Concerns About the Cost of Contraception Among Young Women Attending Community College

Perceived Barriers to Care for Urinary Tract Infections in Emerging Adulthood

BACKGROUND

Urinary tract infections (UTIs) are common in emerging adulthood, yet barriers to care are not well understood.

OBJECTIVE

To examine perceived barriers to UTI care among emerging adults, analyzing differences by social determinants of health.

DESIGN

Supplementary study to a cluster randomized controlled trial in 29 community colleges in California and Texas. Online surveys were administered May to October 2024. Multivariable mixed-effects logistic and linear regression were used to predict the most common barriers to UTI care and number of barriers by participant characteristics.

PARTICIPANTS

A total of 667 individuals aged 19-29, assigned female at birth, and sexually experienced with male partners.

MAIN MEASURES

Outcomes included 14 items assessing perceived barriers to UTI care, developed using the Levesque model of healthcare access as a framework, and a composite score of the total number of barriers.

KEY RESULTS

The average age of participants was 22.6 years; 56% identified as Hispanic and 30% reported a prior UTI. The most common perceived barriers to UTI care were concerns about hearing bad news (59%), appointment delays (46%), cost (45%), fear of parents learning about symptoms (42%), time constraints (40%), and concerns that they might have a sexually transmitted infection (37%). On average, participants reported 4.18 barriers; in multivariable regression, participants reported significantly more barriers if they were younger (β =  - 0.19, SE = 0.06), Asian/Pacific Islander (β = 0.71, SE = 0.35), non-English language speakers at home (β = 0.57, SE = 0.25), food insecure (β = 1.32, SE = 0.24), uninsured (β = 0.65, SE = 0.28), or without a usual source of care (β = 0.97, SE = 0.23).

CONCLUSIONS

Findings showed substantial challenges to UTI care among emerging adults, especially among socially disadvantaged participants. Youth-focused interventions, including education and expanded telehealth services, are needed to promote health equity for UTIs.

Continuity of Health Insurance Coverage and Choice of Contraception Method

Objective: To evaluate whether part-year or year-round uninsurance is associated with reduced likelihood of using prescription contraception methods rather than using nonprescription methods or using no contraceptive methods. Methods: We identified nonpregnant and sexually active female respondents participating in the National Longitudinal Survey of Youth, 1997 cohort between 2007 and 2019. At each interview, we classified the contraceptive method used most frequently as prescription, nonprescription, or none, and used mixed-effects multinomial logistic regression to predict contraceptive method based on health insurance coverage over the past year (classified as continuous private, continuous public, part-year uninsured, or year-round uninsured). Results: Our sample included 3,738 respondents and 18,678 observations (person-years). In the most recent interview, 35% of respondents used prescription contraception, 16% used nonprescription methods only, and 49% used no method. On multivariable analysis using all available years of data, respondents with part-year uninsurance were 20% less likely to use prescription rather than nonprescription methods, as compared to respondents with continuous private insurance (95% confidence interval: -31%, -6%; p = 0.007), but did not differ on the likelihood of using prescription methods rather than no method. Conclusions: Part-year uninsurance was associated with lower use of prescription contraceptive methods rather than nonprescription methods when compared with continuous private insurance coverage. Use of prescription contraceptives was lowest among people with year-round uninsurance. Policy efforts ensuring continuous insurance coverage with greater flexibility of eligibility and enrollment periods may promote greater access to prescription contraceptives.

Mental Health Distress and Delayed Contraception Among Older Adolescents and Young Adults

Background: Symptoms of mental distress increased sharply during the COVID-19 pandemic, especially among older adolescents and young adults. Mental health distress may make it more challenging for young people to seek other needed health care, including contraception. This study explored the association of symptoms of depression, anxiety, and stress with delays in getting a contraceptive method or prescription. Materials and Methods: Data from a supplementary study (May 15, 2020-March 20, 2023) to a cluster randomized trial in 29 sites in Texas and California were used. The diverse study sample included community college students assigned female at birth of ages 18-29 years (n = 1,665 with 7,023 observations over time). We measured the association of depression (CES-D [Center for Epidemiologic Studies Depression Scale]) or anxiety and stress (DASS-21 [Depression Anxiety Stress Scales]) symptoms with delayed contraceptive care-seeking with mixed-effects multivariable regression with random effects for individual and site. We controlled for age and sociodemographic factors important for access to care. Results: Over one-third of participants (35%) reported they delayed getting the contraceptive method they needed. Multivariable regression results showed increased odds of delayed contraceptive care among participants with symptoms of depression (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.27-1.96). Likewise, delays were associated with anxiety and stress symptoms (aOR 1.46, 95% CI 1.17-1.82). Adolescents were more likely to delay seeking contraception than young adults (aOR 1.32, 95% CI 1.07-1.63). Conclusions: Results showed a strong association between mental distress and delayed contraception. Interventions are needed to increase contraceptive access for young people delaying care, along with supportive mental health care services, including for adolescents who face elevated odds of delay. ClinicalTrials.gov Identifier: NCT03519685.

Use of telemedicine to obtain contraception among young adults: Inequities by health insurance

OBJECTIVES

The objective of this study was to describe the use of telemedicine for contraception in a sample of young adults and examine differences by health insurance coverage.

STUDY DESIGN

We analyzed survey data collected from May 2020 to July 2022 from individuals at risk of pregnancy aged 18 to 29 recruited at 29 community colleges in California and Texas. We used multivariable mixed-effects logistic regression models with random effects for site and individual to compare the use of telemedicine to obtain contraception by insurance status, sociodemographic characteristics, and state.

RESULTS

Our analytic sample included 6465 observations from 1630 individuals. Participants reported using a contraceptive method obtained through telemedicine in just 6% of observations. Uninsured participants were significantly less likely than those privately insured to use contraception obtained through telemedicine (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.31-0.97), as were participants who did not know their insurance status (aOR, 0.54; 95% CI, 0.29-0.99). Texas participants were less likely to use contraception obtained via telemedicine than those in California (aOR, 0.42; CI: 0.25-0.69).

CONCLUSIONS

Few young people in this study obtained contraception through telemedicine, and insurance was crucial for access in both states.

IMPLICATIONS

Although telemedicine holds promise for increasing contraceptive access, we found that few young adults were using it, particularly among the uninsured. Efforts are needed to improve young adults' access to telemedicine for contraception and address insurance disparities.

Use of preferred contraceptive method among young adults in Texas and California: A comparison by state and insurance coverage

BACKGROUND

Young people's ability to use their preferred contraceptive method is an indicator of reproductive autonomy and healthcare access. State policies can hinder or facilitate access to a preferred contraceptive method.

OBJECTIVE

This study compared use of preferred contraceptive method in Texas and California, states with contrasting health policy contexts that impact health insurance coverage and access to subsidized family planning services.

METHODS

We used baseline survey data from an ongoing cluster randomized controlled trial of sexually active students, assigned female at birth, ages 18-25, at 29 community colleges in Texas and California (N = 1,974). We described contraceptive preferences and use, as well as reasons for nonuse of a preferred method. We conducted multivariable-adjusted mixed-effects logistic regression analyses for clustered data, and then calculated the predicted probability of using a preferred contraceptive method in Texas and California by insurance status.

RESULTS

More Texas participants were uninsured than Californians (30% vs. 8%, p<0.001). Thirty-six percent of Texas participants were using their preferred contraceptive method compared to 51% of Californians. After multivariable adjustments, Texas participants had lower odds of using their preferred method (adjusted odds ratio = 0.62, 95% confidence interval = 0.48-0.81) compared to those in California. Texas participants in all insurance categories had a lower predicted probability of preferred method use compared to California participants. In Texas, we found a 12.1 percentage-point difference in the predicted probability of preferred method use between the uninsured (27.5%) and insured (39.6%) (p<0.001). Texans reported financial barriers to using their preferred method more often than Californians (36.7% vs. 19.2%, p<0.001) as did the uninsured compared to the insured (50.9% vs. 18.7%, p<0.001).

CONCLUSION

These findings present new evidence that state of residence plays an important role in young people's ability to realize their contraceptive preference. Young people in Texas, with lower insurance coverage and more limited access to safety net programs for contraceptive care than in California, have lower use of preferred contraception. It has become urgent in states with abortion bans to support young people's access to their preferred methods.