The trade-off between hormonal contraceptives and condoms among adolescents.

CONTEXT: Adolescents' dual use of condoms and hormonal contraceptives is low, and the motivations underlying their decisions to combine contraceptives are not understood.

METHODS

To examine how pregnancy concerns, sexually transmitted disease (STD) concerns and type of sexual partner influence contraceptive use, we recruited 436 sexually experienced adolescents from two clinics. In structured interviews, we asked adolescents to describe their recent partners, their method use, and their pregnancy and STD concerns. Data were analyzed using logistic regression.

RESULTS

The odds that adolescents used condoms with main partners were significantly lower among those who used hormonal contraceptives than among nonusers of these methods (odds ratios, 0.4 for young women and 0.3 for young men). With casual partners, no association existed between adolescents' condom and hormonal contraceptive use. Concerns about pregnancy and STDs influenced this association for women with main partners. Among young women who perceived pregnancy as more negative, hormonal contraceptive users had reduced odds of using condoms (0.1). No association existed between use of the two methods among young women whose view of pregnancy was less negative. Young women who perceived themselves to be less at risk of acquiring an STD had reduced odds of using condoms if they were using hormonal contraceptives (0.2). Among young women who perceived themselves to be more at risk of acquiring an STD, no association existed.

CONCLUSIONS

Adolescents trade off between hormonal contraceptives and condoms according to partner type and perceived risks. Adolescents' dual-method use may improve if providers tailor counseling to adolescents' perceived risk of STDs and pregnancy, and if they address prevention of both as a related decision.