Use In Young Women Research Articles

Young women's use of medicines: autonomy and positioning in relation to family and peer norms

Medicine use among youths is widespread and on the increase. This is especially true for young females, whose utilization of a variety of medications grows considerably during the teenage years. This user perspective study aims to obtain a greater understanding of what young women perceive as the norms for medicine use at home and among peers, and how these perceptions are reflected in their own use of medicine. In-depth interviews were conducted with 20 young Danish women between the ages of 16 and 20. During the interviews, participants described their perceptions regarding usual medicine taking practices and ideas about appropriate medicine use within their family and peer group. Young women possessed a keen awareness of medicine-related norms, although medicine use was a topic only rarely discussed with others. At the interface of these themes pertaining to family and peer norms, a unifying concept involving growing autonomy in medicine use emerged. This concept consisted of three parts: the great influence of family norms when autonomy was limited, growing autonomy under changing influences and assertion of autonomy and positioning of own behaviour relative to the norm. This study's findings indicate that despite increases in autonomy in medicine use, normative perceptions continued to serve as important reference points for informants' own medicine taking behaviour. Practitioners involved in the health care and promotion of youth may benefit from an increased awareness of the influential role that perceived norms in peer and family contexts can play in young women's use of medicine.

Young Women's Use of a Vaginal Microbicide Surrogate: The Role of Individual and Contextual Factors in Acceptability and Sexual Pleasure

Currently in clinical trials, microbicides have historically been promoted as a woman-controlled (although more recently woman initiated) method of sexually transmitted infection (STI) prevention. The contradicition that exists in this rationale is that women's bodies, specifically the genitals, have been constructed as a negotiated space within sexual interactions. This study qualitatively explored the factors influencing 40 young women's use of a vaginal moisturizer (VM), utilized as a microbicide surrogate. The results indicated that use of the VM was dependent upon product characteristics (i.e., the lubricating qualities affect on sexual pleasure, timing of insertion), individual factors (i.e., reproductive health goals, experiences with side effects of existing contraceptive methods), and contextual factors (i.e., social norms). An understanding of these bodily and social issues may be beneficial in designing targeted educational campaigns and effective instructional materials as well as in facilitating positive dialogue around women's bodies and their sexuality.

S16-01 Epidemiology of substance use in pregnancy

An understanding of the epidemiology of alcohol and drug use in young women is important to appreciate the considerable morbidity and mortality associated with it and to understand the impact of such use on offspring. Although abstention rates are consistently higher among women than men in general substance misuse is increasing in young women. Differences in definitions, measurement techniques, availability, social acceptability and affordability partly explain the great variability in reported prevalence rates. Alcohol exposure among pregnant women varies from 0.2% to 14.8%. An Australian national survey revealed that nearly half of pregnant and or breast-feeding women up to 6 months postpartum were using alcohol. A Swedish study reported risky use of alcohol during the first 6 weeks of pregnancy, at 15%. Cannabis use among pregnant women varies from 1.8% to 15%. The reported prevalence of opiate use during pregnancy ranges from 1.65 to 8.5%. Cocaine use among pregnant women is reported to be between 0.3% and 9.5. Most pregnant women stop or reduce their substance use during pregnancy and this might be an opportune moment for detection and treatment. Substance use tends to increase sharply in the postpartum period with adverse consequences on mother and baby. Perinatal substance misuse interventions can reduce adverse neonatal outcomes. On the basis of relatively high rate of substance use disorders during pregnancy and postpartum period, effective screening and intervention strategies should be implemented.

S64-04 Epidemiology of substance use in pregnancy

An understanding of the epidemiology of alcohol and drug use in young women is important to appreciate the considerable morbidity and mortality associated with it and to understand the impact of such use on offspring. Although abstention rates are consistently higher among women than men in general substance misuse is increasing in young women. Differences in definitions, measurement techniques, availability, social acceptability and affordability partly explain the great variability in reported prevalence rates. Alcohol exposure among pregnant women varies from 0.2% to 14.8%. An Australian national survey revealed that nearly half of pregnant and or breast-feeding women up to 6 months postpartum were using alcohol. A Swedish study reported risky use of alcohol during the first 6 weeks of pregnancy, at 15%. Cannabis use among pregnant women varies from 1.8% to 15%. The reported prevalence of opiate use during pregnancy ranges from 1.65 to 8.5%. Cocaine use among pregnant women is reported to be between 0.3% and 9.5. Most pregnant women stop or reduce their substance use during pregnancy and this might be an opportune moment for detection and treatment. Substance use tends to increase sharply in the postpartum period with adverse consequences on mother and baby. Perinatal substance misuse interventions can reduce adverse neonatal outcomes. On the basis of relatively high rate of substance use disorders during pregnancy and postpartum period, effective screening and intervention strategies should be implemented.

Young women's perceptions of pregnancy risk and use of emergency contraception: findings from a qualitative study

Background Advance provision of emergency contraception (EC) has increased use but not impacted on pregnancy or abortion rates. Here we describe young women's EC use and experiences of unprotected sex to explore why this difference occurs. Methods In-depth interviews with twenty 20-year-old women from eastern Scotland. Results The majority (16) had used EC; 10 reported some experience of unprotected sex. EC use followed contraceptive failure and unexpected or unplanned, but not frequent, unprotected sex. Acknowledging the need for EC requires recognition of pregnancy risk. Those reporting frequent unprotected sex misperceived their pregnancy risk and did not use EC. This group was from socially disadvantaged backgrounds, and all became pregnant. Conclusions EC remains an important “backup” contraceptive and should continue to be widely available. With high levels of unprotected sex, nonuse of EC and unintended pregnancies, further efforts are required to improve the sexual and reproductive health outcomes of disadvantaged young women.

Young women, late modern politics, and the participatory possibilities of online cultures

New technologies are often perceived as important resources in attracting young people to formal politics, but less is known about how young people use them to create participatory practice on their own terms. This article examines young women's less conventional technology-enabled political and social activity in order to understand how these are operating as emergent modes of participation in a new political environment. It explores young women's use of online DIY culture, blogs, social networking sites and related technologies to open up questions about what counts as politics, and what is possible as politics for young people, and young women in particular, at the present moment. It suggests that these activities represent new directions in activism, the construction of new participatory communities, and the development of new kinds of public selves, while also telling us important things about the limits of the kinds of conventional citizen subject positions offered to young women at this time.

Cognitive Changes After Menopause: Influence of Estrogen

The natural menopause is not associated with substantial cognitive change. Limited clinical trial evidence suggests that estrogen-containing hormone therapy has little effect on cognition during midlife, but prompt initiation after surgical menopause may improve aspects of memory. Among older postmenopausal women, strong clinical trial evidence demonstrates that hormone initiation does not improve cognition. More limited clinical trial evidence indicates no improvement in Alzheimer symptoms, and the Women's Health Initiative Memory Study found an increase in dementia risk among older women. Observational findings of reduced Alzheimer risk may reflect early hormone use in younger women, or findings may be biased. Cognitive effects of selective estrogen receptor modulators are not yet well studied.

Having Plan B Pills on Hand Fails to Alter Young Women's Use

Having Plan B Pills on Hand Fails to Alter Young Women's Use

Impulsivity related to “obesity” and alcohol use in young women

Impulsivity related to “obesity” and alcohol use in young women

Mammographic density. Measurement of mammographic density.

Mammographic density has been strongly associated with increased risk of breast cancer. Furthermore, density is inversely correlated with the accuracy of mammography and, therefore, a measurement of density conveys information about the difficulty of detecting cancer in a mammogram. Initial methods for assessing mammographic density were entirely subjective and qualitative; however, in the past few years methods have been developed to provide more objective and quantitative density measurements. Research is now underway to create and validate techniques for volumetric measurement of density. It is also possible to measure breast density with other imaging modalities, such as ultrasound and MRI, which do not require the use of ionizing radiation and may, therefore, be more suitable for use in young women or where it is desirable to perform measurements more frequently. In this article, the techniques for measurement of density are reviewed and some consideration is given to their strengths and limitations.

Using Analgesics as Tools: Young Women's Treatment for Headache

In this study, the authors explore the context surrounding young women's use of analgesics to deal with headache. In-depth interviews were conducted with 20 young women between the ages of 16 and 20 in Copenhagen, Denmark. Interviews focused on the young women's experiences with medications within the context of their everyday lives. The central elements in the participants' accounts emerged via a phenomenological approach. Analysis revealed that participants attributed headache to stressful conditions in their everyday lives. Analgesic use in treating headache was found to serve highly valued performance- and participation-related functions. Accordingly, analgesics were employed as tools to reach these aims. The threshold for turning to analgesics varied across situations and among participants. Some relied heavily on analgesics, whereas others had success with non-medical strategies. This study's findings demonstrate a need for health education programs aimed at empowering young women to better manage headaches as well as everyday stress.

Childbirth, abortion and subsequent substance use in young women: a population‐based longitudinal study

To investigate the possible linkages between deliveries, abortions and subsequent nicotine dependence, alcohol problems and use of cannabis and other illegal drugs from the ages of 15-27 years. Data were gathered as part of the Young in Norway Longitudinal Study, an 11-year follow-up of a representative sample of Norwegian adolescents and young adults. Information was obtained on (i) the history of childbirths and induced abortions for the participants between the ages of 15-27 years; (ii) measures of nicotine dependence, alcohol problems and use of cannabis and other illegal drugs; and (iii) socio-demographic, family and individual confounding factors. Those who had had an abortion had elevated rates of substance use and problems. Those who gave birth to a child had reduced rates of alcohol problems and cannabis use. These associations persisted after control for confounders. However, those women who still lived with the father of the aborted fetus were not at increased risk. Abortion in women may, under some circumstances, be associated with increased risk of nicotine dependence, alcohol problems and use of cannabis and other illegal drugs. The birth of a child may reduce the use of some substances.

Assessing breast tissue density by transillumination breast spectroscopy (TIBS): an intermediate indicator of cancer risk

Risk assessment by parenchymal density pattern, a strong physical indicator of future breast cancer risk, is available with the onset of mammographic screening programmes. However, due to the use of ionizing radiation, mammography is not recommended for use in younger women, thereby rendering risk assessment unattainable at an earlier age. Visible and near infrared light was used on 292 women with radiologically normal mammograms to determine whether transillumination breast spectroscopy (TIBS) can identify women with a high parenchymal density pattern as an intermediate indicator of breast cancer risk. Principal component analysis (PCA) was used to reduce the spectral data and generate density scores for each woman. To assess the accuracy of TIBS, logistic regression was used to calculate crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) for each score. Receiver operator characteristic (ROC) curves and area under the curve (AUC) were also calculated for the crude and adjusted logistic models. Optical information relating to tissue chromophores, such as water, lipid and haemoglobin content, was sufficient to identify women with high parenchymal density. The resulting AUC for the final and most parsimonious multivariate logistic model was 0.922 (95% CI 0.878-0.967). TIBS provides information correlating to high parenchymal density and is a promising tool for risk assessment, particularly for younger women.

Epidemiology of drug and alcohol use in young women

An understanding of the epidemiology of alcohol and drug use in young women is important for three main reasons: (1) to appreciate that substance use, misuse, harmful use and dependence are associated with considerable mortality and physical and psychological morbidity; (2) to understand the nature and extent of these problems and the likely impact on the fetus, neonate and infant through childhood to adolescence; and (3) to utilize this information as part of a needs assessment to develop effective services, which detect problems and deliver appropriate interventions. Although abstention rates are consistently higher among women than men in general, substance misuse is increasing in young women. Simultaneously, there is great variability in prevalence rates in different countries, regions of countries and in different ethnic groups. This can be explained in part by differences in definitions, measurement techniques, availability, price, social acceptability, seizure and arrest policies, and in patterns and modes of use. During pregnancy, up to 15% of women may be using alcohol and about 5% may be using illicit drugs. The proportion of women using substances is less at term than in the early stages of pregnancy. Despite this, substance use rises sharply in the first 6 months postpartum. Detection of substance use in obstetric units is low but perinatal substance misuse intervention reduces adverse neonatal outcomes. On the basis of the relatively high rate of substance use disorders during pregnancy, effective screening and intervention strategies should be implemented.

34. PATTERNS OF CONTRACEPTIVE USE AFTER REPRODUCTIVE EVENTS: FINDINGS FROM THE AUSTRALIAN LONGITUDINAL STUDY OF WOMEN'S HEALTH

This paper examines changes in young women's contraceptive use over nine years in relation to a range of reproductive life events using longitudinal data from the Australian Longitudinal Study on Women's Health (ALSWH). Little previous research has examined changes in young women's contraceptive use after significant reproductive or health life events. Some research has examined the reasons that women might discontinue contraceptive use in general and there has been some work investigating contraceptive use after the birth of a child and after the termination of a pregnancy. However other events may also cause a woman to re-evaluate her contraception, for example, the diagnosis of an STD, or having an abnormal pap test. The Australian Longitudinal Study on Women's Health is a broad-ranging project which examines relationships between many biological, physiological, social and lifestyle factors and women's physical health, emotional well-being, and use of and satisfaction with health services. Women were selected from the Medicare database which includes all citizens and permanent residents using stratified random sampling, with systematic over-sampling of women from rural and remote areas. This paper presents data from 6716 women who completed a self-report survey in 1996 when they were aged 18-23, and again in 1999, 2002 and 2005. Multinomial analysis is used to explore patterns of contraceptive use before and after events related to pregnancy and birth (pregnancy, live birth, miscarriage and termination of pregnancy) and health (diagnosis with a sexually-transmitted infection and abnormal Pap test) and the factors associated with changes in contraceptive use. The ALSWH provides an exciting opportunity to examine patterns of contraceptive use over time among women of reproductive age.

Plan B and the Politics of Doubt

THE AUGUST 24, 2006, DECISION BY THE US FOOD AND Drug Administration (FDA) to approve over-thecounter (OTC) sales of the emergency contraceptive Plan B—1.5 mg of levonorgestrel taken after unprotectedsexual intercourse—wasamajordevelopment ina long and contentious regulatory process. Since the drug is more effective the sooner it is used, the delay in obtaining it imposed by its prior prescription-only status limited its effectiveness. In the interest of making Plan B available more quickly when needed, the distributor (Women’s Capital Corp, Washington, DC) applied to the FDA in April 2003 for approval of OTC status. In December 2003, a joint FDA advisory committee voted 23-4 in favor of approval. It did so on the basis of evidence that the drug is both effective and safe and that it met all FDA criteria for OTC availability. The committee also took into account the likelihood that improved access could prevent at least some of the 3.1 million unintended pregnancies (including the 25 000 that result from rape)—and, hence, some of the more than 1 million elective abortions—that occur in the United States every year. Although the FDA almost always accepts its advisory committees’ recommendations, in the case of Plan B it twice refused to grant approval of OTC status; the current approval decision came nearly 3 years from the time of the committee vote. As 2 of the committee members who voted for approval, we like many others were surprised and troubled by the FDA’s extended inaction. The agency justified its position primarily on the grounds that the number of women aged 14 to 16 years in the manufacturer’s actual use study (5% of the 585 women actually enrolled in the study) was too small to allow meaningful inferences about the consequences of its use in younger women. Although that narrow statistical point may have some merit, it cannot explain the tortuous and highly irregular process of decision making, uncovered in a subsequent Government Accountability Office inquiry, that led the FDA to withhold initial approval. It is therefore difficult to avoid the conclusion that the Plan B regulatory process was “a story of the entanglement of politics, science and religious beliefs. At the heart of it is the question of whether emergency contraception is or could be a form of abortion.” Public assertions such as the recent claim that “the proven ‘anti-implantation’ action of the morning-after pill is really nothing other than a chemically induced abortion” certainly seem to support that interpretation. The authors of such claims have offered no supporting evidence regarding Plan B’s mechanism of action. On the contrary, what has been offered are assertions that “the exact mechanism of action of Plan B is unknown” and that “the dirty little secret is, nobody really knows.” Such sweepingstatements of uncertainty not only directly contradict the claim that Plan B’s anti-implantation action is “proven” but also promote general misunderstanding and misuse of doubt in science. Doubt is the very core of the scientific enterprise, an essential part of the process by which scientific hypotheses are tested; on the other hand, doubt is sometimes exploited as a powerful way of subverting sound science-based public policy. Driven by the belief by some that interference with implantation is a form of abortion, the politics of doubt about Plan B’s contraceptive mechanism appears to have contributed not only to the delay in its OTC availability but also to the continuing refusal by some emergency services to provide the drug to rape survivors as well as refusal by some pharmacists to make it available to individual patients. In fact, a great deal is known about how Plan B prevents pregnancy. Now that the drug will be more widely available, it is more important than ever that the scientific evidence on its contraceptive mechanisms be as widely known as possible, so that decisions about its use can be fully informed. A summary of that evidence follows.

Ovarian hormone treatment in adults with Turner syndrome

Most women with Turner syndrome (TS) require life-long replacement therapy with oestrogen and progesterone, and we therefore have to consider the optimal strategy for this treatment for 35 years of continuous use. The forms of oestrogen replacement therapy use in young women with TS are usually borrowed from estrogen replacement therapy (ERT) preparations designed for use in postmenopausal women. There have been few attempts at finding an age-appropriate dose of oestrogen for use in young women. There are many end organ responses for exogenous oestrogen that might be used to guide treatment strategies in young women including those in bone, uterus, arterial walls and liver. In this era of caution with ERT brought about by the women's health initiative (WHI) trials in older women, many young women with TS have been advised to reduce the dose of oestrogen replacement or to terminate oestrogen early. This advice may run counter to the concern over quality of life which is already reduced in this group of women. This paper we will consider a selection of target organs for oestrogen for which data are available in women with TS with particular reference to the starting age of oestrogen and possible effects of dose reduction in adult life. Lastly, ovarian androgen secretion is also lost in women with gonadal dysgenesis and some consideration will need to be given to testosterone replacement in the future.

“I Could Probably Run a Marathon Right Now”: Embodiment, Space, and Young Women's Leisure Experience

This research uses Camp Blaze, a firefighting camp for young women, to explore ways that the body and processes of embodiment are integral to learning about firefighting. We also address the role that the leisure space of the camp plays in simultaneously constraining and enabling young women's use and understanding of their bodies. Analysis of observational, interview, and photo data revealed that learning about firefighting involved several interconnected processes of embodiment. Results include how the processes of embodiment operated and the importance of learning and social context.

YOUNG AFRICAN AMERICAN WOMEN, THE STREET CODE, AND VIOLENCE: AN EXPLORATORY ANALYSIS

ABSTRACT A growing body of research has used the street code thesis to examine how young Black males in disadvantaged social environments normalize the use of violence. However, research on the street code has rarely examined whether it is useful for understanding violence among young African American women living in distressed community contexts. Drawing from the experiences of 24 Chicago-area, African American young women, this paper examines their involvement in personal violence while living in a disadvantaged neighborhood. Our findings highlight the young women's use of the street code script to establish violent identities and earn respect among their peers.

Young women's contraception use as a contextual and dynamic behaviour: A qualitative study

A number of models of behaviour have been applied to contraception use including subjective expected utility theory and social cognition models. Whilst correlates of contraception use have been identified, the limitations of these models include their failure to consider either contextual factors or changes in contraception use over time. Researchers have called for integrated and dynamic models of contraception use, which can be related to the changing contraception use of individual women and can also be readily operationalised to explore within and between subject differences in contraception use. The present study therefore used a qualitative methodology to explore women's contraceptive histories and to enable women to define the issues from their perspectives, resulting in a model of contraception use that is firmly located within the context of their own lives and allows an investigation of the factors and processes involved in changes in contraception use/non-use over time. This model conceptualises the predictors of contraception use in terms of the meaning and importance of a range of social goals, perceptions of vulnerability and constraints on or facilitators of contraception. Further the dynamic nature of these factors is described and it is illustrated how these core components vary over time according to situation, experience, and new information. The paper outlines the relevance of the findings for different models of decision-making processes and highlights the way that the model addresses the limitations of previous approaches.