Factors Predicting Ineffective Contraceptive Use

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Project Summary Unintended pregnancy (UP), defined as a mistimed or unwanted pregnancy, is a significant and prevalent public health problem, particularly among low-income women. Over one-half of all pregnancies are reported as unintended and UP has been linked to numerous adverse outcomes including depression, substance use, delayed prenatal care, and adverse child health outcomes. Correct and consistent use of effective contraception is the primary method to prevent UP. The Affordable Care Act of 2012 provides free contraception to women; however, removing financial barriers has not dramatically reduced UP and providing messages only during a clinical visit does not promote consistent use. We, and others, report that high depressive symptoms and low self-esteem are linked to inconsistent contraception use and increased risk of UP however, no interventions or messages address this barrier to contraception use. Thus, there is an urgent need to develop and evaluate interventions to decrease depressive symptoms, improve contraception use and reduce UP. Traditional cognitive behavioral therapy (CBT) is effective in reducing depressive symptoms; but limited utilization, poor response and low adherence to CBT is common. A recent meta-analysis suggests that incorporating peer-specialists in the delivery of CBT messages was most beneficial in reducing depressive symptoms and maintaining high participation rates among low-income women. This proposal will examine the feasibility and effectiveness of a 12-week peer-specialist led CBT intervention compared an observational control condition to reduce depressive symptoms, improve self-esteem and improve consistent contraceptive use to prevent UP among young sexually active women.