Contraceptive Withdrawal in Adolescents

A Complex Picture of Usage

Jennifer L. Woods, Devon Hensel, J. Fortenberry

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Study Objective: Contraceptive withdrawal, or coitus interruptus, is a widespread method in adolescents, but factors affecting usage have not been longitudinally investigated. Study objectives were to examine usage numbers of withdrawal among a group of sexually active adolescent females and to investigate the influence of personal, partner, and family factors on usage patterns. Design/Setting/Participants: Subjects (N = 387; 14 to 17 years at enrollment; 92% African American) were recruited from primary care adolescent health clinics in areas with high rates of pregnancy and sexually transmitted infection. As part of a larger longitudinal study, subjects contributed face-to-face quarterly and annual questionnaires assessing contraceptive behavior, recent sexual behaviors, as well as partner- and family-based attitudes/beliefs. Interventions, Main Outcome Measures: The outcome variable was: withdrawal use during the previous 12 weeks (no/yes); predictor variables included 19 individual, family and partner variables. All models additionally controlled for any current hormonal use (no/yes; any method), current condom use (no/yes) and past withdrawal use (past 30 days; no/yes). Logistic regression, with GEE estimation to adjust for repeated within-subject observations, was performed in SUDAAN, 9.0. Results: Subjects supplied 1632 quarterly interviews; withdrawal was mentioned in about 25% of the interviews (392/1632). Controlling for primary contraceptive method, withdrawal was mentioned in 13.2% (51/307) of interviews with hormonal methods, in 32.4% (255/787) of the interviews with condoms and in 4.7% (78/1632) of interviews with no method. Current hormonal use was associated with a decreased likelihood of also using withdrawal (OR = 0.34), whereas past withdrawal use increased the likelihood of current withdrawal by about 4-fold (OR = 4.18). Condom use was not associated with withdrawal use. Current withdrawal use was more likely with a more diverse sexual repertoire (OR = 1.65), more sexual partners in the past 3 months (OR = 1.46), higher sexual control (OR = 1.15), lower perceived STI risk (OR = 0.46), higher sexual self-efficacy (OR = 1.24), lower sexual coercion (OR = 0.56) higher condom negativity (OR = 1.16), living with a boyfriend (OR = 2.17) and lower family sexual health support (OR = 0.88). Conclusion: Contraceptive withdrawal in adolescents should not be considered 'rare.' Careful clinical consideration of usage within the context of other contraceptive behaviors, sexual behaviors/attitudes, and relationship issues could better inform effective contraceptive counseling efforts.

Original languageEnglish
Pages (from-to)233-237
Number of pages5
JournalJournal of Pediatric and Adolescent Gynecology
Volume22
Issue number4
DOIs
StatePublished - Aug 2009

Fingerprint

Contraceptive Agents
Condoms
Interviews
Contraception Behavior
Sexual Partners
Sexually Transmitted Diseases
Sexual Behavior
Coitus Interruptus
Coercion
Family Health
Reproductive Health
Self Efficacy
Pregnancy Rate
Contraception
African Americans
Longitudinal Studies
Counseling
Primary Health Care
Logistic Models
Outcome Assessment (Health Care)

Keywords

  • Adolescents
  • Contraception
  • Withdrawal

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health

Cite this

Contraceptive Withdrawal in Adolescents : A Complex Picture of Usage. / Woods, Jennifer L.; Hensel, Devon; Fortenberry, J.

In: Journal of Pediatric and Adolescent Gynecology, Vol. 22, No. 4, 08.2009, p. 233-237.

Research output: Contribution to journalArticle

@article{b7a19038164b4051b6048e24bcb7c759,
title = "Contraceptive Withdrawal in Adolescents: A Complex Picture of Usage",
abstract = "Study Objective: Contraceptive withdrawal, or coitus interruptus, is a widespread method in adolescents, but factors affecting usage have not been longitudinally investigated. Study objectives were to examine usage numbers of withdrawal among a group of sexually active adolescent females and to investigate the influence of personal, partner, and family factors on usage patterns. Design/Setting/Participants: Subjects (N = 387; 14 to 17 years at enrollment; 92{\%} African American) were recruited from primary care adolescent health clinics in areas with high rates of pregnancy and sexually transmitted infection. As part of a larger longitudinal study, subjects contributed face-to-face quarterly and annual questionnaires assessing contraceptive behavior, recent sexual behaviors, as well as partner- and family-based attitudes/beliefs. Interventions, Main Outcome Measures: The outcome variable was: withdrawal use during the previous 12 weeks (no/yes); predictor variables included 19 individual, family and partner variables. All models additionally controlled for any current hormonal use (no/yes; any method), current condom use (no/yes) and past withdrawal use (past 30 days; no/yes). Logistic regression, with GEE estimation to adjust for repeated within-subject observations, was performed in SUDAAN, 9.0. Results: Subjects supplied 1632 quarterly interviews; withdrawal was mentioned in about 25{\%} of the interviews (392/1632). Controlling for primary contraceptive method, withdrawal was mentioned in 13.2{\%} (51/307) of interviews with hormonal methods, in 32.4{\%} (255/787) of the interviews with condoms and in 4.7{\%} (78/1632) of interviews with no method. Current hormonal use was associated with a decreased likelihood of also using withdrawal (OR = 0.34), whereas past withdrawal use increased the likelihood of current withdrawal by about 4-fold (OR = 4.18). Condom use was not associated with withdrawal use. Current withdrawal use was more likely with a more diverse sexual repertoire (OR = 1.65), more sexual partners in the past 3 months (OR = 1.46), higher sexual control (OR = 1.15), lower perceived STI risk (OR = 0.46), higher sexual self-efficacy (OR = 1.24), lower sexual coercion (OR = 0.56) higher condom negativity (OR = 1.16), living with a boyfriend (OR = 2.17) and lower family sexual health support (OR = 0.88). Conclusion: Contraceptive withdrawal in adolescents should not be considered 'rare.' Careful clinical consideration of usage within the context of other contraceptive behaviors, sexual behaviors/attitudes, and relationship issues could better inform effective contraceptive counseling efforts.",
keywords = "Adolescents, Contraception, Withdrawal",
author = "Woods, {Jennifer L.} and Devon Hensel and J. Fortenberry",
year = "2009",
month = "8",
doi = "10.1016/j.jpag.2008.11.001",
language = "English",
volume = "22",
pages = "233--237",
journal = "Journal of Pediatric and Adolescent Gynecology",
issn = "1083-3188",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Contraceptive Withdrawal in Adolescents

T2 - A Complex Picture of Usage

AU - Woods, Jennifer L.

AU - Hensel, Devon

AU - Fortenberry, J.

PY - 2009/8

Y1 - 2009/8

N2 - Study Objective: Contraceptive withdrawal, or coitus interruptus, is a widespread method in adolescents, but factors affecting usage have not been longitudinally investigated. Study objectives were to examine usage numbers of withdrawal among a group of sexually active adolescent females and to investigate the influence of personal, partner, and family factors on usage patterns. Design/Setting/Participants: Subjects (N = 387; 14 to 17 years at enrollment; 92% African American) were recruited from primary care adolescent health clinics in areas with high rates of pregnancy and sexually transmitted infection. As part of a larger longitudinal study, subjects contributed face-to-face quarterly and annual questionnaires assessing contraceptive behavior, recent sexual behaviors, as well as partner- and family-based attitudes/beliefs. Interventions, Main Outcome Measures: The outcome variable was: withdrawal use during the previous 12 weeks (no/yes); predictor variables included 19 individual, family and partner variables. All models additionally controlled for any current hormonal use (no/yes; any method), current condom use (no/yes) and past withdrawal use (past 30 days; no/yes). Logistic regression, with GEE estimation to adjust for repeated within-subject observations, was performed in SUDAAN, 9.0. Results: Subjects supplied 1632 quarterly interviews; withdrawal was mentioned in about 25% of the interviews (392/1632). Controlling for primary contraceptive method, withdrawal was mentioned in 13.2% (51/307) of interviews with hormonal methods, in 32.4% (255/787) of the interviews with condoms and in 4.7% (78/1632) of interviews with no method. Current hormonal use was associated with a decreased likelihood of also using withdrawal (OR = 0.34), whereas past withdrawal use increased the likelihood of current withdrawal by about 4-fold (OR = 4.18). Condom use was not associated with withdrawal use. Current withdrawal use was more likely with a more diverse sexual repertoire (OR = 1.65), more sexual partners in the past 3 months (OR = 1.46), higher sexual control (OR = 1.15), lower perceived STI risk (OR = 0.46), higher sexual self-efficacy (OR = 1.24), lower sexual coercion (OR = 0.56) higher condom negativity (OR = 1.16), living with a boyfriend (OR = 2.17) and lower family sexual health support (OR = 0.88). Conclusion: Contraceptive withdrawal in adolescents should not be considered 'rare.' Careful clinical consideration of usage within the context of other contraceptive behaviors, sexual behaviors/attitudes, and relationship issues could better inform effective contraceptive counseling efforts.

AB - Study Objective: Contraceptive withdrawal, or coitus interruptus, is a widespread method in adolescents, but factors affecting usage have not been longitudinally investigated. Study objectives were to examine usage numbers of withdrawal among a group of sexually active adolescent females and to investigate the influence of personal, partner, and family factors on usage patterns. Design/Setting/Participants: Subjects (N = 387; 14 to 17 years at enrollment; 92% African American) were recruited from primary care adolescent health clinics in areas with high rates of pregnancy and sexually transmitted infection. As part of a larger longitudinal study, subjects contributed face-to-face quarterly and annual questionnaires assessing contraceptive behavior, recent sexual behaviors, as well as partner- and family-based attitudes/beliefs. Interventions, Main Outcome Measures: The outcome variable was: withdrawal use during the previous 12 weeks (no/yes); predictor variables included 19 individual, family and partner variables. All models additionally controlled for any current hormonal use (no/yes; any method), current condom use (no/yes) and past withdrawal use (past 30 days; no/yes). Logistic regression, with GEE estimation to adjust for repeated within-subject observations, was performed in SUDAAN, 9.0. Results: Subjects supplied 1632 quarterly interviews; withdrawal was mentioned in about 25% of the interviews (392/1632). Controlling for primary contraceptive method, withdrawal was mentioned in 13.2% (51/307) of interviews with hormonal methods, in 32.4% (255/787) of the interviews with condoms and in 4.7% (78/1632) of interviews with no method. Current hormonal use was associated with a decreased likelihood of also using withdrawal (OR = 0.34), whereas past withdrawal use increased the likelihood of current withdrawal by about 4-fold (OR = 4.18). Condom use was not associated with withdrawal use. Current withdrawal use was more likely with a more diverse sexual repertoire (OR = 1.65), more sexual partners in the past 3 months (OR = 1.46), higher sexual control (OR = 1.15), lower perceived STI risk (OR = 0.46), higher sexual self-efficacy (OR = 1.24), lower sexual coercion (OR = 0.56) higher condom negativity (OR = 1.16), living with a boyfriend (OR = 2.17) and lower family sexual health support (OR = 0.88). Conclusion: Contraceptive withdrawal in adolescents should not be considered 'rare.' Careful clinical consideration of usage within the context of other contraceptive behaviors, sexual behaviors/attitudes, and relationship issues could better inform effective contraceptive counseling efforts.

KW - Adolescents

KW - Contraception

KW - Withdrawal

UR - http://www.scopus.com/inward/record.url?scp=67651089812&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67651089812&partnerID=8YFLogxK

U2 - 10.1016/j.jpag.2008.11.001

DO - 10.1016/j.jpag.2008.11.001

M3 - Article

VL - 22

SP - 233

EP - 237

JO - Journal of Pediatric and Adolescent Gynecology

JF - Journal of Pediatric and Adolescent Gynecology

SN - 1083-3188

IS - 4

ER -