TEENAGE BIRTHRATE MILESTONE

With an 8% decline between 2007 and 2009, the U.S. teenage birthrate hit an all-time low of 39.1 per 1,000 women aged 15–19, according to analyses based on preliminary data for the later year.1 This rate is less than half the all-time high (96.3 births per 1,000, reached in 1957) and about two-thirds the most recent peak (61.8 in 1991). Rates for both 15–17-year-olds and 18–19-year-olds fell, also reaching record lows (20.1 and 66.2 per 1,000, respectively). Likewise, rates fell in all racial and ethnic groups, and hit historic lows in most. Hispanics registered the largest declines between 2007 and 2009—from 47.9 to 41.0 per 1,000 among younger teenagers and from 137.2 to 114.0 among older teenagers. Thirty-one states saw declines in the birthrate for 15–17-year-olds, and 45 in the rate for 18–19-year-olds; the only increase occurred among younger teenagers in West Virginia. The analysts observe that “the recent trend marks a resumption of the long-term decline in teenage childbearing that started in 1991” and comment that soon-to-be-released data from the latest National Survey of Family Growth may help illuminate the causes of the decline.

1. Ventura SJ and Hamilton BE, U.S. teenage birth rate resumes decline, NCHS Data Brief, Hyattsville, MD: National Center for Health Statistics, 2011, No. 58.

WHAT’S AVAILABLE WHERE

Findings from a 2009–2010 survey indicate that office-based physicians who provide family planning services and Title X–supported clinics are about equally likely to make specific contraceptive methods available to their patients, but how they do that differs.1 For example, virtually all providers in both groups reported making combined pills available. However, whereas 92% of clinics offered the method on-site, only 49% of physicians did; another 50% of physicians provided prescriptions for combined pills. Similarly, 95% of each group made the patch available, but clinics did so mainly by on-site provision, and physicians mainly by prescription. Levonorgestrel-releasing IUDs were the only method that physicians directly provided more often than clinics did (56% vs. 47%). Only about one-third of each type of provider offered the implant on-site; the bulk of provision of this method was by referral to other providers. Information about patterns of method availability “can help guide practice, financing, and policy efforts aimed at improving contraceptive delivery,” according to an editorial note accompanying the survey report.2

1. Moskosky SG et al., Contraceptive methods available to patients of office-based physicians and Title X clinics—United States, 2009–2010, Morbidity and Mortality Weekly Report, 2011, 60(1):1–2.

2. Centers for Disease Control and Prevention, Editorial note, Morbidity and Mortality Weekly Report, 2011, 60(1):3–4.

SEND IN THE CLOWNS

When you think of in vitro fertilization and embryo transfer, you probably think of petri dishes, technicians in white coats and the like. Maybe you should also think of Bozo. Women who attended an in vitro fertilization clinic in Israel to undergo embryo transfer on a day when a medical clown visited had a higher pregnancy rate than those who did not get a bedside visit from the joke-making, magic-performing clown: 36% vs. 20%.1 The difference held up in analyses adjusting for age, type of infertility, number of transferred embryos and other potentially confounding factors—none of which was significant. The mechanism by which humor or laughter may be therapeutic is not well understood, and the researchers find the results surprising, since the intervention was quite brief. Nevertheless, they conclude that given the simplicity and low cost of medical clowning, its use “as an adjunct to treatment for infertility deserves further investigation.”

1. Friedler S et al., The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer (IVF-ET), Fertility and Sterility, 2011, DOI: 10.1016/j.fertnstert.2010.12.016.

GETTING A HANDLE ON A HIDDEN POPULATION

Using state-specific census data and information from a nationally representative behavioral survey, analysts have c-onstructed statistical models to help “estimate and characterize the sometimes marginalized and hidden populations of [U.S. men who have sex with men].”1 According to their calculations, about 7.1 million U.S. residents in 2007—6% of all men aged 18 or older—were men who have sex with men. The vast majority of these men (71%) were white; 16% were Hispanic, 9% black and the rest members of other racial or ethnic groups. Southern states were home to the greatest proportion of men who have sex with men (34%), and the Northeast accounted for the smallest share of this population (19%). However, California, the most populous state, had the largest number of men who have sex with men—more than 1.1 million. The analysts note that estimates of this population by region, state, and race or ethnicity “can inform and guide HIV/AIDS surveillance, allocation of resources, and advocacy, as well as help in the planning, implementation, and evaluation of HIV prevention programs and other services.”

1. Lieb S et al., Statewide estimation of racial/ethnic populations of men who have sex with men in the U.S., Public Health Reports, 2011, 126(1):60–72.

GESTATIONAL DIABETES SCREENING RATES FALL SHORT

Because gestational diabetes can have serious consequences for both mothers and their infants, major national obstetrics and diabetes organizations recommend screening for all pregnant women who did not have diabetes before conceiving. However, analyses of data on nearly one million pregnant women who had lab work done through a single diagnostic service suggest that these recommendations are going largely unheeded.1 Only 68% of women aged 25–40 (those who are not in a low-risk age-group) had been screened; 5% of all those screened (including women aged 18–24) tested positive for the condition. In addition, the professional associations recommend that all women with gestational diabetes be retested for diabetes 6–12 weeks postpartum; within six months, however, only 19% were. “Screening for [gestational diabetes] is important,” the analysts write, “because … treating even mild [cases] reduces morbidity for both the mother and newborn.”

1. Blatt AJ, Nakamato JM and Kaufman HW, Gaps in diabetes screening during pregnancy and postpartum, Obstetrics & Gynecology, 2011, 117(1):61–68.

HANGING TOUGH ON ABORTION

Hungary, which saw a 6% decline in the number of births in 2010, wants to boost its population, but the government says that it will not ban abortion to help achieve that goal.1 According to one member of the country’s parliament, “Banning abortion in Hungary isn’t a possibility and it’s nobody’s intention.” Rather, to address the nation’s population decline, and resulting employment problems, the government has resurrected a policy of granting workers three years’ maternity leave (a far more generous benefit than the 14-week average in the European Union) and has put in place a new tax structure that rewards families according to their number of children. It also is examining the nationwide capacity of kindergarten and plans to invest heavily in building that capacity.

1. Gulyas V, Hungary wants more children, but won’t ban abortion, Feb. 25, 2011, <http://blogs.wsj.com/new-europe/2011/02/25/hungary-wants-more-children-b..., accessed Mar. 1, 2011.

BLACKS ARE HIT HARD BY HIV

In 37 states where confidential reporting of HIV diagnoses was in place in 2005–2008, blacks made up 14% of the population but accounted for 50% of newly identified HIV infections during that period.1 By contrast, whites made up 68% of the population but accounted for 29% of HIV diagnoses. Two-thirds of infections in women were diagnosed in blacks, who acquired the infection mainly through heterosexual contact with HIV-positive or high-risk partners (85%). Among men, blacks accounted for 45% of diagnoses; black men with a new HIV diagnosis were infected primarily through sexual activity with a same-sex partner (61%). Black males consistently had a higher rate of diagnosis than any other subgroup defined by race and gender; their rate increased over the period, reaching 131.9 per 100,000 in 2008, while rates for all other groups were stable.

1. Laffoon B et al., Disparities in diagnoses of HIV infection between blacks/African Americans and other racial/ethnic populations—37 states, 2005–2008, Morbidity and Mortality Weekly Report, 2011, 60(4):93–98.

A SLIPPERY SLOPE?

Once adolescents have oral sex, can vaginal intercourse be far behind? Perhaps not, according to findings from a study that followed a sample of 627 California youngsters from ninth to 11th grade.1 In general, among those who began either type of sexual activity during the study, the greatest number reported initiating both vaginal and oral sex in the same six-month interval; those whose first experience was with oral sex far outnumbered those who began with vaginal intercourse. By the end of grade 11, adolescents had a 24% probability of having had vaginal sex; the probability was 7% among those who had never had oral sex, but reached 50% among those who had had oral sex during the second half of ninth grade. In a logistic regression analysis taking into account six-month study intervals and experience with oral sex, the likelihood that vaginal sex had begun by the end of high school was significantly elevated for youth who had started having oral sex during the second half of ninth grade (odds ratio, 3.2), the first half of 10th grade (2.8) or the second half of 10th grade (1.7); it was reduced for those who had not had oral sex by the end of grade 11 (0.6). According to the researchers, a progression from oral to vaginal sex “may be a normative trajectory” for teenagers, which may call for an expansion of “traditional messages” that “typically ignore the role oral sex plays in adolescent sexual behavior.”

1. Song AV and Halpern-Felsher BL, Predictive relationship between adolescent oral and vaginal sex: results from a prospective, longitudinal study, Archives of Pediatrics & Adolescent Medicine, 2011, 165(3):243–249.

YOU CAN’T FOOL THE TEST

Eleven percent of young adults who tested positive for at least one STD at the third wave of the National Longitudinal Study of Adolescent Health said that they had not had penile-vaginal sex in the previous year, and 6% said that they had never done so.1 Logistic regression analyses aimed at identifying social and demographic predictors of discrepancy between STD status and reported sexual activity found none; reports of intercourse within the last year were only modestly associated with the odds of testing positive for an STD. The findings, the analysts comment, suggest that relying strictly on young adults’ reports of their sexual behavior to assess their STD risk “could be problematic.” Furthermore, the analysts write, if physicians do not test all young people, “a substantial number” of STDs are likely to go undiagnosed and untreated, and be passed along to future partners.

1. DiClemente RJ et al., Association between sexually transmitted diseases and young adults' self-reported abstinence, Pediatrics, 2011, 127(2):208–213.