title: Factors associated with lack of effective contraception among obese women in the United States.
abstract: OBJECTIVE
  To identify factors associated with contraceptive nonuse and use of less effective methods among obese women in the US.
  
  
  METHODS
  We analyzed data from sexually active obese women (body mass index >30 kg/m²) age 20-44 using the 2006-2010 National Survey of Family Growth. We conducted multinomial logistic regression to assess associations between current contraceptive use and demographic, reproductive and health services factors. Specifically, we compared contraceptive nonusers, behavioral method users (withdrawal and fertility awareness) and barrier method users (condoms) to prescription method users (pill, patch, ring, injection, implant and intrauterine device).
  
  
  RESULTS
  Of 1345 obese respondents, 21.5% used no method, 10.3% behavioral methods, 20.8% barrier methods and 47.4% prescription methods. Only 42.4% of respondents overall and 20.4% of nonprescription method users reported discussing contraception with a provider in the past year. Similar to findings in the general population, behavioral method users were more likely to have previously discontinued a contraceptive method due to dissatisfaction [adjusted RR (aRR), 1.93; 95% confidence interval (CI), 1.09-3.44], and nonusers were more likely to perceive difficulty becoming pregnant (aRR, 3.86; 95% CI, 2.04-7.29), compared to prescription method users. Respondents using nonprescription methods were significantly less likely to have discussed contraception with a healthcare provider (nonusers: aRR, 0.16; 95% CI, 0.10-0.27; behavioral methods: aRR, 0.13; 95% CI, 0.06-0.25, barrier methods: aRR, 0.15; 95% CI, 0.09-0.25) than prescription method users.
  
  
  CONCLUSIONS
  Obese women who discuss contraception with a provider are more likely to use effective contraception and may be less likely to experience unintended pregnancy; however, over half report no recent discussion of contraception with a provider.
  
  
  CONCLUSIONS
  Efforts are needed to increase contraceptive counseling for obese women, who face increased risks of morbidity from unintended pregnancy.
authors.affiliation: Department of Obstetrics & Gynecology, University of Washington, Seattle WA; Department of Epidemiology, University of Washington, Seattle WA; Health Services Research and Development (HSR&D), Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA. Electronic address: lcallega@uw.edu.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Callegari
authors.affiliation: Health Services Research and Development (HSR&D), Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA; Department of Medicine, University of Washington, Seattle WA.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Nelson
authors.affiliation: Department of Medicine, University of Washington, Seattle WA; Group Health Research Institute, Seattle WA.
authors.forename: David E
authors.initials: DE
authors.lastname: Arterburn
authors.affiliation: Department of Obstetrics & Gynecology, University of Washington, Seattle WA; Department of Health Services, University of Washington, Seattle WA.
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Prager
authors.affiliation: Department of Obstetrics & Gynecology, University of Washington, Seattle WA; Department of Epidemiology, University of Washington, Seattle WA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Schiff
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics & Gynecology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003268:Contraception Behavior; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006293:Health Promotion; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D009017:Morbidity; D009765:Obesity / Q000453:epidemiology / Q000503:physiopathology*; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000503:physiopathology*; D049168:Pregnancy, Unplanned; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Contraception; Contraceptive counseling; Obesity; Unintended pregnancy