114. the Adapt Study: Development of A Multi-Level Intervention Framework to Reduce Disparities in Unintended Teen Pregnancy among Hispanic Adolescents

The purpose of the current project is to investigate factors related to long-acting reversible contraceptive (LARC) uptake among predominately low income, Hispanic youth, receiving medical services in primary care sites. As part of a program of research, we first sought to determine rates of sex, unprotected sex, and LARC uptake among patients. Follow-up research is focusing on socio-structural factors that may impact decision making regarding LARC uptake. As part of a larger clinical trial, all patients, aged 13-19 presenting to primary care for any medical reason were approached in the waiting or exam room and asked to complete a brief questionnaire measuring rates of unprotected sex and LARC use. The current analyses focus only on female patients. In a follow-up study, we conducted qualitative interviews with patients presenting for a first time contraception consultation to examine socio-structural factors that may impact decision making among LARC. Of 1074 female patients who agreed to complete the screening questionnaire, 71.5% (N=767) reported having had sex. Of these, 55.8% (N=428) reported past year unprotected sex. Of the total sample, only 14.3% (N=154) were currently on a LARC, suggesting many patients might benefit from intervention to increase LARC uptake. Thematic analysis of socio-structural factors impact decision making included themes of family, friendship, romantic relationships, and religion. Despite increasing rates of LARC availability, uptake of LARC is often suboptimal. Understanding factors that impact decision making can help researchers and clinicians to develop and test interventions to increase rates of LARC use, particularly among high-risk youth.