Unsafe sex, substance abuse, and domestic violence: how do recently trained obstetricians-gynecologists fare at lifestyle risk assessment and counseling on STD prevention?

Abstract

Background: Unsafe sexual practices, substance abuse, and domestic violence impact women's health. This study examined whether lifestyle risk assessment during a general medical examination and counseling about sexually transmitted disease during consultations for adolescent contraception and treatment of a sexually transmitted disease were more frequently done by recently trained obstetricians-gynecologists compared to those of obstetrician-gynecologists licensed before 1990. It also documented obstetrician-gynecologists' evaluations of their medical training in that area.

Methods: A pretested anonymous mail survey was conducted in 1995 with all 241 obstetrician-gynecologists practicing in Quebec, Canada; 66% responded (N = 158).

Results: Compared to less recently trained obstetrician-gynecologists, recently trained obstetrician-gynecologists reported routinely assessing tobacco use (77 vs 51%, P = 0.01), alcohol use (50 vs 23%, P = 0.004), and illicit drug use (33 vs 17%, P = 0.05) more frequently during a patient's general medical evaluation. However, they did not assess condom use (50%), number of sexual partners, sexual partners' sexually transmitted disease risk (30%), or experiences of sexual abuse or domestic violence (3%) more frequently than less recently trained obstetrician-gynecologists. They were also not more likely to counsel teenagers about sexually transmitted disease prevention during a contraceptive consultation (30-60%) or to discuss human immunodeficiency virus infection (29%) and hepatitis B immunization (13%) during a sexually transmitted disease consultation.

Conclusion: Although evaluation of substance use was better among recently trained OB-Gyn physicians, little or no improvement has been noted regarding STD prevention or the evaluation of sexual abuse or domestic violence, all important lifestyle risks that directly affect women's health and well-being.