title: Barriers to and enablers of contraceptive use among adolescent females and their interest in an emergency department based intervention.
abstract: OBJECTIVE
  Over 15 million adolescents, many at high risk for pregnancy, use emergency departments (EDs) in the United States annually, but little is known regarding reasons for failure to use contraceptives in this population. The purpose of this study was to identify the barriers to and enablers of contraceptive use among adolescent females using the ED and determine their interest in an ED-based pregnancy prevention intervention.
  
  
  METHODS
  We conducted semistructured, open-ended interviews with females in an urban ED. Eligible females were 14-19 years old, sexually active, presenting for reproductive health complaints and at risk for pregnancy, defined as nonuse of effective (per the World Health Organization) contraception. Interviews were recorded, transcribed and coded based on thematic analysis. Enrollment continued until no new themes emerged. A modified Health Belief Model guided the organization of the data.
  
  
  RESULTS
  Participants (n=14) were predominantly Hispanic (93%), insured (93%) and in a sexual relationship (86%). The primary barrier to contraceptive use was perceived health risk, including effects on menstruation, weight and future fertility. Other barriers consisted of mistrust in contraceptives, ambivalent pregnancy intentions, uncertainty about the future, partner's desire for pregnancy and limited access to contraceptives. Enablers of past contraceptive use included the presence of a school-based health clinic and clear plans for the future. All participants were receptive to ED-based pregnancy prevention interventions.
  
  
  CONCLUSIONS
  The identified barriers and enablers influencing hormonal contraceptive use can be used to inform the design of future ED-based adolescent pregnancy prevention interventions.
  
  
  CONCLUSIONS
  Adolescents who visit the emergency department (ED) identify contraceptive side effects, mistrust in contraceptives, limited access, pregnancy ambivalence and partner pregnancy desires as barriers to hormonal contraception use. They expressed interest in an ED-based intervention to prevent adolescent pregnancy; such an intervention could target these themes to maximize effectiveness.
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States. Electronic address: Lc2243@columbia.edu.
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Chernick
authors.affiliation: Department of Nursing, Columbia University Medical Center, NY, NY, United States.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Schnall
authors.affiliation: Department of Nursing, Columbia University Medical Center, NY, NY, United States.
authors.forename: Tracy
authors.initials: T
authors.lastname: Higgins
authors.affiliation: Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States; Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, NY, NY, United States.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Stockwell
authors.affiliation: Department of Obstetrics & Gynecology, Columbia University Medical Center, NY, NY, United States.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Castaño
authors.affiliation: Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States; Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, NY, NY, United States.
authors.forename: John
authors.initials: J
authors.lastname: Santelli
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
mesh_terms: D000293:Adolescent; D003268:Contraception Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology; D036301:Qualitative Research; D012725:Sexual Behavior / Q000523:psychology; D014481:United States; D055815:Young Adult
keywords: Emergency medicine; Family planning counseling; Pregnancy prevention; Sexual health; Teenage pregnancy