Adolescent contraception: An overview

Social Support as a Factor in African-American Adolescents' Sexual Risk Behavior

African-American adolescents (N = 295) reporting high or low levels of social support completed measures of AIDS knowledge, health locus of control, attitudes toward condoms, self-reported sexual behavior for the preceding 12 months, perceptions of personal HIVrisk, and self-and response-efficacy ratings. Adolescents with less social support were less knowledgeable about AIDS, held more negative attitudes toward condoms, and were lower in selfefficacy than adolescents with higher levels of social support. Adolescents with fewer social supports also were significantly more likely to engage in casual sex, reported more nonmonogomouspartners, morefrequent coercions into unwanted sexual activity, and higher rates of sexually transmitted diseases. African-American males with low social support scores engaged in more frequent unprotected sexual activity with a larger number of sex partners and used condoms less often. The implications of these results for prevention efforts targeting minority adolescents are discussed.

Low-dose oral contraceptives: health consequences of discontinuation

Presently, the lowest effective estrogen dose available as a combination oral contraceptive (OC) in the United States is 20 microg of ethinyl estradiol (EE) with different progestins. Twenty micrograms of EE coupled with levonorgestrel results in fewer side effects and cycle control comparable with higher-dose pills. Differences between therapeutically equivalent and brand-name, low-dose oral contraceptives, with respect to the bioavailability of hormones, may interfere with contraceptive efficacy and increase breakthrough bleeding. One of the most common reasons why women discontinue OCs is increased breakthrough bleeding. Because after OC discontinuation most women switch to a less-effective method, or no method, of contraception, an increase in breakthrough bleeding could ultimately result in an increase in unintended pregnancy. Thus, substituting a therapeutically equivalent for a brand-name low-dose oral contraceptive may have significant clinical and economic effects on individual and public health.

Oral contraception and adolescent women with insulin-dependent diabetes mellitus: risks, benefits, and implications for practice

Healthcare providers who work with adolescents with diabetes are in an ideal position to provide education and support regarding contraceptive issues. Diabetes educators and other health professionals who counsel teens focus on other aspects of diabetes care and management but frequently do not address sexual issues or assess contraceptive practices. The purpose of this paper is to review oral contraceptive issues for teens with diabetes and to provide practice implications for health professionals who are in a favorable position to influence the quality of diabetes and general health care for these adolescents.

Contraception in the adolescent. Preparation for the 1990s

An overview of current and future contraceptive methods available to the adolescent is presented. Emphasis is given to oral contraceptives, including low-dose monophasics and triphasics. Current research confirms the efficacy and safety or oral contraceptives for teenagers. Other methods are reviewed, such as the mini-pill, barrier contraceptives (including the cervical cap and female condom), injectable contraceptives, hormonal contraceptive implants, the vaginal ring, postcoital contraception, periodic abstinence, gossypol, and others. Though abstinence is the best contraceptive method for adolescents, contraceptive technology of the 1990s presents clinicians and sexually active youth with many additional options.

Contraceptive and sexual behavior of black female adolescents. A test of a social-psychological theoretical model

To test a previous theoretical model, we studied the relationships between social, attitude, and psychological factors and adolescent contraceptive behavior over a 6-month period. A pretested questionnaire was administered to a random sample of 115 black females aged 12 to 18 years from a low socioeconomic population. Six months after the initial interview 113 of the subjects were administered a second questionnaire assessing their sexual and contraceptive behavior. Based on regression analysis, previous pregnancy and coital frequency explained 12.7% (p less than or equal to 0.0001) of the variation in engaging in unprotected coitus. When controlling for sexual activity, birth control knowledge and previous broken appointments explained an additional 5.5% of variation in the regression model (total R2 = 0.185). Coital frequency of the subjects was positively associated with Tanner stage, length of the relationship, effectiveness of previous contraceptive method(s), and degree of birth control knowledge. Coital frequency was inversely associated with a negative attitude toward pregnancy and negative parental attitudes toward adolescent pregnancy. The perceived risk of pregnancy was positively correlated with coital frequency and previous pregnancy. These findings support our model, but suggest that among low socioeconomic black female adolescents the interpretation of several model components depends on the subjects' attitude toward pregnancy and her perception of her parent's attitude toward adolescent pregnancy.

Female adolescents' compliance with contraceptive regimens

Although today's adolescents have access to a variety of contraceptive options, they remain inconsistent and suboptimal users of these methods. A particularly frustrating problem for those caring for adolescents is the issue of noncompliance with contraceptives, which is an important antecedent of adolescent pregnancy. In the future, new fertility-related developments such as subdermal hormonal implants may reduce the likelihood of noncompliance. For the present, however, systematic monitoring rather than only when noncompliance is suspected is essential in enhancing adolescents' contraceptive compliance.

Hormonal contraception

Increased sexual activity among adolescents demands that the health care provider have a thorough understanding of contraceptive methods and application. In this article, the principles of hormonal contraception are discussed, providing relevant information for use in advising and managing the sexually active adolescent.