Why do teen LARC users not use condoms?
A cross-sectional analysis recently published in JAMA Pediatrics shows that high school girls who use recommended long-acting reversible contraceptives (LARC) may be more likely to not use condoms during sexual intercourse than their peers who use oral contraceptives (OCs).
For the study, the researchers used data from the 2013 national Youth Risk Behavior Survey, a nationally representative sample of US students in grades 9 to 12. Descriptive analyses were performed with sexually active female students (n = 2288) while logistic regression analyses were limited to sexually active female users of LARC (intrauterine devices and implants) and moderately effective contraceptives (n = 619).
Among the 2288 participants (56.7% were white and 33.6% were in 12th grade), 1.8% used LARC; 5.7% used Depo-Provera, patch, or ring; 22.4% used OCs; 40.8% used condoms; 11.8% used withdrawal or some other method; 15.6 used no contraceptive method; and 1.9% were not sure about the method they used. Following an adjust analysis, LARC users were roughly 60% less likely to use condoms than were OC users (adjusted prevalence ratio [aPR], 0.42; 95% CI, 0.21-0.84). There was no significant difference in condom use between LARC users and those who used Depo-Provera, patch, or the ring (aPR, 0.57; 95% CI, 0.26-1.25). The study also raised the concern that LARC users had nearly double the chance of having 2 or more recent sexual partners in comparison to OC users (aPR, 2.61; 95% CI, 1.75-3.90) and Depo-Provera, patch, or ring users (aPR, 2.58; 95% CI, 1.17-5.67).
Researchers were quick to point out that some limitations should be taken into account when interpreting the findings. The survey data used are based on self-report, allowing for misreported behaviors. In addition, the survey only asked about the primary contraceptive method used when a girl last engaged in sexual intercourse, which could mean that some teens polled used condoms in addition to their primary contraceptive choice, but only listed the primary method. Important information not included in the data involved duration of contraceptive use; whether the contraceptive was correctly and consistently; and information about the girls’ partners.
The researchers concluded that girls who use LARCs are far more likely to not use condoms while engaging in sexual intercourse than their peers who use OCs. They speculate that this could be because teens believe that condoms are for backup pregnancy prevention. Given the highly effective nature of LARCs, some girls may not perceive that they are at risk of sexually transmitted infections (STIs). This cognitive disconnect indicates a clear need to emphasize the STI prevention capabilities of condoms.