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Pediatricians' Attitudes and Counseling Practices Regarding Neonatal Male Circumcisions

Douglas S. Diekema, Wally Carlo, Ed Zimmerman, Karen G. O'Conner.. Pediatrics, University of Washington, Seattle, WA; Neonatology, University of Alabama at Birmingham, Birmingham, AL; Practice, American Academy of Pediatrics, Elk Grove Village, IL; Research, American Academy of Pediatrics, Elk Grove Village, IL.
Presented at the May 2010 Pediatric Academic Societies Annual Meeting.
Background: Recent research has rekindled the debate on circumcision's role in halting the spread of HIV and sexually transmitted infections. A 1997 AAP survey found 74% of pediatricians discussed male circumcision with parents and 24% recommended circumcision be performed; little is known about pediatricians' current attitudes and practices.
Objective: Track changes in pediatricians' attitudes and counseling practices regarding circumcision.
Design/Methods: National, random sample, mailed AAP Periodic Survey in 2009 (N=1620; response=57%) and 1997 (N=1165; response=64%). Chi-square analysis and logistic regression examined changes across years and relationships between current counseling practices and practice characteristics. Analyses were limited to 584 (2009) and 734 (1997) pediatricians who provide health supervision to newborns <2 months.
Results: In 2009, similar to 1997, 57% of pediatricians think medical indications regarding circumcision are inconclusive, while 30% say medical benefits outweigh the disadvantages. Discussion of circumcision with most parents of newborn males has significantly declined across years and the percent of pediatricians who routinely make no recommendation has increased.

% Counseling All/Most Parents of Healthy Newborn Males​ ​ ​ ​
1997 2009 p value
Discuss pros/cons of circumcision 74% 66% .004
Make no recommendation 51% 62% .000
Make recommendation based on discussion with parents 30% 23% .010
Recommend for circumcision 6% 4% .167
Recommend against circumcision 2% 2% .839
No clear pattern of recommendation (for or against) 11% 9% .148

In 2009, practice in a solo/2-physician (AOR 2.65, 95%CI 1.40-5.01) or group (AOR 1.90, 95%CI 1.16-3.13) setting compared to hospital/clinic practice and practice in the West (AOR 2.17, 95%CI 1.16-4.06) or South (AOR 1.71, 95%CI 1.01-2.89) versus the Northeast region was associated with discussing pros/cons of circumcision. Personal (age, gender, ethnicity) and other practice (part-time hours, seeing high % infants, practice location) characteristics were not associated with discussion.
Conclusions: While a majority of pediatricians in both years discuss the pro/cons of male newborn circumcision with all/most parents, fewer report doing so in 2009 than in 1997. Most pediatricians think the medical indications for circumcision are inconclusive and over time, have been more likely to make no recommendations regarding circumcision.
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