Oral Contraceptive Use along the US-Mexico Border

描述(由申请人提供)：口服避孕药(OCS)是全世界妇女可用的最有效、最安全和最广泛使用的避孕方法之一。美国与其他许多国家的不同之处在于，女性购买OCS仍然需要医疗保健提供者的处方，通常需要检查。关于处方要求的政策辩论集中在女性是否可以安全有效地使用口服避孕药，而不需要强制与医疗保健提供者接触。具体而言，以下问题仍然存在：女性是否可以对自己进行禁忌症筛查；处方要求在多大程度上阻止了OC候选人开始或继续使用OC；以及书面或其他形式的信息是否有效地替代或改善了临床医生的接触。 这项跨学科的研究将部署在墨西哥华雷斯和德克萨斯州埃尔帕索之间的美墨边境沿线。由于埃尔帕索居民可以而且经常越境在墨西哥药店购买OCS，研究环境提供了一个独特的“自然实验”环境，在这个环境中解决这些悬而未决的问题是不需要处方的。 第一个目标是评估女性是否像卫生专业人员一样有能力筛查自己使用OC的禁忌症。为此，我们将从埃尔帕索的普通人群中招募一名方便的妇女样本，并利用一份简单的禁忌症清单以及护士的临床评估。其次，通过将在华雷斯的药店购买OCS时招募的妇女与从埃尔帕索计划生育诊所招募的对照组进行比较，该研究将探索：妇女在每个地点购买OCS的动机，以及采购地点与妇女对OCS的了解之间的关系。此外，使用随机对照设计，我们将调查一份关于OCS的简单书面说明传单在向在墨西哥药店获得药物的妇女传达信息方面的作用。最后，从墨西哥药店和埃尔帕索计划生育诊所招募的一大批OC潜在使用者将每季度跟踪调查9个月，以评估他们关于OC采购来源的基线决定是否与满意度、遵从性、延续和意外怀孕有关。 我们的研究将回答有关医疗监督在OC条款中的适当角色以及影响遵从性和连续性的因素的重要问题。此外，它将大大增加关于拉美裔生育和避孕实践这一日益重要的领域的薄薄文献。

DESCRIPTION (provided by applicant): Oral contraceptives (OCs) are one of the most effective, safe and widely-used contraceptive methods available to women worldwide. The US differs from many other countries in that women still need a healthcare provider's prescription, often requiring an examination, to purchase OCs. Policy debate about the prescription requirement has focused on whether women could safely and effectively use oral contraceptives without mandatory contact with a healthcare provider. Specifically, questions remain as to whether women can screen themselves for contraindications; the degree to which the prescription requirement dissuades OC candidates from starting or continuing OC use; and whether written or other forms of information are an effective substitute or improvement on clinician contact. This interdisciplinary study will be fielded along the heavily traversed US-Mexico border separating Ciudad Juarez, Mexico and El Paso, Texas. The study setting provides a unique "natural experiment" environment in which to address these unanswered questions due to the fact that El Paso residents can, and frequently do, cross the border to purchase OCs in Mexican pharmacies, where prescriptions are not required. The first aim is to assess whether women are as capable of screening themselves for contraindications to OC use as health professionals. To this end, we will recruit a convenience sample of women from the general population in El Paso and make use of a simple checklist of contraindications as well as nurse's clinical assessment. Second, by comparing women recruited when they purchase OCs at pharmacies in Ciudad Juarez to controls recruited from family planning clinics in El Paso, the study will explore: women's motivations for buying OCs at each location, and the relation between procurement location and women's knowledge about OCs. Also, using a randomized controlled design, we will investigate the role of a simple written instruction leaflet about OCs in conveying information to women obtaining pills in Mexican pharmacies. Finally, a large prospective cohort of OC users recruited from Mexican pharmacies and the El Paso family planning clinics will be followed quarterly for nine months to assess whether their baseline decisions about OC procurement source are associated with satisfaction, compliance, continuation and unintended pregnancy. Our research will answer important questions regarding the appropriate role of medical supervision in OC provision and the factors influencing compliance and continuation. Additionally, it will add substantially to the slim literature on the increasingly important area of Hispanic fertility and contraceptive practice.