Women's experiences with person-centered family planning care: Differences by sociodemographic characteristics.

Objective: Person-centered contraceptive care is associated with positive reproductive health outcomes. Our objective was to analyze patients' ratings on the newly developed Person-Centered Contraceptive Counseling scale (PCCC) to provide distributions for a nationally representative population and to assess differences by sociodemographic characteristics. Study design: Using data from 2017 to 2019 National Survey of Family Growth (NSFG), we analyzed ratings across the four PCCC items among 2242 women who received contraceptive counseling in the past year. Items measured patients' reports of how providers respected them, let them describe their contraceptive preferences, took their preferences seriously, and adequately informed them about their options. We studied each PCCC item individually as well as the combined scale, distinguishing between ratings of "excellent" versus lower ratings. Bivariate and multivariate logistic regression models assessed how patients' characteristics (age, race/ethnicity and English proficiency, sexual orientation, income, and parity) and provider type were associated with the likelihood of experiencing person-centered care. Results: The majority of women (59%-69%) reported that their family planning provider was "excellent" across the four PCCC items and just over half (51%) reported "excellent" on all items. In multivariate analyses, having a lower income, Black race, non-heterosexual identity, and Hispanic ethnicity combined with low English proficiency were associated with lower PCCC ratings. Conclusions: In a nationally representative sample, the PCCC captured variation in women's experiences with person-centered family planning care by sociodemographic characteristics. Findings highlight the need for contraceptive counseling that centers on clients' preferences and experiences, particularly for patients who belong to groups experiencing health inequities. Implications: Person-centered care is a key component of high-quality family planning services. This analysis highlights sociodemographic disparities in person-centered care by analyzing PCCC ratings. Findings show the value of this new health care performance measure and affirm the need for family planning care that centers individuals' preferences and lived experiences.

Impacts of Re:MIX-A School-Based Teen Pregnancy Prevention Program Incorporating Young Parent Coeducators.

BACKGROUND: Latinx adolescents are at increased risk of teen pregnancy. This study evaluates the impact of Re:MIX, a comprehensive sexuality education program cofacilitated by professional health educators paired with young parent educators implemented with primarily Latinx youth in Texas. METHODS: A cluster randomized trial was conducted with students in grades 8-10 in 57 classrooms across three schools. Students completed baseline, post-test, and long-term follow-up surveys to determine the impact of the program on behavioral outcomes-sexual experience and unprotected sex-and on mediating factors including intentions, attitudes, knowledge, and self-efficacy related to sexual activity and contraception. RESULTS: Re:MIX was implemented with fidelity and educators were well-received. At post-test, compared to control students, Re:MIX students were more likely to intend to use hormonal or long-acting contraceptive methods if they had sex, had greater reproductive health knowledge, had more confidence in their ability to ask for and give consent, and were more likely to know where to obtain contraception. Most findings were sustained at the long-term follow-up, but there were no impacts on behaviors. CONCLUSIONS: The implementation and impact findings highlight the promising approach of pairing young parent educators with experienced health educators for teen pregnancy prevention among Latinx students.

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.

Impacts of a School-Wide, Peer-Led Approach to Sexuality Education: A Matched Comparison Group Design.

BACKGROUND: Teen Prevention Education Program (PEP) is a school-wide, peer-led comprehensive sexuality education program currently implemented in more than 50 schools across 2 states. Many teen pregnancy prevention researchers and practitioners view peer-led programs as a promising approach for reducing teen pregnancy and associated sexual risk behaviors. However, prior research on the effectiveness of these programs indicates mixed results. METHODS: We randomly assigned schools to implement Teen PEP immediately (intervention group) or on a delayed schedule (comparison group) and used propensity score matching to improve the comparability of the study groups. We surveyed students at baseline and about 6 months after the program ended. RESULTS: Teen PEP did not significantly impact rates of sexual activity or unprotected sex; however, the program led to improvements in exposure to information about sexual health topics and knowledge of preventing pregnancy and transmission of sexually transmitted infections. CONCLUSIONS: Teen PEP succeeded in accomplishing some of its most proximal goals, increasing students' access to information and knowledge. However, we found little evidence that the program affects sexual risk-taking within 6 months of its conclusion. Future research will examine the program's longer-term impacts on sexual risk behaviors.

Relationship types and contraceptive use within young adult dating relationships.

CONTEXT: Although expanding research has found that relationship characteristics can shape contraceptive use among young adults, limited research has examined how relationship characteristics intersect to form distinct types of relationships and how relationship types are linked to contraceptive use. METHODS: Data from the 2002-2005 rounds of the National Longitudinal Survey of Youth 1997 cohort were used to examine contraceptive use in 3,485 young adult dating relationships. Latent class analysis was employed to develop a typology of relationships using measures of relationship structure (duration) and quality (intimacy, commitment and conflict). Multinomial logistic regression analyses were used to estimate associations between relationship type and contraceptive use and method choice at last sex. RESULTS: Four types of relationships were identified, two shorter term and two longer term, differentiated by levels of intimacy, commitment and conflict. Young adults in longer term relationships with greater conflict and lower intimacy and commitment were less likely than those in other long-term relationships to use hormonal and dual methods versus no method (relative risk ratios, 0.6-0.7). Hormonal method use, versus no method use or condom use, was more prevalent in short-term relationships with greater intimacy and commitment and lower conflict than in other short-term relationships (1.7 and 1.9, respectively). CONCLUSIONS: Classifying short-term relationships as "casual" or long-term ones as "serious" may ignore heterogeneity within these categories that may have implications for contraceptive use. Future qualitative research could provide a better understanding of relationship types and couples' fertility intentions and access to and use of contraceptives.

Relationship Characteristics and the Relationship Context of Nonmarital First Births Among Young Adult Women.

OBJECTIVES: The objectives of this study were to examine whether and how characteristics of the relationship dyad are linked to nonmarital childbearing among young adult women, additionally distinguishing between cohabiting and nonunion births. METHODS: We used the National Longitudinal Survey of Youth, 1997 Cohort and discrete-time event history methods to examine these objectives. RESULTS: Our analyses found that similarities and differences between women and their most recent sexual partner in educational attainment, disengagement from work or school, race/ethnicity, and age were linked to the risk and context of nonmarital childbearing. For example, partner disengagement (from school and work) was associated with increased odds of a nonmarital birth regardless of whether the woman herself was disengaged. Additionally, having a partner of a different race/ethnicity was associated with nonmarital childbearing for whites, but not for blacks and Hispanics. CONCLUSIONS: We conclude that relationship characteristics are an important dimension of the lives of young adults that influence their odds of having a birth outside of marriage.

Social-emotional effects of early childhood education programs in Tulsa.

This article assesses the effects of Tulsa, Oklahoma's early childhood education programs on social-emotional outcomes, examining teacher ratings of children's behavior from the Adjustment Scales for Preschool Intervention and a measure of attentiveness using fixed effects regressions with propensity score matching. The sample includes 2,832 kindergarten students in 2006, of whom 1,318 participated in the Tulsa Public Schools (TPS) pre-K program and 363 participated in the CAP of Tulsa County Head Start program the previous year. Program participation was associated with lower timidity and higher attentiveness for TPS pre-K alumni and a marginally significant reduction in timidity for Head Start alumni. Results were similar for the free lunch-eligible subsample. We conclude that high-quality, school-based preschool programs can enhance social-emotional development.

Risky adolescent sexual behaviors and reproductive health in young adulthood.

CONTEXT: Little research links adolescent risk behaviors to reproductive health outcomes beyond adolescence, although young adults--men and women in their early 20s--bear a disproportionate burden of STDs and unintended childbearing. METHODS: To assess whether individuals who engaged in risk behaviors during adolescence had increased risk of negative reproductive health outcomes in young adulthood, data from Waves 1-4 of the National Longitudinal Study of Adolescent Health on 5,798 sexually active respondents were analyzed. Logistic and multinomial logistic regressions examined associations between risk behaviors (cumulatively and individually) and each of three outcomes. RESULTS: Four in 10 youth reported at least three risk factors during adolescence. Women who were exposed to an increasing number of risks had an elevated likelihood of having had multiple sex partners in the last year, rather than none (relative risk ratio, 1.3); having had an STD (odds ratio, 1.1); and having had an intended or unintended birth, as opposed to no birth (relative risk ratio, 1.1 for each). Inconsistent contraceptive use and having had multiple partners, a non-monogamous partner or a non-romantic partner were associated with reporting multiple partners in the last year; inconsistent use, sexual debut after age 16 and not discussing contraception with a partner were associated with having any birth. CONCLUSIONS: Teenagers' sexual behaviors have both short-term and long-term consequences, and interventions that focus on multiple domains of risk may be the most effective in helping to promote broad reproductive health among young adults.

Relationship characteristics and contraceptive use among young adults.

CONTEXT: Young adults have high rates of unintended childbearing and STDs, yet little research has examined the role of relationship characteristics in their contraceptive use. METHODS: Data collected from the 2002-2005 rounds of the National Longitudinal Survey of Youth yielded a sample of 4,014 dating relationships among sexually active 18-26-year-olds. Bivariate analysis and multivariate logistic and multinomial logistic regressions assessed associations between relationship characteristics and contraceptive use at last sex. RESULTS: In three-quarters of the relationships, respondents had used some method at last intercourse; respondents in 26% of the relationships had used a condom only, in 26% a hormonal method only and in 23% dual methods. Compared with respondents in relationships in which first sex occurred within two months of starting to date, those who first had sex before dating were more likely to have used any method at last sex (odds ratio, 1.4), particularly condoms or dual methods (relative risk ratio, 1.5 for each). The relative risk of using a hormonal method only, rather than no method or condoms only, increased with relationship duration (1.01) and level of intimacy (1.1-1.2). Discussing marriage or cohabitation was associated with reduced odds of having used any method (0.7) and a reduced relative risk of having used condoms alone or dual methods (0.6 for each). Increasing levels of partner conflict and asymmetry were also linked to reduced odds of any method use (0.97 and 0.90, respectively). CONCLUSIONS: Prevention programs should address relationship context in contraceptive decision making, perhaps by combining relationship and sex education curricula to foster communication and negotiation skills.