title: Preventing Unintended Pregnancy Among Young Sexually Active Women: Recognizing the Role of Violence, Self-Esteem, and Depressive Symptoms on Use of Contraception.
abstract: Ineffective contraceptive use among young sexually active women is extremely prevalent and poses a significant risk for unintended pregnancy (UP). Ineffective contraception involves the use of the withdrawal method or the inconsistent use of other types of contraception (i.e., condoms and birth control pills). This investigation examined violence exposure and psychological factors related to ineffective contraceptive use among young sexually active women.
  
  
  
  Young, nonpregnant sexually active women (n = 315) were recruited from an urban family planning clinic in 2013 to participate in a longitudinal study. Tablet-based surveys measured childhood violence, community-level violence, intimate partner violence, depressive symptoms, and self-esteem. Follow-up surveys measured type and consistency of contraception used 9 months later. Multivariate logistic regression models assessed violence and psychological risk factors as main effects and moderators related to ineffective compared with effective use of contraception.
  
  
  
  The multivariate logistic regression model showed that childhood sexual violence and low self-esteem were significantly related to ineffective use of contraception (adjusted odds ratio [aOR] = 2.69, confidence interval [95% CI]: 1.18-6.17, and aOR = 0.51, 95% CI: 0.28-0.93; respectively), although self-esteem did not moderate the relationship between childhood sexual violence and ineffective use of contraception (aOR = 0.38, 95% CI: 0.08-1.84). Depressive symptoms were not related to ineffective use of contraception in the multivariate model.
  
  
  
  Interventions to reduce UP should recognize the long-term effects of childhood sexual violence and address the role of low self-esteem on the ability of young sexually active women to effectively and consistently use contraception to prevent UP.
authors.affiliation: 1 Department of Epidemiology, Biostatistics, and Ob/Gyn, Temple University , Philadelphia, Pennsylvania.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Nelson
authors.affiliation: 2 Department of of Biostatistics and Epidemiology, Temple University School of Medicine , Philadelphia, Pennsylvania.
authors.forename: Huaqing
authors.initials: H
authors.lastname: Zhao
authors.affiliation: 3 Applied Public Health Informatics Fellow, Division of Informatics, Information Technology and Telecommunication Centers for Disease Control , New York, New York.
authors.forename: Rachel
authors.initials: R
authors.lastname: Corrado
authors.affiliation: 4 Department of Obstetrics and Gynecology, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Dimitrios M
authors.initials: DM
authors.lastname: Mastrogiannnis
authors.affiliation: 5 Department of Social and Behavioral Sciences, Temple University , Philadelphia, Pennsylvania.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lepore
mesh_terms: D000293:Adolescent; D017280:Condoms / Q000706:statistics & numerical data; D003267:Contraception / Q000379:methods; D003268:Contraception Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence; D016015:Logistic Models; D008137:Longitudinal Studies; D015999:Multivariate Analysis; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology*; D011275:Pregnancy, Unwanted / Q000523:psychology*; D012649:Self Concept; D012725:Sexual Behavior; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: childhood sexual violence; contraception use; depressive symptoms; self-esteem