1. High school girls using intrauterine devices (IUDs) or implants were less likely to use condoms than girls who used birth control pills.
2. Key findings suggest that long acting reversible contraception (LARC) users may be at increased risk for sexually transmitted diseases compared to pill users.
Evidence Rating Level: 2 (Good)
Study Rundown: Teen pregnancy rates in the United States remain some of the highest of any industrialized country. To battle this public health epidemic, The American College of Obstetrics and Gynecology (ACOG) recommends LARCs, like IUDs and implants, as first-line birth control for all women, including teenagers. LARCs are user independent, or “forgettable,” and are by far the most effective form of contraception available, with failure rates of less than 1 percent. Comparatively, birth control pills have nearly a 10 percent failure rate with typical use. However, LARCs do not protect against sexually transmitted infections (STIs). Some experts fear that given how effective LARCs are, teens won’t use both methods. In fact, several recent studies have suggested as such. In this study, researchers expanded this evidence base by comparing condom use between LARC and moderately effective contraceptive users in a nationally representative sample of US high school students.
Findings demonstrate that high school girls who used IUDs and implants were less likely to additionally use condoms than girls who used birth control pills. LARC users were also more than two times more likely to have had two or more recent sexual partners. While the cohort was nationally representative, it was fairly racially homogenous—nearly 60 percent of students were white. Future investigations might also assess potential confounders like relationship status, STI status, latex allergy, and other reasons teens may not use condoms to better understand how providers can improve counseling and management to increase adherence to safe sex practices.
Relevant Reading: Youth Risk Behavior Surveillance–United States, 2013
In-Depth [cross-sectional study]: Data on sexually active female students (n = 2288) was abstracted from the 2013 national Youth Risk Behavior Survey, which queried a nationally representative sample of US high school students. The primary outcome was contraceptive method used at last sexual intercourse, for which respondents could select birth control pills (22.4%), condoms (40.8%), a LARC method (IUD or implant) (1.8%), injection/patch/ring (5.7%), withdrawal/other (11.8%), not sure (1.9%), and/or none (15.7%). A secondary outcome, assessed by a separate question, was condom use at last sexual intercourse.
Compared to pill users, LARC users were less likely to use condoms (adjusted prevalence ratio [aPR]: 0.42; 95%CI: 0.21-0.84). LARC users were more likely to have had 2 or more recent sexual partners than pill users (aPR: 2.61; 95%CI: 0.21-0.84) or injection/patch/ring users (aPR: 2.58; 95%CI: 1.17-5.67). There was no significant difference in condom use seen between LARC users and injection/patch/ring users.
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