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- Title
Contraception Use and Pregnancy Risk Among Adolescents in Pediatric Emergency Departments.
- Authors
Canter, Hannah; Reed, Jennifer; Palmer, Chella; Casper, T. Charles; Stukus, Kristin; Schmidt, Sarah; Pickett, Michelle; Mollen, Cynthia; Elsholz, Cara; Cruz, Andrea T.; Augustine, Erin; Goyal, Monika K.
- Abstract
Key Points: Question: Among adolescents seeking emergency department (ED) care, what is the prevalence of contraceptive use and pregnancy risk, and what proportion of those eligible receive emergency contraception (EC)? Findings: In this cross-sectional study of 1063 individuals seen at 6 pediatric EDs, 28.9% of sexually active female adolescents reported no contraception use, yielding a pregnancy risk index of 7.89 expected pregnancies per 100 adolescents annually. Although 10.2% of participants were eligible for EC, only 5.6% of those eligible received it. Meaning: In this study, adolescents seeking ED care were at high risk for pregnancy and there is an opportunity to expand pregnancy prevention services in the ED setting. This cross-sectional study examines the use of contraception, pregnancy risk index, and emergency contraception prescriptions among female adolescents in pediatric emergency departments (EDs). Importance: Unintended pregnancy is a major health risk for adolescents in the US, and adolescents face many barriers to obtaining effective and reliable contraception. Objective: To measure and describe the use of contraception, pregnancy risk index (PRI), and emergency contraception (EC) prescriptions among female adolescents accessing the emergency department (ED) for care. Design, Setting, and Participants: This cross-sectional study is a planned secondary analysis of a multicenter trial from April 2021 through April 2022 that used a tablet-based, content-validated, confidential sexual health survey at 6 urban, pediatric tertiary care EDs affiliated with the Pediatric Emergency Care Applied Research Network. Participants were individuals aged 15 to 21 years presenting to the ED who completed the confidential sexual health survey and indicated female sex assigned at birth and prior penile-vaginal sexual intercourse. Data analysis was performed from January 2023 to February 2024. Main Outcomes and Measures: The primary outcomes were the type and proportion of contraception use, the PRI, and provision of EC. Separate multivariable logistic regression models were performed to identify sociodemographic factors associated with these outcomes. Results: A total of 1063 participants (median [IQR] age, 17.5 [16.5-18.3] years) were included in this analysis; 219 (20.8%) identified as Hispanic, 464 (44.1%) identified as non-Hispanic Black, 308 (29.3%) identified as non-Hispanic White, and 61 (5.8%) identified as other races and ethnicities. In total, 756 participants (71.1%) reported contraception use during their last sexual encounter. Long-acting reversible contraception use (LARC) was the least used (164 participants [15.4%]), and 307 (28.9%) reported no contraception use. Sociodemographic factors associated with overall contraception use, and LARC use specifically, included insurance and race and ethnicity. The overall PRI was 7.89, or an expected 8 pregnancies per 100 female individuals per year. Although 108 participants (10.2%) were eligible for EC, EC was ordered for only 6 (5.6%) of those eligible. Conclusions and Relevance: In this cross-sectional study of sexually active adolescents presenting to the ED, the majority of participants reported using at least 1 form of contraception; however, LARCs were the least used option, and 28.9% of participants reported no contraceptive use. The unintended pregnancy risk was almost 8% in the study population. Few patients eligible for EC received it. These data suggest a high need and potential opportunity for provision of contraception services in the ED setting.
- Subjects
RISK assessment; HEALTH services accessibility; CROSS-sectional method; WOMEN; RESEARCH funding; SECONDARY analysis; LOGISTIC regression analysis; HISPANIC Americans; HOSPITAL emergency services; TERTIARY care; WHITE people; DESCRIPTIVE statistics; PEDIATRICS; BLACK people; ODDS ratio; UNPLANNED pregnancy; RESEARCH; CONTRACEPTION; SOCIODEMOGRAPHIC factors; CONFIDENCE intervals; DATA analysis software; NONPRESCRIPTION drugs; SEXUAL health
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2418213
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.18213