Half of pregnancies in the United States are unintended; they have significant consequences and occur at disproportionately higher rates in vulnerable populations. The prevalence of unintended pregnancy is determined largely by contraceptive practice. Combination oral contraceptive pills (OCPs) remain the most common method of reversible contraception; however, the need for daily compliance and problems using the method lead to discontinuation, switching to other less effective barrier methods, and pregnancy. Two new user-controlled methods of combined hormonal contraception promise to offer young women more options for preventing pregnancy: the transdermal patch (Ortho Evra TM) and the vaginal ring (Nuvaringa). While preliminary information on these new methods from contraceptive clinical trials is promising, there is no data on use of these methods in women at highest risk for unintended pregnancy, the context in which they use them, or the influence of socioenvironmental factors, including the family planning clinic setting. We are proposing to conduct a 12-month, longitudinal observational study of a cohort of high-risk women, defined as unmarried, low-income and/or minority women, ages 15-24, who initiate the transdermal patch, the vaginal ring, or OCPs.
The specific aims of the study are to: 1) assess the relationship between individual characteristics, heterosexual partnerships, parental and peer influences, and method choice; 2) evaluate how the above factors and the clinic setting are related to successful use of the methods; 3) identify attributes of the methods associated with user satisfaction and method continuation; and 4) assess factors associated with dual use of condoms. Women will be recruited from two family planning clinics in the San Francisco Bay Area and information on individual and socioenvironmental factors that are potential explanatory variables will be collected at enrollment, 3, 6, and 12-months by ACASI interview. The primary study outcomes of interest are contraceptive use patterns and long-term (year) continuation. Secondary outcomes that will also be assessed include contraceptive failures (pregnancies) and sexually transmitted infections. If women at highest risk for unintended pregnancy do not use these highly effective hormonal methods we will not capitalize on the recent advances. This study will provide information on factors influencing real life use patterns. This type of information is necessary to translate the new developments in contraceptive technology into improvements in reproductive health. ? ? ?
