A Survey of Teenagers' Attitudes Toward Moving Oral Contraceptives Over the Counter Open Access

Abstract

Introduction: Evidence suggests that over-the-counter access to oral contraceptives may improve contraceptive access and use among adult women. Teenagers may particularly benefit from over-the-counter access, as they experience disproportionately high rates of unintended pregnancy and face unique challenges accessing contraception. However, limited research has explored teenagers' attitudes toward over-the-counter access.

Methodology: During September 2014, 348 females aged 14-17 were recruited via Facebook advertisements to participate in an online survey to assess teenagers' attitudes toward over-the-counter access and understanding of how to use oral contraceptives based on reading a prototype over-the-counter product label. Descriptive statistics and bivariate analyses were conducted using SPSS; Pearson chi-square and Fisher's exact tests were conducted for categorical outcomes and independent t-tests and one-way ANOVA for continuous outcomes.

Results: Seventy-three percent of participants reported being in favor of over-the-counter access and 61% reported that they would be likely to use oral contraceptives through over-the-counter access. Participants who had sex were significantly more likely to be interested in using over-the-counter access (77%) compared to participants who had not had sex (48%). Participants understood an average of 7.1 of 8 key concepts that the prototype over-the-counter product label was intended to convey; no significant differences were found among subgroups.

Discussion: Participants in this sample are interested in using oral contraceptives over the counter and can understand how to use an over-the-counter product. These findings, in combination with evidence documenting the safety and effectiveness of over-the-counter access, support continued exploration of reclassification of oral contraceptives to over-the-counter status without age restriction.

Table of Contents

Chapter 1: Introduction. 1

Introduction and Rationale. 1

Problem Statement. 1

Purpose Statement. 3

Significance Statement. 3

Definition of Terms. 5

Chapter 2: Comprehensive Review of the Literature. 7

Unintended Pregnancy and Contraceptive Use Among Teenagers. 7

Over-the-Counter Access to Oral Contraceptive Pills. 8

Safety of Over-the-Counter Access to Oral Contraceptive Pills. 10

Contraceptive Continuation Among Over-the-Counter Users. 14

Attitudes Toward Over-the-Counter Access to Oral Contraceptive Pills. 14

Over-the-Counter Access to Oral Contraceptive Pills under the Affordable Care Act. 19

Chapter 3: Manuscript. 22

Introduction. 26

Methods. 28

Results. 32

Discussion. 35

Tables. 41

Chapter 4: Conclusions and Implications. 47

References. 51

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	United States contraception birth control adolescents teenagers nonprescription drugs
Committee Chair / Thesis Advisor	Kottke, Melissa, Emory University
Committee Members	Rochat, Roger, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs National or regional non-profit organization (e.g., American Cancer Society)

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