National Survey Of Family Growth Research Articles

The Interaction of Race and Pregnancy Intentions on Breastfeeding Initiation Rates and Duration in the United States.

Background: Unintended pregnancy increases adverse perinatal health outcomes. Limited studies exist on the influence of pregnancy intention on breastfeeding. This study examines the interaction of Race and couples' pregnancy intention on breastfeeding initiation and duration. Methods: Using the National Survey of Family Growth (2017-2019), we categorized breastfeeding into three categories (never breastfed, breastfed for 6 months or less, and breastfed for more than 6 months). Multinomial logistic regression and probability marginal effects were estimated across racial categories (Hispanics, non-Hispanic [NH] White, Black, and NH-others or multiracial). Results: The probability (Pr.) of never breastfeeding was the greatest among NH-Black women for all pregnancy intentions-both intended (Pr.: 0.34), mother-only (Pr.: 0.27), father-only (Pr.: 0.45), ambivalent (Pr.: 0.55), and neither intended (Pr.: 0.37). The probability of breastfeeding for 6 months or less is highest for Hispanics for both intended (Pr.: 0.41), NH-White for mother-only intended (Pr.: 0.49), Hispanics for father-only intended (Pr.: 0.56), ambivalent pregnancy intentions (Pr.: 0.60), and NH-others or multiracial for neither intended pregnancies (Pr.: 0.48). The probability of breastfeeding for more than 6 months is highest for NH-others or multiracial for both intended (Pr.: 0.50), ambivalent (Pr.: 0.49), and neither intended (Pr.: 0.36), while highest for NH-Black for mother-only intended (Pr.: 0.43). Conclusions: Our study demonstrates the interaction of Race and couples' pregnancy intention on breastfeeding initiation and duration. Owing to the high volume of unintended pregnancies in the United States, the current study might help maternal and child healthcare providers understand the interaction between race and pregnancy intentions on breastfeeding initiation and duration in the United States.

Inequities between rural and urban realities: young Hispanic women’s pregnancy intentions and birth outcomes

ABSTRACT The present study sought to determine if inequities exist in Hispanic women’s pregnancy intentions and birth outcomes by metropolitan status. In the U.S. pregnancy intentions and birth outcomes of young Hispanic women are a significant public health problem as they are often overlooked on health issues such as pregnancy and childbirth. Data were from the 2015 to 2019 National Survey of Family Growth and focused on the first pregnancies of Hispanic women aged 18 to 24 years old who were not pregnant at the time of the interview and answered the nativity question. Multivariable multinomial regression was used to evaluate how metropolitan status affects pregnancy intentions and birth outcomes. Additionally, multivariable multinomial regression was used to evaluate how metropolitan status affects each pregnancy intention-birth outcome combination. There was no significant association solely between metropolitan status and pregnancy intention (i.e. unintended pregnancy). Metropolitan Hispanic women reported more miscarriages than live births. Hispanic women in the suburbs were more likely to miscarry during an intended pregnancy than those in urban. These findings can improve family planning services for rural women by identifying the specific factors that affect pregnancy intentions and developing targeted interventions to reduce unintended pregnancies.

The Affordable Care Act Dependent Coverage Provision and Unintended Pregnancy.

Background: Nearly half of all pregnancies in the United States are considered unintended (mistimed or unwanted), and this rate is even higher among younger and lower income women. The Affordable Care Act (ACA) dependent coverage provision may have influenced the frequency of unintended pregnancies by increasing accessibility to and affordability of family planning services among young adults. Furthermore, the impact of this provision may differ by young adult income level as those with lower income are less likely to be insured and thus more likely to benefit from this provision. Our objective was to estimate the association between the ACA dependent coverage provision and unintended pregnancy, overall, and by young adult income level. Methods: We applied a difference-in-differences approach to data from multiple cycles of the National Survey of Family Growth (n = 10,104) and compared trends in unintended pregnancy between those who were eligible to benefit (ages 18-25 years) and those who were ineligible to benefit (ages 26-33 years) from the provision, overall, and among income subgroups. Results: We found evidence that the dependent coverage provision was associated with a -7.4 percentage point reduction (95% CI: -13.5, -1.3) in the prevalence of unintended pregnancy among young adults with lower income (<100% of the federal poverty level). There was limited evidence, however, that the provision was associated with unintended pregnancy among young adults with higher income levels. Conclusions: These findings suggest the ACA dependent coverage provision may have reduced unintended pregnancy among a particularly high-risk group (i.e., young adults with lower income).

Continuity of health insurance coverage and sexually transmitted infection screening among US women.

In the US, gaps in health care insurance coverage correlate with lower use of preventive care. We aimed to determine whether part-year or year-round uninsurance was associated with lower use of testing for sexually transmitted infections (STIs). We identified women age 19-49 in the 2017-2019 National Survey of Family Growth (NSFG). Completion of any STI testing in the past year, and location of STI testing, were regressed on pattern of insurance coverage, classified as continuous private, continuous public, part-year uninsured, or year-round uninsured. Based on the analytic sample (N = 4,119), 12% of women age 19-49 experienced part-year uninsurance, and 8% experienced year-round uninsurance; while 31% received an STI test in the past year. On multivariable analysis, respondents with part-year uninsurance were the group most likely to have received STI testing (odds ratio [OR] compared to continuous private coverage: 1.56; 95% confidence interval [CI]: 1.09, 2.23; p = 0.015), whereas respondents with year-round uninsurance were the group least likely to receive STI testing (OR vs. continuous private coverage: 0.37; 95% CI: 0.25, 0.55; p < 0.001). Year-round uninsurance was associated with higher likelihood of receiving a test at locations other than public or private clinics, such as at a hospital or at an in-store clinic. Low use of STI testing among women with year-round uninsurance indicates a need for expanded insurance coverage and greater access to STI testing. However, high rates of STI testing among women with part-year uninsurance challenge the presumed association of insurance continuity with higher uptake of preventive care.

Socioeconomic Inequities in Pap Test Use Among Black Women in the United States: An Intersectional Approach.

Research investigating racialized inequities in cervical cancer screening has rarely considered the influence of socioeconomic position (SEP), a key social determinant of health that intersects with race/ethnicity and racism. Thus, data on socioeconomic inequities in Pap test use within racialized groups-including Black women, who are at elevated risk of cervical cancer morbidity and mortality-are limited. Using 2011-2019 data from the National Survey of Family Growth and guided by an intersectional framework, we used multivariable logistic regression to examine the association between educational attainment, employment status, and income and the adjusted odds of Pap test use in the last 3years among Black U.S. women. Compared to Black women with a bachelor's degree or greater, those with less than a high school diploma ([odds ratio] = 0.45; [95% confidence interval] 0.31-0.67) and a high school diploma/GED (0.57; 0.40-0.81) had significantly lower odds of Pap test use, adjusting for sociodemographic factors. Unemployed women had significantly lower adjusted odds of Pap test use compared to employed women (0.67; 0.50-0.89), and women living below 100% of the federal poverty level (FPL) had significantly lower adjusted odds of Pap test use relative to those living at or above 300% FPL (0.63; 0.45-0.88). Low-SEP Black women had significantly lower adjusted odds of Pap test use relative to their higher SEP counterparts. Interventions that address both racism and economic barriers to care are needed to facilitate access to regular cervical cancer screening among low-SEP Black women.

Pregnancy after Tubal Sterilization in the United States, 2002 to 2015

BackgroundTubal sterilization is the most commonly used method of contraception in the United States. Because contraceptive effectiveness influences contraceptive selection, we examined typical use failure rates after tubal sterilization in the United States.MethodsWe estimated rates of pregnancy after tubal sterilization using data from four waves of the National Survey of Family Growth (NSFG), representative samples of U.S. women aged 15 to 44 years, collected in 2002, 2006 to 2010, 2011 to 2013, and 2013 to 2015. Survey weighting was used in survival analysis to examine time to first pregnancy after tubal sterilization. Data from these participants were censored after a tubal reversal procedure, infertility treatment, hysterectomy, or bilateral oophorectomy. Reported pregnancy rates after tubal sterilization procedures were examined by using Kaplan–Meier curves and then multivariable Cox proportional-hazards models to examine the effects of age at tubal sterilization, race/ethnicity, education, Medicaid funding, and postpartum versus interval procedures.ResultsPregnancy after tubal sterilization was reported by 2.9 to 5.2% of participants across NSFG waves. In the most recent survey wave (2013 to 2015), the estimated percentage of participants with pregnancies within the first 12 months after a tubal sterilization procedure was 2.9%; at 120 months after tubal sterilization, the estimated percentage with a pregnancy was 8.4%. At all the time points examined, pregnancy after tubal sterilization was less common after postpartum procedures than after interval procedures; however, this difference was not evident in multivariable models. In multivariable models, chance of pregnancy decreased with age at time of tubal sterilization. Race/ethnicity, education, and Medicaid funding were not consistently associated with pregnancy after tubal sterilization.ConclusionsThese data suggest that there may be nontrivial rates of pregnancy after tubal sterilization.

Joint modelling of survival and backwards recurrence outcomes: an analysis of factors associated with fertility treatment in the U.S.

Abstract The motivation for this paper is to determine factors associated with time-to-fertility treatment (TTFT) among women currently attempting pregnancy in a cross-sectional sample. Challenges arise due to dependence between time-to-pregnancy (TTP) and TTFT. We propose appending a marginal accelerated failure time model to identify risk factors of TTFT with a model for TTP where fertility treatment is included as a time-varying treatment to account for their dependence. The latter requires extending backwards recurrence survival methods to incorporate time-varying covariates with time-varying coefficients. Since backwards recurrence survival methods are a function of mean survival, computational difficulties arise in formulating mean survival when fertility treatment is unobserved, i.e. when TTFT is censored. We address these challenges by developing computationally friendly forms for the double expectation of TTP and TTFT. The performance is validated via comprehensive simulation studies. We apply our approach to the National Survey of Family Growth and explore factors related to prolonged TTFT in the U.S.

Factors associated with dating app use for sexual "hookups" in the United States: insights from the National Survey of Family Growth.

The use of dating applications for matchmaking and sexual exploits ("hookups") has increased, and this modern phenomenon has supplanted traditional socialization and relationship formation. To date, sociodemographic data on the use of dating apps has been limited. In this study, we sought to identify predictors associated with the use of dating apps in the United States. Using cross-sectional data from the 2017-2019 National Survey of Family Growth, we examined sociodemographic determinants influencing the use of dating apps to find partners for sexual intercourse. We constructed survey-weighted regression models to study these associations, with additional sensitivity analyses performed within specific subgroups. Furthermore, this study investigated the correlation of app use with sexual frequency. Study outcomes were participant data regarding reported use of dating apps for sexual intercourse in the 2017-2019 National Survey of Family Growth. A total of 11,225 respondents were examined, representing a survey-weighted total of approximately 143,201, 286 Americans. Among them, 757 respondents (6.7%), equating to approximately 8, 818, 743 individuals, reported dating app use for sexual hookups. Regression analysis revealed that factors such as male sex, White race, previous sexual experience, substance/alcohol use, history of sexually transmitted infections, same-sex attraction, and bisexuality increased the likelihood of dating app usage. Conversely, reduced odds of dating app use were observed among Catholics, Protestants, married/widowed individuals, and older respondents. Stratified analyses across various demographics, including male and female individuals aged 20 to 40years, heterosexual, and lesbian, gay, and bisexual respondents, generally supported these trends. Notably, dating app use did not correlate with increased sexual frequency (adjusted incidence rate ratio: 1.10; 95% CI: 0.96-1.26; P = .16). Dating app use is prevalent among male patients and White individuals and correlates with increased sexually transmitted infection risk, alcohol/illicit substance use, past sexual experience, and popularity within the lesbian, gay, and bisexual community, all important considerations for public health interventions. Dating app use, however, was not associated with increased sexual encounters. Strengths of our study were the utilization of a national survey of individuals of reproductive age in the United States and focus on a clearly defined outcome of dating app utilization for the purposes of sexual intercourse. Limitations include self-reported survey responses and insufficient detail on the types and duration of dating app platforms and their use. Many sociodemographic factors, including male sex, White race, history of STIs, substance and alcohol use, and same-sex and bisexual attraction, were linked with dating app use. However, there was no increase in sexual frequency associated with dating app utilization. Further research is essential for integrating these technologies into the relational and sexual dynamics of individuals.

Social Determinants of Health and Patient-Reported Difficult Discontinuation of Long-Acting Reversible Contraception.

Background: Some individuals who receive long-acting reversible contraception (LARC) face barriers to discontinuation. The inability to discontinue a contraceptive method when desired negatively impacts a person's reproductive autonomy. Persons impacted by social determinants of health (SDH) may be disproportionately affected. The objective of this study is to evaluate the association of SDH with patient-reported difficult LARC discontinuation. Methods: A retrospective cross-sectional analysis of data from the 2017-2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. Results: A total of 754 respondents reported wanting to have their LARC removed, and 105 (11%) reported difficulty discontinuing LARC methods. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). After adjusting for age, race, education, geographic location, parity, and body mass index (BMI), persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficultly discontinuing LARCs compared with respondents without any SDH (2.11; 95% confidence interval [CI]: 1.21, 3.69). Transportation barriers demonstrated the largest aOR of 2.90 (95% CI: 1.07, 7.87). Conclusions: SDH are associated with challenges to LARC discontinuation. SDH are unique risk factors that can impact one's entire contraceptive experience. A nuanced discussion of SDH at the time of contraceptive counseling may be a critical step in addressing the intersectionality of method selection and reproductive agency.

Sources of condom information among adolescents in the United States

ObjectiveTo describe receipt of condom information from formal sources and parents among sexually experienced and sexually inexperienced adolescents in the United States. Study designData come from the 2015–2019 National Survey of Family Growth and a sample of 15-to-19-year-olds. ResultsMost adolescent females and males reported receipt of condom information from any source, with sexually experienced adolescents more likely to do so. Close to one-third of adolescents, regardless of sexual experience, reported sex education about condoms from only formal sources, with small proportions reporting receipt of this information from only parents. Receiving condom information from both formal sources and parents was more common among sexually experienced adolescents, whereas not receiving this information from either source was more frequently reported among sexually inexperienced adolescents. ConclusionsThis study highlights disparities in condom information receipt based on sexual experience and underscores the need to provide both sexually experienced and sexually inexperienced youth with condom knowledge and information to protect their sexual health.

Pregnancy Intendedness Among Racial and Ethnically Minoritized Women with Disabilities.

Background: A limited number of studies have examined the prevalence of unintended pregnancy among disabled women. However, no studies to date have examined the association between pregnancy intention and disability, in combination with race and ethnicity. Methods: We analyzed data from the National Survey of Family Growth from the period 2011-2019 to estimate the prevalence of pregnancy intendedness among women with disabilities 15-45 years of age. We compared pregnancy intendedness among respondents with and without disabilities. Modified Poisson regressions were conducted to estimate the unadjusted and adjusted prevalence ratios (with 95% confidence intervals) of unintended pregnancy across disability type and by race and ethnicity category. Non-Hispanic White women without disabilities served as the referent group. Results: Unadjusted results found that women with disabilities in all racial or ethnic groups were significantly more likely to report unintended pregnancies compared with non-Hispanic White women with no disabilities. Non-Hispanic Black women were more than three and a half times (PR = 3.72, 95% CI: 2.91-4.75) more likely than their non-Hispanic White counterparts to report an unintended pregnancy. After adjusting for demographic characteristics, results were slightly attenuated in all categories, with the exception of nondisabled Hispanic women, indicating high prevalence of unintended pregnancies. Conclusions: Racial and ethnic minority women with disabilities may experience heightened risk for unintended pregnancy. Targeted efforts are needed to address barriers to comprehensive sexual and reproductive health care and improve reproductive health outcomes among women who experience multiple forms of marginalization.

Neighborhood-level racialized socioeconomic deprivation and contraceptive use in the United States, 2011-2019.

The social and structural environments where people live are understudied in contraceptive research. We assessed if neighborhood measures of racialized socioeconomic deprivation are associated with contraceptive use in the United States. We used restricted geographic data from four waves of the National Survey of Family Growth (2011-2019) limited to non-pregnant women ages 15-44 who had sex in the last 12 months. We characterized respondent neighborhoods (census tracts) with the Index of Concentration at the Extremes (ICE), a measure of spatial social polarization, into areas of concentrated privilege (predominantly white residents living on high incomes) and deprivation (predominantly people of color living on low incomes). We used multivariable binary and multinomial logistic regression with year fixed effects to estimate adjusted associations between ICE tertile and contraceptive use and method type. We also assessed for an interactive effect of ICE and health insurance type. Of the 14,396 respondents, 88.4% in neighborhoods of concentrated deprivation used any contraception, compared to 92.7% in the most privileged neighborhoods. In adjusted models, the predicted probability of using any contraception in neighborhoods of concentrated deprivation was 2.8 percentage points lower than in neighborhoods of concentrated privilege, 5.0 percentage points higher for barrier/coital dependent methods, and 4.3 percentage points lower for short-acting methods. Those with Medicaid were less likely to use any contraception than those with private insurance irrespective of neighborhood classification. This study highlights the salience of structural factors for contraceptive use and the need for continued examination of structural oppressions to inform health policy.

Impact of the oral contraceptive pill on the rate of ovarian cancer incidence in different races of women.

10521 Background: The rate of ovarian cancer incidence has drastically decreased over the years, though it is the fifth most leading cause of cancer death in women. Oral contraceptive pills (OCP) are a major cause for the decline due to decreasing the number of ovulations in a woman’s lifetime. In fact, women who have ever used OCPs have a 30-50% lower risk of ovarian cancer incidence compared to women who have never used OCP. This study compares the use of OCP in different races of women and its effect on the decline in incidence of ovarian cancer. Methods: The average rate of incidence per 100,000 cases per year for ovarian cancer in White, Asian and Black females was obtained from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program SEER*Stat Database: NPCR and SEER Incidence – U.S. Cancer Statistics 2001–2019 Public Use Research Database. The National Center for Health Statistics, National Survey of Family Growth was used to find ever use of OCP among sexually experienced women ages 15–49 in the United States for 2002 and 2015-2019. Results: White women, in the year 2002 and 2019 had a rate of ever OCP use of 87% and 87.5% respectively. During that same time period, they had the most drastic decrease in ovarian cancer incidence of 43%, compared to Black and Asian female population. In 2002, the incidence rate of ovarian cancer for White women was 14.6 per 100,000. 17 years later, in 2019, it dropped to 10.2 per 100,000. Black women had the second highest ever use of OCP and the second highest rate of change for ovarian cancer incidence. In 2002, 79.1% of Black women had ever used OCPs compared to 73% in 2019. In 17 years, the incidence rate per 100,00 decreased 39% for Black women. Incidence rate per 100,000 in 2002 was 10.4 and incidence rate in 2019 was 7.5 per 100,000. Asian women comparatively had the lowest ever use of OCP and the lowest rate of change for ovarian cancer incidence. Data was not available for 2002, but in 2019, Asian women’s ever use of OCP was 65.6%. Incidence of ovarian cancer for Asian women decreased by 21% between the years 2002 to 2019. Rate per 100,000 was 10.8 in 2002 and decreased to 8.9 per 100,000 in 2019. Conclusions: The oral contraceptive pill was made available in the year 1960. Since then, it has been a large factor as to why ovarian cancer incidence has declined. Healthcare disparities and cultural differences play a part in the rate of OCP use across different races of women. This, in turn, leads to varying levels of ovarian cancer incidence decline with White women having the highest rate, followed by Black, then Asian women. Ovarian cancer has a high mortality due to inadequate screening techniques and late diagnosis which is perpetuated by cultural barriers to receiving care. A decreased risk of ovarian cancer should be considered as a benefit when prescribing OCPs and a protective factor among all studied races.

Intersection of Nativity and English Proficiency With Receipt of Person-Centered Contraceptive Counseling

OBJECTIVE: To assess disparities in receipt of person-centered contraceptive counseling among a nationally representative sample of U.S.- and foreign-born individuals with differing English proficiency. METHODS: We conducted a secondary analysis of the 2017–2019 wave of the National Survey of Family Growth and included female respondents aged 15–49 years who received contraception services in the previous 12 months and provided responses to all four items of the Person-Centered Contraceptive Counseling measure. We categorized respondents into four groups: 1) U.S.-born individuals who speak English very well, 2) foreign-born individuals who speak English very well, 3) U.S.-born individuals who speak English less well, and 4) foreign-born individuals who speak English less well. We created an adjusted logistic regression model, with receipt of person-centered contraceptive counseling as the outcome and the four nativity–English proficiency groups as the primary independent variable, then calculated the predicted probability of receiving person-centered contraceptive counseling for each group, adjusted for age, income, urban or rural status, and parity as covariates. We also assessed the four Person-Centered Contraceptive Counseling items individually. RESULTS: Our final study sample included 2,221 respondents (weighted N=26,531,058). Respondents who spoke English very well had comparable adjusted predicted probabilities of reporting person-centered counseling regardless of nativity (52.2% [95% CI, 48.5–55.9%] for U.S.-born individuals and 50.6% [95% CI, 38.2–62.9%] for foreign-born individuals). Among respondents who spoke English less well, U.S.-born individuals had a lower adjusted probability of reporting person-centered counseling than foreign-born individuals (31.0% [95% CI, 13.5–48.5%] vs 40.6% [95% CI, 29.2–52.0%], respectively). The largest disparities were for the items related to letting the respondent say what mattered most to them about their birth control and taking their preferences about their birth control seriously. CONCLUSION: Person-centered contraceptive counseling was lower for respondents with limited English proficiency, particularly among U.S.-born individuals; English proficiency mitigated disparities by nativity. Clinicians should prioritize person-centered contraceptive care, especially for patients with limited English proficiency.

Women with endometriosis in the United States: National Survey of Family Growth, 2011–2019

ObjectiveEndometriosis is a chronic often painful disease associated with infertility, which often leads to diminished quality of life. Therefore, we sought to identify the characteristics of women with endometriosis, focusing on variables that reflect quality of life, and to report the association between infertility and endometriosis Material and methodsWe conducted a cross-sectional study of a nationally representative sample of U.S. women, using data from National Survey of Family Growth, for the period 2011–2019. ResultsOur analytical sample consisted of 17,619 women aged 20–44 years. Several characteristics differed between women with and without endometriosis but the association between endometriosis and some of these characteristics (age, marital status, body mass index, smoking and diabetes) were attenuated in the adjusted logistic regression analysis. There was no significant association between endometriosis and poverty, education or employment. The rate of functional impairment induced by pain associated with endometriosis was 67.50% in the weighted sample of women aged 15–49 years (2017–2019). The weighted prevalence of endometriosis was 6.40% and the weighted prevalence of infertility among women with endometriosis was 7.37%. Compared to fecund women, infertile women had 3.61 times higher odds of having endometriosis (95% CI 2.44–5.35). ConclusionIn the U.S., women with endometriosis demonstrated different characteristics and had a high rate of functional impairment. Various demographic, socioeconomic and reproductive factors were associated with endometriosis. Further longitudinal population-based studies are warranted to examine endometriosis and its association with infertility.

Demographic Correlates of Endometriosis Diagnosis Among United States Women Aged 15-50

To compare demographic characteristics for women with and without a diagnosis of endometriosis. Data were collected from the National Survey of Family Growth - a publicly available survey designed and administered by the Centers for Disease Control, which uses a nationally-representative sample of the United States population. Univariate data were reported as survey-weighted percentages and means, and were analyzed using chi-square, t-tests, and logistic regression. Analyses accounted for complex survey design. United States PARTICIPANTS: Interviews were conducted with 6,141 female respondents, aged 15-50, between 2017 and 2019. Data were collected through in-person interviews. Nationally, 5.7% reported a diagnosis of endometriosis (95% CI 4.6-6.9%). Those with endometriosis were older, with a mean age of 39 (95% CI 38.1-39.9), compared to 31.7 (95% CI 31.2-32.2) among those without (p < 0.0005). Endometriosis diagnosis was significantly associated with race. Compared to non-Hispanic White women, Hispanic women had an adjusted odds ratio (aOR) of 0.37 (95% CI 0.21-0.65) for diagnosis of endometriosis, and non-Hispanic Black women had an aOR of 0.54 (95% CI 0.35-0.84). We also observed a difference in diagnosis by health insurance: compared to those with private insurance or Medi-Gap coverage, those with Medicare or military insurance had an aOR for endometriosis diagnosis of 2.49 (95% CI 1.36-4.55). Finally, compared to those with less than a high school education, those who had completed high school or greater had an aOR for endometriosis diagnosis of 2.84 (95% CI 1.15-6.99). These disparities in endometriosis diagnosis suggest that intersecting barriers may preclude certain groups from accessing timely endometriosis diagnosis and management. Further studies are warranted to explore these hypothesis-generating data, and to identify and address specific barriers to equitable endometriosis diagnosis and management.

Social Determinants of Health and Patient-Reported Difficult Removal of Long-Acting Reversible Contraception [ID 2683430

INTRODUCTION: Lack of access to high-quality reproductive health care has been reported by persons negatively affected by social determinants of health (SDH). The inability to discontinue a contraceptive method when desired can deleteriously affect a person’s reproductive autonomy. The objective of this study is to evaluate the association of SDH with participant-reported difficult long-acting reversible contraception (LARC) removal. METHODS: A retrospective cross-sectional analysis of data from the 2017–2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. RESULTS: Seven hundred fifty-four respondents reported wanting to have their LARC removed. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). 105 (11%) reported difficult LARC removal. After adjusting for age, race, education, geographic location, parity, and body mass index, persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficult LARC removal compared to respondents without any SDH (2.11 [95% CI: 1.21, 3.69]). Transportation barriers demonstrated the largest aOR of 2.90 [95% CI: 1.07, 7.87]. CONCLUSION: Social determinants of health are unique risk factors that can negatively affect reproductive justice. Social determinants of health are associated with participant-reported difficult LARC removal. Consideration of SDH at the time of contraceptive selection may be a critical step in addressing equitable and safe access to contraceptives with attention to method discontinuation.

Does the approach used to measure sexual identity affect estimates of health disparities differently by race? A randomized experiment from the National Survey of Family Growth

The inclusion of “something else” as a response option for survey questions about sexual identity has been shown to significantly moderate estimated differences between sexual identity subgroups in the distributions of various health outcomes in national health surveys, specifically for substance use/misuse and reproductive health. This moderation effect may be larger depending on the respondent's race, possibly due to the intersectionality of multiple minority identities and compounding minority stressors. To test this hypothesis, we conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (2015–2019) [n = 18,903 (8510 males, 10,393 females)] in the United States, where respondents were randomly assigned to receive either a four-category version of the sexual identity question that included “something else” as a response option along with lesbian/gay, bisexual, and heterosexual, or a three-category version that omitted “something else.” We focused on model-based estimates of distributions of health outcomes across subgroups defined by both race and sexual identity and tested the race moderation hypothesis using three-way interactions involving sexual identity, question type received (four-category vs. three-category), and race (Black, White, and other). Based on this randomized experiment, we found evidence of significant differences between the four-category and three-category question versions of sexual identity, in terms of the associations between sexual identity and several health outcomes, along with moderation of these differences by the respondent's race. For some outcomes, such as wanting a child or another child, the magnitudes of the estimated sexual identity differences among racial minority individuals, specifically between bisexual and heterosexual women, were sensitive to the measurement of sexual identity. These results further suggest a need for improved sexual minority measurement, especially among racial minorities. These differences were also mostly found among women, suggesting further intersectionality of groups exposed to specific stressors.

The demand for male contraception: Estimating the potential market for users of novel male contraceptive methods using United States National Survey of Family Growth data

ObjectiveTo estimate the potential market for novel male contraceptives (NMCs) using United States National Survey of Family Growth (NSFG) data, 2015–2017. Study designWe described the market for NMCs via secondary analysis of the 2015–2017 NSFG’s weighted male respondent data, utilizing surrogate markers for contraceptive switching (NSFG) and contraceptive discontinuation data from the Contraceptive CHOICE project. Potential NMC users included men relying on: (1) no methods or less effective methods but who reported that they would be “very upset” if they got someone pregnant, (2) permanent methods but who reported that they might still want more children, (3) a female partner’s method that she might discontinue in the next year, (4) a male method even when his partner uses her own contraceptive. ResultsOf 3340 respondents—representing 55,890,830 sexually active, reproductive-age men—23.2% used no contraception at last intercourse, 15.8% condoms, 5.1% withdrawal, and 5.1% vasectomy. Among respondents relying solely on condoms, withdrawal, or no method, 19.7%, 3.8%, and 4.4% would be “very upset” if they got someone pregnant. For permanent contraceptive users, 17.3%−20.5% wanted another child. For men reliant on their partner’s long-acting reversible or combined hormonal contraceptive, 12–17% and 45–51% of partners might discontinue their method. These data conservatively suggest that 13% or more than 7 million men would potentially use NMCs, rising to 15.5 million with less restrictive contraceptive switching criteria. ConclusionAdjusting for pregnancy attitudes and likelihood of contraceptive switching, a substantial portion (between 7–15.5 million) of reproductive age men in the US are potential NMC users. ImplicationsThe population of potential novel male contraceptive users extends beyond just users of condoms, withdrawal and vasectomy and should include couples practicing dual-partner contraception and female partners using contraceptive methods that they may become dissatisfied with and discontinue.

Trends in Vaginal Intercourse Experience and Timing among Adolescent Men in the United States: A Descriptive Analysis by Race/Ethnicity

Recent reports of declining prevalence of vaginal intercourse (VI) experience among adolescent men are largely silent on differences by race and ethnicity. This visualization illustrates trends by race/ethnicity in VI experience, average age at first VI, and age-specific cumulative probabilities of VI experience for young men, using retrospective data from multiple rounds of the National Survey of Family Growth covering 2006 to 2019. The authors find that although VI engagement is declining universally, the decline is substantially more pronounced among Black men than among their White and Hispanic peers. Although young Black men continue to engage in VI at higher rates and earlier ages, recent trends are narrowing long-standing racial/ethnic differences.