Associations Between Social Determinants of Health and Adolescent Contraceptive Use

Abstract

This research assessed social determinants of contraceptive use among a nationally representative sample of adolescents. This study analyzed nationally representative, publicly available data from the 2013-2015 National Survey of Family Growth (NSFG). The sample consisted of sexually active males and females between the ages of 15 and 19 (n = 775). Independent variables were social determinant questions asked on the NSFG, selected based on the Healthy People Social Determinants of Health Framework. We tested associations between adolescents' social determinants of health and 2 outcomes, use of any contraceptive at last sex, and effectiveness level of contraceptive method at last sex. Results indicated high contraceptive use at last intercourse (91.5%) and a significant association between any use of contraceptive and family structure (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.04-4.03), employment (AOR = 2.00, 95% CI = 1.06-3.77), and education (AOR = 3.43, 95% CI = 1.06-11.13). Few participants reported use of a highly effective method of pregnancy prevention (4.3%). In regression analyses, access to health care (AOR = 0.34, 95% CI = 0.14-0.84) and language and literacy (AOR = 2.92, 95% CI = 1.03-8.26) were found to be associated with using moderately effective contraceptive method to prevent pregnancy compared with not using any method. Although adolescents report overall high rates of contraceptive use, not all contraceptives have the same rates of effectiveness, and adolescents are often choosing those with lower effectiveness. This study found low rates of highly effective contraceptives to prevent pregnancy use (ie, intrauterine device and implant). It is also important to further explore the associations between family structure (measured in this study as intact childhood family) and distal links to contraceptive use. Future research should also further distinguish pathways to adolescent decision-making to use contraceptive methods to protect against STIs and pregnancy.

Usual Source of Care and Contraceptive Use

“…In keeping with prior research, 5,14,24 the current study found that having a usual source of care increased contraceptive options. Unlike a prior national study, 5 we did not find having usual care to predict the use of any contraception.…”

“…Neither EDs nor urgent care clinics focus on reproductive health or connect patients with individual providers over time 7–10 . However, we believe that the limited number of contraceptive differences we found across sources of usual care, and scarce prior evidence of such differences, 5,14,24 in the context of increasing numbers of people without a usual source of primary care, imply re-examining how emergent as well as primary care settings can improve contraceptive access.…”

Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2015-2019

“…The data on teen sexual activity, contraceptive use, and childbearing presented in this report are shown with respect to several key demographic characteristics of the respondent. Three measures of teenagers' families of origin are included because they have well-documented associations with sexual activity and the use of contraception among teenagers, partly through their strong correlation with family socioeconomic status: mother's educational attainment, the age when the mother had her first child, and parental living arrangements (that is, parental presence or absence in the teenager's household) (22)(23)(24).…”

“…In addition, concern remains high over the incidence of HIV and other sexually transmitted infections (STIs) among young people. Sexually active adolescents and young adults (ages [15][16][17][18][19][20][21][22][23][24] are at higher risk of acquiring STIs than adults for reasons that include behavior, physiology, and factors related to healthcare access and services (9). Prevalence estimates suggest that one in four sexually active adolescent females has an STI, such as chlamydia or human papillomavirus (9).…”