March 2012 Issue of Perspectives on Sexual and Reproductive Health

Under our Early View feature, articles in Perspectives on Sexual and Reproductive Health are published online as they complete the production process, which allows us to get material to you weeks before the printed journal arrives in your mailbox. Sign up at this link to receive an alert when new materials become available.

Many of you have already seen these widely circulated articles from our March issue: "Variation in State Unintended Pregnancy Rates in the United States," by Kathryn Kost et al., of the Guttmacher Institute (click here for the news release) and "Missed Conceptions or Misconceptions: Perceived Infertility Among Unmarried Young Adults in the United States," by Chelsea Bernhardt Polis and Laurie Schwab Zabin, of Johns Hopkins Bloomberg School of Public Health (click here for the news release).


Teens Who Receive Comprehensive Sexual Health Information Are More Likely than Others to Use Reproductive Health Services

A new analysis of government data finds that teenage women who receive information about a range of sexual health topics, either from their parents or in a formal setting (such as a school, church or community center), are more likely than others to visit a medical provider for sexual or reproductive health care. However, according to "Associations Between Sexual and Reproductive Health Communication and Health Service Use Among U.S. Adolescent Women," by Kelli Stidham Hall, of Princeton University, et al., teens who received information only about abstinence were less likely than others to have sought out the services that are necessary to improving their sexual and reproductive health outcomes. Even among sexually experienced teens, the data suggest that those who received abstinence-only information from parents were less likely than others to use sexual and reproductive health services. The analyses were based on data from 15–19-year-old respondents to the National Survey of Family Growth. The authors suggest that further investigation is needed to determine whether comprehensive sexual and reproductive health communication facilitates teens’ use of sexual and reproductive health care services, and whether abstinence-only information deters teens’ use of these services.

Early, Adequate Prenatal Care Linked to Healthy Birthspacing

Women who initiate prenatal care in the second or third trimester, or get no care at all, are more likely to have a second child within 18 months than are those who first obtain care early in pregnancy, according to "Prenatal Care and Subsequent Birth Intervals," by Julien O. Teitler, of Columbia University, et al. Using longitudinally linked electronic birth records from New Jersey women who had a first birth between 1996 and 2000, the authors examine the relationship between the timing and adequacy of prenatal care prior to a woman’s first birth and the timing of her second birth. They find that most women (85%) had initiated prenatal care during the first trimester. However, 12% of women had initiated prenatal care in the second trimester, and 3% in the third; fewer than 1% had had no care. The later prenatal care was initiated, the more likely women were to have had a second birth within 18 months. Additionally, the likelihood of having a second birth soon after the first was greater if women had had inadequate rather than adequate prenatal care.

According to the authors, these findings "provide strong evidence that earlier and more intensive exposure to prenatal care during a first pregnancy is associated with more optimal spacing and thus, most likely, better fertility control." They are particularly timely because some states (of which New Jersey is one) have reduced or eliminated state funding for family planning. The authors suggest that providers should take advantage of their encounters with women who initiate prenatal care later in pregnancy in particular, to ensure that these women receive family planning information and services during their prenatal visits. By doing so, providers could bridge the gap left by funding and service cuts to the family planning program; the potential impact on public health is large.

Utah Women Who Overestimate Emergency Contraception’s Effectiveness Are the Most Likely to Use It Repeatedly

Six in 10 women surveyed in Utah thought that levonorgestrel emergency contraception was at least 90% effective in preventing pregnancy (the actual figure is likely 77% at best); these women were more likely than those who had more accurate knowledge of the method’s effectiveness to use it repeatedly, according to "Use of Levonorgestrel Emergency Contraception in Utah: Is It More than ’Plan B’?," by Lindsay Melton et al., of the University of Utah. The authors surveyed 1,040 women aged 18–29 who purchased levonorgestrel emergency contraception at Planned Parenthood clinics in Utah, and found that a greater proportion than expected reported repeat use of the method within the last 12 months (29%). The most common reasons women reported for using this method were contraceptive method failure and unprotected sex. The authors emphasize that levonorgestrel emergency contraception was developed and is promoted as a backup method to reduce unwanted pregnancy and is not as effective as many primary methods of contraception; they raise the concern that women who overestimate the method’s effectiveness may be putting themselves at elevated risk of pregnancy. They also suggest that although over-the-counter sale increases access to the method, it may reduce doctors’ opportunity to provide accurate information about its effectiveness or to recommend more effective primary methods.

Outreach to Parents About the Impact of HPV on Boys’ Health Could Raise Awareness and Ensure Timely Vaccination

Many parents are unaware that human papillomavirus (HPV) can have serious consequences for males, and are surprised to learn that the HPV vaccine is approved for preteenage boys. However, materials that promote vaccination as an important component of male sexual health may help motivate parents to ensure their sons’ timely vaccination, according to "Designing Messages to Motivate Parents to Get Their Preteenage Sons Vaccinated Against Human Papillomavirus," by Joan R. Cates of the University of North Carolina, Chapel Hill, et al. The researchers conducted focus groups with 29 black parents and surveyed a racially diverse sample of 100 parents of preteenage boys to explore ways to encourage parents to have their sons vaccinated before they become sexually active, when the vaccine is most effective.

Nearly all focus group participants and 89% of parents interviewed reported never having heard of the male vaccine, and only 6% of those surveyed indicated that their sons had received at least one of the three required doses. Sixty-one percent of parents in the survey sample said they "definitely" or "probably" will get their sons vaccinated in the next 12 months, while 16% said they "definitely" or "probably" will not. In focus groups, parents expressed concern about the vaccine’s cost, side effects, long-term safety and effectiveness, but many still supported vaccination for their sons.

In both the focus groups and the interviews, participants were presented with a series of messages and images to determine what would motivate them to vaccinate their sons. Most parents responded strongly to images of two parents "lovingly protecting their sons against HPV." Additionally, they preferred racial diversity in the images. The message participants responded to most was one stressing the prevalence and possible consequences of HPV. The authors suggest that these findings "can be used to develop communication strategies that promote … vaccination at the ages when it is most effective, and among racial and ethnic minorities who are disproportionately affected by HPV infection and related diseases."

The U.S. Food and Drug Administration approved HPV vaccine for females in 2006 and for males aged 9–26 in 2009. HPV is the most common STD in the United States and infects approximately 50% of sexually active males and females. The virus causes genital warts and is associated with a range of cancers.

Early First Sex, Relationship Instability Tied to Timing of First Birth in a New Zealand Cohort

First birth before age 21 was more likely among men and women in a New Zealand cohort who initiated intercourse before age 15, and less likely among those who waited until age 18 or later, than it was among those who first had sex at ages 15–17, according to "Patterns of Sexual Partnering and Reproductive History: Associations with Timing of First Birth in a Birth Cohort," by Thea van Roode et al., of the University of Otago Medical School, New Zealand. Using data from members of a 1972–1973 birth cohort who were surveyed at ages 21, 26 and 32, the authors examined participants’ likelihood of reporting a first birth at specific ages. They found that individuals who were married or cohabiting were much more likely to report a first birth at each age than were those not in a regular relationship, suggesting that greater relationship stability was associated with timing of first birth; for women, the association was stronger at later than at earlier ages. Additionally, the analyses revealed an increased likelihood of first birth for both men and women reporting prior failed pregnancies (mainly miscarriages). Van Roode and her colleagues suggest that unstable home environments among younger parents could result in disadvantage for children, whereas children of older parents are more likely to be raised in stable home environments. They suggest that additional research is needed to further explore the relationship between partnering, childbearing and socioeconomic factors.

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