Background: Routine use of a brief psychosocial screening instrument has been proposed as a means of improving recognition, management, and referral of children's psychosocial morbidity in primary care. Editor's Note: I get depressed every time I'm reminded that more than 1 in every 10 children suffer from a psychosocial problem.
Objective
Disparities in unintended pregnancy in the United States are related, in part, to black and Hispanic women being overall less likely to use effective contraceptive methods. However, the fact that these same groups are more likely to use female sterilization, a highly effective method, suggests there may be variability in disparities in contraceptive use across a woman’s life course. We sought to assess the relationship between race/ethnicity and contraceptive use in a nationally representative sample and to approximate a life-course perspective by examining effect modification on these disparities by women’s age, parity and history of unintended pregnancy.
Study Design
We conducted an analysis of the 2006–2010 National Survey of Family Growth to determine the association between race/ethnicity and 1) use of any method; 2) use of a highly or moderately effective method among women using contraception; and 3) use of a highly effective method among women using contraception. We then performed analyses to assess interactions between race/ethnicity and age, parity and history of unintended pregnancy (ies).
Results
Our sample included 7,214 women aged 15–44. Compared to whites, blacks were less likely to use any contraceptive method (AOR: 0.65); and blacks and Hispanics were less likely to use a highly or moderately effective method (AORs: 0.49 and 0.57, respectively). Interaction analyses revealed that racial/ethnic disparities in contraceptive use varied by women’s age, with younger women having more prominent disparities.
Conclusions
Interventions designed to address disparities in unintended pregnancy should focus on improving contraceptive use among younger women.
Objective: Home screening tests could eliminate several barriers to testing sexually transmitted diseases (STDs). Aim: To determine whether offering repeated home screening tests would increase the rate of testing for chlamydia and gonorrhoea in a high-risk sample of young women. Methods: In this randomised controlled trial, 403 young women (mean age 18.9 years, 70% black) with a recent STD or with STD-related risk factors were enrolled. Participants were recruited from clinics and highprevalence neighbourhoods and then randomly assigned to receive either a home testing kit or an invitation to attend a medical clinic for testing at 6, 12 and 18 months after enrollment. Over 80% of women were followed for 2 years. The trial is registered with ClinicalTrials.gov, number NCT 00177437. Results: Of 197 women in the intervention group, 140 (71%) returned at least one home test and 25 of 249 (10%) home tests were positive. Women who received home screening tests completed significantly more STD tests overall (1.94 vs 1.41 tests per woman-year, p,0.001) and more STD tests in the absence of symptoms (1.18 vs 0.75 tests per woman-year, p,0.001). More women in the intervention group completed at least one test when asymptomatic (162 (82.2%) vs 117 (61.3%), p,0.001). The intervention was most effective among women recruited outside medical clinics. There was no significant difference in the overall rate of STDs detected. Conclusions: Home screening significantly increased the utilisation of chlamydia and gonorrhoea testing in this sample of high-risk young women, and thus represents a feasible strategy to facilitate STD testing in young women.
Among young STD clinic attendees, substance use disorders were more common than confirmed STDs. STD clinics may be an appropriate setting to screen for and address substance use disorders in young persons.
et al. Perinatal outcomes of two screening strategies for gestational diabetes mellitus: a randomized controlled trial. Obstet Gynecol 2021;138. The authors provided this information as a supplement to their article.
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