摘要：Objectives. We investigated determinants of and disparities in reproductive health service use among young women in the United States from 2002 to 2008. Methods. Using data on 4421 US women aged 15 to 24 years from the National Survey of Family Growth (2002, n = 2157; 2006–2008, n = 2264), we employed descriptive and univariate statistics and multivariate regression models to examine service use across women's sociodemographic and reproductive characteristics and to investigate potential disparate changes in service use over time. Results. More than half the sample (59%) had used services in the past year. In regression models, predictors of service use included age, education, birthplace, insurance, religious participation, mother's education, childhood family situation, age at menarche, sexual intercourse experience, recent number of partners, and previous gynecological diagnosis. Although service use decreased by 8% overall from 2002 to 2006–2008 ( P < .001), the magnitude of decline was similar across demographic and socioeconomic groups. Conclusions. Inequalities in reproductive health service use exist among women in the United States, particularly among the youngest and socially disadvantaged women, which may translate to poor and disparate reproductive outcomes. Public health and policy strategies are needed to eliminate inequities in reproductive health service. Rates of poor reproductive health and family planning outcomes among young women in the United States, which continue to be higher than in other developed countries, 1 disproportionately affect young women of demographic minority status and socioeconomic disadvantage. 2–7 Despite overall improvements in contraceptive use and declines in adolescent pregnancy, abortion, and sexually transmitted infections (STIs) occurring prior to 2002, 2 progress toward better reproductive health outcomes has since stalled or worsened, 2–7 especially among women of certain subpopulations. 2,7 In the United States, compared with White women of higher socioeconomic status, young Black and Hispanic women as well as poor and undereducated women have experienced increasingly high rates of unintended pregnancy, abortion, and STIs in recent years. 7 Negative reproductive health outcomes appear to be associated with inadequate use of health services, 3,8 and differences in the use of reproductive health services among different demographic and socioeconomic groups may contribute to health inequalities. Indeed, our previous analysis of data from the National Survey of Family Growth (NSFG) for 1995 and 2002 revealed that use of reproductive health services varied by women's socioeconomic and demographic backgrounds, 9 which mirrored disparities in health outcomes by race/ethnicity, education, and income and poverty levels during that time. 7 More recently, we reported on the decline in use of reproductive health services among all young women between 2002 and 2008, 8 which coincided with overall worsening reproductive health outcomes. 2 This increasing unmet need for health services may be even greater for minority and socially and economically vulnerable women. We sought to investigate determinants of reproductive health service use among young women in the United States from 2002 to 2008 and examine potential disparities in service use across demographic and socioeconomic groups.
