Adolescent dual method use: relevant attitudes, normative beliefs and self-efficacy

Sexual self-efficacy and sexual communication among adolescent girls: moderated mediation results from a randomized controlled trial

OBJECTIVE

Guided by the Operating Conditions Framework, the goal of this study was to identify how and for whom an online sexual health program called Health Education and Relationship Training (HEART) worked.

DESIGN

Data come from a randomized controlled trial among 198 U.S. high school girls who completed HEART or an attention-matched control. We conducted mediation and moderated mediation models to determine if sexual self-efficacy was a mediator and if program acceptability and sexual activity status were moderators of HEART efficacy.

MAIN OUTCOME MEASURE

Sexual communication skills were assessed with a behavioral role-play task.

RESULTS

HEART significantly improved sexual communication skills. These effects were fully mediated through sexual self-efficacy. Specifically, HEART improved sexual self-efficacy which in turn increased sexual communication skills. Also, when participants liked the program more, the effect of HEART on sexual self-efficacy was stronger. Further, among girls who had engaged in sexual activity, sexual self-efficacy was significantly associated with sexual communication skills.

CONCLUSION

This study provides insights into the mechanisms of behavior change underlying HEART. Results highlight the need to further 'unpack' the effects of other sexual health programs, as we showed that programs may work better under certain conditions.

Association between relationship characteristics, sexual health attitudes, and dual contraceptive use among young adult college students aged 18-24

Objective Determine the relationship characteristics, sexual health attitudes, and demographic factors associated with dual contraceptive use among college students. Participants: September-October 2018 via campus email, we recruited College of Public Health students attending a large, urban, public university (N = 424). Methods: Respondents completed a cross-sectional, Web-based sexual health questionnaire. Descriptive statistics were calculated. Multiple logistic regression models were run to determine the association between relationship characteristics, pregnancy and condom attitudes, demographics, and dual use the last time having sex. Results: In independent models, one-unit increase in trust (aOR = 0.982; 95% CI: 0.966-0.998) and commitment score (aOR = 0.987, 95% CI: 0.976-0.999) was inversely associated with dual use while sex with a casual date/acquaintance (aOR = 3.149; 95% CI: 1.550-6.397) was positively associated. In a fully adjusted model for all correlates, only trust score was significant (aOR = 0.982; 95% CI: 0.966, 0.998). Conclusions: Emotion-based constructs may be more influential on dual use behaviors than discrete relationship factors.

Barrier Protection Use by Adolescents During Sexual Activity

Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.

Examining dual method contraceptive use among midwestern parenting Latinx teens: Perspectives from adolescent parents, caretakers, and nurses

BACKGROUND

Despite dual method (DM) contraception being effective in reducing repeat-births and sexually transmitted infections (STIs), Latinx adolescent parents who live in non-traditional migration areas remain vulnerable for both outcomes.

OBJECTIVE

This study applied the Unified Theory of Behavior (UTB) and drew upon Bronfenbrenner's social ecological model to explore multiple stakeholders' (adolescent parents, caregivers, and nurses) perceptions of factors that influence DM intentions and use among Latinx adolescent parents.

METHODS

Semi-structured interviews with Latinx adolescent parent-caregiver dyads and nurses were analyzed using thematic analysis.

RESULTS

Study findings revealed that while all participant groups considered medical providers as DM influencers, contradicting views related to caregivers' as DM influencers emerged among adolescent parents and caregivers. Findings suggest that DM is deemed both acceptable and effective; and adolescent parents' reported DM self-efficacy. DM obstacles included negative emotions, environmental constraints, and poor knowledge and skills.

CONCLUSIONS

Study results suggest that constructs from the UTB framework are useful in identifying individual and social factors that can potentially influence DM intentions and use among Latinx adolescent parents.

IMPLICATIONS FOR PUBLIC HEALTH NURSING

This study's findings have potential implications for public health nurses interested in designing community-based interventions to reduce repeat-births and STIs among Latinx adolescent parents.

Pathways to Pleasure and Protection: Exploring Embodiment, Desire, and Entitlement to Pleasure as Predictors of Black and White Young Women’s Sexual Agency

Sexual agency is a fundamental dimension of sexual subjectivity and well-being. Research and theory suggest that it functions in the service of both protection from harm and enabling sexual pleasure. However, sexual agency can be difficult for women to navigate in a social landscape in which femininity ideologies remain powerful social forces, operating in racialized ways. We examined how embodiment, sexual desire, and entitlement to sexual pleasure were associated with sexual agency in the service of protection (i.e., condom use and refusing unwanted sex) and pleasure (i.e., asking for what one wants from a sexual partner) for Black and White heterosexual college women using path analysis and path invariance testing. We found that across race, women’s embodiment was associated with greater comfort with their sexual desire, which in turn was associated with greater entitlement to sexual pleasure and sexual agency in service of both pleasure and protection. While Black and White women evidenced similar levels of both forms of agency, Black participants’ agency in the service of protection was unrelated to their entitlement to sexual pleasure. We discuss these findings in light of racialized discourses of women’s sexuality and the importance of understanding sexual desire as anchored in the body and enabling young women’s sexual agency.

Factors Associated with Choice of Sterilization Among Women Veterans

Background: We sought to compare associations of contraceptive preferences, beliefs, self-efficacy, and knowledge with use of sterilization versus other methods of contraception. Materials and Methods: This is a secondary analysis of a telephone-based survey of a nationally representative sample of women Veterans not desiring future pregnancy. Contraceptive method used at last sex was categorized as female sterilization, long-acting reversible contraception (LARC), short-acting methods, or nonprescription methods/no method. Multinomial regression models were performed to compare the association between independent variables (contraceptive preferences, beliefs, self-efficacy, and knowledge) and use of sterilization versus other contraceptive methods. Results: Six hundred twelve women Veterans aged 18-44 years who were sexually active with men, had no history of hysterectomy or infertility, did not desire future pregnancy, and were not using male sterilization as their method of contraception were surveyed. A total of 208 women Veterans reported using female sterilization (34.0%). While method effectiveness was rated as extremely important by the majority of participants, there was no association between perceiving method effectiveness as extremely important and method selected in adjusted multinomial models. Women Veterans were more likely to use sterilization compared to hormonal methods of contraception if they reported that lack of hormones was an extremely important contraceptive method characteristic (aRRR 3.69, 95% CI 1.94-7.03). Women Veterans who strongly agreed with the belief that birth control decisions are mainly a woman's responsibility were less likely to use sterilization compared to LARC (aRRR 0.54, 95% CI 0.29-0.98). Conclusion: Associations between contraceptive preferences, beliefs, self-efficacy, and knowledge and use of sterilization in a population of women Veterans not desiring future pregnancy are complex, and decisions may not solely be driven by desire to select a highly effective method.

Dimensions of Reproductive Attitudes and Knowledge Related to Unintended Childbearing Among U.S. Adolescents and Young Adults

Measures of attitudes and knowledge predict reproductive behavior, such as unintended fertility among adolescents and young adults. However, there is little consensus as to the underlying dimensions these measures represent, how to compare findings across surveys using different measures, or how to interpret the concepts captured by existing measures. To guide future research on reproductive behavior, we propose an organizing framework for existing measures. We suggest that two overarching multidimensional concepts-reproductive attitudes and reproductive knowledge-can be applied to understand existing research using various measures. We adapt psychometric analytic techniques to analyze two data sets: the National Longitudinal Survey of Adolescent to Adult Health (Add Health) and the Relationship Dynamics and Social Life study (RDSL). Although the specific survey measures and sample composition of the two data sets are different, the dimensionality of the concepts and the content of the items used to measure their latent factors are remarkably consistent across the two data sets, and the factors are predictive of subsequent contraceptive behavior. However, some survey items do not seem strongly related to any dimension of either construct, and some dimensions of the two concepts appear to be poorly measured with existing survey questions. Nonetheless, we argue that the concepts of reproductive attitudes and reproductive knowledge are useful for categorizing and analyzing social psychological measures related to unintended fertility. The results can be used to guide secondary data analyses to predict reproductive behavior, compare results across data sets, and structure future data collection efforts.

Multi-contextual influences on adolescent pregnancy and sexually transmitted infections in the United States

RATIONALE

Rates of adolescent pregnancy and sexually transmitted infections (STIs) in the United States remain high. Norms and beliefs about sex and the use of contraception have been identified as potential contributors to these.

OBJECTIVE

The current study examined multi-contextual links between norms and beliefs about sex and contraception, and adolescent pregnancies and STIs.

METHOD

Hierarchical linear modeling (HLM) was used to test the study questions in the historical data from Add Health dataset (Wave I, 1994-1995, and Wave II, 1995-1996). Measures of beliefs about sex and contraception were administered to adolescents and their caregivers; pregnancies and STIs were reported by adolescents (N = 13,568; level 1). School-reported data (N = 132; level 2) included sexuality education and prevalence of pregnancies at schools. Community data included the density of family planning providers in each county.

RESULTS

Adolescents negative beliefs about contraception were associated with a higher likelihood of pregnancies and STIs via their association with contraception use. The opposite effect was found for negative beliefs about sex. Parental disapproval of contraception was associated with a decreased likelihood of STIs, but with an increased likelihood of pregnancies. A greater number of pregnancies at school was associated with a greater likelihood of STIs. Unexpectedly, the number of county-level family planning providers was associated with a higher likelihood of STIs.

CONCLUSION

Adolescent individual beliefs emerged as the most salient predictors of both pregnancies and STIs.

A Qualitative Assessment to Understand the Barriers and Enablers Affecting Contraceptive Use Among Adolescent Male Emergency Department Patients

Early fatherhood is common in the United States (U.S.). The emergency department (ED) plays a disproportionate role in serving patients with unmet reproductive and sexual health needs. With 8 million adolescent males visiting U.S. EDs annually, the ED is a potential site to implement interventions to minimize early fatherhood and unintended teenage pregnancy. Little is known about how adolescent male ED patients perceive and behave in sexual relationships and how they influence contraceptive decision making. The objective of this study was to identify the barriers and enablers affecting contraceptive and condom use among adolescent male ED patients. Semistructured interviews were conducted with males aged 14-19 in one urban ED. Enrollment continued until saturation of key themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo 10. The Social Ecological Model was used to organize and understand themes. Participants ( n = 24) were predominantly 18-19 years (63%) and Hispanic (92%). Most (71%) had sex ≤3 months prior but infrequently used a condom at last intercourse (42%). The primary barrier influencing contraceptive use was lack of knowledge of effective contraceptives. Other barriers consisted of perceived gender roles, poor partner communication, and little relationship with a primary provider. Enablers included intention not to get a partner pregnant, school-based sexual health education, normalcy to use condoms, and a trustworthy confidante. The identified barriers and enablers influencing adolescent males' perspectives toward contraceptives should be addressed if designing future ED-based pregnancy prevention interventions targeting teen males.

Girls' self-efficacy in the context of neighborhood gender stratification

Scholars have linked neighborhood characteristics to self-efficacy, but few have considered how gender factors into this association. We integrate literature on neighborhoods, gender stratification, and self-efficacy to examine the association between women's relative resources among neighborhood residents and adolescents' self-efficacy. We hypothesize that girls report more self-efficacy when they reside in neighborhoods where women have more socioeconomic resources relative to men. We test this hypothesis using data from the Project on Human Development in Chicago Neighborhoods and the 1990 Census. Results from multilevel regression models with gender-interacted effects indicate the neighborhood level of women's relative resources was not associated with boys' self-efficacy. However, girls reported higher self-efficacy when women's relative resources in their neighborhoods were greater. This association persisted after including potential individual- and neighborhood-level confounding variables. Our study underscores the importance of attending to gendered processes when understanding how neighborhoods impact youth.

Dual Contraceptive Method Use Among Youth in Alternative Schools

Dual contraceptive method use, or using a highly effective contraceptive method plus a barrier method like condoms, is gaining attention as a strategy for preventing unplanned pregnancy and sexually transmitted diseases. We investigated rates of dual method use among a sample of youth in urban alternative schools, and explored the relationship between dual method use and sexual partner type. The study analyzed data from 765 students enrolled in 11 district-run continuation high schools in northern California. We explored the association between dual method use and sexual partner type (steady only, a mix of steady and non-steady, and non-steady only) using logistic regression. Differences in dual rates by partner type were statistically significant, with higher rates of dual methods use reported among young people reporting non-steady sexual partners only, as compared to those with steady partners only. The data illustrate that young people in alternative school settings could gain from further intervention on the benefits, skills, and challenges of using two methods of contraception as opposed to one with both steady and non-steady sexual partners.

Perceptions of adolescent 'simulated clients' on barriers to seeking contraceptive services in health centers and pharmacies in Mexico

OBJECTIVE

To examine adolescent simulated clients' perceived barriers to quality care as they sought information on contraceptives in public-sector healthcare facilities and pharmacies in Mexico.

STUDY DESIGN

We used a qualitative research design and conducted semi-structured interviews with eight young women who posed as simulated clients at health centers and pharmacies in Mexico City. Grounded Theory was used to analyze the transcripts.

RESULTS

Barriers to receiving information about contraceptives included healthcare professionals who gave administrative pretexts to avoid providing services. Simulated clients also felt judged by healthcare professionals and reported a lack of simple, understandable and pertinent information. Healthcare professionals did not ensure clients understood and had no further questions about using contraceptives, which resulted in clients' poor perceived self-efficacy, as well as a lack of confidence in the healthcare system to help them.

CONCLUSIONS

When healthcare professionals fail to provide services according to the World Health Organization's five basic criteria of adolescent friendly care, adolescents perceive important barriers in their access to contraceptive methods. Quality of sexual health care in Mexico would benefit from efforts to improve healthcare professionals' knowledge, attitudes and skills related to adolescent friendly service delivery.

Motivating factors for dual-method contraceptive use among adolescents and young women: a qualitative investigation

OBJECTIVE

This qualitative study explores how adolescents and young women perceive the need for and describe the use of dual method contraception.

STUDY DESIGN

We interviewed 20 sexually active women aged 16-24 who attended an adolescent-focused Title X family-planning clinic and were using a non-barrier contraceptive method. We used a semi-structured interview guide that included domains related to sexual activity, knowledge of and use of contraceptives and condoms, and relationship factors. We coded transcripts using grounded theory techniques and used an iterative process to develop overarching themes.

RESULTS

Dual method contraceptive users primarily discussed pregnancy prevention as their motivating factor. Many expressed anxieties over an unplanned pregnancy and reported condom use as "back-up" contraception. Risk perception for pregnancy or STI acquisition did not necessarily change as relationship trust increased, but rather, their anxiety regarding the negativity of such outcomes decreased. Dual-method contraception use decreased when participants reported that condoms were not readily available, or when they self-described immaturity. Less frequently, participants reported dual method use for sexually transmitted infection (STI) prevention, and many substituted STI testing for condom use. Contraceptive type (short-acting vs. long-acting) did not influence reported attitudes towards dual method use.

CONCLUSION

Health educators and clinicians encourage condom use in young women due to the significant morbidity associated with STI acquisition. Most participants in our study view condoms as a way to improve pregnancy prevention. Acknowledging and addressing this divergence in motivation will allow caregivers to improve strategies for communicating the importance of dual method use.

IMPLICATIONS

Young women primarily describe pregnancy prevention as the reason for dual method use, STI protection is less salient. Consideration of this viewpoint by health educators and clinicians will allow us to communicate more effectively to prevent STI morbidity.

Racial/ethnic differences in contraceptive preferences, beliefs, and self-efficacy among women veterans

BACKGROUND

Significant racial/ethnic disparities in unintended pregnancy persist in the United States, with the highest rates observed among low-income black and Hispanic women. Differences in contraceptive preferences, beliefs, and self-efficacy may be instrumental in understanding contraceptive behaviors that underlie higher rates of unintended pregnancy among racial/ethnic minorities.

OBJECTIVES

Our objective was to understand how contraceptive preferences, beliefs, and self-efficacy vary by race and ethnicity among women veterans.

STUDY DESIGN

We analyzed data from the Examining Contraceptive Use and Unmet Need Study, a national telephone survey of women veterans aged 18-44 years who had received primary care at the Veterans Administration in the prior 12 months. Participants rated the importance of various contraceptive characteristics and described their level of agreement with contraceptive beliefs using Likert scales. Contraceptive self-efficacy was assessed by asking participants to rate their certainty that they could use contraception consistently and as indicated over time using a Likert scale. Multivariable logistic regression was used to examine associations between race/ethnicity and contraceptive attitudes, controlling for age, marital status, education, income, religion, parity, deployment history, and history of medical and mental health conditions.

RESULTS

Among the 2302 women veterans who completed a survey, 52% were non-Hispanic white, 29% were non-Hispanic black, and 12% were Hispanic. In adjusted analyses, compared with whites, blacks had lower odds of considering contraceptive effectiveness extremely important (adjusted odds ratio; 0.55, 95% confidence interval, 0.40-0.74) and higher odds of considering the categories of does not contain any hormones and prevents sexually transmitted infections extremely important (adjusted odds ratio, 1.94, 95% confidence interval, 1.56-2.41, and adjusted odds ratio; 1.99, 95% confidence interval, 1.57-2.51, respectively). Hispanics also had higher odds than whites of considering the category of does not contain any hormones and prevents sexually transmitted infections extremely important (adjusted odds ratio, 1.72, 95% confidence interval, 1.29-2.28, and adjusted odds ratio, 1.63; 95% confidence interval, 1.21-2.19, respectively). Compared with whites, blacks and Hispanics had higher odds of expressing fatalistic beliefs about pregnancy (adjusted odds ratio, 1.79, 95% confidence interval, 1.35-2.39, and adjusted odds ratio, 1.48, 95% confidence interval, 1.01-2.17, respectively); higher odds of viewing contraception as primarily a woman's responsibility (adjusted odds ratio, 1.92, 95% confidence interval, 1.45-2.55, and adjusted odds ratio, 1.77; 95% confidence interval, 1.23-2.54, respectively); and lower odds of being very sure that they could use a contraceptive method as indicated over the course of a year (adjusted odds ratio, 0.73, 95% confidence interval, 0.54-0.98, and adjusted odds ratio, 0.66, 95% confidence interval, 0.46-0.96, respectively).

CONCLUSION

Women veterans' contraceptive preferences, beliefs, and self-efficacy varied by race/ethnicity, which may help explain observed racial/ethnic disparities in contraceptive use and unintended pregnancy. These differences underscore the need to elicit women's individual values and preferences when providing patient-centered contraceptive counseling.

Factors Associated with Contraceptive Use Differ between Younger and Older African-American Female Adolescents

STUDY OBJECTIVE

To examine differences in factors associated with contraceptive use between younger and older adolescent age groups, which has not previously been well described.

DESIGN

Age group-specific analyses were performed on cross-sectional survey data to identify factors associated with any contraceptive use at last sex among younger (14- to 16-year-old) and older (17- to 19-year-old) sexually active African American female adolescents; interaction analyses were used to assess whether these associations differed by age.

SETTING

Adolescent reproductive health clinic in Atlanta, Georgia.

PARTICIPANTS

Sexually active African American female adolescents 14-19 years of age.

INTERVENTIONS

No intervention tested; cross-sectional design.

MAIN OUTCOME MEASURE

Self-reported contraceptive use during most recent vaginal sex with a male partner.

RESULTS

The prevalence of contraceptive use at last sex was identical in both groups; however, factors associated with contraceptive use differed according to age. The only factor associated with contraceptive use in both age groups was involvement in decisions about sexual health in the most recent relationship. Associations between factors and contraceptive use significantly differed according to age. History of sexually transmitted infection, age difference with partner, discussion of condoms with partner, and concurrent partners were important factors among younger adolescents; worry about pregnancy and discussion of birth control with partner were important among older adolescents.

CONCLUSION

Factors associated with contraceptive use at last sex differ according to adolescent age; this should be considered when designing counseling and interventions for teens, as well as research.

Dual protection to address the global syndemic of HIV and unintended pregnancy in Brazil

BACKGROUND

Syndemic HIV and unintended pregnancy is prevalent in Brazil, where 79% of female HIV cases occur in women of reproductive age and 55% of all pregnancies are unintended. Although increasing condom use to prevent HIV may decrease non-barrier contraception and increase unintended pregnancy, few studies focus on dual protection or dual methods (condoms with another modern contraceptive).

AIM

To describe the correlates of dual method use and consistent condom use in women of reproductive age in Brazil.

METHOD

Data are from the 2006 Pesquisa Nacional de Demografia e Saúde da Mulher e da Criança, a decennial nationally representative household survey of women of reproductive age in Brazil. Multivariate logistic regression models identify the socio-demographic, sexual debut, fertility and relationship factors associated with dual method use and consistent condom use.

RESULTS

Two-thirds of contracepting women in Brazil used dual protection (40% exclusive condoms, 27% dual methods). Consistent condom use in the past year occurred among 61% of exclusive condom users and 27% of dual method users. Dual methods (vs exclusive condoms) was associated with some high school education [relative risk ratio (RRR)=1.69, p<0.05], living in the Southern region (RRR=1.59, p<0.01), and number of children (RRR=1.22, p<0.01), net of other factors. Consistent condom use was associated with condom use at sexual debut [adjusted odds ratio (AOR)=1.84, p<0.001], wants no (more) children (AOR=1.86, p<0.001), single/separated relationship status (AOR=2.77/2.45, p<0.001) and using exclusive condoms (vs dual methods: AOR=0.19, p<0.001).

CONCLUSIONS

Findings highlight that targeting and delivering integrated HIV and family planning services should focus on completed/large families. single/separated individuals, and promoting dual protection at sexual debut.

Positive Youth Development and Contraceptive Use Consistency

INTRODUCTION

Understanding protective factors associated with adolescent contraceptive use can guide strategies to prevent unprotected sex and its consequences. The current study investigated associations between a set of protective factors, specifically indicators of positive youth development, and consistency of contraceptive use.

METHOD

This cross-sectional study examined relationships between positive youth development indicators and consistency of contraceptive use among sexually active adolescent girls at elevated risk for pregnancy. Multivariate models assessed whether measures of individual attributes, social attachments, and social norms were associated with consistent condom and hormonal contraceptive use.

RESULTS

Adolescents with higher self-esteem and greater family connectedness reported more consistent hormonal contraceptive use. Two factors, stress management skills and perceived peer prosocial norms, were protective for consistent condom use. In contrast, steady partnership status was associated with less consistent condom use.

DISCUSSION

Findings suggest that interventions targeting protective factors may influence adolescents' contraceptive use, in addition to promoting their healthy development.

Abusive Experiences and Young Women's Sexual Health Outcomes: Is Condom Negotiation Self-Efficacy a Mediator?

CONTEXT

Intimate partner violence and reproductive coercion are associated with unintended pregnancies and STDs. Greater condom negotiation self-efficacy among young women may mediate these associations.

METHODS

A sample of 841 female adolescents (aged 16-19) and 1,387 young adult women (aged 20-24) recruited from 24 family planning clinics in western Pennsylvania in 2011-2012 reported on intimate partner violence, reproductive coercion, condom negotiation self-efficacy and sexual health outcomes at baseline and four- and 12-month follow-ups. Mixed models were used to test associations of intimate partner violence and reproductive coercion with unintended pregnancy and STD diagnosis. The Sobel test of mediation was used to measure indirect effects of condom negotiation self-efficacy.

RESULTS

At baseline, 15% of adolescents and 11% of young adults reported recent intimate partner violence victimization; 7% and 6%, respectively, reported recent reproductive coercion. For both age-groups, intimate partner violence and reproductive coercion were associated with a reduced level of condom negotiation self-efficacy (coefficients, -0.27 to -0.13) and increased odds of STD diagnosis (odds ratios, 1.03-1.1). However, only reproductive coercion was associated with unintended pregnancy (odds ratios, 1.1 for each group). The only association that condom negotiation self-efficacy mediated was between reproductive coercion and unintended pregnancy among young adults (17% of total effect).

CONCLUSIONS

Targeting condom negotiation self-efficacy alone in abusive relationships would likely not translate into improved sexual health outcomes in this population. Other strategies are needed to prevent unintended pregnancy and STDs.

Long-Acting Reversible Contraception and Condom Use Among Female US High School Students: Implications for Sexually Transmitted Infection Prevention

IMPORTANCE

Long-acting reversible contraception (LARC), specifically intrauterine devices and implants, offers an unprecedented opportunity to reduce unintended pregnancies among adolescents because it is highly effective even with typical use. However, adolescent LARC users may be less likely to use condoms for preventing sexually transmitted infections compared with users of moderately effective contraceptive methods (ie, oral, Depo-Provera injection, patch, and ring contraceptives).

OBJECTIVE

To compare condom use between sexually active female LARC users and users of moderately effective contraceptive methods.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional analysis using data from the 2013 national Youth Risk Behavior Survey, a nationally representative sample of US high school students in grades 9 through 12. Descriptive analyses were conducted among sexually active female students (n = 2288); logistic regression analyses were restricted to sexually active female users of LARC and moderately effective contraception (n = 619). The analyses were conducted in July and August 2015.

MAIN OUTCOMES AND MEASURES

Contraceptive method at last sexual intercourse was assessed by 1 item-respondents could select birth control pills; condoms; an intrauterine device or implant; injection, patch, or ring; withdrawal or other method; or not sure. A separate item asked whether respondents used a condom at last sexual intercourse. We created an indicator variable to distinguish those reporting use of (1) LARC (intrauterine device or implant), (2) oral contraceptives, and (3) Depo-Provera, patch, or ring.

RESULTS

Among the 2288 sexually active female participants (56.7% white; 33.6% in 12th grade), 1.8% used LARC; 5.7% used Depo-Provera, patch, or ring; 22.4% used oral contraceptives; 40.8% used condoms; 11.8% used withdrawal or other method; 15.7% used no contraceptive method; and 1.9% were not sure. In adjusted analyses, LARC users were about 60% less likely to use condoms compared with oral contraceptive users (adjusted prevalence ratio [aPR], 0.42; 95% CI, 0.21-0.84). No significant differences in condom use were observed between LARC users and Depo-Provera injection, patch, or ring users (aPR, 0.57; 95% CI, 0.26-1.25). The LARC users were more than twice as likely to have 2 or more recent sexual partners compared with oral contraceptive users (aPR, 2.61; 95% CI, 1.75-3.90) and Depo-Provera, patch, or ring users (aPR, 2.58; 95% CI, 1.17-5.67).

CONCLUSIONS AND RELEVANCE

Observed differences in condom use may reflect motivations to use condoms for backup pregnancy prevention. Users of highly effective LARC methods may no longer perceive a need for condoms even if they have multiple sexual partners, which places them at risk for sexually transmitted infections. As uptake of LARC increases among adolescents, a clear need exists to incorporate messages about condom use specifically for sexually transmitted infection prevention.

Use of Dual Methods for Protection from Unintended Pregnancy and Sexually Transmitted Diseases in Adolescent African American Women

STUDY OBJECTIVE

To characterize factors associated with dual method contraceptive use in a sample of adolescent women. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional survey of sexually active African American women aged 14-19 years who attended an urban Title X clinic in Georgia in 2012 (N = 350). Participants completed a computerized survey to assess contraceptive and condom use during the past 2 sexual encounters with their most recent partner. Dual method use was defined as use of a hormonal contraceptive or intrauterine device and a condom. We applied multinomial logistic regression, using generalized estimating equations, to examine the adjusted association between dual method use (vs use of no methods or less effective methods alone; eg, withdrawal) and select characteristics.

RESULTS

Dual methods were used by 20.6% of participants at last sexual intercourse and 23.6% at next to last sexual intercourse. Having a previous sexually transmitted disease (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.26-4.18), negative attitude toward pregnancy (aOR, 2.25; 95% CI, 1.19-4.28), and a mother who gave birth as a teen (aOR, 2.34; 95% CI, 1.21-4.52) were associated with higher odds of dual method use. Having no health insurance (aOR, 0.39; 95% CI, 0.18-0.82), 4 or more lifetime sexual partners (aOR, 0.42; 95% CI, 0.22-0.78), sex at least weekly (aOR, 0.54; 95% CI, 0.29-0.99), and agreeing to monogamy with the most recent partner (aOR, 0.40; 95% CI, 0.16-0.96) were associated with decreased odds of dual method use.

CONCLUSION

Dual method use was uncommon in our sample. Efforts to increase use of dual methods should address individual and relationship factors.

Identifying Adolescent Patients at Risk for Sexually Transmitted Infections: Development of a Brief Sexual Health Screening Survey

This study examined the association between survey responses to health behaviors, personality/psychosocial factors, and self-reported sexually transmitted infections (STIs) to create a brief survey to identify youth at risk for contracting STIs. Participants included 200 racially diverse 14- to 18-year-old patients from a pediatric primary care clinic. Two sexual behavior variables and one peer norm variable were used to differentiate subgroups of individuals at risk of contracting a STI based on reported history of STIs using probability (decision tree) analyses. These items, as well as sexual orientation and having ever had oral sex, were used to create a brief sexual health screening (BSHS) survey. Each point increase in total BSHS score was associated with exponential growth in the percentage of sexually active adolescents reporting STIs. Findings suggest that the BSHS could serve as a useful tool for clinicians to quickly and accurately detect sexual risk among adolescent patients.

Effective dual method contraceptive use and HPV vaccination among U.S. adolescent and young adult females

BACKGROUND

Problem Behavior Theory posits that risky behaviors cluster in individuals, implying that protective behaviors may follow a similar pattern. The purpose of this study was to determine whether the protective behavior of effective dual method contraception use at first and most recent sexual intercourse is associated with HPV vaccination among adolescent and young adult females.

METHODS

National Survey of Family Growth (2006-2010) data were used to examine the association between women's contraception use during first and most recent sexual intercourse and HPV vaccination. Women aged 15 to 24 years (n = 1,820) served as the study sample.

FINDINGS

At first and last sexual intercourse, effective dual method contraception use was reported by 15.3% and 16.8% women, respectively; 27.8% reported receiving at least one dose of the human papillomavirus (HPV) vaccine. Higher HPV vaccination rates were observed among dual method users at first and last sexual intercourse (36.4% and 48.2%, respectively). This trend was also observed across age groups (15-19 year olds vs. 20-24 year olds). In adjusted models, among all respondents, dual users at last sexual intercourse were significantly more likely to be vaccinated, whereas at first sexual intercourse only younger dual users were more likely to report HPV vaccination.

CONCLUSIONS

Findings suggest that the protective behavior of dual method contraceptive use at first and most recent sexual intercourse may serve as a predictor of another complementary health behavior, HPV vaccination, particularly among adolescent females. More research is needed to understand behavioral clustering to design related multi-focused women's health interventions.

Barriers to and enablers of contraceptive use among adolescent females and their interest in an emergency department based intervention

OBJECTIVE

Over 15 million adolescents, many at high risk for pregnancy, use emergency departments (EDs) in the United States annually, but little is known regarding reasons for failure to use contraceptives in this population. The purpose of this study was to identify the barriers to and enablers of contraceptive use among adolescent females using the ED and determine their interest in an ED-based pregnancy prevention intervention.

STUDY DESIGN

We conducted semistructured, open-ended interviews with females in an urban ED. Eligible females were 14-19 years old, sexually active, presenting for reproductive health complaints and at risk for pregnancy, defined as nonuse of effective (per the World Health Organization) contraception. Interviews were recorded, transcribed and coded based on thematic analysis. Enrollment continued until no new themes emerged. A modified Health Belief Model guided the organization of the data.

RESULTS

Participants (n=14) were predominantly Hispanic (93%), insured (93%) and in a sexual relationship (86%). The primary barrier to contraceptive use was perceived health risk, including effects on menstruation, weight and future fertility. Other barriers consisted of mistrust in contraceptives, ambivalent pregnancy intentions, uncertainty about the future, partner's desire for pregnancy and limited access to contraceptives. Enablers of past contraceptive use included the presence of a school-based health clinic and clear plans for the future. All participants were receptive to ED-based pregnancy prevention interventions.

CONCLUSIONS

The identified barriers and enablers influencing hormonal contraceptive use can be used to inform the design of future ED-based adolescent pregnancy prevention interventions.

IMPLICATIONS

Adolescents who visit the emergency department (ED) identify contraceptive side effects, mistrust in contraceptives, limited access, pregnancy ambivalence and partner pregnancy desires as barriers to hormonal contraception use. They expressed interest in an ED-based intervention to prevent adolescent pregnancy; such an intervention could target these themes to maximize effectiveness.

Dual method use at last sexual encounter: a nationally representative, episode-level analysis of US men and women

OBJECTIVES

Male condom use in conjunction with other contraceptives increases protection against pregnancy and sexually transmitted infections. However, few analyses contextualize dual method use within the sexual episode, include reports from men or explore gendered patterns in reporting.

STUDY DESIGN

We analyzed dual method use patterns using a nationally representative dataset of 18-44 years old in the US (N=404 men, 416 women). Respondents indicated contraceptive methods used at last penile-vaginal intercourse, condom practices and relationship and sexual information about that particular partner.

RESULTS

More than one-in-three penile-vaginal intercourse episodes (40%) involved male condom use: 28% condom only and 12% condom plus a highly effective method. Dual method reporting did not differ significantly by gender. Among dual method users, only 59% reported condom use during the entire intercourse episode, while 35% began intercourse without one and 6% removed the condom during intercourse. A greater proportion of men than women reported incorrect use of condoms (49% versus 35%), though this difference was not statistically significant. Only 50% of dual method users reported condom use in all of their last 10 intercourse episodes.

CONCLUSIONS

Many people classified as "dual users" in previous studies may not be using dual methods consistently or correctly. Researchers and practitioners should inquire how and how often condoms are used when assessing and addressing dual method use. Furthermore, though men have rarely been surveyed about dual method use, they can provide consistent contraceptive estimates and may be more likely to report condom practices such as late application or early removal.

IMPLICATIONS STATEMENT

Many US women and men reporting dual method use also reported late application and early removal of condoms, as well as multiple condom-less prior sexual acts with that partner. Clinicians may wish to inquire how and how often clients use condoms; they may also wish to provide condom instruction and/or tips on better integrating condoms into the sexual experience with one's partner.

Dual method use among a sample of first-year college women

CONTEXT

Dual method use-using one protective method to reduce the risk of STDs and another to prevent pregnancy-is effective but understudied. No prior studies have employed an event-level approach to examining characteristics associated with dual method use among college women.

METHODS

In 12 consecutive monthly surveys conducted in 2009-2010, data on 1,843 vaginal intercourse events were collected from 296 first-year college women. Women reported on their use of condoms and hormonal contraceptives during all events. Multilevel regression analysis was used to assess associations between event-, month- and person-level characteristics and hormonal use and dual method use.

RESULTS

Women used hormonal contraceptives during 53% of events and condoms during 63%. Dual method use was reported 28% of the time, and only 14% of participants were consistent users of dual methods. The likelihood of dual method use was elevated when sex partners were friends as opposed to romantic partners or ex-boyfriends (odds ratios, 2.5-2.8), and among women who had received an STD diagnosis prior to college (coefficient, 2.9); it also increased with level of religiosity (0.8). Dual use was less likely when less reliable methods were used (odds ratio, 0.2) and when women reported more months of hormonal use (0.8), were older than 18 (coefficient, -4.7) and had had a greater number of partners before college (-0.3).

CONCLUSIONS

A better understanding of the characteristics associated with dual method use may help in the design of potential intervention efforts.

Dual use of condoms with other contraceptive methods among adolescents and young women in the United States

PURPOSE

To estimate the prevalence of and factors associated with dual method use (i.e., condom with hormonal contraception or an intrauterine device) among adolescents and young women in the United States.

METHODS

We used 2006-2010 National Survey of Family Growth data from 2,093 unmarried females aged 15-24 years and at risk for unintended pregnancy. Using multivariable logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to assess the associations between dual method use at last sex and sociodemographic, behavioral, reproductive history, and sexual behavior factors.

RESULTS

At last sex, 20.7% of adolescents and young women used dual methods, 34.4% used condoms alone, 29.1% used hormonal contraception or an intrauterine device alone, and 15.8% used another method or no method. Factors associated with decreased odds of dual method use versus dual method nonuse included having a previous pregnancy (aOR = .44, 95% CI .27-.69), not having health insurance coverage over the past 12 months (aOR = .41, 95% CI .19-.91), and having sex prior to age 16 (aOR = .49, 95% CI .30-.78).

CONCLUSIONS

The prevalence of dual method use is low among adolescents and young women. Adolescents and young women who may have a higher risk of pregnancy and sexually transmitted infections (e.g., those with a previous pregnancy) were less likely to use dual methods at last sex. Interventions are needed to increase the correct and consistent use of dual methods among adolescents and young women who may be at greater risk for unintended pregnancy and sexually transmitted infections.

Dual use of long-acting reversible contraceptives and condoms among adolescents

Unintended pregnancy and sexually transmitted infections (STI) continue to be significant public health problems, and adolescents are disproportionately affected by both. With national attention and funding directed toward adolescent pregnancy prevention, promotion of long-acting reversible contraceptive (LARC) use among adolescents is both timely and relevant. However, LARCs provide no protection against STIs, requiring dual-method use of both LARC and barrier methods, most commonly the male latex condom, to address these issues simultaneously. Rates of both LARC and dual-method contraception are low in the United States, but have increased in recent years. Dual-method contraception is highest among younger women and adolescents with multiple or new sex partners. Consistent condom use remains a major barrier to dual-method use, as it necessitates admission of STI risk by both partners, and use is dependent upon two decision-makers rather than a single contraceptive user. Promoting the initiation and maintenance of LARC and condom use across multiple partnered sexual encounters requires understanding of individual, dyadic, and social influences. Successful maintenance of contraceptive and STI prevention behaviors requires individualized, longitudinal reinforcement, and social supports, but can ultimately reduce the burden of unintended pregnancy and STI among adolescents.

Sex, condoms and sexually transmissible infections: a qualitative study of sexual health in young Australian men

Young males have a key role in shaping contraceptive use in a sexual relationship, yet often remain the invisible partner in safe sex promotion. This article describes a conceptual model of STI risk and condom use based on the perceptions and experiences of condom use in a group of young Australian males. An explorative descriptive design was used to conceptualize participants' condom use histories into an organized description of behavior. Forty-two semi-structured interviews were conducted with a purposive sample of males aged 15 to 25 years over an 18 month period. A sequential analytical process of data immersion, coding, and category generation was used to identify personal meanings, motivations, and contextual factors associated with condom use and non-use. Three primary discourses associated with young males' perceptions of STI risk and responding approach to condom use constructed personal commitment to sexual safety as dynamic, context-dependent, and outcome-driven (pregnancy versus STIs as the primary motivator of condom use). A regretful discourse associated with experiences of, or suspected unwanted outcomes, also emerged through changes in risk appraisals and safe sex intentions and behavior. Interventions to increase condom use should go beyond the traditional focus on risky behavior and disease prevention frameworks by addressing the contextual influences on personal risk appraisals and deliver innovative messages to reduce negative social meanings associated with condom use.

Correlates of dual-method contraceptive use: an analysis of the National Survey Of Family Growth (2006-2008)

Objective. To analyze a nationally representative sample of women for correlates of dual-contraceptive-method use. Materials and Methods. We conducted an analysis of the National Survey of Family Growth, 2006–2008, a cross-sectional survey of reproductive-aged women in the United States. Results. Dual method use was reported by 7.3% of the 5,178 women in the sample. Correlates of higher rates of dual-contraceptive-method use included age younger than 36 years and nonmarried marital status. Lower rates of dual method use were observed for women with less than a high-school education and women without consistent health insurance in the past year. Compared to women using oral contraceptives, use of the contraceptive injection or long-acting reversible contraception was associated with lower dual-method use. Conclusions. The overall rate of dual-method use in the USA is low. Future interventions to promote dual method use should target high-risk groups with modifiable risk factors.

Strategies for managing the dual risk of sexually transmitted infections and unintended pregnancy among Puerto Rican and African American young adults

Although young adults in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy, they do not report high rates of dual-method use (condoms plus other contraception) for prevention. We used prospective qualitative data from 69 urban Puerto Rican and African American individuals aged 18 to 25 years to determine how they managed these risks in their heterosexual relationships during a 4- to 8-week period. Hormonal or long-acting contraceptive use, condoms, and withdrawal were the most common unintended pregnancy prevention strategies; condoms, STI testing, and perceived fidelity were dominant among STI prevention strategies. We need to shift the focus from dual-method use toward a broader concept of dual protection to be more responsive to young adults' concerns, perceptions, and priorities.

Dual use of condoms and contraceptives in the USA

Background Use of condoms in conjunction with other contraceptive methods has multiple benefits: prevention of unintended pregnancy, protection against sexually transmissible infections (STI), and sequentially, defence against the threat of infertility. However, few reviews compare dual method use prevalence or trends or systematically review the facilitators and barriers of dual method use across multiple studies. Methods: The authors review the literature on trends and covariates of dual method use in the USA among both nationally representative and smaller samples. Results: Although dual method use prevalence estimates vary widely across study populations, nationally representative estimates are consistently lower than Western European countries, who in turn report lower rates of unintended pregnancies and STI. The majority of published work on dual method use focuses on adolescents. Prior studies have associated dual method use with a range of individual-level factors: socio-demographic variables, such as younger age; STI risk behaviours and risk perception; relationship variables, such as number of partners, relationship length, and partner support of condoms; and educational factors, such as prior exposure to HIV prevention messages. Conclusions: Although dual method use appears to be on the rise, especially among adolescents and young adults, US rates are comparatively low and leave much room for improvement. This review identifies several populations most in need of intervention. However, we encourage public health practitioners to evolve beyond individual-level studies and interventions to focus on the relational, socio-cultural, and structural influences on dual method use. Dual use promotion programs and policies should also equally target men and women, adolescents and adults.

Are dual-method messages undermining STI/HIV prevention?

Adolescent girls and young women who are at risk for unplanned pregnancy and sexually transmitted infection (STI), including HIV, are frequently counseled to use a hormonal contraceptive to protect against the former and condoms to protect against the latter, for example, American College of Obstetricians and Gynecologists, 2011. The present paper reviews the literature on multiple risk messages, compliance with this dual-use recommendation, predictors of dual use, and interventions developed to encourage dual use. Data indicate that simultaneous use of these two methods is not common, and that efforts to encourage dual use have not yielded promising results. An alternative is to recommend condom use alone, since condoms protect very well against STI and HIV, and quite well against pregnancy when used consistently and correctly. The availability of emergency contraception is relevant here. Research utilizing a randomized controlled trial is recommended.

Psychosocial Correlates of Dual Methods for Contraception and STI Protection in Urban Adolescents

Purpose. To identify correlates of combined hormonal contraception and condom use (dual method use) compared with no methods, condoms only or hormonal contraception only. Data are from a baseline assessment of 335 youth (52% female) enrolled in an intervention trial. Multinomial logistic regression identified theory-based factors associated with dual method use. At last intercourse 47% of respondents used dual methods, 29% condom only, 14% hormonal contraception only, and 10% no methods. No method users were less likely than dual-method users to feel "dirty" about pregnancy, to have ask about historical condom use, to have more than two partners, to view condom use as normative for boys and more likely to perceive pregnancy risk as remote. Hormonal-contraception-only users were more likely to have sex weekly and perceive sex as pleasurable for girls, and less likely to view condom use as normative for boys and to ask a partner to use a condom. Condom-only users were more likely to perceive pregnancy chance as remote, and less likely to have more than two partners and to want peers to think they were virgins. Interventions should include benefits of dual methods while counseling about the negative impact of STI and unplanned teen pregnancy.

The role of beliefs in sexual behavior of adolescents: Development and validation of an Adolescent Sexual Expectancies Scale (ASEXS)

This paper reports on the development and psychometric properties of the Adolescent Sexual Expectancies Scale (ASEXS). Data were obtained from three annual longitudinal surveys of youth aged 10 - 17 at the first administration (N = 932 at Wave 3). Confirmatory factor analyses indicated that four correlated factors corresponding to Social Risk, Social Benefit, Health Risk, and Pleasure adequately represented the expectancy items. High alpha coefficients and stability across survey waves indicated good internal and test-retest reliability for these factors. Latent variable autoregressive analyses indicated that Social Risk expectancies predicted changes in sexual behavior over the course of the study. Multi-group analyses established that the measurement and predictive models were equivalent for males and females and across age groups. The ASEXS provides researchers with a useful measure for examining adolescents' expectancy beliefs about the consequences of sexual behavior.

Acceptability of the vaginal contraceptive ring among adolescent women

STUDY OBJECTIVE

Although underutilized, the vaginal contraceptive ring has several advantages over other contraceptive methods that could benefit adolescents. We examined factors that may influence willingness to try the vaginal ring including: sexual and contraceptive history, genital comfort, and vaginal ring characteristics.

DESIGN

Cross sectional

SETTING

Midwestern adolescent health clinics

PARTICIPANTS

Adolescent women (N = 200; 14-18 years; 89% African-American) INTERVENTIONS/MAIN OUTCOME MEASURES: All participants received education about the vaginal ring and viewed pictures demonstrating insertion; they then completed a visual/audio computer-assisted self interview. The primary outcome variable, willingness to try the vaginal ring, was a single Likert-scale item.

RESULTS

Over half the participants reported knowledge of the vaginal ring with healthcare providers identified as the most important source of contraceptive information. Comfort with one's genitals, insertion and removal, using alternative methods of insertion, and knowing positive method characteristics were significantly associated with willingness to try the vaginal ring. A decreased willingness to try the vaginal ring was related to concerns of the ring getting lost inside or falling out of the vagina.

CONCLUSIONS

Willingness to try the ring was associated with positive feelings about genitals (e.g., comfort with appearance, hygiene, function). Thus, to increase willingness to try the vaginal ring among adolescents, providers should make it common practice to discuss basic female reproductive anatomy, raise awareness about female genital health and address concerns about their genitals. Providers can offer alternative insertion techniques (e.g., gloves) to make use more accessible. These strategies may increase vaginal ring use among adolescents.

Predictors of unprotected intercourse for female adolescents measured at their request for a pregnancy test

The purpose of this study was to identify predictors of unprotected intercourse in a sample of female adolescents requesting pregnancy testing. A survey was completed by 305 adolescents at a clinic visit. The dependent variable, unprotected sexual intercourse, was measured by self-reported frequency of condom use. Significant variables in the final regression model predicting condom nonuse included current partner's age, frequency of sexual activity, race, age at menarche, time dating, resiliency, reproductive knowledge, and fertility fear. Fertility fears were identified as a possible motivator for unprotected intercourse, an important finding for health care professionals providing care to adolescents.

Adolescent condom use consistency over time: global versus partner-specific measures

BACKGROUND

The conundrum of measuring condom use consistency, particularly with adolescents, has left researchers with a cacophony of strategies, thereby limiting comparability and interpretation.

OBJECTIVE

The aim of this analysis was to compare and contrast two measures of condom use consistency, global versus partner specific, and their relationships with key covariates, using trajectory groups differentiated by stability of condom use consistency over three time points.

METHOD

Using self-report data from sexually active girls (aged 13-17 years) in a clinic-based intervention study aimed at lowering risk for early pregnancy, this analysis compared two measures of self-reported condom use consistency: (a) a global measure: overall condom use consistency in the past 6 months and (b) a partner-specific measure: condom use consistency with the most recent sex partner in the last 6 months. Using a subjective rule-based approach, the adolescent girls in the study (n = 151) were classified into trajectory groups representing their condom use consistency at three time points (baseline and 6 and 12 months). Then, using bivariate methods, trajectory groups were compared on four baseline covariates (age, treatment condition, hormonal use in the last 6 months, and number of sex partners in the last 6 months) and three time-varying covariates measured at baseline and at 6 and 12 months (hormonal use stability, stability of primary sex partner, and stability of number of sex partners).

RESULTS

For the trajectory groups formed using the global measure of condom use consistency, stability of the primary sex partner differed significantly between trajectory groups. For the partner-specific trajectory groups, two baseline and one time-varying covariate relationships were significant: hormonal use in the 6 months prior to baseline, number of sex partners in the past 6 months (baseline), and stability of the primary sex partner (time varying), with hormonal use stability (time varying) trending toward significance.

DISCUSSION

The larger number of significant covariate relationships with the partner-specific trajectory groups suggests greater utility in assessing partner-linked behavior rather than a global measure. Despite limitations of the analytic strategy, this study sheds light on a measurement conundrum that has been an obstacle to comparing and contrasting indicators of condom use consistency during adolescence.

Predictors of contraceptive use among married youths and their husbands in a rural area of Myanmar

This study aimed to determine the predictors of contraceptive use among married female youths and their husbands using the behavioral theory of the Health Belief Model (HBM). A community-based survey was conducted in a rural area of Myanmar in 2008. A total of 444 respondents (222 couples) were interviewed separately using a pretested, structured questionnaire. Significant predictors of contraceptive use were determined by univariate and multivariate analysis. Wife's HBM perception was a highly significant predictor of contraceptive use in married youths (adjusted odds ratio = 10; 95% confidence interval = 2.7, 37.6). Wives aged 20 to 24 years and having their own income, experience of spousal communication, and shorter distance from home to health center were also significant predictors of contraceptive use. A poor agreement on HBM perception between wife and husband was noted. This study highlights the importance of HBM perceptions, wife's income, spousal communication, and geographic barriers in contraceptive use among married youths in rural Myanmar.

Relationship between child health literacy and body mass index in overweight children

OBJECTIVE

To test the relationship between child health literacy and body mass index (BMI) Z-score in overweight children.

METHODS

Cross-sectional survey of overweight children and parents. Parent and child health literacy was measured by the Short Test of Functional Health Literacy (STOFHLA). Linear regression tested for predictors of childhood BMI Z-score, adjusting for confounders.

RESULTS

Of 171 total children, 107 (62%) participated, of whom 78 (73%) had complete data for analysis. Mean child BMI Z-score (SD) was 2.3 (0.40); median child age (interquartile range) was 11.5 (10-16); 53% were female; 80% were Medicaid recipients. Mean child STOFHLA was 22.9 (9.0); mean parental STOFHLA was 29.1 (8.6). Child STOFHLA correlated negatively with BMI Z-score (r=-0.37, p=0.0009) and positively with child eating self-efficacy (r=0.40, p<0.0001). After adjusting for confounders, child STOFHLA was independently associated with child BMI Z-score (standardized B=-0.43, p<0.0001). Overall adjusted r-squared for the regression model was 38%. Child STOFHLA contributed 13% to the overall model.

CONCLUSIONS

Child health literacy was negatively correlated with BMI Z-scores in overweight children, suggesting the need to consider health literacy in the intersection between self-efficacy and behavior change when planning interventions that aim to improve child BMI.

Confidence as a predictor of sexual and reproductive health outcomes for youth

PURPOSE

To assess the association between four positive youth development (PYD) constructs of confidence and adolescent sexual and reproductive health (ASRH) outcomes.

METHODS

We searched nine online databases to locate behavioral research that examined the association between four constructs of confidence (belief in the future, self-determination, clear and positive identity, and self-efficacy) and ASRH outcomes (e.g., ever had sex, condom use, contraception use, number of partners, pregnancy/birth, and sexually transmitted infection). Findings were coded as "protective," "risk," or "no association." The presence of at least two longitudinal studies reporting consistent significant associations for at least one ASRH outcome indicated evidence for a protective or risk association.

RESULTS

We found evidence to support two of the four PYD constructs of confidence (belief in the future and self-determination) as protective factors for ASRH outcomes. Evidence was insufficient to draw conclusions about clear and positive identity as a protective factor, and was mixed for self-efficacy. Measures of confidence varied considerably across the studies reviewed, reflecting varying definitions; often, the measures used had limited information on reliability. Few longitudinal investigations were identified, and available studies were inconsistent in how they examined the association between the PYD constructs and ASRH outcomes. Evidence for most constructs was insufficient to identify their influence on specific sub-groups of youth.

CONCLUSIONS

Despite the need for additional research, this review suggests that belief in the future and self-determination are promising protective factors. Further research is needed to better understand the potential for self-efficacy and clear and positive identity as protective factors.

Character as a predictor of reproductive health outcomes for youth: a systematic review

To review research examining the influence of character on adolescent sexual and reproductive health (ASRH). We defined character as comprising two positive youth development constructs: prosocial norms and spirituality. We conducted a systematic review of behavioral research published from 1985 through 2007 that examined the association between two character constructs (prosocial norms and spirituality) and ASRH outcomes. We coded results as showing a protective association, risk association, or no association, and as longitudinal, or cross-sectional. We considered consistent associations from at least two longitudinal studies for a given outcome to be sufficient evidence for a protective or risk association. There is sufficient evidence to indicate that prosocial norms and spirituality can be protective factors for some ASRH outcomes including intention to have sex, early sex or ever having sex, contraceptive and condom use, frequency of sex, and pregnancy. The generalizability of findings by age, race/ethnicity, and gender was unclear. Findings suggest that some character sub-constructs are associated with a reduced likelihood of several adverse ASRH outcomes and with an increased likelihood of using contraceptives and intending to use condoms. Further research is needed to better understand mixed results and results showing some character sub-constructs, such as religious affiliation, to be associated with adverse ASRH outcomes.

Condom provision and education in Minnesota public schools: a telephone survey of parents

BACKGROUND

Increasing correct and consistent condom use among sexually active adolescents continues to be a critical public health goal, with schools serving as key agents for achieving this goal through sexuality education and condom use provision. This research aims to describe the views of parents regarding school-based condom distribution and education programs, and examines how these views differ across demographic groups.

METHODS

Parents of school-age children in Minnesota were surveyed in telephone interviews (N = 1605; 63% participation) regarding their beliefs about condom availability and education. Chi-square tests of significance were used to detect differences in agreement with each statement for 10 demographic and personal characteristics.

RESULTS

A majority of respondents held supportive views about condom availability and education programs. Strongest support centered on statements in the survey about teenagers needing information about condoms (86%) and showing actual condoms during classroom lessons (77%). Approximately two thirds of the parents agreed that school-based instruction about condoms should be "allowed" at the high school level (65%), and one fifth (21%) believed that this type of education should be "required." Support for condom availability and education programs differed significantly according to certain personal characteristics, with less supportive views from self-identified Born Again Christians and politically conservative parents.

CONCLUSIONS

Public discourse regarding school-based sexuality education should include the viewpoints of parents of school-aged children as key stakeholders. Parents' perspectives provide unique and critical insights that school administrators and educators should consider as they develop educational and programmatic offerings regarding condoms.

Sexual self-concept and sexual self-efficacy in adolescents: a possible clue to promoting sexual health?

This study examined the associations between sexual self-concept (sexual esteem and sexual anxiety) and sexual self-efficacy (situational and resistive) in a sample of 388 high school students (59% Caucasian, 28% African American). Males reported lower sexual esteem and lower sexual self-efficacy than females. Males and African Americans reported higher levels of sexual anxiety and lower levels of resistive self-efficacy than females and Caucasians. In regression models, higher sexual self-esteem uniquely predicted higher sexual self-efficacy scores, even after controlling for demographic variables, knowledge of sexual risk, and previous coital experience. In post hoc analyses, sexual self-esteem mediated the relation between knowledge of sexual risk and both types of sexual self-efficacy. Results suggest the need for interventions to promote male sexual self-efficacy and sexual esteem and the need for longitudinal research that explicates models of sexual health in adolescence.