Publications (22)42.56 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: To prospectively determine whether individual, family, and community assets help youth to delay initiation of sexual intercourse (ISI); and for youth who do initiate intercourse, to use birth control and avoid pregnancy. The potential influence of neighborhood conditions was also investigated. Methods: The Youth Asset Study was a 4-year longitudinal study involving 1,089 youth (mean age = 14.2 years, standard deviation = 1.6; 53% female; 40% white, 28% Hispanic, 23% African American, 9% other race) and their parents. Participants were living in randomly selected census tracts. We accomplished recruitment via door-to-door canvassing. We interviewed one youth and one parent from each household annually. We assessed 17 youth assets (e.g., responsible choices, family communication) believed to influence behavior at multiple levels via in-person interviews methodology. Trained raters who conducted annual windshield tours assessed neighborhood conditions. Results: Cox proportional hazard or marginal logistic regression modeling indicated that 11 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for ISI; seven assets (e.g., educational aspirations for the future, responsible choices) were significantly associated with increased use of birth control at last sex; and 10 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for pregnancy. Total asset score was significantly associated with all three outcomes. Positive neighborhood conditions were significantly associated with increased birth control use, but not with ISI or pregnancy. Conclusions: Programming to strengthen youth assets may be a promising strategy for reducing youth sexual risk behaviors.
- [Show abstract] [Hide abstract] ABSTRACT: In 2010, malaria caused approximately 216 million infections in people and 655,000 deaths. In the United States, imported malaria cases occur every year, primarily in returning travelers and immigrants from endemic countries. In 2010, five Plasmodium falciparum malaria cases occurred among crew members of one US commercial airline company (Airline A). This investigation aimed to assess the malaria prevention knowledge, attitudes, and practices (KAP) of Airline A crew members to provide information for potential interventions. The web link to a self-administered on-line survey was distributed by internal company communications to Airline A pilots and flight attendants (FA) eligible for international travel. The survey collected demographic information as well as occupation, work history, and malaria prevention education. Of approximately 7,000 nonrandomly selected crew members, 220 FA and 217 pilots completed the survey (6%). Respondents correctly identified antimalarial medication (91% FA, 95% pilots) and insect repellents (96% FA, 96% pilots) as effective preventive measures. While in malaria-intense destinations, few FA and less than half of pilots always took antimalarial medication (4% FA, 40% pilots) yet many often spent greater than 30 minutes outdoors after sundown (71% FA, 66% pilots). Less than half in both groups always used insect repellents (46% FA, 47% pilots). Many respondents were unaware of how to get antimalarial medications (52% FA, 30% pilots) and were concerned about their side effects (61% FA, 31% pilots). Overall, FA and pilots demonstrated good knowledge of malaria prevention, but many performed risky activities while practicing only some recommended malaria preventive measures. Malaria prevention education should focus on advance notification if traveling to a malaria-endemic area, how to easily obtain antimalarial medications, and the importance of practicing all recommended preventive measures.
Dataset: Technical Appendix[Show abstract] [Hide abstract] ABSTRACT: The following pages show a household questionnaire that was pilot tested and administered to 405 households from 27 clusters from resources-limited areas of Cite Soleil, Delmas, Carrefour, and Petion-Ville, Haiti.
- [Show abstract] [Hide abstract] ABSTRACT: Assess whether the 55% increase in Florida's Hispanic infant mortality rate (HIMR) during 2004-2007 was real or artifactual. Using linked data from Florida resident live births and infant deaths for 2004-2007, we calculated traditional (infant Hispanic ethnicity from death certificates and maternal Hispanic ethnicity from birth certificates) and nontraditional (infant and maternal Hispanic ethnicity from birth certificate maternal ethnicity) HIMRs. We assessed trends in HIMRs (per 1,000 live births) using Chi-square statistics. We tested agreement in Hispanic ethnicity after implementation of a revised 2005 death certificate by using kappa statistics and used logistic regression to test the associations of infant mortality risk factors. Hispanic was defined as being of Mexican, Puerto Rican, Cuban, Central/South American, or other/unknown Hispanic origin. During 2004-2007 traditional HIMR increased 55%, from 4.0 to 6.2 (Chi-square, P < 0.001) and nontraditional HIMR increased 20%, from 4.5 to 5.4 (Chi-square, P = 0.03). During 2004-2005, agreement in Hispanic ethnicity did not change with use of the revised certificate (kappa = 0.70 in 2004; kappa = 0.76 in 2005). Birth weight was the most significant risk factor for trends in Hispanic infant mortality (OR = 1.33, 95% CI = 1.10-1.61). Differences in Hispanic reporting on revised death certificates likely accounted for the majority of traditional HIMR increase, indicating a primarily artifactual increase. Reasons for the 20% increase in nontraditional HIMR during 2004-2007 should be further explored through other individual and community factors. Use of nontraditional HIMRs, which use a consistent source of Hispanic classification, should be considered.
- [Show abstract] [Hide abstract] ABSTRACT: In response to the recent cholera outbreak, a public health response targeted high-risk communities, including resource-poor communities in Port-au-Prince, Haiti. A survey covering knowledge and practices indicated that hygiene messages were received and induced behavior change, specifically related to water treatment practices. Self-reported household water treatment increased from 30.3% to 73.9%.
- [Show abstract] [Hide abstract] ABSTRACT: Concerns have been raised regarding possible racial-ethnic disparities in 2009 pandemic influenza A (H1N1) (pH1N1) illness severity and health consequences for U.S. minority populations. Using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, Emerging Infections Program Influenza-Associated Hospitalization Surveillance, and Influenza-Associated Pediatric Mortality Surveillance, we calculated race-ethnicity-specific, age-adjusted rates of self-reported influenza-like illness (ILI) and pH1N1-associated hospitalizations. We used χ(2) tests to evaluate racial-ethnic disparities in ILI-associated health care-seeking behavior and pH1N1 hospitalization. To evaluate pediatric deaths, we compared racial-ethnic proportions of deaths against U.S. population distributions. Prevalence of self-reported ILI was lower among Hispanics (6.5%), higher among American Indians/Alaska Natives (16.2%), and similar among non-Hispanic blacks (7.7%) compared with non-Hispanic whites (8.5%). No racial-ethnic differences were identified in ILI-associated health care-seeking behavior. Age-adjusted pH1N1-associated Emerging Infections Program hospitalization rates were higher among all minority populations (range: 8.1-10.9/100,000 population) compared with non-Hispanic whites (3.0/100,000). The proportion of pH1N1-associated pediatric deaths was higher than expected among Hispanics (31%) and lower than expected among non-Hispanic whites (45%) given the proportions of the U.S. population they comprise (22% and 58%, respectively). Racial-ethnic disparities in pH1N1-associated hospitalizations and pediatric deaths were identified. Vaccination remains the primary intervention for preventing influenza.
- [Show abstract] [Hide abstract] ABSTRACT: Evaluate youth assets or potential strengths and sexual intercourse associations by household income. Data consisted of youth and parent responses from randomly selected households from a cross-sectional study and wave one of a longitudinal extension of that study. Youth assets and sexual intercourse were compared for four income categories. Midwestern racially diverse, inner-city neighborhoods. One adolescent (12-19 years) and one parent (2335 pairs). Adjusted odds ratios (ORs) were calculated using logistic regression. Variables assessed included parent and youth demographics, youth sexual intercourse, and youth assets (adult and peer role models, family communication, use of time [religion or sports], community involvement, future aspirations, responsible choices, and health practices). Youths' mean age was 14.9 (± 1.8) years, and 52% were female; 44% of respondents were white. Use of time (religion) was significantly associated with never having sex for all but the lowest income youth (OR range=1.79-2.64). The variable peer role models was significant for the lowest income (O =2.01) and two upper income groups (ORs=2.52 and 4.27, respectively). The variable future aspirations was significant for the lowest income youth (OR=1.77). The youth asset variable future aspirations was critical for the lowest income households. Other asset variables, such as peer role models and use of time (religion) were critical regardless of income.
- [Show abstract] [Hide abstract] ABSTRACT: Virginity pledges, commitments to remain a virgin until marriage, are advocated by certain adolescent pregnancy-prevention programs. Few studies have examined virginity pledges. This study prospectively examined associations between pledges and self-reported initiation of sexual intercourse (ISI). The Youth Assets Survey is a 5-wave, 4-year longitudinal study of youth-parent pairs to investigate youth risk behaviors and assets. Youth who reported no ISI at baseline or in wave 2 (N=627; mean age=13.7 years; 53% female; 44% white, 18% black, and 28% Hispanic) were included in the analysis. ISI was assessed to determine if statistically significant differences existed among youth taking a virginity pledge and ISI during waves 35. Data were stratified by youth age (1314, 1516, and 1719 years). Logistic regression analysis was conducted controlling for gender, race, parental education, parental income, and family structure. Sixty percent of youth (n=378) reported taking a virginity pledge. Fifty-five percent (n=344) reported ISI in waves 3-5. Youth aged 1516 years who pledged were significantly more likely to report no ISI (odds ratio=3.2; 95% confidence interval, 1.75.9) during waves 35 versus youth aged 1516 who did not pledge. Youth aged 1314 and 1719 years who pledged demonstrated no significant differences in ISI, compared with youth who did not pledge. Virginity pledges were associated with decreased reporting of ISI for youth aged 1516, although not for other age groups. Understanding the role of virginity pledges in adolescent pregnancy prevention will help ensure programs include best practices.
- [Show abstract] [Hide abstract] ABSTRACT: Childhood obesity is a major public health concern and is associated with substantial morbidities. Access to less-healthy foods might facilitate dietary behaviors that contribute to obesity. However, less-healthy foods are usually available in school vending machines. This cross-sectional study examined the prevalence of students buying snacks or beverages from school vending machines instead of buying school lunch and predictors of this behavior. Analyses were based on the 2003 Florida Youth Physical Activity and Nutrition Survey using a representative sample of 4,322 students in grades six through eight in 73 Florida public middle schools. Analyses included χ2 tests and logistic regression. The outcome measure was buying a snack or beverage from vending machines 2 or more days during the previous 5 days instead of buying lunch. The survey response rate was 72%. Eighteen percent of respondents reported purchasing a snack or beverage from a vending machine 2 or more days during the previous 5 school days instead of buying school lunch. Although healthier options were available, the most commonly purchased vending machine items were chips, pretzels/crackers, candy bars, soda, and sport drinks. More students chose snacks or beverages instead of lunch in schools where beverage vending machines were also available than did students in schools where beverage vending machines were unavailable: 19% and 7%, respectively (P≤0.05). The strongest risk factor for buying snacks or beverages from vending machines instead of buying school lunch was availability of beverage vending machines in schools (adjusted odds ratio=3.5; 95% confidence interval, 2.2 to 5.7). Other statistically significant risk factors were smoking, non-Hispanic black race/ethnicity, Hispanic ethnicity, and older age. Although healthier choices were available, the most common choices were the less-healthy foods. Schools should consider developing policies to reduce the availability of less-healthy choices in vending machines and to reduce access to beverage vending machines.
- [Show abstract] [Hide abstract] ABSTRACT: We investigated the association between 2009 IOM recommendations and adverse infant outcomes by maternal prepregnancy body mass index (BMI). Birth outcomes for 570,672 women aged 18-40 years with a singleton full-term live-birth were assessed using 2004-2007 Florida live-birth certificates. Outcomes included large-for-gestational-age (LGA) and small-for-gestational-age (SGA). Associations between gestational weight change and outcomes were assessed for 10 BMI groups by calculating proportions, and logistic regression modeling was used to produce adjusted odds ratios (aORs) to account for the effect of confounders. We created comparison categories below and above recommendations using 2009 IOM recommendations as a reference. Of importance, 41.6% of women began pregnancy as overweight and obese and 51.2% gained weight excessively during pregnancy on the basis of 2009 IOM recommendations. Proportions of LGA were higher among obese women and increased with higher weight gain. Compared with recommended weight gain, aORs for LGA were lower with less than recommended gain (aOR range: 0.27-0.77) and higher with more than recommended gain (aOR range: 1.27-5.99). However, SGA was less prevalent among obese women, and the proportion of SGA by BMI was similar with higher weight gain. Gain less than recommended was associated with increased odds of SGA (aOR range: 1.11-2.97), and gain greater than recommended was associated with decreased odds of SGA (aOR range: 0.38-0.83). Gestational weight gain influenced the risk for LGA and SGA in opposite directions. Minimal weight gain or weight loss lowered risk for LGA among obese women. Compared with 1990 IOM recommendations, 2009 recommendations include weight gain ranges that are associated with lower risk of LGA and higher risk of SGA. Awareness of these tradeoffs may assist with clinical implementation of the 2009 IOM gestational weight gain recommendations. However, our results did not consider other maternal and infant outcomes related to gestational weight gain; therefore, the findings should be interpreted with caution.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose – Previous research has shown that religion plays a role in the lives of many youths. This paper aims to extend previous research and examine attendance at religious services and involvement in religious/church activities as separate items to determine if one aspect was more strongly associated with never having had sexual intercourse among youth in the USA. It also aims to consider the effect of other youth assets, and analyze all by gender. Design/methodology/approach – Cross-sectional data were examined to assess youth assets and risk behaviors. Multivariate regression was used to determine whether the assets or religion questions were significant in the presence of the other assets/religion questions. The eight assets examined, in addition to church attendance and involvement in religious groups were adult role models, peer role models, family communication, involvement in sports and groups, community involvement, aspirations for the future, responsible choices, and good health – diet and exercise. Findings – Involvement in church/religious activities, but not attendance at religious services, was associated with never having had sexual intercourse among males and females. Analysis also determined that several of the other youth assets were protective of sexual intercourse among males and among females. Research limitations/implications – Findings from this study may be limited by the validity of the self-reported measures. The data were cross-sectional, making it impossible to draw inferences about the causal directions of the relationships found in this study. Future research should focus on developing interventions to strengthen youth assets. Practical implications – Developing gender and culturally specific interventions to promote youth assets may reduce the number of young people engaging in sex. Originality/value – The paper extends previous research and examines attendance at religious services and involvement in religious/church activities as separate items to determine if one aspect was more strongly associated with never having had sexual intercourse.
- [Show abstract] [Hide abstract] ABSTRACT: We sought to determine the association of smoking status as a risk factor for reduced initiation and duration of breastfeeding. The Missouri Pregnancy Related Assessment and Monitoring System collected a stratified sample of new mothers in 2005. Surveys were mailed, with telephone follow-up, and completed within 2 to 12 months after delivery. Respondents were classified as nonsmokers, smokers who quit during pregnancy, light smokers (<or=10 cigarettes per day), or moderate/heavy smokers (>10 cigarettes per day). Multivariable binomial regression and Cox proportional hazards models were used to assess breastfeeding initiation and duration according to smoking status. Overall, 1789 women participated (weighted response rate: 61%). Approximately 74% of the women ever breastfed; 31% of the women ever smoked while pregnant. Compared with nonsmokers, the moderate/heavy smokers and light smokers were less likely to initiate breastfeeding, after controlling for sociodemographic characteristics, the presence of other smokers in the household, alcohol use, mode of delivery, and infant hospitalization. Compared with nonsmokers, the moderate/heavy smokers, light smokers, and smokers who quit during pregnancy were more likely to wean over time, controlling for the same covariates. There were no significant differences between nonsmokers and smokers regarding reasons for not initiating or ceasing breastfeeding. Mothers who smoked initiated breastfeeding less often and weaned earlier than nonsmoking mothers. Incorporating knowledge of the association between smoking and breastfeeding into existing smoking-cessation and breastfeeding programs could provide opportunities to reduce perinatal exposure to tobacco smoke, improve interest in breastfeeding, and address other barriers to breastfeeding that smoking mothers may face.
- [Show abstract] [Hide abstract] ABSTRACT: To investigate the reliability and validity of weight, height, and body mass index (BMI) from birth certificates with directly measured values from the Women, Infants, and Children (WIC) Program. Florida birth certificate data were linked and compared with first trimester WIC data for women with a live birth during the last quarter of calendar year 2005 (n = 23,314 women). Mean differences for weight, height, and BMI were calculated by subtracting birth certificate values from WIC values. Reliability was estimated by Pearson's correlation. Validity was measured by sensitivity and specificity using WIC data as the reference. Overall mean differences plus or minus standard error (SE) were 1.93 ± 0.04 kg for weight, -1.03 ± 0.03 cm for height, and 1.07 ± 0.02 kg/m(2) for BMI. Pearson's correlation ranged from 0.83 to 0.95, which indicates a strong positive association. Compared with other categories, women in the second weight group (56.7-65.8 kg), the highest height group (≥167.6 cm), or BMI < 18.5 had the greatest mean differences for weight (2.2 ± 0.08 kg), height (-2.4 ± 0.05 cm), and BMI (1.5 ± 0.06), respectively. Mean differences by maternal characteristics were similar, but statistically significant, likely in part from the large sample size. The sensitivity for birth certificate data was 77.3% (±1.42) for underweight (BMI < 18.5) and 76.4% (±0.51) for obesity (BMI ≥ 30). Specificity was 96.8% (±0.12) for underweight and 97.5% (±0.12) for obesity. Birth certificate data had higher underweight prevalence (6 vs. 4%) and lower obesity prevalence (24 vs. 29%), compared with WIC data. Although birth certificate data overestimated underweight and underestimated obesity prevalence, the difference was minimal and has limited impact on the reliability and validity for population-based surveillance and research purposes related to recall or reporting bias.
Conference Paper: Homicide trends in New Orleans, Louisiana, 19992006[Show abstract] [Hide abstract] ABSTRACT: In 2006, New Orleans had the highest homicide rate in the United States, at 85 homicides/100,000 persons, 15 times the national average of 5.7/100,000. In response to concerns that homicides and gang-related youth violence increased after Hurricane Katrina, we assessed homicide trends for 19992006. We used New Orleans' vital statistics and Uniform Crime Supplemental Homicide Report data for 19992006 to calculate the homicide rate per 100,000 population and the proportion of all deaths attributable to homicides. July 1 census estimates served as the denominator for all years except 2005, where a time-weighted estimate was used to account for hurricane-related population change. We used chi-square and regression analysis to assess temporal trends in homicides by age, sex, and race/ethnicity. The homicide rate in New Orleans has increased linearly since 1999 (P=0.01). The proportion of deaths classified as homicides increased from 2.9% in 1999 to 8.6% in 2006 (P<0.0001). During 19992006, no significant changes in demographic characteristics of victims occurred: 90% were male (P=0.32) and 89% were black (P=0.56). Mean age for victims and offenders was 29.5 (95% confidence interval [CI], 28.930.0) and 30.5 (95% CI, 29.131.9), respectively. In 2007, New Orleans again had the highest homicide rate in the United States. Although we expected homicides to occur predominantly among adolescents, the older mean age for victims and offenders presents a challenge to traditional intervention approaches, which primarily target youth. We are working with state and community partners to develop age-specific strategies to reduce violent crime.
- [Show abstract] [Hide abstract] ABSTRACT: This article assesses the comparability of contraceptive use estimates for adult women obtained from the 2002 Behavioral Risk Factor Surveillance System (BRFSS), using the 2002 National Survey of Family Growth (NSFG) as a benchmark. The 2002 BRFSS uses data collection methods that are considerably different from the NSFG. We compared demographic differences and national estimates of current contraceptive methods being used and reasons for nonuse. Variables were recoded in the BRFSS and NSFG systems to make the two samples comparable. Women in the NSFG and BRFSS were similar in age and race/ethnicity. Compared with the NSFG, the BRFSS sample was more educated and of higher income, less likely to be cohabiting, and more likely to be married. After adjusting for differences in the coding of hysterectomy, many BRFSS estimates for current contraceptive use were statistically similar to those from the NSFG. Small but statistically significant differences were found for vasectomy (7.7% and 6.3%), the pill (21.9% and 19.6%), rhythm (1.5% and 1.0%), the diaphragm (0.5% and 0.2%), and withdrawal (0.3% and 2.7%) for the BRFSS and NSFG, respectively. Major reasons for nonuse were similar: seeking pregnancy and currently pregnant. The percentage of women who were not currently sexually active was higher in the BRFSS (16.0%) compared with the NSFG (12.5%). The BRFSS is a useful source of population-based data on contraceptive use for reproductive health program planning; however, planners should be cognizant that lower-income women are not fully represented in telephone surveys.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Lyme disease (LD) surveillance identifies cases to monitor incidence trends; no immediate interventions are indicated. New Jersey health departments cite LD surveillance as a substantial burden, highlighting increased case-report volume following introduction of electronic laboratory reporting (ELR) in 2002. We evaluated LD surveillance to determine actual burden and quantify ELR's contribution. Methods: To evaluate burden, we analyzed 2001-2006 data and calculated overall case-report volume and ELR volume. We evaluated ELR performance by calculating predictive value positive (PVP) for different case-report types and years. We defined PVP as the percentage of total case-reports that meet the case definition. We also interviewed key personnel about investigation procedures. Results: Report volume increased from 2,460 in 2001 to a high of 11,957 in 2004 (386%) before declining. Confirmed cases only increased 11% during the same period. Each investigation requires approximately one hour, equivalent to 5.75 full-time-equivalent (2080 hours/year) positions at the 2004 peak. Overall PVP was 96% in 2001 and dropped in the first year of ELR implementation to 65%, reaching a low of 22% in 2004 before rebounding. ELR had an aggregate PVP of 16%, while non-ELR reports had a PVP of 55%. Conclusions: ELR is primarily responsible for the increasing burden of LD surveillance, but it is a relatively poor indicator of true cases. Increasing ELR performance is difficult, and the value of ELR for characterization of LD epidemiologic trends is uncertain. Further evaluation of ELR use will facilitate national consensus on LD surveillance to ensure continued sustainability and preserve representativeness.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Although cholera kills thousands each year globally, locally acquired cases are rare in the United States and are most often associated with Gulf Coast seafood. Toxigenic Vibrio cholerae O1, the agent of cholera, is endemic in the brackish waters of southern Louisiana. In the year following Hurricane Katrina, six cholera cases were reported, representing a 10-fold increase over the previous 5-year baseline (2000-2004). We conducted an investigation to identify epidemiologic and environmental risk factors. Methods: We interviewed the six post-Katrina patients and compared their exposures and isolates with previous Louisiana cholera patients. We also interviewed crab wholesalers and fishermen to determine if a common environmental source of implicated seafood existed. We used a negative binomial regression model to determine the probability of six cases of cholera occurring during the post-Katrina year. Results: Post-Katrina isolates were indistinguishable by pulsed-field gel electrophoresis (PFGE) from the Gulf Coast strain. All six patients had handled and eaten locally caught crabs within 5 days of illness onset; three had also eaten shrimp. Patients reported cooking seafood for a sufficient period to kill the bacteria, but cross-contamination was possible in five cases. Fishermen and crab wholesalers reported that since Hurricane Katrina, crabs were being caught in areas they had never been found before the storm. The probability of six cholera cases occurring during the year following Hurricane Katrina was P = .07. Conclusions: Crab continues to be the main source of cholera infection in southern Louisiana, underscoring the need for education regarding safe seafood handling and cooking practices. In addition, ecological changes post-Katrina might have altered crab habitat in southern Louisiana, emphasizing the need for enhanced cholera surveillance.
- [Show abstract] [Hide abstract] ABSTRACT: We examined pregnancy intention measures and contraceptive use behaviors among reproductive-age women using data from two CDC-based surveillance systems. We analyzed data for women aged 18-44 from 4 states that collected information on pregnancy and contraceptive use from both the Behavioral Risk Factor Surveillance System (BRFSS, n = 4201) and the Pregnancy Risk Assessment Monitoring System (PRAMS, n = 7761) in 2000. Standard definitions of intended and unintended pregnancy were used. BRFSS data show that 4% (95% CI: 2.8-5.2) of the women were pregnant at the time of interview and that 57% (95% CI: 41.9-71.9) of these pregnancies were intended. Women who had been pregnant within the last 5 years but were not currently pregnant reported that 61% (95% CI: 55.9-65.3) of their most recent pregnancies had been intended. According to PRAMS, 58% (95% CI: 56.5-60.5) of women with live births had intended pregnancies. Contraceptive use varied across the surveys; 68% (95% CI: 65.7-70.7) of all non-pregnant women from BRFSS and 87% (95% CI: 85.1-87.9) of women with a recent live birth from PRAMS reported using contraceptives. Although contraceptive use differed between the BRFSS and PRAMS, the patterns of pregnancy intention were similar for women who had a pregnancy within the past 5 years, those who recently delivered a live-born infant, and those who were currently pregnant. It appears that reporting of pregnancy intention is not affected by timing of assessment across the two surveys.
- [Show abstract] [Hide abstract] ABSTRACT: Women with chronic medical conditions are at increased risk for adverse pregnancy outcomes, yet contraceptive use by these women has not been well described. The purpose of this study was to describe contraceptive use by diabetic and overweight/obese women compared with women without these conditions. Using cross-sectional data from the 11 states participating in the optional Family Planning Module of the Behavioral Risk Factor Surveillance System in 2000, we analyzed contraceptive use among 7,943 sexually active women of reproductive age (18-44) who were not trying to conceive. Using logistic regression techniques, we modeled the effect of diabetes and overweight/obesity on contraceptive nonuse, controlling for age, race/ethnicity, marital status, education, income, and health insurance coverage. Contraceptive nonuse was reported by 1,500 (18.9%) of the total sample, 31 (25.8%) diabetic women, 371 (20.0%) overweight women, and 385 (23.4%) obese women. In the multivariable model, obesity was significantly associated with contraceptive nonuse (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.16-1.55), but there were no significant differences in contraceptive nonuse for diabetic women (adjusted OR 1.23, 95% CI 0.80-1.87) or overweight women (adjusted OR 1.14, 95% CI 0.99-1.31). Older, Black, Hispanic, married, less educated, and women without health insurance were more likely to report contraceptive nonuse. Among women with need for contraception, obese women were more likely to report contraceptive nonuse than normal weight women. Because women with chronic conditions like obesity are at higher risk of pregnancy-related complications and adverse pregnancy outcomes, proper contraceptive use and unintended pregnancy avoidance is a priority.
- [Show abstract] [Hide abstract] ABSTRACT: Contraceptive use is an important determinant of unintended pregnancy. In the United States, approximately half of all pregnancies are unintended. Population-based information about contraceptive use patterns is limited at the state level. Information about contraceptive use for states can be used to guide the development of state programs and policies to decrease unintended pregnancy and the spread of sexually transmitted infections. Information about contraceptive use for specific subpopulations can be used to further refine state efforts to improve contraceptive use and subsequently decrease the occurrence of unintended pregnancy. Data were collected in 2002 for men and women. The Behavioral Risk Factor Surveillance System (BRFSS) is a random-digit--dialed, telephone survey of the noninstitutionalized U.S. population aged > or =18 years. All 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands participated in BRFSS in 2002. These data can be used to track state progress towards the national health objectives for 2010 for responsible sexual behavior. The 2002 BRFSS data represent the first time state data on contraceptive use in all 50 states will be presented and examined by selected sociodemographic characteristics. The 2002 BRFSS also, for the first time, provided an opportunity to examine state-level contraceptive use patterns among men. Variation across states and territories was observed for the majority of contraceptive methods among the different demographics analyzed and among men and women. The percentage of men and women at risk for pregnancy who said they or their partner was using birth control was high overall and ranged from 67% (Guam) to 88% (Idaho). Oral contraceptives (i.e., the pill), vasectomy, tubal ligation, and condoms were the methods most frequently reported by both male and female respondents who said they or their partner was using birth control. Among female respondents using birth control, the pill was the most common method reported. Among men, vasectomy was the most commonly reported method. The prevalence of use for the four most commonly reported methods (pills, vasectomy, tubal ligation, condoms) varied as much as six-fold among states for vasectomy and three- to four-fold for condoms, pills, and tubal ligation. The findings in this report document substantial differences among states and sociodemographic groups within states in contraceptive method use. These data can help states identify populations with an unmet need for birth control, barriers to birth control use, and gaps in the range of birth control methods offered by health-care providers. An analysis of the prevalence of birth control use by state and selected population characteristics can help states target contraceptive programs to best meet the needs of their population.
Centers for Disease Control and Prevention
Atlanta, Michigan, United States
- Division of Reproductive Health