Psychological Symptoms and Oral Contraceptive Continuation in Young Minorities

DESCRIPTION (provided by applicant): In keeping with targeted priorities of the NIH National Institute of Nursing Research and the National Institute of Child Health and Human Development, the applicant's ultimate goal is to improve reproductive health outcomes in underserved young minority populations. Adolescent pregnancy affects 900,000 girls ages 15- 19 each year, with rates even slightly higher for young adult women ages 20-29. Hispanic and African Americans have a 2-3 fold higher rate as compared to non-Hispanic white women. Unintended pregnancy in these groups is a serious maternal-child health problem with potentially long-term burdens not only for families, but for the US public health system. Although oral contraceptives (OCs) are the safest and most effective method of birth control, their use by sexually active adolescents and young adults is not optimum, with high discontinuation rates after one year. Fear of perceived side effects, including weight gain and mood changes, are the most commonly reported reason for OC discontinuation. Research suggests that psychological symptoms of depressed mood, perceived stress and eating disorder (ED) symptoms contribute to adolescent high-risk sexual behavior, which disproportionately affects minorities. These same psychological problems are also known to compromise prescription medication adherence, but whether they have a similar influence on OC use has never been studied. Taking advantage of outstanding research opportunities and resources at Columbia University, the applicant's training plan is designed to combine advanced course work in interdisciplinary research methods and biostatistics with a multi-disciplinary, co- mentored dissertation project derived from the co-sponsor's randomized, controlled trial of a novel approach to improve OC use rates among minority family planning clinic patients. Guided by The Health Belief Model, the applicant will conduct a descriptive sub-study of prospective data to examine baseline depressed mood, perceived stress, and ED symptoms, as well as beliefs about OC side effects (eg. weight gain, mood changes), in participants ages 12-24 years, as correlates of OC discontinuation rates at 6 months post-randomization to one of two pill supply options. Standardized instruments, including the CES-D, PSS-10, and ESP, will be used to operationalize the independent variables. Identification of risk factors that influence OC discontinuation will provide a better understanding of the complex determinants of adolescent and young adult contraceptive behavior, and lays the groundwork for relevant clinical interventions to promote OC continuation. The proposed training plan will provide the applicant with the foundation to transition into a career as an independent interdisciplinary nurse scientist.