title: Women's experiences with isotretinoin risk reduction counseling.
abstract: OBJECTIVE
  Isotretinoin, an effective anti-acne therapy, is a known teratogen that is strictly regulated through the iPLEDGE program. However, since this program has not significantly reduced rates of pregnancies exposed to isotretinoin, new strategies for reducing rates of isotretinoin-exposed pregnancies are needed.
  
  
  OBJECTIVE
  To explore women's experiences with counseling about isotretinoin risk reduction.
  
  
  METHODS
  Structured interviews were conducted between January and September 2012. Two independent coders performed content analysis using a grounded theory approach. The study participants were 16 women who had used isotretinoin to treat severe skin disease and who were recruited from a single urban community via flyers displayed on college campuses, at dermatology clinics, and at student health facilities.
  
  
  METHODS
  Perceptions of isotretinoin-associated risks and understanding of ways teratogenic risks can be avoided.
  
  
  RESULTS
  Participants clearly understood that isotretinoin is teratogenic but had less understanding of contraceptive methods that effectively prevent pregnancy. Most described the counseling they received as anxiety provoking. Few were counseled about highly effective reversible contraceptives such as the subdermal implant or intrauterine contraception; most counseling focused on oral contraceptives. Women cited multiple influences on their contraceptive choices, including friends, family, physicians, the internet, and other media; however, some expressed concerns about the accuracy of these sources of information. For many, iPLEDGE was their first introduction to contraception. When presented with evidence-based information on the relative effectiveness of available contraceptives, participants expressed surprise that this was not part of the iPLEDGE materials.
  
  
  CONCLUSIONS
  Since few clinicians provide women information on highly effective (ie, intrauterine or subdermal) contraceptives, the iPLEDGE program increases anxiety about isotretinoin more than it helps women feel protected from the teratogenic risks of isotretinoin.
authors.affiliation: School of Medicine, University of Pittsburgh, Pittsbugh, Pennsylvania.
authors.forename: Carly A
authors.initials: CA
authors.lastname: Werner
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Papic
authors.affiliation: Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Ferris
authors.affiliation: Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania5Women's Health Services Research Unit, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Sonya
authors.initials: S
authors.lastname: Borrero
authors.affiliation: Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Noel
authors.initials: N
authors.lastname: Prevost
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania4Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania5Women's Health Services Research Unit, Center for Research on Health Care, University of.
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000379:methods* / Q000523:psychology; D003270:Contraceptive Agents / Q000627:therapeutic use; D003276:Contraceptives, Oral; D003376:Counseling; D003879:Dermatologic Agents / Q000009:adverse effects*; D004343:Drug Implants; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007434:Intrauterine Devices; D015474:Isotretinoin / Q000009:adverse effects*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D040242:Risk Reduction Behavior; D055815:Young Adult
chemical_list: D003270:Contraceptive Agents; D003276:Contraceptives, Oral; D003879:Dermatologic Agents; D004343:Drug Implants; D015474:Isotretinoin