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1、Pregnancy Experience&Use of Emergency ContraceptionAmong Young Women in the Bay AreaShira RutmanJune 2006SignificanceThree and a half million unintended pregnancies occur each year in the United States.(Henshaw 1998)Emergency contraception EC has the potential to prevent 50%of these pregnancies and
2、60-70%of abortions annually.(Trussel 1992)EC is effective when taken 72 to 120 hours after intercourse,but is most effective the sooner it is taken.(Ellertson 2003)“Parent”Study Design&Setting A randomized,single-blind,controlled trialConducted by investigators at UCSFJuly 2001 to June 2003 at four
3、California clinics providing family planning servicesThree arms:advance provision,pharmacy access and clinic(control)Examined reproductive outcomes(pregnancy,STIs and contraceptive/sexual behaviors Total N=2,117Participants Young women 15-24 years old Spoke English or Spanish Had sexual intercourse
4、in the previous six months(“sexually active”)Lived in the San Francisco Bay Area Available for follow-up 6 months laterParticipants continued Not pregnant or desiring pregnancy Not using long-term hormonal contraception(injectables,IUD or implants)Not requesting EC at the enrollment Had not had unpr
5、otected intercourse in the previous three days Not using“patch”or“ring”(not yet FDA approved)“Parent”Study Findings No significant reduction in pregnancy rates in pharmacy access and advance provision groups No increase in STIs No differences by study group in:ocontraceptive patternsocondom use osex
6、ual behaviorsEC use during the study N=571(26.9%)“The public health impact may be negligible because of high rates of unprotected intercourse and relative underutilization of the method.”Raine TR,Harper CC,Rocca CH,Fischer R,Padian N,Klausner JD,Darney PD.Direct access to emergency contraception thr
7、ough pharmacies and effect on unintended pregnancy and STIs:a randomized,controlled trial.JAMA 2005;293:5462.Study Hypotheses1)Young women who have experienced pregnancy are more likely to use EC,than young women who have not experienced pregnancy.2)Among young women who have experienced pregnancy,t
8、hose who have experienced abortion are more likely to use EC,than young women who have not experienced abortion,who may or may not have experienced pregnancy.Measures Outcome Measure(Follow-up visit):oEC use Main Predictor Measures(Baseline visit):oPrevious pregnancy(yes/no)oPrevious abortion(yes/no
9、-includes those who have been pregnant,but not had an abortion and those who have not been pregnant)Measures continuedPredictor Measures:oLevel of access to EC(study arm)oClinic site(enrollment site)oAge(continuous)oRace/Ethnicity oEver used EC(yes/no)oFrequency of intercourse oUnprotected intercour
10、se past 6 mos(yes/no)oContraceptive methodoPregnancy Attitude(very unhappy/other)MethodsChi-square tests:Differences between previous pregnancy/abortion and no previous pregnancy/abortion groups.Crude odds ratios:Association between previous pregnancy/abortion and characteristics of participants at
11、enrollment(demographics,contraceptive/sexual behaviors and pregnancy attitudes).Multivariate logistic regression:Impact of previous pregnancy/abortion(and other predictors)on EC use during the study(adjusted).Previous pregnancy N=686(32.4%)Used EC during study(outcome)N=200(35.0%)Chi-square tests sh
12、owed significant differences between pregnancy experience groups in every characteristic examined except for level of access to EC(study arm)Results:Previous PregnancyMultivariate Logistic Regression:Previous Pregnancy 32%higher odds of EC use among participants who had had a previous pregnancy comp
13、ared to those who had not,adjusting for all the other variablesOdds of EC use:Unprotected intercourse Ever used EC OC use and use of both OC and condoms*Adjusted for all the other variables Multivariate Logistic Regression:Previous Pregnancy Of the 686(32.4%)participants who reported pregnancy at ba
14、seline,562(81.9%)reported that they had had an abortion.Used EC during study N=167(29.2%)Chi-square tests showed significant differences between abortion experience groups in every characteristic examined except for level of access to EC(study arm)and clinic site.Results:Previous AbortionMultivariat
15、e Logistic Regression:Previous Abortion 41%higher odds of EC use among participants who had had a previous abortion compared to those who had not,adjusting for all the other variablesOdds of EC use:Unprotected intercourse Ever used EC OC use and use of both OC and condoms*Adjusted for all the other
16、variables Multivariate Logistic Regression:Previous Abortion Limitations Risk perception was not directly measured in the study Self-reported pregnancy and abortion;likely under-reported,leading to under-estimates of EC use Data were not collected to test my hypothesesConclusions Increased rates of
17、unprotected intercourse and increased EC use among young women with previous pregnancies and abortions(may cancel each other out)A reduction in unintended pregnancies may not be observed in these subgroups of young women Education about contraceptive risk in these subgroups is indicated Thank You!Th
18、esis Committee Members:Drs.Jane Rees(Chair),Cynthia Harper&Hendrika Meischke Nate Mercaldo and the Dept.of Biostatistics consultants Family and Friends(especially the“Friday Thesis Group”members)AdamThis work was supported in part by a grant from the US Department of Health and Human Services,Health
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