{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T05:59:34Z","timestamp":1780466374293,"version":"3.54.1"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi240599-4\"><jats:title>Importance<\/jats:title><jats:p>Unintended pregnancy is a major health risk for adolescents in the US, and adolescents face many barriers to obtaining effective and reliable contraception.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240599-5\"><jats:title>Objective<\/jats:title><jats:p>To measure and describe the use of contraception, pregnancy risk index (PRI), and emergency contraception (EC) prescriptions among female adolescents accessing the emergency department (ED) for care.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240599-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cross-sectional study is a planned secondary analysis of a multicenter trial from April 2021 through April 2022 that used a tablet-based, content-validated, confidential sexual health survey at 6 urban, pediatric tertiary care EDs affiliated with the Pediatric Emergency Care Applied Research Network. Participants were individuals aged 15 to 21 years presenting to the ED who completed the confidential sexual health survey and indicated female sex assigned at birth and prior penile-vaginal sexual intercourse. Data analysis was performed from January 2023 to February 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240599-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcomes were the type and proportion of contraception use, the PRI, and provision of EC. Separate multivariable logistic regression models were performed to identify sociodemographic factors associated with these outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240599-8\"><jats:title>Results<\/jats:title><jats:p>A total of 1063 participants (median [IQR] age, 17.5 [16.5-18.3] years) were included in this analysis; 219 (20.8%) identified as Hispanic, 464 (44.1%) identified as non-Hispanic Black, 308 (29.3%) identified as non-Hispanic White, and 61 (5.8%) identified as other races and ethnicities. In total, 756 participants (71.1%) reported contraception use during their last sexual encounter. Long-acting reversible contraception use (LARC) was the least used (164 participants [15.4%]), and 307 (28.9%) reported no contraception use. Sociodemographic factors associated with overall contraception use, and LARC use specifically, included insurance and race and ethnicity. The overall PRI was 7.89, or an expected 8 pregnancies per 100 female individuals per year. Although 108 participants (10.2%) were eligible for EC, EC was ordered for only 6 (5.6%) of those eligible.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240599-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this cross-sectional study of sexually active adolescents presenting to the ED, the majority of participants reported using at least 1 form of contraception; however, LARCs were the least used option, and 28.9% of participants reported no contraceptive use. The unintended pregnancy risk was almost 8% in the study population. Few patients eligible for EC received it. These data suggest a high need and potential opportunity for provision of contraception services in the ED setting.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.18213","type":"journal-article","created":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T18:21:26Z","timestamp":1719598886000},"page":"e2418213","source":"Crossref","is-referenced-by-count":2,"title":["Contraception Use and Pregnancy Risk Among Adolescents in Pediatric Emergency Departments"],"prefix":"10.1001","volume":"7","author":[{"given":"Hannah","family":"Canter","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Oregon Health and Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Reed","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Cincinnati Children\u2019s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chella","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. Charles","family":"Casper","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Stukus","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nationwide Children\u2019s Hospital, Ohio State University, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital Colorado, University of Colorado School of Medicine, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Pickett","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical College of Wisconsin, Milwaukee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Mollen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cara","family":"Elsholz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea T.","family":"Cruz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Augustine","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ann & Robert H. Lurie Children\u2019s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika K.","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s National Hospital, George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,6,28]]},"reference":[{"issue":"9","key":"zoi240599r1","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1056\/NEJMsa1506575","article-title":"Declines in unintended pregnancy in the United States, 2008-2011.","volume":"374","author":"Finer","year":"2016","journal-title":"N Engl J Med"},{"key":"zoi240599r3","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.jpeds.2017.06.053","article-title":"Examining the role of the pediatric emergency department in reducing unintended adolescent pregnancy.","volume":"189","author":"Solomon","year":"2017","journal-title":"J Pediatr"},{"issue":"6","key":"zoi240599r4","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-053458","article-title":"State-by-state variability in adolescent privacy laws.","volume":"149","author":"Sharko","year":"2022","journal-title":"Pediatrics"},{"issue":"1","key":"zoi240599r5","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1097\/01.AOG.0000459866.14114.33","article-title":"Committee opinion no. 615: access to contraception.","volume":"125","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"12","key":"zoi240599r6","doi-asserted-by":"publisher","first-page":"e1128","DOI":"10.1097\/PEC.0000000000001924","article-title":"Reliance on acute care settings for health care utilization: a comparison of adolescents with younger children.","volume":"37","author":"Goyal","year":"2021","journal-title":"Pediatr Emerg Care"},{"issue":"2","key":"zoi240599r7","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.jadohealth.2011.11.023","article-title":"Identifying adolescent females at high risk of pregnancy in a pediatric emergency department.","volume":"51","author":"Chernick","year":"2012","journal-title":"J Adolesc Health"},{"issue":"7","key":"zoi240599r8","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1111\/acem.2016.23.issue-7","article-title":"Development of a sexual health screening tool for adolescent emergency department patients.","volume":"23","author":"Goyal","year":"2016","journal-title":"Acad Emerg Med"},{"issue":"1","key":"zoi240599r9","doi-asserted-by":"publisher","first-page":"150","DOI":"10.2105\/AJPH.2006.089169","article-title":"Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use.","volume":"97","author":"Santelli","year":"2007","journal-title":"Am J Public Health"},{"issue":"4","key":"zoi240599r10","doi-asserted-by":"publisher","first-page":"e1244","DOI":"10.1542\/peds.2014-2299","article-title":"Contraception for adolescents.","volume":"134","author":"Committee on Adolescence","year":"2014","journal-title":"Pediatrics"},{"issue":"3","key":"zoi240599r12","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1007\/s11524-010-9454-4","article-title":"Pregnancy risk among black, white, and Hispanic teen girls in New York City public schools.","volume":"87","author":"Waddell","year":"2010","journal-title":"J Urban Health"},{"issue":"4","key":"zoi240599r15","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1111\/acem.v27.4","article-title":"Sex without contraceptives in a multicenter study of adolescent emergency department patients.","volume":"27","author":"Chernick","year":"2020","journal-title":"Acad Emerg Med"},{"issue":"62","key":"zoi240599r16","first-page":"1","article-title":"Contraceptive methods women have ever used: United States, 1982-2010.","author":"Daniels","year":"2013","journal-title":"Natl Health Stat Report"},{"issue":"418","key":"zoi240599r18","first-page":"1","article-title":"Births in the United States, 2020.","author":"Martin","year":"2021","journal-title":"NCHS Data Brief"},{"issue":"3","key":"zoi240599r19","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1542\/peds.2008-0193","article-title":"Exploring emergency contraception knowledge, prescription practices, and barriers to prescription for adolescents in the emergency department.","volume":"123","author":"Goyal","year":"2009","journal-title":"Pediatrics"},{"key":"zoi240599r2","unstructured":"National Center for Health Statistics. Rossen? LM, Hamilton? BE, Abma? JC, . Updated methodology to estimate overall and unintended pregnancy rates in the United States: data evaluation and methods research. Vital and Health Statistics, series 2, number 201. April 2023. Accessed May 16, 2024. https:\/\/www.cdc.gov\/nchs\/data\/series\/sr_02\/sr02-201.pdf"},{"key":"zoi240599r11","unstructured":"Center for Reproductive Rights. After Roe fell: abortion laws by state. January 18, 2022. Accessed April 18, 2024. https:\/\/reproductiverights.org\/maps\/abortion-laws-by-state\/"},{"key":"zoi240599r13","unstructured":"Centers for Disease Control and Prevention. Youth risk behavior surveillance\u2014United States, 2019. August 21, 2020. Accessed May 16, 2024. https:\/\/www.cdc.gov\/healthyyouth\/data\/yrbs\/pdf\/2019\/su6901-H.pdf"},{"key":"zoi240599r14","doi-asserted-by":"crossref","unstructured":"Amba? JC, Martinez? GM. Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2015-2019. 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