Rochester community initiative increases adolescent use of long-acting reversible contraception

A new study published in the American Journal of Obstetrics & Gynecology shows that a University of Rochester Medical Center (URMC) community outreach initiative has helped adolescents in Rochester adopt long-acting reversible contraception (LARC) at a rate far higher than the U.S. overall.

The study, "Impact of the Rochester LARC Initiative on Adolescents' Utilization of Long-Acting Reversible Contraception," used Youth Risk Behavior Surveillance System data from the years 2013, 2015, and 2017 for Rochester, New York City, New York State, and the U.S. overall. These years cover the time before and after the Initiative began in 2014.

The study found that usage of LARC among sexually active high school females in Rochester increased from 4 to 24 percent from 2013-2017, compared to an increase from 2.7 to 5.3 percent in New York City, 1.5 to 4.8 percent in New York State, and 1.8 to 5.3 percent in the U.S. overall.

The Greater Rochester LARC Initiative was started six years ago by the Hoekelman Center for Health Beyond Medicine, a unit of the URMC Department of Pediatrics that connects doctors with non-profits to benefit kids and adults by making communities healthier places to live. Primarily funded by the Greater Rochester Health Foundation, the Initiative aims to increase access to highly effective methods of birth control, including intrauterine devices and contraceptive implants (LARCs) for adolescents in Rochester.

Andrew Aligne, M.D., M.P.H., director of the Hoekelman Center, and his team have led the community effort to promote LARC by conducting outreach to local organizations that work with youth. They employ a simple "lunch-and-learn" approach to disseminate accurate information that forms the backbone of the Hoekelman Center's advocacy work.

An interesting aspect of the LARC project is that we talk to adults, not to teens. We work with our community partners to teach adults about birth control. This way, they can help teens to make well-informed choices about preventing unintended pregnancy."

Jessica VanScott, M.P.H., the LARC Initiative's health project coordinator

Through their research with area teens, the LARC project team found that many were interested in learning about birth control, and that they often asked their most trusted peers and adults for advice.

"If teens are learning outside the medical setting from trusted youths and adults, then how do we increase the likelihood that anyone they talk to will share accurate information? We thought it could help if we gave resources with useful information to adults who work with teens in the community," said Aligne, associate professor of Pediatrics at URMC.

So far, the team has presented to more than 2,700 adults in health care settings, as well as those in community settings such as staff of after-school programs. The talks provide information about the safety, efficacy, and availability of LARC, with the goal of improving knowledge and access at the community level.

This approach is different from previous attempts to disseminate information about LARC. Typically, past outreach efforts have focused on targeting primary care providers or utilizing advertising resources to raise awareness. The Hoekelman Center's community-based approach achieved strong results because few of these community organizations had ground-level information available about LARC, according to Aligne.

"Almost nobody knew that the LARC program was free and covered by Medicaid," said Aligne. 26 states offer reimbursement for LARC under the Medicaid Family-Planning Benefit - included as part of the Medicaid expansion in the Affordable Care Act (ACA) - and Aligne believes these states could scale-up the Hoekelman Center's model to raise awareness as well.

Studies have shown that unintended teen pregnancy can lead to a number of critical health and social problems for young parents and their children: low birth weight, unemployment, school failure, and many other serious issues. Because of these risks, the Centers for Disease Control and Prevention (CDC) has declared teen pregnancy a national public health priority, and the CDC -- along with the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists -- recommends LARC as a safe and highly effective method of pregnancy prevention for adolescents seeking contraception.

"LARCs are more effective than pills, patches, and other contraceptives because they remain in place all the time," said Katherine Greenberg, M.D., an adolescent medicine specialist at UR Medicine's Golisano Children's Hospital. "Today's LARCs are safe, effective, invisible, and can be easily removed with no lingering effects when you decide to become pregnant." LARC methods protect against pregnancy for up to three to 12 years, can be removed at any time, and are 40 times more effective for teens than the traditional birth control pill.

The Hoekelman Center's efforts are bolstered by an extensive network of local agencies, including the Initiative's core partners: the Metro Council for Teen Potential, Healthy Baby Network, Highland Family Planning, and Planned Parenthood of Central and Western New York.

"As we strive to fulfill our mission to pursue and invest in solutions that build a healthier region where all people can thrive, we are proud to support the LARC Initiative at URMC, and celebrate its successes," said Matthew Kuhlenbeck, president and CEO of the Greater Rochester Health Foundation.

"The LARC project team takes a proactive, practical approach in its efforts to help reduce teen pregnancy by sharing information and increasing awareness of options, and we are especially grateful for the collaboration among URMC and community partners who are working together to address this challenge."

LARC services have continued during COVID-19, and access expanded at an increasing number of primary care practices serving teens and young adults throughout the Finger Lakes region during the last year, thanks to Accountable Health Partners (AHP), URMC's clinically integrated network of hospitals and physicians. In partnership with the Hoekelman Center team, and funded by a grant from the Finger Lakes Performing Provider System (FLPPS), AHP has promoted training in both reproductive counseling and LARC placement for primary care providers in order to further reduce access barriers for patients.

"The LARC Initiative demonstrates true collaboration between health care and community and is a significant population health success for our region," said Laura Jean Shipley, M.D., professor of clinical pediatrics, vice chair for Population and Behavioral Health at URMC and associate medical director at AHP.