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This study involved women at high risk for unintended pregnancy who received free contraception. Long-acting reversible contraception was associated with a significantly lower risk of pregnancy than contraceptive pills, patch, or ring and was highly effective regardless of age. Unintended pregnancy is a major problem in the United States. Approximately 3 million pregnancies per year — 50% of all pregnancies — are unintended, and this rate is significantly higher than that in other developed countries. 1 Unintended pregnancy in the United States results in 1.2 million abortions per year, 2 has negative effects on women's health and education and the health of newborns, and imposes a considerable personal burden as well as a financial burden on families and society. 3 Approximately half of unintended pregnancies result from contraceptive failure, usually owing to incorrect or inconsistent use of contraception, and the remainder are . . .

Endocrine-disrupting chemicals (EDCs) adversely affect human health. Our objective was to determine the association of EDC exposure with earlier age of menopause. Cross-sectional survey using National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2008 (n = 31,575 females). Eligible participants included: menopausal women >30 years of age; not currently pregnant, breastfeeding, using hormonal contraception; no history of bilateral oophorectomy or hysterectomy. Exposures, defined by serum lipid and urine creatinine-adjusted measures of EDCs, data were analyzed: > 90th percentile of the EDC distribution among all women, log-transformed EDC level, and decile of EDC level. Multi linear regression models considered complex survey design characteristics and adjusted for age, race/ethnicity, smoking, body mass index. EDCs were stratified into long (>1 year), short, and unknown half-lives; principle analyses were performed on those with long half-lives as well as phthalates, known reproductive toxicants. Secondary analysis determined whether the odds of being menopausal increased with EDC exposure among women aged 45-55 years. This analysis examined 111 EDCs and focused on known reproductive toxicants or chemicals with half-lives >1 year. Women with high levels of β-hexachlorocyclohexane, mirex, p,p'-DDE, 1,2,3,4,6,7,8-heptachlorodibenzofuran, mono-(2-ethyl-5-hydroxyhexyl) and mono-(2-ethyl-5-oxohexyl) phthalate, polychlorinated biphenyl congeners -70, -99, -105, -118, -138, -153, -156, -170, and -183 had mean ages of menopause 1.9 to 3.8 years earlier than women with lower levels of these chemicals. EDC-exposed women were up to 6 times more likely to be menopausal than non-exposed women. This study of a representative sample of US women documents an association between EDCs and earlier age at menopause. We identified 15 EDCs that warrant closer evaluation because of their persistence and potential detrimental effects on ovarian function. Earlier menopause can alter the quantity and quality of a woman's life and has profound implications for fertility, human reproduction, and our global society.

Clue cells characteristic of bacterial vaginosis (BV) are thought to arise due to exfoliation of the vaginal epithelium; however, there is little published data connecting total numbers of epithelial cells to markers of BV. The purpose of this study was to enumerate exfoliated epithelial cells (independent of clue cells) and examine the relationship to Nugent score. We conducted a cross-sectional sub-study of the Contraceptive CHOICE Project cohort. Vaginal swabs were used to create vaginal smears for Gram staining and these smears were later scored using the Nugent method, and then two blinded observers used microscopy to enumerate exfoliated epithelial cells. The degree of epithelial cell exfoliation was compared between women diagnosed as BV-negative (Nugent score 0-3), BV-intermediate (Nugent score 4-6), and BV-positive (Nugent score 7-10). BV specimens (Nugent 7-10) were randomly matched to specimens in the two other groups (Nugent low and Nugent-intermediate), in order to avoid comparing groups of women with potentially confounding baseline demographics. Exfoliated epithelial cell counts were higher in the vaginal smears from BV-positive women compared with BV-negative women. Higher levels of epithelial exfoliation were also evident in BV-intermediate women compared to those with low Nugent scores. After adjustment for clustering introduced by matching, the incidence ratio of increased epithelial cell counts was 2.09 (95% CI 1.50-2.90) for the BV-intermediate women and 1.71 (95% CI 1.23-2.38) for the BV positive women. A vaginal epithelial exfoliation phenotype was measured in both Nugent-defined BV-positive and BV-intermediate women. Bacterial vaginosis and intermediate status (Nugent score >3) was associated with significantly more vaginal epithelial exfoliation compared to women with Lactobacillus-dominated microbiotas (Nugent 0-3).

For a half-century, pregnant people in the United States have had the legal right to decide their pregnancies and reproductive health. The Supreme Court's ruling in Dobbs v.Jackson Women's Health Organization eliminated that right for millions of people in 26 states. Legislatures in 13 states have passed \"trigger\" laws that ban abortion if the Roe v. Wade decision is overturned, and 13 have bans that have become enforceable in the absence of Roe. In this environment, public health must continue to seek approaches to improve access to abortion services.In this issue of AJPH, Seymour et al. (p. 1202) estimate how telemedicine could increase access to medication abortion. Medication abortion-a two-medication regimen of mifepristone and misoprostol-is a safe and effective method to end a pregnancy when used within 70 days' gestation.1 First approved in the United States in 2000, medication abortions have increased in the intervening years, and in 2020, they constituted the majority (54%) of abortions.2 This growth reflects increasing acceptance by patients and providers, changes in medicine driven by the COVID-19 pandemic, and the erosion of access caused by federal- and state-level restrictions.

Background: To estimate the association between Trichomonas vaginalis infection (TV) and 6 sexually transmitted infections: chlamydia, gonorrhea, herpes simplex virus (Types 1 and 2), syphilis, and human immunodeficiency virus (HIV) in a nationally representative sample. Methods: We used data from the National Health and Nutrition Examination Survey combining the 2001-2002 and 2003-2004 waves to estimate the association between TV and sexually transmitted infections (STIs) among women in the civilian, noninstitutionalized US population. The final sample included data from 3648 women, which when weighted, represents the experience of 65,563,298 US women between the ages of 14 and 49. Crude and adjusted relative risks were estimated using logistic regression for rare STIs (<10%; chlamydia, syphilis, and HIV) and Poisson regression for common STIs (herpes simplex virus [HSV] Types 1 and 2). Statistical analyses were conducted using Stata (version 9.2). Results: The prevalence of trichomoniasis was 3.2% with over 80% of cases asymptomatic in the past month. All STIs examined (chlamydia, gonorrhea, HSV-1, HSV-2, syphilis, and HIV) were more common among women with a positive test for trichomoniasis. HSV-1 (RR = 1.20, 95% CI: 1.09, 1.34) and HSV-2 (RR = 1.51, 95% CI: 2.32, 3.23) were significantly associated with trichomoniasis after adjusting for race/ethnicity, age, and recent sexual partners. In crude analyses, a positive treponemal test was 6 times (95% CI: 2.07, 18.8) more common and HIV was 13 times (95% CI: 2.88, 59.1) more common among women with trichomoniasis, but these estimates were greatly attenuated after adjustment for potential confounders. Conclusion: Trichomoniasis is significantly associated with concurrent STI.

QUALITY OF INTIMATE PARTNER VIOLENCE RESEARCH Yakubovich et al. evaluated study quality using the Cambridge Quality Checklists, which weighed the impact of sampling, participation rates, sample size, measure of risk or protective factor, validation of outcome measures, and adjustment of confounding.2 The criteria of prospective assessment of outcome and longitudinal follow-up were restricted at the level ofstudy inclusion criteria. Future research and funding should be directed to analyses of IPV predictors that focus on both the multiple levels of causation of IPV and the interactions among levels. [...]our understanding of individuals and relationships is limited when studying them ex vivo, or removed from their environments. [...]researchers should remain mindful of the unintended consequence of \"blaming the victim,\" that is, focusing research and interventions at the level of the woman experiencing IPV-to the exclusion of other causes- without a concrete analysis of the role of structural gender inequities and women's agency. /4JPU Jenifer E. Allsworth, PhD ACKNOWLEDGMENTS The author would like to thank Mary M. Gerkovich, PhD, for her comments on a draft of this editorial.

Objectives. We sought to identify variables associated with being in a particular stage of change for physical activity—a measure of behavioral intention to engage in regular physical activity. Understanding behavioral intentions can be useful in explaining why individuals are physically inactive or active. Methods. Data from the Rhode Island 2000 Behavioral Risk Factor Surveillance System were used to evaluate predictors of stage of change for physical activity. There were 3454 observations in the data set, representing a weighted population of 742636 people. Estimates were obtained from polytomous multiple logistic models. Results. Being a woman, Hispanic, non-Hispanic Black, and older than 55 years of age were associated with being in precontemplation and contemplation stages of change rather than maintenance. Self-perceived health status and rarely feeling healthy or full of energy were strongly predictive of stage of change. Having a health limitation was a dichotomous predictor, predicting being in action and precontemplation stages. Conclusions. Several sociodemographic and health variables were associated with varying patterns of stages of change for physical activity. The complexity of individual intentions for physical activity provides evidence for the potential existence of mediating, effect-modifying, and confounding variables that differ depending on individual characteristics.

Objective. To analyze a nationally representative sample of women for correlates of dual-contraceptive-method use. Materials and Methods. We conducted an analysis of the National Survey of Family Growth, 2006–2008, a cross-sectional survey of reproductive-aged women in the United States. Results. Dual method use was reported by 7.3% of the 5,178 women in the sample. Correlates of higher rates of dual-contraceptive-method use included age younger than 36 years and nonmarried marital status. Lower rates of dual method use were observed for women with less than a high-school education and women without consistent health insurance in the past year. Compared to women using oral contraceptives, use of the contraceptive injection or long-acting reversible contraception was associated with lower dual-method use. Conclusions. The overall rate of dual-method use in the USA is low. Future interventions to promote dual method use should target high-risk groups with modifiable risk factors.

Increasing access to COVID-19 testing in influential, accessible community settings is needed to address COVID-19 disparities among African Americans. We describe COVID-19 testing intervention approaches conducted in Kansas City, Missouri, African American churches via a faith–health–academic partnership. Trained faith leaders promoted COVID-19 testing with church and community members by implementing multilevel interventions using a tailored toolkit and standard education information. The local health department conducted more than 300 COVID-19 tests during or after Sunday church services and outreach ministry activities. (Am J Public Health. 2022;112(S9):S887–S891. https://doi.org/10.2105/AJPH.2022.306981 )

COVID-19 has been the most devasting pandemic in recent history. The United States alone has had more than 88 million COVID-19 cases and more than 1 million related deaths.1 African Americans have been disproportionately burdened by COVID-19, with significantly more COVID-19 cases, hospitalizations, and deaths compared with Whites.2 Thus, access to routine COVID-19 testing is essential. Studies have shown that COVID-19 disparities in the African American population are associated with multilevel social determinants of health, such as mistrust of COVID-19 testing information and health information sources, including government leaders and contact tracers, and limited access to health care services and needed community resources3,4 Also, many African Americans have limited access to home Internet to schedule COVID-19 testing appointments and face other challenges getting tested, including transportation issues or unavailable clinic hours, along with limited ongoing social support for testing from significant others and health professionals.5Health promotion studies have demonstrated that community-based interventions guided by communitybased participatory research (CBPR) approaches can be effective in increasing uptake of health screenings with African Americans, particularly in faithbased settings6\"8 Engagement of faith-based organizations in COVID-19 testing efforts is promising because they can have great influence on members' health screening behaviors, are trusted sources of information, and have multilevel communication channels (interpersonal, church services, outreach ministries)9 Also, African American faith-based organizations have church leaders and members who can provide social support, locations that could facilitate intervention delivery, and outreach ministries (e.g., food and clothing pantries, social services, recovery programs) that serve community members who may have limited access to COVID-19 testing.10,11 Moreover, a national poll in November 2022 found that 35% of Black Protestants reported that they were attending in-person services less often than before the pandemic (the highest of any racial/ethnic denominational groups). However, the same proportion reported attending virtually or by watching services on \"TV more often than before the pandemic,12 thereby providing multiple opportunities for delivery of COVID-19 testing information with church-affiliated populations, particularly in partnership with health agencies and health science researchers committed to CBPR.