Ineffective use of condoms among young women in managed care.

Condoms must be used effectively in order to prevent pregnancy and the spread of HIV/STD. This study investigated two types of ineffective condom use, delayed condom use (initiated after penetration has occurred) and condom slippage and/or breakage. We estimated prevalence and identified predictors of ineffective condom use among young women at risk of STDs. The study used baseline survey data from a randomized trial of women 18-24 years old at two managed care sites; 779 participants who were recent condom users were included in this analysis. Forty-four per cent of the sample reported delayed condom use in the past three months and 19% reported condom slippage and/or breakage. In multivariate logistic regression, younger age, primary partner, lack of partner support, multiple recent sexual partners and using condoms for contraception were positively associated with delayed condom use. Correlates of condom slippage and/or breakage were non-white race/ethnicity and history of any STD. Greater frequency of condom use independently predicted both outcomes. Ineffective condom use was common in this sample of experienced condom users and predictors were different for each outcome. HIV/STD prevention interventions must address more specific aspects of condom use than have previously been their focus, especially when condom use is already high.

Adolescent HMO enrollees' utilization of out-of-plan services.

PURPOSE: To examine use of reproductive health services, correlates of out-of-plan care, and reasons for seeking out-of-plan care among adolescent health maintenance organization (HMO) enrollees. METHODS: We mailed a self-administered questionnaire to a population-based random sample of 18-year-old members of Group Health Cooperative of Puget Sound (GHC) who had been enrolled for at least 12 months. The sample was selected from GHC's computerized enrollment database. Questionnaire topics included reproductive history, sexual behavior, and use of health services. Analysis included Chi-square tests to examine differences by gender and out-of-plan status and multivariate analysis using logistic regression. RESULTS: About one-half of the 997 respondents (69% response rate) reported using out-of-plan care. In multivariate analysis, the strongest correlate of out-of-plan care was having had sexual intercourse [odds ratio (OR) = 1.84; 95% confidence interval (CI) = 1.35-2.52]. Other correlates were using alcohol (OR = 1.79; 95% CI = 1.29-2.48), living with parents (OR = 0.65; 95% CI =.46-.92), and being female (OR = 1.60; 95% CI = 1.21-2.11). During the prior year, over 80% of sexually active respondents had obtained contraceptives out-of-plan and 45% of those tested for sexually transmitted diseases (STDs) reported out-of-plan testing. The primary reasons reported for using any out-of-plan care were lack of convenience (28%), being out of town (26%), and confidentiality (23%; only reported by sexually active respondents). CONCLUSIONS: A substantial proportion of GHC-enrolled adolescents used out-of-plan care. Those who did were more likely to have had STDs and other health problems than those who used only in-plan services. Without continuity of care, these at-risk adolescents may not be receiving optimal services.

Depressive symptoms in users and non-users of depot medroxyprogesterone acetate.

To evaluate the possible effects of depot medroxyprogesterone acetate (DMPA) injectable contraception on depressive symptoms, we conducted a population-based prospective study with women aged 18-39 years old enrolled at a health maintenance organization. At baseline, 183 women used DMPA and 274 were non-users. Data on depressive symptoms and on factors potentially related to DMPA use and depression were collected by questionnaire at 6-month intervals for up to 3 years. In multivariate longitudinal analysis, we found an increased likelihood of reporting depressive symptoms among continuous DMPA users (OR = 1.44; 95% CI = 1.00-2.07) and discontinuers (OR = 1.60; 95% CI = 1.03-2.48) when compared to non-users. Women who discontinued DMPA use had elevated depressive symptoms prior to discontinuation (OR = 2.30; 95% CI = 1.42-3.70) and immediately following discontinuation (OR = 2.46; 95% CI = 1. 46-4.14), and depressive symptoms subsided at subsequent visits relative to non-users. Our prospective analyses found an association between DMPA use and depressive symptoms but further research is needed to determine whether the relationship is causal.

The relative costs and benefits of telephone interviews versus self-administered diaries for daily data collection.

This article compares two methods of collecting daily data: self-administered diaries and telephone interviews. Study participants included 44 men and 56 women between the ages of 16 and 35 who participated in a larger study of drinking, drug use, and sexual activity. Participants were randomly assigned to either the written diary or the telephone interview conditions; question wording and format were identical in both conditions. Daily data were collected for a period of 8 weeks. Results indicate that although telephone interviews resulted in slightly more missed days of data collection, they generally yielded less item-level missing data, produced cleaner data and therefore were less costly to process, and were as palatable to participants as self-administered diaries. Except for reports of drinking and vegetable consumption, telephone and diary conditions did not differ in the amount of behavior reported; more drinking and vegetable consumption were reported with telephone interviews, however. Telephone interviews also imposed considerably higher overall personnel costs.

College students' reasons for nonuse of condoms within dating relationships.

Two hundred ten heterosexual undergraduates in dating relationships were surveyed about reasons for not using condoms every time for vaginal and anal sex and for increasing or decreasing condom use during their relationships. Half of the respondents reported consistent condom use in the first month of their relationships, while only 34% reported consistent condom use in the past month. Subjective assessments of partner safety and the belief that sufficient measures were being taken to avoid pregnancy were important reasons for condom nonuse. Study results suggest that interventions should emphasize the importance of objectively assessing HIV/STD risk before reducing condom use within relationships. Interventions also need to provide additional information on the riskiness of heterosexual anal sex.

Maternal depressive symptoms and child behavior problems in a nationally representative normal birthweight sample.

OBJECTIVE: To evaluate the association between maternal depressive symptoms and child behavior problems in a nationally representative sample of U.S. mothers of normal birthweight babies. METHODS: We analyzed data from the 1988 National Maternal and Infant Health Survey (NMIHS) and a 1991 follow-up survey. Depressive symptoms were measured at both surveys using the CES-D, and child behavior problems were assessed by maternal self-report at follow-up. RESULTS: Approximately 28% of the 5303 mothers reported depressive symptoms at a mean of 17 months after delivery, as did 20% at 36 months. In multivariate analyses, women with depressive symptoms at either or both surveys were significantly more likely than women without depressive symptoms to report that their children had frequent temper tantrums or difficulty getting along with other children, and were difficult to manage, unhappy, or fearful. Compared to women without depressive symptoms, the risks of reporting three out of the five child behavior problems for women with depressive symptoms were OR = 1.6 (CI = 1.1-2.1), 1988 only; OR = 2.3 (CI = 1.6-3.3), 1991 only; and OR = 3.6 (2.6-5.0), both 1988 and 1991. CONCLUSIONS: Study findings indicate that a substantial proportion of mothers of young children in the United States experience depressive symptoms and that their children are at significantly increased risk of maternally reported behavior problems. Our results suggest that efforts to identify and treat depression in new mothers should be increased and that mothers whose children are found to have behavior problems should be assessed for depression.

The association between characteristics of dating relationships and condom use among heterosexual young adults.

Although there is some evidence that relationship-level factors influence sexual behavior, they have received far less attention than individual-level factors as potential correlates of condom use. This study surveyed 210 undergraduate men and women to examine the association between relationship characteristics and condom use. Higher levels of love, longer relationships and more serious and committed relationships were individually associated with less condom use. In a multiple logistic regression model controlling for HIV/sexually transmitted disease (STD) risk perception and contraceptive method, relationship length was the only relationship factor that independently predicted condom use (OR = .91; 95% CI = .84-.99). Use of a hormonal contraceptive method was negatively associated with condom use in the multivariate model (OR = .12; 95% CI = .06-.27), and mediated the association between relationship factors and condom use. Study results suggest that HIV/STD prevention interventions may be improved by addressing relationship characteristics, particularly the length of a dating relationship.

PIP: A study of the associations and effects of relationship factors on condom use was conducted among heterosexual college students at a Pacific Northwest university from January to March 1996. There were 210 undergraduate participants aged 18-25 years. Measures were taken in the categories of frequency of condom use, love rating as measured by the Sternberg Triangular Love Scale, and element of trust as measured by the Dyadic Trust Scale. Findings revealed that condom use was individually associated with love and length and type of relationship. However, only relationship length independently predicted condom use. Hormonal contraceptive method choice mediated the association between relationship characteristics and condom use. The study suggests that HIV and sexually transmitted disease prevention interventions are more effective with young adults in dating relationships if they include components that specifically address relationship characteristics.

Dry sex in Zimbabwe and implications for condom use.

'Dry sex' refers to the preference for a dry, tight vagina during sexual intercourse. Women in Zimbabwe and elsewhere have been found to use a variety of drying agents to achieve these effects. Previous studies of 'dry sex' have concentrated on documentation of the practice and investigation of any associated increased risk of HIV. In contrast, this study examines the impact of 'dry sex' on condom use and effectiveness. Focus group interviews were held with female HIV/AIDS peer educators in Zimbabwe who had a history of commercial sex work. Participants reported that drying agents had physical and psychological consequences. That is, agents were said to dry and tighten a woman's vagina, and also to serve as 'love potions' to attract sexual partners and ensure their faithfulness. Although vaginal dryness was not found to deter the use of condoms, some women were reluctant to use condoms for fear of blocking the 'magic' of drying agents. There was agreement among participants that condoms frequently broke when used in conjunction with drying agents. Participants primarily attributed condom breakage to excessive vaginal tightness. Lubricants were not routinely used during sex or with condoms. However, participants preferred the use of lubricated condoms when they used condoms. Implications of the 'dry sex' practice for AIDS prevention programs and development of new HIV prevention technologies are discussed.

Prevalence and correlates of depressive syndromes among adults visiting an Indian Health Service primary care clinic.

Depression is common among patients visiting primary care clinics. In order to describe the prevalence of depressive syndromes in an American Indian primary care clinic population and to help define the clinical correlates of depressive syndromes in this setting, a clinic-based research study of depression was undertaken by the Indian Health Service (IHS). One hundred and six patients from an IHS primary care clinic were systematically enlisted for participation in the study. Participants completed the Inventory for Diagnosing Depression (IDD). Twenty-two (20.7%) responded with answers scoring positive for a depressive syndrome. Nine of these 22 (8.9% of the 106 participants) met IDD criteria for a major depressive syndrome. A diagnosis of depression, a past history of depression, use of mental health facilities, unexplained pains, and antidepressant medication use were associated with the presence of a depressive syndrome.