Long-Acting Reversible Contraceptive Use among Adolescents and Young Adults: Implications for Integrating Unintended Pregnancy and STI Prevention 公开
Steiner, Riley (Spring 2018)
Abstract
Preventing both unintended pregnancy and sexually transmitted infections (STIs) is important given the prevalence of these adverse outcomes, particularly among adolescents and young adults. Increasing use of long-acting reversible contraception (LARC) by young people has renewed attention to a specific challenge of integrating prevention efforts: the most effective methods for preventing pregnancy and STIs among sexually active individuals differ. Studies have shown that adolescent LARC users, as compared to users of moderately effective contraceptive methods (i.e. oral contraceptives, injectables, patch, ring), are less likely to also use condoms, a critical STI prevention strategy.
This dissertation explores the potential impact of LARC use on recommended STI/HIV-related services, including annual STI testing, and examines possible explanations for findings about condom use. Specifically, we (1) compare receipt of STI/HIV services by contraceptive type using secondary data from the 2011-2015 National Survey of Family Growth; (2) examine the extent to which online pregnancy prevention information for adolescents also addresses STI prevention through a content analysis; and (3) assess adolescent contraceptive users’ condom use motivations from in-depth, individual interviews.
We found little evidence of differences in service receipt between continuing LARC users and users of moderately effective contraceptive methods that require annual clinical visits. However, prevalence of STI testing was low, regardless of contraceptive type. We identified missed opportunities for integrating online content about pregnancy and STI prevention. Moreover, websites often framed condom use with moderate or highly effective contraceptive methods as back-up pregnancy prevention, perhaps undermining STI prevention. Finally, we found that contraceptive users were particularly motivated to use condoms to be on “the safe side” for preventing pregnancy whereas LARC users were primarily motivated by STI prevention. Across contraceptive type, factors influencing condom use motivations included sexual health education, personal awareness and/or experience, and perceived consequences and risk.
Taken together, findings underscore an outstanding need for integrating unintended pregnancy and STI prevention. This research can inform specific strategies for addressing STI prevention while increasing awareness of and access to LARC, including counseling about preventive health services during LARC initiation and health promotion that emphasizes condom use with contraceptive methods specifically for STI prevention.
Table of Contents
151
Chapter One: Introduction and Literature Review................................................................1
Introduction................................................................2
Unintended pregnancy and STI prevention among young people................................................................2
Long-acting reversible contraception and STI prevention................................................................5
The current study................................................................7
Literature Review................................................................8
LARC use among adolescents and young adults................................................................8
LARC use and STI-related outcomes................................................................12
Condom use with more effective contraceptive methods................................................................15
Gaps and opportunities................................................................18
References................................................................27
Chapter Two: Use of Long-Acting Reversible Contraception among Adolescent and Young Adult Women and Receipt of STI/HIV-Related Services................................................................44
Abstract................................................................45
Introduction................................................................46
Methods................................................................48
Results................................................................52
Discussion................................................................54
References................................................................65
Chapter Three: Do Health Promotion Messages Integrate Unintended Pregnancy and STI Prevention? A Content Analysis of Online Information for Adolescents and Young Adults................................................................71
Abstract................................................................72
Introduction................................................................73
Methods................................................................74
Results................................................................76
Discussion................................................................80
References................................................................97
Chapter Four: The Safe Side: A Qualitative Study of Condom Use by Contraceptive Type among Adolescents in Atlanta, GA................................................................101
Abstract................................................................102
Introduction................................................................103
Methods................................................................105
Results................................................................109
Discussion................................................................118
References................................................................129
Chapter Five: Summary and Conclusions................................................................134
Summary and Synthesis of Findings................................................................135
Strengths and Limitations................................................................139
Future Research................................................................143
Practice Implications................................................................146
Conclusions................................................................148
References................................................................151
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