Family planning providers are seeing an increase in adolescent use of long-acting reversible contraceptive (LARC) methods. Efforts to improve LARC access to adolescents seeking contraception at Title X service sites have increased their use.1
Results from a new study indicate that high school girls who use intrauterine devices (IUDs) and implants are less likely to also use condoms, compared with teens who used oral contraceptives.2 This finding is a cause for concern, because half of all new sexually transmitted infections (STIs) occur among young people ages 15-24, and LARC methods, while highly effective against unplanned pregnancy, offer no STI protection.3
To perform the data analysis, Riley Steiner, MPH, health scientist at the Centers for Disease Control and Prevention (CDC), and coauthors compared condom use between sexually active high school girls using LARC methods and users of other contraceptive methods. The researchers looked at data from the 2013 National Youth Risk Behavior Survey, which the CDC conducted among a national sample of approximately 13,000 U.S. high school students, along with results from 42 states and 21 large urban school districts that conducted their own surveys.
The study included 2,288 sexually active female adolescents. Almost 60% were white, and about one-third were high school seniors. Among this population, 1.8% used LARC methods, while 5.7% used the contraceptive injection, patch, or ring. About 25% used oral contraceptives, 40.8% used condoms, 11.8% used withdrawal or other method, and 15.7% used no contraception. Not using a contraceptive method was most common among Hispanic adolescent females (23.7%) and black (21.2%) sexually active female students.
The analysis indicates that LARC users were more than 60% less likely to use condoms compared with girls who used oral contraceptives (adjusted prevalence ratio [aPR], 0.42; 95% confidence interval [CI], 0.21-0.84). However, there were no differences in condom use between LARC users and contraceptive injection, patch, or ring users (aPR, 0.57; 95% CI, 0.26-1.25).
Teens who used LARC methods also were more than twice as likely to have two or more recent sexual partners compared with users of oral contraception (aPR, 2.61; 95% CI, 1.75-3.90) and contraceptive injection, patch, or ring (aPR, 2.58; 95% CI, 1.17-5.67), the results suggest.2
“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,” write Steiner and study authors.
The results of the new study underscore the need to promote dual use of birth control and condoms, said Leslie Kantor, PhD, MPH, vice president of education at the New York City-based Planned Parenthood Federation of America. At Planned Parenthood, clinicians “strongly emphasize” the importance of dual use of condoms with other birth control methods, noted Kantor in a statement accompanying the results.
Strongly encourage a dual-protection approach that addresses pregnancy and STI prevention, states Julia Potter, MD, a physician in adolescent medicine at Boston Medical Center. Studies show that when healthcare professionals recommend condoms with other birth control, condom use increases, she notes.4 Potter co-authored an editorial accompanying the study.5
“Dual protection for sexually active adolescents should be encouraged so that adolescents are not exposed to the risk of pregnancy or the risk of STIs as a result of selecting condom use vs. effective contraception use,” the editorial states. “Condoms and LARC complement each other.”
What are some ways you can communicate with adolescents the importance of dual protection against unintended pregnancy and STIs? The CDC has a free patient education handout, Know Your Condom Dos and Don’ts, which can be accessed at http://1.usa.gov/1KWJJVC.
Counsel each patient that even if she or her partner is using another type of birth control, both should agree to use a condom every time they have sex to reduce the risk to both for HIV and most other STIs.
REFERENCES
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Romero L, Pazol K, Warner L, et al. Vital signs: Trends in use of long-acting reversible contraception among teens aged 15-19 years seeking contraceptive services — United States, 2005-2013. Morb Mortal Wkly Rep 2015; 64(13):363-369.
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Steiner RJ, Liddon N, Swartzendruber AL, et al. Long-acting reversible contraception and condom use among female US high school students: Implications for sexually transmitted infection prevention. JAMA Pediatr 2016; doi: 10.1001/jamapediatrics.2016.0007.
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Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2008. Sex Transm Dis 2013; 40(3):187-193.
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Morroni C, Heartwell S, Edwards S, et al. The impact of oral contraceptive initiation on young women’s condom use in 3 American cities: Missed opportunities for intervention. PLoS One 2014; 9(7):e101804.
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Potter J, Soren K. Long-acting reversible contraception and condom use: We need a better message. JAMA Pediatr 2016; doi:10.1001/jamapediatrics.2016.0141.
