title: Social factors predicting postpartum choice of Norplant among African-American and non-Hispanic white adolescents.
abstract: OBJECTIVE
  This study was designed to determine the factors associated with Norplant choice for postpartum teens.
  
  
  METHODS
  A total of 151 teenagers, ages 12-20 years, who delivered at the Medical Center of Delaware from July to December 1992, were offered insertion of Norplant within 48 h postpartum. A structured interview was conducted in the postpartum period after nondirective counseling sessions including a physical demonstration using anatomical models of various contraceptive methods. Student's t-tests, chi-square, and multivariate analyses were used.
  
  
  RESULTS
  Eighty-six teenagers were African-American (mean age = 17.3 +/- 1.9 years) and 65 non-Hispanic white (NHW) (mean age = 18.3 +/- 1.5 years). The NHW teenagers were older (p < 0.001); the African-American teenagers were more likely to have Medicaid (49% vs. 14%; p < 0.001) and to have one or more friends who use Norplant (62% vs. 34%; p < 0.001). In multivariate analyses, NHW teenagers were more likely to choose Norplant if they had discussed their choice with a parent or guardian [adjusted odds ratio (AOR) = 14.6, 95% confidence interval (CI), 2.12-100.57]; had Medicaid funding (AOR = 12.1; 95% (CI), 10.6-91.34); and had any friends who used Norplant (AOR = 6.3; 95% (CI), 1.38-28.40). However, for African-American teenagers, the strongest predictor for choice of Norplant was number of prior children delivered. After two deliveries, there was a better than four-fold likelihood (AOR = 4.8; 95% (CI), 1.47-15.94) that African-American teenagers would choose Norplant. For the African-American teenagers, parental discussion, Medicaid status, and friends' use of Norplant were not as important as family size, but far greater percentages of the African-American teenagers had access to Medicaid funding and peers who used Norplant.
  
  
  CONCLUSIONS
  NHW and African-American teenagers choose Norplant for different reasons. Lack of funding may have been a barrier to choosing Norplant. Discussions with parents and friends have a positive influence on choosing Norplant for NHW teenagers. African-American teenagers were more likely than NHW to have Medicaid coverage, and more frequently choose Norplant if the current birth was their third child.
authors.affiliation: Department of Pediatrics, Medical Center of Delaware, Newark, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Mears
authors.forename: M L
authors.initials: ML
authors.lastname: Hediger
authors.forename: S S
authors.initials: SS
authors.lastname: Martin
authors.forename: T O
authors.initials: TO
authors.lastname: Scholl
authors.forename: J P
authors.initials: JP
authors.lastname: Kramer
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D005190:Family; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000191:economics; D016015:Logistic Models; D008484:Medicaid; D010298:Parity; D010379:Peer Group; D011247:Pregnancy; D011253:Pregnancy in Adolescence; D014481:United States; D044465:White People
chemical_list: D016912:Levonorgestrel