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\begin{document}

\title{Pediatric Hematology Providers' Contraceptive Practices for Female
Adolescents and Young Adults with Sickle Cell Disease: A national survey}



\author[1]{Megan Askew}%
\author[2]{Arlene Smaldone}%
\author[1]{Melanie Gold}%
\author[3]{Kim Smith-Whitley}%
\author[4]{John Strouse}%
\author[5]{Jin Zhezhen}%
\author[6]{Nancy Green}%
\affil[1]{NewYork-Presbyterian/Columbia University Medical Center}%
\affil[2]{Columbia University Irving Medical Center}%
\affil[3]{The Children's Hospital of Philadelphia}%
\affil[4]{Duke University School of Medicine}%
\affil[5]{Columbia University Mailman School of Public Health}%
\affil[6]{Columbia University}%


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  \date{May 17, 2024}


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\begin{abstract}
Background Adolescent and young adult (AYA) women with sickle cell
disease (SCD) have increased pregnancy-related health risks and are
prescribed potentially teratogenic medications, yet little is known
about pediatric SCD provider contraceptive practices. We aimed to assess
pediatric hematology providers' beliefs, practices, motivators, and
barriers for providing contraceptive care to female AYA with SCD.
Methods Guided by the Health Belief Model (HBM), we developed a
25-question, web-based survey to assess providers' practices. Survey
links were distributed nation-wide to pediatric SCD and/or general
hematology providers through their publicly available emails and by
request to directors of U.S. accredited Pediatric Hematology-Oncology
fellowship programs for distribution to their SCD providers. Data
analysis included descriptive statistics, chi-square analysis, logistic
regression. Results Of 177 respondents, 160 surveys meeting inclusion
criteria were analyzed. Most providers reported counseling (77.5\%) and
referring female AYA patients for contraception (90.8\%), but fewer
reported prescribing contraception (41.8\%). Counseling practices
significantly differed in trainees versus established providers (54\%
vs. 85\%, p\textless{}0.001) with a similar trend for prescribing
(p=0.05). Prescription practices did not differ significantly by
provider beliefs regarding potential teratogenicity of hydroxyurea. Key
motivators included patient request and disclosure of sexual activity.
Key barriers included inadequate provider training, limited visit time,
and perceived patient/parent interest. Conclusion Provider contraceptive
practices for female AYA with SCD varied, especially by provider status.
Health beliefs regarding teratogenic potential of hydroxyurea did not
correlate with contraceptive practices. Clinical guidelines, provider
training, and patient/parent decision-making tools may be tested to
assess whether provider contraceptive practices could be improved.%
\end{abstract}%



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\verb`Table1_SCDContraceptionManuscript 2.18.2022.docx`  available at \url{https://authorea.com/users/462584/articles/557983-pediatric-hematology-providers-contraceptive-practices-for-female-adolescents-and-young-adults-with-sickle-cell-disease-a-national-survey}

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\verb`Table5_SCDContraceptionManuscript 2.18.2022.docx`  available at \url{https://authorea.com/users/462584/articles/557983-pediatric-hematology-providers-contraceptive-practices-for-female-adolescents-and-young-adults-with-sickle-cell-disease-a-national-survey}\selectlanguage{english}
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