title: The impact of oral contraceptive initiation on young women's condom use in 3 American cities: missed opportunities for intervention.
abstract: OBJECTIVE
  To describe women's condom use and assess predictors of consistent condom use and dual method use in the 6 months after the initiation of oral contraception (OC).
  
  
  METHODS
  We conducted a planned secondary cohort analysis among women less than 25 years of age initiating oral contraceptives at public family planning clinics in Atlanta, Dallas and New York City, USA, as part of a randomized trial. These clinics provide care to predominantly African American or Hispanic women of low socioeconomic status. Participants completed interviews at enrollment and at 6 months after OC start. We used multivariate logistic regression to assess factors associated with consistent condom and dual method use at 6 months.
  
  
  RESULTS
  1281 participants met the inclusion criteria for this analysis. At enrollment prior to OC start, 28% were consistent condom users. In the six months after initiation of oral contraception, only 14% always used a condom and 4% always used dual methods. In multivariate analysis, receiving basic advice to always use a condom after OC initiation from a provider during the baseline clinic consultation was associated with a 50% increase in the odds of using condoms consistently. Only 28% of participants were given this condom use advice.
  
  
  CONCLUSIONS
  This study documents a decline in women's condom consistent use subsequent to initiation of the oral contraceptive and suggests that opportunities for positive intervention around condom use among women starting hormonal methods are being missed. Basic condom use advice, which is neither time consuming nor resource dependent, was associated with increased consistent use and should be immediately implemented in all family planning services.
authors.affiliation: Institute for Women's Health/Institute for Global Health, University College, London, United Kingdom.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Morroni
authors.affiliation: Susan Thompson Buffet Foundation, Omaha, Nebraska, United States of America.
authors.forename: Stephen
authors.initials: S
authors.lastname: Heartwell
authors.affiliation: Department of Pediatrics, Mt. Sinai School of Medicine, New York, New York, United States of America.
authors.forename: Sharon
authors.initials: S
authors.lastname: Edwards
authors.affiliation: Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Mimi
authors.initials: M
authors.lastname: Zieman
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States of America.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Westhoff
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002947:Cities; D019111:Single-Use Internal Condom; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003276:Contraceptives, Oral; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D062486:Public Health Surveillance; D012307:Risk Factors; D013997:Time Factors; D014481:United States; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral