Adolescent girls who used long-acting reversible contraceptives, such as intrauterine devices or implants, were significantly less likely also to use condoms compared with girls who used birth control pills, according to recent research in JAMA Pediatrics.
“Among a nationally representative sample of sexually active female U.S. high school students, [long-acting reversible contraceptive (LARC)] users were about 60% less likely to use condoms compared with oral contraceptive users,” Riley J. Steiner, MPH, of the division of adolescent and school health at the CDC, and colleagues wrote. “Establishing the relationship between LARC and condom use among adolescent LARC users prior to widespread adolescent uptake will help provide a useful reference point for future monitoring and can ultimately inform STI prevention efforts as LARC is brought to scale.”
The researchers analyzed data from 2,288 sexually active high school girls, collected from the 2013 national Youth Risk Behavior Survey. Study participants reported their contraceptive methods as either birth control pills, condoms, intrauterine devices, implant, injections, patches, rings, withdrawal method or unknown. The survey also gathered data related to condom use at last sexual intercourse and number of sexual partners.
Study data showed that 1.8% of participants used a form of LARC. Condom use was almost 60% less likely among girls who used LARC compared with girls who used birth control pills (adjusted prevalence ratio = 0.42; 95% CI, 0.21-0.84). The researchers did not find any significant differences between condom use behaviors of LARC users and girls who used injections, patches or rings (aPR = 0.57; 95% CI, 0.26-1.25).
The researchers also wrote that LARC users were more likely to have two or more sexual partners over the last 3 months vs. pill users (aPR = 2.61; 95% CI, 1.75-3.9) and girls who used injections, patches or rings (aPR = 2.58; 95% CI, 1.17-5.67).
“There is a clear need for a concerted effort to improve condom use among adolescent LARC users to prevent STIs, particularly as adolescent LARC use increases,” Steiner and colleagues wrote. “Regardless of the strategy or combination of strategies used, improving dual protection among adolescents will be key to maximizing both pregnancy and STI prevention goals.”
In a related editorial, Julia Potter, MD, of the department of pediatrics at Boston Medical Center, and Karen Soren, MD, of the department of pediatrics at Columbia University Medical Center, wrote that the investigators’ cross-sectional study results need to be teased out to better understand the motivating factors associated with decreased condom use. They emphasized that these results should not be used to discourage LARC use among adolescents.
“We need to work on crafting a clear message about pregnancy prevention and STI prevention,” Potter and Soren wrote. “Withholding LARC — the most effective methods of reversible contraception — owing to concerns about the unintended consequence of decreased condom use is not the answer. Condoms still need to be part of the conversation because STIs are common in the adolescent population. Condoms and LARC complement each other. We need to get the message right.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.