The Impacts of New York State's Paid Family Leave Policy on Parents' Sleep and Exercise.

OBJECTIVES: To assess changes in young parents' health behaviors following implementation of New York State's Paid Family Leave Program (NYSPFL). METHODS: We used synthetic control (N = 117,552) and difference-in-differences (N = 18,973) models with data from the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) from 2011 to 2019 to provide individual-level estimates of the effects of NYSPFL on self-reported exercise in the past month and average daily sleep of adults aged 21-30 years living with one or more children under 18 years of age in New York and comparison states. RESULTS: Synthetic control model results indicate that the NYSPFL increased the likelihood of exercise in the past month among mothers, single parents, and low-income parents by 6.3-10.3% points (pp), whereas fathers showed a decrease in exercise (7.8 pp). Fathers, single parents, and those with two or more children showed increases in daily sleep between 14 and 21 min per day. CONCLUSIONS FOR PRACTICE: State paid family and medical leave laws may provide benefits for health behaviors among young parents with children under 18, particularly those in low-income and single-parent households.

Counseling patients on reproductive aging and elective fertility preservation-a survey of obstetricians and gynecologists' experience, approach, and knowledge.

PURPOSE: What are the experience, approach, and knowledge of US Obstetricians and Gynecologists' (ob-gyn) towards counseling patients on reproductive aging (RA) and elective fertility preservation (EFP). METHODS: A cross-sectional survey emailed by the American College of Obstetricians and Gynecologists (ACOG) to 5000 ACOG fellows consisting of 9 demographic and 28 questions relating to counseling patients on RA and EFP. RESULTS: Seven hundred and eighty-four responders completed the survey. Although 82.8% agreed that conversations relating to RA should take place with patients desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these women aged 18-34 years old, compared to 75.8% aged 35-44 years old (P < 0.01). Limited time (75.8%) and limited knowledge (41.4%) were amongst the most frequent reported barriers towards counseling patients on RA. Fifty-eight percent stated that they have been asked about EFP by patients. Although 74.8% agreed that conversations should take place related to EFP in women desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these patients on EFP (P < 0.01). Limited time (75%) and limited knowledge (59.9%) were amongst the most frequent barriers towards counseling on EFP. CONCLUSIONS: In the USA, methods to improve patient counseling and provider knowledge on RA and EFP are warranted and further studies are needed to address optimal methods to improve counseling and knowledge related to these topics.

Patterns of point-of-care test use among obstetricians and gynaecologists in the US.

Background Point-of-care tests (POCTs) for reproductive health conditions have existed for decades. Newer POCTs for syphilis, HIV and trichomonas are currently available and easy to use. We surveyed practicing obstetricians and gynaecologists to determine current POCT use and perceived obstacles to use. METHODS: Between June and August 2016, 1000 members of the American College of Obstetricians and Gynecologists were randomly selected and invited to complete a Qualtrics (222 West river Park Drive, Provo, Utah 84604, USA) survey; 600 of these were members of the Collaborative Ambulatory Research Network. Respondents who completed at least 60% of the survey were included in the analysis. RESULTS: Of the 1000 selected members, 749 had valid emails and 288 (38%) of these participated in and completed the survey. Of the respondents, 70% were male with a mean of 18 years in practice. Detection of sexually transmissible infections (STIs) once or twice a week was reported by 30%, whereas 45% reported detecting STIs once or twice a month. POCTs used included pregnancy tests (83%), urine dipstick (83%), wet mount tests (79%) and the vagina pH test (54.8%). Few used Gram stain (5%) and stat rapid plasma regain tests (4%). Relatively newer US Food and Drug Administration-approved POCTs were used less frequently, with 25% of respondents reporting using the Affirm VPIII (Becton, Dickinson and Company, 1 Becton Drive, Franklin Lakes, NJ 07471, USA) test use and only 10% using a rapid HIV test. The most common perceived barriers to testing were the amount of reimbursement received for performing the test (61.9%) and the payment coverage from the patient (61.3%). CONCLUSIONS: US obstetricians and gynaecologists rely on laboratory test results and traditional POCTs to diagnosis STIs. Future development and marketing of POCTs should consider not only ease and time of test performance, but also the cost of the tests to the practice and the patient, as well as reimbursement.

Health Insurance Coverage Predicts Health Care Use among Latine Immigrants in Two Policy Contexts.

This study analyzed electronic health record (EHR) data from 2016 through 2019 from a federally qualified health center (FQHC) serving predominantly low-income Latine immigrants in the Washington, D.C. metropolitan area to examine how changes in health insurance coverage relate to changes in health care use. Federally qualified health center clients were insured for an average of 59% to 63% of their annual visits, but about one-third had no coverage throughout the year. Findings from descriptive regression and within-client fixed effects models indicate that in years with higher proportions of insured visits, clients averaged more medical visits and interpreter services but fewer mental health and care coordination visits. Latine immigrant clients in D.C., a city with a universal health insurance option, had health insurance coverage for 89% of their visits, and averaged more medical and fewer coordination visits relative to those in a neighboring county in a state without a universal insurance option.

Physician attitudes and knowledge on prophylactic salpingectomy in perimenopausal patients.

PURPOSE: Eighty percent of the approximately 500,000 hysterectomies performed annually in the US are for benign indications. There is lack of consensus regarding concurrent removal of fallopian tubes and/or ovaries. Ovarian cancer risk reduction is the principal benefit but the adverse consequences of ovarian removal can include vasomotor disturbance, vaginal dryness, cardiovascular disease, osteoporosis, and cognitive decline. Emerging evidence on the role of fallopian tubes in ovarian carcinogenesis and the consequences of oophorectomy have led the American College of Obstetricians-Gynecologists (ACOG) to recommend bilateral salpingectomy with ovarian conservation during benign hysterectomy for women at population risk for ovarian cancer. METHODS: Five hundred members of the ACOG Collaborative Ambulatory Research Network (CARN) were randomly selected to participate in this survey study. RESULTS: 165 completed the survey (35.3% response rate). Most respondents reported that a family history of breast, ovarian or colon cancer and patient age influence their decision to offer salpingectomy more than 75% of the time. Factors that a majority of respondents reported discussing during counseling included possible ovarian cancer risk reduction, surgical menopause, severity of symptoms, and the effects on bone and cardiovascular health. The respondents mean score for the knowledge-based questions was only 1.7 (±0.92) out of 4 points. CONCLUSION: Several factors may affect decision making for prophylactic salpingectomy at the time of hysterectomy however paramount among these is cancer risk reduction. Most physicians found it difficult to discuss and implement a change in care for patients with preconceived notions of ovarian preservation or removal.

Oral and IUD emergency contraception provision among a national sample of obstetrician-gynecologists.

OBJECTIVE: To assess obstetrician-gynecologists' practices related to emergency contraception (EC). We performed a survey of ACOG Fellows and Junior Fellows between August 2016 and March 2017. RESULTS: The final sample was 1280 respondents (52.2% response rate). The majority (84%) reported offering at least one form of EC, with 18% offering ulipristal acetate and 29% offering copper IUDs. Fifty-seven percent of those offering IUDs reported recommending them in the last 12 months. Few had placed IUDs for EC. Half of ob-gyns reported not recommending copper IUDs because patients rarely seek EC. CONCLUSION: Many obstetrician-gynecologists are not offering the most effective forms of EC. IMPLICATIONS: Both patients and clinicians need more outreach about the most effective methods of emergency contraception.

Implementing best practices for the provision of long-acting reversible contraception: a survey of obstetrician-gynecologists.

OBJECTIVE: To examine obstetrician-gynecologists' practices regarding provision of long-acting reversible contraceptive (LARC) methods same-day, immediately postpartum, or to women under age 21. STUDY DESIGN: Between August 2016 and March 2017, the American College of Obstetricians and Gynecologists (ACOG) sent 2500 of their members an electronic survey questionnaire regarding the provision of LARC methods. ACOG mailed nonresponders paper surveys. RESULTS: After exclusions, the final sample was 1280 respondents (52.2% response rate). Although 91% of obstetrician-gynecologists reported providing IUDs, only 29% (95% CI, 26-32%) offered same-day placement. Ninety-two percent (95% CI, 90-94%) offered IUDs to eligible patients under age 21. Nineteen percent (95% CI, 16.1-21.3%) offered immediate postpartum IUD placement and 21% (95% CI, 18-23%) offered immediate postpartum implant placement. Obstetrician-gynecologists practicing in states where Medicaid reimbursed for immediate postpartum LARC devices within the global fee for delivery (versus separate reimbursement) had lower odds of offering them. CONCLUSION: While most ob-gyns are offering IUDs to women under age 21, many are still not offering them same-day. A minority of ob-gyns offer either IUDs or implants immediately postpartum, and there are important geographic and practice setting disparities in this practice. IMPLICATIONS: Efforts to align LARC practices with published evidence and improve access to LARC methods for women desiring them will require a multipronged effort including continuing education of physicians, patient education and outreach, as well as advocacy to improve insurance coverage and reimbursement.

Obstetrician-gynecologists' counseling regarding postpartum sterilization.

INTRODUCTION: Obstetrician-gynecologists (ob-gyns) play a prominent role in counseling patients regarding sterilization, offering alternative contraception, fulfilling sterilization requests, and referring patients if unable to provide the service due to a personal moral belief. Therefore, we sought to better characterize the counseling practices of ob-gyns with respect to postpartum sterilization. MATERIALS AND METHODS: This is a prospective, electronic survey-based study of 1,000 ob-gyn members of the American College of Obstetricians and Gynecologists, half of whom are members of the Collaborative Ambulatory Research Network. RESULTS: A total of 188 of 957 surveyed physicians (19.6%) opened and responded to the survey, after accounting for exclusions. Age (31.9%), body mass index (28.7%), and medical history (27.1%) were the three most frequent reasons for an ob-gyn reported declining to perform sterilization in a patient requesting sterilization. Medical history (36.2%), parity (31.9%), and availability of alternative contraception (27.7%) were the three most frequent reasons that an ob-gyn reported recommending postpartum sterilization in a patient not requesting sterilization. CONCLUSION: Our study has identified both medical and nonmedical factors that impact ob-gyns likelihood to recommend either toward or against postpartum sterilization. Nonmedical factors included clinical logistical issues such as availability of the operating room as well as considerations of a patient's age, parity, gestational age at delivery, and whether the husband was in agreement. Physicians should be cautious of inappropriately blending medical decision-making with paternalistic counseling.

Lesbian, Gay, Bisexual, and Transgender Health: Obstetrician-Gynecologists' Training, Attitudes, Knowledge, and Practice.

BACKGROUND: Deficits in provider training may contribute to disparities impacting lesbian, gay, bisexual, transgender, and gender nonconforming (LGB-TGNC) individuals. METHODS: We sent an anonymous online survey to randomly selected members of the American Congress of Obstetricians and Gynecologists and stratified responses by the history of training. We used logistic regression to predict impact of previous training on provider comfort with LGB-TGNC patients, and secondary outcomes, including provider practices, knowledge, and attitudes. RESULTS: Two hundred twenty-eight of 428 (53.3%) surveys were completed. Of the 169 providers currently practicing gynecology, 72 respondents (42.6%) reported previous training in LGB-TGNC health. Those who self-identified or had a close contact identifying as LGB-TGNC were more likely to report previous training (68.1% vs. 49.5%, p = 0.02). When adjusting for demographic differences, providers reporting previous training were not more likely to be comfortable taking care of transgender/gender-nonconforming patients (aOR 1.8, 95% CI 0.95-3.40). They were more likely to report practice changes such as eliciting sexual orientation (aOR 2.15, 95% CI 1.08-4.28) and gender identity (aOR 3.02, 95% CI 1.07-8.52). Training was not independently associated with differences in provider knowledge (aOR 1.33, 95% CI 0.68-2.58) or likelihood of providing independent medical or surgical care for gender affirmation (aOR 1.64, 95% CI 0.78-3.45). CONCLUSIONS: Less than half of board-certified obstetrician-gynecologists reported training in LGB-TGNC health, with evidence of a familiarity effect in who seeks training and provides care that accounts for differences in attitudes, knowledge, and practices. Training efforts to advance LGB-TGNC health must address bias and comfort in addition to clinical competencies.

Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey.

BACKGROUND: Postpartum women are at risk for unintended pregnancy. Access to immediate long-acting reversible contraception (LARC) may help decrease this risk, but it is unclear how many providers in the United States routinely offer this to their patients and what obstacles they face. Our primary objective was to determine the proportion of United States obstetric providers that offer immediate postpartum LARC to their obstetric patients. METHODS: We surveyed practicing Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (ACOG) about their use of immediate postpartum LARC. These members are demographically representative of ACOG members as a whole and represent all of the ACOG districts. Half of these Fellows were also part of the Collaborative Ambulatory Research Network (CARN), a group of ACOG members who voluntarily participate in research. We asked about their experience with and barriers to immediate placement of intrauterine devices and contraceptive implants after delivery. RESULTS: There were a total of 108 out of 600 responses (18%). Participants practiced in a total of 36 states and/or US territories and their median age was 52 years. Only 26.9% of providers surveyed offered their patients immediate postpartum LARC, and of these providers, 60.7% work in a university-based practice. There was a statistically significant association between offering immediate postpartum LARC and practice type, with the majority of providers working at a university-based practice (p < 0.001). Multiple obstacles were identified, including cost or reimbursement, device availability, and provider training on device placement in the immediate postpartum period. CONCLUSION: The majority of obstetricians surveyed do not offer immediate postpartum long-acting reversible contraception to patients in the United States. This is secondary to multiple obstacles faced by providers.