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Conflicting advice? Australian adolescents' use of condoms or the pill.

CONTEXT: Teenagers are exposed to two potentially conflicting sexual health messages, one emphasizing the prevention of sexually transmitted diseases (STDs) and the other stressing pregnancy prevention. To protect teenagers from both STDs and unwanted pregnancy, it is important to know what method choices they make and why. METHODS: Data from a 1997 national survey of 3,550 Australian secondary school students were used to examine teenagers' method choice and patterns of advice-seeking about contraception and STD prevention. Logistic regression analyses were conducted to identify factors associated with the exclusive use of condoms or the pill. RESULTS: Virtually all 961 currently sexually active students were using at least one contraceptive method--primarily condoms (78%) or the pill (45%). Some 31% were using condoms exclusively, and 10% were using the pill exclusively. Older students and those who had sought contraceptive advice had elevated odds of using the pill rather than condoms exclusively (odds ratios, 4.4 and 2.6, respectively), while those who had had only casual partners in the last year had a reduced likelihood of exclusive pill rather than condom use (0.1). Furthermore, the more students believed that their peers used condoms, the less likely they were to report exclusive pill use (0.4). Parents were the most frequent source of advice about contraception, followed by physicians and teachers. The most common sources of advice about HIV and other STDs were parents, teachers and then physicians. CONCLUSIONS: Young people must be educated about the distinction between safer sex and contraception, and about how to prevent both STDs and pregnancy. Providing parents with current sexual health information may help to improve young people's sexual health.

Adolescent↗

[Contraceptive behavior in the population of the Czech Republic: results of a national survey].

Using an anonymous questionnaire the authors investigated in a representative group of the Czech population above 15 years of age (862 men and 857 women) the use of the main contraceptive methods. During the first intercourse more than half the respondents did not use any contraception, a condom was used only by 19% men and 14% women. In a steady partnership the most frequent method of contraception is coitus interruptus, whereby experience with hormonal contraception was reported by cca one third and with a condom by two thirds of respondents. Among younger men and women there are more users of hormonal contraception and condoms. Only 5% of the examined men and 4% of the women opposed any type of contraception, almost one quarter of respondents use only so-called "natural methods" and almost three quarters of the respondents consider them an essential part of sex life. The attitudes of atheists and junior and more educated women are more liberal.

Adolescent↗

Contraceptive use in a sample of young Danish females.

During the period April 1984-February 1985, 4 test samples of totally 380 young Danish women aged 16-20 years old were invited to interview about contraception and sexual behaviour. The response rate was 75.3%. There were 208 (74.0%) who had had sexual debut. Median age was estimated to 16.8 years. At first intercourse 168 (80.8%) used contraception, 36.5% used condom and 36.1% oral contraception (OC). Among teenage-girls with sexual debut before 15 years old 32.5% were unprotected against pregnancy. At the time of the interview 64.4% did use contraception. The most frequently used contraceptive device was OC (46.6%). Teenage-girls changed the contraceptive method from condom to OC after sexual debut. A small proportion of sexually active girls (8%) did not use contraception neither at first intercourse nor at the moment.

Adolescent↗

Family planning practice among Nigerian student midwives.

An analysis of the various contraceptive methods practiced by a total of 462 student midwives from the Northern and Southern parts of Nigeria over a 3-years period is presented. The differences in age distribution, the type of contraceptive agents used, the reasons for using them, and the side effects in the two groups are statistically significant. The need to provide acceptable contraceptive advice to the rural communities by the midwives is discussed.

Adolescent↗

Determinants of contraceptive use and method choice in Turkey.

In this study, the determinants of contraceptive use and method choice are examined based on various variables, classified as individual, cultural, fertility and contextual. The data used came from the 1993 Turkish Demographic and Health Survey. The main finding is that there exists a positive association between the educational level of both spouses and the use of contraceptive methods in Turkey. After all individual, cultural, fertility and contextual variables are controlled, a woman's education is a stronger predictor of method use and method choice than that of her husband. Increasing the educational level of women may be the most effective means of advancing family planning acceptance and increasing the demand for contraceptive services in Turkey. The study also shows that, to a great extent, contraceptive use and choice of modern method depend on the sex of a couple's living children, implying some preference for sons, although generally women prefer to have children of both sexes.

Adolescent↗

Risk of cervical dysplasia in users of oral contraceptives, intrauterine devices or depot-medroxyprogesterone acetate. The New Zealand Contraception and Health Study Group.

Three cohorts of women aged 20-39 attending medical practitioners or family planning clinics in New Zealand for contraceptive advice were followed prospectively for five years. The three cohorts were defined by use (or at least prescription) of one of three study contraceptive methods at the time of beginning of follow-up--oral contraceptives (OC), intrauterine devices (IUD) or depot-medroxyprogesterone acetate (MPA)--and numbered 2469, 2072 and 1721 women, respectively. Follow-up was intended to be annual and included cervical smear as well as interim contraceptive and medical histories. A positive outcome (referred to here as 'dysplasia') was any degree of definite dysplasia or carcinoma of the cervix diagnosed cytologically by a central study laboratory, and confirmed by histology or analysis of DNA ploidy. In the three cohorts (OC, IUD and MPA, respectively), 12,839, 10,774 and 8,984 person-years of follow-up were accumulated and 125, 92 and 101 cases of dysplasia were confirmed. Crude annual rates of dysplasia per 1,000 person-years were approximately the same in the OC (9.6) and IUD (8.4) cohorts. Crude rates were higher in the MPA cohort (11.3 per 1,000 person-years). However, important confounding factors, principally smoking and sexual behavior, were identified with rate ratios ranging between 1 and 3 over the range of the potentially confounding variables, and multivariate analyses revealed no evidence of increased risk for the MPA cohort when these factors were taken into account. At least over the short term, there appears to be no difference in risk of cervical dysplasia between women using these three methods of contraception if differences between groups in respect to known confounding factors are taken into account.

Adolescent↗

[Hormonal contraception for males--an option for adolescents?].

Although effective contraceptive methods are available, the incidence of teenage pregnancies and consecutive pregnancy interruptions remains high in industrial nations, including Germany. There are several reasons for this high incidence. Apart from earlier sexual maturation, the absence of contraceptive use or the use of inefficient methods contributes mainly towards this increase. Existing contraceptive methods for men either show unsatisfying efficacy (coitus interruptus, use of condoms) or problems of reversibility (vasectomy), which limits their broader use. Of the different experimental approaches towards male contraception, the hormonal approach is closest to practical implementation. Androgens are an essential part of all experimental approaches to hormonal contraception in males; they cause suppression of spermatogenesis through gonadotropin suppression. Previous clinical trials have validated the concept of hormonal contraception in men. However, the application modalities and the ineffectiveness of all self-administered androgen preparations have been unacceptable for practical use. Therefore recent developments focus either on androgen implants or on injectable, long-acting testosterone esters in combination with progestins, which also suppress gonadotropin secretion. Over the last decades various combinations of androgen preparations with different progestins or GnRH antagonists have been tested in clinical trials. Of these, testosterone with either depot medroxyprogesterone acetate, norethisterone, desogestrel or etonogestrel have shown promising efficacy in phase II clinical trials. However, whether hormonal contraception might be given to adolescent males remains to be elucidated. This will have to be assessed once a hormonal contraceptive for men has reached the market. Special attention will need to be given to bone maturation as androgens at the prescribed doses might induce premature closure of the epiphyseal joints.

Abortion, Induced↗

Study on the factors associated with contraceptive discontinuations in Bangkok.

Detailed information was collected from 666 cohorts of pill, injectable-DMPA and IUD acceptors at 14 Bangkok Metropolis Health Clinics (MHCs). The contraceptive status at 12-month follow-up home interview shows that 47% of pill acceptors, 39% of DMPA acceptors and 55% of IUD acceptors were still using the same contraceptive method and receiving them from the original source. The women who initially adopted the pill could seek the oral contraceptive from other sources with a higher significant percentage (14%) than was found in the DMPA and IUD group. The DMPA group revealed the lowest percent of using same method and same source but higher rate of clinic switch (15%), including method and clinic switch (18%), than the pill and IUD acceptors. The women who adopted the pill had stopped using any contraceptive method with the highest percentage (31%). The main reason for method switch among the three contraceptive acceptors was disagreeable health effects; 50% of pill acceptors, 75% for DMPA acceptors and 49% for IUD acceptors. Another important reason for IUD switch was a 32% expulsion of IUD. Those who switched clinic gave the three important reasons of distance inconvenience, opening hour inconvenience and disagreeable health effects. Service-related factors are likely to play a less important role in determining discontinuation of the pill and DMPA, while the reasons on doctors objecting to removing the IUD appear to be the major service-related factor in discontinuation of IUD (19%). The decision to stop using any contraceptive appeared to be related to dissatisfaction with the method and side effects was the primary reason and the secondary reason was that they wanted another child.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

"Female condom" approved.

The Food and Drug Administration approved the first so-called female condom on May 7. Despite limited data on the effectiveness of the Reality Vaginal Pouch in sexually transmitted diseases (STDs) and a relatively high pregnancy rate among users, the device was approved because it is the first barrier contraceptive for women that provides some protection against STDs. The label will be required to emphasize that for "highly effective protection" against STDs, including AIDS, latex condoms for men are the best choice. The panel must also compare the pregnancy rate for the female condom--approximately 26%/year--to rates for other barrier contraceptives, which are lower. For example, the pregnancy rate for male latex condoms is approximately 15%/year. The females condom consists of a lubricated polyurethane sheath with a flexible polyurethane ring on each end. One ring is inserted into the vagina much like a diaphragm; the other remains outside, partially covering the labia. In addition to the labeling restrictions, FDA is also requiring the manufacturer of the product, Wisconsin Pharmacal of Jackson, Wis., to take part in additional effectiveness studies for the product. FDA's decision to approve the female condom was based on a review of clinical data submitted by the manufacturer and the unanimous recommendation of the agency's Obstetrics and Gynecology Devices Advisory Panel at its meeting on December 10, 1992. Wisconsin Pharmacal studies 200 women who used the device for 6 months. The estimated pregnancy rate of 26%/year in the study is believed to have been due in part to improper use of the device by some of the subjects. (The expected rate of pregnancy among women not using any contraceptive method is 85%). Women who use the device correctly each time they have intercourse can expect a lower pregnancy rate.

Americas↗

Recent trends in contraceptive sterilization in Flanders.

Elective sterilization started to spread rather late in Flanders. Despite the sharp increase of this contraceptive method since the end of the 1970s, its frequency is still lower than in many neighbouring countries and much lower than in the US and Canada, mainly due to the lag in male sterilization. Further increase in contraceptive sterilization and a greater participation of men is expected in the near future.

Adult↗

Attitudes to current oral contraceptive use and future developments: the women's perspective.

OBJECTIVES: The study was planned to determine current trends in contraceptive usage and to examine the attitudes, needs and preferences of women with respect to oral contraceptives. METHODS: Semi-structured interviews were carried out with women (n = 1201, aged 16-45 years) in Germany, the UK and France. RESULTS: The study revealed that oral contraceptives were the most popular method of contraception employed, followed by condoms, and that the majority of respondents were aged 16-19 years when they first used an oral contraceptive. An important finding of the study was that an oral contraceptive was first used only after having sexual intercourse for the first time (within 1 year), emphasizing the importance of effective contraceptive information and education for adolescents. Regarding non-contraceptive health benefits, protection from ovarian and endometrial cancer was perceived by respondents to be of the greatest importance; however, few women were spontaneously aware of this benefit. When given a number of different oral contraceptive intake options to assess, the established 'once daily for 21 consecutive days' option remained the most popular, although a 'once weekly' alternative was cited by many women. When asked about the preferred frequency of menstrual bleeding, there was a polarization between women favoring the normal monthly bleed and those wanting a 'no-bleed' regimen. CONCLUSION: Women are poorly informed about oral contraceptive use, and are largely unaware of the important long-term non-contraceptive benefits. Many women would prefer alternative pill intake options and a significant number would favor a 'no-bleed' regimen.

Adolescent↗

The levonorgestrel two-rod implant for long-acting contraception: 10 years of clinical experience.

OBJECTIVE: To estimate the effectiveness, side effects, and retention rate of the levonorgestrel two-rod implant used as a long-acting contraceptive. METHODS: Voluntary participants, ages 18-40 years and desiring long-acting contraception, were enrolled in the study. The original design was to observe the participants for 5 years. Later, the follow-up period was extended to 6 years. RESULTS: A total of 249 women underwent two-rod implant insertion and were observed for a total of 823 woman-years. There were two pregnancies observed during the study, yielding a pregnancy rate of 0.24 per 100 woman-years. One pregnancy occurred in the first month, and the other occurred after 6 years of use. The major side effect was menstrual irregularity. No serious side effects were observed during the study. Insertion of the device was easy and took less than 2 minutes; removal time averaged 4.5 minutes. CONCLUSION: The levonorgestrel two-rod implant system is an effective, convenient, long-acting, and well-tolerated method of contraception.

Adolescent↗

The contraceptive implant and the injectable: a comparison of costs.

A comparison of the relative costs of the injectable contraceptive (depot medroxyprogesterone acetate) and the hormonal implant (Norplant) indicates that the implant is a less costly contraceptive option when it is used for its full five-year lifespan. Over a five-year period, the implant costs $107 annually, compared with $140 per year for the injectable. However, if a woman discontinues the implant before she has used it for at least four years, the injectable becomes the less costly option. Relatively high continuation rates--around 95% annually--are necessary to make the implant the more cost-effective contraceptive method.

Cost-Benefit Analysis↗

Estimating cycle pregnancy probability with incomplete data in contraceptive studies.

In studies on the effectiveness of barrier method contraceptives, researchers need to estimate the risk of pregnancy during consistent use of these methods. However, participants may not use assigned methods consistently, and only consistent-use cycles are included in the estimates. Inconsistent-use cycles are considered missing intervals, and a subject's early discontinuation from the study or pregnancy during inconsistent use is censored from the analysis. In this article, we consider a semiparametric maximum likelihood approach to estimate survival probability for grouped survival data with missing and censored data. The method is flexible in that it is nonparametric with respect to the underlying survival function, yet it can be easily extended to accommodate the covariates in a parametric way. Results from our simulation study show that the proposed method works well in practical sample sizes. Our findings support the U.S. Food and Drug Administration's (FDA) sample size requirements for contraceptive studies. We use data from an effectiveness trial on vaginal contraceptive film (VCF) to illustrate the proposed methods.

Clinical Trials as Topic↗

Frequency of intercourse and contraceptive choice.

The effects of frequency of intercourse on perceptions of two of the most widely used contraceptive methods, the pill and condom, were assessed in 128 female college students currently involved in a sexual relationship. Intercourse frequency was found to be strongly associated with knowledge of both methods. People experiencing more frequent sexual intercourse were more favourably disposed towards the pill and less towards the condom than people experiencing intercourse less frequently. Implications of these results are discussed.

Adult↗