A tailored minimal self-help intervention to promote condom use in young women: results from a randomized trial.

OBJECTIVE: To evaluate the efficacy of a theory-based tailored minimal self-help intervention to increase condom use among young women at risk for HIV/sexually transmitted disease (STD). DESIGN: Randomized controlled trial on an intent-to-treat basis in two managed care plans, in Washington state and North Carolina, with follow-up at 3 and 6 months. PARTICIPANTS: A proactively recruited sample of 1210 heterosexually active, non-monogamous, non-pregnant women, aged 18-24 years recruited June 1999-April 2000; 85% completed the 6-month follow-up. METHOD: Arm 1 received usual care. Arm 2 received a mailed computer-generated self-help magazine, individually tailored on survey items including stage of readiness to use condoms, barriers to condom use, partner type; condom samples and a condom-carrying case were included in the packet; this was followed 3 months later by a tailored 'booster' newsletter. The a priori 6-month main outcomes were percentage of women using condoms during the previous 3 months (overall and by partner type) and proportion of total episodes of intercourse during which condoms were used in the previous 3 months. RESULTS: Relative to usual care, intervention group women reported significantly more condom use overall [adjusted odds ratio (OR), 1.86; 95% confidence interval (CI), 1.32-2.65; P = 0.0005] and with recent primary partners (OR, 1.97; 95% CI, 1.37-2.86; P = 0.0003). They also reported using condoms for a higher proportion of intercourse episodes (52.7% versus 47.9%; P = 0.05). Significantly more intervention women carried condoms, discussed condoms with partners, and had higher self-efficacy to use condoms with primary partners. CONCLUSIONS: Tailored cognitive/behavioral minimal self-help interventions hold promise as HIV/STD prevention strategies for diverse populations of young at-risk women.

Women's reports of smoking cessation advice during reproductive health visits and subsequent smoking cessation.

OBJECTIVE: To examine associations of women's characteristics with reports of provider advice to quit smoking and smoking cessation 1 year after a reproductive health visit. STUDY DESIGN: Prospective survey. METHODS: As part of a randomized smoking cessation trial, 432 women smokers completed telephone surveys 1 month and 1 year after their reproductive health visit. Most women were white (85%) with a mean age of 36 years. RESULTS: Women more likely to report their provider advised them to quit smoking were white rather than another race (adjusted risk ratio, [RR] = 1.4, confidence interval [CI] = 1.14-1.64), employed versus unemployed (RR = 1.3, CI = 1.04-1.49), engaged in safer versus riskier sexual practices (RR = 1.3, CI = 1.09-1.54), were more rather than less ready to quit (RR = 1.3, Cl = 1.08-1.44), and saw family physicians versus gynecologists (RR = 1.3, CI = 1.12-1.41). Reported provider advice to quit smoking was not associated with subsequent cessation. Women were more likely to have quit smoking by the 1-year follow-up if at baseline they reported an annual Papanicolaou test in the prior 3 years (RR = 1.6, Cl = 1.02-2.26), were more rather than less ready to quit smoking (RR = 2.0, CI = 1.36-2.62), and were less rather than more dependent on nicotine (RR = 0.7, CI = 0.59-0.84). CONCLUSIONS: Provider advice to quit is being directed to women who are most likely to quit and contributes little in explaining subsequent cessation. Providers may not be giving enough cessation advice to minority women, those not considering cessation, and those not prevention oriented. Interventions and system improvements are needed to increase providers' counseling of smokers who are unmotivated and from racial/ethnic minorities.

Factors associated with condom use among at-risk women students and nonstudents seen in managed care.

OBJECTIVES: Sexually transmitted diseases (STD) research has focused on high-risk populations such as STD clinic patients and college students. This report examines predictors of unprotected sex among nonstudent women seen in primary care. STUDY DESIGN: Data are taken from the baseline survey of an intervention trial testing tailored print materials to encourage condom use. POPULATION: Eligible women were identified from automated databases of two managed care organizations and were ages 18-25, unmarried, heterosexually active in the prior 6 months, and not in a long-term monogamous relationship. OUTCOMES: The frequency of and relative contribution of risk behaviors to occurrences of unprotected vaginal sex were compared among non-full-time students (n=711) and full-time students (n=390). RESULTS: STD risk behaviors were prevalent and had similar associations with unprotected sex in both subsamples. Older age, using hormonal or no usual contraception, and having a "primary" partner increased unprotected sex; partner approval of condoms and having bought or carried condoms decreased unprotected sex. CONCLUSION: While sexually active single women seen in primary care perceive themselves at low STD risk, their risk profiles are similar to those of higher risk populations. Clinic-based interventions that include proactive identification of at-risk women and systems for encouraging safer sex practices are needed.