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Peer Reviewed

Title: Do instructions for over-the-counter pre-coital female contraceptives promote "perfect use"?
Author: Zite NB; Wallace LS
Source: Contraception. 2009 Mar;79(3):211-5.
Abstract: BACKGROUND: This study was conducted to estimate the readability and related features of English-language over-the-counter (OTC) pre-coital female contraceptive (PFC) instructions. STUDY DESIGN: We identified and purchased all currently available OTC PFCs (n=8), including Encare (Contraceptive Gel and Insert), F.C. Female Condom, Ortho Options (Conceptrol, Delfen and Gyncol II Jelly), Today Sponge and VCF Vaginal Film. Reading grade level was calculated using the Simple Measure of Gobbledygook. Text point size was measured and total number of graphics was tallied. Graphic dimensions were also measured. We also assessed OTC PFC instructions on four main criteria--derived from the "User-Friendliness Tool (UFT)"--including layout features, graphic characteristics, presence of a clear message and presentation of manageable information. RESULTS: Reading level ranged from 8th to 12th grade (mean+/-SD=10.0+/-1.2). Mean page length was 24.4+/-7.0 cm (9.6+/-2.76 in.), while average page width was 20.3+/-13.8 cm (7.99+/-5.43 in.). Average text point size was 7.9+/-2.3 (range=6-12). Illustrations, predominantly line drawings, were used throughout (range=3-11), and most were similar in size to a matchbox. None of the "How to Use" sections scored high in all criteria on the UFT. CONCLUSIONS: "How to Use" sections of OTC PFC instructions should be revised to be easier to read and more user friendly. Ideally, the gap between "typical" and "perfect" contraceptive efficacy could potentially be narrowed if instructions were developed that the large majority of women could easily understand.
Language: English
Keywords:
TENNESSEE | RESEARCH REPORT | EVALUATION | WOMEN | PHARMACY DISTRIBUTION | USER COMPLIANCE | PROMOTION | LANGUAGE | READING | CONTRACEPTIVE METHODS | FEMALE CONTRACEPTION | FAMILY PLANNING EDUCATION | Developed Countries | United States of America | North America | Americas | Demographic Factors | Population | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Behavior | Marketing | Economic Factors | Communication | Literacy | Educational Status | Socioeconomic Status | Socioeconomic Factors | Contraception | Family Planning | Education
Document Number: 330056

Title: Women's preventive screening in rural health clinics.
Author: Edwards JB; Tudiver F
Source: Women's Health Issues. 2008 May-Jun;18(3):155-166.
Abstract: Despite the strong interest in health care quality, little is known about the quality of preventive care among women in rural primary care settings. We sought to assess the quality of screening practices in Rural Health Clinics (RHCs) as measured by the rates at which female patients received screening within national guidelines. A cross-sectional, retrospective chart review of 480 charts of female patients in 12 randomly selected RHCs was conducted. Data were collected on screening activities documented in greater than 3,800 patient visits. Chart data was extracted by trained, standardized chart auditors using the Women's Primary Care Screening Form for patient data and the Revised National Rural Health Clinic Survey for RHC background data. The rates of receipt of 5 preventive screenings received by female patients in RHCs were determined using a standardized and reproducible method, and patient and clinic characteristics associated with women's receipt of these screenings were identified. Demographic characteristics of patients were similar to that of national rural comparisons. Screening rates for Pap tests (66%) and mammograms (55%) were lower than Healthy People 2010 estimates, but similar to other record audit data; screening rates for cholesterol with comorbidity (66%) were near the Healthy People 2010 estimate, and screening rates for cholesterol without comorbidity (61%) exceeded it; and rates of blood pressure screening (99%) exceeded Healthy People 2010 estimates of national rates. Screening rates for depression showed that 35% had received a formal or informal screening. Rates of screenings for insured and uninsured female RHC patients in this retrospective chart review were not significantly different. Methods to improve pap and mammogram screening rates are needed. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | TENNESSEE | RESEARCH REPORT | RURAL AREAS | WOMEN | CLIENTS | HEALTH FACILITIES | PRIMARY HEALTH CARE | QUALITY OF HEALTH CARE | SCREENING | NEEDS | BREAST EXAM | PAP SMEAR | Developed Countries | North America | Americas | Geographic Factors | Population | Demographic Factors | Program Activities | Programs | Organization and Administration | Delivery of Health Care | Health | Health Services | Health Services Evaluation | Program Evaluation | Examinations and Diagnoses | Medical Procedures | Medicine | Economic Factors | Physical Examinations and Diagnoses | Laboratory Examinations and Diagnoses
Document Number: 326658

Peer Reviewed

Title: Efficacy of a pill-swallowing training intervention to improve antiretroviral medication adherence in pediatric patients with HIV / AIDS.
Author: Garvie PA; Lensing S; Rai SN
Source: Pediatrics. 2007 Apr;119(4):e893-e899.
Abstract: We aimed to retrospectively assess the efficacy of pill-swallowing training provided as a clinical intervention to referred pediatric patients with HIV in relation to improved adherence and subsequent related health outcomes. The primary goal of this study was to demonstrate participation in pill-swallowing training is associated with improved medication adherence as documented by routine pharmacy pill counts. Secondary objectives were to assess corresponding improvements in clinically observed biologic indicators of adherence, specifically, immunologic functioning (CD4+ T-cell%) and viral load, over time. A retrospective chart review of 23 pediatric patients with HIV aged 4 to 21 years who were clinically referred for pill-swallowing training by an experienced pediatric psychologist for either noted difficulties with currently prescribed antiretroviral regimens and/or desire to change the child's regimen/ formulary. Patient demographics, reason(s) for pill-swallowing training referral, number of pill-swallowing training sessions required to attain success, adherence, CD4+ T-cell%, and viral load were abstracted at baseline and at ~3 and 6 months posttraining. Modal number of sessions required to acquire the pill-swallowing skill was 1 session. Younger children (aged 4-5 years) required a median of 2 training sessions, while older children required = 3 sessions. A significant improvement in adherence from baseline to 6 months post--pill-swallowing training completion was observed, as were significant related improvements in CD4+ T-cell% and viral load. Participation in pill-swallowing training related to improved medication adherence at 6 months posttraining. Subsequent improvements in related CD4+ T-cell% and viral load were noted over time, most significantly at 6 months postintervention. These preliminary findings provide justification for additional study via a prospective, randomized, controlled clinical trial. Pill-swallowing training potentially is a successful time-limited, cost-effective intervention to improve adherence to antiretroviral therapies, and thus medical status, in children with HIV. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | TENNESSEE | RESEARCH REPORT | RETROSPECTIVE STUDIES | INFANT | CHILD | YOUTH | PERSONS LIVING WITH HIV/AIDS | TREATMENT | ANTIRETROVIRAL THERAPY | ADMINISTRATION AND DOSAGE | TRAINING ACTIVITIES | North America | Americas | Developed Countries | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Drugs | Training Programs | Education
Document Number: 313332

Peer Reviewed

Title: Development and validation of a Medicaid Postpartum Tubal Sterilization Knowledge Questionnaire.
Author: Zite NB; Wallace LS
Source: Contraception. 2007 Oct;76(4):287-291.
Abstract: We sought to describe the development and validation of the Postpartum Tubal Sterilization Knowledge Questionnaire (PTSK-Q), a survey designed to assess Medicaid recipients' understanding of the postpartum tubal sterilization process. Initially, the investigators generated a list of 17 potential items to include in the PTSK-Q. Eleven content experts reviewed two drafts of the PTSK-Q and provided qualitative and quantitative assessments. Eight women completed a field test to determine suitability and clarity of individual PTSK-Q items, while 26 women completed a pilot test to determine internal consistency and test-retest reliability of the PTSK-Q. The Flesch Reading Ease (FRE) was used to assess reading grade level of the PTSK-Q. Seven items were rated as "essential" (content validity ratio=p<.05) by content experts and composed the final PTSK-Q. Internal consistency, using Kuder Richardson-20, was 0.68. Test-retest reliability, using intraclass correlation coefficient, was 0.93. The FRE score of the PTSK-Q was 85.14 (sixth reading grade level). The PTSK-Q is a valid, readable and reliable knowledge assessment instrument for assessing understanding of postpartum sterilization and Medicaid sterilization consent requirements. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | TENNESSEE | RESEARCH REPORT | RELIABILITY | QUESTIONNAIRES | VALIDITY | WOMEN | FEMALE STERILIZATION | TUBAL LIGATION | KNOWLEDGE | TITLE 19 MEDICAL ASSISTANCE | LITERACY | INFORMED CONSENT | Developed Countries | North America | Americas | Measurement | Research Methodology | Demographic Factors | Population | Sterilization, Sexual | Family Planning | Sociocultural Factors | Public Assistance | Government Financing | Financial Activities | Economic Factors | Educational Status | Socioeconomic Status | Socioeconomic Factors | Health Services | Delivery of Health Care | Health
Document Number: 320547

Title: What if: How declines in teen births have improved poverty and child well-being in Tennessee.
Author: National Campaign to Prevent Teen Pregnancy
Source: Washington, D.C., National Campaign to Prevent Teen Pregnancy, 2005 Apr. 3 p.
Abstract: Years of research have closely linked teen pregnancy and early childbearing to a host of other critical social issues, including overall child health and well-being, out-of-wedlock births, educational attainment and workforce readiness, responsible fatherhood, and poverty in particular -- especially child poverty. For example, young children born to a mother who is a teenager, is not married, and did not finish high school are nine times more likely to be poor than children born to mothers without these three risk factors. Adolescent pregnancy and childbearing cost taxpayers at least $7 billion annually and place a serious economic burden on schools and on health, welfare and social service systems. The U.S. teen birth rate declined by 30 percent between 1991 and 2002--a significant decrease that has made major contributions to American communities. Illustrating this very point, the U.S. Congress' Joint Economic Committee completed an analysis in April 2004 that the National Campaign in turn summarized. The congressional study posed an intriguing question: if the nation's teen birth rate had remained at its 1991 level through 2002 (rather than decreasing as it did), how many more children would have been born to teen mothers and to single mothers, and what would have been the effect on poverty and on the living arrangements of children? Findings included the following: if teen birth rates had not declined nationally by 30 percent during that time, there would have been an additional 1.2 million more children born to teen mothers, approximately 460,000 additional children in poverty and almost 700,000 more children living with a single mother. (excerpt)
Language: English
Keywords:
UNITED STATES OF AMERICA | TENNESSEE | RESEARCH REPORT | ADOLESCENTS, FEMALE | ADOLESCENT PREGNANCY | ONE PARENT FAMILY | BIRTH RATE | POVERTY | CHILD HEALTH | SOCIOECONOMIC FACTORS | CAMPAIGNS | FERTILITY DECLINE | North America | Americas | Developed Countries | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Family Characteristics | Family and Household | Sociocultural Factors | Fertility Measurements | Economic Factors | Health | Communication Programs | Communication | Fertility Changes
Document Number: 307013

8.
Peer Reviewed

Title: Use of misoprostol on an outpatient basis for postdate pregnancy.
Author: Kipikasa JH; Adair CD; Williamson J; Breen JM; Medford LK
Source: International Journal of Gynecology and Obstetrics. 2005 Feb;88(2):108-111.
Abstract: Objective: Within the obstetric community, several studies suggest that cervical ripening and labor induction after 40 weeks' gestation leads to improved maternal and neonatal outcomes. The most effective drug regimen to safely promote labor has not been determined. Method: Forty-nine subjects followed in an outpatient obstetrical clinic with pregnancies of at least 40 weeks' gestation, and an unfavorable Bishop score were assigned randomly to receive oral misoprostol 50 or 25 �g every 3 days for a maximum of three doses. Results: Twenty-three subjects received misoprostol 25 �g and 26 received 50 �g. The mean interval (� standard deviation) from start of cervical ripening to delivery was 2.4 days �0.3 vs. 3.9 days �0.7 for the 50 and 25 �g groups (P<0.05). No adverse events were noted. However, due to small sample size, less frequent adverse events may be missed. Type II errors cannot be excluded. Conclusion: In the prevention of postdate pregnancy, outpatients use of oral misoprostol 50 �g appears to result in earlier delivery, as compared to 25 �g. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | TENNESSEE | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | PREGNANT WOMEN | MISOPROSTOL | PREGNANCY, THIRD TRIMESTER | PREGNANCY, PROLONGED | PREGNANCY OUTCOMES | Developed Countries | North America | Americas | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction
Document Number: 280391

10.
Peer Reviewed

Title: Medroxyprogesterone acetate treatment of abnormal uterine bleeding: factors predicting satisfaction.
Author: Richter HE; Learman LA; Lin F; Varner RE; Hendrix SL
Source: American Journal of Obstetrics and Gynecology. 2003 Jul;189(1):37-42.
Abstract: OBJECTIVE: This study was undertaken to identify the determinants of patient satisfaction with a cyclic regimen of medroxyprogesterone acetate (MPA) for abnormal uterine bleeding. STUDY DESIGN: A prospective cohort study of 413 premenopausal women were treated for 3 to 5 months with oral MPA 10 to 20 mg per day for 10 to 14 days per month.We assessed satisfaction with and willingness to continue MPA. Baseline characteristics hypothesized to predict treatment satisfaction were entered into logistic regression analysis. RESULTS: Sixty-five percent of subjects (271) completed at least 3 months of MPA, 79% (215) filled out a satisfaction survey, and 57% (123) expressed satisfaction with MPA. Satisfaction was predicted by age 35 years or older (odds ratio [OR] 2.67, CI 1.07-6.7), desire for uterine conservation (OR 1.36, CI 1.11-1.66), perceived importance of stopping bleeding (OR 0.69, CI 0.54-0.87), and tubal sterilization (OR 0.52, CI 0.28- 0.96). Neither bleeding history nor parity predicted MPA satisfaction. CONCLUSION: These findings underscore the importance of considering patient age, fertility status, attitudes about uterine conservation, and desire for definitive resolution of bleeding when deciding whether to use MPA versus other treatments for abnormal uterine bleeding. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | ALABAMA | TENNESSEE | MICHIGAN | CALIFORNIA | RESEARCH REPORT | PROSPECTIVE STUDIES | COHORT ANALYSIS | STATISTICAL REGRESSION | ADULTS | WOMEN | REPRODUCTIVE AGE | MENORRHAGIA | METRORRHAGIA | FIBROIDS | ANEMIA | MEDROXYPROGESTERONE ACETATE | TREATMENT | SATISFACTION | DEMOGRAPHIC FACTORS | PREVENTION AND CONTROL | Developed Countries | North America | Americas | Studies | Research Methodology | Data Analysis | Age Factors | Population Characteristics | Population | Reproduction | Menstruation Disorders | Diseases | Bleeding | Signs and Symptoms | Neoplasms, Benign | Neoplasms | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Psychological Factors | Behavior
Document Number: 182316

11.

12.
Peer Reviewed

Title: Why do women douche? Results from a qualitative study.
Author: Gazmararian JA; Bruce FC; Kendrick JS; Grace CC; Wynn S
Source: Maternal and Child Health Journal. 2001 Sep;5(3):153-160.
Abstract: The objective of this paper was to explore women's attitudes and practices related to douching. The authors conducted focus groups between July and December 1999 with 34 Black and 27 White women enrolled in a managed care plan in Memphis, Tennessee. Participants were at least 18 years of age and had douched at some time in their lives. Five groups were held with Black women and five with White women. The focus groups identified 13 themes that fell in four broad categories: general perceptions about feminine hygiene, douching behavior, factors perpetuating douching, and health information. Each of these categories is briefly discussed with supporting evidence. First, women have deeply-rooted beliefs about the critical role of douching in making them feel clean. Second, douching generally starts at a young age and is reinforced by family, friends, and the media. Third, douching is a very difficult behavior to change; any efforts to influence this behavior must consider women's belief and the media marketing efforts that promote douching. Finally, simplistic interventions that only provide risk information about douching are not likely to result in behavior change. (author's)
Language: English
Keywords:
ATTITUDES | BEHAVIOR | BLACKS | FOCUS GROUPS | HEALTH SERVICES | HYGIENE | QUALITATIVE RESEARCH | RESEARCH REPORT | RISK FACTORS | TENNESSEE | UNITED STATES OF AMERICA | VAGINA | WHITES | WOMEN | CHANGES | Psychological Factors | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Data Collection | Research Methodology | Delivery of Health Care | Health | Public Health | Biology | Developed Countries | North America | Americas | Genitalia, Female | Genitalia | Urogenital System | Physiology | Social Change
Document Number: 171279

13.
Title: Partner violence: implications for health and community settings.
Author: Petersen R; Gazmararian J; Clark KA
Source: Women's Health Issues. 2001 Mar-Apr;11(2):116-25.
Abstract: To assist in the design and implementation of strategies to address partner violence, the objective of this study was to evaluate differences in mental health, health behaviors, and use of health care and specific community services between women who do or do not report experiences of partner violence as an adult. During interviews with 392 women enrolled in a Medicaid managed care organization, measures of mental health status, health behaviors, use of health care and community services, and experiences of partner violence were collected. Using bivariate statistical analyzes, characteristics between women reporting or not reporting partner violence were compared. Chi-square tests were used to assess significant differences between the groups. The relationships between outcomes of interest and violence were estimated with logistic regression models adjusting for significant demographic and health characteristics. Overall, 28% of women reported experiences of partner violence. Women reporting partner violence had twice the adjusted odds of depression and three times the adjusted odds of negative self-esteem compared with women not reporting experiences of partner violence. Women reporting partner violence, compared with those who did not, indicated higher use of specific types of health and community services such as mental health services [odds ratio (OR) 2.9; confidence interval (CI) 1.5-5.6] and individual counseling (OR 3.6; CI 2.2-6.1). A community wide effort that establishes linkages between health care settings and community services may be important in addressing the needs of women who are experiencing partner violence. (author's)
Language: English
Keywords:
TENNESSEE | UNITED STATES OF AMERICA | EVALUATION REPORT | INTERVIEWS | SURVEYS | COMMUNITY | DOMESTIC VIOLENCE | WOMEN | MENTAL HEALTH | HEALTH | BEHAVIOR | UTILIZATION OF HEALTH CARE | Developed Countries | North America | Americas | Evaluation | Data Collection | Research Methodology | Sampling Studies | Studies | Residence Characteristics | Population Distribution | Geographic Factors | Population | Crime | Social Problems | Demographic Factors | Health Services | Delivery of Health Care
Document Number: 165486

14.
Title: Successful pregnancy in an adolescent woman with a communicating double uterine anomaly.
Author: Savitski JL; Olsen ME
Source: Journal of Pediatric and Adolescent Gynecology. 2001 Nov;14(4):181-183.
Abstract: Women with communicating double uterine anomalies are at increased risk for obstetric complications, including early pregnancy loss, preterm delivery, and breech presentation. We present the pregnancy of a woman with a previously diagnosed communicating double uterine anomaly. An 18-yr-old white female with a previous diagnosis at age 11 of a communicating double uterus, double cervix, and obstructed left hemivagina was followed during the course of her pregnancy. She experienced no complications until 36 6/7 weeks, when she was found to have signs and symptoms of mild preeclampsia. The fetus was in a breech presentation and a cesarean section was performed. Two hemiuteri were identified intraoperatively. The communication was not visualized. A viable male infant was delivered without complications. This patient represents only the sixth report of successful pregnancy in a woman with a Toaff type 5A communicating uterine anomaly. (author's)
Language: English
Keywords:
TENNESSEE | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | ADOLESCENTS, FEMALE | PREGNANT WOMEN | ADOLESCENT PREGNANCY | PREGNANCY COMPLICATIONS | UTERUS | VAGINAL ABNORMALITIES | CESAREAN SECTION | PREECLAMPSIA | PREGNANCY OUTCOMES | Developed Countries | United States of America | North America | Americas | Research Methodology | Studies | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction
Document Number: 299942

15.
Title: The predictive value of five different urinary LH kits in detecting the LH surge in regularly menstruating women.
Author: Ghazeeri GS; Vongprachanh P; Kutteh WH
Source: International Journal of Fertility and Women's Medicine. 2000 Sep-Oct;45(5):321-6.
Abstract: This prospective study compared the predictive value of five different urinary luteinizing hormone (LH) kits in detecting the LH surge in regularly menstruating, reproductive-age women. The study included 11 college-age females with regular menstrual cycles (28-32 days) who were not seeking pregnancy and agreed to participate in the study. The subjects were asked to collect urine daily from cycle 10 through 18. Urinary LH was quantified by radioimmunoassay (RIA), while transvaginal sonography was performed to document ovulation. The five urinary kits selected for testing were 1) ClearPlan Easy One-Step; 2) OvuKit Self-Test; 3) OvuQuick Self-Test; 4) Sure Step Ovulation Predictor; and 5) EZ-LH One Step Ovulation Kit. The findings indicated that the peak urinary LH values by RIA ranged from 13.5 to 73.0 mIU/ml, while the lowest levels detected as positive by the LH kits ranged from 25.5 to 48.7 mIU/ml. These findings suggest that all the commercial kits were able to detect a urinary surge at some level but with significant variability. The percentage of LH surges detected by the urinary kits ranged from 50% to 100%. The lowest value detected as positive varied almost two-fold between different kits. The authors recommend that manufacturers indicate the detection limits of their kits in mIU/ml.
Language: English
Keywords:
UNITED STATES OF AMERICA | TENNESSEE | RESEARCH REPORT | LUTEINIZING HORMONE | MENSTRUAL CYCLE | LABORATORY PROCEDURES | Developed Countries | North America | Americas | Gonadotropins, Pituitary | Gonadotropins | Hormones | Endocrine System | Physiology | Biology | Menstruation | Reproduction | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 153134

16.
Title: Isolated torsion of the fallopian tube in an adolescent: a case report.
Author: Lineberry TD; Rodriguez H
Source: Journal of Pediatric and Adolescent Gynecology. 2000 Aug;13(3):135-138.
Abstract: Isolated torsion of the fallopian tube is an uncommon event. It is a difficult condition to evaluate clinically and surgery if often necessary to establish the diagnosis. This report focuses on a 15-year-old female who presented with acute pelvic pain, nausea, and vomiting. Pelvic ultrasound showed an adnexal mass. A diagnostic laparoscopy was performed which confirmed the diagnosis of isolated tubal torsion. Based on this experience as well as other similar reported cases, isolated torsion of the fallopian tube should be considered in the differential diagnosis of acute lower abdominal/pelvic pain in the female patient. Prompt surgical intervention may allow for preservation of the tube. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | TENNESSEE | RESEARCH REPORT | CASE STUDIES | ADOLESCENTS, FEMALE | FALLOPIAN TUBES | TUBAL EFFECTS | LAPAROSCOPY | North America | Americas | Developed Countries | Studies | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 299792

17.
Title: Localization of concealed Norplant implants and implant fragments by a modified mammography technique.
Author: Rodriguez H; King B; Otis AM
Source: Journal of Pediatric and Adolescent Gynecology. 2000 Nov;13(4):163-166.
Abstract: A modified mammography technique for localization of concealed Norplant implants and Norplant fragments was applied to four patients, ages 18, 35, 22, and 25. A dedicated mammography unit and mammography film screen system affording high resolution and high contrast was applied under the same conditions to each patient. 26 kilovoltage peak (KVp) was used, ranging from 60 to 150 milliamperes. Using both the automatic exposure control and manual techniques, specific milliampere range depended on the specific case. The technique proved successful, as concealed Norplant capsules were exquisitely visualized by films obtained with a Siemens Mammomat 3000. Applying the same modified technique, precise location of the Norplant implants was determined using a fenestrated compression plate with an alphanumeric grid in a manner similar to hookwire localization of breast lesions under mammographic guidance. The capsules were then safely retrieved. We conclude that this modified technique may provide practitioners with valuable assistance in the exact localization of the Norplant capsule(s) or fragments, thereby facilitating their removal. Summary: Application of a modified mammography technique reveals precise localization of concealed Norplant capsules facilitating their removal. (author's)
Language: English
Keywords:
TENNESSEE | UNITED STATES OF AMERICA | SUMMARY REPORT | CASE STUDIES | CONTRACEPTIVE IMPLANTS | LEVONORGESTREL | MAMMOGRAM | Developed Countries | North America | Americas | Studies | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Examinations and Diagnoses
Document Number: 175137

18.
Title: Early childhood mortality from community-acquired infections.
Author: Cooper WO; Hickson GB; Mitchel EF; Edwards KM; Thapa PB; Ray WA
Source: AMERICAN JOURNAL OF EPIDEMIOLOGY. 1999 Sep 1;150(5):517-24.
Abstract: "The present study focused on deaths during a 10-year period [1985-1994] from confirmed community-acquired infections in children less than 5 years of age. The study was conducted in Tennessee and utilized linked birth and death certificate files, U.S. Census Bureau data, Medicaid enrollment files, and hospital medical records. The study objectives were to identify maternal and child characteristics that were independent predictors of death from infection and to determine if these factors could be used to identify a segment of the population with a substantial excess risk of mortality from infection, who might serve as target groups for future interventions." (EXCERPT)
Language: English
Keywords:
UNITED STATES OF AMERICA | TENNESSEE | CHILD MORTALITY | INFECTIONS | Developed Countries | North America | Americas | Mortality | Population Dynamics | Demographic Factors | Population | Diseases
Document Number: 257645

19.
Title: Reading skills and family planning knowledge and practices in a low-income managed-care population.
Author: Gazmararian JA; Parker RM; Baker DW
Source: OBSTETRICS AND GYNECOLOGY. 1999 Feb;93(2):239-44.
Abstract: The association between reading ability and contraceptive knowledge and practice was investigated in 406 women 19-45 years of age enrolled in a Medicaid managed care health plan (TennCare) in Memphis, Tennessee (US), in 1996. Patient reading ability was assessed by an abbreviated version of the Test of Functional Health Literacy of Adults. The majority of respondents were at least 25 years of age, Black, single, high school educated, employed, and poor. 9.6% of respondents had low reading skills (less than 80% correct). Pregnancy intendedness and current use of contraception did not vary by reading level. However, women who had ever relied on an IUD, douching, rhythm, or levonorgestrel implants for fertility control had higher rates of low reading skills than women who used other methods. Compared with women with good reading skills, women with low reading skills were 2.2 times (95% confidence interval (CI), 1.1-4.4) more likely to want to know more about birth control methods and 4.4 times (95% CI, 2.2-9.0) more likely to have incorrect knowledge about when during the menstrual cycle they were most at risk of pregnancy. These associations remained significant after controls for age, race, and marital status. Health care providers who work with poor, underserved populations should be aware of the limitations a low level of reading ability places on family planning education efforts. Innovative educational strategies that do not rely exclusively on written materials are recommended.
Language: English
Keywords:
TENNESSEE | UNITED STATES OF AMERICA | RESEARCH REPORT | CORRELATION STUDIES | LOW INCOME POPULATION | WOMEN | ILLITERATES | LITERACY | CONTRACEPTIVE METHODS CHOSEN | KNOWLEDGE | CONTRACEPTION | Developed Countries | North America | Americas | Statistical Studies | Studies | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Demographic Factors | Population | Educational Status | Contraceptive Usage | Family Planning
Document Number: 139451

20.
Title: Treatment of prepubertal girls with labial adhesions.
Author: Muram D
Source: Journal of Pediatric and Adolescent Gynecology. 1999 May;12(2):67-70.
Abstract: The purpose of this study was to evaluate the efficacy of topical estrogen therapy for the treatment of prepubertal girls with labial adhesions. This was a retrospective chart review at a pediatric and adolescent gynecology clinic in Memphis, Tennessee. Participants included 289 prepubertal girls who were referred for evaluation and treatment of labial adhesions. Interventions were gynecologic evaluation, topical estrogen, and manual and surgical labial separation. Main outcome measures were separation of labial adhesions and relief of symptoms. The use of topical estrogen resulted in a separation of the fused labia in approximately half of patients. Separation with the patient under topical or general anesthesia was required in the remaining patients. Further intervention may be required in many patients with labial adhesions after topical therapy with estrogens. Patients with dense, fibrous adhesions and girls who have undergone previous surgical separation of the labia are less likely to respond to topical estrogen therapy. (author's)
Language: English
Keywords:
TENNESSEE | RESEARCH REPORT | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | CHILD, FEMALE | ESTROGENS | DERMATOLOGICAL EFFECTS | GENITALIA, FEMALE | GYNECOLOGY | United States of America | North America | Americas | Developed Countries | Research Methodology | Studies | Child | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Hormones | Endocrine System | Physiology | Biology | Genitalia | Urogenital System | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 306344

21.
Title: Delayed first pregnancy among African-American adolescent smokers.
Author: Fiscella K; Kitzman HJ; Cole RE; Sidora K; Olds D
Source: JOURNAL OF ADOLESCENT HEALTH. 1998 Oct;23(4):232-7.
Abstract: Adolescent smoking has been linked to adolescent risk-taking behavior, including earlier and unprotected sexual activity, and drug use. The authors compared rates of adolescent pregnancy among Black adolescents who began smoking as adolescents against the rates of those who did not. Adolescent smoking was defined as a report of smoking before reaching age 18 years, while adolescent pregnancy was defined as pregnancy to women under age 18. Cross-sectional data on 1042 primiparous Black women enrolled in a randomized clinical trial of nurse home visitation were examined. Women in the study sample were aged 12-33 years, of mean age 17.9 years, at enrollment, 99% were unmarried, 85% were below 100% of the federal poverty level, and they had 10.2 mean years of education. After adjusting for drug use, contraceptive use, frequency of coitus, and infection with sexually transmitted diseases, women who smoked cigarettes during adolescence had a 50% lower risk of becoming pregnant as adolescents. When time to first pregnancy was examined as a continuous variable, adolescent smoking was associated with a delay in pregnancy of 22.6 months. These findings are consistent with previously reported findings based mainly upon adult White women. The nature of this relationship is unclear, but the data alone cannot establish causation between adolescent smoking and delay in pregnancy.
Language: English
Keywords:
UNITED STATES OF AMERICA | TENNESSEE | RESEARCH REPORT | URBAN POPULATION | ADOLESCENT PREGNANCY | ADOLESCENTS, FEMALE | BLACKS | WOMEN | TOBACCO USE | Developed Countries | North America | Americas | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Adolescents | Youth | Age Factors | Ethnic Groups | Cultural Background | Behavior
Document Number: 137643

22.
Title: Does child abuse predict adolescent pregnancy?
Author: Fiscella K; Kitzman HJ; Cole RE; Sidora KJ; Olds D
Source: PEDIATRICS. 1998 Apr;101(4 Pt 1):620-4.
Abstract: The impact of child sexual abuse on subsequent early sexual activity and adolescent pregnancy was investigated in 1026 primiparous African-American women (mean age, 17.9 years) who were participants in an experimental home visitation program connected to an inner-city teaching hospital in Memphis, Tennessee, in 1990-91. Mean age was 15.5 years at first intercourse and 17.3 years at first pregnancy. 12% of the women reported child sexual abuse before 13 years of age and 62% had experienced at least one episode of physical child abuse. Both types of abuse were associated with significantly lower mental health scores. Mean unadjusted age at first coitus was significantly lower in the sexually abused group (14.9 years) than among the nonabused (15.6 years), as was age at first pregnancy (16.7 and 17.4 years, respectively). After adjustment for confounding factors, child sexual abuse was associated with initiation of consensual sexual intercourse a mean of 7.2 months earlier; each incident of physical abuse was associated with a 1.3 day decrement in this age. When the effects of teen smoking, age of menarche, household income, single parent household, and urban upbringing were controlled, only sexual abuse remained a significant predictor of age at first pregnancy. Any instance of sexual abuse reduced this age by 9.7 months. These findings suggest that adolescents who disclose a history of sexual abuse should be targeted for family planning counseling and referral to a mental health service to reduce the risk of premature pregnancy. Prospective studies of the effects of child sexual and physical abuse on women from differing ethnic and socioeconomic groups are recommended.
Language: English
Keywords:
TENNESSEE | UNITED STATES OF AMERICA | RESEARCH REPORT | CORRELATION STUDIES | CHILD ABUSE | SEXUAL ABUSE | LONGTERM EFFECTS | FIRST INTERCOURSE | ADOLESCENT PREGNANCY | RISK FACTORS | PSYCHOLOGICAL FACTORS | BLACKS | WOMEN | Developed Countries | North America | Americas | Statistical Studies | Studies | Research Methodology | Crime | Social Problems | Time Factors | Population Dynamics | Demographic Factors | Population | Sex Behavior | Behavior | Reproductive Behavior | Fertility | Biology | Ethnic Groups | Cultural Background | Population Characteristics
Document Number: 132509

23.
Peer Reviewed

Title: Alterations in adolescents' sensory taste preferences during and after pregnancy.
Author: Skinner JD; Pope JF; Carruth BR
Source: Journal of Adolescent Health. 1998 Jan;22(1):43-49.
Abstract: The purpose of this study was to determine adolescents" preferences during and after pregnancy for foods that differed in fat, sugar, and salt content, components that are associated with much of the flavor in food and, hence, are related to food acceptance. Sensory taste preferences for 16 foods were assessed by 52 white adolescents during the third trimester of pregnancy and again 11-13 months postpartum. The study design was a randomized, incomplete block design. Each subject evaluated the same eight foods at each interview using a 10-cm hedonic scale, which was scored 0 = "dislike extremely" to 10 = "like extremely." Three pairs of foods differed in fat content (e.g., ice cream vs. ice milk), two pairs differed in sugar content, but neither contained a sugar substitute (e.g., peaches in heavy syrup vs. natural juices), and three pairs differed in salt content (e.g., salted vs. unsalted peanuts). Differences in preferences were determined with least-squares analysis of variance. Although preferences for 13 of the 16 foods did not differ between pregnancy and postpartum assessments, whole milk, skim milk, and salted peanuts were ranked significantly higher (p = 0.02, 0.007, and 0.05) during pregnancy. Hedonic scores were higher (p = 0.002 and 0.005) for whole milk over skim at both assessments, but ice cream was not preferred significantly over lower fat frozen products. During pregnancy, but not after, salted peanuts, chips, and crackers were preferred (p = 0.0003, 0.0001, and 0.03) over the unsalted/low-salt products. The adolescents" increased sensory taste preferences for milk and salty snack foods during pregnancy, as well as personal taste preferences, should be recognized by clinicians, and nutrition recommendations should be individualized to enhance compliance. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | TENNESSEE | RESEARCH REPORT | ADOLESCENTS, FEMALE | ADOLESCENT PREGNANCY | DIET | FOOD AND BEVERAGE | CALORIC INTAKE | North America | Americas | Developed Countries | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Nutrition | Health
Document Number: 301825

24.
Peer Reviewed

Title: Development of the AIDS Health Belief Scale (AHBS).
Author: Zagumny MJ; Brady DB
Source: AIDS Education and Prevention. 1998;10(2):173-9.
Abstract: The AIDS Health Belief Scale (AHBS) was developed to measure the four components of the health belief model (HBM): perceived susceptibility to disease, perceived severity of a specific disease, perceived benefits of preventive behavior, and barriers to preventive behavior. 16 items were developed for the original AHBS. Results of the first phase of AHBS development showed that all 16 items correlating significantly (P < 0.001) with total AHBS scores, collected from 216 undergraduate students. The second phase involved results from 401 completed AHBS and demonstrated a high degree of internal consistency with alphas ranging from 0.82 to 0.93. In addition, factor analysis was conducted to determine the underlying structure of the scale. Results demonstrated that four factors (consistent with the four components of the HBM) explained 64% of the variance in response patterns. Implications for future HIV preventive research and education programs are discussed. (author's)
Language: English
Keywords:
TENNESSEE | UNITED STATES OF AMERICA | RESEARCH REPORT | CORRELATION STUDIES | RELIABILITY | FACTOR ANALYSIS | AIDS PREVENTION | HIV PREVENTION | RISK REDUCTION BEHAVIOR | Developed Countries | North America | Americas | Statistical Studies | Studies | Research Methodology | Measurement | Data Analysis | AIDS | HIV Infections | Viral Diseases | Diseases | Behavior
Document Number: 150114

25.
Title: Genital Chlamydia trachomatis infection in pregnant adolescents in east Tennessee: a 7-year case-control study.
Author: Chokephaibulkit K; Patamasucon P; List M; Moore B; Rodriguez H
Source: JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY. 1997 May;10(2):95-100.
Abstract: A retrospective review of the medical records of the 596 adolescents presenting for prenatal care at the University of Tennessee Medical Center (Knoxville, Tennessee) in 1988-94 examined the prevalence, symptomatology, and risk factors associated with urogenital chlamydial infection in pregnancy. 67 teens (11.24%) were diagnosed with chlamydial infection at their first prenatal visit; 56 non-infected pregnant teens of similar age and socioeconomic status who presented for prenatal care on the same days as cases were designated as controls. Multivariate analysis identified only two significant risk factors for chlamydia: Black race (odds ratio (OR), 4.01; 95% confidence interval (CI), 1.74-9.23) and greater gestational age at first prenatal visit (OR, 1.11; 95% CI, 1.04-1.18). Age, marital status, number of pregnancies, smoking, alcohol or drug use, age at first intercourse, and multiple sex partners were not associated with infection. 70-80% of women with chlamydia experienced no symptoms. Although human papillomavirus infection, trichomonal infection, and dysplasia or atypia were more frequent in cases than controls, the difference was not significant. Treatment with erythromycin base was associated with a cure rate of 95.5%. Given the lack of reliable predictive factors and specific symptoms of chlamydia, routine prenatal screening is recommended.
Language: English
Keywords:
TENNESSEE | UNITED STATES OF AMERICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CASE CONTROL STUDIES | ADOLESCENT PREGNANCY | ADOLESCENTS, FEMALE | PREGNANT WOMEN | CHLAMYDIA | RISK FACTORS | SCREENING | ANTENATAL CARE | PREVENTION AND CONTROL | Developed Countries | North America | Americas | Studies | Research Methodology | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Adolescents | Youth | Age Factors | Population Characteristics | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Biology | Examinations and Diagnoses | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health
Document Number: 128994

26.
Title: Factors associated with elective Norplant removal in Black and White women.
Author: Opara JU; Ernst FA; Gaskin H; Smith L; Nevels HV
Source: JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION. 1997 Apr;89(4):237-40.
Abstract: Premature removal of contraceptive implants (Norplant) is a cause of a sizable national medical expenditure in the US. Understanding the factors that influence the decision to remove the implants and being able to predict which users are likely to elect discontinuation prematurely could provide useful information for counseling patients as they are considering contraceptive implants so that potentially enormous long-term savings could be achieved. This study surveyed 98 women who had Norplant inserted and removed between January 1991 and December 1994. Data were collected from chart review, and, when necessary, a questionnaire was used to extract information not found in the chart. The chi-squared statistic and t-test were used to compare demographic variables. All but one subject received comprehensive pre-implant counseling. The main reason given for electively removing the Norplant prematurely was irregular menstrual bleeding (60%). Pre-implant counseling did not influence the decision for removal. These results indicate the importance of clarifying patients' doubts regarding menstrual bleeding irregularities during follow-up visits rather than relying on the information patients received during pre-implant counseling. (author's modified)
Language: English
Keywords:
TENNESSEE | UNITED STATES OF AMERICA | RESEARCH REPORT | SURVEYS | BLACKS | WHITES | CONTRACEPTION TERMINATION | CONTRACEPTIVE IMPLANTS | LEVONORGESTREL | MENSTRUATION DISORDERS | BLEEDING | COUNSELING | WOMEN | SIDE EFFECTS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | Developed Countries | North America | Americas | Sampling Studies | Studies | Research Methodology | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Contraceptive Methods | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Diseases | Signs and Symptoms | Clinic Activities | Program Activities | Programs | Organization and Administration | Treatment
Document Number: 125569

27.
Title: Senate bill 2394. An act to amend Tennessee Code Annotated, Title 39, Chapter 13, to enact the "Prohibition of Female Genital Mutilation Act of 1996".
Author: United States. Tennessee. Senate
Source: [Unpublished] 1996. [2] p.
Abstract: This paper presents a Senate bill 2394 amending the Tennessee Code Annotated, Title 39, Chapter 13, to enact the "Prohibition of Female Genital Mutilation Act of 1996". The new provision stated that except as otherwise permitted, whoever knowingly circumcises, excises, or infibulates in whole or in part, the labia majora, labia minora, or clitoris of another commits a Class D felony. However, the surgical procedure is not a violation if is it necessary to the health of the person and is connected with medical purposes, such as after giving birth, and should be performed by a licensed physician. This act shall take effect July 1, 1996, as the public welfare required it.
Language: English
Keywords:
TENNESSEE | UNITED STATES OF AMERICA | LAWS AND STATUTES | FEMALE GENITAL CUTTING | LEGISLATION | PREVENTION AND CONTROL | Developed Countries | North America | Americas | Harmful Traditional Practices | Traditional Health Practices | Culture | Diseases
Document Number: 135361

28.
Title: Demographic data and geographic information systems for decision making: the case of public health.
Author: Gobalet JG; Thomas RK
Source: POPULATION RESEARCH AND POLICY REVIEW. 1996 Dec;15(5-6):537-48.
Abstract: The definition of health has been broadened and renewed focus given to public health in the US health care system. As such, demographic analyses are increasingly incorporated into public health decision-making. Analysts are also using geographic information more routinely because Geographic Information System (GIS) software is becoming easier to use. This paper describes three cases in which demographers used the GIS to analyze the spatial distribution of public health data. One case from Santa Clara County, California, focuses upon adolescent sexually transmitted diseases in secondary school districts, while another case maps preventable hospitalizations of senior citizens in the same county. The third case examines the distribution of premature births in Tennessee counties. The researchers applied demographic techniques and perspectives in each case, and each case produced information which is being used by officials who plan health education campaigns and services.
Language: English
Keywords:
CALIFORNIA | TENNESSEE | UNITED STATES OF AMERICA | SUMMARY REPORT | DEMOGRAPHICS | GEOGRAPHIC FACTORS | INFORMATION RETRIEVAL SYSTEMS | PUBLIC HEALTH | DECISION MAKING | Developed Countries | North America | Americas | Demography | Social Sciences | Population | Data Storage and Retrieval | Information Processing | Information | Health | Behavior
Document Number: 120751

29.
Title: The effect of expansions in Medicaid income eligibility on abortion.
Author: Joyce T; Kaestner R
Source: DEMOGRAPHY. 1996 May;33(2):181-92.
Abstract: The issue of abortion has provoked a sustained and volatile public debate in the US. One federal government social policy which may affect abortion is the public funding of prenatal and pediatric health care for low-income women. Between 1987 and 1991, states expanded Medicaid income eligibility in response to federal initiatives, making many women eligible for free health care associated with a birth. As a result, the proportion of all births financed by Medicaid increased from 14.5% in 1985 to 32% by 1991. Together with these expansions in Medicaid eligibility, the fertility rate in the US rose by 6.5% over the period 1986-91, while the abortion rate fell from 28.0 per 1000 women aged 15-44 to 25.9 by 1992. These data suggest that recent changes in Medicaid eligibility may have had a significant impact upon pregnancy outcomes. The authors estimated the effect of expansions in Medicaid income eligibility upon pregnancy outcomes using individual-level data from South Carolina, Tennessee, and Virginia. They found that for unmarried, non-Black women with less than a high school degree, the expansions of income eligibility lowered the probability of abortion by 2-5%. Most of the impact of the Medicaid expansions upon abortion occurred during the first round of expansions from approximately 45% of the federal poverty level to 100%. For Black unmarried women with less than a high school degree, the expansions in Medicaid income eligibility therefore had generally no effect upon abortion.
Language: English
Keywords:
SOUTH CAROLINA | TENNESSEE | VIRGINIA | UNITED STATES OF AMERICA | RESEARCH REPORT | ABORTION | ABORTION RATE | TITLE 19 MEDICAL ASSISTANCE | CHANGES | North America | Americas | Developed Countries | Fertility Control, Postconception | Family Planning | Public Assistance | Government Financing | Financial Activities | Economic Factors | Social Change
Document Number: 113994 Notification

30.
Title: Factors related to planned and unplanned pregnancies.
Author: Rosenfeld JA; Everett KD
Source: JOURNAL OF FAMILY PRACTICE. 1996 Aug;43(2):161-6.
Abstract: In the summers of 1994 and 1995 in northeastern Tennessee, 110 pregnant women 16-37 years old were interviewed either before or after their prenatal care appointment at an outpatient family practice clinic in Bristol. The researchers aimed to identify factors associated with planned and unplanned pregnancies. 39 (35%) women had planned their pregnancy while the remaining 71 (65%) women did not. Divorced or never married women were more likely to have an unplanned pregnancy than a planned pregnancy (47% vs. 19%; p < 0.01). Women with an unplanned pregnancy were more likely to have been using contraception at time of conception than women with a planned pregnancy (23% vs. 3%). They were also more likely to use no contraception or to practice withdrawal before the index pregnancy than women with a planned pregnancy (31% vs. 13%; p < 0.05). All the women in both groups had no problem with availability of their choice of family planning method. Women with an unplanned pregnancy were much more likely than those with a planned pregnancy to be influenced by their partner in terms of contraceptive choice (37% vs. 19%; p = 0.04). Women with a planned pregnancy were more likely to be satisfied or very satisfied with their contraception than those with an unplanned pregnancy (62% vs. 43%). The differences in satisfaction only approached statistical significance, however (p = 0.065). Based on these findings, the family practice researchers suggested that, in order to reduce unplanned pregnancies, clinicians should provide women counseling on their contraception expectations and a careful explanation of the side effects of their contraceptive choice. Male partners or sexually active men should also receive counseling about contraceptive options. Another important step is further research to better understand factors that contribute to satisfaction with contraception.
Language: English
Keywords:
UNITED STATES OF AMERICA | TENNESSEE | CORRELATION STUDIES | PREGNANCY, PLANNED | PREGNANCY, UNPLANNED | MARITAL STATUS | CONTRACEPTIVE USAGE | SATISFACTION | ATTITUDES | COUNSELING | Developed Countries | North America | Americas | Statistical Studies | Studies | Research Methodology | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Nuptiality | Contraception | Family Planning | Psychological Factors | Behavior | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 116994


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