Comparison of Long-Acting Reversible Contraceptive (LARC) Choices by Multiethnic U.S. Adolescents and Young Adults With and Without Eating Disorders: A Multicenter Cohort Study.

STUDY

OBJECTIVE

Body image concerns may influence contraceptive choices of adolescents and young adults (AYAs) with eating disorders (EDOs). We aimed to compare long-acting reversible contraceptive (LARC) choices and continuation rates for AYAs with and without EDOs.

METHODS

We used data on LARC insertions from 2017 to 2021 from four US adolescent medicine practices measuring demographics, menstrual history, reason for LARC device, follow-up, and continuation. Additional record search identified participants with EDOs. We examined associations of EDOs and choice of device using adjusted logistic regression and 1-year discontinuation using Cox proportional hazards survival analysis.

RESULTS

The cohort included 2,346 AYAs; 80 (3%) with EDO; 32% White; 29% Hispanic, 15% Black. Mean age at LARC insertion 18.7 ± 2.4 years (range 12-25). Participants with EDO vs. without had higher odds of choosing intrauterine devices (IUD) over implants (OR = 2.18; 95% CI: 1.31, 3.61; p = .003). One-year LARC continuation rates were 77% overall and similar for those with and without EDOs. AYAs with EDOs vs without had similar likelihood of LARC device removal within 1 year. Participants identifying as Black non-Hispanic (OR = 0.34;95% CI: 0.26, 0.45, p < .001) and Hispanic (OR = 0.34; 95% CI: 0.26, 0.45, p < .001) vs White non-Hispanic had lower odds of choosing IUDs over implants. Black non-Hispanic AYAs had higher likelihood than White non-Hispanics for LARC removal within 1-year (HR = 1.58; 95% CI: 1.11, 2.25; p = .01).

CONCLUSIONS

AYAs with EDOs compared to those without EDOs are more likely to choose IUDs over implants and they have similar high 1-year LARC continuation rates . AYAs of non-White race/ethnicities independent of EDO diagnosis are less likely to choose IUDs.