Laura M. Gaydos

Reasons for and Challenges of Recent Increases in Teen Birth Rates: A Study of Family Planning Service Policies and Demographic Changes at the State Level

PURPOSE After declining for over a decade, the birth rate in the United States for adolescents aged 15-19 years increased by 3% in 2006 and 1% again in 2007. We examined demographic and policy reasons for this trend at state level. METHODS With data merged from multiple sources, descriptive analysis was used to detect state-level trends in birth rate and policy changes from 2000 to 2006, and variations in the distribution of teen birth rates, sex education, and family planning service policies, and demographic features across each state in 2006. Regression analysis was then conducted to estimate the effect of several reproductive health policies and demographic features on teen birth rates at the state level. Instrument variable was used to correct possible bias in the regression analysis. RESULTS Medicaid family planning waivers were found to reduce teen birth rates across all ages and races. Abstinence-only education programs were found to cause an increase in teen birth rates among white and black teens. The increasing Hispanic population is another driving force for high teen birth rates. DISCUSSION Both demographic factors and policy changes contributed to the increase in teen birth rates between 2000 and 2006. Future policy and behavioral interventions should focus on promoting and increasing access to contraceptive use. Family planning policies should be crafted to address the special needs of teens from different cultural backgrounds, especially Hispanics.

Circumstances of pregnancy: low income women in Georgia describe the difference between planned and unplanned pregnancies.

Introduction and Background: The United States has a higher rate of unintended pregnancies than many other developed countries despite the availability of effective contraception. Using Azjens Theory of Planned Behavior and Lukers Theory of Contraceptive Risk Taking this qualitative study explores the reasons for the high rate of unintended pregnancy among low income women in Georgia. Methods: Six focus groups (N=39) were conducted at county health department clinics. Women were recruited at the clinics to participate in a discussion of Pregnancy and Motherhood. All English or Spanish speaking women between the ages of 18 and 49 were eligible for participation. Results: Three dimensions of pregnancy planning emerged-the decision to have a child, taking specific behaviors to increase the likelihood of conception, and making plans to care for a child. Planned pregnancies may occur when a couple or a woman decides that they are ready to have a child, but also occur in less stable situations that pose risks for the family and the child. Unplanned pregnancies may be welcomed or be unwanted depending on the circumstances. Women perceive advantages and disadvantages to planned and unplanned pregnancies. Discussion: There are major differences between the definition and values of planned and unplanned pregnancies promoted by public health practitioners and those of the women in our study. This suggests the need for research on the circumstances in which pregnancies occur, as well as targeted interventions and policies that help women and men define and achieve the circumstances in which they would like to bear and rear children.

State Parity Laws and Access to Treatment for Substance Use Disorder in the United States Implications for Federal Parity Legislation

IMPORTANCE The passage of the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act incorporated parity for substance use disorder (SUD) treatment into federal legislation. However, prior research provides us with scant evidence as to whether federal parity legislation will hold the potential for improving access to SUD treatment. OBJECTIVE To examine the effect of state-level SUD parity laws on state-aggregate SUD treatment rates and to shed light on the impact of the recent federal SUD parity legislation. DESIGN, SETTING, AND PARTICIPANTS We conducted a quasi-experimental study using a 2-way (state and year) fixed-effect method. We included all known specialty SUD treatment facilities in the United States and examined treatment rates from October 1, 2000, through March 31, 2008. Our main source of data was the National Survey of Substance Abuse Treatment Services, which provides facility-level information on specialty SUD treatment. INTERVENTIONS State-level SUD parity laws during the study period. MAIN OUTCOMES AND MEASURES State-aggregate SUD treatment rates in (1) all specialty SUD treatment facilities and (2) specialty SUD treatment facilities accepting private insurance. RESULTS The implementation of any SUD parity law increased the treatment rate by 9% (P < .001) in all specialty SUD treatment facilities and by 15% (P = .02) in facilities accepting private insurance. Full parity and parity only if SUD coverage is offered increased the SUD treatment rate by 13% (P = .02) and 8% (P = .04), respectively, in all facilities and by 21% (P = .03) and 10% (P = .04), respectively, in facilities accepting private insurance. CONCLUSIONS AND RELEVANCE We found a positive effect of the implementation of state SUD parity legislation on access to specialty SUD treatment. Furthermore, the positive association is more pronounced in states with more comprehensive parity laws. Our findings suggest that federal parity legislation holds the potential to improve access to SUD treatment.

Riskier Than We Thought: Revised Estimates of Noncontracepting Women Risking Unintended Pregnancy

Objectives. Risk-taking is defined as non-use of contraception among sexually active women who do not desire pregnancy. The published National Survey of Family Growth (NSFG) definition of risk of unintended pregnancy includes sterilized women and women relying on partner sterilization in the statistic. However, this inclusion skews percentages of risk-taking women to appear smaller than is realistic since sterilized women face minimal risk of pregnancy. The objective of this study was to obtain realistic estimates of risk-taking behavior to identify groups at special need for improved services. Methods. In calculating risk-taking statistics, sterilized women and women relying on partner sterilization are removed from both the numerator and denominator. The numerator includes all non-contracepting women who believe that they are fecund. The authors calculated the proportion of risk-taking women for various age, ethnic, and marital status groups. Results. Overall, 14.0% of sexually active, fecund women are risk-taking. Except for teenagers, who do not use sterilization, the proportions of risk takers are higher than the NSFG estimates of proportion of women at risk of unintended pregnancy in all groups. Differences in risk estimates ranged from 0.4% to 10.7%, with the greatest differences seen among formerly married and Hispanic black women. Conclusions. These results indicate that published NSFG percentages of adult women at risk of unintended pregnancy underestimate risk-taking behavior for groups previously thought to be at lower risk of unintended pregnancy.

Revisiting Safe Sleep Recommendations for African-American Infants: Why Current Counseling is Insufficient

The American Academy of Pediatrics recommends that children be placed in the supine position on firm bedding and not bed share with parents or other children. Health professionals increasingly understand that many African-American parents do not follow these recommendations, but little research exists on provider reactions to this non-compliance. This study was intended to better understand how low-income, African-American mothers understand and act upon safe sleep recommendations for newborns and how providers counsel these mothers. We conducted focus groups with 60 African-American, low-income, first-time mothers and telephone interviews with 20 providers serving these populations to explore provider counseling and patient decision making. The large majority of mothers reported understanding, but not following, the safe-sleeping recommendations. Key reasons for non-compliance included perceived safety, convenience, quality of infant sleep and conflicting information from family members. Mothers often take measures intended to mitigate risk associated with noncompliance, instead increasing SIDS risk. Providers recognize that many mothers are non-compliant and attribute non-compliance largely to cultural and familial influence. However, few provider attempts are made to mitigate SIDS risks from non-compliant behaviors. We suggest that counseling strategies should be adapted to: (1) provide greater detailed rationale for SIDS prevention recommendations; and (2) incorporate or acknowledge familial and cultural preferences. Ignoring the reasons for sleep decisions by African-American parents may perpetuate ongoing racial/ethnic disparities in SIDS.

Reliability and validity testing of the CDC Worksite Health ScoreCard: An assessment tool to help employers prevent heart disease, stroke, and related health conditions

Objective: To develop, evaluate, and improve the reliability and validity of the CDC Worksite Health ScoreCard (HSC). Methods: We tested interrater reliability by piloting the HSC at 93 worksites, examining question response concurrence between two representatives from each worksite. We conducted cognitive interviews and site visits to evaluate face validity of items and refined the instrument for general distribution. Results: The mean question concurrence rate was 77%. Respondents reported the tool to be useful, and on average 49% of all possible interventions were in place at the surveyed worksites. The interviews highlighted issues undermining reliability and validity, which were addressed in the final version of the instrument. Conclusions: The revised HSC is a reasonably valid and reliable tool for assessing worksite health promotion programs, policies, and environmental supports directed at preventing cardiovascular disease.

Racial Disparities in Contraceptive Use Between Student and Nonstudent Populations

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.

Medical Utilization Among Wellness Consumers

This study investigates conventional medicine utilization by wellness-motivated, complementary and alternative medicine (CAM) consumers. While CAM consumers are typically characterized as high health care utilizers, negative correlations have been found between CAM-based wellness programs and the consumption of conventional medical care. We use a nationally representative sample to analyze both illness- and wellness-motivated CAM users, with an interest in whether CAM therapies used for wellness replace conventional medicine, thus potentially offering cost offsets. Results indicate that motivation for CAM use is neither associated with a lower probability nor a lower rate of conventional medicine utilization. Increasingly, individuals, workplaces, and governments incorporate wellness programs involving CAM modalities into health care and policy; as the conventional and unconventional medical spheres begin to integrate and influence one another, understanding our pluralistic medical environment and its consumers will better enable policy makers to balance health and wellness initiatives with economic imperatives.

An Emerging Field in Religion and Reproductive Health

Separate from scholarship in religion and medicine, a burgeoning field in religion and population health, includes religion and reproductive health. In a survey of existing literature, we analyzed data by religious affiliation, discipline, geography and date. We found 377 peer-reviewed articles; most were categorized as family planning (129), sexual behavior (81), domestic violence (39), pregnancy (46), HIV/AIDS (71), and STDs (61). Most research occurred in North America (188 articles), Africa (52), and Europe (47). Article frequency increased over time, from 3 articles in 1980 to 38 articles in 2008. While field growth is evident, there is still no cohesive “scholarship” in religion and reproductive health.

What New Mothers Need to Know: Perspectives from Women and Providers in Georgia

Identifying the educational and resource needs of new mothers is of paramount importance in developing programs to improve maternal and child health outcomes. The primary purpose of this study was to explore the educational needs of new mothers and identify opportunities to enhance healthcare providers’ current educational efforts. A two-part methodology was utilized to qualitatively explore the topic of parenting information needs for new mothers in Georgia. Data collection included information from 11 focus groups with 92 first-time, new mothers and 20 interviews with healthcare providers who serve new mothers. Discussions with both new mothers and providers clearly indicated that new mothers face a significant informational deficit, especially regarding very basic, daily infant care information and health literacy challenges. Educational materials already exist; however, mothers report difficulty accessing and understanding this information. For this reason, both the mothers and the providers stressed a focus on developing programs or interventions that allow in-person education and/or alternative modalities to access information, as opposed to development of new written materials solely. Information from the focus group and interviews provided important insight regarding what improvements need to be made to help new mothers and their families during the early stages of parenthood. By improving the education of new mothers and their families, it is proposed that maternal and infant health status could be improved.