Browsing by Subject "Contraception"
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Item Contraceptive Care for Texas Teens: Access, Advocacy, and Adjudication(2018-12-04) Gessner, McKenna; Aiken, AbigailMy thesis examines the landscape of contraceptive care for adolescents in Texas. While barriers to receiving sexual and reproductive health services have been identified, there is limited research focused on how these barriers manifest at the state level. In my work, I pay special attention to Texas, a state where policies restrict the level of confidentiality guaranteed to minors. This mixed methods project has three distinct elements. The first part of my thesis assesses existing literature on adolescent access barriers to contraceptive services in the United States from the last decade. I synthesize these findings in a systematic review which examines the experiences of both adolescents seeking these services and healthcare providers delivering these services. In this review, I discuss four major types of barriers to obtaining contraception that adolescents must navigate: finances, family, providers, and health systems. The second portion of my thesis involves qualitative data analysis from interviews with key informants in the Austin and Houston areas. These interviews feature the perspectives of those working within the arena of adolescent contraceptive service delivery in Texas. This dataset highlights recent changes in the Texas healthcare system and points to specific state-level challenges that impact the provision of contraception to minors. In the third and final part, the project culminates in an analysis of state policy, with recommendations for how health services might be improved for adolescents in Texas.Item Demographic diversity in the measurement and meaning of unintended pregnancy(2014-08) Aiken, Abigail R. A.; Osborne, Cynthia Anne, 1969-; Potter, Joseph E.Unintended pregnancy is a significant public policy issue in the United States, yet current understanding of the measurement and meaning of women’s pregnancy intentions is incomplete. The aim of this dissertation is to provide new theoretical insight into women’s childbearing intentions and feelings about pregnancy, particularly when these two measures appear to be incongruent (i.e. women report feeling happy about pregnancy, but at the same time report wanting no more children). Incongruence is particularly common among Hispanic women, and current literature tends to view such women as ambivalent, assuming that they lack a clear and strong desire to avoid conception. Ambivalence, in turn, has been linked to less effective contraceptive use. Using a mixed-methods approach, this dissertation examines the hypothesis that incongruent intentions and feelings are not necessarily a reflection of ambivalence but rather two distinct concepts: women may be quite resolute about avoiding future pregnancies, yet for various reasons still express happiness at the prospect of a pregnancy. In Chapter 1, we examine prospectively measured happiness and intentions among a cohort of Latina pill-users at the U.S.-Mexico border, providing evidence that feelings of happiness about pregnancy may co-exist with effective use of contraception and with plans to continue method use long-term to prevent conception. In Chapter 2, we investigate the relationship between happiness and contraceptive desires, demonstrating that women with incongruent intentions and feelings often desire highly effective or permanent methods that they do not have the ability to access. Finally, in Chapter 3, we explore the concepts of happiness and intentions and the factors underlying each from women’s own perspectives through in-depth interviews, and provide a range of explanations for why happiness about pregnancy may be expressed even when another child would be a significant financial or emotional burden. Findings strongly suggest that automatically classifying women with incongruent intentions and feelings as ambivalent may lead to inaccurate measurement of unintended pregnancy, hinder understanding of the difficulties these women face in obtaining effective contraception, and limit the ability to devise strategies to prevent unintended pregnancy and address disparities across racial and ethnic groups.Item Determinants of fertility across context : a comparison of Mexican and Turkish immigrant women(2011-05) White, Kari Lyn; Potter, Joseph E.; Buckley, Cynthia J.; Raley, R Kelly; Hummer, Robert A.; Stolp, ChandlerImmigrant women are frequently found to have higher fertility relative to women in the majority population. This is often attributed to their socioeconomic characteristics, cultural preferences and patterns of childbearing, and adaptation to the destination context. However, several limitations in the research to date may mask the associations and processes which shape women’s fertility: 1) frequently used indicators are not sensitive to the way in which fertility is shaped by the migration process 2) key proximate determinants of fertility are often not integrated into analyses and 3) non‐migrant women in sending countries are often excluded as a reference for immigrant women’s childbearing behavior. In order to assess how women’s migratory moves and social context affect fertility, I compare the risk of first birth and patterns of contraceptive use at higher‐order parities for non‐migrant, immigrant and native‐born women. For these analyses, I use data from nationally‐representative surveys of reproductive health and family formation from Mexico, the United States, Turkey and Germany. The results from these analyses demonstrate that both foreign‐born Mexican‐ and Turkish‐origin immigrant women experience first birth earlier than non-migrants, second generation immigrants, and native-born women at destination. However the underlying determinants of earlier birth are different for these two groups. There are also differences for second generation women; US-born Mexicans experience first birth at significantly younger ages than whites, whereas age at first birth is very similar for German-born Turkish women and ethnic Germans. Furthermore, patterns of contraceptive use among immigrant women who have at least one child are notably different than patterns observed for non-migrants. US-born women have similar contraceptive use compared to whites, but Mexican-born women are less likely to use permanent and highly effective methods, even after controlling for fertility intentions. Turkish-origin women in Germany exhibit large differences in contraceptive use relative to non-migrant women, particularly the very low reported use of withdrawal. These findings indicate that fertility determinants vary across origin and destination context. The observed differences between Mexican- and Turkish-origin women suggest that distinct processes of migration, socialization, and access to contraception lead to variation in the fertility outcomes for these two groups.Item Essays in health economics(2012-05) Mulligan, Karen Michelle; Abrevaya, Jason; Black, Sandra; Hamermesh, Daniel; Trejo, Stephen; Hayward, MarkThis dissertation consists of three chapters on health economics, two of which focus on contraception and the third on vaccination. Chapter one examines the impact of state-level contraception insurance coverage mandates on women's fertility outcomes. It utilizes variation in mandated insurance coverage for contraception across states and over time to determine the causal impact of insurance coverage of contraception on fertility outcomes, specifically abortion rates and birth rates. State-level results indicate that a mandate decreases abortion rates by 6% in the year of introduction and decreases birth rates by 3% two years following introduction, with the magnitude of both effects remaining steady over the long run. Chapter two utilizes longitudinal data on varicella (chicken pox) immunizations in order to estimate the causal effects of state-level school-entry and daycare-entry immunization mandates within the United States. We find significant causal effects of mandates upon vaccination rates among preschool children aged 19-35 months; these effects appear in the year of mandate adoption, peak two years after adoption, and show a minimal difference from the aggregate trend about six years after adoption. For a mandate enacted in 2000, the model and estimates imply that roughly 20% of the short-run increase in state-level immunization rates was caused by the mandate introduction. We find no evidence of differential effects for different socioeconomic groups. Combined with the previous cost-benefit analyses of the varicella vaccine, the estimates suggest that state-level mandates have been effective from an economic standpoint. Chapter three utilizes variations in access to emergency contraception (EC) across states to determine the impact of over the counter access on abortion rates, birth rates, and risky sexual behavior. Using state-level data, a flexible time specification finds that giving individuals over the counter access to EC reduces births and increases risky behavior, which is captured by STD rates. These effects are larger for adults compared with teenagers, however, there are not significant differential effects by race. Finally, the effects are increasing over time following the legislation.Item Essays on education, inequality and society(2013-12) Pechacek, Julie Ann; Youngblood, Sandra BlackThis dissertation consists of three chapters on labor economics. The first two chapters focus on education, and the third examines inequality and incarceration. Chapter one explores whether college students strategically delay exiting college in response to poor labor market conditions. It exploits variation in U.S. state unemployment rates to identify the causal impact of unemployment rates on time to graduation. Strategic delay is observed among both men and women. Results indicate that students delay graduation by approximately 0.4 months for each percentage point increase in junior-year unemployment rates, implying the average student delays by approximately half a semester during a typical recession. Effects are greatest for men with freshman majors in education, professional and vocational technologies, the humanities, business, and the sciences, and for women in education, the sciences, or undeclared. Delays are robust to fluctuations in students’ in-school work hours, earnings, and job market conditions. Chapter two assesses the impact of over-the-counter access to emergency contraception on women’s educational attainment using variation in access produced by state legislation since 1998. Approximately 5% of American women of reproductive age experience an unintended pregnancy annually, indicating a significant unmet need for contraception. Results indicate that cohorts with greater access to emergency contraception are more likely to graduate from high school and attain the associate’s degree. Effects for high school graduation are most pronounced among black women, while increases in associate’s degree attainment are driven primarily by white and Hispanic women. Chapter three explores the relationship between incarceration and generational inequality. Using a calibrated OLG model of criminal behavior with race, inheritance and endogenous education, I calculate how much longer prison sentences, and a higher likelihood of capture and conviction contribute to income inequality. Results indicate that changes to criminal policy mirroring those of the “tough on crime” legislation of the 1980s and 1990s, including an 18% increase in criminal apprehension and a 68% increase in prison sentence length, have little impact on inequality as measured by the Gini coefficient. Instead, the model provides evidence that these enhanced enforcement measures deter crime and decrease incarceration rates.Item The influence of personal characteristics, attitude, subjective norm, perceived behavioral control, and recent past behavior as predictors of university students’ intention to utilize emergency contraception(2011-05) Griggs, Scott Karr; Brown, Carolyn M., Ph. D.; Lawson, Kenneth A.; Rascati, Karen L.; Wilson, James P.; Hargrave, LanceThe purpose of this study was to use the Theory of Planned Behavior (TPB) to predict university students’ intention to use emergency contraception (EC). The study explored the utility of the TPB model constructs (attitude [A], subjective norm [SN], perceived behavioral control [PBC]) as well as recent past behavior (RPB) to predict students’ intention to utilize EC. The study also investigated the significance of demographic and personal characteristics—age and gender in particular—as they relate to the TPB components and RPB. A web-based survey, developed from three structured focus groups, was pretested and emailed to 2,000 university students. An overall usable response rate of 21.0 percent was obtained. In general, university students intended to use EC should the need occur, held favorable attitudes toward the use of EC, were somewhat influenced by social norms regarding EC use, and perceived themselves to have some control over EC utilization. For direct measures (TPB), A, SN, and PBC were significant predictors of intention to use EC. The direct model explained 49.2 percent of the variance in intention. Using indirect measures, A and SN were significant predictors of intention, but PBC was not; the indirect model accounted for 41.3 percent of the variance in intention to take EC. Attitude was the strongest TPB predictor for both models, followed by SN and PBC. The RPB variable did not significantly improve the TPB model. While hypothesized age differences were not significant, gender differences showed female students having a more favorable A and SN as well as a stronger PBC (direct measures) toward the use of EC. In addition, several statistically significant relationships occurred between demographic/personal characteristics and the TPB constructs. In summary, this study identified several key factors that partially explain why university students either intend or do not intend to use EC if needed. The TPB has utility in predicting utilization of EC in university students. Focusing particular attention on A, as well as SN and PBC, will allow researchers, educators, healthcare professionals, and legislators to develop strategies and educational programs to enable men and women to use EC responsibly.Item Peers, knowledge, and experience : influences on frame of reference biases with self-efficacy of contraceptive self-control and teenage pregnancy(2017-12) O'Brien, Joseph Michael; Yeager, David S.Adolescents’ feelings of self-efficacy regarding contraceptive use may be an important contributor to actual contraception use, and, consequentially, the avoidance of undesirable outcomes such as teen pregnancy. However, the meaning of self-assessments of contraceptive self-efficacy—and thus its ability to predict improved outcomes—may be substantially influenced by the context of one’s school peers. Norming responses to the self-efficacy views held by one’s school peers may produce frame of reference biases, lowering average responses in higher average self-efficacy schools. This may obscure or inverting school-level relationships between self-efficacy and teen pregnancy. Additionally, personal and contextual factors may influence the predictive validity of contraceptive self-efficacy, in particular, prior sexual experience and effective contraceptive knowledge. Using a sample of n = 5247 female students from the Add Health database who have contraceptive self-efficacy and longitudinal pregnancy data, we show that student-level self-efficacy predicts reduced teenage pregnancy, but only among individuals with prior sexual experience. School-level variance in contraceptive self-efficacy was minimal, and did not predict school-average teen pregnancy, providing some support for the frame of reference bias account. Additionally, an interaction was observed between school-level self-efficacy and school-level knowledge of proper contraceptive use, suggesting that self-views regarding contraception may also depend on the likelihood that one and one’s partner will use contraception correctlyItem Short-acting hormonal contraceptive use among low-income postpartum women in Texas(2019-12-05) Burke, Kristen Lagasse; Potter, Joseph E.Short-acting hormonal methods of contraception, including the pill, patch, ring, and injectable, are often the first women use after delivery. This study assesses use and continuation of short-acting hormonal methods among low-income postpartum women who began using one of these methods within six months postpartum using data from a cohort study of women who delivered in one of eight Texas hospitals. Additionally, we consider predictors of discontinuation, reasons for discontinuation, and subsequent method use. Six months after initiating use of a short-acting method, over half of women had discontinued, and nearly three-quarters discontinued within one year of initiation. Hispanic, foreign-born women were less likely to discontinue than the Hispanic, U.S. born, and those who preferred a more effective method were more likely to discontinue than those who were using their preferred method. The most common reasons for discontinuation were side effects and access or cost. More than two-thirds of women began using less-effective methods of contraception after discontinuing a short-acting method, while only thirteen percent switched to a method they said they preferred prior to discontinuation. The high rates of discontinuation coupled with subsequent use of less-effective methods, despite preferring methods at least as effective as the pill, patch, ring, or injectable, illuminate the importance of providing low-income postpartum women with high-quality counseling and expanded access to contraceptive care. These changes in policy and practice would allow women to more readily enact their contraceptive preferences, which may involve continuing or switching methods