U.S. Women's Knowledge of Reproductive Biology.

BACKGROUND: Having accurate knowledge of reproductive biology can help women to improve their general, sexual, and reproductive health and assert their sexual and reproductive rights. METHODS: This cross-sectional study examined knowledge of three topics (age-related fertility decline, egg supply, fertile period) among a national probability sample of 1,779 nonsterilized, English-speaking women (aged 18-29 years) in the U.S. general population. Using bivariate and multivariable regressions, we assessed associations between knowledge of these topics and individual characteristics. RESULTS: Most respondents were unmarried (63%), childless (78%), and intended to have children (65%); 51% did not know whether they would have difficulty conceiving, and 44% had discussed fertility-related topics with a health care provider. More respondents knew the age of marked fertility decline (62%) than the fertile period (59%) or that ovaries do not continuously produce new eggs (45%); 22% knew all three topics, and 13% knew none. In multivariable analysis, knowledge was positively associated (p < .001) with education, income, and having regular periods. Black and Asian respondents and those for whom religion was very important were less likely (all p values < .01) than White and nonreligious respondents to know all three topics. Knowledge was unrelated to relationship status, parity, childbearing intentions, receipt of fertility-related counseling or services, self-perceived infertility risk, or health status; the relationship with Hispanic ethnicity approached but did not reach significance (p = .08). CONCLUSIONS: Young U.S. women have incomplete knowledge of aspects of their reproductive biology; these knowledge gaps could increase their risk of adverse health and reproductive outcomes. Policy-, provider-, and client-level interventions are warranted to address these knowledge gaps.

Factors influencing women's decisions about pregnancy spacing: Findings from a focus group discussion study.

OBJECTIVES: Very short interpregnancy intervals are associated with negative health outcomes for mothers and children, and pregnancies with very short interpregnancy intervals are more likely to be unintended than pregnancies that are more widely spaced. The objective of this study was to improve understanding of women's motivations regarding pregnancy spacing. METHODS: In 2017, we conducted 8 focus group discussions with 49 English- and Spanish-speaking postpartum women in central North Carolina. The groups explored participants' preferences for birth spacing and factors that influenced their decisions. We recorded, transcribed, and coded the discussions and analyzed these data for core themes. RESULTS: Participants' ideas about when and whether to have more children were fluid-some had specific ideas during pregnancy or after delivery that changed over time; others had no definite plans. The primary reason for close birth spacing was to promote their children's having a closer relationship. Reasons for wider spacing included recovery from the previous pregnancy, challenges related to having 2 babies concurrently, and desire to wait for more favorable life circumstances. Participants did not mention health risks to children of short interpregnancy intervals and said that no health care providers discussed these risks with them. They had mixed perspectives about whether this information would influence their own child-spacing preferences but agreed that it should be shared with women to promote informed decision-making. CONCLUSION: This study adds to limited research regarding the factors that women consider when determining pregnancy spacing. Better understanding of women's motivations can help inform counseling to help women achieve their desired pregnancy spacing.

A Computerized Family Planning Counseling Aid: A Pilot Study Evaluation of Smart Choices.

CONTEXT: Resource constraints may make it challenging for family planning clinics to provide comprehensive contraceptive counseling; technological tools that help providers follow recommended practices without straining resources merit evaluation. METHODS: A pilot study using a two-group, posttest-only experimental design evaluated Smart Choices, a computer-based tool designed to help providers offer more patient-centered counseling and enable patients to participate proactively in the counseling session. In two North Carolina family planning clinics, 214 women received usual counseling in March-May 2013, and 126 women used Smart Choices in May-July 2013. Exit interviews provided data for the evaluation. Multivariate Poisson and multinomial logistic regression analyses were performed to examine group differences in counseling outcomes. RESULTS: Three of 12 hypotheses tested were supported: Compared with controls, women in the intervention group knew more contraceptive methods (adjusted mean, 11.1 vs. 10.7); discussed more topics related to sexual health during counseling (1.2 vs. 0.9 among those reporting any discussion); and rated counseling as more patient-centered, an indication of how well they felt providers understood their family planning circumstances and ideas (3.9 vs. 3.7 on a scale of 1-4). Contrary to another hypothesis, controls were more likely than women in the intervention group to choose IUDs and implants. CONCLUSIONS: Computerized counseling aids like Smart Choices are in an early stage of development. Future research is warranted to develop tools that lead to more productive and individualized clinic visits and, ultimately, to more effective contraceptive use and reduced levels of unintended pregnancy.

Feasibility and acceptability of a computer-based tool to improve contraceptive counseling.

OBJECTIVE: The objective was to test the feasibility and acceptability of a computerized tool, Smart Choices, designed to enhance the quality of contraceptive counseling in family planning clinics. The tool includes (a) a questionnaire completed by patients and summarized in a printout for providers and (b) a birth control guide patients explore to learn about various contraceptive methods. STUDY DESIGN: In 2 family planning clinics, we conducted interviews with 125 women who used the Smart Choices computerized tool and 7 providers. RESULTS: Smart Choices integrated into clinic flow well in one clinic, but less well in the other, which had very short waiting times. Patients were generally enthusiastic about Smart Choices, including its helpfulness in preparing them and their providers for the counseling session and increasing their knowledge of contraceptive methods. Providers varied in how much they used the printout and in their opinions about its usefulness. Some felt its usefulness was limited because it overlapped with the clinic's intake forms or because it did not match with their concept of counseling needs. Others felt it provided valuable information not collected by intake forms and more honest information. Some found Smart Choices to be most helpful with patients who were unsure what method they wanted. CONCLUSIONS: Smart Choices is feasible to implement and well received by patients, but modifications are needed to increase provider enthusiasm for this tool. IMPLICATIONS: The Smart Choices tool requires refinement before widespread dissemination.

Postpartum contraceptive use among adolescent mothers in seven states.

PURPOSE: To describe postpartum contraceptive use among adolescent mothers and assess the hypothesis that receipt of prenatal contraceptive counseling or a postpartum checkup is associated with the use of more effective methods. METHODS: Data are from the Pregnancy Risk Assessment and Monitoring System for seven states and the city of New York for the years 2006-2008. The sample comprises 3,207 adolescent mothers aged 15-19 years. We conducted descriptive and multinomial logistic regression analyses. The outcome measure was the type of contraceptive method used at the time of the survey. RESULTS: Nineteen percent of adolescent mothers, more than half of whom were sexually active, were using no contraception at the time of the survey. The remaining 81% were using a contraceptive method. Use of long-acting reversible contraception (LARC) was low-11% were using an intrauterine device, and only 1% were using an implant. Receipt of prenatal contraceptive counseling and receipt of a postpartum checkup were both associated with a decreased likelihood of having sex without contraception. A postpartum checkup was also associated with an increased likelihood of using medium-acting contraceptives (injectables, ring, or patch) and a decreased likelihood of relying on condoms. Prenatal contraceptive counseling was also associated with an increased likelihood of pill use. CONCLUSIONS: Given the demonstrated association between LARC use and decreased rates of rapid repeat pregnancy, efforts should be made to increase adolescent mothers' access to LARC. Enhancing the scope and quality of prenatal contraceptive counseling and increasing the proportion of adolescent mothers who return for a postpartum checkup may also improve postpartum contraceptive use.

Adolescent mothers' postpartum contraceptive use: a qualitative study.

CONTEXT: Effective contraceptive use among first-time adolescent mothers can reduce the risk of a rapid repeat pregnancy and associated negative maternal and child health outcomes. Many adolescent mothers begin using a highly effective method after delivery; however, their rates of contraceptive discontinuation are high. Little research has explored the factors that influence adolescents' postpartum contraceptive use. METHODS: In-depth interviews were conducted with 21 black, white and Latina adolescent first-time mothers from rural and urban areas of North Carolina between November 2007 and February 2009. In addition, interviews were conducted with 18 key informants-professionals who work closely with adolescent mothers. Interviews explored adolescent mothers' health behaviors, including contraceptive use, before and after pregnancy. Content analysis was used to identify key themes and patterns. RESULTS: Teenagers' use of contraceptives, particularly injectables, IUDs and implants, increased postpartum. Reasons for this improvement included improved clarity of intention to avoid pregnancy and improved contraceptive knowledge, support and access after delivery. However, this increased access often did not continue long after delivery, and levels of method switching were high. Among the barriers to postpartum contraceptive use that key informants cited were lack of information and parental support, as well as the loss of Medicaid and continuity of care. CONCLUSIONS: Ongoing follow-up may help reduce adolescent mothers' risk of contraceptive discontinuation postpartum. Increasing use of long-acting methods also may help reduce their vulnerability to gaps in contraceptive use and discontinuation, which increase the risk of unintended pregnancy.

Attitudes, experience, and anticipation of sex among 5th graders in an urban setting: does gender matter?

To identify gender differences in correlates of anticipation and initiation of sexual activity in the baseline survey of 562 African-American 5th grade students prior to initiation of a school-based pregnancy prevention intervention curriculum. Students from 16 elementary schools were administered the baseline questionnaire during classroom periods. Using these data, binary and ordered logistic regression models were used to analyze the factors affecting virginity and anticipation of sexual activity separately by gender, and tests of interaction between each factor and gender were conducted on the combined sample. More boys than girls had already had sex (18% vs. 5%) and anticipated having sexual intercourse in the next 12 months (56% vs. 22%). Boys and girls also differed in the factors that affected these outcomes. The perception that their neighborhood was safe reduced the odds that boys anticipated sexual activity but was not associated with this outcome among girls. Pubertal knowledge increased the odds of anticipation, but only among boys. Attitudes favoring abstinence decreased anticipation of sex among both genders, but slightly more among girls than boys. Having more frequent parent-child communication about sex was associated with increased anticipation among girls but decreased anticipation among boys. Curriculum based approaches to adolescent pregnancy prevention are appropriate for 5th grade elementary students who may already be anticipating sexual activity in communities with disproportionate rates of teen pregnancy. The design of the interventions should consider the differences in motivating factors by gender.

Relationships of Pubertal Development Among Early Adolescents to Sexual and Nonsexual Risk Behaviors and Caregivers' Parenting Behaviors.

Using a school-based sample of Washington, DC, fifth graders (mean age 10.38, SD = 0.66) and their parents (N = 408), we examined associations of pubertal development with early adolescents' sexual and nonsexual risk behaviors and their caregivers' parenting behaviors; and of these risk behaviors with parenting behaviors. Youths reporting signs of pubertal development were more likely to engage in these risk behaviors than students reporting no signs. Pubertal development was not related to parenting behaviors; however, parents of youths who reported multiple nonsexual risk behaviors reported more parent-child communication about sexual topics. These results highlight the need to begin risk prevention efforts early, prior to pubertal development. Research is needed to understand how parents can help youths better cope with pubertal development to avoid involvement in sexual and nonsexual risk behaviors.

Evaluation of a randomized intervention to delay sexual initiation among fifth-graders followed through the sixth grade.

US adolescents initiate sex at increasingly younger ages, yet few pregnancy prevention interventions for children as young as 10-12 years old have been evaluated. Sixteen Washington, DC schools were randomly assigned to intervention versus control conditions. Beginning in 2001/02 with fifth-grade students and continuing during the sixth grade, students completed pre-intervention and post-intervention surveys each school year. Each year, the intervention included 10-13 classroom sessions related to delaying sexual initiation. Linear hierarchical models compared outcome changes between intervention and control groups by gender over time. Results show the intervention significantly decreased a rise over time in the anticipation of having sex in the next 12 months among intervention boys versus control boys, but it had no other outcome effects. Among girls, the intervention had no significant outcome effects. One exception is that for both genders, compared with control students, intervention students increased their pubertal knowledge. In conclusion, a school-based curriculum to delay sexual involvement among fifth-grade and sixth-grade high-risk youths had limited impact. Additional research is necessary to outline effective interventions, and more intensive, comprehensive interventions may be required to counteract adverse circumstances in students' lives and pervasive influences toward early sex.ClinicalTrials. gov identifier: NCT00341471.

Mothers, fathers, sons, and daughters: gender differences in factors associated with parent-child communication about sexual topics.

BACKGROUND: In the United States, nearly half of high school students are sexually active, and adolescents experience high rates of unintended pregnancy and sexually transmitted diseases. Parents can have an important influence on their children's sexual behaviour, but many parents do not talk with their children about sexual topics. Research has shown significant differences in parent-child communication about sexual topics depending on the gender of both the parent and the child. Little is known, however, about the reasons for these gender differences. The purpose of this paper is to describe how factors associated with parent-child communication about sexual topics differ by gender. METHODS: Data are from a nationwide online survey with 829 fathers and 1,113 mothers of children aged 10 to 14. For each of the four gender groups (fathers of sons, fathers of daughters, mothers of sons, mothers of daughters), we calculated the distribution of responses to questions assessing (1) parent-child communication about sex-related topics, and (2) factors associated with that communication. We used chi-square tests to determine whether the distributions differed and the false discovery rate control to reduce the likelihood of type I errors. RESULTS: With both sons and daughters, fathers communicated less about sexual topics than mothers did. Fathers also had lower levels of many characteristics that facilitate communication about sex (e.g., lower self-efficacy and lower expectations that talking to their children about sex would have positive outcomes). Compared with parents of sons, parents of daughters (both mothers and fathers) talked more about sexual topics, were more concerned about potential harmful consequences of sexual activity, and were more disapproving of their child having sex at an early age. CONCLUSIONS: Using a large national sample, this study confirms findings from previous studies showing gender differences in parent-child communication about sexual topics and identifies gender differences in factors that may influence parent-child communication about sexual topics. Interventions designed to support parent-child communication about sexual topics should emphasize to both mothers and fathers the importance of talking to sons as well as daughters. Fathers need particular support to overcome the barriers to communication they encounter.

"We're the heroes!": fathers' perspectives on their role in protecting their preteenage children from sexual risk.

CONTEXT: Parents can be an important influence on their children's sexual behavior. However, relatively little research has focused on fathers' roles in protecting children from sexual risk or on their discussions with children about sex. METHODS: Sixteen focus groups comprising 131 parents of children aged 10-12 were conducted in three U.S. cities in 2007. Separate groups were held for mothers and fathers, and for white, black, English-speaking Hispanic and Spanish-speaking Hispanic participants. Content analysis was used to identify core themes and patterns related to fathers' communications with their children about sex. RESULTS: Fathers were highly invested in ensuring that their children are safe and successful in life. Although some had not talked to their children about sex, others had discussed it frequently and openly, and nearly all agreed that fathers' perspectives are important for children to hear. Fathers reported being better suited to discussing some topics (e.g., male puberty, how young men think) than others (menstruation). Fathers also described other strategies that they use to guide their children's development, such as emphasizing future goals and monitoring children's activities and friends. Many fathers, especially Hispanic participants, reported being more protective of daughters than of sons, and some had particular difficulty talking with their daughters about sex. CONCLUSIONS: Research and interventions concerning parent-child communication about sex should not neglect the role of fathers. However, some fathers may need support to overcome barriers to effective communication, especially with their daughters.

Parents' perspectives on talking to preteenage children about sex.

CONTEXT: Although parent-child communication about sex can significantly affect children's sexual behavior, many parents do not talk to their children about sex. Qualitative research can elucidate parents' attitudes toward and experiences with communicating with their children about sex. METHODS: In 2007, 16 focus groups were conducted with 131 mothers and fathers of children aged 10-12 in three cities in different regions of the United States. Separate groups were conducted for mothers and fathers, and for black, white and Hispanic parents. Content analysis was used to identify core themes and patterns. RESULTS: Parents believed it is important to talk to their children about sex and believed that doing so can be effective, but many had not done so. Primary barriers were parents' perception that their children are too young and not knowing how to talk to their children about the subject. Parents found it easiest to talk to their children about sex if they had a good parent-child relationship, took advantage of opportunities to talk and began having the discussions when their children were very young. Some differences were noted by parents' race, ethnicity, gender and location. CONCLUSIONS: Interventions aimed at encouraging parents to talk to their children about sex should enhance parents' understanding of the stages of children's sexual development and focus on the parents of young children. In addition, interventions should support parents in a range of strategies that complement discussions about sex.

Associations between low-income women's relationship characteristics and their contraceptive use.

CONTEXT: Women's relationship context likely influences both their ability and their motivation to use contraceptives. No recent studies, however, have examined associations between women's relationship characteristics and use of different methods. METHODS: Data were collected in a longitudinal study of 839 low-income women at risk of unintended pregnancy who visited public family planning and postpartum clinics and maternity wards in two Southeastern cities. Simulated probabilities calculated from multivariate analyses assessed associations between a wide range of relationship characteristics and the use of no method, condoms, withdrawal, female methods or dual methods. RESULTS: Women who had had a child with their partner had an increased likelihood of contraceptive nonuse and use of withdrawal, and a decreased likelihood of using any female method. Respondents who were in a relationship for a relatively long time had an elevated likelihood of nonuse and use of female methods, but a lowered likelihood of condom use. Furthermore, married or cohabiting women were less likely than others to use dual methods. Respondents who had good communication with their partner had an elevated likelihood of using condoms. In addition, women who expected to receive a lot of emotional support from their partner if they became pregnant were more likely than others to report any condom use or dual method use, and less likely to report contraceptive nonuse. CONCLUSIONS: When counseling family planning clients, providers should consider women in the context of their relationships. Future research exploring factors associated with contraceptive method use should examine variables related to the establishment, quality and expectations of their relationships.

The multistate life table method: an application to contraceptive switching behavior.

In many demographic behaviors (e.g., those relating to marriage, contraception, migration, and health), people change among multiple statuses through time, sometimes leaving and then returning to the same status. Data on such behaviors are often collected in surveys as censored event histories. The multistate life table (MSLT) can be used to properly describe, in a single analysis, these complex transitions among multiple states measured in such data, but MSLT is rarely applied in the demographic literature because practical guidance is lacking on how to compute MSLTs with such data. We provide methods for computing MSLT quantities using censored event-history data: namely, transition intensities and probabilities, "state occupancy" probabilities and standard errors, average time spent in specified states, and average number of visits to specified states. Applying these methods to contraceptive use, we find high levels of switching back and forth, particularly between barrier methods and non-use, resulting in high rates of unintended pregnancy.

Parents' views on sexual debut among pre-teen children in Washington, DC.

OBJECTIVE: Present US parents' perceptions about factors leading to early intercourse and strategies for overcoming them. METHODS: Conducted analysis of eight focus groups with 78 male and female African-American and Hispanic caregivers of fifth-graders and sixth-graders (ages 10-12). RESULTS: Participants gave the following primary reasons for early sexual activity: lack of structured activities, adult supervision, and communication; and influence of peers, society, and media. They suggested strategies targeting these reasons, and the need for parents, schools, and the community to work together. CONCLUSION: Incorporating parents' perspectives would help tailor interventions to the needs of the target population and increase parental support.

The Relationship Context: Its Effects on Low-Income Women's Desire for a Baby.

Little is known about the influence of relationship characteristics on a woman's desire for a baby with her partner. This study addresses that gap, using data from a study of 1,114 low-income women in the southeast who were in a relationship. Controlling for sociodemographic factors, women who were in more established relationships, who had not had a previous child with their partner, or who had higher expectations of their partner were generally more likely to want a baby with him. In investigating women's childbearing desires, it is important to consider not only individual characteristics but also women's relationship characteristics.

The influence of primary caregivers on the sexual behavior of early adolescents.

PURPOSE: To describe rates of sexual intercourse initiation, anticipated level of sexual activity in the next 12 months, and other risk behaviors among fifth graders and to examine parental factors associated with such behaviors. METHODS: This study is based on a cross-sectional, self-administered survey conducted with a nonrandom sample of 408 fifth graders and their caregivers. Children answered questions regarding sexual intercourse initiation, anticipated sexual activity in the next 12 months, and involvement in other risk behaviors. Caregivers answered questions about parenting factors such as monitoring behaviors, parent-child relationship quality, and parent-child communication. Bivariate and multivariable analyses examined the association of these variables with the adolescents' behaviors. RESULTS: Almost 5% of girls and 17% of boys reported they had engaged in sexual intercourse. Only 34% of girls and 13% of boys said they did not expect to engage in any type of sexual contact in the next 12 months if they were going with someone they "liked a lot." Parental factors associated with fewer risk behaviors and expected sexual behaviors included higher levels of monitoring, fewer communication barriers, less permissive attitudes regarding adolescent sexual behavior, higher relationship quality with child, having fewer than five children in the household, higher levels of education, and being employed. Significant gender interactions were found for several variables. CONCLUSIONS: Adolescents are initiating sexual intercourse at extremely young ages. To delay early sexual activity and prevent adolescent pregnancy, prevention efforts must begin during the elementary school years and include those who raise and care for the adolescent.

Context of Acceptability of Topical Microbicides: Sexual Relationships.

Domains central to the effects of sexual relationships on the acceptability of a vaginal protection method were explored in 14 focus groups and 38 in-depth interviews with women and men recruited from a health department's sexually transmitted infections (STI) and family planning clinics. Findings indicate that acceptability depended on a couple's relationship type, classified as serious, casual, or "new." Potential barriers to communication about product use may be overcome through direct or indirect covert use, depending on relationship type. More men than women thought women should always tell their partners if they use microbicides, regardless of relationship type. Results indicate the importance of the relationship context in understanding the likely acceptability of using microbicides, and perhaps any method of STI/HIV protection.