Contraceptive uptake among gender-expansive individuals in the HER Salt Lake Contraceptive Initiative.

OBJECTIVES: We examined differences in contraceptive uptake and discontinuation between gender-expansive individuals and cis-women in the HER Salt Lake Contraceptive Initiative. STUDY DESIGN: We used self-reported survey data to assess associations between gender identity, contraceptive uptake, and discontinuation. RESULTS: Of participants (n = 4289), 178/4289 (4%) identified as gender-expansive with 157/178 (88%) reporting recent sexual activity with men. Selection of IUD or Implant was most common, with 109/178 (61%) of gender-expansive individuals choosing these options. We observed similar methods selected (p = 0.2) and discontinuation rates at three years between participants (OR: 0.93, p = 0.8). CONCLUSION: Gender-expansive individuals had similar method selection and discontinuation rates as cis-women. IMPLICATIONS: Our finding of no difference in the uptake of contraception between cis-women and gender-expansive individuals should empower providers to openly discuss contraception with patients regardless of gender identity.

International medical tourism of US cancer patients for alternative cancer treatments: Financial, demographic, and clinical profiles of online crowdfunding campaigns.

BACKGROUND: Previous research has found that individuals may travel outside their home countries in pursuit of alternative cancer therapies (ACT). The goal of this study is to compare individuals in the United States who propose plans for travel abroad for ACT, compared with individuals who seek ACT domestically. METHODS: Clinical and treatment data were extracted from campaign descriptions of 615 GoFundMe® campaigns fundraising for individuals in the United States seeking ACT between 2011 and 2019. We examined treatment modalities, treatment location, fundraising metrics, and online engagement within campaign profiles. Clinical and demographic differences between those who proposed international travel and those who sought ACT domestically were examined using two-sided Fisher's exact tests. Differences in financial and social engagement data were examined using two-sided Mann-Whitney tests. RESULTS: Of the total 615 campaigns, 237 (38.5%) mentioned plans to travel internationally for ACT, with the majority (81.9%) pursuing travel to Mexico. Campaigns that proposed international treatment requested more money ($35,000 vs. $22,650, p < 0.001), raised more money ($7833 vs. $5035, p < 0.001), had more donors (57 vs. 45, p = 0.02), and were shared more times (377 vs. 290.5, p = 0.008) compared to campaigns that did not. The median financial shortfall was greater for campaigns pursuing treatments internationally (-$22,640 vs. -$13,436, p < 0.003). CONCLUSIONS: Campaigns proposing international travel for ACT requested and received more money, were shared more online, and had more donors. However, there was significantly more unmet financial need among this group, highlighting potential financial toxicity on patients and families.

Similar antiseizure medication refill characteristics in Hispanic and White pediatric patients.

AIM: Previous work has shown that children of Hispanic ethnicity have reduced likelihood to achieve seizure remission, but it was unknown why. The purpose of this study was to evaluate antiseizure medicine (ASM) refill characteristics, comparing Hispanic and non-Hispanic White pediatric patients. METHODS: This was a retrospective population-based study in children between ages 6 months and 15 years. Epilepsy outcome was categorized as seizure free, treatment failure, or undetermined. ASM refill characteristics were determined from an insurance provider. RESULTS: 247 patients were identified: 52 (21 %) were treatment failure; 181 (73 %) were seizure free; and 14 (5.7 %) were undetermined. ASM refill rates were similar in Hispanic and White patients (38.2, 32.1, respectively). Hispanic and White patients had similar numbers of different ASMs prescribed (2.1 and 2.4). There was not a significant difference in proportion of days covered between Hispanic and White patients (0.99 and 0.95). INTERPRETATION: We found no differences between pediatric Hispanic and White epilepsy patients, for number of ASM refills, the number of ASMs prescribed, the choice of ASMs, the proportion of days covered, or the lateness of refills. Our findings suggest that the observation of reduced likelihood to achieve seizure remission in pediatric Hispanic patients is not associated with ASM refill patterns.

Timing and Motivations for Alternative Cancer Therapy With Insights From a Crowdfunding Platform: Cross-sectional Mixed Methods Study.

BACKGROUND: Alternative cancer therapy is associated with increased mortality, but little is known about those who pursue it. OBJECTIVE: We aimed to describe individuals' motivations for using alternative cancer therapies and determine whether motivations differ based on individuals' timing of seeking alternative therapies. METHODS: We used data from 649 campaigns posted on the website GoFundMe between 2011 and 2019 for beneficiaries with cancer pursuing alternative therapy. The data were analyzed using a mixed methods approach. Campaigns were categorized by timing of alternative therapy (either before or after experiencing conventional therapy). Qualitative analysis identified motivational themes. Chi-square tests of independence and Fisher tests (all 2-sided) determined significant differences in the presence of motivational themes between groups. RESULTS: The expression of concerns about the efficacy of conventional therapy was significantly more likely in campaigns for individuals who used conventional therapy first than in campaigns for individuals who started with alternative therapy (63.3% vs 41.7%; P<.001). Moreover, on comparing those who started with alternative therapy and those who switched from conventional to alternative therapy, those who started with alternative therapy more often expressed natural and holistic values (49.3% vs 27.0%; P<.001), expressed an unorthodox understanding of cancer (25.5% vs 16.4%; P=.004), referenced religious or spiritual beliefs (15.1% vs 8.9%; P=.01), perceived alternative treatment as efficacious (19.1% vs 10.2%; P=.001), and distrusted pharmaceutical companies (3.2% vs 0.5%; P=.04). CONCLUSIONS: Individuals sought treatments that reflected their values and beliefs, even if scientifically unfounded. Many individuals who reported prior conventional cancer therapy were motivated to pursue alternative treatments because they perceived the conventional treatments to be ineffective.