Tubal Sterilization and Cervical Cancer Underscreening in the United States.

Background: Tubal sterilization is more commonly utilized by racial/ethnic minority groups and has been implicated in underscreening for cervical cancer. The objective is to determine if prior tubal sterilization is a risk factor for cervical cancer underscreening. Methods: National Survey of Family Growth dataset from 2015 to 2019 used for analysis; data were weighted to represent the 72 million women in the U.S. population aged 22-49. Chi-square tests, Fisher exact tests, and logistic regression were used for analysis. The primary predictor variable was tubal sterilization which was categorized into no previous sterilization, sterilization completed <5 years ago, and sterilization completed ≥5 years ago. The outcome variable was underscreened versus not underscreened. Other predictor variables included age, household income as a percent of federal poverty level, previous live birth, primary care provider, and insurance status. Results: Prevalence of tubal sterilization completed 5 or more years ago was 12.5% and varied by most measured characteristics in univariate analyses. Approximately 8% of women were underscreened for cervical cancer. In multivariable analyses, women with a tubal sterilization 5 or more years ago had 2.64 times the odds (95% confidence interval = 1.75-4.00) of being underscreened for cervical cancer compared with women who did not have a tubal sterilization. Conclusions: Approximately 4.3 million women ages 22-49 in the United States are potentially underscreened for cervical cancer and women with previous tubal ligation ≥5 years ago are more likely to be underscreened. These results may inform the need for culturally sensitive public health messages informing people who have had these procedures about the need for continued screening.

Changes to cervical cancer prevention guidelines: effects on screening among U.S. women ages 15-29.

OBJECTIVE: A shift toward later initiation of cervical cancer screening for women began in 2002. We generated national estimates of screening prevalence rates and guideline-consistent screening among U.S. women ages 15-29 before and after the first evidence-based recommendations for reduced cervical cancer screening. METHOD: We used National Survey of Family Growth data to compare self-reported cervical cancer screening in 2002 and 2006-2008, stratified by age (15-17, 18-20, 21-29) and sexual activity. We also assessed receipt of guideline-consistent screening by selected demographic variables. RESULTS: Among females ages 15-17, the proportion screened decreased from 23% to 12%, and screening was significantly more likely to be guideline-consistent. Among females ages 18-20, 24% were screened too early in 2006-2008, but among those not yet sexually active, screening declined to 8%, appropriately reflecting new guidelines. In multivariable analysis, private health insurance, pregnancy, and hormonal contraceptive use were associated with guideline-consistent screening among sexually-active women. CONCLUSION: Fewer adolescents were being screened before sexual initiation, representing newer guidelines. However, sexually-active young adult women also should have later screening initiation. Factors related to health care access contribute to receipt of screening. Monitoring and provider education are needed to improve guideline-consistent screening, as newer guidelines call for less screening.

Fertility of Men and Women Aged 15-49 in the United States: National Survey of Family Growth,2015-2019.

Objective-This report presents national estimates of selected fertility measures for men and women aged 15-49 in the United States in 2015-2019, based on data from the National Survey of Family Growth (NSFG). Overall estimates for 2015-2019 are compared with those for 2011-2015.

Teenagers in the United States: Sexual Activity,Contraceptive Use, and Childbearing, 2015-2019.

Objective-This report presents national estimates of sexual activity and contraceptive use among males and females ages 15-19 in the United States, based on data from the National Survey of Family Growth (NSFG). Methods-NSFG data were collected through in-person interviews with nationally representative samples of males and females ages 15-49 in the household population of the United States. NSFG 2015-2019 interviews were conducted between September 2015 and September 2019 with 21,441 males and females, including 3,812 teenagers (1,894 females and 1,918 males ages 15-19). Estimates include measures of sexual experience and contraceptive use as well as circumstances of first sexual intercourse (sex), attitudes, and probability of a birth during the teen years. Estimates are shown overall and by Hispanic origin and race, age group, parental living arrangements, and maternal characteristics. The report focuses on the period 2015-2019, with trends shown for selected measures for time points 2002, 2006-2010, 2011-2015, and 2015-2019. Results-In 2015-2019, 40.5% of never-married female teenagers (3.8 million), and 38.7% of never-married male teenagers (3.8 million) had ever had vaginal intercourse with an opposite-sex partner. For females this percentage was stable across the four time points, but for males this percentage decreased from the 2002 (45.7%) and 2011-2015 (44.2%) time points. For teen males, use of any contraception at first sex increased across the four time points, from 82.0% in 2002 to 92.1% in 2015-2019, while no consistent trend was seen for teen females. Nearly four out of five female teenagers (77.3%) in 2015-2019 used a method of contraception at first sex. Among female teenagers, ever-use of long-acting reversible contraception, which includes intrauterine devices and contraceptive implants, increased from 5.8% to 19.2% from 2011-2015 to 2015-2019.

Providing Environmental Enrichment without Altering Behavior in Male and Female Wistar Rats (Rattus norvegicus).

In research using animal models, subjects are commonly maintained under standard housing conditions, mainly because of the idea that enhancing welfare conditions could alter experimental data. Another common practice in many laboratories relates to the preponderant use of males. Several reasons justifying this practice include the rapid hormonal and endocrine change in females, which may require a higher number of female animals to achieve more homogenous groups, thereby creating a dilemma with the reduction principle in animal research. In past decades, a relationship between enriched environments and enhanced cognitive functions has been reported in rats, but many of those enriched environmental protocols were not systematically or rigorously studied, leading to unexpected effects on behavior. Here we report the effects of 4 types of housing conditions (standard, structural changes, exercise, and foraging) in Wistar rats on anxiety (elevated plus maze), exploratory (open field), and stress vulnerability (forced swim test) responses. Sex was used as a blocking factor. Data show no effect of housing conditions on anxiety and exploratory behaviors, but do show an effect on stress responses. These results suggest the possibility of using a protocol for environmental enrichment without concern about altering experimental data. From this stand, new ways to enhance animal welfare in research laboratories could be designed and implemented.

Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006-2010 national survey of family growth.

OBJECTIVE: This report presents national estimates of sexual activity, contraceptive use, and births among males and females aged 15-19 in the United States in 2006-2010 from the National Survey of Family Growth (NSFG). For selected indicators, data are also presented from the 1988, 1995, and 2002 NSFG, and from the 1988 and 1995 National Survey of Adolescent Males, conducted by the Urban Institute. METHODS: Descriptive tables of numbers and percentages are presented and discussed. Data were collected through in-person interviews of the household population of males and females aged 15-44 in the United States, between July 2006 and June 2010. Interviews were conducted with 22,682 men and women, including 4,662 teenagers (2,284 females and 2,378 males). For both the teen subsample and the total sample, the response rate was 77%. RESULTS: In 2006-2010, about 43% of never-married female teenagers (4.4 million), and about 42% of never-married male teenagers (4.5 million) had had sexual intercourse at least once. These levels of sexual experience have not changed significantly from 2002. Seventy-eight percent of females and 85% of males used a method of contraception at first sex according to 2006-2010 data, with the condom remaining the most popular method. Teenagers' contraceptive use has changed little since 2002, with a few exceptions: there was an increase among males in the use of condoms alone and in the use of a condom combined with a partner's hormonal contraceptive; and there was a significant increase in the percentage of female teenagers who used hormonal methods other than a birth-control pill, such as injectables and the contraceptive patch, at first sex. Six percent of female teenagers used a nonpill hormonal method at first sex.

Teenagers in the United States: sexual activity, contraceptive use, and childbearing, national survey of family growth 2006-2008.

OBJECTIVE: This report presents national estimates of sexual activity, contraceptive use, and births among males and females 15-19 years of age in the United States in 2006-2008 from the National Survey of Family Growth (NSFG). Selected data are also presented from the 1988, 1995, and 2002 NSFGs, and from the 1988 and 1995 National Survey of Adolescent Males (NSAM), conducted by the Urban Institute. METHODS: Descriptive tables of numbers and percents are presented and discussed. Data were collected through in-person interviews of the household population in the United States, conducted between July 2006 and December 2008. Interviews were conducted with 7,356 females-1,381 of whom were teenagers--and 6,140 males--1,386 of whom were teenagers-for a total of 2,767 teenagers. The overall response rate for the 2006-2008 NSFG was 75%. The response rate for female teenagers was 77% and for male teenagers 75%. RESULTS: In 2006-2008, about 42% of never-married female teenagers (4.3 million), and about 43% of never-married male teenagers (4.5 million) had had sexual intercourse at least once. These levels of sexual experience have not changed significantly from 2002, the last time the NSFG collected these data. Among never-married teenagers, 79% of females and 87% of males used a method of contraception at first sex. With a few exceptions, teenagers' use of contraceptives has changed little since 2002, and the condom remained the most commonly used method. One exception was an increase in the use of condoms and the use of a condom combined with a hormonal contraceptive (dual method use) among males. Another exception was a significant increase in the percent of female teenagers who had ever used periodic abstinence, or the "calendar rhythm" method. This method had been used by 17% of female teenagers in 2006-2008.

Trends and Patterns in Menarche in the United States: 1995 through 2013-2017.

Objective-This report presents national estimates of age at first menstrual period for women aged 15-44 in the United States in 2013-2017 based on data from the National Survey of Family Growth (NSFG). Estimates for 2013-2017 are compared with those from previous NSFG survey periods (1995, 2002, and 2006-2010). Methods-Data for all survey periods analyzed are based on in-person interviews with nationally representative samples of women in the household population aged 15-44 in the United States. For the 2013-2017 survey period, interviews were conducted with 10,590 female respondents aged 15-44. In 2015-2017, the age range of the NSFG included women aged 15-49, but only those aged 15-44 were included in this analysis. The response rate for the 2013-2017 NSFG was 67.4% for women. Measures of menarche in this report include average age at first menstrual period, probability of first menstrual period at each age, and the relationship between age at menarche and age at first sexual intercourse. Results-The median age at menarche decreased from 1995 (12.1) to 2013-2017 (11.9). The cumulative probability of menarche at young ages was higher in 2013-2017 compared with 1995. Differences in age at menarche exist by Hispanic origin and race, mother's education, and living arrangement at age 14. A decreasing linear trend in the probability of age at first sexual intercourse by age at menarche was seen.

Sexual Activity and Contraceptive Use Among Teenagers Aged 15-19 in the United States, 2015-2017.

Monitoring sexual activity and contraceptive use among teenagers aged 15-19 in the United States informs understanding of the risk of pregnancy. By 2018, the U.S. birth rate for teenagers dropped 72% from its peak in 1991 (1), paralleling a decline in the teen pregnancy rate (1,2). While this represents progress toward national goals, these rates are still higher than those in other developed countries (3,4). Using data from the 2002 through 2015-2017 National Survey of Family Growth (NSFG), this report provides trends and national estimates of sexual activity and contraceptive use among teenagers.

Prevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests Among Adolescent Girls and Young Women Aged 15-20 Years in the United States.

Importance: Pelvic examination is no longer recommended for asymptomatic, nonpregnant women and may cause harms such as false-positive test results, overdiagnosis, anxiety, and unnecessary costs. The bimanual pelvic examination (BPE) is an invasive and controversial examination component. Cervical cancer screening is not recommended for women younger than 21 years. Objectives: To estimate prevalence of potentially unnecessary BPE and Papanicolaou (Pap) tests performed among adolescent girls and women younger than 21 years (hereinafter referred to as young women) in the United States and to identify factors associated with receiving these examinations. Design, Setting, and Participants: A cross-sectional analysis of the National Survey of Family Growth from September 2011 through September 2017 focused on a population-based sample of young women aged 15 to 20 years (n = 3410). The analysis used survey weights to estimate prevalence and the number of people represented in the US population. Data were analyzed from December 21, 2018, through September 3, 2019. Main Outcomes and Measures: Receipt of a BPE or a Pap test in the last 12 months and the proportion of potentially unnecessary examinations and tests. Results: Responses from 3410 young women aged 15 to 20 years were included in the analysis with 6-year sampling weights applied. Among US young women aged 15 to 20 years represented during the 2011-2017 study period, 4.8% (95% CI, 3.9%-5.9%) were pregnant, 22.3% (95% CI, 20.1%-24.6%) had undergone STI testing, and 4.5% (95% CI, 3.6%-5.5%) received treatment or medication for an STI in the past 12 months (Table 1). Only 2.0% (95% CI, 1.4%-2.9%) reported using an IUD, and 33.5% (95% CI, 30.8%-36.4%) used at least 1 other type of hormonal contraception in the past 12 months. Among US young women aged 15 to 20 years who were surveyed in the years 2011 through 2017, approximately 2.6 million (22.9%; 95% CI, 20.7%-25.3%) reported having received a BPE in the last 12 months. Approximately half of these examinations (54.4%; 95% CI, 48.8%-59.9%) were potentially unnecessary, representing an estimated 1.4 million individuals. Receipt of a BPE was associated with having a Pap test (adjusted prevalence ratio [aPR], 7.12; 95% CI, 5.56-9.12), testing for sexually transmitted infections (aPR, 1.60; 95% CI, 1.34-1.90), and using hormonal contraception other than an intrauterine device (aPR, 1.31; 95% CI, 1.11-1.54). In addition, an estimated 2.2 million young women (19.2%; 95% CI, 17.2%-21.4%) reported having received a Pap test in the past 12 months, and 71.9% (95% CI, 66.0%-77.1%) of these tests were potentially unnecessary. Conclusions and Relevance: This analysis found that more than half of BPEs and almost three-quarters of Pap tests performed among young women aged 15 to 20 years during the years 2011 through 2017 were potentially unnecessary, exposing women to preventable harms. The results suggest that compliance with the current professional guidelines regarding the appropriate use of these examinations and tests may be lacking.

Receipt of Pelvic Examinations Among Women Aged 15-44 in the United States, 1988-2017.

Pelvic examination has been commonly performed as part of a physical examination for women in the United States. However, the value of routine pelvic examinations has been questioned recently (1,2). In 2012, the American College of Obstetricians and Gynecologists (ACOG) recommended annual pelvic examinations for women aged 21 and over as part of the well-woman visit (3). In 2018, ACOG advised that pelvic examinations be performed when indicated by medical history or symptoms (4). Using National Survey of Family Growth (NSFG) data through 2017 for women aged 15-44, this report describes trends overall and by age since 1988 in the receipt of pelvic examinations in the past year, and differences by Hispanic origin and race, education, poverty status, and health insurance status for 2015-2017.

Provider communication with adolescent and young females during sexual and reproductive health visits: findings from the 2011-2015 National Survey of Family Growth.

OBJECTIVE: This study assesses provider communication with adolescent and young women about birth control, emergency contraception and condoms during sexual and reproductive health visits. STUDY DESIGN: Using data from sexually active 15-24-year-old women in the 2011-2015 National Survey of Family Growth, we examined provider communication about contraception and condoms at sexual and reproductive health services in the past year and assessed differences by demographics, sexual behavior and source of care. RESULTS: Approximately two thirds of women received provider communication about condoms (65.0%) and birth control (64.0%-66.8%). Communication was higher among Title-X-funded clinic vs. private providers. Differences by age, race/ethnicity, mother's education, number of partners and condom use were also found. CONCLUSION: Most sexually active young women attending sexual and reproductive health visits received provider communication about condoms and birth control, but communication is not universal and varies by source of care, demographics and sexual behavior.

Fertility of Men and Women Aged 15-44 in the United States: National Survey of Family Growth, 2011-2015.

This report presents national estimates of selected fertility measures for men and women aged 15-44 in the United States in 2011-2015 based on data from the National Survey of Family Growth (NSFG). Estimates for 2011-2015 are compared with those for 2006-2010.

Sexual Activity and Contraceptive Use Among Teenagers in the United States, 2011-2015.

Objective-This report presents national estimates of sexual activity and contraceptive use among males and females aged 15-19 in the United States in 2011-2015, based on data from the National Survey of Family Growth (NSFG). For selected indicators, data are also presented from the 1988, 1995, 2002, and 2006-2010 NSFGs, and from the 1988 and 1995 National Survey of Adolescent Males, which was conducted by the Urban Institute. Methods-NSFG data were collected through in-person interviews with nationally representative samples of men and women aged 15-44 in the household population of the United States. NSFG 2011-2015 interviews were conducted between September 2011 and September 2015 with 20,621 men and women, including 4,134 teenagers (2,047 females and 2,087 males). The response rate was 72.5% for male teenagers and 73.0% for female teenagers. Results-In 2011-2015, 42.4% of never-married female teenagers (4.0 million) and 44.2% of never-married male teenagers (4.4 million) had had sexual intercourse at least once by the time of the interview (were sexually experienced). These levels of sexual experience among teenagers are similar to those seen in 2002 and 2006-2010 data. Longer-term trends, from 1988 to 2011-2015, show declines in the percentage of teenagers who were sexually experienced. Female teenagers' use of a method of contraception at first sex increased from 74.5% in 2002 to 81.0% in 2011-2015. Male teenagers' use of a condom at first sex increased from 70.9% in 2002 to 79.6% in 2006-2010 and remained stable at 76.8% in 2011-2015. Overall, in 2011-2015, 5.8% of female teenagers had used a long-acting reversible method (intrauterine device or implant).

Urban and Rural Variation in Fertility-related Behavior Among U.S. Women, 2011-2015.

In 2010, one-fifth of the U.S. population lived in rural areas (1). There is known variation in social, demographic, and health characteristics across urban and rural residence (1­3). Recent National Center for Health Statistics (NCHS) reports show higher teen birth and infant mortality rates in rural counties than in urban counties (4,5). Less is known about urban and rural variation in fertility-related behavior, such as sexual activity and contraceptive use. Using National Survey of Family Growth (NSFG) data from 2011 through 2015 for women aged 18­44, this report describes urban-rural differences in first sexual intercourse, marital and cohabitation status, number of births, and contraceptive use based on residence at the time of interview.

Fertility, contraception, and fatherhood: data on men and women from cycle 6 (2002) of the 2002 National Survey of Family Growth.

OBJECTIVE: This report presents national estimates of fertility, family formation, contraceptive use, and father involvement indicators among males 15-44 years of age in the United States in 2002 from Cycle 6 of the National Survey of Family Growth (NSFG). Data are also shown for women for purposes of comparison. METHODS: Descriptive tables of numbers and percentages are presented. Data were collected through in-person interviews of the household population 15-44 years of age in the United States between March 2002 and March 2003. The sample included 7,643 females and 4,928 males. This report focuses primarily on data from the male sample, but compares findings with the female data whenever appropriate. The overall response rate for Cycle 6 of the NSFG was 79 percent, and the response rate for men was 78 percent. RESULTS: This report covers a wide range of topics including first sexual intercourse and its timing in relation to marriage; contraceptive use; wantedness of births in the past 5 years; marital and cohabiting status at first birth; living arrangement of fathers with their children; father's activities with children they live with and those they do not live with; HIV-risk related behaviors; and infertility services. CONCLUSION: The reproductive experiences of men and women 15-44 years of age in the United States vary significantly, and often sharply, by demographic characteristics such as education, income, and Hispanic origin and race.

Temporal and spatial distribution of immunoreactive PER1 and PER2 proteins in the suprachiasmatic nucleus and peri-suprachiasmatic region of the diurnal grass rat (Arvicanthis niloticus).

The suprachiasmatic nucleus (SCN) of the hypothalamus contains the primary circadian pacemaker in both diurnal and nocturnal mammals. The lower subparaventricular zone (LSPV) immediately dorsal to the SCN may also play an important role in the regulation of circadian rhythms. The SCN contains a multitude of oscillator cells that generate circadian rhythms through transcriptional/translational feedback loops involving a set of clock genes including per1 and per2. Little is known about the temporal and spatial features of the proteins encoded by these genes in day-active mammals. The first objective of this study was to characterize the expression of PER1 and PER2 in the SCN of a diurnal rodent, the unstriped Nile grass rat (Arvicanthis niloticus). The second objective was to evaluate the hypothesis that a molecular clock could exist in the LSPV, where endogenous rhythms in Fos expression are seen in grass rats but not in laboratory rats. Animals were kept on a 12:12 light/dark cycle and perfused at 4-h intervals, and their brains were processed for immunohistochemical detection of PER1 and PER2. Both proteins were seen in the SCN where they peaked early in the dark phase, providing further evidence that the differences between diurnal and nocturnal patterns of behavior emerge from mechanisms lying downstream from the pacemaker within the SCN. Rhythmic expression of PER1 and PER2 was also seen in the LSPV providing support for the hypothesis that this region might participate in circadian time keeping in the diurnal grass rat. In addition, rhythms were seen lateral to the LSPV and the SCN. Results of this study are discussed in light of similarities and differences in the circadian time-keeping systems of day- and night-active animals.

Birth Expectations of U.S. Women Aged 15-44.

KEY FINDINGS: Data from the National Survey of Family Growth •Among U.S. women aged 15-44 in 2013-2015, 50% expected to have a child in the future. •In 2013-2015, differences were seen by age in women's expectations to have a child in the future, regardless of the number of biological children they have had. •In 2013-2015, women on average expected to have 2.2 children in their lifetime. This estimate has decreased since 2002. •A smaller percentage of never married, not cohabiting women expected to have a child within 2 years from the time of interview (5%) compared with currently married (19%) and currently cohabiting (16%) women. •Eighty-two percent of women who already had two or more children did not expect to have more children in the future. Birth expectations have been shown to be related to sexual activity, contraceptive use, and fertility (1-3). While most U.S. women believe that having two children is ideal (4), this varies by sociodemographic characteristics. Using data from the National Survey of Family Growth (NSFG), this report describes women's birth expectations, number of children expected, and when they expected their next child to be born. Data are shown by age, marital or cohabiting status, and number of children. Selected trends are also shown using NSFG data from 2002, 2006-2010, 2011-2013, and 2013-2015.

Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth.

OBJECTIVE: This report presents national estimates of fertility, family planning, and reproductive health indicators among females 15-44 years of age in the United States in 2002 from Cycle 6 of the National Survey of Family Growth (NSFG). For selected indicators, data are also compared with earlier cycles of the NSFG. METHODS: Descriptive tables of numbers and percentages are presented and interpreted. Data were collected through in-person interviews of the household population 15-44 years of age in the United States between March 2002 and March 2003. The sample included 7,643 females and 4,928 males, and this report focuses on data from the female sample. The overall response rate for the Cycle 6 NSFG was 79 percent, and the response rate for women was 80 percent. RESULTS: Given the range of topics covered in the report, only selected findings are listed here. About 14 percent of recent births to women 15-44 years of age in 2002 were unwanted at time of conception, an increase from the 9 percent seen for recent births in 1995. Among recent births, 64 percent occurred within marriage, 14 percent within cohabiting unions, and 21 percent to women who were neither married nor cohabiting. The overall rate of breastfeeding initiation among recent births increased from 55 to 67 percent between 1995 and 2002. About 50 percent of women 15-44 had ever cohabited compared with 41 percent of women in the 1995 survey; the percentage of women currently cohabiting also increased, from 7 to 9 percent between 1995 and 2002.

Three Decades of Nonmarital First Births Among Fathers Aged 15-44 in the United States.

KEY FINDINGS: The percentage of fathers aged 15-44 whose first births were nonmarital was lower in the 2000s (36%) than in the previous 2 decades. Fathers with first births in the 2000s were more likely to be in a nonmarital cohabiting union (24%) than those in the 1980s (19%). The percentage of fathers with a nonmarital first birth over the past 3 decades has remained similar for Hispanic and non-Hispanic white men, but has declined for non-Hispanic black men (1980s, 77%; 2000s, 66%). Fathers with nonmarital first births in the 2000s were less likely to be non-Hispanic black men (21%) than Hispanic (33%) or non-Hispanic white (39%) men. Fathers with nonmarital first births in the 2000s were more likely to be older at the time of the birth (33%) than those in the previous 2 decades.