# Multi-level Emergency Department Intervention to Reduce Pregnancy Risk Among Adolescents

> **NIH NIH R21** · CHILDREN'S MERCY HOSP (KANSAS CITY, MO) · 2021 · $208,442

## Abstract

PROJECT SUMMARY
The burden of adolescent unintended pregnancy in the US is substantial, despite declines in pregnancy rates
in recent years. Although highly effective contraceptive methods exist, adolescents face multi-level barriers to
contraceptive access and use. Research focused on increasing contraception initiation among adolescents is
crucial. The emergency department (ED) is a non-traditional setting that is well-positioned to provide
reproductive care, as almost 19 million adolescents seek care in EDs each year, many are amenable to
receiving care in this setting, and the ED is often the only or primary contact with the health care system for the
highest-risk youth. We propose a novel contraceptive counseling intervention for the ED setting that address
barriers at the patient, provider, and system levels. Building on previous work and drawing on proven
strategies from traditional settings, we will train ED advanced practice nurses to provide counseling utilizing
Motivational Interviewing strategies to facilitate uptake of ED-based contraception or clinic referral among
sexually active females aged 15-18 years. We will conduct a small randomized trial to evaluate these feasibility
constructs using mixed methodology: acceptability, demand, implementation, practicality, adaptation,
integration, expansion, and limited-efficacy. We compare two arms (intervention vs. enhanced standard of
care) to determine size of effect rates on contraception initiation. We gather data to inform a future study to
evaluate individual components and identify the most parsimonious combination of active components using
an adaptive design. We expect these data to inform a trial with adequate sample to evaluate efficacy among
contraceptive subtypes and to identify characteristics that enhance or inhibit contraception use. This project is
significant because the national burden of adolescent childbearing ($9.4 billion for one year alone) is so great,
even a small reduction in incidence should lead to significant cost reductions and reduce generational cycles of
poverty and poor health outcomes.

## Key facts

- **NIH application ID:** 10169483
- **Project number:** 5R21HD098086-02
- **Recipient organization:** CHILDREN'S MERCY HOSP (KANSAS CITY, MO)
- **Principal Investigator:** Melissa Kristine Miller
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $208,442
- **Award type:** 5
- **Project period:** 2020-05-22 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10169483

## Citation

> US National Institutes of Health, RePORTER application 10169483, Multi-level Emergency Department Intervention to Reduce Pregnancy Risk Among Adolescents (5R21HD098086-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10169483. Licensed CC0.

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