Adolescent Self-Reported Use of Highly Effective Contraception: Does Provider Counseling Matter?

Study Objective: To examine associations between provider counseling about specific contraceptive methods and method choices reported by adolescents.

Design: A cross-sectional, secondary analysis of the local 2015 Youth Risk Behavior Survey, to which we added 2 new/modified questions about long-acting reversible contraception (LARC).

Setting: Rochester, New York.

Participants: Female students in 9th-12th grade in the Rochester City School District.

Interventions: An anonymous, standardized survey was administered to collect data.

Main Outcome Measures: We studied associations between students' reported contraceptive use and counseling (LARC, short-acting contraception [SAC], neither), health care factors, and potential risk/protective factors. Data were analyzed using bivariate and multivariate methods.

Results: Among 730 sexually active female respondents, 353/730 (49%) were African American and 182/730 (25%) were Other/Mixed race. 416/730 (57%) used no hormonal method at last sex, and 95/730 (13%) used LARC. 210/730 (29%) of participants recalled any LARC-specific counseling, and 265/730 (36%) any counseling on SAC. Recall of LARC and SAC counseling and use were significantly associated with speaking privately with a provider, but were not related to personal risk/protective factors. Multivariate analyses showed that recollection of LARC counseling was significantly associated with higher odds of using either LARC (adjusted odds ratio, 14.3; P < .001) or SAC (adjusted odds ratio, 2.1; P = .007). Recollection of either LARC or SAC counseling was associated with significantly lower odds of using no contraception.

Conclusion: Adolescents' use of LARC was only 13%, but those who recalled contraceptive counseling had higher odds of using some hormonal method. Efforts are needed to improve provider counseling, maintain confidentiality, and identify effective methods to engage adolescents in meaningful, memorable discussions of LARC.