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 them to you weeks before the full journal becomes available. Sign up at this link to receive an alert when new articles become available.

Thanks to Early View, many of you have already seen the first article in our September issue, "Women's Emotions One Week After Receiving or Being Denied an Abortion in the United States" (click here for the news release), by Corrine H. Rocca et al., of the University of California, San Francisco.



Provision of sexual health resources on college campuses may be related to students' sexual health behaviors and outcomes

Students attending Minnesota colleges that provide sexual health resources on campus are generally more likely to engage in safer sexual behaviors and avoid involvement in unplanned pregnancy than students on campuses that do not offer such resources, according to "Sexual Health Resources at Minnesota Colleges: Associations with Students' Sexual Health Behaviors," by Marla E. Eisenberg, of the University of Minnesota, et al. However, not all behaviors fit this pattern.

The authors analyzed 2010–2011 survey data from more than 6,000 sexually active undergraduate students on 28 two- and four-year Minnesota college campuses. They also assessed the presence of health clinics, the convenience of such clinics, and the availability of specific sexual health services and of condoms on each campus. After controlling for students' personal and demographic characteristics, the researchers found that the higher the level of sexual health resources at a college, the higher the likelihood that students had used birth control or condoms the last time they had sex and the lower the likelihood that they had been involved in an unplanned pregnancy. For example, the researchers estimated that the predicted probability that students had not used birth control the last time they had sex was 14% for those attending a college with no sexual health resources and 7% for those at a college with the highest level of resources. Contrary to expectations, however, the more sexual health resources available on campus, the less likely students were to have received STD or HIV tests; the predicted probability that they had not done so was 32% on campuses with the greatest level of resources and 26% at schools with no resources. The authors hypothesize that students on campuses with more sexual health resources may use condoms more often than others and may be less likely to use available testing services because they feel they are at lower risk of contracting STDs or HIV.

The authors suggest that future research explore the reasons behind the associations found in this study and assess the role of campus resources in promoting students' healthy sexual behavior. Such research could inform interventions on college campuses aimed at reducing students' risky sexual behaviors.


Racial disparities in the use of the most effective reversible contraceptive methods are growing in the United States

In 1995, similar proportions of white, black and Hispanic U.S. women used the most effective reversible methods of contraception. However, by 2006–2010, a significant racial gap had emerged, according to "Racial and Ethnic Differences in U.S. Women's Choice of Reversible Contraceptives, 1995–2010," by Josephine Jacobs, of the University of Toronto, and coinvestigator Maria Stanfors. After controlling for differences in socioeconomic status and other background characteristics, the researchers found that black women were significantly less likely than white women to use the most effective reversible methods in 2006–2010.

Using data from two rounds of the National Survey of Family Growth, the researchers found that 46% of women at risk for unintended pregnancy in 1995 used the most effective reversible methods of contraception (a hormonal method or IUD), compared with 53% in 2006–2010. In 1995, there was no difference between white, black and Hispanic women's use of these methods. However, by 2006–2010, the proportion of women using the most effective reversible methods had increased among whites (from 47% to 58%), but had remained stagnant among blacks and Hispanics. Furthermore, the proportion of black women at risk for unintended pregnancy using no method of contraception grew by 10 percentage points between surveys, an increase more than double that experienced by their white counterparts. After socioeconomic differences were taken into account, use of the most effective reversible methods was similar between white and Hispanic women in the later period.

In the United States, black women are about three times as likely as white women to experience an unintended pregnancy. The study authors recommend that future research investigate how policy, health care practices, women's knowledge and attitudes, and other factors contribute to racial disparities in contraceptive method use.


Relationship characteristics are linked to pregnancy intention and desire for some black and Puerto Rican young adults

Perceptions of partners' feelings about pregnancy were linked to how a sample of urban black and Puerto Rican young adults in relationships felt about pregnancy themselves, and this association was particularly strong among women, according to "Relationship Characteristics and Feelings About Pregnancy Among Black and Puerto Rican Young Adults," by Marion Carter, of the Centers for Disease Control and Prevention, et al. The researchers found that several aspects of young people's relationships were associated with their feelings about pregnancy, which supports the notion that relationship contexts may be important to how pregnancy intentions and desires form and change.

The authors analyzed 2007–2008 data from the Philadelphia and Hartford Research and Education on Sexual Health and Communication project, which included a survey of blacks and Puerto Ricans aged 18–25 living in low-income, urban areas—demographic groups at high risk for unintended pregnancy. Seventy-eight percent of respondents reported that it was very or extremely important to avoid pregnancy at the time they were surveyed. However, when participants were asked how they would react if a pregnancy with their partner occurred, roughly equal proportions said that they would be very upset, a little upset, a little pleased or very pleased. In general, women were less likely than men to report that they would feel positive about a pregnancy. Respondents' likelihood of reporting that they would be pleased about a pregnancy was positively associated with many characteristics of the relationship with their partner: cohabiting, reporting frequent sex, having positive feelings about the relationship, and believing that their partner would be pleased about a pregnancy.

This study adds to knowledge on pregnancy intention by focusing on how multiple dimensions of relationships are related to both men and women's attitudes toward pregnancy. The authors recommend that researchers further explore the complexity of pregnancy intentions and that pregnancy prevention programs consider the importance of relationship contexts when helping young people fulfill their pregnancy desires.


Having multiple disabilities is associated with an increased risk for undergoing hysterectomy

Women with multiple disabilities are more likely to have a hysterectomy than are those with no or one disability, and this increased risk is concentrated among younger women, according to "Hysterectomy and Disability Among U.S. Women," by Julia A. Rivera Drew, of the University of Minnesota. Using data from three rounds of the National Health Interview Survey, the author classified women as having a disability if they had a mental or physical problem that limited their function and if the onset of that disability occurred before they underwent a hysterectomy. After controlling for characteristics that have been linked to increased risk of hysterectomy, including education level, birth year and ethnicity, the author found that women with only one disability had rates of hysterectomy that were similar to those of women with no disabilities. However, women between the ages of 21 and 45—and especially women aged 21–25—who had multiple disabilities were more likely to have had a hysterectomy than were women of comparable ages with no or one disability. No increased risk was evident among most women with multiple disabilities who were 45 or older.

Hysterectomy is a major surgery and can carry significant health risks. The author points out that the findings of this study are consistent with claims that young women with disabilities may face pressure to undergo hysterectomy to manage menstruation, prevent pregnancy and ease caregiving burdens, but the data used in this study did not allow for testing of this hypothesis. Therefore, the author recommends that future research explore the reasons for increased risk among young women with multiple disabilities.