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Lunelle®: a year of experience in an adolescent health clinic
February 2004
SEXUAL ORIENTATION AND CONTRACEPTIVE BEHAVIORS AMONG MINNESOTA ADOLESCENTS Heidi Gallart and Elizabeth Saewyc, Ph.D., R.N., P.H.N. School of Nursing, University of Minnesota, Minneapolis, MN. Purpose: Despite higher risk for pregnancy among sexual minority youth, research on their contraceptive use is limited. This study was compared contraceptive behaviors among teens reporting sex in the past year with opposite-gender partners only (OG), bothgender partners (BG), and same-gender partners only (SG) in a school-based population. The hypotheses for this study were: SG students would be least likely to contracept, followed by BG students, and this pattern would hold for both genders. Methods: A secondary analysis from the 1998 Minnesota Student Survey (MSS) administered to 9th and 12th graders in public schools statewide. This analysis was limited to the 22,241 sexually active students who indicated genders of sexual partners in the past year (49.1% female, 84.9% white, 61.3% in 12th grade). Sexual orientation was derived from combining two items about the number of male and female partners. OG students were 85.9% (n ⫽ 9723) of males and 95.8% (n ⫽ 10457) of females; BG students were 12.5% (n ⫽ 1413) of males and 3.8% (n ⫽ 411) of females; SG students were 1.6% (n ⫽ 185) of males and .5% (n ⫽ 52) of females. Three questions assessed contraceptive use: whether condoms were used during last sexual intercourse, how often birth control was used, and how often condoms were used. Frequency of birth control use and of condom use were 5-point scales ranging from “never” (1) to “always” (5). Cross-tabulations with ⌾2 analysis and ANOVAs were used to determine relationships between orientation and contraceptive use; post-hoc Scheffe’s test compared between group means. Analyses were conducted separately by gender; alpha was set to .05. Results: For males, 61.6% of OG reported using a condom at last intercourse vs. 46.2% BG and 38.6% SG (⌾2 ⫽ 128.45, df ⫽ 2, p ⬍ .001). Of the females, 53.9% of OG reported condom use at last intercourse vs. 47.5% BG and 42.9% SG (⌾2 ⫽ 7.68, df ⫽ 2, p ⬍ .05). Mean response for frequency of birth control was 4.74 for OG males vs. 3.97 BG males and 3.57 for SG males (F ⫽ 150.15, df ⫽ 2, 10579, p ⬍ .001). Mean response was 4.92 for OG females vs. 4.20 BG and 3.50 SG (F ⫽ 54.79, df ⫽ 2, 10580, p ⬍ .001). Post-hoc analyses showed means for all orientation groups were significantly different from each other. Mean frequency of condom use was 4.74 for OG males, 4.05 for BG, and 3.72 for SG males (F ⫽ 130.23, df ⫽ 2, 10670, p ⬍ .001). For females, mean frequency of condom use was 4.50 for OG vs. 4.12 for BG and 3.65 for SG (F ⫽ 16.34, df ⫽ 2, 10620, p ⬍ .001). Post-hoc analyses showed differences in means between OG and both other groups, but none between BG and SG. Conclusions: There were significant differences in the protective and contraceptive practices of OG versus BG and SG students. This may be due to perceptions of SG activity having lower risk (i.e., no risk for pregnancy). However, because the survey items focused on heterosexual behavior, SG or BG may be answering about OG sexual activity more than a year ago or about current SG activity. Surveys should include wording that does not assume only heterosexual risk behaviors. Likewise, clinicians should not assume that an adolescent who is engaging in BG or SG activity is not in need of information regarding safe sexual and contraceptive practices. LUNELLE威: A YEAR OF EXPERIENCE IN AN ADOLESCENT HEALTH CLINIC Cynthia Holland-Hall, M.D., M.P.H. Section of Adolescent Medicine, The Ohio State University College of Medicine and Public Health, Children’s Hospital, Columbus, OH.
CLINICAL AND RESEARCH POSTER PRESENTATIONS
141
Purpose: To describe the use and acceptability of Lunelle (medroxyprogesterone acetate 25 mg and estradiol cypionate 5 mg) monthly contraceptive injection in adolescents. Methods: A retrospective chart review was conducted for 98 adolescents who received at least one Lunelle injection in an urban, hospital based adolescent health clinic between May 2001 and October 2002. Outcomes of interest included continuation rates, weight gain, side effects, and school absence. A subset of 39 current or former Lunelle users completed a questionnaire assessing their attitudes toward Lunelle and other contraceptive methods. Results: Subjects were 13–21 years old (mean 16.8 ⫾ 1.9). For most (90%), contraception was the primary reason for using Lunelle. The average number of injections received was 4.6 (range: 1–16). 48.0% of subjects received 4 or more injections, 22.4% received 8 or more, and 7.1% received 12 or more. At the time of the study’s termination (due to temporary recall of the drug) in October 2002, 44% (43/98) were current users. Average weight gain was 1.8 lbs (⫾ 7.2 lbs) after 3 months of use, 4.6 lbs (⫾ 11.5 lbs) after 6 months, and 8.1 lbs (⫾ 9.1 lbs) after 9 months. Subjects reported bleeding an average of 4.3 days/month. Amenorrhea occurred in 44/168 woman-months of use for which bleeding data were recorded (26.2%); 23.5% of subjects reported amenorrhea during at least one cycle of use. 14.3% reported breakthrough or heavier bleeding; 7.1% complained of weight gain; 3.1% reported nausea. No pregnancies occurred. The 98 subjects experienced a total of 180 school absences during the study period (mean absences per subject ⫽ 1.8; range: 0 –9). Of the 39 subjects who completed the questionnaire, 90% liked Lunelle overall, and 90% stated they had planned to continue this method. 62% chose Lunelle because they feared/experienced weight gain on depot medroxyprogesterone acetate (DMPA), 51% because they could not remember to take a pill daily, and 49% because they wanted regular menses. Reported side effects included breakthrough bleeding (31%), increased mood swings (26%), mastalgia (23%), headache (21%), amenorrhea (15%), nausea (13%), and weight gain (8%). 36% acknowledged that coming for monthly injections was inconvenient. Of former DMPA users, 100% (24/24) preferred Lunelle due to its fewer side effects. Of former oral contraceptive users, 82% (18/22) preferred Lunelle due to difficulty remembering to take a daily pill. Conclusions: Lunelle was well-received by adolescents, who liked its relative ease of use and desirable side effect profile compared to other hormonal contraceptives. Although weight gain was considerable and increased with ongoing use, no control group was available for comparison and relatively few subjects complained of this side effect. School absences for monthly visits were excessive for some users. Should the drug be reintroduced to the market, controlled, prospective studies comparing continuation rates and side effects of Lunelle to other contraceptive methods should be undertaken. ADOLESCENT USE OF THE MONTHLY CONTRACEPTIVE INJECTION Lisa Kessler Tuchman, M.D., M.P.H., Jill S Huppert, M.D., M.P.H., Bin Huang, Ph.D., and Gail B Slap, M.D., M.S. Div of Adolescent Med, Cincinnati Children’s Hosp Med Ctr, Cincinnati, OH. Purpose: A monthly contraceptive injection containing medroxyprogesterone acetate and estradiol cypionate (MPA/E2C) entered the U.S. market in 10/00 and disappeared in 10/02. While studies agree that MPA/E2C was more likely than depot medroxyproges-
SEXUAL ORIENTATION AND CONTRACEPTIVE BEHAVIORS AMONG MINNESOTA ADOLESCENTS Heidi Gallart and Elizabeth Saewyc, Ph.D., R.N., P.H.N. School of Nursing, University of Minnesota, Minneapolis, MN. Purpose: Despite higher risk for pregnancy among sexual minority youth, research on their contraceptive use is limited. This study was compared contraceptive behaviors among teens reporting sex in the past year with opposite-gender partners only (OG), bothgender partners (BG), and same-gender partners only (SG) in a school-based population. The hypotheses for this study were: SG students would be least likely to contracept, followed by BG students, and this pattern would hold for both genders. Methods: A secondary analysis from the 1998 Minnesota Student Survey (MSS) administered to 9th and 12th graders in public schools statewide. This analysis was limited to the 22,241 sexually active students who indicated genders of sexual partners in the past year (49.1% female, 84.9% white, 61.3% in 12th grade). Sexual orientation was derived from combining two items about the number of male and female partners. OG students were 85.9% (n ⫽ 9723) of males and 95.8% (n ⫽ 10457) of females; BG students were 12.5% (n ⫽ 1413) of males and 3.8% (n ⫽ 411) of females; SG students were 1.6% (n ⫽ 185) of males and .5% (n ⫽ 52) of females. Three questions assessed contraceptive use: whether condoms were used during last sexual intercourse, how often birth control was used, and how often condoms were used. Frequency of birth control use and of condom use were 5-point scales ranging from “never” (1) to “always” (5). Cross-tabulations with ⌾2 analysis and ANOVAs were used to determine relationships between orientation and contraceptive use; post-hoc Scheffe’s test compared between group means. Analyses were conducted separately by gender; alpha was set to .05. Results: For males, 61.6% of OG reported using a condom at last intercourse vs. 46.2% BG and 38.6% SG (⌾2 ⫽ 128.45, df ⫽ 2, p ⬍ .001). Of the females, 53.9% of OG reported condom use at last intercourse vs. 47.5% BG and 42.9% SG (⌾2 ⫽ 7.68, df ⫽ 2, p ⬍ .05). Mean response for frequency of birth control was 4.74 for OG males vs. 3.97 BG males and 3.57 for SG males (F ⫽ 150.15, df ⫽ 2, 10579, p ⬍ .001). Mean response was 4.92 for OG females vs. 4.20 BG and 3.50 SG (F ⫽ 54.79, df ⫽ 2, 10580, p ⬍ .001). Post-hoc analyses showed means for all orientation groups were significantly different from each other. Mean frequency of condom use was 4.74 for OG males, 4.05 for BG, and 3.72 for SG males (F ⫽ 130.23, df ⫽ 2, 10670, p ⬍ .001). For females, mean frequency of condom use was 4.50 for OG vs. 4.12 for BG and 3.65 for SG (F ⫽ 16.34, df ⫽ 2, 10620, p ⬍ .001). Post-hoc analyses showed differences in means between OG and both other groups, but none between BG and SG. Conclusions: There were significant differences in the protective and contraceptive practices of OG versus BG and SG students. This may be due to perceptions of SG activity having lower risk (i.e., no risk for pregnancy). However, because the survey items focused on heterosexual behavior, SG or BG may be answering about OG sexual activity more than a year ago or about current SG activity. Surveys should include wording that does not assume only heterosexual risk behaviors. Likewise, clinicians should not assume that an adolescent who is engaging in BG or SG activity is not in need of information regarding safe sexual and contraceptive practices. LUNELLE威: A YEAR OF EXPERIENCE IN AN ADOLESCENT HEALTH CLINIC Cynthia Holland-Hall, M.D., M.P.H. Section of Adolescent Medicine, The Ohio State University College of Medicine and Public Health, Children’s Hospital, Columbus, OH.
CLINICAL AND RESEARCH POSTER PRESENTATIONS
141
Purpose: To describe the use and acceptability of Lunelle (medroxyprogesterone acetate 25 mg and estradiol cypionate 5 mg) monthly contraceptive injection in adolescents. Methods: A retrospective chart review was conducted for 98 adolescents who received at least one Lunelle injection in an urban, hospital based adolescent health clinic between May 2001 and October 2002. Outcomes of interest included continuation rates, weight gain, side effects, and school absence. A subset of 39 current or former Lunelle users completed a questionnaire assessing their attitudes toward Lunelle and other contraceptive methods. Results: Subjects were 13–21 years old (mean 16.8 ⫾ 1.9). For most (90%), contraception was the primary reason for using Lunelle. The average number of injections received was 4.6 (range: 1–16). 48.0% of subjects received 4 or more injections, 22.4% received 8 or more, and 7.1% received 12 or more. At the time of the study’s termination (due to temporary recall of the drug) in October 2002, 44% (43/98) were current users. Average weight gain was 1.8 lbs (⫾ 7.2 lbs) after 3 months of use, 4.6 lbs (⫾ 11.5 lbs) after 6 months, and 8.1 lbs (⫾ 9.1 lbs) after 9 months. Subjects reported bleeding an average of 4.3 days/month. Amenorrhea occurred in 44/168 woman-months of use for which bleeding data were recorded (26.2%); 23.5% of subjects reported amenorrhea during at least one cycle of use. 14.3% reported breakthrough or heavier bleeding; 7.1% complained of weight gain; 3.1% reported nausea. No pregnancies occurred. The 98 subjects experienced a total of 180 school absences during the study period (mean absences per subject ⫽ 1.8; range: 0 –9). Of the 39 subjects who completed the questionnaire, 90% liked Lunelle overall, and 90% stated they had planned to continue this method. 62% chose Lunelle because they feared/experienced weight gain on depot medroxyprogesterone acetate (DMPA), 51% because they could not remember to take a pill daily, and 49% because they wanted regular menses. Reported side effects included breakthrough bleeding (31%), increased mood swings (26%), mastalgia (23%), headache (21%), amenorrhea (15%), nausea (13%), and weight gain (8%). 36% acknowledged that coming for monthly injections was inconvenient. Of former DMPA users, 100% (24/24) preferred Lunelle due to its fewer side effects. Of former oral contraceptive users, 82% (18/22) preferred Lunelle due to difficulty remembering to take a daily pill. Conclusions: Lunelle was well-received by adolescents, who liked its relative ease of use and desirable side effect profile compared to other hormonal contraceptives. Although weight gain was considerable and increased with ongoing use, no control group was available for comparison and relatively few subjects complained of this side effect. School absences for monthly visits were excessive for some users. Should the drug be reintroduced to the market, controlled, prospective studies comparing continuation rates and side effects of Lunelle to other contraceptive methods should be undertaken. ADOLESCENT USE OF THE MONTHLY CONTRACEPTIVE INJECTION Lisa Kessler Tuchman, M.D., M.P.H., Jill S Huppert, M.D., M.P.H., Bin Huang, Ph.D., and Gail B Slap, M.D., M.S. Div of Adolescent Med, Cincinnati Children’s Hosp Med Ctr, Cincinnati, OH. Purpose: A monthly contraceptive injection containing medroxyprogesterone acetate and estradiol cypionate (MPA/E2C) entered the U.S. market in 10/00 and disappeared in 10/02. While studies agree that MPA/E2C was more likely than depot medroxyproges-