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ACCeSS (Adolescent Capacity for Contraceptive Self Screening) Project

Mary Ott, Indiana University

Project abstract

Limited contraceptive access contributes to high adolescent pregnancy rates. Expanding access via over-the-counter (OTC) and pharmacist prescribing has the potential to decrease adolescent pregnancy. Pharmacist prescribing is available in two states and there are efforts to submit a product for OTC approval from the FDA. However, one state limits minor access to those with proof of a prior physician prescription. This age restriction stems from the lack of data on adolescent capacity to self-screen and consent. Our objective is to fill this gap, examining adolescents' ability to self-screen for medical contraindications and to consent to use COCs. In part 1, adolescents 14-21 years complete a self-screening checklist of medical contraindications to COCs prior to their visit. Afterwards, the provider completes a similar checklist, and we examine concordance of adolescent and provider screening. We will oversample participants with chronic illness to assure adequate numbers of adolescents with contraindications. In part 2, adolescents participate in a simulated pharmacy prescribing process for COC use, followed by a validated capacity assessment tool, the MacArthur Competency Assessment Tool-Treatment, to describe adolescents' capacity to understand COCs use, appreciate how it affects them personally, reason about risks/benefits, and make a choice. Together they assess adolescents' capacity to self-diagnose, self-treat, and self-manage. We will compare minors to 18-21 year olds, and examine predictors of capacity, including health literacy, affluence, sexual behavior and previous contraceptive use. These data can inform state and federal policies expanding minor access to contraception, and pharmacist prescribing protocols.

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