The Influence of Oral Contraceptive Knowledge on Oral Contraceptive Continuation Among Young Women

Background: Using a multidimensional approach, we assessed young women's knowledge of oral contraceptives (OC) and its influence on OC continuation rates. Methods: We used data from 659 women aged 13?25 years participating in a randomized controlled trial of an educational text message OC continuation intervention. Women received 6 months of daily text messages or routine care. At baseline and 6 months, we administered a comprehensive 41-item questionnaire measuring knowledge of OC's mechanism, effectiveness, use, side effects, risks, and benefits. We ascertained OC continuation status and reasons for discontinuation at 6 months. We analyzed relationships between OC knowledge and continuation with multivariable logistic regression. Results: Young women scored, on average, 22.8 out of 41 points on the OC knowledge assessment at baseline and 24.7 points at 6 months. The 6-month OC continuation rate was 59%. OC continuers had >2-points-higher OC knowledge scores at 6 months than discontinuers (p2 points lower than women who discontinued for other reasons (p-values<0.001). In multivariable regression models, each correct response on the baseline and 6-month knowledge assessments was associated with a 4% and 6% increased odds of OC continuation, respectively. Six-month OC knowledge scores were negatively associated with OC discontinuation due to side effects (odds ratio [OR] 0.94) and forgetfulness (OR 0.88). Conclusions: OC knowledge, which was low among young women in our study, was associated with OC continuation and common reasons for discontinuation. Continued efforts to characterize relationships between OC knowledge and behavior and to test the effectiveness of different components of interventions aimed at increasing knowledge, addressing side effects, and improving use of OCs are warranted.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140126/1/jwh.2013.4574.pd

Social, Reproductive, and Attitudinal Factors Associated with U.S. Women's Disagreement with the Passage of the Affordable Care Act

Background: Notably absent from research and public and policy dialogue on the Affordable Care Act (ACA) and reproductive health care are women's perspectives and a broader understanding of factors that shape ACA attitudes. We investigated social, reproductive, and attitudinal factors associated with women's disagreement with the passage of the ACA. Methods: Data were drawn from the Women's Health Care Experiences and Preferences Study, our population-based internet survey of 1,078 randomly sampled United States women ages 18?55 years conducted in September 2013. Items measured ACA attitudes, including disagreement with the ACA's passage. We examined relationships between ACA disagreement, sociodemographic and reproductive characteristics, health service experiences, and reproductive health care and policy attitudes with logistic regression. Results: Among women who had heard of the ACA (n=888), 35% disagreed with it and 38% did not know how they felt. Black women (adjusted odds ratio [aOR] 0.12, 95% confidence interval [CI] 0.03?0.55) and women with incomes of >$75k (aOR 0.38, CI 0.17?0.88), Medicare/Medicaid insurance (aOR 0.24, CI 0.10?0.61), and infrequent religious service attendance (aOR 0.57, CI 0.35?0.93) were less likely to disagree with the ACA's passage, compared with their counterparts. Republican party affiliation was the strongest predictor of ACA disagreement (aOR 17.10, CI 9.12?32.09). Negative beliefs about the ACA's ability to improve access to preferred care and regarding employers' and the government's roles in reproductive health care were positively associated with ACA disagreement. Conclusions: Many women who could benefit from the ACA disagree with or do not know how they feel about its passage, which may influence participation in ACA benefits and services.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140134/1/jwh.2014.5175.pd

U.S. Women's Intended Sources for Reproductive Health Care

Introduction: The current sociopolitical climate and context of the Affordable Care Act have led some to question the future role of family planning clinics in reproductive health care. We explored where women plan to get their future contraception, pelvic exam/pap smears, and sexually transmitted infection testing, with a focus on the role of family planning clinics. Methods: Data were drawn from a study of United States adults conducted in January 2013 from a national online panel. We focused on English-literate women aged 18?45 years who answered items on intended sources of care (private office/health maintenance organization [HMO], family planning clinic, other, would not get care) for reproductive health services. We used Rao-Scott F tests to compare intended sources across sociodemographic groups, and logistic regression to model odds of intending to use family planning clinics. Probability weights were used to adjust for the complex sampling design. Results: The response rate was 61% (n?=?2,182). Of the 723 respondents who met the inclusion criteria, approximately half intended to use private offices/HMOs. Among some subgroups, including less educated (less than high school), lower annual incomes (<$25,000) and uninsured women, the proportion intending to use family planning clinics was higher than the proportion intending to use private office/HMO in unadjusted analyses. Across all service types, unmarried and uninsured status were associated with intention to use family planning clinics in multivariable models. Conclusions: While many women intend to use private offices/HMOs for their reproductive health care, family planning clinics continue to play an important role, particularly for socially disadvantaged women.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140133/1/jwh.2014.5116.pd

Bad girl and unmet family planning need among Sub-Saharan African adolescents: the role of sexual and reproductive health stigma

Adolescent pregnancy contributes to high maternal mortality rates in Sub-Saharan Africa. We explored stigma surrounding adolescent sexual and reproductive health (SRH) and its impact on young Ghanaian women’s family planning (FP) outcomes. We conducted in-depth, semi-structured interviews with 63 women ages 15-24 recruited from health facilities and schools in Accra and Kumasi, Ghana. Purposive sampling provided diversity in reproductive/relationship/socioeconomic/religious characteristics. Using both deductive and inductive approaches, our thematic analysis applied principles of grounded theory. Participants described adolescent SRH experiences as cutting across five stigma domains. First, community norms identified non-marital sex and its consequences (pregnancy, childbearing, abortion, sexually transmitted infections) as immoral, disrespectful, and disobedient, resulting in bad girl labeling. Second, enacted stigma entailed gossip, marginalization, and mistreatment from all community members, especially healthcare workers. Third, young sexually active, pregnant, and childbearing women experienced internalized stigma as disgrace, shame and shyness. Fourth, non-disclosure and secret-keeping were used to avoid/reduce stigma. Fifth, stigma resilience was achieved through social support. Collectively, SRH stigma precluded adolescents’ use of FP methods and services. Our resulting conceptual model of adolescent SRH stigma can guide health service, public health, and policy efforts to address unmet FP need and de-stigmatize SRH for young women worldwide

The influence of adverse psychological conditions on oral contraceptive-attributed side effects and discontinuation in minority adolescent and young adult women

Oral contraceptive (OC) discontinuation leading to unwanted pregnancy is a serious maternal-child health problem, particularly for young, minority women. Depressed mood, stress and eating disordered (ED) symptoms contribute to risky sex and medication misuse, but how these adverse psychological conditions influence OC-attributed symptoms and use is unknown. A prospective study of the associations among depressed mood (Center for Epidemiologic Studies-Depression Screen), perceived stress (Perceived Stress Scale-10), and ED symptoms (Eating Disorder Screen for Primary Care) and OC mood and weight changes and discontinuation was conducted among family planning patients participating in an OC continuation intervention trial. Data from interview-administered questionnaires (baseline and 6-month) with 354 adolescents and young adults (ages 13-24 years) were analyzed with multiple logistic regression. Baseline rates of elevated depressed mood, stress, and ED symptoms were 21% (n=73), 19% (n=67), and 24% (n=60), respectively. The 6-month OC discontinuation rate was 62% (n=218). Twenty-five percent of participants (n=87) reported mood changes and 57% (n=200) reported weight changes at 6 months. Subjects with high depressed mood scores at baseline were over twice as likely to report both mood (CI 1.30—4.07, p=.004) and weight changes (yes/no) at 6-months (OR 2.14, CI 1.20—3.80, P=.01) than low scoring participants. Participants with high baseline depressed mood (OR .54, CI .29—.99, p=.05), stress (OR .48, CI .25—.91, p=.03) and ED symptom scores (OR .49, CI .25—.97, p=.04) were less likely to continue OCs at 6-months. Participants reporting weight, but not mood, changes were at increased risk for OC discontinuation (OR .60, CI .38—.94, p=.03). Adolescents were similar to young adults except for lower baseline stress scores (mean difference 2.06, p=.003). Depressed mood, stress, ED symptoms may increase the risk of OC discontinuation in young, minority women. Further investigation is needed to determine the impact of these psychological influences, along with OC-attributed mood and weight symptoms, on OC use. Ultimately, improved understanding of contributing factors to poor contraceptive behavior can promote positive family planning outcomes

TYPES OF COMBINED ORAL CONTRACEPTIVES USED BY US WOMEN, INCLUDING WOMEN AT RISK OF VENOUS THROMBOEMBOLISM

Background—We sought to estimate the prevalence of types of combined oral contraceptives (COC) used among U.S. women. Study Design—We analyzed interview-collected data from 12,279 women ages 15–44 years participating in the National Survey of Family Growth, 2006–2010. Analyses focused on COC use overall, by pill type, across sociodemographics and health factors. Results—The prevalence of current COC use (88 different brands) was 17%. The majority of COC-users used earlier formulation COCs: ≥30 mcg (67%) versus <30 mcg estrogen (33%), monophasic (67%) versus multiphasic (33%) dosages, and traditional 21/7 (88%) versus extended/ other cycle regimens (12%) regimens; Norgestimate (32%) and norethindrone (20%) were the most commonly used progestins. Sociodemographic, gynecological and health risk factors were associated with type of COC use. Conclusion—Further investigation of specific COC use and of the factors associated with types of pills used among U.S. women at the population level is needed

Stress Symptoms and Frequency of Sexual Intercourse Among Young Women

Introduction We have previously documented the relationships between stress and depression symptoms and adolescent women's nonuse and misuse of condoms and other contraceptive methods and on their unintended pregnancy rates. Aim Here, we examine relationships between mental health symptoms and another understudied adolescent reproductive health behavior—frequency of sexual intercourse. Main Outcome Measure Our outcome was weekly sexual intercourse activity. Methods We used panel data from a longitudinal, population‐based cohort study of 992 women ages 18–20. Weekly journals measured sociodemographic, relationship, reproductive, and mental health characteristics, sexual and contraceptive behaviors, and pregnancy history. We examined 27,130 surveys from 952 women during the first study year. Predictors of weekly sexual intercourse were moderate to severe stress (Perceived Stress Scale‐4) and depression (Center for Epidemiologic Studies Depression Scale‐5) symptoms measured at baseline. Multilevel, mixed‐effects logistic regression models estimated the relationships between stress and depression symptoms and the weekly odds of sexual intercourse while adjusting for covariate fixed effects and random woman effects. Results Nearly a quarter of the sample had moderate to severe stress (23%) and depression (24%) symptoms at baseline. Women reported sexual intercourse in 36% of weeks. Proportions of sexually active weeks were higher among women with stress (43%) and depression (40%) compared with those without symptoms (35% and 35%, respectively; P values < 0.001). Controlling for covariates, women with baseline stress symptoms had 1.6 times higher weekly odds of sexual intercourse compared with women without stress (adjusted odds ratio 1.6, confidence interval [1.1, 2.5]; P  = 0.04). Depression symptoms were not associated with sexual intercourse frequency in adjusted models. Conclusions Stress symptoms were positively associated with sexual intercourse frequency among these young women. Research and practice efforts are needed to identify effective sexual health promotion and risk‐reduction strategies, including contraceptive education and counseling, in the context of mental health symptoms and unintended pregnancy. Hall KS, Kusunoki Y, Gatny H, and Barber J. Stress symptoms and frequency of sexual intercourse among young women. J Sex Med 2014;11:1982–1990.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107995/1/jsm12607.pd

Continuing social disparities despite upward trends in sexual and reproductive health service use among young women in the United States

BACKGROUND: Building upon previous work describing declining rates and socioeconomic disparities in sexual and reproductive health (SRH) service use among young women in the United States, we re-examined patterns and determinants of SRH service use in 2006–2010. STUDY DESIGN: We used the latest data from the National Survey of Family Growth to evaluate SRH service use including contraceptive, sexually transmitted infection (STI), and other gynecological exam services among 3,780 women ages 15–24 years. We compared proportions of service use across survey years and employed multiple logistic regression to estimate the influence of time and women’s sociodemographic characteristics on the likelihood of SRH service use. RESULTS: The proportion of women using SRH services increased from 50% (2006–2007) to 54% (2007–2008) and 57% (2008–2010) (all year ORs 1.4, p-values<0.03). Among sexually experienced women, the proportions using SRH and contraceptive services were unchanged while STI service use increased from 22% (2006–2007) to 33% (2008–2009) (OR 1.7, CI 1.1–2.4, p=0.009). Differentials in service use existed across sociodemographic groups, largely with lower proportions of service use among women of social disadvantage. CONCLUSIONS: Our results suggest a reversal of negative trends but continuing social disparities in young women’s use of SRH services in the United States

Progestin-only contraceptive pill use among women in the United States

BackgroundProgestin-only contraceptive pills (POPs) offer a safe and effective contraceptive option, particularly for women at increased risk of venous thromboembolism. However, the prevalence of POP use among women in the United States is unknown.Study designWe analyzed population-based data from 12,279 women aged 15-44 years in the National Survey of Family Growth. Data were collected continuously from 2006 to 2010 by in-person, computerized household interviews. Analyses describe POP use across sociodemographic and reproductive characteristics and thromboembolic risk profiles.ResultsOverall, 0.4% of all reproductive-aged women in the United States currently use POPs. POP use was higher among parous, postpartum and breastfeeding women than their counterparts (all p values&lt;.001). Women at higher risk of thromboembolism (older, obese, diabetic or smoking women) had similar proportions of POP use as women without those risks.ConclusionPOPs are rarely used by US women. While data on chronic disease were limited, our results suggest that relatively few women with increased risk of thromboembolism are considering POPs when choosing an oral contraceptive