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PubMed2001

An analysis of 15-19-year-old first attenders at the Dublin Needle Exchange, 1990-97.

AIMS: Identification of characteristics and trends over time in young injecting drug users at first attendance at needle exchange. DESIGN: Retrospective cross-sectional survey of routinely collected data. SETTING: Dublin needle exchange programme which consists of 11 sites in the greater Dublin area. PARTICIPANTS: First-time attenders (n = 1224) at the needle exchange from 1990 to 1997, between the ages of 15 and 19. MEASUREMENT: Factors associated with a likelihood of needle sharing and condom use were tested using logistic regression. FINDINGS: Increases in both the number and proportion of young injectors, particularly young female injectors, have occurred over the 8 years. Forty-eight per cent of the young injectors were injecting for less than 1 year. Needle sharing prevalence in the year previous to first attendance was 39% and condom use was 61%. The proportion of females not using a condom during sexual relationships was significantly higher than males. Very few of the young attenders had received any treatment for drug dependence. CONCLUSIONS: After the first year of injecting drug use the likelihood of needle sharing increased and we recommend that interventions occur early on and are targeted to the needs of young injecting drug users, in particular young females. It is essential that services are accessible to the young injecting drug user and that barriers to contact with services are minimized or eliminated. Some high-risk behaviours are occurring in the context of the sexual relationship and this should be taken into account when designing prevention programmes, especially for young females.

Adolescent↗
PubMed1993

Have the AIDS campaigns changed the pattern of contraceptive usage among adolescents?

In 1984--just before the extensive public information about prevention of HIV infection by the use of the condom (the AIDS campaigns)--personal interviews about sexual experiences and use of contraception were obtained in random samples of 16-20 year old Danes. The investigation was repeated in 1989 addressing the issue of whether the behavior of adolescents regarding sexual intercourse and use of contraception has changed. In 1984 in all 286 females (respondent rate = 75.3%) and 336 males (respondent rate = 77.8%) agreed to be interviewed. The second investigation in 1989 involved new cohorts of 16-20 year olds and here 359 females (respondent rate = 77.9%) and 400 males (respondent rate = 76.3%) participated. In 1984 approximately 20% and in 1989 approximately 10% reported no use of contraception at first sexual intercourse. In both investigations oral contraception (OC) and condom were by far the predominant methods mentioned. In 1984 38.1% of females and 34.4% of males used OC and 37.2% of females and 42.1% of males employed condom. In 1989 26.7% of females and 30.8% of males used OC and 64.8% of females and 62.1% of males employed condom. No sex difference in the distribution of the various contraceptive methods could be revealed. From 1984 to 1989 the prevalence of condom increased significantly. In the first investigation 15.9% of sexually experienced females reported no present use of contraception. The most frequently used device was OC (62.7%). The second investigation collected information about contraception employed at the most recent sexual intercourse from both females and males. Approximately 5% of both sexes mentioned no use of contraception.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed2001

Provision of emergency contraception in general practice and confidentiality for the under 16's: results of a postal survey by general practitioners in Avon.

OBJECTIVE: To describe the provision of emergency contraception and confidentiality for the under 16's by general practitioners (GPs) in Avon, in order to inform the development of a health promotion intervention in schools in Avon. DESIGN: Confidential postal questionnaire survey. SETTING: All principals in general practice in Avon Health Authority, South West England. SUBJECTS: Five hundred and eighty general practice principals were sent the questionnaire. RESULTS: Four hundred and eighty-six (84%) principals in general practice responded to the questionnaire. Only three (0.6%) GPs did not provide hormonal emergency contraception. Nearly half (232, 47.7%) would fit the intrauterine device (IUD) as emergency contraception. Fitting an IUD was associated with female gender of the GP (OR = 2.34, 95% CI 1.53-3.71), and whether the GP had a family planning qualification (OR = 4.55, 95% CI 2.41-8.60). Three hundred and fifty-two (72%) respondents would provide emergency contraception on a Sunday if requested to do so by a 14-year-old who reported having had unprotected sex the night before. Practice nurses in 26 (5%) of the respondent's practices were available to provide advice and tablets for patients requesting hormonal emergency contraception. However, 74 (21%) respondents employed a family planning trained practice nurse who was not involved in any way in the provision of emergency contraception. Practice nurses remain an under used resource in this area. CONCLUSION: Our findings suggest that most GPs provide hormonal emergency contraception. Only eight (1.6%) of respondents would need to ask for parental consent prior to providing hormonal emergency contraception to a 14-year old-girl. Young people need to be informed of GPs widespread adherence to current confidentiality guidelines.

Adolescent↗
PubMed2002

Reproductive, sexual and contraceptive behaviour of adolescents in Niger State, Nigeria.

This is a multi-stage random sampling study involving 896 male and female adolescents aged 11-25 years in Niger State of Nigeria. Thirty three per cent of them had already had first sexual experience. Only 3.6% were married. Most of the Gwari and Hausa respondents acknowledged that they married at an earlier age than the Yoruba respondents. One half of those who were sexually experienced had more than one sexual partner. Majority of the respondents were informed about HIV/AIDS and STDs. More Gwari and Hausa respondents felt that HIV infection could be prevented by not having multiple sexual partners than Yoruba and Igbo respondents. A wide disparity between contraceptive knowledge and use was found. Knowledge rate was between 41.9% and 63.8%, while use rate was between 0.7% and 12.5% for the contraceptive methods studied. Condom knowledge and use rate was highest. For prevention of HIV/AIDS, more males than females thought condom was useful. Most Gwari and Hausa respondents did not use any FP method during their first sexual relationships. It is imperative for reproductive health programmes to intensify efforts in improving adolescents' attitude towards sexual risk and motivate them to exhibit behaviours that limit it.

Abortion, Induced↗
PubMedDate not supplied

Contraceptive practices and trends in France.

CONTEXT: Contraceptive use has been legal in France for the past 30 years, and patterns of use changed substantially from the 1960s to the 1980s. Given the rapidity with which use patterns change and the possible impact of rising concern about infection with HIV and other sexually transmitted diseases, it is important to determine trends of contraceptive practice into the 1990s. METHODS: A total of 5,900 French households were selected in 1994 for inclusion in the Fertility and Family Survey. Respondents were questioned about their contraceptive use patterns and family formation status. The results were compared with those of comparable surveys conducted in 1978 and 1988. RESULTS: Two-thirds of French women used some form of reversible contraceptive method in 1994. Oral contraceptive use has grown steadily in France: About 40% of women aged 20-44 reported using the pill alone or combined with another method in 1994, compared with 34% in 1988 and 28% in 1978. Condom use has also been on the rise: Nearly 8% of women were using condoms alone or combined with another method in 1994, up from 5% in 1988 and 6% in 1978. IUD use has declined from 19% in 1988 to 16% in 1994, and both male and female sterilizations remain rare. CONCLUSIONS: Contraceptive behavior in France appears unique among developed countries, with fairly high levels of oral contraceptive use--even among older women--relatively high levels of IUD use and little reliance on either male or female sterilization. As with other countries, however, condom use has climbed in recent years, and is especially common at first intercourse.

Adult↗
PubMedDate not supplied

Chronically homeless women's perceived deterrents to contraception.

CONTEXT: Despite the growing number of homeless women of reproductive age, little is known about their reproductive health and contraceptive use. METHODS: A representative sample of 974 currently homeless women surveyed in Los Angeles County in 1997 included 229 who were chronically homeless and at risk for unintended pregnancy. The relationships between perceived deterrents among these women and their frequency of contraceptive use were evaluated using chi-square tests. Logistic regression analyses were performed to identify independent predictors of contraceptive deterrents. RESULTS: The most commonly cited deterrents to contraceptive use were side effects, fear of potential health risks, partner's dislike of contraception and cost (20-27%). Women who reported substantial deterrents were significantly less likely than others to use contraceptives consistently. Perceived deterrents differed by women's characteristics: Hispanic women were more likely than whites to view not knowing how to use contraceptives or which method to use as a deterrent (odds ratios, 9.6-9.8); black women were more likely than whites to cite not knowing which method to use (4.0), lack of storage (5.5), health risks (6.0) and discomfort (3.3). Women with a history of drug abuse had elevated odds of citing not knowing how to use contraceptives, uncertainty about which method to use and cost as deterrents (5.2-7.7). CONCLUSION: Homeless women report substantial deterrents that reduce their contraceptive use. The multiplicity and heterogeneity of their perceived deterrents suggest a need for reproductive health services that are more integrated and culturally competent than those currently offered.

Adolescent↗
PubMed1994

The influence of endogenous and exogenous sex hormones in adolescents with attention to oral contraceptives and anabolic steroids.

The endogenous sex hormones produce dispositional changes in the developing child as well as imparting unique male and female dispositional patterns. Age-related changes have been observed for digoxin disposition and caffeine and theophylline metabolism. These age-related dispositional changes have led to age-dependent dosing recommendations. Studies with caffeine and antipyrine indicate that this change in drug disposition occurs over a short period of time, is seen earlier in girls than in boys, and is related to pubertal (Tanner) stage and the "growth spurt". Significant changes in endogenous sex hormone concentrations occur during the menstrual cycle and during pregnancy, leading to alterations in drug binding, distribution, and clearance. Oral contraceptives (OCs) inhibit the metabolism of certain drugs resulting in toxicity or lack of efficacy. Rifampin induces the OC metabolism, resulting in decreased clinical effectiveness. Most studies did not examine these kinetic and dynamic interactions between adult and adolescent users. It is estimated that there are over 45 anabolic steroid compounds available for abuse by athletes, and their use is increasing among male and female adolescents. Although the adolescent is at increased risk of developing adverse effects from these agents, a systematic evaluation of the long-term effects of anabolic steroid abuse has not been undertaken in this population. Further research is needed regarding the influence of endogenous and exogenous hormones on adolescent drug kinetics and dynamics. Because of their frequency of use among adolescents, OCs and anabolic steroids require particular emphasis.

Adolescent↗
PubMed1976

Measured intelligence in offspring of oral and nonoral contraceptive users.

A study has been made of measures of intelligence of 210 children (5 to 8 years of age) born to mothers who used oral and nonoral contraceptives pregestationally. Ninety-six of these children were born to mothers who used oral contraceptives, and one hundred and fourteen were born to mothers who used vaginal contraceptive methods. The intelligence of the children was measured in the form of the full-scale I.Q. score by the Wechsler Intelligence Scale for Children (WISC) adapted and normalized for Puerto Rico by the Puerto Rico Department of Education. A three-factor analysis of variance was performed on the data collected for comparison of the two groups. It was observed that there was no significant difference between the average I.Q. scores of children born to mothers using oral contraceptives and those born to the mothers using nonoral contraceptives. The average I.Q. in children of the oral contraceptive group was 85.04 and that in children of the nonoral contraceptive group was 85.54. Distributions for both groups were also found to be similar. No significant differences between means were observed for sex, age, and interacitons with the exception of the age and sex interaction, where, again, no specific, meaningful trend could be established. The average I.Q. in the sample fell very close to the center of the "normal" range of the WISC, Puerto Rican adaptation. The results of the study do not offer any evidence as to the effect of the use of oral contraceptives on the intelligence measure (by the WISC) of the offspring born to mothers using them pregestationally. The children under study, on an average, are of "normal" intelligence as measured by the Puerto Rican intelligence standards.

Adult↗
PubMed2006

Prospective cohort study of the association between use of low-dose oral contraceptives and stroke in Chinese women.

PURPOSE: To clarify the association between use of widely distributed low-dose combined oral contraceptives (COCs) in China and the risk of stroke in order to decrease adverse reactions to COCs. METHODS: A prospective surveillance cohort study was undertaken in 25 towns in two counties in Jiangsu Province, China. Women (44,408 ) on hormonal contraceptives (HC) and 75,230 women with an intrauterine device (IUD) were followed up from July 1997 to June 2000 to study the difference in the incidence of stroke. RESULTS: The incidence of haemorrhagic stroke (age- and county-standardised rate) was far higher than that of ischaemic stroke (34.74 vs. 11.25 per 100,000 person years) among HC cohort. The relative risk (RR) of incidence of haemorrhagic stroke in the HC cohort (52 cases) was 2.72 times compared with that in the IUD cohort (23 cases). Compared with IUD users, the current users of HC had a higher RR of 4.20 (95%CI, 2.11-8.36) of haemorrhagic stroke, and still reached 2.17 (95%CI, 1.16-4.06) among past users after they stopped taking COCs for more than 10 years. The RR of haemorrhagic stroke was 3.09 (95%CI, 1.26-7.57) among women who had last used low-dose COCs during the previous 5 years. In women aged less than 45 years, compared to IUD users, the haemorrhagic stroke was strongly associated with current use of low-dose combined norethisterone pills, with RR being 19.06 (95%CI, 3.08-118.03). CONCLUSIONS: There is an increased risk of haemorrhagic stroke among Chinese users of long-term low-dose oral contraceptives, which appears to persist long after discontinuation.

Adult↗
PubMed1975

Fertility reduction in an MCH/family planning program: a model for projection.

One of the important questions in an integrated maternal and child health/family planning program is the likely effects on fertility rates if given proportions of a stated target population can be reached and provided with family planning services. The question is easy, but the process of obtaining viable estimates of potential fertility decline from this type of program is complicated. First of all, the number of women in the target population must be estimated. Next, it is necessary to make various assumptions and estimates concering the types of contraceptives accepted, the age distribution of acceptors, the sets of continuation rates that go with each age/method specific group of women, and a variety of other factors. This article describes and illustrates a procedure for estimating potential fertility declines with an integrated maternal and child health/family planning program.

Age Factors↗
PubMedDate not supplied

Contraceptive prevalence in the slums of Rio de Janeiro.

A community-based family planning operations research project was undertaken in selected low income communities of Rio de Janeiro; project field work began in February 1982. Prevalence data were collected and service delivery strategies were tested, including home visits promoting family planning, home distribution of condoms, and the introduction of community family planning depots. A high baseline contraceptive prevalence rate (CPR) of 70.1 percent was found for nonpregnant women currently in union, as well as substantial use of the private sector for contraceptive supply, despite the presence of free or subsidized sources within the communities. However, the most economically disadvantaged subgroups made the greatest use of the subsidized sources. The provision of additional service delivery sites may have contributed to a small increase in contraceptive prevalence noted over the life of the project; however, the high baseline CPR precluded a large increase in contraceptive use as a result of the program.

Adolescent↗
PubMed2006

Contraceptive use by Maori youth in New Zealand: associated risk and protective factors.

AIMS: To identify risk and protective factors associated with consistent contraception use by sexually active Maori youth. METHODS: Secondary analysis was undertaken utilising Youth2000, an anonymous nationally representative secondary school health and wellbeing survey, undertaken in 2001. We describe the self-reported sexual health and contraceptive use behaviours of Maori students. A multiple logistic regression model was utilised to identify risk and protective factors associated with consistent contraception use by sexually active Maori students. RESULTS: Half of the Maori students have had sexual intercourse (54% males; 48% females) and a third are currently sexually active (33% males; 34% females). Most Maori youth who have ever had sex use condoms for contraception (82%) and most sexually active Maori youth reported consistent use of contraception (71% males; 70% females). Maori youth who use contraception consistently are more likely to report getting enough time with a parent (OR 1.50; 95% CI 1.05-2.14; p=0.03) and less likely to report weekly marijuana use (OR 0.53; 95% CI 0.37-0.76; p=0.0006). CONCLUSIONS: Consistent use of condoms is a common self-reported contraceptive practice by many young Maori. However this behaviour is not universal, and in view of the significant sexual and reproductive health disparities that exist for Maori youth, sexual and reproductive health programs should examine a broader strategy of promoting protective factors such as strengthening youth-parent relationships and reducing risk factors, such as minimising substance misuse. Together with existing efforts in education, whanau (family), and community based programs, these strategies may support healthier sexual health outcomes for Maori youth.

Adolescent↗
PubMed1997

Hepatitis B vaccination in adolescents: knowledge, perceived risk, and compliance.

PURPOSE: The purpose of this study was to evaluate adolescents' and parents' knowledge of hepatitis B, perceived risk of hepatitis B, and compliance with a three-dose vaccine series. METHODS: Two hundred adolescents were recruited into the study. Participants completed a questionnaire that examined hepatitis knowledge, sexual activity, contraceptive use, and perceived risk of acquiring hepatitis B infection at enrollment and the final 8-month follow-up visit. They also had blood drawn for determination of hepatitis B serology at these visits. Their parents completed a questionnaire at enrollment. RESULTS: A total of 174 (87%) participants completed the study. Adolescents initially had very little knowledge about hepatitis but did have significant improvement in their knowledge scores at the 8-month follow-up. Their parents were more knowledgable. Most teens perceived their risk of acquiring the hepatitis B infection as slight or none. Their perceptions of their risk of acquiring hepatitis B were not associated with sexual activity, contraceptive choices, or number of sexual partners. In contrast, the parents' perceptions of their teens' risk of acquiring hepatitis B were associated with the teens' sexual activity, contraceptive choices, and number of sexual partners. CONCLUSIONS: The adolescents studied had little knowledge about hepatitis or their personal risk. In contrast, the adolescents' parents were more knowledgable about hepatitis. The more informed the parent, the less sexual risk-taking behaviors the adolescent reported.

Adolescent↗