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Differences Between Dual-Method and Non–Dual-Method Protection Use in a Sample of Young African American Women Residing in the Southeastern United States FREE

Jessica M. Sales, PhD; Teaniese P. Latham, MPH; Ralph J. DiClemente, PhD; Eve Rose, MSPH
[+] Author Affiliations

Author Affiliations: Rollins School of Public Health at Emory University (Drs Sales and DiClemente, Mss Latham and Rose); Emory Center for AIDS Research (Drs Sales and DiClemente); and the Department of Pediatrics, Division of Infectious, Diseases, Epidemiology, and Immunology, Emory University School of Medicine (Dr DiClemente), Atlanta, Georgia.


Arch Pediatr Adolesc Med. 2010;164(12):1125-1131. doi:10.1001/archpediatrics.2010.230.
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Objectives  To characterize dual-method protection users and report the prevalence of dual-method use among young adult African American women residing in the Southeastern United States.

Design  Analysis of baseline data from a randomized controlled trial.

Setting  A clinic-based sample of young women enrolled in a randomized trial of a human immunodeficiency virus (HIV)–prevention program in Atlanta, Georgia, from June 2005 to June 2007.

Participants  African American women aged 14 to 20 years who reported unprotected sexual activity in the past 6 months. Of the eligible adolescents, 94% (N = 701) were enrolled in the study and completed baseline assessments.

Outcome Measures  Dual-method protection use as well as sociodemographic, individual-level, interpersonal-level, and community-level factors and interpersonal communication skills. Only data from the baseline assessment, before randomization, were used for the analysis.

Results  A total of 102 participants (14.6%) were classified as dual-method protection users. After controlling for age and clinic, significant differences between dual-method users and non–dual-method users were found for impulsivity, self-esteem, social support, relationship style, partner communication self-efficacy, and fear of condom negotiation.

Conclusions  Dual-method protection use is low. Identification of factors that differentiate dual-method users from non–dual-method users at the individual, interpersonal, and community levels in this young African American sample suggests that HIV, sexually transmitted disease, and unintended pregnancy risk–reduction programs should address factors at each level, not simply the individual level, and that this may involve structural and/or clinical counseling practice changes in clinics that serve young women, to optimally facilitate dual-method protection use among young African American women in the Southeastern United States.

Young women are at the greatest risk of pregnancy and sexually transmitted diseases (STD).14 Recently, the Centers for Disease Control and Prevention reported that 1 in 4 girls in the United States has an STD,5 and they are twice as likely to report STDs as boys the same age.6 Despite widespread availability of safe and effective contraceptive technologies, unintended pregnancy is also a significant public health issue in the United States, with an estimated 82% of pregnancies being unintended.7 Furthermore, after declining nearly 30% nationally from its peak in 1991, the teen birth rate rose 3% in 2006 and another 1% in 2007.8

These risks are magnified in the Southeastern United States, where national case surveillance data indicate that the burden of STD/human immunodeficiency virus (HIV) and teen pregnancy disproportionately affects African American youth aged 13 to 24 years.9 Compared with the national average rate of 84 pregnancies per 1000 adolescents, African American pregnancy rates in Alabama, Georgia, and Mississippi are all above the national average (123, 127, and 139 per 1000, respectively).8 Moreover, Georgia has the eighth highest adolescent birth rate in the nation and ranks second highest in repeated births.10 While the pregnancy rate for African American adolescents has declined in Georgia, it remains almost twice the rate of that of white individuals.10

For more than a decade, medical practitioners, researchers, and professional organizations (eg, the Centers for Disease Control and Prevention, American Medical Association, American Academy of Pediatrics, and the American College of Obstetrics and Gynecology) have recommended comprehensive reproductive health counseling for young women that includes recommending dual-method protection strategies to prevent both unintended pregnancy and STD/HIV.1113 Although recommended, dual-protection strategy use is not commonly practiced. A nationally representative survey of young women found that 6.6% used both a condom and oral contraception at their last sexual encounter.14 Findings from the National Survey of Family Growth indicated that 8.5% of adolescent girls reported dual-method protection use (condoms plus oral contraception during the month when the interview occurred).15 Among African American adolescent girls, 13.5% used dual-method protection, suggesting that dual-method use may be slightly higher among certain racial/ethnic groups.16

Few studies have investigated correlates of dual-method protection use. In persons aged 14 to 22 years, dual-method protection use was more likely among younger and African American adolescents, particularly those who communicated with their parents about HIV.14,15 For low-income, predominately minority urban women, dual-method protection use was more likely among those who had a history of STDs and were worried about both pregnancy and HIV. Communicating with male sex partners and parents about family planning and higher self-efficacy to refuse non–condom-protected sex were also associated with increased dual-method protection use.16

Although informative, gaps in the empirical database regarding dual-method protection use remain. Specifically, most studies that explore contraceptive and/or condom use employ a decision-theory framework, an individual-centered explanation for clients' decisions and behavior, to guide the research.17 This framework has strengths for understanding personal decisionmaking but may not adequately address the broader array of contextual influences that affect women's decisions and behaviors.18 Recent findings support the use of a broader contextual perspective because young women make behavioral choices within a complex web of social systems and structures,19 and each system (individual-, interpersonal- [ie, romantic relationship, family, and peers], community-, and society-level systems) influences STD/HIV preventive and contraceptive behaviors.19,20

This study identifies the prevalence of dual-method protection use among young African American women in the Southeastern United States and characterizes dual-method users along an array of contextual influences including individual-, interpersonal-, and community-level factors. For this study, dual-method use was conceptualized as young women's concurrent use of a hormonal birth control method and use of a condom at their last sexual encounter.

SETTING

Participants were part of a larger study evaluating a sexual risk-reduction intervention for young African American girls. Analyses reported in this article are based on data from the baseline assessment. From June 2005 to June 2007, African American adolescent women aged 14 to 20 years were recruited from 3 clinics in Atlanta, Georgia, that provided sexual health services to predominantly inner-city adolescents. A young, female, African American recruiter approached adolescents in the clinic waiting area, described the study, solicited participation, and assessed eligibility. Eligibility criteria included self-identifying as African American, being 14 to 20 years of age, and reporting vaginal intercourse at least once without a condom in the past 6 months. Adolescents who were married, currently pregnant, or attempting to become pregnant were excluded. Adolescents returned to the clinic to complete informed consent procedures and baseline assessments and to be randomized to trial conditions. Written informed consent was obtained from all adolescents, with parental consent waived for those younger than 18 years owing to the confidential nature of clinic services. Of the eligible adolescents, 94% (N = 701) were enrolled in the study, completed baseline assessments, and were randomized to study conditions. The Emory University Institutional Review Board approved all study protocols.

PARTICIPANTS

The sample comprised 701 participants recruited from either a county health department STD clinic (n = 373), hospital-based adolescent clinic (n = 81), or Planned Parenthood clinic (n = 247). Participants' mean (SD) age was 17.6 (1.7) years. Most (65.3%) were full-time students; the remaining 34.8% had graduated, which represents appropriate levels of education for their age. Most reported living in a mother-only household (42.5%). Most (79.5%) reported being in a current relationship (mean [SD] length of relationship, 14.4 [14.9] months).

PROCEDURES

Data collection consisted of a 60-minute survey administered via audio computer-assisted self-interviewing technology. Questions on the baseline survey included demographics, sexual history, attitudes and outcome expectancies, psychosocial variables, HIV/STD knowledge, and peer norms. Participants were compensated $50 for their participation.

MEASURES
Dual-Method Use

Dual-method use was based on current hormonal birth control use and condom use at last sexual encounter, assessed by 2 questions: “The very last time you had sex, did you use a condom to prevent STDs or pregnancy?” and, “The very last time you had sex, did you use the pill, patch or Depo?” Response choices were yes (1) or no (0). Participants responding yes to both questions were classified as dual-method users. All others were classified as non–dual-method users.

Sociodemographic Measures

Age was assessed by asking, “How old are you (in years)?” Receiving federal assistance for living expenses was assessed by 4 binary response format questions (yes/no). Responses were summed to create an index of family aid.

Individual-Level Measures
Depressive Symptomatology

Depressive symptoms were assessed with the 8-item Center for Epidemiological Studies-Depression scale.21 This scale assesses the presence of depressive symptoms in the past 7 days and has been shown to be a valid measure of depressive symptoms in African Americans.22 Cronbach α, a measure of the scale's internal consistency, was .91.

Perceived Interpersonal Stress

We used 13 items modified from the African American Women's Stress Scale23 to measure perceived interpersonal stress. Questions assess the amount of stress an individual feels in various interpersonal relationships. Cronbach α was .87.

Self-esteem

The 10-item Rosenberg Self-Esteem Scale24 measured global self-esteem. Possible scores range from 10 to 40, with higher scores indicating higher levels of self-esteem. Cronbach α was 0.86.

Impulsivity

Impulsivity was assessed using Zimmerman's 15-item impulsivity scale.25 Possible scores range from 15 to 75, with higher scores indicating higher levels of impulsivity. Sample scale items include, “I like to do things as soon as I think about them” and, “I act on the spur of the moment.” Cronbach α was .76.

History of Forced Vaginal or Anal Sex

History of sexual violence was determined based on 2 questions assessing forced vaginal intercourse or forced anal intercourse: “Has anyone ever forced you to have vaginal sex when you didn't want to?” and, “Has anyone ever forced you to have anal sex when you didn't want to?” Response choices were yes (1) and no (0).26

Current Alcohol Use

Recent alcohol use was assessed by asking, “In the past 90 days, how many days have you used alcohol?” Participants entered the number of days, with options ranging from 0 to 90 days.

Current Marijuana Use

Recent marijuana use was assessed by asking, “In the past 90 days, how many days have you used marijuana?” Participants entered the number of days, with options ranging from 0 to 90 days.

Interpersonal-Level Measures
Social Support

Perceived social support was assessed with a 12-item scale developed by Zimet et al.27 Sample scale items include (1) my family really tries to help me, and (2) I can count on my friends when things go wrong. Responses were coded so that higher scores reflected higher levels of perceived social support. Cronbach α was .90.

Relationship Questionnaire

The Relationship Questions is a procedure developed by Bartholomew and Horowitz28 in which participants rate the degree to which each of 4 descriptive vignettes describe their feelings about significant others (ie, boyfriends/other intimate relationships) on a scale from 1 to 4 (1 = not at all like me; 4 = very much like me). The vignettes represent 4 distinct types of relationship styles: secure, fearful, dismissing, and preoccupied. Higher scores indicate a preference for a particular relationship style.

Currently Having a Boyfriend

Current relationship status was assessed by a single question, “Do you have a boyfriend?” Boyfriend was defined as a current partner that you have a sexual relationship with or someone you have a special or committed relationship. Response choices were yes (1) or no (0).

Currently Having a Casual Sex Partner

Currently having a casual sex partner, defined as someone other than a current boyfriend who you occasionally have sex with and are not in a committed relationship with, was assessed by a single item, “Do you currently have a casual sex partner(s)?” Response choices were yes (1) or no (0).

Interpersonal Communication Measures
Fear of Consequences of Condom Negotiation

Fear of consequences of condom negotiation with a sexual partner was assessed by a 7-item scale.29 Sample consequences were to “ignore my request,” “hit, push or kick me,” “leave me,” and “go out with other girls.” Cronbach α was .87.

Partner Communication Self-efficacy

A 6-item scale assessed partner sexual communication self-efficacy.30 Sample items included, “With a sex partner, how hard is it for you to ask how many sex partners he has had?” and, “With a sex partner, how hard is it for you to ask if he would use a condom?” Cronbach α was .82.

Partner Communication Frequency

Partner communication frequency was assessed by a 5-item scale that assess adolescents' frequency of communicating with male sex partners.31 Each item required a response based on a 4-point Likert-type scale (never to a lot/7 or more times). Higher values indicate more frequent sexual communication. Cronbach α was .85.

Parent-Adolescent Communication Scale

The Parent-Adolescent Communication Scale is composed of 5-items assessing adolescents' frequency of communicating about sexually related topics with their parents.32 Each item required a response based on a 4-point Likert-type scale from 1 (never) to 4 (often). Higher values indicated more frequent parent-adolescent communication. Cronbach α was .91.

Community-Level Measures
Clinic

Participants were recruited from 3 downtown Atlanta reproductive health/STD clinics where they were currently receiving services. Participant's clinic choice was recorded by assessment staff during baseline assessment. Clinic was selected as a community-level factor because clinic differences such as counseling practices with adolescent clients or clinic atmosphere (eg, teen-friendly, easy for teens to access) may influence dual-method use.

Neighborhood Quality

Neighborhood quality was assessed with 3 questions about the physical condition of participants' neighborhood. A sample item is, “On your street, are there abandoned homes or apartments?” Responses to all 3 yes/no questions were summed to create an index of neighborhood quality.33 Neighborhood quality was included as a community-level factor because it has been associated with STD infections in prior research,33 and it has been suggested that a disordered physical environment is a signal to residents that behaviors that are usually prohibited are tolerated.

STATISTICAL ANALYSIS

Descriptive statistics summarized sociodemographics and dual-method use for the entire sample. In addition, analyses examined differences between groups (dual-method users vs non–dual-method users) on sociodemographic variables, individual-level, interpersonal-level, and community-level measures. Differences were assessed using independent-samples t tests for continuous variables and χ2 analyses for categorical variables. Individual and interpersonal factors (which are commonly targeted in intervention programs because they are amenable to change) that differed significantly between dual-method users and nonusers were subsequently analyzed using analyses of covariance, controlling for any significant sociodemographic and community-level variables (which are less amenable to change).

DESCRIPTIVE ANALYSIS

The prevalence of dual-method use in this sample of young Southern African American women was 14.6% (n = 102). Several participants reported using only 1 method during their last sexual encounter, with 28.5% (n = 200) reporting using only a condom at their last sexual encounter and 20% (n = 140) reporting using only hormonal birth control. The remaining 36.9% (n = 259) reported not using a condom or hormonal birth control during their last sexual episode.

GROUP DIFFERENCES IN MULTILEVEL FACTORS

The only sociodemographic difference between dual-method users and non–dual-method users that demonstrated a statistically significant difference was age: dual-method users were younger (mean age, 17.2 years vs 17.70 years; P = .01).

Several individual-level factors such as abuse history, depression, and impulsivity were compared between dual-method users and non–dual-method users (Table 1).

Table Graphic Jump LocationTable 1. Differences in Individual-Level Factors by Dual-Method Use or Non–Dual-Method Use

Interpersonal-level factors such as social support, relationship style, and current relationship status were compared between dual-method users and non–dual-method users (Table 2).

Table Graphic Jump LocationTable 2. Differences in Interpersonal-Level Factors by Dual-Method Use or Non–Dual-Method Use

Interpersonal communication skills such as partner sexual communication self-efficacy, parent-adolescent sexual communication frequency, and fear of condom negotiation were compared between dual-method users and non–dual-method users (Table 3).

Table Graphic Jump LocationTable 3. Differences in Interpersonal Communication Factors by Dual-Method Use or Non–Dual-Method Use

The only statistically significant difference between dual-method users and non–dual-method users was clinic site; although dual-method use was uniformly low across all clinic sites, participants who received services at the hospital-based adolescent clinic used dual-method protection (28.4%) more frequently than participants who received services at the county health department (11.8%) or Planned Parenthood clinics (14.2%; χ2 = 14.79; P = .001).

ADJUSTED ANALYSIS: INDIVIDUAL-LEVEL AND INTERPERSONAL-LEVEL DIFFERENCES CONTROLLING FOR AGE AND CLINIC

Because significant differences in age and clinic were identified between dual-method and non–dual-method users, both variables that are not amenable to behavioral intervention, all significant individual and interpersonal factors were reanalyzed using analyses of covariance, controlling for age and clinic site (Table 4). After controlling for age and clinic, significant differences between dual-method users and non–dual-method users remain for impulsivity, self-esteem, social support, relationship style, partner communication self-efficacy, and fear of condom negotiation.

Table Graphic Jump LocationTable 4. Differences in All Factors by Dual-Method Use or Non–Dual-Method Use, Adjusting for Age and Clinic

The prevalence of dual-method use among young African American girls was low (14.6%), although it was higher than reported in national surveys of adolescent girls (6.6% and 8.5%)14,15 and similar to that reported in another sample of adolescent African American girls (13.5%).16 Our findings replicate others suggesting that dual-method users were younger and felt more self-efficacious to talk about sexually related topics, including condom use, with sex partners.14,16,34 However, we extend the empirical literature by identifying several other individual-level, interpersonal-level, and community-level factors that significantly differentiate dual-method users from non–dual-method users. For instance, we identified a marked difference in dual-method use among young women at the 3 recruitment clinics. Identifying potential factors associated with dual-method use at more than the individual-level provides a multifaceted understanding of the problem that may guide development of intervention efforts to increase dual-method use among young African American women.

The findings have clinical practice implications for reducing the risk of unintended pregnancy and STDs among adolescents. First, providers who interface with adolescents will routinely need to assess the frequency of adolescent patients' use of dual protection to avoid pregnancy and STDs. There is, however, limited guidance, specifically regarding how best to assess dual-protection use. Moreover, the extent to which pediatricians/adolescent providers are actually monitoring adolescents' dual-protection use is unclear. In a recent study by the American Academy of Pediatrics35 of pediatricians who provide reproductive health services, 61.2% and 60.8%, respectively, described always discussing contraception and condoms with adolescent patients at preventive care visits. However, it is unclear whether contraceptive use and condom use were independently discussed rather than being linked as a way to assess the frequency of adolescents' dual-method use.

Second, pediatricians/adolescent providers, regardless of venue or clinic type (eg, STD clinic, reproductive health clinic, or teen services clinic) will need to broaden prevention messages to specifically include dual-method protection. Published recommendations to encourage providers to convey information about STD/HIV infection to their adolescent patients and to assist adolescents in understanding the responsibilities of their sexual behavior have primarily focused on promoting consistent and appropriate use of latex condoms during sexual intercourse.36,37 While consistent condom use is a dual-protection strategy, as condoms are effective in reducing the risk of STDs as well as pregnancy, there is evidence that adolescents may overestimate their condom use, inaccurately report their level of condom use,38 and experience condom use errors39 that markedly degrade the protective capability of condoms. Thus, the prevention message for all sexually active girls needs to be dual-pronged for optimal protection (ie, the use of condoms and another form of effective contraception).

Third, innovative clinic-based approaches are needed to improve dual-protection use. One strategy is to use the clinical interaction between the provider and adolescent patient as an opportunity to provide high-intensity counseling. The US Preventive Services Task Force recommends high-intensity behavioral counseling to prevent STDs for all sexually active adolescents.40 Although effective interventions for girls exist,41 most are impractical for relatively brief pediatrician-patient interactions in clinical venues. Thus, it would be beneficial, from a practice perspective, to enhance providers' counseling skills by using newly developed behavior-change theory and techniques42 such as motivational interviewing,4346 which can be seamlessly integrated into pediatrician counseling and used during a clinical encounter. Of course, like any new skill, an investment of time is required to become proficient with this counseling technique.

Fourth, while most providers who were engaged in providing reproductive health services surveyed by the American Academy of Pediatrics thought that personalized preventive counseling was effective in reducing high-risk sexual behaviors, 76% believed they did not have sufficient time to provide such counseling. This may be related to both volume of patients and lack of reimbursable time for providing preventive counseling. In general, although a variety of possible approaches for facilitating the integration of a broader array of sexual risk-reduction activities into clinical practice exist, to facilitate the adoption and delivery of these preventive services will require resources or an adequate system for financing and provider reimbursement.47

Finally, given the cost and time constraints of the clinical interaction between providers and adolescent patients, it is conceivable that the next generation of clinic-based sexual risk–reduction programs will need to adopt a 2-tier system of providing preventive counseling. In this system, at-risk adolescents could initially be triaged by their provider for preventive counseling delivered in the clinic.48 Subsequently, adolescents would be referred to community-based prevention services designed to extend, reinforce, and amplify prevention messages from providers (ie, extend beyond addressing only individual-level factors to include relational factors such as partner and parent communication). This approach would necessitate developing an inventory of community-based services and tailoring referrals based on type of risk practices (eg, drug use, abuse history), possibly sex (eg, sex-appropriate intervention programs), and perhaps race/ethnicity (eg, race/ethnicity-appropriate intervention programs). In essence, the pediatrician or adolescent health care provider acts as both a provider of prevention services and a broker of out-of-clinic prevention services by linking adolescents with service agencies that can continue to engage youth in more intensive, tailored, long-term sexual risk-reduction programs.

This study is not without limitations. First, the sample consisted of young women who were already seeking services at local sexual health clinics and therefore may not be generalizable to individuals who are not accessing similar clinics or to individuals who did not meet the eligibility criteria for the parent study (eg, engaged in unprotected sex in the past 6 months or trying to get pregnant). Additionally, our findings may not generalize to African American girls who reside in other geographical areas of the United States. Further, given our narrow definition of dual-method use, our findings may not be comparable with other studies that use different definitions of dual-method use. Finally, it is important to acknowledge that several potentially important factors that could be associated with dual-method use, including societal-level factors like media messages and cultural beliefs, were not assessed.

The identification of factors differentiating dual-method users from non–dual-method users at the individual, interpersonal, and community levels in this sample of young African American women have significant implications for both clinical practice and the design of HIV/STD/unintended pregnancy risk–reduction programs. Given the high rates of both STDs and unintended pregnancy among young African American women and low prevalence of dual-method protection use, the design of HIV/STD risk–reduction programs for African American adolescent girls should include an unintended pregnancy prevention component and, likewise, pregnancy prevention programs should include an STD/HIV risk-reduction component. Moreover, all STD/unintended pregnancy prevention efforts should address, whenever feasible, factors beyond the individual in an attempt to reduce sexual risk taking and the adverse consequences of unintended pregnancy and STDs.

Correspondence: Jessica M. Sales, PhD, Department of Behavioral Science and Health Education, Emory University, Rollins School of Public Health, 1520 Clifton Rd NE, Room 266, Atlanta, GA 30322 (jmcderm@emory.edu).

Accepted for Publication: May 19, 2010.

Author Contributions:Study concept and design: Sales and DiClemente. Acquisition of data: Sales, Latham, DiClemente, and Rose. Analysis and interpretation of data: Sales, Latham, and DiClemente. Drafting of the manuscript: Sales and Latham. Critical revision of the manuscript for important intellectual content: Sales, DiClemente, and Rose. Statistical analysis: Sales. Obtained funding: DiClemente. Administrative, technical, and material support: Latham. Study supervision: Rose.

Financial Disclosure: None reported.

Funding/Support: This study was supported by grants K01 MH085506 (Dr Sales) and 5 R01 MH070537 (Dr DiClemente) from the National Institute of Mental Health.

Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, 2002: Year End Edition.  Atlanta, GA US Department of Health and Human Services2003;
Gaydos  CAHowell  MRPare  B  et al.  Chlamydia trachomatis infections in female military recruits. N Engl J Med 1998;339 (11) 739- 744
PubMed
Ho  GYBierman  RBeardsley  LChang  CJBurk  RD Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med 1998;338 (7) 423- 428
PubMed
Fleming  DT McQuillan  GMJohnson  RE  et al.  Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med 1997;337 (16) 1105- 1111
PubMed
Forhan  SEGottlieb  SLSternberg  MR  et al.  Prevalence of sexually transmitted infections and bacterial vaginosis among female adolescents in the United States: Data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004.  Paper presented at the National STD Prevention Conference March 11, 2008 Chicago, Illinois
Crosby  RLeichliter  JSBrackbill  R Longitudinal prediction of sexually transmitted diseases among adolescents: results from a national survey. Am J Prev Med 2000;18 (4) 312- 317
PubMed
Finer  LBHenshaw  SK Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006;38 (2) 90- 96
PubMed
 The DCR Report. National Campaign to Prevent Teen and Unplanned Pregnancy Web site. http://www.thenationalcampaign.org/resources/dcr/. Accessed April 10, 2009
Rangel  MCGavin  LReed  CFowler  MGLee  LM Epidemiology of HIV and AIDS among adolescents and young adults in the United States. J Adolesc Health 2006;39 (2) 156- 163
PubMed
The Alan Guttmacher Institute, US teenage pregnancy statistics: overall trends, trends by race and ethnicity and state-by-state information. Alan Guttmacher Institute Web site. http://www.guttmacher.org/pubs/USTPtrends.pdf. Accessed February 19, 2004
Kaplan  DWFeinstein  RAFisher  MM  et al. Committee on Adolescence, Condom use by adolescents. Pediatrics 2001;107 (6) 1463- 1469
PubMed
Workowski  KABerman  SMCenters for Disease Control and Prevention, Sexually transmitted diseases treatment guidelines 2006: clinical prevention guidance.  MMWR Morb Mortal Wkly Rep 2006;55 (RR-11) 2- 6
Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit, FFPRHC Guidance (October 2004) contraceptive choices for young people. J Fam Plann Reprod Health Care 2004;30 (4) 237- 251
PubMed
Santelli  JSWarren  CWLowry  R  et al.  The use of condoms with other contraceptive methods among young men and women. Fam Plann Perspect 1997;29 (6) 261- 267
PubMed
Piccinino  LJMosher  WD Trends in contraceptive use in the United States: 1982-1995. Fam Plann Perspect 1998;30 (1) 4- 10, 46
PubMed
Crosby  RADiClemente  RJWingood  GM  et al.  Correlates of using dual methods for sexually transmitted diseases and pregnancy prevention among high-risk African-American female teens. J Adolesc Health 2001;28 (5) 410- 414
PubMed
Luker  K Taking Chances: Abortion and the Decision not to Contracept. 2nd ed. Berkeley, CA University of California Press1991;
Bull  SSShlay  JC Promoting “dual protection” from pregnancy and sexually transmitted disease: a social ecological approach. Health Promot Pract 2005;6 (1) 72- 80
PubMed
DiClemente  RJSalazar  LFCrosby  RA A review of STD/HIV preventive interventions for adolescents: sustaining effects using an ecological approach. J Pediatr Psychol 2007;32 (8) 888- 906
PubMed
Voisin  DRDiClemente  RJSalazar  LFCrosby  RAYarber  WL Ecological factors associated with STD risk behaviors among detained female adolescents. Soc Work 2006;51 (1) 71- 79
PubMed
Melchior  LAHuba  GJBrown  VBReback  CJ A short depression index for women. Educ Psychol Meas 1993;53 (4) 1117- 112510.1177/0013164493053004024
Radloff  LS The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults. J Youth Adolesc 1991;20 (2) 149- 16610.1007/BF01537606
Watts-Jones  D Toward a stress scale for African-American women. Psychol Women Q 1990;14 (2) 271- 27510.1111/j.1471-6402.1990.tb00019.x
Rosenberg  M Conceiving the Self.  New York, NY Basic Books1979;
Donohew  LZimmerman  RCupp  PSNovak  SColon  SAbell  R Sensation seeking, impulsive decision making, and risky sex: implications for risk taking and design of interventions. Pers Individ Dif 2000;28 (6) 1079- 109110.1016/S0191-8869(99)00158-0
Salazar  LFWingood  GMDiClemente  RJLang  DLHarrington  K The role of social support in the psychological well-being of African American girls who experience dating violence victimization. Violence Vict 2004;19 (2) 171- 187
PubMed
Zimet  GDahlem  NZimet  SFarley  GK The multidimensional scale of perceived social support. J Pers Assess 1988;52 (1) 30- 41
PubMed10.1207/s15327752jpa5201_2
Bartholomew  KHorowitz  LM Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol 1991;61 (2) 226- 244
PubMed
Wingood  GMDiClemente  RJ Child sexual abuse, HIV sexual risk, and gender relations of African-American women. Am J Prev Med 1997;13 (5) 380- 384
PubMed
Wingood  GMDiClemente  RJ Partner influences and gender-related factors associated with noncondom use among young adult African American women. Am J Community Psychol 1998;26 (1) 29- 51
PubMed
Milhausen  RRSales  JMWingood  GM  et al.  Validation of a partner communication scale for use in HIV prevention intervention. J HIV/AIDS Prev Child Youth 2007;8 (1) 11- 3310.1300/J499v08n01_02
Sales  JMMilhausen  RRWingood  GMDiclemente  RJSalazar  LFCrosby  RA Validation of a Parent-Adolescent Communication Scale for use in STD/HIV prevention interventions. Health Educ Behav 2008;35 (3) 332- 345
PubMed
Cohen  DSpear  SScribner  RKissinger  PMason  KWildgen  J “Broken windows” and the risk of gonorrhea. Am J Public Health 2000;90 (2) 230- 236
PubMed
Riehman  KSSly  DFSoler  HEberstein  IWQuadagno  DHarrison  DF Dual-method use among an ethnically diverse group of women at risk of HIV infection. Fam Plann Perspect 1998;30 (5) 212- 217
PubMed
Henry-Reid  LMO’Connor  KGKlein  JDCooper  EFlynn  PFutterman  DC Current pediatrician practices in identifying high-risk behaviors of adolescents. Pediatrics 2010;125 (4) e741- e747
PubMed
American Academy of Pediatrics Committee on Adolescence, Sexually transmitted diseases. Pediatrics 1994;94 (4, pt 1) 568- 572
PubMed
American Academy of Pediatrics. Committee on Pediatric AIDS and Committee on Adolescence; Committee on Pediatric AIDS and Committee on Adolescence, Adolescents and human immunodeficiency virus infection: the role of the pediatrician in prevention and intervention. Pediatrics 2001;107 (1) 188- 190
PubMed
Rose  EDiclemente  RJWingood  GM  et al.  The validity of teens' and young adults' self-reported condom use. Arch Pediatr Adolesc Med 2009;163 (1) 61- 64
PubMed
Sanders  SAGraham  CAYarber  WLCrosby  RA Condom use errors and problems among young women who put condoms on their male partners. J Am Med Womens Assoc 2003;58 (2) 95- 98
PubMed
U.S. Preventive Services Task Force, Behavioral counseling to prevent sexually transmitted infections: US Preventive Services Task Force recommendation statement. Ann Intern Med 2008;149 (7) 491- 496, W95
PubMed
DiClemente  RJCrittenden  CPRose  E  et al.  Psychosocial predictors of HIV-associated sexual behaviors and the efficacy of prevention interventions in adolescents at-risk for HIV infection: what works and what doesn't work? Psychosom Med 2008;70 (5) 598- 605
PubMed
DiClemente  RJ The psychological basis of health promotion for adolescents. Fisher  MJuszczak  LKlerman  LVPrevention Issues in Adolescent Health Care. Philadelphia, PA Hanley & Belfus, Inc1999;13- 22
Emmons  KMRollnick  S Motivational interviewing in health care settings. Opportunities and limitations. Am J Prev Med 2001;20 (1) 68- 74
PubMed
Rollnick  SMiller  WRButler  C Motivational Interviewing in Health Care: Helping Patients Change Behavior.  New York, NY Guilford Press2008;
Miller  WRRose  GS Toward a theory of motivational interviewing. Am Psychol 2009;64 (6) 527- 537
PubMed
Rollnick  SButler  CCKinnersley  PGregory  JMash  B Motivational interviewing. BMJ 2010;340c1900
PubMed
Rosen  DSElster  AHedberg  VPaperny  D Clinical preventive services for adolescents: position paper of the Society for Adolescent Medicine. J Adolesc Health 1997;21 (3) 203- 214
PubMed
DiClemente  RJMilhausen  RSales  JMSalazar  LFCrosby  RA A programmatic and methodological review and synthesis of clinic-based sexually transmitted infection risk reduction interventions: research and practice implications. Semin Pediatr Infect Dis 2005;16 (3) 199- 216
PubMed

Figures

Tables

Table Graphic Jump LocationTable 1. Differences in Individual-Level Factors by Dual-Method Use or Non–Dual-Method Use
Table Graphic Jump LocationTable 2. Differences in Interpersonal-Level Factors by Dual-Method Use or Non–Dual-Method Use
Table Graphic Jump LocationTable 3. Differences in Interpersonal Communication Factors by Dual-Method Use or Non–Dual-Method Use
Table Graphic Jump LocationTable 4. Differences in All Factors by Dual-Method Use or Non–Dual-Method Use, Adjusting for Age and Clinic

References

Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, 2002: Year End Edition.  Atlanta, GA US Department of Health and Human Services2003;
Gaydos  CAHowell  MRPare  B  et al.  Chlamydia trachomatis infections in female military recruits. N Engl J Med 1998;339 (11) 739- 744
PubMed
Ho  GYBierman  RBeardsley  LChang  CJBurk  RD Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med 1998;338 (7) 423- 428
PubMed
Fleming  DT McQuillan  GMJohnson  RE  et al.  Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med 1997;337 (16) 1105- 1111
PubMed
Forhan  SEGottlieb  SLSternberg  MR  et al.  Prevalence of sexually transmitted infections and bacterial vaginosis among female adolescents in the United States: Data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004.  Paper presented at the National STD Prevention Conference March 11, 2008 Chicago, Illinois
Crosby  RLeichliter  JSBrackbill  R Longitudinal prediction of sexually transmitted diseases among adolescents: results from a national survey. Am J Prev Med 2000;18 (4) 312- 317
PubMed
Finer  LBHenshaw  SK Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006;38 (2) 90- 96
PubMed
 The DCR Report. National Campaign to Prevent Teen and Unplanned Pregnancy Web site. http://www.thenationalcampaign.org/resources/dcr/. Accessed April 10, 2009
Rangel  MCGavin  LReed  CFowler  MGLee  LM Epidemiology of HIV and AIDS among adolescents and young adults in the United States. J Adolesc Health 2006;39 (2) 156- 163
PubMed
The Alan Guttmacher Institute, US teenage pregnancy statistics: overall trends, trends by race and ethnicity and state-by-state information. Alan Guttmacher Institute Web site. http://www.guttmacher.org/pubs/USTPtrends.pdf. Accessed February 19, 2004
Kaplan  DWFeinstein  RAFisher  MM  et al. Committee on Adolescence, Condom use by adolescents. Pediatrics 2001;107 (6) 1463- 1469
PubMed
Workowski  KABerman  SMCenters for Disease Control and Prevention, Sexually transmitted diseases treatment guidelines 2006: clinical prevention guidance.  MMWR Morb Mortal Wkly Rep 2006;55 (RR-11) 2- 6
Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit, FFPRHC Guidance (October 2004) contraceptive choices for young people. J Fam Plann Reprod Health Care 2004;30 (4) 237- 251
PubMed
Santelli  JSWarren  CWLowry  R  et al.  The use of condoms with other contraceptive methods among young men and women. Fam Plann Perspect 1997;29 (6) 261- 267
PubMed
Piccinino  LJMosher  WD Trends in contraceptive use in the United States: 1982-1995. Fam Plann Perspect 1998;30 (1) 4- 10, 46
PubMed
Crosby  RADiClemente  RJWingood  GM  et al.  Correlates of using dual methods for sexually transmitted diseases and pregnancy prevention among high-risk African-American female teens. J Adolesc Health 2001;28 (5) 410- 414
PubMed
Luker  K Taking Chances: Abortion and the Decision not to Contracept. 2nd ed. Berkeley, CA University of California Press1991;
Bull  SSShlay  JC Promoting “dual protection” from pregnancy and sexually transmitted disease: a social ecological approach. Health Promot Pract 2005;6 (1) 72- 80
PubMed
DiClemente  RJSalazar  LFCrosby  RA A review of STD/HIV preventive interventions for adolescents: sustaining effects using an ecological approach. J Pediatr Psychol 2007;32 (8) 888- 906
PubMed
Voisin  DRDiClemente  RJSalazar  LFCrosby  RAYarber  WL Ecological factors associated with STD risk behaviors among detained female adolescents. Soc Work 2006;51 (1) 71- 79
PubMed
Melchior  LAHuba  GJBrown  VBReback  CJ A short depression index for women. Educ Psychol Meas 1993;53 (4) 1117- 112510.1177/0013164493053004024
Radloff  LS The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults. J Youth Adolesc 1991;20 (2) 149- 16610.1007/BF01537606
Watts-Jones  D Toward a stress scale for African-American women. Psychol Women Q 1990;14 (2) 271- 27510.1111/j.1471-6402.1990.tb00019.x
Rosenberg  M Conceiving the Self.  New York, NY Basic Books1979;
Donohew  LZimmerman  RCupp  PSNovak  SColon  SAbell  R Sensation seeking, impulsive decision making, and risky sex: implications for risk taking and design of interventions. Pers Individ Dif 2000;28 (6) 1079- 109110.1016/S0191-8869(99)00158-0
Salazar  LFWingood  GMDiClemente  RJLang  DLHarrington  K The role of social support in the psychological well-being of African American girls who experience dating violence victimization. Violence Vict 2004;19 (2) 171- 187
PubMed
Zimet  GDahlem  NZimet  SFarley  GK The multidimensional scale of perceived social support. J Pers Assess 1988;52 (1) 30- 41
PubMed10.1207/s15327752jpa5201_2
Bartholomew  KHorowitz  LM Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol 1991;61 (2) 226- 244
PubMed
Wingood  GMDiClemente  RJ Child sexual abuse, HIV sexual risk, and gender relations of African-American women. Am J Prev Med 1997;13 (5) 380- 384
PubMed
Wingood  GMDiClemente  RJ Partner influences and gender-related factors associated with noncondom use among young adult African American women. Am J Community Psychol 1998;26 (1) 29- 51
PubMed
Milhausen  RRSales  JMWingood  GM  et al.  Validation of a partner communication scale for use in HIV prevention intervention. J HIV/AIDS Prev Child Youth 2007;8 (1) 11- 3310.1300/J499v08n01_02
Sales  JMMilhausen  RRWingood  GMDiclemente  RJSalazar  LFCrosby  RA Validation of a Parent-Adolescent Communication Scale for use in STD/HIV prevention interventions. Health Educ Behav 2008;35 (3) 332- 345
PubMed
Cohen  DSpear  SScribner  RKissinger  PMason  KWildgen  J “Broken windows” and the risk of gonorrhea. Am J Public Health 2000;90 (2) 230- 236
PubMed
Riehman  KSSly  DFSoler  HEberstein  IWQuadagno  DHarrison  DF Dual-method use among an ethnically diverse group of women at risk of HIV infection. Fam Plann Perspect 1998;30 (5) 212- 217
PubMed
Henry-Reid  LMO’Connor  KGKlein  JDCooper  EFlynn  PFutterman  DC Current pediatrician practices in identifying high-risk behaviors of adolescents. Pediatrics 2010;125 (4) e741- e747
PubMed
American Academy of Pediatrics Committee on Adolescence, Sexually transmitted diseases. Pediatrics 1994;94 (4, pt 1) 568- 572
PubMed
American Academy of Pediatrics. Committee on Pediatric AIDS and Committee on Adolescence; Committee on Pediatric AIDS and Committee on Adolescence, Adolescents and human immunodeficiency virus infection: the role of the pediatrician in prevention and intervention. Pediatrics 2001;107 (1) 188- 190
PubMed
Rose  EDiclemente  RJWingood  GM  et al.  The validity of teens' and young adults' self-reported condom use. Arch Pediatr Adolesc Med 2009;163 (1) 61- 64
PubMed
Sanders  SAGraham  CAYarber  WLCrosby  RA Condom use errors and problems among young women who put condoms on their male partners. J Am Med Womens Assoc 2003;58 (2) 95- 98
PubMed
U.S. Preventive Services Task Force, Behavioral counseling to prevent sexually transmitted infections: US Preventive Services Task Force recommendation statement. Ann Intern Med 2008;149 (7) 491- 496, W95
PubMed
DiClemente  RJCrittenden  CPRose  E  et al.  Psychosocial predictors of HIV-associated sexual behaviors and the efficacy of prevention interventions in adolescents at-risk for HIV infection: what works and what doesn't work? Psychosom Med 2008;70 (5) 598- 605
PubMed
DiClemente  RJ The psychological basis of health promotion for adolescents. Fisher  MJuszczak  LKlerman  LVPrevention Issues in Adolescent Health Care. Philadelphia, PA Hanley & Belfus, Inc1999;13- 22
Emmons  KMRollnick  S Motivational interviewing in health care settings. Opportunities and limitations. Am J Prev Med 2001;20 (1) 68- 74
PubMed
Rollnick  SMiller  WRButler  C Motivational Interviewing in Health Care: Helping Patients Change Behavior.  New York, NY Guilford Press2008;
Miller  WRRose  GS Toward a theory of motivational interviewing. Am Psychol 2009;64 (6) 527- 537
PubMed
Rollnick  SButler  CCKinnersley  PGregory  JMash  B Motivational interviewing. BMJ 2010;340c1900
PubMed
Rosen  DSElster  AHedberg  VPaperny  D Clinical preventive services for adolescents: position paper of the Society for Adolescent Medicine. J Adolesc Health 1997;21 (3) 203- 214
PubMed
DiClemente  RJMilhausen  RSales  JMSalazar  LFCrosby  RA A programmatic and methodological review and synthesis of clinic-based sexually transmitted infection risk reduction interventions: research and practice implications. Semin Pediatr Infect Dis 2005;16 (3) 199- 216
PubMed

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