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Purpose: To examine the attitudes of adolescent and young adults (AYA) toward long-acting reversible contraception (LARC), and to assess how attitudes are associated with acceptability., Design: Survey., Setting: Children's Hospital Colorado Adolescent Family Planning Clinic in Aurora, Colorado., Participants, Interventions, and Main Outcome Measures: Young persons 14-24 years of age presenting for any type of visit between March and August 2018., Results: A total of 332 participants were enrolled; the majority (62.3%) had high LARC acceptability. We found 5 "attitude" factors: 77.7% of the sample endorsed "Effective" attitudes (eg, wants most effective method), 37.3% endorsed "Good attributes" (eg, discreet, convenient), 23.1% endorsed "Scary" (eg, fears device will move), 16.1% endorsed "Bad for health," (eg, too many side effects), and 9% endorsed "Not for me" (eg, concerns about pain). Although participants who endorsed "Effective" (OR 6.60, 95% CI 3.01-14.49) and "Good attributes" (OR 3.17, 95% CI 1.51-6.66) were more likely to have high LARC acceptability than those who endorsed "Scary" (OR 0.28, 95% CI: (0.13-0.61)) and "Not for me" (OR 0.07, 95% CI 0.01-0.41) factors, approximately 10% of participants with high LARC acceptability endorsed "Scary" or "Bad for health" attitudes, whereas 54% of those with low LARC acceptability endorsed "Effective" attitudes., Conclusion: Although most participants had high LARC acceptability and valued contraceptive effectiveness, the association between LARC attitudes and acceptability is nuanced. Providers should identify and discuss young people's contraceptive knowledge, attitudes, and acceptability., (Copyright © 2020 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)