Is Long-Acting Reversible Contraceptive Use Increasing? Assessing Trends Among U.S. College Women, 2008–2013

Objective To assess LARC use trends among college women (18–24 years) and identify groups that have increased LARC use. Methods Data were extracted from the National College Health Assessment-II (NCHA-II) fall 2008–2013 surveys. Logistic regression statistics were used to assess LARC use. Results Although LARC use increased from 2008 to 2013 (aOR?=?2.62; 95% CI 2.23–3.07), less than half of the sample (44%) reported using contraception at last vaginal sex. Only 2.5% of college women in this study reported using a LARC method; of LARC users, 90% reported using an intrauterine device. Nearly all sociodemographic factors were significantly associated with increases in LARC use including: age, sexual orientation, and insurance status. Conclusions LARC use significantly increased among college women. However, less effective methods such as condoms and short-acting reversible contraceptives are used more frequently. Promoting LARC use for women who desire to effectively prevent pregnancy can reduce unintended pregnancy and improve health outcomes for women while in college. Future work should examine the importance of individual and lifestyle factors that influence college women’s decision to choose a LARC method and seek to eliminate barriers to college women choosing a contraceptive method they believe works best for them.     

The Rise of Female Sterilization: A Closer Look at Colombia

Objective In the 1970s, OCPs and IUDs were the most popular contraceptive methods in Colombia. According to data from the most recent Demographic and Health Survey (DHS), sterilization has become the most common form of birth control in Colombia. This study aims to examine the characteristics of Colombian women desiring long-acting contraception. Methods This study uses the 2005 and 2010 Colombian DHS dataset. Women who choose long-acting contraception were divided into those using female sterilization and those using long-acting reversible contraception (LARC). A multivariate logistic regression model was used to compare demographic and social determinants of contraceptive choice among reproductive age women seeking long-acting contraception between the years 2005 and 2010. Results Among women using a long-acting contraceptive method in 2010, compared to 2005, women were significantly more likely to be sterilized (1.14 OR, 95% CI 1.09–1.18) and less likely to use LARC (0.88 OR, 95% CI 0.85–0.92). Of women seeking long-acting contraception, those exposed to a family planning provider were less likely to undergo sterilization (0.54 OR, 95% CI 0.51–0.58) and more likely to use LARC (1.84 OR, 95% CI 1.73–1.96). When compared to all contraceptive users, younger women and women with less than two children were more likely to use LARC than sterilization. Conclusion Between 2005 and 2010, an increase in the proportion of contracepting women being sterilized in Colombia occurred. Our findings suggest that exposure to a family planning provider and appropriate contraceptive counseling appears to be key determinants of long-acting contraceptive choice. To improve use of long-acting, effective contraception, efforts should be made to increase access to family planning providers.     

Exploring Body Image,Contraceptive Use,and Sexual Health Outcomes Among an Ethnically Diverse Sample of Women

This cross-sectional study examined the links between body appreciation, contraceptive use, and sexual health outcomes. Body appreciation has been shown to influence contraceptive use in homogenous samples of women. However, a common problem in body image literature is a lack of racial and ethnic diversity with regard to sample; this study was able to take steps toward overcoming that limitation. A sample of 499 women aged 18–56 (M = 26.24; SD = 6.15) was recruited via Reddit.com—White (29.3%, n = 120), Asian (19%, n = 78), Black (17.3%, n = 73), multiracial (13.9%, n = 57), and Latina (13.9%, n = 57). Covariates included race/ethnicity, body size as measured by body mass index, relationship status, age, sexual orientation, and education level. Results indicated that higher levels of body appreciation were related to a higher likelihood of using non-barrier contraception. Regarding the covariates, race, relationship status, age, and education were related to non-barrier contraceptive use and age was related to dual contraceptive use. Further exploration is needed to determine how body appreciation may affect contraceptive use and sexual health outcomes and how these differ by race/ethnicity.     

Associations between Pregnancy Intention,Attitudes, and Contraceptive Use among Women Veterans in the ECUUN Study

Background

Although pregnancy intention is strongly associated with contraceptive use, little is known about the interaction between pregnancy intention and attitude, or how they jointly affect contraceptive use.

Delayed and Forgone Care for Children with Special Health Care Needs in New York State

Objective: To identify characteristics associated with delayed/forgone care for children with special health care needs (CSHCN) in New York State (NYS) as reported by their parents. Methods: Data come from NYS participants in the 2000–2002 National Survey of Children with Special Health Care Needs. Data were analyzed using weighted bivariate and multivariate regression models. The dependent variable was report of delayed/forgone routine health care. Independent variables included illness characteristics, potential and actual access to care, and provider care characteristics. Results: In NYS, 8.4% reported delayed/forgone health care for their child. Parents of children with delayed/forgone care were more likely to report that their child was uninsured (adjusted odds ratio [aOR] 3.8, 95% confidence interval[CI] 1.3–11.8), had experienced interrupted health insurance (aOR 3.9, 95% CI 1.5–9.7), or their child’s insurance was not adequate for CSHCN (aOR 3.6, 95% CI 1.4–9.1). Further, these parents were more likely to report that providers never spend adequate time (aOR 6.3, 95% CI 1.2–34.4), provide sufficient information (aOR 8.0, 95% CI 2.5–25.0), act as partners in care (aOR 6.7, 95% CI 2.3–19.7), or display cultural sensitivity (aOR 5.4, 95% CI 1.2–24.3). Conclusions: An estimated 40,771 NYS CSHCN experience delayed/forgone routine health care. Their families report two noteworthy barriers: inadequate or discontinuous insurance coverage and poor communication with health-care providers. Access to care for CSHCN can be improved by increasing consistent comprehensive insurance coverage and increasing sensitivity in relationships between health care providers and families of CSHCN.     

Contraceptive use by disability status: new national estimates from the National Survey of Family Growth

Objective

The objective was to determine population-based estimates of use of contraception among women 15–44?years of age in the United States by disability status.

Condom use in adolescents and young women following initiation of long- or short-acting contraceptive methods

Objective

The objective was to determine if young women initiating long-acting reversible contraceptives (LARCs) who report new sexual partner(s) would be less likely to report use of a condom than women using short-acting reversible contraceptive (SARC) methods.

Maternal Sociodemographic Characteristics,Experiences and Health Behaviors Associated with Postpartum Care Utilization: Evidence from Maryland PRAMS Dataset, 2012–2013

Objectives Postpartum visits are increasingly recognized as a window of opportunity for health care providers to counsel new mothers and promote healthy behaviors, including increasing contraceptive use and screening for postpartum depression. In Maryland, there is a lack of research on postpartum visit (PPV) attendance and the specific risk factors associated with not receiving postpartum care. In this study, we estimated the proportion of mothers in Maryland who attended a PPV and assessed maternal sociodemographic characteristics and health behaviors associated with PPV non-attendance. Methods Data were analyzed from the 2012 and 2013 Maryland Pregnancy Risk Assessment Monitoring System (n?=?2204). Bivariate and multivariable logistic regression were performed to examine the association between covariates and PPV non-attendance. Results Overall, 89.6% of women reported PPV attendance. Bivariate analyses between maternal sociodemographic and health behavior characteristics and PPV non-attendance indicated that being unmarried (OR 3.03, 95% CI 2.12–4.31), experiencing infant loss (OR 7.17, 95% CI 2.57–19.97), working during pregnancy (OR 0.44, 95% CI 0.31–0.63) and not receiving dental care (OR 2.03, 95% CI 1.43–2.88) as significant risk factors for PPV non-attendance. After controlling for known and theoretical confounders, experiencing an infant loss (aOR 5.18, 95% CI 1.54–17.4), not receiving dental care (aOR 1.54, 95% CI 1.06–2.26) and working during pregnancy (aOR 0.61, 95% CI 0.41–0.93) emerged as strong predictors of PPV non-attendance. Conclusions for Practice Mothers who recently experienced an infant death were at greatest risk for not attending a PPV, suggesting the need to establish comprehensive support networks, including grief counseling and additional service reminders for mothers who experienced an infant death.     

Contraceptive Use Effectiveness and Pregnancy Prevention Information Preferences Among Heterosexual and Sexual Minority College Women

Background

Previous research shows that sexual minority women have higher rates of unintended pregnancy than heterosexual women, but has not considered the wide range of contraceptive method effectiveness when exploring this disparity. We examine contraceptive use effectiveness and desire for pregnancy prevention information among college women across sexual orientation identity as a risk factor for unintended pregnancy.

Disparities in Infant Mortality by Race Among Hispanic and Non-Hispanic Infants

Objectives

U.S.-born Hispanic infants have a well-documented health advantage relative to other minority groups. However, little published research has examined racial heterogeneity within the Hispanic population, in relation to health outcomes. The current study aims to explore possible implications of racial identification for the health of U.S. born Hispanic compared to non-Hispanic infants. Methods Data were drawn from 2007 to 2008 NCHS Cohort Linked Live Birth—Infant Death Files, restricted to deliveries of Hispanic black, Hispanic white, non-Hispanic black (NHB) and non-Hispanic white mothers (NHW) (n?=?7,901,858). Adjusted odds ratios for first week mortality, neonatal, postneonatal, and overall infant mortality were calculated for each group, using NHW as the reference group. Results: A distinct health gradient was observed in which NHB infants (n?=?1,250,222) had the highest risk of first week (aOR?2.29, CI 2.21–2.37), neonatal (aOR 2.23, CI 2.17–2.30), postneonatal (aOR 1.74, CI 1.68–1.81), and infant mortality (aOR 2.05, CI 2.00–2.10) compared to NHW infants (n?=?4,578,150). Hispanic black infants (n?=?84,377) also experienced higher risk of first-week (aOR?1.28 (1.12–1.47), neonatal (aOR .27, CI 1.13–1.44), postneonatal (aOR?1.34, CI 1.15–1.56), and infant mortality (aOR 1.30, CI 1.18–1.43) compared to both NHW and Hispanic white infants (n?=?1,989,109). Conclusions for Practice: Risk of infant mortality varies among Hispanic infants by race, with poorer outcomes experienced by Hispanic black infants. Compared to non-Hispanic infants of the same race, Hispanic black infants experience a smaller health disadvantage and Hispanic white infants have better or similar infant health outcomes. Our findings suggest implications of racial heterogeneity on infant health outcomes, and provide insight into the role of race as a social construct.

     

Understanding Factors Associated with Postpartum Visit Attendance and Contraception Choices: Listening to Low-Income Postpartum Women and Health Care Providers

Background While there is considerable variability with respect to attendance at the postpartum visit, not much is known about women’s preferences with respect to postpartum care. Likewise, there is also limited information on providers’ practices regarding the postpartum visit and care including the delivery of contraception. To understand and address deficits in the delivery and utilization of postpartum care, we examined the perceptions of low-income postpartum women with respect to barriers to and preferences for the timing and location of the postpartum visit and receipt of contraception. We also examined providers’ current prenatal and postnatal care practices for promoting the use of postpartum care and their attitudes toward alternative approaches for delivering contraceptive services in the postpartum period. Methods Qualitative face-to-face interviews were completed with 20 postpartum women and in-depth qualitative phone interviews were completed with 12 health care providers who had regular contact with postpartum women. Interviews were coded using Atlas.ti software and themes were identified. Results Women believed that receiving care during the postpartum period was an important resource for monitoring physical and mental health and also strongly supported the provision of contraception earlier than the 6-week postpartum visit. Providers reported barriers to women’s use of postpartum care on the patient, provider, and system levels. However, providers were receptive to exploring new clinical practices that may widen the reach of postpartum care and increase access to postpartum contraception. Conclusion Approaches that increase the flexibility and convenience of postpartum care and the delivery of postpartum contraception may increase the likelihood that women will take advantage of essential postpartum services.     

Factors influencing self-reported anxiety or depression following stroke or TIA using linked registry and hospital data

Purpose

Approximately 30–50% of survivors experience problems with anxiety or depression post-stroke. It is important to understand the factors associated with post-stroke anxiety or depression to identify effective interventions.

Methods

Patient-level data from the Australian Stroke Clinical Registry (years 2009–2013), from participating hospitals in Queensland (n?=?23), were linked with Queensland Hospital Emergency and Admission datasets. Self-reported anxiety or depression was assessed using the EQ-5D-3L, obtained at 90–180 days post-stroke. Multivariable multilevel logistic regression, with manual stepwise elimination of variables, was used to investigate the association between self-reported anxiety or depression, patient factors and acute stroke processes of care. Comorbidities, including prior mental health problems (e.g. anxiety, depression and dementia) coded in previous hospital admissions or emergency presentations using ICD-10 diagnosis codes, were identified from 5 years prior to stroke event.

Results

2853 patients were included (median age 74; 45% female; 72% stroke; 24% transient ischaemic attack). Nearly half (47%) reported some level of anxiety or depression post-stroke. The factors most strongly associated with anxiety or depression were a prior diagnosis of anxiety or depression [Adjusted Odds Ratio (aOR) 2.37, 95% confidence interval (95% CI) 1.66–3.39; p?<?0.001], dementia (aOR 1.91, 95% CI 1.24–2.93; p?=?0.003), being at home with support (aOR 1.41, 95% CI 1.12–1.69; p?=?<?0.001), and low socioeconomic advantage compared to high (aOR 1.59, 95% CI 1.21–2.10; p?=?0.001). Acute stroke processes of care were not independently associated with anxiety or depression.

Conclusions

Identification of those with prior mental health problems for early intervention and support may help reduce the prevalence of post-stroke anxiety or depression.

     

Sexual Knowledge,Sexual Attitude,and Life Satisfaction Among Korean Older Adults: Implications for Educational Programs

The aim of this study was to: identify the sexual knowledge, sexual attitude, and life satisfaction in Korean older adults; and explore significant factors among demographic characteristics, sexual activity, sexual knowledge, and sexual attitude, that influence life satisfaction among Korean older adults. Participants were recruited in community centers and public parks (N = 571). Data were collected on sexual knowledge, sexual attitudes, and life satisfaction using three valid and reliable instruments. Data were analyzed using t test, ANOVA, Pearson’s correlation, and hierarchical multiple regression. Educational level, gender, and living arrangement significantly affected sexual knowledge and attitudes (p < .001) among older adults. There was a positive relationship between sexual knowledge and attitudes (r = .490, p < .001), life satisfaction and sexual knowledge (r = .144, p = .001), and life satisfaction and sexual attitudes (r = .121, p = .004). Age (β = .16, t = 3.45, p < .01), gender (β = .52, t = 2.07, p < .05), presence of spouse (β = ?.12, t = ?2.42, p < .05), and sexual knowledge (β = .10, t = 2.17, p < .05) were factors with a significant influence on life satisfaction for older adults. When designing and implementing sexual counseling and education programs for older adults, individual background, sexual knowledge, and sexual attitudes must be assessed and considered. Also, those without spouses who live alone may need more attention because they tend to have low knowledge levels and negative attitudes toward sexual activity.     

Evaluation of the Responsible,Engaged, and Loving (REAL) Fathers Initiative on Physical Child Punishment and Intimate Partner Violence in Northern Uganda

Violence against women and violence against children in Uganda are recognized as significant public health concerns. Exposure to violence at home as a child can increase the likelihood of perpetrating or experiencing violence later in life. These two forms of violence share similar risk factors and often, but not always, co-occur at the household level. Parenting programs have shown promise in reducing physical child punishment. Targeting men has also been proven effective in transforming attitudes related to gender roles and expectations and intimate partner violence (IPV) against women. The REAL Fathers Initiative is a 12-session father mentoring program implemented by volunteers that is designed to reduce child exposure to violence at home, breaking the cycle of intergenerational violence. Evaluation results comparing survey data among men exposed to the intervention and those unexposed demonstrate significant reductions in IPV at end line (aOR 0.48, CI 0.31, 0.76, p?<?0.001) and over the longer term follow-up (aOR 0.47, CI 0.31, 0.77, p?<?0.001) and significant reductions in physical child punishment at long-term follow-up (aOR 0.52, CI 0.32, 0.82, p?<?0.001).