title: Using behavioral economic theory to increase use of effective contraceptives among opioid-maintained women at risk of unintended pregnancy.
abstract: An unsettling aspect of the US opioid epidemic is the high rate of in utero exposure, especially since most of these pregnancies are unintended, due in part to low rates of effective contraceptive use among opioid-using women. This study tested an intervention informed by behavioral economic theory and aimed at promoting effective contraceptive use among opioid-maintained women at risk of unintended pregnancy in the Burlington, VT, area between 2011 and 2013.
  
  
  
  Thirty-one women were assigned (initial 5 consecutively, subsequent 26 randomly) to either usual care or an experimental intervention. Participants in usual care received condoms, a dose of emergency contraception, and referral to local providers. Participants in the experimental condition received usual care plus the World Health Organization's contraception initiation protocol, including free prescription contraceptives, and financial incentives for attending 13 follow-up visits over 6months to help manage side effects and other issues.
  
  
  
  Significantly more women in the experimental vs. usual care control conditions initiated prescription contraceptive use (100% vs. 29%) and reported prescription contraceptive use at 1-month (63% vs. 13%), 3-month (88% vs. 20%), and 6-month (94% vs. 13%) assessments. None of the experimental condition participants became pregnant during the 6-month protocol vs. three women (20%) in the control condition.
  
  
  
  These results provide the first experimental evidence supporting the efficacy of an intervention for increasing prescription contraceptive use among opioid-maintained women at risk of unintended pregnancy.
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, Burlington, VT 05401, USA; Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA; Department of Psychology, University of Vermont, Burlington, VT 05401, USA. Electronic address: sarah.heil@uvm.edu.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Heil
authors.affiliation: Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hand
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, Burlington, VT 05401, USA; Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA; Department of Psychology, University of Vermont, Burlington, VT 05401, USA.
authors.forename: Stacey C
authors.initials: SC
authors.lastname: Sigmon
authors.affiliation: Department of Medical Biostatistics(4), University of Vermont, Burlington, VT 05401, USA.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Badger
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT 05401, USA.
authors.forename: Marjorie C
authors.initials: MC
authors.lastname: Meyer
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, Burlington, VT 05401, USA; Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA; Department of Psychology, University of Vermont, Burlington, VT 05401, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Higgins
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003267:Contraception / Q000379:methods*; D003270:Contraceptive Agents / Q000008:administration & dosage*; D060909:Economics, Behavioral; D005260:Female; D006801:Humans; D009042:Motivation; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010349:Patient Compliance; D011247:Pregnancy; D049168:Pregnancy, Unplanned
chemical_list: D003270:Contraceptive Agents
keywords: Behavioral economics; Birth control; Contraceptives; Incentives; Long-acting reversible contraceptives (LARCs); Opioid substitution therapy; Unintended pregnancy