Validity of adolescent and young adult self-report of Papanicolaou smear results

OBJECTIVE: To assess the validity of adolescent and young adult report of Papanicolaou smear results and to determine sociodemographic, cognitive, and behavioral factors associated with incorrect reporting. METHODS: We conducted a cross-sectional study of 477 female subjects aged 12 to 24 years who attended an adolescent clinic and had a previous Papanicolaou smear. Subjects completed a self-administered survey assessing self-report of Papanicolaou smear results, knowledge about Papanicolaou smears and human papillomavirus (HPV), attitudes about Papanicolaou screening and follow-up, and risk behaviors. The sensitivity, specificity, positive predictive value, and negative predictive value of self-reported results were calculated using the cytology report as the standard. Variables significantly associated with incorrect reporting were entered into logistic regression models controlling for age and race to determine independent predictors for incorrect reporting. RESULTS: Of the 477 participants, 128 (27%) had abnormal cytology reports and 66 (14%) had incorrect self-reports. Sensitivity of self-report was 0.79, specificity 0.89, positive predictive value 0.72, negative predictive value 0.92, and kappa (kappa) 0.66. The adjusted odds ratios (OR) and 95% confidence intervals (CI) of the variables comprising a logistic regression model predicting incorrect reporting were an HPV knowledge source of zero (OR 2.4, CI 1.0, 5.8), low perceived communication with the provider (OR 2.1, CI 1.1, 4.0), and no contraception at last intercourse (OR 5.5, CI 2.7, 11.0). CONCLUSION: The validity of adolescent and young adult self-reported Papanicolaou smear result is high, except among those who lack knowledge of HPV, perceive poor communication with the provider, and use contraception inconsistently.     

Associations between Religiosity and Sexual and Contraceptive Behaviors

Study ObjectiveTo determine associations between religiosity and female adolescents' sexual and contraceptive behaviors.DesignWe conducted a secondary analysis on data from a randomized controlled trial comparing interventions designed to prevent pregnancy and sexually transmitted diseases (STDs). Multivariable modeling assessed the association between a religiosity index consisting of items related to religious behaviors and impact of religious beliefs on decisions and sexual outcomes.Participants572 female adolescents aged 13 to 21, recruited via a hospital-based adolescent clinic and community-wide advertisements.Main Outcome MeasuresSexual experience, pregnancy, STDs, number of lifetime partners, frequency of sexual activity, previous contraceptive use, and planned contraceptive use.ResultsMean participant age was 17.4 ± 2.2 years and 68% had been sexually active. Most (74.1%) had a religious affiliation and over half (52.8%) reported that their religious beliefs impact their decision to have sex at least “somewhat.” Multivariate analyses showed that, compared with those with low religiosity, those with high religiosity were less likely to have had sexual intercourse (OR = 0.23, 95% CI = 0.14, 0.39). Among sexually active participants, those with high religiosity were less likely to have been pregnant (OR = 0.46, 95% CI = 0.22, 0.97), to have had an STD (OR = 0.42, 95% CI = 0.22, 0.81), or to have had multiple (≥4) lifetime partners (OR = 0.38, 95% CI = 0.21, 0.68) compared to those with low religiosity. Levels of religiosity were not significantly associated with frequency of intercourse, contraception use at last intercourse, or planned contraceptive use.ConclusionIn this cohort, religiosity appeared to be a protective factor rather than a risk factor with regard to sexual behavior and was not associated with contraception use.     

Paradoxical adolescent reproductive decisions

OBJECTIVE: To determine why teenagers who say they do not plan to parent if they become pregnant fail to use contraceptives consistently enough to avoid conceiving by default. METHODS: A racially diverse group of 333 inadequately contracepting, nulligravida teens, 45 (13.5%) of whom did not plan to parent if they became pregnant was studied. Participants completed scales assessing traditional teen pregnancy risk factors, deterrents to contraceptive use, expectations about the effect of pregnancy, the desire to remain non-pregnant, and sexual behavior. RESULTS: Teens who said they would not parent if pregnant were less apt to report boyfriends who wanted them to conceive (RR=0.7; 95% CI=0.5-0.9) and deterrents to contraceptive use (RRs around: 0.6; 95% CI: 0.3-0.9) and more apt to anticipate that childbearing would negatively impact their lives (RR: 1.9; 95% CI: 1.6-2.2), to want to remain non-pregnant (RR: 2.2; 95% CI: 1.8-2.4), and to have used contraception at last sexual intercourse (RR: 1.8; 95% CI: 1.3-2.4). In the group that did not intend to parent the only difference between those who had and had not used contraception at last intercourse was their willingness to plan for sexual activity (OR: 4.6; 95% CI: 1.3-16.7). CONCLUSION: This study suggests that further progress toward preventing unwanted teen pregnancies might be made by dispelling the notion that for young, unmarried women, unplanned sexual intercourse is preferable to planned sexual intercourse.     

Adolescents' contraceptive use and pregnancy history: is there a pattern?

OBJECTIVE: To examine the association between pregnancy experience and adolescents' contraceptive use. METHODS: We conducted a retrospective study of 920 sexually active adolescents not desiring pregnancy. Adjusted multivariable logistic regression analyses were used to assess the explanatory value of previous birth and abortion as well as first pregnancy at presentation on contraceptive practice. RESULTS: Twenty-seven percent of the adolescents had been pregnant. Regardless of pregnancy history, 52% of adolescents used noneffective contraception (ie, condoms inconsistently or no method). Adolescents with previous abortion were three times (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.6, 7.3) more likely than never-pregnant adolescents to use hormonal contraception. However, although more likely to use contraceptive injections or implants, adolescent mothers were not more likely than never-pregnant adolescents to use oral contraceptives. Adolescents with prior abortion or birth were less than half (ORs 0.3 and 0.4, 95% CIs 0.2, 0.5 and 0.2, 0.6, respectively) as likely as never-pregnant adolescents to use condoms consistently. CONCLUSION: Previous pregnancy is associated with increased likelihood to use hormonal methods; however, a significant proportion of adolescents use noneffective methods and, thus, are at risk for repeat teenage pregnancies.     

The effects of advance provision of emergency contraception on adolescent women's sexual and contraceptive behaviors

CONTEXT: Advance provision of emergency contraception (EC) may increase timely access and improve effectiveness, but the impact on adolescent sexual and contraceptive behaviors is not known. OBJECTIVE: To determine whether adolescents given advance EC have higher sexual and contraceptive risk-taking behaviors compared to those obtaining it on an as-needed basis. DESIGN AND SETTING: Randomized trial conducted at urban, hospital-based adolescent clinic in Pittsburgh, PA, from June 1997 to June 2002. PARTICIPANTS: 301 predominantly minority, low-income, sexually active adolescent women, age 15-20 years, not using long-acting contraception. INTERVENTIONS: Advance EC vs instruction on how to get emergency contraception. OUTCOME MEASURES: Self-reported unprotected intercourse and use of condoms, EC, and hormonal contraception ascertained by monthly 10-minute telephone interviews for 6 months post-enrollment. Reported timing of EC use after unprotected intercourse. RESULTS: At both 1- and 6-month followup interviews, there were no differences between advance EC and control groups in reported unprotected intercourse within the past month or at last intercourse. At 6 months, more advance EC participants reported condom use in the past month compared to control group participants (77% vs 62%, P=0.02), but not at last intercourse (advance EC 83% vs control 78%, P=0.34). There were no significant differences by group in hormonal contraception use reported by advance EC or control groups in the past month (44% vs 53%, P=0.19) or at last intercourse (48% vs 58%, P=0.20). At the first followup, the advance group reported nearly twice as much EC use as the control group (15% vs 8%, P=0.05) but not at the final followup (8% vs 6%, P=0.54). Advance EC group participants began their EC significantly sooner (11.4 hours vs 21.8 hours, P=0.005). CONCLUSIONS: Providing advance EC to adolescents is not associated with more unprotected intercourse or less condom or hormonal contraception use. In the first month after enrollment, adolescents provided with advance EC were nearly twice as likely to use it and began EC sooner, when it is known to be more effective.     

Prevalence,Risk Factors,and Predictors of Female Sexual Dysfunction in a Primary Care Setting: A Survey Finding

IntroductionFemale sexual dysfunction (FSD) is a highly prevalent sexual health problem but poorly investigated at the primary care level.AimThis article examines the prevalence of sexual dysfunction and its possible risk factors associated with women at high risk of FSD in a hospital-based primary practice.MethodsA validated Malay version of the Female Sexual Function Index (MVFSFI) was utilized to determine FSD in a cross-sectional study design, involving 163 married women, aged 18–65 years, in a tertiary hospital-based primary care clinic in Kuala Lumpur, Malaysia. Sociodemographic, marital profile, health, and lifestyle for women at high risk of FSD and those who were not at high risk were compared and their risk factors were determined.Main Outcome MeasuresPrevalence of FSD in Malaysian women based on the MVFSFI, and its risk factors for developing FSD.ResultsSome 42 (25.8%) out of 163 women had sexual dysfunction. Prevalence of sexual dysfunction increased significantly with age. Sexual dysfunctions were detected as desire problem (39.3%), arousal problem (25.8%), lubrication problem (21.5%), orgasm problem (16.6%), satisfaction problem (21.5%) and pain problems (16.6%). Women at high risk of FSD were significantly associated with age (OR 4.1, 95% CI 1.9 to 9.0), husband's age (OR 4.3 95% C.I 1.9 to 9.3), duration of marriage (OR 3.3, 95% CI 1.6 to 6.8), medical problems (OR 8.5, 95% CI 3.3 to 21.7), menopausal status (OR 6.6, 95% CI 3.1 to 14.3), and frequency of sexual intercourse (OR 10.7, 95% CI 3.6 to 31.7). Multivariate analysis showed that medical problem (adjusted OR 4.6, 95% CI 1.6 to 14.0) and frequency of sexual intercourse (adjusted OR 7.2, 95% CI 2.1 to 24.0) were associated with increased risk of having FSD. Those who practiced contraception were less likely to have FSD.ConclusionSexual health problems are prevalent in women attending primary care clinic where one in four women were at high risk of FSD. Thus, primary care physician should be trained and prepared to address this issue. Ishak IH, Low WY, and Othman S. Prevalence, risk factors and predictors of female sexual dysfunction in a primary care setting: A survey finding.     

Risk factors for placental abruption in an Asian population

The objective of this study was to identify risk factors for placental abruption in an Asian population. The authors conducted a retrospective review of 37 245 Taiwanese women who delivered between July 1990 and December 2003. Pregnancies complicated by placenta previa, multiple gestation, and fetal anomalies were excluded. Multivariable logistic regression was used to adjust for potentially confounding variables and to identify independent risk factors for placental abruption. Three hundred thirty-two women had placental abruption (9 per 1000 singleton deliveries). Women who smoked during pregnancy (adjusted odds ratio [OR] = 8.4; 95% confidence interval [CI] = 3.0-23.9), had gestational hypertensive diseases (adjusted OR = 4.9; 95% CI = 3.3-7.3), pregnancies complicated by oligohydramnios (adjusted OR = 4.2; 95% CI = 2.7-6.7), polyhydramnios (adjusted OR = 3.3; 95% CI = 1.4-7.7), preterm premature rupture of membranes (adjusted OR = 1.9; 95% CI = 1.1-3.1), entanglement of umbilical cord (adjusted OR = 1.6; 95% CI = 1.2-2.1), were of or more than 35 years of age (adjusted OR = 1.5; 95% CI = 1.1-2.0), and had a low prepregnancy body mass index (adjusted OR = 1.3; 95% CI = 1.0-1.6) were at increased risk for placental abruption. Some risk factors for placental abruption among Taiwanese women are the same as those of other ethnic groups, whereas some of the risk factors are different.     

Advance provision of emergency contraception for pregnancy prevention: a meta-analysis

OBJECTIVE: Advance provision of emergency contraception can circumvent some obstacles to timely use. We performed a meta-analysis to summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. DATA SOURCES: In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE, a specialized emergency contraception article database, and contacted experts to identify published or unpublished trials. METHODS OF STUDY SELECTION: We included randomized controlled trials comparing advance provision to standard access, defined as any of the following: counseling (with or without information about emergency contraception) or provision of emergency contraception on request at a clinic or pharmacy. TABULATION, INTEGRATION AND RESULTS: Two reviewers independently assessed study quality. We performed a meta-analysis using Review Manager software. Eight randomized controlled trials met inclusion criteria, representing 6,389 patients in the United States, China, and India. Advance provision did not decrease pregnancy rates, despite increased use (single use, odds ratio [OR] 2.52, 95% confidence interval [CI] 1.72-3.70; multiple use: OR 4.13, 95% CI 1.77-9.63) and faster use (weighted mean difference -14.6 hours, 95% CI -16.77 to -12.4 hours). Advance provision did not increase rates of sexually transmitted infections (OR 0.99, 95% CI 0.73-1.34), unprotected intercourse, or changes in contraceptive methods. Women who received emergency contraception in advance were as likely to use condoms as other women. CONCLUSION: Advance provision of emergency contraception did not reduce pregnancy rates and did not negatively affect sexual and reproductive health behaviors and outcomes compared with conventional provision. LEVEL OF EVIDENCE: III.     

Changing childbirth: lessons from an Australian survey of 1336 women

Objective To investigate the views and experiences of care in labour and birth of a representative sample
Design Cross-sectional survey mailed to women 6–7 months after giving birth.
Population All women who gave birth in a two week period in Victoria, Australia in September 1993, except those who had a stillbirth or neonatal death.
Results After adjusting for parity, the risk status of the pregnancy, and social and obstetric factors, specific aspects of care with the greatest negative impact on the overall rating of intrapartum care were: caregivers perceived as unhelpful (midwives: adjusted OR 12.03 [95% CI 7–8–1 8.1, doctors: adjusted OR 6.76 [95% CI 4.–10.31); and having an active say in decisions only sometimes, rarely or not at all (adjusted OR 8.0 [95% CI 4.–16–11). In a separate regression analysis including parity, risk status, obstetric and social factors, but not specific aspects of care, factors associated with dissatisfaction with intrapartum care included participation in a shared antenatal care programme (adjusted OR 1.9 [95% CI 1.–3.1) and being of nonEnglish speaking background (adjusted OR 1.0 [95% CI 1.–2.1). The following factors lowered the odds of dissatisfaction: attending a birth centre (adjusted OR 0.34 [95% CI 0.–1.]) and knowing the midwives before going into labour (adjusted OR 0.8 [95% CI 0.–0.]).
Conclusion The survey demonstrates the potential for 'new' models of care to have either positive or negative effects on women's experiences of care. Evaluation of innovations in perinatal care taking into account women's views is a prerequisite for improvements in maternity care. of women who gave birth in Victoria, Australia in 1993.     

Long-acting reversible contraception in adolescents in Sub-Saharan Africa: evidence from demographic and health surveys

Abstract

Objective: To explore (1) long-acting reversible contraception (LARC) use and (2) future contraceptive preferences in Sub-Saharan African adolescents as undesired pregnancies in Sub-Saharan African adolescents are associated with significant maternal/neonatal morbidity.

Methods: Nationally-representative Demographic and Health Surveys (USAID) obtained informed consent and interviewed 45,054 adolescents, including 19,561 (43.4% of total) sexually active adolescents (aged 15–19) from 18 least developed Sub-Saharan African nations regarding contraception (years 2005–2011, response rate 89.8–99.1% for all women interviewed). Frequencies and percentages of contraceptive use, prior pregnancies, and unwanted births were reported. Categorical variables were analyzed through χ² and unadjusted and binary logistic regression, adjusted for confounders, evaluated LARC use.

Results: A majority of sexually active adolescents were not using contraception (n?=?16,165 non-users; 82.6% of all sexually active adolescents). Many (n?=?8465, 43.3% of sexually active adolescents) interviewed already had at least one child, with 31.5% (n?=?2646) of those with previous children reporting the pregnancy was not wanted at the time it occurred. Sexually active adolescents using contraception (n?=?3384) used LARCs (injectable contraception, implants, or intrauterine devices; 29.8%, n?=?1007) barrier contraceptives (31.9%), oral contraceptives (10.9%), and other methods (27.4%). Adolescents using LARCs were more likely to be urban [OR 1.76 (95% CI 1.39–2.22)], to have been visited by a family planning worker in the last 12 months [OR1.62 (95% CI 1.24–2.11)], and to have visited a health facility in the past 12 months [OR1.84 (95% CI 1.53–2.21)]. Injectable contraception was the most preferred (39.9%, n?=?3036) future method by sexually-active non-contracepting adolescents who were asked about future methods (n?=?7605) compared to other methods. An unfortunate percentage of adolescents surveyed cannot read (35.7%, n?=?16,084).

Conclusion: A majority of sexually-active adolescents in Sub-Saharan Africa are not using contraception and are desirous of doing so. Offering LARCs during post-abortive or postpartum care with particular focus on rural adolescents may reduce undesired pregnancy and subsequent morbidity/mortality. Educational materials should limit printed information as many teens are unable to read.     

Risk factors for a complicated clinical course among women hospitalized with pelvic inflammatory disease

The aim of this study was to identify factors ascertainable at initial presentation that predict a complicated clinical course in HIV-negative women hospitalized with pelvic inflammatory disease (PID). We used data from a cross-sectional study of women admitted for clinically diagnosed PID to a public hospital in New York City. A complicated clinical course was defined as undergoing surgery, being readmitted for PID, or having a prolonged hospital stay (> or = 14 days) but no surgery. Logistic regression was used to identify independent predictors of complications. In adjusted analyses, older age (> or = 35 years) was a risk factor for prolonged hospital stay (adjusted odds ratio [OR] = 3.9; 95% confidence interval [CI] = 1.3-11.6) and surgery (OR = 10.4; CI = 2.5-44.1); self-reported drug use was a risk factor for readmission for PID (OR = 7.7; CI = 1.4-41.1) and surgery (OR = 6.2; CI = 1.8-20.5). Older age and self-reported drug use appear to be independent risk factors for a complicated clinical course among women hospitalized with PID.     

Sexual behaviour, knowledge and awareness of related reproductive health issues among single youth in Ethiopia

This nationally representative study, encompassing all single youth (15-24 years), was carried out on the subpopulation of Ethiopia DHS 2000 to determine the influences of socio-demographic characteristics on sexual behaviour, and assess the knowledge and awareness of HIV/AIDS and other STIs. There were a total of 890 male and 3,988 female youth. 25.5% of males and 16.1% of females ever had sexual intercourse. Among these, 65.8% males and 24.6% females had two or more sexual partners in the last 12 months. Condom use in the last sexual act was reported by 22.7% and 10% of male and female youth. 19.4% of male and 22.2% of female youth who ever had sexual intercourse ever used family planning method. Although the majority of youth is aware of HIV/AIDS, awareness about other STIs is low. On binary logistic regression analysis, the odds of ever having sexual intercourse were higher for the employed and older youth. Male urban youth was more likely to ever have sexual intercourse than male rural youth (Adjusted OR 4.2; 95% CI 1.8-9.5). Male youth with some form of education were more likely to use condom (Adjusted OR 4.9; 95% CI 1.01-24.7). Female youth with some form of education, the risk of ever having sexual intercourse was reduced by 50% but they were more likely to report having 2 sexual partners in the last 12 months (Adjusted OR 2.1; 95% CI 1.1-4.1). Female youth who had media exposure were more likely to report having 2 sexual partners in the last 12 months (Adjusted OR 2.9; 95% CI 1.3-6.8) but more likely to use condom during last sexual intercourse (Adjusted OR 15.7; 95% CI2.2-117). Among single Ethiopian youth the overall sexual activity is relatively lower than reported from other African countries but high risk sexual behaviour is common. Socio-demographic factors influence youth sexual behaviour.     

Advance supply of emergency contraception. effect on use and usual contraception--a randomized trial

OBJECTIVE: To evaluate whether advance provision of emergency contraception increases its use and/or adversely affects usual contraceptive practices. METHODS: We performed a randomized controlled trial comparing advance provision of emergency contraception with usual care in 370 postpartum women from an inner-city public hospital. Participants were followed for 1 year; 85% were available for at least one follow-up session. All participants received routine contraceptive education. The intervention group received a supply of emergency contraception (eight oral contraceptive pills containing 0.15 mg of levonorgestrel and 30 microg of ethinyl estradiol) and a 5-minute educational session. We compared use of emergency contraception and changes in contraceptive behaviors between groups. RESULTS: Women provided with pills were four times as likely to have used emergency contraception as women in the control group over the course of the year (17% versus 4%; relative risk [RR] 4.0; 95% confidence interval [CI] 1.8, 9.0). Women were no more likely to have changed to a less effective method of birth control (30% versus 33%; RR 0.92; 95% CI 0.63, 1.3), or to be using contraception less consistently (18% versus 25%; RR 0.74; 95% CI 0.45, 1.2). About half of each group reported at least one episode of unprotected intercourse during follow-up, but women who received emergency contraception were six times as likely to have used it (25% versus 4%; RR 5.8; 95% CI 2.1, 16.4). CONCLUSION: Advance provision of emergency contraception significantly increased use without adversely affecting use of routine contraception. It is safe and appropriate to provide emergency contraception to all postpartum women before discharge from the hospital.     

Maternal admission characteristics as risk factors for preterm birth

OBJECTIVE: The aim of this study is to identify a subset of women presenting with preterm labor not responding upon tocolytic therapy, eventually resulting in preterm birth. STUDY DESIGN: The maternal admission characteristics of 185 women with preterm labor receiving tocolysis were analysed for risk factors that could predict which women will deliver within 48 h after the start of tocolysis, or before 34 weeks gestation. Univariate analysis and multivariate logistic regression analysis was performed. RESULTS: Logistic regression analysis identified the following risk factors for delivery within 48 h after the start of tocolysis: cervical dilatation at admission (odds ratio (OR, cm(-1)) 1.47; 95% confidence interval (CI), 1.44-1.49), elevated leukocyte count at admission (per 10(3) leukocytes/mm(3)) (OR 1.27; 95% CI, 1.26-1.28), use of nifedipine (OR 0.49; 95% CI, 0.26-0.49), and developing signs suggestive of chorioamnionitis following admission (OR 2.12; 95% CI, 1.04-4.33). For delivery before 34 weeks of gestation the following risk factors were identified: use of steroids (OR 5.87; 95% CI, 2.34-14.7), use of nifedipine (OR 0.46; 95% CI, 0.27-0.85), developing signs suggestive of chorioamnionitis following admission (OR 10.6; 95% CI, 3.1-35.9), and preterm premature rupture of the membranes (OR 12; 95% CI, 4.1-35.2). CONCLUSIONS: Risk factors associated for delivery within 48 h after starting tocolysis are: cervical dilatation at admission, elevated leukocyte count at admission, and developing signs suggestive of chorioamnionitis following admission. Use of nifedipine was associated with a delay of delivery >48 h. Risk factors associated for delivery within 34 weeks gestation are: use of steroids, developing signs suggestive of chorioamnionitis following admission, and ruptured membranes. Use of nifedipine was associated with a delay >34 weeks.     

Pelvic floor morbidity up to one year after difficult instrumental delivery and cesarean section in the second stage of labor: a cohort study

OBJECTIVE: This study was undertaken to assess symptoms of pelvic floor morbidity at 6 weeks and at 1 year after difficult instrumental vaginal delivery or cesarean section during the second stage of labor. STUDY DESIGN: Prospective cohort study of 393 women with term, singleton, cephalic pregnancies who required operative delivery in surgery at full dilatation between February 1999 and February 2000. Postal questionnaires were used for follow-up at 6 weeks and at 1 year. RESULTS: Instrumental delivery was associated with a greater risk of urinary incontinence at 6 weeks and at 1-year postdelivery, adjusted odds ratio [OR] 7.8 (95% CI, 2.6-23.6) and OR 3.1 (95% CI, 1.3-7.6), respectively. Although instrumental delivery was associated with an increased risk of moderate-to-severe dyspareunia at 6 weeks, adjusted OR 3.35 (95% CI, 1.36-8.25), this difference was not significant at 1 year. Cesarean section after attempted instrumental delivery was associated with an increased risk of moderate-to-severe pain during intercourse at 1 year compared with immediate cesarean section, (18% vs 9%) P=.01. CONCLUSION: Although cesarean section at full dilatation does not completely protect women from pelvic floor morbidity, those that followed instrumental delivery had a significantly greater prevalence of urinary symptoms and dyspareunia. Urinary symptoms persist up to 1 year after delivery.     

Sexual Behavior and Contraceptive Use Among Cisgender and Gender Minority College Students Who Were Assigned Female at Birth

Study ObjectiveOur objective was to describe sexual behavior and contraceptive use among assigned female cisgender and gender minority college students (ie, those whose gender identity does not match their sex assigned at birth).DesignCross-sectional surveys administered as part of the fall 2015 through spring 2018 administrations of the National College Health Assessment.SettingColleges across the United States.ParticipantsA total of 185,289 cisgender and gender minority assigned females aged 18-25 years.Main Outcome MeasuresRecent vaginal intercourse; number and gender of sexual partners; use of contraception; use of protective barriers during vaginal intercourse.ResultsBoth gender minority and cisgender students often reported having male sexual partners, but gender minority students were more likely to report having partners of another gender identity (eg, women, trans women). Gender minorities were less likely than cisgender students to report having vaginal intercourse (adjusted odds ratio [AOR]: 0.86; 95% confidence interval [95% CI]: 0.80, 0.93). Gender minorities were less likely than cisgender students to report using any contraceptive methods (AOR: 0.86; 95% CI: 0.73, 1.03), and were less likely to consistently use barrier methods (AOR: 0.72; 95% CI: 0.64, 0.81) or emergency contraception (AOR: 0.56; 95% CI: 0.48, 0.65). However, gender minorities were more likely to use Tier 1 and Tier 3 contraceptive methods than cisgender women.ConclusionsProviders must be trained to meet the contraceptive counseling needs of cisgender and gender minority patients. Providers should explicitly ask all patients about the sex/gender of the patients’ sexual partners and the sexual behaviors in which they engage, to assess sexual risk and healthcare needs.     

To know that we know what we know: perceived knowledge and adolescent sexual risk behavior

STUDY OBJECTIVE: To examine the relationship between perceived knowledge about sex and adolescent sexual behaviors. DESIGN: Secondary analysis of the 2001 Minnesota Student Survey. Bivariate and multivariate relationships between perceived knowledge about sex and sexual behaviors were examined. SETTING: Minnesota. PARTICIPANTS: 83,481 9(th) and 12(th) grade public school students. MAIN OUTCOME MEASURES: Students' report of sexual experience and sexual behaviors. RESULTS: Students with low perceived knowledge were less likely to be sexually experienced (OR=0.22, CI=0.17-0.29, females, OR=0.70, CI=0.59-0.82, males, P=0.00). Among sexually active students, those with low perceived knowledge also had significantly higher odds of engaging in risky sexual behaviors. Sexually experienced females with low perceived knowledge were more likely to report not talking with their partners about STIs (OR=1.83, CI=1.1-3.16, P=0.02), a history of pregnancy (OR=2.87, CI=1.59-5.18, P=0.00), and had higher numbers of male (P=0.03) and female (P=0.00) sexual partners. Sexually experienced males with low perceived knowledge were more likely to report not talking with their partners about pregnancy (OR=1.43, CI=1.11-1.84, P=0.01), pregnancy involvement (OR=2.22, CI=1.65-2.95, P=0.00), inconsistent use of birth control (OR=1.30, CI= 1.01-1.68, P=0.04), inconsistent use of condoms (OR=1.79, CI=1.38-2.32, P=0.00), not using a condom at last intercourse (OR=1.58, CI=1.22-2.04, P=0.00), and had a higher numbers of male (P=0.00) and female (P=0.00) sexual partners. CONCLUSIONS: Perceived knowledge may be a salient antecedent of adolescent sexual risk behavior. Health care providers and programs should incorporate the construct of perceived knowledge into their assessments of and interventions targeted at adolescents.     

Emergency cesarean delivery in induction of labor: an evaluation of risk factors

BACKGROUND: Induction of labor has been associated with an increased risk of emergency cesarean delivery. Knowledge of factors that influence the risk of cesarean delivery in women with induced labor is limited. METHODS: We performed a case-control study, nested within a population-based cohort of women with induced labor at term during 1991-1996 in Uppsala County, Sweden. Cases were women delivered with emergency cesarean delivery, and controls were women vaginally delivered (n = 193, respectively). Using logistic regression, analyses were performed. Odds ratio (OR) with 95% confidence intervals (CI) was used as a measure of relative risk. RESULTS: Women with a previous cesarean delivery had high risks of cesarean delivery (adjusted OR = 10.10, 95% CI = 3.30-30.92). The risk of cesarean delivery was also increased among nulliparous (adjusted OR = 4.92, 95% CI = 2.81-8.61), short (adjusted OR = 2.20, 95% CI = 1.06-4.59), and obese women (adjusted OR = 2.03, 95% CI = 1.07-3.84). A cervix dilatation less than 1.5 cm doubled the risk of cesarean delivery (adjusted OR = 2.26, 95% CI = 1.09-4.66). Mother's age, epidural analgesia, oxytocin augmentation, gestational age, and birthweight were not significantly associated with risks of cesarean delivery. CONCLUSIONS: Women with a previous cesarean delivery, nulliparous, short, and obese women with induced labor are at high risk of a cesarean delivery. When there is a need to deliver a woman with a previous cesarean section or a nulliparous woman with other risk factors for cesarean delivery, it may be prudent to consider an elective cesarean section.     

Barrier methods, length of preconception intercourse, and preeclampsia.

BACKGROUND: The immune maladaptation theory suggests that tolerance to paternal antigens, resulting from prolonged exposure to sperm, protects against the development of preeclampsia. We tested whether barrier contraception and shorter sexual experience with the father of the pregnancy would increase the risk of preeclampsia. METHODS: Of 2211 women delivering singleton births after enrollment in a pregnancy cohort study, 85 (3.8%) developed preeclampsia as defined by antepartum systolic blood pressure > or = 140 or diastolic blood pressure > or = 90 plus proteinuria. At a mean of 10.2 weeks of gestation, all women in the cohort were asked about preconception contraception and timing of first sexual intercourse with the father of the pregnancy. Odds ratios (OR) comparing cases with preeclampsia to the rest of the cohort were adjusted for age, smoking, parity, and body mass index (BMI). RESULTS: Women using barrier contraception prior to conception were no more likely than women not using barrier contraception to develop preeclampsia (adjusted OR 1.0, 95% CI 0.6-1.6). In unadjusted analyses, a prolonged time to conception was associated with preeclampsia (OR 1.9), however, after adjustment, the association was less prominent (OR 1.6) and after stratification by contraception method, the link between time to conception and preeclampsia was eliminated. CONCLUSION: These data do not support the immune maladaptation theory of preeclampsia.