Carolyn Westhoff

Columbia University, New York City, New York, United States

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Publications (172)671.96 Total impact

  • Carolyn L. Westhoff, Beverly Winikoff
    Contraception 10/2014; 90(4):353. · 3.09 Impact Factor
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    ABSTRACT: Health care providers may restrict intrauterine device (IUD) insertion until menstruation occurs secondary to device labeling. We describe pregnancy and bleeding patterns when IUD insertions occur at any time in the menstrual cycle. We enrolled women initiating the copper T380A or levonorgestrel intrauterine system after pregnancy test regardless of cycle day. Participants recorded bleeding and cramping with paper calendars or text message for 90 days. We enrolled 230 participants; 131 (57%) provided adequate data for analyses. Intrauterine devices were inserted through cycle day 7 (n=34), later (n=76), or when a cycle day could not be determined (eg, recently pregnant) (n=21). Copper IUD users (n=67) reported a median of 26 days of bleeding overall. Median bleeding days reported were 22 when the device was inserted during cycle week 1, 28 when inserted at any other time, and 24 when cycle day could not be determined (P=.1). Levonorgestrel intrauterine system users (n=64) overall had a median of 38 bleeding days and 37 bleeding days for insertion during cycle week 1, 39 at any other time, and 35 if indeterminate cycle day (P=.6). Sixty-seven percent of copper IUD insertions and 80% of levonorgestrel intrauterine system insertions occurred beyond cycle week 1. No pregnancies occurred in the month of IUD insertion. Bleeding was reported more frequently by levonorgestrel intrauterine system users. Reported bleeding days did not differ by timing of IUD insertion. Intrauterine devices can, thus, be inserted any time during the menstrual cycle.
    Obstetrics and Gynecology 05/2014; 123 Suppl 1:12S. · 4.80 Impact Factor
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    ABSTRACT: Unintended pregnancy remains persistently high in the United States. Few randomized interventions have effectively reduced pregnancy. We conducted a cluster randomized trial in 40 Planned Parenthood sites, including family planning and abortion, to assess the effect of a clinic-wide training in long-acting reversible contraceptives (LARCs) on patient outcomes. A cohort of 1,500 patients, 18-25 years, who received contraceptive counseling and did not want to become pregnant in the next 12 months, were recruited from intervention and control clinics. Pregnancy was measured over 12 months with questionnaires, pregnancy tests, and medical record review. In blinded intent-to-treat analyses, we used survival analysis with shared frailty for clustered data to measure the intervention effect compared with standard care. The trial was registered with ClinicalTrials.gov and followed CONSORT (Consolidated Standards of Reporting Trials) guidelines. Participants were similar in baseline characteristics by arm. At enrollment, after counseling, participants in arm 1 were twice as likely to choose a LARC method as those in arm 2 using generalized estimating equation models for clustered data and robust standard errors (odds ratio 2.0, 95% confidence interval [CI] 1.3-2.9). In family planning settings, pregnancy during the study was lower in arm 1 (7.5%) than in arm 2 (13.8%). Analyses of the intervention effect in a model with an interaction for setting type showed a highly significant effect on reduced pregnancy in family planning settings (hazard ratio 0.5, 95% CI 0.3-0.8). However, there were no significant differences in pregnancy by arm in the abortion setting. A half-day replicable LARC intervention effectively reduced pregnancy in family planning clinics.
    Obstetrics and gynecology; 05/2014
  • Article: In Reply.
    Obstetrics and Gynecology 05/2014; 123(5):1107-1108. · 4.80 Impact Factor
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    ABSTRACT: Short-term bleeding patterns after intrauterine device (IUD) insertion are poorly characterized. Most young women text message daily. We aimed to assess success of collecting 90 days bleeding data after IUD insertion by method of data collection (text message compared with traditional paper diaries). We enrolled women with cell phones initiating the copper T380A IUD or levonorgestrel intrauterine system and randomized participants (one-to-one) to record bleeding through daily text messages or monthly paper calendars. Women in the text group received automated daily prompts. The groups received equal compensation for completing the diaries. We enrolled 230 participants. The groups were similar in baseline characteristics, including age, parity, ethnicity, and education. Twenty percent of participants provided no bleeding data; of these, 76% were in the paper group; only 20% in each group provided complete 90-day data. The median diary completion was 82 days for the text group (interquartile range 40-89) and 36 days in the paper group (interquartile range 0-88). Those with 30 or fewer responses were less educated and more likely to self-identify as Hispanic than those providing more than 60 responses. Women providing bleeding data electronically by daily text message gave more complete data than women using traditional paper diaries; however, bleeding data were incomplete in both groups. For future studies of contraception and bleeding patterns, use of text may be superior to paper diaries.
    Obstetrics and Gynecology 05/2014; 123 Suppl 1:12S-3S. · 4.80 Impact Factor
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    ABSTRACT: Although fertility drugs stimulate ovulation and raise estradiol levels, their effect on breast cancer risk remains unresolved. An extended follow-up was conducted among a cohort of 12,193 women evaluated for infertility between 1965 and 1988 at five U.S. sites. Follow-up through 2010 was achieved for 9,892 women (81.1% of the eligible population) via passive as well as active (questionnaires) means. Cox regression determined HRs and 95% confidence intervals (CI) for fertility treatments adjusted for breast cancer risk factors and causes of infertility. During 30.0 median years of follow-up (285,332 person-years), 749 breast cancers were observed. Ever use of clomiphene citrate among 38.1% of patients was not associated with risk (HR = 1.05; 95% CI, 0.90-1.22 vs. never use). However, somewhat higher risks were seen for patients who received multiple cycles, with the risk for invasive cancers confirmed by medical records being significantly elevated (HR = 1.69; 95% CI, 1.17-2.46). This risk remained relatively unchanged after adjustment for causes of infertility and multiple breast cancer predictors. Gonadotropins, used by 9.6% of patients, mainly in conjunction with clomiphene, showed inconsistent associations with risk, although a significant relationship of use with invasive cancers was seen among women who remained nulligravid (HR = 1.98; 95% CI, 1.04-3.60). Although the increased breast cancer risk among nulligravid women associated with gonadotropins most likely reflects an effect of underlying causes of infertility, reasons for the elevated risk associated with multiple clomiphene cycles are less clear. Given our focus on a relatively young population, additional evaluation of long-term fertility drug effects on breast cancer is warranted. Cancer Epidemiol Biomarkers Prev; 23(4); 584-93. ©2014 AACR.
    Cancer Epidemiology Biomarkers &amp Prevention 04/2014; 23(4):584-93. · 4.56 Impact Factor
  • Kelli Stidham Hall, Paula M Castaño, Carolyn L Westhoff
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    ABSTRACT: Abstract Background: Using a multidimensional approach, we assessed young women's knowledge of oral contraceptives (OC) and its influence on OC continuation rates. Methods: We used data from 659 women aged 13-25 years participating in a randomized controlled trial of an educational text message OC continuation intervention. Women received 6 months of daily text messages or routine care. At baseline and 6 months, we administered a comprehensive 41-item questionnaire measuring knowledge of OC's mechanism, effectiveness, use, side effects, risks, and benefits. We ascertained OC continuation status and reasons for discontinuation at 6 months. We analyzed relationships between OC knowledge and continuation with multivariable logistic regression. Results: Young women scored, on average, 22.8 out of 41 points on the OC knowledge assessment at baseline and 24.7 points at 6 months. The 6-month OC continuation rate was 59%. OC continuers had >2-points-higher OC knowledge scores at 6 months than discontinuers (p<0.001). Those who reported discontinuing their OCs for side effects and forgetfulness scored >2 points lower than women who discontinued for other reasons (p-values<0.001). In multivariable regression models, each correct response on the baseline and 6-month knowledge assessments was associated with a 4% and 6% increased odds of OC continuation, respectively. Six-month OC knowledge scores were negatively associated with OC discontinuation due to side effects (odds ratio [OR] 0.94) and forgetfulness (OR 0.88). Conclusions: OC knowledge, which was low among young women in our study, was associated with OC continuation and common reasons for discontinuation. Continued efforts to characterize relationships between OC knowledge and behavior and to test the effectiveness of different components of interventions aimed at increasing knowledge, addressing side effects, and improving use of OCs are warranted.
    Journal of Women's Health 02/2014; · 1.90 Impact Factor
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    ABSTRACT: To compare a new low-dose levonorgestrel and ethinyl estradiol contraceptive patch (Patch) with a combination oral contraceptive (Pill; 100 micrograms levonorgestrel, 20 micrograms ethinyl estradiol) regarding efficacy, safety, compliance, and unscheduled uterine bleeding. Women (17-40 years; body mass index 16-60) were randomized in a 3:1 ratio to one of two groups: Patch only (13 cycles) or Pill (six cycles) followed by Patch (seven cycles). Investigators evaluated adverse events during cycles 2, 4, 6, 9, and 13. Participants recorded drug administration and uterine bleeding on daily diary cards. Compliance was assessed by measuring levonorgestrel and ethinyl estradiol plasma levels. Pearl Index (pregnancies per 100 woman-years) was calculated to evaluate efficacy. Participants (N=1,504) were randomized to Patch (n=1,129) or Pill (n=375). Approximately 30% were obese, more than 40% were racial or ethnic minorities, and more than 55% were new users of hormonal contraceptives. Laboratory-verified noncompliance (undetectable plasma drug levels) was 11% of Patch and 12.6% of Pill users at cycle 6. Pearl Indices (95% confidence intervals) for the intention-to-treat population (cycles 1-6) were 4.45 (2.34-6.57) for Patch and 4.02 (0.50-7.53) for Pill; excluding laboratory-verified noncompliant participants, Pearl Indices were 2.82 (0.98-4.67) for Patch and 3.80 (0.08-7.52) for Pill (differences not statistically significant). Incidence of unscheduled bleeding and incidence and severity of adverse events were similar for both contraceptives (no statistically significant difference). Efficacy and safety of the new contraceptive Patch are comparable to those of a Pill. Laboratory-verified noncompliance and bleeding profile are similar between the two treatments. The Patch was well tolerated. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01181479. LEVEL OF EVIDENCE:: I.
    Obstetrics and Gynecology 01/2014; · 4.80 Impact Factor
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    ABSTRACT: To describe women's condom use and assess predictors of consistent condom use and dual method use in the 6 months after the initiation of oral contraception (OC).
    PLoS ONE 01/2014; 9(7):e101804. · 3.53 Impact Factor
  • Noa’a Shimoni, Anne Davis, Carolyn Westhoff
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    ABSTRACT: Objectives Our randomized trial compared early and delayed IUD insertion following medical abortion. In this planned sub-study, we explore if endometrial thickness and initial IUD position were associated with IUD expulsion. We also describe IUD movement within the uterus during the six months after insertion. Study Design We recruited women undergoing medical abortion and choosing the copper IUD for contraception (n = 156). Participants were randomly assigned to early insertion one week after mifepristone or delayed insertion 4–6 weeks later. We measured endometrial thickness by transvaginal sonogram one week after abortion, and IUD distance from the fundal aspect of the endometrial cavity three times: at insertion, 6–8 weeks later, and at 6 months. Results We analyzed endometrial thickness in 113 women, baseline IUD position in 114 women, and IUD movement in 65 women. Women who expelled IUDs (n = 15) had slightly thicker endometria (p = .007) and slightly lower baseline IUD positions (p = .03) than those who retained IUDs, but no clear cutoffs emerged in the ROC analysis. Retained IUDs commonly moved up and down throughout the six months (from 14 mm towards the fundus to 32 mm towards the cervix ). Overall, retained IUDs moved a median of 2 mm towards the cervix between insertion and exit (p < .0001). Conclusions After medical abortion, the risk of IUD expulsion increases with thicker endometria and lower baseline position. Since no clear cutoffs emerged in the analysis and expulsion remained uncommon even with thicker endometria, we do not recommend restricting IUD insertion based on ultrasound data. Implication Copper T IUDs often move within the uterus without expelling. Expulsion is uncommon and we do not recommend restricting IUD insertion based on ultrasound data.
    Contraception 01/2014; · 3.09 Impact Factor
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    ABSTRACT: Objectives To evaluate feasibility, acceptability, continuation, and trough serum levels following self-administration of subcutaneous (SC) depot medroxyprogesterone acetate (DMPA). Study Design Women presenting to a family planning clinic to initiate, restart, or continue DMPA were offered study entry. Participants were randomized in a 2:1 ratio to self or clinician administered SC DMPA 104mg. Those randomized to self-administration were taught to self-inject and were supervised in performing the initial injection; they received printed instructions and a supply of contraceptive injections for home use. Participants randomized to clinician administration received usual care. Continued DMPA use was assessed by self-report and trough MPA levels at six and twelve months. Results 250 women were invited to participate and 137 (55%) enrolled. Of these, 91 were allocated to self-administration, and 90/91 were able to correctly self-administer SC DMPA. Eighty-seven percent completed follow-up. DMPA use at one year was 71% for the self-administration group and 63% for the clinic group (p=0.47). Uninterrupted DMPA use was 47% and 48% for the self and clinic administration groups at one year (p = 0.70), respectively. Serum analyses confirmed similar mean DMPA levels in both groups and therapeutic trough levels in all participants. Conclusions Sixty-three percent of women approached were interested in trying self-administration of DMPA, even in the context of a randomized trial, and nearly all eligible for enrollment were successful at doing so. Self-administration and clinic administration resulted in similar continuation rates and similar DMPA serum levels. Self-administration of SC-DMPA is feasible, and may be an attractive alternative for many women. Implications Self-administration of SC DMPA is a feasible and attractive option for many women. Benefits include increased control over contraceptive measures and less time spent on contracepting behaviors. Globally, self-administration has the potential to revolutionize contraceptive uptake by increasing the number of women with access to DMPA.
    Contraception 01/2014; · 3.09 Impact Factor
  • Carolyn L Westhoff
    Contraception 01/2014; 89(1):1-2. · 3.09 Impact Factor
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    ABSTRACT: Background Body mass index (BMI) may influence ovulation inhibition resulting from transdermal hormone delivery. Investigation of this effect is important given the high prevalence of obesity in the US. Study Design This open-label, uncontrolled, Phase 2b trial stratified 173 women (18–35 years) according to three BMI groups (Group 1, n = 56, ≤ 30 kg/m2; Group 2, n = 55, > 30 kg/m2 and ≤ 35 kg/m2; and Group 3, n = 47, > 35 kg/m2). Women used a contraceptive patch containing 0.55 mg ethinyl estradiol (EE) and 2.1 mg gestodene (GSD). The EE/GSD patch was used weekly for three 28-day cycles (one patch per week for 3 consecutive weeks followed by a 7-day, patch-free interval) and its effect on ovulation was assessed by the Hoogland score, a composite score that comprises transvaginal ultrasound and estradiol (E2) and progesterone levels every 3 days in Cycles 2 and 3. Evaluation of PK parameters was a secondary aim of the study, and blood samples for analytic determination of EE, GSD and SHBG were taken during the pre-treatment cycle, Cycle 2 and Cycle 3. Compliance was assessed using diary information and serum drug levels. Results In the per-protocol set, there were only six ovulations during the study, and no participant ovulated in both study cycles. One ovulation occurred in Group 1, three in Group 2, and two in Group 3. Ovulation inhibition was unaffected by BMI; in all groups, most participants had Hoogland scores of 1 or 2 (i.e. follicle-like structures < 13 mm (Group 1, ≤ 30 kg/m2, 80.0% in Cycle 2, 85.7% in Cycle 3; Group 2, > 30 kg/m2 and ≤ 35 kg/m2, 61.4% in Cycle 2, 75.0% in Cycle 3; Group 3, > 35 kg/m2, 78.0% in Cycle 2, 72.5% in Cycle 3). Serum levels of follicle-stimulating hormone, luteinizing hormone, E2 and progesterone were similar between groups. Body weight had a limited effect on EE clearance that was unlikely to be clinically relevant. Conclusion The EE/GSD patch provided effective ovulation inhibition, even in women with higher BMI. Implications This is the largest-to-date study of physiologic endpoints and found no clinically important differences in ovarian suppression among obese and normal-weight users of the EE/GSD contraceptive patch, thus providing reassurance that obese women can achieve the same high level of contraceptive protection as normal-weight users.
    Contraception 01/2014; · 3.09 Impact Factor
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    ABSTRACT: Objectives. We evaluated the impact of influenza vaccine text message reminders in a low-income obstetric population. Methods. We conducted a randomized controlled trial that enrolled 1187 obstetric patients from 5 community-based clinics in New York City. The intervention group received 5 weekly text messages regarding influenza vaccination starting mid-September 2011 and 2 text message appointment reminders. Both groups received standard automated telephone appointment reminders. The prespecified endpoints were receipt of either pre- or postpartum influenza vaccination calculated cumulatively at the end of each month (September-December 2011). Results. After adjusting for gestational age and number of clinic visits, women who received the intervention were 30% more likely to be vaccinated as of December 2011 (adjusted odds ratio [AOR] = 1.30; 95% confidence interval [CI] = 1.003, 1.69 end of September: AOR = 1.34; 95% CI = 0.98, 1.85; October: AOR = 1.35; 95% CI = 1.05, 1.75; November: AOR = 1.27; 95% CI = 0.98, 1.65). The subgroup of women early in the third trimester at randomization showed the greatest intervention effect (December 31: 61.9% intervention vs 49.0% control; AOR = 1.88; 95% CI = 1.12, 3.15). Conclusions. In this low-income obstetric population, text messaging was associated with increased influenza vaccination, especially in those who received messages early in their third trimester. (Am J Public Health. Published online ahead of print December 19, 2013: e1-e6. doi:10.2105/AJPH.2013.301620).
    American Journal of Public Health 12/2013; · 3.93 Impact Factor
  • Elizabeth R Mayeda, Anupama H Torgal, Carolyn L Westhoff
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    ABSTRACT: Abstract Background: Oral contraceptive (OC) use seems to have little effect on weight change in normal weight women. Most previous studies have excluded obese women, so the effect of OC use on weight change in obese women is unknown. Methods: This analysis evaluates weight and body composition change with OC use among obese (body mass index [BMI] 30.0-39.9) and normal weight (BMI 19.0-24.9) women who were randomly assigned to two OC doses: 20 μg ethinyl estradiol (EE) and 100 μg levonorgestrel (LNG) OCs or 30 μg EE and 150 μg LNG OCs. Follow-up occurred after three to four OC cycles. Weight and body composition were measured at baseline and at follow-up using a bioelectrical impedance analyzer. Results: Among 150 women (54 obese and 96 normal weight) who used OCs for 3 to 4 months, there were no clinically or statistically significant weight or body composition changes in the overall group or by BMI or OC formulation group. Conclusions: These findings add to evidence that EE/LNG OCs are not associated with short term weight or body composition change for normal weight women and suggest that OCs are also are not associated with short term weight or body composition change in obese women.
    Journal of Women's Health 10/2013; · 1.90 Impact Factor
  • Paula M Castaño, Carolyn L Westhoff
    Contraception 10/2013; 88(4):475-6. · 3.09 Impact Factor
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    ABSTRACT: Etonogestrel (ENG) is a progestin used in the contraceptive vaginal ring NuvaRing and the subdermal implant Implanon. A sensitive method for measuring ENG is useful for further investigating the progestin's pharmacokinetics with these alternative contraceptive formulations and generating important information about possible continued efficacy or potential failure to remove the subdermal implant. Standards and serum samples were spiked with D8-progesterone (internal standard) and subsequently extracted with dichloromethane, dried, and reconstituted in 25% methanol with formic acid. ENG was analyzed by positive electrospray ionization in multiple reaction monitoring mode with a run time of 5.5 minutes using a C18 BEH column. The mobile phase was a gradient of water:acetonitrile, with 0.1% formic acid. The method was applied successfully to study the pharmacokinetics of ENG during vaginal ring use. The method was also used in routine patient care to assess ENG levels. The method is linear from 50 to 2000 pg/mL. The limits of detection and quantification are 25 and 50 pg/mL, respectively. There was no observed ionization suppression within the linear range of the assay, and the average recovery was 87%. Serum ENG levels of n = 3 subjects were all within the linear range of the assay for a total study period of 42 days after insertion of the ring. Of n = 20 patients with nonpalpable subdermal implants, n = 13 had ENG levels >25 pg/mL, whereas n = 7 had levels <25 pg/mL. We developed a rapid, sensitive, and robust ultra performance liquid chromatography-tandem mass spectometry (UPLC-MS/MS) method for the quantification of ENG in serum that is useful to study the progestin's pharmacokinetics and inform physicians about successful implantation or potential failure to remove a subdermal device.
    Therapeutic drug monitoring 09/2013; · 2.43 Impact Factor
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    ABSTRACT: Providers often underestimate patient pain. This study investigated if providers accurately assess pain during intrauterine device (IUD) insertion. This is a secondary analysis of a randomized trial. Participants rated pain on a 100-mm visual analogue scale (VAS). Providers marked a similar VAS for maximum level and timing of participant pain. The mean patient maximum pain was 64.8 mm (SD, 27) compared to 35.3 mm (SD, 26) rated by the provider (p<.001). Patient and provider agreement on most painful time point of procedure was weak (kappa statistic, 0.16). Providers underestimate pain during IUD insertion. To our knowledge, this is the first paper to compare provider and patient perceptions of pain during IUD insertion. Understanding this relationship will help guide further research about IUD insertion pain and techniques and could improve patient counseling.
    Contraception 09/2013; · 3.09 Impact Factor
  • American journal of epidemiology 09/2013; · 5.59 Impact Factor
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    ABSTRACT: An estimated 80% of sexually active young women in the United States use hormonal contraceptives during their reproductive years. Associations between hormonal contraceptive use and mood disturbances remain understudied, despite the hypothesis that estrogen and progesterone play a role in mood problems. In this study, we used data from 6,654 sexually active nonpregnant women across 4 waves of the National Longitudinal Study of Adolescent Health (1994-2008), focusing on women aged 25-34 years. Women were asked about hormonal contraceptive use in the context of a current sexual partnership; thus, contraceptive users were compared with other sexually active women who were using either nonhormonal contraception or no contraception. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale. At ages 25-34 years, hormonal contraceptive users had lower mean levels of concurrent depressive symptoms (β = -1.04, 95% confidence interval: -1.73, -0.35) and were less likely to report a past-year suicide attempt (odds ratio = 0.37, 95% confidence interval: 0.14, 0.95) than women using low-efficacy contraception or no contraception, in models adjusted for propensity scores for hormonal contraceptive use. Longitudinal analyses indicated that associations between hormonal contraception and depressive symptoms were stable. Hormonal contraception may reduce levels of depressive symptoms among young women. Systematic investigation of exogenous hormones as a potential preventive factor in psychiatric epidemiology is warranted.
    American journal of epidemiology 09/2013; · 5.59 Impact Factor

Publication Stats

2k Citations
671.96 Total Impact Points

Institutions

  • 2001–2014
    • Columbia University
      • Department of Obstetrics and Gynecology
      New York City, New York, United States
  • 2013
    • New York City Department of Health and Mental Hygiene
      New York, United States
    • Inha University Hospital
      Sinhyeon, South Gyeongsang, South Korea
  • 2010–2013
    • Princeton University
      Princeton, New Jersey, United States
    • The University of Manchester
      • Manchester Medical School
      Manchester, ENG, United Kingdom
  • 2002–2013
    • New York Presbyterian Hospital
      • • Department of Obstetrics and Gynecology
      • • Department of Urology
      New York City, New York, United States
    • University of Rochester
      • Department of Family Medicine
      Rochester, NY, United States
  • 2012
    • University of Miami Miller School of Medicine
      • Department of Obstetrics and Gynecology
      Miami, FL, United States
    • University of California, Irvine
      • Department of Obstetrics & Gynecology
      Irvine, CA, United States
    • University of Michigan
      • Department of Obstetrics and Gynecology
      Ann Arbor, MI, United States
    • Albert Einstein College of Medicine
      New York City, New York, United States
  • 2007–2012
    • University of Colorado
      • Department of Obstetrics and Gynecology
      Denver, Colorado, United States
    • University of North Carolina at Chapel Hill
      • Department of Obstetrics and Gynecology
      Chapel Hill, NC, United States
    • Devry College of New York, USA
      New York City, New York, United States
    • Sahlgrenska University Hospital
      Goeteborg, Västra Götaland, Sweden
  • 2011
    • Baystate Medical Center
      • Department of Obstetrics-Gynecology
      Springfield, Massachusetts, United States
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
    • Baylor College of Medicine
      • Department of Obstetrics and Gynecology
      Houston, TX, United States
    • University of California, San Francisco
      San Francisco, California, United States
  • 2010–2011
    • Medical University of South Carolina
      • Department of Obstetrics and Gynecology
      Charleston, SC, United States
  • 2006–2011
    • University of Southern California
      • • School of Social Work
      • • Department of Obstetrics and Gynecology
      Los Angeles, California, United States
  • 2004–2011
    • University of Miami
      • Department of Obstetrics and Gynecology
      Coral Gables, FL, United States
    • University of Cape Town
      • School of Public Health and Family Medicine
      Cape Town, Province of the Western Cape, South Africa
  • 2009
    • Washington University in St. Louis
      • Department of Obstetrics and Gynecology
      San Luis, Missouri, United States
    • ZEG – Berlin Center for Epidemiology and Health Research
      Berlín, Berlin, Germany
    • University of Groningen
      • Department of Obstetrics and Gynaecology
      Groningen, Province of Groningen, Netherlands
  • 2008
    • Mount Sinai Medical Center
      New York City, New York, United States
  • 2006–2008
    • University of Pittsburgh
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      Pittsburgh, PA, United States
  • 2001–2008
    • CUNY Graduate Center
      New York City, New York, United States
  • 2005
    • Rutgers New Jersey Medical School
      • Department of Pathology and Laboratory Medicine
      Newark, NJ, United States
    • University of Utah
      • College of Nursing
      Salt Lake City, UT, United States
  • 2004–2005
    • National Cancer Institute (USA)
      • • Division of Cancer Epidemiology and Genetics
      • • Hormonal and Reproductive Epidemiology
      Bethesda, MD, United States
  • 2000–2001
    • Oregon Health and Science University
      Portland, Oregon, United States