Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy
Abstract Study Objective In the United States, teen pregnancy rates are declining. However, the United States still has the highest teen pregnancy rate among high-income countries. Understanding factors that predict discontinuation of effective contraception might help to further decrease teen pregn...
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| Veröffentlicht in: | Journal of pediatric & adolescent gynecology 2016-06, Vol.29 (3), p.269-275 |
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| creator | Maslyanskaya, Sofya, MD Coupey, Susan M., MD Chhabra, Rosy, PsyD Khan, Unab I., MD, MS |
| description | Abstract Study Objective In the United States, teen pregnancy rates are declining. However, the United States still has the highest teen pregnancy rate among high-income countries. Understanding factors that predict discontinuation of effective contraception might help to further decrease teen pregnancy. We aimed to assess predictors of early discontinuation of effective contraception during typical use by high-risk teens. Design, Setting, Participants, Interventions, and Main Outcome Measures We recruited 145 women aged 13-20 years (mean, 17.7 ± 1.8 years); 68% (99/145) Hispanic; 26% (38/145) black; 14% (20/145) ever pregnant; and 4% (6/145) high school dropouts who chose an effective contraceptive method during a health care visit and we prospectively assessed use of the method after 6 months. Contraceptive choices of the 130 participants who were reassessed at 6 months (90% retention) were: intrauterine device (IUD), 26% (34/130); depot medroxyprogesterone acetate (DMPA), 8% (10/130); combined oral contraceptives (COCs), 48% (62/130); transdermal patch (Patch), 13% (17/130); and intravaginal ring (Ring), 5% (7/130). Results After 6 months, only 49 of 130 (38%) continued their chosen method; 28 of 130 (22%) never initiated the method; and 53 of 130 (40%) discontinued. Users and nonusers at 6 months did not differ according to cultural and/or social characteristics (age, ethnicity, acculturation, education, health literacy) but differed according to contraceptive method type. For the 102 of 130 who initiated a method, 88% continued use of the IUD, 20% DMPA, 43% COC, 17% Patch and Ring ( P |
| doi_str_mv | 10.1016/j.jpag.2015.10.014 |
| format | Article |
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However, the United States still has the highest teen pregnancy rate among high-income countries. Understanding factors that predict discontinuation of effective contraception might help to further decrease teen pregnancy. We aimed to assess predictors of early discontinuation of effective contraception during typical use by high-risk teens. Design, Setting, Participants, Interventions, and Main Outcome Measures We recruited 145 women aged 13-20 years (mean, 17.7 ± 1.8 years); 68% (99/145) Hispanic; 26% (38/145) black; 14% (20/145) ever pregnant; and 4% (6/145) high school dropouts who chose an effective contraceptive method during a health care visit and we prospectively assessed use of the method after 6 months. Contraceptive choices of the 130 participants who were reassessed at 6 months (90% retention) were: intrauterine device (IUD), 26% (34/130); depot medroxyprogesterone acetate (DMPA), 8% (10/130); combined oral contraceptives (COCs), 48% (62/130); transdermal patch (Patch), 13% (17/130); and intravaginal ring (Ring), 5% (7/130). Results After 6 months, only 49 of 130 (38%) continued their chosen method; 28 of 130 (22%) never initiated the method; and 53 of 130 (40%) discontinued. Users and nonusers at 6 months did not differ according to cultural and/or social characteristics (age, ethnicity, acculturation, education, health literacy) but differed according to contraceptive method type. For the 102 of 130 who initiated a method, 88% continued use of the IUD, 20% DMPA, 43% COC, 17% Patch and Ring ( P < .001). Using Cox proportional hazards multivariable analysis, compared with IUDs, all other methods predicted discontinuation: DMPA (hazard ratio [HR], 5.6; 95% confidence interval [CI], 1.2-26.7; P < .05); COCs (HR, 6.6; 95% CI, 1.8-25; P < .01); Patch and Ring (HR, 12; 95% CI, 3.0-48; P < .001). Discontinuation was also predicted by past use of hormonal contraceptives (HR, 1.9; 95% CI, 1.0-3.6; P < .05) and high school dropout (HR, 8.2; 95% CI, 1.6-41; P < .01). Conclusion Contraceptive method type is the strongest predictor of early discontinuation; compared with IUDs, all other methods are 6-12 times more likely to be discontinued. Cultural and/or social characteristics, with the exception of school dropout, are of little predictive value. Increasing the use of IUDs by high-risk teens could decrease discontinuation rates and possibly teen pregnancy rates.]]></description><identifier>ISSN: 1083-3188</identifier><identifier>EISSN: 1873-4332</identifier><identifier>DOI: 10.1016/j.jpag.2015.10.014</identifier><identifier>PMID: 26526036</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adolescent pregnancy ; Adult ; Choice Behavior ; Contraception - methods ; Contraception - psychology ; Contraception Behavior - psychology ; Contraception Behavior - statistics & numerical data ; Contraceptive continuation ; Female ; Hormonal contraceptive ; Humans ; Intrauterine device ; Obstetrics and Gynecology ; Patient Compliance - psychology ; Pediatrics ; Pregnancy ; Pregnancy in Adolescence - psychology ; Risk Factors ; United States ; Young Adult</subject><ispartof>Journal of pediatric & adolescent gynecology, 2016-06, Vol.29 (3), p.269-275</ispartof><rights>North American Society for Pediatric and Adolescent Gynecology</rights><rights>2016 North American Society for Pediatric and Adolescent Gynecology</rights><rights>Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-3de7e01de988170428616ec06a15d7c84c94fa3b0bf90b4f7cfebaf992821ff13</citedby><cites>FETCH-LOGICAL-c411t-3de7e01de988170428616ec06a15d7c84c94fa3b0bf90b4f7cfebaf992821ff13</cites><orcidid>0000-0002-6352-5395</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpag.2015.10.014$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27926,27927,45997</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26526036$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maslyanskaya, Sofya, MD</creatorcontrib><creatorcontrib>Coupey, Susan M., MD</creatorcontrib><creatorcontrib>Chhabra, Rosy, PsyD</creatorcontrib><creatorcontrib>Khan, Unab I., MD, MS</creatorcontrib><title>Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy</title><title>Journal of pediatric & adolescent gynecology</title><addtitle>J Pediatr Adolesc Gynecol</addtitle><description><![CDATA[Abstract Study Objective In the United States, teen pregnancy rates are declining. However, the United States still has the highest teen pregnancy rate among high-income countries. Understanding factors that predict discontinuation of effective contraception might help to further decrease teen pregnancy. We aimed to assess predictors of early discontinuation of effective contraception during typical use by high-risk teens. Design, Setting, Participants, Interventions, and Main Outcome Measures We recruited 145 women aged 13-20 years (mean, 17.7 ± 1.8 years); 68% (99/145) Hispanic; 26% (38/145) black; 14% (20/145) ever pregnant; and 4% (6/145) high school dropouts who chose an effective contraceptive method during a health care visit and we prospectively assessed use of the method after 6 months. Contraceptive choices of the 130 participants who were reassessed at 6 months (90% retention) were: intrauterine device (IUD), 26% (34/130); depot medroxyprogesterone acetate (DMPA), 8% (10/130); combined oral contraceptives (COCs), 48% (62/130); transdermal patch (Patch), 13% (17/130); and intravaginal ring (Ring), 5% (7/130). Results After 6 months, only 49 of 130 (38%) continued their chosen method; 28 of 130 (22%) never initiated the method; and 53 of 130 (40%) discontinued. Users and nonusers at 6 months did not differ according to cultural and/or social characteristics (age, ethnicity, acculturation, education, health literacy) but differed according to contraceptive method type. For the 102 of 130 who initiated a method, 88% continued use of the IUD, 20% DMPA, 43% COC, 17% Patch and Ring ( P < .001). Using Cox proportional hazards multivariable analysis, compared with IUDs, all other methods predicted discontinuation: DMPA (hazard ratio [HR], 5.6; 95% confidence interval [CI], 1.2-26.7; P < .05); COCs (HR, 6.6; 95% CI, 1.8-25; P < .01); Patch and Ring (HR, 12; 95% CI, 3.0-48; P < .001). Discontinuation was also predicted by past use of hormonal contraceptives (HR, 1.9; 95% CI, 1.0-3.6; P < .05) and high school dropout (HR, 8.2; 95% CI, 1.6-41; P < .01). Conclusion Contraceptive method type is the strongest predictor of early discontinuation; compared with IUDs, all other methods are 6-12 times more likely to be discontinued. Cultural and/or social characteristics, with the exception of school dropout, are of little predictive value. Increasing the use of IUDs by high-risk teens could decrease discontinuation rates and possibly teen pregnancy rates.]]></description><subject>Adolescent</subject><subject>Adolescent pregnancy</subject><subject>Adult</subject><subject>Choice Behavior</subject><subject>Contraception - methods</subject><subject>Contraception - psychology</subject><subject>Contraception Behavior - psychology</subject><subject>Contraception Behavior - statistics & numerical data</subject><subject>Contraceptive continuation</subject><subject>Female</subject><subject>Hormonal contraceptive</subject><subject>Humans</subject><subject>Intrauterine device</subject><subject>Obstetrics and Gynecology</subject><subject>Patient Compliance - psychology</subject><subject>Pediatrics</subject><subject>Pregnancy</subject><subject>Pregnancy in Adolescence - psychology</subject><subject>Risk Factors</subject><subject>United States</subject><subject>Young Adult</subject><issn>1083-3188</issn><issn>1873-4332</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhi0Eol_8AQ4oRy5ZZux8OBJCQktLkSqBoD1bjjNenGadxU4q5d_jdAsHDpxszbzvO5pnGHuNsEHA6l2_6Q96t-GAZSpsAItn7BRlLfJCCP48_UGKXKCUJ-wsxh4A6rKSL9kJr0pegahOmf4WqHNmGkPMRptd6jAs2ScXzegn52c9udE_NqwlM7kHyrapE7Shw2OrXbJbIh8zPWXXbvcz--7i_WpIuTuvvVku2Aurh0ivnt5zdnd1ebu9zm--fv6y_XiTmwJxykVHNQF21EiJNRRcVliRgUpj2dVGFqYprBYttLaBtrC1sdRq2zRccrQWxTl7e8w9hPHXTHFS-7QGDYP2NM5RYd2g4E0j6iTlR6kJY4yBrDoEt9dhUQhqRat6taJVK9q1ltAm05un_LndU_fX8odlErw_Ciht-eAoqGgceZP4hsROdaP7f_6Hf-xmcN4ZPdzTQrEf5-ATP4UqcgXqx3rc9bZYQpoOpfgN13CfgA</recordid><startdate>20160601</startdate><enddate>20160601</enddate><creator>Maslyanskaya, Sofya, MD</creator><creator>Coupey, Susan M., MD</creator><creator>Chhabra, Rosy, PsyD</creator><creator>Khan, Unab I., MD, MS</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6352-5395</orcidid></search><sort><creationdate>20160601</creationdate><title>Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy</title><author>Maslyanskaya, Sofya, MD ; Coupey, Susan M., MD ; Chhabra, Rosy, PsyD ; Khan, Unab I., MD, MS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-3de7e01de988170428616ec06a15d7c84c94fa3b0bf90b4f7cfebaf992821ff13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adolescent pregnancy</topic><topic>Adult</topic><topic>Choice Behavior</topic><topic>Contraception - methods</topic><topic>Contraception - psychology</topic><topic>Contraception Behavior - psychology</topic><topic>Contraception Behavior - statistics & numerical data</topic><topic>Contraceptive continuation</topic><topic>Female</topic><topic>Hormonal contraceptive</topic><topic>Humans</topic><topic>Intrauterine device</topic><topic>Obstetrics and Gynecology</topic><topic>Patient Compliance - psychology</topic><topic>Pediatrics</topic><topic>Pregnancy</topic><topic>Pregnancy in Adolescence - psychology</topic><topic>Risk Factors</topic><topic>United States</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maslyanskaya, Sofya, MD</creatorcontrib><creatorcontrib>Coupey, Susan M., MD</creatorcontrib><creatorcontrib>Chhabra, Rosy, PsyD</creatorcontrib><creatorcontrib>Khan, Unab I., MD, MS</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric & adolescent gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maslyanskaya, Sofya, MD</au><au>Coupey, Susan M., MD</au><au>Chhabra, Rosy, PsyD</au><au>Khan, Unab I., MD, MS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy</atitle><jtitle>Journal of pediatric & adolescent gynecology</jtitle><addtitle>J Pediatr Adolesc Gynecol</addtitle><date>2016-06-01</date><risdate>2016</risdate><volume>29</volume><issue>3</issue><spage>269</spage><epage>275</epage><pages>269-275</pages><issn>1083-3188</issn><eissn>1873-4332</eissn><abstract><![CDATA[Abstract Study Objective In the United States, teen pregnancy rates are declining. However, the United States still has the highest teen pregnancy rate among high-income countries. Understanding factors that predict discontinuation of effective contraception might help to further decrease teen pregnancy. We aimed to assess predictors of early discontinuation of effective contraception during typical use by high-risk teens. Design, Setting, Participants, Interventions, and Main Outcome Measures We recruited 145 women aged 13-20 years (mean, 17.7 ± 1.8 years); 68% (99/145) Hispanic; 26% (38/145) black; 14% (20/145) ever pregnant; and 4% (6/145) high school dropouts who chose an effective contraceptive method during a health care visit and we prospectively assessed use of the method after 6 months. Contraceptive choices of the 130 participants who were reassessed at 6 months (90% retention) were: intrauterine device (IUD), 26% (34/130); depot medroxyprogesterone acetate (DMPA), 8% (10/130); combined oral contraceptives (COCs), 48% (62/130); transdermal patch (Patch), 13% (17/130); and intravaginal ring (Ring), 5% (7/130). Results After 6 months, only 49 of 130 (38%) continued their chosen method; 28 of 130 (22%) never initiated the method; and 53 of 130 (40%) discontinued. Users and nonusers at 6 months did not differ according to cultural and/or social characteristics (age, ethnicity, acculturation, education, health literacy) but differed according to contraceptive method type. For the 102 of 130 who initiated a method, 88% continued use of the IUD, 20% DMPA, 43% COC, 17% Patch and Ring ( P < .001). Using Cox proportional hazards multivariable analysis, compared with IUDs, all other methods predicted discontinuation: DMPA (hazard ratio [HR], 5.6; 95% confidence interval [CI], 1.2-26.7; P < .05); COCs (HR, 6.6; 95% CI, 1.8-25; P < .01); Patch and Ring (HR, 12; 95% CI, 3.0-48; P < .001). Discontinuation was also predicted by past use of hormonal contraceptives (HR, 1.9; 95% CI, 1.0-3.6; P < .05) and high school dropout (HR, 8.2; 95% CI, 1.6-41; P < .01). Conclusion Contraceptive method type is the strongest predictor of early discontinuation; compared with IUDs, all other methods are 6-12 times more likely to be discontinued. Cultural and/or social characteristics, with the exception of school dropout, are of little predictive value. Increasing the use of IUDs by high-risk teens could decrease discontinuation rates and possibly teen pregnancy rates.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26526036</pmid><doi>10.1016/j.jpag.2015.10.014</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6352-5395</orcidid></addata></record> |
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| subjects | Adolescent Adolescent pregnancy Adult Choice Behavior Contraception - methods Contraception - psychology Contraception Behavior - psychology Contraception Behavior - statistics & numerical data Contraceptive continuation Female Hormonal contraceptive Humans Intrauterine device Obstetrics and Gynecology Patient Compliance - psychology Pediatrics Pregnancy Pregnancy in Adolescence - psychology Risk Factors United States Young Adult |
| title | Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy |
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