Impact of individual values on adherence to emergency contraception practice guidelines among pediatric residents: implications for training.
OBJECTIVE
To evaluate the impact of individual, system, and interpersonal factors on emergency contraception practices. We hypothesized that abortion attitudes and attitudes toward teen sex would be significant individual factors influencing emergency contraception practices.


METHODS
This was a cross-sectional, anonymous Internet survey.


METHODS
Four pediatric residency programs in the Baltimore, Maryland-Washington, DC, metropolitan area during April to June 2007.


METHODS
One hundred forty-one pediatric residents completed the survey.


METHODS
Abortion attitudes were assessed by participants' level of agreement with abortion in 7 scenarios. Attitudes toward teen sex were assessed by participants' level of agreement with 5 statements about the acceptability of teens having sex.


METHODS
Emergency contraceptive counseling behavior was assessed by reported frequency of including emergency contraception in routine contraceptive counseling. Intention to prescribe emergency contraception was assessed by reported likelihood of prescribing in 5 scenarios.


RESULTS
When controlling for demographics and other predictors, residents with less favorable abortion attitudes were more likely to have the lowest intention to prescribe emergency contraception. Residents with more positive attitudes toward teen sex and who had a preceptor encourage emergency contraception prescription were more likely to include emergency contraception in routine contraceptive counseling most/all the time and to have the highest intention to prescribe.


CONCLUSIONS
Efforts to challenge and affect attitudes toward teen sex and to prompt residents to prescribe emergency contraception in clinical settings may be needed to encourage more proactive emergency contraceptive practice in accordance with national practice guidelines.
Upadhya
Krishna K
KK
Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, U SA. kupadhy2@jhmi.edu
Trent
Maria E
ME
Ellen
Jonathan M
JM
D000028:Abortion, Induced / Q000523:psychology; D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D015142:Baltimore; D003281:Contraceptives, Postcoital; D003376:Counseling; D003430:Cross-Sectional Studies; D004219:District of Columbia; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D010372:Pediatrics / Q000193:education*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control; D012945:Social Values
D003281:Contraceptives, Postcoital