Objective. To analyze a nationally representative sample of women for correlates of dual-contraceptive-method use. Materials and Methods. We conducted an analysis of the National Survey of Family Growth, 2006–2008, a cross-sectional survey of reproductive-aged women in the United States. Results. Dual method use was reported by 7.3% of the 5,178 women in the sample. Correlates of higher rates of dual-contraceptive-method use included age younger than 36 years and nonmarried marital status. Lower rates of dual method use were observed for women with less than a high-school education and women without consistent health insurance in the past year. Compared to women using oral contraceptives, use of the contraceptive injection or long-acting reversible contraception was associated with lower dual-method use. Conclusions. The overall rate of dual-method use in the USA is low. Future interventions to promote dual method use should target high-risk groups with modifiable risk factors. 1. Introduction Sexually transmitted infections (STIs) and unintended pregnancy are important and costly public health issues. The United States has an estimated incidence of 19 million cases of STIs each year which incurs $15.9 billion in cost to the health care system [1, 2] and unintended pregnancy rates continue to hover at nearly 50% [3]. One proposed strategy to reduce the risks of unintended pregnancy and STI is the promotion of dual-contraceptive-method use. Dual-method protection includes use of a highly effective pregnancy prevention in conjunction with a barrier (e.g., male condom). The male condom is the most commonly used method of sexually transmitted infection (STI) prevention, whereas the oral contraceptive pill and female sterilization are the most common methods of pregnancy prevention in the USA [4]. The burden of unintended pregnancy and STIs is greater among younger and economically disadvantaged men and women [3, 5]. While nearly all women report having used birth control and most have used a condom [4], dual-method use is relatively uncommon. An analysis of the Youth Risk Behavior Surveillance System (YRBS) noted 6.6% of young women using oral contraceptives also used a condom at last intercourse [6]. According to another study of the YRBS, use of dual-contraceptive methods increased from 3.2% in 1991 to 7.2% in 2001 [7]. A more recent publication reviewing data from the National Longitudinal Study of Adolescent Health noted 14–25% of participants report using dual methods at last intercourse [8]. Most of the previous research focused on adolescents or
References
[1]
H. Weinstock, S. Berman, and W. Cates Jr., “Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000,” Perspectives on Sexual and Reproductive Health, vol. 36, no. 1, pp. 6–10, 2004.
[2]
H. W. Chesson, J. M. Blandford, T. L. Gift, G. Tao, and K. L. Irwin, “The estimated direct medical cost of sexually transmitted diseases among American youth, 2000,” Perspectives on Sexual and Reproductive Health, vol. 36, no. 1, pp. 11–19, 2004.
[3]
L. B. Finer and S. K. Henshaw, “Disparities in rates of unintended pregnancy in the United States, 1994 and 2001,” Perspectives on Sexual and Reproductive Health, vol. 38, no. 2, pp. 90–96, 2006.
[4]
W. D. Mosher and J. Jones, “Use of contraception in the United States: 1982–2008. National Center for Health Statistics,” Vital and Health Statistics. Series 23, no. 29, 2010.
[5]
CDC, Sexually Transmitted Disease Surveillance 2009, Centers for Disease Control and Prevention, Atlanta, Ga, USA, 2010.
[6]
J. S. Santelli, C. W. Warren, R. Lowry et al., “The use of condoms with other contraceptive methods among young men and women,” Family Planning Perspectives, vol. 29, no. 6, pp. 261–267, 1997.
[7]
J. E. Anderson, J. Santelli, and B. C. Gilbert, “Adolescent dual use of condoms and hormonal contraception: trends and correlates 1991–2001,” Sexually Transmitted Diseases, vol. 30, no. 9, pp. 719–722, 2003.
[8]
R. E. Sieving, L. H. Bearinger, M. D. Resnick, S. Pettingell, and C. Skay, “Adolescent dual method use: relevant attitudes, normative beliefs and self-efficacy,” Journal of Adolescent Health, vol. 40, no. 3, pp. 275–e15–22, 2007.
[9]
J. M. Lepkowski, W. D. Mosher, K. E. Davis, R. M. Groves, and J. Van Hoewyk, “The 2006–2010 National Survey of Family Growth: sample design and analysis of a continuous survey,” Vital and Health Statistics. Series 2, no. 150, pp. 1–36, 2010.
[10]
W. D. Mosher and J. Jones, “Use of contraception in the United States: 1982–2008,” Vital and Health Statistics. Series 23, no. 29, pp. 1–51, 2010.
[11]
CDC, 2006-2010 NSFG Codebooks, Centers for Disease Control and Prevention, Atlanta, Ga, USA, 2011, http://www.cdc.gov/nchs/nsfg/nsfg_2006_2010_codebooks.htm/.
[12]
J. Trussell, “Contraceptive failure in the United States,” Contraception, vol. 70, no. 2, pp. 89–96, 2004.
[13]
K. Pazol, M. R. Kramer, and C. J. Hogue, “Condoms for dual protection: patterns of use with highly effective contraceptive methods,” Public Health Reports, vol. 125, no. 2, pp. 208–217, 2010.
[14]
R. A. Crosby, R. J. DiClemente, G. M. Wingood et al., “Correlates of using dual methods for sexually transmitted diseases and pregnancy prevention among high-risk african-american female teens,” Journal of Adolescent Health, vol. 28, no. 5, pp. 410–414, 2001.
[15]
J. M. Sales, T. P. Latham, R. J. DiClemente, and E. Rose, “Differences between dual-method and non-dual-method protection use in a sample of young African American women residing in the Southeastern United States,” Archives of Pediatrics and Adolescent Medicine, vol. 164, no. 12, pp. 1125–1131, 2010.
[16]
K. R. Culwell and J. Feinglass, “The association of health insurance with use of prescription contraceptives,” Perspectives on Sexual and Reproductive Health, vol. 39, no. 4, pp. 226–230, 2007.
[17]
R. K. Jones and K. Kost, “Underreporting of induced and spontaneous abortion in the United States: an analysis of the 2002 National Survey of Family Growth,” Studies in Family Planning, vol. 38, no. 3, pp. 187–197, 2007.
[18]
R. Pear, “Insurance coverage for contraception is required,” New York Times, 2011.
