Brittany M Charlton1, Elizabeth Janiak2, Audrey J Gaskins3, Amy D DiVasta4, Rachel K Jones5, Stacey A Missmer6, Jorge E Chavarro7, Vishnudas Sarda8, Margaret Rosario9, S Bryn Austin10. 1. Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA. Electronic address: bcharlton@mail.harvard.edu. 2. Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA; Planned Parenthood League of Massachusetts, 1055 Commonwealth Avenue, Boston, MA, USA. 3. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, USA. 4. Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA. 5. Research Division, Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, USA. 6. Department of Obstetrics, Gynecology, and Reproductive Biology College of Human Medicine, Michigan State University, 965 Fee Road, East Lansing, MI, USA. 7. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, USA. 8. Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA. 9. Department of Psychology, City University of New York-City College and Graduate Center, 365 Fifth Avenue, New York, NY, USA. 10. Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.
Abstract
OBJECTIVES: To examine contraceptive methods used across sexual orientation groups. STUDY DESIGN: We collected data from 118,462 female participants in two longitudinal cohorts-the Nurses' Health Study (NHS) 2 (founded in 1989, participants born 1947-1964) and NHS3 (founded in 2010, born 1965-1995). We used log-binomial models to estimate contraceptive methods ever used across sexual orientation groups and cohorts, adjusting for age and race. RESULTS: Lesbians were the least likely of all sexual orientation groups to use any contraceptive method. Lesbians in NHS2 were 90% less likely than heterosexuals to use long-acting reversible contraceptives (LARCs; adjusted risk ratio [aRR]; 95% confidence interval [CI]: 0.10 [0.04, 0.26]) and results were similar for other contraceptive methods and in the NHS3 cohort. Compared to the reference group of completely heterosexual participants with no same-sex partners, those who identified as completely heterosexual with same-sex partners, mostly heterosexual, or bisexual were generally more likely to use any method of contraception. Use of LARCs was especially striking across sexual minority groups, and, with the exception of lesbians, they were more likely to use LARCs; as one illustration, NHS3 bisexuals were more than twice as likely to use LARCs (aRR [95% CI]: 2.01 [1.67, 2.42]). CONCLUSIONS: While certain sexual minority subgroups (e.g., bisexuals) were more likely than heterosexuals to use contraceptive methods such as LARCs, lesbians were less likely to use any method. IMPLICATIONS: Many sexual minority patients need contraceptive counseling and providers should ensure to offer this counseling to patients in need, regardless of sexual orientation.
OBJECTIVES: To examine contraceptive methods used across sexual orientation groups. STUDY DESIGN: We collected data from 118,462 female participants in two longitudinal cohorts-the Nurses' Health Study (NHS) 2 (founded in 1989, participants born 1947-1964) and NHS3 (founded in 2010, born 1965-1995). We used log-binomial models to estimate contraceptive methods ever used across sexual orientation groups and cohorts, adjusting for age and race. RESULTS: Lesbians were the least likely of all sexual orientation groups to use any contraceptive method. Lesbians in NHS2 were 90% less likely than heterosexuals to use long-acting reversible contraceptives (LARCs; adjusted risk ratio [aRR]; 95% confidence interval [CI]: 0.10 [0.04, 0.26]) and results were similar for other contraceptive methods and in the NHS3 cohort. Compared to the reference group of completely heterosexual participants with no same-sex partners, those who identified as completely heterosexual with same-sex partners, mostly heterosexual, or bisexual were generally more likely to use any method of contraception. Use of LARCs was especially striking across sexual minority groups, and, with the exception of lesbians, they were more likely to use LARCs; as one illustration, NHS3 bisexuals were more than twice as likely to use LARCs (aRR [95% CI]: 2.01 [1.67, 2.42]). CONCLUSIONS: While certain sexual minority subgroups (e.g., bisexuals) were more likely than heterosexuals to use contraceptive methods such as LARCs, lesbians were less likely to use any method. IMPLICATIONS: Many sexual minority patients need contraceptive counseling and providers should ensure to offer this counseling to patients in need, regardless of sexual orientation.
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