Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
Research & Evaluation, Comagine Health, Portland, OR, USA.
J Gen Intern Med. 2023 Jan;38(1):98-106. doi: 10.1007/s11606-022-07558-6. Epub 2022 Jun 15.
Women who use drugs (WWUD) have low rates of contraceptive use and high rates of unintended pregnancy. Drug use is common among women in rural U.S. communities, with limited data on how they utilize reproductive, substance use disorder (SUD), and healthcare services.
We determined contraceptive use prevalence among WWUD in rural communities then compared estimates to women from similar rural areas. We investigated characteristics of those using contraceptives, and associations between contraceptive use and SUD treatment, healthcare utilization, and substance use.
Rural Opioids Initiative (ROI) - cross-sectional survey using respondent-driven sampling (RDS) involving eight rural U.S. regions (January 2018-March 2020); National Survey on Family Growth (NSFG) - nationally-representative U.S. household reproductive health survey (2017-2019).
Women aged 18-49 with prior 30-day non-prescribed opioid and/or non-opioid injection drug use; fecundity determined by self-reported survey responses.
Unweighted and RDS-weighted prevalence estimates of medical/procedural contraceptive use; chi-squared tests and multi-level linear regressions to test associations.
Of 855 women in the ROI, 36.8% (95% CI 33.7-40.1, unweighted) and 38.6% (95% CI 30.7-47.2, weighted) reported contraceptive use, compared to 66% of rural women in the NSFG sample. Among the ROI women, 27% had received prior 30-day SUD treatment via outpatient counseling or inpatient program and these women had increased odds of contraceptive use (aOR 1.50 [95% CI 1.08-2.06]). There was a positive association between contraception use and recent medications for opioid use disorder (aOR 1.34 [95% CI 0.95-1.88]) and prior 6-month primary care utilization (aOR 1.32 [95% CI 0.96-1.82]) that did not meet the threshold for statistical significance.
WWUD in rural areas reported low contraceptive use; those who recently received SUD treatment had greater odds of contraceptive use. Improvements are needed in expanding reproductive and preventive health within SUD treatment and primary care services in rural communities.
使用毒品的女性（WWUD）的避孕措施使用率较低，意外怀孕率较高。在美国农村社区，女性吸毒现象较为普遍，但有关她们如何利用生殖、物质使用障碍（SUD）和医疗保健服务的数据有限。
我们确定了农村社区 WWUD 的避孕措施使用率，然后将这些估计值与来自类似农村地区的女性进行比较。我们调查了使用避孕药具的人的特征，以及避孕药具使用与 SUD 治疗、医疗保健利用和物质使用之间的关联。
农村阿片类药物倡议（ROI）-使用受访者驱动抽样（RDS）的横断面调查，涉及美国八个农村地区（2018 年 1 月至 2020 年 3 月）；全国家庭生育调查（NSFG）-美国全国代表性家庭生殖健康调查（2017-2019 年）。
年龄在 18-49 岁之间，过去 30 天内有非处方阿片类药物和/或非阿片类药物注射药物使用史；通过自我报告的调查回答确定生育能力。
未加权和 RDS 加权的医疗/程序避孕措施使用率估计值；卡方检验和多水平线性回归检验关联。
在 ROI 中的 855 名女性中，36.8%（95%CI 33.7-40.1，未加权）和 38.6%（95%CI 30.7-47.2，加权）报告了避孕措施的使用，而 NSFG 样本中农村女性的这一比例为 66%。在 ROI 女性中，27%的人曾通过门诊咨询或住院计划接受过 30 天内的 SUD 治疗，这些女性使用避孕药具的几率增加（优势比 1.50[95%CI 1.08-2.06]）。避孕药具的使用与最近治疗阿片类药物使用障碍的药物（优势比 1.34[95%CI 0.95-1.88]）和过去 6 个月的初级保健利用（优势比 1.32[95%CI 0.96-1.82]）呈正相关，但未达到统计学意义的阈值。
农村地区的 WWUD 报告避孕措施使用率较低；最近接受 SUD 治疗的人使用避孕药具的几率更高。需要在农村社区的 SUD 治疗和初级保健服务中扩大生殖和预防保健服务。
