This multi-site study is employing a brief contraception counseling intervention in the Emergency Department (ED) to shed light on factors that affect decision making as well as barriers and facilitators to conception initiation in the Emergency Department (ED) setting. The overarching goal of the study is to reduce unintended pregnancy among females ages 15 to 18 who present to the Emergency Department (ED).

This study is a prospective cohort study involving females who present to one of two emergency departments (ED) between the ages of 16 and 18, who are at risk of unintended pregnancy.

Our primary objective is to assess intention to initiate contraception ("high"=very/somewhat likely vs "low"=unsure/not likely/definitely not on Likert scale survey) among females aged 15 to 18 years who receive emergency department-based contraceptive counseling.

Our secondary objectives are as follows:

1. Among the same population, assess completion of a referral for any contraceptive care, defined as attendance at a referral site within 4 weeks after the index ED visit.
2. Assess the proportion who ultimately initiate contraception through electronic medical record documentation (i.e., visit note, procedure note, medication review) and participant report (follow-up calls).
3. Use qualitative interview methodology to explore attitudes, barriers, and facilitators that affect decisions to A) express intention to initiate contraception, B) complete a referral for contraceptive care, and C) ultimately initiate contraception among this unique group of high-risk adolescents.

Inclusion Criteria:

1. Females aged 15-18 years who are at high-risk of pregnancy, defined as sexual activity within the last 6 months or likely future sexual activity.
2. Females who do not desire to become pregnant within the next year.
3. Eligible individuals must be proficient in speaking and reading in English.
4. Consent of the adolescent.

Exclusion Criteria:

1. Females who are currently using hormonal contraception or an intrauterine device.
2. Females who are pregnant.
3. Patient has a developmental delay limiting participation.
4. Patient is presenting in the ED after sexual assault.
5. Patient is too ill to be screened.

APPs: [no age limit]] Have been working in ED 6 months

Individuals who identify as females and are at risk of getting pregnant.

Only the site PIs and team will have access to study data.

96 participants were assessed at baseline, received the adolescent counseling intervention and completed outcome information. Please note, no baseline measures were collected for the APP participants.

Up to eight weeks

Up to eight weeks after the index ED visit participants were contacted by text message to complete a follow-up survey assessing referral completion and contraception initiation.

Coronavirus (COVID) 19 occurred during the study recruitment period and impacted the duration of time needed to reach our recruitment goals, and our ability to reach our initial recruitment goals. The sample size was recalculated to establish a suitable reduced sample size achievable within the confines of the study enrollment period and study budget.