Perceived Access to Contraception via Telemedicine Among Young Adults: Inequities by Food and Housing Insecurity

Jennifer Yarger; Kristine Hopkins; Sarah Elmes; Irene Rossetto; Stephanie De La Melena; Charles E McCulloch; Kari White; Cynthia C Harper

doi:10.1007/s11606-022-07669-0

Perceived Access to Contraception via Telemedicine Among Young Adults: Inequities by Food and Housing Insecurity

J Gen Intern Med. 2023 Feb;38(2):302-308. doi: 10.1007/s11606-022-07669-0. Epub 2022 Jun 3.

Authors

Jennifer Yarger¹, Kristine Hopkins², Sarah Elmes³, Irene Rossetto², Stephanie De La Melena³, Charles E McCulloch⁴, Kari White², Cynthia C Harper³

Affiliations

¹ Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. jennifer.yarger@ucsf.edu.
² Population Research Center, University of Texas at Austin, Austin, TX, USA.
³ Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
⁴ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.

Abstract

Background: Telemedicine expanded rapidly during the COVID-19 pandemic, including for contraceptive services. Data are needed to understand whether young people can access telemedicine for contraception, especially in underserved populations.

Objective: To compare young people's perceived access to telemedicine visits for contraception during the COVID-19 pandemic by food and housing insecurity.

Design: Supplementary study to a cluster randomized controlled trial in 25 community colleges in California and Texas. Online surveys were administered May 2020 to April 2021. Mixed-effects logistic regression models with random effects for site were used to examine differences in access to contraception through telemedicine by food and housing insecurity status, controlling for key sociodemographic characteristics, including race/ethnicity, non-English primary language, health insurance status, and state of residence, and contraceptive method used.

Participants: 1,414 individuals assigned female at birth aged 18-28.

Main measures: Survey measures were used to capture how difficult it would be for a participant to have a telemedicine visit (phone or video) for contraception.

Key results: Twenty-nine percent of participants were food insecure, and 15% were housing insecure. Nearly a quarter (24%) stated that it would be difficult to have a phone or video visit for contraception. After accounting for sociodemographic factors and type of method used, food insecure (adjusted odds ratio [aOR], 2.17; 95% confidence interval [CI], 1.62-2.91) and housing insecure (aOR, 1.62; 95% CI, 1.13-2.33) participants were significantly more likely to report that it would be difficult to use telemedicine for contraception during the pandemic.

Conclusions: Underserved patients are those who could benefit most from the expansion of telemedicine services, yet our findings show that young people experiencing basic needs insecurity perceive the greatest difficulty accessing these services for essential reproductive care.

Trial registration: ClinicalTrials.gov Identifier: NCT03519685.

Keywords: COVID-19; access to care; contraception; food insecurity; housing insecurity; telemedicine.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
COVID-19*
Contraception
Female
Food Supply
Health Services Accessibility
Housing
Housing Instability
Humans
Infant, Newborn
Pandemics
Telemedicine*
Young Adult

Associated data

ClinicalTrials.gov/NCT03519685