IF YOU SELL IT, THEY COME?

Roughly a year after California enacted a law allowing pharmacists to dispense emergency contraceptive pills without a prescription, state residents were largely unaware of this option.¹ In a telephone survey conducted in 2003 among a representative sample of 1,151 Californians aged 15-44, three in five were aware that emergency contraception is available in the United States; of these, only 18% knew of the "pharmacy access" option. Whereas 46% of 18-44-year-olds who knew of emergency contraception had heard about it on TV, only 7% had heard about it from a health care professional; 90% had never discussed it with a health care provider. Half of women who were or anticipated being sexually active said they would be at least somewhat likely to use emergency contraception if they had unprotected sex or experienced method failure. Fifty-three percent said that pharmacy access would make them more likely to use the method, and 65% each said that their likelihood of using it would be increased if they had the pills on hand and if their doctor informed them about the method. While one in five sexually active women would be unwilling to pay for emergency contraception, one in three would pay $50 or more. The researchers conclude that "'over-the-counter' availability could broadly expand both knowledge and use of emergency contraception, but public education efforts will still be necessary to increase awareness."

WHAT WOMEN NEED TO KNOW

Only 59% of U.S. women of reproductive age know that treatment is available to reduce the chance that an HIV-positive woman will transmit the virus to her baby.¹ Using data from the 2001 Behavioral Risk Factor Surveillance System, researchers conducted multivariate analyses to identify factors associated with knowledge that mother-to-child HIV transmission can be prevented. Results showed that the odds of having such knowledge are significantly elevated among black women (odds ratio, 1.3), women younger than 35 (1.2-1.3), college graduates (1.6) and women who have ever been tested for HIV (1.6); they are reduced among residents of the Midwest and the South (0.9 each). Pregnant women are no more likely than nonpregnant women to know about treatment for preventing perinatal HIV transmission. The analysts urge clinical, public health and social marketing efforts aimed at increasing awareness of the "very low transmission rates achievable with appropriate interventions."

MINNESOTA STUDENTS JUST SAY NO TO ABSTINENCE

After taking an abstinence-only sex education course, 12% of students in three Minnesota junior high schools said that they were sexually active—twice the proportion who gave this response before taking the course.¹ A similar pattern is apparent statewide. Furthermore, despite the state's policy to teach that abstaining from intercourse is the only way to avoid pregnancy and sexually transmitted disease, 77% of parents surveyed said that they want their children to be taught about both abstinence and contraception. While supporters of abstinence-only education fault the program for teaching that young people should refrain from having intercourse only until adulthood, rather than until marriage, opponents label such thinking "naive." The director of a group that advocates comprehensive sex education comments that "just telling kids to abstain doesn't meet their needs."

WHEN IS A TEST A RED FLAG?

Teenagers' use of home pregnancy tests may be an indicator of their attitude toward early childbearing, according to findings from a study of 340 sexually active patients at three urban adolescent health clinics.¹ Twenty-eight percent of the sample had taken a home pregnancy test; analyses that adjusted for a number of factors related to sexual decision-making revealed that these teenagers were significantly more likely than other young women to be living apart from their biological parents, have more than 10 well-established risk factors for teenage pregnancy and not view adolescent pregnancy as having negative consequences (odds ratios, 2.0-2.2). In unadjusted analyses, teenagers who had taken a home pregnancy test appeared to have a reduced likelihood of having used a contraceptive at last intercourse and of accepting a method during the clinic visit, but these differences were not significant in adjusted analyses. The researchers conclude that "teenagers who use home pregnancy test kits might benefit more from counseling aimed at altering their childbearing expectations than from traditional discussions of contraceptive options." They thus recommend that providers who serve sexually active teenagers "regard a history of home pregnancy test taking as a red flag."

MONEY-SAVING PILL REGIMEN

An oral contraceptive regimen consisting of 84 days of hormonally active pills followed by a seven-day pill-free interval could be less costly to users and society than the standard regimen of 27 days of active pills followed by a weeklong pill-free interva1.¹ In an analysis taking into account various direct costs of pill use (e.g., costs for the prescription, female hygiene products and doctor visits for menstrual-related concerns) and indirect costs (e.g., wages lost because of menstrual problems and opportunity costs of doctor visits), researchers found that if the pills were priced comparably, a year of the new regimen would cost a user $41 less than a year of the standard regimen; societal costs per user would also be reduced by $41 annually, but direct costs for third-party payers would not differ by regimen. The analysts caution that their calculations did not take into account possible health benefits or risks related to use of an extended pill regimen. Nevertheless, they conclude that "under an appropriate drug pricing policy," such a regimen "may hold considerable promise for adding value over existing standard [regimens]."

SMOKING IS HAZARDOUS TO...

Smoking is harmful to sexual and reproductive health, in men and women, from puberty onward; this is the message of a report issued by the British Medical Association in February 2004.¹ Using the most up-to-date data, researchers estimated that 120,000 British men are impotent as a result of the effects of tobacco, 1,200 cases of malignant cervical cancer and 3,000-5,000 miscarriages each year are related to smoking, and the chances of conception are reduced by 40% per cycle among women who smoke. The investigators also concluded that smokers do not respond as well as nonsmokers to fertility treatment, and they documented the effects of smoking on pregnancy outcomes, as well as the effects of secondhand smoke on child health. Among the recommendations offered in the report are that employers grant leave with full pay to pregnant workers who cannot be protected from secondhand smoke in the workplace and that tobacco products carry pictorial health warnings that reflect risks to reproductive health.

CATCH THE WAVE, PREVENT MISCARRIAGE?

Doppler ultrasound, a more sensitive technology than conventional ultrasound, can detect congestive heart failure in a six-week- old embryo, according to a study based on results for 1,530 pregnant women.¹ Embryonic congestive heart failure occurs when not enough oxygen is reaching the heart, possibly because blood vessels feeding the placenta are malformed or underdeveloped; the condition is a factor in 40% of miscarriages. The researcher comments that results of Doppler imaging "provide prospective parents with early information about what they are facing": an almost certain risk of miscarriage. However, he suggests that an intervention as simple as administering oxygen early in pregnancy to a woman with abnormal results of a Doppler evaluation may help reduce that risk. Further research into embryonic congestive heart failure, he adds, may lead to the development of new approaches to preventing miscarriage.

MEN, WOMEN AND HIV

In 29 states with name-based reporting of HIV or AIDS, 35% of newly diagnosed HIV infections reported among individuals aged 13 and older in 1999-2002 were acquired through heterosexual contact.¹ According to an analysis by the Centers for Disease Control and Prevention, women accounted for 64% of heterosexually acquired infections, 89% of those among 13-19-year-olds and more than half of those in each racial or ethnic group examined. Black and Hispanic men and women, who made up 21% of the population of the 29 states, accounted for 84% of infections acquired through heterosexual contact; the great majority of these infections (74% overall) were among blacks. One-fifth of individuals with heterosexually acquired HIV received an AIDS diagnosis in the same month that they learned of their HIV infection; concurrent diagnosis of the two conditions was more likely among males than among females. The author of a commentary on the analysis urges the development of culturally sensitive HIV prevention interventions and prevention education aimed at sexually active teenagers.

IN BRIEF

•In response to research indicating that nonoxynol-9 may increase women's risk of HIV and other sexually transmitted diseases by damaging the lining of the vagina and cervix, the manufacturer of Durex condoms has stopped making condoms containing the spermicide. Health care organizations and advocates have praised the company for "putting public health above profits in this matter." [Kaiser Family Foundation, Durex stops making condoms with nonoxynol-9 due to possible increased risk of HIV transmission, Daily HIV/AIDS Report, Jan. 21, 2004, , accessed Jan. 23, 2004.]

•The second edition of State Minor Consent Laws: A Summary is available from the Center for Adolescent Health & the Law. The monograph describes relevant laws in each state and the District of Columbia, includes information about the legal context and provides lists of background resources. More information is available at www.cahl.org.

•New Frontiers in Contraceptive Research: A Blueprint for Action can be purchased or read online at www.nap.edu. The report, by an Institute of Medicine committee, reviews advances in contraceptive research and presents recommendations aimed at ensuring "that future investments in contraceptive research, discovery, and development are brought to fruition."