Person:

Charlton, Brittany

Purpose—The influence of reproductive factors on colorectal cancer, including oral contraceptive (OC) use, has been examined, but less research is available on OC use and adenomas.

Methods—Participants of the Nurses' Health Study who had a lower bowel endoscopy between 1986 (when endoscopies were first assessed) through 2008 where included in this study. Multivariable logistic regression models for clustered data were used to estimate odds ratios and 95% confidence intervals [OR (95% CIs)].

Results—Among 73,058 participants, 51% (N=37,382) reported ever using OCs. Ever OC use was associated with a slight increase of non-advanced adenomas [OR=1.11 95% CI (1.02, 1.21)] but not with any other endpoints. Duration of OC use was not associated with adenomas, but longer times since last OC use were associated with increased odds of adenomas [e.g., compared to never use, 15+ years since last use: OR=1.17 (1.07, 1.27)]. Shorter times since last OC use were inversely associated [e.g., ≤4 years since last use: OR=0.74 (0.65, 0.84)].

Conclusions—We observed a modest borderline increase in risk of colorectal adenomas with any prior OC use. Additionally, more recent OC use may decrease risk while exposure in the distant past may modestly increase risk of adenomas.

Background—It remains unclear if oral contraceptive (OC) use is associated with the incidence of colorectal cancer. Few studies have examined this association by duration of OC use, time since last OC use, and different cancer subsites.

Methods—Among 88,691 participants of the Nurses’ Health Study I (NHSI) and 93,080 participants of the Nurses’ Health Study II (NHSII), we assessed OC use every 2 years between 1976-2010 and categorized it as ever use, duration of use, and time since last use. We included incident colorectal cancer cases through 2010 (NHSI: age at diagnosis=36-88, N=1,764, NHSII: age at diagnosis=33-64, N=206). Multivariable hazard ratios and 95% confidence intervals [HR (95% CIs)] were estimated using Cox proportional hazards regression models.

Results—Ever OC use was not associated with colorectal cancer in NHSI [1.01 (0.91, 1.12)] nor NHSII [1.03 (0.69, 1.53)]. In NHSII, when compared to never-users, longer durations (5+ years)of OC use were inversely associated with the risk of colon cancers (test for trend p=0.02) but the number of endpoints was limited. No other colorectal cancer subsites were associated with OC durations or times since last OC use in either cohort.

Conclusions—In two large prospective cohorts, we found little evidence that OC use may be protective for colorectal cancer, except potentially with longer durations of use among younger women. Impact—Our results do not support the previous initial studies that reported an inverse association of recent OC use with colorectal cancer but instead support newer, larger studies demonstrating no such association.

Objective: To determine whether use of oral contraceptives is associated with all cause and cause specific mortality.

Design: Prospective cohort study.

Setting: Nurses’ Health Study, data collected between 1976 and 2012.

Population: 121 701 participants were prospectively followed for 36 years; lifetime oral contraceptive use was recorded biennially from 1976 to 1982.

Main outcome measures: Overall and cause specific mortality, assessed throughout follow-up until 2012. Cox proportional hazards models were used to calculate the relative risks of all cause and cause specific mortality associated with use of oral contraceptives.

Results: In our population of 121 577 women with information on oral contraceptive use, 63 626 were never users (52%) and 57 951 were ever users (48%). After 3.6 million person years, we recorded 31 286 deaths. No association was observed between ever use of oral contraceptives and all cause mortality. However, violent or accidental deaths were more common among ever users (hazard ratio 1.20, 95% confidence interval 1.04 to 1.37). Longer duration of use was more strongly associated with certain causes of death, including premature mortality due to breast cancer (test for trend P<0.0001) and decreased mortality rates of ovarian cancer (P=0.002). Longer time since last use was also associated with certain outcomes, including a positive association with violent or accidental deaths (P=0.005).

Conclusions: All cause mortality did not differ significantly between women who had ever used oral contraceptives and never users. Oral contraceptive use was associated with certain causes of death, including increased rates of violent or accidental death and deaths due to breast cancer, whereas deaths due to ovarian cancer were less common among women who used oral contraceptives. These results pertain to earlier oral contraceptive formulations with higher hormone doses rather than the now more commonly used third and fourth generation formulations with lower estrogen doses.

Objective—HPV infections and abnormal Pap tests are common, and most do not progress to cervical cancer. Since it is difficult to predict which mild Pap abnormalities will develop into precancerous lesions, many women undergo painful and costly evaluations, and even unnecessary treatment. The objective of this study was to develop a risk prediction model based on clinical and demographic information to identify women most likely to develop significant precancerous lesions (CIN2/3 or AIS) among women with mild Pap abnormalities (ASCUS/LSIL).

Materials and Methods—The Abnormal Pap Smear Registry includes women who received treatment at the Brigham and Women’s Hospital/Dana Farber Cancer Institute Pap Smear Evaluation Center beginning in 2006. It includes 1,072 women with mild cervical dysplasia (ASCUS or LSIL Pap tests) on their referral Pap test. We derived a clinical prediction model to predict the probability of developing CIN2/3 or AIS using multivariate logistic regression with a split-sample approach.

Results—By the end of follow-up, 93 of the 1,072 women developed CIN2/3 or AIS (8.7%). There were several differences between women who developed CIN2/3 or AIS and women who did not. However, once we put these into the regression model, the only variable that was significantly associated with CIN2/3 or AIS was having a prior history of an abnormal Pap or biopsy [OR=2.44, 95% CI (1.03 to 5.76)]. The resulting prediction model had poor discriminative ability and was poorly calibrated.

Conclusions—Despite accounting for known risk factors, we were unable to predict individual patients’ probability for progression on the basis of available data.

OBJECTIVE: To examine whether sexual orientation is associated with disparities in teen pregnancy and hormonal contraception use among adolescent females in 2 intergenerational cohorts.

STUDY DESIGN: Data were collected from 91,003 women in the Nurses' Health Study II (NHSII), born between 1947-1964, and 6463 of their children, born between 1982-1987, enrolled in the Growing Up Today Study (GUTS). Log-binomial models were used to estimate risk ratios for teen pregnancy and hormonal contraception use in sexual minorities compared with heterosexuals and metaanalysis techniques were used to compare the 2 cohorts.

RESULTS: Overall, teen hormonal contraception use was lower and teen pregnancy was higher in NHSII than GUTS. In both cohorts, lesbians were less likely, whereas the other sexual minorities were more likely, to use hormonal contraception as teenagers compared with their heterosexual peers. All sexual minority groups in both cohorts, except NHSII lesbians, were at significantly increased risk for teen pregnancy, with risk ratios ranging from 1.61 (95% confidence interval, 0.40-6.55) to 5.82 (95% confidence interval, 2.89-11.73). Having an NHSII mother who was pregnant as a teen was not associated with teen pregnancy in GUTS participants. Finally, significant heterogeneity was found between the 2 cohorts.

CONCLUSION: Adolescent sexual minorities have been, and continue to be, at increased risk for pregnancy. Public health and clinical efforts are needed to address teen pregnancy in this population.

Purpose To examine sexual orientation group disparities in Pap and STI/HPV tests among adolescents and young adult females.

Methods Survey data from 4,224 adolescents and young adults aged 17-25 who responded to the 2005 wave questionnaire of the Growing Up Today Study were examined cross-sectionally with multivariable generalized estimating equations regression. We examined associations between sexual orientation and reproductive health care utilization as well as abnormal results with completely heterosexuals as the referent group, controlling for age, race/ethnicity, geographic region, and sexual history.

Results After accounting for sociodemographics and sexual history, mostly heterosexual/bisexual females had 30% lower odds of having a Pap test within the last year and almost 40% higher odds of being diagnosed with an STI, as compared to the completely heterosexual group. Additionally, lesbians had very low odds of having a Pap test in life (OR=.13, p-value=<.0001) and having a Pap test within the last year (OR=.25, p-value=.0002), compared to completely heterosexuals.

Conclusions Our study demonstrates that sexual minority adolescent and young adult women underutilize routine reproductive health screenings including Pap smears and STI tests. Providers and health educators should be aware of these disparities so that they can provide appropriate care to young women and their families and ensure that all young women receive reproductive health screening. Further research is needed to explore reasons sexual minority females are not accessing care as recommended since this may suggest opportunities to improve reproductive health screenings as well as broader health care access issues.

Study question Is oral contraceptive use around the time of pregnancy onset associated with an increased risk of major birth defects? Methods: In a prospective observational cohort study, data on oral contraceptive use and major birth defects were collected among 880 694 live births from Danish registries between 1997 and 2011. We conservatively assumed that oral contraceptive exposure lasted up to the most recently filled prescription. The main outcome measure was the number of major birth defects throughout one year follow-up (defined according to the European Surveillance of Congenital Anomalies classification). Logistic regression estimated prevalence odds ratios of any major birth defect as well as categories of birth defect subgroups. Study answer and limitations Prevalence of major birth defects (per 1000 births) was consistent across each oral contraceptive exposure group (25.1, never users; 25.0, use >3 months before pregnancy onset (reference group); 24.9, use 0-3 months before pregnancy onset (that is, recent use); 24.8, use after pregnancy onset). No increase in prevalence of major birth defects was seen with oral contraceptive exposure among women with recent use before pregnancy (prevalence odds ratio 0.98 (95% confidence interval 0.93 to 1.03)) or use after pregnancy onset (0.95 (0.84 to 1.08)), compared with the reference group. There was also no increase in prevalence of any birth defect subgroup (for example, limb defects). It is unknown whether women took oral contraceptives up to the date of their most recently filled prescription. Also, the rarity of birth defects made disaggregation of the results difficult. Residual confounding was possible, and the analysis lacked information on folate, one of the proposed mechanisms. What this study adds Oral contraceptive exposure just before or during pregnancy does not appear to be associated with an increased risk of major birth defects. Funding, competing interests, data sharing BMC was funded by the Harvard T H Chan School of Public Health’s Maternal Health Task Force and Department of Epidemiology Rose Traveling Fellowship; training grant T32HD060454 in reproductive, perinatal, and paediatric epidemiology and award F32HD084000 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and grant T32CA09001 from the National Cancer Institute. The authors have no competing interests or additional data to share.

Aspects of positive parenting have previously been linked to better offspring health and well-being1,2, though often, individual outcomes have been examined separately. Examining multiple outcomes simultaneously, over multiple aspects of parenting, may provide a more holistic picture of the parenting–health dynamics3,4. Methodological limitations such as reverse causation—good childhood outcomes that make parenting easier—also remain a concern in many previous observational studies5. Here we examined the associations between multiple aspects of parenting (including parent–child relationship satisfaction concerning love, parental authoritativeness and family dinner frequency) and various subsequent offspring psychosocial, mental, behavioural and physical health and well-being outcomes. We analysed longitudinal data from the Growing Up Today Study 1 (N = 8,476, mean baseline age = 12.78 years) and Growing Up Today Study 2 (N = 5,453, mean baseline age = 17.75 years). Both parenting and health outcomes were based on offspring self-reports. The results suggest that greater relationship satisfaction was associated with greater emotional well-being, lower risk of mental illness, eating disorders, overweight or obesity and marijuana use. To a lesser extent, greater parental authoritativeness and regular family dinner were also associated with greater offspring emotional well-being, fewer depressive symptoms, lower risk of overeating and certain sexual behaviours. This study strengthens the evidence for a public health focus on improving parenting to promote population health and well-being.