Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey

Ximena A. Levander; Canyon A. Foot; Sara L. Magnusson; Ryan R. Cook; Jerel M. Ezell; Judith Feinberg; Vivian F. Go; Kathryn E. Lancaster; Elizabeth Salisbury-Afshar; Gordon S. Smith; Ryan P. Westergaard; April M. Young; Judith I. Tsui; P. Todd Korthuis

doi:10.1007/s11606-022-07558-6

Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey

Ximena A. Levander, Canyon A. Foot, Sara L. Magnusson, Ryan R. Cook, Jerel M. Ezell, Judith Feinberg, Vivian F. Go, Kathryn E. Lancaster, Elizabeth Salisbury-Afshar, Gordon S. Smith, Ryan P. Westergaard, April M. Young, Judith I. Tsui, P. Todd Korthuis

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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.

Original language	English
Pages (from-to)	98-106
Number of pages	9
Journal	Journal of General Internal Medicine
Volume	38
Issue number	1
DOIs	https://doi.org/10.1007/s11606-022-07558-6
State	Published - Jan 2023

Bibliographical note

Funding Information:
This publication is based upon data collected and/or methods developed as part of the Rural Opioid Initiative (ROI), a multi-site study with a common protocol that was developed collaboratively by investigators at eight research institutions and at the National Institute of Drug Abuse (NIDA), the Appalachian Regional Commission (ARC), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Research presented in this manuscript is the result of secondary data harmonization and analysis and was supported by grant U24DA048538 from NIDA. Primary data collection was supported by grants UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044830/UH3DA044830, UG3DA044823/UH3DA044823, UH3DA044822/UH3DA044822, UG3DA044831/UH3DA044831, UG3DA044825, UG3DA044826/UH3DA044826, and U24DA044801 co-funded by NIDA, ARC, CDC, and SAMHSA. XAL and RRC were supported by the AHRQ K12 HS026370. ESA was supported by the NIDA 0099148/00070029, NIDA UG1 DA050066-01, AHRQ 1R18HS027088-01, and NIDA 1U2CDA050098-01. KEL was supported by the NIDA K01DA048174.

Publisher Copyright:
© 2022, The Author(s).

Keywords

contraception
opioid-related disorders
rural health services
substance use
women’s health

ASJC Scopus subject areas

Internal Medicine

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10.1007/s11606-022-07558-6

Cite this

Levander, X. A., Foot, C. A., Magnusson, S. L., Cook, R. R., Ezell, J. M., Feinberg, J., Go, V. F., Lancaster, K. E., Salisbury-Afshar, E., Smith, G. S., Westergaard, R. P., Young, A. M., Tsui, J. I., & Korthuis, P. T. (2023). Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey. Journal of General Internal Medicine, 38(1), 98-106. https://doi.org/10.1007/s11606-022-07558-6

@article{49fb657235e845a992e95c89e7666eb1,

title = "Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey",

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.",

keywords = "contraception, opioid-related disorders, rural health services, substance use, women{\textquoteright}s health",

author = "Levander, {Ximena A.} and Foot, {Canyon A.} and Magnusson, {Sara L.} and Cook, {Ryan R.} and Ezell, {Jerel M.} and Judith Feinberg and Go, {Vivian F.} and Lancaster, {Kathryn E.} and Elizabeth Salisbury-Afshar and Smith, {Gordon S.} and Westergaard, {Ryan P.} and Young, {April M.} and Tsui, {Judith I.} and Korthuis, {P. Todd}",

note = "Funding Information: This publication is based upon data collected and/or methods developed as part of the Rural Opioid Initiative (ROI), a multi-site study with a common protocol that was developed collaboratively by investigators at eight research institutions and at the National Institute of Drug Abuse (NIDA), the Appalachian Regional Commission (ARC), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Research presented in this manuscript is the result of secondary data harmonization and analysis and was supported by grant U24DA048538 from NIDA. Primary data collection was supported by grants UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044830/UH3DA044830, UG3DA044823/UH3DA044823, UH3DA044822/UH3DA044822, UG3DA044831/UH3DA044831, UG3DA044825, UG3DA044826/UH3DA044826, and U24DA044801 co-funded by NIDA, ARC, CDC, and SAMHSA. XAL and RRC were supported by the AHRQ K12 HS026370. ESA was supported by the NIDA 0099148/00070029, NIDA UG1 DA050066-01, AHRQ 1R18HS027088-01, and NIDA 1U2CDA050098-01. KEL was supported by the NIDA K01DA048174. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2023",

month = jan,

doi = "10.1007/s11606-022-07558-6",

language = "English",

volume = "38",

pages = "98--106",

number = "1",

}

Levander, XA, Foot, CA, Magnusson, SL, Cook, RR, Ezell, JM, Feinberg, J, Go, VF, Lancaster, KE, Salisbury-Afshar, E, Smith, GS, Westergaard, RP, Young, AM, Tsui, JI & Korthuis, PT 2023, 'Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey', Journal of General Internal Medicine, vol. 38, no. 1, pp. 98-106. https://doi.org/10.1007/s11606-022-07558-6

TY - JOUR

T1 - Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities

T2 - a Cross-Sectional Survey

AU - Levander, Ximena A.

AU - Foot, Canyon A.

AU - Magnusson, Sara L.

AU - Cook, Ryan R.

AU - Ezell, Jerel M.

AU - Feinberg, Judith

AU - Go, Vivian F.

AU - Lancaster, Kathryn E.

AU - Salisbury-Afshar, Elizabeth

AU - Smith, Gordon S.

AU - Westergaard, Ryan P.

AU - Young, April M.

AU - Tsui, Judith I.

AU - Korthuis, P. Todd

N1 - Funding Information: This publication is based upon data collected and/or methods developed as part of the Rural Opioid Initiative (ROI), a multi-site study with a common protocol that was developed collaboratively by investigators at eight research institutions and at the National Institute of Drug Abuse (NIDA), the Appalachian Regional Commission (ARC), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Research presented in this manuscript is the result of secondary data harmonization and analysis and was supported by grant U24DA048538 from NIDA. Primary data collection was supported by grants UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044830/UH3DA044830, UG3DA044823/UH3DA044823, UH3DA044822/UH3DA044822, UG3DA044831/UH3DA044831, UG3DA044825, UG3DA044826/UH3DA044826, and U24DA044801 co-funded by NIDA, ARC, CDC, and SAMHSA. XAL and RRC were supported by the AHRQ K12 HS026370. ESA was supported by the NIDA 0099148/00070029, NIDA UG1 DA050066-01, AHRQ 1R18HS027088-01, and NIDA 1U2CDA050098-01. KEL was supported by the NIDA K01DA048174. Publisher Copyright: © 2022, The Author(s).

PY - 2023/1

Y1 - 2023/1

N2 - 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.

AB - 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.

KW - contraception

KW - opioid-related disorders

KW - rural health services

KW - substance use

KW - women’s health

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Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey

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