Racial/ethnic differences in contraceptive preferences, beliefs, and self-efficacy among women veterans
Racial/ethnic differences in contraceptive preferences, beliefs, and self-efficacy among women veterans
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DOI：
10.1016/j.ajog.2016.12.178
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发表时间：
2017-05-01
影响因子：
9.8
通讯作者：
Borrero, Sonya
中科院分区：
文献类型：
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作者：
Callegari, Lisa S.;Zhao, Xinhua;Borrero, Sonya
背景技术背景：在美国，意外怀孕的种族/民族差异仍然存在，在低收入黑人和西班牙裔妇女中观察到的比率最高。避孕偏好、信念和自我效能的差异可能有助于理解避孕行为，这些行为是少数种族/民族意外怀孕率较高的基础。结论：我们的目的是了解女性退伍军人的避孕偏好、信念和自我效能如何因种族和民族而异。我们分析了来自检查避孕药具使用和未满足需求研究的数据，这是一项全国性的电话调查，调查对象是18-44岁的女性退伍军人，她们在过去12个月内在退伍军人管理局接受过初级保健。参与者评价了各种避孕特征的重要性，并使用李克特量表描述了他们对避孕信念的认同程度。通过要求参与者评估他们的确定性，他们可以持续使用避孕措施，并随着时间的推移使用Likert量表来评估避孕自我效能。多变量Logistic回归分析，以检查种族/民族和避孕态度之间的关联，控制年龄，婚姻状况，教育，收入，宗教，奇偶校验，部署历史，和历史的医疗和心理健康conditions.Results：在2302女性退伍军人谁完成了一项调查，52%是非西班牙裔白色，29%是非西班牙裔黑人，12%是西班牙裔。在调整后的分析中，与白人相比，黑人认为避孕有效性非常重要的几率较低（调整后的比值比; 0.55，95%置信区间，0.40-0.74）和更高的几率考虑类别不含任何激素和预防性传播感染极其重要（校正比值比，1.94，95%置信区间，1.56-2.41，校正比值比; 1.99，95%置信区间，1.57-2.51）。西班牙裔也比白人认为不含任何激素和预防性传播感染非常重要的类别的几率更高（调整后的比值比，1.72，95%置信区间，1.29-2.28，和调整后的比值比，1.63; 95%置信区间，1.21-2.19，分别）。与白人相比，黑人和西班牙裔人对怀孕表达宿命论信念的几率更高（校正比值比，1.79，95%置信区间，1.35-2.39，校正比值比，1.48，95%置信区间，1.01-2.17）;将避孕视为女性主要责任的可能性更高（校正比值比，1.92，95%置信区间，1.45-2.55，校正比值比，1.77; 95%置信区间，1.23-2.54）;并且非常确定他们可以在一年内使用避孕方法的几率较低（校正比值比，0.73，95%可信区间，0.54-0.98;校正比值比，0.66，95%可信区间，0.46-0.96）。女性退伍军人的避孕偏好，信仰和自我效能因种族/民族而异，这可能有助于解释观察到的种族/民族差异避孕药具的使用和意外怀孕。这些差异强调了在提供以患者为中心的避孕咨询时，需要引起妇女的个人价值观和偏好。
BACKGROUND: Significant racial/ethnic disparities in unintended pregnancy persist in the United States, with the highest rates observed among low-income black and Hispanic women. Differences in contraceptive preferences, beliefs, and self-efficacy may be instrumental in understanding contraceptive behaviors that underlie higher rates of unintended pregnancy among racial/ethnic minorities.OBJECTIVES: Our objective was to understand how contraceptive preferences, beliefs, and self-efficacy vary by race and ethnicity among women veterans.STUDY DESIGN: We analyzed data from the Examining Contraceptive Use and Unmet Need Study, a national telephone survey of women veterans aged 18-44 years who had received primary care at the Veterans Administration in the prior 12 months. Participants rated the importance of various contraceptive characteristics and described their level of agreement with contraceptive beliefs using Likert scales. Contraceptive self-fficacy was assessed by asking participants to rate their certainty that they could use contraception consistently and as indicated over time using a Likert scale. Multivariable logistic regression was used to examine associations between race/ethnicity and contraceptive attitudes, controlling for age, marital status, education, income, religion, parity, deployment history, and history of medical and mental health conditions.RESULTS: Among the 2302 women veterans who completed a survey, 52% were non-Hispanic white, 29% were non-Hispanic black, and 12% were Hispanic. In adjusted analyses, compared with whites, blacks had lower odds of considering contraceptive effectiveness extremely important (adjusted odds ratio; 0.55, 95% confidence interval, 0.40-0.74) and higher odds of considering the categories of does not contain any hormones and prevents sexually transmitted infections extremely important (adjusted odds ratio, 1.94, 95% confidence interval, 1.56-2.41, and adjusted odds ratio; 1.99, 95% confidence interval, 1.57-2.51, respectively). Hispanics also had higher odds than whites of considering the category of does not contain any hormones and prevents sexually transmitted infections extremely important (adjusted odds ratio, 1.72, 95% confidence interval, 1.29-2.28, and adjusted odds ratio, 1.63; 95% confidence interval, 1.21-2.19, respectively). Compared with whites, blacks and Hispanics had higher odds of expressing fatalistic beliefs about pregnancy (adjusted odds ratio, 1.79, 95% confidence interval, 1.35-2.39, and adjusted odds ratio, 1.48, 95% confidence interval, 1.01-2.17, respectively); higher odds of viewing contraception as primarily a woman's responsibility (adjusted odds ratio, 1.92, 95% confidence interval, 1.45-2.55, and adjusted odds ratio, 1.77; 95% confidence interval, 1.23-2.54, respectively); and lower odds of being very sure that they could use a contraceptive method as indicated over the course of a year (adjusted odds ratio, 0.73, 95% confidence interval, 0.54-0.98, and adjusted odds ratio, 0.66, 95% confidence interval, 0.46-0.96, respectively).CONCLUSION: Women veterans' contraceptive preferences, beliefs, and self-efficacy varied by race/ethnicity, which may help explain observed racial/ethnic disparities in contraceptive use and unintended pregnancy. These differences underscore the need to elicit women's individual values and preferences when providing patient-centered contraceptive counseling.