RESUMO

OBJECTIVE: To determine whether condom use among high-risk female adolescents could be increased by a behavioral intervention, with the use of infection with Chlamydia trachomatis as a biomarker of condom practices. DESIGN: Prospective, randomized, controlled intervention. SETTING: Urban family planning and sexually transmitted disease clinics. PARTICIPANTS: Two hundred nine female adolescents, aged 15 through 19 years, who were treated for C. trachomatis genitourinary infection, were randomly assigned to standard (control) or experimental (behavioral intervention) groups. One hundred twelve subjects returned for follow-up 5 to 7 months after enrollment and comprise the study subjects. MEASUREMENTS: Subjects completed a multiinstrument questionnaire measuring sexual behavior, condom practices, attitudes and beliefs, cognitive complexity, sociodemographics, and motivation at enrollment and follow-up. Endourethral and endocervical sites were sampled for C. trachomatis. RESULTS: Among the 112 subjects who returned for repeated examination, those who had received the experimental intervention reported increased use of condoms by their sexual partners for protection against sexually transmitted diseases (odds ratio = 2.4; p = 0.02) and for vaginal intercourse (odds ratio = 3.1; p = 0.005) at the 6-month follow-up. Multivariable logistic regression analysis controlling for condom use at enrollment demonstrated that the experimental intervention (odds ratio = 2.8; p = 0.03) and the higher cognitive complexity (odds ratio = 4.6; p = 0.02) independently contributed to greater condom use at follow-up. Despite greater use of condoms among the group who had received the intervention, use remained inconsistent and rates of reinfection with C. trachomatis were not significantly different (26% vs 17%; p = 0.3). CONCLUSION: Although a brief behavioral intervention among high-risk female adolescents can increase condom use by their sexual partners, incident infection does not appear to be reduced, because condom use remained inconsistent.

PIP: In Indianapolis, Indiana, health workers randomly assigned 209 female adolescents, 15-19 years old, all of whom were sexually active and had Chlamydia trachomatis infection, to either the standard education group or to the behavioral intervention group to determine whether a behavioral intervention could increase condom use among this high-risk group. Researchers used infection with C. trachomatis as a biomarker of condom practices. The standard intervention was an individual discussion with the clinic nurse about sexually transmitted diseases (STDs) (e.g., importance of partner treatment and condom use) using the normal clinic procedure and printed material on chlamydia infection. The behavioral intervention included a discussion of chlamydia infection using the printed pamphlet as a guide, demonstration of how to use a condom correctly using a plastic banana, encouragement to practice putting a condom on the proxy phallus during the visit, and providing skills to negotiate condom use with sexual partners. 54% (112) of the adolescents returned for follow-up 5-7 months after enrollment. Adolescents in the intervention group were much more likely to use condoms for protection against STDs at follow-up than at baseline (odds ratio [OR] = 2.4; p = 0.02) and for vaginal intercourse (OR = 3.1; p = 0.005). They were not more likely to use condoms during last intercourse, however. When the researchers controlled for the frequency of use of condoms for vaginal intercourse at enrollment, adolescents in the intervention group were significantly more likely to use condoms during vaginal intercourse at follow-up than at baseline (p = 0.01). The multivariable logistic regression revealed that the experimental intervention and higher cognitive complexity among some adolescents had an independent positive influence on condom use at follow-up (OR = 2.8, p = 0.03 and OR = 4.6, p = 0.02, respectively). Despite higher condom use rates in the intervention group, the rate of reinfection with C. trachomatis was not significantly different than the control group (26% vs. 17%; p = 0.3). In conclusion, the intervention did not achieve consistent condom use.

Assuntos

RESUMO

A health belief model of condom use was used to identify factors associated with condom use in 390 sexually active female adolescents, aged 12 through 19 years, recruited at the time of a visit for reproductive health care. Fifty-six percent were white and the remainder black. Nineteen percent had genitourinary infections with Chlamydia trachomatis. Forty-six percent reported having had more than one sexual partner in the preceding year. Reported condom use for at least one specific reason (prevention of pregnancy, sexually transmitted disease, or acquired immunodeficiency syndrome) increased as behavioral, emotional, and sexually transmitted disease risk decreased, and as cognitive maturity and positive condom attitudes increased. Although uses of condoms to prevent pregnancy, sexually transmitted disease, and acquired immunodeficiency syndrome were positively intercorrelated, each made a contribution to explaining condom use at most recent coitus (odds ratios 2.95, 3.96, and 2.81, respectively). After statistical adjustment for the reported reasons for previous condom use, behavioral risk was the only additional factor associated with condom use at the most recent sexual encounter; women who participated in more risk behaviors (substance and alcohol use and minor delinquency) were less likely to have used a condom (odds ratio 0.61). Knowledge about sexually transmitted disease and acquired immunodeficiency syndrome, and concurrent use of contraceptive pills, were not related to condom practices. The data suggest that adolescents' perceptions about condoms, including the individual functions of condoms for contraception and for prevention of sexually transmitted disease, may be important in determining their use. Engaging in unprotected intercourse may be part of a larger behavioral domain that includes other unhealthy behaviors.

Assuntos

RESUMO

Five hundred sixty-eight adolescent female patients receiving routine gynecologic care at urban clinics were screened by culture for Chlamydia trachomatis infection at both the urethra and endocervix. Culture results for 562 were available from either or both sites. Positive cultures were obtained from 139 (25%). Urethral infection was not associated with either urinary tract symptoms or sterile pyuria, but urethral or endocervical infection was associated with cervical friability (P = less than 0.0001), endocervical mucopus (P = 0.0001), cervical erythema (P = 0.0002), and cervical ectopy or erosion (P = 0.01). Increased chlamydial infection rates were associated with older age (P = 0.01), history of more frequent intercourse (P = 0.01), and history of more than one lifetime partner (P = 0.023), with a marginal association for being black (P = 0.05). Method of contraception, reason for attending clinic, age at menarche, age at first intercourse, years sexually active, number of sexual partners in preceding 6 months, parity, and prior history of sexually transmitted disease were not associated with having chlamydial genitourinary infection.

Assuntos