Teenage pregnancy rates in the U.S. are among the highest in the world for industrialized countries. The generally accepted reason is not that American teenagers are more sexually active but that they contracept less than do teenagers in other industrialized countries. This dissertation reports on a study that was undertaken for two purposes. One purpose was to develop and test two models of contraceptive choice among American teenagers: a "likelihood-of-use" model to predict the likelihood of sexually active teenagers' using contraception, and a "medical-or-nonmedical" model to predict whether teenagers who use contraception are likely to use medical or nonmedical methods. The second purpose was to explore the level of support for the two models among black and white teenagers separately. The theoretical underpinning of the models is value-expectancy theory. The models' exogenous variables are based on the prevailing strategy for preventing teenage pregnancy among American teenagers, a strategy initially advocated by Joy G. Dryfoos. The strategy involves the use of access-to-contraception programs, educational programs, and life options programs. The data used in the study were on 449 subjects drawn from the 1979 National Survey of Young Women, a probability-sample survey of women in the U.S. aged 15-19. The subjects were those survey respondents who were black or white, sexually active, never married, and never pregnant. The statistical technique used in the study was logistic regression. Test results supported three of four hypotheses constituting the medical-or-nonmedical model and two of seven hypotheses constituting the likelihood-of-use model. The results for each model offered support for using two of the three programs constituting the prevailing pregnancy-prevention strategy: access-to-contraception programs and educational programs. Exploration of the level of support for each of the two models among black and white teenagers indicated that support for each model differed between the two groups of teenagers.

Thesis (M.S.C.E.) / OBJECTIVES: Half of all U. S. pregnancies are unintended, and of these, about 6 out of 10 are carried to term. These are known as “unintended births,” and they are at elevated risk for adverse social, economic and health outcomes. The goal of this study was to examine, using the latest data from the National Survey of Family Growth (2006-2010), whether women with unintended births were more likely than their counterparts to use effective postpartum contraception. METHODS: In this retrospective cohort study of U.S. women ages 15-44, all births within three years of the study interview were classified as intended or unintended, and the method and timing of postpartum contraception were ascertained. Our primary outcome was time to initiation of a highly effective postpartum contraceptive method during the first postpartum year. Highly effective contraception was defined as a method with less than one pregnancy per 100 woman-years of typical use. Secondary outcomes included time to initiation of any contraceptive use over the first postpartum year, and postpartum contraceptive non-use. RESULTS: Complete data was available for 2,691 births. Young, black, undereducated, unmarried, and poor women, as well as those who paid for their delivery with Medicaid were more likely than their counterparts to have unintended births (p<0.0001). After adjustment for confounders, women with unintended births were 1.4 (95% CI: 1.2-1.6) times as likely to use highly effective postpartum contraception compared to women with intended births. During the first month postpartum, women with unintended pregnancies were 0.8 times as likely to use no contraceptive method as women with intended births (95% CI 0.7-0.9, p=0.0046); there were no differences between groups for the rest of the first postpartum year. Married women, white women, women with college degrees, and women with who were giving birth for the first time were somewhat more likely than others to initiate effective contraception after an unwanted pregnancy. CONCLUSION: A relatively small difference in time to initiation of highly effective postpartum contraception, along with an almost 1 in 5 prevalence of postpartum contraceptive nonuse for the entire first postpartum year, indicates that women in this study sample are not well-prepared to prevent recurrence of unintended birth. These results add to the body of data supporting effective postpartum contraception as a public health priority.

In order to evaluate the short term metabolic effects of gossypol on the testes as well as any possible effects on the secondary sex organs, Balb C mice were injected subcutaneously with various doses of gossypol (0.25‐25.0 mg/kg body weight) in corn oil for 10 days. Wet weights of several different secondary sex reproductive organs decreased during gossypol treatment. However, wet weights of the testes during treatment remained equal to or greater than control values. Following 10 days of gossypol treatment, incorporation of [3H]thymidine or [3H]amino acids into trichloroacetic acid precipitable macromolecules was inhibited in the seminal vesicles and ventral prostates normalized to either DNA or wet weight. Treatment with gossypol also had an inhibitory effect on epididymal sperm count at the two highest doses. These results demonstrate that gossypol will decrease sperm count at high dose levels after treatment of male mice for as short as 10 days. However, its overall effects are not limited to the testes and spermatogenesis but, in addition, it has dramatic inhibitory effects on protein and nuclei acid metabolism in the secondary sex organs.

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The uterine endometrium undergoes cyclical phases of cell proliferation, cell differentiation, and menstruation under the influence of the ovarian hormones, estrogen and progesterone. Since the data necessary to create a classical kinetic model of these signaling pathways is lacking, we used a Boolean network approach that includes the influences of various growth factors and the differential expression of their receptors under the influence of estrogen and progesterone. Results show a gain in endometrial tissue and loss of tissue during menstruation that mirrors what can be expected over the course of a normal menstrual cycle in women, where the endometrium typically reaches a thickness of approximately 10 mm. We utilized an existing model of the normal menstrual cycle that was used to predict hormonal changes following administration of GnRH analogues. We adapted this model to provide the hormonal and ovarian compartments that would interact with our model of the endometrial cycle.

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INTRODUCTION) Modern contraception is a safe and effective clinical service for reducing unintended pregnancy and improving birth spacing for women. Provider counseling is an important factor that may influence women’s decision making, satisfaction, and self-efficacy with contraception use. This study measures women’s perceptions of recent provider interactions and examines the extent to which these perceptions are associated with method satisfaction and confidence in use. We hypothesize that women who perceive more positive interactions are ultimately more satisfied and confident with their contraceptive method choice. METHODS) A cross-sectional survey of adult reproductive-aged women in two southern states (aged 18 to 44 years old) was used for the analysis. The Statewide Survey of Women was conducted in 2017 by NORC at the University of Chicago. Women were asked to rate providers across a series of statements reflecting aspects of patient-centered contraceptive counseling using a 5-point Likert scale. Responses were dichotomized to reflect those with very good/excellent experiences compared to those with less favorable experiences (Poor, Fair, Good). Women were subsequently asked about their level of satisfaction with current contraceptive methods and confidence in use, also using a 5-point Likert scale. These measures were also dichotomized. A chi-squared test for independence and unadjusted logistic regression models were used to examine associations between patient-provider interactions, satisfaction and confidence in contraceptive use. FINDINGS) The survey included 4,281 respondents. The majority of women reported being satisfied with their current contraceptive method (92.6%) and confident in its use (94.9%). Approximately 93% of women who felt respected as a person by their provider also reported being satisfied with their current birth control method, compared to 73% among women who did not feel respected as a person (p<0.001). Among women who felt their provider allowed them to say what mattered to them about their birth control method, 93.5% were satisfied with their current method, compared to 75% among those who did not feel allowed to say what mattered (p<0.001). Women who felt like their provider took their preferences for birth control into consideration were also more satisfied with their current birth control method compared to those who did not feel the same way (93.7% versus 73.5%; p<0.001). Women who felt their provider allowed them to say what mattered and those who felt their provider took their preferences into consideration were also associated with higher rates of confidence in correct use. Women reporting that their provider gave them enough information to make the best decision about their birth control method was also associated with greater confidence in correct use (95.6% versus 87.5%; p=0.007). CONCLUSION) Findings suggest that positive patient-provider interactions are associated with increased satisfaction in current contraceptive method use. Interestingly, women reporting that providers did not give them enough information to make the best decision about birth control methods also reported being less confident in using their current method. Collectively, these findings support existing evidence suggesting that patient-provider interactions are important for patient-centered care and can be used to inform future clinical practice guidelines around contraceptive counseling.

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