Demographic, social and reproductive history characteristics of the pooled sample (2002 and 2006–2008 combined) are reported in Table , and were similar across survey years. The mean age of the sample was 19 years, with 53% adolescent and 47% young adult women. Over half the sample identified as White race/ethnicity (56%), while 18% identified as Black, 20% as Hispanic and 6% as other. Forty-two percent reported education level as still in secondary school, while 35% reported having had at least some college. Fifty-two percent of the sample was below 200% of the federal poverty line; 25% reported being uninsured at some point during the previous year. For sexual activity status, 63% reported ever having had vaginal intercourse.
Demographic, social and reproductive characteristics of adolescent and young adult women in the USA, 2002 and 2006–2008.
Reproductive health service use is described in Tables and . Among the pooled sample, 58% of women reported ever receiving any family planning services at a clinic. For recent service use, 59% of the total sample reported they visited a medical provider for reproductive health care one or more times during the past 12 months. Nearly half of the sample (48%) reported having used contraceptive services, including provision of contraceptive method (41%) or EC (3%), contraceptive and EC counseling (23 and 7%, respectively) and contraceptive check-ups (27%). Over one-third of women reported having received any counseling by a health provider during a non-counseling service visit (37%). Other services less commonly used included STI testing and/or treatment (17%), pregnancy testing (16%) and abortion (1%) services.
Reproductive health and contraceptive service use by adolescent and young adult women in the USA, 2002 and 006–2008.
Reproductive health service use by US adolescent and young adult women who have had sexual intercourse, 2002 and 2006–2008.
All types of service use were more common among women who had experienced sexual intercourse when compared with virgin women (P<0.001) (Table ). Among the 63% of non-virgin women, 79% reported recent reproductive health and 65% contraceptive service use. Eighty percent of non-virgin women reported ever having used family planning clinic services.
Service use also varied by age (results not shown). Adolescents reported less use of all types of recent reproductive health (33% less) and contraceptive services (25% less) than young adults (P<0.001). For lifetime clinic service use, 41% of adolescents (n=524 in 2002, 439 in 2006) reported use when compared with 77% of young adults (n=890 in 2002, 721 in 2006) (P<0.001).
We examined changes in types of reproductive health and contraceptive services used from 2002 to 2006–2008 (Table ). The proportion of all young women reporting lifetime service use declined 15% between 2002 and 2006–2008 (P<0.001). Recent reproductive service use also decreased over time, 8% overall (P=0.01) and 6% for contraceptive services (P=0.02), including birth control and EC counseling (4%, P≤0.001 and 1%, P=0.04, respectively). Gynecological exam service use decreased by 8% (P=0.03). Service use that remained stable over time included visits for STI testing and/or treatment (P=0.89), pregnancy testing (P=0.83), abortion (P=0.34) and receipt of provider counseling at the time of a non-counseling visit (P=0.17).
Changes in types of services used from 2002 to 2006–2008 were consistent when stratified by sexual intercourse experience (Table ). Among the sexually experienced young women, lifetime service use declined by 10% (P<0.001) from 2002 to 2006–2008 and recent service use declined by 5% (P=0.04), including a decrease in any contraceptive services (5%, P=0.04), contraceptive counseling (3%, P=0.007) and pelvic exam services (5%, P=0.03).
In multivariate regression models, controlling for key demographic, social and reproductive history variables noted in Table , by 2006–2008, women were 40% less likely to use any recent reproductive health services than in 2002 [odds ratio (OR) 0.6, 95% confidence interval (CI) 0.5,0.8, P<0.001]. The odds of contraceptive service use were 30% less (OR 0.7, CI 0.6, 0.9 P=0.005). Similar to reduced odds, though smaller in magnitude, were found among sexually experienced women for reproductive health (OR 0.7, CI 0.6, 1.0, P=0.02) and contraceptive (OR 0.8, CI 0.6, 1.0, P=0.03) service use in 2006–2008 versus 2002.