Health Literacy and Contraceptive Use: A Critical Perspective on Unintended Pregnancy

In a society where education and health literacy have been extensively linked to better health outcomes, researchers at Emory University have been exploring how these factors impact healthcare decisions. Two studies, conducted by David H. Howard and colleagues, examine the effect of health literacy on socioeconomic and racial differences in health status and receipt of vaccinations among the elderly population. Another study, led by H. Klein, identifies predictors of suicidal ideation among cocaine-using African-American women, a critical area of concern for prevention and intervention programs. A third study, conducted by L.R.B. Huber and colleagues, highlights the need for physician consultation before discontinuing contraceptives.

Key Takeaways:

• Health literacy significantly impacts health status in elderly populations, particularly in terms of physical and mental health and self-reported health status. Accounting for health literacy reduces differences in health status by 22% to 41%.
• Black individuals have worse self-reported health status and lower influenza and pneumococcal vaccination rates, which are reduced by 25% with health literacy accounted for.
• Low health literacy exacerbates differences between racial and socioeconomic groups in terms of health status and receipt of vaccinations.
• Suicidal ideation among cocaine-using African-American women is associated with unemployment, sexual abuse, and other psychosocial factors, with unemployment and sexual abuse being significant predictors.
• Approximately 39.8% of cocaine-using women reported thinking about committing suicide at least once during the 90 days prior to interview.
• Most women who discontinued oral contraceptives did so due to medical side effects, with 26.4% reporting sexual intercourse on days they missed pills just before or after their placebo week.
• Clinicians may need to encourage patients to discuss their reasons for discontinuing contraceptives and assist them with concerns or to switch to other effective methods to prevent unintended pregnancy.

Statistics:

• 3,260 noninstitutionalized elderly persons participated in the study on health literacy and socioeconomic differences in health status.
• 88 (39.8%) of 221 cocaine-using women reported suicidal ideation, while 133 (60.2%) did not.
• 369 women completed the baseline questionnaire for the study on contraceptive use and discontinuation.
• 145 oral contraceptive users were enrolled in a 5-week diary-based study of adherence and sexual activity.
• 26.4% of OC users had sexual intercourse on days they missed pills just before or after their placebo week.

Sources:

• Impact of health literacy on socioeconomic and racial differences in health in an elderly population. J Gen Intern Med, 2006;21(8):857-861.
• Predictors of suicidal ideation among "at risk" cocaine-using African American women. Suicide Life Threat Behav, 2006;36(3):336-348.
• Contraceptive use and discontinuation: Findings from the contraceptive history, initiation, and choice study. Am J Obstet Gynecol, 2006;194(5):1290-1295.