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Appendix I
Title X–and OPA-Funded Research
Section 1004 of the Title X Act authorizes the Secretary of Health and Human Services to award grants and enter into contracts for research projects in the biomedical, contraceptive development, behavioral, and program implementation fields related to family planning and population. Research funded by the program includes Title X Service Delivery Improvement research—applied research aimed at generating knowledge that will enable the program to improve the delivery of reproductive health services to women and men who need them. Research is also conducted through cooperative agreements. The purpose of these agreements is to analyze data on family planning needs and services over time, develop tools for assessing and improving the quality of care in clinics, and analyze national survey data to better understand the determinants of unintended pregnancy and childbearing (www.hhs.gov/opa/ore/research/index.html [accessed August 19, 2008]). In addition to these grants, the Office of Population Affairs uses 1 percent funds from the Department of Health and Human Services (HHS) to contribute to the National Survey of Family Growth (NSFG) and Adolescent Health Surveys.
SERVICE DELIVERY GRANTS AND COOPERATIVE AGREEMENTS
The awards listed below are categorized by fiscal year (FY). These include grants made under the Service Delivery Improvement research standing announcement and through cooperative agreements (three were awarded in FY 2004). Note that grants were not awarded in FY 2002 and FY 2003.
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Fiscal Year 2008
Integration of Family Planning Services into an STD Clinic Setting
Grantee Organization:
Denver Health and Hospital Authority
Denver Public Health Department
Denver, CO
Principal Investigator: Judith Shlay, M.D.
Project Period: 9/01/2008–8/31/2011
This study will investigate how providing integrated family planning with STD clinical services in an STD clinic affects quality of care, cost of services, staff duties, clinic flow, clients’ family planning needs, satisfaction with services, and incidence rates of STDs and pregnancies. The study will specifically (1) assess the feasibility and replicability of the clinical processes used by clinicians to provide family planning services in an STD clinic setting, (2) assess and compare the costs of providing family planning and STD services in separate clinical settings and through separate programs to the costs of an integrated program, (3) establish computerized procedures to identify clients eligible for family planning services in an STD clinic, and (4) assess the need for family planning services among all clients seen for STD clinical services. In addition, the study will evaluate the effectiveness of a reminder system that notifies staff of a person’s eligibility to receive family planning services; and compare rates of STDs and unintended pregnancies among clients seen in the clinic.
Sexual and Reproductive Health Outreach for Young Women of Color: A New Approach
Grantee Organization:
The Trustees of Columbia University
Columbia University Health Sciences Center
New York, NY
Principal Investigator: Debra Kalmuss, Ph.D.
Project Period: 9/01/2008–8/31/2011
The study will develop innovative and practical ways to embed sexual and reproductive health (SRH) referrals, as well as promotional information and messages, into workforce development (WFD) programs; train WFD program staff to interview men about their use of and/or need for SRH care and how to make care referrals; train staff at Title X clinics how to enhance their facilities and services to be gender sensitive to men, based
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on the results of a male friendliness needs assessment; and implement and evaluate the efficacy and sustainability of the capacity building outreach model in promoting men’s SRH utilization. The proposed research will occur with two WFD programs that serve low-income Hispanic and African-American males seeking new job training, and two Title X clinics.
Increasing Family Planning Utilization Among Hispanic Teen and Young Adult Women
Grantee Organization:
Child Trends
Washington, DC
Principal Investigator: Jennifer Manlove, Ph.D.
Project Period: 9/01/2008–8/31/2011
The specific aim for the project is to reduce the high rate of teen and unintended pregnancies among Hispanics in the United States. This will be accomplished by using quantitative, qualitative and applied research methods to better assess who is or is not accessing family planning services and why. The project work will be performed in three stages. In Stage 1, the project will analyze family, individual, and community factors associated with the utilization of family planning services using data from several cycles of the National Survey of Family Growth. For Stage 2, focus groups will be conducted in three target cities with Hispanic female teens and young adults to gather group insights into their decisions to access or not access services. The project will also include three focus groups with clinics and service providers to discuss the challenges of reaching Hispanic clients. In Stage 3, project staff will work with a clinic or provider in each of the target cities to assess how the programs can use the study’s findings; translate the findings; and construct implementation guidelines for the broader family planning practitioner community.
Fiscal Year 2007
Medicaid Family Planning Waivers: Service Delivery, Use, and Intended Pregnancy
Grantee Organization:
Emory University
Rollins School of Public Health
Atlanta, GA 30322
Principal Investigator: Kathleen Adams, Ph.D.
Project Period: 9/30/2007–9/29/2010
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Six states will be study sites for examining the effects of changes in the organization and delivery of family planning services through Medicaid section 1115 waivers on three key outcomes—(1) access to services, (2) use of contraceptive/preventive services, and (3) unintended pregnancy. In each state, the aim will be to test whether the state’s waiver reduced barriers and increased use of services and thereby reduced unintended pregnancy. Overall, variation in the impact of waivers across states and across different subgroups, such as married women, teens and minority women, will be analyzed. Both quantitative analyses (PRAMS and BRFSS data sets available from CDC) and qualitative research (informant interviews and focus groups) will be carried out. A synthesis of states’ concerns, approaches, successes/failures and client perceptions of the waivers will be generated. A key goal of the analyses is to elucidate the pathways whereby sexually active women not desiring to become pregnant are or are not served under the delivery systems each state has in place under its waiver. The six states are Arkansas, Illinois, New York, California, Washington, and Wisconsin; the project will provide a case study for each of these states.
Sexual and Reproductive Health Services: Reaching Latino Men in Rural Areas
Grantee Organization:
Oregon State University
Department of Public Health
Corvalis, OR 97331
Principal Investigator: S. Marie Harvey, Dr.P.H.
Project Period: 9/30/2007–9/29/2010
The objective of this research project is to increase understanding of the sexual and reproductive health needs of heterosexual Latino men who live in rural areas. In this two-part study, the focus is on Latino men in the new settlement areas of rural Oregon. Study 1 will consist of in-depth interviews of a convenience sample of 80 men to assess their attitudes and behavior pertaining to sexual activity and contraception, and their perceptions of their needs and of the barriers to accessing services and to determine how their attitudes and behaviors vary by age, type of sexual partner and acculturation. Study 2 will include in-depth interviews with administrators and practitioners from publicly funded family planning agencies who serve Latinos in rural areas. The specific aims of Study 2 are to (a) explore experiences providing family planning and HIV/STI prevention services to Latino males; (b) identify barriers and facilitators to serving male Latinos; (c) explore advantages and disadvantages of integrating men into sexual and reproductive health services for family planning agencies and for male
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clients; (d) identify preferred context for providing sexual and reproductive health services to men (e.g., couples, male only, traditional family setting or other contexts); and (e) explore how agencies can build their capacity to improve sexual and reproductive health services for Latino males.
Couples-Based Family Planning Services: Is There a Need?
Grantee Organization:
The Guttmacher Institute
New York, NY 10038
Principal Investigator: Rachel Jones, Ph.D.
Project Period: 9/30/2007–9/29/2010
The project aims to improve contraceptive use and reduce unintended pregnancy among Title X family planning clients by providing information on a new and mostly untested programmatic strategy of fostering joint decision-making around family planning through couples-oriented services. Three interrelated activities are proposed:
Provide a national overview of the extent to which Title X female and male clients, 18–44 years of age, as well as the clients’ partners, express a desire for programs oriented to couples designed to improve joint decision making around contraceptives and method selection;
Explore the issue from the point of view of providers, to determine what strategies clinics have so far adopted in terms of couples-oriented counseling or services, as well as perceived need for and barriers to implementing such programs; and
Disseminate findings to relevant audiences to inform public discussion about the potential for contraceptive counseling and services targeting couples in order to foster or promote joint decision making around contraceptive use.
The sampling approach is based on 80 randomly drawn clinics from a universe of U.S. clinics. Individual clients will receive and complete surveys at the clinic site and be provided survey forms to take to partners; the sample size of clients is expected to be 2,500 women and 125 men. Clients’ openness to a couples approach will be analyzed by relationship type (married, co-habiting, neither married nor co-habiting) and by racial/ethnic groupings. Staff at sampled clinics will complete a provider survey on couples-oriented services as well.
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The Fort Peck Sexual Health Project: A Contextual Analysis of American Indian Men
Grantee Organization:
Montana State University
Department of Health and Human Development
Bozeman, MT 59717
Principal Investigator: Elizabeth Lynne Rink, Ph.D.
Project Period: 9/30/2007–09/29/2009
The study will elucidate the individual, social and environmental factors that most greatly influence American Indian men’s sexual and reproductive health. Individual characteristics to be examined include: knowledge of contraceptive methods and sexually transmitted infections (STIs); perceptions of pregnancy; perceived risk of STIs; perceptions of abstinence, monogamy and contraceptive use. Social dynamics to be examined are: relationships with family; relationships with peers; culture; religion; and relationships with sexual partners. The relevant environmental factors will include: characteristics of family planning services, access to family planning services, and utilization of family planning services. The target population for this project is American Indian men ages 18–24 years living on the Fort Peck Indian Reservation in northeastern Montana. The research plan includes a Community Based Participatory Research (CBPR) approach and qualitative research methods. CBPR will entail engaging the Fort Peck Indian Reservation as full and equal partners in the research project, by establishing an 8–10 member community advisory board to provide oversight and coordination of the project. Qualitative research methods will include (1) 12–15 key informant interviews with health care professionals and (2) 112 in-depth interviews with American Indian men. Research results will be used to design effective, culturally sensitive, family planning intervention strategies for American Indian men.
Fiscal Year 2006
CONnecting with Teens About Contraceptive Use (CONTAC-U)
Grantee Organization:
Johns Hopkins Bloomberg School of Public Health
615 N. Wolfe Street
Baltimore, MD 21205
Principal Investigator: Kathleen M. Cardona, Dr.P.H., M.P.H.
Project Period: 09/01/2006–08/31/2009
Project Description: The objective of this study is to develop and evaluate a clinic-based intervention intended to increase contraceptive use and
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consistency of use, and reduce 1-year pregnancy rates among adolescents. Specifically, the plan is to design an easily replicable, technology-based and adolescent-friendly means of continuing contact to enhance contraceptive protection, while encouraging parental involvement. This will involve all female clients under age 20 who present to the youth center in Baltimore City over an 18 month period. Individualized methods counseling sessions will be provided to clients who will be contacted at regular intervals beginning 2 weeks post-enrollment and then at least monthly to discuss issues related to method use, and appointment reminders. One technological innovation is clients’ use of text-messaging, e-mail, or phone as a means of clinic contact. A second innovation is the use of a new web-based database to be designed for this project, which will permit contacts to be scheduled, initiated, and recorded, and which will enable the clinic to provide regular, longitudinal follow-up. Clients will also be encouraged to identify a parent or key adult to participate in order to learn about contraceptive options and how to communicate with the teen to reinforce appropriate use of contraception.
Chlamydia and Race/Ethnicity in Title X Region X Female Clients Age 15–24 Years
Grantee Organization:
Center for Health Training
1809 7th Avenue, Suite 400
Seattle, WA 98101
Principal Investigator: David Fine, Ph.D.
Project Period: 9/01/2006–08/31/2007
Project Description: The research goal for this project is to explore, assess, and begin to address possible racial/ethnic disparities in chlamydia (CT) screening, prevalence and prevention services in Title X family planning clinics using existing data sets. Specific aims are to (1) assess racial and ethnic disparities in chlamydia screening coverage among Title X Region X family planning (FP) clinic female clients aged 15–24, from 2004–2005; (2) assess racial and ethnic disparities in chlamydia positivity among Region X FP clinic female clients aged 15–24 from 1997–2005; and (3) assess an enhanced array of behavioral, demographic, and socioeconomic status measures in relation to race/ethnicity and chlamydia positivity in a sample of FP clinic female clients age 15–24. Data sources to be used for specific aims #1 and #2 include (1) a two-year (2004–2005) data set from the Region X Title X FP client information system that captures patient characteristics and service provision for all Title X encounters; and (2) data from the Infertility Prevention Project (IPP) for the assessment of racial and ethnic disparities
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in chlamydia positivity. Data for specific aim #3 will come from recruiting female FP clients (375 CT+/375 CT-) age 15–24 from clinics where race/ethnic disparities were found based on results from specific aim #2.
Disparities in Reproductive Health Care Access Among Vulnerable Populations
Grantee Organization:
Research Triangle Institute
3040 Cornwallis Road
Research Triangle Park, NC 27709
Principal Investigator: Christina Fowler, Ph.D., M.P.H.
Project Period: 09/01/2006–08/31/2008
Project Description: This study proposes a comprehensive and systematic examination of disparities in reproductive health service access across multiple vulnerable populations. The objective of this project is to examine whether disparities in access to family planning and other reproductive health services exist for vulnerable groups of women and men, specifically non-Hispanic black and Hispanic, relative to non-Hispanic white; poor (<100% of federal poverty level [FPL]) and near-poor or low income (100%–199% of FPL), relative to nonpoor (>200% of FPL); teens (aged 15–19) and young adults (aged 20–24), relative to older adults (aged 25–44); and residents of nonmetropolitan counties and metropolitan suburban counties, relative to residents of metropolitan urban counties. Data from the 1995 (women) and 2002 (women and men) National Survey of Family Growth (NSFG), will be used to analyze whether group differences exist in service utilization, quality, and contraceptive use and to assess the role of Title X clinics in reducing differences. The IOM’s 1993 Model of Access to Personal Health Care Services, adapted to reproductive health care, will guide the study.
Impact of Pack Supply on Contraceptive Continuation
Grantee Organization:
Columbia University Medical Center
630 West 168th Street
New York, NY 10032
Principal Investigator: Katherine J. O’Connell, M.D., M.P.H.
Project Period: 09/30/2006–09/29/2009
Project Description: The objective of this project is to determine whether providing an enhanced, seven-month supply of oral contraception (OC) versus the standard 7-month supply of OC results in less contraceptive dis-
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continuation. It is believed that an extended initial supply of contraception requires fewer visits to obtain refills and may remove a common obstacle to method continuation. The proposed strategy is a randomized trial to compare two approaches to the initial supply of hormonal contraception in women aged 29 and under who receive family planning care at a publicly funded clinic (n = 750). The approaches are (1) a standard 3-month supply of OC, versus (2) an enhanced 7-month supply of OC. Interviews will be conducted at a 6-month follow-up to determine OC continuation rates and adverse events. The researchers believe that the approach of extending the initial supply of contraception has the potential to improve rates of OC, particularly among adolescents who are at the highest risk of early discontinuation, and by removing a obstacle to method continuation, would ultimately help to reduce the rate of unintended pregnancy.
Fiscal Year 2005
How Well Do Family Planning Providers Link Their Low-Income Clients to Primary and/or Specialty Care?
Grantee Organization:
University of Alabama-Birmingham
1530 3rd Avenue South
Birmingham, AL 35294
Principal Investigator: Janet M. Bronstein, Ph.D.
Project Period: 09/30/2005–09/29/2007
Project Description: The specific aims of this project are (1) to examine the range of referral facilitation activities provided in family planning settings serving low-income women; (2) to explore the factors associated with family planning clients’ decisions to seek and ability to receive care for other medical conditions, including the role played by referral facilitation and discussions of the problem at the family planning visits; and (3) to compare the level of concern about the ability to refer family planning clients for needed primary and specialty care between clinicians who do and do not provide family planning care to clients with Medicaid coverage for these services. Family planning providers who participate in and clients who are enrolled in Medicaid family planning demonstration programs in Alabama and Arkansas are the populations under study. Data for this project will be collected through three surveys: (1) a survey of family planning clinicians to assess referral practices; (2) a survey of these clinicians’ family planning clients, to examine their care-seeking behavior for general health problems and the role played by their family planning providers; and (3) a survey of
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office physicians who are authorized as Medicaid family planning providers but are seeing few or no Medicaid clients.
Men’s Reproductive and Sexual Health Practices, Attitudes and Service Utilization
Grantee Organization:
Columbia University Medical Center
60 Haven Avenue, Suite B-2
New York, NY 10032
Principal Investigator: Debra S. Kalmuss, Ph.D.
Project Period: 09/30/2005–09/29/2008
Project Description: The objective of the proposed study is to examine men’s reproductive and sexual health (RSH) practices, attitudes, and service utilization in order to inform the development of programs for adolescent and older men. The research plan is to employ both quantitative and qualitative methods to examine men’s RSH status, attitudes and practices and how they vary across race/ethnic, socioeconomic, age, and marital/relationship status in order to increase the utilization of RSH services for men. The quantitative approach would use national data from Cycle 6 of the National Survey of Family Growth (NSFG) supplemented by two data sets targeting high-risk groups of males aged 18–30 from northern Manhattan and the Bronx. The qualitative component—use of focus groups—is intended to obtain a more in-depth understanding of men’s perceptions regarding utilization, such as barriers to men’s use of RSH and possible strategies to increase men’s utilization of such services. The final step in the proposed study will involve the translation of research findings into suggestions for program development and/or enhancement.
Improving Services for Latina Women and Their Partners: A CAPACITIES Approach
Grantee Organization:
Georgetown University, Department of OB/GYN
3900 Reservoir Road, NW
Washington, DC 20007
Principal Investigator: Rebecka Lundgren, M.P.H.
Project Period: 09/30/2005–09/29/2008
Project Description: This intervention research, which will be conducted collaboratively by the Institute for Reproductive Health, Georgetown University, and Planned Parenthood of San Diego and Riverside Counties,
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will determine whether including the Standard Days Method (SDM) as an option for clients results in an increased focus on the couple in counseling for all methods of contraception; whether incorporating a couple perspective into services results in improved satisfaction with and use of services; whether it increases couple communication and participation in family planning use and decision-making; and whether it results in improved used of and satisfaction with family planning methods. SDM is a simple, effective fertility awareness-based method that is being offered in programs around the world, including a growing number in the United States. The importance of addressing couples may be particularly relevant for Latinos, given cultural considerations.
Couples and Contraceptive Practice
Grantee Organization:
Family Planning Council
260 S. Broad Street, Suite 1000
Philadelphia, PA 19102-5076
Principal Investigator: Paul Whittaker, Ph.D.
Project Period: 09/30/2005–09/29/2008
Project Description: The Family Planning Council proposes to conduct a mixed methods investigation to study the feasibility and effectiveness of couples-focused contraceptive services, which will use an integrated complement of ethnographic and quantitative methods to attain three aims. The first is to compare the attitudes, subjective norms, and behavioral beliefs of young adult men and women regarding the involvement of intimate partners in contraception decisions and the influence of these partners on contraceptive use. The second is to identify the attitudes, subjective norms, and behavioral beliefs of Title X providers regarding the current and potential provision of couples-focused contraception services. The third is to develop and field-test the potential utility of a culturally relevant couples-focused intervention that promotes informed contraception decisions and effective contraception use.
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Project Description: This project developed a mathematical staff planning and resource allocation model to assist decision makers in multiclinic family planning programs or districts. The model, which was tested with actual data from South Carolina Family Planning Districts, may provide planning and allocation methods such as assigning itinerant staff and scheduling individual clinic operations to meet client demand with minimal cost and staff time.
An Integrated Services Model: Family Planning and Pediatrics
Grantee Organization:
University of Texas Southwestern Medical Center at Dallas
Department of Obstetrics and Gynecology
Division of Maternal Health/Family Planning
5323 Harry Hines Blvd.
Dallas, TX 75235
Principal Investigator: Stephen F. Heartwell, Dr.P.H.
Project Period: 10/1984–9/1986
Project Description: The study examined quality of care, recruitment and retention of patients, appointment keeping, clinic costs and efficiency, repeat pregnancies and other factors as they are affected by combining family planning with post-partum and new infant assessment so that mothers may receive these services at a single clinic appointment.
Effects of the Integration Model on Family Planning Programs
Grantee Organization:
The Center for Health Training
400 Tower Building
1809 7th Avenue
Seattle, WA 98101
Principal Investigator: Susan DeLisle, M.P.H.
Project Period: 10/1986–11/1987
Project Description: This project studied how integration of family planning services with other services affects the character of family planning service provision. It described and compared DHHS Regions I and X using the quality-assurance guidelines of Dimensions of Care (clinical appropriateness, continuity, efficiency, comprehensiveness, accessibility, and accountability). Regional databases, computerized and archival, were utilized.
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Role of Private Physician
Private Physician Family Planning Services in the United States
Grantee Organization:
The Alan Guttmacher Institute
111 Fifth Avenue
New York, NY 10003
Principal Investigator: Margaret Terry Orr, Ph.D.
Project Period: 10/1983–9/1984
Project Description: This project analyzed data previously obtained from a large national sample of private physicians (obstetricians/gynecologists, general and family practitioners, and general surgeons). The analysis focused on (1) describing the role of private physicians in providing contraceptive and infertility services to poor women and (2) estimating the cost of family planning services obtained by poor women from private physicians.
Family Planning Services for Economically Disadvantaged Women: Utilization, Cost, and Patient Satisfaction
Grantee Organization:
University of Southern California
School of Medicine
Department of Medical Education
KAM Room 200
1975 Zonal Avenue
Los Angeles, CA 90033
Principal Investigator: Robert C. Mendenhall, Ph.D.
Project Period: 10/1983–3/1985
Project Description: The study involved interviewing low-income Los Angeles–area women concerning source of family planning care and satisfaction with such care. Interview responses were augmented with data supplied by identified physicians and clinics, to provide comparative pictures of private and clinic-provided family planning care. The results may enable family planning clinics to initiate improvements to increase clients’ acceptability of the services offered.
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Natural Family Planning
Factors Affecting the Choice of Natural Family Planning
Grantee Organization:
International Population Center
San Diego State University
San Diego, CA 92182-3083
Principal Investigator: John R. Weeks, Ph.D.
Project Period: 9/1987–8/1988
Project Description: The aim of this study was to identify possible stumbling blocks to wider utilization of NFP, particularly in Title X settings. Specifically, it assessed the extent to which knowledge of and attitudes toward NFP on the part of family planning clinic administrators, clinic service providers, and physicians in private settings affect the availability of NFP services, controlling for program characteristics, client characteristics, and the sociodemographic background of respondents. Questionnaires were sent to 1,000 providers in Los Angeles and San Diego counties; the results were analyzed and then translated into a set of policy recommendations for removing existing barriers.
Infertility Services
Infertility Services in the United States: Need, Accessibility, and Utilization
Grantee Organization:
The Alan Guttmacher Institute
111 Fifth Avenue
New York, NY 10003
Principal Investigator: Jacqueline D. Forrest, Ph.D.
Project Period: 10/1984–9/1985
Project Description: This project utilized several data sets to estimate (1) need for infertility services among poor women and (2) their ability to access such services from various sources, including family planning agencies.
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Counseling Services
Computerized Contraceptive Counseling Aid
Grantee Organization:
University of Wisconsin-Madison
425 North Charter
Madison, WI 53706
Principal Investigator: Betty A. Chewning, Ph.D.
Project Period: 1/1/1988–6/30/1991
Project Description: The objective of this project was to evaluate the potential of a computerized contraceptive counseling aid to improve Title X family planning services for women under age 20. Specifically, it evaluated (1) the receptivity of Title X clients and staff to the computerized aid; (2) whether the computer aid could strengthen the contraceptive knowledge, satisfaction, and confidence of clients in using a method; (3) whether the computer can reduce sexual risk-taking by promoting consistent use of the selected contraception; (4) the computer’s ability to encourage the male partner’s support for the client’s choice; and (5) whether the computer aid can improve contraceptive compliance.
The Effectiveness of Contingency Planning Counseling
Grantee Organization:
Columbia University
Center for Population and Family Health
60 Haven Avenue, B-3
New York, NY 10032
Principal Investigator: Pearila B. Namerow, Ph.D.
Project Period: 10/1984–3/1987
Project Description: Approximately 1,500 young adult family planning clients were studied in a randomized clinical trial of an innovative counseling approach which involved the use of a written plan to deal with contingencies that may affect birth control use over time. Effects on continued clinic attendance, use of contraception at last coitus, consistency of contraceptive use, and unintended pregnancy were examined at 6- and 12-month intervals.
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Aid for Contraceptive Decision Making
Grantee Organization:
University of Wisconsin
Sonderegger Center
School of Pharmacy
425 North Charter
Madison, WI 53706
Principal Investigator: Betty A. Chewning, Ph.D.
Project Period: 11/1985–12/1986
Project Description: This project developed and assessed the content and software of a computerized counseling aid to be used in conjunction with and prior to seeing a health provider. The counseling aid was designed to help the female client gather accurate information regarding tradeoffs associated with different contraceptives, clarify her priorities and select a method which best fits her preferences and circumstances.
Other Research: A second grant was awarded to Dr. Chewning in June 1988 to evaluate the developed computerized counseling aid in clinic settings.
Strategies of Counseling and Follow-up in Family Planning Clinics
Grantee Organization:
Family Planning Council of Southeastern Pennsylvania
260 South Broad Street
Suite 1900
Philadelphia, PA 19102-3865
Principal Investigator: Kay A. Armstrong, M.S.
Project Period: 11/1985–10/1987
Project Description: This project was conducted to determine which of three counseling approaches—directive, anticipatory, and information (with and without a follow-up component)—is most effective in promoting clinic continuity and contraceptive compliance. Data were obtained from approximately 3,500 clients of six comparable family planning clinics in Southeastern Pennsylvania at the initial visit and 9 months later.
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Cross-National Studies
An International Comparison of Unintended Pregnancy, Contraceptive Practice and Family Planning Services
Grantee Organization:
The Alan Guttmacher Institute
111 Fifth Avenue
New York, NY 10003
Principal Investigator: Jacqueline D. Forrest, Ph.D.
Project Period: 10/1985–9/1987
Project Description: This study searched the experiences of other countries to learn how family planning can be delivered in the United States more efficiently and effectively. Existing quantitative and qualitative data on 22 developed countries were assembled to provide an overview and frame of reference for in-depth study of four countries—the United States, the United Kingdom (England and Wales), Canada, and the Netherlands.
Family Planning Services Delivery: Danish Experience
Grantee Organization:
Transnational Family Research Institute
8307 Whitman Drive
Bethesda, MD 20817
Principal Investigator: Henry P. David, Ph.D.
Project Period: 11/1985–10/1987
Project Description: Population subgroups whose family planning needs are underserved in the United States, but better met in Denmark were the focus of this study, with an emphasis on identifying successful service delivery features that are transferable from Denmark to the United States. Focus group discussions with Danish users, providers, and policymakers were conducted.
PEER-REVIEWED RESEARCH FROM TITLE X–FUNDED RESEARCH
The Office of Research and Evaluation requested from grantees and compiled published peer-reviewed research from the past several years. There were 5 grantees funded in 2001, 4 each year during 2005–2007, and 3 cooperative agreements funded in 2004, totaling 20 grantees. The 5-year Alan Guttmacher Institute (AGI) project funded from 1999 to 2004 was also included in the request sent to current and former grantees (overall
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total 21). The list below includes responses from 6 of the 21 individual grantees that have had at least one peer-reviewed publication.
Men’s Reproductive and Sexual Health Practices, Attitudes, and Service Utilization
Grantee: Columbia University Medical Center
Kalmuss, D., and C. Tatum. 2007. Patterns of men’s use of sexual and reproductive health services: Results from cycle 6 of the national survey of family growth. Perspectives on Sexual and Reproductive Health 39(2):74–81.
Kalmuss, D., B. Armstrong, M. Franks, G. Hecker, and J. Gonzalez. 2008. Evaluation of a community-based sexual health intervention for young adult Latino and African-American men. Journal of Men’s Health 5(4):318–326.
Family Planning Needs and Services in the United States
Grantee: Guttmacher Institute
Frost, J. J. 2008. Trends in U.S. women’s use of sexual and reproductive health care services, 1995–2002. American Journal of Public Health 98(10).
Frost, J. J., L. B. Finer, and A. Tapales. 2008. The impact of publicly funded family planning clinic services on unintended pregnancies and government cost savings. Journal of Health Care for the Poor and Underserved 19(2008):778–796.
Lindberg, L. D., J. J. Frost, C. Sten, and C. Dailard. 2006. The provision and funding of contraceptive services at publicly funded family planning agencies: 1995–2003. Perspectives on Sexual and Reproductive Health 38(1):37–45.
Lindberg, L. D., J. J. Frost, C. Sten, and C. Dailard. 2006. Provision of contraceptive and related services by publicly funded family planning clinics, 2003. Perspectives on Sexual and Reproductive Health 38(3):139–147.
Child Trends/OPA Cooperative Agreement for Family Planning Research
Grantee: Child Trends
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Manlove, J., E. Terry-Humen, and E. Ikramullah. 2006. Young teenagers and older sexual partners: Correlates and consequences for males and females. Perspectives on Sexual and Reproductive Health 38(4):197–207.
Manlove, J., S. Ryan, and K. Franzetta. 2007. Risk and protective factors associated with the transition to a first sexual relationship with an older partner. Journal of Adolescent Health 40:135–143.
Manlove, J., E. Terry-Humen, L. Mincielli, and K. Moore. Forthcoming. Outcomes among children of teen mothers at kindergarten entry and through adolescence: Analyses of recent data. In Kids having kids updated edition: Economic costs and social consequences of teen pregnancy. Edited by R. Maynard and S. Hoffman. Washington, DC: Urban Institute Press.
Manlove, J., E. Ikramullah, and E. Terry-Humen. Forthcoming. Condom use and consistency among U.S. teen males. Journal of Adolescent Health.
Ryan, S., K. Franzetta, J. Manlove, and E. Holcombe. 2007. Adolescents’ discussions about contraception or STDs with partners before first sex. Perspectives on Sexual and Reproductive Health 39(3):149–157.
Ryan, S., K. Franzetta, J. Manlove, and E. Schelar. 2008. Older sexual partners during adolescence: Links to reproductive health outcomes in young adulthood. Perspectives on Sexual and Reproductive Health 40(1):17–26.
Strengthening the Capacity of Family Planning Agencies to Improve the Quality of Family Planning Services
Grantee: Johns Hopkins University
Becker, D., M. A. Koenig, Y. M. Kim, K. Cardona, and F. Sonenstein. 2007. The quality of family planning services in the United States: Findings from a literature review. Perspectives on Sexual and Reproductive Health 39(4):206–213.
Women Leaving Prison: Two Models of Family Planning Service Delivery
Grantee: Rhode Island Hospital
Clarke, J. G., C. Rosengard, J. S. Rose, M. R. Herbert, J. Peipert, and M. D. Stein. 2006. Improving birth control service utilization by
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offering services prerelease vs. postincarceration. American Journal of Public Health 96(5):841–845.
Clarke, J. G., M. R. Herbert, C. Rosengard, J. S. Rose, K. M. DaSilva, and M. D. Stein. 2006. Reproductive health care and family planning needs among incarcerated women. American Journal of Public Health 96(5):834–839.
Assessing Family Planning and Reproductive Health Needs and Services in the United States
Grantee: Alan Guttmacher Institute
Donovan, P. 1996. Taking family planning services to hard-to-reach populations. Family Planning Perspectives 28(3):120–126.
Finer, L. B., J. E. Darroch, and S. Singh. 1999. Sexual partnership patterns as a behavioral risk factor for sexually transmitted diseases. Family Planning Perspectives 31(5):228–236.
Finer, L. B., J. E. Darroch, and J. J. Frost. 2002. U.S. agencies providing publicly funded contraceptive services in 1999. Perspectives on Sexual and Reproductive Health 34(1):15–24.
Finer, L. B., J. E. Darroch, and J. J. Frost. 2003. Services for men at publicly funded family planning agencies, 1998–1999. Perspectives on Sexual and Reproductive Health 35(5):202–207.
Forrest, J. D., and R. Samara. 1996. Impact of publicly funded contraceptive services on unintended pregnancies and implications for Medicaid expenditures. Family Planning Perspectives 28(5):188–195.
Frost, J. J. 1996. Family planning clinic services in the United States, 1994. Family Planning Perspectives 28(3):120–126.
Frost, J. J. 1998. Clinic provision of contraceptive services to managed care enrollees. Family Planning Perspectives 30(4):156–162.
Frost, J. J. 2001. Public or private providers? U.S. women’s use of reproductive health services. Family Planning Perspectives 33(1):4–12.
Frost, J. J., and M. Bolzan. 1997. The provision of public-sector services by family planning agencies in 1995. Family Planning Perspectives 29(1):6–14.
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Frost, J. J., N. Ranjit, K. Manzella, J. E. Darroch, and S. Audam. 2001. Family planning clinic services in the United States: Patterns and trends in the late 1990s, Family Planning Perspectives 33(3):113–122.
Frost, J. J., L. Frohwirth, and A. Purcell. 2004. The availability and use of publicly funded family planning clinics: U.S. trends, 1994–2001. Perspectives on Sexual and Reproductive Health 36(5):206–215.
Gold, R. B., and C. Richard. 1998. Lessons learned: The managed care experiences of family planning providers. Journal of Public Health Management and Practice 4(6):1–13.
Gold, R. B., and A. Sonfield. 1999. Family planning funding through four federal-state programs, FY 1997. Family Planning Perspectives 31(4):176–181.
Landry, D. J., and J. D. Forrest. 1996. Public health departments providing sexually transmitted disease services. Family Planning Perspectives 28(6):261–266.
Landry, D. J., and J. D. Forrest. 1996. Private physician’s provision of contraceptive services. Family Planning Perspectives 28(5):203–209.
Lindberg, L. D., F. L. Sonenstein, L. Ku, and G. Levine. 1997. Young men’s experience with condom breakage. Family Planning Perspectives 29(3):128–131, 140.
Murphy, J. J., and S. Boggess. 1998. Increased condom use among teenage males, 1988–1995. Family Planning Perspectives 30(6):276–280, 303.
Sollom, T., R. B. Gold, and R. Saul. 1996. Public funding for contraceptive, sterilization and abortion services, 1994. Family Planning Perspectives 28(4):166–173.
Sonfield, A., R. B. Gold, and J. J. Frost. 2004. U.S. insurance coverage of contraceptives and the impact of contraceptive coverage mandates, 2002. Perspectives on Sexual and Reproductive Health 36(2):72–79.
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OPA LARGE-SCOPE EVALUATION EFFORTS
Through OPA’s Office of Research and Evaluation, evaluation projects are carried out under contracts funded by HHS 1 percent evaluation funds. The evaluation activities cover a wide range of issues.
OPA collaborates with other federal agencies in efforts related to family planning and reproductive health. OPA is one of the major funding contributors to the NSFG, which is conducted by the National Center for Health Statistics. The NSFG has completed six cycles and currently proceeds on a continuous interviewing basis. OPA also has funded several research initiatives at the National Institute of Child Health and Human Development. It provides support for the National Longitudinal Study of Adolescent Health.
A number of comprehensive final 1 percent evaluation reports are relevant to Title X. They include Healthy People 2010 content related to family planning and STDs/HIV, documents outlining Food and Drug Administration approval of the hormonal contraceptive skin patch and hormonal vaginal contraceptive ring, the Family Planning Annual Report, and reports on parent involvement strategies in programs serving adolescents and on statutory rape.
In 2007, OPA and the Administration for Children and Families cosponsored an Abstinence Education Evaluation Conference for the abstinence education community. In addition, OPA contracted with The Lewin Group to conduct the Developing Theoretical Frameworks for Abstinence Education project. The goal of this project is to develop theoretical frameworks that can help explain primary and secondary abstinence for adolescents and provide likely mechanisms for behavior change.