CONTEXT
Sterilization is the most commonly used contraceptive in the United States, yet access to this method is limited for some.
METHODS
A 2006–2008 prospective study of low‐income pill users in El Paso, Texas, assessed unmet demand for sterilization among 801 women with at least one child. Multivariable logistic regression analysis identified characteristics associated with wanting sterilization. In 2010, at an 18‐month follow‐up, women who had wanted sterilization were recontacted; 120 semistructured and seven in‐depth interviews were conducted to assess motivations for undergoing the procedure and the barriers faced in trying to obtain it.
RESULTS
At baseline, 56% of women wanted no more children; at nine months, 65% wanted no more children, and of these, 72% wanted sterilization. Only five of the women interviewed at 18 months had undergone sterilization; two said their partners had obtained a vasectomy. Women who had not undergone sterilization were still strongly motivated to do so, mainly because they wanted no more children and were concerned about long‐term pill use. Among women's reasons for not having undergone sterilization after their last pregnancy were not having signed the Medicaid consent form in time and having been told that they were too young or there was no funding for the procedure.
CONCLUSIONS
Because access to a full range of contraceptive methods is limited for low‐income women, researchers and providers should not assume a woman's current method is her method of choice.
Objective
To estimate differences in continuation of oral contraceptive pills (OCPs) between U.S.-resident women obtaining pills in U.S. family planning clinics compared with over-the-counter in Mexican pharmacies.
Methods
In El Paso, Texas, we recruited 514 OCP users who obtained pills over-the-counter from a Mexican pharmacy and 532 who obtained OCPs by prescription from a family planning clinic in El Paso. A baseline interview was followed by three consecutive surveys over 9 months. We asked about date of last supply, number of pill packs obtained, how long they planned to continue use, and experience of side effects. Retention was 90%, with only 105 women lost to follow-up.
Results
In a multivariable Cox proportional hazards model, discontinuation was higher for women who obtained pills in El Paso clinics (25.1%) compared with those who obtained their pills without a prescription in Mexico (20.8% [hazard ratio 1.6, 95% CI: 1.1--2.3]). Considering the number of pill packs dispensed to clinic users, discontinuation rates were higher (hazard ratio 1.8, 95% CI: 1.2 -- 2.7) for clinic users who received 1-5 pill packs. However, there was no difference in discontinuation between clinic users receiving 6 or more pill packs and users obtaining pills without a prescription.
Conclusion
Results suggest providing OCP users with more pill packs and removing the prescription requirement would both lead to increased continuation.
Social transformations in Brazil in recent years have included a substantial increase in adolescent fertility, a dramatic rise in membership of Protestant religious denominations, and an accompanying decline in the number of Catholics. We used the 2000 Brazil Census to examine differentials in fertility and family formation among adolescents living in Rio de Janeiro by the following religious denominations: Catholic; Baptist; other mainline Protestant; Assembly of God Church; Universal Church of the Kingdom of God; other Pentecostal Protestant; and no religion. Results from logistic regression models show that the majority of the Protestants are at a lower risk of adolescent fertility than Catholics, and that among adolescents who have had a child, most Protestants are more likely than Catholics to be in a committed union. Our findings offer some support for the hypothesis that Protestant churches are more effective than the Catholic Church in discouraging premarital sexual relations and childbearing among adolescents.
Participation is a primary goal of neurorehabilitation; however, most individuals post stroke experience significant restrictions in participation as they attempt to resume their everyday roles and routines. Despite this emphasis on participation, there is a paucity of evidence-based interventions for optimizing this outcome and a limited understanding of factors that contribute to poor participation outcomes. Caregiver support at discharge from inpatient rehabilitation positively influences physical and psychological outcomes after stroke but more research is needed to understand the association between social support and participation. This study aimed to examine the independent contribution of perceived social support to participation 3 months post discharge from inpatient stroke rehabilitation. This study was a secondary analysis of the Stroke Recovery in Underserved Populations 2005–2006 data. Participants were adults ≥55 years old, living in the community 3 months post discharge from inpatient rehabilitation for ischemic stroke (n = 422). Hierarchical linear regressions were performed. The primary variables of interest were the PAR-PRO Measure of Home and Community Participation and the Duke–University of North Carolina Functional Social Support Questionnaire. Perceived social support at discharge from inpatient rehabilitation for ischemic stroke contributed uniquely to the variance in participation 3 months later (β = 0.396, P < 0.001) after controlling for race, sex, age, years of education, comorbidities, stroke symptoms, depression, FIM Motor, and FIM Cognitive. Social support accounted for 12.2% of the variance in participation and was the strongest predictor of participation relative to the other independently significant predictors in the model including FIM Motor and depression. There is already a focus on caregiver training during inpatient rehabilitation related to basic self-care, transfers, and medical management. These findings suggest the need for rehabilitation professionals to also address social support during discharge planning in the context of promoting participation. Given the findings, expanding caregiver training is necessary but novel interventions and programs must be carefully developed to avoid increasing caregiver burden.
Alcohol abuse is a serious problem for students on college campuses. The authors conducted a cross-sectional study to (1) compare measures of alcohol-risk behaviors among college students attending a university on the US-Mexico border with other students and (2) identify factors associated with risk behaviors among border students. They used a self-administered survey to collect data from 286 freshman and sophomore students. Rates of binge drinking were higher among study respondents than among respondents in a national survey of freshman and sophomore college students (46% vs 42% to 45%, respectively). Drinking in high school and drinking in Mexico were significantly associated with all outcomes (binge drinking, drinking and driving, and riding with a drinker). The findings underscore the need for targeted prevention programs among this high-risk population.
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