Racial/ethnic differences in contraceptive preferences, beliefs, and self-efficacy among women veterans

Lisa S. Callegari, Xinhua Zhao, Eleanor Schwarz, Elian Rosenfeld, Maria K. Mor, Sonya Borrero

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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-efficacy 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.

Original languageEnglish (US)
Pages (from-to)504.e1-504.e10
JournalAmerican Journal of Obstetrics and Gynecology
Volume216
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Veterans
Self Efficacy
Contraceptive Agents
Odds Ratio
Confidence Intervals
Hispanic Americans
Contraception
Sexually Transmitted Diseases
Pregnancy
Contraception Behavior
Hormones
United States Department of Veterans Affairs
Marital Status
Religion
Pregnancy Rate
Parity
Telephone
Counseling
Primary Health Care
Mental Health

Keywords

  • attitudes
  • beliefs
  • contraception
  • fatalism
  • health equity
  • preferences
  • racial disparities
  • self-efficacy
  • unintended pregnancy
  • veteran health
  • women veterans

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Racial/ethnic differences in contraceptive preferences, beliefs, and self-efficacy among women veterans. / Callegari, Lisa S.; Zhao, Xinhua; Schwarz, Eleanor; Rosenfeld, Elian; Mor, Maria K.; Borrero, Sonya.

In: American Journal of Obstetrics and Gynecology, Vol. 216, No. 5, 01.05.2017, p. 504.e1-504.e10.

Research output: Contribution to journalArticle

Callegari, Lisa S. ; Zhao, Xinhua ; Schwarz, Eleanor ; Rosenfeld, Elian ; Mor, Maria K. ; Borrero, Sonya. / Racial/ethnic differences in contraceptive preferences, beliefs, and self-efficacy among women veterans. In: American Journal of Obstetrics and Gynecology. 2017 ; Vol. 216, No. 5. pp. 504.e1-504.e10.
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abstract = "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-efficacy 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.",
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T1 - Racial/ethnic differences in contraceptive preferences, beliefs, and self-efficacy among women veterans

AU - Callegari, Lisa S.

AU - Zhao, Xinhua

AU - Schwarz, Eleanor

AU - Rosenfeld, Elian

AU - Mor, Maria K.

AU - Borrero, Sonya

PY - 2017/5/1

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N2 - 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-efficacy 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.

AB - 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-efficacy 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.

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KW - beliefs

KW - contraception

KW - fatalism

KW - health equity

KW - preferences

KW - racial disparities

KW - self-efficacy

KW - unintended pregnancy

KW - veteran health

KW - women veterans

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