Objective To assess multiple dimensions of long acting reversible contraception (LARC) knowledge and perceived multi-level barriers to LARC use among a sample of college women. Study Design We conducted an internet-based study of 1,982 female undergraduates at a large mid-western university. Our 55-item survey used a multi-level framework to measure young women’s understanding of, experiences with intrauterine devices (IUD) and implants and their perceived barriers to LARC at individual, health systems, and community levels. The survey included a 20-item knowledge scale. We estimated and compared LARC knowledge scores and barriers using descriptive, bivariate, and linear regression statistics. Results Few college women had used (5%) or heard of (22%) LARC, and most self-reported “little” or “no” knowledge of IUDs (79%) and implants (88%). Women answered 50% of LARC knowledge items correctly (mean 10.4, range 0–20), and scores differed across sociodemographic groups (p-values<0.04). Factors associated with scores in multivariable models included race/ethnicity, program year, sorority participation, religious affiliation and service attendance, employment status, sexual orientation, and contraceptive history. Perceived barriers to IUDs included: not wanting a foreign object in body (44%); not knowing enough about the method (42%); preferring a “controllable” method (42%); cost (27%); and not being in a long-term relationship (23%). Implant results were similar. “Not knowing enough” was women’s primary reason for IUD (18%) and implant (22%) nonuse. Conclusion Lack of knowledge (both perceived and actual) was the most common barrier among many perceived individual, systems, and community-level factors precluding these college women’s LARC use. Findings can inform innovative, multi-level interventions to improve understanding, acceptability, and uptake of LARC on campuses.

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ImportanceGreater than 20% of cases and 0.4% of deaths from COVID-19 occur in children. Following demonstration of the safety and efficacy of the adjuvanted, recombinant spike protein vaccine NVX-CoV2373 in adults, the PREVENT-19 trial immediately expanded to adolescents.ObjectiveTo evaluate the safety, immunogenicity, and efficacy of NVX-CoV2373 in adolescents.Design, Setting, and ParticipantsThe NVX-CoV2373 vaccine was evaluated in adolescents aged 12 to 17 years in an expansion of PREVENT-19, a phase 3, randomized, observer-blinded, placebo-controlled multicenter clinical trial in the US. Participants were enrolled from April 26 to June 5, 2021, and the study is ongoing. A blinded crossover was implemented after 2 months of safety follow-up to offer active vaccine to all participants. Key exclusion criteria included known previous laboratory-confirmed SARS-CoV-2 infection or known immunosuppression. Of 2304 participants assessed for eligibility, 57 were excluded and 2247 were randomized.InterventionsParticipants were randomized 2:1 to 2 intramuscular injections of NVX-CoV2373 or placebo, 21 days apart.Main Outcomes and MeasuresSerologic noninferiority of neutralizing antibody responses compared with those in young adults (aged 18-25 years) in PREVENT-19, protective efficacy against laboratory-confirmed COVID-19, and assessment of reactogenicity and safety.ResultsAmong 2232 participants (1487 NVX-CoV2373 and 745 placebo recipients), the mean (SD) age was 13.8 (1.4) years, 1172 (52.5%) were male, 1660 (74.4%) were White individuals, and 359 (16.1%) had had a previous SARS-CoV-2 infection at baseline. After vaccination, the ratio of neutralizing antibody geometric mean titers in adolescents compared with those in young adults was 1.5 (95% CI, 1.3-1.7). Twenty mild COVID-19 cases occurred after a median of 64 (IQR, 57-69) days of follow-up, including 6 among NVX-CoV2373 recipients (incidence, 2.90 [95% CI, 1.31-6.46] cases per 100 person-years) and 14 among placebo recipients (incidence, 14.20 [95% CI, 8.42-23.93] cases per 100 person-years), yielding a vaccine efficacy of 79.5% (95% CI, 46.8%-92.1%). Vaccine efficacy for the Delta variant (the only viral variant identified by sequencing [n = 11]) was 82.0% (95% CI, 32.4%-95.2%). Reactogenicity was largely mild to moderate and transient, with a trend toward greater frequency after the second dose of NVX-CoV2373. Serious adverse events were rare and balanced between treatments. No adverse events led to study discontinuation.Conclusions and RelevanceThe findings of this randomized clinical trial indicate that NVX-CoV2373 is safe, immunogenic, and efficacious in preventing COVID-19, including the predominant Delta variant, in adolescents.Trial RegistrationClinicalTrials.gov Identifier: NCT04611802

Purpose To characterize the association between pelvic examination and adolescent contraceptive method use in two time periods in the 2006–2010 National Survey of Family Growth (NSFG). Methods Using data from the 2006–2010 NSFG, we used descriptive statistics and multivariable regression models to examine the association between pelvic examination and/or Pap smear, and use of effective or highly effective contraceptive methods during 2 time periods. (2006–2008 and 2008–2010). We used the design characteristics of the NSFG to produce population estimates. Results More than half (57.3%) of our target population reported that they had a pelvic examination and/or Pap smear in the preceding 12 months. After considering health service use, pregnancy history and demographic characteristics, receipt of pelvic/Pap remained significantly associated with use of effective or highly effective methods of contraception. (aOR= 1.86, 95% CI; 1.17, 2.97). When we examined the relationship between pelvic/Pap and use of effective or highly effective methods within time periods, we found that the odds of effective contraception use was higher among adolescents who had received a Pap/pelvic exam in period 1 (June 2006–May 2008) but not in period 2 (June 2008–May 2010). (OR=3.05, 95% CI;1.53, 6.03 and OR=1.52, 95% CI; 0.88, 2.62, periods 1 and 2 respectively.) Conclusion This finding provides some reassurance that while indications for pelvic examination and Pap smear among adolescents have decreased, the previously documented association between pelvic examination and effective or highly effective contraception appears to have decreased.