Department of Sociology and Criminal Justice, University of Delaware, Newark, Delaware.
Biden School of Public Policy & Administration, University of Delaware, Newark, Delaware.
Womens Health Issues. 2022 Sep-Oct;32(5):431-439. doi: 10.1016/j.whi.2022.05.002. Epub 2022 Jun 22.
Public health professionals have raised concern that increased use of long-acting reversible contraceptives (LARC) could raise women's risk for sexually transmitted infections (STIs), because LARC's superior pregnancy protection may decrease women's motivation to use a barrier method for supplemental pregnancy prevention. This study uses population-based data to examine whether condom use is lower, particularly among young women who are at increased STI risk, after initiating LARC versus moderately effective methods.
With the 2011-2019 data files of the National Survey of Family Growth, we examine the percent of sexually active months with condom use in the year after LARC or moderately effective method initiation for a nationally representative sample of 2,018 women aged 15-44 years. Multinomial logistic models regressed condom use on method type and age group, as well as their interaction, while adjusting for key confounders.
The unadjusted likelihood of any condom use is substantially lower among women who initiated LARC versus moderately effective methods (12% vs. 37%), and this difference is greater among younger versus older women. After accounting for differences in women's reproductive and sociodemographic profiles, however, a statistically significant difference in condom use by method initiated remains only for those aged 20-34 years.
Crude estimates suggest that condom use is lower after initiating LARC versus moderately effective methods, especially among young women. After accounting for the confounding effects of LARC users' distinct profiles-particularly in terms of parity and teenage childbearing-the difference is decreased overall and no longer significant for adolescent women. Overall results indicate a need for new STI prevention strategies and policies that emphasize the importance of dual prevention for LARC users at risk of STIs.
公共卫生专业人员担心，长效可逆避孕措施（LARC）的使用增加可能会增加女性感染性传播感染（STI）的风险，因为 LARC 对怀孕的卓越保护可能会降低女性使用屏障方法来补充怀孕预防的动机。本研究使用基于人群的数据来检查在开始使用 LARC 与中度有效方法后，特别是在感染性传播感染风险增加的年轻女性中，使用避孕套的情况是否会降低。
利用 2011-2019 年全国家庭增长调查的数据文件，我们检查了在 2011-2019 年全国家庭增长调查的数据文件中，在开始使用 LARC 或中度有效方法后的一年中，在有性行为的月份中，使用避孕套的比例在全国代表性样本的 2018 名 15-44 岁的女性中。多变量逻辑模型根据方法类型和年龄组以及它们的相互作用，回归避孕套的使用情况，同时调整了关键混杂因素。
与使用中度有效方法的女性相比，使用 LARC 的女性使用避孕套的可能性明显较低（12%比 37%），而且这种差异在年轻女性中更大。然而，在考虑到女性的生殖和社会人口统计学特征的差异后，只有在 20-34 岁的女性中，开始使用的方法在避孕套使用方面存在统计学上显著的差异。
粗略的估计表明，与使用中度有效方法相比，使用 LARC 后避孕套的使用频率较低，尤其是在年轻女性中。在考虑到 LARC 用户独特的特征的混杂效应后，尤其是在生育和未成年生育方面，整体差异降低，对青少年女性来说不再具有统计学意义。总体结果表明，需要新的性传播感染预防策略和政策，强调对有性传播感染风险的 LARC 用户进行双重预防的重要性。
