Current contraceptive status among women aged 15-44: United States, 2011-2013

Nearly all women use contraception at some point in their lifetimes, although at any given time they may not be using contraception for reasons such as seeking pregnancy, being pregnant, or not being sexually active. Using data from the 2011-2013 National Survey of Family Growth (NSFG) on contraceptive use in the month of the interview, this report provides a snapshot of current contraceptive status among women aged 15-44 in the United States. In addition to describing use of any method by age, Hispanic origin and race, and educational attainment, patterns of use are described for the four most commonly used contraceptive methods: the oral contraceptive pill, female sterilization, the male condom, and long-acting reversible contraceptives, which include contraceptive implants and intrauterine devices.

Ear Disease following Cleft Lip and Palate Surgery without Tympanostomy Tube Placement

Objectives:

(1) Describe the current benefits and risks associated with perioperative prophylactic myringotomy during cleft lip/palate surgery. (2) Recognize potential predictive factors associated with middle ear disease following cleft lip/palate surgery. (3) Incorporate ethnic differences into treatment algorithms regarding tympanostomy tubes.

Methods:

A total of 241 children (129 Ecuadorian, 112 Chinese) underwent cleft lip/palate repair (2000-2009). Veau classification, age, history of ear infections, and cleft side were recorded. Average age was 2.4 years and 11.1 years for Ecuadorian and Chinese children, respectively. No patients underwent tympanostomy tube placement. Following surgical correction, serial otoacoustic emissions (OAE) testing, and tympanometry were performed, and a parental questionnaire was administered regarding behavioral hearing deficits and history of ear infections before and after surgery. Data were recorded and compared individually for the 2 populations and as a group to identify disease prevalence and correlative factors.

Results:

No association existed between Veau classification and deficits in tympanometry, OAE, or subjective hearing. Reported ear infections after surgery were fewer than before but were not significant (26% to 21%). Abnormal OAE testing was associated with abnormal tympanometry and subjective hearing deficits ( P < .0001 and P = .004). Ecuadorian children had higher number of ear infections pre- and postoperatively ( P = .043 and P < .001) and higher number of abnormal tympanograms ( P = .003). No significant difference existed regarding OAE testing.

Conclusions:

Severity of the cleft lip/palate is not a predictive factor of middle ear disease and hearing impairment when no tympanostomy tube is placed. Ideal pressure equalization tube protocols should incorporate ethnic differences.

First premarital cohabitation in the United States: 2006-2010 National Survey of Family Growth

OBJECTIVE

This report provides an updated description of trends and patterns in first premarital cohabitations among women aged 15-44 in the United States using the National Survey of Family Growth (NSFG). Trends in pregnancies within first premarital cohabiting unions and differences by Hispanic origin and race, and education are also presented.

METHODS

Data for 2006-2010 were collected through in-person interviews with 22,682 women and men aged 15-44 in the household population of the United States. This report is based primarily on the sample of 12,279 women interviewed in 2006-2010, and is supplemented by data from the 1995 and 2002 NSFGs.

RESULTS

Forty-eight percent of women interviewed in 2006-2010 cohabited with a partner as a first union, compared with 34% of women in 1995. Between 1995 and 2006-2010, the percentage of women who cohabited as a first union increased for all Hispanic origin and race groups, except for Asian women. In 2006-2010, 70% of women with less than a high school diploma cohabited as a first union, compared with 47% of women with a bachelor's degree or higher. First premarital cohabitations were longest for foreign-born Hispanic women (33 months) and shortest for white women (19 months). In 2006-2010, 40% of first premarital cohabitations among women transitioned to marriage by 3 years, 32% remained intact, and 27% dissolved. Nearly 20% of women experienced a pregnancy in the first year of their first premarital cohabitation.

Contraceptive methods women have ever used: United States, 1982-2010

OBJECTIVE

This report presents national estimates of the proportion of sexually experienced women aged 15-44 who have ever used various methods of contraception in the United States. Trends are shown since 1982, and results are shown by Hispanic origin and race, education, and religious affiliation. The number of methods ever used is also shown, along with reasons for stopping use of selected methods.

METHODS

Data for 2006-2010 were collected through in-person interviews with 22,682 women and men aged 15-44 in the household population of the United States. Interviews were conducted by female interviewers in the homes of sampled persons. This report is based primarily on the sample of 12,279 women interviewed in 2006-2010 from the National Survey of Family Growth (NSFG). Data from earlier NSFGs are presented to show trends in method choice since 1982.

RESULTS

Virtually all women of reproductive age in 2006-2010 who had ever had sexual intercourse have used at least one contraceptive method at some point in their lifetime (99%, or 53 million women aged 15-44), including 88% who have used a highly effective, reversible method such as birth control pills, an injectable method, a contraceptive patch, or an intrauterine device. In 2006-2010, the most common methods that women or their partners had ever used were: the male condom (93%), the pill (82%), withdrawal (60%), and the injectable, Depo-Provera (23%). Method use varied by race and Hispanic origin, nativity among Hispanics, education, and religious affiliation, with significant proportions of women in all categories having used one or more of the most effective methods. The median number of methods ever used by women was about three, but nearly 30% have used five or more methods. Side effects were the most common reason for discontinuing use of the pill, Depo-Provera, and the patch among women who had ever discontinued using these methods due to dissatisfaction.

Use of emergency contraception among women aged 15-44: United States, 2006-2010

Emergency contraception can be used by women after sexual intercourse in an effort to prevent an unintended pregnancy. Roughly one-half of all pregnancies in the United States are unintended (1,2). The FDA first approved emergency contraceptive pills in 1998, but there is evidence of limited use of hormonal contraceptives for emergency contraception since the 1960s (3,4). Now, there are at least four brands of emergency contraceptive pills; most are available over the counter for women aged 17 and over (5). Although insertion of a copper intrauterine device can be used for emergency contraception (1,4), this report focuses only on emergency contraceptive pills. This report describes trends and variation in the use of emergency contraception and reasons for use among sexually experienced women aged 15-44 using the 2006-2010 National Survey of Family Growth.

Current contraceptive use in the United States, 2006-2010, and changes in patterns of use since 1995

OBJECTIVE

Use of contraception and the effectiveness of the method used to prevent pregnancy are major factors affecting national pregnancy and birth rates and the ability of women to plan their pregnancies. This report presents national estimates of contraceptive use among women of childbearing age (15-44 years) in 2006-2010. Selected comparisons are made with 1995 data to describe changes in contraceptive use and in method choice over time.

METHODS

Data for 2006-2010 were collected through in-person interviews with 22,682 women and men aged 15-44 years in the household population of the United States. Interviews were conducted by female interviewers in the homes of sampled persons. This report is based primarily on the sample of 12,279 women interviewed in 2006-2010; some tables are supplemented with the sample of 10,847 women interviewed in 1995.

RESULTS

Sixty-two percent of women of reproductive age are currently using contraception. Of women using a contraceptive method in the month of the interview, the most common methods used are the pill (28%, or 10.6 million women) and female sterilization (27%, or 10.2 million women). Use of intrauterine devices as a current method has increased since 1995 (from 0.8% in 1995 to 5.6% in 2006-2010), whereas fewer women report that their partners are using condoms as their current, most effective contraceptive method. Of women at risk of an unintended pregnancy, 11% report not currently using a method of contraception.

Young Adults' Fertility Expectations and Events: Associations With College Enrollment and Persistence

The analyses described in this article investigated the association between adolescent fertility expectations and college enrollment (N = 7,838). They also explored the potential impact of fertility expectations and events on college persistence among 4-year (n = 2,605) and 2-year (n = 1,962) college students. The analysis, which used data from the National Longitudinal Survey of Youth 1997 cohort, showed a significant association between expectations for early parenthood and the likelihood of going to a 4-year college or 2-year college for both men and women. In addition, the authors found that pregnancies were associated with an increased risk of college dropout for women; however, if all of the estimated effect of pregnancies on the risk of dropout were causal, they would still not be a major factor contributing to educational attainment because fertile pregnancies among college women are so rare.

Fertility of men and women aged 15-44 years in the United States: National Survey of Family Growth, 2006-2010

OBJECTIVE

This report presents national estimates of the fertility of men and women aged 15-44 years in the United States in 2006-2010 based on the National Survey of Family Growth (NSFG). Data are compared with similar measures for 2002.

METHODS

Descriptive tables of numbers, percentages, and means are presented and discussed. Data were collected through in-person interviews of a nationally representative sample of the household population aged 15-44 years in the United States between July 2006 and June 2010. The 2006-2010 NSFG sample is comprised of 22,682 respondents including 10,403 men and 12,279 women. The overall response rate for the 2006-2010 NSFG was 77%, 75% for men and 78% for women.

RESULTS

Many of the fertility measures among men and women aged 15-44 based on the 2006-2010 NSFG were generally similar to those reported based on the 2002 NSFG. The mean age at first child's birth for women was 23 and the mean age at first child's birth for men was 25. One-half of first births to women were in their 20s and two-thirds of first births were fathered by men who were in their 20s. On average, women aged 15-44 have 1.3 children as of the time of the interview. By age 40, 85% of women had had a birth, and 76% of men had fathered a child. In 2006-2010, 22% of first births to women occurred within cohabiting unions, up from 12% in 2002. These measures differed by Hispanic origin and race and other demographic characteristics.

First marriages in the United States: data from the 2006-2010 National Survey of Family Growth

OBJECTIVES

This report shows trends and group differences in current marital status, with a focus on first marriages among women and men aged 15-44 years in the United States. Trends and group differences in the timing and duration of first marriages are also discussed. These data are based on the 2006-2010 National Survey of Family Growth (NSFG). National estimates of probabilities of first marriage by age and probabilities of separation and divorce for women and men's first marriages are presented by a variety of demographic characteristics. Data are compared with similar measures for 1982, 1995, and 2002.

METHODS

The analyses presented in this report are based on a nationally representative sample of 12,279 women and 10,403 men aged 15-44 years in the household population of the United States. The overall response rate for the 2006-2010 NSFG was 77%-78% for women and 75% for men.

RESULTS

The percentage of women who were currently cohabiting (living with a man in a sexual relationship) rose from 3.0% in 1982 to 11% in 2006-2010; it was higher in some groups, including Hispanic groups, and the less educated. In 2006-2010, women and men married for the first time at older ages than in previous years. The median age at first marriage was 25.8 for women and 28.3 for men. Premarital cohabitation contributed to the delay in first marriage for both women and men.

Early Family Formation among White, Black and Mexican American Women

Using data from Waves I and III of Add Health, we examine early family formation among 6,144 White, Black, and Mexican American women. Drawing on cultural and structural perspectives, we estimate models of the first and second family transitions (cohabitation, marriage, or childbearing) using discrete time multinomial logistic regression. Complex differences by race/ethnicity and generation are partially explained by differences in attitudes and values in adolescence and family SES; marriage values are especially important in first-generation Mexican women's early entry into marriage. Examination of sequential family transitions sheds light on race/ethnic differences in the meaning and consequences of early cohabitation and pre-union births.

Single- versus double-layer hysterotomy closure at primary caesarean delivery and bladder adhesions

OBJECTIVE

To determine the association between single-layer (one running suture) and double-layer (second layer or imbricating suture) hysterotomy closure at primary caesarean delivery and subsequent adhesion formation.

DESIGN

A secondary analysis from a prospective cohort study of women undergoing first repeat caesarean section.

SETTING

Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA.

POPULATION

One hundred and twenty-seven pregnant women undergoing first repeat caesarean section.

METHODS

Patient records were reviewed to identify whether primary caesarean hysterotomies were closed with a single or double layer. Data were analysed by Fisher's exact tests and multivariable logistic regression.

MAIN OUTCOME MEASURE

Prevalence rate of pelvic and abdominal adhesions.

RESULTS

Of the 127 women, primary hysterotomy closure was single layer in 56 and double layer in 71. Single-layer hysterotomy closure was associated with bladder adhesions at the time of repeat caesarean (24% versus 7%, P = 0.01). Single-layer closure was associated in this study with a seven-fold increase in the odds of developing bladder adhesions (odds ratio, 6.96; 95% confidence interval, 1.72-28.1), regardless of other surgical techniques, previous labour, infection and age over 35 years. There was no association between single-layer closure and other pelvic or abdominal adhesions.

CONCLUSIONS

Primary single-layer hysterotomy closure may be associated with more frequent bladder adhesions during repeat caesarean deliveries. The severity and clinical implications of these adhesions should be assessed in large prospective trials.

Confidence in the use of donor insemination: an evaluation of the impact of participating in a group preparation programme

This paper argues that infertility can result in a range of negative emotional reactions, including a lack of confidence. This is more marked when donor insemination (DI) is used because of the additional shame this is associated with. Parents who do not feel confident may be less likely to share information about their use of DI with others and their child. Legislation in several countries has been introduced to abolish donor anonymity, but this has does not necessarily have an impact on parental confidence. In order to evaluate whether educational preparation programmes can impact on parental confidence and their intention to share information about DI, the confidence levels of 60 participants of three seminars were examined at three different points in time: before, immediately after and several months after attending the programme. Results indicate that most participants' confidence increased markedly as a result of attending an educational seminar. Furthermore, this increased confidence also impacted positively on the intention to share information about DI with future children. Both remained high several months after having attended the programme. These results point out that group preparation programmes can enhance levels of confidence, both as treatment is begun and as family building is undertaken.

Primary health care nurses implement and evaluate a community outreach approach to health care in the South African agricultural sector

BACKGROUND

Early detection and effective case management of tuberculosis (TB) among a high-risk group of materially poor farm workers in an area of the Cape Winelands, South Africa, presents special challenges to the health community, where resource constraints lead to service reduction. In order to address this problem, local nurses established a collaborative partnership between permanent farm workers and their families, their employers, selected non-governmental organizations and the public health sector. In consultation with stakeholders, they developed an intervention primarily focusing on having peer selected trained lay health workers (LHWs) on farms, mentored and managed by nurses.

PURPOSE

To describe the complex process of implementation and evaluation of the LHW project, and provide a summary of a number of discrete studies evaluating the effectiveness, cost implications, and the perceptions and experiences of key stakeholders of the intervention.

METHODS

Quantitative and qualitative research methods conducted within the context of a pragmatic unblinded community cluster randomized control trial were used. Emphasis was placed on an iterative participatory interaction between the researchers and key stakeholders.

RESULTS

The intervention contributed to significantly better successful treatment completion rates among adult new smear-positive TB cases. The process implemented proved cost-effective and was pivotal in initiating a community-based social development programme.

CONCLUSIONS

The use of peer-selected LHWs within a wider programme of integrated care designed to merge technical biomedical approaches to disease management with more holistic social development activities, appears essential to meet the complex health needs in conjunction with public health of the rural poor.

Family transitions in Young Adulthood

Using the first (1995) and third (2001–2002) waves of the Add Health survey, we examine women’s family transitions up to age 24. Only a third of all women marry, and a fifth of those marriages dissolve before age 24. Three out of eight women have a first birth, with a substantial majority of those births outside of marriage: 66% for whites, 96% for blacks, and 72% for Mexican Americans. Cohabitation is the predominant union form; 59% of women cohabit at least once by age 24. Most cohabitations are short lived, with approximately one in five resulting in a marriage. We summarize the family and relationship experience of women up to age 24 in terms of four categories, each accounting for roughly a quarter of all women. Category 1 has the women who remain single nonparents. Category 2 has the early marriers, women whose marriage is not preceded by a first birth. Category 3 has those who become single parents. Category 4 has the women who cohabit at least once, but who do not marry or have a birth by age 24. The strictly ordered transitions of the 1950s are long gone and have been replaced by a variety of paths to adulthood.

Otophyma: a case report

Objective:

We report a rare case of otophyma.

Method:

A case report of otophyma and a review of the current literature concerning otophyma and the more common rhinophyma, are presented.

Results:

A 46-year-old male presented with slow growing fleshy growths on both auricles which were excised. A diagnosis of otophyma was made. Although rosacea is more common, otophyma and other ‘phymas’ are thought to be the end stage of the rosacea spectrum of skin disease. However, unlike rhinophyma, otophyma is rarely seen and as a result there is little in the English language literature regarding it. Consequently, the management of otophyma is largely based on previous experiences with rhinophyma.

Conclusion:

To our knowledge this is the first case report of otophyma in the otolaryngology literature and only the second described in the English language literature. This case demonstrates the difficulties faced in diagnosing this rare condition and our successful management of this case.