Correlates of Consistent Use of Effective Contraceptive Methods Among Male and Female Adolescent and Young Adult Soldiers in Training

Abstract

CORRELATES OF CONSISTENT USE OF EFFECTIVE CONTRACEPTIVE METHODS AMONG MALE AND FEMALE ADOLESCENT AND YOUNG ADULT SOLDIERS IN TRAINING Stephanie Adrianse, MD, Lance M. Pollack, PhD, Cherrie B. Boyer, PhD. University of California, San Francisco. Purpose: Over 50% of pregnancies among adolescents and young adults in the US are unintended. Similar to civilians, the high rates of unintended pregnancy (UIP) in Army soldiers are, in part, attributed to ineffective and inconsistent use of contraceptive methods. This study aimed to identify the sociodemographic, psychosocial, and behavioral factors associated with consistent use of effective contraceptive methods (consistent-effective use) in male and female soldiers in training. Methods: This cross-sectional study reflects baseline data of a randomized-controlled intervention trial to prevent sexually transmitted infections and UIP in Army soldiers, aged 17-36 years, during their first year of military service. Participants completed a self-administered baseline questionnaire, including measures on sociodemographic factors (gender, age, race/ethnicity, marital status, education), psychosocial factors (condom and UIP knowledge, condom and UIP attitudes, perceptions of vulnerability for UIP, and perceptions of self-efficacy, behavioral skills and behavioral intentions for preventing UIP) and behavioral risk factors (age at coitarche, number of sexual partners, history of prior unintended or intended pregnancies, and type and frequency of contraceptive method(s) used). Bivariate logistic regression analyses were performed to determine variables for entry into the multivariate analyses. Iterative implementation of a two-block hierarchical logistic regression model identified statistically significant correlates of consistent-effective use (i.e., use of any of the following during each sexual encounter: condoms, contraceptive pills, contraceptive patch, contraceptive ring, contraceptive implant, contraceptive injection, intrauterine device, sterilization, avoidance of vaginal sex, and sex with only same-sex partner). Results: Only participants who reported a history of sexual experience (n ¼ 672, 93.5%) were included in this research. Participants were young (mean age ¼ 21), male (86.2%), racially/ethnically diverse (51.8% white, 22.2% black, 16.4% Hispanic, 9.6% other) and unmarried (87.2%). Overall, 26.6% reported a prior pregnancy of which 76.9% reported an UIP and 22.2% were consistent-effective users. Compared with non-consistent-effective users, consistenteffective users were significantly more likely to report: higher condom (OR ¼ 1.90, CI ¼ 1.16-3.12) and UIP knowledge (OR ¼ 1.82, CI ¼ 1.18-2.80), more positive condom attitudes (OR ¼ 1.36, CI ¼ 1.05-1.75), disagreement that their sexual behaviors place them at high UIP risk (OR ¼ 0.36, CI ¼ 0.14-0.95), neutral agreement that UIP would hurt their career (OR ¼ 1.85, CI ¼ 1.09-3.15), higher levels of behavioral skills (OR ¼ 2.53, CI ¼ 1.42-4.51), greater behavioral intentions for preventing UIP (women only; OR ¼ 7.91, CI ¼ 1.86-33.65), and no prior unintended (OR ¼ 0.30, CI ¼ 0.10- 0.93) or intended pregnancies (OR ¼ 0.56, CI ¼ 0.32-0.97). Conclusions: Consistent-effective contraceptive use is associated with having knowledge, positive condom attitudes, lower perceived UIP risk, and behavioral skills to prevent UIP. With the exception of behavioral intentions for preventing UIP, no gender differences were found. UIP prevention interventions to increase consistent-effective use in adolescents and young adults are still warranted. Sources of Support: U.S. Army Medical Research and Material Command, Fort Detrick, MD, and the Health Resources and Services Administration/Maternal and Child Health Bureau, Leadership Education in Adolescent Health Training Grant.