The Influence of Psychosocial Factors on Contraceptive Use among Sexually Active Adolescent and Young Adult Women in Atlanta, Georgia Open Access

Shah, Rajvi J. (Spring 2018)

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Sexually transmitted infections and unintended pregnancies remain two pertinent public health concerns for young individuals in the U.S. Nearly half of all new sexually transmitted infections are acquired by adolescent and young adults and almost half of all pregnancies in the U.S. are unplanned. Protective behaviors, such as the correct and consistent use of contraception can prevent the occurrence of these adverse health outcomes. Researchers have identified numerous determinants of women’s contraceptive behaviors. However, adverse social circumstances and psychological factors have been studied to a lesser extent. To better understand the psychosocial dynamics of women’s contraceptive use, this study applied the Social Cognitive Theory as a model for examining the association between young women’s social discrimination and depressive symptoms and their current contraceptive use.

Baseline data of a sub-sample of sexually active 15-24-year-old adolescent and young adult females (n=122) enrolled in the Young Women’s Stress Study were utilized to evaluate these relationships. Bivariate indicators of moderate/high social discrimination and moderate/severe depressive symptoms were created to examine differences in contraceptive use between those who experienced unfair treatment and depressive symptoms and those who did not. A mediation analysis was also performed to assess whether depressive symptoms explained the relationship between social discrimination and contraceptive use. Multivariable models adjusted for sociodemographic covariates were created for analyses. Results revealed that social discrimination and depression were individually associated with lower contraceptive use among women at risk for STIs and unintended pregnancies. Findings also suggest that depressive symptoms may have mediated the pathway linking social discrimination with contraceptive use, although this was not clearly established.

This study shows that sexually active women with greater perceived social discrimination and elevated depressive symptoms may be at an increased risk of STIs and unintended pregnancies due to contraception nonuse. Based on these findings among a cohort of young females in the Southeast, where rates of STIs and unintended pregnancy tend to be higher, family planning clinics as well as school and university health centers should incorporate screening measures to account for women’s social situations and mental health status when recommending and providing contraceptive services.

Table of Contents


Risk Factors for Contraceptive Use.....2

Gaps in Literature.....4

Purpose of Current Study.....5


Literature Review.....7

STI and Unintended Pregnancy in the U.S......7

Trends in Sexual Activity and Contraceptive Use.....9

Contraception Benefits.....9

Reproductive-aged Women’s Contraceptive Method Use.....10

Dual Contraceptive Method Use.....11

Demographic Disparities in Contraceptive Use.....12

Psychosocial Determinants of Contraceptive Use.....13


Study Design and Sample......19


Statistical Analyses.....23



Strengths and Limitations......31


Future Direction.....33


Table 1. Young Women’s Sociodemographic, Reproductive, & Psychosocial Characteristics.....51

Table 2. Percent Distribution of Reasons Cited for Perceived Social Discrimination.....53

Table 3. Influence of Depressive Symptoms on Young Women’s Level of Functioning.....54

Table 4. Adjusted Odds Ratio (aOR) for current contraceptive users vs. non-users among young women at risk for STIs and unintended pregnancies.....55

Table 5. Depressive Symptoms Mediation Model.....56

Appendix I: Full Regression Models for Social Discrimination and Depressive Symptoms.....57

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