotropins and testosterone without significant impact on mood. If ongoing studies demonstrate that daily 11β-MNTDC consistently suppresses spermatogenesis to <1 million/mL in healthy men, oral 11β-MNTDC could be an effective HMC pill. Surveys of participant satisfaction and method acceptability for promising HMC pill prototypes, like oral 11β-MNTDC, are needed. Objective: To determine satisfaction with and acceptability of a daily oral 11β-MNTDC HMC pill Study Design: In a double-blind, randomized, placebo-controlled trial of a 28-day regimen of daily oral 11β-MNTDC at two academic medical centers, healthy male volunteers completed baseline and end-of-treatment surveys assessing their experience, satisfaction with, and willingness to use daily oral 11β-MNTDC. Results: Of 42 participants, 40 (30 11β-MNTDC, 10 placebo) completed end-of-treatment surveys. Respondents were primarily college-educated, sexually active white men between 21-40 years old. Less than 20% of participants cited initial concerns about safety and missing doses. Following treatment, nearly 90% of participants affirmed that taking the pill was easy to remember and did not interfere with their daily routine. Although one-third (37% 11β-MNTDC vs. 20% placebo, p=0.45) reported bothersome side effects, and 28% (30% 11β-MNTDC vs. 20% placebo, p=0.66) reported potential concerns about safety, these rates were neither statistically different in those taking active drug versus placebo nor associated with method satisfaction. The majority of participants reported satisfaction with the method (73% 11β-MNTDC vs. 70% placebo, p=0.84), that they would recommend it to others (90% 11β-MNTDC vs. 100% placebo, p=0.56), and that they would use the drug regimen as their primary contraceptive even if having to pay (67% 11β-MNTDC vs. 50% placebo, p=0.35). Half of participants (50% 11β-MNTDC vs. 67% placebo, p=0.51) affirmed that the method exceeded initial expectations. Respondents who reported being more likely to miss a dose were also more likely to report dissatisfaction with the study drug (p=0.03). Conclusion: The majority of participants in a 28-day trial of daily, oral 11β-MNTDC pills were satisfied with the regimen, would recommend the drug to others, and would pay to use the drug even when adverse or off-target effects (e.g. changes in libido and/or mood) were considered. If 11β-MNTDC is demonstrated to suppress spermatogenesis uniformly to very low levels, it would be acceptable to men desiring reversible contraception.
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Affiliation(s)
| | - Fiona Yuen
- The Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | | | | | - Cindy Pham
- The Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | | | | | | | | | - Jill E Long
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Peter Y Liu
- Los Angeles Biomedical Research Institute, Torrance, CA, USA
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Nguyen BT, Nelson AL. Time for the US food and drug administration approval of condoms for anal intercourse. EClinicalMedicine 2019; 17:100226. [PMID: 31891150 PMCID: PMC6933260 DOI: 10.1016/j.eclinm.2019.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/27/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Brian T. Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California
| | - Anita L. Nelson
- Department of Obstetrics and Gynecology, Western University of Health Sciences, 1457 3rd ST, Manhattan Beach, CA 90266-6335, United States
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Nguyen BT, Chang EJ, Bendikson KA. Advanced paternal age and the risk of spontaneous abortion: an analysis of the combined 2011-2013 and 2013-2015 National Survey of Family Growth. Am J Obstet Gynecol 2019; 221:476.e1-476.e7. [PMID: 31128112 DOI: 10.1016/j.ajog.2019.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/08/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Maternal and paternal age at first birth are increasing across the global population. Spontaneous abortion, one of the most common abnormal pregnancy outcomes, is known to occur more frequently with increasing maternal age. However, the relationship of advanced paternal age and spontaneous abortion is poorly understood, and previous results have yielded conflicting results. OBJECTIVE To examine the influence of paternal age on the risk of spontaneous abortion among singleton pregnancies conceived without assisted reproductive technologies. MATERIALS AND METHODS This was a retrospective, case-control study using combined pregnancy data from the Centers for Disease Control and Prevention's 2011-2013 and 2013-2015 National Survey of Family Growth. Spontaneous, singleton pregnancy data from women aged 15-45 years were analyzed. Ongoing pregnancies, induced abortions, ectopic pregnancies, preterm births, and intrauterine fetal deaths were excluded. Bivariate associations of pregnancy outcome (spontaneous abortion at <20 weeks and ≤12 weeks vs. live birth at ≥37 weeks) and paternal age were determined, along with those of maternal age and selected demographic and pregnancy characteristics. Significant associations were included in a multivariable logistic regression, which accounted for multiple pregnancies derived from the same respondent. RESULTS A total of 12,710 pregnancies from 6979 women were analyzed, consisting of 2300 (18.2%) spontaneous abortions and 10,410 (81.8%) term live births. Median maternal and paternal ages were 25 and 28 years, respectively. After adjusting for maternal age, race/ethnicity, socioeconomic status, marital status, and pregnancy intention, pregnancies resulting in spontaneous abortions had 2.05 (95% confidence interval, 1.06-2.20) times the odds of being from a father aged 50 years or older, vs. 25-29 years of age. These relationships remained significant when defining SABs at ≤12 weeks (adjusted odds ratio, 2.30; 95% confidence interval, 1.17-4.52). CONCLUSION Paternal age may increase the odds of spontaneous abortion, independent of selected factors, including demographics, pregnancy intention, and maternal age. This association was robust across several gestational age-based definitions of spontaneous abortion, even after adjustment.
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Nguyen BT, Violette C, Li HZ, Jensen JT. Expectations for Sex without Birth Control among Young Men: Risk Factors from the USA National Survey of Reproductive and Contraceptive Knowledge. World J Mens Health 2019; 38:573-581. [PMID: 31749339 PMCID: PMC7502322 DOI: 10.5534/wjmh.190098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 11/15/2022] Open
Abstract
Purpose Male partner engagement in family planning can influence women's contraceptive behaviors and risk of unintended pregnancy. We identified factors associated with self-reported expectations for future contraceptive use among a nationally-representative sample of young men. Materials and Methods The National Survey of Reproductive and Contraceptive Knowledge asked unmarried, sexually active men (ages, 18–29 y), who were neither involved in nor trying for a pregnancy, about their likelihood of having sex without contraception in the following three months. Demographics, social factors, and contraceptive awareness and attitudes were examined for potential associations using weighted analyses. Results Of 903 men surveyed, nearly 600 were sexually active and expected to have sex in the following 3 months; nearly half (43%) reported at least some likelihood (23% slightly, 7% very, 13% extreme likely) that they would have sex without any contraception. Factors independently associated with sex without contraception included: not completing high school, not being in school full-time, not receiving sex education, limited awareness of contraceptive methods, multiple sexual partners, and friends with unintended pregnancies. Conclusions Despite not wanting a pregnancy, many young men report they will have sex without contraception. While comprehensive sex education may increase contraceptive use, interpersonal and social factors also influence men's expected use of contraception.
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Affiliation(s)
- Brian T Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, OR, USA.
| | | | - Hong Z Li
- Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, OR, USA
| | - Jeffrey T Jensen
- Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, OR, USA
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