Abstract
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.
Original language | English (US) |
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Pages (from-to) | e2418213 |
Journal | JAMA network open |
Volume | 7 |
Issue number | 6 |
DOIs | |
State | Published - Jun 28 2024 |
Funding
This project was supported by the Eunice Kennedy Shriver NICHD (grant R01HD094213 to Drs Reed and Goyal). It was also supported in part by the Pediatric Emergency Care Applied Research Network (PECARN). PECARN is supported by the HRSA of the US Department of Health and Human Services (HHS), in the Maternal and Child Health Bureau, under the Emergency Medical Services for Children (EMSC) program through the following cooperative agreements: EMSC Data Center (EDC), University of Utah (grant UJ5MC30824); GLACiER, Nationwide Children\u2019s Hospital (grant U03MC28844); HOMERUN, Cincinnati Children\u2019s Hospital Medical Center (grant U03MC22684); PEMNEWS, Columbia University Medical Center (grant U03MC00007); PRIME, University of California at Davis Medical Center (grant U03MC00001); CHaMP node, State University of New York at Buffalo (grant U03MC33154); STELAR, Seattle Children\u2019s Hospital (grant U03MC33156); and SPARC node, Emory University School of Medicine (grant U03MC49671).
ASJC Scopus subject areas
- General Medicine