Tweeting about pain: comparing self-reported toothache experiences with those of backaches, earaches and headaches.

BACKGROUND: The authors conducted a study of tweets posted on Twitter to compare self-reported toothache experiences with those of backache, earache and headache in regard to pain intensity, action taken, perceived cause and effect of pain. METHODS: From a total of 508,591 relevant tweets collected on seven nonconsecutive days, the authors randomly selected 1,204 tweets (301 per pain type) and conducted content analyses of each tweet. RESULTS: Toothaches were described as having higher pain intensity than were earaches or headaches but pain intensity comparable with that of backaches. Despite people who experience toothache being more likely to seek health care than those experiencing backaches (odds ratio [OR], 3.91; 95 percent confidence interval [CI], 1.57-9.71) or headaches (OR, 6.11; 95 percent CI, 2.16-17.25), only one in 10 people with toothaches mentioned seeking health care for their pain. People with toothaches were less likely to report an effect on daily functioning compared with those with backaches (OR, 0.13; 95 percent CI, 0.03-0.56) or earaches (OR, 0.19; 95 percent CI, 0.05-0.77). CONCLUSIONS: Using unsolicited self-reported data from Twitter, the authors found similarities and differences in the experiences of people with toothaches compared with those of people with other common pains. These findings offer insights into understanding dental pain and dental care utilization. PRACTICAL IMPLICATIONS: The use of social media, such as Twitter, to discuss health issues provides opportunities for dental professionals to better understand dental care experiences from the patients' perspective. Furthermore, social media such as Twitter offer providers the opportunity to share information with the public and to facilitate provider-patient communication.

Counseling patients on preventing prenatal environmental exposures--a mixed-methods study of obstetricians.

OBJECTIVE: Describe the attitudes, beliefs, and practices of U.S. obstetricians on the topic of prenatal environmental exposures. STUDY DESIGN: A national online survey of American Congress of Obstetricians and Gynecologists (ACOG) fellows and 3 focus groups of obstetricians. RESULTS: We received 2,514 eligible survey responses, for a response rate of 14%. The majority (78%) of obstetricians agreed that they can reduce patient exposures to environmental health hazards by counseling patients; but 50% reported that they rarely take an environmental health history; less than 20% reported routinely asking about environmental exposures commonly found in pregnant women in the U.S.; and only 1 in 15 reported any training on the topic. Barriers to counseling included: a lack of knowledge of and uncertainty about the evidence; concerns that patients lack the capacity to reduce harmful exposures; and fear of causing anxiety among patients. CONCLUSION: U.S. obstetricians in our study recognized the potential impact of the environment on reproductive health, and the role that physicians could play in prevention, but reported numerous barriers to counseling patients. Medical education and training, evidence-based guidelines, and tools for communicating risks to patients are needed to support the clinical role in preventing environmental exposures that threaten patient health.

Dentists' willingness to provide expanded HIV screening in oral health care settings: results from a nationally representative survey.

OBJECTIVES: Using a nationally representative survey, we determined dentists' willingness to provide oral rapid HIV screening in the oral health care setting. METHODS: From November 2010 through November 2011, a nationally representative survey of general dentists (sampling frame obtained from American Dental Association Survey Center) examined barriers and facilitators to offering oral HIV rapid testing (n = 1802; 70.7% response). Multiple logistic regression analysis examined dentists' willingness to conduct this screening and perceived compatibility with their professional role. RESULTS: Agreement with the importance of annual testing for high-risk persons and familiarity with the Centers for Disease Control and Prevention's recommendations regarding routine HIV testing were positively associated with willingness to conduct such screening. Respondents' agreement with patients' acceptance of HIV testing and colleagues' improved perception of them were also positively associated with willingness. CONCLUSIONS: Oral HIV rapid testing is potentially well suited to the dental setting. Although our analysis identified many predictors of dentists' willingness to offer screening, there are many barriers, including dentists' perceptions of patients' acceptance, that must be addressed before such screening is likely to be widely implemented.

The impact of an oral health program on domestic violence survivors within community shelters.

BACKGROUND: The authors conducted a study to evaluate the impact of an oral health treatment program on oral health-related quality of life (OHRQoL) for women who were domestic violence (DV) survivors living in community shelters. METHODS: After completing DV education, dental residents provided treatment to female survivors of DV (n = 37) at on-site clinics. They administered pretest and posttest surveys to participants to assess their OHRQoL in terms of pain, impact of oral health on functioning and discomfort, embarrassment and quality of life overall to the participants. The authors also administered patient satisfaction surveys to participants to assess their satisfaction with treatment and the program. RESULTS: Participants reported significantly improved OHRQoL for seven of the eight items assessed (P < .05). They were satisfied with their treatment and with dental residents' performance. CONCLUSIONS: The program was effective and well received. Practical Implications. By participating in a one-day DV education program and using portable dental equipment installed in community shelters, dental residents and dentists can provide much needed dental treatment to a population of women who otherwise may not seek or have access to oral health care. Treatment can play an important role in DV survivors' self-esteem and reintegration into normal social and workplace activities.

Oral health education for pediatric nurse practitioner students.

The aim of this study was to evaluate whether an interdisciplinary, multifaceted oral health education program delivered to pediatric nurse practitioner students at the University of California, San Francisco, would improve their knowledge, confidence, attitudes, and behaviors regarding the provision of oral health assessments, consultations, referrals, and services to young children during well-child visits. Thirty pediatric nurse practitioner students were included in the study. Participants completed a written survey before and after receiving an interdisciplinary educational intervention that included didactic education, simulation exercises, and clinical observation by a pediatric dental resident. Between pre-intervention and post-intervention, a significant improvement was seen in the pediatric nurse practitioners' knowledge of oral health topics (p<0.001), confidence when providing oral health counseling (p<0.001), and attitudes about including oral health counseling in their examinations (p=0.006). In the post-intervention survey, 83 percent of the subjects reported having incorporated oral examinations into their well-child visits. Our study suggests that providing an interdisciplinary oral health educational program for pediatric nurse practitioner students can improve their knowledge, confidence, attitudes, and behaviors regarding the incorporation of oral health care services during routine well-child visits.

PRE-VIEW: Development and Pilot Testing of An Interactive Video Doctor Plus Provider Alert to Increase Cancer Screening.

BACKGROUND: Interventions to increase recommended cancer screening tests and discussions are needed. METHODS: We developed PRE-VIEW (The PREventive VIdeo Education in Waiting Rooms Program), a multimedia cancer prevention intervention for primary care clinics based on the Transtheoretical Model of Behavior Change We pilot tested PRE-VIEW An Interactive Video Doctor plus Provider Alert for feasibility and acceptability in primary care clinic settings in the San Francisco Bay Area, California in 2009-2010. RESULTS: Eighty participants (33 men and 47 women; more than half non-white) at 5 primary care clinics were included. After PRE-VIEW, 87% of women were definitely interested in mammography when due and 77% were definitely interested in a Pap test. 73% of participants were definitely interested in colorectal cancer screening when due, and 79% of men were definitely interested in a discussion about the PSA test. The majority indicated that they received an appropriate amount of information from PRE-VIEW and that the information presented helped them decide whether or not to be screened. CONCLUSIONS: PRE-VIEW was well received and accepted and potentially provides an innovative and practical way to support physicians' efforts to increase cancer screening.

A collaboration to enhance oral health care for survivors of domestic violence: women's domestic violence shelters and Nova Southeastern University's College of Dental Medicine.

Nova Southeastern University College of Dental Medicine (NSU-CDM) has developed a program to educate its Advanced Education in General Dentistry (AEGD) residents to provide oral health services to survivors of domestic violence. NSU-CDM worked in collaboration with three community-based sites in Florida's Dade and Broward counties that provide residential and outpatient services to women survivors of domestic violence. The educational program includes didactic instruction and clinical rotations utilizing portable dental equipment assembled at the community-based sites. The central element of the program was the establishment of a partnership between NSU-CDM and local community-based organizations that serve women who have experienced domestic violence. This collaboration enabled the school to involve a range of key stakeholders in program development and implementation and to successfully establish dental clinics at two shelter sites. In total, NSU-CDM provided dental care to over 250 women, and twenty AEGD residents completed both the didactic and clinical rotations of the domestic violence education program. Elements identified as being essential to successful collaborations between oral health clinics and shelter settings are described.

Prenatal weight gain: who is counseled?

BACKGROUND: Because prenatal counseling is associated with adherence to weight gain guidelines, we sought to identify patient-level characteristics associated with the receipt of counseling on weight gain, nutrition, and exercise during prenatal care. METHODS: We performed a secondary data analysis on a cohort of women enrolled in a prenatal counseling intervention study. We controlled for study group assignment (intervention versus usual care) as well as patient characteristics in a multivariable analysis. We performed three separate multivariable analyses for predictors of provider-patient discussions about (1) weight gain, (2) nutrition, and (3) exercise. RESULTS: The cohort consisted of 311 predominantly low-income prenatal patients receiving care at several sites in the San Francisco Bay Area. Prepregnancy body mass index, nutrition knowledge, maternal age, parity, and type of insurance were not significantly associated with receipt of counseling about weight gain, nutrition, and exercise. In the multivariable analysis, white women were significantly less likely to be counseled about nutrition than non-white women (p=0.02). Former smokers were more likely to receive counseling about nutrition and exercise than never smokers (p<0.05). More advanced gestational age was associated with a higher rate of counseling on weight gain (p=0.01). CONCLUSIONS: Despite having the highest rates of excessive weight gain nationally, white women were the least likely to receive counseling about nutrition during pregnancy. Interventions that prompt clinicians and simplify counseling may improve counseling rates for all patients during prenatal care.

Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial.

OBJECTIVE: To determine if an interactive, computerized Video Doctor counseling tool improves self-reported diet and exercise in pregnant women. METHODS: A randomized trial comparing a Video Doctor intervention to usual care in ethnically diverse, low-income, English-speaking pregnant women was conducted. Brief messages about diet, exercise, and weight gain were delivered by an actor-portrayed Video Doctor twice during pregnancy. RESULTS: In the Video Doctor group (n=158), there were statistically significant increases from baseline in exercise (+28 min), intake of fruits and vegetables, whole grains, fish, avocado and nuts, and significant decreases in intake of sugary foods, refined grains, high fat meats, fried foods, solid fats, and fast food. In contrast, there were no changes from baseline for any of these outcomes in the usual care group (n=163). Nutrition knowledge improved significantly over time in both groups but more so in the Video Doctor group. Clinician-patient discussions about these topics occurred significantly more frequently in the Video Doctor group. There was no difference in weight gain between groups. CONCLUSION: A brief Video Doctor intervention can improve exercise and dietary behaviors in pregnant women. PRACTICE IMPLICATIONS: The Video Doctor can be integrated into prenatal care to assist clinicians with effective diet and exercise counseling.

Increasing discussions of intimate partner violence in prenatal care using Video Doctor plus Provider Cueing: a randomized, controlled trial.

PURPOSE: To report the effectiveness of a prenatal intervention and to provide evidence that prenatal visits provide an opportune time for health assessment and counseling with abused women. METHODS: Fifty ethnically diverse pregnant women who presented for routine prenatal care and who also reported being at risk for intimate partner violence (IPV) were recruited to the study. Participants were assigned to either usual care or the Video Doctor plus Provider Cueing intervention. At baseline and 1 month later at another routine prenatal visit, intervention group participants received a 15-minute Video Doctor assessment and interactive tailored counseling. Their providers received a printed Cue Sheet alert and suggested counseling statements. MAIN FINDINGS: Participants in the intervention group were significantly more likely to report provider-patient discussions of IPV compared with participants receiving usual care at baseline (81.8% vs. 16.7%; p < .001) and at the 1-month follow-up (70.0% vs. 23.5%; p = .005). Summing the number of patient-provider discussions across the two visits at baseline and 1 month later, intervention participants were significantly more likely to have IPV risk discussion with their providers at one or both visits (90.0% vs. 23.6%; p < .001) compared with the participants who received usual care. When specifically asked about the helpfulness of these IPV-related discussions, 20 out of 22 (90.9%) participants rated the discussion as helpful or very helpful at baseline and all 18 (100%) participants rated the discussion as helpful or very helpful at the 1-month follow-up. CONCLUSION: Video Doctor plus Provider Cueing intervention significantly increases the likelihood of provider-patient IPV discussion with pregnant women with a history of abuse.

Promoting smoking cessation in pregnancy with Video Doctor plus provider cueing: a randomized trial.

OBJECTIVE: This study examined the use of a Video Doctor plus provider cueing to promote provider advice and smoking cessation outcomes in pregnancy. DESIGN: A randomized clinical trial was conducted from 2006 to 2008. SETTING: Five community prenatal clinics in the San Francisco Bay Area of the United States. PARTICIPANTS: A total of 410 pregnant patients completed screening for behavioral risks including tobacco use in the past 30 days. Pregnant smokers (n = 42) were randomized regardless of their intention to quit smoking. METHODS: Participants were assigned to either usual care or intervention. Intervention participants received 15-minute Video Doctor sessions plus provider cueing, at baseline and one month, prior to their routine prenatal visit. The Video Doctor delivered interactive tailored messages, an educational worksheet for participants, and a cueing sheet for providers. MAIN OUTCOME MEASURES: Receipt of advice from the provider and 30-day smoking abstinence, both by self-report. RESULTS: Intervention participants were more likely to receive provider advice on tobacco use at both prenatal visits during the intervention period (60.9 vs. 15.8%, p = 0.003). The intervention yielded a significantly greater decrease in the number of days smoked and in cigarettes smoked per day. The 30-day abstinence rate at two months post baseline was 2.5 times greater in the intervention group; the difference was not significant (26.1 vs. 10.5%, p = 0.12). CONCLUSIONS: The Video Doctor plus provider cueing is an efficacious adjunct to routine prenatal care by promoting provider advice and smoking reduction among pregnant smokers.

Preventing excessive weight gain in pregnancy: how do prenatal care providers approach counseling?

BACKGROUND: Excessive weight gain during pregnancy is becoming more common and is associated with many adverse maternal and infant outcomes. There is a paucity of data on how weight gain counseling is actually provided in prenatal care settings. Our objective was to study prenatal care providers and their knowledge, attitudes, and practices regarding prevention of excessive weight gain during pregnancy and, secondarily, their approach to nutrition and physical activity counseling during pregnancy. METHODS: We conducted seven focus groups of general obstetrician/gynecologists, midwives, and nurse practitioners. We analyzed data using qualitative methods. RESULTS: Providers agreed to participate because they were unsure of the effectiveness of their counseling efforts and wanted to learn new techniques for counseling patients about weight gain, nutrition, and physical activity. We identified several barriers to weight gain counseling, including insufficient training, concern about the sensitivity of the topic, and the perception that counseling is ineffective. Providers all agreed that weight gain was an important topic with short-term and long-term health consequences, but they described widely disparate counseling styles and approaches. CONCLUSIONS: Prenatal care providers are deeply concerned about excessive weight gain and its sequelae in their patients but encounter barriers to effective counseling. Providers want new tools to help them address weight gain counseling during pregnancy.

Assessment of the validity of HLD (CalMod) in identifying orthodontic treatment need.

OBJECTIVE: The purpose of this study was to assess the validity of the Handicapped Labio-Lingual Deviation index with California modifications, HLD (CalMod), in identifying handicapping malocclusions. METHODS: A set of 153 study casts representing all types of malocclusion was utilized in this study. Models were randomly chosen the UCSF Division of Orthodontics clinic. Treatment need was determined by the HLD (CalMod) index and by a panel of 13 orthodontists, conventionally established as the 'gold standard'. Spearman Rank correlation analysis was used to evaluate the correlation between HLD (CalMod) and the gold standard. The Classification and Regression Tree (CART) modeling was used to determine the HLD (CalMod) cut-off point of orthodontic treatment need according to the gold standard. RESULTS: A Spearman Rank correlation Coefficient of 0.71 demonstrated a moderately high correlation between HLD (CalMod) and the gold standard. The CART modeling determined a value of 18.5 as the cut-off point of HLD (CalMod) for orthodontic treatment need, considerably lower than the cut-off point of 26 currently used by Medi-Cal. At a value of 26 points as the cut-off HLD (CalMod) displayed a low sensitivity (25.9%) and high specificity (96.8%).With a cut-off point of 18.5, specificity decreased to 55.6% while sensitivity increased dramatically to 92.9%. CONCLUSION: Our results show that the HLD (CalMod) with a cut-off point of 26 fails to indentify a considerable percentage of handicapping malocclusions. More studies should be done assessing the efficacy of the HLD (CalMod) in identifying handicapping malocclusion.

Computerized counseling for folate knowledge and use: a randomized controlled trial.

BACKGROUND: Periconception folate supplementation significantly reduces the risk of neural-tube defects, but few U.S. women start folate supplementation before pregnancy, and the amount of clinician time available to counsel patients about folate is limited. This study evaluated whether computer-assisted counseling and the provision of free folate tablets increases women's knowledge and use of folate supplements. DESIGN: Randomized controlled trial; follow-up began 6 months after enrollment and was completed on average 7 months after enrollment. SETTING/PARTICIPANTS: A total of 446 women, aged 18-45 years, were recruited from two urgent care clinics in San Francisco from March to July 2005 (data collection was completed in 2006; data were analyzed in 2007). INTERVENTION: Participants received a 15-minute computerized educational session and 200 folate tablets. MAIN OUTCOME MEASURES: The primary outcome was the knowledge that folate can prevent birth defects; secondary outcomes included the self-reported use of a folate supplement at follow-up. RESULTS: At follow-up, women in the intervention group were more likely to know that folate prevents birth defects (46% vs 27%, relative risk [RR]=1.72, 95% CI=1.32, 2.23); to know that folate is most important in early pregnancy (36% vs 17%, RR=2.11, 95% CI=1.50, 2.97); and to report the recent use of a folate supplement (32% vs 21%, RR=1.54, 95% CI=1.12, 2.13). CONCLUSIONS: A one-time, brief, computerized counseling session about folate with the provision of free folate tablets increased the knowledge and use of folate supplements among women > or =6 months later. TRIAL REGISTRATION: NCT00177515.

Interactive "Video Doctor" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings.

BACKGROUND: Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their HIV-positive patients for ongoing behavioral risks, it is unknown how to best provide "prevention with positives" in clinical settings. Positive Choice, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors. METHODOLOGY AND FINDINGS: We conducted a parallel groups randomized controlled trial (December 2003-September 2006) at 5 San Francisco area outpatient HIV clinics. Eligible patients (HIV-positive English-speaking adults) completed an in-depth computerized risk assessment. Participants reporting substance use or sexual risks (n = 476) were randomized in stratified blocks. The intervention group received tailored risk-reduction counseling from a "Video Doctor" via laptop computer and a printed Educational Worksheet; providers received a Cueing Sheet on reported risks. Compared with control, fewer intervention participants reported continuing illicit drug use (RR 0.81, 95% CI: 0.689, 0.957, p = 0.014 at 3 months; and RR 0.65, 95% CI: 0.540, 0.785, p<0.001 at 6 months) and unprotected sex (RR 0.88, 95% CI: 0.773, 0.993, p = 0.039 at 3 months; and RR 0.80, 95% CI: 0.686, 0.941, p = 0.007 at 6 months). Intervention participants reported fewer mean days of ongoing illicit drug use (-4.0 days vs. -1.3 days, p = 0.346, at 3 months; and -4.7 days vs. -0.7 days, p = 0.130, at 6 months) than did controls, and had fewer casual sex partners at (-2.3 vs. -1.4, p = 0.461, at 3 months; and -2.7 vs. -0.6, p = 0.042, at 6 months). CONCLUSIONS: The Positive Choice intervention achieved significant cessation of illicit drug use and unprotected sex at the group-level, and modest individual-level reductions in days of ongoing drug use and number of casual sex partners compared with the control group. Positive Choice, including Video Doctor counseling, is an efficacious and appropriate adjunct to risk-reduction efforts in outpatient settings, and holds promise as a public health HIV intervention. TRIAL REGISTRATION: Clinicaltrials.gov NCT00447707.

Computer-assisted provision of emergency contraception a randomized controlled trial.

BACKGROUND: Emergency contraception (EC) can prevent unintended pregnancy. However, many women continue to lack information needed to use EC effectively and clinician time to counsel women about EC is limited. OBJECTIVE: To evaluate whether computer-assisted provision of EC can increase knowledge and use of EC among women able to access EC without a prescription. DESIGN: We conducted a randomized controlled trial in which the intervention group received a 15-minute computerized educational session and 1 pack of EC. The control group received education about periconception folate supplementation, but no information about EC. Participants were contacted 7 months after enrollment. PARTICIPANTS: Four hundred forty-six women recruited from 2 urgent care clinics in San Francisco in 2005. MEASUREMENTS: Knowledge of EC, use of EC, and self-reported pregnancy. RESULTS: At follow-up, women in the intervention group answered an average of 2 more questions about EC correctly than they had at baseline, whereas women in the control group answered only 1 more item correctly (2.0 vs 1.2, p < .001). There was a trend toward more use of EC during the study period in the intervention group (10% vs 4% of women followed, p = .06; 6% vs 3%, p = .09 of women enrolled). Fewer women in the intervention group were pregnant at the time of follow-up (0.8% vs 6.5%, p = .01 of women followed; 0.5% vs 4.0%, p = .01 of women enrolled). CONCLUSIONS: Computer-assisted provision of EC in urgent care waiting areas increased knowledge of EC in a state where EC had been available without a prescription for 3 years.

Cueing prenatal providers effects on discussions of intimate partner violence.

BACKGROUND: Intimate partner violence (IPV) during pregnancy poses a significant health risk to the mother and developing fetus. Practice guidelines recommend that prenatal providers screen for and counsel their patients about IPV, yet many physicians express reluctance or discomfort regarding such discussions. The Health in Pregnancy (HIP) computer program was designed to improve prenatal providers' counseling about behavioral risks. METHODS: English-speaking women 18 years or older, less than 26-weeks pregnant, and receiving prenatal care at one of the five participating clinics in the San Francisco area, were randomized in parallel groups in a controlled trial (June 2006-present; data analyzed June 2007). Participants reporting one or more risks were randomized to intervention or control in stratified blocks. Providers received summary "cueing sheets" alerting them to their patient's risk(s) and suggesting counseling statements. RESULTS: Thirteen percent (37/286) of the sample reported current IPV. Provider cueing resulted in 85% of the IPV-intervention group reporting discussions with their provider, compared to 23.5% of the control group (p<0.001). CONCLUSIONS: IPV discussions were influenced strongly by cueing providers. Provider cueing is an effective and appropriate adjunct to routine risk counseling in prenatal care.

Dental students' knowledge, attitudes, and intended behaviors regarding caries risk assessment: impact of years of education and patient age.

Dental caries remains the single most common chronic childhood disease; without intervention, the prevalence and severity of caries increase into adulthood. Dental schools have begun to integrate caries risk assessment (CRA) and prevention counseling into the curriculum. We sought to assess the knowledge, attitudes, and intended behaviors of dental students regarding CRA and prevention counseling with children and adults. We also examined the extent to which these findings were influenced by the years of instruction that students received on these topics. We conducted a cross-sectional survey of dental students at the University of California, San Francisco. All first-year (D1) through fourth-year (D4) students were eligible to participate. Of the 322 eligible students, 290 (90 percent) participated. D4 students correctly answered a mean of 70.4 percent of the knowledge-based questions on CRA; the mean score among D1 students was 50.4 percent. Whereas 95 percent of D4 students identified themselves as confident in their ability to assess adult patients for caries risk, only 68 percent had such confidence with patients less than five years. To effectively prevent early childhood caries, dental schools should provide students with the skills necessary to be confident and willing to perform CRA and prevention counseling for all age groups.

How health care setting affects prenatal providers' risk reduction practices: a qualitative comparison of settings.

BACKGROUND: We sought to understand how systemic factors might facilitate or impede providers' ability to screen for and intervene on prenatal behavioral risks. METHODS: We convened eight focus groups of 60 prenatal care providers to explore methods for assessing and counseling pregnant women about tobacco, alcohol, and illicit drug use. Because practice setting was often mentioned as either an inducement or barrier to risk prevention, we conducted a re-analysis of focus group transcripts to examine systemic factors. RESULTS: Practice setting strongly influenced providers' behavior, and settings differed by continuity of care, availability of resources, and organized support for risk prevention. The most striking contrasts were found between private practice and a large HMO. CONCLUSION: Each setting had features that facilitated prevention counseling. Understanding such systemic factors could lead to improved risk prevention practices during pregnancy across all health care settings.

Need for emergency contraception in urgent care settings.

BACKGROUND: Emergency contraceptive (EC) pills are safe and effective in preventing pregnancy up to 5 days after unprotected sex. OBJECTIVE: This study was conducted to determine the proportion and characteristics of women seeking urgent care who might benefit from receiving EC. METHODS: We used a computerized survey to assess desire for pregnancy and frequency of sex without contraception among 360 fertile women aged 18 to 45 years, who were seeking urgent care at two clinics in San Francisco, CA. Medical records were abstracted to assess whether clinicians discussed contraception. RESULTS: At both clinics, 11% (95% confidence interval, 8-15%) of women seeking urgent care might have benefited from immediately using EC. Few (8%) women reported a personal objection to EC, but few (7%) women had used EC in the prior 6 months. Chart review showed no evidence that any participants discussed EC with a clinician during their visit. CONCLUSIONS: Many women presenting for urgent care might benefit from EC.