Dual method use among long-acting reversible contraceptive users

Abstract

Objective: To compare rates of dual method use (concurrent use of condoms and an effective method of contraception) in long-acting reversible contraceptive (LARC) and non-LARC hormonal contraceptive users, and to determine factors associated with dual method use.

Methods: We conducted a secondary analysis of the Contraceptive CHOICE Project, an observational, prospective cohort study of 9256 women in St. Louis, MO, USA. Our sample included 6744 women who initiated a contraceptive method within 3 months of enrollment, continued use at 6 months post-enrollment, and responded regarding dual method use. Our primary outcome was the rate of dual method use at 6 months post-enrollment.

Results: Dual method use was reported by 32% of LARC and 45% of non-LARC hormonal contraceptive users (p < .01). After adjusting for other covariates and comparing to non-LARC hormonal contraceptive users, LARC users were less likely to report dual method use (RR_adj 0.76, 95% CI 0.70–0.83). Factors associated with dual method use in our multivariable analysis were age <25 years, black race, lower education, single relationship status, baseline dual method use, baseline diagnosis of sexually transmitted infection (STI), greater partner willingness to use a condom, and higher condom self-efficacy score.

Conclusions: LARC users are less likely to report dual method use compared to non-LARC hormonal contraceptive users, but other factors also impact dual method use. Further studies should be performed to determine whether this lower dual method use increases the risk of STI.

Clinical trials registration: Clinicaltrials.gov Identifier NCT01986439.

Chinese abstract

目的：比较长效可逆避孕(LARC)和非LARC激素避孕中的双法同用 (同时用避孕套和有效的避孕方法)率, 并确定与双法同用的相关因素。

方法：对美国密苏里州圣路易斯的9256名妇女开展了避孕选择项目的二次分析, 这是一项观察性的前瞻性队列研究。样本来自入选后3个月内开始应用, 入选后6个月继续用双法的6744名妇女, 并对双法应用作出反馈。主要观察结果是入选后6个月仍在用双法的比率。

结果：32%的LARC和45%的非LARC激素避孕者采用双重避孕方法(P<.01)。在调整其他协变量并与非LARC激素避孕者比较后, LARC应用者报告双法同用的可能性较小 (RRadj 0.76, 95%CI 0.70-0.83)。多变量分析双法应用的相关因素是：年龄＜25岁、黑人种族、低学历、单身状态、双法同用基线, 性传播感染(STI)基线诊断, 性伴侣用避孕套意愿, 和较高的避孕套自我效能评分。

结论：与非LARC激素避孕者相比, LARC使用者报告双法同用的可能性较小, 但其他因素也影响双法的应用。仍需进一步研究确定这种较低的双法应用是否增加了性传播感染的风险。

Keywords:

• Dual method use
• LARC
• condom use
• sexually transmitted infections
• unintended pregnancy

Acknowledgements

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Disclosure statement

J.F.P receives research funding/support from Bayer, Teva, and Merck, and serves on advisory boards for Teva and Perrigo Pharmaceuticals. C.B. and Q.Z report no conflicts of interest.

Additional information

Funding

This publication was supported by the Clinical and Translational Science Award (CTSA) program of the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) under Award Numbers UL1 TR000448 and TL1 TR000449 and NIH Reproductive Epidemiology Training Grant number T32HD055172.