SRF061: Trends in initiation and continuation of long acting reversible contraception among adolescent females in North Carolina

Bianca Allison, MD, MPH; Kori Flower; Feng-Chang Lin, PhD; Victor Ritter; Martha Perry


Context: North Carolina has higher adolescent pregnancy and birth rates than the national average. Hispanic and African American adolescents have higher birth rates compared to their white peers, and adolescents in rural counties having higher birth rates compared to adolescents in urban counties. Despite the efficacy of LARC in pregnancy prevention, rates of long-acting reversible contraception (LARC) initiation and continuation have not been previously examined in North Carolina adolescents. Objective: 1) to describe rates of adolescent LARC initiation and continuation in adolescents receiving Medicaid in North Carolina; 2) to examine the association of patient factors (including age, race/ethnicity, parity, rural vs urban residence) as well as provider factors (including specialty, geography, type of facility) with LARC initiation and continuation; 3) to examine the effects of the updated 2014 American Academy of Pediatrics (AAP) guidelines recommending LARC use in adolescents. Study Design: Retrospective cohort and secondary data analysis. Setting or Dataset: A North Carolina Medicaid database from 2013-2018. Population Studied: Females 13-18 years old who have vs. have not initiated LARC. Intervention: LARC initiation and continuation. Outcome Measures: by objective: 1) descriptive statistics of factors associated with LARC initiation, bivariable analysis to examine LARC initiation, and Kaplan Meier curves of LARC continuation; 2) multivariable analysis to examine patient and provider associated with LARC initiation and continuation, 3) an interrupted time series analysis to examine the effects of the AAP recommendation changes on LARC initiation rates. Results: We hypothesize that uptake and continuation is lower for adolescents at highest risk for unintended pregnancy (i.e. racial minorities or living in rural counties) compared to those at lower risk, and that more urban or academic facilities will be associated with higher LARC use. In addition, we hypothesize that LARC initiation and continuation has overall increased in North Carolina during the study period, with the largest increase after the 2014 AAP guidelines. Expected Outcomes: Describing which adolescents are accessing contraception is an important step in impacting the teen pregnancy rate in North Carolina. Our study can provide evidence for increasing and improving adolescents' access to reproductive health services across all geographic regions in North Carolina.
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Jack 11/21/2020

great project. thanks

lauren.oshman 11/24/2020

Very excited to see your final results. Important topic. Curious what the distribution of Catholic or religious providers are in your region. In Chicago this is important in the distribution of contraception care.

Bianca 12/22/2020

Great question, thanks for asking Lauren! There are certainly a large percentage of Christian affiliated citizens in NC, so I presume there are a large number in both our adolescent and our provider population. We unfortunately don't have that information in more detail, and won't have access to any religious affiliation information for either the adolescents or their providers in our dataset, though we appreciate you mentioning that these are definitely factors that would influence initiation of LARC (or any contraception).

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