553800
research-article2014
JPCXXX10.1177/2150131914553800Journal of Primary Care & Community HealthRicciotti et al
Pilot Studies
Long-Acting Reversible Contraceptive Use in Urban Women From a Title X–Supported Boston Community Health Center
Journal of Primary Care & Community Health 2015, Vol. 6(2) 111–115 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/2150131914553800 jpc.sagepub.com
Hope A. Ricciotti1,2,3, Laura E. Dodge1, Christina I. Ramirez2, Katherine Barnes1,2, and Michele R. Hacker1,2
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. Keywords long-acting reversible contraception, adolescent pregnancy, minority women, racial and ethnic differences contraception use, community health
Introduction Unintended pregnancy disproportionately affects minority populations, but the effect of age, race, and ethnicity on use of long-acting reversible contraception (LARC) has not been well studied. Half of unintended pregnancies occur in women using contraception; therefore, a highly effective contraceptive method such as LARC has potential to have a large impact on unintended pregnancy rates.1 There are racial and ethnic differences in contraceptive selection.2-5 LARC, which includes intrauterine contraceptive devices (IUDs) and implants, is highly effective and safe for preventing unintended pregnancy. However, its use remains low in women of all reproductive ages, particularly in adolescents, who are at disproportionately higher risk for unintended pregnancy.6 The decline in the US teen pregnancy rate across all racial and ethnic groups7 is in large part attributable to increases in the proportion of female adolescents using highly effective contraception.8,9 IUDs or hormonal methods are used by 60% of sexually experienced adolescents, most often by non-Hispanic white adolescents (66%), followed by Hispanic adolescents (54%) and non-Hispanic black adolescents (46%).9 Issues of cost and access affect
adolescent LARC use, and when these barriers are eliminated, 69% of adolescents 14 to 17 years old and 61% of those 18 to 20 years old choose LARC.8,9 This study examined the initiation and continuation of LARC utilization in an urban Boston Title X–supported community health center with a large black and Hispanic population over a 5-year period among older and younger women to understand the effect of age, race, and ethnicity on LARC use in order to reduce the unintended pregnancy rate.
Materials and Methods We conducted a retrospective cohort study of all women who received a LARC method (IUD or etonogestrel implant) from 2006 through May, 2010 at the Dimock 1
Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Boston, MA, USA 3 Dimock Center, Roxbury, MA, USA 2
Corresponding Author: Hope A. Ricciotti, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3, Boston, MA 02215, USA. Email: [email protected]
Downloaded from jpc.sagepub.com at MOUNT ALLISON UNIV on November 18, 2015
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Journal of Primary Care & Community Health 6(2)
Center, a Title X–supported community health center in the Roxbury neighborhood of Boston, Massachusetts. We reviewed the charts of all women who, based on International Classification of Diseases, Ninth Revision and Current Procedural Terminology coding, had an IUD or implant inserted during the study period. There were no exclusion criteria. The institutional review board at our institution approved this study. We collected demographic data and information regarding the reason for selecting LARC, number of prior contraceptive methods, reason for discontinuing, duration of use, and whether the device was in place at the time of chart review. When multiple reasons for placement or discontinuation were documented, all were included in the analysis. Participants were stratified into the following groups based on age at the time of IUD or implant placement: (a) younger women, defined as those
research-article2014
JPCXXX10.1177/2150131914553800Journal of Primary Care & Community HealthRicciotti et al
Pilot Studies
Long-Acting Reversible Contraceptive Use in Urban Women From a Title X–Supported Boston Community Health Center
Journal of Primary Care & Community Health 2015, Vol. 6(2) 111–115 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/2150131914553800 jpc.sagepub.com
Hope A. Ricciotti1,2,3, Laura E. Dodge1, Christina I. Ramirez2, Katherine Barnes1,2, and Michele R. Hacker1,2
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. Keywords long-acting reversible contraception, adolescent pregnancy, minority women, racial and ethnic differences contraception use, community health
Introduction Unintended pregnancy disproportionately affects minority populations, but the effect of age, race, and ethnicity on use of long-acting reversible contraception (LARC) has not been well studied. Half of unintended pregnancies occur in women using contraception; therefore, a highly effective contraceptive method such as LARC has potential to have a large impact on unintended pregnancy rates.1 There are racial and ethnic differences in contraceptive selection.2-5 LARC, which includes intrauterine contraceptive devices (IUDs) and implants, is highly effective and safe for preventing unintended pregnancy. However, its use remains low in women of all reproductive ages, particularly in adolescents, who are at disproportionately higher risk for unintended pregnancy.6 The decline in the US teen pregnancy rate across all racial and ethnic groups7 is in large part attributable to increases in the proportion of female adolescents using highly effective contraception.8,9 IUDs or hormonal methods are used by 60% of sexually experienced adolescents, most often by non-Hispanic white adolescents (66%), followed by Hispanic adolescents (54%) and non-Hispanic black adolescents (46%).9 Issues of cost and access affect
adolescent LARC use, and when these barriers are eliminated, 69% of adolescents 14 to 17 years old and 61% of those 18 to 20 years old choose LARC.8,9 This study examined the initiation and continuation of LARC utilization in an urban Boston Title X–supported community health center with a large black and Hispanic population over a 5-year period among older and younger women to understand the effect of age, race, and ethnicity on LARC use in order to reduce the unintended pregnancy rate.
Materials and Methods We conducted a retrospective cohort study of all women who received a LARC method (IUD or etonogestrel implant) from 2006 through May, 2010 at the Dimock 1
Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Boston, MA, USA 3 Dimock Center, Roxbury, MA, USA 2
Corresponding Author: Hope A. Ricciotti, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3, Boston, MA 02215, USA. Email: [email protected]
Downloaded from jpc.sagepub.com at MOUNT ALLISON UNIV on November 18, 2015
112
Journal of Primary Care & Community Health 6(2)
Center, a Title X–supported community health center in the Roxbury neighborhood of Boston, Massachusetts. We reviewed the charts of all women who, based on International Classification of Diseases, Ninth Revision and Current Procedural Terminology coding, had an IUD or implant inserted during the study period. There were no exclusion criteria. The institutional review board at our institution approved this study. We collected demographic data and information regarding the reason for selecting LARC, number of prior contraceptive methods, reason for discontinuing, duration of use, and whether the device was in place at the time of chart review. When multiple reasons for placement or discontinuation were documented, all were included in the analysis. Participants were stratified into the following groups based on age at the time of IUD or implant placement: (a) younger women, defined as those
