Sarah McKinnon

Continuation of Prescribed Compared With Over-the-Counter Oral Contraceptives

OBJECTIVE: To estimate differences in continuation of oral contraceptive pills (OCPs) between U.S. resident women obtaining pills in U.S. family planning clinics compared with over-the-counter in Mexican pharmacies. METHODS: In El Paso, Texas, we recruited 514 OCP users who obtained pills over the counter from a Mexican pharmacy and 532 who obtained OCPs by prescription from a family planning clinic in El Paso. A baseline interview was followed by three consecutive surveys over 9 months. We asked about date of last supply, number of pill packs obtained, how long they planned to continue use, and experience of side effects. Retention was 90%, with only 105 women lost to follow-up. RESULTS: In a multivariable Cox proportional hazards model, discontinuation was higher for women who obtained pills in El Paso clinics compared with those who obtained their pills without a prescription in Mexico (hazard ratio 1.6, 95% confidence interval [CI] 1.1–2.3). Considering the number of pill packs dispensed to clinic users, discontinuation rates were higher (hazard ratio 1.8, 95% CI 1.2–2.7) for clinic users who received one to five pill packs. However, there was no difference in discontinuation between clinic users receiving six or more pill packs and users obtaining pills without a prescription. CONCLUSION: Results suggest providing OCP users with more pill packs and removing the prescription requirement would lead to increased continuation. LEVEL OF EVIDENCE: II

Adolescent fertility and religion in Rio de Janeiro, Brazil in the year 2000: the role of Protestantism.

Social transformations in Brazil in recent years have included a substantial increase in adolescent fertility, a dramatic rise in membership of Protestant religious denominations, and an accompanying decline in the number of Catholics. We used the 2000 Brazil Census to examine differentials in fertility and family formation among adolescents living in Rio de Janeiro by the following religious denominations: Catholic; Baptist; other mainline Protestant; Assembly of God Church; Universal Church of the Kingdom of God; other Pentecostal Protestant; and no religion. Results from logistic regression models show that the majority of the Protestants are at a lower risk of adolescent fertility than Catholics, and that among adolescents who have had a child, most Protestants are more likely than Catholics to be in a committed union. Our findings offer some support for the hypothesis that Protestant churches are more effective than the Catholic Church in discouraging premarital sexual relations and childbearing among adolescents.

Frustrated Demand for Sterilization Among Low-Income Latinas in El Paso, Texas

CONTEXT Sterilization is the most commonly used contraceptive in the United States, yet access to this method is limited for some. METHODS A 2006-2008 prospective study of low-income pill users in El Paso, Texas, assessed unmet demand for sterilization among 801 women with at least one child. Multivariable logistic regression analysis identified characteristics associated with wanting sterilization. In 2010, at an 18-month follow-up, women who had wanted sterilization were recontacted; 120 semistructured and seven in-depth interviews were conducted to assess motivations for undergoing the procedure and the barriers faced in trying to obtain it. RESULTS At baseline, 56% of women wanted no more children; at nine months, 65% wanted no more children, and of these, 72% wanted sterilization. Only five of the women interviewed at 18 months had undergone sterilization; two said their partners had obtained a vasectomy. Women who had not undergone sterilization were still strongly motivated to do so, mainly because they wanted no more children and were concerned about long-term pill use. Among womens reasons for not having undergone sterilization after their last pregnancy were not having signed the Medicaid consent form in time and having been told that they were too young or there was no funding for the procedure. CONCLUSIONS Because access to a full range of contraceptive methods is limited for low-income women, researchers and providers should not assume a womans current method is her method of choice.

Alcohol use and abuse by adolescents: the impact of living in a border community.

PURPOSE To determine the rates of alcohol consumption and alcohol-related risk behaviors among a sample of high school students living on the U.S.-Mexico border, as well as to investigate factors associated with alcohol use among this population. METHODS A self-administered anonymous questionnaire was administered to students in grades 9-12 during Fall and Spring semesters of 2001 (n = 1366; 639 males and 722 females) in 16 high schools in a community along the U.S.-Mexico border. The questionnaire addressed demographic factors, alcohol consumption, and alcohol-related behaviors. Surveys were completed by Chi-square tests for homogeneity of the odds ratio and logistic regression models were used to identify factors significantly associated with the outcome variables. RESULTS Rates of binge drinking (45%), drinking and driving (19%), and riding with a driver who had been drinking (46%) were higher for our study population when compared with state and national rates. Students who consumed alcohol were more likely to report alcohol-related problems and lower academic grades. Drinking while in Mexico was significantly associated with binge drinking (OR = 6.44), drinking and driving (OR = 5.39), and riding with a driver who has been drinking (OR = 3.12). CONCLUSIONS The high rates of alcohol risk behaviors among students living on the U.S.-Mexico border underscore the need to develop and implement culturally appropriate prevention programs that address alcohol consumption in Mexico, particularly in terms of students driving back home.

Increased Risk of Alcohol Abuse Among College Students Living on the US-Mexico Border: Implications for Prevention

Abstract Alcohol abuse is a serious problem for students on college campuses. The authors conducted a cross-sectional study to (1) compare measures of alcohol-risk behaviors among college students attending a university on the US-Mexico border with other students and (2) identify factors associated with risk behaviors among border students. They used a self-administered survey to collect data from 286 freshman and sophomore students. Rates of binge drinking were higher among study respondents than among respondents in a national survey of freshman and sophomore college students (46% vs 42% to 45%, respectively). Drinking in high school and drinking in Mexico were significantly associated with all outcomes (binge drinking, drinking and driving, and riding with a drinker). The findings underscore the need for targeted prevention programs among this high-risk population.

Efficacy of a secondary adolescent pregnancy prevention program: an ecological study before, during and after implementation of the Second Chance Club.

Teen mothers are at increased risk of subsequent adolescent births. Interventions to reduce secondary teen pregnancies are expensive and difficult to evaluate. An ecological evaluation compared change in the repeat teen birth rate in an intervention community in Charleston, South Carolina over time to state birth certificate data to determine the efficacy of a school-based pregnancy prevention program. Evaluation included comparison of birth rates for multigravida teens in the programs school catchment area (intervention zip codes) to selected state and community data before, during and after program implementation. The intervention community demonstrated a decrease in repeat teen births during the intervention period of the program with a rebound after it was discontinued. This trend differed from a 50% linear decrease across these time periods in the state. This low cost evaluation method may be useful for evaluation of teen pregnancy prevention programs with limited resources for program evaluation.

Screening for Alcohol Risk in Predominantly Hispanic Youths: Positive Rates and Behavioral Consequences

The present study examined relationships between CAGE alcohol risk scores and predisposing factors for alcohol use, current alcohol use, and behavioral consequences in a large sample of secondary students. Students completed the CAGE, measures of demographics, potential predisposing factors, and consequences of alcohol use. More than 18% of students screened positive for potential alcohol risk using traditional CAGE criteria, and another 23% scored moderate risk using a more liberal criterion. CAGE scores were related to a variety of predisposing factors and were strongly related to current drinking and alcohol-related behavioral consequences. It was recommended that investigators examine multiple options for appropriate alcohol screening instruments.