Adolescents' attitudes and experiences regarding levonorgestrel 100 mcg/ethinyl estradiol 20 mcg

STUDY OBJECTIVE

Oral contraceptive pills (OCs) are a commonly prescribed method of birth control for sexually experienced adolescents. The purpose of the current study was to describe anticipated parental involvement and adolescent compliance with pill taking, and to describe experiences with a 20-mcg OC regarding satisfaction and side effects after six cycles.

DESIGN

Anticipated parental involvement and anticipated compliance, and experiences with an OC, were assessed at baseline, and after the first and sixth cycles during a clinical trial of oral contraceptives, which required parental consent.

SETTING

Three adolescent medicine clinics in New York, NY; Cincinnati, OH; and San Juan, Puerto Rico.

PARTICIPANTS

The sample consisted of 43 female adolescents with a mean age of 17 years.

RESULTS

The majority of adolescents living with a parent anticipated parental involvement, and few adolescents anticipated difficulties with consistent pill taking. For two side effects (weight and mood changes), more than 30% of the adolescents anticipated the occurrence or worsening of side effects. However, few adolescents actually experienced increases in any of the nine side effects assessed. Ninety-seven percent of adolescents in this trial reported being satisfied with a 20-mcg OC.

CONCLUSIONS

Health care providers can assess adolescents' anticipated difficulties with compliance with daily pill taking, and desire for help from their parents. This information can be incorporated into counseling to promote consistent and correct use.

Women's efforts to prevent pregnancy: consistency of oral contraceptive use

CONTEXT

An understanding of determinants of inconsistent pill-taking could be useful to service providers who are trying to help women prevent unwanted pregnancy. This article explores the predictors of inconsistent use in a nationally representative sample of U.S. women aged 15-44.

METHODS

Data on 1,485 pill users participating in the 1995 National Survey of Family Growth are used to describe users' characteristics, and logistic regression analyses are conducted to identify factors that predict inconsistent use (defined as missing two or more pills in a three-month period) among both users of the pill only and dual method users.

RESULTS

While 85% of pill users rely solely on the pill, 15% also use another method. Overall, 16% of users are inconsistent in their pill-taking (16% of those using the pill alone and 20% of dual method users). Among users of the pill only, Hispanic and non-Hispanic black women have a significantly increased likelihood of inconsistent use (odds ratios, 2.5 and 2.1, respectively), as do those who recently began use (2.7) and those who have had an unintended pregnancy (1.6). For dual method users, the odds are significantly elevated among women whose income is less than 250% of the federal poverty level (4.3) and among new users (4.5).

CONCLUSION

Service providers may need to better address consistency of pill-taking among women who have characteristics associated with inconsistent use.

Depot medroxyprogesterone acetate pioneers. A retrospective study at a North Carolina Health Department

This article examines the characteristics of the first group of depot medroxyprogesterone acetate (DMPA) acceptors after US Food and Drug Administration (FDA) approval of the method and evaluates their continuation rates and factors associated with discontinuation. This was a population based retrospective study based on 12 months of clinic data for 510 women who began using DMPA in 1993 at a large county health department. Cumulative 12 month life table rates were calculated for the entire group and were then stratified by selected characteristics. The 4, 8, and 12 month continuation rates were 67%, 46%, and 35%, respectively. More than half of these women discontinued because of bleeding and nonbleeding side effects (25% and 28%, respectively). Almost 20% of these women were considered discontinuers because they waited longer than 16 weeks to return for an injection. As measured in this study, continuation rates for this first group of DMPA acceptors were low. The next step is to determine if the characteristics and patterns of use of these "pioneer" acceptors are representative of more recent acceptors, and if lessons learned from this group will lead to higher continuation rates.

How effective are contraceptives? The determination and measurement of pregnancy rates

OBJECTIVES

To provide an overview of contraceptive effectiveness and its determinants as well as reasons for the gap between the actual and expected number of unplanned pregnancies for various categories of users; to provide some guidelines for more precise, consistent terminology and measurements for use in future research; and to provide specific counseling guidelines; using combined oral contraceptives (OCs) as the example.

DATA SOURCES

Fifty-three articles on contraceptive effectiveness were reviewed, with a particular focus on pregnancy rates among OC users and the quality of use contributing to those rates. Definitions and measurement of contraceptive effectiveness, its components, and its determinants were examined and discrepancies explored.

METHODS OF STUDY SELECTION

Papers discussed were selected because they had special relevance. Only a few of the papers discussed in this article were quantitative studies of contraceptive behavior and effectiveness. Others were review articles, discussions of the appropriate measurement of various components of effectiveness. Others provided conceptual frameworks for studying method effectiveness. All published studies of OC compliance were reviewed.

TABULATION, INTEGRATION, AND RESULTS

Comparing the definitions and measurement of both compliance and effectiveness revealed important inconsistencies. However, some trends did emerge, and these papers did provide a framework for the following discussion. The findings were used to develop a more coherent set of definitions, measurement approaches, and counseling strategies. Characteristics of the user, the method, and the service delivery system all play a role in contraceptive effectiveness. However, it is the quality of use, ie, the user's own behavior, that is the immediate determinant of the effectiveness of any short-term contraceptive method. The mean pregnancy rate for better-than-average users is 4%; for poorer-than-average users, it is 8%.

CONCLUSIONS

The range of contraceptive effectiveness rates is closely associated with user characteristics. Oral contraceptive users need to know that their own chance of becoming pregnant will vary with their fecundability, when and how frequently they have sexual intercourse, and, especially, how consistently and correctly they take their pills. The likelihood that any one user will take OCs correctly and consistently also is associated with her life-style, socioeconomic status, age, and other factors. Further research is needed to determine how forgiving OCs are of various pill-taking errors, to determine the impact of dual method use (eg, OCs and condoms), and to assess the effects of user, method, and programmatic characteristics on correct and consistent use and, in turn, on effectiveness.

User characteristics and oral contraceptive compliance in Egypt

Results from the 1988 Egypt Demographic and Health Survey show that many women are not taking oral contraceptives in a manner that ensures full protection by the method. Reports from 1,258 current pill users show a range of incorrect use; 63 percent of women surveyed reported an interruption in their use of the pill in the past month, and of those women, only 40 percent took the correct action when they missed a pill. The majority (89 percent) did not wait the correct number of days between packs. Multivariate analysis revealed that rural women were more likely to take pills out of sequence, compared with their urban counterparts. Failure to take a pill within the previous month was strongly associated with the experience of side effects. The younger women surveyed were more likely to know the correct interval between pill packs than were older women; and women who wanted more children were more likely to know the correct interval than those who did not. The use patterns exhibited by the pill users may be the result of their receiving confusing, incorrect, or incomplete information, and highlight the need to provide women with accurate, updated, and comprehensible information about oral contraceptives.

Current oral contraceptive use instructions: an analysis of patient package inserts

Oral contraceptive use instructions contained in manufacturers' patient package inserts (PPIs) are often inconsistent or conflicting, both among manufacturers and among different brands and regimens from the same manufacturer. Instructions on what to do about missed pills are often incomplete or inadequate, as are instructions on backup contraceptive use when pills are missed. The format of many PPIs is confusing and makes instructions difficult to find and read. Comprehending the PPIs requires the user to read at a 10th-12th-grade level, far higher than the generally accepted 5th-6th grade level considered standard for health education materials.

Hypertension screening in the eye clinic

We studied the suitability of the eye clinic as a site for hypertension detection with attention to the ophthalmologist's role in the broad context of hypertension control. Sixty of 300 consecutive eye clinic patients were referred to their primary care physician for re-evaluation of an elevated blood pressure recording. Only seven of these were started on therapy or had a change made in their existing regimen by the primary physician. When the benefit to this small percentage is weighed against the potential effects of such a high "false positive" referral rate we cannot support the proposal that the ophthalmologist does more good than harm by measuring the blood pressure of every patient.