Community intervention boosts LARC use among adolescents

Long-acting reversible contraception (LARC) use among sexually active female adolescents in Rochester, New York, rose from about 4% before a local community intervention to roughly 24% after the initiative. In comparison, during the same time period LARC use increased from about 2% to only 5% in the nation overall among a similar population, according to a study in the American Journal of Obstetrics and Gynecology.

Begun in 2014, the Greater Rochester LARC Initiative has disseminated accurate information about contraceptive options, with a focus on LARC methods, by delivering interactive lunch-and-learn talks throughout the Greater Rochester area. Audiences comprise mostly healthcare providers and adults who engage with adolescents in nonmedical community-based organizations.

“Unintended teen pregnancy is a national public health priority, and prior to the start of the intervention, our city was a ‘hot spot,’” said principal investigator Andrew Aligne, MD, MPH, an associate professor of pediatrics at the University of Rochester School of Medicine and Dentistry, who was instrumental in developing the initiative. “In fact, prior to the initiative, six of the top 10 zip codes for teen pregnancy in New York State were located in Rochester.”

At the time, the Contraceptive CHOICE studies showed that women, including adolescents, would often choose a highly effective type of birth control like LARC when all methods were made available, Dr. Aligne said. However, despite LARC advocacy by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics, “use among adolescents remained near 0%,” he said.

The study investigators used publicly available Youth Risk Behavior Surveillance System data from the years 2013, 2015, and 2017 for the intervention site of Rochester and for the United States overall.

Between 2013 and 2017, LARC use in Rochester rose from 4% to 24% among sexually active female high school students (P < 0.0001). Over the same period, LARC use in New York State increased from 1.5% to 4.8%, and in New York City it rose from 2.7% to 5.3%. In the United States overall, LARC use rose from 1.8% to 5.3%.

“We were pleasantly surprised by the magnitude of the increase in LARC use in Rochester,” Dr. Aligne told Contemporary OB/GYN. “Yet these results are plausible to me in retrospect because there were lots of misperceptions out there about LARC, so this was a topic where sharing accurate information in a friendly way could make a big difference in overcoming barriers to access.”

Dr. Aligne noted that an unusual aspect of the initiative is that it does not engage directly with adolescents. “The initiative is more about diffusion of innovation into standard practice than about adolescent adherence,” he said. “We just want adolescents to have evidence-based options.”

The goal of the initiative was never for 100% of sexually active adolescents to use LARC. “But if the number is close to zero, this suggests inadequate access to accurate information, counseling or medical services,” Dr. Aligne said. “We ensure our talks highlight information on where LARC is available confidentially and at no cost.”

One of the reasons LARC is more effective than oral contraceptives for adolescents is because it eliminates the need for daily action. “Thus, promoting LARC is a great way to reduce unwanted lapses in birth control usage,” Dr. Aligne said.
The Greater Rochester LARC Initiative is supported by a grant from the Greater Rochester Health Foundation.
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Dr. Aligne reports no relevant financial disclosures.