Purpose: To estimate the prevalence of and factors associated with dual method use (i.e., condom with hormonal contraception or an intrauterine device) among adolescents and young women in the United States.Methods: We used 2006-2010 National Survey of Family Growth data from 2,093 unmarried females aged 15-24 years and at risk for unintended pregnancy. Using multivariable logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to assess the associations between dual method use at last sex and sociodemographic, behavioral, reproductive history, and sexual behavior factors.Results: At last sex, 20.7% of adolescents and young women used dual methods, 34.4% used condoms alone, 29.1% used hormonal contraception or an intrauterine device alone, and 15.8% used another method or no method. Factors associated with decreased odds of dual method use versus dual method nonuse included having a previous pregnancy (aOR = .44, 95% CI .27-.69), not having health insurance coverage over the past 12 months (aOR = .41, 95% CI .19-.91), and having sex prior to age 16 (aOR = .49, 95% CI .30-.78).Conclusions: The prevalence of dual method use is low among adolescents and young women. Adolescents and young women who may have a higher risk of pregnancy and sexually transmitted infections (e.g., those with a previous pregnancy) were less likely to use dual methods at last sex. Interventions are needed to increase the correct and consistent use of dual methods among adolescents and young women who may be at greater risk for unintended pregnancy and sexually transmitted infections. Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine.

Since the first U.S. infant conceived with Assisted Reproductive Technology (ART) was born in 1981, both the use of advanced technologies to overcome infertility and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which both eggs and embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Women who undergo ART procedures are more likely to deliver multiple-birth infants than those who conceive naturally because more than one embryo might be transferred during a procedure. Multiple births pose substantial risks to both mothers and infants, including pregnancy complications, preterm delivery, and low birthweight infants. This report provides state-specific information on U.S. ART procedures performed in 2011 and compares infant outcomes that occurred in 2011 (resulting from procedures performed in 2010 and 2011) with outcomes for all infants born in the United States in 2011.2011.In 1996, CDC began collecting data on all ART procedures performed in fertility clinics in the United States as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA) (Public Law 102-493). Data are collected through the National ART Surveillance System (NASS), a web-based data collecting system developed by CDC.In 2011, a total of 151,923 ART procedures performed in 451 U.S. fertility clinics were reported to CDC. These procedures resulted in 47,818 live-birth deliveries and 61,610 infants. The largest numbers of ART procedures were performed among residents of six states: California (18,808), New York (excluding New York City) (14,576), Massachusetts (10,106), Illinois (9,886), Texas (9,576), and New Jersey (8,698). These six states also had the highest number of live-birth deliveries as a result of ART procedures and together accounted for 47.2% of all ART procedures performed, 45.3% of all infants born from ART, and 45.1% of all multiple live-birth deliveries, but only 34% of all infants born in the United States. Nationally, the average number of ART procedures performed per 1 million women of reproductive age (15-44 years), which is a proxy indicator of ART use, was 2,401. In 11 states (Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Virginia), the District of Columbia, and New York City, this proxy measure was higher than the national rate, and of these, in three states (Massachusetts, New Jersey, and New York) and the District of Columbia, it exceeded twice the national rate. Nationally, among ART cycles with patients using fresh embryos from their own eggs in which at least one embryo was transferred, the average number of embryos transferred increased with increasing age (2.0 among women aged <35 years, 2.3 among women aged 35-40 years, and 2.9 among women aged >40 years). Elective single-embryo transfer (eSET) rates decreased with increasing age (12.2% among women aged <35 years, 4.7% among women aged 35-40 years, and 0.7% among women aged >40 years). Rates of eSET also varied substantially between states (range: 0.7% in Idaho to 53% in Delaware among women aged <35 years). The number of ART births as a percentage of total infants born in the state is considered as another measure of ART use. Overall, ART contributed to 1.5% of U.S. births (range: 0.2% in Puerto Rico to 4.5% in Massachusetts) with the highest rates (≥3.5% of all infants born) observed in four states (Connecticut, Massachusetts, New Jersey, and New York state), and the District of Columbia. Infants conceived with ART comprised 20% of all multiple-birth infants (range: 4.7% in Puerto Rico to 41.3% in New York state), 19% of all twin infants (range: 4.1% in Mississippi to 39.7% in Massachusetts), and 32% of triplet or higher order infants (range: 0 in several states to 71.4% in Hawaii). Among infants conceived with ART, 45.6% were born in multiple-birth deliveries (range: 23.1% in Delaware to 61.3% in Wyoming), compared with only 3.4% of infants among all births in the general population (range: 1.9% in Puerto Rico to 4.8% in New Jersey). Approximately 43% of ART-conceived infants were twins, and 3% were triplets and higher order infants. Nationally, infants conceived with ART comprised 5.7% of all low birthweight (<2,500 grams) infants (range: 0.6% in Puerto Rico to 15% in Massachusetts) and 5.9% of all very low birthweight (<1,500 grams) infants (range: 0.8% in Mississippi to 17.3% in Massachusetts). Overall, among ART-conceived infants, 31% were low birthweight (range: 18% in District of Columbia to 44.6% in Puerto Rico), compared with 8.1% among all infants (range: 6% in Alaska to 12.5% in Puerto Rico); 5.7% of ART infants were very low birthweight (range: 0 in North Dakota to 8.5% in Hawaii), compared with 1.4% among all infants (range: 0.9% in Alaska to 2.2% in Mississippi). Finally, ART-conceived infants comprised 4.6% of all infants born preterm (<37 weeks; range: 0.5% in Puerto Rico to 13% in Massachusetts) and 5.2% of all infants born very preterm (<32 weeks; range: 0 in Wyoming to 17.1% in Massachusetts). Overall, among infants conceived with ART, 36.2% were born preterm (range: 12.5% in Vermont to 56.9% in Puerto Rico), compared with 11.8% among all infants born in the general population (range: 8.8% in Vermont to 17.6% in Puerto Rico); 6.7% of ART infants were born very preterm (range: 0 in Wyoming to 12.5% in Alaska), compared with 1.9% among all infants born in the general population (range: 1.3% in Wyoming to 3.0% in Puerto Rico). The percentage of infants conceived with ART who were low birthweight varied from 8.8% (range: 3.9% in the District of Columbia to 17.9% in Puerto Rico) among singletons, to 56.4% (range: 34.6% in Vermont to 70.4% in Mississippi) among twins, and 95.7% (range: 79.5% in North Carolina to 100% in several states) among triplets or higher-order multiples; comparable percentages for all infants were 6.4% (range: 4.5% in Idaho and Oregon to 11.3% in Puerto Rico), 56.3% (range: 47.7% in Vermont to 72.1% in Puerto Rico), and 93.9% (range: 50% in Wyoming to 100% in several states), respectively. The percentage of ART infants who were preterm varied from 13.2% (range: 7.3% in the District of Columbia to 28.6% in Puerto Rico) among singletons, to 61.8% (range: 46% in the District of Columbia to 82.7% in Oklahoma) among twins, and 97.1% (range: 76.9% in Iowa to 100% in several states) among triplets or higher-order multiples; comparable percentages for all infants were 10.1% (range:7.5% in Oregon to 16.6% in Puerto Rico), 57.3% (range: 46.8% in New Hampshire to 68.8% in Louisiana), and 93.4% (range: 73.3% in Rhode Island to 100% in several states), respectively. Only nonsuppressed values from reporting areas are provided to protect confidentiality.The percentage of infants conceived with ART varied considerably by state (range: 0.2% to 4.5%). In most states, multiples from ART comprised a substantial proportion of all twin, triplet, and higher-order infants born in the state, and the rates of low birthweight and preterm infants were disproportionately higher among ART infants than in the birth population overall. Even among women aged <35 years, for whom elective single embryo transfers should be considered (particularly in patients with a favorable prognosis), on average, two embryos were transferred per cycle in ART procedures, influencing the overall multiple infant rates in the United States. Compared with ART singletons, ART twins were approximately 5 times more likely to be born preterm, and approximately six times more likely to be low birthweight. Singleton infants conceived with ART had slightly higher rates of preterm delivery and low birthweight than among all singleton infants born in the United States. However, all multiple-birth infants, regardless of whether they were ART-conceived or not, were more likely to be preterm and low birthweight compared with singletons. Further, ART use per population unit was distributed disproportionately in the United States, with 11 states showing ART use above the national rate. Of the four states (Illinois, Massachusetts, New Jersey, and Rhode Island) with comprehensive statewide-mandated health insurance coverage for ART procedures (e.g., coverage for at least four cycles of in vitro fertilization, three states (Illinois, Massachusetts, and New Jersey) also had rates of ART use >1.5 times the national level. This type of mandated insurance has been associated with greater use of ART and might account for the differences in per capita ART use observed among states.Reducing the number of embryos transferred per ART procedure and promoting eSET procedures, when clinically appropriate, are needed to reduce multiple births and related adverse consequences of ART. Improved patient education and counseling on the health risks of having twins might be useful in reducing twin births given that twins account for the majority of ART-conceived multiple births. Although ART contributes to increasing rates of multiple births, it does not explain all of the increases, and therefore other explanations for multiple births not investigated in this report, such as the possible role of non-ART fertility treatments, warrants further study.

OBJECTIVE: To estimate trends in good perinatal outcomes (singleton live births at term with birthweight more than 2,500 g) among live births after assisted reproductive technology in the United States from 2000 to 2008, and associated factors among singletons in 2008.METHODS: Using retrospective cohort data from the National Assisted Reproductive Technology Surveillance System from 2000 to 2008, we calculated relative change and chi(2) tests for trend in the proportion of good perinatal outcomes among assisted reproductive technology live births (n=444,909) and liveborn singletons (n=222,500). We conducted univariable analyses followed by multiple logistic regression to estimate the effects of various characteristics on the outcome among singletons born in 2008 after fresh, nondonor assisted reproductive technology cycles (n=20,780).RESULTS: The proportion of good perinatal outcomes among all liveborn neonates increased from 38.6% in 2000 to 42.5% in 2008, whereas it declined marginally among singletons from 83.6% to 83.4%. One previous birth, transfer of fewer than three embryos, and the presence of fewer than three fetal hearts on 6-week ultrasound examination were associated with good perinatal outcome among singletons. Non-Hispanic black race, tubal factor infertility, uterine factor infertility, ovulatory disorder, and 5-day embryo culture were associated with reduced odds for a good outcome. The strongest association was the presence of one fetal heart compared with more than two (adjusted odds ratio 2.43, 95% confidence interval 1.73-3.42).CONCLUSION: From 2000 to 2008, good perinatal outcomes increased among assisted reproductive technology live births. Among singleton live births, odds for good outcome were greatest with the presence of a single fetal heart and lowest in women of non-Hispanic black race.

Background: Vasectomy has been found to be a highly cost-effective contraceptive method. For couples, tubal sterilization and vasectomy have the same result, but the two methods are used by different segments of the population. Study design: We conducted an analysis of data from male and female samples of the 2006–2008 National Survey of Family Growth, nationally representative samples of men and women in the United States aged 15–44 years. Results: Among married men, 13.1% reported vasectomies (95% confidence interval 10.4%–16.3%), compared to 21.1% (17.8%–24.9%) of married women who reported tubal sterilizations. Men with higher education and income had greater prevalence of vasectomy than those less educated, while women with lower education and income had the highest prevalence of tubal sterilization. Conclusions: Efforts to promote vasectomy use need to understand the reasons behind these differences. Increasing the availability and use of vasectomy will require education about its benefits. Published by Elsevier Inc.

PROBLEM/CONDITION Since the birth of the first U.S. infant conceived with Assisted Reproductive Technology (ART) in 1981, use of advanced technologies to overcome the problem of infertility has increased steadily, as has the number of fertility clinics providing ART services in the United States. ART includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Women who undergo ART procedures are more likely to deliver multiple-birth infants than those who conceive naturally. Multiple births pose substantial risks to both mothers and infants, including pregnancy complications, preterm delivery, and low birthweight infants. This report presents the most recent data on ART use and birth outcomes for U.S. states and territories. REPORTING PERIOD COVERED 2009. DESCRIPTION OF SYSTEM In 1996, CDC began collecting data on all ART procedures performed in the United States, as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA) (Public Law 102-493 [October 24, 1992]). ART data for 1995-2003 were obtained from the Society of Assisted Reproductive Technology (SART) through its proprietary Clinical Outcomes Reporting System data base (SART CORS). Since 2004, CDC has contracted with Westat, Inc., a statistical survey research organization, to obtain data from fertility clinics in the United States through the National ART Surveillance System (NASS), a web-based data collection system developed by CDC. RESULTS In 2009, a total of 146,244 ART procedures were reported to CDC. These procedures resulted in 45,870 live-birth deliveries and 60,190 infants. The largest numbers of ART procedures were performed among residents of California (18,405), New York (14,539), Illinois (10,192), Massachusetts (9,845), New Jersey (9,146), and Texas (8,244). Together, these six states reported the highest number of live-birth deliveries as a result of ART and accounted for 48% of all ART procedures initiated, 46% of all infants born from ART, and 45% of all ART multiple-birth deliveries but only 34% of all births in the United States. Nationally, the average number of ART procedures performed per 1 million women of reproductive age (15-44 years), which is a proxy indicator of ART utilization, was 2,361. In four states (Massachusetts, New York, New Jersey, and Connecticut) and the District of Columbia, this proxy measure of ART use exceeded twice the national average. Nationally, the average number of embryos transferred was 2.1 among women aged <35 years, 2.5 among women aged 35-40 years, and 3.0 among women aged >40 years (and varied most in this age group from 1.7 in Maine to 3.5 in Missouri). Age-specific elective single-embryo transfer (eSET) rates were approximately 7% among women aged <35 years, 3% among women aged 35-40 years, and 0.5% among women aged >40 years. The highest rates of eSET were observed among women aged <35 years (41% in Delaware, 20% in Iowa, and 17% Massachusetts). Overall, ART contributed to 1.4% of U.S. births (ranging from 0.2% in Puerto Rico to 4.3 % in Massachusetts). The proportion of ART to total infants born in the state or territory, which is another measure of ART utilization, was highest in Massachusetts (>4%) with high rates also observed in New Jersey, New York, Connecticut, and the District of Columbia (>3% of all infants born). Infants conceived with ART accounted for 20% of all multiple-birth infants (ranging from 4% in Maine to 41% in New York), 19% of all twin births (ranging from 4% in Maine to 42% in New York) and 34% of triplet or higher order births (ranging from 0 in several states to 61.5% in New Jersey). Among infants conceived with ART, 47% were born as multiple-birth infants (ranging from 35% in Delaware to 60.8% in Wyoming), compared with only 3% of infants among the general birth population (ranging from 1% in New York to 5% in Connecticut). Nationally, infants conceived with ART contributed to approximately 6% of all low birthweight (<2,500 grams) infants, ranging from 1.3% in Mississippi to 15% in Massachusetts and to 6% of all very low birthweight (<1,500 grams) infants, ranging from 1% in Alaska to 15% in New Jersey. Overall, among ART-conceived infants, 32% were low birthweight (ranging from 20% in Alaska to 48% in Puerto Rico), compared with 8% among the general birth population (ranging from 5.8% in South Dakota to 12.2% in Mississippi), and 6% of ART infants were very low birthweight (ranging from 1.5% in Alaska to 13% in South Dakota), compared with 1% among the general birth population (ranging from 1% in Alaska to 2% in Mississippi and District of Columbia). Finally, ART-conceived infants accounted for 3.9% of all preterm (<37 weeks; range: 0.5% in Puerto Rico to 11.1% in Massachusetts) and 4.5% of all very preterm births (<32 weeks; range: 0.5% in Puerto Rico to 12% in New York). Overall, among infants conceived with ART, 33.4% were born preterm (ranging from 21.3% in Vermont to 47.1% in Wyoming), compared with 12.2% of the general birth population (ranging from 9.3% in Vermont to 18.0% in Mississippi), and 6.1% of ART infants were very preterm births (ranging from 1.5% in Alaska to 14.7% in South Dakota), compared with 2% among the general birth population (ranging from 1.4% in Alaska, Oregon, Utah, and Washington to 3% in Mississippi). INTERPRETATION The proportion of births from ART varied considerably by state and territory (ranging from 0.2% to 4.3%) with substantial impact on perinatal outcomes in some states. In most states, multiple births from ART accounted for substantial proportions of twins and triplets and higher order infants, and the rates of low birthweight and preterm births were disproportionately higher among ART infants than in the general birth population. More than one embryo was transferred per procedure in most states and territories for all age groups, influencing the overall multiple birth rates in the United States. ART use was represented disproportionately in the United States, with only 13 states having above-average ART use. High rates of ART utilization were observed in Massachusetts and New Jersey, which have comprehensive statewide-mandated health insurance coverage for ART procedures. Insurance mandates might influence ART utilization and ART-related birth outcomes. PUBLIC HEALTH ACTIONS Promotion of single-embryo transfer, where feasible, is needed to reduce multiple births and related adverse consequences of ART. Nevertheless, because ART accounts for a relatively small fraction of total births in most states and territories, the overall prevalence of low birthweight and preterm births cannot be explained solely by the use of ART, and therefore non-ART causes of these adverse outcomes must be examined. Monitoring the use of non-ART infertility treatments (e.g., ovulation stimulation medications without ART) in the general population might be useful because these treatments also might be associated with high rates of multiple births and adverse outcomes such as preterm delivery and infants born with low birthweight.

Objective: To evaluate the determinants of intrauterine device (IUD) use and reasons for choosing IUDs over other reversible contraceptive methods.Design: Descriptive statistics and multinomial logistic regression were used to assess multiple factors associated with IUD use and the use of other reversible methods in the United States.Setting: Not applicable.Patient(s): Women at risk of pregnancy from the 2006 to 2008 National Survey of Family Growth and a 2004 Guttmacher Institute survey.Intervention(s): None.Main Outcome Measure(s): Sociodemographic and reproductive characteristics, family background, and health insurance coverage.Result(s): IUD use was positively associated with women's parity and the highest education level of respondent's mother; it was less common among women who had >= 4 sexual partners in the last 12 months and those who were widowed, divorced, or separated. IUD users reported pregnancy prevention, provider recommendation, and no interruption of sex as the most important reasons for choosing the method and reported a high level of satisfaction.Conclusion(s): IUD users differed substantially from users of other reversible contraceptives. IUD use was especially uncommon among nulliparae. Most current IUD users were satisfied with their choice. (Fertil Steril (R) 2011;96:1138-44. (C) 2011 by American Society for Reproductive Medicine.)

Background: Vasectomy has been found to be a highly cost-effective contraceptive method. For couples, tubal sterilization and vasectomy have the same result, but the two methods are used by different segments of the population.Study design: We conducted an analysis of data from male and female samples of the 2006-2008 National Survey of Family Growth, nationally representative samples of men and women in the United States aged 15-44 years.Results: Among married men, 13.1% reported vasectomies (95% confidence interval 10.4%-16.3%), compared to 21.1% (17.8%-24.9%) of married women who reported tubal sterilizations. Men with higher education and income had greater prevalence of vasectomy than those less educated, while women with lower education and income had the highest prevalence of tubal sterilization.Conclusions: Efforts to promote vasectomy use need to understand the reasons behind these differences. Increasing the availability and use of vasectomy will require education about its benefits. Published by Elsevier Inc.

The prevalence of condom use at last intercourse, estimated from questions added to a national survey, was estimated to be 20.2%. Use of condom was significantly higher for sex outside ongoing relationships and among those with 2 or more past-year sex partners and its use increased slightly but significantly from 1996 to 2008.

The objectives of this study were to determine risk factors for early (less than 34 weeks gestation) and late (34–36 weeks gestation) preterm singleton birth, by assisted reproductive technology (ART) status. We linked data from Massachusetts birth records and ART records representing singleton live births from 1997 through 2004. Using multinomial regression models, we assessed risk factors for early and late preterm birth by ART status. From 1997 to 2004 in Massachusetts, among non-ART births, risk factors for early and late preterm birth were similar and included women <15 and ≥35 years of age, those of non-white race or Hispanic ethnicity, those with ≤12 years of education, those with chronic diabetes, those with gestational diabetes, those with gestational hypertension, those who smoked during pregnancy, those who used fertility medications, and those who had not had a previous live birth. Among ART births, risk factors for early and late preterm birth differed and odds of early preterm birth were increased among women with ≤12 years of education while odds of late preterm birth were increased among women with gestational diabetes. Odds of both early and late preterm birth were increased among women of non-white race or Hispanic ethnicity and among women with gestational hypertension. Among non-ART births, increased risk for preterm birth was more strongly related to socioeconomic factors than among ART births. Medical conditions were associated with an increased risk for preterm birth regardless of women’s ART status. Efforts to prevent preterm births should focus on reducing modifiable risk factors.

BACKGROUND:Surgical sterilization has many advantages. Previous information on prevalence and correlates was based on surveys of women. STUDY DESIGN:We estimated the prevalence of vasectomy and tubal ligation of partners for male participants in the 2002 National Survey of Family Growth, a nationally representative survey of US residents aged 15-44 years. We identified factors associated with sterilizations using bivariate and multivariate techniques. RESULTS:The findings revealed that 13.3% of married men reported having had a vasectomy and 13.8% reported tubal sterilization in their partners. Vasectomy increased with older age and greater number of biological children, non-Hispanic white ethnicity, having ever gone to a family planning clinic. Tubal sterilization use was more likely among men who had not attended college, those of older age and those with live births. DISCUSSION:One in eight married men reported having vasectomies. Men who rely on vasectomies have a somewhat different profile than those whose partners have had tubal sterilizations.

Objective: To frame the discussion of the nation's health within the context of maternal and child health.Methods: We used national data or estimates to assess the burden of 46 determinants.Results: During 2002-2004, U.S. women of reproductive age experienced significant challenges from macrosocial determinants, to health care access, and to their individual health preservation. Two-thirds of women do not consume recommended levels of fruits and vegetables. Overall, 29% experienced income poverty, 16.3% were uninsured. About one in four women of reproductive age lived with poor social capital. Compared with white women of reproductive age, non-white women reported higher levels of dissatisfaction with the health care system and race-related discrimination. Among all U.S. women, chronic diseases contributed to the top nine leading causes of disability adjusted life years. About one-third of women had no prophylactic dental visits in the past year, or consumed alcohol at harmful levels and smoked tobacco. One in three women who had a child born recently did not breast feed their babies. Demographics of women who are at increased risk for the above indicators predominate among the socioeconomically disadvantaged.Conclusions: At least three-fourths of the U.S. women of reproductive age were at risk for poor health of their own and their offspring. Social intermediation and health policy changes are needed to increase the benefits of available health and social sector interventions to women and thereby to their offspring. Published by Elsevier Ireland Ltd

We appreciate the interest of Hayford et al in our manuscript describing trends of unwanted childbearing among young women in the United States. Dr. Hayford and colleagues suggest that the increasing trend of unwanted childbearing that we observed among young women from 1990–1995 to 1997–2002 is “attributable to survey effects.” We believe, however, that the brief letter from Hayford et al offers no conclusive evidence to suggest that minor changes in questionnaire items between the 1995 and 2002 National Survey of Family Growth (NSFG) cycles were responsible for the major shift in the reporting of unwanted childbearing. As the basis for their argument, Dr. Hayford and colleagues cite their unpublished analysis, in which they observed substantially higher rates of reporting of unwanted births during the period of 1990 to 1994 when the authors used the 2002 NSFG cycle data, compared with when they used 1995 cycle data. The only conclusion that can reasonably be drawn from such analysis is that 1995 and 2002 NSFG cycles produced different rates of unwanted births for the period of 1990 to 1994. There are many possible explanations for the different findings from the 1995 and 2002 surveys. Research might focus on such questions as whether these younger cohorts of women want fewer children than earlier cohorts, are increasingly likely to report births out of wedlock as unwanted rather than mistimed, and/or are better covered by the 2002 NSFG cycle than by the 1995 cycle, or whether new, supplementary measures of wantedness (available beginning in the 2002 NSFG) may be needed to adequately capture their attitudes toward children. Further research on this question might best be done using the next NSFG, which should be available within the next year. Despite known methodological limitations with using survey questions to assess unwanted and mistimed fertility [1Kissin D.M. Anderson J.E. Kraft J.M. et al.Is there a trend of increased unwanted childbearing among young women in the United States?.J Adolesc Health. 2008; 43: 364-371Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar, 2Luker K.C. A reminder that human behavior frequently refuses to conform to models created by researchers.Fam Plann Perspect. 1999; 31: 248-249Crossref PubMed Scopus (86) Google Scholar, 3Williams L. Piccinino L. Abma J. et al.Pregnancy wantedness: attitude stability over time.Soc Biol. 2001; 48: 212-233PubMed Google Scholar, 4Santelli J. Rochat R. Hatfield-Timajchy K. et al.The measurement and meaning of unintended pregnancy.Perspect Sex Reprod Health. 2003; 35: 94-101Crossref PubMed Scopus (474) Google Scholar, 5Trussell J. Vaughan B. Stanford J. Are all contraceptive failures unintended pregnancies? Evidence from the 1995 National Survey of Family Growth.Fam Plann Perspect. 1999; 31 (260): 246-247Crossref PubMed Scopus (201) Google Scholar], the findings of our article suggest that the problem of unintended childbearing by young women merits the attention of health researchers and others. Any data that conclusively suggest that changes in the wording of one question may influence the results of the national survey in such a dramatic way deserve more investigation and a fuller discussion in the literature. Whether unwanted and unintended childbearing is increasing or merely not decreasing, we hope that attention to this issue will result in the relevant policy changes that can bring us closer to the Healthy People 2010 goal aimed at reducing the proportion of pregnancies that are unintended [[6]U.S. Department of Health and Human Services Tracking Healthy People 2010. U.S. Government Printing Office, Washington, DC2000Google Scholar].

Objective: To determine demographic characteristics associated with pregnancy and, separately, discontinuation of infertility services when unsuccessful at achieving pregnancy, among a national sample of women who received infertility services.Design: Using a log-linear regression model, we examined associations with becoming pregnant among women who had received infertility services; and using a Cox proportional hazards model, we examined associations with earlier infertility service discontinuation.Setting: 2002 National Survey of Family Growth, Cycle 6.Participant(s): A total of 530 women aged 18-44 years in the 2002 National Survey of Family Growth who had received infertility services.Intervention(s): None.Main Outcome Measure(s): Relative risks for predictors of pregnancy after receiving infertility services; median time to discontinuation of infertility services; hazard ratios for predictors of earlier discontinuation of services.Result(s): Fifty-nine percent of respondents became pregnant while receiving infertility services, and 32% reported discontinuing infertility services before establishing a pregnancy. Women received infertility services for a median of 8 months: among those who discontinued services, more than half did so within I month. Among women who received infertility services, those who were white, nonsmokers, nulliparous.. had insurance coverage, and received more than advice had a higher likelihood of pregnancy. Non-whites, parous women, and smokers discontinued infertility services earlier than others.Conclusion(s): Patients should be adequately counseled regarding modifiable behaviors and the range of services available before making decisions regarding their infertility. (Fertil Steril (R) 2009;91:988-97. (C) 2009 by American Society for Reproductive Medicine.)

OBJECTIVE: The purpose of this study was to estimate the national prevalence and predictors of sexually transmitted disease/human immunodeficiency virus (STD/HIV) service receipt in the preceding year among young women who received contraceptive services.STUDY DESIGN: Weighted self-reported data from the 2002 National Survey of Family Growth was used to estimate the prevalence and multivariable odds ratios for the receipt of STD/HIV services among 1009 unmarried, sexually active 15- to 24-year-old women who received contraceptive services.RESULTS: Of the women who received contraceptive services, 35% (2.7 million) did not receive STD/HIV services. Predictors of the receipt of STD/HIV services included younger age at first sexual intercourse (<= 14 years; adjusted odds ratio [aOR], 2.0; 15-17 years; aOR, 1.7), having ever been pregnant (aOR, 2.2); having had >= 2 partners in the past year (aOR, 2.6), receipt of a pregnancy test or abortion in the past year (aOR, 2.3), and having visited a Title X clinic in the last 12 months (aOR, 3.3).CONCLUSION: Interventions are needed to help integrate contraceptive and STD/HIV services.

To the Editor: In a recent issue of Journal of Adolescent Health, Kissin and colleagues [[1]Kissin D.M. Anderson J.E. Kraft J.M. Warner L. Jamieson D.J. Is there a trend of increased unwanted childbearing among young women in the United States?.J Adolesc Health. 2008; 43: 364-371Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar] examined trends in unintended and unwanted childbearing in the United States. They report that the proportion of unwanted births increased between 1995 and 2002, particularly among women under age 25. Kissin and colleagues [[1]Kissin D.M. Anderson J.E. Kraft J.M. Warner L. Jamieson D.J. Is there a trend of increased unwanted childbearing among young women in the United States?.J Adolesc Health. 2008; 43: 364-371Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar] analyze trends using multiple waves of the National Survey of Family Growth (NSFG). This survey was designed to study change over time. However, recent research suggests that the 1995 and 2002 measures of unwanted fertility are not, in fact, comparable, and that the apparent increase in unwanted fertility is attributable to survey effects. As in all surveys, question wording and sampling procedures in the NSFG vary slightly over time. The effects of these differences can be assessed by comparing measures for periods of time in which the two surveys overlap. In an article presented at the 2008 NSFG User's Conference, my colleagues and I [[2]Hayford SR, Wildsmith E, Guzzo KB. Changes in the measurement of unintended fertility, 1995 and 2002 National Surveys of Family Growth. National Survey of Family Growth User's Conference, October 16–17, Hyattsville, MD, 2008.Google Scholar] compared proportions of births reported as unwanted during the period 1990–1994 using both the 1995 and 2002 NSFG. Unwanted birth rates during this period are substantially higher when measured using the 2002 survey than when measured using the 1995 survey. Furthermore, measurement differences are largest for adolescent women. These measurement differences are large enough to completely explain the apparent trend reported by Kissin and colleagues [[1]Kissin D.M. Anderson J.E. Kraft J.M. Warner L. Jamieson D.J. Is there a trend of increased unwanted childbearing among young women in the United States?.J Adolesc Health. 2008; 43: 364-371Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar]. Using the 1995 NSFG, an estimated 10% of births between 1990 and 1994 to non-Hispanic white, non-Hispanic black, and U.S. born Hispanic women age 15–19 were unwanted. Using the 2002 NSFG to measure births to women the same age during the same time period, 20% of births were unwanted. Thus, unwanted fertility in this age group appears more than twice as common when measured using the 2002 survey than when measured using the 1995 survey. The wording of the NSFG question on unwanted fertility was changed during this period. In 1995, and in earlier cycles, the primary question on fertility intentions was “At the time you became pregnant, did you yourself actually want to have (a)nother baby at some time?” In the 2002 survey, the question was changed to “Right before you became pregnant, did you yourself want to have a(nother) baby at any time in the future?” Although only a few words were changed, cognitive testing suggests that the changes influence the way women respond to the question [[3]Klerman L.V. Pulley L.V. Approaches to studying the intendedness of pregnancy in Cycle 6 of the National Survey of Family Growth. Monograph prepared for the staff of the National Survey of Family Growth, National Center for Health Statistics. School of Public Health. University of Alabama at Birmingham, 1999Google Scholar]. It is also possible that the sample for the 1995 NSFG was distinctive in some way. Comparisons of unwanted fertility measured in the 1988, 1995, and 2002 NSFG suggest that the 1995 survey is distinctive, and measurement in 2002 and 1988 is consistent. By any measure, levels of unintended fertility in the United States are too high. However, Kissin and colleagues' [[1]Kissin D.M. Anderson J.E. Kraft J.M. Warner L. Jamieson D.J. Is there a trend of increased unwanted childbearing among young women in the United States?.J Adolesc Health. 2008; 43: 364-371Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar] description of recent fertility trends among young women is likely mistaken.

OBJECTIVES: To determine the trends in sexual activity and unprotected sex among substance-using youth, we examined data from the 1991-2005 Youth Risk Behavior Surveys on drug and alcohol use and sexual risk behaviors.METHOD: We examined the association of alcohol and illicit drug use with recent sexual activity and unprotected sex. We assessed linear trends in behaviors and assessed logistic regression models to examine the relationship of alcohol and illicit drug use on trends in the behavioral outcomes.RESULTS: Strong associations exist between recent sexual activity and alcohol and illicit drug use from 1991 to 2005. In the multivariate model, the odds ratio of having sex in the past 3 months for lifetime illicit drug users compared with nonusers was 3.84 (CI = 3.48-4.23). Among past-month alcohol users compared to nonusers, the odds ratio was 3.23 (CI = 2.93-3.58). Overall, the trend in sexual activity was downward but not for users of alcohol and illicit drugs. Among the sexually active, unprotected sex was not associated with alcohol use over this time period but was associated with illicit drug use.CONCLUSIONS: Illicit drug and alcohol use have a strong association with being recently sexually active. Trends in reported sexual activity declined during 1991-2005, but the trends among alcohol and drug users have not. Many youth remain at dual risk from both substance use and sexual behaviors.

Objective: To describe the extent to which men report they or their partners had made use of infertility services, what services and conditions were reported, and what factors were associated with their use of services.Design: Analysis of the male sample of the 2002 National Survey of Family Growth, a nationally-representative household survey of men 15-44. Analysis involved estimation of percentages, chi-squared tests of difference, and multivariate logistic regression analysis.Setting: The 2002 National Survey of Family Growth, Cycle 6.Patient(s): A total of 4109 sexually experienced men aged 15-44 years in the 2002 National Survey of Family Growth who had received infertility services.Intervention(s): None.Main Outcome Measure(s): Percentage of men reporting that they had sought help with having a baby.Result(s): A total of 7.5% of all sexually experienced men reported a visit for help with having a child; 2.2% reported a visit in the past year, equivalent to 3.3-4.7 million men reporting a lifetime visit and 787,000-1.5 million a past-year visit. Visits were reported more frequently by older men, those currently or previously married, and the more highly educated. Male-related infertility conditions were reported by 18.1% of those who sought help, the most frequent being sperm or semen problems and varicocele.Conclusion(s): Previous estimates of infertility help-seeking were based on data from women. Men report a percentage seeking help that appears to be somewhat lower than reported by women. About I in 5 of those seeking help reported male-related infertility conditions. (Fertil Steril (R) 2009;91:2466-70. (c) 2009 by American Society for Reproductive Medicine.)

Purpose: The majority of births to young women are unintended (either mistimed or unwanted), bearing an increased risk of poor health outcomes for both mother and child. In this analysis, we describe trends of unwanted, mistimed, and intended births reported by all women and specifically by young women in the National Survey of Family Growth (NSFG).Methods: Using data from the 1982, 1988, 1995, and 2002 NSFG surveys, we calculated the proportion of unwanted, mistimed, and intended births by maternal age at birth. For the 1995 and 2002 NSFG surveys, we also assessed birth intentions among 15-24-year-old nulliparous women and the mean number of unwanted births in the past 5 years among all 15-24-year-old women.Results: The proportion of unintended births decreased between 1988 and 1995 but increased between 1995 and 2002. This recent increase was attributed to the increased proportion of unwanted births reported by women <25 years of age from 10.4% in 1995 to 18.6% in 2002 (p < .01). Between 1995 and 2002, the proportion of 15-24-year-old nulliparous women who intended no future births incerased from 8.1% to 10.4% (p < .05), and the mean number of unwanted births per 1000 women aged 15-24 years increased from 25 to 48 (p < .01).Conclusions: Our analyses suggest an increasing trend in unwanted childbearing among young women between 1995 and 2002. Further research is needed to understand the meaning and causes of increased unwanted childbearing among young women and to identify characteristics of those at risk. (C) 2008 Society for Adolescent Medicine. All rights reserved.