A qualitative assessment of condom use decisions by female adolescents who use hormonal contraception

College-attending young men's sexual and reproductive health knowledge, attitudes and practices

ObjectiveMale involvement in contraceptive practice remains low. Family planning and pediatric health associations have recommended an emphasis on long-acting reversible contraceptives (LARC) in clinical counseling with adolescents and young adults, raising concerns about the resulting adverse impact on sexually transmitted infection (STI) rates. Participants: College-attending men responded to an internet based questionnaire (n=31) and a phone-based qualitative interview (n=25). Methods: Our survey solicited attitudes toward and knowledge of contraceptive methods and assessed communication practices with sexual partners regarding use of contraception and disease prevention. Results: Knowledge about female methods of contraception was low, with a comparatively high level of knowledge about Plan B. Parents and health care providers were cited as the most helpful sources of information. Conversations about protection with sexual partners were reported by most men, due mainly to fear of unplanned pregnancy, not STI. Conclusion: Addressing couple communication and dual protection among college-attending men needs greater emphasis.

Teen Perceptions of Sexual Activity: Influences, consequences, realities, and thoughts on safe sexual health practices

Teens’ engagement in sexual activity and safe sexual practices is an important public health issue in the US today. This descriptive survey study explored teens’ thoughts about the influences, consequences, and realities associated with teen sexual activity and pregnancy and their perceptions of access to sexual health education and contraception. Surveys were administered to 856 Delaware youth in 39 high school health classes from 16 schools. Of the 31 survey items, 25 offered significantly different responses; participants agreed with 16 and disagreed with 9 items (p < .005), revealing important findings concerning teen perceptions as the basis for meaningful interventions.

What influences adolescents' contraceptive decision-making? A meta-ethnography

Increased access to and use of contraception has contributed significantly to the decline in teen birth rates since 1991, yet many teens use contraception inconsistently or not at all. This meta-ethnography was conducted to identify the factors that influence adolescents' contraceptive decision-making. Fourteen qualitative studies were examined using G. W. Noblit and R. D. Hare's (1988) meta-ethnographic approach. Three themes of self, partner and family were found to influence contraceptive decision-making in both positive and negative ways. Assisting adolescents to maximize positive and reduce negative influences regarding contraceptive decision-making has the potential to assist teens to more effectively avoid unintended pregnancy and sexually transmitted infections.

Perception of susceptibility to the negative outcomes associated with unprotected sex among University of Venda students

Objectives: The purpose of this study was to determine the perception of University of Venda students on their susceptibility to the negative outcomes associated with unprotected sex.

Methods: This cross sectional study involved 408 (206 females and 202 males) University of Venda students residing within the university campus. Simple and systematic sampling methods were used to select participants. A 4-likert scaled self-administered questionnaire was used for data collection and a cut-off point of 75% of the total scores was used as criteria for assessing perception.

Results: Majority (90.90%) of the participants understood the magnitude and problems posed by HIV and other sexually transmitted infection in the society, 94.60% believe that anyone can be infected with HIV or fall pregnant when exposed to unprotected sex. Majority (87.30%) believed that alcohol consumption while engaging in sexual activities increases the chances of being infected with HIV, other STI or falling pregnant, 92.40% believed that having multiple sexual partnerships increases the risk of being infected with HIV and other sexually transmitted infections. Eighty six percent of participants agreed or strongly agreed that pregnancy could occur with one sexual intercourse in a month and only 68.45% of the participants believed that practising oral sex could expose them to HIV infection (with no significant difference between male and female).

Conclusion: Majority of the students showed high perception regarding their susceptibility to the negative outcomes associated with unprotected sex, especially when they consume alcohol while engaging in sexual activities and when having multiple sexual partnerships. Contrastingly, the students demonstrated low perception regarding susceptibility to HIV transmission through the practice of oral sex. There is a need to create awareness on the dangers posed by the practise of oral sex.

Multiple method contraception use among African American adolescents in four US cities

We report on African American adolescents' (N = 850; M age = 15.4) contraceptive practices and type of contraception utilized during their last sexual encounter. Respondents completed measures of demographics, contraceptive use, sexual partner type, and ability to select "safe" sexual partners. 40% endorsed use of dual or multiple contraceptive methods; a total of 35 different contraceptive combinations were reported. Perceived ability to select "safe" partners was associated with not using contraception (OR = 1.25), using less effective contraceptive methods (OR = 1.23), or hormonal birth control (OR = 1.50). Female gender predicted hormonal birth control use (OR = 2.33), use of less effective contraceptive methods (e.g., withdrawal; OR = 2.47), and using no contraception (OR = 2.37). Respondents' age and partner type did not predict contraception use. Adolescents used contraceptive methods with limited ability to prevent both unintended pregnancies and STD/HIV. Adolescents who believed their partners posed low risk were more likely to use contraceptive practices other than condoms or no contraception. Reproductive health practitioners are encouraged to help youth negotiate contraceptive use with partners, regardless of the partner's perceived riskiness.

Sexual risk behavior has decreased among men who have sex with men in Los Angeles but remains greater than that among heterosexual men and women

We examined changes and correlates of sexual risk behavior of men who have sex with men (MSM) compared with heterosexual men and women over three time periods. Data from the 1997, 1999, and 2003 Los Angeles County Health Surveys, a population-based telephone survey, were analyzed to examine the association of sociodemographic and health-related factors with sexual risk behaviors among the three groups. In each time period, MSM reported a significantly greater percentage of sexual risk (i.e., both inconsistent condom use and multiple sex partners in the past 12 months) compared with heterosexual men and women. Multivariate analyses indicated that MSM and heterosexual men reported greater sexual risk than heterosexual women. Respondents who were younger, U.S. born, reported heavy alcohol consumption, or had been tested for HIV in the past 24 months were more likely to report sexual risk behavior. The findings suggest the need for continued targeted prevention for MSM and prevention efforts for segments of the general population at elevated risk for HIV.

A qualitative analysis of accounts of hormonal contraceptive use: experiences and beliefs of British adolescents

OBJECTIVES

Britain has high rates of unintended adolescent pregnancy compared to other European countries. Relatively little is known about the beliefs, attitudes and experiences of using hormonal contraceptive methods amongst middle-class adolescents, and mention of their views in the literature will add to the knowledge in this area. The current qualitative study addresses these issues to some extent.

METHODS

Middle-class 16-18-year-old men and women were interviewed about their understanding and use of hormonal contraceptives. The interviews were transcribed verbatim and transcripts subjected to an adaptation of interpretative phenomenological analysis (IPA).

RESULTS

Six emergent themes represent important aspects of these adolescents' experiences: negative experiences, experiences unrelated to pregnancy prevention, mistrust of the pill, risk reduction, issues of communication and trust, and perceptions of pill promotion by adults.

CONCLUSIONS

The findings illustrate the complexities inherent in contraceptive health care in relation to hormonal methods and highlight not only potential targets for enhancing effective use, but the importance of the way such information is disseminated.

A brief, low-cost, theory-based intervention to promote dual method use by black and Latina female adolescents: a randomized clinical trial

HIV/AIDS disproportionately affects young women of color. Young women who use hormonal contraception are less likely to use condoms. Brief, inexpensive HIV-prevention interventions are needed for high-volume clinics. This study was a randomized clinical trial of two interventions: (a) a video made for this study and (b) an adaptation of Project RESPECT counseling. Four hundred Black and Latina teenage women completed a questionnaire about their sexual behaviors and were randomly assigned to (a) see the video, (b) get counseling, (c) see the video and get counseling, or (d) receive usual care. At 3-month follow-up, those who saw the video and received counseling were 2.5 times more likely to have used a condom at last intercourse with their main partner than teens in the usual care group. These differences did not persist at 12-month follow-up. This suggests that a brief intervention can positively affect condom use in the short term.

Condom use, frequency of sex, and number of partners: multidimensional characterization of adolescent sexual risk-taking

Sexual health research often relies on single risk indicators. However multi-variable composites may better capture the underlying construct of risk-taking. Latent Profile Analysis identified subgroups based on condom use consistency, partner numbers, and sex frequency among 605 adolescents. Three profiles were identified for each of grades 8 to 10 (Condom Users, Few Partners, and Risk-Takers) and 4 in grades 11 and 12 (Condom Users, One Partner Two Partners, and Risk-Takers). Inconsistent condom use groups reported more non-condom (and often less effective) birth control use and STD and pregnancy histories. Females had greater representation in the Few Partners, One Partners, and Two Partners groups, which also contained increasing proportions of participants in each subsequent year. Males had greater representation in the Risk-Takers group. A profile approach to measurement has methodological advantages, can add to substantive knowledge, and can inform content, timing, and targets of sexual health interventions.

Towards an understanding of barriers to condom use in rural Benin using the Health Belief Model: a cross sectional survey

Background

HIV/AIDS is the most dramatic epidemic of the century that has claimed over two decade more than 3 million deaths. Sub Saharan Africa is heavily affected and accounts for nearly 70% of all cases. Despite awareness campaigns, prevention measures and more recently promotion of anti viral regimens, the prevalence of cases and deaths is still rising and the prevalence of systematic condom use remains low, especially in rural areas. This study identifies barriers to condom use based on the Health Belief Model (HBM) in Benin, West Africa.

Methods

The study was a cross-sectional survey conducted from June to July 2002. Two hundred fifty one (251) individuals were interviewed using a structured questionnaire adapted from a standardized WHO/GAP questionnaire. A logistic regression was used to identify factors associated with condom use.

Results

In spite of satisfactory knowledge on HIV/AIDS transmission, participants are still at high risk of contracting the infection. Sixty three (63) percents of the interviewees reported being able to recognize infected people, and condom use during the last occasional intercourse was declared by only 36.8% of males and 47.5% of females. Based on the HBM, failure to use condom was related to its perceived lack of efficacy [OR = 9.76 (3.71–30.0)] and perceived quality [OR = 3.61 (1.31–9.91)].

Conclusions

This study identifies perceived efficacy (incomplete protective effect) and perceived utilization-related problem (any reported problem using condoms) as the main barriers to condom use. Hence, preventions strategies based on increasing perceived risk, perceived severity or adequate knowledge about HIV/AIDS may not be sufficient to induce condom use. These data will be useful in designing and improving HIV/AIDS prevention outreach programs in Sub Saharan Africa.

Developing a culturally appropriate video to promote dual-method use by urban teens: rationale and methodology

This article describes the development and production of a video targeted to urban adolescent women who use hormonal contraception. Research has shown that this population is at high risk for nonuse of condoms. Extensive preliminary qualitative and quantitative studies were done to understand the situations in which young women do and do not ask their partners to use a condom. Combining constructs from the health belief model, social cognitive learning theory and the theory of reasoned action with insights gleaned from the preliminary studies, the researchers developed a video that features two young HIV-positive women and two young HIV-negative men. Focus groups with young women helped the researchers edit the video to its current length of 21 minutes. Responses from the focus groups suggest that the video has a strong impact on young women. The video is currently part of a randomized controlled trial of two HIV prevention interventions.

The relationship between attitudes toward pregnancy and contraception use among drug users

Use of alcohol and drugs during pregnancy is regarded as a serious problem in the medical field. The current study explored gender and ethnic differences in attitudes and behaviors related to sexuality and contraceptive use among European American, Mexican American and Native American female and male clients in drug recovery programs. The study also examined the relationship between sexual abuse, concern for pregnancy, concern for contracting sexually transmitted diseases and contraception use among women drug users. Results showed gender and ethnic differences in attitudes toward pregnancy, abortion and contraceptive use. In addition, both Mexican American and Native American women who had a high concern for pregnancy were more likely to use birth control when they reported sexual abuse than when they reported no abuse. In contrast, European American women with a high concern for pregnancy showed a tendency to use birth control less when they reported abuse than when they did not. The observed attitudinal and behavioral differences between genders and ethnic groups are discussed in relation to design of treatment program components to increase contraceptive use and decrease unwanted pregnancies among drug users.

[Condom use among the young engaging in vaginal intercourse]

OBJECTIVE

To describe young people's use of condoms in penetrative vaginal intercourse, and to identify the factors associated with this use.

METHOD

The information was collected using a self-administered questionnaire put in 1,000 people between 14 and 24 years of age resident in the region of Andalusia (Spain). The results of the sample were representative and the trust interval was 95%. A bivariante analysis was carried out and hierarchical logistic regression equations were adjusted to verify associations between the dependent variable use of the condom in the vaginal intercourse and the variables proposed from PRECEDE model (predisposing, enabling, and reinforcing). The adjustment of the model was of a 38%, according to the Nagelkerke's statistic.

RESULTS

Of the people surveyed, 750 had affective and/or sexual relations with physical contact, and 63% of these had vaginal intercourse (47% of all surveyed). Of those, people that only had vaginal intercourse once (12% of all surveyed), 83% (10,3% of all surveyed) used a condom, whereas, people that had sex more than once (34% of all surveyed), 49% always used a condom (16,9% of all surveyed). The variables associated with always using a condom were: intention of safe behaviour with their regular partner and low frequency of practice. The variables associated with never using a condom were: living emancipated, having an external locus of control (thinking that becoming infected depends upon external factors), low number of zones of the body identified as pleasure-sensitive, thinking that a condom is not necessary if one trusts his or her partner, intention of unsafe behaviour with their regular partner, and not talking with the partner about preventive methods before having sex.

DISCUSSION

The most associated factors with using or not a condom in vaginal intercourse are predisposing (attitudes, values and believes) that are related with the kind of sexual partner. Interventions (based on the young active participation) are suggested to make them perceived the compatibility between the trust with the partner and the use of condom, and put in doubt the false safety given by a partner perceived as habitual.