E. B. Schwarz

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (19)57.92 Total impact

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    ABSTRACT: BACKGROUND AND OBJECTIVE: Little is known about contraceptive use and adherence in the Veterans Health Administration (VA) health care system. We assessed contraceptive adherence among women who were using hormonal contraception (pill, patch, ring, and injectable) and examined the relationships between race/ethnicity and months of contraceptive supply dispensed with contraceptive adherence. MATERIALS AND METHODS: We conducted a retrospective analysis of data from national VA administrative databases. The study cohort included all women veterans ages 18-45 years who made at least 1 visit to a VA primary care clinic or women's health clinic during the study period (FY 2008: Oct. 1, 2007, through Sept. 30, 2008) and who had hormonal contraceptive (pills, patch, vaginal ring, or injection) coverage during the first week of the study timeframe. Women who had undergone hysterectomy or tubal sterilization or who used an IUD or implant in FY 2008 were excluded. We constructed several patient-level indicators of contraceptive adherence over FY 2008. These indicators included gaps of ≥7 days between refills, total months of contraceptive coverage, and presence of contraceptive coverage during the last week of FY 2008. For the last outcome we distinguished between coverage with gaps and continuous coverage throughout the year (perfect adherence). Our primary predictors of interest were race/ethnicity and months of contraceptive supply dispensed. In this analysis, "3-month supply" indicates that the woman received a 3-month supply of contraception at each fill all year; "1-month supply" indicates that the woman received only a 1-month supply at each fill. Anyone who received a 2-month supply or varied months of supply over the course of the year received "other supply." We summarized the indicators of contraceptive adherence (gaps of ≥7 days, total months of contraceptive supply, and contraceptive coverage during the last week of FY 2008) and compared the differences across the key independent variables: race/ethnicity and months of supply dispensed with the use of descriptive statistics and adjusted Cox and logistic regression models. RESULTS: Our study cohort included 6946 women, of whom 46.9% were white, 5.7% Hispanic, 22.2% black, and 3.1% of other race; race information was missing for 22.1%. Most women (83.5%) received a 3-month supply at each fill; 3.6% received a 1-month supply; and 12.9% received other supply. Overall, 64.2% of women had at least 1 gap during the year. Compared to white women, Hispanics were significantly more likely to have a gap (63.7% vs 69.6%, P=.02). Women who received a 1-month supply were significantly more likely than women who received a 3-month supply to have any gap (71.5% vs 63.2%, P=.008). Women had a mean of 9.2 months of contraceptive coverage over the year, with Hispanics and blacks having fewer months of coverage than whites (8.9 and 9.0 months vs 9.3 months, respectively, P<.001). Women who received a 1-month contraceptive supply had significantly fewer months of coverage than those who received a 3-month supply (6.9 vs 9.3 months, P<.001). Of the full cohort, 65.6% had contraceptive coverage the last week of the fiscal year, but the majority (66.9%) of these women had experienced one or more gaps during that time. Only 21.7% of women received a full 12 months of contraception with no gaps between refills (perfect adherence). Bivariable analysis found no racial/ethnic differences related to the likelihood of having contraceptives on hand during the last week of FY 2008. Compared to women who received 3-month supplies, those who received only 1-month supplies were significantly less likely to be on a method the last week of the fiscal year (65.5% vs 43.0%, P<.001) and to have achieved perfect adherence than those who received 3-month supplies (22.2% vs 10.8%, P<.001). Kaplan-Meier curves demonstrating time to first gap of ≥7 days between refills showed that Hispanics experienced shorter time to first gap compared to white and black women (P=.02) (Figure). Women who received 1-month supplies experienced shorter time to first gap than those who received 3-month supplies (P<.001). In adjusted Cox regression analysis, Hispanics remained significantly more likely to experience a gap than white women (hazard ratio [HR],1.18; 95% CI,1.03-1.34). Women who received 1-month supplies remained more likely to experience a gap than women who received 3-month supplies (HR, 1.62; 95% CI, 1.39-1.90). Adjusted models of perfect adherence identified no statistically significant differences by race/ethnicity. Women receiving 1-month supplies were significantly less likely to achieve perfect adherence than those receiving 3-month supplies (odds ratio [OR], 0.46; 95% CI, 0.30-0.69).
    American journal of obstetrics and gynecology 03/2013; · 3.28 Impact Factor
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    Contraception 01/2011; 84(3):323-323. · 3.09 Impact Factor
  • Contraception 01/2011; 84(3):327-327. · 3.09 Impact Factor
  • Contraception 01/2011; 84(3):329-330. · 3.09 Impact Factor
  • J. K. Lee, S. M. Parisi, E. B. Schwarz
    Contraception 01/2011; 84(3):323-324. · 3.09 Impact Factor
  • Contraception 01/2011; 84(3):328-328. · 3.09 Impact Factor
  • Contraception 08/2010; 82(2):200-200. · 3.09 Impact Factor
  • Contraception 01/2010; 82(2):214-215. · 3.09 Impact Factor
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    ABSTRACT: Minority women are more likely than white women to choose tubal sterilization as a contraceptive method. Disparities in rates of unintended pregnancy may help explain observed racial/ethnic differences in sterilization, but this association has not been investigated. To examine the associations among race/ethnicity, unintended pregnancy, and tubal sterilization. Cross-sectional analysis of data from a nationally representative sample of women aged 15-44 years [65.7% white, 14.8% Hispanic, and 13.9% African American (AA)] who participated in the 2002 National Survey of Family Growth. Race/ethnicity, history of unintended pregnancy, and tubal sterilization. A logistic regression model was used to estimate the effect of race/ethnicity on unintended pregnancy while adjusting for socio-demographic variables. A series of logistic regression models was then used to examine the role of unintended pregnancy as a confounder for the relationship between race/ethnicity and sterilization. Overall, 40% of white, 48% of Hispanic, and 59% of AA women reported a history of unintended pregnancy. After adjusting for socio-demographic variables, AA women were more likely (OR: 2.0; 95% CI: 1.6-2.4) and Hispanic women as likely (OR: 1.0; 95% CI: 0.80-1.2) as white women to report unintended pregnancy. Sterilization was reported by 29% of women who had ever had an unintended pregnancy compared to 7% of women who reported never having an unintended pregnancy. In unadjusted analysis, AA and Hispanic women had significantly higher odds of undergoing sterilization (OR: 1.5; 95% CI: 1.3-1.9 and OR: 1.4; 95% CI: 1.2-1.7, respectively). After adjusting for unintended pregnancy, this relationship was attenuated and no longer significant (OR: 1.2; 95% CI: 0.95-1.4 for AA women and OR: 1.3; 95% CI: 1.0-1.6 for Hispanic women). Minority women, who more frequently experience unintended pregnancy, may choose tubal sterilization in response to prior experiences with an unintended pregnancy.
    Journal of General Internal Medicine 12/2009; 25(2):122-8. · 3.28 Impact Factor
  • A M Stuebe, E B Schwarz
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    ABSTRACT: Infant feeding decisions affect maternal and child health outcomes, worldwide. Even in settings with clean water and good sanitation, infants who are not breast-fed face an increased risk of infectious, as well as non-infectious morbidity and mortality. The decision not to breast-feed can also adversely affect mothers' health by increasing the risk of pre-menopausal breast cancer, ovarian cancer, type II diabetes, hypertension, hyperlipidemia and cardiovascular disease. Clinicians who counsel mothers about the health impact of infant feeding and provide evidence-based care to maximize successful breast-feeding, can improve the short and long-term health of both mothers and infants.
    Journal of perinatology: official journal of the California Perinatal Association 08/2009; 30(3):155-62. · 1.59 Impact Factor
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    ABSTRACT: To examine dose-response relationships between the cumulative number of months women lactated and postmenopausal risk factors for cardiovascular disease. We examined data from 139,681 postmenopausal women (median age 63 years) who reported at least one live birth on enrolling in the Women's Health Initiative observational study or controlled trials. Multivariable models were used to control for sociodemographic (age, parity, race, education, income, age at menopause), lifestyle, and family history variables when examining the effect of duration of lactation on risk factors for cardiovascular disease, including obesity (body mass index [BMI] at or above 30), hypertension, self-reported diabetes, hyperlipidemia, and prevalent and incident cardiovascular disease. Dose-response relationships were seen; in fully adjusted models, women who reported a lifetime history of more than 12 months of lactation were less likely to have hypertension (odds ratio [OR] 0.88, P<.001), diabetes (OR 0.80, P<.001), hyperlipidemia (OR 0.81, P<.001), or cardiovascular disease (OR 0.91, P=.008) than women who never breast-fed, but they were not less likely to be obese. In models adjusted for all above variables and BMI, similar relationships were seen. Using multivariate adjusted prevalence ratios from generalized linear models, we estimate that among parous women who did not breast-feed compared with those who breast-fed for more than 12 months, 42.1% versus 38.6% would have hypertension, 5.3% versus 4.3% would have diabetes, 14.8% versus 12.3% would have hyperlipidemia, and 9.9% versus 9.1% would have developed cardiovascular disease when postmenopausal. Over an average of 7.9 years of postmenopausal participation in the Women's Health Initiative, women with a single live birth who breast-fed for 7-12 months were significantly less likely to develop cardiovascular disease (hazard ratio 0.72, 95% confidence interval 0.53-0.97) than women who never breast-fed. Among postmenopausal women, increased duration of lactation was associated with a lower prevalence of hypertension, diabetes, hyperlipidemia, and cardiovascular disease.
    Obstetrics and Gynecology 06/2009; 113(5):974-82. · 4.80 Impact Factor
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    ABSTRACT: To estimate the interest in using intrauterine contraception among women and adolescent girls seeking emergency contraception or walk-in pregnancy testing. We surveyed 412 women and adolescent girls who requested emergency contraception or pregnancy testing at four family planning clinics in Pittsburgh, Pennsylvania. The 41-item survey assessed knowledge of, attitudes toward, and interest in using an intrauterine device (IUD). Data were analyzed using chi2 and Fisher exact tests and multivariable logistic regression methods. The response rate was 85%. Twelve percent (95% confidence interval [CI] 9-15) of women and adolescent girls surveyed expressed interest in same-day insertion of an IUD, and 22% (95% CI 18-26) wanted more information about IUDs. Interest in same-day IUD insertion increased with higher education level, prior unwanted pregnancy, and experience with barriers to use of contraception. Same-day IUD insertion may be a reasonable way to increase the use of highly-effective contraception among women and adolescent girls seeking emergency contraception or walk-in pregnancy testing. II.
    Obstetrics and Gynecology 05/2009; 113(4):833-9. · 4.80 Impact Factor
  • Contraception 01/2009; 80(2):204-205. · 3.09 Impact Factor
  • International Journal of Gynecology & Obstetrics - INT J GYNECOL OBSTET. 01/2009; 107.
  • E. B. Schwarz, S. Borrero, E. Douglas, A. Akers
    Contraception 01/2009; 80(2):214-214. · 3.09 Impact Factor
  • Contraception 01/2009; 80(2):206-206. · 3.09 Impact Factor
  • Contraception 01/2008; 78(2):178-178. · 3.09 Impact Factor
  • E. B. Schwarz, M. L. Kavanaugh, T. Dubowitz
    Contraception 01/2008; 78(2):183-184. · 3.09 Impact Factor
  • Contraception 08/2006; 74(2):193. · 3.09 Impact Factor

Publication Stats

131 Citations
57.92 Total Impact Points

Institutions

  • 2009–2011
    • University of Pittsburgh
      • • Department of Obstetrics, Gynecology and Reproductive Sciences
      • • Center for Research on Health Care
      Pittsburgh, Pennsylvania, United States
    • Magee-Womens Hospital
      Pittsburgh, Pennsylvania, United States
    • University of North Carolina at Chapel Hill
      • Department of Obstetrics and Gynecology
      Chapel Hill, NC, United States