Ximena A Levander1, Canyon A Foot2, Sara L Magnusson3, Ryan R Cook2, Jerel M Ezell4, Judith Feinberg5,6, Vivian F Go7, Kathryn E Lancaster8, Elizabeth Salisbury-Afshar9, Gordon S Smith10, Ryan P Westergaard11, April M Young12,13, Judith I Tsui14, P Todd Korthuis2. 1. Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA. levander@ohsu.edu. 2. Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA. 3. Research & Evaluation, Comagine Health, Portland, OR, USA. 4. Africana Studies and Research Center, Cornell Center for Health Equity, Cornell University, Ithaca, NY, USA. 5. Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA. 6. Department of Medicine Section of Infectious Diseases, West Virginia University, Morgantown, WV, USA. 7. Department of Health Behavior, School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA. 8. Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA. 9. Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA. 10. Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA. 11. Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA. 12. Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA. 13. Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA. 14. Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
Abstract
BACKGROUND: 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. OBJECTIVE: 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. DESIGN: 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). PARTICIPANTS: 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. MAIN MEASURES: Unweighted and RDS-weighted prevalence estimates of medical/procedural contraceptive use; chi-squared tests and multi-level linear regressions to test associations. KEY RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. OBJECTIVE: 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. DESIGN: 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). PARTICIPANTS: 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. MAIN MEASURES: Unweighted and RDS-weighted prevalence estimates of medical/procedural contraceptive use; chi-squared tests and multi-level linear regressions to test associations. KEY RESULTS: 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. CONCLUSION: 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.
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