Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy

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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.

Original languageEnglish (US)
JournalJournal of Pediatric and Adolescent Gynecology
DOIs
StateAccepted/In press - 2016

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High-Risk Pregnancy
Contraception
Pregnancy in Adolescence
Student Dropouts
Contraceptives, Oral, Combined
Medroxyprogesterone Acetate
Confidence Intervals
Pregnancy Rate
Cultural Characteristics
Intrauterine Devices
Contraceptive Agents
Transdermal Patch
Health Literacy
Acculturation
Hispanic Americans
Outcome Assessment (Health Care)
Delivery of Health Care
Education

Keywords

  • Adolescent pregnancy
  • Contraceptive continuation
  • Hormonal contraceptive
  • Intrauterine device

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health

Cite this

@article{696507e5ff5d4138982a3533f54cf5a9,
title = "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 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.",
keywords = "Adolescent pregnancy, Contraceptive continuation, Hormonal contraceptive, Intrauterine device",
author = "Sofya Maslyanskaya and Coupey, {Susan M.} and Rosy Chhabra and Khan, {Unab I.}",
year = "2016",
doi = "10.1016/j.jpag.2015.10.014",
language = "English (US)",
journal = "Journal of Pediatric and Adolescent Gynecology",
issn = "1083-3188",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy

AU - Maslyanskaya, Sofya

AU - Coupey, Susan M.

AU - Chhabra, Rosy

AU - Khan, Unab I.

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

KW - Adolescent pregnancy

KW - Contraceptive continuation

KW - Hormonal contraceptive

KW - Intrauterine device

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