Mycoplasma genitalium symptoms, concordance and treatment in high-risk sexual dyads.

The objective of this study was to determine the prevalence and concordance of Mycoplasma genitalium (MG) among Mexican American and African American women and their male sexual partners. Secondary objectives were to determine symptoms of MG infection and persistence of MG after antibiotic therapy. Heterosexual couples were tested for MG and interviewed separately regarding symptoms and behavioural/epidemiologic variables at baseline, six and 12 months. The overall prevalence of MG among women and men was 9.5% and 10.6%, respectively. Subjects were five times more likely to be infected with MG if their sexual partner was MG positive. Among men and women, MG prevalence and mean bacterial loads were similar after receiving single-dose azithromycin, doxycycline or no antibiotics. MG was associated with current urethral discharge in men. No clinical symptoms were specifically diagnostic of MG infection in women.

Sexually transmitted infection risk exposure among black and minority ethnic youth in northwest London: findings from a study translating a sexually transmitted infection risk-reduction intervention to the UK setting.

OBJECTIVES: Young black women are disproportionately affected by sexually transmitted infections (STI) in the UK, but effective interventions to address this are lacking. The Young Brent Project explored the nature and context of sexual risk-taking in young people to inform the translation of an effective clinic-based STI reduction intervention (Project SAFE) from the USA to the UK. METHODS: One-to-one in-depth interviews (n = 37) and group discussions (n = 10) were conducted among men and women aged 15-27 years from different ethnic backgrounds recruited from youth and genitourinary medicine clinic settings in Brent, London. The interviews explored the context within which STI-related risks were assessed, experienced and avoided, the skills needed to recognise risk and the barriers to behaviour change. RESULTS: Concurrent sexual partnerships, mismatched perceptions and expectations, and barriers to condom use contributed to STI risk exposure and difficulties in implementing risk-reduction strategies. Women attempted to achieve monogamy, but experienced complex and fluid sexual relationships. Low risk awareness, flawed partner risk assessments, negative perceptions of condoms and lack of control hindered condom use. Whereas men made conscious decisions, women experienced persuasion, deceit and difficulty in requesting condom use, particularly with older partners. CONCLUSIONS: Knowledge of STI and condom use skills is not enough to equip young people with the means to reduce STI risk. Interventions with young women need to place greater emphasis on: entering and maintaining healthy relationships; awareness of risks attached to different forms of concurrency and how concurrency arises; skills to redress power imbalances and building self-esteem.

Risk and protective behaviours of bisexual minority women: a qualitative analysis.

BACKGROUND: Public health messages urging women to seek health care services such as sexually transmitted diseases (STD) and cervical cancer screening or family planning services fail to address women who have sex with women (WSW). This negligence may have led to a false sense of security amongst WSW concerning sexual risk behaviour. Research has shown that WSW engaged in more high-risk sexual behaviours than heterosexual women. WSW has been identified as an important vector in the spread of STDs in all populations because of bisexuality. To prevent and reduce transmission of STDs amongst WSW, perceptions of risk for STD amongst WSW need to be understood so that effective interventions may be developed. AIM: To describe the relationship between sexual risk and protective behaviour and STD transmission amongst bisexual minority women with a history of STD. METHODS: Life history methods were used to interview 23 African-American bisexual women with a history of STD. FINDINGS: Various themes unfolded during analysis of the patient interviews, including bisexual women's perceptions of STD risk, the context of sexual relationships with women and STD prevention, screening, and treatment practices. CONCLUSIONS: The contexts of sexual relationships including multiple or concurrent partner relationships with both men and women placed these women at high risk for STD. Regardless of the type of relationship or belief it is possible to get an STD, protection was often not used. These circumstances identify an extremely high-risk population of women with need for more extensive research to identify strategies for health care interventions.

Sexual abuse and sexual risk behaviors of minority women with sexually transmitted diseases.

The relationship between sexual abuse and sexually transmitted disease (STD) represents an important and underinvestigated context of domestic violence. This study examined the association between sexual abuse, sexual risk behaviors, and risk for reinfection and HIV among minority women with STD. Mexican American and African American women (n = 617) with active STD entered a randomized study of behavioral intervention to reduce STD recurrence. Each underwent questioning at entry regarding sexual abuse and sexual risk behaviors. Comparisons of these behaviors using chi-square, t tests, and logistic regression were made by history of sexual abuse. Sexually abused women were more likely to have lower incomes, earlier coitus, STD history, currently abusive partners, new sex partners, anal sex, and bleeding with sex, placing them at increased risk for STD reinfection and HIV. Due to this association with sexual risk behavior, assessment for sexual abuse is essential in programs focusing on STD/HIV prevention.

Predictors of the vaginal microflora.

OBJECTIVE: Our purpose was to define influences on the patterns of the vaginal microflora. STUDY DESIGN: We enrolled 617 African American and Mexican American women in a 1-year longitudinal study of sexual behaviors and the vaginal microflora on the basis of the presence of gonorrhea, chlamydial infection, trichomoniasis, or syphilis at the initial visit. The patients were assigned randomly to a behavioral intervention or standard counseling regarding sexually transmitted disease. We reevaluated 508 (82%) and 549 (89%) women at 6 and 12 months, respectively. A comprehensive survey of lower genital tract organisms was conducted at baseline and at 6 and 12 months. Behavioral and microbiologic associations were screened by bivariate analysis. All variables associated with an organism at P < or = .15 were included in a multivariate analysis. Associations between behavior and the genital tract microflora were identified by logistic regression coefficients with P <.05. RESULTS: African American race had a consistent association with vaginal microflora, specifically, Mycoplasma hominis, Trichomonas vaginalis, bacterial vaginosis, group B streptococci, Neisseria gonorrhoeae, and Chlamydia trachomatis. Various behaviors had a less consistent effect, including multiple partners, douching, frequency of coitus >3 times a week, and cunnilingus, fellatio, and anal intercourse at the last sexual encounter. M hominis (but not Ureaplasma urealyticum ), Gardnerella vaginalis, and Lactobacillus species were associated with bacterial vaginosis. Lactobacillus species appeared to protect against bacterial vaginosis and infection with G vaginalis. Sexually transmitted diseases (caused by M hominis, N gonorrhoeae, C trachomatis, and T vaginalis ) were associated with each other. In contrast, hormonal status, vaginal blood, and foreign bodies had little effect. CONCLUSION: The presence of other microorganisms and race have a more consistent association with the presence or absence of a cervical-vaginal organism than sexual behavior, hormonal status, vaginal devices, or the presence of abnormal vaginal bleeding.

Minority women with sexually transmitted diseases: sexual abuse and risk for pelvic inflammatory disease.

Mexican American and African American women (N = 617) with a sexually transmitted disease (STD) underwent a targeted physical exam and questioning regarding sexual abuse, current genitourinary symptomatology, and pelvic inflammatory disease (PID) risk behaviors to determine the relationship between sexual abuse and risk for PID. Sexually abused women (n = 194) reported higher PID risk behaviors, including earlier coitus, more sex partners, higher STD recurrence, and a tendency toward delayed health-seeking behavior. They also reported more severe genitourinary symptomatology, confirmed by physical exam, and presumptive diagnoses of PID. These characteristics identify sexually abused women at high risk for PID. Because of its considerable impact on risk for PID, assessment for sexual abuse is essential in clinical management of women with STD and for diagnosis of PID.

Hematological changes in hospital workers due to chronic exposure to low levels of ethylene oxide.

We conducted a cross-sectional study to determine whether occupational exposure to low levels of ethylene oxide can cause hematological abnormalities. Blood samples were collected from a group of 47 hospital workers who were exposed to ethylene oxide during a mean period of 6.6 years (standard error, 1.1). Ethylene oxide range levels measured were < 0.01 to 0.06 ppm. The control group, individually matched by age, sex, and smoking habits, consisted of 88 workers from the administrative sector. We found significant differences between the exposed and the control group in the frequency of workers with white blood cells lower than the normal range. Although there was no significant difference in the absolute mean number of the total white blood cells, we found an elevation in the absolute mean number of monocytes and eosinophils (P < 0.01) and a decrease (P < 0.01) in the absolute mean number of lymphocytes in the exposed group compared with the control group. We also found an elevation (P < 0.01) in the percentage of hematocrit and the mean absolute number of the red blood cells, and a decrease (P < 0.01) in the mean absolute number of platelets, in the exposed group compared with the control group. The mean absolute number of eosinophils, red blood cells, and percentage of hematocrit was significantly higher, and the mean absolute number of lymphocytes and platelets was significantly lower, in the subgroups with a higher cumulative dose of exposure. A positive dose-response was found between cumulative dose exposure and the absolute mean number of eosinophils. In view of our findings, we suggest that the use of complete blood cells with differential in routine medical surveillance and for early detection of hygiene problems should be reexamined with special attention to the eosinophils count.

A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women.

BACKGROUND: African-American and Hispanic women are disproportionately affected by sexually transmitted diseases, including the acquired immunodeficiency syndrome (AIDS). In the effort to reduce infection rates, it is important to create and evaluate behavioral interventions that are specific to the target populations. METHODS: We enrolled women with nonviral sexually transmitted diseases in a randomized trial of a sex- and culture-specific behavioral intervention. The intervention consisted of three small-group sessions of three to four hours each designed to help women recognize personal susceptibility, commit to changing their behavior, and acquire necessary skills. The control group received standard counseling about sexually transmitted diseases. The design of the intervention was based on the AIDS Risk Reduction Model and ethnographic data on the study populations. Participants in both groups underwent screening, counseling, and an interview before randomization and at the 6- and 12-month follow-up visits. The principal outcome variable was subsequent chlamydial or gonorrheal infection, which was evaluated on an intention-to-treat basis by logistic-regression analysis. RESULTS: A total of 424 Mexican-Americans and 193 African-American women were enrolled; 313 were assigned to the intervention group and 304 to the control group. The rate of participation in the intervention was 90 percent. The rates of retention in the sample were 82 and 89 percent at the 6- and 12-month visits, respectively. Rates of subsequent infection were significantly lower in the intervention group than in the control group during the first 6 months (11.3 vs. 17.2 percent, P=0.05), during the second 6 months (9.1 vs. 17.7 percent, P=0.008), and over the entire 12-month study period (16.8 vs. 26.9 percent, P=0.004). CONCLUSIONS: A risk-reduction intervention consisting of three small-group sessions significantly decreased the rates of chlamydial and gonorrheal infection among Mexican-American and African-American women at high risk for sexually transmitted disease.

The context of sexually transmitted disease: life histories of woman abuse.

Approximately 25%-50% of women with sexually transmitted diseases (STDs), including AIDS, are involved in abusive relationships. Numerous characteristics associated with a past history of abuse are also risk factors for STD infection, including multiple partner relationships, substance abuse, early age at first coitus, and partner control of the relationship. Research has identified psychological effects of previous abuse, including depression, minimal control in relationships, and decreased self-efficacy. These effects may prevent abused women with STDs from making behavioral changes to prevent recurrence and transmission of disease. Life history methodology was used to understand the context of the interrelationships between STD and woman abuse in 30 Mexican American and African American women's lives. A focus on the context of abused women's partner relationships and aspects of personal control within these relationships may facilitate effective behavioral change, risk reduction, and subsequent decrease in incidence of STDs and woman abuse.

Sexual behavior and vaginal colonization by group B streptococcus among minority women.

OBJECTIVE: To test the hypothesis that sexual behaviors predict colonization of the vagina by group B streptococcus among minority women. METHODS: We conducted a prospective, descriptive study of 192 consecutive African-American (37%) and Hispanic women (63%). Each woman underwent a detailed interview concerning sexual behavior. Separate specimens were taken from the endocervix, upper vagina, lower vagina, and anorectum and placed in selective broth media for isolation of group B streptococcus. Significant behavioral predictors of vaginal group B streptococcus colonization and heavy (3-4+) colonization were identified using stepwise logistic regression. RESULTS: The incidence of vaginal colonization was 39% and heavy colonization was 35%. Nineteen percent reported anal intercourse, 46% reported sex at least two times per week, and 21% reported more than one partner in the previous 30 days. The significant predictors of vaginal group B streptococcal infection were: African-American ethnicity, adjusted odds ratio (OR) 6.1 (95% confidence interval [CI] 2.5-15.1); presence of rectal group B streptococcus, adjusted OR 100.6 (95% CI 26.7-379.3); nulliparous, adjusted OR 3.6 (95% CI 1.4-9.5); and nonpregnant status, adjusted OR 3.9 (95% CI 1.3-12.2). The significant predictors of heavy colonization were: more than one partner in the last 30 days, adjusted OR 2.6 (95% CI 1.2-5.6); and African-American ethnicity, adjusted OR 2.3 (95% CI 1.2-4.5). Anal intercourse was associated with a reduced likelihood of vaginal group B streptococcal infection, adjusted OR 0.34 (95% CI 0.12-0.91). CONCLUSION: Sexual behavior, especially anal intercourse, does not predict vaginal colonization by group B streptococcus. African-American women are more likely to have vaginal and heavy group B streptococcus colonization. Heavy vaginal colonization is associated with multiple partners in African-American women.

Monitoring blood lead levels in workers overexposed to occupational lead: an analysis of Israeli data.

In a retrospective cohort study, we followed the blood lead [Pb(B)] and zinc protoporphyrin (ZPP) determinations of 292 workers found to have Pb(B) levels above the biological exposure index (BEI) during 1987-1993. The results indicated that (a) 22.6% of these workers were never retested for Pb(B) during the follow-up period; (b) 38.5% of the workers tested in the first year of the follow-up continued to exhibit Pb(B) levels above the BEI (84.7% of them also had ZPP > or = 100 micrograms/dl); (c) about 25% of the remaining cohort had at least one more result above the BEI during the fourth, fifth, and sixth years of follow-up; and (d) the incidence density rate of recurrence of Pb(B) concentrations above the BEI was 0.236. We recommend the establishment of a target value lower than the BEI that should be reached before the reinstatement of the overexposed worker. In our view this target value, combined with an efficient control of industrial hygiene conditions, will decrease the rate of recurrence of overexposure.

Determination of consumer satisfaction: a basic step for quality improvement of an occupational hygiene service.

In order to define priorities for improvement of the Occupational Hygiene Service, Institute for Occupational Health, Tel Aviv University, consumer satisfaction was evaluated by postal questionnaire. The questionnaire covered items on service accessibility and quality, including staff courtesy and respect for the consumer, cost, satisfaction with the service in general over time, and satisfaction with the last service received, and was sent to all 144 regular clients of the institute during the years 1990 and 1991. Satisfaction items were rated from 1 (not at all satisfied) to 5 (completely satisfied). Multivariant analysis showed that: (i) satisfaction with the waiting period for the last service report and satisfaction with the courtesy of the last service and respect for the consumer had the strongest influence on general satisfaction with the service over time; (ii) satisfaction with the waiting period for the last service report was also the most important component in satisfaction with the last service received. Despite the increasing interest in Israel in health service costs, and because the price of the service is subsidized (50%), this item was not found to be significant with regard to satisfaction with the service. In conclusion, we recommend the use of this relatively easy and inexpensive methodology which allowed us to define precisely the key factor for service improvement, ie the waiting period for the service report.

Women's reasons for not seeking prenatal care: racial and ethnic factors.

Our objective was to determine if there were differences in the reasons for not seeking early prenatal care among low-income black, Hispanic, and white women who had four or fewer prenatal care visits or care only in the third trimester, and who gave birth at Denver General Hospital in Colorado. Data were gathered from 606 women (48% Hispanic, 26% black, 26% white) after delivery, using a 188-item questionnaire and abstracted medical charts. The most important reasons for not seeking early prenatal care were attitudinal (47%), financial (26%), and structural and system problems (8.5%). Financial reasons were more important to white than to black or Hispanic women, and attitudinal reasons were more important to black and Hispanic than to white women. The analysis showed that education and marital status were sometimes confounding variables. Clear differences in reasons for not seeking prenatal care were reported by women of dissimilar racial and ethnic groups in this public hospital. Cultural variations in women's views should be taken into account in developing programs intended to improve prenatal care and pregnancy outcome in Denver.

A model of pre-sterilization ambivalence and post-sterilization regret in married couples.

"We have presented a general theoretical perspective on couple decision-making and subsequent adaptation which serves as a framework for understanding the complex phenomenon commonly referred to as post-sterilization regret. We have anchored this framework by means of a series of specific hypotheses about ambivalence and post-sterilization regret among both tubal ligation and vasectomy married couples. Using our hypotheses, we constructed three models. These were tested on data gathered from 400 married couples.... The results, including unanticipated pathways and differences in specific areas of each model between sexes and method groups, not only provide a confirmation of our general theoretical perspective but also allow us to have insights and to speculate about the psychological and marital dynamics of sterilization decision-making and adaptation." Data are from a longitudinal study conducted in Santa Clara, California, in 1985.

The pre- and poststerilization predictors of poststerilization regret in husbands and wives.

Husbands and wives from 141 tubal sterilization couples and 162 vasectomy couples were interviewed just prior to sterilization and then again 1 and 2 years later. We conducted linear regression analyses to determine the pre- and poststerilization predictors of poststerilization regret in each of the four gender x method groups (tubal husbands, tubal wives, vasectomy husbands, vasectomy wives). We confirmed a number of hypotheses based on the research literature and our own earlier work. Both individual and couple factors contributed to the development of regret, as did both pre- and poststerilization factors. An important finding was the degree to which regret among the nonsterilized respondents (tubal husbands, vasectomy wives) was affected by pre- and poststerilization interaction with their spouses.

PIP: Researchers followed 303 couples who sought and then experienced sexual sterilization through the prepaid health care plan of Kaiser Foundation Hospital in Santa Clara, California for 2 years to determine pre- and poststerilization predictors of poststerilization regret. They examined regret in 4 gender x method groups (tubal husbands, tubal wives, vasectomy husbands, and vasectomy wives) by using a latent variable model of regret (LISREL) and a multiple regression analysis. The study results revealed that, prior to sterilization, predictors of poststerilization regret included respondent motivation for additional children and against sterilization, poor husband-wife communication, and much conflict during decision making, and dominance of the decision by 1 spouse. Indeed these negative effects supported a previous study with similar results which concluded that negative effects contribute considerably to the process of developing regret. These effects fit into 5 behavior fields: reproduction, marital harmony, self image, sexuality, and health. The study also found that the feelings of the spouse who was not sterilized, less motivated and less dominant were particularly sensitive to the feelings of the spouse who had a sterilization, especially when the sterilized spouse regretted having undergone sterilization. Therefore physicians should equally consider the attitude of the spouse who did not seek sterilization and realize that his/her poststerilization regret may be influenced by interactions with the often more motivated, more dominant spouse. Since at least 10% of sterilized couples regret their decision, this study should improve the understanding of this mental health issue.

Tubal sterilization or vasectomy: how do married couples make the choice?

OBJECTIVE: To examine the relative importance of husband, wife, and couple factors as determinants of sterilization method choice. DESIGN: Married couples seeking sterilization interviewed before surgery and again 1 year later. SETTING: Kaiser Permanente Medical Care Program subscribers seeking care at the Kaiser Foundation Hospital, Santa Clara, California. PARTICIPANTS: Two hundred married women seeking a tubal sterilization and their husbands and 200 married men seeking a vasectomy and their wives. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sterilization method chosen. RESULTS: In a logistic regression model, nine predictor variables correctly classified 94.9% of 395 couples (P less than 0.000). CONCLUSIONS: The choice of a sterilization method is achieved primarily through processes that involve both spouses. The motivations of both husband and wife, their mutual influence and communication, their present pattern of contraceptive use, and what they know about the satisfactions or dissatisfactions of other people who have had sterilizations are all factors that should be taken into account when the clinician helps a patient make the method-choice decision.

PIP: The objective of this study was to examine the relative importance of husband, wife, and couple factors as determinants of sterilization method choice. Participants were married couples seeking sterilization who were interviewed prior to surgery and again 1 year later at the Kaiser Foundation Hospital, Santa Clara, California. 200 married women seeking tubal sterilization and their husbands and 200 married men seeking vasectomy and their wives were evaluated concerning sterilization method chosen. In a logistic regression model, 9 predictor variables correctly classified 94.9% of 395 couples (p.000). The choice of sterilization method is achieved primarily through processes that involve both spouses. Motivations of both partners, their mutual influence and communication, their present pattern of contraceptive usage, and what they know concerning method acceptability or lack thereof of others who have undergone sterilization are all factors that must be taken into account when the clinician helps a patient make a method-choice decision.

Impact of tubal sterilization and vasectomy on female marital sexuality: results of a controlled longitudinal study.

To determine if female or male sterilization affects long-term female marital sexuality, we prospectively compared baseline data and 5 consecutive years of follow-up data from 152 tubal sterilization women, 106 vasectomy wives, and 83 women not planning sterilization. By follow-up year 5, no group of women expressed any change in satisfaction with their own sexual response; however, all groups showed a significant decrease across time in satisfaction with their sexual relationship, in coital desire, and in coital frequency. There were no group differences in overall net changes or in rates of change over the 5-year period. However, two short-term group differences were noted: a decrease in coital desire among women not planning sterilization between baseline and follow-up year 4, compared with increases for both sterilization groups, and an increase in coital frequency at the first follow-up year only in the tubal sterilization group. These data indicate that there are no detrimental effects and some short-term benefits of both sterilization procedures on female marital sexuality.

Menstrual pattern change 1 year after sterilization: results of a controlled, prospective study.

To determine if female sterilization is associated with adverse menstrual change, we compared prospectively collected menstrual data from women who underwent sterilization via bipolar cauterization, banding, and Pomeroy ligation with data from women whose husbands obtained a vasectomy and from women who were not planning sterilization. At first-year follow-up, sterilization via banding with Falope rings was not associated with adverse change. After excluding initially abnormal cases: (1) cauterization women were bleeding more heavily than all other groups excepting Pomeroy; (2) cauterization and Pomeroy women experienced more dysmenorrhea than women not planning sterilization; and (3) more cauterization and Pomeroy women (collapsed samples) developed abnormal length cycles than did the two control groups. There were no group differences regarding development of beneficial/neutral change (e.g., decreased dysmenorrhea). However, cauterization and Pomeroy groups experienced a significantly higher average number of adverse changes than did the other groups and were at significantly greater risk of developing one or more adverse changes than were women not planning sterilization. The only pattern of association among adverse menstrual changes occurred significantly more often in the cauterization and next in the Pomeroy groups.

Acceptability of an experimental intracervical device: results of a study controlling for selection bias.

We analyzed baseline and 12-month follow-up interview data from 98 women who had volunteered to use an experimental intracervical device (ICD) and from 155 women who had been randomly assigned to two control groups, the levonorgestrel-releasing intrauterine device (LNG-IUD; N = 86) and the copper Nova-T IUD (N = 69). All participants were clinic patients in Helsinki, Finland. Initial analysis of 12-month discontinuation data indicated that a significantly higher percent of ICD users (22.4) discontinued their device than did either LNG-IUD (7.0) or Nova-T (8.7) users. However, we were no longer able to detect significant differences in discontinuation after controlling for baseline variables that assessed predisposition to be dissatisfied with contraception in general. Adjusted probabilities of discontinuing the ICD, LNG-IUD, and Nova-T were 11.8%, 6.2% and 7.9%, respectively. These data indicate that the ICD is likely to be acceptable to Helsinki clinic patients; moreover, they suggest a definite place for hormonal intrauterine devices in the contraceptive armamentarium. Most importantly, the methodology used here can be generalized to acceptability studies of other contraceptive devices and drugs undergoing Phase I and early Phase II clinical trials (in situations where randomization may not be feasible) in order to identify and control for the bias introduced by nonrandom assignment procedures.

PIP: 253 women aged 18-38 participated in comparative and clinical studies of 3 contraceptive devices in Helsinki during 1983 and 1985. The newest and most experimental device was the intracervical device. (ICD), currently in Phase II clinical trials. The ICD is placed in the cervical canal with its horizontal arm resting in the lower part of the uterus. On its vertical arm is a Silastic rod containing 50% levonorgestrel covered by Silastic tubing. The device releases 20mcg levonorgestrel/day. The advantages of the ICD are that it is independent of the size of the uterus, and its insertion does not require trained medical personnel. The levonorgestrel improves contraceptive efficacy, reduces pain and bleeding, and minimizes risk of infection. The control devices were the Nova-T copper IUD and the levonorgestrel-releasing IUD. The Nova-T is a plastic device with its vertical arm bound with copper wire with a silver Nova-T containing 50% levonorgestrel, released at 20mcg /day. It is currently completing Phase III clinical trials. The final study sample consisted of 98 volunteers using the ICD, 86 randomly selected women using the levonorgestrel IUD, and 69 randomly selected women using the Nova-T. All of the women were previous users of some form of effective contraception; 70-80% had used nonhormonal IUDs, and 1-8% had used hormonal IUDs. The dependent variable was the discontinuation rate during the 12-month test period. At 1st analysis, it appeared that a significantly higher proportion of ICD users (22.4%) discontinued than levonorgestrel IUD users (8.7%). However, these results reflect severe selection bias,since the 98 volunteer were self-selected and predisposed to be dissatisfied with contraceptive methods in general and IUDs in particular. 9 specific variables associated with discontinuation were identified and used to construct and IUD attitude index representing negative attitudes toward prior methods. After adjustment for these group differences through logistic regression analysis, the estimated probability of discontinuing became 11.8% for the ICD, 6.2% for the levonorgestrel IUD, and 7.9% for the Nova-T. These low probabilities of discontinuation indicate that the ICD is likely to be accepted by women and that hormonal IUDs in general are more acceptable than nonhormonal IUDs. The study also showed the importance of attitude, and therefore of counseling, in contraceptive decision-making. The most important implication of the study, however, is meaningful data can be extracted from an experimental study participants were not selected randomly.