Oral Contraceptive Use along the US-Mexico Border

描述（由申请人提供）：口服避孕药（OC）是全球女性可用的最有效，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不同，女性仍然需要医疗保健提供者的处方，通常需要检查，才能购买OC。关于处方要求的政策辩论集中在妇女是否可以安全有效地使用口服避孕药，而无需与医疗保健提供者进行强制性接触。具体而言，问题仍然是妇女是否可以筛选自己的禁忌症;处方要求劝阻OC候选人开始或继续使用OC的程度;以及书面或其他形式的信息是否是有效的替代品或改善临床医生的联系。 这项跨学科的研究将被部署在沿着穿越的美国-墨西哥边境，将墨西哥的华雷斯城和德克萨斯州的埃尔帕索分开。研究设置提供了一个独特的“自然实验”环境，以解决这些悬而未决的问题，因为埃尔帕索居民可以，而且经常这样做，越过边境购买在墨西哥药店，处方是不需要的。 第一个目的是评估妇女是否有能力像卫生专业人员一样筛查自己使用OC的禁忌症。为此，我们将从埃尔帕索的一般人群中招募一个方便的妇女样本，并使用一个简单的禁忌症清单以及护士的临床评估。其次，通过比较在华雷斯城药房购买OC时招募的女性与从埃尔帕索计划生育诊所招募的对照组，该研究将探讨：女性在每个地点购买OC的动机，以及购买地点之间的关系和女性对OC的了解。此外，使用随机对照设计，我们将调查的作用，一个简单的书面说明传单有关业主立案法团在传达信息的妇女获得药丸在墨西哥药店。最后，从墨西哥药店和埃尔帕索计划生育诊所招募的OC用户的大型前瞻性队列将每季度进行为期9个月的随访，以评估他们对OC采购来源的基线决定是否与满意度，依从性，延续性和意外怀孕相关。 我们的研究将回答有关医疗监督在OC提供中的适当作用以及影响依从性和持续性的因素的重要问题。此外，它将大大增加对西班牙裔生育率和避孕实践的日益重要的领域苗条的文献。

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.