Evidence map›Paper›PMID 26091743›Full record

Trial reportLancet (London, England)2015

Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomised trial.

Cynthia C Harper, Corinne H Rocca, Kirsten M Thompson, Johanna Morfesis, Suzan Goodman, Philip D Darney, Carolyn L Westhoff, J Joseph Speidel

Registry-linked trialOpen access · greenAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03519685 (UCSF College Health Study), which is not on this map. Cited by 79 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
79citing papers in PubMed, 3 pooled it
31.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03519685 nacompletednot on this mapstarted 2018, after this paper: background citation

UCSF College Health Study: A Cluster Randomized Trial on Contraceptive Training and Education at Community Colleges

TypeinterventionalSponsorUniversity of California, San FranciscoRan2018 to 2024Enrolled2,086ConditionsContraceptionArmsContraceptive Training and Education, Placebo Nutrition Education
3 · Its place in the literature

Who cites it

79 citing papers in PubMed, 3 syntheses or guidelines pooled it, 200 citations in OpenAlex.

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  14. Long-Acting Reversible Contraception Counseling and Use for Older Adolescents and Nulliparous Women.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2016
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19 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Cynthia C HarperBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. Electronic address: cynthia.harper@ucsf.edu.
Corinne H RoccaBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
Kirsten M ThompsonBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
Johanna MorfesisPlanned Parenthood Federation of America, New York, NY, USA.
Suzan GoodmanBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
Philip D DarneyBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
Carolyn L WesthoffPlanned Parenthood Federation of America, New York, NY, USA; Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
J Joseph SpeidelBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
Ibis Reproductive Health · USPlanned Parenthood · USUniversity of California, San Francisco · US

Funding

UCSF CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTEUL1RR024131 · NCRR · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI JOHNSTON, S. CLAIBORNE · 2006 to 2011
$111.2M
NCRR NIH HHS UL1 RR024131
6 · The paper itself

Abstract

backgroundUnintended pregnancy remains a serious public health challenge in the USA. We assessed the effects of an intervention to increase patients' access to long-acting reversible contraceptives (LARCs) on pregnancy rates.

methodsWe did a cluster randomised trial in 40 reproductive health clinics across the USA in 2011-13. 20 clinics were randomly assigned to receive evidence-based training on providing counselling and insertion of intrauterine devices (IUDs) or progestin implants and 20 to provide standard care. Usual costs for contraception were maintained at all sites. We recruited women aged 18-25 years attending family planning or abortion care visits and not desiring pregnancy in the next 12 months. The primary outcome was selection of an IUD or implant at the clinic visit and secondary outcome was pregnancy within 12 months. We used generalised estimating equations for clustered data to measure the intervention effect on contraceptive selection, and used survival analysis to assess pregnancy rates.

findingsOf 1500 women enrolled, more at intervention than control sites reported receiving counselling on IUDs or implants (565 [71%] of 797 vs 271 [39%] of 693, odds ratio 3·8, 95% CI 2·8-5·2) and more selected LARCs during the clinic visit (224 [28%] vs 117 [17%], 1·9, 1·3-2·8). The pregnancy rate was lower in intervention group than in the control group after family planning visits (7·9 vs 15·4 per 100 person-years), but not after abortion visits (26·5 vs 22·3 per 100 person-years). We found a significant intervention effect on pregnancy rates in women attending family planning visits (hazard ratio 0·54, 95% CI 0·34-0·85).

interpretationThe pregnancy rate can be reduced by provision of counselling on long-term reversible contraception and access to devices during family planning counselling visits.

fundingWilliam and Flora Hewlett Foundation.

Indexed as

ContraceptionDirective CounselingPregnancy, UnplannedAdolescentAdultCluster AnalysisContraceptive Agents, FemaleDrug ImplantsFamily Planning ServicesFemaleHumansIntrauterine DevicesLevonorgestrelPregnancyPregnancy RateUnited StatesContraceptive Agents, FemaleDrug ImplantsLevonorgestrel

Identifiers

PMID26091743
PMCPMC12987576
OpenAlexW1828969765

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.