The promotion of dual protection, defined as simultaneous prophylaxis against sexually transmitted infection (STI) and unintended conception, is an important intervention for women in the United States, especially for young, minority women. For sexually active women dual protection can be achieved either by consistently and correctly using a male or female condom alone or by using a condom consistently along with the consistent use of an effective non-barrier contraceptive (known as "dual-method use"). This dissertation focuses on determining the levels of and identifying predictors of condom use and dual method use among young minority women initiating oral contraception (OC). Data for the dissertation are drawn from a cohort of 15-24 year old women recruited from five public clinics in three U.S. cities (Atlanta, Georgia, Dallas, Texas, and New York, New York) and enrolled into the Quickstart Study, a randomized trial comparing two different approaches to oral contraceptive initiation. This study enrolled 1716 young women of whom 36% are African American and 59% are Hispanic and followed them for six months to assess contraceptive continuation, condom use and pregnancy outcomes. The key findings from this research are: (1) condom use prior to OC initiation is very low in this population, despite their STI risk, (2) there is a clear and substantial decline in condom use once the OC is initiated, and (3) opportunities for intervention to increase condom use in this population are being missed by family planning services.; The development and evaluation of interventions which focus on simple counseling messages to increase condom use among contraceptive users must be a research priority. Greater efforts need to be made by healthcare providers, health services, policy makers and researchers to address this problem.
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