Reasons For Non-use Research Articles

Seat-Belt Use and Related Behaviors Among Young Adults

Seat-belt use among young adults was examined to identify factors associated with nonuse. This research was part of the Dunedin Multidisciplinary Health and Development Study, which is a study of the health, development, and behavior of a birth cohort of young New Zealanders ( n = 1037). At age 21 years, 948 (93%) members of this cohort were administered a face-to-face interview where they were asked about seat-belt use (self and friends), reasons for nonuse, and also their involvement in risky driving practices, motor-vehicle traffic crashes, and some thrill-seeking activities. Results showed relatively high front seat-belt use (85–96%) but low rear use (29–47%). Some differences in use were a function of gender and seating location. Generally, users had higher academic qualifications and lower risky driving behavior (males only), but did not differ significantly as far as crash experiences and thrill-seeking activity was concerned. The main reasons for not using a seat belt were forgetfulness/laziness, a perceived low risk of injury, and discomfort. This study provided information about the background and behavior of young adults who do not use seat belts, which could be helpful when designing strategies to promote seat-belt use in this age group.

Booster seat use and reasons for nonuse.

Many children 4 to 9 years old are inappropriately restrained in vehicles and are at risk for injury in crashes. This study was undertaken to determine the rate of booster seat use and the reasons for nonuse. Observations were conducted at a random sample of day care centers, and drivers of unrestrained children 4 to 8 years old were interviewed to determine the reasons for lack of booster seat use. Observations were conducted on 149 children. Shoulder belt use significantly increased with the age of the child; 28.3% of 4-year-olds and 70.0% of 6- to 8-year-olds used lap-shoulder belts. Overall, 27.7% of children in the target age group used booster seats; only 10% of children 6 to 8 years old were restrained with booster seats. Booster seat use decreased when there were 3 or more passengers in the vehicle. The most common reason for lack of booster seat use was that parents thought the child was large enough to use the regular lap-shoulder belt system, or problems with attempting to use the seat in the vehicle. More than one half of parents who were not using booster seats at the time of the survey reported owning seats. This study indicates that parental misconceptions about size and safety of regular restraint equipment are the most common reason that children are not appropriately restrained in vehicles. This information can be used to guide community intervention programs.

School-Based Health Center Utilization: A Survey of Users and Nonusers

Background As school-based health centers (SBHCs) continue to grow, it remains important to study use of the centers. The extent to which mental health problems exist in the students with access to the centers, whether those students are using the available services, if they are satisfied with the services, and the reasons for nonuse by those students who do not enroll are all meaningful questions. Methods The above issues were studied in an urban high school with a 2-year-old SBHC by administering questions during physical education classes on health center use and mental health concerns. The 630 respondents were 45% male, 55% female, 61% black, 29% Hispanic, 54% in grades 9 or 10, 46% in grades 11 or 12. Results Sixty percent of the students were registered in the SBHC; 40% were not registered. Seventy-five percent of registered students reported average use (≤3 visits); females were more likely than males ( P =.017) to be frequent (>3 visits) users of SBHC services. Mental health problems among all participants included depression in 31%, use of alcohol 1 time or more per month in 21%, use of alcohol daily in 5%, suicidal ideation in 16%, history of a suicide attempt in 10%, knowing someone who had been murdered in 50%, and being in at least 1 fight at school in 26%. Frequent users, average users, and nonusers did not differ by age, grade, race, or any of the measured mental health problems. Among the 472 students who completed the survey section on SBHC perceptions, 305 described health center use: 92% were satisfied with health center services, 79% were comfortable being seen in the SBHC, 74% believed visits were kept confidential, 61% told their parents about each visit, and 51% considered the SBHC their regular health care source. The health center was used for mental health services by 34% and sexuality-related care by 15%. The 167 students who described reasons for not using the SBHC most frequently reported that they already had a physician (60%), did not need it (50%), prefer continuing previous health care (45%), did not get around to it (30%), parents were opposed (20%), were not comfortable (19%), did not know about the service (19%), and did not want problems known (19%). Conclusions We conclude that, in this urban high school, (1) average users, frequent users, and nonusers did not differ in the mental health problems measured in this study; (2) those who used the SBHC indicated strong satisfaction with the care received; and (3) those who did not use the SBHC chose to stay away for a variety of reasons, most commonly the availability of other care or the perception of lack of need.

Self-Reported Use of an Implanted FES Hand System by Adolescents with Tetraplegia

The Freehand System®, an eight-channel functional electrical stimulation (FES) system, was implanted in five adolescents with C-5 or C-6 tetraplegia to provide stimulated lateral pinch and palmar grasp. Following completion of inpatient training on how to use the Freehand System for predefined and self-selected activities of daily living (ADL), the adolescents were discharged to use their Freehand systems at home and school. A telephone survey was administered on a weekly basis to obtain information on the type of ADL performed with the Freehand System, reasons for not using the Freehand System, and perceived barriers and motivators to FES use. Twenty surveys were obtained on each adolescent, resulting in a total of 100 surveys. The most common type of activity performed with the Freehand System was self-care, which included tasks such as eating, grooming, and brushing teeth. The Freehand System was also used for productivity activities defined as writing, socialization, and manipulation of school and household objects. Motivators to Freehand System use included perceived need and importance to perform an ADL in an independent fashion, physical ease of using the Freehand System, and availability of social supports that facilitated Freehand System use. While there were several reported barriers to Freehand System use, incompatibility with multiple transfers to and from the wheelchair and lack of physical assistance during morning care to don the system were perceived as two of the more common reasons for nonuse.

Pregnancy termination and contraceptive failure in Viet Nam

In Viet Nam, health workers conducted focus groups with women seeking pregnancy termination at 2 rural district hospitals in Thai Binh Province and at 2 urban district hospitals in Hanoi to learn why contraceptives failed and why some of these women did not use contraceptive. Researchers used information from the focus groups to design questions for a July-September 1991 survey of 2088 women seeking an abortion at all 9 rural district hospitals in Thai Binh Province and at 5 district hospitals in Hanoi. 85.3% of the women were married and lived with their husbands. Most women were eligible for menstrual regulation (53.7% in Hanoi and 64.9% in Thai Binh). 50% of all women (52.8% in Hanoi and 47.4% in Thai Binh) had had at last 1 prior pregnancy termination (1.6 pregnancy terminations/woman), suggesting that induced abortion is being used as a substitute for family planning methods. Effective modern contraceptive use by 50% of these women would have reduced the number of abortions during the 3 months by 25%. 36.8% (54.7% in Hanoi and 19.9% in Thai Binh) used traditional family planning methods. 38.3% (25.7% in Hanoi and 49.9% in Thai Binh) did not use any method. The leading reason for not using oral contraceptives (OCs) were personal health problems, unavailability, and the perception that contraceptives were bad for one's health. For IUDs, they were bleeding, lumbago, headache, loss of energy, and dizziness. For condoms, reasons for nonuse were disliked by one spouse and unavailability. Women's fear and husband's disapproval were key reasons for not choosing sexual sterilization. Reasons for failure of condoms, IUDs, and OCs were irregular use (62.6%) and poor quality (27.9), retained but still missed menstruation (74.3%), and used irregularly (23/28), respectively. The researchers recommended using these findings to develop an IEC campaign and training curricula for health workers.

Differential front and back seat safety belt use by prehospital care providers

The object of the study was to assess the habits and attitudes of prehospital care personnel regarding safety belt use in the front and rear ambulance compartments. Therefore, a cross-sectional descriptive survey was administered at emergency medical service conferences and through provider agencies throughout the United States and Canada. Approximately 900 public, private, and volunteer prehospital care providers participated. Demographic information, traffic collision history, percent of time safety belts were used, belief in safety belt use, and reasons for nonuse in the rear compartment of the ambulance were measured. The results showed that safety belt use was highest in the front seat during emergency runs (median, 100%) and rarest in the back compartment during emergency runs (median, 0%). Respondents cited the following reasons for non-use in the rear compartment: inhibited patient care (67.9%), restricted movement (34.7%) inconvenience (15.1%), or lack of efficacy (5.3%). Prehospital care personnel typically wear safety belts when in the front seat, but not while in the rear compartment of the ambulance. More intensive efforts at educating prehospital care providers about the importance of safety restraints in the rear compartment, enumerating patient care activities that can be performed while wearing a safety belt, and design of a functional restraint system for the rear compartment may increase ambulance safety.

Home Phototherapy: Not Seeing the Light

In this issue of Pediatrics, Meropol and her associates1 report an interesting survey of the opinions and practices of urban pediatricians regarding home phototherapy. They report that fewer than a third of pediatricians in their survey used home phototherapy in their practices. A variety of reasons for nonuse were elicited, mostly related to difficulties in getting phototherapy done at home. A minority of nonusers were concerned about potential complications, such as dehydration. On the other hand, many of the reasons given by nonusers were not experienced as actual problems by the pediatricians who reported using home phototherapy. In their conclusions, the authors suggest that until more is known, the American Academy of Pediatrics guidelines for home phototherapy should be followed and that we should strive to improve the benefit-risk ratio for the treatment of neonatal hyperbilirubinemia.

Jordan 1990: Results from the Demographic and Health Survey

Summary results from the 1990 Jordan Demographic and Health Survey are reported in a series of 27 charts and tables. The sample survey represented regions and the nation. A household questionnaire was collected from 16,296 households; 6461 ever married women 15-49 years completed an individual questionnaire. Information is provided on the general population characteristics and the educational status and urban/rural residence of ever married women. Population was reported as 3.86 million and a growth rate of 3.17%. Fertility is represented as the total fertility rate in 5-year groups since 1955, fertility differentials by residence and educational level, and age specific fertility. Fertility preferences are expressed by age and preferences by number of living children. The desire to stop childbearing is reported by the number of living children among currently married women. The planning status by the number of living children is also reported. Contraceptive prevalence is shown by residence and educational level in one chart and by age and by number of living children in another chart. Current contraceptive usage is revealed by source of supply and method used. Knowledge and use patterns among currently married women is indicated by whether respondent ever used or was currently using. Currently married nonusers were asked to indicate their intention to use in the future, which was tabulated by the number of living children women had. The reason for nonuse by age is provided. Marital and contraceptive status is in terms of marital status by age group, differences in age at first birth, and contraceptive status by marital status. The median duration of postpartum interval is indicated by status: breast feeding, nonsusceptible, amenorrhea, and abstinence. Differences in breast feeding and amenorrhea are shown by residence and educational level. Infant mortality trends and differences by education and residence are given as well as the number of children ever born and surviving by age of mother. Vaccination coverage, diarrhea incidence, and type of childbirth delivery personnel are given in addition to anthropometric measures.

Irish Women Who Seek Abortions in England

In 1991 4158 women from Ireland and 1766 from Northern Ireland traveled to England for abortions. This situation has been ignored by Irish authorities. The 1992 case of the 14-year old seeking an abortion in England finally caught legal attention. This study attempts to help define who these abortion seekers are. Questionnaires from 200 Irish abortion seeking women attending private Marie Stopes clinics in London and the British Pregnancy Advisory Services clinic in Liverpool between September 1988 and December 1990 were analyzed. Findings pertain to demographic characteristics characteristics of first intercourse family discussion of sexual activity and contraceptive use. From this limited sample it appears that Irish women are sexually reserved and without access to modern methods of birth control and abortion. Sex is associated with shame and guilt. 23% had intercourse before the age of 18 years and 42% after the age of 20. 76% were single and 16% were currently married. 95% were Catholic; 33% had been to church the preceding Sunday and 68% within the past month. Basic information about menstruation is also limited and procedures such as dilatation and curettage may be performed selectively. 28% of married women were uninformed about menstruation prior to its onset. Only 24% had been using birth control around the time of pregnancy. The reason for nonuse was frequently the unexpectedness of intercourse. 62% of adults and 66% of women believe in legalizing abortion in Ireland. British groups have tried to break through the abortion information ban by sending telephone numbers of abortion clinics to Irish firms for distribution to employees. On November 25 1992 in the general election there was approval of constitutional amendments guaranteeing the right to travel for abortions and to receive information on abortion access. The amendment to allow abortion to save the life of the mother was not accepted.

Paraguay 1990: Results from the Demographic and Health Survey

Preliminary results from the Paraguay Demographic and Health Survey, 1990, are presented for population, fertility, contraceptive usage, postpartum activity, infant mortality, immunization coverage, oral rehydration treatment, use of health personnel during delivery, and nutritional status. Data were compiled by the Paraguay Center of Population Studies. Surveys were conducted in only the eastern region which contains 98% of the population. Interviews were conducted with 5827 women aged 15-49 years between May 21 and August 24, 1990. 28 tables, graphs, or charts are provided. General demographic data is presented for 1965 and 1985 and the percent change. The percentage of urban or rural women by their educational status is provided. Total fertility rate is shown in 5-year spans between 1955 and 1985, with estimates given for 1990. Fertility differentials are shown for urban or rural residence and educational level. Age-specific fertility is given. The ideal number of children is plotted against the number of living children. Also given the number of women desiring to stop childbearing and the planning status by birth order. Contraceptive prevalence is expressed for residence and educational level, as well as for age and parity. Sources of supply are indicated by choice of modern method, Knowledge of contraception by method of use and knowledge is provided. Intention to use contraception is supplied in terms of number of living children. The reasons for nonuse are generated by age group 30 years and 30 years. Duration of postpartum by status (breast feeding, nonsusceptible, amenorrhea, abstinence) is provided. Status is given by months and mean duration. Survival of children ever born indicates ever born, surviving, and dead. Infant mortality differences are expressed by residence and educational level. Demographic characteristics of those immunized by type of vaccine is given. Statistics on the percentage of children 5 years of age with diarrhea 2 weeks prior to the survey are given. Health personnel involved during the delivery are given. Nutritional status is measured by the status of undernourishment based on weight for height and age data and residence and mother's educational level.

Sexual Behavior and Contraceptive Use Among 15-24-Year-Olds in Uganda

Based on the findings of the Ugandan Adolescent Fertility Survey sexual behavior and contraceptive use among young adults aged 15-24 in both rural and urban Uganda were examined. The survey consisted of 2 phases which took place on August through October 1988 and August and September 1989. The data from 4510 eligible respondents were analyzed. A description of the social and demographic characteristics of the respondents is provided. As the survey data reveal sexual activity begins at an early age in Uganda. At the time of the survey 85% of the male sample and 81% of the female sample were sexually experienced. The mean age at first coitus was 15.1 among sexually experienced males and 15.5 among sexually experienced females. The survey also found that nearly 1/2 of all female respondents had ever been pregnant (11% were pregnant at the time of the survey). While 34% of women in small urban centers reported ever being pregnant the ratio was 61% for rural young women. Of the women who had ever been pregnant 14% reported having an abortion. Since Uganda allows abortion only for medical reasons it is suggested that in reality abortion is far more common. Awareness of contraceptive methods was over 80% for both males and females but fewer than 25% of the sexually active respondents who desired no children actually used contraception. Contraceptive prevalence was significantly lower in rural areas. lack of access to contraception led the reasons for nonuse of contraception followed by safety concerns and lack of knowledge. These findings suggest the need to make contraceptive service delivery available to adolescents in all parts of the country.

The Black Elderly and Community-Based Social Services

The author explores service awareness, service use, and reasons for nonuse of six community-based social services among a sample of older black persons living in Florida. Results indicated that service awareness and use were extremely low. Reasons for nonuse of services included a lack of need, dissatisfaction with services, uncertainty about eligibility requirements, and health problems. The author concludes that more effective means of disseminating information on services and consideration of appropriateness of services are needed.

Reasons for Non-Use of Condoms by Homosexually Active Men during Anal Intercourse

Sixty-eight homosexually active men attending an STD clinic were questioned to ascertain the percentage of the time they did not use condoms during anal intercourse, and the reasons for this. Data indicated that the reasons most commonly given were being in a steady relationship (32.8%), being unprepared (19.4%), couldn't be bothered (19.4%), use of alcohol or drugs (7.5%), being bisexual (4.5%), attractiveness of partner or partner attitude toward sex, and knowing the partner (3% each). These data suggest that both trust and situational variables are barriers to consistent condom use in homosexually active men.

Utilization of Services by the Elderly

This article examines levels of service awareness and use, correlates of use, and reasons for nonuse for a sample of 250 residents aged sixty and over of a small city. A regression analysis reveals that service use is greater for those elderly who are aware of more services, are not married, have less education, use their cars less, report a greater number of sick days, and have less contact with their children. Lack of need is identified as the major reason for nonuse.

Nutrition Labels: An Exploratory Study of Consumer Reasons For Nonuse

Studies of consumer usage of nutrition labels required by the Food and Drug Administration have found that usage levels are low. A mailback survey of food shoppers in Madison, Wisconsin was conducted to determine who uses nutrition labels as well as reasons for nonuse. Multiple regression analysis revealed that compared to users, nonusers did not rate themselves as highly on nutrition knowledge, were less likely to plan meals in advance, and were not as highly educated. When asked why they did not use labels, most nonusers said they did not need them, and a sizable group reported their shopping practices pre‐empt label usage. Nonusers also felt that a sample label had too much information. When asked to perform computations from sample label information, nonusers were less successful than users. The implications of these findings for nutrition education efforts are discussed.

The Initiation and Avoidance of Drugs by Adolescents in the Southwest

The primary purpose of this paper is to provide a descriptive study of youthful drug use in a rural southwestern community at the start of the 1980's. To this end, we focus on three major concerns. First, we examine the nature and extent of the drug problem extant in the community. The second focus of the paper is on the reasons cited for using drugs (e.g., personal problem resolution, hedonism, peer pressures). Third, we examine the characteristics of abstainers and their reasons for nonuse (e.g., illegality of drug use, physical and psychological dangers, and parental pressures), and compare this group with former drug users and the reasons they offer for their disuse. In addition, where applicable, we link our observations to current social deviance theories in general and theories of drug use in particular.

Premarital Sexual Guilt and Contraceptive Attitudes and Behavior

The relationship between premarital sexual guilt and contraceptive attitudes and behavior including reasons for nonuse of contraception were obtained for 335 sexually active single women ages 13-20 attending birth control centers in Ontario. Significant relationships were found between premarital sexual guilt and type of contraceptive method used at last intercourse and consistency of use of contraceptive methods. High guilt subjects were significantly more embarrassed about coming to the birth control clinic and having an internal examination than were low guilt subjects. Also high guilt subjects were more likely to believe that it was difficult to obtain birth control pills and were less likely to receive birth control information by reading on their own. Sexual guilt was also significantly related to 7 of 20 reasons for not using contraception. (Authors)

Contraceptives Available by Prescription

The article presents a comprehensive review of the common contraceptive methods. Contraceptive preferences are ranked in tables by physicians and patients with unanimity on oral contraceptives as first preference. Tables also show combination oral contraceptives, sequential oral, and pregestin only contraceptives by trade name, manufacturer, number of tablets per dispensing unit, and progestogen and/or estrogen content. Women using sequential pills are seen to run a greater risk of thromboembolism. Discussion on contraceptive pills includes the effectiveness of various types of pills, the infertility mechanism, physicians' attitudes towards prescribing, risks, side effects and other reasons for nonuse, contraindications, and prescriptive precautions. IUDs are described and discussed regarding comparative effects and action of various types IUD, detractive aspects, precautions, and evaluation of the IUD as a contraceptive. Other contraceptives discussed are the diaphragm, cervical cap, sterilization, and abortion.