Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Kate Beatty

Committee Members

Debbie Slawson, Mike Smith, Katie Baker


Introduction: In recent years, high quality contraceptive care for adolescents has shifted away from tiered effectiveness counseling and toward youth-friendly, patient-centered counseling (YFPCCC). YFPCCC is essential in the South, which has higher rates of sexual activity, lower rates of contraception use, and higher teen birth rates. This study examined Southern clinics’ characteristics which support YFPCCC and youth’s perceptions of the contraceptive care they receive.

Methods: This mixed methods study examined secondary data collected in two surveys and primary data collected through key-informant interviews. The first survey examined clinic characteristics impacting YFPCCC, and the second survey examined adolescents’ (aged 16-24) perspectives of their care. For each survey, outcome measures were dichotomized and examined through logistic regression models. Lastly, interviews with administrators at FQHCs and HDs in AL and SC and examined the facilitators and barriers to providing YFPCCC in these clinics.

Results: FQHCs were 89% less likely to notify youth of their right to confidentiality (aOR 0.11, 95% CI (0.05, 0.26)) and 80% less likely to notify youth of their right to consent to care (aOF 0.20, 95% CI (0.10, 0.40)). Non-Hispanic Black youth were 47% less likely to receive patient-centered contraceptive care (aOR 0.53, 95% CI (0.40, 0.70)). Minor youth (ages 16-17) were 34% less likely to receive patient-centered contraceptive care (ages 20-24) (aOR 0.66, 95% CI (0.45, 0.98)). Clinic administrators noted the continued use of tiered effectiveness counseling. SC administrators noted that minor youth were allowed to consent to receiving the implant but could not consent to removing it.

Discussion: Overall, clinic capacity to provide YFPCCC varied by clinic type, with FQHCs less likely to have notify youth of their rights to consent to and receive confidential contraceptive care. The receipt of YFPCCC varied by youth’s age and race/ethnicity, with minors and non-Hispanic Black youth being less likely to report YFPCCC. Clinic administrators noted that they continue to use the tiered effectiveness model of counseling, which may inadvertently pressure or coerce youth. To improve their capacity to provide YFPCCC, clinics should enhance their policies protecting consent and confidentiality and ensure that their providers are trained in patient-centered contraceptive care for youth.

Document Type

Dissertation - embargo


Copyright by the authors.

Available for download on Saturday, June 15, 2024