TIME Sex/Relationships

Teenage Girls Given Choice of Free Contraceptives Get Far Fewer Abortions

IUDs
Illustration by Miles Donovan for TIME

Girls allowed to choose between free contraceptive methods had 76% fewer abortions than their peers in the general population — and most chose IUDs

Three in 10 teenage girls in the U.S become pregnant each year—a rate far higher than in other industrialized countries. But when girls are counseled about the most effective contraceptives and given their pick of birth control at no cost, their rates of pregnancy drop by 78% and they get 76% fewer abortions than the general population of sexually active teens.

That’s what a new study published in the New England Journal of Medicine suggests, in which researchers at Washington University School of Medicine in St. Louis attempted to see what would happen when they tore down the three main barriers to teenage birth control—ignorance of options, limited access and prohibitive cost.

They studied a group of 1,404 teenage girls enrolled in the Contraceptive CHOICE project, a study of adolescents and women at high risk for unintended pregnancy. 62% of the girls were black and 99% were sexually active. Black teens have even higher rates of pregnancy than the rest of the population: 4 in 10 become pregnant, compared with 2 in 10 white teens.

In the study, peer educators, volunteers, medical students and others interested in health education counseled the girls on the available methods, presenting them in order of effectiveness—IUDs and implants, followed by Depo-Provera injection, pills, patch and ring, and condoms. They stuck to a script that encouraged the girls to choose for themselves, emphasizing that they can always change their method later. The contraceptives were in the room for the girls to see and touch. The clinic had flexible scheduling so that even if a teen was late to her appointment, she was guaranteed to be seen, and every girl received her birth control right after the counseling session.

That’s a world away from the experience of girls in the outside world, who are often asked by providers to come back several times before they start a method, given false information about IUD risks, and eventually mass-prescribed pills, says project director Gina Secura. “It’s often a one-sentence conversation: what do you want, and here’s a prescription,” she says.

MORE: How Having an (Insurance-Covered) IUD Is Saving My Life

Focusing the conversation purely on effectiveness was, well, extremely effective. “When we first started the project, we had hoped to double the national rate [of IUD or implant use]—about 5%,” says Secura. Instead of the hoped-for 10%, a whopping 72% of teems chose IUDs or implants. “We were shocked,” she says. And they stuck with them. Two-thirds of the girls were still on long-acting reversible contraception (LARC, which includes implants and IUDs) after 2 years, compared to one third of girls on short-acting methods like the pill.

IUDs are a solid choice according to the American Academy of Pediatrics, who just endorsed IUDs as the best method of birth control for teenage girls. And the evidence bears it out. The researchers tracked the girls for 2-3 years and followed up every few months by phone. They found that 3.4% of CHOICE teens got pregnant, compared to 15.85% of sexually experienced teens in the general population. Fewer than 1% of CHOICE teens got abortions (0.97%, to be exact), while 4.15% of the other population did.

That means that girls in the program were 78% less likely to get pregnant and had 76% fewer abortions than their peers in the general population. Of course, it’s not quite fair to compare these two groups, since the girls in the research project were given free access and would have been more encouraged to stick to their methods with follow-ups, but the implications are incredibly important for clinics and counselors.

Most notable of all, the low pregnancy rates between white and black teenagers in the project were almost identical. “If we really want to tackle this health disparity, that shows we can actually do it,” Secura says.

These rates far outpace even the CDC’s 2015 goal for teenage births; they’re aiming for 30.3 teenage births per 1,000 teens. The CHOICE rate was 36% lower than that, at 19.4 teenage births.

Secura attributes these dramatic drops largely to the high uptake of long-term contraceptive methods, options that are cost-prohibitive to many low-income teens and free clinics. “It can be difficult to justify spending the same amount of money on 10 devices, where they could buy five times as many packs of pills,” Secura says.

The researchers put their CHOICE methods on a site called LARC FIRST designed to guide clinics, and since data from the study began coming out over the past two years, Secura says they’ve gotten about 300 requests from clinics asking for help in implementing their best practices—including training people who aren’t time-pressed providers and nurse practitioners to deliver effectiveness counseling. Having a kind of AmeriCorps for contraceptive effectiveness counselors, Secura says, would be a dream.

Though the study is over, several clinics are trying to adapt some of CHOICE’s methods to their real world practices and evaluate them scientifically. “I’m hoping we build the demand in terms of teens wanting these,” Secura says.

TIME has called IUDs the best form of birth control that no one is using—but when teens are informed and cost barriers disappear, this study shows that teenage girls are clearly hungry for better birth control.

TIME Research

You Asked: Is It Good or Bad to Take a Nap?

Illustration by Peter Oumanski for TIME

Snooze, or skip it?

You’re right to be confused. Even as a recent study linked napping to higher mortality, companies and colleges across the U.S. are installing nap rooms to boost productivity. Truly, it would be a dream to get some napping consensus.

But whether or not napping is right for you depends. “First of all, it’s important to ask yourself why you’re taking the nap,” says Dr. Sara Mednick, a psychologist at the University of California, Riverside and author of Take a Nap! Change Your Life. If you’re spending a big chunk of your day feeling sleepy and out of sorts, then your desire to snooze may be driven by stress, insomnia, sleep apnea or a hundred other slumber-disrupting health conditions, Mednick says.

“Daytime napping is an early indicator of underlying ill health,” adds Yue Leng, a University of Cambridge sleep researcher and coauthor of the study linking naps to higher mortality rates. Like Mednick, Leng suggests daytime drowsiness is likely a symptom of other health issues, not their cause.

Put simply, blaming naps for higher mortality rates is like blaming your doctor for heart disease; you’re more likely to see a doc if you have heart issues, but that doesn’t mean she’s to blame.

MORE: The Power of Sleep

Actually, naps are good for most people, Mednick says. Her research shows a nap—defined as daytime sleeping that lasts between 15 and 90 minutes—can improve brain functions ranging from memory to focus and creativity. “For some people, naps are as restorative as a whole night of sleep,” she adds. More research shows a quick nap can lower stress and recharge your willpower. And napping has also been linked to lower rates of cardiovascular disease and inflammation.

But all of these benefits depend on you getting a good night of sleep to begin with, Mednick stresses. Also, not everyone is a good napper. “Some people wake up from naps feeling like crap,” she says.

Genetics could explain why some people are nappers and some aren’t. But regardless of the explanation, there’s clearly a difference between the two groups. “People who aren’t habitual nappers tend to fall into very deep sleep during naps, and waking up from that leaves them feeling groggy,” Mednick explains. On the other hand, natural nappers—you know who you are—don’t plunge into deep slumber during their daytime snoozes, Mednick says. This allows them to wake up from naps feeling energized and alert, not discombobulated.

MORE: Pass The Pillow: “Google Naps” Is Google Maps for Places to Nap

For natural nappers, she says it’s “incredibly important” that you do catch your daytime ZZZs. “These people—and they probably account for about 40% of the population—tend to do really poorly if they don’t nap,” she explains. Without their much needed daytime shuteye, habitual nappers often reach for energy drinks, caffeine or other stimulants that perk them up but don’t recharge their cognitive batteries the way a short, healthy snooze would.

“For these people, skipping their nap is a huge productivity killer,” Mednick says, and that’s a compelling reason for employers and universities to provide nap spaces for employees and students.

While the length of an ideal siesta varies from person to person, 20 to 30 minutes is plenty for most. But up to 90 minutes—about the length of one full sleep cycle—could also be beneficial, Mednick says. She recommends trying different nap lengths to find the one that leaves you feeling the most refreshed.

If you’ve never been a napper but want to cash in on napping’s brain and health benefits, Mednick says you may be able to teach yourself to nap. The trick is to keep your daytime shuteye very short—no more than 15 minutes at first. This will prevent your brain and body from slipping into the deeper levels of slumber that leave you feeling foggy upon waking, she adds.

But if you’re just not a born napper, don’t sweat it. “Everyone’s different,” Mednick says. “If you feel good, whatever you’re doing is fine.”

TIME Mental Health/Psychology

The Reason You Make Unhealthy Choices

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Self love isn’t just for hippies and millennials. If you’re trying to stick to a diet or scrape together the motivation to get to the gym, it might be for you, too.

So finds a new meta-analysis published in the journal Health Psychology. Self-compassion—accepting yourself without judgment when times get tough—is linked to better health behaviors.

People often think that they are motivated by self-criticism, but a burgeoning area of research suggests the opposite. Being kind to yourself, as opposed to tearing yourself down, leads to fewer bad feelings and, in turn, healthier actions. One study found that when people were assigned to practice self-compassion, they were able to curb their smoking habit faster. The reason self-compassion works, researchers think, might be its ability to improve self-regulation: the follow-through you need to stay loyal to healthy behaviors.

This analysis looked at 15 studies of more than 3,000 total people across the age spectrum and discovered a link between self-compassion and four key health-promoting behaviors: eating better, exercising more, getting more restful sleep, and stressing less. People who were more self-compassionate practiced these health habits more often.

“So much research right now is suggesting that not engaging in these behaviors can be the precursor to a variety of different life-threatening and chronic diseases such as diabetes, hypertension, cardiovascular disease, arthritis, you name it,” says study author Fuschia Sirois, professor of psychology at Bishop’s University in Quebec. Developing self-compassion is a way to commit to the behaviors you already know you should do, she says.

In addition to just being nice to yourself, self-compassion requires you to embrace that you’re part of the human race that shares common miseries, and mindfully recognize negative feelings without getting enmeshed in them. If that sounds impossible, Sirois assures us it’s not.

“One of the reasons we were quite excited by the findings is that self-compassion is a quality that can be cultivated,” says Sirois. Writing a letter to yourself—as if you were your own friend—and opening it up in times of stress or failure is one way to start, she suggests. Kristin Neff, a pioneer in this field of research, offers guided self-compassion meditations and exercises on her site.

Find out where you currently fall on the scientific scale for self-love here.

TIME Aging

‘Senior Moments’ Could Be Early Signs of Dementia: Study

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Scientists hope that early identification of warning signs may help prevent memory problems from becoming so severe

So-called senior moments, like failing to recall your missing sunglasses are perched on your head, might not be just benign mishaps, but early harbingers of Alzheimer’s disease, reports a new paper.

The study, published in the journal of the American Academy of Neurology, suggests that self-reported worries about memory lapses are strong predictors of a later diagnosis of dementia. The research indicates that it takes about 12 years from initial signs of forgetfulness for the problem to become severe enough to be called dementia.

Of course, forgetfulness is a natural part of aging, and a spotty memory by no means guarantees that bigger problems are in the works, the researchers say. However, that does not mean concerns about errant sunglasses should necessarily be brushed off.

That’s because “there may be a significant window of opportunity for intervention before a diagnosable problem shows up,” Richard Kryscio, the study’s lead author and associate director of the Alzheimer’s Disease Center at the University of Kentucky, said in a statement. “Certainly, someone with memory issues should report it to their doctor so they can be followed.”

Right now, there are no definitive ways of preventing dementia, though early research suggests that a healthy lifestyle — including exercise, good eating habits and abstention from smoking — might help ward off the disease, the National Institutes of Health says. Antianxiety drugs have also recently been fingered as possibly increasing a user’s risk of developing memory problems later in life.

In the study, scientists at the University of Kentucky asked 531 people, average age 73 and without dementia, if they had noticed any changes in their memory in the past year.

People who reported such changes were about three times more likely to develop dementia than those who reported no such symptoms. In fact, of the 1 in 6 participants who developed dementia, 80% of those first reported memory changes.

Meanwhile, separate research published in Cognitive and Behavioral Neurology suggests that people with dementia may not remember specific events, like a visit from a relative, but do remember how those forgotten events made them feel.

“This confirms that the emotional life of an Alzheimer’s patient is alive and well,” Edmarie Guzman-Velez, lead author and a doctoral student in clinical psychology at the University of Iowa, said in a statement. “Our findings should empower caregivers by showing them that their actions toward patients really do matter.”

In the study, 17 people with Alzheimer’s disease and 17 healthy participants were asked to view 20 minutes of sad and happy movies. About five minutes after each movie clip finished, participants took a test on what they’d watched: though participants with dementia remembered much less about films than did the nondementia participants — one didn’t remember watching any movies — they still reported heightened levels of either sadness or happiness for up to 30 minutes after watching the films, according to the research.

In general, the researchers said, sadness lasted longer than happiness.

TIME Innovation

Five Best Ideas of the Day: September 24

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Because of America’s unique relationship with Liberia, we have an obligation to help fight the Ebola outbreak there.

By James Ciment in Slate

2. Medical research often doesn’t account for different ethnicities, and underrepresented groups suffer.

By Estaban G. Burchard in Nature

3. One way to head off sexual violence in professional sports: start with high school coaches.

By Libby Nelson in Vox

4. Beyond the sharing economy: Is “reputation” the next important currency?

By Heather Schlegel on CNN

5. Powerful protests over climate change target corporations – and new leadership is needed to restore faith in capitalism.

By Judith Samuelson in the Huffington Post

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME singles

Why 25% of Millennials Will Never Get Married

A new report from Pew Research predicts that more folks under 35 will be single forever. Here's why

The number of Americans who have always been single and will never marry is at a historic high, says a new Pew Research report, partly because they don’t have jobs and partly because marriage is becoming less highly-regarded. Most people think it’s important for couples who intend to stay together to be married, but the number of single Americans who want to get married has dropped significantly even in the last four years.

The report, based on census data and Pew’s surveys, is the latest in a series of indicators that marriage’s stock is on a sharp downward trajectory. Fewer young people are getting married and many are getting married later. About 20% of Americans older than 25 had always been single in 2012, up from 9% in 1960. In the black community, the numbers are even starker: 36% of black Americans older than 25 have never been married, a fourfold increase from 50 years ago.

The one number that hasn’t really budged is the percentage of 64 year olds who have never been married. In 1960, it was 8% and in 2012, it was 7%. But the report’s authors Wendy Wang and Kim Parker say this might be changing. Each decade, the percentage of people of marriageable age who are single has grown. “When today’s young adults reach their mid-40s to mid-50s, a record high share (roughly 25%) is likely to have never been married,” they write. “This is not to say that adults in their mid-40s to mid-50s who still haven’t married will never marry, but our analysis suggests that the chance of getting married for the first time after age 54 is relatively small,” adds Parker.

Why aren’t people getting married anymore? The three main reasons people give for their singleness are that they haven’t found the right person (30%), aren’t financially stable enough (27%) and are not ready to settle down (22%). Many more young people are eschewing tying the knot, at least for a while, for shacking up. The researchers don’t see that as the new normal yet. “Cohabitation is much less common than marriage and cohabiting relationships are much less stable than marriages,” says Parker.”It’s hard to imagine marriage being replaced any time soon.”

But the Pew researchers teased out a bunch of other reasons by asking what people wanted in a partner.

The quality most women want in a husband, somewhat unromantically, is a secure job, followed very closely by similar ideas on raising kids, which was the quality most men wanted in a spouse. The problem is, the report points out, that young men are increasingly less likely to be employed. “In 1960, 93% of men ages 25 to 34 were in the labor force; by 2012 that share had fallen to 82%.” Those young men who are employed are not bringing home as much bacon as they once did. In fact, if you adjust for inflation, the median hourly wages of men aged 25 to 34 are a fifth less than they were in 1980.

Compounding that issue is that women have entered the labor force in much higher numbers. So while there are more men than women who are single and available, there are far fewer employed men who are single than employed women. Fifty years ago there were 139 single young men with jobs for every 100 single young women; that ratio has now dropped to 91:100. “If all never-married young women in 2012 wanted to find a young employed man who had also never been married, 9% of them would fail,” says the report, “simply because there are not enough men in the target group.”

But lest that bum all the single ladies out too much, the report points out that single young women don’t have to marry single young men: they can marry guys who are divorced, widowed or much older. Should they bother? Now that comedian Sarah Silverman has declared marriage barbaric, is it done? The Pew researchers don’t think so.

“Marriage hasn’t fallen out of favor,” says Parker, “but financial constraints and imbalances in the marriage market may be holding people back from taking the plunge.”

TIME Obesity

Are Diabetes Rates Really “Leveling Off”?

For the first time in several decades, we’re starting to see a slowing of new diabetes diagnoses, suggests new data published in JAMA.

The study authors examined data collected from more than 600,000 adults between ages 20-79 from 1980 to 2012—part of the Centers for Disease Control and Prevention (CDC)’s National Health Interview Survey. A broad view paints a grim picture: From 1990 to 2008, the prevalence of diabetes as well as new cases of the disease both doubled. But from 2008-2012, those rates of change leveled off. So while people are still being diagnosed with diabetes, the rate of growth is decelerating.

“It’s encouraging that we may be seeing this slowing and plateauing,” says Ann Albright, PhD, RD, director of the division of diabetes translation at the CDC and one of the study’s authors. The study cites a slowing of rates of obesity—one of the biggest contributors to type 2 diabetes, found one study—as a partial explanation for the results. Black and Hispanic adults, however, have continued to see a rise in new diabetes cases, and prevalence also grew among people with a high school education or less. These disparities, Albright says, could get worse.

“This data is telling us that we are doing some things right,” Albright says, which is especially important given that the population is aging, and baby boomers are hitting peak years for diabetes. Driving down diabetes prevalence is great, but the best way to get there is to curb new cases—not to have people in the diabetes pool die off early, she adds.

“[This study] is important to note, but it doesn’t mean we have this licked and we’re all done,” she says. “We still have a lot of work to do.”

TIME Mental Health/Psychology

70% of People Suffer After Violent Crime, But Few Get Help

Victims who knew the perpetrator were more likely to report it

Nearly 70% of people endure severe social or emotional problems after being the victim of a violent crime, but only about 12% of those who had problems received help from victim services, according to a new report from the Department of Justice. Just over half of victims who suffered from socio-emotional problems reported the crime to the police.

“A victim with socio-emotional problems may experience a range of emotional and physical symptoms,” the report reads, citing anxiety, trouble sleeping and depression.

Trends varied across demographic groups, particularly gender. Women were much more likely than men to experience socio-emotional problems. Nearly 80% of women who suffered from a serious violent crime said they had such problems, while only 58% percent of their male counterparts said the same.

Whether the victim knew the crime’s perpetrator also affected whether they experienced social or emotional problems. Victims harmed in acts of intimate partner violence were more likely to experience issues, regardless of the type of crime. Nearly three in four victims of intimate partner violence suffered from physical problems, with 61 percent saying they had trouble sleeping.

The report, which looked at data from more than 160,000 people across the U.S., also found low rates of reporting violent crime. Only about a third of victims who experienced severe distress reported the crime to the police. About half of victims who knew the perpetrator reported the crime, while 41% of those who didn’t know the offender did so.

TIME Research

Gun Fatality Rates Vary Wildly By State, Study Finds

New York Mayor Michael Bloomberg with Rep. Peter T. King, R-N.Y. at a photo op in the Cannon House Office Building with mayors from around the country participating in the 2007 National Summit of Mayors Against Illegal Guns.
New York Mayor Michael Bloomberg with Rep. Peter T. King, R-N.Y. at a photo op in the Cannon House Office Building with mayors from around the country participating in the 2007 National Summit of Mayors Against Illegal Guns. Scott J. Ferrell—CQ-Roll Call,Inc./Getty Images

While the national mortality rate stayed level between 2000 and 2010, death rates rose in Massachusetts and Florida and declined in states like California

The rate of death by firearm remained constant in the United States over the 2000s, according to a new study in health journal BMJ — but the situation varied dramatically between states.

Research found that the rates of gun fatalities rose in Massachusetts and Florida between 2000 and 2010 and declined in states like California, North Carolina and Arizona.

“We showed no change in national firearm mortality rates during 2000–2010, but showed distinct state-specific patterns with racial and ethnic variation and by intent,” the study reads.

State gun restrictions appeared to have a varying effect on gun fatality rates, according to the study. California, for instance, has some of the most stringent laws regarding gun ownership and saw a decline in violence. But Massachusetts enacted tough gun laws in 1998, just before the beginning of the study, and still saw an increase in the rate of gun deaths. The study suggests that the increase can be attributed to an influx in firearms from surrounding states.

Looking at the overall numbers over the 11-year period, the chance of dying from a firearm varied dramatically between states, from a death rate of 3 per 100,000 in Hawaii to more than 18 per 100,000 in Louisiana.

The study also found that racial disparities persist across the country. African Americans are twice as likely to die of a gun death than their white counterparts.

TIME psychology

Brains Get a Performance Boost From Believing Effort Trumps Genetics

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David Disalvo is the author of Brain Changer: How Harnessing Your Brain's Power to Adapt Can Change Your Life.

It's all about your state of mind

How much of our intelligence is a genetic gift or the product of hard work is difficult, perhaps impossible, to know for sure. But for our brains to perform their best, new research suggests, it’s better to believe that effort trumps heredity.

Researchers publishing in the journal Biological Psychology wanted to know what happens in the brain when people receive the message that their performance is the result of native intelligence versus the fruits of hard work. Previous studies have found that the latter seems to prompt people to work even harder the next time, while the former has a dampening effect on performance. But it’s unclear what either message triggers in the brain to cause those outcomes.

This time around, two groups of study participants were outfitted with electroencephalogram (EEG) headgear and asked to read two different articles about intelligence. One article conveyed the message that intelligence is solidly genetic; the other that brilliance is born of a challenging environment with very little genetic influence.

The study participants were then told to complete a computer task while their brain activity was recorded.

The EEG results revealed that the group given the article supporting a genetic basis for intelligence showed the highest levels of attention paid to their responses on the task, indicating an especially high concern for performance. But members of this group didn’t recover well from errors, indicating that their elevated attention upfront didn’t translate into consistently applied attention when the going got rough.

In contrast, the group given the article arguing that genetics play a minor role in intelligence showed the highest levels of attention after each error, and their recovery from mistakes became increasingly more efficient as the task went on.

The researchers think that by coloring the participants’ mindsets about intelligence, they changed how their brains responded to challenges. Believing that intelligence is hardwired seemed to elevate a concern for performance, but did nothing to boost actual performance when the task became harder. Believing that intelligence is forged through difficulty, on the other hand, seemed to increase attention paid to mistakes, with the result of improving performance.

The takeaway: How we’re predisposed to think about problems changes the way our brains handle them. Beyond the abilities we’ve inherited, the most important factor in achievement may be believing that it’s within reach.

David Disalvo is the author of Brain Changer: How Harnessing Your Brain’s Power to Adapt Can Change Your Life and the best-selling What Makes Your Brain Happy and Why You Should Do the Opposite, which has been published in 10 languages. His work has appeared in Scientific American Mind, Forbes, Psychology Today, The Wall Street Journal, Slate, Salon, Esquire, Mental Floss and other publications.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

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