234. Disclosure Patterns of Female Adolescents Accessing Long-Acting Reversible Contraception At Urban School-Based Health Centers

Abstract

Studies have shown that greater communication by female adolescents with parents and friends about sexual relationships is associated with increased contraceptive use. However, little is known about disclosure patterns for young women choosing to initiate Long-Acting Reversible Contraception (LARC). We completed a retrospective chart review of female adolescents who accessed Implant or Intrauterine Device (IUD) services at a network of school-based health centers at 13 high school campuses in the Bronx, New York, between November 2015 and December 2017. Demographic data, previous hormonal contraception and pregnancy history were obtained from a standard data report form completed at the time of each LARC insertion encounter. Data about disclosure patterns were obtained from review of a structured Adolescent Sexuality flow sheet within the electronic health record for each LARC insertion encounter; if the field was incomplete, the provider’s note was reviewed for documentation of disclosure. Chi-square analyses were used to examine differences between the two LARC groups in their personal characteristics and disclosure patterns. Of the 518 female adolescents ages 13-21 years who had a LARC insertion procedure during the time period, 68.5% chose an Implant and 31.5% chose an IUD. Their mean age was 16.5 years (SD 1.3). 75.1 % identified as Hispanic/Latina and 18.3% as Black. 56.4% had Medicaid health insurance and 30.7% had no or unknown health insurance. There were no differences by LARC type. 8.1% reported having ever been pregnant and 3.7% reported having ever given birth, with a higher percentage among those choosing an Implant (4.8%) compared to those choosing an IUD (1.2%) (p=0.045). A lower percentage of those who chose an Implant (43.7%) compared to an IUD (63.2%) reported previously using hormonal contraception (p<0.000). Only 51% of procedures had information about disclosure documented by the provider, with 84.4% of these documented within the structured flow sheet. Overall, 26.2% reported disclosure about the decision for LARC to a parent, 17.9% to another adult relative, 31.2% to a best friend and 46.8% to a partner; 20.5% disclosed to none. There were no differences between LARC types except for disclosure to a best friend (37.6% for Implant vs. 19.4% for IUD, p=0.002). In this cohort of adolescents accessing Implant and IUD insertion services at Bronx SBHCs, twice as many chose Implant compared to IUD. Adolescents who chose Implant insertions were more likely to have given birth and less likely to have previously used hormonal contraception. Only half of the insertion encounters had information documented about disclosure. Notably, over 40% reported disclosure about LARC contraceptive choice to a parent or another adult relative with no differences between the types of LARC. However, more young women choosing an Implant reported disclosure to a best friend compared to those choosing an IUD. Further exploration of predictors for and outcomes of the different disclosures, including perceived support and contraception continuation rates, is needed. Performance improvement efforts are warranted to improve provider counseling and documentation about disclosure.