Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study.

BACKGROUND: Population-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women. OBJECTIVE: Our objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM. METHODS: Participants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity. RESULTS: The mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor's degree or higher. Response and abstinence rates were similar across race, ethnicity, and education. CONCLUSIONS: Enrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized.

'I wanted to enjoy our marriage first but I got pregnant right away': a qualitative study of family planning understandings and decisions of women in urban Yogyakarta, Indonesia.

BACKGROUND: Despite several decades of investment into family planning and maternal health systems strengthening, Indonesia's maternal mortality ratio remains among the highest in Southeast Asia. Among postpartum women unmet need for family planning is greater than at any other time, thus there is great potential to improve the reproductive health outcomes of Indonesian women through enhanced postpartum family planning access. This article explores the socially embedded nature of family planning choices in the Indonesian context, drawing on the experiences of a sample of urban dwelling and predominantly middle class women. METHODS: This was an ethnographic study which explored the reproductive experiences of women residing in Yogyakarta City, and Sleman and Bantul regencies. Fieldwork was undertaken over 18 months from September 2014 to March 2016. This article draws on 31 in-depth interviews (IDIs) conducted with 20 women aged 21 to 38 years who had given birth less than two years prior. RESULTS: Though there was great variance across women's reproductive trajectories, the majority had limited understandings of family planning, especially in relation to contraception. Societal norms pertaining to women's fertility and reproduction underpinned women's desires to become pregnant soon after marriage. Normative ideals concerning family size and the composition of families underpinned women's desires for a maximum of two to three children, with at least one child of each sex. Negotiations concerning timing of pregnancies and family size occurred within spousal relationships. The majority of women were using some form of fertility control to prevent or space pregnancies, with method choice decisions often informed by family members, friends and family planning providers. Quality of care among family planning providers was often lacking, perpetuating misinformation, and women's choices were not always respected. CONCLUSIONS: Our analysis reveals the socially embedded nature of women's postpartum family planning understandings and choices, and the ways in which social and relational factors sometimes constrain and at other times support women's reproductive agency. We identify key areas for health sector reform to enhance women's understandings of postpartum family planning and improve family planning quality of care.

Rates of abstinence following psychological or behavioral treatments for binge-eating disorder: Meta-analysis.

OBJECTIVE: Standardized effect sizes reported in previous meta-analyses of binge-eating disorder (BED) treatment are sometimes difficult to interpret and are criticized for not being a useful indicator of the clinical importance of a treatment. Abstinence from binge eating is a clinically relevant component of a definition of a successful treatment outcome. This meta-analysis estimated the prevalence of patients with BED who achieved binge eating abstinence following psychological or behavioral treatments. METHOD: This meta-analysis included 39 randomized controlled trials, with 65 treatment conditions and 2,349 patients. Most conditions comprised cognitive-behavioral therapy (n = 40). Pooled event rates were calculated at posttreatment and follow-up using random effects models. RESULTS: The total weighted percentage of treatment-completers who achieved abstinence at posttreatment was 50.9% (95% CI = 43.9, 57.8); this estimate was almost identical at follow-up (50.3%; 95% CI = 43.6, 56.9). The total weighted percentage of patients who achieved abstinence at posttreatment in the intention-to-treat analysis (all randomized patients) was 45.1% (95% CI =40.7, 49.5), and at follow-up it was 42.3% (95% CI =37.5, 47.2). Interpersonal psychotherapy (IPT) produced the highest abstinence rates. Clinician-led group treatments produced significantly higher posttreatment (but not follow-up) abstinence estimates than guided self-help treatments. Neither timeframe for achieving abstinence, assessment type (interview/questionnaire), number of treatment sessions, patient demographics, nor trial quality, moderated the abstinence estimates. DISCUSSION: The present findings demonstrate that 50% of patients with BED do not fully respond to treatment. Continued efforts toward improving eating disorder treatments are needed.

Use of non-medical contraceptive methods: a survey of women in western Sweden.

OBJECTIVES: To describe women's self-reported use of non-medical contraceptive methods (including barrier methods, fertility awareness-based methods and withdrawal), explore reasons for and satisfaction with choice of contraceptive methods and examine women's fertility awareness. METHODS: A cross-sectional survey was conducted among women consulting at primary healthcare clinics not using medical contraceptives. RESULTS: Most of the 648 participants (67%) reported using a mix of condom use, withdrawal and a calendar method, while 23% used only condoms. Eleven percent reported using the Billings ovulation method, diaphragm/cap or fertility monitor and found these methods highly satisfactory. A majority of the women who primarily used condoms also reported being satisfied. Most women actively chose non-medical contraception because it was perceived as without adverse effects, uncomplicated and effective. Fertility awareness was generally poor. CONCLUSION: Frequent use of withdrawal and a calendar method, as well as poor fertility awareness, suggests a need for improved counselling at contraceptive clinics on fertility awareness and more effective non-medical contraceptive methods to assist women in making an informed contraceptive choice.

Impacto en la percepción de intimidad conyugal en parejas usuarias de Métodos naturales para regular fertilidad / Impact on the perception of marital intimacy in couples using natural methods for regular fertility

Introducción: El uso de métodos naturales para regular la fertilidad requiere de cooperación y aceptación en las parejas usuarias. Nuestra hipótesis es que esta dinámica psicosexual influencia positivamente la percepción de la calidad de la intimidad conyugal. Diseño del estudio: Cohorte prospectiva con análisis pre y post intervención utilizando el PAIR (instrumento desarrollado para el análisis de la intimidad conyugal). Resultados: Un total de veinte parejas fueron estudiadas luego de que cumplieran todos los criterios definidos previamente. El análisis descriptivo mostró un aumento en los valores positivos en ambos sexos al comparar la evaluación inicial con la posterior a 6 meses de uso del registro de fertilidad. El índice de convencionalidad mostró valores elevados, tanto dentro de la pareja como al compararse con las demás. Los resultados evidencian satisfacción en la intimidad conyugal en todas las áreas evaluadas. En las mujeres, y a los 6 meses de uso, la experiencia de intimidad mejora en todas las áreas excepto en el área social. En los hombres, mejora la experiencia en todas las áreas, incluyendo el área social. Al analizar el área recreacional, tanto en hombres como en mujeres, hay un aumento significativo en la experiencia de intimidad luego de la intervención. Conclusiones: Nuestros resultados sugieren que el aprendizaje y uso de los métodos naturales para regular la fertilidad tiene efectos beneficiosos en la percepción de la intimidad conyugal.

Background: the use of NFP demands cooperation and acceptance between the couple. We propose that this psychosexual dynamics could influence the perception on the quality of the couple's intimacy. Study design: a prospective cohort with pre and post intervention analysis using the PAIR (Personal Assessment of Intimacy Relationships) instrument. Results: Twenty couples fulfilled the prerequisites for study. The descriptive analysis showed an increase in the positive values for both sexes between the initial taking of test, and after six months. The conventionality index showed high values, but very similar in the members of each couple, and also between couples. The results show satisfaction of couple intimacy in all areas. At six months the experience of intimacy in women increases in all areas, except in the social area. Among men the experience of intimacy increases in all areas and significantly in the social area. In the case of the recreational area, for women as much as for men, the increase is significant after the intervention. Conclusions: It seems that couples who learn and use natural family planning methods have a better perception of their intimacy.

A Feasibility Study of Women's Confidence and Comfort in Use of a Kit to Monitor Ovulation.

INTRODUCTION: The focus of this study was to examine whether low-income adult women will use ovulation test strips, a menstrual calendar chart, thermometer, temperature graph, and cervical mucus assessment to monitor their ovulation time and other menstrual changes. Women's confidence in their ability to detect ovulation time and understand the menstrual cycle changes were also examined. METHODS: This is a descriptive study. Twenty-two low-income women aged 18 to 39 years living in medically underserved neighborhoods participated in this study. The women were introduced to and taught how to use a knowing your body (KB) kit, which consisted of ovulation test strips, monthly calendars for menstrual logs, digital thermometer for basal body temperature, and graphs to chart temperature. The women were interviewed 6 to 8 weeks later to confirm their experiences with the use of the KB kit. RESULTS: Ninety-one percent of the women used the ovulation test strips (mean, 3.8 strips); 77.3% were very to extremely confident that they could properly use the ovulation strip, 54.6% knew when they ovulated, and 31.8% could use the thermometer to confirm when they were ovulating. Seventy-three percent of the women were very to extremely comfortable using the ovulation test strips, 81.8% using the thermometer, 45.5% using the temperature graph, and 31.8% using the TwoDay Method (cervical mucus observation). DISCUSSION: The use of the ovulation test strip and other content of the KB kit provides a new opportunity for low-income women to learn about their bodies by monitoring their ovulation time and other menstrual changes as a pregnancy planning and early pregnancy recognition tool.

Transition from the Lactational Amenorrhea Method to other modern family planning methods in rural Bangladesh: barrier analysis and implications for behavior change communication program intervention design.

The timely transition from Lactational Amenorrhea Method (LAM)(2) to another modern family planning method contributes to healthy spacing of pregnancies by increasing the adoption of family planning during the first year postpartum. Yet, literature suggests challenges in completing a timely LAM transition. To guide program implementation in Bangladesh, this study identified factors influencing women's transition decisions. Eighty postpartum women, comprising 40 who transitioned from LAM(3) and 40 who did not,(4) participated. Half of each group participated in in-depth interviews to explore the decision-making process. All participants responded to a "Barrier Analysis" questionnaire to identify differences in eight behavioral determinants. More than half of transitioners switched to another modern method before or within the same month that LAM ended. Of the 18 transitioners who delayed,(5) 15 waited for menses to return. For non-transitioners, key barriers included waiting for menses to return, misconceptions on return to fertility, and perceived lack of familial support. The LAM transition can help women prevent unintended pregnancy during the first year postpartum. Increased emphasis on counseling women about the risk of pregnancy, and misconceptions about personal fertility patterns are critical for facilitating the transition. Strategies should also include interventions that train health workers and improve social support.

Influence of motivation on the efficacy of natural family planning.

PURPOSE: To determine the influence of mutual motivation on unintended pregnancy rates of couples who used natural family planning (NFP) methods to avoid pregnancy. STUDY DESIGN AND METHODS: Using an online taught NFP method, 358 women and (their male partners) indicated "how much" and "how hard" they wished to avoid pregnancy on a scale of 0 to 10 before each menstrual cycle charted over 12 month of use. This motivation scale is used in the National Survey of Family Growth as a measure of motivation. All pregnancies were verified with an online pregnancy evaluation and urine-based pregnancy test. A combined motivation score was used in analysis. RESULTS: There were 28 pregnancies among the low-motivation participants (N = 60) and 16 among the high-motivation participants (N = 298). At 12 months of use, there were 75 pregnancies per 100 users for the low-motivation group and only 8 for the high-motivation group. There was an 80% greater likelihood of a pregnancy with the low-motivation group (χ = 25.5, p < .001, odds ratio = 1.80; 95% confidence interval = 1.61-1.90). CLINICAL IMPLICATIONS: High motivation to avoid pregnancy by both the female user of a behavioral method of family planning and her male partner is required for high efficacy. Assessing motivation of both the woman and her male partner before prescribing NFP methods is recommended.

Engaging men in family planning services delivery: experiences introducing the Standard Days Method® in four countries.

Family planning is often regarded as the woman's responsibility, but there is growing recognition of the need to involve men in family planning programs. Since 2001, the fertility-awareness-based Standard Days Method® (SDM) has been introduced in more than 30 countries, providing a natural, effective birth control option. SDM requires the cooperation of the male partner, and its introduction created an opportunity to test innovative strategies to engage couples in family planning. Such strategies included couple counselling, outreach activities that encouraged men to participate in family planning and integration of family planning into traditionally male programs. Due to the SDM's intrinsic characteristics as a couple method, SDM providers are sensitized to the importance of exploring other critical sexual and reproductive health topics, including intimate partner violence, HIV, sexuality and partner communication. This paper presents several case studies describing how men were engaged in SDM introduction activities in four countries.

Female genital cutting and other intra-vaginal practices: implications for TwoDay Method use.

This report examines the implications of female genital cutting and other intra-vaginal practices for offering the TwoDay Method® of family planning.This fertility awareness-based method relies on the identification of cervicovaginal secretions to identify the fertile window. Female genital cutting and traditional vaginal practices, such as the use of desiccants, may affect the presence or absence of secretions and therefore the woman's perception of her fertility. These issues and their implications for service delivery of the method are discussed.

[Family planning methods based on fertility awareness]. / Métodos de planificación familiar basados en el conocimiento de la fertilidad.

The desire to limit fertility is recognized both by individuals and by nations. The concept of family planning is based on the right of individuals and couples to regulate their fertility and is based in the area of health, human rights and population. Despite the changes in policies and family planning programs worldwide, there are large geographic areas that have not yet met the minimum requirements in this regard, the reasons are multiple, including economic reasons but also ideological or religious. Knowledge on the physiology of the menstrual cycle, specifically ovulation process has been further enhanced due to the advances in reproductive medicine research. The series of events around ovulation are used to detect the "fertile window", this way women will look for the possibility of postponing their pregnancy or actually start looking for it. The aim of this article is to review the current methods of family planning based on fertility awareness, from the historical methods like the core temperature determination and rhythm, to the most popular ones like the Billings ovulation method, the Sympto-thermal method and current methods like the two days, and the standard days method. There are also mentioned methods that require electronic devices or specifically computer designed ones to detect this "window of fertility". The spread and popularity of these methods is low and their knowledge among physicians, including gynecologists, is also quite scarce. The effectiveness of these methods has been difficult to quantify due to the lack of well designed, randomized studies which are affected by small populations of patients using these methods. The publications mention high effectiveness with their proper use, but not with typical use, what indicates the need for increased awareness among medical practitioners and trainers, obtaining a better use and understanding of methods and reducing these discrepancies.

The role of the Standard Days Method in modern family planning services in developing countries.

BACKGROUND: The mere availability of family planning (FP) services is not sufficient to improve reproductive health; services must also be of adequate quality. The introduction of new contraceptive methods is a means of improving quality of care. The Standard Days Method (SDM) is a new fertility-awareness-based contraceptive method that has been successfully added to reproductive health care services around the world. CONTENT: Framed by the Bruce-Jain quality-of-care paradigm, this paper describes how the introduction of SDM in developing country settings can improve the six elements of quality while contributing to the intrinsic variety of available methods. SDM meets the needs of women and couples who opt not to use other modern methods. SDM providers are sensitised to the potential of fertility-awareness-based contraception as an appropriate choice for these clients. SDM requires the involvement of both partners and thus offers a natural entry point for providers to further explore partner communication, intimate partner violence, condoms, and HIV/STIs. CONCLUSION: SDM introduction broadens the range of FP methods available to couples in developing countries. SDM counselling presents an opportunity for FP providers to discuss important interpersonal and reproductive health issues with potential users.

The Standard Days Method: an addition to the arsenal of family planning method choice in Ethiopia.

BACKGROUND AND METHODOLOGY: The Standard Days Method ® (SDM) is a fertility awareness-based method of family planning that helps users to identify the fertile days of the reproductive cycle (Days 8-19). To prevent pregnancy users avoid unprotected sexual intercourse during these days. A cross-sectional community-based study was conducted from December 2007 to June 2008 in four operational areas of Pathfinder International Ethiopia. A total of 184 SDM users were included in the study. Quantitative and qualitative methods of data collection were used. The aim of the study was to examine the experience of introducing the SDM at community level in Ethiopia. RESULTS: Of the 184 participants, 80.4% were still using the SDM at the time of the survey, with 35% having used it for between 6 and 12 months, while 42% had used it for more than a year. The majority (83%) knew that a woman is most likely to conceive halfway through her menstrual cycle, and nearly 91% correctly said that the SDM does not confer protection from sexually transmitted infections/AIDS. A substantial majority (75%) had correctly identified what each colour-coded bead represents in the CycleBeads ®, and an aggregate of 90.5% of women practised all the elements of correct use. DISCUSSION AND CONCLUSIONS: This study demonstrates the importance of the SDM in increasing the availability and accessibility of family planning, and the potential to improve family planning method choice and method mix by expanding use of the SDM.

Religion, culture and male involvement in the use of the Standard Days Method: evidence from Enugu and Katsina states of Nigeria.

AIM: This paper presents findings from an exploratory study on the use of the Standard Days Method® (SDM) of family planning (FP) in Katsina and Enugu states of Nigeria. BACKGROUND: Potential users of FP often do not use modern methods if its practice is in dissonance with cultural and religious values. Increasing FP options through the introduction of effective natural methods is important, as it will ensure that FP providers, particularly nurses, can provide appropriate non-hormonal methods to women who are interested in their use. This will bring about an increased contraceptive prevalence in countries with strong religious barriers to modern FP methods. METHODS: A qualitative study using focus group discussions and in-depth interviews was conducted with nurses, community FP providers and users of the SDM following the introduction of the method in two Nigerian states. DISCUSSION: Both users and providers perceive the SDM to be religiously and culturally acceptable. They found it useful particularly among women who could not use hormonal methods for medical reasons. CONCLUSION: There was no religious/cultural opposition to the use of SDM. Spousal involvement in use within localities where hormonal methods are not accepted was perceived as an important factor in making the method acceptable. It is imperative to scale up the intervention to other areas both in Nigeria and in other countries that have similar religious and cultural resistance to modern FP methods.

Acceptability of contraception for men: a review.

Methods of contraception for use by men include condoms, withdrawal and vasectomy. Prevalence of use of a method and continuation rates are indirect measures of acceptability. Worldwide, none of these "male methods" accounts for more than 7% of contraceptive use although uptake varies considerably between countries. Acceptability can be assessed directly by asking about intended (hypothetical) use and assessing satisfaction during/after use. Since they have been around for a very long time, there are very few data of this nature on condoms (as contraceptives rather than for prevention of infection), withdrawal or vasectomy. There are direct data on the acceptability of hormonal methods for men but from relatively small clinical trials which undoubtedly do not represent the real world. Surveys undertaken among the male general public demonstrate that, whatever the setting, at least 25% of men - and in most countries substantially more - would consider using hormonal contraception. Although probably an overestimate of the number of potential users when such a method becomes available, it would appear that hormonal contraceptives for men may have an important place on the contraceptive menu. Despite commonly expressed views to the contrary, most women would trust their male partner to use a hormonal method.

Adding the Standard Days Method® to the contraceptive method mix in a high-prevalence setting in Peru.

OBJECTIVE: To determine what contribution the Standard Days Method® (SDM) makes to the contraceptive mix offered by regular health services in areas of Peru where contraceptive prevalence rates (CPR) are already high. METHODS: SDM was added to the family planning methods offered by the Ministry of Health in two provinces in Peru in September 2002. Retrospective interviews were conducted in March-June 2004 with 1 200 women who had chosen SDM as their contraceptive method and had used it for 2-20 months. Data were also obtained from the databases of the participating health services. The evaluation covered SDM demand, whether or not clients were switching to SDM from other modern methods, and SDM continuation and effectiveness. RESULTS: Demand for SDM stabilized at 6% of all new family planning users. Most users had not been using any reliable contraception at the time they started using SDM. About 89% of those who began using SDM at least 6 months before the interview were still using it at 6 months. The 12-month typical use pregnancy rate was estimated to be around 10.0 per 100 women years. CONCLUSIONS: Adding SDM to a program's existing contraceptive method mix can increase coverage even in an already high-CPR setting. Most women who choose SDM do not switch from any other modern family planning method. Continuation compares well with other modern user-directed methods. SDM effectiveness, when offered in regular service delivery circumstances, compares well to efficacy trial findings.

Adding the Standard Days Method® to the contraceptive method mix in a high-prevalence setting in Peru / Adición del Método de Días Fijos® a la combinación de métodos anticonceptivos en un entorno de alta prevalencia de anticoncepción en el Perú

OBJECTIVE: To determine what contribution the Standard Days Method® (SDM) makes to the contraceptive mix offered by regular health services in areas of Peru where contraceptive prevalence rates (CPR) are already high. METHODS: SDM was added to the family planning methods offered by the Ministry of Health in two provinces in Peru in September 2002. Retrospective interviews were conducted in March-June 2004 with 1 200 women who had chosen SDM as their contraceptive method and had used it for 2-20 months. Data were also obtained from the databases of the participating health services. The evaluation covered SDM demand, whether or not clients were switching to SDM from other modern methods, and SDM continuation and effectiveness. RESULTS: Demand for SDM stabilized at 6 percent of all new family planning users. Most users had not been using any reliable contraception at the time they started using SDM. About 89 percent of those who began using SDM at least 6 months before the interview were still using it at 6 months. The 12-month typical use pregnancy rate was estimated to be around 10.0 per 100 women years. CONCLUSIONS: Adding SDM to a program's existing contraceptive method mix can increase coverage even in an already high-CPR setting. Most women who choose SDM do not switch from any other modern family planning method. Continuation compares well with other modern user-directed methods. SDM effectiveness, when offered in regular service delivery circumstances, compares well to efficacy trial findings.

OBJETIVO: Definir la contribución del Método de Días Fijos® (MDF) a la combinación de métodos anticonceptivos que ofrecen los servicios de salud en dos provincias del Perú, donde las tasas de prevalencia de anticoncepción ya son altas. MÉTODOS: El MDF se agregó a los métodos de planificación familiar ofrecidos por el Ministerio de Salud en dos provincias en el Perú en septiembre del 2002. Entre marzo y junio del 2004, se llevaron a cabo entrevistas retrospectivas a 1 200 mujeres que habían escogido este método anticonceptivo y lo habían usado durante un período de 2 a 20 meses. Se obtuvo también información a partir de las bases de datos de los servicios de salud que participaron en el estudio. Se recogieron datos para determinar la demanda del MDF, si las usuarias hicieron la transición del MDF a otros métodos modernos por el de los días fijos y con la continuidad del uso del método y su eficacia. RESULTADOS: La demanda del MDF se estabilizó en 6 por ciento de todas las nuevas usuarias de planificación familiar. La mayoría de ellas no estaba utilizando otro método de anticoncepción en el momento de comenzar a usar este método. Cerca de 89 por ciento de las mujeres que habían empezado a usar el MDF al menos 6 meses antes de la entrevista, todavía lo estaban usando 6 meses después. Se calculó que la tasa de embarazo con un uso típico del método durante 12 meses fue alrededor de 10,0 por 100 años-mujer. CONCLUSIONES: La adición del MDF a las opciones de métodos anticonceptivos propuestos por un programa puede aumentar la cobertura, incluso en entornos que ya cuentan con una alta tasa de prevalencia de anticoncepción. La mayoría de las mujeres que eligieron el MDF no había usado antes otro método moderno de planificación familiar. La continuación de su uso es comparable con la continuación de otros métodos modernos que dependen del usuario. La eficacia del MDF, cuando se ofrece en un contexto de prestación de servicios regulares es comparable con los resultados que se obtuvieron en el estudio de eficacia.

Reducing sexual risk with practice of periodic secondary abstinence.

OBJECTIVE: Test a novel intervention to help sexually experienced girls increase abstinence behaviors and attitudes. DESIGN: A quasi-experimental repeated measures design using qualitative and quantitative data. SETTING: Two alternative public schools. PARTICIPANTS: Thirty-three females whose mean age was 16 and who were 79% African American participated. Most (79%) had experienced a pregnancy. INTERVENTION: A 6 session, weekly, interactive intervention was delivered. Data were collected at baseline, last session, and at 5 and 7 month follow-ups. MAIN OUTCOME MEASURES: Measured outcomes related to abstinence included participants' reasons, behaviors, stages of change, and attitudes. RESULTS: The most common reason for abstinence was not wanting to have sex. At each postintervention data collection point, most participants (greater than or equal to 74%) reported that they had purposefully avoided sex. Duration of consecutive days of abstinence increased although only significantly at 5 month follow-up. Abstinence behaviors increased with the largest change from first to last session. Stage of change advanced from preparation to action by 7 month follow-up. Attitudes toward abstinence became more favorable. CONCLUSION: Effective sexual risk reduction interventions are critically needed to promote safety. Nurses may assist young women to decrease their sexual risks by teaching them to practice periodic abstinence.