ABSTRACT
Objective: Studies addressing effective contraceptive use by population density are
lacking. We hypothesize that contraception counseling and effective contraception
use vary by population density. Study Design: This is a cross-sectional
study using the 2006-2010 National Survey of Family Growth data, including
female subjects ages 15 to 19. The primary exposure was population density, defined
as Principal city of a Metropolitan Statistical Area (MSA) or “city”, Other MSA
or “non-city urban”, and Not MSA or “rural.” The primary outcome was effective contraception use and the secondary outcome was contraceptive
counseling exposure. Multivariate analysis using logistic regression was performed
to estimate the association between population density and effective
contraception use, as well as the likelihood of receiving contraceptive counseling. Results: 2284 subjects were studied. Compared to non-city urban dwellers, city
adolescents had similar effective contraception use (aOR: 0.99, [0.79, 1.24]),
whereas rural adolescents had significantly higher use (aOR: 1.79, [1.35,
2.36]). Among sexually active respondents who were not using contraception, the
rate of contraception counseling in non-city urban adolescents was 66.7%. In comparison,
the city dwellers had higher rate of counseling (79.1%, aOR: 1.87; 95% CI:
[1.09, 3.22]). Similarly, rural adolescents also had higher rate of counseling
(81.5%, aOR: 2.37; 95% CI: [1.08, 5.19]). Conclusions: Rural residents were more likely to use effective contraception methods than
their city and non-city urban counterparts. However, higher rates of
contraception counseling among sexually active adolescents not using
contraception in city and rural densities could suggest ineffective counseling
in these groups.