Five years later: Can women in Los Angeles County, California, get adequate pill supplies?

OBJECTIVES: This study sought to determine if pharmacies in Los Angeles County had implemented 2017 legislation requiring insurance companies based in California to fully reimburse for 13 cycles of oral contraceptives dispensed at once. STUDY DESIGN: We conducted a secret shopper telephone survey of Los Angeles County pharmacies nearly 5 years after the legislation went into effect. We chose the categorical state family program (Family PACT) to represent all programs covered by the legislation. Representative numbers of pharmacies were randomly selected in each of Los Angeles County's eight service planning areas in proportion to the number of women living in each area. We asked pharmacies if they would fill a prescription for a year's supply of contraception all at once for a patient enrolled in Family PACT. RESULTS: We contacted a total of 582 pharmacies and excluded the 150 unresponsive pharmacies. Of the 432 pharmacies contacted, only 3.2% said they would dispense a 1-year supply of pills at once to a patient enrolled in this representative program. Nearly 50% explicitly said they would not dispense 13 cycles at one time regardless of the prescription. CONCLUSIONS: Only 3.2% of surveyed pharmacies in Los Angeles County said they would comply with current legislation, which requires dispensing 1-year supply of pills at once. IMPLICATIONS: Collaboration among physicians, pharmacies, and patients along with enhanced insurance company oversight will be needed to improve dispensing practices to achieve the lower unintended pregnancy rates associated with providing adequate contraceptive supplies.

Treating Individuals With Eating Disorders: Part 1.

According to the American Psychiatric Association, eating disorders (EDs) are characterized by a persistent disturbance of eating or eating-related behaviors that result in altered consumption or absorption of food and that significantly impair physical health and/or psychosocial functioning. EDs are chronic psychiatric illnesses and are notoriously difficult to treat. The etiology of eating disorders is unknown and thought to be a complex interplay among biological predisposition, environmental and sociocultural factors, neurobiological influences, and psychological factors. Moreover, prevalence of eating disorders is increasing despite variation in prevalence estimates across studies. Nurses are well-positioned to implement appropriate screening for and comprehensive assessment of EDs as well as offer patient-centered treatment options including referrals when indicated. As the first in a two-part series, this article provides an overview of the clinical characteristics of EDs and key areas for assessment and diagnostic considerations. The follow-up article in this series will focus on pharmacological treatment strategies. [Journal of Psychosocial Nursing and Mental Health Services, 58(3), 7-13.].

Treating Individuals With Eating Disorders: Part 2.

Health care providers often need additional training to understand the recommended treatment for eating disorders (EDs). Treatment varies by diagnosis and particularly for vulnerable populations (e.g., adolescents, pregnant women). EDs have life-threatening consequences and require timely interventions. Treatment tends to focus on decreasing disordered eating behaviors, psychological suffering, and nutritional deficits associated with EDs while simultaneously promoting whole health. An overview of EDs was presented in the first article of this two-part series about treating EDs. The current article discusses pharmacological and nonpharmacological evidence-based treatments for EDs. [Journal of Psychosocial Nursing and Mental Health Services, 58(4), 9-15.].

Perceptions of health risks associated with pregnancy compared to oral contraceptive use.

OBJECTIVE: To assess beliefs about the safety of oral contraceptives compared to pregnancy to determine if men and women possess accurate information to make informed choices. STUDY DESIGN: In each of six surveys conducted in Southern California from 2008 to 2017, participants were asked "Which do you think is more hazardous to a woman's health - birth control pills or pregnancy?" RESULTS: A total of 28.4% of all 1839 male and female respondents and 29.1% of the 1712 female respondents answered correctly that the health risks posed by pregnancy were greater. In subgroup analyses, 64.4%-81.9% rated oral contraceptives at least as hazardous to a woman's health as pregnancy. CONCLUSION: The vast majority of respondents incorrectly believed that oral contraceptives are more hazardous than pregnancy. IMPLICATIONS: Health decision making relies upon patients' understanding of the relative risks and benefits of each available option. Most sexually active women do not understand that there is no contraceptive method current guidelines would offer them that is as hazardous to their health as pregnancy. Such misconceptions can lead to risky decisions. Clinicians need to explicitly provide their sexually active patients more accurate and balanced information, putting contraception in the context of its probable alternative - pregnancy.

Contraceptive Beliefs and Practices of American Muslim Women.

Objective: To assess contraceptive beliefs and practices among American Muslim women residing in Southern California. Materials and Methods: English speaking Muslim women were approached in Southern California mosques and online and asked to participate in a survey about birth control. Primary outcome measures included the belief that Islam permitted use of contraceptives to prevent pregnancy, to treat menstrual disorders, and to suppress menstrual flow that would prevent attendance at religious rituals; personal contraceptive use was also assessed. Subgroup analysis investigated potential impacts of demographic variables. Results: The interview response rate was 88%. Among the convenience sample of 276 women, 64.4% were younger than 35 years of age, most were well educated, and had an above average income. Eighty percent of respondents believed that Islam allowed the use of contraception to prevent pregnancy, and 85.1% believed that it allowed for the treatment of menstrual disorders. Overall, 93.4% believed that Islam allowed the use of all reversible contraceptive methods, but 35% believed that Islam did not permit permanent contraceptive methods. Belief was related to higher income or educational level, headscarf use, and being Muslim from birth. Of the reproductive age sexually experienced participants, 96.5% reported ever using any contraceptive method. The most commonly ever-used methods included oral contraceptive pills (72.5%), male condoms (68.9%), coitus interruptus (39.9%), and intrauterine devices (21.2%). Conclusion: The vast majority of American Muslim women surveyed believe that their religion permits use of reversible contraceptive methods. They have used contraceptive methods at rates similar to other women in the United States.

Attention Deficit Hyperactivity Disorder, Aggression, and Illicit Stimulant Use: Is This Self-Medication?

This study compares adults with and without attention deficit hyperactivity disorder (ADHD) on measures of direct and displaced aggression and illicit drug use. Three hundred ninety-six adults were administered the Wender Utah Rating Scale, the Risk Behavior Assessment, the Aggression Questionnaire (AQ), and the Displaced Aggression Questionnaire (DAQ). Those with ADHD were higher on all scales of the AQ and DAQ, were younger at first use of amphetamines, and were more likely to have ever used crack and amphetamines. A Structural Equation Model found a significant interaction in that for those with medium and high levels of verbal aggression, ADHD predicts crack and amphetamine. Follow-up logistic regression models suggest that blacks self-medicate with crack and whites and Hispanics self-medicate with amphetamine when they have ADHD and verbal aggression.

Impulsiveness, and trait displaced aggression among drug using female sex traders.

OBJECTIVE: This study compared women who sex trade for drugs, money, or both compared to neither (did not sex trade), and introduced the concept of trait displaced aggression to the literature on sex trading. METHODS: Female participants (n=1055) were recruited from a low-income area of southern California. Measures included: the Risk Behavior Assessment (RBA), Barratt Impulsivity Scale (BIS), Eysenck Impulsiveness Scale (EIS), and the Displaced Aggression Questionnaire (DAQ). RESULTS: Women who traded sex for both drugs and money used crack cocaine, powder cocaine, and alcohol significantly more, scored higher on the BIS, and the EIS, and were significantly older. Those who only sex traded for drugs used more amphetamine, heroin, and injected drugs more days. They were also higher on the DAQ and all of the DAQ subscales. Those who traded for money only used marijuana more and were more likely to use marijuana before sex. CONCLUSIONS: This study may help address specific issues unique to those who sex trade for different commodities in that the drugs used are different and the underlying personality characteristics are different.

Reproductive Life Planning and Preconception Care 2015: Attitudes of English-Speaking Family Planning Patients.

BACKGROUND: Reproductive life planning has become an essential element in programs designed to promote preconceptional care and increase utilization of effective contraceptive methods. This study sought to determine if women have reproductive life plans and what they think women should do to prepare for pregnancy. MATERIALS AND METHODS: Indigent English-speaking women in a family planning clinic were asked individually about their reproductive life plans, preparations needed for pregnancy, and the relative health risks of pregnancy compared to oral contraceptives. RESULTS: Of the 250 women interviewed, only 53% were confident how many pregnancies they wanted in their lifetime; 46.3% were confident about when they desired their next pregnancy. Although virtually all agreed that women should plan and prepare for pregnancy, only 25.8% of women mentioned that any medical preparations were necessary before pregnancy. Women's choice of contraception did not match their pregnancy intentions. Over 60% of women thought that the pill was at least as hazardous to a woman's health as pregnancy. CONCLUSIONS: In this study, many English-speaking women had no distinct reproductive life plans. Most did not think that medical preparations are needed before pregnancy. New approaches may be useful to more productively identify women who need individualized counseling, preconception care, and/or more effective contraceptive methods.

Application of the Extended Health Control Belief Model to Predict Hepatitis A and B Vaccinations.

BACKGROUND: Adult vaccination compliance rates vary according to sample and type of vaccine administered (influenza, pneumococcal). This study looked at vaccination of a community sample of low-income, minority adults. METHODS: Nurses offered free vaccination for hepatitis A and B in the form of the combined Twinrix vaccine to adults on a walk-in basis. In addition to dosing information, participants completed the Risk Behavior Assessment, the Coping Strategies Indicator and the Cardiovascular Risk Assessment. Skaff's extended Health Belief Model was used as the theoretical framework. Count regression was used to model receipt of one, two, or three doses. RESULTS: The majority of participants were male with a mean age of 40 years. The distribution of doses was: 173 individuals (27.6%) received one dose only, 261 (41.7%) received two doses, and 191 (30.5%) received three doses of vaccine. The multivariate count regression model including being male, having previously been told by a health care provider that one has syphilis, having severe negative emotions, and perceived social support were associated with participants' receiving fewer doses of hepatitis vaccine. A greater problem-solving score was associated with a higher number of vaccine doses received. CONCLUSION: Despite free vaccinations offered in an easily accessible community setting, the majority of participants failed to complete the hepatitis vaccine series. More effort is needed to get adult men to participate in hepatitis vaccination clinics. Additional research is necessary to understand barriers other than cost to adults receiving vaccination.