An evaluation of the Be Your Own Baby public awareness campaign.

OBJECTIVE: Assess the impact of the Be Your Own Baby (BYOB) public awareness campaign including population-level exposure, the effectiveness of ad platforms, and the effect of the campaign on family planning clinic attendance, the campaign's primary goal. DATA SOURCES: The study relied on administrative data on traffic and engagement from the campaign's website, population survey data measuring campaign exposure, and clinic attendance volumes from state-by-year restricted-use versions of the Office of Population Affairs' Family Planning Annual Reports (2006-2018). STUDY DESIGN: Bivariate analyses were used to assess website traffic and engagement and population-level exposure across key subgroups. We then used the synthetic control method to examine the impact of the BYOB campaign on per capita Title X clinic attendance among the target demographic, women 18-29 years of age. DATA COLLECTION/EXTRACTION METHODS: Not applicable. We relied on secondary sources. PRINCIPAL FINDINGS: Primary media platforms used by the campaign included social media, digital display, streaming audio, YouTube, and search. Website traffic was driven primarily by digital display ads, but engagement was highest for search. Our results suggest nearly 12% of Delaware women 18-29 years of age were exposed to the campaign. However, exposure was measured at the end of the campaign and was likely much larger during its peak. Our results indicated that the campaign was associated with between 13 and 23 additional Title X clinic visits per 1000 women compared with 110 users per 1000 at baseline in 2014. CONCLUSIONS: Our findings suggest the BYOB campaign was successful at increasing clinic attendance among the target demographic. These results have important implications for other programs seeking to use public awareness messaging to increase participation in the health care system and are especially important for Title X administrators who have faced declining patient volumes for over 10 years.

Postpartum contraception method type and risk of a short interpregnancy interval in a state Medicaid population.

OBJECTIVE: To evaluate the likelihood of a short interpregnancy interval (IPI) resulting in a birth among women covered by Medicaid, as a function of postpartum contraceptive method type. STUDY DESIGN: We used Medicaid claims and eligibility data to identify women (aged 15-44) who had a Medicaid-financed birth in Delaware in the years 2012-2014 (n = 10,328). Claims were analyzed to determine postpartum contraceptive type within 60 days of the index birth, and linked birth certificates were used to determine the incidence and timing of a subsequent birth through 2018 (regardless of payer). We used logistic regression to analyze the likelihood of having a short IPI following the index birth as a function of postpartum contraceptive type, controlling for preterm births, parity, having a postpartum checkup, and maternal characteristics including age, race, education, and marital status. RESULTS: Compared to patients receiving postpartum long-acting reversible contraceptive methods (LARC), patients with no contraceptive claims had nearly 5 times higher odds (odds ratio [OR] = 4.98, confidence interval [CI] = 3.05-8.13) and those with claims for moderately effective methods (injectable, pill, patch, or ring) had 3.5 times higher odds (OR = 3.51, CI = 2.13-5.77) of a subsequent birth following a short IPI. CONCLUSIONS: In a state population of Medicaid-enrolled women, women with claims for postpartum LARC had substantially lower risk of a short IPI resulting in a birth. IMPLICATIONS: Women who received LARC within 60 days postpartum are less likely to experience a short interpregnancy interval resulting in a birth. The evidence suggests that recent state policy changes that make postpartum LARC more accessible to those that desire it will be an effective strategy in helping patients obtain desired birth intervals.

"Power of Mom": A Mixed Methods Investigation of Mothers' Influence on Women's Contraceptive Attitudes and Behaviors.

OBJECTIVES: Unintended pregnancy is an individual and public health problem with significant social and economic consequences. The literature has established that parents, especially mothers, play an important role in shaping the contraceptive attitudes and behaviors of young women and could therefore affect the likelihood of their daughter experiencing an unintended pregnancy. However, research has yet to fully explore the nuances of how mothers influence their daughters with respect to contraception. METHODS: We conducted a mixed methods study to explore the impact of mothers on women's contraceptive attitudes and behaviors. In-depth interviews were conducted with 86 women of reproductive age to identify potential patterns and explore the nature of mothers' influences. We then analyzed medical and prescription claims for a cohort of 9813 pairs of women (mother-daughter proxies) enrolled in Medicaid, to determine if such patterns of contraceptive use held in a larger sample. RESULTS: In-depth interviews reveal how and why mothers shape women's contraceptive attitudes and behaviors, particularly highlighting the nuances of communication, knowledge, and relationships. The statistical claims data supported such findings on a broader scale. For instance, across several types of contraceptives, including oral, injectable, and long-acting reversible contraceptives (LARCs), young women were significantly more likely to use a particular method if an older woman in the household (mother proxy) also used that method (AOR (95% CI) 1.99 (1.67-2.37), 2.06 (1.58-2.68) and 2.83 (1.64-4.88) respectively). CONCLUSIONS FOR PRACTICE: This study fills a gap in the literature regarding the nuanced ways in which mothers influence women's contraceptive behavior. In turn, it supports the importance of familial context-especially the influence of mothers-in contraception decision-making and suggests that interventions aimed at improving access to and uptake of effective methods of contraception consider this context in their design and implementation.

Digital photography as an educational food logging tool in obese patients with type 2 diabetes: lessons learned from a randomized, crossover pilot trial.

PURPOSE: The purpose of this pilot study is to investigate the utility of, and areas of refinement for, digital photography as an educational tool for food logging in obese patients with type 2 diabetes (T2DM). METHODS: Thirty-three patients aged 18 to 70 with T2DM, body mass index at least 30 kg/m(2), and A1C 7.5% to 9% were recruited from an endocrinology clinic and randomized to a week of food logging using a digital camera (DC) or paper diary (PD), crossing over for week 2. Patients then viewed a presentation about dietary effects on blood glucose, using patient DC and blood glucose entries. Outcomes of adherence (based on number of weekly entries), changes in mean blood glucose and frequency of blood glucose checks, and patient satisfaction were compared between methods. Patient feedback on the DC intervention and presentation was also analyzed. RESULTS: Thirty patients completed the study. Adherence was identical across methods. The mean difference in number of entries was not significant between methods. This difference increased and neared statistical significance (favoring DC) among patients who were adherent for at least 1 week (21 entries, with 2 entries per day for 5 of 7 days, n = 25). Mean blood glucose did not significantly decrease in either method. Patient satisfaction was similar between interventions. Feedback indicated concerns over photograph accuracy, forgetting to use the cameras, and embarrassment using them in public. CONCLUSION: Although the DC method was comparable to PD in adherence, blood glucose changes, and patient satisfaction in this pilot trial, patient feedback suggested specific areas of refinement to maximize utility of DC-based food logging as an educational tool in T2DM.