Drexel University, College of Nursing and Health Professions, Philadelphia, Pennsylvania, USA.
University of Pennsylvania, Perelman School of Medicine, USA.
Policy Polit Nurs Pract. 2020 Aug;21(3):140-150. doi: 10.1177/1527154420923747. Epub 2020 May 12.
The 2012 implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive coverage mandate removed financial barriers to contraception access for many insured women. Since that time, increases in sexually transmitted disease (STD) rates have been noted, particularly among Black adolescent and young adult women aged 15 to 24 years. It is unclear whether changes in dual-method contraception use (simultaneous use of nonbarrier contraceptive methods and condoms) are associated with the increase in STD rates. A repeated cross-sectional analysis was conducted among adolescent and young adult women to compare pre-ACA data from the 2006-2010 cohort and post-ACA data from the 2013-2015 cohort of the National Survey for Family Growth. A significant decrease in short-acting reversible contraception use (SARC; 78.2% vs. 67.5%; <.01) and a significant increase in long-acting reversible contraception use (LARC; 8.9% vs. 21.8%; <.01) were found, but no significant change in dual-method contraception use was found among pre- versus post-ACA SARC users and SARC nonusers (odds ratio [OR]: 1.88, 95% confidence interval [CI]: 0.64-5.46, =.25), LARC users and LARC nonusers (adjusted odds ratio [AOR]: 1.62, 95% CI: 0.42-6.18, =.48), or White and Black women (AOR: 1.45, 95% CI: 0.66-3.18, =.35). There was no direct association between changes in contraception use and decreased condom use and therefore no indirect association between changes in contraception use and increased STD rates. Health care providers should continue promoting consistent condom use. Additional research is needed to understand recent increases in STD rates among Black women in the post-ACA era.
2012 年实施的《患者保护与平价医疗法案》（ACA）避孕覆盖规定消除了许多参保女性获得避孕的经济障碍。此后，性传播疾病（STD）的发病率有所上升，尤其是在 15 至 24 岁的黑人青少年和年轻成年女性中。目前尚不清楚双重避孕方法（同时使用非屏障避孕方法和避孕套）的使用变化是否与 STD 发病率的上升有关。对青少年和年轻成年女性进行了重复的横断面分析，比较了国家家庭增长调查 2006-2010 年队列的 ACA 前数据和 2013-2015 年队列的 ACA 后数据。短效可逆避孕方法（SARC）的使用显著下降（78.2%比 67.5%；<.01），长效可逆避孕方法（LARC）的使用显著增加（8.9%比 21.8%；<.01），但 SARC 使用者和 SARC 非使用者之间（比值比[OR]：1.88，95%置信区间[CI]：0.64-5.46，=.25）、LARC 使用者和 LARC 非使用者之间（调整后比值比[AOR]：1.62，95%CI：0.42-6.18，=.48）以及白人和黑人女性之间（AOR：1.45，95%CI：0.66-3.18，=.35），在 ACA 前后的双重避孕方法使用中未发现显著变化。避孕方法的改变与 condom 使用的减少没有直接关联，因此避孕方法的改变与 STD 发病率的增加之间没有间接关联。医疗保健提供者应继续提倡 condom 的持续使用。需要进一步研究以了解 ACA 后时期黑人女性 STD 发病率上升的原因。
