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Kirubarajan A, Li X, Yau M, Yu C, Got T, Li Q, Huszti E, Leung S, Thangavelu N, Sobel M. Awareness, knowledge, and misconceptions of adolescents and young people regarding long-acting reversible contraceptives: a systematic review and meta-analysis. Fertil Steril 2022; 118:168-179. [DOI: 10.1016/j.fertnstert.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/04/2022]
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Levonorgestrel Intrauterine Device Use for Medical Indications in Nulliparous Adolescents and Young Adults. J Adolesc Health 2021; 68:357-363. [PMID: 32646831 DOI: 10.1016/j.jadohealth.2020.05.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Intrauterine devices (IUDs) are highly effective at preventing pregnancy. Levonorgestrel (LNG) IUDs also have beneficial effects on menstrual bleeding and abdominal and pelvic pain. Although there are increasing data on use of IUDs for contraception in adolescents and for medical indications in adults, there are extremely limited data on LNG IUD use for medical indications in adolescents. Our objective is to describe the characteristics and experiences of LNG IUD use in nulliparous adolescents and young women using IUDs for medical indications. METHODS We conducted a retrospective chart review of all nulliparous patients aged 22 years and younger who underwent LNG IUD insertion at a tertiary care children's hospital between July 1, 2004 and June 30, 2014 primarily for noncontraceptive indications. Descriptive statistical analysis was performed. RESULTS We identified 231 LNG IUDs placed in 219 nulliparous women for medical indications during this time period. Mean patient age was 16.8 years (±2.2). Only 41% reported ever being sexually active. IUD continuation rate at 1 year was 86%. The amenorrhea rate at 1 year was 51%. Approximately 80% of women reported improvements in menstrual bleeding and abdominal and pelvic pain. Side effects and complications were low. CONCLUSIONS This study provides evidence that LNG IUDs are effective, well-tolerated, and safe menstrual management options in young nulliparous women, including younger adolescents and those who have never been sexually active. This method is an excellent first-line therapy option for adolescents and young women for both contraceptive and noncontraceptive indications, regardless of age, parity, or sexual activity.
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Abstract
Long-acting reversible contraceptives are the most effective methods to prevent pregnancy and also offer noncontraceptive benefits such as reducing menstrual blood flow and dysmenorrhea. The safety and efficacy of long-acting reversible contraception are well established for adolescents, but the rate of use remains low for this population. The pediatrician can play a key role in increasing access to long-acting reversible contraception for adolescents by providing accurate patient-centered contraception counseling and by understanding and addressing the barriers to use.
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Affiliation(s)
- Seema Menon
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Use of Long-Acting Reversible Contraception (LARC) and the Depo-Provera Shot in Adolescents. Curr Probl Pediatr Adolesc Health Care 2018; 48:321-332. [PMID: 30466840 DOI: 10.1016/j.cppeds.2018.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The intrauterine devices (IUDs) and the subdermal implant, collectively known as long-acting reversible contraceptives (LARC), along with the Depo-Provera shot, represent highly efficacious methods of birth control for all reproductive-age women, including adolescents. They are also safe, private, and convenient, and can be used for their noncontraceptive benefits. Additionally, LARC and Depo-Provera represent methods of contraception that do not contain estrogen and may be safely used in young women who have contraindications to estrogen-containing medications. The LARC methods have traditionally been underused by adolescents due to lack of knowledge and misperceptions about safety and effects on future fertility. However, studies have found that when barriers to the use of LARC are removed, adolescents have increasingly chosen the IUD and implant for birth control and most continue to use these methods with satisfaction. This chapter will provide an overview of IUDs, the subdermal implant and Depo-Provera, address barriers to care for adolescents, efficacy, continuation rates, common side effects and reasons for discontinuation, contraindications, and noncontraceptive benefits.
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Tebb KP, Rodriguez F, Pollack LM, Trieu SL, Hwang L, Puffer M, Adams S, Ozer EM, Brindis CD. Assessing the effectiveness of a patient-centred computer-based clinic intervention, Health-E You/Salud iTu, to reduce health disparities in unintended pregnancies among Hispanic adolescents: study protocol for a cluster randomised control trial. BMJ Open 2018; 8:e018201. [PMID: 29326184 PMCID: PMC5780691 DOI: 10.1136/bmjopen-2017-018201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Teen pregnancy rates in the USA remain higher than any other industrialised nation, and pregnancies among Hispanic adolescents are disproportionately high. Computer-based interventions represent a promising approach to address sexual health and contraceptive use disparities. Preliminary findings have demonstrated that the Health-E You/Salud iTu, computer application (app) is feasible to implement, acceptable to Latina adolescents and improves sexual health knowledge and interest in selecting an effective contraceptive method when used in conjunction with a healthcare visit. The app is now ready for efficacy testing. The purpose of this manuscript is to describe patient-centred approaches used both in developing and testing the Health-E You app and to present the research methods used to evaluate its effectiveness in improving intentions to use an effective method of contraception as well as actual contraceptive use. METHODS AND ANALYSIS This study is designed to assess the effectiveness of a patient-centred computer-based clinic intervention, Health-E You/Salud iTu, on its ability to reduce health disparities in unintended pregnancies among Latina adolescent girls. This study uses a cluster randomised control trial design in which 18 school-based health centers from the Los Angeles Unified School District were randomly assigned, at equal chance, to either the intervention (Health-E You app) or control group. Analyses will examine differences between the control and intervention group's knowledge of and attitudes towards contraceptive use, receipt of contraception at the clinic visit and self-reported use of contraception at 3-month and 6-month follow-ups. The study began enrolling participants in August 2016, and a total of 1400 participants (700 per treatment group) are expected to be enrolled by March 2018. ETHICS AND DISSEMINATION Ethics approval was obtained through the University of California, San Francisco Institutional Review Board. Results of this trial will be submitted for publication in peer-reviewed journals. This study is registered with the US National Institutes of Health. TRIAL REGISTRATION NUMBER NCT02847858.
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Affiliation(s)
- Kathleen P Tebb
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Felicia Rodriguez
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Lance M Pollack
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
| | - Sang Leng Trieu
- The Los Angeles Trust for Children's Health, Los Angeles, California, USA
| | - Loris Hwang
- Department of Pediatrics, University of California, Los Angeles, California, USA
| | - Maryjane Puffer
- The Los Angeles Trust for Children's Health, Los Angeles, California, USA
| | - Sally Adams
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Elizabeth M Ozer
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Claire D Brindis
- Institute for Health Policy Studies, University of California, San Francisco, California, USA
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Smith AJB, Harney KF, Singh T, Hurwitz AG. Provider and Health System Factors Associated with Usage of Long-Acting Reversible Contraception in Adolescents. J Pediatr Adolesc Gynecol 2017; 30:609-614. [PMID: 28502827 DOI: 10.1016/j.jpag.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE Long-acting reversible contraception (LARC) is recommended as first-line contraception for adolescents. Surveys of primary care providers suggest that physician and clinic factors might influence LARC counseling, but their effect on usage is unknown. Our objective was to explore provider and clinic characteristics associated with LARC usage in adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional study of 5363 women ages 15-21 years receiving primary care within a large health system in Massachusetts in 2015. We used data abstracted from electronic medical records to characterize rates of LARC usage. We analyzed the association of provider (specialty, degree, gender, resident status, LARC credentialing) and clinic (Title X funding, onsite LARC provision, onsite obstetrician-gynecologist) factors with adolescents' LARC usage using multivariate logistic regression. RESULTS Overall, 3.4% (95% confidence interval [CI], 2.9-3.9) of adolescents were documented as currently using a LARC method. Older adolescents were significantly more likely to use a LARC method (adjusted odds ratio, 2.41; 95% CI, 1.62-3.58 for women ages 20-21 years compared with ages 15-17 years). Adolescents whose primary care provider was a resident were significantly more likely to use a LARC method (adjusted odds ratio, 1.65; 95% CI, 1.02-2.68). Provider specialty, degree, gender, onsite LARC provision, and onsite obstetrician-gynecologist were not significantly associated with LARC usage in adolescents. CONCLUSION Being older and having a primary care provider early in their training increased the odds of LARC usage among adolescents in a large Massachusetts health system. Across primary care specialties, educating providers about the appropriate uses of LARC methods in nulliparous adolescents might facilitate LARC usage.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Kathleen F Harney
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Tara Singh
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Anita Gupta Hurwitz
- Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Cambridge Health Alliance, Cambridge, Massachusetts
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Factors Associated With Contraceptive Method Choice and Initiation in Adolescents and Young Women. J Adolesc Health 2017; 61:454-460. [PMID: 28712596 DOI: 10.1016/j.jadohealth.2017.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/15/2017] [Accepted: 04/14/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of the study was to identify factors associated with uptake of contraceptive implants or intrauterine devices (IUDs) by adolescents and young women. METHODS For this prospective cohort study, we recruited English-speaking female contraceptive initiators aged 14-24 years attending a Title X-supported, youth-focused clinic. Immediately prior to their visits, participants completed surveys assessing demographic and reproductive characteristics and awareness of, interest in, and intent to initiate specific contraceptive methods. Participants also answered questions about their social contacts' contraceptive experiences. Following the visit, participants reported the method initiated and the perceived importance of provider counseling. We used a multivariable regression model to ascertain factors associated with initiation of an IUD, an implant, or a short-acting reversible method. RESULTS We enrolled 1,048 contraceptive initiators: 277 initiated short-acting methods, 384 IUDs, and 387 implants. High previsit personal acceptability of the method was associated with choosing that method for both implants and IUDs. Knowing someone who uses a specific method and likes it was predictive of personal acceptability of that method (IUD adjusted odds ratio: 10.9, 95% confidence interval: 3.8-31.1; implant adjusted odds ratio: 7.0, 95% confidence interval: 2.3-21.0). However, 10.4% of those initiating IUDs and 14.2% of those initiating implants had never heard of the method before their appointment. Even women with previsit intent to initiate a specific method found importance in contraceptive counseling. CONCLUSIONS Previsit personal acceptability, which was associated with social contacts' experiences, was the strongest predictor of specific method uptake in our study. However, counseling informed the decisions of those with low previsit awareness and supported patients with formed intent.
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Kottke M, Hailstorks T. Improvements in Contraception for Adolescents. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Greenberg KB, Jenks SC, Piazza N, Malibiran BR, Aligne CA. A Snapshot of Urban Adolescent Women's Contraceptive Knowledge at the Onset of a Community Long-Acting Reversible Contraceptive Promotion Initiative. J Pediatr Adolesc Gynecol 2017; 30:474-478. [PMID: 28088438 DOI: 10.1016/j.jpag.2017.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/29/2016] [Accepted: 01/05/2017] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To contextualize young women's knowledge and attitudes regarding contraception at the outset of an intervention promoting long-acting reversible contraceptive (LARC) use for teen pregnancy prevention. DESIGN AND SETTING Our intervention was on the basis of diffusion of innovation theory, and at the outset we were interested in likely early adopters' existing knowledge and attitudes toward contraception. This mixed methods study consisted of focus groups within positive youth development programs in Rochester, New York; we discussed young women's knowledge and sources of information for all US Food and Drug Administration-approved contraceptive methods. PARTICIPANTS Seven focus groups and 24 female adolescent participants aged 15-19 years. INTERVENTIONS AND MAIN OUTCOME MEASURES Quantitative ranking of all contraceptive methods; qualitative themes from focus group discussions. RESULTS Our findings showed a high level of knowledge about a select group of methods, which included LARC methods, and that participants received contraceptive information from peers and family. Participants had more concerns than positive impressions regarding the effectiveness, safety, practicality, and partner reception of the contraceptive methods, with the exception of the condom. Quantitatively, the condom received the highest average rating. CONCLUSION The importance of personal anecdotes in our findings supports the use of outreach and information campaigns; providing medically accurate information and spreading positive personal anecdotes will be key to improving young women's impressions of the safety and acceptability of LARC use. This snapshot of contraceptive knowledge indicates that young women can be mature, informed consumers of sexual and reproductive health care, and through diffusion of innovation could be key players in promoting the most effective means of pregnancy prevention.
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Affiliation(s)
- Katherine Blumoff Greenberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Obstetrics/Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Sara Catherine Jenks
- Hoekelman Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nina Piazza
- Hoekelman Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Beatriz Ramos Malibiran
- Hoekelman Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - C Andrew Aligne
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York; Hoekelman Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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O'Rourke-Suchoff DK, Arora KS, Hildebrand VM, Singer ME. Exploring maternal attitudes towards adolescent contraception: implications for use of LARC. Int J Adolesc Med Health 2017; 30:/j/ijamh.ahead-of-print/ijamh-2016-0120/ijamh-2016-0120.xml. [PMID: 28598796 DOI: 10.1515/ijamh-2016-0120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/27/2016] [Indexed: 06/07/2023]
Abstract
Introduction Maternal attitudes have been shown to impact adolescent girls' sexual decision making and attitudes towards contraception. Given the potential for maternal influence on adolescent contraceptive use, we undertook an exploratory study of mothers' perceptions of the maternal role in adolescent contraceptive decision making, and maternal perceptions of long acting reversible contraceptives (LARC) for adolescent girls. Materials and methods We utilized a mixed methods study design. Acceptability of contraceptive methods and attitudes towards adolescent contraceptive use were assessed using a paper survey of 162 mothers of girls aged 11-19 years in Cleveland, Ohio, USA. Seven survey participants completed subsequent semi-structured interviews, which were analyzed using grounded theory methodology. Results Pills, condoms and injections were most frequently selected as acceptable by 55.4%, 55.4%, and 51.6% of women, respectively. One or more LARC methods were selected by 16.6% of the women. Of those (94.4%) agreed or strongly agreed that, "It is expected of me to make sure that my daughter knows about birth control methods." Important themes that emerged during interviews were the responsibility mothers felt to help their daughters navigate contraception options, appreciation of the effectiveness of LARC methods and concerns about the use of those methods by teenagers due to the invasiveness. Conclusion Our data suggest that mothers want to be involved and support adolescent decision making about contraceptives. We also found that mothers viewed LARC as less acceptable than other forms of birth control for adolescents and have specific concerns about LARC. These results suggest directions for future work to better characterize the impact of maternal attitudes on adolescent LARC use.
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Affiliation(s)
- Danielle K O'Rourke-Suchoff
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106,USA
- Department of Epidemiology and Biostatistics, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-4945,USA, Phone: 216-368-3725
| | - Kavita S Arora
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106,USA
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, 2500 Metrohealth Dr., Cleveland, OH 44109,USA
- Department of Bioethics, Case Western Reserve University, School of Medicine TA200, 10900 Euclid Ave, Cleveland, OH 44106-4976,USA
| | - Vanessa M Hildebrand
- Department of Anthropology, Case Western Reserve University, Mather Memorial Room 238, 11220 Bellflower Road, Cleveland, OH 44106-7125,USA
| | - Mendel E Singer
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106,USA
- Department of Epidemiology and Biostatistics, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-4945,USA, Phone: 216-368-3725
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Pritt NM, Norris AH, Berlan ED. Barriers and Facilitators to Adolescents' Use of Long-Acting Reversible Contraceptives. J Pediatr Adolesc Gynecol 2017; 30:18-22. [PMID: 27477904 DOI: 10.1016/j.jpag.2016.07.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 12/27/2022]
Abstract
Most pregnancies among teenagers are unintended and many can be attributed to contraception misuse or nonuse. The etonogestrel implant and intrauterine devices, referred to as long-acting reversible contraceptives, or LARCs, are the most effective reversible contraceptive methods. These methods are safe for use by adolescents, yet the number of LARC users remains low among adolescents in the United States. In this review we examine recent literature about barriers and facilitators to LARC use among adolescent women. Factors that influence decision-making and provision are organized into 4 categories: (1) cost and clinical operations; (2) adolescent awareness and attitudes; (3) confidentiality, consent, and parental attitudes; and (4) health care provider knowledge, attitudes, and counseling. Knowledge deficits and misconceptions among adolescents and their health care providers are key barriers to adolescent LARC use.
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Affiliation(s)
- Nicole M Pritt
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Alison H Norris
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio; Division of Infectious Diseases, The Ohio State University College of Medicine, Columbus, Ohio
| | - Elise D Berlan
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
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12
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Long-Acting Reversible Contraception Counseling and Use for Older Adolescents and Nulliparous Women. J Adolesc Health 2016; 59:703-709. [PMID: 27665153 PMCID: PMC6653632 DOI: 10.1016/j.jadohealth.2016.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/09/2016] [Accepted: 07/12/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE The majority of pregnancies during adolescence are unintended, and few adolescents use long-acting reversible contraception (LARC) due in part to health care providers' misconceptions about nulliparous women's eligibility for the intrauterine device. We examined differences in LARC counseling, selection, and initiation by age and parity in a study with a provider's LARC training intervention. METHODS Sexually active women aged 18-25 years receiving contraceptive counseling (n = 1,500) were enrolled at 20 interventions and 20 control clinics and followed for 12 months. We assessed LARC counseling and selection, by age and parity, with generalized estimated equations with robust standard errors. We assessed LARC use over 1 year with Cox proportional hazards models with shared frailty for clustering. RESULTS Women in the intervention had increased LARC counseling, selection, and initiation, with similar effects among older adolescent and nulliparous women, and among young adult and parous women. Across study arms, older adolescents were as likely as young adults to receive LARC counseling (adjusted odds ratio [aOR] = .85; 95% confidence interval [CI]: .63-1.15), select LARC (aOR = .86; 95% CI: .64-1.17), and use LARC methods (adjusted hazard ratio [aHR] = .94; 95% CI: .69-1.27). Nulliparous women were less likely to receive counseling (aOR = .57; 95% CI: .42-.79) and to select LARC (aOR = .53; 95% CI: .37-.75) than parous women, and they initiated LARC methods at lower rates (aHR = .65; 95% CI: .48-.90). Nulliparous women had similar rates of implant initiation but lower rates of intrauterine device initiation (aHR = .59; 95% CI: .41-.85). CONCLUSIONS Continued efforts should be made to improve counseling and access to LARC methods for nulliparous women of all ages.
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Kumar N, Brown JD. Access Barriers to Long-Acting Reversible Contraceptives for Adolescents. J Adolesc Health 2016; 59:248-253. [PMID: 27247239 DOI: 10.1016/j.jadohealth.2016.03.039] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/28/2016] [Accepted: 03/28/2016] [Indexed: 01/08/2023]
Abstract
The United States continues to have the highest adolescent birth rate of any industrialized country. Recently published guidelines by the American Academy of Pediatrics create a new consensus among professional organizations around the suitability of long-acting reversible contraceptives as first-line contraception for adolescents. Through a narrative review of U.S. studies published after 2000, this study seeks to summarize existing access barriers to long-acting reversible contraceptives for adolescents and highlight areas that warrant further intervention so that the recommendations of these professional organizations can be effectively integrated into clinical practice. Existing barriers include costs for institutions providing contraceptive care and for recipients; consent and confidentiality for adolescent patients; providers' attitudes, misconceptions and limited training; and patients' lack of awareness or misconceptions. Systemic policy interventions are required to address cost and confidentiality, such as the Affordable Care Act's mandate that contraceptive coverage be a part of essential health benefits for all insurance providers. Individual-level access barriers such as providers' misconceptions and gaps in technical training as well as patients' lack of awareness can be addressed directly by professional medical organizations, health care training programs, and other interventions.
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Affiliation(s)
- Natasha Kumar
- Warren Alpert Medical School of Brown University, Providence Rhode Island.
| | - Joanna D Brown
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Hoopes AJ, Ahrens KR, Gilmore K, Cady J, Haaland WL, Amies Oelschlager AM, Prager S. Knowledge and Acceptability of Long-Acting Reversible Contraception Among Adolescent Women Receiving School-Based Primary Care Services. J Prim Care Community Health 2016; 7:165-70. [PMID: 27067583 DOI: 10.1177/2150131916641095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A key strategy to reduce unintended adolescent pregnancies is to expand access to long-acting reversible contraceptive (LARC) methods, including intrauterine devices and subdermal contraceptive implants. LARC services can be provided to adolescents in school-based health and other primary care settings, yet limited knowledge and negative attitudes about LARC methods may influence adolescents' utilization of these methods. This study aimed to evaluate correlates of knowledge and acceptability of LARC methods among adolescent women at a school-based health center (SBHC). METHODS In this cross-sectional study, female patients receiving care at 2 SBHCs in Seattle, Washington completed an electronic survey about sexual and reproductive health. Primary outcomes were (1) LARC knowledge as measured by percentage correct of 10 true-false questions and (2) LARC acceptability as measured by participants reporting either liking the idea of having an intrauterine device (IUD)/subdermal implant or currently using one. RESULTS A total of 102 students diverse in race/ethnicity and socioeconomic backgrounds completed the survey (mean age 16.2 years, range 14.4-19.1 years). Approximately half reported a lifetime history of vaginal sex. Greater LARC knowledge was associated with white race (regression coefficient [coef] = 26.8; 95% CI 13.3-40.4; P < .001), history of vaginal intercourse (coef = 29.9; 95% CI 17.1-42.7; P < .001), and current/prior LARC use (coef = 22.8; 95% CI 6.5-40.0; P = .007). Older age was associated with lower IUD acceptability (odds ratio = 0.53, 95% CI 0.30-0.94; P = .029) while history of intercourse was associated with greater implant acceptability (odds ratio 5.66, 95% CI 1.46-22.0; P = .012). DISCUSSION Adolescent women in this SBHC setting had variable knowledge and acceptability of LARC. A history of vaginal intercourse was the strongest predictor of LARC acceptability. Our findings suggest a need for LARC counseling and education strategies, particularly for young women from diverse cultural backgrounds and those with less sexual experience.
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Affiliation(s)
- Andrea J Hoopes
- University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Kym R Ahrens
- University of Washington School of Medicine, Seattle, WA, USA Seattle Children's Research Institute, Seattle, WA, USA
| | - Kelly Gilmore
- University of Washington School of Medicine, Seattle, WA, USA University of Washington School of Public Health, Seattle, WA, USA
| | - Janet Cady
- University of Colorado Denver School of Medicine, Aurora, CO, USA University of Washington School of Public Health, Seattle, WA, USA
| | | | | | - Sarah Prager
- University of Washington School of Medicine, Seattle, WA, USA
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Satterwhite CL, Ramaswamy M. Let's talk about sex (again): advancing the conversation around long-acting reversible contraception for teenagers. ACTA ACUST UNITED AC 2015; 11:841-50. [PMID: 26626398 DOI: 10.2217/whe.15.66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Long-acting reversible contraception (LARC) has incredible potential for decreasing teenage pregnancy rates in the USA, but use among adolescents remains low. LARC methods, including intrauterine devices and implants, are recommended as first-line choices for teenagers by multiple medical professional associations. Barriers at the system, provider and patient level persist, but new demonstration projects, in addition to provisions of the Affordable Care Act, show great promise in facilitating LARC use. A renewed national discourse should acknowledge the reality that many US teenagers have sex, that LARC is safe and effective and that LARC offers an opportunity to prevent teenage pregnancy. By encouraging widespread access and use, a large, positive impact across multiple health and economic sectors can be achieved.
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Affiliation(s)
| | - Megha Ramaswamy
- Department of Preventive Medicine & Public Health, University of Kansas School of Medicine, Kansas City, KS, USA
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Bachorik A, Friedman J, Fox A, Nucci AT, Horowitz CR, Diaz A. Adolescent and Young Adult Women's Knowledge of and Attitudes Toward Etonogestrel Implants. J Pediatr Adolesc Gynecol 2015; 28:229-33. [PMID: 26024942 PMCID: PMC4457713 DOI: 10.1016/j.jpag.2014.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/27/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE Long acting reversible contraceptives, including etonogestrel implants, are top tier contraceptives for adolescents, yet they remained underutilized. This study aimed to assess awareness of and attitudes toward etonogestrel implants among adolescent and young adult women. DESIGN, MAIN OUTCOME MEASURES This is a cross sectional study. We distributed an original, self-administered survey to a convenience sample of anonymous subjects. The survey assessed demographic information, pregnancy and sexual history, general contraceptive preferences, and awareness of implants. Subjects then read a brief description of implants before completing the section assessing attitudes toward them. We used chi-square and t-test analyses to identify factors associated with awareness of and positive attitudes toward implants. SETTING, PARTICIPANTS Women aged 10-24 attending a birth control education group at an adolescent health center in New York City. RESULTS Of the 129 participants, only 40% had heard of etonogestrel implants. Some (33%) reported positive attitudes toward implants. Positive attitudes were associated with preferences for birth control convenience (OR = 3.3, 95% CI = 1.1- 9.5) and privacy (OR = 2.2, 95% CI = 1.0- 4.8). Neutral or negative attitudes were associated with a preference for birth control that maintained menstrual regularity (OR = 0.4, 95% CI = 0.2- 0.8) and with having experienced at least 1 unintended pregnancy (OR = 0.4, 95% CI = 0.2- 0.9). Age, race, and education were not associated with participants' attitudes toward implants. CONCLUSIONS Women who value convenience and privacy are more likely to report positive attitudes toward implants, and thus may represent especially receptive candidates for them.
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Affiliation(s)
- Alexandra Bachorik
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Joy Friedman
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashley Fox
- Department of Health Evidence & Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anne T Nucci
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carol R Horowitz
- Department of Health Evidence & Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Angela Diaz
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
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Johnson KM, Dodge LE, Hacker MR, Ricciotti HA. Perspectives on family planning services among adolescents at a Boston community health center. J Pediatr Adolesc Gynecol 2015; 28:84-90. [PMID: 25850588 DOI: 10.1016/j.jpag.2014.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/23/2014] [Accepted: 05/27/2014] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE The aim of this project was to investigate adolescent perspectives on family planning services at a community-health center, with the intent to inform health center programs aimed at stemming the adolescent pregnancy rate. DESIGN This project was cross-sectional and employed mixed methods, including surveys and interviews, for the purposes of quality improvement. SETTING The project was conducted in the obstetrics and gynecology clinic at an urban community health center in Boston. PARTICIPANTS Twenty adolescent females (age 16-20) who used services at the health center. INTERVENTION Participants were individually interviewed to assess perspectives on family planning services and to identify major influences on methods of pregnancy prevention. MAIN OUTCOME MEASURE Major themes were categorized into contraceptive usage, reproductive health knowledge, adult influence and communication, barriers to contraceptive care and expectations of a family planning clinic. RESULTS All participants were sexually active and 80% had experienced pregnancy. Reproductive health knowledge was variable and in many cases limited. Concern about disapproval was a prominent barrier to going to a clinician for contraception or advice and parents were not often involved in the initial contraception discussion. Other barriers to use of contraception included forgetting to use the methods and fear of side effects. CONCLUSION We identified several potentially modifiable factors, including lack of knowledge, concern for provider disapproval and fear of side effects that may limit effective use of family planning services by adolescents. Further attention should be paid to these factors in designing and improving youth-friendly services in ob-gyn clinics.
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Affiliation(s)
- Katherine M Johnson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA; Department of Obstetrics and Gynecology, Dimock Center, Roxbury, MA
| | - Laura E Dodge
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - Hope A Ricciotti
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA; Department of Obstetrics and Gynecology, Dimock Center, Roxbury, MA.
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Kaneshiro B, Salcedo J. Contraception for Adolescents: Focusing on Long-Acting Reversible Contraceptives (LARC) to Improve Reproductive Health Outcomes. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015; 4:53-60. [PMID: 27635305 PMCID: PMC5021306 DOI: 10.1007/s13669-015-0112-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adolescent pregnancy rates in the U.S. have reached an all-time low from their peak in the 1980s and 1990s. However, the U.S. maintains the highest rate of teenage pregnancy among developed nations. Adolescents experience higher typical use failure rates for user-dependent contraceptives compared to their adult counterparts. Long-acting reversible contraception (LARC), IUDs and implants, have failure rates that are both very low and independent of user age. In settings where the most effective methods are prioritized and access barriers are removed, the majority of adolescents initiate LARC. Use of LARC by adolescents significantly reduces rates of overall and repeat teen pregnancy. All methods of contraception are safe for use in teens, including IUDs and DMPA. Dual use of LARC and barrier methods to reduce risk of sexually transmitted infection, is the optimal contraceptive strategy for most adolescents. Adolescent access to evidence-based and confidential contraceptive services, provided in a manner that respects autonomy, is a vital public health goal.
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Affiliation(s)
- Bliss Kaneshiro
- Department of Obstetrics, Gynecology and Women’s Health University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street #824, Honolulu, HI 96826, Phone: (808) 203-6500, Fax: (808) 955-2175
| | - Jennifer Salcedo
- Department of Obstetrics, Gynecology and Women’s Health University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street #824, Honolulu, HI 96826, Phone: (808) 203-6500, Fax: (808) 955-2175
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Friedman JO. Factors associated with contraceptive satisfaction in adolescent women using the IUD. J Pediatr Adolesc Gynecol 2015; 28:38-42. [PMID: 25555299 DOI: 10.1016/j.jpag.2014.02.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 02/20/2014] [Accepted: 02/20/2014] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To estimate satisfaction and to identify factors contributing to an adolescent woman's satisfaction with the levonorgestrel-containing or copper intrauterine device (IUD). DESIGN Adolescent women presenting to an urban clinic within 1 month of IUD insertion completed survey questionnaires about prior use of contraception, gynecologic/obstetric history, and a pain scale. Participants were contacted at 3 and 6 months post-insertion to complete surveys regarding satisfaction with the IUD, their menstrual bleeding patterns, and pain and cramping due to the IUD. Chi-square test, Fisher exact test, and logistic regression were used for analysis. SETTING Mount Sinai Adolescent Health Center in New York City. PARTICIPANTS Seventy-nine adolescent women aged 15-24 y. INTERVENTIONS None. MAIN OUTCOME MEASURE Satisfaction was measured at 3 and 6 months post-IUD insertion as a 10-point Likert item. RESULTS 82% and 76% percent of participants were available for follow-up at 3 and 6 months, respectively. Satisfaction with the IUD was high overall with 75.4% (49/65) of participants choosing a satisfaction rating of eight or higher on the 10-point scale at 3 months and 76.7 % (46/60) at 6 months. Prior history of pregnancy and selecting the levonorgestrel containing IUD were predictive of higher satisfaction at 3 months, but not at 6 months. Parity and prior use of contraceptive methods were not predictive of satisfaction. CONCLUSION The finding of high satisfaction across participants supports the current recommendation for the IUD as a first-line contraceptive for adolescents. Nulliparous young women and those who are naïve to contraception should be considered as candidates for the IUD.
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Affiliation(s)
- Joy O Friedman
- Oakland University William Beaumont School of Medicine, Hough Center for Adolescent Health, Beverly Hills, MI.
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20
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Ricciotti HA, Dodge LE, Ramirez CI, Barnes K, Hacker MR. Long-acting reversible contraceptive use in urban women from a title X-supported Boston community health center. J Prim Care Community Health 2014; 6:111-5. [PMID: 25301380 DOI: 10.1177/2150131914553800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Unintended and adolescent pregnancy disproportionately affects minority populations, but the effect of age, race and ethnicity on the use of long-acting reversible contraception (LARC) has not been well studied. OBJECTIVE The objective of this pilot study was to examine LARC use over a 5-year period among women receiving care at a Boston community health center. METHODS Retrospective cohort study of LARC method use among black, Hispanic, and white women receiving care at the Dimock Center from 2006 to 2010. RESULTS This study included 276 women (60.1% black, 18.5% Hispanic, and 9.1% white). LARC was not used as a first-line method in the majority (96.0%), regardless of age, race, and ethnicity; yet nearly half identified a long-acting contraceptive as their method of choice. CONCLUSIONS The findings of this pilot study reveal opportunities to reduce unintended pregnancy through increased LARC use, which may be accomplished by provider and patient education.
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Affiliation(s)
- Hope A Ricciotti
- Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Boston, MA, USA Dimock Center, Roxbury, MA, USA
| | - Laura E Dodge
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Katherine Barnes
- Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Michele R Hacker
- Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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Potter J, Rubin SE, Sherman P. Fear of intrauterine contraception among adolescents in New York City. Contraception 2014; 89:446-50. [PMID: 24560479 PMCID: PMC4141332 DOI: 10.1016/j.contraception.2014.01.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/10/2014] [Accepted: 01/14/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The intrauterine contraceptive device (IUD) is one of the most effective contraceptive methods, but it remains underutilized, especially among adolescents. Little is known about how adolescents perceive IUDs. The objective of this study is to explore urban, minority female adolescents' attitudes and beliefs about IUDs and to identify barriers to IUD use. STUDY DESIGN Qualitative semistructured interviews were conducted with 21 adolescents aged 14 to 21 years who had heard about the IUD but never used one personally. Participants were recruited from two urban school-based health clinics and one community health center. Individual interviews were audiotaped and transcribed. Themes were identified by two independent researchers through line-by-line analysis of interview transcripts. RESULTS Fear of the IUD predominated. Respondents related fears about pain, expulsion, foreign body and the potential for physical harm. Common themes in support of the IUD included the IUD's superior efficacy compared to other contraceptive methods and the ability to use this method long term. Despite identifying IUD benefits, most respondents did not appear to think the method would be well suited for them. CONCLUSION Though the IUD is safe and effective for adolescents, we found that urban female adolescents have many device-related concerns which must be addressed to make this method more acceptable. IMPLICATIONS Understanding urban, minority adolescents' perspective on IUDs and their specific concerns about IUD method use can help clinicians provide targeted and relevant contraceptive counseling.
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Affiliation(s)
- Julia Potter
- Adolescent Medicine Fellow, Department of Pediatrics, New York-Presbyterian/Columbia, New York, NY, 10032.
| | - Susan E Rubin
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, 10461
| | - Peter Sherman
- Department of Pediatrics, Bronx Lebanon Hospital, New York, NY, 10456
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22
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Intrauterine contraception: attitudes, practice, and knowledge among Swedish health care providers. Contraception 2014; 89:407-12. [DOI: 10.1016/j.contraception.2013.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/10/2013] [Accepted: 12/23/2013] [Indexed: 11/21/2022]
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Teal SB, Romer SE. Awareness of long-acting reversible contraception among teens and young adults. J Adolesc Health 2013; 52:S35-9. [PMID: 23535055 DOI: 10.1016/j.jadohealth.2013.01.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
Abstract
Adolescents and young women were historically excluded from receiving long-acting reversible contraceptives (LARC) such as intrauterine devices (IUDs) after widespread concerns about infection and infertility 40 years ago reduced IUD use for all women. Over the last several years, concerted efforts by professional health organizations have promoted LARC as an excellent solution to the epidemic of unintended pregnancy in adolescents and young adults, yet uptake has increased slowly. In this article we review evidence regarding awareness of LARC among young women, and perceptions and knowledge of LARC in this population. We review evidence on clinical providers' knowledge and beliefs about LARC, and their beliefs about the appropriateness or risks of LARCs for adolescents and young women. We discuss an active role for providers in increasing awareness of LARC among young women, rather than relying on patient request for methods of which they have little knowledge. Finally, we suggest avenues of future research into the most effective and efficient ways to increase awareness of LARC among adolescents.
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Affiliation(s)
- Stephanie B Teal
- Section of Family Planning, University of Colorado, School of Medicine, Aurora, Colorado 80045, USA.
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