High school girls who used intrauterine devices and implants for long-acting reversible contraception were less likely to also use condoms compared with girls who used oral contraceptives, according to an article published online by JAMA Pediatrics.
Long-acting reversible contraception (LARC) is a promising strategy to reduce unintended pregnancies in teens. But LARC and other contraceptive methods, including oral contraceptives, don't protect against sexually transmitted infections (STIs) and nearly half of all new STIs occur among young people in their teens and 20s. Guidelines recommend contraception to avoid pregnancy and a condom to prevent STIs, including the human immunodeficiency virus (HIV), for sexually active couples. However, such dual use is uncommon among adolescents.
Riley J. Steiner, M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and coauthors compared condom use between sexually active high school girls using LARC and users of other contraceptive methods. The authors used data from the 2013 national Youth Risk Behavior Survey of high schools students.
The study included 2,288 sexually active girls of whom almost 57 percent were white and about one-third were high school seniors. Among the girls: 1.8 percent used LARC; 5.7 percent used Depo-Provera injection, patch or ring; 22.4 percent used oral contraceptives; 40.8 percent used condoms; 11.8 percent used withdrawal or other method; 15.7 percent used no contraception; and 1.9 percent weren't sure. Not using a contraceptive method was most common among Hispanic (23.7 percent) and black (21.2 percent) sexually active female students.
The authors report that LARC users were more than 60 percent less likely to use condoms compared with girls who used oral contraceptives. There were no differences in condom use between LARC users and Depo-Provera injection, patch or ring users. LARC users also were more than twice as likely to have two or more recent sexual partners compared with users of oral contraception and Depo-Provera injection, patch or ring, the results suggest.
Limitations to the study include self-reported data and behaviors that may have been inaccurately reported.
"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," the study concludes.
Editorial: We Need a Better Message
"We need to work on crafting a clear message about pregnancy prevention and STI prevention. 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. ... 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. Condoms and LARC complement each other. We need to get the message right," write Julia Potter, M.D., of the Boston Medical Center, Massachusetts, and Karen Soren, M.D., of the Columbia University Medical Center, New York, in a related editorial.