ESC Congress Library. Downey A. 05/10/18; 208102; ESC98 Disclosure(s): Advisory Board and CME activities with Pfizer and Bayer and research support from Mithra Pharmaceuticals.
Prof. Dr. Amanda Downey
Prof. Dr. Amanda Downey
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BACKGROUND: Understanding adolescent sexual behaviours and factors associated with contraceptive use/lack of use may help guide programs/policies designed to reduce adolescent pregnancies and STIs.  Our objectives:  (1) Characterize adolescent women's contraceptive choices, contraceptive adherence, and barriers to consistent use; and (2) Determine trends in contraceptive use and sexual behaviours among Canadian adolescents over the last decade. METHODS: With IRB approval, a national cross-sectional survey was conducted in November 2006 and again in 2016.  A standardized, confidential, Internet-based questionnaire was administered to a nationally representative cohort of adolescent women.  Unmarried sexually active adolescent women aged 15-19 were included in the analysis.  Outcomes included contraceptive methods used and contraceptive adherence. Descriptive analyses were used to summarize data and chi-square test for categorical variables.  Multivariate logistic regression analyses predicting consistent contraceptive use were performed. RESULTS: In the 2006 and 2016 surveys, 1,313 and 1,325 adolescent females respectively were eligible for inclusion in the data analysis. In both surveys, the most frequently used contraceptive methods among contraceptive users were condoms (51% in 2006 vs. 71% in 2016), oral contraceptive pills (69.3% in 2006 vs. 32.1% in 2016), and withdrawal (16.4% vs. 16.1%, p=0.8). There was a significant increase in IUCD use (0.6% vs. 3.6%, p < 0 .0001).  The proportion of sexually active adolescents who reported that they 'never' used contraception in the last 6 months increased significantly (4% in 2006 vs. 9.4% in 2016, p < 0 .0001). 'Always' use of contraception decreased significantly (73.4% to 61.2%, p < 0 .0001). The percentage that reported that they 'always' used condoms in the last 6 months increased from 41% to 53.8% (p < 0 .0001). Among adolescents who used condoms, there was a significant increase in the percentage that used condoms for both STI and pregnancy prevention (54.6% in 2006 vs. 67.8% in 2016, p < 0 .0001).  Statistically significant changes in sexual behaviours were observed. The percentage that had engaged in oral sex or vaginal intercourse in the previous 6 months decreased significantly, while the percentage that had engaged in anal sex increased significantly (9.1% to 16.4%, p < 0 .0001).  CONCLUSION: Despite many available contraceptive options, Canadian adolescent women continue to use a narrow range of contraceptive methods and to use contraception inconsistently. There have been significant decreases in consistent contraceptive use in the last 10 years and changes in sexual behaviours.  Condom use and IUCD use both increased significantly; however, OCs remained one of the most commonly used contraceptive methods while overall IUCD use remained low. Initiatives to encourage LARC use to prevent unintended pregnancy in combination with condom use to prevent STIs should continue to be a public health priority for adolescents. 
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