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PubMed1996

Factors related to choosing oral contraception at age 15.

This report aims to identify factors which are related to use of oral contraceptives at an early age. A self-administered questionnaire was completed at schools in 1988 and 1992 in southern and western Finland (N = 1339). Sexually experienced girls (mean age 15.8 years) who had answered the question concerning their oral contraceptive use were included (N = 389). Logistic regression analysis was used to compare oral contraceptive users (N = 121) with the group of non-users. Total number of coital experiences was associated with oral contraceptive use: the odds ratio for those having at least 10 coital experiences was 6.30 compared with those with only one intercourse. The proportion was 73% among oral contraceptive users and 30% among non-users. Girls using oral contraceptives perceived more often (67%) that parents accept their sexual relationship (30% among non-users). Oral contraceptive users were less afraid of getting pregnant (9% compared with 31% among non-users) and felt more often that sex was very important in their life (31 and 13%, respectively). Other factors that entered the model were age at menarche, having a steady partner and frequency of disco visits. When a young girl asks for oral contraceptives, she is probably at true risk of pregnancy, and regular contraception should be considered both in view of effective prevention of pregnancies and sexually transmitted diseases.

Adolescent↗
PubMed1996

Contraceptive use and attitudes in Italy 1993.

Surveys conducted between 1979 and 1991 indicated that contraceptive practice in Italy underwent rapid changes over that period. In order to assess current contraceptive use and attitudes, a survey was conducted among a random sample of 2000 Italian women aged 15-45 years. Replies were received from 1542 women (77.1%). Of the self-defined non-sterile, sexually active women who wished to avoid pregnancy, 30.3% were using oral contraceptives, 8.1% an intrauterine device, and 1.1% sterilization, while 29.6% were using traditional methods, principally coitus interruptus. In reply to questions about the relative advantages and disadvantages of various contraceptive methods, women expressed worries with respect to the safety of oral contraceptives, intrauterine devices and sterilization. Relatively high percentages of women answered 'do not know' with respect to the various aspects of intrauterine devices, periodic abstinence and sterilization that were investigated. In view of the findings of previous studies, the current data obtained suggested that traditional methods are being gradually displaced by modern methods in Italy. Nevertheless, the use of traditional contraceptive is widespread, the same probably being true of inconsistent use of condoms. Furthermore, lack of information on the contraceptive options available seems to be a central issue in Italy.

Adolescent↗
PubMed1992

A case-control study of the risk of breast cancer in relation to oral contraceptive use.

The relation of oral contraceptive use to the risk of breast cancer was evaluated in a case-control study of women under the age of 70 years, conducted in Toronto, Canada, from 1982 through 1986. A total of 607 breast cancer cases identified in a cancer hospital were compared with 1,214 controls matched to the cases on neighborhood and decade of age. Information on oral contraceptive use and risk factors for breast cancer was collected in home interviews. Conditional logistic regression was used to control multiple confounding factors. For women aged 40-69 years (527 cases, 1,054 controls), the results suggest that oral contraceptive use does not increase the risk of breast cancer. Multivariate relative risk estimates were close to or below 1.0 for long durations of use overall and in various categories of parity status and other factors. For women under the age of 40 years, the data were sparse (80 cases, 160 controls). Although there were some elevated relative risk estimates, most were not statistically significant, and there were no consistent patterns across duration of use. The present data add to the body of evidence that indicates that oral contraceptive use does not adversely affect the risk of breast cancer in older women; the data are inadequate to clarify the effect in younger women.

Adult↗
PubMed1992

Oral contraceptive use and breast cancer risk: a meta-analysis of variations with age at diagnosis, parity and total duration of oral contraceptive use.

OBJECTIVE: To review published reports of risk of breast cancer with oral contraceptive use. DESIGN: Meta-analysis of study results, using regression techniques to explore the inter-study heterogeneity. SETTING: Twenty-seven epidemiological studies of breast cancer risk and oral contraceptive use published 1980-1989. MAIN OUTCOME MEASURES: Relative risk of breast cancer with oral contraceptive use; variations by age at diagnosis, parity, and total duration of use, and with study design characteristics. RESULTS: The overall relative risk estimate was 1.16 (95% CI 1.07-1.25) for the less than 45 years group, 1.21 (95% CI 0.99-1.47) for the nulliparous subgroup, and 1.27 (95% CI 1.12-1.44) for durations of use of more than 8 years. Source of subjects, their marital status, the type of study, data collection methods, matching for geographical area, the number of adjustment factors used in the study analysis, the country of study and the calendar period in which the study ended were all important explanatory factors for inter-study variation, but a substantial proportion of inter-study variation remained unexplained. CONCLUSIONS: These meta-analyses suggest that risk of breast cancer may be raised by around 20% in younger, nulliparous and long use duration subgroups of oral contraceptive users. Risk estimates appear to be influenced by several study design factors, which should be considered carefully in designing and reviewing future studies.

Age Factors↗
PubMed1999

Mortality associated with oral contraceptive use: 25 year follow up of cohort of 46 000 women from Royal College of General Practitioners' oral contraception study.

OBJECTIVE: To describe the long term effects of the use of oral contraceptives on mortality. DESIGN: Cohort study with 25 year follow up. Details of oral contraceptive use and of morbidity and mortality were reported six monthly by general practitioners. 75% of the original cohort was "flagged" on the NHS central registers. SETTING: 1400 general practices throughout Britain. SUBJECTS: 46 000 women, half of whom were using oral contraceptives at recruitment in 1968-9. Median age at end of follow up was 49 years. MAIN OUTCOME MEASURES: Relative risks of death adjusted for age, parity, social class, and smoking. RESULTS: Over the 25 year follow up 1599 deaths were reported. Over the entire period of follow up the risk of death from all causes was similar in ever users and never users of oral contraceptives (relative risk=1.0, 95% confidence interval 0.9 to 1.1; P=0.7) and the risk of death for most specific causes did not differ significantly in the two groups. However, among current and recent (within 10 years) users the relative risk of death from ovarian cancer was 0.2 (0.1 to 0.8; P=0.01), from cervical cancer 2.5 (1.1 to 6.1; P=0.04), and from cerebrovascular disease 1.9 (1.2 to 3.1, P=0.009). By contrast, for women who had stopped use >/= 10 years previously there were no significant excesses or deficits either overall or for any specific cause of death. CONCLUSION: Oral contraceptives seem to have their main effect on mortality while they are being used and in the 10 years after use ceases. Ten or more years after use ceases mortality in past users is similar to that in never users.

Cause of Death↗
PubMed1995

Sixteen-year-old oral contraceptive users in Finland, 1981-1993.

While adolescent fertility and abortion rates continue to decline in Finland, regional variations in teenage pregnancies persist, particularly among 16-17-year-olds. We studied differences in the use of oral contraceptives (OCs) among 16-year-old girls according to sociodemographic variables between 1981 and 1993. Questionnaires were mailed to national samples (N = 462-1594) of 16-year-old girls biannually, giving response rates ranging from 86% to 91% (the Adolescent Health and Lifestyle Survey). The increasing trend in OC use levelled off in 1989 at around 17-19%. OC use was most frequent in the lower socioeconomic groups, least frequent in the rural areas, but did not vary significantly according to region of the country. The pace of adopting OCs did not vary across the socioeconomic groups or regions. The socioeconomic and regional distributions of OC use were consistent with previous studies on teenage sexual activity. The results suggest equal accessibility of family planning services; regional variation in pregnancy rates cannot be explained by unequal distribution of OC use.

Adolescent↗
PubMed1990

Human papillomavirus infection in sexually active adolescent females: prevalence and risk factors.

We examined the prevalence of human papillomavirus (HPV) infection, and associated risk factors for infection with HPV types 6, 11, 16, 18, 31, 33, and 35, in 661 sexually active adolescent females attending family planning clinics. Fifteen percent were positive for HPV DNA by RNA-DNA dot-blot hybridization. More than 60% of the HPV-positive subjects harbored at least one of the following cancer-related HPV types: 16, 18, 31, 33, or 35. Those with HPV had a mean range of four to 10 lifetime sexual partners compared with a mean range of one to three in those without HPV (p less than 0.001). After the analysis was adjusted for number of lifetime sexual partners, no other risk factor was associated with HPV infection. We conclude that oncogenic-related HPV types are common sexually transmitted organisms found in our population. The strong relationship with number of sexual partners suggests that acquisition of HPV infection is predominantly influenced by sexual behavior. However, in our population, confounders such as oral contraceptive use, past history of Chlamydia trachomatis infection, or substance abuse were not found to be significant independent risk factors.

Adolescent↗
PubMed1977

New acceptors reach 72% of target according to IMCH mid-year report.

Cumulative number of new acceptors since January-June was 49,958, 72% of the target of average number of 331 reporting clinics. Average number of new acceptors recruited per clinic per month was 24. Method profile showed the same trend as previous year but with increasing number of acceptors for fertility termination and IUD. Total caseload was 467,112 with an average caseload of 235/clinic/month. Total number of old acceptors serviced was 382,036 with an average of 211/clinic/month. On the trend and level of return visits, there were 434,477 return visits of which 58.9% was for the purpose of getting supplies, 32.0% for routine checkup, and 8.9% for medical consultation or checkup. Total number of shifters was 12,609 of which 33% shifted to condom, 28% to pills, 13.9% to sterilization, 10.9% to IUD, and 10% to rhythm. It is interesting to note that 909 pill users shifted to IUD and 371 condom users to IUD. Continuing users reported was 94,987, about 25% of total number of old acceptors serviced during the 6 months. Dropouts - 2438 of which about 48% were pill dropouts, 27% condom, 12% rhythm, and 9.2% IUD. Failures - 4696, 45% of which were pills, 37% condom, 12.5% rhythm, and 2.7 IUD. Sterilization services - a total of 3486 sterilizations of which 569 were vasectomies and 2947 were tubal occlusions. 7% of total new acceptors registered during the 6-month period were for sterilization and about 14% of shifters shifted to sterilization. Expansion of family planning services through utilization of nurses and midwives in IUD insertion and pill dispensing: Average number of nurses and midwives reporting performance was 266/month. The total number of pill acceptors serviced was 10,767 about 41% of the 26,431 number of pill acceptors recruited. There were 739 who complained of side effects and were managed by the midwives. For comprehensive service - out of the 694 nurses and midwives, only 22 were trained in comprehensive service. Average number of midwives reporting performance was 15 and had serviced 652 IUD acceptors (18%) and 618 pill acceptors (12%). The impact of the service could hardly be felt because of the limited number of staff trained in comprehensive service. However, there is an increasing trend for IUD method.

Ambulatory Care Facilities↗