School-Based Health Centers and Use of Effective Contraception among Sexually Active Female Teens in NYC Public High Schools.

The goal of the School-Based Health Center (SBHC) Reproductive Health Project (RHP) was to increase access to effective methods of contraception for New York City (NYC) public school students. This paper evaluates the impact of the SBHC RHP by examining differences in contraceptive use between sexually active female high school students with and without project access. Data from the 2011-2019 NYC Youth Risk Behavior Surveys were pooled and flagged for SBHC RHP access. Complete case descriptive analyses compared contraceptive use at last sex, reported by weighted percentages. Multinomial logistic regression was conducted to identify the association between access to the SBHC RHP and use of more effective contraception. We found that the percentage of any contraceptive use at last sex did not differ between the intervention and comparison groups; however, there were significant differences in the category of method used. Compared to those without access, more students at schools with the SBHC RHP reported use of moderately effective hormonal contraception (28.6% vs 16.3%) or long-acting reversible contraception (LARC; 4.4% vs 1.8%). SBHC RHP access significantly increased the probability of primary use of moderately effective hormonal contraception (pill/patch/ring/Depo-Provera shot) and LARC at last sex by 12.9 and 1.9 percentage points, respectively. While these more effective methods are generally less accessible to teens, the provision of these methods within an SBHC setting can increase access and use.