标题：Trends and Disparities in Sexual and Reproductive Health Behaviors and Service Use Among Young Adult Women (Aged 18–25 Years) in the United States, 2002–2015
摘要：Objectives. To describe trends in sexual and reproductive health behaviors and service utilization among young women in the United States. Methods. We analyzed data from 8835 female respondents aged 18 to 25 years from 4 cycles of the National Survey of Family Growth, a nationally representative cross-sectional survey, from 2002 to 2015. We used bivariate and multivariable logistic regression to compare rates of self-reported sexual activity, sexually transmitted infection–related care, and contraception use over time and by race/ethnicity. Results. Sexually transmitted infection–related care and human papilloma virus vaccination increased from 2002 to 2013–2015, whereas sexual activity and contraception use remained stable. Compared with White women, racial/ethnic minority women were less likely to report effective contraception use, and Black women were less likely to report human papilloma virus vaccination; these differences did not change over time. Conclusions. Sexual and reproductive health service utilization increased from 2002 to 2015 among young women, whereas sexual activity remained stable. Overall, rates of recommended care were low, and racial and ethnic disparities persisted. Public Health Implications. Young women could benefit from clinical interventions and health policies to increase recommended care and reduce disparities. Young adult women (typically defined as those aged 18–25 years) in the United States face a unique set of health and health care issues, including higher sexual and reproductive health (SRH) risks and lower levels of health care access compared with other age groups. 1 Young women aged 18 to 24 years had the highest rate of unintended pregnancy of all age groups in 2008 and 2011, 2 and those aged 15 to 24 years accounted for nearly half of all incident sexually transmitted infections (STIs) in 2014. 3 Black and Hispanic young adult women have generally fared even worse on major SRH indicators; they have been shown to experience lower rates of contraception use, 4 higher rates of unintended pregnancy, 2 higher rates of STI diagnoses, 3 and lower rates of human papilloma virus (HPV) vaccination 5 compared with their White peers. Lower health care access and utilization among young adult women likely compound their SRH risks. Data from 2005 to 2012 showed that young adults in the United States had lower rates of overall and preventive health care utilization than did persons in other age groups 6 and lower rates of health insurance coverage than did adolescents. 1 Health care utilization and spending were lower among Black and Hispanic young adults than among White young adults, even after adjusting for insurance, usual source of care, and income. 6 Several events since the early 2000s have had the potential to improve the health of young adult women in the United States, especially in the domain of SRH (Appendix A, Figure A [available as a supplement to the online version of this article at http://www.ajph.org ]). Relevant advances in clinical guidelines included recommendations for highly effective long-acting reversible contraceptives (LARCs), 7 HPV vaccination, 8,9 and routine HIV testing. 10 Recent health policy changes through the Patient Protection and Affordable Care Act (ACA) also aimed to improve young adults’ access to SRH services. In 2010 the ACA expanded public insurance, mandated private insurance plans to extend coverage to dependents aged 26 years and younger, and made preventive health services free for anyone with insurance. 11 Furthermore, a contraception coverage mandate, added in 2012 and implemented by most plans in 2013, required insurance companies to cover all Food and Drug Administration–approved contraceptive methods at no cost to women. Since 2011, studies have shown expanded insurance coverage among young adults, 12 increased use of prescription contraception among reproductive-aged women, 13 and narrowed gaps in access to care between Black and Hispanic and White populations. 14 However, studies have yielded mixed results on recent trends in SRH behaviors and care 8,12,15 and few conclusions about whether improved access to care has reduced racial and ethnic disparities, 16 particularly among young adults. 17 There also remains political controversy about whether increased access to SRH services affects sexual behavior and risk. 18 Understanding trends in SRH services and sexual behaviors over a time of increasing access to care could help clarify this issue. We aimed to define trends in sexual activity, STI-related health care, and contraception use among young adult women in the United States from the early 2000s through 2015, a period of multiple significant changes in women’s health policy and practice. We also aimed to understand changes in the relationship of race and ethnicity with SRH services over time. The causes of racial and ethnic health disparities are complex and include differential access to health care and unequal content and quality of care received. 19,20 We hypothesized that updated SRH care guidelines, increased contraceptive choice, and policies to improve access to health care would increase rates of SRH service utilization among young adult women and would reduce racial and ethnic disparities.
