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
Measures
Outcome Measure (Follow-up visit): o EC use
Main Predictor Measures (Baseline visit): o Previous pregnancy (yes/no) o Previous abortion (yes/no-includes those who have been pregnant, but not had an abortion and those who have not been pregnant)
Emergency contraception [EC] has the potential to prevent 50% of these pregnancies and 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)
Data were not collected to test my hypotheses
Conclusions
Increased rates of unprotected intercourse and increased EC use among young women with previous pregnancies and abortions (may cancel each other out)
Study Hypotheses
1) 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, those 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.
No increase in STIs No differences by study group in:
o contraceptive patterns o condom use o sexual behaviors
EC 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.”
Multivariate logistic regression: Impact of previous pregnancy/abortion (and other predictors) on EC use during the study (adjusted).
Results:
Previous Pregnancy
Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized, controlled trial. JAMA 2005; 293: 54–62.
“Parent” Study Design & Setting
A randomized, single-blind, controlled trial Conducted by investigators at UCSF July 2001 to June 2003 at four California clinics
Pregnancy Experience &
Use of Emergency Contraception
Among Young Women in the Bay Area
Shira Rutman June 2006
Significance
Three and a half million unintended pregnancies occur each year in the United States. (Henshaw 1998)
Participants 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 unprotected intercourse in the
Participants
Young women 15-24 years old Spoke English or Spanish Had sexual intercourse in the previous six
months (“sexually active”) Lived in the San Francisco Bay Area Available for follow-up 6 months later
Results:
Previous Abortion
Of the 686 (32.4%) participants who reported pregnancy at baseline, 562 (81.9%) reported that they had had an abortion.
Used EC during study N=167 (29.2%) Chi-square tests showed significant differences
Methods
Chi-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 enrollment (demographics, contraceptive/sexual behaviors and pregnancy attitudes).
Previous pregnancy N=686 (32.4%) Used EC during study (outcome) N=200 (35.0%) Chi-square tests showed significant differences
between pregnancy experience groups in every characteristic exato EC (study arm)
providing family planning services Three arms: advance provision, pharmacy access
and clinic (control) Examined reproductive outcomes (pregnancy,
STIs and contraceptive/sexual behaviors Total N=2,117
Measures continued
Predictor Measures: o Level of access to EC (study arm) o Clinic site (enrollment site) o Age (continuous) o Race/Ethnicity o Ever used EC (yes/no) o Frequency of intercourse o Unprotected intercourse past 6 mos (yes/no) o Contraceptive method o Pregnancy Attitude (very unhappy/other)
Multivariate Logistic Regression:
Previous Pregnancy
Odds of EC use: Unprotected intercourse Ever used EC OC use and use of both OC and condoms
*Adjusted for all the other variables
between abortion experience groups in every characteristic examined except for level of access to EC (study arm) and clinic site.