Condom use by Hispanic and African-American adolescent girls who use hormonal contraception

Acceptability of sexually transmitted infection screening among women in short-term substance abuse treatment

BACKGROUND

Substance abuse treatment centers provide an opportunity to offer sexually transmitted infection (STI) screening to a high-risk and hard-to-reach population.

GOAL

The goal was to assess STI prevalence, risk factors, and acceptability of STI screening among females at substance abuse treatment centers with use of urine testing by ligase chain reaction and self-collected swab specimens.

STUDY DESIGN

Adult, female inpatients were offered free testing and treatment for chlamydia infection, gonorrhea, and trichomonas infection. Interviews were conducted to collect risk behavior data.

RESULTS

Eighty-six percent of inpatients (180/209) accepted testing. Twenty-three percent (41/177) had an STI. Of those with an STI, 90% (37/41) had trichomonas infection. All 41 infected patients received treatment. Drug use before sex, exchange of sex for money/drugs, and any gynecological complaint were significantly associated with infection. Most women were uninsured (76%). Only 45% had undergone a medical examination in the past year.

CONCLUSION

STI screening is highly acceptable among women in substance abuse treatment centers. Substance users are at high risk for STIs and may not otherwise receive medical care.

[Self-assessment of STD/AIDS vulnerability among women, Brazil]

OBJECTIVE

To investigate risk behaviors and self-assessment of the vulnerability to sexually transmitted diseases (STD) and acquired immunodeficiency syndrome (AIDS) among women.

METHODS

A systematic sample including 48 of 281 census tracts in the urban area of Pelotas, Brazil, was selected. There were interviewed 1,543 women, aged between 15 and 49 years, who had ever been sexually active. Risk behaviors were assessed using a confidential questionnaire that consisted of three sections: socioeconomic profile, interviewers' and self-administered questions. Data analysis was conducted using Epi-Info software, version 6.0. Statistical analysis was carried out using Kappa test and odds ratio.

RESULTS

Of all women in the sample, 64% considered impossible or almost impossible for them to acquire an STD or AIDS. The main risk behaviors were non-use of condoms in their last intercourse (72%); onset of sexual activity before age 18 years (47%); drug or alcohol use by the partner (14%) or the woman (7%) before their last intercourse; two or more partners in the last three months (7%); and anal sex in the last intercourse (3%); 44% reported two or more risk behaviors. Using a risk score of two or more points as the gold standard, sensitivity and specificity of self-assessment were 41% and 67%, respectively.

CONCLUSIONS

Self-assessment of vulnerability is not an adequate indicator of STD and AIDS vulnerability since women do not have an appropriate perception of their risks.

Sexually transmitted infection. A challenge for nurses working with adolescents

Sexually active adolescents have high rates of STIs and many barriers to prevention and treatment because of developmental immaturity, difficulty with access to health care, and need for confidential care. Serious health consequences of STIs may occur many years after infection, further compounding adolescents' ability to link cause and effect. Nurses who are committed to the challenge of providing services for adolescents to prevent STIs can help by providing access to confidential care and promoting sexual health. High-risk youth require intensive preventive efforts. Nurses are in an ideal position to meet this challenge in their roles as providers, counselors, and sexuality educators in individual health care encounters and in prevention programs in clinics, schools, and community centers. Effective STI prevention programs should apply theories of behavior change, incorporate adolescents' attitudes and beliefs, and solicit input from the adolescents themselves.

Pregnant African-American teens are less likely than their nonpregnant peers to use condoms

OBJECTIVE

The aim of this study was to prospectively compare pregnant and nonpregnant adolescents' recent condom use and sexually transmitted disease (STD) acquisition.

METHODS

Sexually active African-American females (N = 522), ages 14-18, were recruited from clinics and schools. Adolescents completed baseline interviews and provided vaginal swabs for STD testing, and urine for pregnancy testing. Assessments were repeated 6 and 12 months post baseline assessment. Analyses compared adolescents who became pregnant between baseline and the 6-month assessment with their peers who had negative pregnancy tests. Condom use between the 6- and 12-month assessments and incidence of STDs at the 12-month assessment served as outcomes. Adolescents who did not report sexual activity between the 6- and 12-month assessments were excluded.

RESULTS

Ten percent of the adolescents became pregnant and continued sexual activity. Pregnant adolescents reported less overall condom use (P < 0.0001), more infrequent condom use (adjusted odds ratio [AOR] = 4.5, P < 0.001), and more unprotected vaginal sex (AOR = 4.7, P < 0.003). Pregnant adolescents were equally likely to test positive for STDs (31% vs 26%) and to self-report having STDs at the 12-month follow-up period (30% vs 23%).

CONCLUSIONS

Findings suggest that pregnant adolescents may be less likely to use condoms than their nonpregnant peers and that STD incidence among pregnant adolescents may be high. Condom use promotion may be important during adolescents' prenatal care.

A qualitative assessment of condom use decisions by female adolescents who use hormonal contraception

Young women who use hormonal contraception are at increased risk of HIV. This study, based on the Health Belief Model, was designed to understand how adolescent women who use hormonal contraceptives make decisions about condom use. Thirty-nine young, minority women participated in open-ended interviews. The interviews were transcribed and analyzed by both authors separately. The results suggest that barriers to condom use include use of a hormonal method of contraception, perceived trust in a partner, and a perception of the condom as "irritating." Facilitators for condom use included not being with a steady partner and fear of pregnancy and infection. The young women also suggested that being able to talk to their parents about condom use, having condoms widely available, and seeing HIV-prevention messages in many venues would increase their use of condoms. They noted that seeing young, HIV-positive women demographically similar to themselves would also prompt them to use condoms. Nurses should incorporate these factors into HIV-prevention interventions for adolescents.

Correlates of using dual methods for sexually transmitted diseases and pregnancy prevention among high-risk African-American female teens

PURPOSE

To identify correlates of consistent dual-method use among African-American female adolescents at risk of sexually transmitted diseases (STDs) and pregnancy.

METHODS

A convenience sample of 522 sexually active female teens attending adolescent medicine clinics, health department clinics, and school health classes volunteered. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a questionnaire and a face-to-face interview and provided vaginal swab specimens for laboratory diagnosis of STDs. Those reporting use of condoms and at least one other method of contraception, for each of the last five occasions they had sex were classified as consistent dual-method users. The questionnaire assessed frequency of adolescents' communication with their parents and partners about sex. The questionnaire also assessed two measures of parental supervision and adolescents' desire to avoid pregnancy. Multiple logistic regression assessed the independent contribution of each correlate of consistent dual-method use.

RESULTS

Seventy-one adolescents (13.6%) were classified as consistent dual-method users. A strong desire to avoid pregnancy was the most influential correlate of consistent dual-method use [odds ratio (OR) =2.3]. Adolescents reporting that their parents generally knew whom they were with (OR = 2.0) and those reporting more frequent communication with parents (OR = 1.9) were also more likely to be consistent dual users.

CONCLUSION

The findings suggest the need for research to examine the efficacy of interventions building on adolescent females' desire to avoid pregnancy. Study findings also suggest that interventions promoting improved parent-adolescent communication and improved parental supervision may contribute to adolescents' use of dual methods for STD and pregnancy prevention.

Psychosocial correlates of adolescents' worry about STD versus HIV infection: similarities and differences

BACKGROUND

Adolescents' worry (perceived threat) of sexually transmitted diseases (STDs) and HIV infection may have different correlates. This study examined associations between selected psychosocial and behavioral constructs and adolescents' worry about STD and HIV infection.

GOAL

To assess levels and correlates of worry about STD and HIV among a high-risk sample of black adolescent females.

STUDY DESIGN

High-risk black females (n = 522), enrolled in a randomized, controlled HIV and STD prevention trial, completed a questionnaire and structured interview at baseline. Worry about STD and HIV infection, recent risk behaviors, and several measures potentially related to worry were assessed.

RESULTS

Levels of worry for both STD and HIV were low. Recent history of STD infection was associated with STD worry (OR, 4.6) and HIV worry (OR, 2.0). Infrequent communication about sex (OR, 2.0) and low perceived ability to negotiate condom use (OR, 2.0) were related to STD worry; whereas, only partner-specific barriers were related to HIV worry (OR, 1.9).

CONCLUSIONS

Despite high risk, adolescents were generally complacent about the threat of infection with STD and HIV. Adolescents' worry about STD and HIV infection had different sets of correlates.

Implantable contraception

Although levonorgestrel contraceptive implants have been available for over 15 years, innovations have only recently led to a wider choice. These new implants offer easier insertion and removal and other advantages depending on the type of progestin. Implants prevent pregnancy by several mechanisms, including inhibition of ovulation and luteal function and alteration of cervical mucus and the endometrium. The high efficacy and ease of maintenance make implants an ideal contraceptive for many women, including adolescents, a population that uses implants infrequently but reports high satisfaction. Implants are appropriate for women who are breastfeeding, who have contraindications to estrogen, or who have diseases such as diabetes, hypertension, sickle cell anemia, or an HIV infection because implants have few metabolic or hematologic effects. Long-term use has not been associated with a decrease in BMD and generally leads to increased blood levels and iron stores. Women who wish to space their pregnancies appreciate the nearly immediate onset of action with insertion and the rapid termination of all effects with removal. All types of implants lead to menstrual changes and other side effects in some women. Adverse effects that occur in implant users more than the general population include headaches and acne. Women must be thoroughly counseled regarding the potential for menstrual alteration, side effects, and sexually transmitted infections if they do not use condoms. Despite their initial high cost, implants are a cost-effective method over several years, even when discontinued before the life of the implant.

Longitudinal prediction of sexually transmitted diseases among adolescents: results from a national survey

BACKGROUND

Although adolescent use of condoms has been increasing, incidence of sexually transmitted diseases (STDs) among young people remains high. To identify adolescent behavioral risk factors for acquiring STDs, this study assessed adolescent self-reports of acquired chlamydia, gonorrhea, syphilis, and trichomoniasis within 1 year after a baseline interview.

METHODS

We used data from the National Longitudinal Survey of Adolescent Health for this study. Data were collected in the homes of survey respondents, using audio-computer-assisted self-interview (audio-CASI) technology and interviews. Participants were enrolled in grades 7-11 from 134 U.S. schools. A cohort of 4593 sexually experienced adolescents was followed for 1 year. We conducted separate analyses for both genders.

RESULTS

About 3.1% of the male adolescents and nearly 4.7% of the female adolescents reported having had at least one STD after the baseline interview. For both genders, self-reported STD infection before baseline interview was the best predictor of self-reported STD infection 1 year after baseline interview. Female adolescents were more likely to report diagnosis with an STD after baseline if they self-identified as a minority race (other than Asian) and perceived that their mother did not disapprove of their having sex. Female adolescents were less likely to report STDs if they perceived that adults care about them. No additional variables predicted STD diagnosis after baseline for male adolescents.

CONCLUSIONS

We conclude that past history of STD infection is the most important indicator of subsequent STD infection among adolescents. Thus, this study suggests the benefit of specific clinical efforts designed to promote preventive behavior among adolescents newly diagnosed with an STD.