Data Opportunities for Studying the Sexual and Reproductive Health of Immigrants in the United States.

This paper aims to identify, review, and evaluate publicly available national- and local-level data sources that collect information on the sexual and reproductive health (SRH) of immigrants in the United States. We review public-use sources from the last 30 years that include information on immigration, SRH, health service utilization, and race/ethnicity. For each source, we evaluated the strengths and challenges of the study design and content as they relate to studying immigrant SRH. We identified and reviewed 22 national and seven local sources. At the national level, the National Longitudinal Study of Adolescent to Adult Health and the National Survey of Family Growth contained the most information; at the local level, the New York City Community Health Survey was the most robust. These sources present opportunities to advance research, improve public health surveillance, and inform policies and programs related to the SRH of this rapidly growing and often underserved population.

The sexual and reproductive health of foreign-born women in the United States.

OBJECTIVE: To explore the sexual and reproductive health (SRH) behaviors, health insurance coverage and use of SRH services of women in the United States (U.S.) by nativity, disaggregated by race and ethnicity. STUDY DESIGN: We analyzed publicly available and restricted data from the National Survey of Family Growth to assess differences and similarities between foreign-born and U.S.-born women, both overall and within Hispanic, non-Hispanic (NH) white, NH black and NH Asian groups. RESULTS: A larger proportion of foreign-born women than U.S.-born women lacked health insurance coverage. Foreign-born women utilized SRH services at lower rates than U.S.-born women; this effect diminished at the multivariate level, although race and ethnicity differences remained. Overall, foreign-born women were less likely to pay for SRH services with private insurance than U.S.-born women. Foreign-born women were less likely to use the most effective contraceptive methods than U.S.-born women, with some variation across race and ethnicity: NH white and NH black foreign-born women were less likely to use highly effective contraceptive methods than their U.S.-born counterparts, but among Hispanic women, the reverse was true. CONCLUSION: Our findings demonstrate that the SRH behaviors, needs and outcomes of foreign-born women differ from those of U.S-born women within the same race/ethnic group. IMPLICATIONS: This paper contributes to the emergent literature on immigrants in the U.S. by laying the foundation for further research on the SRH of the foreign-born population in the country, which is critical for developing public health policies and programs to understand better and serve this growing and diverse population.

Using Longitudinal Data to Understand Changes in Consistent Contraceptive Use.

CONTEXT: Most studies of contraceptive behavior rely on cross-sectional data and are unable to adequately measure fluctuations in contraceptive use or changes in circumstances and attitudes that are likely to be associated with this outcome. METHODS: Between November 2012 and May 2014, four waves of data were gathered from a national sample of 1,842 women aged 18-39 at baseline. Cross-tabulations were used to examine change and stability in time-varying characteristics theorized to be associated with consistent contraceptive use. Random-effects and fixed-effects logistic regression models were used to examine variables associated with consistent contraceptive use. RESULTS: While a majority of women were at risk of unintended pregnancy during each survey period, only 42% were at risk during all four. Random-effects logistic regression analysis revealed that the odds of being a consistent contraceptive user were 10 times as high for a woman who expressed a strong pregnancy avoidance attitude as for a woman who had a weak attitude. This strong association was confirmed in the fixed-effects model. However, having a strong desire to avoid pregnancy was not static; among women at risk of unintended pregnancy during at least one survey period, 53% reported a change in attitude. CONCLUSIONS: These findings build on prior research suggesting that pregnancy avoidance attitudes are an important motivator for contraceptive use. It is critical to recognize that the context in which many women make decisions about pregnancy and contraceptive use changes over relatively short periods of time.

Impact of the federal contraceptive coverage guarantee on out-of-pocket payments for contraceptives: 2014 update.

BACKGROUND: The Affordable Care Act requires most private health plans to cover contraceptive methods, services and counseling, without any out-of-pocket costs to patients; that requirement took effect for millions of Americans in January 2013. STUDY DESIGN: Data for this study come from a subset of the 1842 women aged 18-39 years who responded to all four waves of a national longitudinal survey. This analysis focuses on the 892 women who had private health insurance and who used a prescription contraceptive method during any of the four study periods. Women were asked about the amount they paid out of pocket in an average month for their method of choice. RESULTS: Between fall 2012 and spring 2014, the proportion of privately insured women paying zero dollars out of pocket for oral contraceptives increased substantially, from 15% to 67%. Similar changes occurred among privately insured women using injectable contraception, the vaginal ring and the intrauterine device. CONCLUSIONS: The implementation of the federal contraceptive coverage requirement appears to have had a notable impact on the out-of-pocket costs paid by privately insured women, and that impact has increased over time. IMPLICATIONS: This study measures the out-of-pocket costs for women with private insurance prior to the federal contraceptive coverage requirement and after it took effect; in doing so, it highlights areas of progress in eliminating these costs.

Unintended pregnancy and the changing demography of American women, 1987-2008.

BACKGROUND: In 1987, the U.S. unintended pregnancy rate was 59 per 1,000 women aged 15-44; the rate fell to 54 in 2008. Over this period, American women experienced dramatic demographic shifts, including an aging population that was better educated and more racially and ethnically diverse. OBJECTIVE: This study aims to explain trends in unintended pregnancy and understand what factors contributed most strongly to changes in rates over time, focusing on population composition and group-specific changes. METHODS: We used the 1988 and 2006-10 waves of the National Survey of Family Growth and employed a decomposition approach, looking jointly at age, relationship status, and educational attainment. RESULTS: When we decomposed by the demographic factors together, we found that changes in population composition contributed to an increase in the overall rate, but this was more than offset by group-specific rate declines, which had an impact nearly twice as great in the downward direction. Increases in the share of the population that was cohabiting and the share that was Hispanic were offset by declines in rates among married women. CONCLUSIONS: Our findings suggest that a combination of compositional shifts and changes in group-specific rates drove unintended pregnancy, sometimes acting as counterbalancing forces and at other times operating in tandem.

The impact of publicly funded family planning clinic services on unintended pregnancies and government cost savings.

Publicly funded family planning clinics serve millions of low-income women each year, providing a range of critical preventive services and enabling women to avoid unintended pregnancies. It is important to quantify the impact and cost-effectiveness of such services, in addition to these health benefits. Using a methodology similar to prior cost-benefit analyses, we estimated the numbers of unintended pregnancies prevented by all U.S. publicly funded family planning clinics in 2004, nationally (1.4 million pregnancies) and for each state. We also compared the actual costs of providing these services ($1.4 billion) with the anticipated public-sector costs for maternity and infant care among the Medicaid-eligible women whose births were averted ($5.7 billion) to calculate net public-sector savings ($4.3 billion). Thus, public expenditures for family planning care not only help women to achieve their childbearing goals, but they also save public dollars: Our calculations indicate that for every $1 spent, $4.02 is saved.

Can government policies help adolescents avoid risky behavior?

BACKGROUND: This study examines the extent to which policies influence participation of adolescents in alcohol and tobacco consumption and in unsafe sex. METHODS: Data were obtained from the 1995 Youth Risk Behavior Surveys (YRBS) conducted by 20 different states and cities in the U.S. These data were combined with state data on cigarette taxes, vending machine laws, beer taxes, and family planning clinic availability. A model of teenage risk taking suggested that the three risk behaviors were codetermined by a common latent risk-taking propensity. We used a structural equation model (SEM) accounting for this shared latent propensity to estimate the extent of participation in terms of frequency of smoking, drinking, and the number of sex partners. RESULTS: Estimating simultaneous equations for all three risk behaviors was statistically more efficient than equation-by-equation estimates of each behavior. Estimates indicated significant deterrent effects of beer taxes, vending machine restrictions, and increased density of family planning clinics on teenage risk behavior. CONCLUSIONS: State policies, such as taxes on beer, and restrictions on location of cigarette vending machines, and placement of family planning clinics influence adolescents' behavior. Because there is interrelationship between these behaviors, systems estimators, can offer improved estimates of these effects.