HER Salt Lake Papers


Contraceptive Method Use During the Community-Wide HER Salt Lake Contraceptive Initiative. Jessica N. Sanders, Kyl Myers, Lori Gawron, Rebecca G. Simmons, David K. Turok. American Journal of Public Health | February 2018

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Objectives. To describe a community-wide contraception initiative and assess changes in methoduse when cost and access barriers are removed in an environment with client-centered counseling.

Methods. HER Salt Lake is a prospective cohort study occurring during three 6-month periods (September 2015 through March 2017) and nested in a quasiexperimental observational study. The sample was women aged 16 to 45 years receiving new contraceptive services at health centers in Salt Lake County, Utah. Following the control period, intervention 1 removed cost and ensured staffing and pharmacy stocking; intervention 2 introduced targeted electronic outreach. We used logistic regression and interrupted time series regression analyses to assess impact.

Results. New contraceptive services were provided to 4107 clients in the control period, 3995 in intervention 1, and 3407 in intervention 2. The odds of getting an intrauterine device or implant increased 1.6 times (95% confidence interval [CI] = 1.5, 1.6) during intervention 1 and 2.5 times (95% CI = 2.2, 2.8) during intervention 2, relative to the control period. Time series analysis demonstrated that participating health centers placed an additional 59 intrauterine devices and implants on average per month (95% CI = 13, 105) after intervention 1.

Conclusions. Removing client cost and increasing clinic capacity was associated with shifts in contraceptive method mix in an environment with client-centered counseling; targeted electronic outreach further augmented these results. (Am J Public Health. Published online ahead of print February 22, 2018: e1–e7. doi:10.2105/AJPH.2017.304299)


1 in 3: Utah Family Planning Clinics Challenge Heteronormative Assumptions. Bethany Everett, Jessica N. Sanders, Kyl Myers, Claudia Geist, & David K. Turok. Contraception. | June 2018.

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Objectives. To estimate the prevalence of sexual-minority women among clients in family planning centers and explore differences in LARC uptake by both sexual identity (i.e., exclusively heterosexual, mostly heterosexual, bisexual, lesbian) and sexual behavior in the past 12 months (i.e., only male partners, both male and female partners, only female partners, no partners) among those enrolled in the survey arm of the HER Salt Lake Contraceptive Initiative.

Methods. This survey categorized participants into groups based on reports of sexual identity and sexual behavior. We report contraceptive uptake by these factors, and we used logistic and multinomial logistic models to assess differences in contraceptive method selection by sexual identity and behavior.

Results. Among 3901 survey respondents, 32% (n=1230) identified with a sexual-minority identity and 6% had had a female partner in the past 12 months. By identity, bisexual and mostly heterosexual women selected an IUD or implant more frequently than exclusively heterosexual women and demonstrated a preference for the copper T380 IUD. Exclusively heterosexual and lesbian women did not differ in their contraceptive method selection, however, by behavior, women with only female partners selected IUDs or implants less frequently than those with only male partners.

Conclusion. One in three women attending family planning centers for contraception identified as a sexual minority. Sexual-minority women selected IUDs or implants more frequently than exclusively heterosexual women.

Implications. Providers should avoid care assumptions based upon sexual identity. Sexual-minority women should be offered all methods of contraception and be provided with inclusive contraceptive counseling conversations.


Beyond Intentions: The Relationship Between Feelings about Pregnancy and Contraceptive Choices. Claudia Geist, Jessica N. Sanders, Bethany Everett, Kyl Myers, Abigail Aiken, Patty Cason, & David K. Turok. Contraception. | August 2018.

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Objectives. To explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important is pregnancy prevention) about hypothetical pregnancies and associations with contraceptive method selection among individuals who present as new contraceptive clients and desire to prevent pregnancy for at least 1 year.

Study Design.The HER Salt Lake Contraceptive Initiative provided no-cost contraception to new contraceptive clients for 1 year at family planning health centers in Salt Lake County. Those who wanted to avoid pregnancy for at least 1 year and completed the enrollment survey are included in the current study. We used Poisson regression to explore the association between survey-adapted PATH questions and contraceptive method selection.

Results. Based on an analytic sample of 3121 individuals, we found pregnancy timing and happiness about hypothetical pregnancies to be associated with method selection. Clients who report plans to wait more than 5 years [prevalence rate (PR) 1.14; 95% confidence interval (CI) 1.05–1.24], those who never wanted to become pregnant (PR 1.16; 95% CI 1.07–1.26) or those who were uncertain (PR=1.19; 95% CI 1.09–1.30) were all more likely to select IUDs and implants than women who reported wanting to become pregnant within 5 years. Greater happiness was associated with lower chance of choosing an IUD or implant (PR 0.98; 95% CI 0.96–0.999). Expressed importance of pregnancy prevention was not significantly associated with any specific contraceptive choice.

Conclusions. Pregnancy intentions and happiness about a hypothetical pregnancy were independently associated with selection of IUDs and implants.

Implications. Pregnancy attitudes, plans and emotions inform clients' contraceptive needs and behaviors. Client-centered contraceptive care may benefit from a more nuanced PATH approach rather than relying on a single time-oriented question about pregnancy intention.


HER Salt Lake Posters

Acknowledgments

Support from the Society of Family Planning Research Fund, the William and Flora Hewlett Foundation, and an anonymous foundation. Contraceptive support from: Bayer Women’s Healthcare, Merck & Co. Inc., and Teva Pharmaceuticals. Use of REDCap provided by Eunice Kennedy Shriver National Institute of Child Health and Development grant (8UL1TR000105 (formerly UL1RR025764) NCATS/NIH). The Eunice Kennedy Shriver National Institute of Child Health & Human Development supports JNS via Award Number K12HD085852 and DKT via K24HD087436. We also want to thank the HER Salt Lake research team and all the participants. 

  1. Comparing Reduced-Cost Versus No-Cost Contraception on Postabortal Contraceptive Method Mix: A Prospective Cohort Study. Ashley E. Benson, Holly Bullock, Jessica N. Sanders, & David K. Turok. The North American Forum on Family Planning. Atlanta, Georgia | October 2017.

  2. Predictors of Contraceptive Method Switching and Discontinuation Six Months Post-abortion. Jennifer E. Kaiser, Rebecca Simmons, Kyl Myers, Jessica N. Sanders, Lori Gawron, & David K. Turok. The North American Forum on Family Planning. New Orleans, Louisiana | October 2018.

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  3. Changing Lives, Shifting Plans? The Relationship Between Circumstances and Pregnancy Intentions and Emotions. Claudia Geist, Kyl Myers, Rebecca Simmons, Jessica N. Sanders, Lori Gawron, Bethany Everett, & David K. Turok. The North American Forum on Family Planning. New Orleans, Louisiana | October 2018.

Acknowledgments

Support from the Society of Family Planning Research Fund, the William and Flora Hewlett Foundation, and an anonymous foundation. Contraceptive support from: Bayer Women’s Healthcare, Merck & Co. Inc., and Teva Pharmaceuticals. Use of REDCap provided by Eunice Kennedy Shriver National Institute of Child Health and Development grant (8UL1TR000105 (formerly UL1RR025764) NCATS/NIH). The Eunice Kennedy Shriver National Institute of Child Health & Human Development supports JNS via Award Number K12HD085852 and DKT via K24HD087436. We also want to thank the HER Salt Lake research team and all the participants.