Determinants and Correlates of Preventive Behaviors at First Sex With a First Partner and Second Partner: Analysis of the FECOND Study

Development of a risk estimation model for condomless sex among college students in Zhuhai, China: a cross-sectional study

BACKGROUND

Condom use at last intercourse is an effective indicator for human immunodeficiency virus (HIV) prevention. To identify at-risk individuals and improve prevention strategies, this study explored factors associated with condomless sex at last intercourse in the last year and developed a risk estimation model to calculate the individual possibility of condomless sex among college students in Zhuhai, China.

METHODS

A cross-sectional study was conducted among 1430 college students who had sex in the last year from six universities in Zhuhai. The least absolute shrinkage and selection operator (LASSO) and logistic regression were performed to explore the predictors of condomless sex. The nomogram was constructed to calculate the individual possibility of condomless sex. Discrimination and calibration of the nomogram were evaluated using the area under the receiver-operator characteristic curve (AUROC) and the calibration curve.

RESULTS

The proportion of students who had condomless sex at last intercourse was 18.2% (260/1430). Students who had experienced more types of intimate partner violence (aOR, 1.58; 95% CI, 1.31 ~ 1.92) and had anal sex (aOR, 1.75; 95% CI, 1.06 ~ 2.84) were more likely to have condomless sex. Students who had heterosexual intercourse (aOR, 0.37; 95% CI, 0.21 ~ 0.70), used condoms at first sex (aOR, 0.20; 95% CI, 0.14 ~ 0.27), had high attitudes towards condom use (aOR, 0.87; 95% CI, 0.80 ~ 0.95) and self-efficacy for condom use (aOR, 0.84; 95% CI, 0.78 ~ 0.90) were less likely to have condomless sex. The nomogram had high accuracy with an AUROC of 0.83 and good discrimination.

CONCLUSIONS

Intimate partner violence, anal sex, condom use at first sex, attitude towards condom use, and self-efficacy for condom use were associated with condomless sex among college students. The nomogram was an effective and convenient tool for calculating the individualized possibility of condomless sex among college students. It could help to identify individuals at risk and help universities and colleges to formulate appropriate individualized interventions and sexual health education programs.

Contraceptive switch and abandonment among women using the pill, condoms and injectables in Brazil

OBJECTIVE

The aim of our study was to assess the covariates of contraceptive switching and abandonment among Brazilian women stratified by oral pills, condoms and injectables.

MATERIALS AND METHODS

Women attending primary health care services in three Brazilian mid- to large-sized cities were interviewed face-to-face about their contraceptive practices (n = 2,051). Data were collected using a contraceptive calendar. Analysis included estimates using Kaplan-Meier multiple-decrement life-table probabilities and discrete-time hazards modelling of switching from a method to another or to no method.

RESULTS

Among 3,280 segments of contraceptive use, we observed that five-year contraceptive switching rates ranged from 34.9% among injectable users to 56.1% among pill users. Of particular concern were the high discontinuation rates of abandonment, which ranged from 50.9% among injectable users to 77.4% among pill users. Covariates of method switching and abandonment varied by type of method, but age, race/ethnicity, religion and relationship status must be highlighted as key elements of discontinuation.

CONCLUSION

Contraceptive method switching and abandoning are frequent outcomes of contraceptive use. Understanding the factors that shape women's decisions to continue or discontinue the use of a contraceptive method can help tailoring comprehensive contraceptive counselling that meet their expectations and reproductive needs when starting using a method.

Young people's proposals for a web-based intervention for sexual health promotion: a French qualitative study

BACKGROUND

Promoting sexual health is key to improving the supportive behaviors and well-being of young people. With the advent of the Internet, web-based features for sexual health promotion may be attractive to a diverse range of young people. This study aims to assess young people's proposals regarding a web-based intervention for sexual health promotion.

METHODS

Nineteen French young people aged 15-24 years participated to the study. In a semi-structured interview, they presented their views on a web-based intervention for sexual promotion. Data were coded with N'Vivo and subjected to qualitative thematic analysis to explore their proposals.

RESULTS

The majority of participants (n = 18) thought that a web-based intervention for sexual health promotion would be attractive. Young people interviewed made 31 concrete proposals for sexual health promotion on the Internet. Participatory and interactive dimensions on the internet appeared essential, with the need for stimulating activities and interaction with peers, but also with competent professionals and moderation. Face to the risks of the internet, they expressed the need of a secure and confidential space, to generate trust and participation in intervention. For participants, sexual health should be addressed in all its dimensions, taking into account the relational, sexual, and gender dimensions, and by incrementing on the internet valid, credible and personalized content.

CONCLUSIONS

In sexual health promotion, young people are indispensable stakeholders who can make concrete proposals and can also participate in content creation and research. More broadly, in health promotion, involving target audiences in decisions represents a promising perspective.

Contraceptive discontinuation: frequency and associated factors among undergraduate women in Brazil

BACKGROUND

In Brazil, high contraceptive prevalence rates coexist with high rates of unintended pregnancies. Contraceptive discontinuation may explain this context, but few studies have focused on highly educated young women in countries with low unmet need for modern contraception. This paper explores frequency and associated factors of contraceptive discontinuation among undergraduate students in Brazil within 12-months.

METHODS

This retrospective cohort study was conducted among a probability sample of 1679 undergraduates of São Paulo University. Data were collected online using a contraceptive calendar. We examined factors related to monthly discontinuation of oral pills and male condoms using Generalized Estimating Equation models.

RESULTS

Altogether, 19% of oral pill users and 48% of male condom users discontinued their method for method-related reasons within 12-months, and 18% of oral pill users and 15% of male condom users abandoned/or switched to less effective methods. Women in casual relationships were at increased odds of oral pill (OR = 1.4 [1.1-1.8]) and male condom discontinuation (OR = 1.3 [1.0-1.7]), and at increased odds of switching from oral pill to less effective or no method (OR = 1.4 [1.1-1.7]). Other associated factors were method specific. Women from lower socioeconomic status or who had multiple lifetime partners were more likely to discontinue or abandon the oral pill, while more sexually experienced women were less likely to discontinue the male condom.

CONCLUSION

Frequent method discontinuation in Brazil calls for greater attention to the difficulties women face when using short acting methods. Discontinuation was associated with type of partner and sexual experience highlighting the changing contraceptive needs of women at the early stages of their professional careers.

Sexual activity and weekly contraceptive use among young adult women in Michigan

Past studies on the influence of sexual activity on contraceptive behaviours are inconclusive, relying heavily on cross-sectional data. We used a population-based longitudinal sample of young women in Michigan to evaluate weekly associations between sexual activity and contraceptive use at three levels of measurement: comparing between women, among individual women's partnerships, and from week to week within partnerships. We used multinomial logistic regression accounting for correlations within partnerships and women. Relative to use of least effective methods, weekly sexual activity was significantly associated with increased use of condoms, pills, and highly effective methods. For pills and highly effective methods, partnership-, woman-, and week-level effects were similar. For condoms, there was no significant woman-level effect. Evidence of immediate effects of sexual activity on contraceptive use highlights the importance of longitudinal data. These dynamics may be diluted or missed altogether when relying on cross-sectional data approaches that compare groups of individuals.

Contraceptive Initiation Among Women in the United States: Timing, Methods Used, and Pregnancy Outcomes

BACKGROUND

Timely contraceptive initiation is increasingly common, yet population trends by method and among subgroups with increased risk of unintended pregnancy are not well described. The impact of timing and type of contraceptive initiation on risk of unwanted pregnancy is unknown.

METHODS

We used nationally representative cross-sectional data from 4 cycles of the National Survey of Family Growth, 2002-2015. We calculated outcomes from self-reported dates of sexual debut, contraceptive initiation, and unwanted pregnancy. We compared trends in timely contraceptive initiation (within 1 month of sexual debut) by method and by race and/or ethnicity and income. Using multivariable regression, we identified predictors of delayed contraceptive initiation. We compared the risk of unwanted pregnancy for delayed versus timely contraceptive initiation.

RESULTS

We analyzed responses from 26 359 women with sexual debuts in 1970-2014. One in 5 overall and 1 in 4 African American, Hispanic, or low-income respondents reported delayed contraceptive initiation, which was associated with unwanted pregnancy within 3 months of sexual debut (adjusted risk ratio 3.7 versus timely contraceptive initiation; 99.9% confidence interval: 2.3-5.9; P < .001). Timely contraceptive initiation with less effective versus effective methods was not associated with unwanted pregnancy within 3 months.

CONCLUSIONS

Delayed contraceptive initiation is more common among African American, Hispanic, and low-income women and is strongly associated with short-term risk of unwanted pregnancy. Pediatricians play a key role in making timely contraception available to adolescents at or before sexual debut. More research is needed to understand the importance of early contraceptive methods on pregnancy risk.

Is there a need for better sexual education of young men? Sexual behaviour and reproductive health in Swiss university students: a questionnaire-based pilot study

OBJECTIVES

There is evidence that men's perception of contraceptive methods and of their effectiveness and health risks have a major impact on couples contraceptive choices. Engaging men in decision making improves reproductive health outcomes. If they are better informed, men can potentially contribute to more effective use of contraception, thus reducing the rate of sexually transmitted infections and abortion. In Central European countries, few data are available on male contraceptive knowledge and behaviour.

METHODS

To collect more data we conducted an anonymous survey among young men studying at Zürich University in Switzerland. A questionnaire was distributed to 1500 male students which included a broad range of items addressing sexual behaviour, condom use and knowledge, and attitudes regarding contraceptive methods.

RESULTS

Three hundred and sixty-one questionnaires were eligible for evaluation. Condoms and the combined oral contraceptive pill were the most frequently used methods. However, at last intercourse 15.6% of respondents had not used any method of contraception. Many respondents (37%) had had a one-night stand without protection. Contraceptive methods most regarded as unhealthy for women were the combined oral contraceptive pill, progestin-only methods, intrauterine devices (IUDs) and emergency contraception. Characteristics considered by young men to be important in determining contraceptive method choice were: efficacy, partner satisfaction and no impact on fertility and libido.

CONCLUSIONS

Awareness among male Swiss students about contraceptive methods is high, but in-depth knowledge is limited. Myths were expressed about the combined oral contraceptive pill, progestin-only methods, IUDs and the emergency contraceptive pill. High-risk behaviour occurs frequently. The internet was reported to be the most important source of information about contraception.

Teenage pregnancy prevention: the role of young men

PURPOSE OF REVIEW

Although teenage pregnancy is declining in many parts of the world, it remains associated with considerable social, health, and economic outcomes. Pregnancy prevention efforts focus primarily on young women, with minimal attention to young men. This review highlights recent literature pertaining to the role of young men in pregnancy prevention.

RECENT FINDINGS

Young men have varying views on contraception as well as which partner(s) should be responsible for its use. Limited contraception knowledge reduces young men's sexual health communication as well as their contraception use. Healthcare providers play a major role as one of the main sources of sexual health information for young men, but there are gaps in young men's sexual health care so new guidelines have emerged.

SUMMARY

Recent literature highlights young men's range of views on contraception as well as their low sexual health knowledge and sexual health communication. To address teenage pregnancy and improve young men's overall wellness, healthcare providers should routinely address sexual health. Healthcare providers may use our newly proposed acronym, HIS BESTT, (Hello. Initiate. Sexual health assessment. Both condoms and female dependent methods. Examine genitals. STI screening. Talking to partner(s). Talking to parent(s) or guardians), to incorporate current clinical recommendations.