Loren Dobkin - Academia.edu (original) (raw)

Papers by Loren Dobkin

American Journal of Public Health, Mar 1, 2008

In response to rising gonorrhea rates among African American youth in San Francisco, Calif, Inter... more In response to rising gonorrhea rates among African American youth in San Francisco, Calif, Internet Sexuality Information Services, Inc, in partnership with the San Francisco Department of Public Health, developed SEXINFO, a sexual health text messaging service. SEXINFO is an information and referral service that can be accessed by texting “SEXINFO” to a 5-digit number from any wireless phone. A consortium of community organizations, religious groups, and health agencies assisted with identifying culturally appropriate local referral services. We conducted focus group sessions among youth aged 15 to 19 years to discuss the viability of the service. Usage of the service has been greater than expected, and an initial evaluation to assess the impact of SEXINFO on increasing access to sexual health services among at-risk adolescents has had promising results.

Current Problems in Pediatric and Adolescent Health Care, 2013

Women's Health Issues, 2016

The safety of abortion in the United States has been documented extensively. In the context of un... more The safety of abortion in the United States has been documented extensively. In the context of unwanted pregnancy, however, there are few data comparing the health consequences of having an abortion versus carrying an unwanted pregnancy to term. We examine and compare the self-reported physical health consequences after birth and abortion among participants of the Turnaway Study, which recruited women seeking abortions at 30 clinics across the United States. We also investigate and report maternal mortality among all women enrolled in the study. In our study sample, women who gave birth reported potentially life-threatening complications, such as eclampsia and postpartum hemorrhage, whereas those having abortions did not. Women who gave birth reported the need to limit physical activity for a period of time three times longer than that reported by women who received abortions. Among all women enrolled in the Turnaway Study, one maternal death was identified-one woman who had been denied an abortion died from a condition that confers a higher risk of death among pregnant women. These results reinforce the existing data on the safety of induced abortion when compared with childbirth, and highlight the risk of serious morbidity and mortality associated with childbirth after unwanted pregnancy.

The Turnaway Study is a five-year prospective longitudinal study which aims to understand the eff... more The Turnaway Study is a five-year prospective longitudinal study which aims to understand the effect of abortion on women's lives. Women were recruited from 30 abortion clinics across the country where no clinic nearby performs procedures at a later gestation. The study includes women just above the gestational limit who were denied an abortion (n=231), women just below the limit who received an abortion (n=452), and women who received a first trimester abortion (n=273). This analysis presents the mental and physical health consequences of receiving or being denied an abortion. One week after receiving or being denied an abortion, women denied an abortion had significantly higher anxiety than women who received the abortion. At one year there were no differences in anxiety or depression. However, women who gave birth were more likely to report feeling that they have more to do than they can get done. We find physical health complications are more common and severe following birt...

Women's Health Issues, 2014

The Turnaway Study is designed to prospectively study the outcomes of women who sought-but did no... more The Turnaway Study is designed to prospectively study the outcomes of women who sought-but did not all obtain-abortions. This design permits more accurate inferences about the health consequences of abortion for women, but requires the recruitment of a large number of women from remote health care facilities to a study a sensitive topic. This paper explores the Turnaway Study's recruitment process. From 2008 to 2010, the staff at 30 abortion-providing facilities recruited eligible female patients. Eight interventions were evaluated using multilevel logistic regression for their impact on eligible patients being approached, approached patients agreeing to go through informed consent by phone, and enrolled patients completing the baseline interview. After site visits, patients had roughly twice the odds of being approached by facility staff and twice the odds of then agreeing to go through informed consent. When all recruitment steps were considered together, the net effect of site visits was to increase the odds that eligible patients participated by nearly a factor of six. After the introduction of a patient gift card incentive, patients had over three times the odds of agreeing to go through informed consent. With each passing month, however, staff demonstrated a 9% reduced odds of approaching eligible patients about the study. Prioritizing scientific rigor over the convenience of using existing datasets, the Turnaway Study confronted recruitment challenges common to medical practice-based studies and unique to sensitive services. Visiting sites and communicating frequently with facility staff, as well as offering incentives to patients to hear more about the study before informed consent, may help to increase participation in prospective health studies and facilitate evaluation of sensitive women's health services.

Journal of Adolescent Health, 2007

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2009

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2008

Mentoring is critical to develop and nurture early career investigators, helping them to succeed ... more Mentoring is critical to develop and nurture early career investigators, helping them to succeed in building networks of colleagues, and is especially important for investigators focused on HIV research. We piloted a multidiscipline mentoring program targeting postdoctoral scholars and early career faculty concentrating on HIV/AIDS research. The pilot mentoring program was conducted at the Center for AIDS Research (CFAR) at the University of California San Francisco and the Gladstone Institute of Virology and Immunology. Mentees were self-referred postdoctoral scholars and early career faculty. Mentors were drawn from the senior faculty. Early career mentees were matched with senior investigators for individual meetings, a monthly workshop on topics directed by the mentees, and single-day mentoring seminars. More than 30 mentees and 20 mentors have participated in the pilot project. Most mentees reported that the 1-on-1 mentoring was a satisfying experience. The most highly valued activities were those that facilitated networking among mentees, networking between mentors and mentees, and workshops that focused on grant applications and first academic appointments and promotions. A multidisciplinary mentoring program for postdoctoral scholars and early career faculty focused on HIV/AIDS research is valuable. Umbrella organizations, such as the CFAR, are well suited to create and provide highly valued mentoring experiences.

American Journal of Public Health, 2008

Alcoholism: Clinical and Experimental Research, 2012

Current Problems in Pediatric and Adolescent Health Care, 2013

Current clinical guidelines for counseling adolescent patients about their pregnancy options fail... more Current clinical guidelines for counseling adolescent patients about their pregnancy options fail to give concrete suggestions for how to begin and hold conversations that support patient autonomy, provide accurate and unbiased information, and address barriers to care. Recent research suggests that relative to adult women, adolescents are at increased risk of being denied abortion because they present beyond facilities' gestational age limits. Counseling that neglects to address the structural and developmental challenges that adolescents face when seeking care may contribute to the risk of abortion denial as well as subsequent delays in prenatal care. The task of providing non-directive, patient-centered, evidence-based pregnancy options counseling to an adolescent while ensuring that she receives her chosen course of care in a timely manner is challenging. This article presents a shared decision-making framework and specific suggestions for healthcare providers to support adolescent patients in coming to their decision about whether to continue or terminate an unplanned pregnancy and access follow-up care within the current sociopolitical environment.

American Journal of Public Health, Mar 1, 2008

In response to rising gonorrhea rates among African American youth in San Francisco, Calif, Inter... more In response to rising gonorrhea rates among African American youth in San Francisco, Calif, Internet Sexuality Information Services, Inc, in partnership with the San Francisco Department of Public Health, developed SEXINFO, a sexual health text messaging service. SEXINFO is an information and referral service that can be accessed by texting “SEXINFO” to a 5-digit number from any wireless phone. A consortium of community organizations, religious groups, and health agencies assisted with identifying culturally appropriate local referral services. We conducted focus group sessions among youth aged 15 to 19 years to discuss the viability of the service. Usage of the service has been greater than expected, and an initial evaluation to assess the impact of SEXINFO on increasing access to sexual health services among at-risk adolescents has had promising results.

Current Problems in Pediatric and Adolescent Health Care, 2013

Women's Health Issues, 2016

The safety of abortion in the United States has been documented extensively. In the context of un... more The safety of abortion in the United States has been documented extensively. In the context of unwanted pregnancy, however, there are few data comparing the health consequences of having an abortion versus carrying an unwanted pregnancy to term. We examine and compare the self-reported physical health consequences after birth and abortion among participants of the Turnaway Study, which recruited women seeking abortions at 30 clinics across the United States. We also investigate and report maternal mortality among all women enrolled in the study. In our study sample, women who gave birth reported potentially life-threatening complications, such as eclampsia and postpartum hemorrhage, whereas those having abortions did not. Women who gave birth reported the need to limit physical activity for a period of time three times longer than that reported by women who received abortions. Among all women enrolled in the Turnaway Study, one maternal death was identified-one woman who had been denied an abortion died from a condition that confers a higher risk of death among pregnant women. These results reinforce the existing data on the safety of induced abortion when compared with childbirth, and highlight the risk of serious morbidity and mortality associated with childbirth after unwanted pregnancy.

The Turnaway Study is a five-year prospective longitudinal study which aims to understand the eff... more The Turnaway Study is a five-year prospective longitudinal study which aims to understand the effect of abortion on women's lives. Women were recruited from 30 abortion clinics across the country where no clinic nearby performs procedures at a later gestation. The study includes women just above the gestational limit who were denied an abortion (n=231), women just below the limit who received an abortion (n=452), and women who received a first trimester abortion (n=273). This analysis presents the mental and physical health consequences of receiving or being denied an abortion. One week after receiving or being denied an abortion, women denied an abortion had significantly higher anxiety than women who received the abortion. At one year there were no differences in anxiety or depression. However, women who gave birth were more likely to report feeling that they have more to do than they can get done. We find physical health complications are more common and severe following birt...

Women's Health Issues, 2014

The Turnaway Study is designed to prospectively study the outcomes of women who sought-but did no... more The Turnaway Study is designed to prospectively study the outcomes of women who sought-but did not all obtain-abortions. This design permits more accurate inferences about the health consequences of abortion for women, but requires the recruitment of a large number of women from remote health care facilities to a study a sensitive topic. This paper explores the Turnaway Study's recruitment process. From 2008 to 2010, the staff at 30 abortion-providing facilities recruited eligible female patients. Eight interventions were evaluated using multilevel logistic regression for their impact on eligible patients being approached, approached patients agreeing to go through informed consent by phone, and enrolled patients completing the baseline interview. After site visits, patients had roughly twice the odds of being approached by facility staff and twice the odds of then agreeing to go through informed consent. When all recruitment steps were considered together, the net effect of site visits was to increase the odds that eligible patients participated by nearly a factor of six. After the introduction of a patient gift card incentive, patients had over three times the odds of agreeing to go through informed consent. With each passing month, however, staff demonstrated a 9% reduced odds of approaching eligible patients about the study. Prioritizing scientific rigor over the convenience of using existing datasets, the Turnaway Study confronted recruitment challenges common to medical practice-based studies and unique to sensitive services. Visiting sites and communicating frequently with facility staff, as well as offering incentives to patients to hear more about the study before informed consent, may help to increase participation in prospective health studies and facilitate evaluation of sensitive women's health services.

Journal of Adolescent Health, 2007

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2009

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2008

Mentoring is critical to develop and nurture early career investigators, helping them to succeed ... more Mentoring is critical to develop and nurture early career investigators, helping them to succeed in building networks of colleagues, and is especially important for investigators focused on HIV research. We piloted a multidiscipline mentoring program targeting postdoctoral scholars and early career faculty concentrating on HIV/AIDS research. The pilot mentoring program was conducted at the Center for AIDS Research (CFAR) at the University of California San Francisco and the Gladstone Institute of Virology and Immunology. Mentees were self-referred postdoctoral scholars and early career faculty. Mentors were drawn from the senior faculty. Early career mentees were matched with senior investigators for individual meetings, a monthly workshop on topics directed by the mentees, and single-day mentoring seminars. More than 30 mentees and 20 mentors have participated in the pilot project. Most mentees reported that the 1-on-1 mentoring was a satisfying experience. The most highly valued activities were those that facilitated networking among mentees, networking between mentors and mentees, and workshops that focused on grant applications and first academic appointments and promotions. A multidisciplinary mentoring program for postdoctoral scholars and early career faculty focused on HIV/AIDS research is valuable. Umbrella organizations, such as the CFAR, are well suited to create and provide highly valued mentoring experiences.

American Journal of Public Health, 2008

Alcoholism: Clinical and Experimental Research, 2012

Current Problems in Pediatric and Adolescent Health Care, 2013

Current clinical guidelines for counseling adolescent patients about their pregnancy options fail... more Current clinical guidelines for counseling adolescent patients about their pregnancy options fail to give concrete suggestions for how to begin and hold conversations that support patient autonomy, provide accurate and unbiased information, and address barriers to care. Recent research suggests that relative to adult women, adolescents are at increased risk of being denied abortion because they present beyond facilities' gestational age limits. Counseling that neglects to address the structural and developmental challenges that adolescents face when seeking care may contribute to the risk of abortion denial as well as subsequent delays in prenatal care. The task of providing non-directive, patient-centered, evidence-based pregnancy options counseling to an adolescent while ensuring that she receives her chosen course of care in a timely manner is challenging. This article presents a shared decision-making framework and specific suggestions for healthcare providers to support adolescent patients in coming to their decision about whether to continue or terminate an unplanned pregnancy and access follow-up care within the current sociopolitical environment.