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Carter G, Pangasa M, Sexsmith CD, Elliott S, Turok DK, Gawron LM. Selection of long acting reversible contraception methods by emergency contraception clients: A prospective observational study. Contraception 2024:110701. [PMID: 39241904 DOI: 10.1016/j.contraception.2024.110701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/27/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVES To describe long acting reversible contraception (LARC) initiation in emergency contraception (EC) visits. STUDY DESIGN EC clients age 18-35 years at four Utah family planning clinics between February 2021 and April 2023 chose between oral EC and three LARC options. RESULTS Of 2106 EC clients approached, 306 (14.5%) requested LARC and 293 initiated a device: 160 (55%) an etonogestrel implant+ oral levonorgestrel (LNG), 72 (25%) a copper intrauterine device (IUD), and 61 (21%) a 52 mg levonorgestrel IUD (p < 0.001). CONCLUSIONS In this observational study, one in seven EC clients initiated a LARC method and more frequently selected the etonogestrel implant with oral levonorgestrel over an IUD. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT04678817; registered 12/16/20.
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Affiliation(s)
- Gentry Carter
- ASCENT Center Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States
| | - Misha Pangasa
- ASCENT Center Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States
| | - Corinne D Sexsmith
- ASCENT Center Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States
| | - Sarah Elliott
- ASCENT Center Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States
| | - David K Turok
- ASCENT Center Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States
| | - Lori M Gawron
- ASCENT Center Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States.
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Ketterer T, Sieke E, Min J, Quidgley-Martin M, Barral RL, Akers A, Adams A, Miller E, Miller MK, Mollen C. Contraception Initiation in the Emergency Department: Adolescent Perspectives. J Adolesc Health 2024; 75:147-154. [PMID: 38493394 PMCID: PMC11219217 DOI: 10.1016/j.jadohealth.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 01/26/2024] [Accepted: 02/14/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The purpose of this study was to identify factors affecting contraceptive intention and behavior among adolescent females in the pediatric Emergency Department. METHODS We conducted a qualitative interview study nested within a larger prospective cohort study examining adolescent contraceptive counseling for females ages 15-18 years at-risk of unintended pregnancy presenting to the pediatric Emergency Department. Interviews were conducted in a subset of participants. The ecologically expanded Theory of Planned Behavior, expert opinion, and literature review informed the interview guide. Interviews were recorded, transcribed, coded and monitored for thematic saturation. RESULTS Twenty-eight interviews were analyzed. Mean age was 17.1 years. Themes were mapped to ecologically expanded Theory of Planned Behavior constructs. Within health system influences, prior contraceptive experiences and patient-clinician interactions were described. Within community influences, contraceptive education, knowledge and misinformation, teen pregnancy norms, and social media impacts were described. Within attitudes influences, side-effect and safety concerns, contraceptive motivations and teen pregnancy beliefs were described. Within subjective norm influences, peer and family impacts were described. Within perceived behavioral control, Emergency Department (ED) counseling intervention impacts were described. DISCUSSION We identified factors affecting contraceptive initiation/behavior among an ED adolescent population that otherwise may not have received contraceptive education in similar detail as provided by study clinicians. Adolescents' prior contraceptive and clinician interactions, limited access to contraceptive education, knowledge and misinformation, and side-effect and safety concerns affected initiation. Peer/family sharing and social media were leading contraceptive information sources. Future studies should incorporate insights into adolescent ED intervention design to make optimal use of resources while maximizing potential benefit.
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Affiliation(s)
- Tara Ketterer
- Policylab, Children's Hospital of Philadelphia (CHOP), Roberts Center for Pediatric Research, Philadelphia, Pennsylvania.
| | - Erin Sieke
- Department of Pediatrics, CHOP, Philadelphia, Pennsylvania
| | - Jungwon Min
- Department of Biomedical and Health Informatics, CHOP, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania
| | | | - Romina L Barral
- Division of Adolescent Medicine, Children's Mercy Hospital and Clinics, University of Missouri-Kansas City School of Medicine, University of Kansas School of Medicine, Children's Mercy at the University of Kansas Hospital, Kansas City, Kansas
| | - Aletha Akers
- Division of Adolescent Medicine, CHOP, Specialty Care Center, Philadelphia, Pennsylvania
| | - Amber Adams
- Department of Emergency Medicine, Children's Mercy Hospital (CMH), Kansas City, Missouri
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Public Health and Clinical and Translational Science, University of Pittsburgh School of Medicine, University Center, Pittsburgh, Pennsylvania
| | - Melissa K Miller
- Department of Emergency Medicine, CMH, University of Missouri-Kansas City School of Medicine, University of Kansas School of Medicine, Kansas City, Missouri
| | - Cynthia Mollen
- Department of Pediatrics, Department of Emergency Medicine, CHOP, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Wagner B, Brogan N, Cleland K. "A Lot of My Friends Don't Know How It Works": Student Activists Describe Gaps in College Students' Emergency Contraception Knowledge. Womens Health Issues 2024; 34:66-71. [PMID: 37563061 DOI: 10.1016/j.whi.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Despite the high potential need for emergency contraception (EC) among college students, lack of accurate knowledge may decrease the likelihood of its use in this population. We examined knowledge about EC methods, potential outcomes of use, and access among college students in the United States. METHODS We recruited college students from a listserv devoted to EC campus activism for an online survey about EC knowledge (N = 150) and conducted 24 follow-up in-depth interviews. We describe the share of respondents that correctly answered each question and provide additional context and insight from interview respondents. RESULTS Gaps in EC knowledge were noted in our sample of college student EC activists. Awareness of different methods of EC was not universal; 38% of the sample was unaware of ulipristal acetate (ella®) and 61% was unaware of the intrauterine device inserted after intercourse as EC. Many respondents also incorrectly perceived additional barriers to acquiring EC such as minimum age or an ID requirement to purchase EC (64% and 49%, respectively). Interview respondents describe how medical providers, such as student health services and pharmacists, can pose barriers to EC access through either their actions or how college students expect they will act. CONCLUSIONS We document several gaps in knowledge surrounding EC in college students, even in an activist sample. Additional efforts to inform students about the variety of available EC methods and address mistaken perceptions about barriers to access may allow college students to better meet their needs for EC.
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Affiliation(s)
- Brandon Wagner
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, Lubbock, Texas.
| | - Nicola Brogan
- American Society for Emergency Contraception, Lawrenceville, New Jersey
| | - Kelly Cleland
- American Society for Emergency Contraception, Lawrenceville, New Jersey
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Wagner B, Cleland K. Retail demand for emergency contraception in United States following New Year holiday: time series study. BMJ 2023; 383:e077437. [PMID: 38123174 PMCID: PMC10731423 DOI: 10.1136/bmj-2023-077437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To estimate the increase in sales of emergency contraception following the New Year's Eve/New Year's Day holiday. DESIGN Time series analysis using autoregressive integrated moving average (ARIMA) model. SETTING Traditional (that is, "bricks and mortar") retail outlets-grocery stores, drug stores, mass merchandisers, club stores, dollar stores, and military outlets-in the United States from 2016 to 2022. DATA SOURCE Marketing data on weekly aggregated sales of items classified as emergency contraception gathered between 2016 and 2022 (n=362). On the basis of dates, weeks were classified as following the New Year holiday (n=6) or not (n=356). MAIN OUTCOME MEASURE Weekly sales of levonorgestrel emergency contraception per 1000 women of reproductive age in the US population. RESULTS Sales of levonorgestrel emergency contraception significantly increased after the New Year holiday (0.63 (95% confidence interval 0.58 to 0.69) unit increase per 1000 women aged 15-44). Holidays that share some aspects of the elevated risks of unprotected sexual intercourse with the New Year holiday (Valentine's Day, St Patrick's Day, US Independence Day) were associated with increased sales, albeit to a lesser degree, with respective sales increases per 1000 women aged 15-44 of 0.31 (0.25 to 0.38), 0.14 (0.06 to 0.23), and 0.20 (0.11 to 0.29). Holidays without these expectations (Easter, Mother's Day, Father's Day) were not significantly associated with sales of levonorgestrel emergency contraception. CONCLUSIONS Increased sales of emergency contraception following the New Year's holiday suggest that this period is associated with increased risks of unprotected vaginal intercourse compared with other holidays. Targeting behavioral risks, prevention strategies to mitigate sexual violence, and improving access to contraception around holidays may limit the risks associated with unprotected vaginal intercourse.
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Affiliation(s)
- Brandon Wagner
- Department of Sociology, Anthropology, and Social Work, Texas Tech University. Texas, USA
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Simmons RG, Baayd J, Elliott S, Cohen SR, Turok DK. Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research. Implement Sci Commun 2022; 3:129. [PMID: 36494859 PMCID: PMC9737706 DOI: 10.1186/s43058-022-00377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emergency contraception prevents unwanted pregnancy after sexual intercourse. New evidence has demonstrated that the levonorgestrel 52 mg IUD is a highly effective method of emergency contraception. However, translating this research finding into clinical practice faces existing barriers to IUD access, including costs and provider training, novel barriers of providing IUDs for emergency contraception at unscheduled appointments. The purpose of this study was to identify barriers and facilitators to the utilization of the levonorgestrel IUD as emergency contraception from client, provider, and health systems perspectives. METHODS We conducted English and Spanish-speaking focus groups (n=5) of both contraceptive users (n=22) and providers (n=13) to examine how the levonorgestrel IUD as EC was perceived and understood by these populations and to determine barriers and facilitators of utilization. We used findings from our focus groups to design a high-fidelity in-situ simulation scenario around EC that we pilot tested with clinical teams in three settings (a county health department, a community clinic, and a midwifery clinic), to further explore structural and health systems barriers to care. Simulation scenarios examined health system barriers to the provision of the levonorgestrel IUD as EC. We coded both focus groups and in-clinic simulations using the modified Consolidated Framework for Implementation Research (CFIR). We then applied our findings to the CFIR-Expert Recommendations for Implementing Change (ERIC) Barrier Busting Tool and mapped results to implement recommendations provided by participants. RESULTS Ultimately, 9 constructs from the CFIR were consistently identified across focus groups and simulations. Main barriers included suboptimal knowledge and acceptability of the intervention itself, appropriately addressing knowledge and education needs among both providers and contraceptive clients, and adequately accounting for structural barriers inherent in the health system. The CFIR-ERIC Barrier Busting Tool identified eight strategies to improve levonorgestrel IUD as EC access: identifying implementation champions, conducting educational meetings, preparing educational toolkits, involving patients and their partners in implementation, conducting a local needs assessment, distributing educational materials, and obtaining patient feedback. CONCLUSIONS To sustainably incorporate the levonorgestrel IUD as EC into clinical practice, education, health systems strengthening, and policy changes will be necessary.
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Affiliation(s)
- Rebecca G. Simmons
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jami Baayd
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Sarah Elliott
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Susanna R. Cohen
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - David K. Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
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Dam A, Yeh PT, Burke AE, Kennedy CE. Contraceptive values and preferences of pregnant women, postpartum women, women seeking emergency contraceptives, and women seeking abortion services: A systematic review. Contraception 2021; 111:39-47. [PMID: 34742718 DOI: 10.1016/j.contraception.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We sought to systematically review the literature on contraceptive values and preferences of pregnant women, postpartum women, women seeking emergency contraception, and women seeking abortion services, globally. STUDY DESIGN We searched ten electronic databases for articles from January 1, 2005 through July 27, 2020 regarding users' values and preferences for contraception. Results were divided into four sub-groups. RESULTS Twenty-three studies from 10 countries met the inclusion criteria. Values and preferences across all four sub-groups were influenced by method effectiveness, access, availability, convenience, cost, side effects, previous experience, partner approval, and societal norms. Similarities and differences were evident across sub-groups, especially concerning contraceptive benefits and side effects. No contraceptive method had all the features users deemed important. Many studies emphasized values and preferences surrounding long-acting reversible contraception (LARC), including convenience of accessing LARCs and concerns about side effect profiles. DISCUSSION Individuals must have access to a full range of safe and effective modern contraceptive options, allowing people to make decisions based on evolving contraceptive preferences over time. Future contraception guideline development, policy, and programmatic implementation should continue considering the added influence of these specific reproductive experiences on contraceptive values and preferences of users to improve access, counseling, and method choice.
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Affiliation(s)
- Anita Dam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Anne E Burke
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Pagano HP, Zapata LB, Curtis KM, Whiteman MK. Changes in U.S. Healthcare Provider Practices Related to Emergency Contraception. Womens Health Issues 2021; 31:560-566. [PMID: 34511322 PMCID: PMC11079952 DOI: 10.1016/j.whi.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Emergency contraception (EC), including EC pills (ECPs) and the copper intrauterine device, can prevent pregnancy after sexual encounters in which contraception was not used or used incorrectly. The U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), initially released in 2013, provides evidence-based clinical recommendations on the provision of EC. The objective of this analysis was to assess the percentage of health care providers reporting frequent provision of select EC practices around the time of and after the release of the U.S. SPR. METHODS We conducted two cross-sectional mailed surveys using different nationwide samples of office-based physicians and public-sector providers in 2013 and 2014 (n = 2,060) and 2019 (n = 1,420). We compared the percentage of providers reporting frequent provision of select EC practices by time period, overall, and by provider type. RESULTS In 2019, few providers frequently provided an advance prescription for ECPs (16%), an advance supply of ECPs (7%), or the copper intrauterine device as EC (8%), although 41% frequently provided or prescribed regular contraception at the same time as providing ECPs. Providers in 2019 were more likely than providers in 2013 and 2014 to provide or prescribe contraception at the same time as providing ECPs (adjusted prevalence ratio, 1.26; 95% confidence interval, 1.001-1.59) and to provide a copper intrauterine device as EC (adjusted prevalence ratio, 3.87; 95% confidence interval 2.10-7.15); there were no other significant differences by time period. CONCLUSIONS Few providers report frequent implementation of recommended EC practices. Understanding the barriers faced by providers and clinics in implementing these practices may improve access to EC.
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Affiliation(s)
- H Pamela Pagano
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Lauren B Zapata
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathryn M Curtis
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maura K Whiteman
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Mahony H, Spinner C, Vamos CA, Daley EM. Social Network Influences on Young Women's Choice to Use Long-Acting Reversible Contraception: A Systematic Review. J Midwifery Womens Health 2021; 66:758-771. [PMID: 34491002 DOI: 10.1111/jmwh.13280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Long-acting reversible contraception (LARC; including intrauterine devices and implants) is recommended as the first-line contraceptive choice by several professional organizations (eg, American College of Obstetricians and Gynecologists); however, rates of uptake are lower than those of other contraceptive methods. A young woman's social network may influence the decision to use LARC. The purpose of this review was to determine the role of health care providers (HCPs), family, peers, and sexual partner(s) on young women's decisions to initiate LARC. METHODS Several databases (PubMed, CINAHL, and PsycINFO) were searched for articles published between 2000 and 2020 that studied the social network influences of HCPs, family, peers, and sexual partner(s) on LARC initiation among women in the United States aged 18 to 25. A narrative synthesis of the included articles was conducted. RESULTS Twenty-nine articles met the inclusion criteria (21 qualitative, 6 quantitative, 2 mixed methods). HCPs are an important influence on a young woman's LARC decision-making. Peers and family also have a role but were often sources of negative or inaccurate information. Gaps in the literature were identified, including a lack of data on implant users and a dearth of studies on the role of sexual partner influence; most studies were not guided by theory. DISCUSSION HCPs are integral to LARC initiation and may be more influential than other social network members. Future research should focus on understanding how social network members interact to result in LARC initiation. Gaining insight into these influences may improve existing interventions or contribute to the development of new interventions and ultimately promote LARC use among young women.
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Affiliation(s)
- Helen Mahony
- College of Public Health, University of South Florida, Tampa, Florida
| | - Chelse Spinner
- College of Public Health, University of South Florida, Tampa, Florida
| | - Cheryl A Vamos
- College of Public Health, University of South Florida, Tampa, Florida
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, Florida
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Alspaugh A. Updates from the Literature, May/June 2021. J Midwifery Womens Health 2021; 66:407-412. [PMID: 34061457 DOI: 10.1111/jmwh.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Amy Alspaugh
- ACTIONS Program, University of California San Francisco, San Francisco, California
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Berglas NF, Kaller S, Mays A, Biggs MA. The Role of Health Care Providers in Young Women's Attitudes about and Willingness to Use Emergency Contraceptive Pills. Womens Health Issues 2021; 31:286-293. [PMID: 33536133 DOI: 10.1016/j.whi.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/16/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Emergency contraceptive pills (ECPs) are an underused resource among adolescent and young adult women who have unprotected sex. This analysis examines young women's attitudes about and willingness to use ECPs, with particular attention to their experiences with health care providers. METHODS Sexually active young women (ages 15-25, assigned female at birth, N = 212) completed a self-administered survey at 10 family planning clinics in the San Francisco Bay Area. Participants reported attitudes about ECP effectiveness, safety, effect on sex drive, and whether it should not be taken often, and their willingness to use ECPs in the next 3 months. The predictors of interest were past and current contraceptive experiences with health care providers. Data were analyzed through descriptive statistics and multivariable logistic regression analyses controlling for sociodemographic characteristics, prior contraceptive use, pregnancy history, and pregnancy intentions. RESULTS Most young women agreed that ECPs are effective at preventing pregnancy (75%) and safe to use (71%); few reported that they reduce sex drive (11%). Yet, the majority (62%) believed ECPs should not be taken often and only 35% reported willingness to use ECPs. In multivariable analyses, more positive health care experiences were associated with more positive attitudes about ECP safety, less concern that ECPs should not be taken often, and greater willingness to use ECPs (p < .05). CONCLUSIONS Health care providers play an important role in the acceptance and provision of ECPs, especially for young women who prefer ECPs over other contraceptive methods. In particular, providers can use the contraceptive visit as an opportunity to destigmatize repeat ECP use.
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Affiliation(s)
- Nancy F Berglas
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California.
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
| | - Aisha Mays
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
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