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Menlo Park, California, Henry J. Kaiser Family Foundation, 1996 Jan 31.  p.This series of tables illustrates findings from the Kaiser Family Foundation's 1996 National (US) Survey on Public Perceptions about Contraception. Pie charts show that 43% of women aged 18-44 (women of reproductive age [WRA]) and 39% of all Americans believe that oral contraceptives (OCs) are somewhat safe and an additional 25 and 17%, respectively, believe OCs are very safe. The charts indicate that 61% of WRA and 44% of all Americans cite potential health risks as their primary safety concerns (20 and 24%, respectively, cite lack of protection against disease, and 20 and 7%, respectively, doubt the contraceptive efficacy of OCs). Most WRA (58%) believe that OCs have no effect on the likelihood of developing osteoporosis, but only 41% believe that chances of acquiring breast cancer are unaffected by OC use (32% believe chances are heightened). Most WRA (57%) believe that OCs increase chances of blood clots, and only 16% believe that OC use reduces chances of developing ovarian cancer. Nearly half (47%) of the WRA believe that women's chances of getting heart disease are not affected by OC use. WRA receive most of their contraceptive information from physicians (88%), nurses (75%), family/friends (60%), television (48%), magazines (43%), advertisements (41%), and printed media (40%). Among WRA who have ever used OCs, 53% reported that their partner had no influence in their decision to use this method (19% reported that their partner had a lot of influence). Most men (76%) whose current or most recent partner used OCs reported that their partner had a lot of influence in this decision.
Perceptions and realities: How safe is the pill? The role of the media, healthcare providers, and the pharmaceutical industry in shaping American women's perceptions about birth control. Q and A.
New York, New York, AGI, 1996 Jan 31. 4 p. (Emerging Issues in Reproductive Health: A Briefing Series for Journalists)Contraceptive choice and usage is affected by various factors at different stages of reproductive life including childbearing hopes, sexual behavior, health history, exposure to sexually transmitted diseases (STDs), ability to use a method consistently and correctly, the side effects and/or health benefits of various methods, and the degree of risk associated with unplanned pregnancy. Survey data indicate that most adults in the US gain family planning information from health professionals as well as from friends and family and the mass media. Perceptions about various methods can influence contraceptive usage in general and method choice in particular. While a majority of US adults find oral contraceptives (OCs) "very" or "somewhat" safe, 21% think OCs are somewhat unsafe, and 11% find them very unsafe. Most safety concerns center on the inability of the OC to protect from STDs and ignore specific health effects that vary for individual women. The fact is that failure to use a contraceptive poses greater risk than any method and that OCs are effective contraceptives that do not hinder future fertility. While the relationship of OC use and breast cancer remains uncertain, OCs are known to protect against ovarian and endometrial cancers. OC use is associated with a relatively small increased risk of cardiovascular disease, and the risk increases in older women and women who smoke. Pregnancy also increases the risk of cardiovascular disease. Recent studies reporting 1) an increased risk of venous thrombosis and 2) a decreased risk of myocardial infarction with new formulations of the OC underscore the importance of taking individual circumstances into account when prescribing OCs. The new studies also indicate a need for additional research on the effects of OC use.
Evaluation of a prescription based record-linkage model for epidemiological studies of long-term adverse effects of drugs -- with special regard to combined oral contraceptives.
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY. 1991; 40(5):489-93.The Swedish Department of Drugs of the National Board of Health and Welfare undertook a study of the possibilities of post-marketing surveillance of combined oral contraceptives (COC) and epidemiological studies based on individual cancer, death and demographic registries. In Sweden, there are a Cancer Registry, a Cause of Death Registry, a hospital In-Patient Registry, and registries of prescription drugs purchased through the Swedish National Corporation of Pharmacies, all accessed by individual National Registration Numbers. An agency to link these data in an individual-based exposure register would require long-term staff continuity, and large central computer facilities for data processing. In addition, questionnaires would be needed to obtain exposure before the start of the project. A model employing 258,000 women in each 5-year group, with at least 100 cases in each group, would require up to 13 years for cardiovascular outcomes, or 28 years for cancer outcomes, to include induction time and observation time. Data would have to be gathered to prevent bias due to confounding, selective recall, and diagnostic bias. An important obstacle is public objection to intrusion into personal integrity. Advantages of the study included relative ease of linking data, compared to systems in place in other countries. Major impediments cited were long study periods, high costs, and uncertainty about policies of future COC prescriptions. The study concluded that such a project would not be cost-effective. There is a need to study current low-dose COC on a scale begun by the British Royal College of General Practitioners Study and the Oxford Family Planning Association Study. It is suggested that strategies be implemented to improve retrospective epidemiological studies, for example by validating drug exposure by independent sources.
JOURNAL OF THE FLORIDA MEDICAL ASSOCIATION. 1986 Oct; 73(10):763-8.The increase in safety and public confidence in oral contraceptives (OCs) stems essentially from 3 factors: the availability of lower dose OCs, a better identification of risk factors, and more public awareness of noncontraceptive health benefits associated with OC use. The combination OC, used by 99% of women using OCs, continues to contain estrogen and progesterone in synthetic form, but the dosages and formulations have changed, giving the new pill a wider margin of safety. The OCs of today contain 1/5 the estrogen and 1/10 the progesterone as in the original OCs. During the decade of the 1980s, with estrogen dosage as low as therapeutically possible, medical research has shifted toward a more thorough evaluation of the progesterone component. In 1974 the Royal College of General Practitioners Study found a correlation between progesterone dosage and the frequency of high blood pressure developing in OC users. Subsequent studies reported that high blood pressure, which was likely to develop in about 5% of OC users on higher dose pill, will revert to normal when OC use is stopped. Additional research has linked pills containing progesterone in high dosages to elevations in blood sugar and blood cholesterol. Since progesterone dosage has declined from 10 milligrams in the original pill to 1 milligram or less in current formulations, there appears to be a wide margin of safety for most healthy young women using OCs. In the mid-1980s, further research on OCs has become more fine tuned with greater emphasis on how different types and combinations of hormones influence side effects and safety. The most recent development has been the introduction of "multiphasics" or sometimes called "triphasics." Multiphasic pills are basically low dose pills which vary hormone dosage in each of 3 separate phases in an effort to roughly simulate changes that would occur in a normal menstrual cycle. A better understanding of risk factors has increased markedly the margin of safety for women considering OC use. The report of the Alan Guttmacher Institute, "Making Choices," revealed that if women over 35 or who smoked did not use OCs, 86% of the approximately 500 pill-related deaths that occurred each year could be prevented. The Guttmacher report also attempted to quantify health benefits and risks to provide a more accurate overall picture of OC effects. Table 1 shows that many more hospitalizations are prevented than are caused by OC use. Among hospitalizations prevented, most were for benign breast disease, pelvic inflammatory disease, ectopic pregnancy, ovarian cysts, ovarian cancer, and endometrial cancer. No evidence has linked defects or miscarriages to pregnancies conceived immediately after stopping OC use. The overall fertility of OC users and non-OC users is identical regardless of how long a woman uses OCs. A lack of consistent health education programs in the public schools has contributed in some instances to misinformation about OC and other contraceptive methods.
American Journal of Obstetrics and Gynecology. April 15, 1971; 109(8):1118-1127.The 1970 Nelson Committee hearings were held to determine whether Pill users were properly told about the side effects and suspected complications. The author charges the Committee hearings of sensationalizing adverse results of the Pill, causing 18% of all U.S. users to stop this treatment and another 23% to seriously consider quitting. A survey following the Nelson hearings showed 97% of the 13,000 U.S. obstetricians and gynecologists questioned believed oral contraceptives to be medically acceptable. The Scowen report of England (1970) said the Pill is the best contraceptive available, and the low-estrogen pill (50 mcg) is the safest. Because of the relationship of the pill to thromboembolism brought out by Nelson hearings oral contraceptives now must carry a health warning, and the result of the Scowen Committee will most likely encourage doctors to prescribe low dosage estrogen pills.