David J. Landry

Guttmacher Institute, New York, New York, United States

Are you David J. Landry?

Claim your profile

Publications (14)6.67 Total impact

  • David J Landry · Junhow Wei · Jennifer J Frost ·
    [Show abstract] [Hide abstract]
    ABSTRACT: This study measured differences in the provision of care between public and private providers of contraceptive services, what problems using contraception these providers perceived their patients to have and providers' views on how to improve their patients' method use. A nationally representative mixed-mode survey (mail, Internet and fax) of private family practice and obstetrician/gynecologist physicians who provided contraceptive care in 2005 was conducted. A parallel survey was administered to public contraceptive care providers in community health centers, hospitals, Planned Parenthood clinics and other sites during the same period. Descriptive and multivariate analyses were conducted across both surveys. A total of 1256 questionnaires were completed for a response rate of 62%. A majority of providers surveyed believed that over 10% of their contraceptive clients experienced ambivalence about avoiding pregnancy, underestimated the risk of pregnancy and failed to use contraception for one or more months when at risk for unintended pregnancy. Implementation of protocols to promote contraceptive use ranged widely among provider types: a full 78% of Panned Parenthood clinics offered quick-start pill initiation, as did 47% of public health departments. However, 38% of obstetrician-gynecologists, 27% of "other public" clinics and only 13% of family physicians did so. Both public and private providers reported that one of the most important things they could do to improve patients' contraceptive method use was to provide more and better counseling. At least 46% of private providers and at least 21% of public providers reported that changing insurance reimbursement to allow more time for counseling was very important. Strategies to improve contraceptive use for all persons in need in the United States have the potential to be more effective if the challenges contraceptive providers face and the differences between public and private providers are taken into account.
    Contraception 08/2008; 78(1):42-51. DOI:10.1016/j.contraception.2008.03.009 · 2.34 Impact Factor
  • Jennifer J. Frost · David J. Landry ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Unintended pregnancy and contraceptive failure continue to be significant problems in the U.S. today. By comparing information obtained from women about their difficulties using methods successfully with information from providers about their services and perceptions of women's needs, we have developed recommendations for improving contraceptive service provision. Methods: We conducted nationally representative surveys of women and of contraceptive service providers. The women's sample was generated through random-digit-dialing and 1,978 eligible women were interviewed over the phone. The provider samples were drawn from lists of obstetrician/gynecologist and family practice physicians and publicly funded family planning clinics. Mailed questionnaires were collected from 382 private physicians and 805 clinics. Descriptive and multivariate analyses were conducted for each survey and the results compared across surveys. Results: Both women and providers report that inconsistent method use is common and that some women experience periods of contraceptive nonuse while remaining at risk for unintended pregnancy. Although women report that method dissatisfaction often precedes gaps in use, not all providers discussed these difficulties with patients. Other factors identified by women as contributing to difficultiesfor example, motivation to prevent pregnancy, life changes, and method side effectswere discussed by some, but not all, providers during contraceptive visits. Conclusions: The findings suggest a number of strategies that have the potential to help women improve their ability to use contraception consistently and correctly. Specific recommendations are presented within each of the following categories: counseling and follow-up; clinical practices; information and education; access and funding; and technology and training.
    135st APHA Annual Meeting and Exposition 2007; 11/2007
  • David Landry · Junhow Wei · Jennifer J. Frost ·

    Contraception 08/2007; 76(2):176-176. DOI:10.1016/j.contraception.2007.05.075 · 2.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: While sex education is almost universal in U.S. schools, its content varies considerably. Topics such as abstinence, and basic information on HIV and other sexually transmitted diseases (STDs), are commonly taught; birth control and how to access STD and contraceptive services are taught less often. Factors potentially associated with these variations need to be examined. Data on 1,657 respondents to a 1999 national survey of teachers providing sex education in grades 7-12 were assessed for variation in topics covered. Logistic regression was used to ascertain factors associated with instruction on selected topics. The content of sex education varied by region and by instructors' approach to teaching about abstinence and contraception. For example, teaching abstinence as the only means of pregnancy and STD prevention was more common in the South than in the Northeast (30% vs. 17%). Emphasizing the ineffectiveness of contraceptives was less common in the Northeast (17%) than in other regions (27-32%). Instructors teaching that methods are ineffective and presenting abstinence as teenagers' only option had significantly reduced odds of teaching various skills and topics (odds ratios, 0.1-0.5). Instructors' approach to teaching about methods is a very powerful indicator of the content of sex education. Given the well-documented relationship between what teenagers learn about safer sexual behavior and their use of methods when they initiate sexual activity, sex education in all U.S. high schools should include accurate information about condoms and other contraceptives.
    Perspectives on Sexual and Reproductive Health 09/2003; 35(6):261-9. DOI:10.1363/psrh.35.261.03 · 2.00 Impact Factor
  • Jacqueline E. Darroch · David J. Landry · Susheela Singh ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Since the late 1980s, both the political context surrounding sexuality education and actual teaching approaches have changed considerably. However, little current national information has been available on the content of sexuality education to allow in-depth understanding of the breadth of these changes and their impact on current teaching. In 1999, a nationally representative survey collected data from 3,754 teachers in grades 7-12 in the five specialties most often responsible for sexuality education. Results from those teachers and from the subset of 1,767 who actually taught sexuality education are compared with the findings from a comparable national survey conducted in 1988. In 1999, 93% of all respondents reported that sexuality education was taught in their school at some point in grades 7-12; sexuality education covered a broad number of topics, including sexually transmitted diseases (STDs), abstinence, birth control, abortion and sexual orientation. Some topics--how HIV is transmitted, STDs, abstinence, how to resist peer pressure to have intercourse and the correct way to use a condom--were taught at lowergrades in 1999 than in 1988. In 1999, 23% of secondary school sexuality education teachers taught abstinence as the only way of preventing pregnancy and STDs, compared with 2% who did so in 1988. Teachers surveyed in 1999 were more likely than those in 1988 to cite abstinence as the most important message they wished to convey (41% vs. 25%). In addition, steep declines occurred between 1988 and 1999, overall and across grade levels, in the percentage of teachers who supported teaching about birth control, abortion and sexual orientation, as well as in the percentage actually covering those topics. However, 39% of 1999 respondents who presented abstinence as the only option also told students that both birth control and the condom can be effective. Sexuality education in secondary public schools is increasingly focused on abstinence and is less likely to present students with comprehensive teaching that includes necessary information on topics such as birth control, abortion and sexual orientation. Because of this, and in spite of some abstinence instruction that also covers birth control and condoms as effective methods of prevention, many students are not receiving accurate information on topics their teachers feel they need.
    Family Planning Perspectives 09/2000; 32(5):204-11, 265. DOI:10.2307/2648173
  • Source
    David J. Landry · Susheela Singh · Jacqueline E. Darroch ·
    [Show abstract] [Hide abstract]
    ABSTRACT: While policymakers, educators and parents recognize the need for family life and sexuality education during children's formative years and before adolescence, there is little nationally representative information on the timing and content of such instruction in elementary schools. In 1999, data were gathered from 1, 789 fifth- and sixth-grade teachers as part of a nationally representative survey of 5,543 public school teachers in grades 5-12. Based on the responses of 617 fifth- and sixth-grade teachers who said they teach sexuality education, analyses were carried out on the topics and skills sexuality education teachers taught, the grades in which they taught them, their teaching approaches, the pressures they experienced, whether they received support from parents, the community and school administrators, and their needs. Seventy-two percent of fifth- and sixth-grade teachers report that sexuality education is taught in their schools at one or both grades. Fifty-six percent of teachers say that the subject is taught in grade five and 64% in grade six. More than 75% of teachers who teach sexuality education in these grades cover puberty, HIV and AIDS transmission and issues such as how alcohol and drugs affect behavior and how to stick with a decision. However, when schools that do not provide sexuality education are taken into account, even most of these topics are taught in only a little more than half of fifth- and sixth-grade classrooms. All other topics are much less likely to be covered. Teaching of all topics is less prevalent at these grades than teachers think it should be. Gaps between what teachers say they are teaching and teachers' recommendations for what should be taught and by what grade are especially large for such topics as sexual abuse, sexual orientation, abortion, birth control and condom use for STD prevention. A substantial proportion of teachers recommend that these topics be taught at grade six or earlier. More than half (57%) of fifth- and sixth-grade sexuality education teachers cover the topic of abstinence from intercourse--17% as the only option for protection against pregnancy and STDs and 40% as the best alternative or one option for such protection. Forty-six percent of teachers report that one of their top three problems in teaching sexuality education is pressure, whether from the community, parents or school administrators. More than 40% of teachers report a need for some type of assistance with materials, factual information or teaching strategies. A large proportion of schools are doing little to prepare students in grades five and six for puberty, much less for dealing with pressures and decisions regarding sexual activity Sexuality education teachers often feel unsupported by the community, parents or school administrators.
    Family Planning Perspectives 09/2000; 32(5):212-9. DOI:10.2307/2648174
  • David J. Landry · Lisa Kaeser · Cory L. Richards ·
    [Show abstract] [Hide abstract]
    ABSTRACT: For more than two decades, abstinence from sexual intercourse has been promoted by some advocates as the central, if not sole, component of public school sexuality education policies in the United States. Little is known, however, about the extent to which policies actually focus on abstinence and about the relationship, at the local district level, between policies on teaching abstinence and policies on providing information about contraception. A nationally representative sample of 825 public school district superintendents or their representatives completed a mailed questionnaire on sexuality education policies. Descriptive and multivariate analyses were conducted to identify districts that had sexuality education policies, their policy regarding abstinence education and the factors that influenced it. Among the 69% of public school districts that have a district-wide policy to teach sexuality education, 14% have a comprehensive policy that treats abstinence as one option for adolescents in a broader sexuality education program; 51% teach abstinence as the preferred option for adolescents, but also permit discussion about contraception as an effective means of protecting against unintended pregnancy and disease (an abstinence-plus policy); and 35% (or 23% of all U.S. school districts) teach abstinence as the only option outside of marriage, with discussion of contraception either prohibited entirely or permitted only to emphasize its shortcomings (an abstinence-only policy). Districts in the South were almost five times as likely as those in the Northeast to have an abstinence-only policy. Among districts whose current policy replaced an earlier one, twice as many adopted a more abstinence-focused policy as moved in the opposite direction. Overall, though, there was no net increase among such districts in the number with an abstinence-only policy; instead, the largest change was toward abstinence-plus policies. While a growing number of U.S. public school districts have made abstinence education a part of their curriculum, two-thirds of districts allow at least some positive discussion of contraception to occur. Nevertheless, one school district in three forbids dissemination of any positive information about contraception, regardless of whether their students are sexually active or at risk of pregnancy or disease.
    Family Planning Perspectives 11/1999; 31(6):280-6. DOI:10.2307/2991538
  • Jacqueline E. Darroch · David J. Landry · Selene Oslak ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Researchers have examined the age of partners of young women at first intercourse and of young women who have given birth, but little is known about the age of partners of young women in current sexual relationships or young women who have had an abortion. Data from the 1995 National Survey of Family Growth (NSFG) were used to examine age differences between women and their current partner and women's use of contraceptives at last intercourse, by marital status and by the age difference between women and their partner. Data from the NSFG and the 1994-1995 Alan Guttmacher Institute Abortion Patient Survey, with supplemental information from other sources, were used to estimate 1994 pregnancy rates for women by their age and marital status, according to the age difference between the women and their partner. Among all sexually active women aged 15-44, 10% had a partner who was three or more years younger, 52% a partner who was within two years of their age, 20% a partner who was 3-5 years older, and 18% a partner who was six or more years older. In contrast, 64% of sexually active women aged 15-17 had a partner within two years of their age, 29% a partner who was 3-5 years older, and 7% a partner who was six or more years older. Among women younger than 18, the pregnancy rate among those with a partner who was six or more years older was 3.7 times as high as the rate among those whose partner was no more than two years older. Among women younger than 18 who became pregnant, those with a partner who was six or more years older were less likely to have an unintended pregnancy (70%) or to terminate an unintended pregnancy (21%) than were those whose partner was no more than two years older (82% and 49%, respectively). Among women younger than 18 who were at risk of unintended pregnancy, 66% of those who had a partner who was six or more years older had practiced contraception at last sex, compared with 78% of those with a partner within two years of their own age. Young women who were Catholic and those who had first had sex with their partner within a relatively committed relationship were less likely to be involved with a man who was six or more years older than were young women who were Protestants and those who first had sex with their partner when they were dating, friends or had just met. Young women who had ever been forced to have sex were twice as likely as those who had not to have a partner who was 3-5 years older. Although the proportion of 15-17-year-old women who have a much older partner is small, these adolescents are of concern because of their low rate of contraceptive use and their relatively high rates of pregnancy and birth. Research is needed to determine why some young women have relationships with an older man, and how their partner's characteristics affect their reproductive behavior.
    Family Planning Perspectives 07/1999; 31(4):160-7. DOI:10.2307/2991588
  • Source
    Jacqueline E. Darroch · David J. Landry · Selene Oslak ·
    [Show abstract] [Hide abstract]
    ABSTRACT: When rates of pregnancy, birth and abortion are calculated only for the women involved, men's role in reproduction is ignored, resulting in limited understanding of their influence on these outcomes. Data from the 1995 National Survey of Family Growth and from the 1994-1995 Alan Guttmacher Institute Abortion Patient Survey were combined with national natality statistics to estimate pregnancy rates in 1994 for women and their male partners, by age and marital status at the time of conception. Nine percent of both men and women aged 15-44 were involved in conceiving a pregnancy in 1994 (excluding those resulting in miscarriages). Pregnancy levels were highest among women aged 20-24 and among male partners aged 25-29. Men younger than 20 were involved in about half as many pregnancies as were women this age (9% compared with 18%). In contrast, men aged 35 and older were involved in roughly twice as many pregnancies as were similarly aged women (19% compared with 9%). Three out of every four pregnancies in 1994 resulted in a birth. However, 47% of pregnancies involving men younger than 18 ended in abortion, compared with about 34% of those involving men aged 40 and older. In comparison, 31% of pregnancies among women younger than 18 resulted in abortion, while 39% of those among women aged 40 and older were terminated. The overall rate at which men were involved in causing a pregnancy is similar to the pregnancy rate among women. Men are typically older than women when they are involved in a pregnancy, however. This implies that men may bring more experience and resources to the pregnancy experience.
    Family Planning Perspectives 05/1999; 31(3):122-6, 136. DOI:10.2307/2991694
  • Source
    Kost KD · David J. Landry · Jacqueline E. Darroch ·
    [Show abstract] [Hide abstract]
    ABSTRACT: The planning status of a pregnancy may affect a woman's prenatal behaviors and the health of her newborn. However, whether this effect is independent or is attributable to socioeconomic and demographic factors has not been explored using nationally representative data. Data were obtained on 9,122 births reported in the 1988 National Maternal and Infant Health Survey and 2,548 births reported in the 1988 National Survey of Family Growth. Multiple logistic regression analyses were employed to examine the effects of planning status on the odds of a negative birth outcome (premature delivery, low-birth-weight infant or infant who is small for gestational age), early well-baby care and breastfeeding. The proportion of infants born with a health disadvantage is significantly lower if the pregnancy was intended than if it was mistimed or not wanted; the proportions who receive well-baby care by age three months and who are ever breastfed are highest if the pregnancy was intended. In analyses controlling for the mother's background characteristics, however, a mistimed pregnancy has no significant effect on any of these outcomes. An unwanted pregnancy increases the likelihood that the infant's health will be compromised (odds ratio, 1.3), but the association is no longer significant when the mother's prenatal behaviors are also taken into account. Unwanted pregnancy has no independent effect on the likelihood of well-baby care, but it reduces the odds of breastfeeding (0.6). Knowing the planning status of a pregnancy can help identify women who may need support to engage in prenatal behaviors that are associated with healthy outcomes and appropriate infant care.
    Family Planning Perspectives 09/1998; 30(5):223-30. DOI:10.2307/2991608
  • Kathryn Kost · David J. Landry · Jacqueline E. Darroch ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Women's behavior during pregnancy, which can affect the health of their infant, may be influenced by their attitude toward the pregnancy. Multivariate analyses of data from the 1988 National Maternal and Infant Health Survey and the 1988 National Survey of Family Growth were conducted to investigate whether women with unplanned births differ from other women in their pregnancy behavior, independent of their social and demographic characteristics. Women with intended conceptions are more likely than similar women with unintended pregnancies to recognize early signs of pregnancy and to seek out early prenatal care, and somewhat more likely to quit smoking, but they are not more likely than women with comparable social and demographic characteristics to adhere to a recommended schedule of prenatal visits once they begin care, to reduce alcohol intake, or to follow their clinician's advice about taking vitamins and gaining weight. Social and demographic differences in these behaviors are largely unaffected by planning status, indicating that these differences are independently related to pregnancy behaviors. Both the intendedness of a pregnancy and the mother's social and demographic characteristics are important predictors of pregnancy-related behavior.
    Family Planning Perspectives 03/1998; 30(2):79-88. DOI:10.2307/2991664
  • Source
    David J. Landry · Jacqueline Darroch Forrest ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Results of a 1995 survey reveal that 1,437 local health departments-half of those in the country-provide sexually transmitted disease (STD) services and receive about two million client visits each year. Their clients are predominantly individuals with incomes of less than 250% of the poverty level (83%), women (60%) and non-Hispanic whites or blacks (55% and 35%, respectively); 36% of clients are younger than 20, and 30% are aged 20-24. On average, 23% of clients tested for STDs have chlamydia, 13% have gonorrhea, 3% have early-stage syphilis, 18% have some other STD and 43% have no STD. Virtually all public STD programs offer testing and treatment for gonorrhea and syphilis; only 82% test for chlamydia, but 97% provide treatment for it. Some 14% offer services only in sessions dedicated to STD care, 37% always integrate STD and other services, such as family planning, in the same clinic sessions, and 49% offer both separate and integrated sessions. STD programs that integrate services with other health care typically cover nonmetropolitan areas, have small caseloads, serve mainly women and provide a variety of contraceptives. In contrast, those that offer services only in dedicated sessions generally are in metropolitan areas and have large caseloads; most of their clients are men, and few provide contraceptive methods other than the male condom.
    Family Planning Perspectives 11/1996; 28(6):261-6. DOI:10.2307/2136055
  • D J Landry · J D Forrest ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Private physicians provide family planning services to the majority of American women. According to data from the National Ambulatory Medical Care Survey, office-based physicians received on average 13.5 million visits annually for contraceptive services during 1990-1992. Private insurance was the expected from of payment for 38% of visits, while managed care covered 22% of visits, and Medicaid or another source of public assistance subsidized 12%; 22% were self-paid and 6% covered by other sources. The majority of patients who received contraceptive services gave a reason other than general family planning or care regarding a specific contraceptive as the primary purpose for their visit, although women covered by a managed care plan or through public funding were the most likely to give general family planning needs as the main reason. Women whose visit was listed as publicly funded were less likely to have a contraceptive prescribed or provided or to obtain a Pap test than were those expected to pay with private insurance.
    Family Planning Perspectives 09/1996; 28(5):203-9. DOI:10.2307/2135839
  • David J. Landry · Jacqueline Darroch Forrest ·
    [Show abstract] [Hide abstract]
    ABSTRACT: One in every six U.S. birth certificates have no information on the age of the baby's father; for more than four in 10 babies born to adolescent women, no data are available on the father's age. Information from mothers aged 15-49 who had babies in 1988 and were surveyed in the National Maternal and Infant Health Survey indicates that fathers for whom age is not reported on the birth certificate are considerably younger than other fathers. In 1988, 5% of fathers were under age 20, and 20% were aged 20-24. Fathers typically are older than mothers, especially when the mothers are teenagers. Fathers who are unmarried, black or partners of lower income women are younger than other fathers.
    Family Planning Perspectives 07/1995; 27(4):159-61, 165. DOI:10.2307/2136260