School of Public Health
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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.
Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.
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Item A NATIONAL SURVEY EVALUATING FACTORS INFLUENCING AMERICANS’ WILLINGNESS TO USE AND UPTAKE OF EMERGENCY CONTRACEPTIVE PILLS(2022) Jasczynski, Michelle; Aparicio, Elizabeth M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In the United States, a paradox exists around the issue of contraception; there are more highly effective contraceptive methods available than ever before, including emergency contraception, yet unintended pregnancies have increased in the last 2 decades. Currently, 1 in 2 pregnancies in the United States are unplanned. These disparities are not equitably distributed among women of reproductive age and people who can become pregnant; the burden disproportionately falls upon those with limited access to healthcare, people of color, gender and sexual minorities, those with lower socioeconomic status, and people living in the South. Recognizing the multiple factors driving decisions made about contraception, evaluation of the underutilization and other potential barriers to emergency contraceptive pills (ECP) can be in part addressed by the completion of a national survey. Most of the existing survey data for the United States provide insight into the perceptions of pharmacists, healthcare providers in emergency rooms, and college-aged women. A survey capturing the needs and experiences of a wider range of Americans has not yet been developed—most notably the need for a survey that is inclusive of an expansive understanding of gender identity and sexual orientation to evaluate what, if any, differences exist in how members of these groups view and choose to use ECPs. A web survey was completed in March 2022. Two groups of participants were recruited simultaneously: a group of cisgender, heterosexual women (n = 351), and a group of cisgender sexual minority women and gender minorities assigned female at birth (n = 408), for a total of 759 participants. Comparisons between cisgender heterosexual participants and cisgender sexual minority participants were completed using chi-squared tests and t tests to determine if there were differences in willingness to use and uptake of ECPs by sexual orientation. Latent class analysis (LCA) was completed to identify subgroups among the respondents. The latent class model was then used to determine if membership in the three latent classes predicted willingness to use ECPs and the number of times ECPs were used. Differences between classes on these two outcomes of interest were compared using chi-squared tests. Among each group, approximately 1 in 3 respondents had used ECPs at least once. Cisgender sexual minority participants had a higher willingness to use ECPs when compared to cisgender heterosexual participants (F[2, 708] = 16.33, p < .001). Cisgender sexual minority participants who used ECPs previously also were found to be less willing to reuse ECPs again when compared to their cisgender, heterosexual counterparts (χ2 [2] = 5.14, p = .023), with the most common reason of not wanting to use ECPs again due to participants indicating they would desire to be pregnant. The LCA final model had three classes: high reproductive coercion/low stigma (Class 1), low reproductive coercion/low stigma (Class 2), and low reproductive coercion/high stigma (Class 3). When regressed on the number of times ECPs were used, the three-class model was found to be statistically significant for the overall model (χ2 = 28.95, p < .001). Class 3 (low reproductive coercion, high stigma) was significantly different from Class 1 and Class 2 when comparing the mean number of times ECPs had been used, with members of Class 3 averaging using ECPs 1.56 times versus Class 1 and Class 2 both averaging .56 times use (p < .001). The high levels in which sexual minority women were willing to use ECPs but were less likely to reuse them again should be explored more in depth to understand underlying factors in decision making around contraceptive uptake and pregnancy intentions. The desire to become pregnant is the most common reason given for why sexual minority women would not use ECPs, highlighting the need for healthcare providers to have regular conversations with their patients about sexual behavior, contraceptive use, and pregnancy intentions. Individuals experiencing higher levels of stigma toward their use of ECPs have a higher prevalence of use. Although the direction of this association is yet to be determined, further investigation of this phenomenon can inform practice and policy to understand the impact of stigma and promote reproductive justice.Item UNDERSTANDING CHANGES IN CONTRACEPTIVE INTENTION, KNOWLEDGE, AND ATTITUDES IN THE CONTEXT OF THE DELCAN INITIATIVE TO REDUCE UNINTENDED PREGNANCY(2022) Skracic, Izidora; Steinberg, Julia R; Lewin, Amy B; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Unintended pregnancies are consistently linked to a higher risk of negative health, social, and economic outcomes for both mother and child. A Delaware public health initiative sought to expand statewide access to all contraceptive methods, particularly IUDs and implants (also known as long-acting reversible contraception (LARC)), due to their high effectiveness, upfront costs, and provision barriers. This study examined changes in self-reported planned contraceptive use, knowledge, and attitudes prior to and following a visit with a medical provider to better understand the provider role in contraceptive outcomes. A diverse group of women (N=474) were recruited at primary care and women’s health Title-X-funded clinics in Delaware. Pre-visit contraceptive use or plan was assessed with two measures: current method use and a composite of current method use and planned method use. Incorporating women’s contraceptive plans in the pre-visit measure resulted in fewer participants being categorized as switching to LARC (2.3%) after a provider visit, compared to the measure that only accounted for current contraceptive use (8.2%). The strongest predictor of changing to a method of higher effectiveness was pre-visit contraceptive choice. On average, women’s knowledge increased; participants with lower pre-visit knowledge were more likely to improve in knowledge post-visit (p<0.001). On average, positive attitudes about LARC decreased, although some individual items changed in the positive direction while others changed in the negative direction. Those with more versus less positive attitudes before the clinic visit had larger decreases in positive attitudes (p<0.001). The full rollout of the DelCAN initiative was associated with an increase in LARC knowledge, while its association with change in LARC attitudes and effectiveness level of planned method use was mixed. These findings suggest that measuring contraceptive plans as opposed to only current method use before a visit is important when applying a pre-post visit design to evaluations of contraceptive use or plans; broadening the conceptualization and measurement of pre-visit contraceptive use or plans could better capture the sources of change that may manifest in post-visit. Additionally, clinic visits may serve as effective education events, particularly for women with lower contraceptive knowledge, and they may provide a more realistic understanding of different contraceptive methods’ advantages and disadvantages. It is possible that the lack of increase in positive contraceptive attitudes may be attributable to the negativity bias following changes in knowledge and personal experience, but more research is needed to replicate and understand the phenomenon.Item "Sin Querer Queriendo": Exploring The Factors Associated With Pregnancy Prevention And Pregnancy Intention Among Latino Youth In Montgomery County(2010) Martinez-Garcia, Genevieve; Atkinson, Nancy; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study seeks to determine the factors that influence pregnancy desire and pregnancy prevention behavioral intentions among Latino youth. One out of two Latino girls in the U.S. will become pregnant before they turn 20. A pregnancy significantly hinders a teen's ability to pursue an education and develop professionally, and places an undue economic burden on the family. In order to appropriately address the factors that fuel teen birth rates, it is imperative to study behavioral, social, and cultural dynamics associated with pregnancy prevention and sexual behavior in the local Latino community. This study utilized the Theory of Planned Behavior (TPB) to explore factors associated with pregnancy prevention behaviors, namely abstinence, condom use, and birth control pill use. The study specifically addresses attitudes, subjective norms, and perceived behavioral controls of Latino adolescents/teens regarding three pregnancy prevention behaviors. The Pregnancy Wantedness Scale was designed to specifically measure pregnancy attitudes among youth. The study answered three main questions: 1) What are the characteristics of Latino youth who desire a pregnancy during their adolescent years?; 2) Are pregnancy prevention behavioral intentions associated with pregnancy wantedness?; and 3) Are attitudes, subjective norms and perceived behavioral control associated with pregnancy prevention behavioral intentions? A questionnaire was designed in English and Spanish using input from local community stakeholders. A total of 949 Latino youth were recruited using a central location intercept approach. Univariate and multiple linear regression analyses were used to answer the three research questions. Analyses were conducted separately for males and females with some and no sexual experience. Psychometric studies and factor analysis were conducted to assess the reliability and underlying structure of the scale. This study found that multiple demographic, familial and acculturation factors influenced youth's pregnancy intentions. For most groups, pregnancy wantedness was mostly influenced by youth's religion salience, acculturation level and living with a parent. Only condom use intention was associated with lower pregnancy wantedness for males. Perceived behavioral control and parental norms was positively associated with increased behavioral intentions across all three behaviors for most groups. This study suggests that practitioners should be aware of the gender, sexual experience and acculturation level of Latino youth when designing education interventions. Moreover, the findings of this study suggest that strengthening parental role and communication will protect youth from desiring a pregnancy and motivate them to use contraception effectively.