title: Adverse Birth Outcomes in Colorado: Assessing the Impact of a Statewide Initiative to Prevent Unintended Pregnancy.
abstract: OBJECTIVE
  We assessed whether living in counties with Title X clinics and increased use of long-acting reversible contraception (LARC) in Colorado are associated with decreased risk of adverse birth outcomes.
  
  
  METHODS
  We linked Title X clinic counties to the Colorado birth data set by using the mother's county of residence. We compared low birth weight (LBW) and preterm birth (PTB) in 2008 and 2012, in counties with and without Title X clinics. We compared the relationship between LARC use and the incidence of LBW or PTB in 2012 for women living in counties with Title X clinics.
  
  
  RESULTS
  For women living in counties with Title X clinics, the odds of PTB were significantly lower in 2012 compared with 2008 (odds ratio = 0.85; 95% confidence interval = 0.81, 0.89; interaction P = .02). For women living in Title X clinic counties in 2012, a higher proportion of LARC use (> 12.4%) was significantly associated with decreased risk of PTB (P = .02) compared with a low proportion of LARC use (≤ 4.96%).
  
  
  CONCLUSIONS
  Improved access to family planning services and increased use of LARC are associated with lower risk of PTB.
authors.affiliation: At the time that this research was conducted, Lisa M. Goldthwaite, Lindsey Duca, Randi K. Johnson, and Danielle Ostendorf were all students at the Colorado School of Public Health, Aurora. Lisa M. Goldthwaite is also with the Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora. Lindsey Duca is also with the Barbara Davis Center for Diabetes, University of Colorado School of Medicine. Danielle Ostendorf is also with the Anschutz Health and Wellness Center, University of Colorado, Aurora. Jeanelle Sheeder is with the Departments of Obstetrics and Gynecology and Pediatrics, University of Colorado School of Medicine.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Goldthwaite
authors.affiliation: At the time that this research was conducted, Lisa M. Goldthwaite, Lindsey Duca, Randi K. Johnson, and Danielle Ostendorf were all students at the Colorado School of Public Health, Aurora. Lisa M. Goldthwaite is also with the Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora. Lindsey Duca is also with the Barbara Davis Center for Diabetes, University of Colorado School of Medicine. Danielle Ostendorf is also with the Anschutz Health and Wellness Center, University of Colorado, Aurora. Jeanelle Sheeder is with the Departments of Obstetrics and Gynecology and Pediatrics, University of Colorado School of Medicine.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Duca
authors.affiliation: At the time that this research was conducted, Lisa M. Goldthwaite, Lindsey Duca, Randi K. Johnson, and Danielle Ostendorf were all students at the Colorado School of Public Health, Aurora. Lisa M. Goldthwaite is also with the Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora. Lindsey Duca is also with the Barbara Davis Center for Diabetes, University of Colorado School of Medicine. Danielle Ostendorf is also with the Anschutz Health and Wellness Center, University of Colorado, Aurora. Jeanelle Sheeder is with the Departments of Obstetrics and Gynecology and Pediatrics, University of Colorado School of Medicine.
authors.forename: Randi K
authors.initials: RK
authors.lastname: Johnson
authors.affiliation: At the time that this research was conducted, Lisa M. Goldthwaite, Lindsey Duca, Randi K. Johnson, and Danielle Ostendorf were all students at the Colorado School of Public Health, Aurora. Lisa M. Goldthwaite is also with the Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora. Lindsey Duca is also with the Barbara Davis Center for Diabetes, University of Colorado School of Medicine. Danielle Ostendorf is also with the Anschutz Health and Wellness Center, University of Colorado, Aurora. Jeanelle Sheeder is with the Departments of Obstetrics and Gynecology and Pediatrics, University of Colorado School of Medicine.
authors.forename: Danielle
authors.initials: D
authors.lastname: Ostendorf
authors.affiliation: At the time that this research was conducted, Lisa M. Goldthwaite, Lindsey Duca, Randi K. Johnson, and Danielle Ostendorf were all students at the Colorado School of Public Health, Aurora. Lisa M. Goldthwaite is also with the Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora. Lindsey Duca is also with the Barbara Davis Center for Diabetes, University of Colorado School of Medicine. Danielle Ostendorf is also with the Anschutz Health and Wellness Center, University of Colorado, Aurora. Jeanelle Sheeder is with the Departments of Obstetrics and Gynecology and Pediatrics, University of Colorado School of Medicine.
authors.forename: Jeanelle
authors.initials: J
authors.lastname: Sheeder
mesh_terms: D000293:Adolescent; D000328:Adult; D003120:Colorado; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D003692:Delayed-Action Preparations; D005193:Family Planning Services / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007230:Infant, Low Birth Weight; D011247:Pregnancy; D011256:Pregnancy Outcome; D049168:Pregnancy, Unplanned; D047928:Premature Birth / Q000453:epidemiology*; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations