Goodman Melody, Onwumere Ojiugo, Milam Laurel, Peipert Jeffrey F
Department of Biostatistics, College of Global Public Health, New York University.
Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO.
Am J Obstet Gynecol. 2017 Apr;216(4):382.e1-382.e5. doi: 10.1016/j.ajog.2016.12.015. Epub 2016 Dec 23.
While the rate of unintended pregnancy has declined in the United States in recent years, unintended pregnancy among teens in the United States is the highest among industrialized nations, and disproportionately affects minority teens.
Our objective of this secondary analysis was to estimate the risk of unintended pregnancy for both Black and White teens age 15-19 years when barriers to access, cost, and knowledge are removed. Our hypothesis was that the Black-White disparities would be reduced when access, education, and cost barriers are removed.
We performed an analysis of the Contraceptive CHOICE Project database. CHOICE is a longitudinal cohort study of 9256 sexually active girls and women ages 14-45 years in the St Louis, MO, region from 2007 through 2013. Two measures of disparities were used to analyze teenage pregnancy rates and pregnancy risk from 2008 through 2013 among teens ages 15-19 years. These rates were then compared to the rates of pregnancy among all sexually active teens in the United States during the years 2008, 2009, 2010, and 2011. We estimated an absolute measure (rate difference) and a relative measure (rate ratio) to examine Black-White disparities in the rates of unintended pregnancy.
While national rates of unintended pregnancy are decreasing, racial disparities in these rates persist. The Black-White rate difference dropped from 158.5 per 1000 in 2008 to 120.1 per 1000 in 2011; however, the relative ratio disparity decreased only from 2.6-2.5, suggesting that Black sexually active teens in the United States have 2.5 times the rate of unintended pregnancy as White teenagers. In the CHOICE Project, there was a decreasing trend in racial disparities in unintended pregnancy rates among sexually active teens (age 15-19 years): 2008 through 2009 (rate difference, 18.2; rate ratio, 3.7), 2010 through 2011 (rate difference, 4.3; rate ratio, 1.2), and 2012 through 2013 (rate difference, -1.5; rate ratio, 1.0).
When barriers to cost, access, and knowledge were removed, such as in the Contraceptive CHOICE Project, Black-White disparities in unintended pregnancy rates among sexually active teens were reduced on both absolute and relative scales. The rate of unintended pregnancy was almost equal between Black and White teens compared to large Black-White disparities on the national level.
近年来，美国意外怀孕率有所下降，但美国青少年意外怀孕率在工业化国家中是最高的，且对少数族裔青少年的影响尤为严重。
本次二次分析的目的是估计在消除获取障碍、成本和知识因素后，15至19岁黑人和白人青少年意外怀孕的风险。我们的假设是，消除获取、教育和成本障碍后，黑人和白人之间的差距将会缩小。
我们对避孕选择项目数据库进行了分析。避孕选择项目是一项针对密苏里州圣路易斯地区9256名年龄在14至45岁之间有性行为的女孩和妇女的纵向队列研究，研究时间从2007年至2013年。我们使用两种差异衡量方法来分析2008年至2013年期间15至19岁青少年的怀孕率和怀孕风险。然后将这些比率与2008年、2009年、2010年和2011年美国所有有性行为青少年的怀孕率进行比较。我们估计了一个绝对衡量指标（率差）和一个相对衡量指标（率比），以研究意外怀孕率方面的黑白差异。
虽然全国意外怀孕率在下降，但这些比率中的种族差异仍然存在。黑人和白人的率差从2008年的每1000人158.5例降至2011年的每1000人120.1例；然而，相对比率差异仅从2.6降至2.5，这表明美国有性行为的黑人青少年意外怀孕率是白人青少年的2.5倍。在避孕选择项目中，有性行为的青少年（15至19岁）意外怀孕率的种族差异呈下降趋势：2008年至2009年（率差为18.2；率比为3.7），2010年至2011年（率差为4.3；率比为1.2），以及2012年至2013年（率差为 -1.5；率比为1.0）。
在避孕选择项目中，当消除成本、获取和知识障碍后，有性行为青少年意外怀孕率的黑白差异在绝对和相对尺度上均有所缩小。与全国层面上较大的黑白差异相比，黑人和白人青少年的意外怀孕率几乎相等。
