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Adolescents' and Young Adults' Ability to Self-Screen for Contraindications to Hormonal Contraception and the Role of Chronic Illness

      Abstract

      Purpose

      Multiple states allow pharmacists to prescribe hormonal contraception but can have age restrictions. The study objective was to examine how age influences adolescents' and young adults' (AYAs) ability to self-report potential contraindications to hormonal contraception compared with physician reports (our “gold standard”).

      Methods

      Between February 2017 and August 2018, girls aged 14–21 years and their physicians were recruited in outpatient adolescent primary and subspecialty care clinics. Screeners were completed separately for medical conditions that are potential contraindications to hormonal contraception as defined by the Centers for Disease Control Medical Eligibility Criteria. Overall, discordance was defined as differences between the patient's and provider's answers, and potential unsafe discordance was defined as AYAs underreporting of contraindications. Multivariable logistic regression was used to examine predictors of overall and unsafe discordance.

      Results

      Of 394 AYA/physician pairs, 45% were from subspecialty clinics, 35% identified as African American, the mean age was 16.7 ± 1.9 years, and 38% were sexually active. Fifty percent of patients reported potential contraindications to hormonal contraception. There was only an 18% rate of unsafe discordance, with no statistical difference by age but a higher rate in subspecialty clinics (28% vs. 10%). No variables were predictive of higher rates of unsafe discordance in general or subspecialty clinics.

      Conclusions

      Potential overall and unsafe discordance between AYAs' and physicians' reports of medical contraindications to combined hormonal contraception were not related to younger age and thus support expansion of pharmacy access to adolescents. Pediatric subspecialists need to proactively address hormonal contraceptive needs and safety as pharmacy access expands.

      Keywords

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      Linked Article

      • Self-Screening for Contraindications to Contraception: Are Adolescents up to the Task?
        Journal of Adolescent HealthVol. 69Issue 4
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          Adolescent pregnancy rates in the U.S. have declined dramatically in the past decade, a trend that is widely attributed to increased availability and use of hormonal contraception [1]. Nonetheless, the U.S. still has high teen pregnancy rates relative to other industrialized nations [2], and racial/ethnic, geographic, and socioeconomic disparities in pregnancy rates persist [3]. Ongoing efforts to increase adolescents’ access to effective contraception are therefore critical.
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