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

Contraceptive Use and Its Associations With Social Determinants of Health Among Young Adults

BACKGROUND

Nonuse and inconsistent use of contraception in young adults can result in undesired pregnancies. Prior research on contraceptive use has primarily focused on individual influences such as attitudes, beliefs, and skills related to contraceptive use, with little consideration of the social and economic determinants.

OBJECTIVE

This study explored domains from the Healthy People 2030 Social Determinants of Health (SDH) framework and examined their cross-sectional associations with young adults' self-reported contraceptive use (ie, any use in the past year and consistent use of contraception).

METHODS

Eleven measures related to 5 SDH domains were extracted from the Add Health dataset collected from 2001 to 2002 (Wave III). The final sample included 11,172 youth with a mean age of 21.88 years (SD: 1.84) and was 53.8% female.

RESULTS

Measures associated with the past year's use of contraceptives included non-poverty status, employment, housing instability, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, and access to primary care. For consistent use of contraception, associated measures were participants' non-poverty status, employment, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, incarceration, and access to health care.

CONCLUSIONS

Interventions that address social determinants of health can potentially promote contraceptive use.

Long-acting reversible contraception and condom use: A cohort study of female adolescents and young adults in New York City

OBJECTIVES

This study aimed to determine whether condom use varied between adolescents and young women using long-acting reversible contraception (LARC) vs non-LARC hormonal methods and assess if the initiation of LARC was associated with lower condom use.

STUDY DESIGN

This study used data from a large longitudinal study of sexually active females aged 13-25 years. Questionnaires assessed contraception, condom use, sexual history, and partner characteristics at the baseline visit and every 6 months. Log-binomial regression analyses examined associations between hormonal contraceptive methods and condom use, and the moderating effects of age and number of sexual partners. Exploratory analyses compared condom use based on partner characteristics.

RESULTS

Of 1512 participants, 1116 reported LARC or non-LARC hormonal method use during any study visit. Among baseline and new LARC users, 75.7% and 84.7% reported intrauterine device (IUD) use, respectively. Condom use at baseline among hormonal non-LARC users (37.5%) was significantly higher (p < 0.01) than LARC users (23.5%). Condom use among LARC vs non-LARC users was moderated by age in that LARC was associated with lower condom use among participants aged 13-18 years, but not those aged 19-25 years. Number of sexual partners was not a significant moderator. Among participants with increased sexually transmitted infection (STI) risk based on partner characteristics, LARC users had lower condom use compared to non-LARC users.

CONCLUSIONS

Condom discontinuation was common following initiation of LARC and hormonal non-LARC methods. However, condom use was lower in LARC users at baseline, among younger adolescents, and if partners had risk factors for STIs.

IMPLICATIONS

Condom discontinuation following initiation of highly effective contraception increases the risk of STI. Young women using LARC may be at greater risk than non-LARC users given lower condom use despite having partners with risk factors for STIs. Condom use counseling for STI protection is critical for adolescents.

Long-Acting Reversible Contraception, Condom Use, and Sexually Transmitted Infections: A Systematic Review and Meta-analysis

INTRODUCTION

Given mixed findings regarding the relationship between long-acting reversible contraception and condom use, this systematic review and meta-analysis synthesizes studies comparing sexually transmitted infection‒related outcomes between users of long-acting reversible contraception (intrauterine devices, implants) and users of moderately effective contraceptive methods (oral contraceptives, injectables, patches, rings).

METHODS

MEDLINE, Embase, PsycINFO, Global Health, CINAHL, Cochrane Library, and Scopus were searched for articles published between January 1990 and July 2018. Eligible studies included those that (1) were published in the English language, (2) were published in a peer-reviewed journal, (3) reported empirical, quantitative analyses, and (4) compared at least 1 outcome of interest (condom use, sexual behaviors other than condom use, sexually transmitted infection‒related service receipt, or sexually transmitted infections/HIV) between users of long-acting reversible contraception and users of moderately effective methods. In 2020, pooled ORs were calculated for condom use, chlamydia/gonorrhea infection, and trichomoniasis infection; findings for other outcomes were synthesized qualitatively. The protocol is registered on the International Prospective Register of Systematic Reviews (CRD42018109489).

RESULTS

A total of 33 studies were included. Long-acting reversible contraception users had decreased odds of using condoms compared with oral contraceptive users (OR=0.43, 95% CI=0.30, 0.63) and injectable, patch, or ring users (OR=0.58, 95% CI=0.48, 0.71); this association remained when limited to adolescents and young adults only. Findings related to multiple sex partners were mixed, and only 2 studies examined sexually transmitted infection testing, reporting mainly null findings. Pooled estimates for chlamydia and/or gonorrhea were null, but long-acting reversible contraception users had increased odds of trichomoniasis infection compared with oral contraceptive users (OR=2.01, 95% CI=1.11, 3.62).

DISCUSSION

Promoting condom use specifically for sexually transmitted infection prevention may be particularly important among long-acting reversible contraception users at risk for sexually transmitted infections, including adolescents and young adults.

Contraception in Adolescents

Adolescents are at risk for unwanted pregnancy when they become sexually active, and contraception is an important part of mitigating this risk. Use of contraceptive methods, and long-acting reversible contraceptive methods such as implants and intrauterine devices in particular, has increased among adolescents. Although sexual activity has declined and contraceptive use has increased among adolescents in the United States in recent years, the unintended pregnancy rate remains high. All of the currently available contraceptive methods are safe and effective for adolescents to use; however, adolescents may have specific concerns about side effect profiles and unscheduled bleeding that should be addressed during contraceptive counseling. Healthcare providers should prioritize adolescents' needs and preferences when approaching contraceptive counseling, and also consider the unique access and confidentiality issues that adolescents face when accessing contraception.

Use of concurrent multiple methods of contraception in the United States, 2008 to 2015

OBJECTIVE

To identify prevalence of, characteristics associated with, and combinations of, use of more than one method of contraception at last intercourse among US women between 2008 and 2015.

METHODS

We conducted bivariate and multivariable logistic regression analyses using data on concurrent contraceptive use from 2 nationally representative samples of women ages 15 to 44 who had used some form of contraception at last intercourse in the past 3 months in the 2006-2010 (n = 6601) and 2013-2017 (n = 5562) cycles of the National Survey of Family Growth.

RESULTS

Use of more than one method of contraception at last sex increased from 14% in 2008 to 18% in 2015 (p<0.001), with increases in use documented across many population groups. Among multiple method users, the majority combined condoms with other methods (58%), while the rest combined other methods (42%). When compared to single method users, dual method users employing condoms are a more homogeneous group of individuals than are dual method users not employing condoms. As age increases, dual use with condoms decreases, but there is no similar linear relationship between age and dual method use without condoms.

CONCLUSIONS

A sizable proportion of US women use more than one contraceptive method during sex; current estimates of contraceptive use focused exclusively on single method use may underestimate the extent to which women are protected from unintended pregnancy. The needs and goals of individuals combining contraceptive methods in different ways may change over the life course as pregnancy desires and life circumstances change.

IMPLICATIONS

A sizable proportion of US women use more than one contraceptive method during sex; clinicians and health educators in nonclinical settings should assess and acknowledge these more complicated contraceptive strategies in order to help individuals achieve autonomy in method choice and meet their goals around pregnancy and sexually transmitted infection prevention.

Long-Acting Reversible Contraceptive Users' Knowledge, Conversations with Healthcare Providers, and Condom Use: Findings from a U.S. Nationally Representative Probability Survey

Objectives To describe long-acting reversible contraceptive (LARC) users' knowledge, patient-provider interactions, and condom use associated with LARC use. Methods: Data are from the 2018 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14-49. Results: Of 1,451 sexually active women, 11.2% used intrauterine devices, and 3.1% used implants. Approximately 19-26% of LARC users reported inaccurately on LARC longevity, and 30% reported relying on their provider to indicate the timing of intrauterine device removal. Consistent condom use among LARC users was rare (6.1%). Conclusions: Our findings have implications for how clinicians educate patients on LARC and condom use.

Refining assessment of contraceptive use in the past year in relation to risk of unintended pregnancy

OBJECTIVES

Healthy People 2020 establishes objectives for reducing the proportion of pregnancies in the United States that are unintended and for improving contraceptive use. This analysis describes ways to more closely align measurement of contraceptive use with periods of risk for unintended pregnancy using the National Survey of Family Growth (NSFG).

METHODS

Using the 2011-2015 NSFG we constructed two measures of contraceptive use for women we defined as at risk of an unintended pregnancy: (1) we augmented a measure of recent contraceptive use by recoding non-users according to their method use during their last month of sex in the past 12 months; (2) we augmented use at last sex in the past 12 months by excluding women who were pregnant at last sex. Estimates were compared overall and within 5-year age groups.

RESULTS

The augmented measure of recent contraceptive use found fewer women to be using no contraception than the standard measure (7.3% vs 15.4%; p < .001); greater differences were found between the two measures for younger women. When considering contraceptive use at last sex, the augmented measure identified fewer women as using no contraception (15.8% vs 21.0%; p < .001) than the standard measure and more women to be using a most effective method (33.3% vs 31.1%; p = .04) than the standard measure.

CONCLUSIONS

Aligning periods of unintended pregnancy risk with contraceptive use assessment reduced estimates of no contraceptive use; changes in estimates by method type varied by age.

IMPLICATIONS

When assessing contraceptive use for the purpose of unintended pregnancy prevention, researchers may consider the methods described here to further align contraceptive use measurement with periods of unintended pregnancy risk.

High Rates of Repeat Chlamydial Infections Among Young Women-Louisiana, 2000-2015

BACKGROUND

Chlamydial infections are common among young women and can lead to serious reproductive health complications. We assessed the risk of reported repeat chlamydial infection among young women in Louisiana and time interval between infections by age and race/ethnicity.

METHODS

We analyzed surveillance data on chlamydial infections reported among women in Louisiana from January 1, 2000, to December 31, 2015. Multiple reports for the same person were matched using unique codes. Chlamydial infections reported more than 30 days after a previous positive test were considered new infections. Women aged 15 to 34 years at first infection during 2000 to 2012 were censored after 3 years or after they had a repeat infection. Cumulative incidence and incidence rate of repeat chlamydial infection among women were determined by year of first infection. Race- and age-specific results were obtained using stratified analyses.

RESULTS

One in 4 women diagnosed with a chlamydial infection at 15-34 years of age in Louisiana had a reported repeat infection in 3 years or less. Risk of repeat infection increased for younger women, racial/ethnic minorities, and women in more recent cohorts. Young black women aged 15 to 19 years in 2012 had the highest risk (44%). Black women also had shorter intervals between infections than white women.

CONCLUSIONS

Repeat chlamydial infections were common, especially among young black women. The true number is likely higher because surveillance data only count infections that were detected and reported. Comprehensive prevention strategies are needed to address high rates of repeat chlamydial infections among women.

Dual-Method Contraception Among Adolescents and Young People: Are Long-Acting Reversible Contraception Users Different? A Qualitative Study

STUDY OBJECTIVE

The purpose of this study was to understand the factors and influences that affect dual-method contraception in adolescent and young adult women using long-acting reversible contraception (LARC) and whether these are unique to LARC users.

DESIGN

Qualitative semistructured interview study.

SETTING AND PARTICIPANTS

Adolescents and young women aged 14-24 years using LARC methods, adolescents and young women aged 14-24 years using short-acting reversible contraception (SARC), and men aged 14-30 years.

INTERVENTIONS

Interviews were conducted until thematic saturation was reached.

MAIN OUTCOME MEASURES

The team used a grounded theory approach to identify common themes relating to dual-method contraception.

RESULTS

Interviews were conducted with 20 LARC users, 26 SARC users, and 13 men. There were no differences in dual-method contraception use between LARC users and SARC users. Most participants used condoms primarily for pregnancy prevention rather than sexually transmitted infection (STI) prevention. Relationship context played an important role in dual-method contraception among all 3 groups; participants were less likely to use condoms in a long-term or monogamous relationship than with new or casual partners. Most participants perceived themselves to be at low risk for STI acquisition, although even those who identified themselves to be at risk did not consistently use condoms. Immediate availability of condoms was a determinant of condom use in all 3 groups, whereas knowledge, access, and negotiation of condom use were not.

CONCLUSION

LARC users are similar to SARC users in their decision-making about condom use. Relationship factors and STI risk assessment are important components to be included in contraceptive counseling.

Condom Use With Long-Acting Reversible Contraception vs Non-Long-Acting Reversible Contraception Hormonal Methods Among Postpartum Adolescents

Importance

Increased use of long-acting reversible contraception (LARC; intrauterine devices [IUDs] and implants) has likely contributed to declining US teenage pregnancy and birth rates, yet sexually transmitted infection (STI) rates among teenagers remain high. While LARC methods are highly effective for pregnancy prevention, they, as with all nonbarrier methods, do not protect against STIs, including HIV. Studies of the general adolescent population suggest condom use is lower among LARC vs non-LARC hormonal methods users (birth control pill, contraceptive patch, vaginal ring, or injection). Despite the high use of LARC among postpartum teenagers, no studies have examined whether condom use differs by contraceptive method in this population.

Objective

To compare condom use among sexually active postpartum teenagers using LARC vs those using non-LARC hormonal methods.

Design, Setting, and Participants

Cross-sectional analysis using 2012 to 2015 data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a multisite and population-based surveillance system that collects data on maternal attitudes, behaviors, and experiences before, during, and shortly after pregnancy. We used data from 37 sites. Using multivariable survey-weighted logistic regression, we assessed the association of condom use by contraceptive methods. Participants were teenage mothers (≤19 years) with a recent live birth reporting LARC or non-LARC hormonal method use. Data were analyzed between March 2018 and April 2018.

Main Outcomes and Measures

Condom use with LARC vs condom use with non-LARC hormonal methods.

Results

Among the 5480 (weighted N = 245 847) postpartum teenage mothers in our sample, most were aged 18 to 19 years, unmarried, had current Medicaid coverage, were first-time mothers, had reported their pregnancy was unintended, and almost half were non-Hispanic white. Overall, condom use was reported by 28.8% of these teenagers. Users of LARC compared with non-LARC hormonal methods were half as likely to use condoms (17.8% vs 35.6%; adjusted prevalence ratio [aPR], 0.50; 95% CI, 0.41-0.60). Users of IUDs (15.1%) were less likely to report condom use than those using an implant (21.5%; aPR, 0.70; 95% CI, 0.51-0.98), patch, ring, or injection users (24.9%; aPR, 0.61; 95% CI, 0.47-0.79), and pill users (47.2%; aPR, 0.32; 95% CI, 0.25-0.40).

Conclusions and Relevance

Self-reported condom use was low overall among postpartum teenage mothers and lower among users of LARC vs non-LARC hormonal methods. Given the high rates of STIs among teenage mothers combined with higher use of LARC among postpartum teenaged mothers, interventions to promote condom use for STI/HIV prevention during the postpartum period are critically important.

Childbearing Motivations and Desires, Fertility Beliefs, and Contraceptive Use among Urban African-American Adolescents and Young Adults with STI Histories

This study explored the influence of STI history on childbearing motivations, fertility beliefs, current childbearing desires, and contraception use among urban African-American adolescents and young adults (AYA). Secondary data were from the Neighborhood Influences on Adolescent and Young Adult Health (NIAAH) study, conducted from 2004 to 2007. Sample included 517 AYA ages 15-24 years (male: n = 199, female: n = 318). Linear and logistic regression models examined gender differences in childbearing motivations (CBM) and desires, fertility beliefs, condom, and contraception use. Logistic regression models were constructed to examine age, pregnancy history, and STI fertility knowledge as potential confounders. AYA men (3.29) and AYA women (3.23) had similar CBM mean scores. AYA women had more positive CBM and used condoms less. Condom use was not associated with CBM among AYA men (OR = 0.71, p = 0.069). Low beliefs about fertility (OR = 0.52, p = 0.003) and prior pregnancy (OR = 5.27, p = 0.002) were associated with current childbearing desires among AYA women. AYA men's low fertility beliefs were only associated with current childbearing desires (OR = 0.56, p = 0.044). AYA men reported more contraception use (67.46 vs. 55.04%), especially with no partner pregnancy history (OR = 0.26, p = 0.017). Younger men (15 to 18 years old) reported more contraception or condom use compared to older AYA men (19-25 years old) (OR = 0.40, p = 0.016). Young men reporting a partner's prior pregnancy used fewer condoms or contraception (OR = 0.23, p = 0.028). STI history did not influence CBM in this sample of urban youth. Prior pregnancy experiences and chronological age, however, were important milestones shaping proximal motivations and desires to bear children, beliefs about fertility, and contraception behaviors.

Misalignment of sexual and reproductive health priorities among older Latino adolescents and their mothers

OBJECTIVE

The study describes maternal and adolescent perspectives on sexual decision making and the role of mothers in shaping use of contraception for the prevention of unplanned pregnancies and sexually transmitted infections (STIs) among older Latino adolescents.

STUDY DESIGN

Researchers used a semistructured interview guide to conduct focus group discussions with 21 mother-adolescent Latino dyads (n=42). Latino adolescents ages 17-19 were eligible for the study. We recruited families from the South Bronx, New York City, using area sampling methodology. For analysis of qualitative data, we used the framework method involving open coding, identification of dominant themes, refining of codebooks and indexing.

RESULTS

Overwhelmingly, results suggest asymmetric priorities and preferences regarding maternal involvement in older adolescent sexual and contraceptive decision making. Mothers primarily employed practices designed to prevent adolescent sexual activity. Most teens reported already having experienced sexual debut and were currently sexually active. Adolescents expressed a strong interest in practical support for sexual decision making, including maternal guidance regarding effective access to and use of contraception. Mothers offered limited guidance or support with such matters. Maternal views focused entirely on the health and social consequences of sex in lieu of specific guidance on contraception for older sexually active adolescents. The findings highlight a missed opportunity for Latino mothers to support their older adolescent children to prevent unplanned pregnancies, STIs and HIV.

CONCLUSION

Mothers have the potential to positively shape adolescent contraceptive decision making and behavior. Misalignment of priorities between mothers and adolescents diminishes the potential of reducing adolescent sexual and reproductive health (SRH) disparities.

IMPLICATIONS

Mothers are influential in reducing adolescent SRH risk. However, asymmetric priorities among Latino adolescents and their mothers regarding support for SRH reduce likelihood of reducing adolescent negative SRH outcomes and supporting adolescent health. Programs supporting better alignment of maternal guidance and adolescent SRH needs are warranted.

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.

Norms and stigma around unintended pregnancy in Alabama: Associations with recent contraceptive use and dual method use among young women

The role of unintended pregnancy norms and stigma in contraceptive use among young women is understudied. This study investigated relationships between anticipated reactions from others, perceived stigma, and endorsed stigma concerning unintended pregnancy, with any and dual contraceptive use in this population. From November 2014 to October 2015, young women aged 18-24 years (n = 390) and at risk for unintended pregnancy and sexually transmitted infections participated in a survey at a university and public health clinics in Alabama. Multivariable regression models examined associations of unintended pregnancy norms and stigma with contraceptive use, adjusted for demographic and psychosocial characteristics. Compared to nonusers, more any and dual method users, were White, nulliparous, and from the university and had higher income. In adjusted models, anticipated disapproval of unintended pregnancy by close others was associated with greater contraceptive use (adjusted Odds Ratio [aOR] = 1.54, 95 percent confidence interval [CI] = 1.03-2.30), and endorsement of stigma concerning unintended pregnancy was associated with lower odds of dual method use (aOR = 0.71, 95 percent CI = 0.51-1.00). Unintended pregnancy norms and stigma were associated with contraceptive behavior among young women in Alabama. Findings suggest the potential to promote effective contraceptive use in this population by leveraging close relationships and addressing endorsed stigma.

Contraceptive behavior of Portuguese higher education students

ABSTRACT Objective: To characterize the contraceptive practices of higher education students and to identify factors that contribute to the use of different contraceptive methods. Method: A cross-sectional, descriptive correlational study was carried out with a sample of 1946 students, with a mean age of 21 years (20.74±2.32), who attended courses at a University in the North of Portugal. Results: Of the factors studied, the female gender, younger ages, previous behavior of condom use, knowledge about contraception, attitude and self-efficacy for condom use were associated with safer contraceptive choices. Conclusion: Investing in sexual education for young people is an important public health strategy that can empower youth to make more appropriate choices and improve adherence to contraceptive methods, reducing the risk of unintended pregnancies and sexually transmitted diseases.

Condom use and incident sexually transmitted infection after initiation of long-acting reversible contraception

BACKGROUND

Use of more effective contraception may lead to less condom use and increased incidence of sexually transmitted infection.

OBJECTIVE

The objective of this study was to compare changes in condom use and incidence of sexually transmitted infection acquisition among new initiators of long-acting reversible contraceptives to those initiating non-long-acting reversible contraceptive methods.

STUDY DESIGN

This is a secondary analysis of the Contraceptive CHOICE Project. We included 2 sample populations of 12-month continuous contraceptive users. The first included users with complete condom data (baseline, and 3, 6, and 12 months) (long-acting reversible contraceptive users: N = 2371; other methods: N = 575). The second included users with 12-month sexually transmitted infection data (long-acting reversible contraceptive users: N = 2102; other methods: N = 592). Self-reported condom use was assessed at baseline and at 3, 6, and 12 months following enrollment. Changes in condom use and incident sexually transmitted infection rates were compared using χ2 tests. Risk factors for sexually transmitted infection acquisition were identified using multivariable logistic regression.

RESULTS

Few participants in either group reported consistent condom use across all survey time points and with all partners (long-acting reversible contraceptive users: 5.2%; other methods: 11.3%; P < .001). There was no difference in change of condom use at 3, 6, and 12 months compared to baseline condom use regardless of method type (P = .65). A total of 94 incident sexually transmitted infections were documented, with long-acting reversible contraceptive users accounting for a higher proportion (3.9% vs 2.0%; P = .03). Initiation of a long-acting reversible contraceptive method was associated with increased sexually transmitted infection incidence (odds ratio, 2.0; 95% confidence ratio, 1.07-3.72).

CONCLUSION

Long-acting reversible contraceptive initiators reported lower rates of consistent condom use, but did not demonstrate a change in condom use when compared to preinitiation behaviors. Long-acting reversible contraceptive users were more likely to acquire a sexually transmitted infection in the 12 months following initiation.

Examining the Role of the Pediatric Emergency Department in Reducing Unintended Adolescent Pregnancy

OBJECTIVES

To determine pregnancy risk and receptiveness to emergency department (ED)-based pregnancy prevention interventions among adolescents accessing care in the ED.

STUDY DESIGN

Cross-sectional electronic survey of adolescent females in a pediatric ED used to calculate the Pregnancy Risk Index, a validated measure estimating the annual risk of becoming pregnant based on recent sexual activity, contraceptive method(s), method-specific contraceptive failure rates, and interest in receipt of ED-based contraceptive services.

RESULTS

Of 229 participants, 219 were not pregnant, and 129 reported sexual experience. Overall, 72.4% (n = 166) endorsed negative pregnancy intentions. The overall Pregnancy Risk Index for the 219 nonpregnant participants was 9.6 (95% CI 6.8-12.4), and was 17.5 (95% CI 12.8-22.2) for the 129 sexually experienced participants. A Pregnancy Risk Index greater than the national average of 5 was associated with older age (aOR 3.0; 95% CI 1.5-5.85), nonprivate insurance (aOR 7.1; 95% CI 1.6-32.1), prior pregnancy (aOR 2.7; 95% CI 1.2-6.0), and chief complaint potentially related to a reproductive health concern (aOR 2.6; 95% CI 1.4-5.1). In this cohort, 85.1% (n = 194) believed that the ED should provide information about pregnancy prevention, the majority of whom (64.9%; n = 148) believed that pregnancy prevention services should be offered at all ED visits.

CONCLUSION

This study demonstrates a high unintended pregnancy risk among adolescents accessing care in the ED. Adolescents report interest in receiving pregnancy prevention information and services in the ED, regardless of reason for visit. Strategies to incorporate successfully the provision of reproductive health services into ED care should be explored.

Can psychosocial and socio-demographic questions help identify sexual risk among heterosexually-active women of reproductive age? Evidence from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Background

Contraceptive advice and supply (CAS) and sexually transmitted infection (STI) testing are increasingly provided in primary care. Most risk assessment tools are based on sexual risk behaviours and socio-demographics, for use online or in specialist services. Combining socio-demographic and psychosocial questions (e.g. religious belief and formative experience) may generate an acceptable tool for targeting women in primary care who would benefit from intervention. We aimed to identify psychosocial and socio-demographic factors associated with reporting key sexual risk behaviours among women in the British general population.

Methods

We undertook complex survey analysis of data from 4911 hetero-sexually active women aged 16–44 years, who participated in Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a national probability sample survey undertaken 2010–2012. We used multivariable regression to examine associations between the available psychosocial and socio-demographic variables in Natsal-3 and reports of three key sexual behaviours: a) 2+ partners in the last year (2PP); b) non-use of condoms with 2+ partners in the last year (2PPNC); c) non-use of condoms at first sex with most recent sexual partner (FSNC). We adjusted for key socio-demographic factors: age, ethnicity and socio-economic status (measured by housing tenure).

Results

Weekly binge drinking (6+ units on one occasion), and first sex before age 16 were each positively associated with all three sexual behaviours after adjustment. Current relationship status, reporting drug use (ever), younger age and living in rented accommodation were also associated with 2+ partners and 2 + partners without condoms after adjustment. Currently being a smoker, older age and respondent ethnicity were associated with FSNC after adjustment for all other variables. Current smoking status, treatment for depression (last year), and living at home with both parents until the age of 14 were each associated with one or more of the behaviours.

Conclusions

Reported weekly binge drinking, early sexual debut, and age group may help target STI testing and/or CAS among women. Further research is needed to examine the proportion of sexual risk explained by these factors, the acceptability of these questions to women in primary care and the need to customise them for community and other settings.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3918-8) contains supplementary material, which is available to authorized users.

The Complexity of Multiple Contraceptive Method Use and the Anxiety That Informs It: Implications for Theory and Practice

Despite clinical guidelines and national data describing the use of one contraceptive method as the best and most common way to prevent unintended pregnancy, limited evidence indicates a more complex picture of actual contraceptive practice. Face-to-face in-depth interviews were conducted in November of 2013 with a sample of women from two cities in the United States (n = 52). The interviews explored the ways participants used contraception to protect themselves from unintended pregnancy over the past 12 months. Most respondents reported using multiple methods, many of which are considered to be less-effective, within this timeframe. The practice of combining methods in order to increase one's level of protection from pregnancy was prevalent, and was mainly enacted in two ways: by backing up inconsistent method use with other methods and by "buttressing" methods. These practices were found to be more common, and more complex, than previously described in the literature. These behaviors were mainly informed by a deep anxiety about both the efficacy of contraceptive methods, and about respondents' own perceived ability to prevent pregnancy. These findings challenge prevailing assumptions about women's contraceptive method use and have implications for clinical contraceptive counseling practice.

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.

Trends of contraception among ladies of local population in Pakistan; why, how, when and what?

Objective:

To analyze trends of use of methods of contraception along with study of impact of various demographic and social factors on contraception in Peshawar, Pakistan.

Methods:

A cross-sectional descriptive study with random purposive sampling was conducted at Combined Military Hospital Peshawar, from Mar 2015-Nov 2015. Self-designed questionnaire with demographic details and questions pertinent to contraceptive practices was utilized as study instrument. Females reporting to concerned hospital for contraceptive advice and prescription were distributed with questionnaire and written informed consent form. Formal approval was taken from ethical committee of hospital. Data was analyzed via descriptive analysis (SPSS-21), qualitative data was expressed as frequencies and percentages; quantitative as mean±standard deviation (SD). Main outcome variable i-e contraceptive device used; was cross-tabulated with independent variables.

Results:

Response rate was 53.2% (n-426). Usage of contraceptive device was as follows; 51.2% Nil, 9.4% barriers, 22.3% oral/injectable hormones, 13.4% IUCDs, 3.8% sterilization. There was a strong relationship between type of contraceptives used and age (p<0.001), client’s education (p<0.001), husband’s education (p<0.001), number of children (p<0.001), religion (p0.013), socioeconomic class (p<0.001), and religious beliefs about use of contraceptives (p<0.001). More Muslims considered contraception irreligious than non-Muslims (p 0.02). There was no significant impact of husbands’ pressure to not to use contraceptives on type of contraception practised (p 0.114).

Conclusion:

Contraceptive devices are under-utilized in the study participants. Multidisciplinary approach should be applied to enhance client education, awareness and counseling to utilize these devices more appropriately and regularly.

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.

Racial residential segregation and risky sexual behavior among non-Hispanic blacks, 2006-2010

Sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) have disproportionately affected the non-Hispanic black population in the United States. A person's community can affect his or her STI risk by the community's underlying prevalence of STIs, sexual networks, and social influences on individual behaviors. Racial residential segregation-the separation of racial groups in a residential context across physical environments-is a community factor that has been associated with negative health outcomes. The objective of this study was to examine if non-Hispanic blacks living in highly segregated areas were more likely to have risky sexual behavior. Demographic and sexual risk behavior data from non-Hispanic blacks aged 15-44 years participating in the National Survey of Family Growth were linked to Core-Based Statistical Area segregation data from the U.S. Census Bureau. Five dimensions measured racial residential segregation, each covering a different concept of spatial variation. Multilevel logistic regressions were performed to test the effect of each dimension on sexual risk behavior controlling for demographics and community poverty. Of the 3643 participants, 588 (14.5%) reported risky sexual behavior as defined as two or more partners in the last 12 months and no consistent condom use. Multilevel analysis results show that racial residential segregation was associated with risky sexual behavior with the association being stronger for the centralization [aOR (95% CI)][2.07 (2.05-2.08)] and concentration [2.05 (2.03-2.07)] dimensions. This suggests risky sexual behavior is more strongly associated with neighborhoods with high concentrations of non-Hispanic blacks and an accumulation of non-Hispanic blacks in an urban core. Findings suggest racial residential segregation is associated with risky sexual behavior in non-Hispanic blacks 15-44 years of age with magnitudes varying by dimension. Incorporating additional contextual factors may lead to the development of interventions that promote healthier behaviors and lower rates of HIV and other STIs.

The demands of human dignity: Sexuality in the young person with intellectual disabilities

The topic of sexuality among the disabled is often ignored within Catholic seminaries; within pediatrics, it is treated as a "problem" where the best solution is contraception or sterilization. In this article, the authors argue for an approach to sexuality in disabled youth that is grounded in the inherent dignity of the person, borne out of Christ's own humanity. Because sexuality is a part of the human person in his or her totality, it cannot be ignored or obscured; on the other hand, it cannot also be the overriding "problem" which defines them. Rather, by friendship, love, and covenantal solidarity with the disabled person, we can begin to set an example for them and for society that there are goods to be strived for beyond the physical. The demands of dignity require practical changes in seminary and medical education and practice.