Background: Focus4Teens is a CDC-funded initiative to reduce teen pregnancy in three target counties in the Mississippi Delta (Coahoma, Quitman, and Tunica) by increasing access to and use of youth-friendly sexual and reproductive health services (SRHS) among 15-19 year olds. This initiative is urgent, as these target counties have a combined teen birth rate (TBR) of 58/1,000 girls aged 15-19 (MSDH, 2016) and high rates of sexually transmitted infections (STI). Key stakeholders in these rural, resource-limited, and culturally conservative counties include youth, parents, schools and other youth-serving organizations (S/YSO), and school- and local Aaron E. Henry (AEH) Federally Qualified Health Centers.

Methods: To identify important knowledge gaps related to teen pregnancy prevention in these counties, we conducted youth focus groups (N=35) and in-depth interviews with parents, S/YSO, and AEH staff (N=29).

Results: We identified four key knowledge deficits around 1) adolescents’ rights to birth control and confidential SRHS, 2) what to expect at teens’ SRH visits, 3) recommended birth control for teens, and 4) adolescent STI/TBR statistics in the target counties.

Conclusions: With teens’ input, we developed and disseminated a suite of culturally relevant and stakeholder-tailored health communication tools (HCT) to teens, parents, S/YSO, and AEH, including: 1) “Minors Rights” materials, 2) “What To Expect At Your Teen’s Healthcare Visit” parent flyers,3) “Stuff You Need To Know. For Real.” and “Birth Control Methods” cards, brochures, posters, and teen referral guide, and 4) “Mississippi: By The Numbers” STI/TBR 1-pager with target county statistics. We discuss impacts of these HCT for stakeholders.

Objectives: To evaluate an innovative contraceptive support program involving health education and text messaging for adolescents

Methods: We used a pre- and post- study design to evaluate a contraception support intervention at an adolescent clinic in an academic medical center that serves a low-income minority population. From Feb 2018-Jan 2019 a health educator approached consecutive adolescents ages 14-21 with intentions to initiate new contraception, discussed motivations, and provided ongoing support through text messaging. Contraceptives were classified as short acting (pill/patch/ring), intermediate (DMPA) and LARC (IUD, implant). The primary outcome was continuation of contraception at 6 months compared to a historical control group receiving standard care April 2017-Oct 2017.

Results: 212 adolescents participated (107 intervention, 106 control): median age 18, African American 87%, low income (Medicaid) (87%), ever pregnant 19%; no differences between groups.

Teens in the intervention group were significantly more likely to select LARC (38% v 24%), than DMPA (19% vs 28%), and equally likely to choose short acting methods (43% v 48%) p<0.05. Teens in the intervention group were no more likely to use any contraceptive at 6 months (p=0.49). Most teens continued use of LARC methods at 6 months (13/17 intervention, 17/19 control).

Conclusion: An innovative contraceptive support program involving health education and text messaging did not change contraception continuation rates among adolescents at high risk of pregnancy compared to a historical control receiving standard care. More teens in the intervention group selected LARC; both groups had high rates of continuation of LARC methods at 6 months.

background: Physicians and Advanced Practice Providers may enter clinical practice with little to no experience providing family planning services to adolescents. Many training programs do not provide adequate contraceptive counseling and long-acting reversible contraceptive (LARC) placement training. Supplemental training programs can help close this practice gap. The purpose of this study was to evaluate the impact of a training program on providers’ self-reported comfort with and utilization of contraceptive counseling and LARC placement in adolescents.

methods: We conducted a mixed methods study by distributing online follow-up surveys to all past participants (38) and performing key informant phone interviews with nine past participants who completed the program between 2016 and 2018. Questions focused on comfort with skills, clinical behaviors, barriers to care and program curriculum. We used descriptive statistics to summarize quantitative follow-up survey data. We coded qualitative data from key informant phone interviews to identify themes.

results: All respondents reported being comfortable counseling on contraception. The majority of respondents reported being comfortable placing LARC. Respondents who were unsure of their comfort with placing LARC also reported that they do not place LARC in their current practice and have not placed it since entering practice. Feedback from key informant interviews identified that repeated, hands-on practice was the most helpful aspect of the training.

conclusions: Findings indicate that the program equips participants with the skills to counsel on contraception and place long-acting reversible contraception. Repeatedly applying these acquired skills develops greater comfort providing family planning services to patients.

Background:

The City University of New York (CUNY) enrolls over 250,000 students: the majority are low-income, Black, Latinx and/or immigrants, all at various stages of the reproductive life course. Because education is a social determinant of health and economic mobility, assessing the relationship between reproductive health (RH) and academic success among diverse students is important for developing supportive interventions.

Methods:

In 2017, CUNY students were recruited for a web-based survey. The sample (N=2112) was weighted to reflect the demographic distribution of all CUNY students. Frequencies are reported for RH factors [own/partner’s pregnancy in previous year; being a parent/guardian] and pregnancy interfering with school. Chi-square and t-tests were used to test bivariate associations between RH factors and academic success [leave of absence (LOA) in previous year; GPA].

Results:

Of the 4.3% of students reporting pregnancy, half stated it interfered with school (52%). Nearly 14% of students were parents/guardians. Students experiencing pregnancy were more likely to take a LOA than students without pregnancy (20% vs. 12%, p<.05). Although student parents took more LOAs than non-parents, this difference only approached significance (15% vs. 11.7%, p=.11). Becoming pregnant was not associated with GPA, but student parents had significantly higher GPAs than non-parents (3.28 vs. 3.16, p<.01).

Conclusion:

Pregnant or parenting students may experience academic delays but, for those who persist, may perform better than non-parents. Exploring options for fertility-related LOA could be a supportive mechanism toward academic success. Universities can strengthen health and academic equity for minority communities through interventions supportive of students’ reproductive life course.

Background: Urban African American male adolescents and young adults face multiple barriers to effective engagement in healthcare, resulting in significant disparities in care (e.g., sexual health). While this population is generally healthy, there are significant social and health problems that need to be addressed during this period. Thus, it is important to know the health priorities and resources that are available to reduce the health disparities within this population.

Purpose: To conduct a needs assessment to enhance service delivery of adolescent males and young adults at Detroit Community Health Connection (DCHC) clinics.

Methods: Semi-structured interviews were conducted (N=10) at Detroit Community Health Connection Clinic sites. Interviews were recorded, transcribed and analyzed to determine themes related to the health status of adolescents and young adults who come to DCHC.

Results: The needs assessment determined the following priorities for adolescents and young adults seeking care at DCHC are (1) sexual health (e.g., STI testing) (2) mental health (e.g., depression and anxiety) (3) substance abuse and (4) obesity. Available resources include (1) a robust referral system (2) professional expertise and (3) ability to provide “brown bags” filled with condoms and sexual health education.

Conclusion: A needs assessment is a valuable tool to use when learning about the issues that are faced by a community. The information here has been used as supplemental information for grants and has provided evidence to inform future program planning, evaluation, and research outcomes/interventions that may impact the sexual health service use of African American male youth within Detroit.

Many schools have limited access to and curricula time for evidence based sexual and reproductive health programming. Seventeen Days is an evidence-based intervention known reduce sexual risk-taking behavior (i.e. decreases in current sex and STI diagnosis). The present study describes the implementation of Seventeen Days in fifteen Title X Clinics including 10 school-based health centers in Baltimore City Public High and Middle Schools. Specifically, the presentation highlights (a) facilitator training and integration into school-based health centers, (b) the role of health educators’ involvement on program implementation and recruitment, and (c) the impact of clinic context on recruitment. Data include training evaluations, clinic implementation plans, clinic staff interviews, and observations of clinic implementation conducted by members of the research team. Findings suggest that school and clinic leadership are supportive of the implementation of Seventeen Days in their schools. Recruitment efforts are often dependent on collaborations within the clinical staff and between the school-based health center staff and school staff. Although facilitators received individualized training, the quality of program implementation and the ability to recruit participants varied across health educators and schools. Solutions to common challenges, such as strategies for increasing recruitment and improving communication school-based health center staff and the research team will be discussed.

Purpose: Behaviors initiated during adolescence have implications for health over the lifespan. Yet little is known about the ways in which parent-child sexual risk communication influences intention to have sex among lesbian, gay, bisexual, and questioning (LGBQ) adolescents. This work examines the relationship between parent-child sex communication, sexual orientation and intention to have sex among urban adolescents, controlling for age, sex, and ethnicity.

Method: In 2015, high school students in an urban school district in the Western United States completed the Youth Risk Behavior Survey and a supplement survey (N=1,825). Logistic regressions explored the associations between parent-child communication about sex (abstinence, contraceptive use), sexual orientation (heterosexual vs. LGBQ), age, sex (male vs. female), and ethnic identity (Latinx vs non-Latinx).

Results: Intention to have sex was associated with reporting parent-child communication about birth control (OR=1.50, 95% CI:1.20-1.87) and abstinence (OR=1.41, 95% CI:1.12-1.79), LGBQ-identity (OR=2.04, 95% CI:1.33-3.13), age (OR=1.41, 95% CI:1.30-1.53), and female sex (OR=0.31, 95% CI:0.25-0.38). Interactions were tested and for LGBQ students; talking to parents about abstinence reduced their intention to have sex (OR=0.40, 95% CI:0.21-0.78).

Conclusion: Parents are a resource in promoting healthy sexual behavior and have the power to influence sexual decision-making. In our sample, LGBQ adolescents who talked to their parents about the benefits of abstinence were less likely to report intentions for sex in the next three months. Interventionists working to promote sexual health among LGBQ adolescent populations should encourage parents to engage in earnest discussions of sex and sexuality with their LGBQ children.

Purpose: To evaluate the comfort and perceived competence of California registered nurses (RNs) in the provision of adolescent contraception and sexual and reproductive health (SRH) care following the recent California legislation that expanded RNs scope of practice to include provision of self-administered and injectable hormonal contraception (Assembly Bill [AB] 2348).

Methods: We analyzed data from a previously conducted survey of a California statewide representative sample of pediatric registered nurses to assess (1) their understanding AB2348 and (2) their comfort and perceived competence in the provision of contraception and SRH care. Analysis were completed using descriptive statistics and chi-square tests.

Results: The majority of pediatric nurses (82%, n = 36) had no knowledge of AB 2348 and expressed a lack of comfort discussing age appropriate patient information on safer sex practices (62%, n = 28). Nearly half (49%) expressed a lack of comfort dispensing contraception or providing sexually transmitted infection (STI) screening to patients. 27% (n=12) felt that they needed comprehensive training in order to feel competent independently providing contraceptive services and 22% (n= 8) were not interested in providing these services.

Conclusion: While most of the pediatric RNs reported frequently providing care to pediatric patients of reproductive age the majority are not comfortable providing contraception and STI screening and are unaware that it is within their scope of practice in the state of California to provide these services. Evidence-based training in the provision of contraception is needed among pediatric RNs to increase adolescents' access to contraception.

Background: African-American (AA) adolescents have disproportionately high rates of pregnancy and sexually transmitted infections due to increased sexual risk behaviors. AA parents influence adolescent attitudes, values, and beliefs regarding sexual health through sexual risk communication (SRC), however, the literature is lacking systematic reviews of AA-specific parent-adolescent SRC research.

Objective: To evaluate methodologic quality and examine outcomes of quantitative research assessing SRC between AA parents and their 10-17 year old adolescent.

Methods: Electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, and ERIC) were searched using terms related to parent-adolescent communication and sexual risk. US-based studies published in English in peer-reviewed journals from 2000-2018 that enrolled AA parents of 10-17 year old adolescents and measured ≥1 parent-adolescent SRC outcome were included. Dissertations and conference abstracts were excluded. Quality was assessed using the Methodologic Quality Scoring system.

Results: Among the 22 studies, there was variation in the SRC-specific outcomes assessed (frequency, timing, content). Most studies focused on mothers (n=13) versus fathers (n=3) as primary communicators. Studies examining associations between parent-adolescent SRC and adolescent sexual risk behavior, suggest that AA parents independently influence adolescent sexual risk behaviors. Few studies focused on the quality of parent-adolescent SRC communication. Methodologic limitations related to lack of theoretical application, sampling methods, and cross-sectional study design. Cross-study comparisons were limited due to heterogeneity of measures.

Discussion: Future research should evaluate the quality of information shared between parents and adolescents during SRC. Standardizing measures of parent-adolescent SRC is important to a comprehensive understanding of how AA parents influence adolescent sexual risk behaviors.