Objective To estimate the contraceptive failure rates of the etonogestrel subdermal contraceptive implant in overweight and obese women, and compare failure rates to women of normal weight and women using intrauterine devices (IUDs). Methods The Contraceptive CHOICE Project is a large prospective cohort study designed to promote the use of long-acting reversible contraceptive methods to reduce unintended pregnancies in the St. Louis region. Participants are provided reversible contraception of their choice at no cost. We collected baseline height and weight of each participant. During each survey, participants were asked about missed menses and possible pregnancies. Any participant who suspected a pregnancy was asked to come in for urine pregnancy testing. Analysis includes the first 8,445 participants enrolled in CHOICE of which 1,168 chose the implant and 4,200 chose the IUD. Student’s t-test, χ2 test, and Kaplan-Meier survival curves were used to perform statistical analyses to estimate failure rates in overweight and obese women using the implant and IUDs. Results Of the women choosing the implant, 28% were overweight and 35% were obese. Of the women who chose an IUD, 27% were overweight and 35% were obese. The 3-year cumulative failure rates for implant and IUD users were less than 1 per 100 women-years and did not vary by body mass index (BMI). Conclusion We found no decrease in the effectiveness of the implant in overweight or obese women. The implant may be offered as a first-line contraceptive method to any woman seeking a reversible, and reliable birth control method.

Background Preventing sexually transmitted diseases (STD) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) remains a public health challenge. The U.S. Preventive Services Task Force suggests STD screening among men will likely lead to a decrease in infection rates of women. However, innovative approaches are necessary to increase the traditionally low rates of male screening. The purpose of this study is to compare the acceptability and effectiveness of home-based versus clinic-based urine screening for CT/GC in men. Methods We conducted a randomized clinical trial of 200 men ages 18-45 years who reside in St. Louis, Missouri. Men were enrolled via telephone and randomly assigned to receive a free urine CT/GC screening kit in-person at the research clinic or mailed to a preferred address. Participants completed questionnaires at baseline and 10-12 weeks post-enrollment. The primary outcome was whether a STD screening kit was completed. Results Sixty percent (120/200) completed STD screening. Men assigned to home-based screening were 60% more likely to complete screening compared to clinic-based screening (72% versus 48%, RRadj=1.6, 95% CI, 1.3, 2.00). We identified four cases of CT or GC in the home-based group compared to three cases of CT in the clinic group. Men who completed screening were significantly more likely to be white, younger, and college-educated. Conclusions Home-based screening for CT and GC among men is more acceptable than clinic-based screening and resulted in higher rates of screening completion. Incorporating home-based methods as adjuncts to traditional STD screening options shows promise in improving STD screening rates in men.

Knowledge gained from these programs will help to develop guidelines for surgical removal of tissue-embedded fragments.