{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:34:09Z","timestamp":1777944849958,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Anonymous"},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["P2CHD058484"],"award-info":[{"award-number":["P2CHD058484"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Womens Health (Lond Engl)"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>While rural Appalachian adults tend to experience poorer reproductive health and more social drivers of poor health compared to other populations, data on contraception use in rural Appalachia are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>We aimed to analyze the relationship between rural Appalachian residence and contraception use, focusing on methods that require a provider to access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>The study used a population-representative cross-sectional survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We analyzed 2018\u20132019 cross-sectional data from the Ohio Survey of Women (n\u2009=\u20092568), a population-representative survey of women aged 18\u201344\u2009years in Ohio. Our outcome was provider-reliant contraception, defined as methods requiring either a prescription or a procedure performed by a healthcare provider. Key independent variables included residence (rural Appalachian versus other regions), disruptive life events (e.g. family or friend\u2019s death, unemployment), and difficulty accessing health care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among rural Appalachian reproductive-age women at risk of unintended pregnancy in Ohio, 71% used provider-reliant contraception compared to 64% of those elsewhere in the state (p\u2009=\u20090.02). A higher proportion of rural Appalachian women used provider-reliant contraception in models adjusting for demographic factors and medical care access (odds ratio: 1.43, 95% confidence interval: 1.04\u20131.97). This difference did not remain after adjusting for disruptive life events. When women with permanent contraception were excluded from the analytic sample, we observed no differences in provider-reliant contraceptive use by residence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>We found statistically significant differences in provider-reliant contraception by rural Appalachian residence in most analyses, but these disappeared when those with female permanent contraception were excluded. Observed differences in the full sample appear to be driven by higher use of permanent contraception among rural Appalachian women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17455057251351416","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T04:30:26Z","timestamp":1756096226000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Provider-reliant contraception use among reproductive-aged women in rural Appalachian Ohio"],"prefix":"10.1177","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3396-0122","authenticated-orcid":false,"given":"Kayla M.","family":"Alvis","sequence":"first","affiliation":[{"name":"School of Environment and Natural Resources, College of Food, Agricultural, and Environmental Science, The Ohio State University, Columbus, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikaela H.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abigail Norris","family":"Turner","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA"},{"name":"Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria F.","family":"Gallo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,8,24]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Appalachian Regional Commission. About the Appalachian region n.d. https:\/\/www.arc.gov\/about-the-appalachian-region\/ (cited 10 May 2022)."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.4135\/9781412939645.n101"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.5406\/jappastud.22.2.0187"},{"key":"e_1_3_3_5_2","unstructured":"Marshall JL Thomas L Lane NM et al. Health disparities in Appalachia: disparities and bright spots (Internet). Robert Wood Johnson Foundation; Appalachian Regional Commission; Foundation for a Healthy Kentucky 2017 https:\/\/www.arc.gov\/wp-content\/uploads\/2020\/06\/Health_Disparities_in_Appalachia_August_2017.pdf (cited 31 March 2022)."},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/08901171211011388"},{"issue":"11","key":"e_1_3_3_7_2","first-page":"1","article-title":"Maternal characteristics and infant outcomes in Appalachia and the Delta","volume":"68","author":"Driscoll AK","year":"2019","unstructured":"Driscoll AK, Ely DM. Maternal characteristics and infant outcomes in Appalachia and the Delta. Natl Vital Stat Rep 2019; 68(11): 1\u201315.","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1080\/03630242.2015.1101736"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1080\/00981389.2020.1769249"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20196862"},{"key":"e_1_3_3_11_2","unstructured":"Ohio Department of Medicaid. Medicaid and Appalachian Ohio health socioeconomic status and ecological OMAS assessment study (Internet) 2018 https:\/\/medicaid.ohio.gov\/wps\/wcm\/connect\/gov\/90c370e3-5891-4f93-8ea4-976867c2b12e\/OMAS-Study.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-90c370e3-5891-4f93-8ea4-976867c2b12e-nC50m4R (cited 7 February 2023)."},{"key":"e_1_3_3_12_2","unstructured":"Ruhil AVS Robinson H Das P et al. Health in rural Ohio: 2019 update (Internet). Ohio Medicaid Assessment Survey 2021 https:\/\/grc.osu.edu\/sites\/default\/files\/inline-files\/OMAS_Rural_Health_2019.pdf (cited 31 March 2022)."},{"key":"e_1_3_3_13_2","unstructured":"Srygley S Khairunnisa N Elliott D. The Appalachian region: a data overview from the 2018\u20132022 American Community Survey chartbook."},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12259"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2020.12.009"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12116"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040296"},{"issue":"1","key":"e_1_3_3_18_2","article-title":"Design and implementation of the surveys of women: protocol for an address-based sampling multimodal study","volume":"12","author":"Poland S","year":"2023","unstructured":"Poland S, Stern M, English N, et al. 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