Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, MB. Pat_Martens@cpe.umanitoba.ca
OBJECTIVES: To report teen pregnancy and sexually transmitted infections (STI) rates among Manitoba adolescents, and associated factors including rates of sexual intercourse and contraceptive use. METHODS: Teen pregnancy rates in females aged 15 to 19 for the fiscal years 1994/95 through 1998/99 were derived from the Population Health Research Data Repository and reported by geographical areas and income quintiles. Premature mortality rate (PMR) and the Socioeconomic Factor Index (SEFI) measured the overall health and socioeconomic well-being of regional populations. Data on sexual activity and contraceptive use were derived from the 1996 National Population Health Survey for males and females ages 15 through 19 years. RESULTS: The teen pregnancy rate for Manitoba was 63.2/1000, varying by geography and inversely correlated with income, PMR, and SEFI. 39%(95% CI 33-45) of teens reported sexual intercourse, with higher rates in urban areas (46%, 95 % CI 35-57) and the North (48%, 95% CI 36-60) compared to South Rural (30%, 95% CI 25-34), and in low-income families (68%, 95% CI 53-83) compared with middle/high (33%, 95% CI 26-40). For sexually active females, 42%(95% CI 28-57) used the birth control pill, with higher rates in low-income families (70%, 95% CI 50-90) compared to middle/high income (31%, 95% CI 14-48). Condom use (at last sexual intercourse) was reported by 82%(95% CI 72-92) of adolescents, with trends (though not statistically significant) to lower use in low-income families and the North. CONCLUSION: Reliance on the pill for contraception, combined with low rates of condom use, are public health concerns for adolescents where STI and unintended pregnancy rates are high.
Infection Prevention and Control, Calgary Health Region, Calgary, AB, Canada. email@example.com
OBJECTIVES To examine the spatial patterning of the individuals with gonorrhea or chlamydia infection in the Calgary Health Region (CHR) to target prevention and control activities. METHODS A Geographic Information System was used to map the prevalence rates of gonorrhea and chlamydia infection in the CHR to 2001 Census Tracts in the CHR. Data from the 2001 Canadian Census were used to describe the socioeconomic status (SES) of these areas. RESULTS Low SES indicators correlated with each other (low median household income, lower education, single mothers) as did high SES indicators (married, owning a dwelling, high median income, university education). A correlation was detected between areas of low SES and areas of high prevalence rates for gonorrhea and for chlamydia. These areas clustered primarily downtown and in the northeast part of the city. CONCLUSIONS Nodes and corridors of activity in Calgary were detected in correlation studies of the 2001 Census variables used. The core (high prevalence) areas should be the areas targeted for sexually transmitted infection prevention and control. This can be done at the community level through measures such as more sexually transmitted infection clinics operating with longer hours in areas identified from this mapping.
Deprivation indices, population health and geography: an evaluation of the spatial effectiveness of indices at multiple scales.
Department of Geography, Simon Fraser University, RCB 7123, Burnaby, BC V5A 1S6, Canada. firstname.lastname@example.org
Area-based deprivation indices (ABDIs) have become a common tool with which to investigate the patterns and magnitude of socioeconomic inequalities in health. ABDIs are also used as a proxy for individual socioeconomic status. Despite their widespread use, comparably less attention has been focused on their geographic variability and practical concerns surrounding the Modifiable Area Unit Problem (MAUP) than on the individual attributes that make up the indices. Although scale is increasingly recognized as an important factor in interpreting mapped results among population health researchers, less attention has been paid specifically to ABDI and scale. In this paper, we highlight the effect of scale on indices by mapping ABDIs at multiple census scales in an urban area. In addition, we compare self-rated health data from the Canadian Community Health Survey with ABDIs at two census scales. The results of our analysis confirm the influence of spatial extent and scale on mapping population health-with potential implications for health policy implementation and resource distribution.
BMC Health Serv Res. 2006 ;6 :79 16792810
Demographic and Health Research Division, ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705, USA. email@example.com
BACKGROUND Both availability and quality of family planning services are believed to have contributed to increasing contraceptive use and declining fertility rates in developing countries. Yet, there is limited empirical evidence to show the relationship between the quality of family planning services and the population based prevalence of contraceptive methods. This study examined the relationship between quality of family planning services and use of intrauterine devices (IUD) in Egypt. METHODS The analysis used data from the 2003 Egypt Interim Demographic and Health Survey (EIDHS) that included 8,445 married women aged 15-49, and the 2002 Egypt Service Provision Assessment (ESPA) survey that included 602 facilities offering family planning services. The EIDHS collected latitude and longitude coordinates of all sampled clusters, and the ESPA collected these coordinates for all sampled facilities. Using Geographic Information System (GIS) methods, individual women were linked to a facility located within 10 km of their community. A facility-level index was constructed to reflect the quality of family planning services. Four dimensions of quality of care were examined: counseling, examination room, supply of contraceptive methods, and management. Effects of quality of family planning services on the use of IUD and other contraceptive methods were estimated using multinomial logistic regression. Results are presented as relative risk ratios (RRR) with significance levels (p-values). RESULTS IUD use among women who obtained their method from public sources was significantly positively associated with quality of family planning services (RRR = 1.36, p < 0.01), independent of distance to the facility, facility type, age, number of living children, education level, household wealth status, and residence. Quality of services related to counseling and examination room had strong positive effects on use of IUD (RRR = 1.61 for counseling and RRR = 1.46 for examination room). Obtaining IUD from a private source or using other contraceptive methods was not associated with quality of services. CONCLUSION This study is one among the few that used geographic information to link data from a population-based survey with an independently sampled health facility survey. The findings demonstrate that service quality is an important determinant of use of clinical contraceptive methods in Egypt. Improving quality of family planning services may help further increase use of clinical contraceptive methods and reduce fertility.
Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Clinical Research Centre, Halifax, NS. firstname.lastname@example.org
PURPOSE: Little is known about associations of adolescents' socio-economic status (SES) and their sexual activity and risk behaviours. This study examined these associations in Nova Scotia adolescents aged 15-19. METHODS: Students at four high schools in northern Nova Scotia completed surveys examining relationships of family SES factors and: 1) sexual activity (having had vaginal or anal intercourse, intercourse before age 15 (early intercourse)); and 2) risk behaviours (use of contraception/condoms, number of partners and unplanned intercourse after substance use). RESULTS: Of students present when the survey was administered, 2,135 (91%) responded. Almost half (49%) had had vaginal intercourse, and 7% anal intercourse. In univariate analysis for young women, non-intact family structure and lower parental education were associated with having vaginal, anal and early intercourse. Female risk behaviours showed no significant univariate associations with SES. Young men had univariate associations of family structure, lower maternal education and paternal unemployment with early intercourse, and lower paternal education with anal intercourse. Condom use was higher for young men with employed fathers; those living with both parents less often had >1 sexual partner. In multivariate analysis, most SES associations with females' sexual activities held, while most for males did not, and few associations of SES and risk behaviours were seen for females. CONCLUSIONS: Indicators of lower SES are associated with sexual activity in young women. Sexual risk behaviours are not often associated with SES in females, though they are more so in males. These findings have implications for sexual health promotion and health services.
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Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, MB. Pat_Martens@cpe.umanitoba.ca
OBJECTIVE: The Manitoba Centre for Health Policy was commissioned by Manitoba's provincial health department to examine the health of newborns born 1994 through 1998, using three indicators: preterm birth (< 37 weeks gestation), birthweight, and type of infant feeding. METHODS: Data were derived from the Population Health Research Data Repository and the National Longitudinal Survey of Children and Youth 1996. Variation by 12 Regional Health Authorities (RHAs) and by 12 Winnipeg Community Areas (CAs) was examined, as well as associations with the population's health and socioeconomic well-being. RESULTS: Manitoba's preterm birth rate was 6.7% of live births, from 5.3% to 7.4% by RHA, and 5.7% to 8.0% by Winnipeg CA. Manitoba's low birthweight rate (< 2500 g) was 5.3%, from 2.7% to 5.7% by RHA, and 4.4% to 7.2% by Winnipeg CA. The lower the income, the greater the likelihood of low birthweight (p < 0.05). Manitoba's breastfeeding initiation rate was 78%, from 64% to 87% by RHA, and 66% to 90% by Winnipeg CA. The lower the income and the poorer the health status of the population, the lower the breastfeeding rate (p < 0.001). Of those initiating breastfeeding, 42% breastfed for at least six months. CONCLUSION: Factors affecting child health in Manitoba could be addressed through systematic programs both during pregnancy and during the postpartum period, including support for nutritional counselling, promotion of breastfeeding, smoking cessation programs, and social policy decisions designed to overcome disparities within low-income groups and populations with poorer health status.
Marni Brownell, Teresa Mayer, Patricia J Martens, Anita Kozyrskyj, Patricia Fergusson, Jennifer Bodnarchuk, Shelley Derksen, David Friesen, Randy Walld
Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, MB. Anita_Kozyrskyj@cpe.umanitoba.ca
OBJECTIVE: This paper describes the population-based analyses of measures of child health status used throughout this supplement. METHODS: The articles in this supplement examine health-related data for children 0 to 19 years. Most analyses cover the period from April 1, 1994 to March 31, 1999. Administrative and survey data were used to assess child health and well-being. For regional comparisons, data were broken down by subregions of Manitoba, called Regional Health Authorities (RHAs), and neighbourhoods of Winnipeg, called Winnipeg Community Areas (Winnipeg CAs). The premature mortality rate (PMR) was used as a proxy of the overall health of the population. All graphs comparing rates among RHAs and Winnipeg CAs rank these subregions in the same order, from lowest to highest PMR. Income was operationalized by dividing the province's population into urban and rural quintiles based upon household income. Other aspects of methodology are discussed. RESULTS: Results are presented in the articles that follow this one. CONCLUSION: The relationships between key child health indicators and geographic and socioeconomic factors for Manitoba children are discussed in the articles following this one.
Predictors of hospital readmission of Manitoba newborns within six weeks postbirth discharge: a population-based study.
Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. email@example.com
OBJECTIVES To examine the proportion, geographic variation, and predictors of infant hospital readmission within 6 weeks of the postbirth discharge. METHODS A cross-sectional, population-based study was conducted of all infants who were born from 1997 through 2001, linkable to the birth mother, and discharged alive from the hospital (N = 68 681) using hospital discharge files in the Canadian province of Manitoba. The following predictors of readmission were examined using logistic regression: preterm, low birth weight, neighborhood income, geographic location (the North, Rural South, and Urban areas of Winnipeg and Brandon), breastfeeding status, length of stay, maternal age, and type of delivery. Using 9 non-Winnipeg regions and 12 Winnipeg subregions, ecologic correlations (1-tailed Spearman) between newborn hospital readmission rates and the following were examined: 1) a region's overall health status, measured by the premature mortality rate (PMR), or death before aged 75 years and 2) a region's socioeconomic risk, using the Socio-Economic Factor Index (SEFI). RESULTS The proportion of infants who were readmitted to the hospital at least once within 6 weeks of postbirth hospital discharge was 3.95%, with respiratory illness the leading cause (22.3% of readmissions). Risk of readmission was higher for infants who were born preterm (adjusted odds ratio [AOR]: 1.80; 95% confidence interval [CI]: 1.55-2.10), who were of the 3 lowest income quintiles (lowest: AOR: 2.02; 95% CI: 1.77-2.32; low: AOR: 1.48; 95% CI: 1.29-1.71; middle: AOR: 1.26; 95% CI: 1.08-1.47), who resided in the North (AOR: 1.85; 95% CI: 1.66-2.07) or Rural South (AOR: 1.25; 95% CI: 1.14-1.36), who were not breastfed (AOR: 1.32; 95% CI: 1.20-1.44), whose mother's age was 17 or younger (AOR: 1.30; 95% CI: 1.10-1.55), whose mother was 18 to 19 years of age (AOR: 1.25; 95% CI: 1.09-144), or who were born by cesarean section (AOR: 1.30; 95% CI: 1.19-1.43). Regional readmission rates were correlated with PMR (9 non-Winnipeg regions: r = 0.77 for PMR and r = 0.68 for SEFI; 12 Winnipeg Community Areas: r = 0.49 for PMR and r = 0.73 for SEFI). CONCLUSIONS Income and geography are strongly associated with newborn hospital readmission. Modifiable risk factors include increasing breastfeeding rates, decreasing cesarean section rates, and decreasing adolescent pregnancy rates (or increasing adolescent parental support), but these need additional study to establish causation.
Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, MB. Pat_Martens@cpe.umanitoba.ca
OBJECTIVE: To determine the fertility and child mortality rates for Manitoba. METHODS: Fertility and mortality rates were derived from the Population Health Research Data Repository and Vital Statistics, for 1994 through 1998. Data are presented by 12 Regional Health Authorities (RHAs), 12 Winnipeg Community Areas (CAs) and by income quintile. Each indicator is correlated with PMR (the age- and sex-adjusted premature mortality rate, i.e., death before age 75) and SEFI (Socioeconomic Factor Index, a standardized composite index), both considered proxies for overall health and socioeconomic well-being of populations. RESULTS: Manitoba's total fertility rate was 1.77 children per woman, ranging from 1.62 to 3.15 by RHA, and 1.21 to 2.30 by Winnipeg CA. Manitoba's infant mortality rate was 6.6/1000 (or 5.5/1000 excluding < 500 g or < 20 weeks gestation), ranging from 4.5 to 10.2 by RHA (4.2 to 9.8 exclusive), and 3.7 to 8.4 by Winnipeg CA (2.7 to 6.7). There was a gradient of infant mortality by income quintile (p < 0.001), with double the rate comparing lowest to highest. Child mortality rates varied geographically and by gender, with northern children at greatest risk. Injury was the leading cause of death (52% for ages 1 through 9, 75% for ages 15 to 19). CONCLUSION: Fertility rates, as well as infant and child mortality rates, were positively associated with PMR and SEFI, with substantial geographical variation.
Embedding child health within a framework of regional health: population health status and sociodemographic indicators.
OBJECTIVE: The description of regional variation in children's health requires regional population-based context. But what is the best way to measure the health of a region's population? METHODS: The use of two indicators is described--one a health status measure and the other a measure of socioeconomic wellbeing. It is well known that the population's premature mortality rate (PMR), the age/sex-adjusted rate of death before age 75 years, is highly related to overall health status of an area's residents. Socioeconomic characteristics of an area's residents are also indicative (and likely causative) of health status differences. RESULTS: The Socioeconomic Factor Index (SEFI) was developed at the Manitoba Centre for Health Policy, using a Principal Components Analysis of census data. PMR and SEFI are highly correlated (Spearman's correlation coefficient r = 0.85, p < 0.0001). CONCLUSION: PMR can be used as a surrogate measure for both the health status and socioeconomic well-being of regional populations in Manitoba.
J Urban Health. 2012 Jul 7;: 22772770
Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada, firstname.lastname@example.org.
As health equity researchers, we need to produce research that is useful, policy-relevant, able to be understood and applied, and uses integrated knowledge translation (KT) approaches. The Manitoba Centre for Health Policy and its history of working with provincial government as well as regional health authorities is used as a case study of integrated KT. Whether or not health equity research "takes the day" around the decision-making table may be out of our realm, but as scientists, we need to ensure that it is around the table, and that it is understood and told in a narrative way. However, our conventional research metrics can sometimes get in the way of practicality and clear understanding. The use of relative rates, relative risks, or odds ratios can actually be detrimental to furthering political action. In the policy realm, showing the rates by socioeconomic group and trends in those rates, as well as incorporating information on absolute differences, may be better understood intuitively when discussing inequity. Health equity research matters, and it particularly matters to policy-makers and planners at the top levels of decision-making. We need to ensure that our messages are based on strong evidence, presented in ways that do not undermine the message itself, and incorporating integrated KT models to ensure rapid uptake and application in the real world.
Inj Prev. 2012 Jun 30;: 22753529
Effectiveness of breed-specific legislation in decreasing the incidence of dog-bite injury hospitalisations in people in the Canadian province of Manitoba.
Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
BackgroundThe city of Winnipeg was the first among several jurisdictions in Manitoba, Canada, to introduce breed specific legislation (BSL) by banning pit-bull type dogs in 1990. The objective of the present work was to study the effectiveness of BSL in Manitoba.MethodsTemporal differences in incidence of dog-bite injury hospitalisations (DBIH) within and across Manitoba jurisdictions with and without BSL were compared. Incidence was calculated as the number of unique cases of DBIH divided by the total person-years at risk and expressed as the number per 100 000 person-years. Year of implementation determined the pre-BSL and post-BSL period for jurisdictions with BSL; for jurisdictions without BSL to date, the entire study period (1984-2006) was considered as the preimplementation period. The annual number of DBIH, adjusted for total population at risk, was modelled in a negative binomial regression analysis with repeated measures. Year, jurisdiction and BSL implementation were independent variables. An interaction term between jurisdiction and BSL was introduced.ResultsA total of 16 urban and rural jurisdictions with pit-bull bans were identified. At the provincial level, there was a significant reduction in DBIH rates from the pre-BSL to post-BSL period (3.47 (95% CI 3.17 to 3.77) per 100 000 person-years to 2.84 (95% CI 2.53 to 3.15); p=0.005). In regression restricted to two urban jurisdictions, DBIH rate in Winnipeg relative to Brandon (a city without BSL) was significantly (p<0.001) lower after BSL (rate ratio (RR)=1.10 in people of all ages and 0.92 in those aged <20 years) than before (RR=1.29 and 1.28, respectively).ConclusionsBSL may have resulted in a reduction of DBIH in Winnipeg, and appeared more effective in protecting those aged <20 years.
BMC Cancer. 2012 May 17;12 (1):182 22607726
Does access to a colorectal cancer screening website and/or a nurse-managed telephone help line provided to patients by their family physician increase fecal occult blood test uptake?: A pragmatic cluster randomized controlled trial study protocol.
Kathleen M Clouston, Alan Katz, Patricia J Martens, Jeff Sisler, Donna Turner, Michelle Lobchuk, Susan McClement
ABSTRACT: BACKGROUND: Fecal occult blood test screening in Canada is sub-optimal. Family physicians play a central role in screening are limited by the time constraints of clinical practice. Patients face multiple barriers that further reduce completion rates. Tools that support family physicians in providing their patients with colorectal cancer information and that support uptake may prove useful. The primary objective of the study is to evaluate the efficacy of a patient decision aid (nurse-managed telephone support line and/or colorectal cancer screening website) distributed by community-based family physicians, in improving colorectal cancer screening rates. Secondary objectives include evaluation of (dis)incentives to patient FOBT uptake and internet use among for health-related questions. Challenges faced by family physicians in engaging in collaborative partnerships with primary healthcare researchers will be documented. METHODS: A pragmatic, two-arm, randomized cluster controlled trial conducted in 22 community-based family practice clinics (36 clusters) with 76 fee-for-service family physicians in Winnipeg, Manitoba, Canada. Each physician will enroll 30 patients attending their periodic health examination and at average risk for colorectal cancer. All physicians will follow their standard clinical practice for screening. Intervention group physicians will provide a fridge magnet to each patient that contains information facilitating access to the study-specific colorectal cancer screening decision aids (telephone help-line and website). The primary endpoint is patient Fecal occult blood test completion rate after four months (intention to treat model). Multi-level analysis will include clinic, physician and patient level variables. Patient Personal Health Identification Numbers will be collected from those providing consent to facilitate analysis of repeat screening behavior. Secondary outcome data will be obtained through the Clinic Characterization Form, Patient Tracking Form, In-Clinic Patient Survey, Post-Study Follow-Up Patient Survey, and Family Physician Survey. Study protocol approved by The University of Manitoba Health Research Ethics Board. DISCUSSION: The study intervention has the potential to increase patient fecal occult blood test uptake, decrease colorectal cancer mortality and morbidity, and improve the health of Manitobans. If utilization of the website and/or telephone support line result in clinically significant increases in colorectal cancer screening uptake, changes in screening at the policy- and system-level may be warranted. Trial Registration: clinicaltrials.gov identifier NCT01026753.
J Hum Lact. 2012 Aug ;28 (3):335-42 22584874
What Do Kramer's Baby-Friendly Hospital Initiative PROBIT Studies Tell Us? A Review of a Decade of Research.
1University of Manitoba, Winnipeg, Canada.
Background: Kramer et al's PROBIT (Promotion of Breastfeeding Intervention Trial) research in Belarus studied effects of the Baby-Friendly Hospital Initiative (BFHI) training on breastfeeding duration, exclusivity, and health outcomes. Aims: To critique inclusion criteria, context, approaches to data analysis, and health outcome results. Method: Twenty-two articles were retrieved from PubMed and the PROBIT Website for 2001-2010; 6 were excluded as not focusing on breastfeeding and health outcomes. Results: PROBIT data from the cluster randomized hospital comparisons included only breastfed babies since all non-breastfed babies were excluded from the research. Context may affect outcomes, knowing that Belarus has good basic health services, 3-year maternity leaves with little use of daycare, 95% breastfeeding initiation rate, and a well-educated population. PROBIT data were analyzed in 2 ways:(a) intent-to-treat analyses of breastfeeding and health differences by cluster randomized intervention and control site mother/baby pairs; and (b) as an observational cohort study of health outcomes for all mother/baby pairs, analyzed by various breastfeeding categorizations and controlling for biases. PROBIT demonstrated links between BFHI and longer breastfeeding duration (19.7% vs 11.4% at 12 months, P <.001) and exclusivity (43.3% vs 6.4% at 3 months, P <.001), reductions in gastrointestinal episodes and rashes, higher verbal IQ scores, and longer exclusive breastfeeding rates for subsequent children but no statistically significant differences in the child's body mass index, blood pressure, or dental health. Conclusion: PROBIT provides foundational evidence for BFHI policy and follow-up care. Knowing that non-breastfed babies were excluded, caution must be exercised for health comparisons.
Associate Professor, School of Health Sciences, University of Northern British Columbia, Prince George, BC.
The objective of this study was to estimate the impact of the First Nations and Inuit Home and Community Care Program (FNIHCCP) on the rates of hospitalization for ambulatory care sensitive conditions (ACSCs) in the province of Manitoba. A population-based time trend analysis was conducted using the de-identified administrative data housed at the Manitoba Centre for Health Policy, including data from 1984/85 to 2004/05. Findings show a significant decline in the rates of hospitalization (all conditions) following the introduction of the FNIHCCP in communities served by health offices (p<0.0001), health centres (p<0.0001) and nursing stations (p=0.0022). Communities served by health offices or health centres also experienced a significant reduction in rates of hospitalization for chronic conditions (p<0.0001).The results of this study suggest that investment in home care resulted in a significant decline in rates of avoidable hospitalization, especially in communities that otherwise had limited access to primary healthcare.
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Factors associated with unintended pregnancy, poor birth outcomes and post-partum contraceptive use among HIV-positive female adolescents in Kenya.
ABSTRACT: BACKGROUND: Although the experiences of unintended pregnancies and poor birth outcomes among adolescents aged 15--19 years in the general population are well documented, there is limited understanding of the same among those who are living with HIV. This paper examines the factors associated with experiencing unintended pregnancies, poor birth outcomes, and post-partum contraceptive use among HIV-positive female adolescents in Kenya. METHODS: Data are from a cross-sectional study that captured information on pregnancy histories of HIV-positive female adolescents in four regions of Kenya: Coast, Nairobi, Nyanza and Rift Valley provinces. Study participants were identified through HIV and AIDS programs in the four regions. Out of a total of 797 female participants, 394 had ever been pregnant with 24% of them experiencing multiple pregnancies. Analysis entails the estimation of random-effects logit models. RESULTS: Higher order pregnancies were just as likely to be unintended as lower order ones (odds ratios [OR]: 1.2; 95% confidence interval [CI]: 0.8--2.0) while pregnancies occurring within marital unions were significantly less likely to be unintended compared to those occurring outside such unions (OR: 0.1; 95% CI: 0.1--0.2). Higher order pregnancies were significantly more likely to result in poor outcomes compared to lower order ones (OR: 2.5; 95% CI: 1.6--4.0). In addition, pregnancies occurring within marital unions were significantly less likely to result in poor outcomes compared to those occurring outside such unions (OR: 0.3; 95% CI: 0.1--0.9). However, experiencing unintended pregnancy was not significantly associated with adverse birth outcomes (OR: 1.3; 95% CI: 0.5--3.3). There was also no significant difference in the likelihood of post-partum contraceptive use by whether the pregnancy was unintended (OR: 0.9; 95% CI: 0.5--1.5). CONCLUSIONS: The experience of repeat unintended pregnancies among HIV-positive female adolescents in the sample is partly due to inconsistent use of contraception to prevent recurrence while poor birth outcomes among higher order pregnancies are partly due to abortion. This underscores the need for HIV and AIDS programs to provide appropriate sexual and reproductive health information and services to HIV-positive adolescent clients in order to reduce the risk of undesired reproductive health outcomes.
Correspondence to Dr Fiona Straw, Safeguarding Children's Team, Children's Clinic South, B Floor, South Block, QMC Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK; email@example.com.
Sexual health encompasses 'sexual development and reproductive health, as well as the ability to develop and maintain meaningful interpersonal relationships; appreciate one's own body; interact with both genders in respectful and appropriate ways; express affection, love and intimacy in ways consistent with one's own values'. The 2008 WHO Consensus Statement additionally noted that 'responsible adolescent intimate relationships' should be 'consensual, non-exploitative, honest, pleasurable and protected against unintended pregnancy and STDs if any type of intercourse occurs'. Young people (YP) must, therefore, be able to access sexual health information and services that meet their needs. For most YP, interest in sexual activity begins with puberty, and this is associated with increasingly sexualised behaviour, including exploration of themselves and others. Most YP find this a confusing time, and so it is important that health professionals are able to offer advice regarding the wide range of sexual health issues, including sexuality, choice of partner, contraception, risk and management of sexually transmitted infections (STI) in a confident and approachable manner. YP have never had so much choice or information available to them, and this can be confusing for them. There is good evidence that YP who get information from their parents are likely to initiate sexual activity later than their peers who access information from their friends. However, there is also evidence that some YP would prefer to get sexual health information from health professionals. It is therefore imperative that all health professionals who see YP have an awareness of sexual health issues, and know where to signpost YP should they need more specialist sexual health advice and/or treatment. Where appropriate, one-to-one sexual health advice should be provided to YP on how to prevent and get tested for STIs, and how to prevent unwanted pregnancies. Advice should also be given on all methods of reversible contraception, including long-acting reversible contraception, emergency contraception and other reproductive issues.
1Safeguarding Children's Team, QMC Nottingham University Hospitals NHS Trust, Nottingham, UK.
Sexual health encompasses 'sexual development and reproductive health, as well as the ability to develop and maintain meaningful interpersonal relationships; appreciate one's own body; interact with both genders in respectful and appropriate ways; express affection, love and intimacy in ways consistent with one's own values'. The 2008 WHO Consensus Statement additionally noted that 'responsible adolescent intimate relationships' should be 'consensual, non-exploitative, honest, pleasurable and protected against unintended pregnancy and STDs if any type of intercourse occurs'. Young people (YP) must, therefore, be able to access sexual health information and services that meet their needs.For most YP, interest in sexual activity begins with puberty, and this is associated with increasingly sexualised behaviour, including exploration of themselves and others.Most YP find this a confusing time, and so it is important that health professionals are able to offer advice regarding the wide range of sexual health issues, including sexuality, choice of partner, contraception, risk and management of sexually transmitted infections (STI) in a confident and approachable manner. YP have never had so much choice or information available to them, and this can be confusing for them. There is good evidence that YP who get information from their parents are likely to initiate sexual activity later than their peers who access information from their friends. However, there is also evidence that some YP would prefer to get sexual health information from health professionals. It is therefore imperative that all health professionals who see YP have an awareness of sexual health issues, and know where to signpost YP should they need more specialist sexual health advice and/or treatment.Where appropriate, one-to-one sexual health advice should be provided to YP on how to prevent and get tested for STIs, and how to prevent unwanted pregnancies. Advice should also be given on all methods of reversible contraception, including long-acting reversible contraception, emergency contraception and other reproductive issues.
Contraception. 2012 Jul 25;: 22840278
A randomized controlled study of two educational interventions on adherence with oral contraceptives and condoms.
BACKGROUND: The study was conducted to examine the effectiveness of two different interventions on oral contraception (OC) adherence and condom use. STUDY DESIGN: A total of 1,155 women 16-24 years of age requesting OC were randomized to receive either face-to-face behavioral counseling and education at their baseline clinic visit (C group; n=383) or this same intervention followed by monthly phone calls for 6 months (C+P group; n=384) or standard care (S group; n=388). Phone interviews at 3, 6 and 12 months after the initial visit as well as a medical record review assessed OC continuation, condom use and several other secondary and clinically meaningful outcomes such as pregnancy and sexually transmitted infection (STI) rates and correct use of pills. RESULTS: The interventions did not have a significant effect on OC continuation after 3 (C+P: 58%; C: 50%; S: 55%), 6 (39%; 32%; 37%) or 12 months (20%; 18%; 20%)(p>.05). Condom use at last sexual intercourse did not differ by intervention methods (p>.05). Moreover, no effect was observed on pregnancy [S=48 (12.4%), C =63 (16.5%), C+P=52 (13.5%); p=.22] and STI [S=18 (4.6%), C=12 (3.1%), C+P=13 (3.4%); p=.50] rates, and mean number of correctly used pill packs (p=.06). However, those randomized to C+P were more likely than C and S patients to identify a cue and report that the cue worked as a reminder to take their OC on time based on 3 and 6 months follow-up information (p<.01 for all relationships). CONCLUSIONS: Neither intervention in this study improved OC adherence among young women.
Pals Solutions P.O. Box TL 430, Tamale-Ghana. firstname.lastname@example.org
Within the past one and half decades many efforts have been made to improve the availability and access to adolescent sexual and reproductive health services. Despite these efforts, adolescents still face a number of sexual and reproductive health problems. This paper uses data from the 2003 and 2008 Ghana Demographic and Health Surveys to examine changes in contraceptive use among sexually active female adolescents (15-19 years old). The results show that between 2003 and 2008 there was a significant increase in the current use of any contraceptive method (from 23.7% to 35.1%, p = 0.03). It also indicates a shift from modern to traditional contraceptive methods. Traditional methods recorded about 60%(7.8 percentage points) increase as compared to 5.5%(2.6 percentage points) for modern methods. Also ever use of any traditional method recorded a higher increase as compared to any modem method. There was a slight decline 7%(4.4 parentage points) in the number of non-users who intended to use contraceptives in the future. On the whole the findings indicate increasing unmet need for modern contraception due to barriers such as limited access, cost and misconceptions about the effects of contraceptives.
Lower Use of Sexual and Reproductive Health Services among Women with Frequent Religious Participation, Regardless of Sexual Experience.
1 Office of Population Research, Center for Health and Wellbeing, Princeton University , Princeton, New Jersey.
Abstract Purpose: To investigate associations between religious characteristics and sexual and reproductive health (SRH) service use among young women in the United States. Methods: We combined two cycles of data from the U.S. population-based reproductive health survey, The National Survey of Family Growth (2002 and 2006-2008). Our analysis was restricted to young women aged 15-24 years (n=4421). We tested relationships between religious characteristics, including religious affiliation, service participation, and importance of religion in daily life, and use of SRH services for contraception, sexually transmitted infection (STI) testing/treatment, and routine gynecologic examination care within the last year. Results: Nearly all young women identified a current religious affiliation (82%), with 46% identifying Protestant and 28% Catholic. Three quarters (75%) of young women reported current religious service participation, the majority of whom had experienced sexual intercourse (70%); 31% reported weekly religious service participation. Over half (59%) had used SRH services recently. In unadjusted analyses, young women with current religious affiliation who participated in services weekly and deemed religion important had lower proportions of SRH service use than their counterparts (all p<0.001). In multivariate regression models, young women with less-than-weekly religious service participation were 50% more likely to use services than those participating weekly (odds ratio [OR] 1.5, confidence interval [CI] 1.3, 2.1, p<0.001), even among sexually experienced women. Conclusions: Increasing frequency of current religious service participation was negatively associated with SRH service use among young women, despite sexual experience. Religiously and sexually active young women in the United States may have an unmet need for SRH care.
Healthy Youth Development * Prevention Research Center, Division of Adolescent Health and Medicine, Department of Pediatrics, University of Minnesota Medical School, 717 Delaware Street SE, 3rd Floor West, Minneapolis, Minnesota 55414, USA. Italiafe@umn.edu
The negative outcomes of early childbearing and sexually transmitted infections (STIs), including HIV/AIDS, threaten the health of adolescents more than any other age group. Ensuring the sexual and reproductive health of the more than 1.5 billion young people aged 10 to 25 around the world is central to global health. Country-level indicators show dramatic variations in sexual risk. Percentages of those who engage in sexual intercourse range from less than 1% of females in Pakistan to 54% of males in Cuba. Divergent rates of early pregnancy and STIs between countries and regions parallel variations in sexual behaviors, including age of sexual debut; number of partners; and use of contraception, including condoms. To understand these variations, many factors affecting the sexual and reproductive health of young people around the world such as age of marriage, norms and expectations around sexual behavior, gender inequities, and educational and economic opportunities must be considered.
Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006-2010 national survey of family growth.
Division of Vital Statistics, Centers for Diseases Control and Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USA.
OBJECTIVE This report presents national estimates of sexual activity, contraceptive use, and births among males and females aged 15-19 in the United States in 2006-2010 from the National Survey of Family Growth (NSFG). For selected indicators, data are also presented from the 1988, 1995, and 2002 NSFG, and from the 1988 and 1995 National Survey of Adolescent Males, conducted by the Urban Institute. METHODS Descriptive tables of numbers and percentages are presented and discussed. Data were collected through in-person interviews of the household population of males and females aged 15-44 in the United States, between July 2006 and June 2010. Interviews were conducted with 22,682 men and women, including 4,662 teenagers (2,284 females and 2,378 males). For both the teen subsample and the total sample, the response rate was 77%. RESULTS In 2006-2010, about 43% of never-married female teenagers (4.4 million), and about 42% of never-married male teenagers (4.5 million) had had sexual intercourse at least once. These levels of sexual experience have not changed significantly from 2002. Seventy-eight percent of females and 85% of males used a method of contraception at first sex according to 2006-2010 data, with the condom remaining the most popular method. Teenagers' contraceptive use has changed little since 2002, with a few exceptions: there was an increase among males in the use of condoms alone and in the use of a condom combined with a partner's hormonal contraceptive; and there was a significant increase in the percentage of female teenagers who used hormonal methods other than a birth-control pill, such as injectables and the contraceptive patch, at first sex. Six percent of female teenagers used a nonpill hormonal method at first sex.
Department of Mathematics, Islamic University, Kushtia, Bangladesh. email@example.com
OBJECTIVES To investigate the socioeconomic determinants of childbearing and contraceptive use among married adolescents in Bangladesh. METHODS The study used the Bangladesh Demographic and Health Survey 2007 data. Both bivariate and multivariate statistical analyses were used to examine the association between the socioeconomic factors and childbearing and contraceptive use among married female adolescents. RESULTS Overall, 69% of the married adolescents initiated childbearing and 25% of the most recent pregnancies were unintended. The current contraceptive prevalence rate was 42%. The multivariate logistic regression yielded a significantly increased risk of childbearing among adolescents with no formal education, those who were married-off before age 16, the poor and those who had ever used any contraceptive method. Inter-spousal communication on family planning (FP) appeared as the most single significant determinant of any contraceptive use. Number of living children, working status and visitations by FP workers are also important determinants of contraceptive use among the married female adolescents. CONCLUSIONS Early childbearing, lower use rate of contraceptive methods and unintended pregnancies are common among married adolescents in Bangladesh. Expanded schooling and reproductive health programmes in Bangladesh should promote increased communication about FP within the couples in order to achieve successful contraception and better reproductive outcomes, particularly among adolescents.
Department of Obstetrics and Gynecology, Women and Infants' Hospital, Providence, RI.
The number of women of childbearing age who are active-duty service members or veterans of the US military is increasing. These women may seek reproductive health care at medical facilities operated by the military, in the civilian sector, or through the Department of Veterans Affairs. This article reviews the current data on unintended pregnancy and prevalence of and barriers to contraceptive use among active-duty and veteran women. Active-duty servicewomen have high rates of unintended pregnancy and low contraceptive use, which may be due to official prohibition of sexual activity in the military, logistic difficulties faced by deployed women, and limited patient and provider knowledge of available contraceptives. In comparison, little is known about rates of unintended pregnancy and contraceptive use among women veterans. Based on this review, research recommendations to address these issues are provided.