Factors associated with condom use among at-risk women students and nonstudents seen in managed care

Sexual Behavior and Heavy Episodic Drinking Across the Transition to Adulthood: Differences by College Attendance

Despite a growing literature on college students' sexual behaviors, little is known about how sexual behaviors, and their associations with alcohol, differ for college and noncollege attenders, and whether these patterns represent changes during college or an extension of pre-college behaviors. This paper applied time-varying effect models to data from the National Longitudinal Study of Adolescent to Adult Health to examine (1) prevalence of four sexual behaviors from ages 14 to 24 and (2) how their association with frequent heavy episodic drinking varied across these ages for college and noncollege attenders. Nonattenders have higher prevalence of all sexual behaviors than college attenders across most ages; however, the association between heavy episodic drinking and sexual behaviors is stronger for college attenders during ages 18-20.

Risk drinking and contraception effectiveness among college women

Risk drinking, especially binge drinking, and unprotected sex may co-occur in college women and increase the risks of STI exposure and pregnancy, but the relationships among these behaviors are incompletely understood. A survey was administered to 2012 women of ages 18-24 enrolled in a public urban university. One-quarter of the college women (23%) drank eight or more drinks per week on average, and 63% binged in the past 90 days, with 64% meeting criteria for risk drinking. Nearly all sexually active women used some form of contraception (94%), but 18% used their method ineffectively and were potentially at risk for pregnancy. Forty-four percent were potentially at risk for STIs due to ineffective or absent condom usage. Ineffective contraception odds were increased by the use of barrier methods of contraception, reliance on a partner's decision to use contraception, and risk drinking, but were decreased by the use of barrier with hormonal contraception, being White, and later age to initiate contraception. In contrast, ineffective condom use was increased by reliance on a partner's decision to use condoms, the use of condoms for STI prevention only, and by risk drinking. Thirteen percent of university women were risk drinkers and using ineffective contraception, and 31% were risk drinkers and failing to use condoms consistently. Risk drinking is related to ineffective contraception and condom use. Colleges should promote effective contraception and condom use for STI prevention and consider coordinating their programs to reduce drinking with programs for reproductive health. Emphasizing the use of condoms for both pregnancy prevention and STI prevention may maximize women's interest in using them.

The potential of alcohol "heat-of-the-moment" scenarios in HIV prevention: A qualitative study exploring intervention implications

Scenarios simulating real-world risk situations have proven effective for substance use intervention methods and could potentially prove useful as an HIV-prevention method. This study explored qualitatively the development and use of such "in-the-moment" methods. We interviewed 97 moderate-drinking women (50 % Caucasian) after participation in an experiment requiring that they project themselves into a risky-sex scenario. Most participants (58 %) reported experiencing the scenario as a reflective tool characterized by two primary themes: (1) increased awareness of risk and (2) contemplation of behavior change. Findings suggest that "in-the-moment" methods depicting real-world risk situations and providing opportunities to reflect about behavioral choices and subsequent outcomes could prove a useful adjunct to HIV/AIDS-prevention interventions. Such methods could potentially augment existing prevention protocols.

Hormonal contraceptive use and discontinuation among HIV-infected women in Uganda and Zimbabwe

BACKGROUND

Hormonal contraception (HC) use by HIV-infected women has been identified by the World Health Organization as an important strategy for reducing vertical HIV transmission. Little is known about the factors associated with HC discontinuation among HIV-infected women.

METHODS

We analyzed data from a prospective study of HC use among 231 HIV-infected users with oral contraceptive (OC) or injectable depot medroxyprogesterone acetate (DMPA) in Uganda and Zimbabwe. We used Kaplan-Meier survival curves to estimate the median duration of OC and DMPA use and use of any highly effective contraceptive method. Cox proportional hazards models were used to investigate factors associated with HC discontinuation.

RESULTS

Median duration was 36 months [95% confidence interval (CI): 14 to 61] for OC use and 19 months (95% CI: 14 to 24) for DMPA use. Median duration of any highly effective method was 36 months (95% CI: 26 to N/A) for OC users and 22 months (95% CI: 14 to 38) for DMPA users. In multivariable analyses, living in Zimbabwe [hazard ratio (HR): 0.39; 95% CI: 0.18 to 0.83], no partner (HR: 7.18; 95% CI: 3.05 to 16.88), and cervical infection (HR: 1.99; 95% CI: 0.90 to 4.41) were associated with OC discontinuation. No partner (HR: 2.00; 95% CI: 1.12 to 3.58), nausea (HR: 1.84; 95% CI: 1.02 to 3.34), and excessive night sweats (HR: 1.80; 95% CI: 0.95 to 3.40) were associated with DMPA discontinuation.

CONCLUSION

Long-term use of HC methods is acceptable to HIV-infected women. Women discontinue for a variety of reasons, primarily unrelated to HIV. Alternative methods and ongoing contraceptive counseling is essential to reduce unplanned pregnancies and vertical HIV transmission.

Contraception Behavior and Related Factors in Unmarried Female and Male

PURPOSE

This study aimed to identify differences in contraception behavior and related factors between unmarried female and male.

METHODS

A cross-sectional survey design with a convenient sampling was used. From Seoul, 107 women and 96 men were recruited. A structured questionnaire was self-administered from July 14, 2008 to September 2, 2008.

RESULTS

The average ages of women and men were 26.9 and 27.8 years old, respectively. Fifty-six percent of women and 85.4% of men have experienced sexual intercourse. There were no differences between female and male in attitude toward contraception, subjective norm, and contraception behavior, while female had higher score of self-efficacy for contraception (p=.02) and intention of contraception (p=.02). There was positive correlation with subjective norm (r=.22, p<.05), self-efficacy (r=.53, p<.01) in male and attitude (r=.32, p<.05), self-efficacy (r=49, p<.01) in female. According to the result of multiple regression, the significant factor of contraception behavior was self-efficacy for both female (beta=.49, p=.00) and male (beta=.53, p=.00).

CONCLUSION

To improve contraception behavior for unmarried female and male, it is necessary to develop proper sex education program to enhance self-efficacy for contraception. Adjusted education program by this result will contribute to increase sexual health for female and male.

Discontinuation of oral contraceptives and depot medroxyprogesterone acetate among women with and without HIV in Uganda, Zimbabwe and Thailand

BACKGROUND

We examined hormonal contraceptive (HC) discontinuation and factors associated with discontinuation among HIV-uninfected women and the effect of HIV diagnosis on subsequent contraceptive use.

STUDY DESIGN

We analyzed 4461 HIV-uninfected women from a prospective study of HC and HIV acquisition in Uganda, Zimbabwe and Thailand. Participants were ages 18-35 years, not pregnant, and using oral contraceptives (OCs) or injectable depot medroxyprogesterone acetate (DMPA) for at least 3 months before enrollment (median duration of OC and DMPA use before enrollment was 11.7 and 8.9 months, respectively). We compared the probability of OC and DMPA discontinuation using survival analysis and factors related to discontinuation using Cox regression. We also analyzed contraceptive patterns among 194 women who became infected with HIV.

RESULTS

Median duration of use after study enrollment was 15.6 months for OCs and 18.5 months for DMPA. Continuation rates for both methods were highest in Thailand. Factors associated with OC discontinuation included, nausea, breast tenderness, condom use, and no sex. Factors associated with DMPA discontinuation included young age, breast tenderness, nausea, irregular bleeding, high-risk sexual behaviors, partner risk, condom use, and no sex. Following an HIV diagnosis, 135 (98.5%) of 137 hormonal users continued HC and 14 (25%) of 57 nonusers began using HC.

CONCLUSIONS

Contraceptive continuation for OCs and DMPA was relatively high over 2 years. Young women, those reporting side effects, and those using condoms are more likely to discontinue and need ongoing contraceptive counseling. Many women receiving HIV-positive diagnoses desire effective contraception.

Testing a model of contraception use behavior among sexually active female adolescents in Taiwan

The purpose of this cross-sectional study was to test a model of contraception use among sexually active Taiwanese female adolescents, using structural equation modeling. Anonymous questionnaires were distributed to 404 female adolescents who had had sexual intercourse in the previous 3 months. A model was produced in which past contraception use, self-efficacy for contraception use, and decisional balance for using contraception had significant direct effects on current contraception use. Social influences had not only significant direct effects on self-efficacy and on decisional balance, but also a significant indirect effect on current contraception use. These findings provide a reference for the development of contraceptive intervention programs for sexually active female adolescents in Taiwan.

New, and some not-so-new, vaccines for adolescents and diseases they prevent

Adolescents in the United States now have the opportunity to receive new vaccines that prevent invasive meningococcal infections, pertussis (whooping cough), and cervical cancer. Except for their potential to cause serious illness, these infections could not be more different. Their incidence ranges from extremely low to quite high. Early clinical manifestations of infection range from none to life-threatening illness. Two of the vaccines are similar to those already in use, whereas 1 is completely new. In conjunction with the 4 vaccines previously recommended for adolescents (the tetanus and diphtheria booster, hepatitis B, measles-mumps-rubella, and varicella), the 3 new vaccines (meningococcal, human papillomavirus, and the tetanus-diphtheria-pertussis booster [which replaced the tetanus-diphtheria booster]) bring the number recommended for adolescents to 6. In this article, we describe key characteristics of the 3 new vaccines and infections they were designed to prevent. We also briefly discuss other vaccines recommended for all adolescents who have not already received them and new vaccines that are still under development.

Women at risk for sexually transmitted diseases: correlates of intercourse without barrier contraception

OBJECTIVE

The purpose of this study was to evaluate the correlates of vaginal intercourse without barrier contraception (unprotected intercourse).

STUDY DESIGN

Baseline data from a randomized trial were analyzed to evaluate factors that are associated with intercourse without barrier method use among women < 35 years old. Logistic regression models provided estimates of the association of demographic, reproductive, and sexual history variables with unprotected intercourse.

RESULTS

Intercourse without barrier contraception was common; 65% of participants had > or = 2 episodes of intercourse without barrier contraception use in the past month. Factors that were associated with increased odds of unprotected intercourse included the number of coital episodes, a male partner's unwillingness to use condoms (adjusted odds ratio, 4.1; 95% CI, 2.3-6.9), and, among women < 20 years old, low condom use self-efficacy score (adjusted odds ratio, 1.6; 95% CI, 1.0-2.9).

CONCLUSION

Risk factors for unprotected intercourse included coital frequency and the male partner's unwillingness to use condoms. Self-efficacy for condom use was especially important for women < 20 years old.

Liquid courage: alcohol fosters risky sexual decision-making in individuals with sexual fears

The interaction of sexual fear and acute alcohol intoxication on the likelihood of risky sexual behavior was explored. Participants (Ps; N = 115) completed a measure of sexual fears and were randomly assigned to no-, low-, or high-dose alcohol conditions. Ps then read an eroticized vignette, where they were the protagonist, and rated their likelihood of sex with a new partner when no condom was available. Controlling for gender and social desirability, compared to sober Ps, highly intoxicated Ps indicated that they were more likely to engage in risky sexual behaviors. Sexual fear was modestly negatively related to risky sex likelihood among sober or mildly intoxicated Ps but strongly positively related to risky sex likelihood among highly intoxicated Ps. Findings underscore the notion that alcohol affects different types of individuals differently and indicate that alcohol may foster sexual risk-taking, in part, by attenuating or counteracting fear or anxiety.

Contraception for college students

An important issue for human beings is the acquisition of normal sexual health, including the understanding and application of reproductive health when needed. Comprehensive sexuality education is not a topic provided to many children, adolescents, or college students in the United States, however. Students who were sexually active in high school may continue to be at risk for unwanted pregnancies and sexually transmitted diseases in their college life; those who chose abstinence in high school may abandon this concept in college, choosing coital behavior at all levels of university life-freshman through graduate levels. Most American college students are sexually active and many have multiple partners. This article reviews current contraceptive methods available to college students. College health providers and pediatricians are urged to be vigilant about the reproductive health needs of the college students they serve.

A collaborative approach to nutrition education for college students

It is well established in the literature that college students have poor eating habits and that many barriers exist to achieving optimal nutrition for this busy population. Little is known about students' perceptions of this problem or suggestions for improving their dietary habits. Similarly, college health professionals need innovative approaches to nutritional education. In an effort to develop an online nutrition resource specifically geared to college students, the authors assessed the availability of Internet-based nutritional information for this population and conducted focus groups with students and health professionals to identify relevant nutrition concerns. They used concept-mapping techniques to conduct a systematic analysis of the qualitative information generated from their focus group participants. Their findings emphasize the need for targeted resources for college students and the importance of using students' suggestions in developing nutrition programs.