title: Public Funding for Contraception, Provider Training, and Use of Highly Effective Contraceptives: A Cluster Randomized Trial.
abstract: OBJECTIVE
  We determined whether public funding for contraception was associated with long-acting reversible contraceptive (LARC) use when providers received training on these methods.
  
  
  METHODS
  We evaluated the impact of a clinic training intervention and public funding on LARC use in a cluster randomized trial at 40 randomly assigned clinics across the United States (2011-2013). Twenty intervention clinics received a 4-hour training. Women aged 18 to 25 were enrolled and followed for 1 year (n = 1500: 802 intervention, 698 control). We estimated the effects of the intervention and funding sources on LARC initiation with Cox proportional hazards models with shared frailty.
  
  
  RESULTS
  Women at intervention sites had higher LARC initiation than those at control (22 vs 18 per 100 person-years; adjusted hazard ratio [AHR] = 1.43; 95% confidence interval [CI] = 1.04, 1.98). Participants receiving care at clinics with Medicaid family planning expansion programs had almost twice the initiation rate as those at clinics without (25 vs 13 per 100 person-years; AHR = 2.26; 95% CI = 1.59, 3.19). LARC initiation also increased among participants with public (AHR = 1.56; 95% CI = 1.09, 2.22) but not private health insurance.
  
  
  CONCLUSIONS
  Public funding and provider training substantially improve LARC access.
authors.affiliation: Kirsten M. J. Thompson, Corinne H. Rocca, Suzan Goodman, Maya Blum, J. Joseph Speidel, Philip D. Darney, and Cynthia C. Harper are with the Bixby Center for Global Reproductive Health, University of California, San Francisco. Julia E. Kohn and Lisa Stern are with Planned Parenthood Federation of America, New York, NY.
authors.forename: Kirsten M J
authors.initials: KM
authors.lastname: Thompson
authors.affiliation: Kirsten M. J. Thompson, Corinne H. Rocca, Suzan Goodman, Maya Blum, J. Joseph Speidel, Philip D. Darney, and Cynthia C. Harper are with the Bixby Center for Global Reproductive Health, University of California, San Francisco. Julia E. Kohn and Lisa Stern are with Planned Parenthood Federation of America, New York, NY.
authors.forename: Corinne H
authors.initials: CH
authors.lastname: Rocca
authors.affiliation: Kirsten M. J. Thompson, Corinne H. Rocca, Suzan Goodman, Maya Blum, J. Joseph Speidel, Philip D. Darney, and Cynthia C. Harper are with the Bixby Center for Global Reproductive Health, University of California, San Francisco. Julia E. Kohn and Lisa Stern are with Planned Parenthood Federation of America, New York, NY.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Kohn
authors.affiliation: Kirsten M. J. Thompson, Corinne H. Rocca, Suzan Goodman, Maya Blum, J. Joseph Speidel, Philip D. Darney, and Cynthia C. Harper are with the Bixby Center for Global Reproductive Health, University of California, San Francisco. Julia E. Kohn and Lisa Stern are with Planned Parenthood Federation of America, New York, NY.
authors.forename: Suzan
authors.initials: S
authors.lastname: Goodman
authors.affiliation: Kirsten M. J. Thompson, Corinne H. Rocca, Suzan Goodman, Maya Blum, J. Joseph Speidel, Philip D. Darney, and Cynthia C. Harper are with the Bixby Center for Global Reproductive Health, University of California, San Francisco. Julia E. Kohn and Lisa Stern are with Planned Parenthood Federation of America, New York, NY.
authors.forename: Lisa
authors.initials: L
authors.lastname: Stern
authors.affiliation: Kirsten M. J. Thompson, Corinne H. Rocca, Suzan Goodman, Maya Blum, J. Joseph Speidel, Philip D. Darney, and Cynthia C. Harper are with the Bixby Center for Global Reproductive Health, University of California, San Francisco. Julia E. Kohn and Lisa Stern are with Planned Parenthood Federation of America, New York, NY.
authors.forename: Maya
authors.initials: M
authors.lastname: Blum
authors.affiliation: Kirsten M. J. Thompson, Corinne H. Rocca, Suzan Goodman, Maya Blum, J. Joseph Speidel, Philip D. Darney, and Cynthia C. Harper are with the Bixby Center for Global Reproductive Health, University of California, San Francisco. Julia E. Kohn and Lisa Stern are with Planned Parenthood Federation of America, New York, NY.
authors.forename: J Joseph
authors.initials: JJ
authors.lastname: Speidel
authors.affiliation: Kirsten M. J. Thompson, Corinne H. Rocca, Suzan Goodman, Maya Blum, J. Joseph Speidel, Philip D. Darney, and Cynthia C. Harper are with the Bixby Center for Global Reproductive Health, University of California, San Francisco. Julia E. Kohn and Lisa Stern are with Planned Parenthood Federation of America, New York, NY.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Darney
authors.affiliation: Kirsten M. J. Thompson, Corinne H. Rocca, Suzan Goodman, Maya Blum, J. Joseph Speidel, Philip D. Darney, and Cynthia C. Harper are with the Bixby Center for Global Reproductive Health, University of California, San Francisco. Julia E. Kohn and Lisa Stern are with Planned Parenthood Federation of America, New York, NY.
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000191:economics* / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000191:economics; D003692:Delayed-Action Preparations; D004343:Drug Implants / Q000191:economics; D004496:Education, Continuing; D005193:Family Planning Services / Q000191:economics* / Q000193:education / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education; D006801:Humans; D007434:Intrauterine Devices / Q000191:economics / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D004343:Drug Implants