Mary Losch

Young Women’s Knowledge, Attitudes, and Behaviors Related to Long-Acting Reversible Contraceptives

BACKGROUND The present study explored 18- to 30-year-old womens knowledge and perceptions of the long-acting, reversible contraceptives (LARCs) Mirena and Implanon in a Midwestern state in the United States. METHODS A telephone survey (n = 543) and 18 focus groups (n = 106) were conducted with women across a rural, Midwestern state. During the telephone survey, women answered questions related to their awareness and knowledge of two LARCs. During the focus groups, participants were asked to respond to questions related to their awareness, knowledge, behaviors, and perceptions of LARCs. RESULTS In the telephone survey, half of the women reported hearing of Mirena. Only 8.0% of women had heard of Implanon. In the focus groups, most women reported knowing little about LARCs. Benefits associated with other contraceptives were not associated with LARCs. Women were concerned about potential side effects and problems stemming from using a contraceptive that is new to them. CONCLUSION Increased use of LARCs would likely reduce the unintended pregnancy rate. As described, although some young women are aware of these long-term contraceptive options, there is still a need to educate women on their availability, use, and potential benefit.

Race/ethnicity and perinatal depressed mood

This study examined the extent to which race/ethnicity is a risk factor for depressed mood in late pregnancy and the early postpartum period apart from its relationship with other demographic and infant outcome variables. Data obtained from 26,877 women with newborns in Iowa indicate that 15.7% endorsed a single depression item. Logistic regression results indicate that race/ethnicity was a significant predictor of depressed mood, controlling for age, marital status, income and educational level, and infant health outcome. Compared to White women, African‐American women were significantly more likely to report depressed mood (OR = 1.25, 95% CI = 1.03–1.52). Hispanic women were significantly less likely to report being depressed (OR = 0.74, 95% CI = 0.61–0.88). The role of social support in understanding these findings is explored.

Ambivalence, communication and past use: Understanding what influences women's intentions to use contraceptives

Unintended pregnancy among women in the 18–30 age group is a public health concern. The Extended Parallel Process Model (EPPM) provides a framework for exploring how womens perceptions of threat, efficacy, and fear influence intentions to use contraceptives. Past use and communication with best friends and partners were also considered. A telephone survey of 18–30-year-old women (N = 599) was completed. After univariate and bivariate analyses were conducted, the variables were entered into a hierarchal, multi-variate linear regression with three steps consistent with the EPPM to predict behavioral intention. The first step included the demographic variables of relationship status and income. The constructs for the EPPM were entered into step 2. Step 3 contained the fear measure. The model for the third step was significant, F(10,471) = 36.40, p < 0.001 and the variance explained by this complete model was 0.42. Results suggest that perceived severity of the consequences of an unintended pregnancy (p < 0.01), communication with friends (p < 0.01) and last sexual partner (p < 0.05), relationship status (p < 0.01), and past use (p < 0.001) were associated with womens intentions to use contraceptives. A womans perception of the severity was related to her intention to use contraceptives. Half of the women (50.3%) reported ambivalence about the severity of an unintended pregnancy. In our study, talking with their last sexual partner had a positive effect on intentions to use contraceptives, while talking with friends influenced intentions in a negative direction. These results reconfirm the need for public health practitioners and health care providers to consider level of ambivalence toward unintended pregnancy, communication with partner, and relationship status when trying to improve womens contraceptive behaviors. Implications for effective communication interventions are discussed.

Preventing unintended pregnancies and improving contraceptive use among young adult women in a rural, midwestern state: health promotion implications.

Despite high rates of unintended pregnancy among women aged 18 to 30 years, little research has been conducted to understand the factors associated with their contraceptive use. Eighteen focus groups were conducted with young adult women (N = 106) who were mostly white, non-Hispanic. Results suggested that contraceptive use was negatively affected by low contraceptive knowledge; use of alcohol; a lack of planning for sex; a misperception of the likelihood of pregnancy; forgetting to use contraceptives; and concerns about side effects, cost, and confidentiality. Women liked the peace of mind that using contraceptives gave them and the benefits of regular periods from some hormonal methods. Implications for reducing unintended pregnancies through interventions are offered.

The Green Acres Effect: The Need for a New Colorectal Cancer Screening Campaign Tailored to Rural Audiences

National health communication campaign developers have ignored rural audiences in campaign development and testing, despite the health disparities that exist for this group. Researchers in a rural Midwestern state tested the appropriateness of CDCs national colorectal cancer screening campaign, Screen for Life. Based on focus groups and a quasiexperimental design evaluation, researchers determined that the national campaign did not adequately address the needs of the rural audience. A new print and radio campaign was developed based on previous findings, grounded in social marketing and the health belief model. New tailored campaign materials were refined in focus groups. Final versions were tested in two quasiexperimental designs. Results support the campaigns reach and efficacy. Those in the intervention county were significantly more likely than the unexposed to (a) report recent exposure to ads, (b) plan to seek out information regarding screening, and (c) plan to get screened in the near future.

Across the fertility lifespan: desire for pregnancy at conception.

Purpose:To illustrate trends in unintended pregnancy over a 5-year period and to describe variations in desire for pregnancy at conception in relation to maternal age, race/ethnicity, income, and education. Study Design and Methods:Data were collected as part of the Iowa Barriers to Prenatal Care Project, a large, multiyear study of new mothers. A brief questionnaire eliciting maternal experiences and behaviors during pregnancy was administered to new mothers in all Iowa hospitals providing maternity care following the birth of their baby. Sample sizes ranged from 16,714 to 19,421 over the 5 years included in this analysis (1997 to 2001), and response rates ranged from 44% to 53%. Results:The study sample closely matched the overall statewide profile of women in this age group. In each of the 5 years, about one third of the mothers giving birth indicated that they did not intend to become pregnant at that time, and another 4% to 5% indicated that they did not want to be pregnant at that time or in the future. There were no substantive variations across years. Maternal age, race/ethnicity, income, and education were significantly related to intendedness of pregnancy. Clinical Implications:The findings underscore the continuing challenge of unintended pregnancy, despite recent national attention to this issue. All women of childbearing age should be considered at risk for unintended pregnancy. Additional work is needed to examine reasons, attitudes, and behaviors associated with unintended pregnancies and to determine the relative predictive strength of key demographic variables to improve interventions aimed at decreasing unintended pregnancy rates.

Prenatal Office Practices Regarding Infant Feeding Choices

The objective of this study was to determine the obstetric care providers’ roles in breast-feeding promotion during prenatal care. A questionnaire addressing breast-feeding issues was sent to family practitioners (FP), obstetric-gynecologists (OB/GYN), and nurse midwives (NM) in Iowa, USA. All NM, 97% of FP, and 85% of OB/GYN reported asking infant feeding preference—usually only at the first prenatal visit. NM (73%) were most likely to provide extensive breast-feeding counseling. OB/GYN (68%) and FP physicians (90%) reported doing their own breast-feeding counseling. Breast examinations targeting future breast-feeding problems were done in 82% to 84% of patients. NM practices shared more information supportive of breast-feeding. Nearly all providers offered prenatal classes, but only 41% of FP offered breast-feeding classes. Free formula samples were available in 73% of FP, 54% of OB/GYN, and 36% NM offices. Pamphlets on formula feeding and also breast-feeding were readily available. Overall NM (64%) reported being strong breast-feeding advocates compared to only 13% of FP and 7% of OB/GYN. In conclusion, little promotion of breast-feeding occurs in most prenatal practice settings.

“Wow, That Was Funny”: The Value of Exposure and Humor in Fostering Campaign Message Sharing

In this study, we examined whether or not exposure to a humorous surround campaign in Iowa (United States) could produce a multiplicative effect based on Intermedia Theory. Until You’re Ready, AvoidtheStork.com© was designed to prevent unintended pregnancies among young women. In the case of unintended pregnancy, interpersonal sharing is important because women’s contraceptive decisions are influenced by what others, including their friends, think about the health issue. In a sample of college students (n = 594), cross-sectional survey results indicated that campaign exposure and humor were significant predictors of talking with and/or showing the campaign to others. Based on our results, we suggest that campaign practitioners should consider humor-based campaigns as a way to generate not only exposure-based effects but also conversation-based effects. Specifically, humor-based campaigns can increase the reach of a campaign through sharing.

Segmenting Audiences and Tailoring Messages Using the Extended Parallel Process Model and Cluster Analysis to Improve Health Campaigns

Half of all pregnancies in young adult women are unintended, but few interventions have been successful in encouraging contraceptive use. The group heterogeneity likely contributes to the lack of success. Segmenting based on theories that provide meaningful information may improve tailoring and targeting of behavioral interventions. Previous research has indicated that threat, efficacy, and fear were important factors in influencing intentions to use contraceptives; therefore, the extended parallel process model (EPPM) was used for this cluster analysis. A telephone survey of randomly selected 18- to 30-year-old women in Iowa was conducted (N = 401). The constructs of EPPM and age were used for conducting a K means cluster analysis with four clusters. The cluster analysis pointed to the importance of fear, perceived susceptibility, and age. All of the clusters had varying degrees of ambivalence about the severity of a pregnancy. Cluster 1 (27.8%) had high susceptibility, with little fear. Cluster 2 (23.8%) had high efficacy and higher fear. The third cluster (34.7%) was not fearful and had low susceptibility. The final cluster (13.8%) was younger than the other groups and had the lowest efficacy. Additional analyses were conducted to explore how the clusters varied on other variables. The clusters help campaign developers prioritize audiences and tailor messages.

Baby? Baby Not?: Exploring Women's Narratives About Ambivalence Towards an Unintended Pregnancy.

Unintended pregnancy among adult women is a significant public health challenge in the United States. Research has identified ambivalence as a risk factor for not using contraceptives. The qualitative study presented here examined women’s narratives about ambivalence toward unintended pregnancy. In-depth interviews were conducted in 2012 with 28 women aged 20–45 years old who were recruited primarily via flyers in family planning clinics in a rural, Midwestern state. The interviews were coded for salient themes. Almost 40 percent of the women said that they had experienced an unintended pregnancy. All but two women expressed ambivalence, stating that they had both good and bad feelings about getting pregnant unintentionally. Women expressed if a pregnancy did occur, they would just have to step up and “deal with it.” They recognized a baby was something special but not without negative aspects. Those who were less ambivalent (and more negative) had compelling reasons why, but even those women expressed some positive feelings. At times, ambivalence was expressed by negative reactions about having a child that coincided with believing that becoming a parent or having another child would have a positive impact on themselves. This study provides an examination of women’s narratives about ambivalence toward pregnancy. Overall, women’s narratives constructed ambivalence as arising from both positive and negative emotions, as well as beliefs about costs and benefits, associated with unintended pregnancy. Given its association with a lack of contraceptive use, understanding the components of ambivalence (e.g., feelings, beliefs) is important to bolstering interventions aimed toward decreasing ambivalence and increasing contraceptive use.