With Pills, Patches, Rings, and Shots: Who Still Uses Condoms? A Longitudinal Cohort Study

• Published in: Journal of adolescent health Vol. 52; no. 1; pp. 77 - 82
• Main Authors: Goldstein, Rachel L., M.D, Upadhyay, Ushma D., Ph.D., M.P.H, Raine, Tina R., M.D., M.P.H
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.01.2013; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Cohort analysis; Cohort Studies; Condoms; Condoms, Female - statistics & numerical data; Contraception; Contraception - statistics & numerical data; Contraception Behavior - statistics & numerical data; Contraceptive patch; Contraceptives, Oral; Depot medroxyprogesterone acetate; Discontinued; Dual method; Environment. Living conditions; Family planning; Female; Humans; Logistic Models; Longitudinal Studies; Medical sciences; Oral contraceptives; Pediatrics; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Sexual behaviour; Sexually transmitted diseases; Surveys and Questionnaires; Vaginal ring; Women; Young Adult; Contraceptive patch; Vaginal ring; Sexually transmitted diseases; Depot medroxyprogesterone acetate; Adolescent; Young adult; Contraception; Condoms; Oral contraceptives; Dual method; Human; Family planning; Condom; Sexual behavior; Infection; Prevention; Sexually transmitted disease; Follow up study; Cohort study; Female; Public health
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2012.08.001

Abstract Purpose To describe women's condom use patterns over time and assess predictors of dual method use 12 months after initiating hormonal contraceptives. Methods We conducted a prospective cohort study among women aged 15–24 years initiating oral contraceptive pills, patch, ring, or depot medroxyprogesterone and attending public family planning clinics. Participants completed questionnaires at baseline and 3, 6, and 12 months after enrollment. We used multivariable logistic regression to assess baseline factors associated with dual method use at 12 months among 1,194 women who were sexually active in the past 30 days. Results At baseline, 36% were condom users, and only 5% were dual method users. After initiation of a hormonal method, condom use decreased to 27% and remained relatively unchanged thereafter. Dual method use increased to a peak of 20% at 3 months but decreased over time. Women who were condom users at baseline had nearly twice the odds of being a dual method user at 12 months compared with nonusers (adjusted odds ratio [AOR] = 2.01, 95% CI: 1.28–3.14). Women who believed their main partner thought condoms were "very important," regardless of perceived sexually transmitted infection risk or participant's own views of condoms, had higher odds of dual method use (AOR = 2.89, 95% CI: 1.47–5.71). Conclusions These results highlight a potential missed opportunity for family planning providers. Providers focus on helping women initiate hormonal methods, however, they may improve outcomes by giving greater attention to method continuation and contingency planning in the event of method discontinuation and to the role of the partner in family planning.