Effect of a counseling intervention at the time of self-referred pregnancy testing on contraceptive use among adolescents

Background: Teens who self-refer for pregnancy testing are at high risk for unintended pregnancy. We evaluated the effect of a brief, clinic-based intervention at the time of pregnancy testing, which uses motivational interviewing to counsel teens and offers same-day initiation of hormonal contraception, on contraceptive use and subsequent pregnancy rates. Methods: A retrospective cohort study was conducted on 702 teens aged 13-17 who self-referred for pregnancy testing within a large integrated health care system. Teens with a negative self-referred pregnancy test between 9/1/2007-12/31/2009 at facilities with and without the intervention were included in the study. Demographic and clinical characteristics and contraceptive use (prescribed) over the 12 months following the pregnancy test were obtained through electronic database extraction and medical record review. Chi-square tests and logistic regression were used to estimate associations. Results: Preliminary data demonstrated that teens without effective contraception who received the intervention at the time of self-referred pregnancy testing were significantly more likely to use effective contraception at 3 months (OR=1.9), 9 months (OR=1.7) and 12 months (OR=1.9), (all p<0.04). Age and median household income were not significantly associated with effective continuous contraception use. Compared to white teens, Hispanic teens were significantly less likely to be using effective contraception at 3 months (OR=0.43), 6 months (OR=0.53), and 9 months (OR=0.41), (all p<0.04). Conclusions: A brief, clinic-based counseling intervention at the time of a self-referred pregnancy test improved continuous use of effective contraception among teens over 1 year follow-up.