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Background: The few studies on post-Essure hysterosalpingogram (HSG) adherence rates show inconsistent results. This study examined associations between sociodemographic variables not examined in prior studies and HSG adherence among low-income women., Study Design: Medical records of 286 women who underwent sterilization between August 31, 2005, and September 30, 2011, were reviewed. chi-Square and Mann-Whitney U tests were used to determine variable associations with HSG adherence., Results: The adherence rate for the first HSG was 85.0% (243/286). Variables associated with adherence were lower education level (p=.01), not working outside the home (p=.04), being married (p<.0001), lower gravidity (p=.03), fewer lifetime number of sexual partners (p<.0001), no sexually transmitted infection history (p<.01), Hispanic ethnicity (p<.0001), Spanish as a primary language (p<.0001) and living farther from the clinic (p<.01)., Conclusions: This study demonstrates that achieving high rates of adherence with the recommended HSG following Essure placement is feasible among low income populations. Furthermore, not speaking English or having to commute a far distance to the clinic do not appear to be barriers. This is encouraging considering the importance of this test to confirm tubal occlusion., (© 2013.)

Background: The study was conducted to examine the hypotheses that adolescent and young adult women who perceived they are susceptible to pregnancy when birth control is not used are less likely to practice unsafe sex, discontinue oral contraception (OC) and become pregnant during a 12-month follow-up period., Study Design: We conducted secondary analyses using data collected for a randomized controlled trial on OC adherence among 1155 low-income women 16-24 years of age. Demographics, lifestyle variables, perceived susceptibility to pregnancy assessed at baseline, and data on OC and condom use and pregnancy status collected during 12 months of follow-up were used for the analyses., Results: Overall, 62.3% of women accurately understood the risks of pregnancy without using any birth control method. However, perceived susceptibility was not associated with OC continuation [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.79-1.11], condom use at last sexual intercourse (OR 1.02, 95% CI 0.84-1.24), dual method use (OR 1.17, 95% CI 0.92-1.48) and subsequent pregnancy (hazards ratio 1.08, 95% CI 0.77-1.49) during the 12-month follow-up period., Conclusions: Perceived susceptibility to pregnancy, an important component of the health belief model, does not seem to have any impact on use of birth control methods, safer sex or rate of subsequent pregnancy among low-income adolescent and young adult women., (Copyright © 2013 Elsevier Inc. All rights reserved.)

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., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: The study was conducted to estimate the effect of depot medroxyprogesterone acetate (DMPA) and oral contraceptives (OC) containing 20 mcg ethinyl estradiol on serum B12 and whether observed changes impact bone mineral density (BMD)., Study Design: Serum B12 and BMD at the lumbar spine and femoral neck were measured on 703 women using OC, DMPA or nonhormonal (NH) birth control at baseline and every 6 months thereafter for 3 years., Results: OC and DMPA users experienced greater decreases in B12 than NH users (p<.001). A sharp decrease in B12 was observed during the first 6 months of hormonal contraceptive use (OC: 97 pg/mL and DMPA: 64 pg/mL) in contrast to 14 pg/mL among NH users (20%, 13% and 3% of their baseline values, respectively). Over the following 30 months, B12 levels of OC users remained almost flat, while DMPA users had a further 22-unit decrease. Very few women demonstrated B12 deficiency. Moreover, B12 levels were not associated with BMD., Conclusion: Hormonal contraception causes B12 levels to decrease, but this does not appear to be clinically significant or affect BMD., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: There is a growing body of literature on placement rates of the Essure® procedure, yet prior studies have not attempted to identify tubal-associated risk factors for placement failures. The current study examines risk markers associated with the inability to deploy the Essure® coils into the tubal lumen using the new ESS305 design., Study Design: We used electronic medical record data to assess risk markers associated with the inability to place the Essure coils in the tubal lumen using the new ESS305 design. A total of 310 attempted procedures between June 14, 2007, and April 29, 2011, were analyzed., Results: There were 18 tubal failures (5.8%) out of the 310 attempted procedures. A history of a prior sexually transmitted infection (STI) was associated with tubal failure (odds ratio 2.64, 95% confidence interval 1.01-6.90, p=.048)., Conclusions: We speculate that the observed association between a prior STI and an inability to place the coil was due to a past history of pelvic inflammatory disease., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: The study was conducted to examine the relationship between cultural adaptation (acculturation), contraceptive use, personal history of induced abortion, and emergency contraceptive (EC) awareness and acquisition among a sample of young sexually active Hispanic women., Study Design: A total of 959 Hispanic women between 16 and 24 years of age (mean±SD 20.71±2.42 years) completed a survey containing questions on EC acquisition and awareness, acculturation, contraceptive used at last intercourse and history of induced abortion. Data were analyzed using logistic regression analyses., Results: Acculturation (p=.017), income (p=.024) and education (p<.001) were positively associated with awareness of EC. Additionally, acculturation (p=.003) and a history of an induced abortion (p=.026) were positively associated with acquisition of EC., Conclusions: Educational programs should make an effort to include Hispanic women with lower acculturation levels as increasing their knowledge about EC use and its mechanism of action may greatly reduce the number of unplanned pregnancies in this population., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Introduction: The relationship between the source of sexual information and adolescent sexual behavior is not well understood., Materials and Methods: As part of a larger study, 892 sexually active female adolescents between 15 and 18 years of age completed a paper-and-pencil survey which assessed discussions about sexual intercourse, contraceptive use and condom use among friends and family members and their own sexual behavior. Multivariate logistic regression analyses were performed to examine associations while controlling for key demographics., Results: Adolescents who had never used condoms were less likely to report having had discussions about sexual intercourse with their friends [adjusted odds ratio (AOR) = 0.2]. Discussions about condom use among friends and family members were associated with condom use in the past 3 months, with adolescents who used condoms at least half of the time being more likely to report hearing discussions relative to adolescents who never used condoms (AORs 2.0-3.8). Furthermore, the number of sexual partners was related to whether the adolescent had heard discussions among her family about condom use; the higher the number of sexual partners, the more likely the adolescent was to have heard discussions. For adolescents reporting 2-3, 4-5 and 6 or more partners (relative to one partner), the AORs were 1.7, 2.3 and 2.7, respectively., Discussion: Adolescents exposed to information about condom use among the primary individuals in their lives are more likely to be engaging in this behavior themselves.

Presumably, Latino women engage in little family planning because of religious or cultural objections to contraception. The purpose of this study was to examine how acculturation, religion and various demographic factors were related to the family-planning behaviors of Latino women in the United States. Data were collected on 234 pregnant women (aged 18-40 years), on their family size, how actively they planned their current pregnancy, and how consistently they used contraception in the past. Through path analysis, we found that Spanish-speaking women were more consistent contraceptive users than their English-speaking counterparts, suggesting that acculturation negatively impacts contraceptive use. However, Spanish-speaking women with longer US residency were more likely to be consistent contraceptive users than Spanish-speaking women who had lived in the United States for briefer periods, suggesting a positive effect of acculturation. Religiosity and years of education were associated with family size, but not contraceptive use. Women who were married and had fewer children were more likely to plan their current pregnancy, indicating that Latino women take family size and marital status into consideration when actively deciding to become pregnant.

The goal of this study was to assess factors associated with hormonal emergency contraception (EC) awareness and acceptability among a sample of low-income Latino women receiving care in two university reproductive health clinics. A total of 297 Latino women, 18-43 years of age, completed a survey about EC awareness during a clinic visit, between January and May 2003. Those women with some degree of awareness (n = 73) also completed questions related to their acceptance of EC. Factors examined included language preference, demographic characteristics, pregnancy history, contraceptive use history and knowledge and concerns about EC usage. We found that only 41% of English-speaking and 17% of Spanish-speaking women had ever heard of EC [adjusted odds ratio (OR) = 2.9, confidence interval (CI): 1.3, 6.4]. Among those aware of EC, unwillingness to use this method was associated with low levels of knowledge about the EC mechanism of action, but not about the EC regimen (adjusted OR = 0.5; CI: 0.3, 0.9). Specific misconceptions underlying their objections included the belief that women are more likely to get pregnant in the beginning of their cycle compared to the middle (unadjusted OR = 6.3; CI: 1.8, 22.6), and a belief that EC prevents implantation rather than ovulation (unadjusted OR = 5.7; CI: 1.2, 28.1). The extent to which the women considered EC to be morally wrong depended on their misconceptions about the EC mechanism, not on their religious background. The link between expressed moral concerns and incorrect knowledge coupled with its lack of association to religiosity suggests that enhanced education can help to alleviate moral objections, thereby increasing potential usage of EC to prevent unintended pregnancy.