title: Racial/ethnic differences in contraceptive preferences, beliefs, and self-efficacy among women veterans.
abstract: Significant racial/ethnic disparities in unintended pregnancy persist in the United States, with the highest rates observed among low-income black and Hispanic women. Differences in contraceptive preferences, beliefs, and self-efficacy may be instrumental in understanding contraceptive behaviors that underlie higher rates of unintended pregnancy among racial/ethnic minorities.
  
  
  
  Our objective was to understand how contraceptive preferences, beliefs, and self-efficacy vary by race and ethnicity among women veterans.
  
  
  
  We analyzed data from the Examining Contraceptive Use and Unmet Need Study, a national telephone survey of women veterans aged 18-44 years who had received primary care at the Veterans Administration in the prior 12 months. Participants rated the importance of various contraceptive characteristics and described their level of agreement with contraceptive beliefs using Likert scales. Contraceptive self-efficacy was assessed by asking participants to rate their certainty that they could use contraception consistently and as indicated over time using a Likert scale. Multivariable logistic regression was used to examine associations between race/ethnicity and contraceptive attitudes, controlling for age, marital status, education, income, religion, parity, deployment history, and history of medical and mental health conditions.
  
  
  
  Among the 2302 women veterans who completed a survey, 52% were non-Hispanic white, 29% were non-Hispanic black, and 12% were Hispanic. In adjusted analyses, compared with whites, blacks had lower odds of considering contraceptive effectiveness extremely important (adjusted odds ratio; 0.55, 95% confidence interval, 0.40-0.74) and higher odds of considering the categories of does not contain any hormones and prevents sexually transmitted infections extremely important (adjusted odds ratio, 1.94, 95% confidence interval, 1.56-2.41, and adjusted odds ratio; 1.99, 95% confidence interval, 1.57-2.51, respectively). Hispanics also had higher odds than whites of considering the category of does not contain any hormones and prevents sexually transmitted infections extremely important (adjusted odds ratio, 1.72, 95% confidence interval, 1.29-2.28, and adjusted odds ratio, 1.63; 95% confidence interval, 1.21-2.19, respectively). Compared with whites, blacks and Hispanics had higher odds of expressing fatalistic beliefs about pregnancy (adjusted odds ratio, 1.79, 95% confidence interval, 1.35-2.39, and adjusted odds ratio, 1.48, 95% confidence interval, 1.01-2.17, respectively); higher odds of viewing contraception as primarily a woman's responsibility (adjusted odds ratio, 1.92, 95% confidence interval, 1.45-2.55, and adjusted odds ratio, 1.77; 95% confidence interval, 1.23-2.54, respectively); and lower odds of being very sure that they could use a contraceptive method as indicated over the course of a year (adjusted odds ratio, 0.73, 95% confidence interval, 0.54-0.98, and adjusted odds ratio, 0.66, 95% confidence interval, 0.46-0.96, respectively).
  
  
  
  Women veterans' contraceptive preferences, beliefs, and self-efficacy varied by race/ethnicity, which may help explain observed racial/ethnic disparities in contraceptive use and unintended pregnancy. These differences underscore the need to elicit women's individual values and preferences when providing patient-centered contraceptive counseling.
authors.affiliation: Department of Obstetrics and Gynecology, Seattle, WA; Department of Health Services, University of Washington, Seattle, WA; Health Services Research and Development, Department of Veterans Affairs, Veterans Affairs Puget Sound Health Care System, Seattle, WA. Electronic address: lcallega@uw.edu.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Callegari
authors.affiliation: Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Medicine, University of California, Davis, Davis, CA.
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.affiliation: Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA.
authors.forename: Elian
authors.initials: E
authors.lastname: Rosenfeld
authors.affiliation: Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA; Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
authors.forename: Maria K
authors.initials: MK
authors.lastname: Mor
authors.affiliation: Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Sonya
authors.initials: S
authors.lastname: Borrero
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D058443:Catastrophization; D003268:Contraception Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D057240:Patient Preference; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology; D044469:Racial Groups / Q000706:statistics & numerical data*; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans; D055815:Young Adult
keywords: attitudes; beliefs; contraception; fatalism; health equity; preferences; racial disparities; self-efficacy; unintended pregnancy; veteran health; women veterans