HIV prevention heuristics and condom use among African-Americans at risk for HIV

The goal of this study was to improve understanding of whether incorrect HIV/AIDS heuristics and characteristics-based risk theories are barriers to HIV prevention among young African-Americans at increased risk for HIV. We explored: (1) the beliefs of men and women regarding disease prevention strategies, and (2) the relationship of such beliefs to safer sexual behaviours. In Phase I, semistructured individual interviews were conducted with both members of 22 heterosexual couples at increased risk for HIV/STIs. Subsequently, in Phase II, structured individual interviews were conducted with another 40 women and 40 men (not couples). Participants in Phase I reported use of condoms and monogamy as major strategies for disease prevention. The beliefs that were endorsed by the largest percentage of Phase II participants were related to the 'known partners are safe partners' and 'trusted partners are safe partners' heuristics. Moreover, stronger endorsement of the 'known partners' heuristic was negatively associated with measures of condom use and pregnancy prevention behaviour. Our findings highlight the need for interventions and programmes to encourage intimate partners to consistently use condoms until both members of the dyad are tested and agree to mutual monogamy.

Choice of and satisfaction with methods of medical and surgical abortion among U.S. clinic patients

CONTEXT

Abortion induced by drugs is now a viable alternative to surgically induced abortion for U. S. women. Women's willingness to use these new methods of medical abortion hinges on the extent to which they prove acceptable, however.

METHODS

Among 304 women participating in a clinical trial of medical abortion, 186 received a methotrexate-induced abortion and 118 were offered the option of a medical abortion but chose a surgical procedure instead. Study participants completed self-administered questionnaires before the abortion and again at a follow-up visit.

RESULTS

Women in the medical and surgical abortion groups did not differ significantly with regard to demographic and other background characteristics: Their mean age was about 27, more than two-thirds were white, and three-quarters were unmarried and worked either part-time or full-time. However, women's ratings of seven attributes of abortion methods were significant predictors of choosing a medical abortion: Women were more likely to choose medical abortion if they placed greater importance on a method that was nonsurgical, one that resembled a miscarriage or one that could take place at home (odds ratios, 2.0-3.3). Conversely, women were less likely to choose medical abortion if they valued methods that were quick, that did not involve painful cramping or seeing blood or blood clots and that needed a doctor or nurse to be present (odds ratios, 0.3-0.5). Compared with those who had a surgical abortion, women who had a methotrexate-induced abortion expected more bleeding (mean scores, 3.5 vs. 3. 1) and reported more pain (3.4 vs. 2.9), heavier bleeding (3.4 vs. 2.5) and bleeding of longer duration (3.3 vs. 2.6). The overwhelming majority of women in the medical and surgical abortion groups reported that they were either very or somewhat satisfied with their abortion method (81% and 82%, respectively), would recommend it to others (82% and 78%) and would choose the method again (89% and 93%).

CONCLUSIONS

Factors affecting the choice of abortion method appear to be numerous and complex. Providers need to be sensitive to differences in women's values and life circumstances when counseling them about an abortion method. In particular, providers should incorporate into their counseling sessions what women need to know about the characteristics of abortion methods and help women to identify what is the best option for them.

Emergency contraception: knowledge and attitudes of health care providers in a health maintenance organization

One hundred sixty-four health care providers in a health maintenance organization were surveyed in 1996 regarding their knowledge of, attitudes toward, and perception of barriers regarding emergency contraceptive pills (ECPs), as well as their ECP prescribing practices. Providers reported primarily positive attitudes regarding ECPs. Only 42% reported having ever prescribed ECPs; those who had prescribed had more positive attitudes about ECPs. Knowledge of ECP provision was incomplete, with 40% believing treatment had to be initiated in 48 hours or less. Barriers identified by providers included lack of a dedicated product, lack of awareness of ECPs among providers, and liability issues.

Comparing the acceptability of manual vacuum aspiration and electric vacuum aspiration as methods of early abortion

OBJECTIVE

to compare the acceptability of manual vacuum aspiration (MVA) and electric vacuum aspiration (EVA) as methods of early (< or = 77 days' gestation) abortion.

METHODS

We interviewed 42 women who had been randomly assigned to either MVA or EVA and compared their perceptions of the two procedures.

RESULTS

The experiences and perceptions of women in the two groups were similar in many ways. The majority of women in both procedure groups were very satisfied with the method used, and most indicated that they would prefer the same method if they were to have another abortion.

CONCLUSION

This study found no major differences in the acceptability of MVA and EVA among women undergoing early abortions.

Changes in providers' views and practices about emergency contraception with education

OBJECTIVE

To assess changes in the prescribing practices, knowledge, attitudes, and perceptions of health care providers after an educational program about emergency contraception.

METHODS

Health care providers completed self-administered questionnaires before and 1 year after full implementation of the project. The 102 providers who completed both questionnaires were physicians (64%) and mid-level professionals from 13 San Diego County Kaiser Permanente medical offices working in departments such as obstetrics and gynecology, primary care, and emergency medicine.

RESULTS

The frequency of prescription for emergency contraceptive pills increased significantly from baseline to follow-up. There was an increase of almost 20% in the percentage who prescribed emergency contraception at least once a year. Knowledge also improved significantly, and perceptions of barriers to prescribing emergency contraceptive pills within the health maintenance organization decreased significantly. In contrast, attitudes about emergency contraception showed little change.

CONCLUSION

This study suggests that providers who participate in in-service training and other aspects of a demonstration project show changes in perceptions, knowledge, and behavior. However, findings also suggest that significant gaps remain in knowledge about medications, side effects, and mode of action. It is likely that many providers in other health care settings also need additional information and training concerning protocols of emergency contraception provision and its modes of action and effects.

Beyond marital status: relationship type and duration and the risk of low birth weight

CONTEXT

Unmarried women have higher rates of low birth weight than married women. However, assumptions that unmarried women are uniformly at a disadvantage may be unfounded. A woman's relationship characteristics may be more relevant for infant health than her formal marital status.

METHODOLOGY

Data from the 1995 National Survey of Family Growth were used to analyze associations between relationship characteristics and low birth weight among U.S. women aged 15-44 with a recent singleton live birth. Unadjusted odds ratios were generated to indicate the crude effects of independent variables, including relationship type and relationship duration at the time of conception. Multiple logistic regressions were performed to assess the impact of relationship variables on the likelihood of low birth weight, taking into account the effects of other covariates.

RESULTS

In multivariate models of all women and non-Hispanic black women, relationship type and duration were not associated with low birth weight. However, low birth weight was almost six times as likely among Hispanic women in nonmarital, noncohabiting relationships as among those who were married. Surprisingly, among non-Hispanic white women, low birth weight was less likely among those in nonmarital, noncohabiting relationships than among those who were married. Unexpected associations also were found among low birth weight, race and ethnicity, and relationship duration: Low birth weight was more likely among non-Hispanic white women in relationships of from five to 10 years in length than among those in relationships of longer than 10 years and less likely among Hispanic women in relationships of one year or less than among those in a relationship for more than 10 years.

CONCLUSION

Although unmarried women in the United States have higher rates of low birth weight than married women, many unmarried women are at no greater risk of low birth weight than their married counterparts. The findings confirm the need to consider the characteristics of relationships when examining the association of mother's "union status" and birth outcomes.

A magnetic field exposure facility for evaluation of animal carcinogenicity

Several animal studies have been carried out at the Institut Armand Frappier (IAF) to determine whether chronic exposure to 60 Hz linearly polarized sinusoidal magnetic fields might increase the risk of cancer development of female Fisher rats. The magnetic field exposure facility was developed to meet the requirements of the study protocol for chronic exposure of large number of animals to field intensities of sham < 0.2 microT, 2 microT, 20 microT, 200 microT, and 2000 microT. At each exposure level, including sham, the animals are distributed in a group of four exposure units. Each exposure unit contains two exposure volumes having uniform distribution of magnetic fields for the animals, while the magnetic field external to the unit falls off rapidly due to the "figure-eight" coil topography used. A program of "shake down" tests, followed by verification and calibration of the exposure facility, was carried out prior to starting the animal experiments. Continuous monitoring of the magnetic field and other environmental parameters was an important part in the overall quality assurance program adopted.

Experiences and satisfaction with providing methotrexate-induced abortions among US providers

OBJECTIVE

This study examined the acceptability of and experiences with methotrexate as an abortifacient among health care providers in the United States.

METHODS

Seventy-six telephone interviews were conducted with providers (28% physicians, 13% midlevel providers, 29% administrators, and 30% counselors/other medical staff) of methotrexate-induced abortions during May and June of 1997. We examined provider satisfaction and several key operational issues relative to medical abortion, including: time spent with patients and staffing, training, and space needs.

RESULTS

The majority of providers agreed that overall, more time was spent with methotrexate than with surgical abortion patients. Most agreed that the number of staff needed was the same for both methods, and that methotrexate required less office space. There were differing views on whether methotrexate required more, an equal amount of, or less training than surgical. Overall, providers were satisfied with methotrexate as an abortifacient.

CONCLUSION

These data suggest that as knowledge of the method spreads, more providers will add this technique to their services.

Acceptability of suction curettage and mifepristone abortion in the United States: a prospective comparison study

OBJECTIVE

We sought to compare the acceptability of suction curettage abortion with that of medical abortion with mifepristone and misoprostol in American women.

STUDY DESIGN

We performed a prospective, serially enrolled, cohort analysis. The study population consisted of 152 subjects receiving mifepristone and misoprostol and 174 subjects undergoing suction curettage abortion aged > or =18 years with intrauterine pregnancies of up to 63 days' estimated gestation. Questionnaires regarding expectations and experiences were administered before the abortion and at the 2-week follow-up visit.

RESULTS

Subjects undergoing medical abortions reported significantly greater satisfaction than those undergoing surgical abortions (mean rank, 121 vs 149; P <.01) but were no more likely to recommend the method they had just experienced to a friend (97% vs 93.3%). If a future abortion was required, however, 41.7% of subjects undergoing surgical abortions indicated they would opt for a medical abortion, whereas only 8.6% of subjects receiving medical abortions would choose a surgical abortion (P <.001). Failure of the abortion decreased satisfaction in the medical group and increased the likelihood of choosing a surgical abortion for a subsequent procedure (P <.001). Surgical subjects who experienced more anxiety than expected during the abortion were more likely to choose a medical procedure for a subsequent abortion (P <.01).

CONCLUSION

Women receiving mifepristone and misoprostol were more satisfied with their method and more likely to choose the same method again than were subjects undergoing surgical abortion. Failure of a medical abortion and increased anxiety during surgical abortion were associated with preference for the alternative technique in a future procedure.

Women's experience and satisfaction with emergency contraception

CONTEXT

If any new contraceptive technology is to become a viable option for decreasing unintended pregnancies, women must be willing to use the method and find it acceptable. However, because emergency contraceptive pills have not been widely used, very little is known about this method's acceptability.

METHODS

Telephone interviews were conducted with 235 women who had received emergency contraceptive pills through a demonstration project at 13 Kaiser Permanente medical offices in San Diego to assess women's experience and satisfaction with the pills.

RESULTS

More than two-thirds of the women (70%) were using a contraceptive method prior to their need for emergency contraception, and 73% of these users were relying on condoms. When asked about the situation that led to unprotected intercourse, 45% reported that their condom broke or slipped, while 23% said they had had unplanned sex. More than three-quarters of the sample (81%) experienced at least one side effect. The overwhelming majority were satisfied with emergency contraceptive pills (91%) and would recommend them to friends and family members (97%). Just one-quarter of the sample (28%) believed that emergency contraceptive pills should be dispensed over the counter, and an even lower proportion agreed that they should be available from vending machines (6%).

CONCLUSIONS

Because women were overwhelmingly accepting of emergency contraceptive pills, found them easy to use and did not intend to substitute them for regular contraceptive use, this new method is an important addition to the contraceptive options available to women, providing a way to prevent pregnancy after unprotected intercourse or method failure.

Nitrogen cycling and community structure of proteobacterial beta-subgroup ammonia-oxidizing bacteria within polluted marine fish farm sediments

A multidisciplinary approach was used to study the effects of pollution from a marine fish farm on nitrification rates and on the community structure of ammonia-oxidizing bacteria in the underlying sediment. Organic content, ammonium concentrations, nitrification rates, and ammonia oxidizer most-probable-number counts were determined in samples of sediment collected from beneath a fish cage and on a transect at 20 and 40 m from the cage. The data suggest that nitrogen cycling was significantly disrupted directly beneath the fish cage, with inhibition of nitrification and denitrification. Although visual examination indicated some slight changes in sediment appearance at 20 m, all other measurements were similar to those obtained at 40 m, where the sediment was considered pristine. The community structures of proteobacterial beta-subgroup ammonia-oxidizing bacteria at the sampling sites were compared by PCR amplification of 16S ribosomal DNA (rDNA), using primers which target this group. PCR products were analyzed by denaturing gradient gel electrophoresis (DGGE) and with oligonucleotide hybridization probes specific for different ammonia oxidizers. A DGGE doublet observed in PCR products from the highly polluted fish cage sediment sample was present at a lower intensity in the 20-m sample but was absent from the pristine 40-m sample station. Band migration, hybridization, and sequencing demonstrated that the doublet corresponded to a marine Nitrosomonas group which was originally observed in 16S rDNA clone libraries prepared from the same sediment samples but with different PCR primers. Our data suggest that this novel Nitrosomonas subgroup was selected for within polluted fish farm sediments and that the relative abundance of this group was influenced by the extent of pollution.

Emergency contraception: preliminary report of a demonstration and evaluation project

Kaiser Permanente Southern California and the Pacific Institute for Women's Health began a demonstration and evaluation project on emergency contraceptive pills (ECPs) in the summer of 1996 with the goal of evaluating the feasibility and acceptability of ECPs in a large health maintenance organization and developing institutional templates, provider training and patient education materials that could be used to replicate the project. The ECP program had six components: repackaging of oral contraceptives in an ECP "kit," development of provider education materials, development of patient education materials, in-service training, making ECPs kits available in convenient locations, and development of materials to support replication of the project inside and outside Kaiser Permanente. Although data are still being analyzed, preliminary results are promising. The success of the project within this relatively conservative, but well-established medical care organization provides a model for others. The development of a standard set of educational materials and approaches to implementation should facilitate dispensing ECPs in other settings.

Emergency contraceptive pills: an exploratory study of knowledge and perceptions among Mexican women from both sides of the border

A focus group study was conducted to explore what Mexican women from both sides of the US-Mexican border do to prevent pregnancy after unprotected intercourse, including their use of emergency contraceptive pills (ECPs); to examine their knowledge and perceptions of ECPs; and to explore what might influence Mexican women's use of ECPs. Eight focus groups (four in Mexico and four in California) were conducted with 55 sexually active Mexican women age 18 to 34. The women discussed a variety of postcoital methods intended to prevent pregnancy including herbs and injections. Although a third of the women had heard of ECPs, their knowledge was very limited. After being informed about the characteristics of ECPs, participants had many positive comments, preferring them to unplanned pregnancies and abortions. A major topic was whether or not ECPs are abortifacients. Having information about ECPs, a woman's personal circumstances, interpersonal factors, and the role of culture and religion were factors they thought would influence a woman's use of ECPs. After the focus group discussions, 95% of the women said they would use ECPs. Mexican women's acceptance and use of ECPs will likely depend on a host of factors within the broader context of their lives.

Risk factors for rifampin mono-resistant tuberculosis

Use of rifampin is required for short-course treatment regimens for tuberculosis. Tuberculosis caused by isolates of M. tuberculosis with resistance to rifampin and susceptibility to isoniazid is unusual, but it has been recognized through surveillance. Patients with tuberculosis (cases) with rifampin mono-resistance were compared with HIV-matched controls with tuberculosis caused by a drug-susceptible isolate. A total of 77 cases of rifampin mono-resistant tuberculosis were identified in this multicenter study. Three were determined to be laboratory contaminants, and 10 cases had an epidemiologic link to a case with rifampin mono-resistant tuberculosis, suggesting primary acquisition of rifampin-resistant isolates. Of the remaining 64 cases and 126 controls, there was no difference between cases and controls with regard to age, sex, race, foreign birth, homelessness, or history of incarceration. Cases were more likely to have a history of prior tuberculosis than were controls. Of the 38 cases and 74 controls with HIV infection, there was no difference between cases and controls with regard to age, sex, race, foreign birth, homelessness, history of incarceration, or prior tuberculosis. Cases were more likely to have histories of diarrhea, rifabutin use, or antifungal therapy. Laboratory analysis of available isolates showed that there was no evidence of spread of a single clone of M. tuberculosis. Further studies are needed to identify the causes of the development of rifampin resistance in HIV-infected persons with tuberculosis and to develop strategies to prevent its emergence.

Comparisons of cost and accuracy of DNA probe test and culture for the detection of Neisseria gonorrhoeae in patients attending public sexually transmitted disease clinics in Los Angeles County

BACKGROUND

Strict handling and transport requirements for the successful use of culture in the detection of Neisseria gonorrhoeae warrant investigation of accurate and cost-effective test alternatives such as the Gen-Probe PACE 2 DNA probe assay (Gen-Probe, Inc., San Diego, CA).

STUDY DESIGN

The Gen-Probe PACE 2 DNA probe assay for N. gonorrhoeae was compared with conventional culture methods in the principal Los Angeles County (LAC) Department of Health Services (DHS) Public Health Laboratory and three of its branch laboratories. Urethral and endocervical samples were collected from 1,566 patients (921 males; 645 females) attending six LAC DHS sexually transmitted disease clinics. Cost analysis was performed comparing material and labor costs of the two test methods.

RESULTS

The overall prevalence based on culture was 11.8% (15.7% for males; 6.4% for females). Nine samples were culture positive, Gen-Probe negative and four samples were culture negative, Gen-Probe positive and remained discordant after discrepant analysis. The sensitivity and specificity were 94.6% and 99.7%, respectively, for the PACE 2 assay compared with culture. The positive and negative predictive values were 97.8% and 99.3%, respectively. No statistically significant difference was found between the two tests. A cost analysis found an average cost of $3.11/test for culture and $3.85/test for PACE 2, given the approximate 12% disease prevalence in this population.

CONCLUSIONS

Gen-Probe's PACE 2 assay may provide an acceptable, cost-effective alternative to culture, especially among high-risk males.

Factors affecting the consistent use of barrier methods of contraception

OBJECTIVES

To discuss the major issues involved in the consistent and effective use of barrier methods of contraception.

DATA SOURCES

Major research and review articles on barrier methods published within the last 10 years were considered. One major source of articles was Family Planning Perspectives.

METHODS OF STUDY SELECTION

This paper is a focused review and integration of recent literature rather than a comprehensive literature review. Only selected articles published since 1986 that are pertinent to the issues raised are included.

TABULATION, INTEGRATION, AND RESULTS

All barrier methods have common characteristics that influence their patterns of use. The correct and consistent use of such methods is determined by the complex interaction of characteristics of the methods themselves, characteristics of users, and the situational context. Method characteristics include the extent of interference with sexual spontaneity and enjoyment, the amount of partner cooperation required, and the ability of the method to protect against human immunodeficiency virus and other sexually transmitted diseases. User characteristics include motivation to avoid unintended pregnancy, ability to plan, comfort with sexuality, and previous contraceptive use. Stage of sexual career, relationship characteristics, and physical and sexual abuse are important situational influences.

CONCLUSIONS

Even though most barrier methods can be obtained without a prescription from a provider, clinicians have an extremely important role in promoting effective and consistent method use. Four major ways to improve the use of barrier methods currently available include: 1) improve method characteristics and the distribution systems; 2) change consumers' perceptions of method attributes; 3) train consumers to use methods correctly and overcome-perceived negative characteristics of the methods; and 4) change values about the perceived importance of method characteristics. There also is an urgent need for the development of better barrier methods.

Attitudes about condoms and condom use among college students

The authors assessed the relationships of ethnicity, gender, previous condom use, and intended condom use to perceived attributes of the condom and the contraceptive pill in a multiethnic sample of 197 college students. Factors that appeared to underlie attitudes toward the condom and the Pill included prevention of health problems, peer acceptance, sexual pleasure and spontaneity, convenience, embarrassment, and effectiveness in preventing HIV and sexually transmitted diseases. African American participants viewed the condom more positively than did students from other ethnic groups and were more likely to use condoms than White participants were. The African Americans appeared to know less about the characteristics of the Pill and were less likely to use it than were the White respondents. Only 60% of the persons in the student sample had used condoms in the last 6 months, and less than one half definitely intended to use condoms in the next month. Those who had used a condom at their most recent intercourse and those who intended to use a condom in the next month viewed the condom more favorably than others did. Intended condom use was associated with a perception of oral contraceptives as a less convenient method of birth control.

Listening and learning from women about mifepristone: implications for counseling and health education

The careful, reflective, and honest way in which the women in the study analyzed, questioned, and explored the benefits and disadvantages of a mifepristone abortion compared with vacuum aspiration yielded an extensive list of information needed by women to make informed choices as well as an understanding of the diverse social contexts in which choices are made. Needed information identified by this study included technical information about the drugs themselves and their mechanisms of action, roles and responsibilities of health personnel, and descriptions of other women's experiences with mifepristone. A multiplicity of factors entered the decision-making process, demonstrating at the same time a complexity and flexibility of thought. In their hypothetical evaluation of mifepristone, women weighed such factors as experience with childbirth, spontaneous abortion and vacuum aspiration, specific issues for teenagers, lack of a support system, experience with herbal emenagogues and nonprescription drugs intended as abortifacients, and the relative dependence on health care providers. Social, personal, and cultural factors entered into women's interpretation of the different options. These socio-cultural contexts can profoundly influence decisions and potentially affect clinical outcomes. If health care professionals are not proactive, do not fully provide answers to questions (even if unasked), and fail to probe for specific life circumstances, then poor choices and poor outcomes may follow with long term negative consequences for clients.(ABSTRACT TRUNCATED AT 250 WORDS)

Knowledge and perceptions of medical abortion among potential users

Nearly two-thirds of 73 women aged 18-34 who participated in focus groups on medical abortion conducted in three cities had heard about this new abortion method, but only a few could describe it accurately. Once the method was described to them, they cited its potential advantages over vacuum aspiration as being fewer major complications, the absence of surgery, a greater "naturalness," and its use earlier in pregnancy. Women listed as disadvantages the multiple visits needed for medical abortion, the unknown aspects of the new technology, especially regarding the expulsion of the conceptus, and concern that mifepristone would make an abortion too easy and lead some women to take the decision lightly. More than one-third of discussants said they would choose mifepristone if the method were available.

Setting and provider of prenatal care: association with pregnancy outcomes among low-income women

Although the importance of prenatal care is widely recognized, little is known about the impact of different models of care on health outcomes. We examined the relationships of setting and provider of prenatal care to birth outcomes among low-income women in a predominantly rural county in the northwest United States. Three study populations were compared: all women who received care from certified nurse-midwives (CNMs) at a hospital-based prenatal clinic; all Medicaid recipients who obtained care from CNMs in private practice; and a randomly selected sample of Medicaid recipients who obtained care from physicians in private practice. Data on sociodemographics, prenatal care use, health indicators, and birth outcomes were collected from birth certificates. When other factors known to affect birth weight were controlled through multiple regression analyses, results indicated that receiving care from CNMs and receiving care in the private setting were related to higher mean infant birth weight.

A treatment model for women substance users

This paper sets forth a multifaceted program which consists of drug user women-centered counseling plus ancillary services based on the five basic steps of Freire's empowerment theory. The program is designed to increase self-awareness, skills, and knowledge acquisition, to reduce feelings of isolation by broadening interpersonal networks, includes activities to enhance assertiveness and communication skills, and parenting education to counteract inappropriate mother-child interaction as well as to positively influence role modeling. Both transportation and child care are recommended ancillary services.

Factors associated with sexual behavior among adolescents: a multivariate analysis

Multiple factors associated with engaging in sexual intercourse among a sample of adolescents were examined. A self-administered survey was completed by 1,026 high school students in a classroom setting. Discriminant function analyses were performed to discriminate factors most important in predicting the sexual status of the adolescent. Compared to males who had never engaged in sexual intercourse, sexually active males reported more frequent use of alcohol, had higher levels of stress, were less likely to use seat belts, were more likely to engage in physical fights, and were more likely to worry about the spread of AIDS. Sexually active females reported more frequent use of alcohol and cigarettes, and had higher levels of stress than did female adolescents who had never had sexual intercourse. These findings suggest that effective interventions to address teenage pregnancy need to utilize a multifaceted approach to the prevention of high-risk behaviors.

Obstacles to prenatal care following implementation of a community-based program to reduce financial barriers

A study of women who gave birth in a rural Oregon county during 1988-1990 found that despite the establishment of a program to provide prenatal care to low-income women who could not afford it, the most common reasons cited for inadequate prenatal care were financial obstacles. All 13 financial, personal and organizational barriers studied were reported more frequently by the 236 women who received inadequate or no care than by the 246 women who received adequate care. Among the reasons most frequently cited by women who received inadequate care were difficulty paying for prenatal care (70%), difficulty with medical insurance (55%), ambivalence or fear about the pregnancy (46%) and transportation problems (42%). In a logistic regression analysis that controlled for social and demographic characteristics, six barriers were significant predictors of inadequate care: The odds of receiving inadequate care were 7.9 among women who had a poor understanding of or attached a low value to prenatal care compared with those who did not cite this barrier, 3.4 among those who cited financial difficulties, 3.4 among those who said they had difficulty scheduling appointments, 3.0 among those who suffered excessive physical or psychological stress, 2.7 among those who said they did not know where to go for prenatal care, and 1.8 among those who felt ambivalence or fear regarding the pregnancy.

Dimensions of the contraceptive attributes questionnaire

This article describes the development and evaluation of the Contraceptive Attributes Questionnaire (CAQ), a research instrument designed to assess the subjective importance of specific contraceptive attributes (Importance) and the perceived characteristics of specific contraceptives (Agreement). Three birth control methods are examined—the sponge, pill, and diaphragm. Factor analyses indicate that the four scales are multidimensional, and as subscales the factors have reasonable internal consistency reliability. The validity of the CAQ was established through comparisons of ratings of women who use different contraceptive methods. The women differed by user status on the ratings of the importance factors and on the ratings of the agreement factors for all three methods rated.

Tests for detecting degradation of gelatin: comparison of five methods

Five methods for detecting degradation of gelatin by bacteria were compared. These were liquefaction in nutrient broth, hydrolysis in nutrient agar, hydrolysis of charcoal gelatin strips, degradation of the gelatin on strips of photographic film, and alkalinization of gelatin agar. Degradation of photographic film is a rapid and convenient method but, like hydrolysis of gelatin in broth and in agar, may fail to detect weakly positive strains of bacteria. Alkalinization of gelatin in an agar medium is a convenient and sensitive method to detect degradation of gelatin, particularly by Pseudomonas fluorescens, but this method may not be applicable to some species.

Hazard assessment of video display units

This report describes the results of a study of potential health hazards of video display units (VDUs). The specific elements of the study included characterizing the emissions of ionizing and nonionizing radiation and exposures to electromagnetic fields. There was no evidence that operators are exposed to electric, magnetic, or ionizing radiation fields significantly above ambient levels. Significant x-ray leakage cannot occur under any credible conditions. In addition to the ergonomic aspects of VDU work, reports on the health aspects of VDU operators were investigated. The results of the study, based on the specific hazards evaluated, do not support allegations that VDU operation is hazardous beyond the identified transient discomforts associated with characteristics of the work performed. A high-profile employee education program was initiated to minimize discomforts and unwarranted concerns.

Health care provider and contraceptive care setting: the relationship to contraceptive behavior

This study examines contraceptive delivery characteristics and their association with contraceptive behavior. Data were collected in telephone interviews from a national sample of 1057 women who were using female contraceptives. The overwhelming majority of the sample obtained contraceptive services from gynecologists and other physician specialists and were seen in private facilities. Whereas nearly half of the providers recommended use of specific methods, only one-fourth discouraged use of particular methods. The pill was both the most frequently recommended and most commonly discouraged method. With regards to the provision of contraceptive information, practitioners were most likely to discuss the effectiveness of a method. In three of the four categories examined, a higher percentage of non-MDs than MDs gave information to their patients. Although the majority of women reported they were satisfied with the quality of care, mean satisfaction ratings were higher for female providers compared to male providers.

The contraceptive sponge: factors in initiation and discontinuation of use

This study examined characteristic of the contraceptive sponge that were important in women's decisions to use the contraceptive sponge and reasons why women discontinued sponge use. A sample of 385 current sponge users and 407 former sponge users participated in a national telephone survey on sponge use. Important reasons for trying the sponge were effectiveness, comfort, convenience and ease of use and it "would not interfere with sexual pleasure." The media and physicians were of considerable influence in women's decisions to initiate sponge use, but sexual partners, friends, parents and relatives exerted little influence. The most important reasons for discontinuing use of the sponge were pregnancy, both planned and accidental, and irritation, discomfort or vaginal infection. Women may decide to use the sponge because they have unrealistically positive perceptions of sponge characteristics.

Choice of a childbirth method after cesarean

Concern about the rising cesarean-section rate and the high percentage of elective repeat cesareans led to an exploratory, retrospective examination of women's decision-making about a childbirth method after cesarean. Fifty women who had delivered by a repeat cesarean (RC) or vaginal birth after cesarean (VBAC) participated in a telephone interview. Three questions were addressed: (1) who made the decision for a birth method; (2) what factors were associated with the choice of method; and (3) was the choice of method associated with the actual method of delivery? The majority of women (90%) perceived that they were the primary decision-maker for a birth method, and choice of birth method was positively associated with actual method of delivery. The major reason for VBAC choice was to experience a vaginal birth, whereas the primary reason for RC choice was to avoid an unsuccessful labor. Other factors associated with choice of a birth method were: sources of information and support, beliefs, previous cesarean experience and locus of control. These findings have important implications for enhancing women's health-care decision-making, as well as for reducing the rate of repeat-cesarean deliveries.

Factors associated with use of the contraceptive sponge

A study of 264 current sponge users, 266 pill users and 45 diaphragm users shows that women who adopted the sponge were older, more educated and more likely to be married, to have higher incomes and to have had more pregnancies and children than were women who had used oral contraceptives. Compared with diaphragm users, sponge users were more likely to be never-married, had had fewer children and were more likely to be Protestant. Users of all three methods cited physicians as being the greatest source of influence in the decision to adopt their current method; however, sponge users were the least likely to cite physicians, and they were more likely to have been favorably influenced by the media than were pill or diaphragm users. Sponge users were more likely than pill users to have ever relied on other contraceptive methods and to have correctly answered more questions on contraceptive knowledge. Sponge users and diaphragm users were similar in the range of methods they had ever used and in contraceptive knowledge. However, sponge users reported more consistent use than did diaphragm users.

Lesbian mothers. Health care experiences

A self-administered questionnaire was completed by 35 women who had delivered within the last five years and were self-identified lesbians when they conceived. The majority of women conceived through donor insemination and used the medical care system to achieve pregnancy. All sought prenatal care within the first 16 weeks, 89% participated in childbirth classes, and 80% breastfed for six months or more. Over half of the women (51%) sought obstetrical care from physicians, while 49% selected midwives. The majority (91%) disclosed their sexual orientation to their provider. Overall the women described their experience with obstetrical care providers as positive. However, a greater percentage of women who selected midwives reported higher levels of support from and satisfaction with their provider compared to those who selected physicians.

Female sexual behavior: fluctuations during the menstrual cycle

This longitudinal prospective study was designed to examine the influence of menstrual cycle phase on female sexuality. Sixty-nine normally cycling women monitored their sexual behavior including both heterosexual and autosexual activities and their basal body temperature daily over two or three consecutive menstrual cycles. Temperature charts were used to ascertain five cycle phases (menstrual, postmenstrual, ovulatory, luteal and premenstrual) and data were analyzed using analyses of variance with repeated measures. The results supported a significant cyclic fluctuation in sexual behavior with both female-initiated and male-initiated sexual activities peaking in the ovulatory phase. Moreover, the findings indicated that women experienced increased sexual arousal and sexual pleasure as they progressed from the menses to the premenstruum. These data suggest that human sexual behavior may be influenced by hormonal fluctuations and cognitive factors associated with the menstrual cycle.

Alcohol consumption, female sexual behavior and contraceptive use

To examine the effects of alcohol consumption on female sexuality and contraceptive use, 69 sexually active women between the ages of 18 and 34 completed daily logs of their drinking behavior, sexual activity and contraceptive use over three consecutive menstrual cycles. In addition, participants completed a post-study questionnaire that assessed personal beliefs regarding alcohol use and sexual behavior. Although the results from the daily logs failed to show any significant effects of alcohol on subsequent sexual arousal, sexual pleasure or orgasm, female-initiated sexual activity appeared to be inversely related to alcohol use with women initiating significantly fewer sexual activities following the consumption of alcohol. On the contrary, the retrospective questionnaire data indicated that women believed alcohol enhanced sexual desire, enjoyment and activity. The findings further indicated that alcohol consumption immediately prior to sexual intercourse did not significantly alter the use of coitus-dependent contraceptives. These data suggest that women view alcohol as an aphrodisiac despite their physiological and reported behavioral responses.

Cyclic fluctuation in alcohol consumption among female social drinkers

The main objective of this study was to investigate the relationship between menstrual cycle phase and alcohol use in female social drinkers. Sixty-nine normally menstruating women monitored alcohol consumption and basal body temperature daily over three consecutive menstrual cycles. Temperature charts were used to ascertain five cycle phases (menstrual, postmenstrual, ovulatory, luteal, and premenstrual) and data were analyzed using single-group repeated measures analysis of variance. Whereas frequency of alcohol use did not vary among the five cycle phases, quantity of alcohol consumed significantly fluctuated and peaked in the luteal phase. These data suggest that female drinking patterns may be influenced by hormonal fluctuations associated with the menstrual cycle.

Electric-field exposure of persons using video display units

Electric fields produced by a selection of video display units have been measured over a frequency range from DC to 1 MHz. The magnitude and the time variation of the electric fields were both recorded by means of a single broadband capacitive sensor located on the surface of a simple simulation of the human body. The electric field at a given location was found to be the sum of three discrete components, each having a different spatial and time variation. These components are produced by, respectively, the charged CRT screen, the flyback transformer, and the low-voltage circuitry. For the units tested, operator exposures are substantially below the limits of existing workplace guidelines.

Probable Campylobacter fetus subsp. fetus gastroenteritis

Three strains of Campylobacter fetus subsp. fetus isolated from cases of gastroenteritis are reported. DNA-DNA hybridizations in addition to biochemical tests were used to confirm the identification of the isolates as C. fetus since all strains grew at 42 degrees C. These isolates, like other C. fetus strains, are susceptible to cephalothin and thus would not have been detected in laboratories with Campylobacter isolation media containing this component.

Trends in contraceptive use at one university: 1974-1978

In a group of 2,700 women making initial visits to the contraception clinic at one university (California State University at Fullerton) between 1974 and 1978, oral contraceptives were the most frequently chosen of three prescription methods. (The others were the IUD and diaphragm.) The proportion of women choosing the pill, however, declined sharply over the period--from 89 percent of patients in 1974 to 63 percent in 1978. Choice of the diaphragm rose substantially: In 1978, 33 percent chose it, compared to six percent in 1974. The proportion of women choosing the IUD fluctuated over the four-year period, showing no clear trend, and averaging eight percent over the entire span. The decline in the proportion of women choosing the pill was sharpest among white Anglo students--down from 85 percent to 63 percent; among nonwhites and Hispanics, the proportion fell from 89 percent to 80 percent. The increase in the choice of the diaphragm was also greatest among the Anglo students. These trends of decreased choice of the pill and increased acceptance of the diaphragm are much sharper than those shown among young married women at the national level.

Hippurate hydrolysis by Campylobacter fetus

An additional method for differentiating between Campylobacter fetus subsp. jejuni and C. fetus subsp. intestinalis is reported. Strains of C. fetus subsp. jejuni (18/20) were shown to hydrolyze hippurate in the 2-h rapid test, whereas strains of C. fetus subsp. intestinalis did not.

Yersinia enterocolitica. Experimental pathogenicity for chinchilla

An intragastric inoculation of approx. 2 × 10¹⁰ Yersinia enterocolitica cells killed chinchillas in three days in the case of four strains out of six tested. Because of the sensitivity of chinchillas to this bacterium, the test is useful for the evaluation of the virulence and invasiveness of Y. enterocolitica isolates. This animal model could also be used for studies on the mechanism of the infection.

Yersinia enterocolitica: in vitro antimicrobial susceptibility

Using 21 antimicrobial agents, agar dilution susceptibility tests were carried out against 190 strains of Yersinia enterocolitica. Isolates from human, environmental, and animal sources had essentially equal susceptibility patterns.