Sex Differences in Contraception Non-Use Among Urban Adolescents: Risk Factors for Unintended Pregnancy

Depression, Contraception, and Ambivalence Concerning Fertility

Individuals suffering from depression exhibit a higher rate of unintended pregnancies, which are associated with negative outcomes for both parents and children. Often, unintended pregnancies result from contraceptive mistakes. Here, we examine the relationship between depression and the consistency of contraceptive behavior, testing ambivalence as a possible mediator. The analyses were based on cross-sectional data from the second and third waves of the German Relationship and Family Panel Pairfam. A German-speaking sample without children (N = 190; 117 female, 73 male), who reported not attempting to conceive or become pregnant during the last 12 months, was analyzed in comparison with a propensity score matched sample. Ambivalence was operationalized as the difference between the ideal and realistic number of children in wave 2. Data from wave 3 were used to assess contraceptive behavior. Depressed mood in wave 2 and consistency of contraceptive behavior in wave 3 were negatively correlated. After including ambivalence in wave 2 as a mediator in the model, the direct path between depressed mood and consistency of contraceptive behavior remained significant, with no significant mediation found. For men only, we observed a significant negative association of ambivalence with the consistency of contraceptive behavior in the last 3 months. No significant relationship was found between depressed mood and ambivalence. We conclude that future research aiming to better understand the consistency of contraceptive behavior should incorporate measures of ambivalence.

Using the intervention mapping for adaption framework to adapt an evidence-based sexual health intervention for youth affected by trauma

BACKGROUND

Children exposed to household challenges (i.e., parental substance use, incarceration, and mental illness) are among the groups most vulnerable to sexual risk-taking in adolescence. These behaviors have been associated with a range of negative outcomes later in life, including substance abuse, low educational attainment, and incarceration. Adapting an evidence-based intervention (EBI) to be suitable for this population is one strategy to address the needs of this group.

METHODS

In this study, we describe the use of the Intervention Mapping for Adaption (IM-Adapt) framework to adapt an evidence-based, sexual health intervention (Focus on Youth with Informed Children and Parents). We describe the actions taken at each step of the IM-Adapt process which are to assess needs, search for EBIs, assess fit and plan adaptions, make adaptions, plan for implementation and plan for evaluation.

RESULTS

Key changes of the adapted intervention include the incorporation of trauma-informed principles and gender inclusive language, standardization of the session length, and modernization of the content to be more appropriate for our priority population.

CONCLUSIONS

The adapted intervention shows promise toward meeting the behavioral health needs of Black youth exposed to household challenges. Our process and approach can serve as a model for researchers and practitioners aiming to extend the reach of EBIs.

Clustering of characteristics associated with unplanned pregnancies: the generation R study

Background

Unplanned or unintended pregnancies form a major public health concern because they are associated with unfavorable birth outcomes as well as social adversity, stress and depression among parents-to-be. Several risk factors for unplanned pregnancies in women have previously been identified, but studies usually take a unidimensional approach by focusing on only one or few factors, disregarding the possibility that predictors might cluster. Furthermore, data on predictors in men are largely overlooked. The purpose of this study is to determine predictors of unplanned versus planned pregnancy, to determine predictors of ambivalent feelings regarding pregnancy, and to investigate how characteristics of men and women with an unplanned pregnancy cluster together.

Methods

This study was embedded in Generation R, a multiethnic population-based prospective cohort from fetal life onwards. Pregnancy intention was reported by 7702 women and 5367 partners. Information on demographic, mental, physical, social, and sexual characteristics was obtained. Logistic regression, multinomial regression and cluster analyses were performed to determine characteristics that were associated with an unplanned pregnancy, with ambivalent feelings regarding the unplanned pregnancy and the co-occurrence of characteristics in women and men with unplanned pregnancy.

Results

Twenty nine percent of the pregnancies were unplanned. Logistic regression analyses showed that 42 of 44 studied predictors were significantly associated with unplanned pregnancy. The most important predictors were young age, migration background, lower educational level, lower household income, financial difficulties, being single, lower cognitive ability, drug use prior to pregnancy, having multiple sexual partners in the year prior to the pregnancy, younger age of first sexual contact and a history of abortion. Multinomial regression analyses showed that a Turkish or Moroccan background, Islamic religion, little financial opportunities, being married, having ≥3 children, high educational level, more mental health and social problems and older age of first sexual contact were associated with prolonged ambivalent feelings regarding pregnancy. Different combinations of characteristics were observed in the four clusters of women and men with unplanned pregnancy.

Conclusions

Many predictors are related with unplanned pregnancies, ambivalent feelings toward the pregnancy, and we identified very heterogeneous groups of women and men with unplanned pregnancies. This calls for heterogeneous measures to prevent unplanned pregnancies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14342-y.

Association between relationship characteristics, sexual health attitudes, and dual contraceptive use among young adult college students aged 18-24

Objective Determine the relationship characteristics, sexual health attitudes, and demographic factors associated with dual contraceptive use among college students. Participants: September-October 2018 via campus email, we recruited College of Public Health students attending a large, urban, public university (N = 424). Methods: Respondents completed a cross-sectional, Web-based sexual health questionnaire. Descriptive statistics were calculated. Multiple logistic regression models were run to determine the association between relationship characteristics, pregnancy and condom attitudes, demographics, and dual use the last time having sex. Results: In independent models, one-unit increase in trust (aOR = 0.982; 95% CI: 0.966-0.998) and commitment score (aOR = 0.987, 95% CI: 0.976-0.999) was inversely associated with dual use while sex with a casual date/acquaintance (aOR = 3.149; 95% CI: 1.550-6.397) was positively associated. In a fully adjusted model for all correlates, only trust score was significant (aOR = 0.982; 95% CI: 0.966, 0.998). Conclusions: Emotion-based constructs may be more influential on dual use behaviors than discrete relationship factors.

Social support reduces the risk of unintended pregnancy in a low-income population

Almost half of all pregnancies (45%) in the United States (US) are unintended, with the highest concentration in women with low incomes. Targeted research is warranted to identify risk and protective factors that influence pregnancy intention to improve maternal/child health.

PURPOSE

To identify individual and interpersonal level associations to pregnancy intention to use as leverage points to build resilience.

METHOD

A cross-sectional, secondary analysis of Medicaid eligible pregnant women in Kentucky (n = 309).

RESULTS

Sixty-two percent reported their current pregnancy was unintended. Older age, partnered, negative drug screen, and increased social support were associated with decreased odds of unintended pregnancy. For every 1 unit increase of belonging and tangible social support, women were 13% and 14% (respectively) less likely to have an unintended pregnancy (OR = 0.87, 95% CI = 0.78-0.97, p = .011, OR = 0.86, 95% CI = 0.77-0.95, p = .005). A positive drug screen was associated with an almost three-fold increase in the odds of unintended pregnancy (OR = 2.88, 95% CI = 1.49-5.58, p = .002).

CONCLUSION

Public health nurses can play a critical role in reducing unintended pregnancy rates by promoting social support, inclusion, and acceptance. There remains a critical need to identify barriers and facilitators to pregnancy planning for persons who use illicit drugs.

Associated factors and sex differences in condom non-use among adolescents: Brazilian National School Health Survey (PeNSE)

Background

Condom non-use among sexually active adolescents is a major cause of unintended pregnancy and sexually transmitted infections. In order to promote condom use, it is essential to understand factors associated with condom non-use.

Aim

Our aim was to evaluate sex differences and associated factors of condom non-use based on the nationally representative Brazilian National School Health Survey.

Methods

The study participants were 100,962 adolescents 13–18 years old, 9th graders from both public and private schools throughout Brazil. The following factors were considered as explanatory group variables for the outcome of condom non-use among adolescents: school and health service, sexual behavior, substance use, and self-reported body and health perception. Poisson regression model was performed.

Results

Of the total students, 28% (n = 28,157) had had sexual intercourse at least once. (boys, 37.1%; girls, 19.5%). Of these, 69.2% had used condoms the last time they had intercourse (girls: 68%; boys: 69.9%). The variables associated with condom non-use for both sexes were not having accessed a health service or approached a health professional for health-related care; not having received pregnancy prevention counseling or guidance on AIDS or STI prevention at school; early sexual initiation; no additional contraception method; substance use; feeling alone; not being satisfied with their own body; feeling fat or thin; and poor self-reported health. The number of sexual partners was also associated with condom non-use; however, contrasting behavior was indicated between sexes. A higher number of sexual partners indicated less use of condoms among girls, while for boys, a higher number of sexual partners indicated higher condom use.

Conclusion

High condom non-use appears to be associated with lack of health care access and sexual health education, poor sexual practices, substance use, and poor self-perception, indicating areas for health promotion programs.