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Din HN, Strong D, Singh-Carlson S, Corliss HL, Hartman SJ, Madanat H, Su HI. The effect of changing pregnancy intentions on preconception health behaviors: a prospective cohort study. J Cancer Surviv 2023; 17:1660-1668. [PMID: 36289184 PMCID: PMC10539193 DOI: 10.1007/s11764-022-01281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Pregnancy intentions are associated with preconception health behaviors but are understudied among female adolescent and young adult (AYA) cancer survivors. Preconception health is critical for survivors because they face unique risks to fertility and pregnancy from late effects of cancer treatments. This study prospectively assessed the effect of pregnancy intention on physical activity (PA) and smoking behaviors among female AYA survivors. METHODS A cohort of 1049 female AYA survivors were recruited between 2013 and 2017. Participants were 18-39 years and had completed primary cancer treatment. Longitudinal mixed effects analysis was conducted on participants who completed at least 2 of 4 questionnaires over 1.5 years. Two measures were used to capture multiple dimensions of pregnancy intention. The pregnancy intention score (PIS) captured wanting and planning dimensions and represented a scaled response of low to high intention. The trying dimension captured urgent intention and ranged from not trying, ambivalent (neither attempting nor avoiding pregnancy), and trying now. Intention change was assessed between each consecutive time points. Final analysis was conducted with multiple imputations. RESULTS Survivors with increased intention measured by trying was associated with increased PA over time (adjusted B [95%CI]: 0.3 [0.01, 0.5]) compared to survivors with no changes or decreased trying intention. PIS was not significantly associated with preconception behaviors. No measure of intention was associated with smoking behavior. CONCLUSIONS Increasingly urgent pregnancy intention (trying dimension) was associated with higher preconception PA. IMPLICATIONS FOR CANCER SURVIVORS Screening for immediate intentions can identify AYA survivors in need of early preconception health promotion.
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Affiliation(s)
- Hena Naz Din
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA.
| | - David Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr., La Jolla, CA, 92037, USA
| | - Savitri Singh-Carlson
- School of Nursing, San Diego State University, 5500 Campanile Mall, San Diego, CA, 92182, USA
| | - Heather L Corliss
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
- Center for Research On Sexuality and Sexual Health, Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr., La Jolla, CA, 92037, USA
| | - Hala Madanat
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
- Division of Research & Innovation, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - H Irene Su
- Division of Reproductive Endocrinology and Infertility, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
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Dennis CL, Brennenstuhl S, Brown HK, Bell RC, Marini F, Birken CS. High-risk health behaviours of pregnancy-planning women and men: Is there a need for preconception care? Midwifery 2022; 106:103244. [DOI: 10.1016/j.midw.2021.103244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022]
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Socioeconomic Status, Alcohol Use, and Pregnancy Intention in a National Sample of Women. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016. [PMID: 26220497 DOI: 10.1007/s11121-015-0578-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Using data from the 2004 and 2006 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional study was conducted to explore the role of socioeconomic status as a potential modifier on the relationship between a woman's intention to become pregnant and her drinking behaviors. The analytic sample included 37,777 fertile women aged 18-44 years. The primary outcomes were any, heavy, or binge drinking. The analysis included three separate multivariable logistic regression models to account for the complex survey methodology utilized in the BRFSS. In the unadjusted models, women intending a pregnancy were less likely to drink at heavy (OR = 0.68, CI = 0.50, 0.93) or binge (OR = 0.80, CI = 0.67, 0.96) levels compared to those not intending a pregnancy. Adjusted regression models indicated that both education and income modified the relation between pregnancy intention and any drinking and binge drinking. After performing a multivariable regression model stratified by education, women who had more than a high school education and were intending to become pregnant were 28 % less likely to binge drink than those not intending a pregnancy (OR = 0.72, CI = 0.57, 0.90). Stratification by income indicated that women intending to become pregnant within the middle income categories were less likely to drink any alcohol compared to those not intending a pregnancy. Pregnancy intention and binge drinking were associated among women with more than a high school education, with those intending a pregnancy being less likely to binge drink. Generally, as education increased, the association between income and binge drinking weakened.
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Barrett G, Shawe J, Howden B, Patel D, Ojukwu O, Pandya P, Stephenson J. Why do women invest in pre-pregnancy health and care? A qualitative investigation with women attending maternity services. BMC Pregnancy Childbirth 2015; 15:236. [PMID: 26432278 PMCID: PMC4592566 DOI: 10.1186/s12884-015-0672-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 09/25/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite the importance attributed to good pre-pregnancy care and its potential to improve pregnancy and child health outcomes, relatively little is known about why women invest in pre-pregnancy health and care. We sought to gain insight into why women invested in pre-pregnancy health and care. METHODS We carried out 20 qualitative in-depth interviews with pregnant or recently pregnant women who were drawn from a survey of antenatal clinic attendees in London, UK. Interviewees were purposively sampled to include high and low investors in pre-pregnancy health and care, with variation in age, partnership status, ethnicity and pre-existing medical conditions. Data analysis was conducted using the Framework method. RESULTS We identified three groups in relation to pre-pregnancy health and care: 1) The "prepared" group, who had high levels of pregnancy planning and mostly positive attitudes to micronutrient supplementation outside of pregnancy, carried out pre-pregnancy activities such as taking folic acid and making changes to diet and lifestyle. 2) The "poor knowledge" group, who also had high levels of pregnancy planning, did not carry out pre-pregnancy activities and described themselves as having poor knowledge. Elsewhere in their interviews they expressed a strong dislike of micronutrient supplementation. 3) The "absent pre-pregnancy period" group, had the lowest levels of pregnancy planning and also expressed anti-supplement views. Even discussing the pre-pregnancy period with this group was difficult as responses to questions quickly shifted to focus on pregnancy itself. Knowledge of folic acid was poor in all groups. CONCLUSION Different pre-pregnancy care approaches are likely to be needed for each of the groups. Among the "prepared" group, who were proactive and receptive to health messages, greater availability of information and better response from health professionals could improve the range of pre-pregnancy activities carried out. Among the "poor knowledge" group, better response from health professionals might yield greater uptake of pre-pregnancy information. A different, general health strategy might be more appropriate for the "absent pre-pregnancy period" group. The fact that general attitudes to micronutrient supplementation were closely related to whether or not women invested in pre-pregnancy health and care was an unanticipated finding and warrants further investigation.
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Affiliation(s)
- Geraldine Barrett
- Department of Clinical Sciences, Brunel University London, Uxbridge, UB8 3PH, UK.
| | - Jill Shawe
- School of Health Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
| | - Beth Howden
- Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK.
| | - Dilisha Patel
- Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK.
| | - Obiamaka Ojukwu
- Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK.
| | - Pranav Pandya
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK.
| | - Judith Stephenson
- Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK.
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Ramage SM, McCargar LJ, Berglund C, Harber V, Bell RC. Assessment of Pre-Pregnancy Dietary Intake with a Food Frequency Questionnaire in Alberta Women. Nutrients 2015; 7:6155-66. [PMID: 26225996 PMCID: PMC4555116 DOI: 10.3390/nu7085277] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 06/30/2015] [Accepted: 07/09/2015] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Pre-pregnancy is an under-examined and potentially important time to optimize dietary intake to support fetal growth and development as well as maternal health. The purpose of the study was to determine the extent to which dietary intake reported by non-pregnant women is similar to pre-pregnancy dietary intake reported by pregnant women using the same assessment tool. METHODS The self-administered, semi-quantitative food frequency questionnaire (FFQ) was adapted from the Canadian version of the Diet History Questionnaire, originally developed by the National Cancer Institute in the United States. Pregnant women (n = 98) completed the FFQ which assessed dietary intake for the year prior to pregnancy. Non-pregnant women (n = 103) completed the same FFQ which assessed dietary intake for the previous year. Energy, macronutrients, and key micronutrients: long-chain omega-3 fatty acids, folate, vitamin B6, vitamin B12, calcium, vitamin D and iron were examined. RESULTS Dietary intake between groups; reported with the FFQ; was similar except for saturated fat; trans fat; calcium; and alcohol. Pregnant women reported significantly higher intakes of saturated fat; trans fat; and calcium and lower intake of alcohol in the year prior to pregnancy compared to non-pregnant women who reported intake in the previous year. CONCLUSIONS Despite limitations; a FFQ may be used to assist with retrospective assessment of pre-pregnancy dietary intake.
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Affiliation(s)
- Stephanie M Ramage
- Department of Agricultural, Food and Nutritional Science, 4-002 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada.
| | - Linda J McCargar
- Department of Agricultural, Food and Nutritional Science, 4-002 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada.
| | - Casey Berglund
- Department of Agricultural, Food and Nutritional Science, 4-002 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada.
| | - Vicki Harber
- Faculty of Physical Education and Recreation , 3-100 University Hall, Van Vliet Complex, University of Alberta, Edmonton, AB T6G 2H9, Canada.
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, 4-002 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada.
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Stephenson J, Patel D, Barrett G, Howden B, Copas A, Ojukwu O, Pandya P, Shawe J. How do women prepare for pregnancy? Preconception experiences of women attending antenatal services and views of health professionals. PLoS One 2014; 9:e103085. [PMID: 25058333 PMCID: PMC4109981 DOI: 10.1371/journal.pone.0103085] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/27/2014] [Indexed: 11/30/2022] Open
Abstract
MAIN OBJECTIVE To determine the extent to which women plan and prepare for pregnancy. METHODS Cross-sectional questionnaire survey of pregnant women attending three maternity services in London about knowledge and uptake of preconception care; including a robust measure of pregnancy planning, and phone interviews with a range of health care professionals. MAIN RESULTS We recruited 1173/1288 (90%) women, median age of 32 years. 73% had clearly planned their pregnancy, 24% were ambivalent and only 3% of pregnancies were unplanned. 51% of all women and 63% of those with a planned pregnancy took folic acid before pregnancy. 21% of all women reported smoking and 61% reported drinking alcohol in the 3 months before pregnancy; 48% of smokers and 41% of drinkers reduced or stopped before pregnancy. The 51% of all women who reported advice from a health professional before becoming pregnant were more likely to adopt healthier behaviours before pregnancy [adjusted odds ratios for greatest health professional input compared with none were 2.34 (95% confidence interval 1.54-3.54) for taking folic acid and 2.18 (95% CI 1.42-3.36) for adopting a healthier diet before pregnancy]. Interviews with 20 health professionals indicated low awareness of preconception health issues, missed opportunities and confusion about responsibility for delivery of preconception care. SIGNIFICANCE OF THE FINDINGS Despite a high level of pregnancy planning, awareness of preconception health among women and health professionals is low, and responsibility for providing preconception care is unclear. However, many women are motivated to adopt healthier behaviours in the preconception period, as indicated by halving of reported smoking rates in this study. The link between health professional input and healthy behaviour change before pregnancy is a new finding that should invigorate strategies to improve awareness and uptake of pre-pregnancy health care, and bring wider benefits for public health.
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Affiliation(s)
- Judith Stephenson
- Reproductive Medicine, Institute of Women's Health, UCL, London, United Kingdom
| | - Dilisha Patel
- Reproductive Medicine, Institute of Women's Health, UCL, London, United Kingdom
| | - Geraldine Barrett
- Health Sciences and Social Care, Brunel University, Uxbridge, United Kingdom
| | - Beth Howden
- Reproductive Medicine, Institute of Women's Health, UCL, London, United Kingdom
| | - Andrew Copas
- Infection & Population Health, Institute of Epidemiology, UCL, London, United Kingdom
| | - Obiamaka Ojukwu
- Reproductive Medicine, Institute of Women's Health, UCL, London, United Kingdom
| | - Pranav Pandya
- University College London Hospitals, London, United Kingdom
| | - Jill Shawe
- Reproductive Medicine, Institute of Women's Health, UCL, London, United Kingdom
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A prospective study of prevalence and predictors of concurrent alcohol and tobacco use during pregnancy. Matern Child Health J 2013; 17:76-84. [PMID: 22350683 DOI: 10.1007/s10995-012-0949-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Concurrent drinking and smoking during pregnancy is a major public health concern. Changes in these behaviours are under-researched, although essential if effective interventions are to be implemented. Hence this paper investigated characteristics of women who decreased concurrent drinking and smoking during pregnancy. 1,591 women were identified as pregnant at one of three surveys from 2000 to 2006 of the Australian Longitudinal Study on Women's Health and not pregnant at the previous survey. Relative risks (RRs) were calculated for concurrent drinkers and smokers before pregnancy of (1) decreasing drinking, (2) decreasing smoking and (3) decreasing drinking and smoking during pregnancy. Three hundred and fifty-four women (22%) were concurrent drinkers and smokers before pregnancy; of these women, 73% decreased drinking, 72% decreased smoking and 53% decreased drinking and smoking during pregnancy. Decreased concurrent drinking and smoking was significantly higher among women who had at least 12 years education (RRs: 1.5-1.6), who drank at least 1-2 days/week (RRs: 1.5-1.6) and who had 3 or more drinks per occasion (RRs: 1.6-1.8), and significantly lower among heavy smokers, mothers of other children (RRs: 0.8) and disadvantaged women: those stressed about money, with poor mental health, low social support and experience of partner violence (RRs: 0.6-0.7). Clearly programs are needed to tackle concurrent drinking and smoking during pregnancy. Given many pregnancies are unplanned, these programs should target drinking and smoking before and during pregnancy, as well as disadvantaged women, to reduce the deleterious effects of concurrent substance use on their babies and themselves.
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Denny CH, Floyd RL, Green PP, Hayes DK. Racial and ethnic disparities in preconception risk factors and preconception care. J Womens Health (Larchmt) 2012; 21:720-9. [PMID: 22559934 DOI: 10.1089/jwh.2011.3259] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE At-risk drinking, cigarette smoking, obesity, diabetes, and frequent mental distress, as well as their co-occurrence in childbearing aged women, are risk factors for adverse pregnancy outcomes. This study estimated the prevalence of these five risk factors individually and in combination among nonpregnant women aged 18-44 years by demographic and psychosocial characteristics, with a focus on racial and ethnic disparities. METHODS Data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) on nonpregnant women aged 18-44 years (n=54,612) were used to estimate the prevalences of five risk factors, pairs of co-occurring risk factors, and multiple risk factors for poor pregnancy outcomes. RESULTS The majority of women had at least one risk factor, and 18.7% had two or more risk factors. Having two or more risk factors was highest among women who were American Indian and Alaska Native (34.4%), had less than a high school education (28.7%), were unable to work (50.1%), were unmarried (23.3%), and reported sometimes, rarely, or never receiving sufficient social and emotional support (32.8%). The most prevalent pair of co-occurring risk factors was at-risk drinking and smoking (5.7%). CONCLUSIONS The high proportion of women of childbearing age with preconception risk factors highlights the need for preconception care. The common occurrence of multiple risk factors suggests the importance of developing screening tools and interventions that address risk factors that can lead to poor pregnancy outcomes. Increased attention should be given to high-risk subgroups.
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Affiliation(s)
- Clark H Denny
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Abstract
Despite the frequency of and significant costs related to unintended pregnancy, it has received less attention in research and prevention guidelines development than other important health threats. This lack of attention has resulted in a system-wide failure to provide care to reproductive aged women who are at risk of unintended pregnancy. An evidence-based blueprint for a coordinated system of primary, secondary, and tertiary prevention is proposed for health professionals who provide care for patients at risk for unintended pregnancy.
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Affiliation(s)
- Diana Taylor
- School of Nursing University of California, San Francisco, Oakland, CA 94612, USA.
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Green RF, Ehrhardt J, Ruttenber MF, Olney RS. Use of Family History Information for Neural Tube Defect Prevention. AMERICAN JOURNAL OF HEALTH EDUCATION 2011. [DOI: 10.1080/19325037.2011.10599200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ridgely Fisk Green
- a Carter Consulting, Inc. , National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention , Atlanta , GA , 30333
| | - Joan Ehrhardt
- b Michigan Department of Community Health , Bureau of Epidemiology , Lansing , MI , 48913
| | - Margaret F. Ruttenber
- b Michigan Department of Community Health , Bureau of Epidemiology , Lansing , MI , 48913
| | - Richard S. Olney
- c Colorado Department of Public Health and Environment , Colorado Responds to Children with Special Needs , Denver , CO , 80246
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Chuang CH, Hillemeier MM, Dyer AM, Weisman CS. The relationship between pregnancy intention and preconception health behaviors. Prev Med 2011; 53:85-8. [PMID: 21539855 PMCID: PMC3143280 DOI: 10.1016/j.ypmed.2011.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 04/11/2011] [Accepted: 04/14/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe smoking, heavy drinking, and folic acid supplementation in preconception women and determine if the likelihood of healthy preconception behaviors differs by whether and when women intend future pregnancy. METHODS Analysis was based on 35,351 nonpregnant women who participated in the 2004 Behavioral Risk Factor Surveillance System who were of reproductive age (18-44 years), sexually active, and capable of future pregnancy. The association between future pregnancy intention and preconception behaviors was determined adjusting for diabetes, weight category, age group, race/ethnicity, marital status, education, income, and children living in household. RESULTS Eighty percent of women were non-smokers, 94.3% were non-heavy drinkers, and 42.6% were daily folic acid users. In adjusted analysis, only the odds of folic acid supplementation remained higher in women intending pregnancy in the next 12 months (adjusted odds ratio, 1.57; 95% confidence interval, 1.21-2.04) compared with women not intending future pregnancy. Women intending pregnancy later or ambivalent about future pregnancy were no more likely to be engaging in healthy preconception behaviors than women not intending future pregnancy. CONCLUSION Women intending pregnancy within 12 months were more likely to use folic acid, but pregnancy intention was not associated with preconception smoking or heavy drinking.
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Affiliation(s)
- Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA 17033, USA.
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Tenkku LE, Mengel MB, Nicholson RA, Hile MG, Morris DS, Salas J. A Web-Based Intervention to Reduce Alcohol-Exposed Pregnancies in the Community. HEALTH EDUCATION & BEHAVIOR 2011; 38:563-73. [DOI: 10.1177/1090198110385773] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite warnings that drinking during pregnancy is unsafe, many women are still at risk for an alcohol-exposed pregnancy (AEP). This article describes the outcomes of a web-based, self-guided change intervention designed to lower the risk for AEPs in a community. A sample of 458 women, between the ages of 18 and 44 years and at risk for an AEP (i.e., any drinking in the past 30 days and not using reliable contraception), participated in the study. A total of 58% of the women enrolled in the self-guided change intervention were no longer at risk for an AEP at the 4-month follow-up. Sublevel analysis revealed that mail and online versions of the intervention were equally successful at reducing risk for an AEP. This study represents a successful implementation of a web-based, self-guided change intervention to reduce risk for an AEP, an intervention with community-wide reach due to the Internet platform.
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Affiliation(s)
| | - Mark B. Mengel
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Gaydos LM, Neubert BD, Hogue CJR, Kramer MR, Yang Z. Racial disparities in contraceptive use between student and nonstudent populations. J Womens Health (Larchmt) 2010; 19:589-95. [PMID: 20136552 PMCID: PMC6468939 DOI: 10.1089/jwh.2009.1385] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In order to explore opportunities for eliminating the persistent racial disparities in contraceptive use between Caucasian and African American young adults, we examined whether student populations display a reduced racial disparity in overall contraceptive use and use of highly effective contraceptives. METHODS Using data collected from the Behavioral Risk Factor Surveillance System (BRFSS) over 3 years, we conducted multivariate analysis to compare racial disparities in contraceptive use in the nonstudent, young adult (18-24 years) population with those in the student population. Analyses are controlled for age, income, education, and insurance status. RESULTS Both African American students and nonstudents demonstrate a trend of being more likely than their Caucasian counterparts to forego use of contraception, but the findings are statistically significant only for the impact of race on nonstudents (OR = 1.45, 95% CI 1.15-1.84). However, African American students show a greater disparity in using effective contraceptive methods compared with Caucasian peers (OR = 0.459, 95% CI 0.316-0.668) than in the nonstudent population (OR = 0.591, 95% CI 0.488-0.715). CONCLUSIONS Although race is not significant for predicting overall use of contraceptives among students, racial disparities are magnified among student populations with regard to use of highly effective contraceptives. Contraceptive counseling for African American young adults should focus on method effectiveness and consider additional issues, such as insurance coverage for contraceptives. For students, targeted counseling or interventions may be required.
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Affiliation(s)
- Laura M Gaydos
- Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Differences between women at higher and lower risk for an unintended pregnancy. Womens Health Issues 2009; 19:306-12. [PMID: 19733800 DOI: 10.1016/j.whi.2009.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 06/15/2009] [Accepted: 06/16/2009] [Indexed: 11/21/2022]
Abstract
CONTEXT Little is known about the preconception health status of women that are at risk for an unintended pregnancy. OBJECTIVE We hypothesized that women at high risk for an unintended pregnancy would engage in less healthy behaviors and would have fewer health care encounters than women at lower risk. DESIGN Using the Behavioral Risk Factor Surveillance System (2002 and 2004 datasets), we examined health factors of 18- to 44-year-old, fertile women who were not intending a pregnancy, grouped into high-risk (n=16,113) or low-risk (n=39,426) groups. Women were designated as high risk for an unintended pregnancy based on their non-use of birth control, and women were designated as low-risk for an unintended pregnancy based on their use of birth control. RESULTS Controlling for variables that mask or exacerbate relationships between risk factors and outcomes was an important component of this study. After controlling for the effects of demographic characteristics, we found that high-risk women remained 1.23 times more likely to be obese (confidence interval [CI], 1.12-1.34) and 1.2 times more likely to smoke (CI, 1.11-1.31), both significant findings. We also found high-risk women to be 27% less likely to exercise (CI, 0.67-0.79), 62% less likely to receive a Pap test (CI, 0.31-0.46), 19% less likely to have HIV testing (CI, 0.75-0.87), and 44% less likely to have received sexually transmitted diseases counseling (CI, 0.50-0.63) compared with low-risk women. Interestingly, high-risk women were 27% less likely to use any alcohol (CI, 0.67-0.79) and 11% less likely to binge drink (CI, 0.80-0.99) compared with women at low-risk for an unintended pregnancy. CONCLUSIONS Nearly one third of women at risk for an unintended pregnancy are not using any contraceptive method (29%), and these high-risk women also have higher proportions of unhealthy behaviors and significantly lower clinical health encounters than women using any form of birth control (low-risk women).
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