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Many of you have already seen the first article in our March issue, "Abortion Incidence and Service Availability in the United States, 2011" (click here for the news release), by Rachel Jones and Jenna Jerman.



1. Young Women's Contraceptive Microbicide Preferences: Associations with Contraceptive Behavior and Sexual Relationship Characteristics
2. Changes in State Prescription Mandates for Insurers: The Effect on Women's Contraceptive Use
3. Associations Between Life Contexts and Early Sexual Initiation Among Young Women in France
4. Relationship Types and Contraceptive Use Within Young Adult Dating Relationships
5. Digests (summaries of other important research in the field)

Some Young Women Would Prefer a Microbicide that Protects Against Both Pregnancy and STDs

When asked their preferences for features of a hypothetical microbicide (a cream or jelly comparable to spermicide that protects against STDs), a sample of young women in Indianapolis reported caring most about how its ability to protect against STDs compared with that of condoms and about how well it prevented pregnancy. According to "Young Women's Contraceptive Microbicide Preferences: Associations with Contraceptive Behavior and Sexual Relationship Characteristics," by Candace Best, of Georgia Regents University, et al., the texture of the microbicide and how long before or after sex it would be used were considered less important features. The study is based on data collected in 2004–2008, from 14–22-year-old women attending three primary care clinics.

The researchers also found that women's preference for a microbicide that could act as a contraceptive was linked to certain characteristics of their sexual relationships and contraceptive use: The more women were committed to avoiding pregnancy and the more they communicated with their partner, the more they preferred contraceptive microbicides. However, if they reported no past or current contraceptive use, or said that they and their partner were trying to become pregnant, they were relatively unlikely to prefer a contraceptive microbicide.

The authors advise that future research is needed to determine how microbicide features that women prefer, as well as women's pregnancy desires and relationships, are related to their potential choice of a microbicide. They note that it is essential that adolescents and young women be involved in clinical trials of new microbicides. They also note that that these products could play a key role in reducing the enormous costs of unwanted pregnancy and STDs.


Contraceptive Coverage Mandates May Help Increase the Use of Effective Contraceptives

State laws that require insurance coverage for contraceptives if other prescription drugs are covered appear to increase women's likelihood of using the most effective methods, according to "Changes in State Prescription Mandates for Insurers: The Effect on Women's Contraceptive Use," by Danielle N. Atkins, of the University of Tennessee, and W. David Bradford, of the University of Georgia. The authors relied on data from more than 20,000 women at risk of unintended pregnancy who participated in the Behavioral Risk Factor Surveillance System between 1998 and 2010, as well as data on state laws from the National Conference of State Legislatures, to examine how contraceptive coverage mandates affect women's use of a range of contraceptive methods.

The analysis showed that insured women who lived in a state that implemented a contraceptive coverage mandate were 5% more likely than their counterparts in states without such laws to use an effective contraceptive method (i.e., a prescription method, condoms or sterilization). In addition, among women choosing such methods, those in coverage states were 5% more likely than others to use any prescription contraceptive method and 4% more likely to use the pill. The study yielded no evidence that contraceptive coverage legislation influenced the use of effective methods among uninsured women, which the authors suggest provides further evidence that their findings among insured women reflect an effect of the policy change rather than a general trend in contraceptive use. The analysis also revealed that the legislation appears to increase pill use without lowering the use of other methods. By increasing women's use of effective methods, the authors suggest that contraceptive coverage mandates may have the added benefit of helping to reduce the numbers of unintended pregnancies in the United States.

In 2010, the passage of the Affordable Care Act created the first federal requirement for insurance coverage of prescription contraceptive methods without cost-sharing. The authors suggest that the findings from this study of state mandates can be used to inform expectations as the Affordable Care Act rolls out nationwide. They anticipate that these findings are an underestimate of what can be expected under this new program.


Little Evidence Links Neighborhood Characteristics to French Teens' Early Sexual Initiation

Twenty-five percent of teens participating in a school-based survey in France had had sex before age 16 (considered early initiation), according to "Associations Between Life Contexts and Early Sexual Initiation Among Young Women in France," by Sonia Jovic of INSERM U1027 in Toulouse, France, et al. The authors found that early initiation of sex was primarily associated with individual-level characteristics, rather than environmental ones.

Most studies of correlates of teen sexual behavior have involved U.S. adolescents; this is the first study of its kind providing comparable analysis for French teens, who face a different social environment. The authors analyzed data from the 2010 Health Behaviour in School-Aged Children survey in France, which includes information on more than 1,000 females in grades 8–10. They found that teens were more likely to report early initiation of sex if they went out after school more than four times per week rather than less frequently; had two or more male friends rather than none; lived with a single parent or stepfamily rather than with both biological parents; or perceived a low level of parental monitoring rather than a moderate or high one. Additionally, teens who had repeated a grade were more likely than others to report early initiation. The only environmental association the authors found was a reduced likelihood of sexual initiation among teens who went to school in neighborhoods in which high proportions of residents were foreigners.

The authors point out that these findings are consistent with those of other countries, which have shown negative associations between early sex and both intact family structure and levels of parental monitoring. They recommend further research to better understand the relationship between individual behaviors and environmental factors and early sexual initiation, and to identify "entry points for intervention" to reduce risky behavior among young teens.


Length and Quality of Young Adult Dating Relationships are Linked to Contraceptive Use

Young adults in short-term relationships with high levels of intimacy and commitment and low levels of conflict are more likely than those in more casual short-term relationships to use hormonal contraceptives rather than no method or condoms, according to "Relationship Types and Contraceptive Use Within Young Adult Dating Relationships," by Jennifer Manlove, of Child Trends, et al. Similarly, young adults in longer term relationships with high conflict and low intimacy and commitment are less likely than those in more serious long-term relationships to use hormonal methods, alone or with condoms, rather than no method.

The authors analyzed data from the 2002–2005 waves of the National Longitudinal Survey of Youth 1997 cohort to examine different types of dating relationships and how those variations link to contraceptive use. They characterized four relationship types—short-term/casual, short-term/rosy outlook, long-term/cloudy outlook and long-term/serious—on the basis of the length of the couple's relationship, as well as levels of intimacy, commitment and conflict.

The researchers note that classifying all short-term relationships as "casual" or all long-term relationships as "serious" can ignore the variation within those categories. And as this study showed, the context and characteristics of a relationship are linked in significant ways to young adults' contraceptive use. The investigators also note that couples in a long-term relationship with a cloudy outlook are least likely both to sustain a committed relationship and to use contraceptives. They advise that future research could lead to better understanding of how to improve contraceptive use among these couples in particular, and that all young adult couples could benefit from pregnancy and STD prevention programs.



The Digests section of this issue contains summaries by Perspectives editors of recent research on a range of topics: sexual behavior among men who have received HIV preexposure prophylaxis, trends in receipt of STD services by U.S. women, abortion decision making among minors, how teenagers think of abstinence and virginity, the relationship between adolescents’ bacterial STD acquisition and subsequent risk of HIV, and the inclusion of discussion of sexuality during adolescents’ annual checkups. Click here to access these valuable resources.