Liletta: New IUD approved by the FDA

The U.S. Food and Drug Administration (FDA) recently approved Liletta™, a new hormonal intrauterine device (IUD). This levonorgestrel-releasing IUD inhibits uterine lining from thickening and has been FDA approved for up to three years to prevent pregnancy. Liletta, found to be more than 99 percent effective, is already available in Europe and should arrive in the USA within the next few months.

Liletta was developed by Actavis and the non-profit Medicines360. Given the current high cost of IUDs, Medicines360 has focused on making Liletta affordable and accessible to all women. FDA approval was based on results from the largest hormonal IUD trial conducted in the U.S. The Section of Family Planning has been proud to participate in this study since 2010, as part of our broader commitment to research that improves contraceptive access for women.

Our previous research revealed various barriers in accessing the most effective methods, including cost. One recent study, conducted with support from the Office of Population Affairs, explored systems-level barriers to IUD provision. This research led to the development of a toolkit for clinical staff and health care providers to use in identifying and addressing barriers in their own clinics. We are also currently researching the feasibility and effectiveness of using mobile applications for contraceptive counseling in clinic waiting rooms. Our current studies follow previous research on an initial application, available here as an iOS app.

The Section supports the FDA’s approval of Liletta given its effectiveness at preventing pregnancy and ease of use for most women.

“Increasing the array of available and affordable contraceptive methods helps women find a method that best helps them achieve their reproductive health goals”, said Dr. Melissa Gilliam, Chief of the Section of Family Planning and lead investigator for the Section’s study site.

 

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‘Bystander’: Game Designer Ashlyn Sparrow on the Power of Intervention

Patrick Jagoda and Ashlyn Sparrow

Ashlyn Sparrow (L) with GCC Co-Founder Dr. Patrick Jagoda. Photo by Nabiha Khan.

This is the first of a series of posts on Bystander, Ci3 and Game Changer Chicago Design Lab‘s digital game and intervention. Now in development, Bystander seeks to empower youth to help end sexual violence. In the following post, GCC Lab Director Ashlyn Sparrow shares why Bystander, and bystander intervention, is important to her.

2012, my senior year in college. It was late at night and I was in my dorm’s lobby. I had just finished talking with my dad. He worked overseas at the time so I relished any chance to talk with him, even if it was 3 am.  As I stood up from my chair, a guy came around the corner.  He smelled of alcohol.

He started to touch me. I tried to escape but his grip was too strong.  A few moments later, his friend found us in the lobby and quickly pulled him away from me.  He asked if I was okay and the only thing I could say was “yeah…”

What’s stopped me from talking about this incident was my own definition of sexual assault.  If it’s not rape, there’s nothing to talk about, and it’s not harassment if it doesn’t continue over an extended period of time.  So where did that put me? Who do I talk to? What could I do? What was I supposed to do?

I went back to my room and I cried myself to sleep, careful not to disturb my roommate.  I didn’t cry because of what happened, but what could have happened.

Three years later, I’m now working on a game about sexual assault called Bystander. This is an interactive narrative that targets high school youth, helping to increase awareness, skills and attitudes needed to help end sexual violence just like my own bystander helped me. You might be thinking a bystander is a person who does not take part in certain situations. Technically, that is true. However, we want to empower youth to become “active bystanders,” those who speak up and act.

In Bystander, the player takes the role of Casey, a high school junior on his way to school. While Casey sends text messages to his friends, Kaleb and Amy, a weekend event triggers his memories of a school presentation on bystander intervention. As the presenter speaks, Casey vividly imagines four scenarios as interactive moments through which the player learns skills to be a successful bystander.

In the first scenario, players navigate a high school identifying instances of sexual harassment. As the player clicks through the game, they will interact with different moments that might be sexual harassment. A couple kissing is vastly different from grabbing a stranger’s butt. However, many youth do not realize that unwanted catcalling is also a form of sexual harassment. Sexual harassment is simply defined as conduct that is sexual in nature, unwanted, and creates a hostile environment. Every school is required to follow reporting guidelines laid out by Title IX, a law requiring educational institutions to have policies and procedures against sexual harassment. With this knowledge at hand, players must work through each scenes and correctly ways to intervene, finally reporting all forms of sexual harassment to their guidance counselor.

The next scenario deals with partner sexual assault, as the player has a conversation with a young woman assaulted by her boyfriend. The player must deny rape myths as she tells her story by choosing the proper dialogue options. In this scenario we represent culturally accepted rape myths such as “she asked for it,” “she lied,” or “he didn’t mean to.” Here, we begin to model dialogue that affirms but does not place blame on the victim. It doesn’t matter what a one wears, or how one acts, sex without consent is wrong.

Our third scenario focuses on alcohol and sexual assault in a party. The player is at a party and witnesses an impending assault by a male friend. Alternating between two points of view, the player must interact with each scene finding ways to they could potentially intervene, however not every prop is a potential solution.

Finally, scenario four has players search for resources to help a male friend who has been sexually assaulted.  The friend asks a series of questions that will be displayed on screen (e.g. “Who could I report this to?”).  The player must type an answer into an empty text field. If the answer isn’t known they can use their phone, which allows players to explore in-game websites on sexual violence and assault. Here, the player can look for answers and find more information to the friend’s questions.

The game design process has not been terribly difficult. But it does help that we’ve solidified our educational game design process that includes:

  • Extensive literature review
  • Set learning objectives
  • Find a basic game mechanic
  • Prototype and test

Bystander is the first Game Changer project to go through this pipeline from start to finish.  Researchers and game designers are slowly becoming more accustomed to working with each other—emphasis on slowly. It’s hard to work across disciplines but ultimately allows us to create new and innovative ways to engage youth in sexual reproductive health.

We are putting the final touches on the narrative script, and securing actors to portray the main characters. By late January, Bystander will be ready to play test with youth.  Hopefully, we’ll see some attitudes change but our research phase will not begin until April.

Working on this game has opened my eyes and releasing this to high schools is giving back the only way I know how. I never really thought of myself as an activist, just a humble game designer. However, like a bystander, there are multiple ways to intervene.

Ci3 Intern Receives Two-Year Fellowship for Work With LGBTQ Youth

Kara Ingelhart headshot

Ci3 intern Kara Ingelhart, a third-year student at The University of Chicago Law School, has been awarded a Skadden Fellowship. The prestigious two-year fellowship will support Ingelhart’s work with LGBTQ youth with juvenile or criminal records by addressing the many barriers they face in housing, employment and educational opportunities. The Skadden Fellowship Program was established in 1988 to commemorate the law firm’s 40th anniversary, and has been described as a “legal Peace Corps.”

At Ci3, Ingelhart works with Executive Director Dr. Brandon Hill on the Transgender Military Mental Health project. Her internship is supported by the Quern Endowment, a fellowship through the Graduate Program in Health and Administration Policy that supports projects aimed at developing students’ leadership skills in the fields of health policy and management.

Congratulations, Kara!

New Section publication discusses reproductive counseling and weight-loss surgery

Women of reproductive age often pursue weight-loss surgery; in fact, they account for nearly half of all bariatric surgery patients. The relationship between reproduction and rapid weight loss has been well documented and includes an increased risk of infertility, menstrual irregularities, and changing sexual function. Women who receive bariatric surgery are also more likely to have an unplanned pregnancy. Because of these reproductive risks, the American Society for Metabolic and Bariatric Surgery recommends using effective birth control methods when experiencing rapid weight loss and the American College of Obstetricians and Gynecologists recommends delaying pregnancy one to two years after bariatric surgery.

Yet, according to one survey, 31 percent of female bariatric surgery patients planned to become pregnant after obtaining surgery, and nearly one-third planned to do so within two years. These intentions, as well as contraceptive efficacy following weight loss, warrant close collaboration between bariatric surgeons and women’s health providers.

Section faculty Dr. Julie Chor conducted a national survey of bariatric surgeons to assess perioperative reproductive counseling and contraceptive provision. Her findings were published in Surgery for Obesity and Related Diseases.

http://www.soard.org/

Image courtesy of http://www.soard.org

The study found that 74% of bariatric surgeons preoperatively screen patients regarding contraceptive use more than 50% of the time. The most common method prescribed, however, were oral contraceptive pills, which may have decreased efficacy in the obese and in the postoperative state, depending on the type of surgery.

Most respondents (90 percent) recommended delaying pregnancy 12 to 24 months, yet 84% did not require a gynecologic consultation for female patients of reproductive age and 35% further stated that they did not know how their patients obtained contraception.

One-fifth of respondents did not assess their patients’ pregnancy intentions. This disparity suggests that practitioners should counsel patients preoperatively about reproductive changes that can occur after weight loss from bariatric surgery as well as discuss contraception with all women of reproductive age, whether or not they desire a future pregnancy.

Dr. Chor’s findings suggest implementing a routine gynecology consultation for female bariatric surgery patients prior to an operation. These women would greatly benefit from increased education on fertility changes associated with weight loss and on highly effective methods of contraception, such as intrauterine devices and contraceptive implants.

Read the full article here.

Youth Ages 14-18 Needed for PAID Research Study 12/9

hexacago playtest

Ci3/Game Changer Chicago are seeking youth ages 14-18 to participate in a paid research study on Tuesday, December 9 from 5:30-7 p.m. The study will take place at Ci3 (1225 E. 60th St., on The University of Chicago campus in Hyde Park).

Participants will play the Hexacago board game (pictured above) with peers and complete two short surveys. Time commitment is approximately 75 minutes, and each participant will be compensated $15. Feel free to bring a friend!

Please note, parental consent is required for all participants under 18.

For more information or to register, contact Erin Jaworski at (773) 834-9965 or ejaworski@bsd.uchicago.edu. Note: you are NOT officially registered until you receive a confirmation email from Erin.

 

South Side Stories Spotlight, November 2014: Sexual Coercion

South Side Stories November

Each month, Ci3’s South Side Stories project features digital stories that spotlight the lives of adolescents and young adults from the South Side of Chicago.

November’s South Side Spotlight focuses on sexual coercion, a critical topic for adolescents. Sexual coercion refers to the act of making another person engage in sexual activity against their will (Brousseau, Bergeron, Hébert & McDuff, 2011). This term includes rape and sexual assault, as well as acts that persuade someone to engage in unwanted sexual activity, such as using pressure, drugs or alcohol. Sexual violence is achieved through physical force, threats, emotional manipulation, consistent pressure, fear or coercion.

Two stories are presented, one from a young man, who experienced childhood sexual abuse, and another from a young woman, who experienced rape. In The Unveiling, the male narrator is just beginning to talk about his sexual trauma, although several years have passed since the event occurred. I was 10 and barely knew about sex. But this tragic process was continuously repeated.  And I? …Remained silent.  It’s seven years later and I’m finally starting to confront my feelings, I am wondering why it has taken so long.

In his story, the narrator discusses a challenge common to many victims of sexual assault: the difficulty of telling people what has happened, which may be especially hard for boys and men. Who could I have turned to? he asks. Family? Friends? Someone at school…where teachers are too busy and social workers switch year after year? The silence that shrouds his experience is depicted by the word “Shhh” on the blackboard. His comments highlight the importance of ensuring that youth have trusting relationships with adults with whom they can share their experiences regarding sexual violence. Despite this violence, he ends his story on a hopeful note, with the declaration that he still “deserves love and care.”

The second story, Untitled, recounts the experience of a young woman who was raped by a man. The narrator shares her memories of the event and how she felt disassociated from her experience with sexual violence: I am watching the situation as if it isn’t even me. Watching her underneath him. Panting. Crying. Pleading for him to stop. Too weak to fight, too scared to scream. I want to ask her: How did you get into this situation? I want to ask him: If she’s so beautiful… how could you do this?

Remembering the event trigger[s] memories that leave you feeling stuck. We also hear the narrator’s disappointment at not having experienced first love in the way she imagined: Her first love, her first kiss, it should be a positive thing, but that’s not her story. Though impacted by her experience, she is aware that she can move past this. There’s this beautiful girl trapped inside of me, who is not running, or scared of her dreams.

We thank the authors for sharing their stories and honor their courage.

The following are national resources available to victims of sexual violence:

Rape, Abuse and Incest National Network (RAINN)

1 (800) 656-HOPE

https://www.rainn.org/get-help/national-sexual-assault-hotline

Department of Defense Hotline

(877) 995-5247

https://www.safehelpline.org/ 

Stop It Now

If you need immediate assistance, please contact either your local police, 911 or hospital. You can also contact ChildHelp at 1.800.4ACHILD (1.800.422.4453).

(413) 587-3500

http://www.stopitnow.org/warning_signs_child_behavior

Men Can Stop Rape

(202) 265-6530

http://www.mencanstoprape.org/

National Sexual Violence Resource Center

(717) 909-0710 Phone
(877) 739-3895 Toll Free

http://www.nsvrc.org/bystander-intervention-campaigns-and-programs

The following resources are available to victims of sexual violence in the Greater Chicago Metropolitan area.

Rape Crisis Hotline

Call (888) 293-2080 in Chicago Metropolitan Area
Call (630) 971-3927 in DuPage County
Call (708) 748-5672 in the South Suburbs

http://www.ywcachicago.org/site/c.fmJWKcOZJkI6G/b.8243031/k.F95D/Rape_Crisis_Hotline.htm

Rape Victim Advocates (RVA)

(312) 443-9603

http://www.rapevictimadvocates.org

Young Women’s Association of Metropolitan Chicago (YWCA)

(312) 733-2102, ext. 2146

http://www.ywcachicago.org/

Click here for a full Spotlight including broader research and policy implications.

South Side Stories is made possible through the generous support of the Ford Foundation.

Three new studies focus on lowering clinic barriers to help women obtain desired contraceptive method

Contraception is the cornerstone of pregnancy prevention and the intrauterine device (IUD) is one of the most effective methods available. IUDs require little user maintenance, last between 7 and 12 years, and are more than 99 percent effective at preventing pregnancy. Thus, it is critical to remove unnecessary obstacles that prevent women from receiving a desired IUD.

The University of Chicago Section of Family Planning (the Section) has published three articles that discuss research on implementing interventions to the systematic barriers to IUD care. This research was funded by the Office of Population Affairs.

In collaboration with three Planned Parenthood of Illinois clinics, the research began with an in depth evaluation of all aspects of IUD service delivery called Failure Modes Effects and Criticality Analysis (FMECA). Health care providers and patients were interviewed to see the way in which the system could be redesigned to better deliver care. This step-by-stop process identified “failures” using qualitative and quantitative data, and determined the frequency and impact in order to prioritize redesign and improvements.

A systematic approach to improving intrauterine device services in family planning clinics appeared in Contraception. This publication outlines the Section’s analysis of the FMECA approach and identification of three main failures during the scheduling and intake processes: 1) The patient does not show up for appointment or cancels; 2) The patient recently had unprotected intercourse; and 3) Limited time for counseling, informing, and placing IUDs.

After reviewing the FMECA data, the research and clinical care teams created two solutions to the identified failures: implementing a revised scheduling call script, and developing an iOS counseling app to be used in the waiting room.

Impact of a revised appointment scheduling script on IUD service delivery in three Title X family planning clinics, also published in Contraception, discusses the implementation of the revised scheduling script.

Mindful of the systems-level barriers identified by the FMECA, Section researchers created a simple and scalable intervention: revising the appointment-scheduling call script. Along with the revised script, visual tools reminded schedulers to explain behavior prerequisites such as “Do not have unprotected sex at least two weeks prior to an appointment” and “Continue to use pills, patches, or rings up until the appointment.” The script also prompted schedulers to communicate logistical requirements such as bringing an ID, proof of insurance or cash to pay for the procedure, and instructions to call and cancel an appointment if necessary.

Through implementation of the revised script, no-show rates decreased from 40 to 23 percent, and in particular, young women were more likely to keep their scheduled appointment.

Development and Testing of an iOS Waiting Room “App” for Contraceptive Counseling in a Title X Family Planning Clinic, published in the American Journal of Obstetrics and Gynecology, describes the Section’s development and testing of a theory-based behavioral app. The app, developed with young women, features young women describing their contraceptive experiences. Testers were highly satisfied with the app and found it easy to use. A brief (<15 min) app session significantly improved women’s knowledge scores on the relative effectiveness of LARC compared with other methods.

The Section continues to research the app for comprehensive contraceptive counseling.

The research team has also developed an online toolkit describing processes, procedures, and tools for an FMECA and shared with Title X clinics nationally.

For more about recent Section research and publications, visit familyplanning.uchicago.edu or our Sexual and Reproductive Health and Justice blog.

Special thanks to the Office of Population Affairs and Planned Parenthood of Illinois for their support.

TOMORROW: Research/Playtest Opportunity for Teens at Ci3/GCC

the source hexacago
Ci3 and Game Changer Chicago are seeking high school students ages 14-18 to participate in a paid research study tomorrow night (Tuesday, Nov. 25) from 5-6:30 p.m. on The University of Chicago campus in Hyde Park. The time commitment is approximately 75 minutes, during which teens will play the Hexacago board game with peers and complete two short surveys. Teens will be compensated $15 for the session. Feel free to bring a friend! Please note, parental consent will be required for all participants under 18.
 
If you are interested, please contact Erin Jaworski through phone (773-834-9965) or by email (ejaworski@bsd.uchicago.edu).  You are not officially registered until you received a confirmation email from Erin. 

 

Ci3 Seeks Youth Ages 15-24 for Mobile App Dev – First Meeting 12/3

Creating Belief 4

Are you between the ages of 15-24 years and interested in contraception, STI prevention and technology?

Ci3 is seeking young people to assist in the development of a mobile app to help youth make healthy decisions about contraception and STI prevention.

Our first meeting will be held Wednesday, December 3, from 4:30-6 p.m. at Ci3’s offices at 1225 E. 60th St., on The University of Chicago campus in Hyde Park.

RSVP is required. Please contact Dr. Lucy Hebert at (773) 834-7196 or lhebert@bsd.uchicago.edu to confirm your spot.

  • What will I be doing? You will help to design a mobile app, by engaging in a series of group discussions focusing on pregnancy and STI prevention. We will lead every session, all you have to do is come ready to participate. We even provide dinner!
  • What is the time commitment? You will participate in 8 sessions over the next 2 years. Each session will last 1-2 hours.
  • Where will it take place? All sessions will be held at the Ci3 offices (1225 E. 60th St. on The University of Chicago campus in Hyde Park).
  • What do I get out of it? Over the course of 2 years, you will be compensated $300.

Why you should work with us:

  • Help create a dynamic tool to encourage young people like you to engage in healthy sexual behavior
  • Learn about mobile app development, human-centered design, and sexual and reproductive health
  • Collaborate with clinicians, researchers and your peers as an interdisciplinary team

For more information or to RSVP to the Dec. 3 session, please contact Dr. Lucy Hebert at (773) 834-7196 or lhebert@bsd.uchicago.edu.

 

 

Tomorrow Night: Teen Research Study – Spaces Still Available!

ADITL playtest cropped

Ci3 and Game Changer Chicago are seeking high school students ages 14-18 to participate in a research study tomorrow night, November 18 from 5-6:30 p.m. on The University of Chicago campus.

The session will take approximately 75 minutes and will consist of playing the “Hexacago” board game and completing two short surveys. Participants will be compensated $15.

Learn more, sign up and share.