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Knowledge and Attitudes Toward Long-Acting Reversible Contraception at the Grady Memorial Hospital Teen Services Clinic
Poster Abstracts
Knowledge and Attitudes Toward Long-Acting Reversible Contraception at the Grady Memorial Hospital Teen Services Clinic Jennifer Meyer, MD, Peggy Goedken, MPH, Sarah Nash, MPH, and Melissa Kottke, MD (faculty advisor) Emory University Department of Gynecology & Obstetrics, Grady Memorial Hospital, Atlanta, GA
Introduction: The Grady Memorial Hospital Teen Services Clinic serves an inner-city population of adolescent girls with a rate of teenage pregnancy that was higher than national averages at 13.8% during 2008. It is hoped that increased use of long-acting reversible contraceptives (LARCs) such as subdermal implants and intrauterine devices could significantly decrease this. The purpose of this study is to assess via questionnaire the knowledge of and attitudes towards these methods of contraception in this patient population. Methods: An anonymous piloted questionnaire was developed which included questions on pregnancy history, past contraceptive use, contraceptive decision-making, sources of contraceptive information and knowledge of contraceptive efficacy. The questionnaire was administered online to a convenience sample of teens enrolled from clinic. Descriptive statistics were performed and crude and adjusted odds ratios were calculated for the likelihood of desiring LARCs. This study received IRB approval. Results: 196 teens participated in the survey. 39.3% had heard of subdermal implants and 43.8% had heard of IUDs. Having ever been pregnant or having had children did not significantly increase the awareness of these methods. The most commonly cited reason for choosing a birth control method was that a healthcare provider recommended its use, followed by superior efficacy. Having children and self-reported 100% condom use were associated with a significantly higher likelihood of desiring LARCs. When adjusted for young age and having children, girls that reported desiring a pregnancy in more than three years were also significantly more likely to desire LARCs (OR 2.4277, CI 1.0670, 5.7983). Having heard of LARCs from a healthcare provider did not significantly increase desire for a long-acting method. Teens who correctly answered the efficacy questions regarding LARCs were five times more likely to desire long-acting contraception (OR 5.4, CI 1.1320, 51.49).
e79
Conclusions: Overall, awareness of LARCs and knowledge of their superior efficacy was poor. This study showed that LARCs have many of the qualities that teens stated were important in their birth control methods, but there is a disconnect between indicated contraceptive priorities, life goals, and contraceptive behavior in this patient population. While the teens reported that a healthcare provider’s recommendation was important to them, having heard of subdermal implants or intrauterine devices from a healthcare provider did not significantly increase the likelihood of desiring LARCs. It is unclear if this discrepancy signifies a bias against LARCs on the part of providers or that current methods of counseling are ineffective. Promoting positive attitudes towards LARCs and reeducation for providers on LARC counseling may be important first steps towards increasing awareness, and ultimately use. doi:10.1016/j.jpag.2010.01.035
Four-Year Remission After a Conservative Treatment in a Teenager with a Low-Grade Adenosarcoma of the Cervix Elise Dubuc, MD, and Suzy Gascon, MD CHU Ste-Justine, Obstetrics and Gynecology Department, Universite´ de Montre´al, Que´bec, Canada
Background: Very little literature exists about conservative treatment in low-grade adenosarcoma of the cervix in children or adolescent. We present here a case of a 14 year-old teenager who was treated with a conization and who is free of disease after a fouryear follow-up. Case: A 14 year-old teenager presented in March 2005 for a vaginal mass that was progressively growing since six months and wouldn’t allow her to use tampons. She did have irregular vaginal bleeding, was taking oral contraceptives and never had intercourse. An exam under anesthesia showed a 7x7cm polypoid mass with a sessile base that originated from the uterine cervix. The mass was resected and sent to pathology with a final diagnosis of low-grade adenosarcoma of the cervix. A consult was asked to the oncology reference center. An extension scan revealed a normal pelvis with no suspicious lymph node. A conization was done in June 2005 and no residual lesion was found in the pathology specimen. The tumor board of the oncology reference center suggested no further treatment and a follow-up every 6 months.
Knowledge and Attitudes Toward Long-Acting Reversible Contraception at the Grady Memorial Hospital Teen Services Clinic Jennifer Meyer, MD, Peggy Goedken, MPH, Sarah Nash, MPH, and Melissa Kottke, MD (faculty advisor) Emory University Department of Gynecology & Obstetrics, Grady Memorial Hospital, Atlanta, GA
Introduction: The Grady Memorial Hospital Teen Services Clinic serves an inner-city population of adolescent girls with a rate of teenage pregnancy that was higher than national averages at 13.8% during 2008. It is hoped that increased use of long-acting reversible contraceptives (LARCs) such as subdermal implants and intrauterine devices could significantly decrease this. The purpose of this study is to assess via questionnaire the knowledge of and attitudes towards these methods of contraception in this patient population. Methods: An anonymous piloted questionnaire was developed which included questions on pregnancy history, past contraceptive use, contraceptive decision-making, sources of contraceptive information and knowledge of contraceptive efficacy. The questionnaire was administered online to a convenience sample of teens enrolled from clinic. Descriptive statistics were performed and crude and adjusted odds ratios were calculated for the likelihood of desiring LARCs. This study received IRB approval. Results: 196 teens participated in the survey. 39.3% had heard of subdermal implants and 43.8% had heard of IUDs. Having ever been pregnant or having had children did not significantly increase the awareness of these methods. The most commonly cited reason for choosing a birth control method was that a healthcare provider recommended its use, followed by superior efficacy. Having children and self-reported 100% condom use were associated with a significantly higher likelihood of desiring LARCs. When adjusted for young age and having children, girls that reported desiring a pregnancy in more than three years were also significantly more likely to desire LARCs (OR 2.4277, CI 1.0670, 5.7983). Having heard of LARCs from a healthcare provider did not significantly increase desire for a long-acting method. Teens who correctly answered the efficacy questions regarding LARCs were five times more likely to desire long-acting contraception (OR 5.4, CI 1.1320, 51.49).
e79
Conclusions: Overall, awareness of LARCs and knowledge of their superior efficacy was poor. This study showed that LARCs have many of the qualities that teens stated were important in their birth control methods, but there is a disconnect between indicated contraceptive priorities, life goals, and contraceptive behavior in this patient population. While the teens reported that a healthcare provider’s recommendation was important to them, having heard of subdermal implants or intrauterine devices from a healthcare provider did not significantly increase the likelihood of desiring LARCs. It is unclear if this discrepancy signifies a bias against LARCs on the part of providers or that current methods of counseling are ineffective. Promoting positive attitudes towards LARCs and reeducation for providers on LARC counseling may be important first steps towards increasing awareness, and ultimately use. doi:10.1016/j.jpag.2010.01.035
Four-Year Remission After a Conservative Treatment in a Teenager with a Low-Grade Adenosarcoma of the Cervix Elise Dubuc, MD, and Suzy Gascon, MD CHU Ste-Justine, Obstetrics and Gynecology Department, Universite´ de Montre´al, Que´bec, Canada
Background: Very little literature exists about conservative treatment in low-grade adenosarcoma of the cervix in children or adolescent. We present here a case of a 14 year-old teenager who was treated with a conization and who is free of disease after a fouryear follow-up. Case: A 14 year-old teenager presented in March 2005 for a vaginal mass that was progressively growing since six months and wouldn’t allow her to use tampons. She did have irregular vaginal bleeding, was taking oral contraceptives and never had intercourse. An exam under anesthesia showed a 7x7cm polypoid mass with a sessile base that originated from the uterine cervix. The mass was resected and sent to pathology with a final diagnosis of low-grade adenosarcoma of the cervix. A consult was asked to the oncology reference center. An extension scan revealed a normal pelvis with no suspicious lymph node. A conization was done in June 2005 and no residual lesion was found in the pathology specimen. The tumor board of the oncology reference center suggested no further treatment and a follow-up every 6 months.