Access to emergency contraception on US college campuses

Abstracts / Contraception 76 (2007) 157–178 Bandura's Social Cognitive Theory were used to test the effects of the education intervention. Instruments used included the Sexually Transmitted Infection Knowledge Survey (STIKS) and the Sexual Self-Efficacy Survey.

Results: Significant differences from pretest to posttest were obtained between the experimental and control group on knowledge of STIs (pb.001). The education intervention on sexual self-efficacy also resulted in significant difference between groups at posttest on refusing sexual intercourse (pb.001), questioning potential sex partners (pb.001) and condom use (pb.001). These findings indicate that the brief (30-min) education intervention had an effect on the experimental group. Conclusion: The findings of the study indicate the importance of healthcare providers reinforcing cultural competent STI information during clinical encounters with African-American women. African-American women need to understand that STIs contribute greatly to morbidity associated with reproductive health. P22 SEX, THAT ACT, INTERCOURSE, DOING IT: THE LANGUAGE OF SEXUAL HEALTH IN E-MAILS TO THE EMERGENCY CONTRACEPTION WEBSITE Wynn LL Office of Population Research, Princeton University, Princeton, NJ, USA Foster AM, Trussell J

Introduction: The words and metaphors that people use to describe health and sexuality reflect experiences with peers, sexual partners, health service providers and public health campaigns. This study analyzes the terminology used in e-mails to the emergency contraception website to explore the language used to describe contraception, sexual acts and reproductive health. Methods: We analyzed 1134 e-mails received during 1 year. We tracked different terms for emergency contraception and other contraceptive methods, sexual acts, sexual organs and fluids, bleeding, reproductive processes and embryos. We performed a quantitative assessment of language use and analyzed the terminology in context. In contrast with methodologies that use computer-assisted keyword searches, our analysis involved reading each e-mail to identify content that may be missed by computer searches, including terms that may not have been anticipated by study authors, long phrases and expressions, and misspelled terms. Results: The meanings given to terms for “sex” and “unprotected sex” varied widely. One striking finding was the number of writers who described sex without a condom but with a hormonal contraceptive as “unprotected sex.” We argue that the contexts where assessments of sexual activity take place — whether evaluating pregnancy risk, disease transmission risk or moral risk — influence the definitions people give to terms with culturally contested definitions, such as “sex.”

Conclusion: Confusion over what constitutes protection from unintended pregnancy may be the unintended effect of public health campaigns designed to educate the public about protecting themselves against STI transmission. We discuss the implications for doctor–patient communication and health education campaigns. P23

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Materials and Methods: Research participants were male and female African-American and Hispanic adolescents between the ages of 15 and 21 from community-based agencies in New York City. Short surveys (n=57) were administered to determine general EC awareness. Semi-structured indepth interviews (n=18) were conducted to gather thoughts, feelings and experiences with EC and other birth control methods. Finally, four additional focus groups were held to supplement the original data with respect to the FDA's recent approval of behind-the-counter sale of EC. Results: Over half of the survey sample responded “yes” when asked if a woman could prevent pregnancy after sex. When asked to list the most common terminology for emergency contraception, half mentioned “the morning-after pill,” one-third said “emergency contraception” and a quarter said “Plan B.” Two-thirds reported that they would use EC if needed. The most common misconception involved confusing EC with the abortion pill. Conclusion: Participants seemed aware of the existence of EC, but were unclear about what it is, how it works or the specifics of where to get it. Along with the provision of information on teen knowledge and attitudes around EC, interviews and focus groups highlight the need for further education and outreach around this valuable birth control method. P24 EMERGENCY CONTRACEPTION: BARRIER OR BRIDGE TO EFFECTIVE CONTRACEPTION? Moreau C Office of Population Research, Princeton, NY, USA Trussell J, Michelot F, Bajos N

Introduction: No studies up to date have shown that improved access to emergency contraceptive pills (ECPs) results in reduced unintended pregnancy rates. While this lack of a direct public health impact may be disappointing, more indirect benefits of ECPs on regular contraception use still need to be investigated. In this study, we examine the impact of ECP use on women's regular contraceptive use patterns in the French context of direct pharmacy access to ECPs. Materials and Methods: The study was drawn from the COCON survey, a French population-based cohort of 2863 women (18–44 years) interviewed by telephone each year (2000 and 2004) on their contraceptive practices and recourse to abortion. The analysis included 272 ECP episodes. Results: ECPs were essentially used to compensate for contraceptive errors: 45% of episodes resulted from inconsistent pill use and 35% from misuse of condoms. Six months after ECP use, women were more likely to use highly effective methods of contraception (61% vs. 49%, pb.001) and less likely to use condoms (25% vs. 33%, pb.001) than at the time of ECP use. The same situation was true 6 months before ECP use. Analysis of individual contraceptive paths from the time of 6 months after ECP use shows a continuous pattern of use in 71% of the cases: highly effective methods (41%) or non-highly effective methods (30%). Twenty percent switched from non-highly to highly effective methods. Conclusion: This study suggests that the elimination of the prescription requirement for ECPs does not hinder building a bridge to more effective contraceptive use. P25

THERE IS ALWAYS PLAN B: ADOLESCENT KNOWLEDGE, ATTITUDES AND INTENTION TO USE EMERGENCY CONTRACEPTION

ACCESS TO EMERGENCY CONTRACEPTION ON US COLLEGE CAMPUSES

Cohall AT Harlem Health Promotion Center, Harlem, NY, USA

Devine K Albert Einstein College of Medicine, New York, NY, USA

Nye A, Nshom M

Hessing E, Gold M

Introduction: Little is known about adolescent and young adult knowledge and utilization of emergency contraception (EC). Therefore, we conducted short surveys, in-depth interviews and focus groups with high-risk youth in NYC to ascertain general EC awareness and opinions on EC availability.

Introduction: College-aged women have high rates of unintended pregnancy. Little data exist regarding information given to students by student health centers (SHCs) on emergency contraception (EC), especially at crucial times such as weekends.

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Abstracts / Contraception 76 (2007) 157–178

Materials and Methods: Researchers posed as students seeking EC 48 h after unprotected intercourse and called SHCs at 50 US colleges, both on weekdays and Sunday afternoons. Results: During business hours, 29/50 (58%) could dispense EC promptly, although 21% of these required a pregnancy test or pelvic exam. Two centers gave misinformation, specifically that “EC is abortifacient” and “EC is only efficacious within 24 hrs.” Reasons for not providing EC included no reason (n=10), religious affiliation (n=8), and staff discomfort, no perceived need and lack of resources (n=1 for each). On Sundays: only 3/50 (6%) of SHCs could dispense EC. Another 6% referred callers to alternative providers (one via recorded message); none of these gave misinformation. Most (44/50, 88%) could not answer questions or provide EC, 15 gave no answer, 15 gave instructions to call security/911 or go to ED and 14 required student's information (often including insurance) to have nurse/doctor return call. Conclusions: Most SHCs provided EC and correct information during business hours, with little variation by geography. Small and religiously affiliated institutions were less likely to provide EC. Outside business hours, the majority were unable to provide information or a prescription. Answering machine referral provided an effective alternative to limited weekend staffing but was only used by 2%. Further study of this population's use of EC following OTC status is warranted.

uterine vessel reanastomosis (pig, sheep, goat), (2) to determine the rates of “successful” uterine transplant by assessing histological studies and tissue rejection, (3) to develop a control group to determine the success rate of pregnancy (sheep) and (4) to evaluate the role of omentopexy as a source of neovascularization for the transplanted uterus (dogs).

Materials and Methods: Our research project explores the feasibility of uterine transplantation by comparing avascular and vascular uterine transplantations and by exploring the impact of immunosuppressive therapy on fertility. Our endpoint is delivery of a viable live born from the transplanted organ. As we develop surgical methods and techniques, pathological assessment of vascularity, and tissue rejection will be quantified.

Results: Our preliminary results demonstrate the following: an 80% success rate in dogs (n=11), a 66% mortality rate in pigs (n=9), a 94% success rate in ovine (n=42) and cabra (n=14) allo-transplantation models, with a 7% pregnancy rate in sheep. Our preliminary results were comparable to the above with the exception of higher mortality in pigs. Animals that died underwent complete necropsy with sampling of tissue to document the presence and extent of neovascularization and/or tissue rejection.

Conclusion: By exploring the different alternatives for fertility such as in vitro fertilization, gamete intrafallopian tube transfer, intracytoplasmic sperm injection and surrogacy, the uterine transplant may be considered another alternative for infertility.

P26 P28 STATEWIDE EC AVAILABILITY IN NEBRASKA Bruner M University of Nebraska Medical Center, Omaha, NE, USA

INTIMATE PARTNER VIOLENCE IN POSTPARTUM WOMEN

Amoura J

Certain H Wm S Middleton Memorial VA Hospital, Madison, WI, USA

Introduction: The state of Nebraska ranked 51st in the Guttmacher

Mueller M, Jagodzinski T, Fleming M

Institute's 2006 assessment of states' efforts to help women avoid unintended pregnancy. This study sought to report on the current availability or intention to stock EC at Nebraska pharmacies after the August 2006 approval for over-the-counter (OTC) use.

Materials and Methods: All pharmacies listed by the Nebraska Department of Health and Human Services were catalogued. Pharmacies were contacted for telephone interview from November 2006 to March 2007 using stratified sampling of urban and rural areas. The head pharmacist was asked about current availability or future plans to stock EC and management of clients requesting EC. Reasons for not carrying EC were elicited. Results: Fifty-two pharmacies agreed to participate, 33 in urban areas, 19 in rural areas. In urban areas, 70% currently stock EC and 30% do not. In rural areas, 47% stock EC while 53% do not. OTC status appeared to have little or no influence on pharmacy stocking decisions for EC. The most frequent reason given for not stocking EC was lack of demand, followed by pharmacists unwilling to dispense EC and lack of training in patient counseling. Conclusion: Nebraska is a state with significant need for increased access to family planning. Inadequate availability of EC in pharmacy inventories, both urban and rural, may serve as one barrier. Because lack of demand for EC is the most commonly cited reason for its unavailability, greater public awareness programs may increase demand and therefore supply of EC.

P27 AN ANIMAL MODEL OF UTERINE AUTO- AND ALLO-TRANSPLANTATION WITH A SUCCESSFUL PREGNANCY Ramirez E New York Medical College, Pasadena, TX, USA Ramirez H, Ramirez D, Pillari V, Baldwin D, Ramirez J

Introduction: The purpose of this project was fourfold: (1) to investigate an animal model of uterine transplantation after ovarian vessel ligation and

Introduction: Intimate partner violence (IPV) has a negative effect on the health of many women, making it imperative for physicians to identify victims of abuse. While multiple studies have identified risk factors for IPV, few studies have examined the relationship between postpartum depression and IPV. This study describes the prevalence of IPV in women presenting for a postpartum visit and examines factors associated with IPV, including postpartum depression, alcohol use and socio-demographic characteristics. Materials and Methods: This study used a cross-sectional survey of women presenting for a post-partum visit at 35 clinics between 2002 and 2005. Multivariate logistic regression was used to determine the characteristics of women reporting IPV in the past year. Results: Valid surveys were received from 1519 women. One hundred twelve (7.4%) women had been emotionally or physically abused in the previous 12 months. Women who reported abuse were more likely to screen positive for postpartum depression [odds ratio (OR) 4.21, 95% CI 2.19–8.09]. Other risk factors for IPV included being unmarried (OR 7.05, 95% CI 3.39–14.64), being aged 36 and over (OR 2.45, 95% CI 1.10–5.50), being not in the labor force (OR 2.39, 95% CI 1.16–4.90), Hispanic race (OR 2.73, 95% CI 1.07–6.96) and having a partner who is a binge drinker (OR 3.09, 95% CI 1.49–6.43). Conclusion: One in 15 women who present for a postpartum visit report emotional or physical abuse in the previous year. Physicians should screen for IPV in postpartum women with depression and those who are unmarried, older, stay-at-home moms and of Hispanic ethnicity. P29 THE PREVALENCE OF DOMESTIC VIOLENCE IN WOMEN WHO VOLUNTEER FOR GYNECOLOGIC RESEARCH STUDIES Kazi S University of Pittsburgh, Pittsburgh, PA, USA Reeves MF, Creinin MD