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PubMed1996

The determinants of the duration of contraceptive use in China: a multilevel multinomial discrete-hazards modeling approach.

Often in demography, individuals may change state over time for a variety of reasons. Competing-risks hazards models have been developed to model such situations. This paper describes the extension of the discrete-time competing-risks hazards model to a multilevel framework that allows for data at different levels of aggregation. The model is illustrated with data from the 1988 Chinese National Survey of Fertility and Contraceptive Prevalence, which collected complete contraceptive histories. Women may stop using a method of contraception for a number of reasons; this paper describes how one can control for correlations between the outcomes of repeated spells of contraceptive use.

Adolescent↗
PubMed2005

The longue durée of contraceptive methods.

Medical history has so far paid hardly any attention to the longue durée, a history in which, according to Braudel, 'all change is slow'. It is therefore one of the challenges of the emerging field of the social history of medicine to work audaciously across time as well as across space. An interesting subject, for example, is the history of contraception. Throughout history, there has been almost nothing people have worried about more than having sex without fear of consequence. At first sight, the story of contraception seems to be one of progress, from the Ancient Egyptian crocodile-dung pessary to the modern-day condom and contraceptive pill. A closer look, however, shows a pattern of remarkable continuities in the reproductive behaviour of men and women over the last two thousand years. In this paper, I shall attempt to show why traditional male-dominated contraceptive methods still linger on despite the sexual revolution brought about by the invention of the 'pill' in the late 1950s.

Attitude to Health↗
PubMed1978

Meeting the special needs of pregnant teenagers.

There is no one best method of contraception for postpregnant teenagers. Most emphasis, however, needs to be on preventing unwanted teenage pregnancies. Contraceptive history must be considered in prescribing. Effective and continuing contraceptive use is enhanced by careful counseling and follow-up and sensitivity to the special needs of teenage users of contraceptives for support, reinstruction, reassurance, guarantee of privacy, and comfort in the clinical setting. Use of oral contraceptives or IUDs should be encouraged since their use-effectiveness in teenagers is so much greater than other methods. But even more important is acceptability to the teenager as this provides the greatest assurance that the method will be used effectively.

Adolescent↗
PubMed1995

The epidemiology of ovarian cancer.

Ovarian cancer is the second most common cancer of the female reproductive system and the leading cause of death from gynecologic malignancies. In 1995, 26,600 women will be diagnosed with ovarian cancer in the U.S., and 14,500 women will die from the disease. Between 1986-1900, the overall age-adjusted incidence was 14.3/100,000 women; mortality was 7.8/100,000 women. Ovarian cancer, rare before age 40, increases steeply thereafter and peaks at ages 65-75. Incidence and mortality rates are higher among white women than among African-American women. Over the last three decades, ovarian cancer incidence has remained stable in high-risk countries, while an increasing trend has been reported in low-risk countries. Despite recent advancements in treatment, the overall five-year survival rates continues to be low (39%). Over 70% of ovarian tumors are diagnosed when regional or distant involvement has already occurred, causing survival rates to remain stable. The etiology of ovarian cancer is poorly understood. Most studies have focused on the epidemiology of invasive epithelial ovarian tumors, while few have explored the epidemiology of epithelial tumors of low malignant potential and nonepithelial tumors. Factors associated with an increased risk for invasive epithelial ovarian cancer include age, race, nulliparity, family history of ovarian cancer, and history of endometrial or breast cancer. Factors associated with a reduced risk are history of one or more full-term pregnancies, use of oral contraceptives, history of breast feeding, tubal ligation, and hysterectomy. Other factors such as infertility drugs, hormone replacement therapy, age at menarche, age at menopause, dietary factors, lactose intolerance, talc use, coffee and alcohol consumption have been suggested, but their role is still inconclusive.

Female↗
PubMedDate not supplied

Risk factors of having high-grade cervical intraepithelial neoplasia/invasive carcinoma in women with atypical glandular cells of undetermined significance smears.

The objective of this study was to find the risk factors of having high-grade cervical intraepithelial neoplasia/invasive carcinoma in women with atypical glandular cells of undetermined significance (AGUS) smears. A retrospective study of the women with AGUS smears during the 3-year period was performed to determine the correlation between the suspected variables and the histopathologic diagnoses. Among 44,071 smears performed, 119 (0.27%) smears were reported as AGUS. Colposcopies were performed in 102 (88.7%) cases, and high-grade cervical intraepithelial neoplasia/invasive carcinoma was found in 18 (17.6%) cases. Among the following variables, which included age, menopausal status, hormonal contraception, history of previous Pap smears, medical diseases, clinical symptoms, and subclassification of AGUS, both hormonal contraception and AGUS favor neoplasia were risk factors with an odds ratio of 5.4 and 5.0, respectively. Although clinical symptoms seemed to be a significant variable in univariate analysis, it appeared as a confounding factor in multivariate analysis.

Adolescent↗
PubMed1990

History of sexual abuse in incarcerated adolescents with gonorrhea or syphilis.

From July 1983 to June 1984, 2521 adolescents were medically screened at entry into a detention facility in New York City. A medical history, physical examination, serology for syphilis, and culture for gonorrhea were obtained from each entrant. A retrospective chart review was conducted for 136 persons with gonorrhea and/or syphilis (79 boys and 57 girls) and 136 sex-matched infection-negative controls. Several characteristics were compared including age, age at first sexual intercourse, sexual abuse history, contraceptive use, and pregnancy status. Among infected cases, 8% of males and 32% of females reported a history of sexual abuse, whereas among controls, no males and 14% of females reported abuse. A history of sexual abuse was strongly associated with gonorrhea or syphilis (odds ratio = 3.4; 95% confidence intervals, 1.5-8.0). These data suggest an association between sexual abuse and subsequent high-risk sexual behavior manifested by a gonorrhea or syphilis infection.

Adolescent↗
PubMed1997

A longitudinal study of birth control and pregnancy outcome among women in a Swedish population.

The prevalence of contraception and pregnancy outcome in the same women, at 19, 24, and 29 years of age, was assessed in a longitudinal cohort study using a postal questionnaire technique. A one-in-four random sample of all women born in 1962 and resident in the city of Göteborg in 1981, was obtained from the population register (n = 656). Respondents from 1981 were re-assessed in 1986 and 1991. Four hundred thirty women (66%) answered the questionnaire on all three occasions and are included in the analysis. Contraceptive usage was as follows (at 19, 24, and 29 years of age, respectively): oral contraception (OC) 47%/51%/22%; intrauterine device 3%/11%/19%; barrier methods 12%/12%/20%; depot gestagen 0/0.2%/0.4%; no contraception 39%/26%/25%. OCs had been taken at some time by 93%. Reasons give for cessation of OC were: contraception not required 10%/21%/20%; fear of OC 28%/32%/35%; menstrual disorder 17%/13%/14%; weight increase 20%/16%/15%; mental side effects 14%/ 21%/20%; desire to become pregnant 7%/33%/52%. Pregnancy outcome was as follows: Ever pregnant 17%/42%/ 71%; children 5% had 1-2 children/27% had 1-3 children/ 59% had 1-5 children; 12%/25%/30% > or = 1 legal abortion; 3%/8%/15% > or = 1 miscarriage; and > or = 1 ectopic pregnancy 0.2%/1.2%/2.1%. On all three survey occasions, more than 97% of the legal abortions were performed < or = 12 weeks gestation. The complication rate following legal abortion was 7%. The proportion of live births to the total number of pregnancies was 25%, 45%, and 61%. The relationship between method of contraception, history of pregnancy, legal abortion, and smoking habits was analyzed in detail. Despite the availability of effective contraception, the ratio of legal abortions to live births was high. Fear of side effects was the commonest reason for discontinuing OC.

Adult↗
PubMed1998

Epidemiologic differences between women with extraovarian primary peritoneal carcinoma and women with epithelial ovarian cancer.

OBJECTIVE: To describe the epidemiologic features of women with extraovarian primary peritoneal carcinoma and compare them with those of women with primary epithelial ovarian cancer. METHODS: The epidemiologic features of 50 women with extraovarian primary peritoneal carcinoma were compared with those of 503 women with primary epithelial ovarian cancer. We included all women with the respective diagnoses admitted to the Roswell Park Cancer Institute between October 1982 and October 1996 who returned an epidemiologic questionnaire. Epidemiologic features of the study and control groups were extracted from a database compiled from a self-administered questionnaire that has been given to patients as part of the admission process since 1982. Individual variables between the study and control groups were compared using Student t test, chi2 analysis, and Wilcoxon nonparametric test. Two-tailed P < .05 was considered significant. RESULTS: We found few significantly different epidemiologic features between women with extraovarian primary peritoneal carcinoma and those with primary epithelial ovarian cancer. Women with extraovarian primary peritoneal carcinoma were significantly older (mean age 63.8 versus 55.0 years, P < .001), had later menarche (13.3 versus 12.8 years, P = .024), and were less likely to have used perineal talc powder (26.0% versus 48.1%, P = .003). There were no significant differences with respect to reproductive history, contraceptive use, or use of hormone replacement therapy. A larger proportion of ovarian cancer patients reported a family history of breast cancer, but the numbers were too small to reach statistical significance. CONCLUSION: The epidemiologic features of women with extraovarian primary peritoneal carcinoma compared with women with primary epithelial ovarian cancer show few differences. The observed areas of difference warrant further research to determine whether they suggest the occurrence of distinct disease entities.

Epidemiologic Factors↗
PubMed1996

Female adolescent contraceptive use or nonuse at first and most recent coitus.

The purpose of this study was to determine factors that differentiate contraceptive use behaviors of sexually active adolescent women. A sample of 159 subjects, recruited from three publicly supported family planning clinics, were classified according to nonuse, inconsistent, or consistent use of contraceptives at first and most recent coitus. The Health Promotion Model provided the organizing framework for this study. Factors entered into the discriminate functions included self-image, problem solving, health-promoting behavior, race, age at first coitus, previous pregnancy, contraceptive history, chronological age, family structure and size, mother's education, and Medicaid status. Three-group multivariate discriminate analysis resulted in two significant functions that explained 38.7% of the variance in contraceptive behavior. The three groups of adolescents were discriminated by age at first coitus, history of previous pregnancy, health-promoting behavior, self-image, problem-solving skill, chronological age, family size, and race. In particular, the findings suggest public health nurses and other health care providers can reduce unintended pregnancy through interventions that address the alterable factors.

Adolescent↗
PubMed1991

Contraception and sexuality in an area-specific group of Swedish women 15-34 years of age.

In a community-based study in a Swedish suburban/rural area, all women aged 15-34 years (n = 671) were invited to the local health centre to be examined for chlamydia infection and for an interview. The attenders were asked about contraceptive history, age at first intercourse, number of life-time sexual partners and socioeconomic background. The net attendance was 69%, and contraceptive information on an additional 20% could be gathered through medical records. The average age at first intercourse was around 16 years, and the average number of sexual partners in the age-groups 20-24, 25-30 and 31-34 years was 4.0, 5.6 and 6.1, respectively. Of all women, around 75% had used contraception at first intercourse, and there was no tendency to a changing pattern during the past 20 years studies through the interviews. Combined estrogen-progestagen pills were by far the most used contraceptive method, presently being used by 42% of the contracepting women, followed by condom (23%), IUD (19%) and other hormonal methods (10%). It is concluded that sexual life in Sweden starts earlier than it did 30 years ago, that the number of sexual partners is higher, that most women in the studied group were efficient contraceptors, and that hormonal contraception was by far the most common method.

Adolescent↗
PubMedDate not supplied

Contraceptive prevalence in Paraguay.

Contraceptive use, source of contraception, history of abortion, current pregnancy intention, and fertility rates are evaluated for a national sample of women using data from the Paraguay Contraceptive Prevalence Survey, conducted in 1977. The survey found that 15.5 percent of all women aged 15--44 and 23.6 percent of ever-married women were using effective contraceptive methods. The urban/rural difference in contraceptive use paralleled fertility differentials: over 40 percent of ever-married women were using contraception in Greater Asuncion and other urban areas compared with 15 percent in rural areas. Overall, the data indicate that high-parity rural women have the greatest need for family planning services in Paraguay.

Abortion, Induced↗
PubMed1994

Interval between menarche and first sexual intercourse, related to risk of human papillomavirus infection.

The purpose of this investigation was to study the occurrence of human papillomavirus (HPV) infection in relation to the interval between menarche and first intercourse. Two hundred eight subjects, aged 13 to 21 years, were recruited from an ambulatory adolescent clinic. Patients were excluded if they had a history of genital warts or an abnormal Papanicolaou smear. All subjects completed a self-administered questionnaire regarding demographics and their menstrual, sexual, and contraceptive histories. HPV infection was determined by in situ hybridization or changes consistent with HPV on a Papanicolaou smear, or both. The prevalence of HPV infection was 19.2%. The average interval between menarche and onset of sexual activity was 26.6 months for those who were found to have HPV infection compared with 35.7 months for those whose test results were negative (p = 0.02). First sexual intercourse within 18 months of menarche was associated with a significant elevation of risk of HPV infection, in comparison with that in adolescents who postpone first intercourse 3 to 4 years after menarche. These data suggest that factors such as increased biologic vulnerability may play a role in HPV infections among adolescent women.

Adolescent↗
PubMedDate not supplied

Finding the best fit: a grounded theory of contraceptive decision making in women.

PROBLEM: Half of the pregnancies in the United States that occur annually are unintended, and of these, half occur among women using contraceptives. METHODS: Interviews with 16 women,field notes, and memos were analyzed using constant comparative analysis and the methods of open, axial, and selective coding were used until saturation occurred. FINDINGS: The core category that describes the process of contraceptive decision making in women is "finding the best fit." Women choose a method or methods to prevent pregnancy based on their knowledge, experience, and evaluation of what would be the best fit within the context of their current life situation. CONCLUSIONS: It is important that nurses obtain a thorough contraceptive history, and realize that women may have different perceptions and knowledge level of methods.

Adaptation, Psychological↗
PubMed1977

Post-"pill" amenorrhoea--cause or coincidence?

The relationship of contraceptive history to diagnostic category of amenorrhoea was analysed in 131 consecutively investigated cases of secondary amenorrhoea. Amenorrhoea occurred in 52 patients immediately after discontinuing the oral contraceptive. Twenty-two had had amenorrhoea before oral contraceptive treatment and 23 patients before the episode of non-contraceptive-related amenorrhoea investigated here. When these cases were excluded from analysis there was no significant difference in the distribution of any of the diagnostic categories between those who had used the oral contraceptive and those who had not. The results suggest that using oral contraceptives does not cause subsequent amenorrhoea.

Age Factors↗
PubMed1986

Psychosocial factors influencing American men and women in their decision for sterilization.

A self-administered questionnaire was answered by nearly 300 surgically sterilized men and over 200 such women 6 weeks after their surgery. Nearly half of these Americans were from large families. More women than men reported a history of medical, gynecologic, or psychiatric problems; one half had been pregnant four or more times; one third reported recent pregnancy. Most sterilized people reported an unsatisfactory contraceptive history. Despite that women had more complications from the procedure than men, improved psychosocial adjustment between 6 weeks before and 6 weeks after sterilization was reported by more women than men.

Adaptation, Psychological↗
PubMed1989

Risk factors for ovarian cancer: a case-control study.

A hospital-based case-control study of ovarian cancer was conducted in London and Oxford between October 1978 and February 1983. Menstrual characteristics, reproductive and contraceptive history and history of exposure to various environmental factors were compared between 235 women with histologically diagnosed epithelial ovarian cancer and 451 controls. High gravidity, hysterectomy, female sterilisation and oral contraceptive use were associated with a reduced risk of ovarian cancer. Infertility and late age at menopause were associated with an increase in risk. While these factors were related, they were each found to be independently associated with ovarian cancer risk after adjusting for the effect of the other factors.

Adult↗
PubMed1996

Intrauterine Devices: Separating Fact From Fallacy.

IUDs currently available in the US provide safe and effective contraception. History has falsely led patients and clinicians alike to believe that IUDs are unsafe. For a woman in a long-standing, mutually monogamous relationship, no method of reversible contraception is more effective. The main risk associated with an IUD is infection; this is usually related to insertion, and the risk lasts for approximately 20 days. Currently available IUDs work by various mechanisms to prevent fertilization. The copper-containing IUD is also a highly effective form of emergency contraception. It is important for clinicians to re-educate themselves and their patients about the importance of the IUD as an option for contraception.

Journal Article↗