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Durham, N.C.--Most sexually active single women believe they are at low risk for contracting sexually transmitted diseases (STDs), but a new study says their risk profiles are in fact similar to those women in higher risk populations.
Researchers from Duke University Medical Center, the University of Washington, Seattle, and Group Health Cooperative of Puget Sound say their study highlights the need for health care clinicians to spend more time with young women identifying risk factors, explaining consequences of unprotected sex and promoting condom use. The study was published in the August 2003 issue of Preventive Medicine. The research was supported by a grant from the National Institute of Mental Health.
Sexually transmitted diseases are a significant health problem for young women. Nationally, the rates of human papillomavirus (HPV), genital herpes and chlamydia are particularly high for women ages 15 to 24. STDs increase the risk of infertility, pelvic inflammatory disease, negative birth outcomes and chronic pain. Recent research indicates that HPV may be a cause of cervical cancer.
"Even though they are having unprotected sex, most young women would say they are at low-risk of contracting an STD," said Kimberly Yarnall, M.D., associate clinical professor in the department of community and family medicine, and lead author of the study. "Some don't see STDs as a big deal and are desensitized to the risk."
In the study, the researchers surveyed 1,210 women by phone about demographic characteristics and risk behaviors such as episodes of binge drinking, history of vaginal sex and STDs, perceived STD risk, overall condom use and partner-specific condom use. Women in the study were sexually active, unmarried, not pregnant, and heterosexual, between the ages 18 and 25. The researchers included both students and non-students in the analysis.
"Most research into condom use and STD risk focuses on populations considered 'high risk,' such as patients seen at STD clinics, inner-city clinics and student clinics." said Yarnall. "In this study we wanted to include women not currently enrolled in college to find out what the average 'Jane' thinks. Non-students in this age group haven't really been surveyed to understand their views about condom use and STD risk."
Yarnall said that the non-students tended to be older and non-white; they reported more lifetime partners having more partners over the previous 12 months than students. Non-students were also more likely to have had prior STDs. Both groups reported the same rates of unprotected sex in the last three months, and more than 75 percent of all women surveyed perceived themselves at low-risk for acquiring an STD in the next year.
"In both groups, women were less likely to use condoms if they were older, white, on birth control pills or had partners that didn't see condoms as important," said Yarnall. "In the non-student women, binge drinking was significantly associated with unprotected sex among non-students, but that was not the case with the students."
While college students have educational programs focusing on binge drinking and impaired judgement, Yarnall said most non-students to not have access to such programs and information. The lack of these educational programs may explain the connection between binge drinking and unprotected sex in non-students.
Yarnall also points out that the non-students in general were more likely to have unprotected sex with someone they did not consider to be a committed partner.
"Neither group had a great track record as far as safer sex," said Yarnall. "But the college students did a little better overall. Students were less likely to have unprotected sex with someone they met at a party or bar. Non-students were just as likely to have unprotected sex with their boyfriend as they were a man they had just met."
Yarnall believes that recognizing predictors of unprotected sex is important to understand so clinicians can identify and counsel women who may not see themselves at risk for sexually transmitted diseases.
"We can't assume that all women of the same age have the same risk behaviors. By pinpointing patterns involving condom use and partner type, we can then create screening questions that may alert us to this behavior. Once we identify at-risk women, we should refer them for appropriate testing, follow-up counseling and education," she said.
Co-authors include Colleen McBride, Ph.D., Pauline Lyna, and Laura Fish, all of Duke University Medical Center; Diane Civic, Ph.D., and Louis Grothaus, both of Group Health Cooperative of Puget Sound; and Delia Scholes, Ph.D., of University of Washington, Seattle.
Journal
Preventive Medicine