MEDIATION MODELS OF PREGNANCY DESIRES AND UNPLANNED PREGNANCY IN YOUNG, UNMARRIED WOMEN.

This paper examines the proposition that sexual and contraceptive behaviours mediate the relationship between the pregnancy desires of young, unmarried women and their having an unplanned pregnancy. The sample consisted of 854 18- to 19-year-old women living in Michigan, USA. First, the positive and negative pregnancy desires of these women were measured, as were the women's perceptions of the positive and negative desires of their sexual partners. Then the extent to which these four types of desires, as well as several types of interactions between them, prospectively predicted the occurrence of subsequent pregnancies were tested with logistic regression analyses, initially alone and then after the addition of several types of sexual and contraceptive mediator variables. The results demonstrated that four of the ten significant motivational predictors became non-significant following the introduction of the contraceptive mediator variables and that the predictive strength of the other six significant motivational predictors was substantially reduced by their introduction. A number of factors that may account for only a partial mediational effect in some models are discussed.

Young women's perceptions and experiences with contraception supply in community pharmacies.

BACKGROUND: Unintended pregnancy is a major public health problem in the United States.Correct contraceptive use can reduce the rate of unintended pregnancy. Community pharmacies are well positioned to provide contraceptives and advice about contraception. OBJECTIVES: To determine young women's perceptions and experiences with contraception supply in community pharmacies and to identify whether pharmacy characteristics predicted very positive experiences. DESIGN: This study comprised two cross-sectional surveys including an online women's pharmacy perceptions and experiences (PPE) survey and a faxed/observed survey of community pharmacies. SETTING: One county in Michigan. PARTICIPANTS: Young women and community pharmacies. MAIN OUTCOME MEASURE: The two surveys were merged to explore pharmacy characteristics that may impact women's perceptions and experiences with community pharmacies. Multiple logistic regression analysis was used to explore relationships between pharmacy characteristics and positive outcomes. RESULTS: The response rate for the PPE survey was 54% (n = 343/637). Data from all community pharmacies in the county was retrieved via fax (n = 41/94, 43.6%) or observation (n = 53/94, 56.4%). Women were included in this analysis if they indicated a regular pharmacy (one they go to most often) in the county of interest (n = 210). More than 50% of women (n = 125/210) visited a pharmacy more than once per month. Sixty percent of women were currently using something to prevent pregnancy (n = 124/210, 60.8%). Thirty-five percent of women had a positive experience (n = 73/210, 34.8%). In the multiple logistic regression, women who visited a chain pharmacy had almost 65% lower odds of an overall positive experience with their regular pharmacy compared with women who visited a grocery or mass merchandise pharmacy (odds ratio 0.35 [95% CI 0.16], P = 0.75). CONCLUSION: Young women visit community pharmacies and use contraceptives frequently. Interventions need to be developed and implemented to improve young women's perceptions and experiences with contraception at community pharmacies.

Pregnancy scares and subsequent unintended pregnancy.

BACKGROUND: A substantial number of young women experience pregnancy scares - thinking they might be pregnant, and later discovering that they are not. Although pregnancy scares are distressing events, little is known about who experiences them and whether they are important to our understanding of unintended pregnancy. OBJECTIVE: We describe the young women who experience pregnancy scares, and examine the link between pregnancy scares and subsequent unintended pregnancy. METHODS: We used data from the Relationship Dynamics and Social Life Study. T-tests and regression analyses were conducted using baseline and weekly data to estimate relationships between respondent characteristics and subsequent pregnancy scares. Event history methods were used to assess pregnancy scares as a predictor of unintended pregnancy. RESULTS: Nine percent of the young women experienced a pregnancy scare during the study. African-American race, lack of two-parent family structure, lower GPA, cohabitation, and sex without birth control prior to the study are associated with experiencing a pregnancy scare and with experiencing a greater number of pregnancy scares. Further, experiencing a pregnancy scare is strongly associated with subsequent unintended pregnancy, independent of background factors. Forty percent of the women who experienced a pregnancy scare subsequently had an unintended pregnancy during the study period, relative to only 11% of those who did not experience a pregnancy scare. CONCLUSIONS: Young women from less advantaged backgrounds are more likely to experience a pregnancy scare, and pregnancy scares are often followed by an unintended pregnancy.

The effects of ambivalent fertility desires on pregnancy risk in young women in the USA.

Many different definitions of the construct of motivational ambivalence have appeared in the literature on reproductive health. Using a theoretical framework in which motivational ambivalence is defined as an interaction between positive and negative pregnancy desires, we propose two hypotheses. The first is that positive and negative pregnancy desires independently predict the risk of an unplanned pregnancy. The second is that ambivalence and three related constructs that are also based on the interaction between positive and negative desires are each important predictors of pregnancy risk. We use weekly journal data collected from a US sample of 1,003 women aged 18-19 years and conduct hazard model analysis to test our hypotheses. Using both dummy and continuous predictors, we report results that confirm both hypotheses. The proposed interaction framework has demonstrated validity, compares favourably with previously reported alternative approaches, and incorporates a set of constructs that have potential importance for further research directed at the prevention of unplanned pregnancy.

Physical Intimate Partner Violence and Contraceptive Behaviors Among Young Women.

BACKGROUND: Understanding the link between physical intimate partner violence (IPV) and contraception is key to preventing unintended pregnancy and sexually transmitted infections. MATERIALS AND METHODS: Data from the Relationship Dynamics and Social Life study, a longitudinal study of a racially and socioeconomically diverse population-representative random sample of 18- to 19-year-old women residing in a Michigan county in 2008-2009 and followed weekly through 2011-2012, were used. Logistic regression models of contraceptive behaviors on temporally specific measures of physical violence victimization: recent, history in the current relationship, and history in prior relationships were conducted among 711 women. RESULTS: Women who experienced physical IPV in their current relationship had lower odds of using contraception (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.28, 0.76 for recent; OR, 0.53; 95% CI, 0.33, 0.83 for past). Condom use was lower among women who experienced past physical IPV in their current relationship (OR, 0.44; 95% CI, 0.26, 0.73), while withdrawal use was higher (OR, 1.99; 95% CI, 1.24, 3.19). Women who experienced physical IPV used condoms less consistently (OR, 0.34; 95% CI, 0.13, 0.85 for recent; OR, 0.27; 95% CI, 0.14, 0.52 for prior relationships). CONCLUSIONS: Physical IPV victimization is a dynamic and strong predictor of contraceptive use, method type, and consistency of condom use.

Effects of intensive longitudinal data collection on pregnancy and contraceptive use.

We use an experiment based on the Relationship Dynamics and Social Life (RDSL) study of sexual behavior, pregnancy, and contraceptive use to investigate whether participation in weekly self-reports over one year result in differential effects on related behaviors and attitudes, compared to participation in a one-time follow-up interview requiring retrospective self-reporting for the prior year. We randomly assigned 200 subjects to either a control group or a journal group. All subjects were interviewed at the beginning of the study (baseline interview) and 12 months later (closeout interview). Subjects in the journal group also completed a five-minute web- or phone-based survey every week during the 12-month study period. We found no statistically significant difference in pregnancy rates across the two groups at closeout. Contrary to our expectation, the control group experienced a slightly larger increase in having ever used a contraceptive method, although this was mainly due to increases in the least effective methods, such as condoms and withdrawal. Respondents in the weekly interview group became slightly more positive toward childbearing in terms of one specific attitude measure, but not for the vast majority of measures. We conclude that intensive longitudinal data collection does not appear to have a large or consistent impact on respondents' pregnancy, contraceptive use, or related attitudes, relative to the more standard longitudinal approach.

Maximizing Data Quality using Mode Switching in Mixed-Device Survey Design: Nonresponse Bias and Models of Demographic Behavior.

Conducting survey interviews on the internet has become an attractive method for lowering data collection costs and increasing the frequency of interviewing, especially in longitudinal studies. However, the advantages of the web mode for studies with frequent re-interviews can be offset by the serious disadvantage of low response rates and the potential for nonresponse bias to mislead investigators. Important life events, such as changes in employment status, relationship changes, or moving can cause attrition from longitudinal studies, producing the possibility of attrition bias. The potential extent of such bias in longitudinal web surveys is not well understood. We use data from the Relationship Dynamics and Social Life (RDSL) study to examine the potential for a mixed-device approach with active mode switching to reduce attrition bias. The RDSL design allows panel members to switch modes by integrating telephone interviewing into a longitudinal web survey with the objective of collecting weekly reports. We found that in this design allowing panel members to switch modes kept more participants in the study compared to a web only approach. The characteristics of persons who ever switched modes are different than those who did not - including not only demographic characteristics, but also baseline characteristics related to pregnancy and time-varying characteristics that were collected after the baseline interview. This was true in multivariate models that control for multiple of these dimensions simultaneously. We conclude that mode options and mode switching is important for the success of longitudinal web surveys to maximize participation and minimize attrition.

Black-White Differences in Attitudes Related to Pregnancy Among Young Women.

In this article, we use newly available data from the Relationship Dynamics and Social Life (RDSL) study to compare a wide range of attitudes related to pregnancy for 961 black and white young women. We also investigate the extent to which race differences are mediated by, or net of, family background, childhood socioeconomic status (SES), adolescent experiences related to pregnancy, and current SES. Compared with white women, black women generally have less positive attitudes toward young nonmarital sex, contraception, and childbearing, and have less desire for sex in the upcoming year. This is largely because black women are more religious than white women and partly because they are more socioeconomically disadvantaged in young adulthood. However, in spite of these less positive attitudes, black women are more likely to expect sex without contraception in the next year and to expect more positive consequences if they were to become pregnant, relative to white women. This is largely because, relative to white women, black women had higher rates of sex without contraception in adolescence and partly because they are more likely to have grown up with a single parent. It is unclear whether attitudes toward contraception and pregnancy preceded or are a consequence of adolescent sex without contraception. Some race differences remain unexplained; net of all potential mediators in our models, black women have less desire for sex in the upcoming year, but they are less willing to refuse to have sex with a partner if they think it would make him angry and they expect more positive personal consequences of a pregnancy, relative to white women. In spite of these differences, black women's desires to achieve and to prevent pregnancy are very similar to white women's desires.

New strategies for biosample collection in population-based social research.

This paper aims to increase understanding of the methodological issues involved in adding biomeasures to social research by investigating the potential of an event-triggered, self-collection technique for monitoring biological response to social events. We use data from the Relationship Dynamics and Social Life (RDSL) study, which collected saliva samples triggered by a life event important to the aims of the study - the end of a romantic relationship. Our investigation found little evidence that those who complied in the biosample collection were different from those who did not comply in terms of key study measures and sociodemographic characteristics. We also found no evidence that the biosample collection had adverse consequences for subsequent panel participation. We did find that prior cooperation in the study was an important predictor of biosample cooperation, which is important information in developing biosample collection strategies. As demand for biological samples directly linked to social data continues to grow, effective low-cost collection methods will become increasingly valuable. The evidence here indicates that self-collected biosamples may offer tremendous potential to meet this demand.

Willingness to Participate in Research during Pregnancy: Race, Experience, and Motivation.

This paper examines the willingness of pregnant women to participate in research on health. We investigate attitudes toward multiple methods of data collection including survey and biomarker data collection. Complete interviews were obtained from a sample of 90 pregnant women in a matched control-comparison study of patients receiving prenatal care in private practice and clinic settings. Women experiencing prenatal care at a clinic reported less willingness to participate in research than women experiencing prenatal care at a private practice. Women who deemed "contributing to science", "learning about pregnancy health", and "helping future patients" as important motivations for participating in research were more likely to express willingness to participate in a study. African American women reported less willingness to answer questions in a survey compared to white women. The results suggest that motivational factors should be integrated into the design of a study of pregnant women to encourage participation.

Design and implementation of an online weekly journal to study unintended pregnancies.

In this article we describe new research to investigate unintended pregnancies during the transition to adulthood. The Relationship Dynamics and Social Life (RDSL) study begins with a 60-minute in-person interview about family background and current relationship characteristics. At the conclusion of the interview, respondents are enrolled in an ongoing journal, which consists of a 5-minute survey via web or phone and occurs weekly for 2.5 years. We have enrolled over 1,000 young women in the study and have experienced excellent baseline response rates and high journal participation rates. Below we describe the limitations of past research on unintended pregnancy as a background for our study. Then we provide a detailed description of the study and its design strengths and weaknesses.