Hormonal Contraceptive Side Effects and Nonhormonal Alternatives on TikTok: A Content Analysis.

The use of hormonal contraceptives is decreasing in the United States alongside a growing interest in nonhormonal contraceptive options. Social media messaging may be contributing to this trend. TikTok thus offers a novel opportunity to understand how people share information about risks and alternatives for pregnancy prevention. To describe the availability and content of information about hormonal contraceptive side effects and nonhormonal contraceptive options on TikTok, we conducted a content analysis of 100 videos using the hashtags #birthcontrolsideeffects and #nonhormonalcontraception. We found that these videos were popular and often framed hormonal contraceptives and patient-provider interactions negatively, with users frequently discussing discontinuation of hormonal contraception and no plans for uptake of another contraceptive. When uptake of a new contraceptive method is mentioned, creators typically mention a fertility awareness-based method, which requires specialized knowledge to use safely and effectively. The risks and side effects of hormonal options were often overemphasized compared with the possible risks and side effects of nonhormonal options. This framing may suggest opportunities for providers and health educators to reassess how they counsel about contraceptive options. We conclude with recommendations for future research on TikTok and consider the policy implications of these findings.

A Pregnant Pause: System-Level Barriers to Perinatal Mental Health Care.

Perinatal mood and anxiety disorders, defined as mood and anxiety disorders during pregnancy and the year following birth, affect one in five pregnant and postpartum individuals in the United States and are associated with substantial morbidity and mortality for both pregnant individuals and their infants. Despite this tremendous prevalence and associated disease burden, the overwhelming majority of those affected do not receive treatment. Although prior research has identified several patient-level barriers to effective treatment, the contributions of system-level factors have been underappreciated. We present a pilot study using a simulated patient approach to describe the accessibility and affordability of mental health care through the 18 clinics affiliated with U.S. reproductive psychiatry fellowship programs. Based on our experience, a prospective patient seeking care from these 18 clinics without a prior referral would only have been successful half of the time-and even then may have to wait as long as 2 months for an initial appointment. These data underscore the need for clinicians, public health professionals, and institutions to address system-level barriers that undermine effective referrals for care, including implementing "warm-handoffs" to mental health providers and ending practices that restrict appointments to existing patients within a health care system. They also reinforce the importance of contemporary federal policy efforts to address maternal health, particularly among low-income and racially minoritized communities. Key policies include expanding postpartum insurance coverage, which plays a critical role in reducing insurance disruptions that can undermine the accessibility of mental health care and other vital health services.

Sex Education on TikTok: A Content Analysis of Themes.

Leading medical and public health societies endorse comprehensive sex education, but only 20 states and Washington, D.C., currently require information about contraception when sex education is taught, and even fewer require the inclusion of topics such as gender diversity or consent. At the same time, social media use, especially the video-sharing app TikTok, is increasing among teens. TikTok, therefore, offers a novel opportunity to make up for shortcomings in sex education and convey sexual health information to adolescents. To describe the availability and content of sexual education on TikTok, we conducted a content analysis of themes for 100 sex education-focused videos. We found that female anatomy was the most frequently addressed topic. Sexual pleasure was the second most common theme, within which discussions of the female orgasm and arousal constituted the most common subtheme. Other common themes include contraception and sexual health. These sought-after topics may be incongruent with those presented in standard school- or home-based sex education or interactions with health care providers, and this disconnect suggests opportunities for health care providers and educators to initiate conversations or offer resources on these themes as part of routine interaction. We conclude with recommendations for future research to consider the factual accuracy of sex education on TikTok and determine how exposure to this content affects adolescents' understanding of the risks and benefits of intercourse, sexual practices, age- and gender-based sexual norms, and other health behaviors.

Readability and Accessibility of Terms of Service and Privacy Policies for Menstruation-Tracking Smartphone Applications.

Over 100 million women track their menstruation using mobile applications (apps). In addition to comparatively unremarkable personal information such as height and weight, these apps collect intimate data like characteristics of vaginal discharge and cervical position. In exchange, many apps claim to predict the timing and duration of menstruation and windows of fertility. From this information, users may modify their sexual behavior based on their reproductive intentions. Though these apps are popular, news reports and prior studies reveal that user expectations about privacy and accuracy often do not align with the content of terms of service and privacy policies. In this article, we analyzed the readability and accessibility of terms of service and privacy policies for 15 popular menstruation-tracking apps. We found that information about data-sharing practices and accuracy is often neither easily accessible nor understandable. As a result, terms of service and privacy policies likely obscure material information about privacy and accuracy, posing safety and reproductive health risks to users. To date, no regulatory body oversees or approves the vast majority of menstruation trackers, leaving the market open to apps that vary widely in quality, accuracy, and levels of protection. We encourage health care professionals to ask their patients and clients about app use and understanding, encourage them to review relevant app-specific information, and discourage use as contraception when indicated. We conclude with recommendations for future research to establish the appropriate standards of disclosure that should govern these and similar types of smartphone-based consumer health technologies.

From Cervical Cap to Mobile App: Examining the Potential Reproductive Health Impacts of New Technologies.

Web- and application-based prescription services have been heralded as "Uber for birth control," offering patients the convenience of obtaining hormonal contraceptives at the touch of a smartphone screen. This innovation stands poised to disrupt a system that currently fails to meet the contraceptive needs of many women, particularly adolescents and those who are rural or low-income. The creation of online contraceptive prescribers provides a new and promising avenue for increased access to hormonal birth control. However, the reach and coverage of these services, as well as their implications for public health goals, including unintended pregnancy and various health screenings, remains unclear. In this article, we describe the current landscape of online contraceptive services and identify the potential impacts on unplanned pregnancy and other health outcomes. We find these services may reduce geographic and logistical barriers for rural and low-income populations. However, their impact on access for adolescents is likely to be minimal, as more than half the services do not prescribe to minors. Furthermore, increasing use of telemedicine may reduce rates of screening for public health concerns, including interpartner violence, sexually transmitted infections, and cervical cancer. We offer specific recommendations for future research to evaluate the impact of these services on unplanned pregnancy and other public health outcomes.

Continuous Reproductive Surveillance.

The Dobbs opinion emphasizes that the state's interest in the fetus extends to "all stages of development." This essay briefly explores whether state legislators, agencies, and courts could use the "all stages of development" language to expand reproductive surveillance by using novel developments in consumer health technologies to augment those efforts.

UNLIMITED MEDICAL LIABILITY?

Pursuant to the standard account of the law, physicians only owe special legal duties within the confines of an established treatment relationship. However, this well- accepted adage of black letter medical malpractice law does not, in fact, reflect reality. Indeed, the physician-patient relationship is rarely well-defined, and-perhaps more troublingly-courts have been willing to find liability outside of its boundaries. This Essay scrutinizes the notion that doctors have heightened legal obligations solely to their current patients. It concludes that physicians may be liable for far more conduct than the conventional account implies. It ends by suggesting ways to cabin this potentially unlimited liability.

A matter of life and longer life.

While the major scientific discoveries that would extend the length and health of human lives are not yet here, the research that could create them is already underway. As prospects for a world in which extended and improved lives inches closer into reality, the discourse about what to consider as we move forward grows richer, with corporate executives, ideologues, scientists, theologians, ethicists, investigative journalists, and philosophers taking part in imagining and anticipating the rich array of humanity's possible futures. Drawing from in-depth interviews with key stakeholders (n = 22), we offer empirical insights into key values and beliefs animating the "longevity movement," including what constitutes an ideal human state, the imperative to intervene, and the role of individual liberty and concerns for equality. Emerging from these interviews are common concerns about reducing suffering, preserving diversity in visions of successful aging and how best to promote access to a future that may not remain hypothetical for long.