Contraception Provision in the Emergency Department: Are We Ready to Overcome the Obstacles?
Contraception Provision in the Emergency Department: Are We Ready to Overcome the Obstacles?
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急诊科的避孕措施：我们准备好克服障碍了吗？
DOI：
10.1089/jwh.2020.8294
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Chernick,LaurenS
中科院分区：
文献类型：
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作者：
Fischer,Kayleigh;Chernick,LaurenS
尽管出生率最近有所下降，但美国15-19岁的青少年男性怀孕率在工业化国家中是最高的之一，其中大多数是意外怀孕。1青春期意外怀孕对怀孕的青少年、儿童、医疗领域和整个社会都有负面的医疗、经济、社会和情感后果。2、3、青春期母亲增加了高中辍学率，只有50%的人在22年后获得高中文凭，导致终身收入潜力降低，社会经济劣势持续存在。4-6青春期父母的孩子早产的风险更高，健康问题的风险更高，学习成绩更低，高中辍学率更高，监禁的可能性也更高。在照顾高危青少年的新地方，需要采取8项策略来减少意外怀孕。减少青少年怀孕仍然是疾病控制和预防中心和美国卫生与公众服务部的首要任务。他们与包括美国儿科学会和美国妇产科学会在内的多个国家科学院一起，认识到需要增加避孕保健，这是预防怀孕的支柱。10-12鼓励医疗提供者向所有青少年提供避孕措施，并减少障碍，使更多人能够获得有效的荷尔蒙避孕措施。此外，有关激素避孕选择的研究表明，长效可逆避孕(LARC)方法，如植入物或宫内节育器，高效且易于使用，是14-45岁妇女首选的避孕方法。13这些选择应该在所有年龄段的青少年中进行探索。我们的青少年就医地点是在急诊科(ED)。每年有1800多万青少年使用急诊室，其中许多人保险不足，没有初级保健医生。14、15以前的研究表明，使用ED的青春期女性参与高危行为，特别是危险的性行为。16-18有效的节育措施很少使用，单中心的研究表明，高达五分之一的青春期女性预计在第二年怀孕。避孕套使用不一致，增加了性传播感染的风险。此外，在一项全国性的研究中，13-17岁的青少年在没有避孕措施的情况下发生性行为与其他高危行为有关，如酗酒、抑郁和行为障碍。20鉴于儿科急诊室中高危青少年的数量，这迫使我们思考，急诊室是否应该成为获得荷尔蒙避孕的一个点。在这一期的《妇女健康杂志》上，Gutman等人说。探讨儿科急诊室青少年人群的生殖健康实践，以及他们在此背景下对避孕咨询和启动的意愿。21他们在一个城市儿科急诊室对381名年龄在16-21岁的女性进行了方便的抽样调查。作者发现，39%的参与者正在使用避孕措施，超过一半(57.2%)的人对此感到满意。三分之二的人有兴趣了解更多关于激素避孕的知识，三分之一(37.5%)的人对LARC方法感兴趣。超过四分之一(28%)的人有过孕产史。这项研究的结果与之前发表的文献一致，即儿科ED中的青少年人群避孕使用率不足，但对学习和…感兴趣
Despite recent declines in birth rates, adolescent fe-males aged 15–19 years in the United States have one of the highest pregnancy rates among industrialized nations, with the majority of these pregnancies unintended. 1 Adolescent unintended pregnancy has negative medical, financial, social, and emotional consequences for the pregnant adolescent, the child, the medical field, and society as a whole. 2, 3 Adolescent mothers have increased high school dropout rates, with only 50% achieving high school diplomas by 22 years, leading to lower lifetime income potential and perpetuating socioeconomic disadvantages. 4–6 The children of adolescent parents have higher risk of preterm birth, higher risk of health issues, lower school achievements, higher high school dropout rates, and higher likelihood of incarceration. 7, 8 Strategies are needed to decrease unintended teen pregnancy in novel places caring for high-risk teens. The reduction of adolescent pregnancy remains a top priority of both the Center for Disease Control and Prevention and US Department of Health and Human Services. 6, 9 They, along with multiple national academies, including The American Academy of Pediatrics and the American College of Obstetrics and Gynecology, have recognized the need for increased contraceptive care, which is the mainstay of pregnancy prevention. 10–12 Medical providers are encouraged to offer contraception to all adolescents and reduce barriers to allow increased access to effective hormonal contraception. In addition, studies involving choice of hormonal contraception reveal that long-acting reversible contraceptive (LARC) methods such as the implant or intrauterine device, which are highly effective and easy to use, are a preferred method of contraception for women aged 14–45 years. 13 These options should be explored with teens of all ages. Our location where adolescent do seek medical care is in the emergency department (ED). More than 18 million adolescents use EDs every year with many being underinsured and having no primary care physician. 14, 15 Previous studies have demonstrated that adolescent females who use the ED participate in high-risk behaviors, in particularly risky sexual behaviors. 16–18 Effective birth control use is infrequent, with single center studies showing up to one in five adolescent females expected to become pregnant in the subsequent year. 17 Condom use is inconsistent, increasing the risk of sexually transmitted infections. 19 Furthermore, in a national study, sex without contraceptives among teens aged 13–17 years was associated with other high-risk behaviors, such as binge drinking, depression, and conduct disorder. 20 Given the number of high-risk adolescents seen in pediatric EDs, it forces us to wonder if the ED should be a point of access to hormonal contraception. In this issue of The Journal of Women’s Health, Gutman et al. explore the reproductive health practices of the adolescent population in the pediatric ED and their desire for contraceptive counseling and initiation in this setting. 21 They surveyed a convenient sample of 381 females aged 16–21 years in one urban pediatric ED. The authors found that 39% of participants were using contraception, with more than half (57.2%) satisfied with it. Two thirds were interested in learning more about hormonal contraception with one-third (37.5%) interested in a LARC method. More than one quarter (28%) had a history of a prior pregnancy. The results of this study are consistent with previously published literature that the adolescent population in the pediatric ED have inadequate rates of contraception use but are interested in learning and …