Graduation Date

Winter 12-14-2018

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Promotion and Disease Prevention Research

First Advisor

Melissa Tibbits

Second Advisor

Shireen Rajaram

Third Advisor

Denise H. Britigan

Fourth Advisor

Hongmei Wang


Despite recent declines in unintended pregnancy rates among adolescent and young adult women, barriers to family planning services and contraception continue to exist for young women living in the United States. Various initiatives have been implemented over the years from programmatic interventions to enactment of policies around family planning, yet more work needs to be done to help adolescent and young adult women successfully prevent unintended pregnancy. The Contraceptive Access Project (CAP) is a multi-component initiative in Nebraska to reduce unintended pregnancy among women aged 15-24. This dissertation comprises three separate studies each of which contributes to the overall objective of examining and understanding barriers to sexual and reproductive health (SRH) services for adolescents and young adults aged 15-24 in Nebraska and the role of the CAP in reducing those barriers. Results from the first study showed that racial and ethnic background, rather than age, of young women receiving CAP services (e.g. no-cost contraception) were predictive of whether a Tier 1 method of contraception (e.g. intrauterine device or subdermal implant) were obtained. The second study found that barriers to the adoption and implementation of quality family planning best practices continue to exist for Title X organizations across the state. The final study found that despite high knowledge about long-acting reversible contraceptives (LARCs) among clinical staff in Title X organizations across Nebraska, misconceptions about LARCs, as well as attitudes and beliefs around LARCs for adolescents and young adults, continue to present as barriers to young people’s access of contraception, particularly in rural parts of the state. Overall there are several strengths to this dissertation. First, this work adds to the overall literature on barriers to SRH services for young women, not only in Nebraska but across the U.S. Second, results from these studies can help other communities in the U.S. to implement initiatives around reducing barriers to SRH services. Finally, we have expanded upon the literature comparing adolescent women aged 15-19 to young adult women aged 20-24. Future studies can use this work to reduce barriers to SRH services for young people throughout the United States.