Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Trace Kershaw

Abstract

While disparities by race/ethnicity in reproductive and sexual health outcomes are well documented, the role that healthcare providers play in contributing to these disparities is only beginning to be explored. This investigation sought to examine medical and nursing students' bias surrounding the prescription of intrauterine devices (IUDs, i.e., long-acting reversible contraception) to adolescents based on the patient's race and sexual history. An online survey presented participants with a clinical vignette of an IUD-seeking sexually active adolescent, with the patient's race and number of past sexual partners systematically manipulated. Participants reported predictions about patient risk of getting pregnant with and without an IUD, patient risk of HIV/STI, willingness to prescribe IUD, and other clinical judgments. Analyses revealed that the patient with multiple partners was rated as more likely to get pregnant without an IUD and acquire HIV/STI than a patient with a single partner, although the prescription rates were similarly high across conditions. Further analyzing the impact of socio-demographic characteristics of providers revealed that White providers were more likely to find it appropriate to prescribe an IUD and to rate a sexually active adolescent at high risk of pregnancy without an IUD than non-White providers. Lastly, non-White providers were significantly less likely to prescribe to White adolescents than Black adolescents. These findings suggest that it is important to examine the extent to which both patient and provider's characteristics contribute to differences in access to and utilization of contraceptive methods, as well as to determine what types of interventions might alleviate differences in prescription habits and assumptions about patients, in order to address health care disparities.

Comments

This is an Open Access Thesis.

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