title: Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy.
abstract: OBJECTIVE
  In the United States, teen pregnancy rates are declining. However, the United States still has the highest teen pregnancy rate among high-income countries. Understanding factors that predict discontinuation of effective contraception might help to further decrease teen pregnancy. We aimed to assess predictors of early discontinuation of effective contraception during typical use by high-risk teens. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We recruited 145 women aged 13-20 years (mean, 17.7 ± 1.8 years); 68% (99/145) Hispanic; 26% (38/145) black; 14% (20/145) ever pregnant; and 4% (6/145) high school dropouts who chose an effective contraceptive method during a health care visit and we prospectively assessed use of the method after 6 months. Contraceptive choices of the 130 participants who were reassessed at 6 months (90% retention) were: intrauterine device (IUD), 26% (34/130); depot medroxyprogesterone acetate (DMPA), 8% (10/130); combined oral contraceptives (COCs), 48% (62/130); transdermal patch (Patch), 13% (17/130); and intravaginal ring (Ring), 5% (7/130).
  
  
  RESULTS
  After 6 months, only 49 of 130 (38%) continued their chosen method; 28 of 130 (22%) never initiated the method; and 53 of 130 (40%) discontinued. Users and nonusers at 6 months did not differ according to cultural and/or social characteristics (age, ethnicity, acculturation, education, health literacy) but differed according to contraceptive method type. For the 102 of 130 who initiated a method, 88% continued use of the IUD, 20% DMPA, 43% COC, 17% Patch and Ring (P < .001). Using Cox proportional hazards multivariable analysis, compared with IUDs, all other methods predicted discontinuation: DMPA (hazard ratio [HR], 5.6; 95% confidence interval [CI], 1.2-26.7; P < .05); COCs (HR, 6.6; 95% CI, 1.8-25; P < .01); Patch and Ring (HR, 12; 95% CI, 3.0-48; P < .001). Discontinuation was also predicted by past use of hormonal contraceptives (HR, 1.9; 95% CI, 1.0-3.6; P < .05) and high school dropout (HR, 8.2; 95% CI, 1.6-41; P < .01).
  
  
  CONCLUSIONS
  Contraceptive method type is the strongest predictor of early discontinuation; compared with IUDs, all other methods are 6-12 times more likely to be discontinued. Cultural and/or social characteristics, with the exception of school dropout, are of little predictive value. Increasing the use of IUDs by high-risk teens could decrease discontinuation rates and possibly teen pregnancy rates.
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, New York. Electronic address: smaslyan@montefiore.org.
authors.forename: Sofya
authors.initials: S
authors.lastname: Maslyanskaya
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, New York.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Coupey
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Rosy
authors.initials: R
authors.lastname: Chhabra
authors.affiliation: Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Student Health Services, Brown University, Providence, Rhode Island.
authors.forename: Unab I
authors.initials: UI
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D003267:Contraception / Q000379:methods / Q000523:psychology*; D003268:Contraception Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010349:Patient Compliance / Q000523:psychology*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology*; D012307:Risk Factors; D014481:United States; D055815:Young Adult
keywords: Adolescent pregnancy; Contraceptive continuation; Hormonal contraceptive; Intrauterine device