The Effect of Increased Access to Emergency
Contraception Among Young Adolescents
Cynthia C. Harper, PhD, Monica Cheong, MD, Corinne H. Rocca, MPH, Philip D. Darney, MD, MSc, and
Tina R. Raine, MD, MPH
Objectives: The United States Food and Drug Administra-
tion cited an absence of data on young adolescents as the
reason the emergency contraceptive, Plan B, could not be
moved over-the-counter. This study analyzed data on
young adolescents with increased access to emergency
Methods: We conducted an age-stratified analysis with
previously published data from a randomized, controlled
trial of Plan B with a sample size of 2,117, including 964
adolescents, 90 of whom were aged younger than 16 years.
Participants were randomly assigned to nonprescription
pharmacy access, advance provision of 3 packs, or clinic
access (control). We measured contraceptive and sexual
risk behaviors at baseline and 6-month follow-up and tested
for pregnancy and sexually transmitted infections. We used
contingency table and logistic regression analysis to mea-
sure the effect of the intervention on risk behaviors in young
adolescents (? 16 years), compared with middle adoles-
cents (16–17 years), older adolescents (18–19 years), and
adults (20–24 years).
Results: Adolescents aged younger than 16 years behaved
no differently in response to increased access to emergency
contraception (EC) from the other age groups. As with
adults, EC use was greater among adolescents in advance
provision than in clinic access (44% compared with 29%;
P ? .001), and other behaviors were unchanged by study
arm, including unprotected intercourse, condom use, sex-
ually transmitted infection acquisition, or pregnancy. Addi-
tionally, adolescents with increased access to EC did not
become more vulnerable to unwanted sexual activity.
Conclusion: Young adolescents with improved access to
EC used the method more frequently when needed, but did
not compromise their use of routine contraception nor
increase their sexual risk behavior.
(Obstet Gynecol 2005;106:483–491)
Level of Evidence: I
aged younger than 16 years as the reason that the
emergency contraceptive, Plan B, could not be
moved to over-the-counter status. The FDA decision
ran counter to the recommendations of the expert
scientific advisory committees reviewing the data.1
The American Medical Association and the Ameri-
can College of Obstetricians and Gynecologists, have
publicly endorsed over-the-counter access to emer-
gency contraception (EC) for all women (Foubister V.
OTC emergency contraceptives pushed, but not im-
minent. American Medical News 2001. Available at:
www.amednews.com/2001/prsc0305. Accessed July
15, 2005; American College of Obstetricians and
Gynecologists (2001). ACOG supports safety and
availability of over-the-counter emergency contracep-
tion [ACOG news release]. Available at: http://www.
nr02-28-01-2.cfm. Accessed June 30, 2005). Further-
more, the Society for Adolescent Medicine does not
place an age limit on access to emergency contracep-
Adolescents are an important target group for
improving access to all forms of contraceptives, in-
cluding emergency contraception, given their high
he United States Food and Drug Administration
(FDA) cited an absence of data on adolescents
From the Center for Reproductive Health Research and Policy, Department of
Obstetrics, Gynecology and Reproductive Sciences, University of California , San
Francisco, San Francisco, California.
Supported by grants from the Compton Foundation, Inc., the Open Society
Institute, the Walter Alexander Gerbode Foundation, and the William and
Flora Hewlett Foundation. The Women’s Capital Corporation, distributor of
Plan B, donated the emergency contraception for use in the trial. The San
Francisco Department of Public Health and Diagnology Ltd. donated the tests for
sexually transmitted infections.
Corresponding author: Cynthia C. Harper, PhD, Assistant Professor, Depart-
ment of Obstetrics, Gynecology and Reproductive Sciences, Box 0744, UCSF,
3333 California Street, Suite. 335, San Francisco, CA; email: harperc@obgyn.
© 2005 by The American College of Obstetricians and Gynecologists. Published
by Lippincott Williams & Wilkins.
VOL. 106, NO. 3, SEPTEMBER 2005OBSTETRICS & GYNECOLOGY
rate of unintended pregnancy. Although adolescent
pregnancy rates in the United States have declined
over the last decade, they remain a significant public
health concern. Pregnancy rates, as well as rates of
sexually transmitted infection (STI) are higher in the
United States than in comparable countries, such as
Canada, England, or France.3,4In the year 2000, just
over 820,000 women aged 15 to 19 years became
pregnant, and almost 30% of these pregnancies re-
sulted in abortion.5More than half of adolescents
have had intercourse by the age of 17 years,6and
most adolescent pregnancies are unintended.
In France, EC is available to adolescents for free
without a prescription at pharmacies and is also
dispensed by school nurses in junior and senior high
schools, and in the United Kingdom, EC is available
to women aged older than 16 years without a pre-
scription.7,8In the United States 6 states allow phar-
macy access to EC (Alaska, California, Hawaii,
Maine, New Mexico, and Washington). A small study
in Washington state of adolescents who received EC
directly from a pharmacist showed that they were
very satisfied with the pharmacy service; only 58% of
the adolescents stated they would see a doctor if they
could not get EC from the pharmacist.9However, all
pharmacists may not be equipped to dispense contra-
ceptives to adolescents while respecting confidential-
ity. One study found that pharmacists’ attitudes and
practices toward adolescents, particularly the younger
adolescents, jeopardized access and confidentiality.10
Increased access to emergency contraception re-
mains controversial, especially for adolescents. Policy
makers have asked about the implications for risky
sexual behavior and use of routine contraception.
While adolescents have been included in studies on
advance provision of EC that show these fears to be
unfounded, none of the studies tested for age differ-
ences between adolescents and adults.11–13There were
a few adolescent studies on advance provision and
contraceptive behaviors, which reached similar con-
clusions as the studies on adults.14–16However, the
studies did not measure the impact on young adoles-
cents (younger than age 16), they had relatively small
samples and high attrition rates, and provided only 1
course of EC, so are difficult to extrapolate to an
over-the-counter situation. Opponents to EC have
begun to speculate that it will be used as a new date
rape drug. The existing literature on young adoles-
cents and EC is scarce, and no studies have provided
evidence of the effect of increased access to EC on
unwanted sexual activity.
A large randomized, controlled trial of 2,117
young women in the United States recently showed
that sexual behavior did not become more risky
among those with increased access to EC, from either
direct pharmacy access or advance provision of 3
packets.17In this article, we present the data on the
adolescent participants from that trial, focusing on
those aged younger than 16 years. We examined the
influence of young age on use of emergency contra-
ception and sexual risk-taking and address concerns
that have been raised in policy decisions. The ques-
tion that remains unanswered in the literature is
whether young adolescents are any different in their
response to increased access to EC from older ado-
lescents and adult women. This question is important
to address to inform policy decisions on access to
MATERIALS AND METHODS
Adolescents comprised 45.5% (n ? 964) of the full
sample of the study. Participants were recruited from
4 clinics in the San Francisco Bay Area from 2001 to
2003. The study was approved by The Committee on
Human Research at the University of California, San
Francisco and by The Planned Parenthood Federa-
tion of America. The methods, including study par-
ticipants, randomization, procedures, and flow chart
are described in full elsewhere.17Briefly, women who
were not pregnant and did not wish to become
pregnant, and were using oral contraceptives, con-
doms, or other barriers or no method were eligible to
participate. Women requesting EC or who had un-
protected intercourse in the past 3 days were ineligi-
Participants were randomized into 1 of 3 study
groups with different access to emergency contracep-
tion: pharmacy access, advance provision, or clinic
access (control). A screening eligibility form was
administered to all age-eligible women at the partici-
pating clinic sites. Eligible participants were given a
urine test for pregnancy (Clearview One Step,
Unipath Diagnostics, Waltham, MA, or equivalent)
and for Chlamydia (BD ProbeTec, Becton Dickinson
& Co., Sparks, MD). They also gave a finger stick
sample of whole blood to test for herpes simplex virus
type 2 (HSV-2) (POCkit HSV-2 Rapid Test, Diagnol-
ogy Inc, Dublin, Ireland). All participants completed
a survey, administered by research assistants, with
items on sociodemographics, contraception, and sex-
ual behavior. Participants were randomly assigned to
groups and given identical-looking boxes. For the
pharmacy group, the box contained a card explaining
how to get EC directly from the pharmacy without a
prescription. The cards listed the addresses of 13
pharmacies close to the clinic sites, including 2 24-
hour stores. Trained pharmacists at the stores dis-
pensed EC to study participants for free, as well as
pamphlets on STIs and contraception. The advance
provision group received 3 packets of Plan B emer-
Harper et alYoung Adolescents and Emergency ContraceptionOBSTETRICS & GYNECOLOGY
gency contraception. The clinic access group received
a card telling them to return to the clinic if they
needed EC, where they would have access to EC
according to standard clinic protocol. In 6 months,
the participants returned for follow-up visits, and
again had a urine test for pregnancy and Chlamydia
and a finger stick blood sample for HSV-2. Partici-
pants completed a follow-up questionnaire with items
measuring EC use, unprotected intercourse, use of
routine contraception and sexual behaviors. We also
reviewed medical charts for positive test results on
pregnancies and STIs during the study period.
Although the overall study was powered to detect
differences in pregnancy between advance provision
and clinic access in the full sample, we calculated that
within the adolescent sample, using a 2–tailed test, we
had a power of 86% to detect a difference in EC use
between the advance provision group (n ? 379) and
the clinic group (n ? 142), with an alpha of 0.05 and
a 2–sample comparison of proportions. Among ado-
lescents, use in advance provision was 44% and in
clinic access 29%.
We measured a series of outcome variables at
follow-up to assess our hypothesis that adolescent
contraceptive and risk behaviors were affected no
differently by the intervention from adult behaviors.
We included the set of variables already reported on
the full sample17as a reference point for comparison
with the adolescents, but for this analysis we also
included additional measures that had particular rel-
evance for young adolescents. The first set of mea-
sures intended for comparison with published results
included use of EC (yes, no); repeat use of EC (yes,
no); unprotected intercourse (yes, no); consistent con-
dom use, ie, used a condom at every act at enrollment
and follow-up (yes, no); contraceptive method (none,
condom, hormonal, dual use of hormonal plus con-
dom); more than 1 sexual partner (yes, no); STI
acquisition (yes, no); pregnancy (yes, no). The mea-
sures that we selected specially for the adolescent
anayses were whether they were able to take the EC
regimen correctly, ie, took the 2nd pill (yes, no); and
whether their ability to prevent unwanted sexual
activity was compromised, including whether they
were pressured into sex (yes, no) or were threatened
into sex (yes, no). For the adolescents, we also exam-
ined whether their predictions at baseline about their
own sexual risk behavior in response to the interven-
tion (whether participants thought they would have
more unprotected intercourse if they had increased
access to EC) were in fact accurate at follow-up.
Our predictor variables were age group (young
adolescents aged ? 16 years, middle adolescents aged
16–17 years, older adolescents aged 18–19 years, adults
aged 20–24 years) and type of access to EC (pharmacy
access, advance provision, clinic access). The measures
came from questionnaire items, whereas the STI and
pregnancy measures included test results and diagnoses
from medical record reviews.
We used modified intent-to-treat analysis on par-
ticipants completing the study. In the first stage of the
analysis, we presented the data for each outcome and
age group by intervention arm. We measured the
effect of the intervention on each outcome among the
adolescents (aged 15–19 years) using contingency
table analysis and ?2statistics, and for comparative
purposes, we also measured the effect of the interven-
tion on the adult participants (20–24 years). We tested
for differences in outcomes between participants in
the advance provision group and those in the clinic
access group, and we compared those in pharmacy
access to those in clinic access.
In the second stage of the analysis, we tested
whether the intervention had a differential effect on
the youngest group of adolescents (? 16 years of age)
using logistic regression analysis on a series of out-
come variables. To test whether access to multiple
packs of EC had a differential effect for that age
group, we included interaction terms of the youngest
adolescents (under age 16) with the advance provision
treatment group. A significant interaction term means
that the intervention has a different effect for the
youngest adolescents on the outcome measured. If the
interaction term is not significant, then the interven-
tion has a similar effect on the youngest adolescents as
it does on the other age groups for the outcome
measured. The logistic regression analysis was per-
formed on the following outcomes: EC use, unpro-
tected intercourse, consistent condom use, multiple
sexual partners, STI acquisition and pregnancy. In-
cluded in the model were main effects for age group
(? 16 years, 16–17 years, 18–19 years, 20–24 years),
treatment group (advance provision, pharmacy ac-
cess, clinic access) and an interaction variable to test
the effect of the advance provision treatment specifi-
cally for the youngest adolescents (? 16 years). We
also measured the effect of advance provision for all
adolescents (aged 15–19 years) compared with adults.
We included tests for pharmacy and clinic access, but
found no differences and did not present results. We
did not correct for multiple comparisons in the results
presented. However, we conducted all analyses with
Bonferroni corrections to ensure consistency with the
results presented. Results are reported in odds ratios
(ORs) with P values. The significance level was set at
0.049 rather than 0.050 because an interim analysis was
performed on the data, according to Fleming et al.18
VOL. 106, NO. 3, SEPTEMBER 2005 Harper et al Young Adolescents and Emergency Contraception
Adolescent participants ranged in age from 15 to 19
years, with a mean age of 17.4 years. Ninety participants
were aged 15 years, 166 aged 16 years, 227 aged 17
years, 230 aged 18 years, and 251 aged 19 years. The
20% of adolescents had used EC in the past 6 months
(Table 1). The mean age of first intercourse was 15.3
years (? 1.5 years), and 24% had previously experi-
of STIs or tested positive for Chlamydia or HSV-2.
Although 37% reported a strong desire to avoid preg-
nancy, 52% reported having unprotected intercourse in
the past 6 months. The condom was the most frequently
used contraceptive method (59%), with the youngest
adolescents, aged 15 years, more likely to report relying
solely on condoms (76%) than the middle adolescents
aged 16–17 years (64%) or the older ones (52%).
Of the 964 enrolled adolescents, 93% (n ? 893)
completed the study. The pharmacy access arm had
372 adolescent participants, advance provision 379,
and clinic access 142; there was no difference in
proportion of participants lost to follow-up by study
arm. An attrition analysis showed those adolescents
who completed follow-up were no different from all
adolescents in age, race and ethnicity, contraceptive
method, use of EC, history of pregnancy, or STIs.
During the course of the study, 36% (n ? 320) of
all adolescents used emergency contraception, with a
significantly higher proportion reporting use in the
advance provision group than in clinic or pharmacy
access (44%, 29%, and 30% respectively; P ? .001). In
general, use among the youngest adolescents (38%)
was the same as the middle group (38%), and slightly
higher than the older adolescents aged 18–19 years
(33%). Adult participants aged 20–24 years had lower
levels of overall use (24%) (Table 2). Nevertheless, the
effect of the intervention was similar among adoles-
cents and adults, with a positive effect for advance
provision and no difference between pharmacy and
clinic access. Logistic regression results of EC use
show lower levels among adults, but a similar effect of
the intervention: the significant main effects on EC
use for adult age group (OR ? 0.50; P ? .001) shows
lower use levels among the adults, whereas the non-
significant interaction term for youngest adolescents
and advance provision (OR ? 1.41; P ? .468) shows
that the effect of the intervention did not vary for that
age group (Table 3).
Sixty-two percent of adolescents who used emer-
gency contraception only used it once, similar to 65%
of adults. A logistic regression analysis of those par-
ticipants who used EC more than once also showed
that the overall level of use for adolescents was
significantly higher than for adults, but that the effect
of the intervention on repeat use did not vary by age.
Table 1. Characteristics of Adolescent Compared With Adult Participants at Enrollment, by Age Group
(< 16 y)
(n ? 90)
(n ? 393)
(n ? 481)
(n ? 1,153)
Race or ethnicity
Multiracial or other
Mean age at 1st intercourse (y)
Oral contraceptives ? condoms
Would have more unprotected
intercourse with EC available
Ever been pregnant
Ever had STI
Positive STI test at enrollment
14.0 (? 0.9)
15.0 (? 1.3)
15.9 (? 1.6)
16.7 (? 2.3)
477 (41.4) .618
EC, emergency contraception; STI, sexually transmitted infection.
Values are n (%) or mean (? standard deviation).
* P ? .001.
†In past 6 months.
‡P ? .049.
Harper et alYoung Adolescents and Emergency Contraception OBSTETRICS & GYNECOLOGY
Fewer than 1% of adolescents reported that they
thought it would be very difficult to take EC correctly.
Indeed, 93% of adolescents who took EC used it
correctly (n ? 295), including 95% in the advance
provision group (n ? 157). Among the participants
aged younger than 16 years, 97% (n ? 30) reported
correct use. Among adults 94% (n ? 232) reported
The large majority of participants at baseline did
not think that availability of EC would have an effect
on their likelihood of having unprotected intercourse
(92%). However, adolescents were significantly more
Table 2. Contraception and Sexual Risk-taking, by Age: Follow-up Data by Study Group
Used emergency contraception
Adolescents 15-19 y (n ? 893)*
Adults 20-24 y (n ? 1,057)‡
Adolescents 15-19 y (n ? 892)
Adults 20-24 y (n ? 1,057)
Consistent condom use
Adolescents 15-19 y (n ? 888)
Adults 20-24 y (n ? 1,051)
Pressured into sex
Adolescents 15-19 y (n ? 891)
Adults 20-24 y (n ? 1,056)
More than 1 sexual partner
Adolescents 15-19 y (n ? 892)
Adults 20-24 y (n ? 1,057)
Adolescents 15-19 y (n ? 893)
Adults 20-24 y (n ? 1,057)
Adolescents 15-19 y (n ? 892)
Adults 20-24 y (n ? 1,057)
STI, sexually transmitted infection.
Values are n (%).
* The P values in the row for adolescents are from ?2statistics testing for differences in the treatment compared with clinic groups among
all adolescents aged15-19 years.
†P ? .010.
‡The P values in the row for adults are from ?2statistics testing for differences in the treatment compared with clinic groups among all adults
aged 20-24 years.
§P ? .001.
VOL. 106, NO. 3, SEPTEMBER 2005 Harper et al Young Adolescents and Emergency Contraception
Table 3. Differential Effect of Emergency Contraception Intervention in Youngest Adolescents: Logistic Regression Analysis of 6 Contraception
and Sexual Risk Outcomes
Age group (y)
Age by treatment interaction
Youngest adolescents by advance provision
No. of Observations
Values are odds ratio (95% confidence interval) unless otherwise specified.
* Reference category.
†P ? .001.
‡P ? .010.
§P ? .049.
Harper et al Young Adolescents and Emergency ContraceptionOBSTETRICS & GYNECOLOGY
likely than adults to believe that it would increase
their chances of unprotected intercourse, particularly
the young adolescents (P ? .009). Nevertheless, un-
protected intercourse at follow-up did not vary by
level of access to EC, not even among the adolescents
(Table 2). Overall, adolescents reported higher levels
of unprotected intercourse than adult participants
(43% compared with 32%). Logistic regression results
confirmed the higher levels of unprotected inter-
course, but also showed that the effect of the inter-
vention was no different for the youngest age group
from that for the other ages (OR ? 1.34; P ? .508)
We included 2 measures of the adolescents’ abil-
ity to avoid unwanted sexual activity, whether they
were pressured or threatened into sex. Few partici-
pants reported having been pressured into sex, and
there were no differences by age: 3% of the adoles-
cents (n ? 27) compared with 4% of adults (n ? 42).
Younger adolescents were not any more likely to
report being pressured into sex than the other adoles-
cents (P ? .437). Adolescents in the advance provi-
sion group were not any more likely to be pressured
into sex than those in the control group (P ? .953).
Reports of being threatened into sex were uncom-
mon: fewer than 1% of participants were threatened
and there was no detectable difference between age
groups or intervention arms.
Adolescents were far more likely than adults to
rely on the condom as their contraceptive method,
both at baseline and follow-up. At follow-up, 67% of
the youngest adolescents reported condoms as their
contraceptive method, as did 54% of the middle
adolescent group and 48% of older adolescents, com-
pared with 39% of adults. However, there was no
difference in contraceptive method by study arm
among adolescents at follow-up (advance provision
compared with clinic P ? .181; pharmacy access
compared with clinic P ? .345). Among the adoles-
cents, the youngest age group was significantly more
likely to report consistent condom use both at enroll-
ment and follow-up (30%) than the middle and older
adolescents (16% and 13%, respectively; P ? .001).
Adults, who were less likely to rely on condoms as
their contraceptive method, were correspondingly the
least likely to report consistent condom use (10%). In
the logistic regression analysis, the significant main
effects for age confirmed greater consistent condom
use among adolescents than adults. The interaction
term for the youngest adolescents and the treatment
arm was not significant (OR ? 1.455; P ? .454).
Another measure of risk behavior, multiple sex-
ual partners, showed no variation by age. Twenty-
three percent of adolescents reported more than 1
sexual partner in the past 6 months (21% of the
youngest, 27% middle, 24% older), similar to the 21%
of adults. For adolescents, as for adults, there was no
variation in number of sexual partners by type of
access to EC. Results from the logistic regression
analysis of multiple sexual partners did not vary by
age, and the youngest adolescents had similar expe-
riences to participants of other age groups.
Sexually transmitted infection acquisition was not
any higher among adolescents than adults. Thirteen
percent of the youngest adolescents acquired an STI,
similar to 12.6% of the middle adolescents and 13.7%
of the older adolescents. Type of access to EC had no
effect on STI rates (pharmacy compared with clinic P
? .808; advance provision compared with clinic P ?
.702). The main effects for age and study group (ie,
the additive effects) were insignificant in the logistic
regression results, although the interaction term for
the youngest age group and advance provision
showed a significant negative effect, that is, the young-
est adolescents were less likely to acquire an STI than
older participants in the advance provision group.
This finding runs counter to the hypothesis of in-
creased risk in the youngest age group.
Pregnancy rates, however, were higher among
adolescents than among adults (10% compared with
6%; P ? .001). Rates were highest among the young-
est adolescents (14%) and progressively decreased by
age: 12% of middle adolescents, 8% of older adoles-
cents, and 6% of adults. There were no differences in
pregnancy rates by study arm among the adolescents.
Logistic regression confirmed that pregnancy rates
were significantly higher among adolescents than
adults, but that the effect of the intervention did not
vary by age group. The outcomes presented above
were also estimated with models with Bonferroni
corrections, and results were consistent with those
without the corrections.
As a society we tend to be more protective of
adolescents and concerned with their sexual risk and
negative reproductive health outcomes than we are of
adults.19Adolescents in this study were indeed at
higher risk of pregnancy than the adult participants,
due to differences in contraceptive use. Adolescents,
particularly the youngest age group, were more likely
to rely on condoms as their contraceptive method,
rather than hormonal methods, and were more likely
to have unprotected intercourse than adults. These
differences in contraceptive and risk behavior by age
are seen in national statistics as well; adolescents are
more likely to use less effective forms of contraception
and to use contraception intermittently compared
Studies in the United States also show adults are
VOL. 106, NO. 3, SEPTEMBER 2005Harper et alYoung Adolescents and Emergency Contraception
more likely to use EC even when they are less likely
to know about it.23–25In contrast, in our intervention
of increased access to EC, adolescents were signifi-
cantly more likely to report use of EC than adults.
Perhaps surprisingly, the younger and middle adoles-
cents were slightly more likely to use EC than the
older adolescents, even though they reported similar
levels of unprotected intercourse. The findings from
this study, that adolescents demonstrated a greater
willingness to use the method when needed, suggests
that a policy change toward greater access to EC
could be of particular benefit to this age group.
Results showed that although most adolescents
did not believe that their risk behavior would worsen
with easy access to EC, the adolescents were more
likely than adults to believe that it would. Neverthe-
less, despite their own concerns, their behavior did
not become riskier. The overall high level of unpro-
tected intercourse among adolescents points to the
importance of including adolescents in efforts to
increase use of contraception, including EC. It is
especially critical for the young adolescents who are
sexually active to have access to effective forms of
routine contraception to help to prevent the higher
rates of pregnancy experienced in this age group.
Although research has explored how certain
characteristics of adolescents can enhance or compro-
mise their ability to refuse unwanted sex,26,27it is
important to understand how contraceptive interven-
tions might affect unwanted sex among adolescents.
Although concerns exist that adolescents with EC on
hand might be more vulnerable to unwanted sexual
activity, these results showed that this was not the
case, including for the youngest participants.
The adolescents were equally capable as adults in
taking EC correctly, with the youngest adolescents,
under 16 years, showing the best results. These results
are consistent with findings from our previous study
that specifically examined young adolescents: an ob-
servational study of 13 to 16 year olds showed that
correct use of EC, the effect on the menses, and the
adverse effects were consistent with data on adult
women and that there was no reason to restrict access
in this age group.28The high levels of correct use in
the advance provision group in this study suggest that
physician supervision does not improve adherence to
the regimen and that young adolescents should not be
singled out due to concerns about their inability to
follow the regimen correctly.
A limitation of this study is that participants were
enrolled from clinics, and the results are not general-
izable to all adolescents. Research has shown that
adolescents are likely to start sexual activity before
obtaining contraception or visiting a provider.29How-
ever, the sexually active adolescents who have never
visited a clinic would presumably have the greatest
need for EC, and to be able to locate it through
over-the-counter access. A second study limitation is
that we had 90 adolescents aged younger than 16
years. Our research design, however, which included
adolescents age 16 and older as well as young adults,
did allow us to make comparisons between the age
groups. Additional studies on younger adolescents
would be useful in helping us to understand how to
reduce unintended pregnancy among this age group.
Similar to adult participants, pharmacy access did
not increase use over clinic access, although advance
provision of 3 packs did. In summary, results showed
the effect of the EC intervention on the youngest
adolescents to be the same as it was on the adult
participants: easier access led to greater use of the
method, but it did not lead to any changes in sexual
risk behavior or use of routine contraception.
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VOL. 106, NO. 3, SEPTEMBER 2005 Harper et alYoung Adolescents and Emergency Contraception