Edwards Sharon M, Zieman Mimi, Jones Kandice, Diaz Angela, Robilotto Christina, Westhoff Carolyn
Department of Pediatrics, Mount Sinai Medical Center, New York, New York 10029, USA.
J Adolesc Health. 2008 Nov;43(5):432-6. doi: 10.1016/j.jadohealth.2008.06.008.
Conventional practice for initiating oral contraceptive (OC) pills involves waiting to start the pills with the next menstrual period. We investigated whether immediate initiation of OCs would lead to improved continuation rates and therefore decreased pregnancy rates in adolescents aged 12-17 years.
Study subjects were recruited from adolescent women presenting to 2 inner city clinics requesting OCs. A total of 539 adolescents between 12 and 17 years old were randomized to conventional initiation of the OC pill (Conventional Start [CS]) versus immediate, directly observed OC pill ingestion in the clinic (Quick Start [QS]). At 3 and 6 months the participants completed interviews that questioned them about their OC continuation and pregnancies.
In all, 86% of our adolescents completed follow-up interviews at 3 months, and 77% at 6 months. There were 45 pregnancies during the study period. QS was associated with continuing OCs to a second pack (adjusted OR 1.8, 95% CI 1.1-3.3). There was no difference in OC continuation rates at 3 or 6 months. Only 26% of adolescents continued OCs at 6 months and we identified 45 pregnancies during follow-up.
We conclude that directly observed, immediate initiation of oral contraceptives (QS) with adolescents briefly improves continuation although overall continuation rates are discouraging low. Health care providers could use this simple strategy to start adolescents on OCs at the initial visit. The low 6-month OC continuation rates highlight the need to seek novel ways to provide adolescents with the necessary tools to be successful at contraception.
开始口服避孕药（OC）的传统做法是等待至下次月经期开始服药。我们调查了立即开始服用OC是否会提高12至17岁青少年的持续服药率，从而降低妊娠率。
研究对象从前往两家市中心诊所要求服用OC的青春期女性中招募。共有539名12至17岁的青少年被随机分为传统方式开始服用OC（传统起始组[CS]）和在诊所直接观察下立即服用OC（快速起始组[QS]）。在3个月和6个月时，参与者完成了关于OC持续服用情况和妊娠情况的访谈。
总体而言，86%的青少年在3个月时完成了随访访谈，77%在6个月时完成。研究期间有45例妊娠。QS与继续服用OC至第二包相关（调整后的比值比为1.8，95%置信区间为1.1 - 3.3）。3个月或6个月时的OC持续服药率没有差异。6个月时只有26%的青少年继续服用OC，且我们在随访期间发现了45例妊娠。
我们得出结论，直接观察下立即为青少年开始口服避孕药（QS）虽能短暂提高持续服药率，但总体持续服药率低得令人沮丧。医疗保健提供者可以使用这种简单策略在初次就诊时就让青少年开始服用OC。6个月时较低的OC持续服药率凸显了需要寻找新方法为青少年提供成功避孕所需工具的必要性。
