CONSPIRACY THEORIES—AND MORE

In a sample of adults aged 50 and older surveyed at public health sites in Los Angeles that offered HIV testing, belief in AIDS-related conspiracy theories was not uncommon, mistrust in government ran high and these attitudes were related to the likelihood of recent HIV testing.1 The 226 men and women in the sample participated in computer-assisted interviews in 2006–2007 as part of a larger study. Close to half were uninsured, and most did not have a regular private physician; levels of HIV knowledge and perceived risk were moderate. Forty-five percent of participants had not had an HIV test in the past year, and 27% had never had one. (By design, the sample consisted only of individuals who had never tested positive for HIV.) On average, 30% endorsed each of four AIDS-related conspiracy theories (e.g., a cure exists, but is being hidden by the government); 70% expressed mistrust in government. Results of multivariate analysis revealed that participants' odds of having had an HIV test within the last year rose as scores on a conspiracy scale increased (odds ratio, 1.9) and fell as scores on a mistrust scale increased (0.4). The researchers observe that most studies of attitudes and beliefs focus on their links to risk behaviors; however, they contend, their findings "underscore the need to better understand the implications for preventive behaviors such as routine testing."

1. Ford CL et al., Belief in AIDS-related conspiracy theories and mistrust in government: relationship with HIV testing among at-risk older adults, Gerontologist, 2013, doi:10.1093/geront/gns192, accessed Jan. 30, 2013.

SHIFTING PAP SMEAR NORMS

Even before current guidelines on Pap testing were in place, trends in screening were headed in the recommended direction.1 In 2012, three major organizations—the American College of Obstetricians and Gynecologists, the American Cancer Society and the U.S. Preventive Services Task Force—recommended that women younger than 21 not undergo Pap tests and that those aged 21–30 be screened no more than once every three years. An analysis of data from the nationwide Behavioral Risk Factor Surveillance System shows that between 2000 and 2010, the proportion of 18–21-year-olds who had never been tested rose from 26% to 48%; change was apparent in all racial and ethnic groups, in every region of the country and regardless of women's health insurance status. Another positive sign is that the proportion of women aged 22–30 who had had a Pap test within the previous year dropped from 78% to 67%. On the other hand, the proportion in this age-group who had never been screened increased from 7% to 9%.

1. Saraiya M et al., Cervical cancer screening among women aged 18–30 years—United States, 2000–2010, Morbidity and Mortality Weekly Report, 2013, 61(51&52):1038–1042.

RURAL TEENAGERS HAVE HIGH BIRTHRATES

The teenage birthrate is higher in rural areas of the United States than in metropolitan areas—43 vs. 33 births per 1,000 women aged 15–19 in 2010—according to analyses based on vital statistics.1 Rural teenagers had the highest birthrate in every racial and ethnic group examined. The most dramatic difference was among American Indians and Alaska Natives: Within this group, the teenage birthrate was 66 per 1,000 in rural areas and 18 per 1,000 in large urban centers. Birthrates differed sharply among 18–19-year-olds (75 in rural areas, compared with 58 in large urban centers), but fairly modestly among those aged 15–17. Furthermore, while teenage birthrates have fallen since 1990 in all areas, regardless of degree of urbanization, the decline has not been as steep in rural areas as in others (32% vs. 40–49%). The analysts urge pregnancy prevention programs to focus on rural teenagers "as a particularly high-risk group."

1. The National Campaign to Prevent Teen and Unplanned Pregnancy, Teen childbearing in rural America, Science Says, Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy, 2013, No. 47.

HARD-TO-BEAT SAFETY RECORD

More than 99% of medication abortions performed at Planned Parenthood clinics in 2009 and 2010 were successful and had no known complications.1 A review of the organization's database indicated that of the more than 200,000 medication abortions performed in those two years, 0.2% were followed by a "significant adverse event"—hospitalization, blood transfusion, emergency department treatment, infection requiring hospitalization or intravenous antibiotic treatment, or death. Some 0.5% of cases had a "clinically significant outcome"—an ongoing intrauterine pregnancy or an ectopic pregnancy that was not recognized until after the abortion regimen was begun. Rates of adverse events and outcomes were similar in both years. The most common significant outcome was continuing intrauterine pregnancy. (The analysts note that this event is risky if not recognized because of "the potential teratogenicity of misoprostol.") One medication abortion patient died, as a result of a previously undiagnosed ectopic pregnancy. The analysts acknowledge the possibility that the data are incomplete—because, for example, women did not return to the clinic for treatment, or reports of complications were inadvertently omitted from clinic records. Nevertheless, they suggest that their findings "confirm that evidence-based medical abortion is highly effective and extremely safe."

1. Cleland L et al., Significant adverse events and outcomes after medical abortion, Obstetrics & Gynecology, 2013, 121(1):166–171.

CIVIL RIGHTS, HUMAN RIGHTS AND PREGNANCY

Between 1973 and 2005, at least 413 U.S. women were arrested, incarcerated, detained in hospitals or treatment programs, or subjected to forced medical interventions for reasons pertaining to a current pregnancy.1 A review of legal, medical and news sources, supplemented by the researchers' own involvement in relevant cases and anecdotal evidence, suggests that pregnant women's rights are curtailed in a wide variety of ways and for a wide variety of reasons. For example, a woman who had a stillbirth as a result of an infection was convicted of homicide by child abuse because she used cocaine; another was forced to deliver by cesarean because she had done so previously, and lost a suit claiming that her civil rights had been violated. The cases identified in the review occurred in every region of the country, largely among women of low socioeconomic status; 52% involved black women, and 41% whites. Some 86% of the women were charged with at least one crime, including child abuse or neglect (51%), drug possession or use (22%), and homicide (12%). For 64% of cases, the documentation includes no mention of reported adverse outcomes for the fetus; documents for 20% note that the woman refused treatment orders, and for 7% that she had a forced medical intervention. The researchers argue that "far more than the right to decide to have an abortion is at stake if [personhood] laws pass."

1. Paltrow LM and Flavin J, Arrests of and forced intervention on pregnant women in the United States, 1973–2005: implications for women's legal status and public health, Journal of Health Politics, Policy and Law, 2013, 38(2):299–343.

DOES SEQUENCE MATTER?

The order in which teenagers initiate vaginal and oral sex, and the timing of these events, is associated with their likelihood of experiencing a pregnancy before age 20, according to results of analyses using data from the 1995 and 2008 waves of the National Longitudinal Study of Adolescent Health.1 Among survey respondents who had had vaginal sex as adolescents, 31% of those who then waited a year or more before having oral sex had a teenage pregnancy; by contrast, 21% of those who initiated both behaviors within the same year, and 8% of those who first had oral sex and then delayed vaginal intercourse for at least a year, had a teenage pregnancy. The differences were statistically significant and remained so in analyses controlling for demographic and socioeconomic characteristics. While the analysts emphasize that the mechanisms underlying these associations remain to be explored, they suggest a number of possibilities: Delaying vaginal intercourse may give teenagers "time to develop better skills related to planning sexual encounters and negotiating contraception decisions with partners"; adolescents who are particularly motivated to avoid pregnancy and STDs may choose sexual activity that they view as low-risk and "proceed at a slower pace to protect their future"; or "there may be truth to both explanations."

1. Reese BM et al., The association between sequences of sexual initiation and the likelihood of teenage pregnancy, Journal of Adolescent Health, 2013, 52(2):228–233.

BREAST CANCER, STERILIZATION: NO LINK IN LARGE STUDY

Analyses using data from a study of cancer incidence in 21 states revealed no evidence that women who have tubal sterilizations are at increased risk for breast cancer.1 More than 77,000 participants in the Cancer Prevention Study II Nutrition Cohort, who were followed up for 15 years, were included in the analyses. All of the women were postmenopausal at enrollment (in 1992–1993), and 9% had been sterilized; roughly 4,000 received diagnoses of invasive breast cancer during follow-up. In multivariate analyses that "comprehensively [controlled] for known and suspected breast cancer risk factors," the risk of the disease did not differ between sterilized women and others. Results were similar in analyses stratified by various characteristics related to the sterilization, and were not modified by a history of surgery on reproductive organs or by parity. The researchers also conducted a meta-analysis of eight studies, including their own, and again found no association between tubal sterilization and the risk of breast cancer.

1. Gaudet MM et al., Tubal sterilization and breast cancer incidence: results from the Cancer Prevention Study II Nutrition Cohort and meta-analysis, American Journal of Epidemiology, 2013, 177(6):492–499.

WHERE THERE'S NO SMOKE…

Declines in the incidence of preterm birth in Flanders coincided with the phasing in of legislation aimed at reducing exposure to secondhand smoke throughout Belgium.1 Phase 1 of the legislation, implemented in January 2006, banned smoking in public spaces and most workplaces; phase 2, which went into effect a year later, prohibited smoking in restaurants; phase 3, effective in January 2010, included bars that serve food. Analysts examining information from a data set that includes virtually all births in Flanders found that the rate of preterm births was essentially stable in the years leading up to phase 1 of the antismoking legislation but fell between the first two phases and then again (although not steadily) between the second and third. Using logistic regression models controlling for maternal and population characteristics, they found declines of about 3–4% between consecutive phases of the legislation; results were similar for all births and spontaneous births. (The analyses were restricted to liveborn singleton infants.) According to the analysts, although their findings do not demonstrate a causal relationship, they "[support] the notion that smoking bans have public health benefits from early life."

1. Cox B et al., Impact of a stepwise introduction of smoke-free legislation on the rate of preterm births: analysis of routinely collected birth data, BMJ, 2013, 346:f441, doi: 10.1136/bmj.f441, accessed Feb. 14, 2013.