When I think of teenage women this photograph conjures up an adage I largely agree with that 'girls just want to have fun.' Perhaps that accounts at least in part for the rather astonishing prevalence of adolescent pregnancy in the US: more than 600,000 each year, for an overall rate of 3 in 10 teenage women becoming pregnant before age 20. On this week's PodMed, Rick and I talk about a study in the New England Journal of Medicine that assesses a multipronged approach to intervention, with stellar results.
The study enrolled just over 1400 adolescents 15 to 19 years of age at any time during the study period. They were part of a larger study known as the 'Contraceptive CHOICE Project.' This project employed long acting reversible contraceptives (LARC) as the method of choice to reduce unwanted pregnancy among almost 10,000 women 14 to 45 years of age living in the St. Louis area. Participants in the study were provided with education regarding reversible contraceptive methods, identified from most to least effective. Side effects, risks and benefits of each method were also identified. Women were provided with their chosen method free of charge the same day they attended an education session. Women were offered same day insertion of their method of choice among the LARCs, either intrauterine devices or implants, and they could obtain another shorter acting method if they were ineligible for same day insertion until their chosen method became available to them.
Telephone interviews were conducted by study staff at 3 and 6 months after employment of the chosen contraceptive method, then every 6 months thereafter up to 2 or 3 years, depending on enrollment date. Subjects received a $10 gift card at completion of each survey, which gathered data on satisfaction with the method, sexual behavior and pregnancy. Pregnancy outcomes were recorded for those subjects who became pregnant.
The study states that the "majority of teens in both age groups chose LARC methods, but teens 14 to 17 years of age were more likely than older teens to do so (77.5% vs. 68.4%,). The implant was the most common contraceptive choice for participants 14 to 17 years of age, whereas an IUD was most commonly chosen by older teens." Here's what the conclusions are: " During the 2008–2013 period, the mean annual rates of pregnancy, birth, and abortion among CHOICE participants were 34.0, 19.4, and 9.7 per 1000 teens, respectively. In comparison, rates of pregnancy, birth, and abortion among sexually experienced U.S. teens in 2008 were 158.5, 94.0, and 41.5 per 1000, respectively." Wow! Those are some very impressive results, and suggest, at least to Rick and me, that provision of both information and free contraceptive methods can have a huge impact on this persistent problem.
Two aspects of this issue remain concerning for me. One is that while 2 in 10 white teenagers will experience pregnancy before age 20, the number is twice that for blacks and Hispanics, so cultural sensitivity must play a role in such interventions. Of even greater concern is the fact that none of these methods protect against STIs, some of which are livelong and even life threatening. Rick and I agree with the American Academy of Pediatrics which also issued recommendations this week, citing first abstinence as the most effective contraceptive, but also advocating for condom use in addition to other methods for everyone's protection.
Other topics this week include early gluten introduction and celiac disease, also in NEJM, and two from JAMA: acupuncture for knee pain and heart valves in middle-aged adults. Until next week, y'all live well.