Unintended pregnancies (UIPs) affect 3 million women each year. Women age 18-24 experience the highest rate of UIP, accounting for more than 21% of the total number for all age groups. UIP is a risk factor for inadequate pre-natal care, poor maternal-child outcomes, and abortion (1.3 million UIPs end in abortion), and contributes to the $13 billion in medical costs spent for unintended or mistimed pregnancies. Social context influences women when they are confronted with a UIP and access to means of pregnancy prevention is often closely associated with use of the health care system. Understanding the complex circumstances through which women must navigate is necessary in order to understand the processes that impact health care access and health policy. The long-term goal of my program of research is to examine the context in which health disparities are created or perpetuated, which is consistent with the NINR's mission and research portfolio. The proposed study will contribute to the research base by illuminating the interplay of health behavior mitigated by community, government, and individual responses. An equivalent, sequential, transformative, mixed-methods study of college women will be conducted using a web-based survey and open-ended interviews.
The specific aims are to: 1) Describe college women's levels of EC awareness, knowledge, acceptance, and use of EC; 2) Determine the relationships among EC awareness, knowledge, acceptance, use, demographic characteristics, contraceptive behavior and reproductive history and selected contextual variables such as peer influence, partner support, family planning education, and provider access; 3) Explore the role of social context, including the perceived influence of attitudes of primary relationships, community stakeholders, and governmental policies, within the experiences of women who have used or considered using EC using a qualitative, semi-structured interview format; and 4) Integrate quantitative and qualitative study outcomes to explain potential implications of the role of social context for other issues within health care access and policy to build theory and allow for projections of future research. All phases of the research will be conducted in collaboration and under the supervision of expert research mentors. The findings of the study will have several potential public health benefits, including a better understanding of how society's beliefs influence individual health behavior. This knowledge will contribute to improved public health interventions, lead to a decrease in disparities in access to health care, and allow for informed health policy decisions. ? ? ?

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Bryan, Yvonne E
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University of Iowa
Schools of Nursing
Iowa City
United States
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Loew, Nicole; Lehan Mackin, Melissa; Ayres, Lioness (2018) Collegiate Women's Definitions of Responsible Sexual Behavior. West J Nurs Res 40:1148-1162
Lehan Mackin, Melissa; Clark, M Kathleen; McCarthy, Ann Marie et al. (2015) Knowledge and use of emergency contraception in college women. West J Nurs Res 37:462-80