With Pills, Patches, Rings, and Shots: Who Still Uses Condoms? A Longitudinal Cohort Study



      To describe women's condom use patterns over time and assess predictors of dual method use 12 months after initiating hormonal contraceptives.


      We conducted a prospective cohort study among women aged 15–24 years initiating oral contraceptive pills, patch, ring, or depot medroxyprogesterone and attending public family planning clinics. Participants completed questionnaires at baseline and 3, 6, and 12 months after enrollment. We used multivariable logistic regression to assess baseline factors associated with dual method use at 12 months among 1,194 women who were sexually active in the past 30 days.


      At baseline, 36% were condom users, and only 5% were dual method users. After initiation of a hormonal method, condom use decreased to 27% and remained relatively unchanged thereafter. Dual method use increased to a peak of 20% at 3 months but decreased over time. Women who were condom users at baseline had nearly twice the odds of being a dual method user at 12 months compared with nonusers (adjusted odds ratio [AOR] = 2.01, 95% CI: 1.28–3.14). Women who believed their main partner thought condoms were "very important," regardless of perceived sexually transmitted infection risk or participant's own views of condoms, had higher odds of dual method use (AOR = 2.89, 95% CI: 1.47–5.71).


      These results highlight a potential missed opportunity for family planning providers. Providers focus on helping women initiate hormonal methods, however, they may improve outcomes by giving greater attention to method continuation and contingency planning in the event of method discontinuation and to the role of the partner in family planning.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Martinez G.M.
        • Copen C.E.
        • Abma J.C.
        Teenagers in the United States: Sexual activity, contraceptive use, and childbearing. 2006-2010 National Survey of Family Growth.
        Vital Health Stat. 2011; 23: 1-44
      1. The DCR report: Section A - Unplanned pregnancy in the United States among all women, The National Campaign to Prevent Teen and Unplanned Pregnancy. Available at: Accessed April 16, 2011.

        • Finer L.B.
        • Zolna M.R.
        Unintended pregnancy in the United States: Incidence and disparities, 2006.
        Guttmacher Institute, New York2011
        • Finer L.B.
        Unintended pregnancy among U.S. adolescents: Accounting for sexual activity.
        J Adolesc Health. 2010; 47: 312-314
        • Centers for Disease Control and Prevention
        Sexually transmitted disease surveillance 2009.
        CDC, Atlanta2010
        • Mosher W.D.
        • Jones J.
        Use of contraception in the United States: 1982-2008.
        Vital Health Stat. 2010; 23: 1-44
        • Crosby R.A.
        • DiClemente R.J.
        • Wingood G.M.
        • et al.
        Correlates of using dual methods for sexually transmitted diseases and pregnancy prevention among high-risk African-American female teens.
        J Adolesc Health. 2001; 28: 410-414
        • Pazol K.
        • Kramer M.R.
        • Hogue C.J.
        Condoms for dual protection: patterns of use with highly effective contraceptive methods.
        Public Health Rep. 2010; 125: 208-217
        • Riehman K.S.
        • Sly D.F.
        • Soler H.
        • et al.
        Dual-method use among an ethnically diverse group of women at risk of HIV infection.
        Fam Plann Perspect. 1998; 30: 212-217
        • Roye C.F.
        Condom use by Hispanic and African-American adolescent girls who use hormonal contraception.
        J Adolesc Health. 1998; 23: 205-211
        • Darney P.D.
        • Callegari L.S.
        • Swift A.
        • et al.
        Condom practices of urban teens using Norplant contraceptive implants, oral contraceptives, and condoms for contraception.
        Am J Obstet Gynecol. 1999; 180: 929-937
        • Sangi-Haghpeykar H.
        • Posner S.F.
        • Poindexter III, A.N.
        Consistency of condom use among low-income hormonal contraceptive users.
        Perspect Sex Reprod Health. 2005; 37: 184-191
        • Cushman L.F.
        • Romero D.
        • Kalmuss D.
        • et al.
        Condom use among women choosing long-term hormonal contraception.
        Fam Plann Perspect. 1998; 30: 240-243
        • Raine T.R.
        • Foster-Rosales A.
        • Upadhyay U.D.
        • et al.
        One-year contraceptive continuation and pregnancy in adolescent girls and women initiating hormonal contraceptives.
        Obstet Gynecol. 2011; 117: 363-371
        • Minnis A.M.
        • van der Straten A.
        • Gerdts C.
        • Padian N.S.
        A comparison of four condom-use measures in predicting pregnancy, cervical STI and HIV incidence among Zimbabwean women.
        Sex Transm Infect. 2010; 86: 231-235
        • Lopez L.M.
        • Tolley E.E.
        • Grimes D.A.
        • Chen-Mok M.
        Theory-based interventions for contraception.
        Cochrane Database Syst Rev. 2009;
        • Rimer B.K.
        • Glanz K.
        Theory at a Glance: A guide for Health Promotion Practice.
        National Institutes of Health, National Cancer Institute, Washington, DC2005
        • Ott M.A.
        • Adler N.E.
        • Millstein S.G.
        • et al.
        The trade-off between hormonal contraceptives and condoms among adolescents.
        Perspect Sex Reprod Health. 2002; 34: 6-14
        • Cates Jr., W.
        • Steiner M.J.
        Dual protection against unintended pregnancy and sexually transmitted infections: what is the best contraceptive approach?.
        Sex Transm Dis. 2002; 29: 168-174
        • Ford C.A.
        • Jaccard J.
        • Millstein S.G.
        • et al.
        Perceived risk of chlamydial and gonococcal infection among sexually experienced young adults in the United States.
        Perspect Sex Reprod Health. 2004; 36: 258-264
        • Ethier K.A.
        • Kershaw T.
        • Niccolai L.
        • et al.
        Adolescent women underestimate their susceptibility to sexually transmitted infections.
        Sex Transm Infect. 2003; 79: 408-411
        • Tschann J.M.
        • Adler N.E.
        • Millstein S.G.
        • et al.
        Relative power between sexual partners and condom use among adolescents.
        J Adolesc Health. 2002; 31: 17-25
        • Peipert J.F.
        • Zhao Q.
        • Meints L.
        • et al.
        Adherence to dual method contraceptive use.
        Contraception. 2011; 84: 252-258
        • Harvey S.M.
        • Henderson J.T.
        • Branch M.R.
        Protecting against both pregnancy and disease: predictors of dual method use among a sample of women.
        Women Health. 2004; 39: 25-43
        • Zolna M.R.
        • Lindberg L.D.
        • Frost J.J.
        Couple-focused services in publicly funded family planning clinics: Identifying the need, 2009.
        Guttmacher Institute, New York2011
        • Langhaug L.F.
        • Cheung Y.B.
        • Pascoe S.J.
        • et al.
        How you ask really matters: randomized comparison of four sexual behaviour questionnaire delivery modes in Zimbabwean youth.
        Sex Transm Infect. 2011; 87: 165-173