Elsevier

Journal of Adolescent Health

Volume 39, Issue 3, September 2006, Pages 388-395
Journal of Adolescent Health

Original article
The Developmental Association of Relationship Quality, Hormonal Contraceptive Choice and Condom Non-Use among Adolescent Women

https://doi.org/10.1016/j.jadohealth.2005.12.027Get rights and content

Abstract

Purpose

Consistent condom use is critical to efforts to prevent sexually transmitted infections among adolescents, but condom use may decline as relationships and contraceptive needs change. The purpose of this research is to assess changes in condom non-use longitudinally in the context of changes in relationship quality, coital frequency and hormonal contraceptive choice.

Methods

Participants were women (aged 14–17 years at enrollment) recruited from three urban adolescent medicine clinics. Data were collected at three-month intervals using a face-to-face structured interview. Participants were able to contribute up to 10 interviews, but on average contributed 4.2 interviews over the 27-month period. Independent variables assessed partner-specific relationship quality (five items; scale range 5–25; α = .92, e.g., this partner is a very important person to me); and, number of coital events with a specific partner. Additional items assessed experience with oral contraceptive pills (OCP) use and injected depo medroxy-progesterone acetate (DMPA). The outcome variable was number of coital events without condom use during the past three months. Analyses were conducted as a three-level hierarchical linear growth curve model using HLM 6. The Level 1 predictor was time, to test the hypothesis that condom non-use increases over time. Level 2 predictors assessed relationship quality and coital frequency across all partners to assess hypotheses that participants’ condom non-use increases over time as a function of relationship quality and coital frequency. Level 3 predictors assessed the participant-level influence of OCP or DMPA experience on time-related changes in condom non-use.

Results

A total of 176 women reported 279 sex partners and contributed 478 visits. Both average coital frequency and average condom non-use linearly increased during the 27-month follow-up. At any given follow-up, about 35% reported recent OCP use, and 65% reported DMPA use. HLM analyses showed that condom non-use increased as a function of time (β = .12; p = .03, Level 1 analysis). Increased condom non-use over time was primarily a function of increased coital frequency (β = .01; p = .00), although higher levels of relationship quality were associated with increased condom non-use at enrollment (β = .44; p = .00, Level 2 analysis). The temporal rise in condom non-use significantly increased among DMPA users (β = .06; p = .00) but not OCP users (Level 3 analysis) (β = −.04; p = .06).

Conclusions

Developmentally, relationship characteristics and coital frequency appear to have increasing weight in decisions about condom use. Hormonal contraceptive methods are not equivalently associated with the overall temporal decline in condom use. Future research associated with dual contraceptive/condom use should address differential factors associated condom use in combination with different hormonal methods.

Section snippets

Study design and procedures

Data were collected as part of a larger longitudinal study of risk and protective factors (initiated in 1999) associated with sexually transmitted infections among women in middle adolescence. Briefly, the larger study consisted of an enrollment visit and follow-up clinic visits each three months during a 27-month study period (up to 10 visits total). At each visit, a structured face-to-face interview with trained research assistants provided detailed information regarding sexual and

Results

The original sample contained 237 women providing 732 enrollment and visits at three-month intervals over the 27-month follow-up. In order to focus appropriately on the effects of hormonal contraceptive choice, and partner-specific relationship quality and partner-specific coital frequency on change in condom non-use over time, analyses were limited to the 176 women using OCP or DMPA (Level 3 variables), during relationships with 279 sex partners (and thus 275 assessments of partner-specific

Discussion

The results of this study clearly demonstrate a temporal increase in condom non-use during a 27-month follow-up. Both relationship characteristics and coital frequency influence the rate of increase in condom non-use, with adolescent women perceiving higher relationship quality and reporting greater coital frequency at greater risk for STI exposure. Hormonal contraceptive methods are not equivalently associated with the overall temporal decline in condom use: more experienced DMPA users become

Conclusion

The sometimes competing needs for effective contraception and effective STI prevention represent complex behavioral targets to achieve even for a short period of time. These data demonstrate, however, that condom use, especially, represents a developmental “moving target” subject to change over time and in response to changes in relationships, sexual behaviors and contraceptive choices. Perhaps the most important message to derive from our data is the suggestion that efforts to encourage condom

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