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In Missouri, there are 114 counties with 101 rural counties; 41 of these rural counties have teen pregnancy rates that vary from 42.4 to 90.1 per 1,000 (national rate is 43 per 1,000; Kost et al., 2017; TPPP, 2013). Nationally, teen pregnancy rates have been decreasing; however, some of the rural Missouri counties have seen an increase in pregnancy rates (e.g., Dunklin County saw an increase from 55.07 per 1,000 to 62.37 per 1,000, and Pettis County saw an increase from 38.43 per 1,000 to 43.07 per 1,000 from 2015-2016). Most literature on teen pregnancy and pregnancy prevention has focused on urban populations. This is problematic because many rural communities have characteristics that result in disparately high teen pregnancy rates. The theory of planned behavior (Ajzen, 1991) and the health belief model (Kirscht, 1974) provide a theoretical framework for the current study. This study aimed to better understand teen girls' contraceptive use in rural Missouri specifically, how attid side effects, subjective norms about contraceptive use, and knowledge about contraceptive side effects relate to girls halting contraceptive use. A convenience sample of 183 girls from the 41 rural Missouri counties participated in an online survey. The majority of the sample identified as White (72.6 percent). Age and education levels varied; 10.9 percent 15 years old, 24 percent 16 years old, 23.5 percent 17 years old, 25.7 percent 18 years old, and 15.8 percent 19 years old; 40.4 percent completed high school or GED, 11.5 percent completed 8th grade, 24 percent completed some high school, 15.8 percent completed some college, 3.8 percent completed trade/technical/vocational training, 1.6 percent completed an associate's degree, and 0.5 percent completed a bachelor's degree. About half the sample identified as religious (54.6 percent). A series of logistic regression were performed in R version 3.4.1. The results showed that girls who perceived birth control pills to have major side effects were more likely to have experienced a side effect from contromeone important to them who supported the use of condoms, IUD, and birth control pills were more likely to experience a side effect and halt use. The girls who had experienced a side effect from contraceptive use and halted use were more likely to believe that they would become pregnant in the next year if not using any form of contraception. The girls who had not been told about side effects associated with contraceptives were more likely to associate major side effects with IUDs and birth control pills. This study greatly contributes to the literature regarding rural teens' contraceptive use and how their attitudes and knowledge about perceived side effects informs the girls' decision to use or halt contraceptive use. More research is needed to fully understand these factors and better improve intervention strategies as well as contraceptive counseling to reduce teen pregnancy rates in rural Missouri.

Examining contraceptive use and perceived side effects among teen girls in rural Missouri