Condom practices of urban teens using Norplant contraceptive implants, oral contraceptives, and condoms for contraception,☆☆,

Presented at the Seventeenth Annual Meeting of The American Gynecological and Obstetrical Society, Hot Springs, Virginia, September 3-5, 1998.
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Abstract

Objectives: The availability of long-acting hormonal birth control methods has created new contraceptive options for adolescents. The purpose of this study was to determine whether teens initiating these methods use condoms less frequently than teens using oral contraceptive pills or condoms alone and may therefore be at an increased risk of acquiring sexually transmitted infections. Study Design: To investigate ongoing condom behavior in teens using levonorgestrel (Norplant) contraceptive implants, oral contraceptives, and condoms alone, we examined data from a 2-year prospective cohort study of 399 urban teens. The study consisted of 3 clinic-based cohorts of adolescent female contraceptive users: Norplant contraceptive implants (n = 200), oral contraceptives (n = 100), and condoms alone (n = 99). Data were collected at an admission interview and at 1- and 2-year follow-up from method continuers. Results: Norplant contraceptive implant users were less likely than oral contraceptive or condom users to report condom use at last sex or consistent condom use at 1- and 2-year follow-up. The implant group showed a significant decrease in condom use from admission to 2 years after method initiation. The proportion of implant users self-reporting new sexually transmitted infections at 2-year follow-up, however, was not significantly greater than that of oral contraceptive or condom users. Conclusions: Our findings indicate that teen users of Norplant contraceptive implants are less likely to use condoms than teens who choose oral contraceptives but, probably because of differences in sexual behavior, are no more likely to self-report sexually transmitted infections. Our findings also indicate that teens who choose oral contraceptives and condoms do not use them consistently enough to avoid pregnancies or sexually transmitted infections. (Am J Obstet Gynecol 1999;180:929-37.)

Section snippets

Study design

We conducted a prospective 2-year cohort study of 399 sexually active adolescent women using either Norplant contraceptive implants, oral contraceptives, or condoms alone. Sample sizes were based on a power calculation performed for continuation rates, the original primary outcome to be evaluated by means of these data and to be reported elsewhere. A 37% difference in continuation rates between implant and oral contraceptive accepters and between implant and condom accepters was expected at 2

Comment

This study’s findings support our first primary hypothesis that teens using Norplant contraceptive implants would use condoms less often than teens using oral contraceptives or condoms alone. Whereas, at admission, the groups did not differ substantially, the discrepancies were significant at both 1 and 2 years of follow-up. Both condom use variables (condom use at last sex and frequency of use) confirmed the general trend of less frequent condom use by implant users than by oral contraceptive

Acknowledgements

We are grateful to Planned Parenthood Golden Gate and to the Balboa High School Teen Clinic for allowing us to interview their clients.

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Supported by grants from the Henry J. Kaiser Family Foundation, Menlo Park, California, and the Stuart Foundations, San Francisco.

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