@article{aa7f04a060f148ff97bcec53e25e9de5,
title = "Contraceptive provision in Oregon school-based health centers: Method type trends and the role of Title X",
abstract = "Objective: We describe provision of contraception to adolescents at Oregon school-based health centers (SBHCs). We examine trends over time, by race/ethnicity, and by Title X clinic status and test whether these factors are associated with provision of long-acting reversible contraception (LARC; intrauterine devices/IUDs and implants). Study design: We conducted a retrospective cohort study of 33 SBHCs participating in a shared electronic health record 2012-2016. We identified 20,339 contraception provision visits to 5,934 adolescent females ages 14-19 using diagnosis and procedure codes. We used logistic regression to evaluate the association of clinic Title X status, race/ethnicity, and year with receipt of LARC, controlling for individual-, clinic-, and residence-level factors. We calculated adjusted probabilities. Results: Provision of IUDs and implants increased at Oregon SBHCs between 2012 and 2016. IUD provision increased almost 5-fold, (from 0.9% to 4.4% of contraception provision visits), and implants increased approximately 6.5-fold (from 1.1% to 7.2%). More adolescent contraception provision visits occurred at Title X SBHCs, which had greater than twice the adjusted probability of providing LARCs than non-Title X SBHCs (4.4% versus 1.7%). After adjusting for adolescent-, clinic-, and residence-level covariates, non-white adolescents had lower probabilities of receiving LARC methods than white adolescents. Conclusions: SBHCs play an important role in providing access to contraceptive services to adolescents in Oregon. Access to IUDs and implants is increasing over time in SBHCs, particularly those that participate in the Title X program. Implications: Adolescents have expanding access to IUDs and implants in SBHCs over time in Oregon. Participation in the Title X program can help further increase access to effective contraception in SBHCs.",
keywords = "Adolescent, Contraception, LARC, SBHC, School-based health center, Title X",
author = "Boniface, {Emily R.} and Rodriguez, {Maria I.} and John Heintzman and Sarah Knipper and Rebecca Jacobs and Darney, {Blair G.}",
note = "Funding Information: Funding: This work was supported by the Office of Population Affairs (5 FPRPA006071-02-00). The sponsor had no role in the design, implementation, or reporting of the study. Funding Information: Funding: This work was supported by the Office of Population Affairs (5 FPRPA006071-02-00). The sponsor had no role in the design, implementation, or reporting of the study. Declaration of competing interest: Dr. Rodriguez has served as a contraceptive trainer for Merck and the American Congress of Obstetricians and Gynecologists. She has served on an advisory board for Bayer. She has served as a consultant for the World Health Organization. Her institution has received research funding from the Laura and John Arnold Foundation, the National Institutes of Health, Merck and the Robert Wood Johnson Foundation on projects where she is the primary investigator. These potential conflicts of interest for MI Rodriguez have been reviewed and managed by OHSU. Dr. Heintzman receives funding from the National Institutes of Health, and serves as the Lead Clinician Scientist at OCHIN, Inc. Dr. Darney receives research funding from Merck. Ms. Boniface, Ms. Knipper and Ms. Jacobs have nothing to disclose. Funding Information: Declaration of competing interest: Dr. Rodriguez has served as a contraceptive trainer for Merck and the American Congress of Obstetricians and Gynecologists. She has served on an advisory board for Bayer. She has served as a consultant for the World Health Organization. Her institution has received research funding from the Laura and John Arnold Foundation, the National Institutes of Health, Merck and the Robert Wood Johnson Foundation on projects where she is the primary investigator. These potential conflicts of interest for MI Rodriguez have been reviewed and managed by OHSU. Dr. Heintzman receives funding from the National Institutes of Health, and serves as the Lead Clinician Scientist at OCHIN, Inc. Dr. Darney receives research funding from Merck. Ms. Boniface, Ms. Knipper and Ms. Jacobs have nothing to disclose. Publisher Copyright: {\textcopyright} 2021 The Author(s)",
year = "2021",
month = aug,
doi = "10.1016/j.contraception.2021.03.020",
language = "English (US)",
volume = "104",
pages = "206--210",
journal = "Contraception",
issn = "0010-7824",
publisher = "Elsevier USA",
number = "2",
}