Relationship Violence Typologies and Condom Use in Young Adult Dating Relationships.

CONTEXT: Intimate partner violence is one dimension of relationships that may influence condom use, yet few studies have examined male- and female-initiated violence in efforts to understand variation in condom use. METHODS: Power dynamics and relationship conflict approaches were employed to examine the association between relationship violence and condom use. In a latent class analysis of 8,599 dating relationships from Wave 3 (2001-2002) of the National Longitudinal Study of Adolescent to Adult Health, when the respondents were aged 18-25, relationship violence was characterized by the severity and frequency of violence and the perpetrator's gender. Random-effects logistic regression analyses assessed the association between violence classes and condom use. RESULTS: One in five young adult dating relationships involved violence in the past year. Four violence classes were identified: one male-dominant class (3% of relationships), in which many relationships had reciprocal violence; two female-dominant classes, differentiated by the frequency and severity of violence (2% low-intensity, 4% medium-intensity); and one class with limited or no violence (91%). Male-perpetrated violence was reported less frequently but was more severe than female-perpetrated violence. Respondents in relationships in the male-dominant/high-intensity and the female-dominant/medium-intensity classes were less likely to report condom use than those in relationships in the no/low-violence class (odds ratios, 0.4-0.5). CONCLUSIONS: This work expands on research focusing only on male-perpetrated violence and highlights the importance of capturing relationship violence in national data sets. Future surveys that collect information about violence from both partners can inform efforts to prevent violence and to support victims.

Reassessing the importance of long-acting contraception.

BACKGROUND: Several recent studies have highlighted the need for greater use of long-acting contraception. The most influential of these studies is the Contraceptive CHOICE Project, which was credited with substantially reducing participants' pregnancy risk by increasing their use of long-acting methods such as intrauterine devices and subdermal implants. However, because participants' rates of nonuse and condom use fell to zero at the outset of the intervention, it is possible that sizable pregnancy reductions could still have been achieved if enrollees had chosen shorter-acting, female-controlled methods such as oral contraception. OBJECTIVE: The objective of the study was to estimate the proportion of the CHOICE Project's fertility impacts that could have been achieved without any increase in long-acting method use. STUDY DESIGN: The FamilyScape 3.0 microsimulation model was used to estimate CHOICE's impact on pregnancy risk and to simulate the counterfactual effect of moving all nonusers and condom users onto shorter-acting, female-controlled methods. FamilyScape models the sexual and contraceptive behaviors of women in the United States between 2006 and 2010, which is the period when CHOICE was implemented. RESULTS: Nearly three quarters of the CHOICE intervention's effects on pregnancy risk could have been achieved if participants had chosen shorter-acting, female-controlled methods over long-acting methods. CONCLUSION: Prioritizing the adoption of long-acting contraception may not be the most advisable strategy for reducing unintended pregnancy. The most impactful interventions will likely be those that increase the use of female-controlled methods, long-acting or otherwise.

The intensive and extensive margins of contraceptive use: comparing the effects of method choice and method initiation.

OBJECTIVES: The risk of pregnancy is estimated to be 20 times as high among women who use oral contraception, and 90 times as high among condom users, as among women who use certain long-acting contraceptive methods. We explored the population-level implications of this variation in contraceptive efficacy. STUDY DESIGN: We used the FamilyScape 3.0 microsimulation model to study the effects on the nonmarital pregnancy rate of movements along two different margins of contraceptive behavior: the extensive margin, which captures decisions about whether to initiate use of any method of contraception among noncontraceptors; and the intensive margin, which captures the choice of methods among contraceptors. The model is populated with a nationally representative sample of 50,000 women who are of childbearing age. RESULTS: The impact on the number of nonmarital pregnancies would not be substantially different if noncontraceptors adopted long-acting methods than if they began using oral contraception. Moreover, the nonmarital pregnancy rate would be reduced by about twice as much if a subset of noncontraceptors began using condoms as if an equal number of pill users took up long-acting methods. CONCLUSIONS: The prevailing emphasis on long-acting contraception is somewhat misplaced. Policymakers and practitioners will have the largest effects on fertility outcomes if they can change the behavior of sexually active women who neglect to use birth control when they are not seeking pregnancy. IMPLICATIONS: Women's decisions about which methods to use are less impactful than their decisions about whether to use contraception at all. The policies that affect method choice are likely to differ from the policies that address the underlying motivations of noncontraceptors who are not seeking pregnancy.