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Objective: Per- and polyfluoroalkyl substances (PFAS) alter immune function increasing infectious diseases risk. We examined the relationship between PFAS and chlamydia., Methods: A total of 3965 nonpregnant adults ages 18-39 years from the National Nutrition Examination Survey 2003-2016 cycles were included. Poisson regression with robust error variance estimated the prevalence ratio and 95% confidence intervals for the association between PFAS and chlamydia. A g computation model was used to examine PFAS mixtures and chlamydia., Results: In adjusted age and sex-stratified models, an increase in PFAS mixtures by one quintile was associated with chlamydia in older males and younger females. Associations were not observed before stratification., Conclusions: PFAS exposure associated with higher chlamydia prevalence, but only in stratified models suggesting biological differences by gender and age. However, small sample sizes could have affected the precision of our models., Competing Interests: Conflict of interest: None declared., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Objective: Despite disproportionally high prevalence of HIV and depression in persons with disabilities, no data have been published on the incidence and correlates of depression in Medicare beneficiaries with disabilities. We assessed the effect of HIV infection on developing depression in this population., Design: We conducted a retrospective matched cohort study using a 5% sample of Medicare beneficiaries who qualified for disability coverage (1996-2015)., Methods: Beneficiaries with incident ( n  = 2438) and prevalent ( n  = 5758) HIV were individually matched with beneficiaries without HIV (HIV-, n  = 20 778). Fine-Gray models with death as a competing risk were used to assess the effect of HIV status, age, and cohort period on developing depression by sex strata., Results: Beneficiaries with HIV had a higher risk of developing depression within 5 years ( P  < 0.0001). Sex differences were observed ( P  < 0.0001), with higher subdistribution hazard ratios (sHR) in males with HIV compared with controls. The risk decreased with age ( P  < 0.0001) and increased in recent years ( P  < 0.0001). There were significant age-HIV ( P  = 0.004) and period-HIV ( P  = 0.006) interactions among male individuals, but not female individuals. The sHR was also higher within the first year of follow-up among male individuals, especially those with incident HIV., Conclusion: Medicare enrollees with disabilities and HIV had an increased risk of developing depression compared to those without HIV, especially among males and within the first year of HIV diagnosis. The HIV-depression association varied by sex, age, and cohort period. Our findings may help guide screening and comprehensive management of depression among subgroups in this vulnerable population., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: People with HIV infection experience excessive mortality compared with their noninfected counterparts. It is unclear whether the impact of HIV infection on mortality varies by comorbidities or whether sex difference exists in this relationship. This study assessed the effect of newly diagnosed HIV infection on overall mortality among Medicare beneficiaries for both disabled and older adults (≥65 years old) based on their original entitlement., Methods: We constructed a retrospective matched cohort using a 5% nationally representative sample of Medicare beneficiaries between 1996 and 2015. People with incident HIV diagnoses were individually matched to up to three controls based on demographics. Cox proportional hazards models adjusted for baseline demographics and comorbidities were used to assess the effect of HIV status on survival among four disabled groups by sex strata. Within each stratum, interactions between comorbidity variables and HIV status were examined., Results: People with HIV, especially older women, had a higher prevalence of baseline comorbidities than controls. HIV--mortality association varied according to sex in older adults (P = 0.004). Comorbidity--HIV interactions were more pronounced in disabled groups (P < 0.0001). People with HIV with more chronic conditions had a less pronounced increase in the risk of death than those with fewer conditions, compared with uninfected controls., Conclusion: Medicare enrollees with newly diagnosed HIV had more prevalent baseline comorbidities and were at higher risk of death than people without HIV. HIV infection has a more pronounced effect among those with fewer comorbidities. Sex differences in HIV--mortality association exist among older Medicare enrollees., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To examine changes in prevalence of vaginal human papillomavirus (HPV) between 2009-2010 and 2013-2014 among both vaccinated and unvaccinated U.S. women., Methods: We evaluated HPV prevalence among women 18-59 years old using cross-sectional survey data from three different cycles of the National Health and Nutrition Examination Survey. Data were stratified into four age groups (18-26, 27-34, 35-44, and 45-49 years) to examine trends over time among women of different ages in the postvaccine era. Multivariable analyses, which controlled for descriptive variables, were used to examine the prevalence of quadrivalent vaccine-type HPV by vaccination status., Results: We observed a significant decrease in the prevalence of vaccine-type HPV among women 18-59 years of age from 2009-2010 to 2013-2014. This decline was only significant in those 18-26 years old when the sample was stratified into the four age groups. Among vaccinated 18-26 year olds, HPV prevalence remained low from 2009-2010 (3.9%) to 2013-2014 (2.0%; prevalence ratio 0.51, 95% CI 0.18-1.46). Unvaccinated women 18-26 years old also demonstrated a significant decrease over time from 19.5% in 2009-2010 to 9.7% in 2013-2014 (prevalence ratio 0.44, 95% CI 0.22-0.91). Prevalence did not significantly change among unvaccinated women 26 years old or older., Conclusions: The decline in HPV infections among unvaccinated 18- to 26-year-old women suggests that young women in the United States are beginning to benefit from herd immunity resulting from the introduction of the HPV vaccine.

Objective: To evaluate the nutritional habits and weight management strategies of women trying to conceive as compared with women not trying to conceive., Methods: This was a cross-sectional survey of health behaviors including nutritional habits and weight management strategies of women aged 16-40 years who were low income, racially diverse, (n=1,711), and attending reproductive health clinics. Multivariable logistic regression analyses were performed to examine the association between pregnancy intention and various health behaviors after adjusting for demographic variables, gravidity, and obesity status., Results: A total of 8.9% (n=153) of the participants stated they were trying to get pregnant. Women trying to conceive were more likely than those not trying to have participated in a number of unhealthy weight loss practices in the past year. These included taking diet pills, supplements, or herbs (13.5% compared with 8.8%; adjusted odds ratio [OR] 1.97, 95% confidence interval [CI] 1.11-3.49), using laxatives or diuretics or inducing vomiting (7.7% compared with 3.0%; adjusted OR 2.70, CI 1.23-5.91), and fasting for 24 hours (10.7% compared with 5.5%; adjusted OR 2.15, CI 1.03-4.51). There were no significant differences between the two groups in amount of exercise, current smoking status, or current alcohol consumption Furthermore, fruit, green salad and other vegetables, and intake of soda and fast food were unrelated to pregnancy intention., Conclusion: This study highlights that women trying to conceive are more likely to participate in unhealthy and potentially dangerous weight loss practices than women not trying to conceive., Level of Evidence: II.

Objective: Many U.S. health care providers remain reluctant to prescribe intrauterine devices (IUDs) to teenagers as a result of concerns about serious complications. This study examined whether 15-19-year-old IUD users were more likely to experience complications, failure, or early discontinuation than adult users aged 20-24 years and 25-44 years and whether there were differences in these outcomes between users of levonorgestrel-releasing intrauterine systems and copper IUDs., Methods: A retrospective cohort study was conducted using health insurance claims obtained from a private insurance company of 90,489 women who had an IUD inserted between 2002 and 2009. Logistic regression models were used to estimate the odds of experiencing complications, method failure, or early discontinuation within 12 months of insertion by age group and type of IUD inserted., Results: Serious complications, including ectopic pregnancy and pelvic inflammatory disease, occurred in less than 1% of patients regardless of age or IUD type. Women aged 15-19 years were more likely than those aged 25-44 years to have a claim for dysmenorrhea (odds ratio [OR] 1.4, confidence interval [CI] 1.1-1.6), amenorrhea (OR 1.3, CI 1.1-1.5), or normal pregnancy (OR 1.4, CI 1.1-1.8). Overall, early discontinuation did not differ between teenagers and women aged 25-44 years (13% compared with 11%, P>.05). However, use of the levonorgestrel-releasing intrauterine system was associated with fewer complications and less early discontinuation than the copper IUD in all age groups., Conclusions: The IUD is as appropriate for teenagers to use as it is for older women, with serious complications occurring infrequently in all groups. The levonorgestrel-releasing intrauterine system may be a better choice than the copper IUD as a result of lower odds of complications, discontinuation, and failure., Level of Evidence: II.

Objective: To estimate continuation rates, complications, and psychiatric hospitalizations among women with bipolar disorder using levonorgestrel-releasing or copper-containing intrauterine devices (IUDs) as compared with those using depot medroxyprogesterone acetate or sterilization for birth control., Methods: Data for this cohort study were obtained from a nationwide health insurance claims database on an employed, commercially insured population. Women aged 18-44 years with a prior diagnosis of bipolar disorder (n=849) who were using the levonorgestrel intrauterine system, a copper-containing IUD, depot medroxyprogesterone acetate, or sterilization were evaluated. Outcomes included continuation rates over a 12-month interval, infectious and noninfectious complications, and hospitalizations for bipolar disorder or depression., Results: Women using an IUD were more likely than those using depot medroxyprogesterone acetate to continue the method for at least 12 months (copper-containing IUD, 86%; levonorgestrel intrauterine system, 87%). In comparison, only 31% of those who initiated depot medroxyprogesterone acetate received three more injections during the next year (P<.001). No significant differences were noted in infectious or noninfectious complications by contraceptive type. Finally, no differences were observed in the number of hospitalizations for bipolar disorder or depression among the four contraceptive groups., Conclusion: More women with bipolar disorder continued using IUDs at one year than women using depot medroxyprogesterone acetate. The rates of complications and psychiatric hospitalizations were not different among women using an IUD, depot medroxyprogesterone acetate, or sterilization., Level of Evidence: II.

Objective: To estimate the effect of using two methods of hormonal contraceptives (depot medroxyprogesterone acetate) or an oral contraceptive pill (OCP) containing 20 micrograms ethinyl estradiol and 0.15 mg desogestrel) on serum glucose and insulin levels, as well as predictors of any observed changes., Methods: Fasting glucose and insulin levels were measured on 703 white, African-American, and Hispanic women using depot medroxyprogesterone acetate, OCPs, or nonhormonal birth control at baseline and every 6 months thereafter for 3 years. Participants also completed questionnaires containing demographic and behavioral measures every 6 months. Mixed-model regression analyses were used to estimate changes over time in glucose and insulin levels by method, along with their predictors., Results: Depot medroxyprogesterone acetate, but not OCP, users experienced slightly greater increases in glucose and insulin as compared with nonhormonal users (P<.001). Among depot medroxyprogesterone acetate users, a small but steady increase in serum glucose levels (2 mg/dL at 6 months to 3 mg/dL at 30 months) was observed throughout the first 30 months, but it leveled off after that. In contrast, serum insulin levels showed an upward (3 units at 6 months to 4 units at 18 months) trend for the first 18 months of depot medroxyprogesterone acetate use and then remained almost flat thereafter. Elevation of insulin and glucose levels was slightly more pronounced in obese and overweight depot medroxyprogesterone acetate users than those who were normal weight., Conclusion: Use of depot medroxyprogesterone acetate, but not very-low-dose OCPs containing desogestrel, can lead to slightly higher fasting glucose and insulin levels., Level of Evidence: II.

Objectives: To examine weight misperceptions and their predictors and association with weight-related behaviors among low-income, multiethnic, reproductive-age women., Methods: We assessed perceptions of body weight and weight-related behaviors of women aged 18 to 25 attending one of five publicly funded reproductive clinics in Texas between August 2008 and March 2010. Data were collected through self-administered questionnaires and chart review. Overweight and normal-weight women were divided into four categories based on self-perception of their body weight: overweight misperceivers, overweight actual perceivers, normal-weight misperceivers, and normal-weight actual perceivers. Multivariable logistic regression analyses were performed to examine the predictors of misperception and the association with weight-related behaviors., Results: Twenty-three percent (267/1,162) of overweight and 16% (170/1,062) of normal-weight women were misperceivers. Overweight African-American women were more likely to consider themselves normal weight (28% compared with 15%; odds ratio [OR], 2.84; 95% confidence interval [CI], 1.79-4.50), whereas normal-weight African-American women were less likely than whites to consider themselves overweight (7% compared with 16%; OR 0.40; 95% CI 0.22-0.74). Overweight women who had at least some college education (14% compared with 29%; OR 0.53; 95% CI 0.32-0.86) and used the Internet (18% compared with 28%; OR 0.47; 95% CI 0.31-0.70) were less likely to misperceive their body weight. Normal-weight misperceivers were more likely to report healthy and unhealthy weight-reduction behaviors compared with normal-weight actual perceivers, after adjusting for age, race, ethnicity, and body mass index. Opposite scenarios were observed for overweight misperceivers., Conclusion: Weight misperception is common among both overweight and normal-weight women of reproductive age. Clinicians should provide patient-specific counseling related to healthy weight management goals that take each patient's perceptions into consideration.

Objective: To compare the National Institutes of Health's (NIH) body mass index (BMI)-based classification to identify obesity in comparison with the World Health Organization (WHO), which uses percent body fat, among white, black, and Hispanic reproductive-aged women., Methods: Body weight, height, BMI, and percent body fat (dual-energy X-ray absorptiometry generated) were determined for 555 healthy adult women aged 20-33 years (mean+/-standard deviation 26.5+/-4.0 years). Diagnostic accuracy of the NIH-based obesity definition (BMI of 30 kg/m or higher) was determined using the WHO criterion standard (percent body fat greater than 35%)., Results: Obesity as defined by the NIH (BMI 30 kg/m or higher) and by WHO (percent body fat greater than 35%) classified 205 (36.9%) and 350 (63.1%) of the women as obese, respectively. The NIH-defined obesity cutoff values had 47.8%, 75.0%, and 53.9% sensitivity in white, black and Hispanic, women, respectively. White and Hispanic women had 2.9% greater percent body fat than black women for a given BMI. Receiver operating characteristics curves analyses showed that the respective sensitivities improved to 85.6%, 81.3%, and 83.2%, and that 311 women (56.0%) were classified as obese as a whole when race or ethnic-specific BMI cutoff values driven by our data (BMI at or above 25.5, 28.7, and 26.2 kg/m for white, black, and Hispanic women, respectively) were used to detect percent body fat-defined obesity., Conclusion: Current BMI cutoff values recommended by the NIH failed to identify nearly half of reproductive-aged women who met the criteria for obesity by percent body fat. Using race or ethnic-specific BMI cutoff values would more accurately identify obesity in this population than the existing classification system.

Objective: To identify possible predictive factors of higher bone loss, defined as at least 5%, at the spine or femoral neck, over time in depot medroxyprogesterone acetate (DMPA) users., Methods: Bone mineral density (BMD) was measured at the lumbar spine and femoral neck every 6 months in 240 white, African-American, and Hispanic women using DMPA. For the purpose of analysis, an arbitrary value of at least 5% BMD loss from the baseline value after 24 months of DMPA use at either the lumbar spine or the femoral neck was considered as higher BMD loss. Logistic regression analysis was then used to examine factors predictive of at least 5% BMD loss at either site., Results: Of the initial 240 DMPA users, 95 completed 24 months of follow-up. Forty-five of the 95 DMPA users (47.4%) had at least 5% BMD loss at the lumbar spine or femoral neck by 24 months. Multivariable logistic regression model showed that at least 5% BMD loss was associated with current smoking (adjusted odds ratio [OR] 3.88, 95% confidence interval [CI] 1.26-11.96), calcium intake (in 100 mg) (OR 0.81, 95% CI 0.65-0.99), and parity (OR 0.49, 95% CI 0.29-0.82). Age, race or ethnicity, previous contraceptive use, and body mass index were not associated with higher BMD loss., Conclusion: The risk of higher BMD loss associated with DMPA use may be reduced by quitting smoking and increasing calcium intake. Having had a child is also protective., Level of Evidence: II.

Objective: To estimate the effects of using depot medroxyprogesterone acetate (DMPA) or oral contraceptives (OCs) containing 20 micrograms ethinyl estradiol and 0.15 mg desogestrel on serum lipid levels., Methods: Serum lipids were measured at baseline and every 6 months thereafter for 3 years in 703 white, African-American, and Hispanic women using DMPA, OC, or nonhormonal birth control. Those who discontinued DMPA were followed for up to 2 additional years. Participants completed questionnaires containing demographic and behavioral measures every 6 months and underwent 24-hour dietary recalls annually. Mixed-model regression analyses and general-estimating-equations procedures were used to estimate changes over time in lipids by method along with their predictors., Results: Users of OCs experienced significantly greater increases in levels of triglycerides, total cholesterol, very-low-density lipoprotein (VLDL) cholesterol, and high-density lipoprotein (HDL) cholesterol than did nonhormonal-contraceptive users (P<.001). However, no difference was noted in the low-density lipoprotein (LDL) cholesterol:HDL ratio between OC users and nonhormonal-contraceptive users. Among DMPA users, HDL levels initially decreased for 6 months but then returned to baseline. The LDL:HDL ratio rose in the first 6 months of DMPA use but then dropped back to baseline over the next 24 months. After DMPA was discontinued, triglyceride, VLDL, and HDL levels were significantly higher in women who used OCs than in those who chose nonhormonal (P<.05) methods., Conclusion: Use of very-low-dose OCs containing desogestrel can elevate lipid levels. Users of DMPA were at increased risk of developing an abnormally low HDL level as well as an abnormally high LDL level and an increase in the LDL:HDL cholesterol ratio, although these effects appeared to be temporary., Level of Evidence: II.

Objective: To examine if early weight gain in depot medroxyprogesterone acetate (DMPA) users predicts continued excessive weight gain and to identify risk factors of early weight gain in DMPA users., Methods: Depot medroxyprogesterone acetate users (N=240) were assessed before initiating contraception and every 3 months for 36 months. Early weight gain was defined as more than 5% baseline weight gain within 6 months of DMPA use. Mean weight gain at 6-month intervals was estimated based on early weight gain status (at or below 5% gain compared with above 5% gain). Multiple logistic and mixed-model regression analyses were used., Results: About one-fourth of DMPA users had early weight gain. The mean weight gain of the at or below 5% group and above 5% group was 0.63 kg and 8.04 kg, 1.48 kg and 10.86 kg, and 2.49 kg and 11.08 kg after 12, 24, and 36 months (P<.001 at all observations), respectively. Early weight gainers also had a much steeper slope of weight gain over time than the regular weight gainers (0.35 kg/month compared with 0.08 kg/month, P<.001). Risk factors for early weight gain were body mass index less than 30 (odds ratio [OR] 4.00, 95% confidence interval [CI] 1.513-10.455), parity (OR 2.23, 95% CI:1.040-4.761), and self-reported increased appetite after 6 months of DMPA use (OR 3.06, 95% CI 1.505-6.214)., Conclusion: Most DMPA users who gain excessive weight experience more than a 5% weight increase within 6 months. These data help physicians predict who is at risk of excessive gain and counsel them appropriately., Level of Evidence: II.

Objective: Hormonal contraceptives may adversely affect bone mineral density. However, racial differences and the reversibility of these changes are poorly understood. This study measured bone mineral density changes during hormonal contraceptive use and after discontinuation in a triethnic population., Methods: Bone mineral density was measured every 6 months for up to 3 years in 703 white, African-American, and Hispanic women using oral contraceptives (OCPs), depot medroxyprogesterone acetate (DMPA), or nonhormonal contraceptives, and in 68 DMPA discontinuers for up to 2 additional years. Mixed-model regression analyses were used to estimate the percentage change in bone mineral density for each contraceptive method., Results: Over 3 years, DMPA and OCP users lost more bone mineral density than did nonhormonal contraceptive users (-3.7% and -0.5% compared with +1.9% at lumbar spine, and -5.2% and -1.3% compared with +0.6% at femoral neck, respectively). No differences were observed by race in bone mineral density changes that resulted from DMPA or OCP use. However, DMPA users aged 16-24 years lost more bone mineral density at the spine (4.2% compared with 3.2%, P=.006) and femoral neck (6.0% compared with 4.2%, P=.001) than those aged 25-33 years. After DMPA discontinuation, women who selected nonhormonal contraceptives gained bone mineral density (+4.9% at spine, +3.2% at femoral neck), whereas those who selected OCP recovered spinal (+2.3%) but not femoral neck bone mineral density (-0.7%)., Conclusion: Use of very-low-dose OCPs may result in a small amount of bone loss. Use of DMPA results in greater bone loss, but this is largely reversible at the spine. Use of very-low-dose OCPs after DMPA discontinuation may slow bone recovery.

Objective: To estimate the prevalence of depressive symptoms among women of reproductive age attending family planning clinics across southeast Texas in addition to demographic and reproductive characteristics associated with these symptoms., Methods: A retrospective, self-reported, paper-and-pencil survey designed to assess health and risk behaviors was administered to 4726 low-income suburban women, aged 12 and 40 years, attending a family planning clinic in southeast Texas. The survey contained a background and demographic section in addition to six sections addressing health risk behaviors. Women also completed the 13-item Beck Depression Inventory to assess depressive symptoms., Results: A total of 11.8% exhibited mild symptoms of depression, 14.0% had moderate symptoms, and 4.8% had severe symptoms. Women were at increased risk of moderate to severe symptoms of depression if they were Hispanic, had not graduated high school, were unemployed, or currently smoked cigarettes. Sexual or reproductive characteristics associated with moderate to severe symptoms included two or more lifetime sexual partners, having used hormonal contraception before age 13, not using any birth control at last intercourse, having had a sexually transmitted disease, not having had sexual intercourse in the last 3 months or having had it under the influence of alcohol or drugs, and having heard a family member worry about contracting a sexually transmitted disease or discuss use of alcohol or drugs before sex., Conclusion: A large percentage of women experience moderate to severe depressive symptoms during their reproductive years. These symptoms are associated with numerous risk behaviors, including inconsistent use of birth control. Women's health care providers have the opportunity to provide a valuable service by screening for depressive symptoms.

Objective: To compare the effect of depot medroxyprogesterone acetate (DMPA) and two types of oral contraceptives (OC) on bone mineral density (BMD) among women 18-33 years of age with those not using hormonal contraception., Methods: Data from 155 women were analyzed. Depot medroxyprogesterone acetate was administered to 33 women; 63 women who chose oral contraception were randomly assigned to receive either a norethindrone-containing pill (n = 28) or a desogestrel-containing pill (n = 35). Fifty-nine women who did not use hormonal contraception served as controls. Lumbar spine BMD was determined using dual-energy x-ray absorptiometry at baseline and after 12 months of contraceptive use. We analyzed method-related percent change in BMD while controlling for body mass index, calcium intake, exercise, and smoking. We had approximately 90% power to detect a 2.5% difference between any two groups., Results: Users of DMPA experienced a mean BMD loss of 2.74% over 12 months compared with controls who sustained a 0.37% loss (P = .01). Users of OCs generally demonstrated a gain (2.33% for norethindrone-containing pills, 0.33% for desogestrel-containing pills), which was different from controls among users of norethindrone-containing pills (P = .01), but not among users of desogestrel-containing pills (P = .99). Observed changes in BMD among DMPA users differed from women who used either type of pill (P < .002)., Conclusion: Depot medroxyprogesterone acetate has an adverse effect on BMD, in comparison with OCs or nonhormonal methods, when used for 12 months. Results must be interpreted cautiously until it is determined whether these effects endure or are reversible.

Objective: To assess shifts over a 4-year period in attitudes of low-income US women regarding use of levonorgestrel implants., Methods: An anonymous questionnaire was administered at two different points in time to English-speaking women of reproductive age seeking gynecologic or obstetric care in southeast Texas. The first survey, administered to 762 women in 1992, elicited information on demographic and reproductive characteristics, as well as exposure to information on implants and attitudes regarding use of this method. This same survey was administered again in 1995-1996 to 502 women. chi2, Student t, or Kruskal-Wallis nonparametric tests were used to evaluate shifts in attitudes and perceived barriers to use across the 4-year period., Results: Women portrayed less positive attitudes about levonorgestrel implants when surveyed in 1995-1996 as compared with 1992. Most notably, they appeared less appreciative of the convenience associated with implant use and more concerned with potential side effects. Nulliparous and parous women surveyed in 1995-1996 were significantly less likely than those surveyed in 1992 to state that they would consider using this method for birth control (P < .001) and were more likely to state that their partner, friends, and family would object to their use of levonorgestrel implants., Conclusion: This study documents the decline in popular perceptions of levonorgestrel implants among low-income English-speaking women over the 4-year period following the introduction of this contraceptive method to the US market.

Objective: To identify the prevalence of chorioaminionitis and unique risk factors for this disorder among adolescents under 18 years of age., Methods: At their first prenatal visit we interviewed 352 adolescents who received prenatal care and delivered an infant at our institution between April 20, 1992, and November 10, 1994, to elicit information on demographic characteristics and behavioral risk factors. Retrospective chart review confirmed the presence of chorioamnionitis using accepted clinical criteria. We determined reproductive history, evidence of sexually transmitted disease, duration of labor, use of oxytocin, an internal uterine pressure monitor or conduction anesthesia, timing and duration of ruptured membranes, type of delivery, and infant birth weight from review of subjects' charts. Logistic regression analysis was used to develop adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors of chorioaminionitis., Results: Ten percent (34 of 352) of adolescents met the clinical definition for chorioamnionitis. Alcohol and tobacco use during pregnancy (OR 7.6; 95% CI 2.3, 25.8) and being married or living with a partner (OR 2.7; 95% CI 1.1, 6.5) were significantly associated with chorioamnionitis, as was conduction anesthesia (OR 4.1; 95% CI 1.1, 15.4), a second stage labor longer than 2 hours (OR 3.5; 95% CI 1.4, 8.5), and rupture of the membranes longer than 18 hours (OR 6.9; 95% CI 2.5, 18.9). Parity or preterm delivery did not differ significantly between those with or without chorioamnionitis., Conclusion: These data suggest that in addition to risk factors observed in adults, adolescents who concurrently use tobacco and alcohol during pregnancy, are married or living with a male partner, and have conduction anesthesia are at increased risk for chorioamnionitis.

Objective: To assess patterns and predictors of reliable and unreliable contraceptive use among adolescent mothers in the first 6 months following delivery., Methods: We surveyed 462 women, 18 years of age or younger, at delivery and again at 6 months postpartum. Contraceptive behaviors were evaluated among the 359 adolescents who stated they were sexually active and not trying to conceive., Results: Method discontinuation and switching were common during the 6-month interval. Only 100 of 189 adolescents (53%) initially prescribed oral contraceptives were still using this method 6 months after delivery; ten of these 100 stated that they had missed at least three pills in the last cycle. Twelve (10%) of the 115 adolescents who initiated depot-medroxyprogesterone acetate failed to obtain a second injection within 4 months of the initial injection or use an alternative method. In contrast nine of the ten women who received levonorgestrel implants were still using this method 6 months after delivery. Overall, 76% of the sample reported using reliable contraception at last intercourse. Multivariate analyses identified seven factors as predictive of reliable contraceptive use: school enrollment, not having failed a grade in school, adequate support, belief that pregnancy is likely without birth control, attendance at postpartum visit, prior abortion, and the adolescent's desire to wait at least 2 years before having another child., Conclusion: Interventions designed to reduce rapid repeat pregnancy during the adolescent years should address emotional, financial, and educational, as well as contraceptive, needs.

For many reasons including the recent increase in the reporting of sexual abuse, more physicians are being asked to perform genital examinations on prepubertal girls. Recent studies have clarified the appearance of structures in this area in nonabused children and demonstrated both acute and chronic changes that may result from trauma.

Two hundred four post-cesarean adolescents were compared with 751 adults to determine whether age was a risk factor for endometritis. Adolescents had an infection rate of 23%, compared with 11% for controls (P less than .001). Length of labor, duration of ruptured membranes, and the use of an internal monitor were noted to be risk factors for endometritis in adults, but not in adolescents. Endometrial aspirates from adolescents exhibited significantly higher isolation rates of Chlamydia trachomatis (21 versus 6%, P less than .05) and Gardnerella vaginalis (32 versus 9%, P less than .005) than did those from adults. Antepartum isolation of these organisms in teenagers may help to identify those at risk for postpartum endometritis.