PURPOSE:Consistent condom use is critical to efforts to prevent sexually transmitted infections among adolescents, but condom use may decline as relationships and contraceptive needs change. The purpose of this research is to assess changes in condom non-use longitudinally in the context of changes in relationship quality, coital frequency and hormonal contraceptive choice. METHODS:Participants were women (aged 14-17 years at enrollment) recruited from three urban adolescent medicine clinics. Data were collected at three-month intervals using a face-to-face structured interview. Participants were able to contribute up to 10 interviews, but on average contributed 4.2 interviews over the 27-month period. Independent variables assessed partner-specific relationship quality (five items; scale range 5-25; alpha = .92, e.g., this partner is a very important person to me); and, number of coital events with a specific partner. Additional items assessed experience with oral contraceptive pills (OCP) use and injected depo medroxy-progesterone acetate (DMPA). The outcome variable was number of coital events without condom use during the past three months. Analyses were conducted as a three-level hierarchical linear growth curve model using HLM 6. The Level 1 predictor was time, to test the hypothesis that condom non-use increases over time. Level 2 predictors assessed relationship quality and coital frequency across all partners to assess hypotheses that participants' condom non-use increases over time as a function of relationship quality and coital frequency. Level 3 predictors assessed the participant-level influence of OCP or DMPA experience on time-related changes in condom non-use. RESULTS:A total of 176 women reported 279 sex partners and contributed 478 visits. Both average coital frequency and average condom non-use linearly increased during the 27-month follow-up. At any given follow-up, about 35% reported recent OCP use, and 65% reported DMPA use. HLM analyses showed that condom non-use increased as a function of time (beta = .12; p = .03, Level 1 analysis). Increased condom non-use over time was primarily a function of increased coital frequency (beta = .01; p = .00), although higher levels of relationship quality were associated with increased condom non-use at enrollment (beta = .44; p = .00, Level 2 analysis). The temporal rise in condom non-use significantly increased among DMPA users (beta = .06; p = .00) but not OCP users (Level 3 analysis) (beta = -.04; p = .06). CONCLUSIONS:Developmentally, relationship characteristics and coital frequency appear to have increasing weight in decisions about condom use. Hormonal contraceptive methods are not equivalently associated with the overall temporal decline in condom use. Future research associated with dual contraceptive/condom use should address differential factors associated condom use in combination with different hormonal methods.

译文

目的:持续使用避孕套对于预防青少年性传播感染至关重要,但是随着人际关系和避孕需求的变化,避孕套的使用可能会减少。这项研究的目的是在关系质量,性交频率和激素避孕选择的变化的背景下,纵向评估未使用安全套的变化。
方法:参与者是从三个城市青少年医学诊所招募的女性(入学年龄14-17岁)。使用面对面的结构化访谈,每三个月收集一次数据。参加者最多可以贡献10个访谈,但在27个月内平均贡献了4.2个访谈。自变量评估了特定于伴侣的关系质量(五个项目;等级范围5-25;α= 0.92,例如,这个伴侣对我来说是非常重要的人);以及与特定伴侣发生性行为的次数。其他项目评估了口服避孕药(OCP)的使用经验和注射醋酸去甲羟孕酮(DMPA)的经验。结果变量是在过去三个月中未使用安全套的性交事件的数量。使用HLM 6作为三级分层线性增长曲线模型进行了分析。1级预测因子是时间,以检验安全套不使用随时间增加的假设。 2级预测变量评估了所有伴侣之间的关系质量和性交频率,以评估以下假设:参与者不使用安全套会随着时间的推移而增加,这是关系质量和性交频率的函数。 3级预测变量评估了OCP或DMPA经验对安全套不使用时间相关变化的参与者水平影响。
结果:总共176名妇女报告了279个性伴侣,并贡献了478次探视。在27个月的随访中,平均性交频率和平均不使用安全套均呈线性增加。在任何给定的随访中,约35%的患者报告了最近的OCP使用,而65%的患者报告了DMPA的使用。 HLM分析表明,不使用安全套随时间增加(β= .12; p = .03,1级分析)。随着时间的流逝,不使用安全套的增加主要是性交频率增加的函数(β= .01; p = .00),尽管较高的关系质量与入学时不使用安全套的增加相关(β= .44; p = .00,第2级分析)。在DMPA用户中,未使用安全套的时间增加显着增加(β= .06; p = .00),但在OCP用户中则没有(第三级分析)(β= -.04; p = .06)。
结论:在发展上,关系特征和性交频率似乎在有关使用安全套的决策中具有越来越大的重要性。激素避孕方法与使用避孕套的总体时间下降没有同等的联系。与双重避孕/避孕套使用相关的未来研究应解决与不同激素方法结合使用避孕套相关的差异因素。

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