This article was downloaded by: [Johns Hopkins University] On: 11 January 2015, At: 03:54 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
Barrier versus Oral Contraceptive Use: A Study of Female College Students a
b
Susan M. Radius Ph.D. , Alain Joffe MD & Marilyn J. Gall RN, CFNP
c
a
Health Science Department , Towson State University , Towson, Maryland, USA
b
Department of Pediatrics , Johns Hopkins Hospital , Baltimore, USA
c
Johns Hopkins Student Health Clinic , USA Published online: 09 Jul 2010.
To cite this article: Susan M. Radius Ph.D. , Alain Joffe MD & Marilyn J. Gall RN, CFNP (1991) Barrier versus Oral Contraceptive Use: A Study of Female College Students, Journal of American College Health, 40:2, 83-85, DOI: 10.1080/07448481.1991.9936260 To link to this article: http://dx.doi.org/10.1080/07448481.1991.9936260
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Barrier Versus Oral Contraceptive Use: A Study of Female College Students
Downloaded by [Johns Hopkins University] at 03:54 11 January 2015
Susan M. Radius, PhD; Alain Joffe, MD; and Marilyn J. Gall, RN, CFNP
Abstract. Although they provide birth control and are easier to use, oral contraceptives (OCPs)are not the preferred approach to preventing sexually transmitted disease (STD). Do the knowledge, attitudes, and experiences of oral contraceptive users place them at greater risk for STDs than those who employ barrier methods? This study examined differences between sexually active female college students (ie, those who reported ever having had vaginal intercourse) who used OCPs and those who employed barrier methods of contraception at the time of their most recent intercourse. The authors analyzed HIV- and other STD-related knowlege, attitudes, and behaviors from three consecutive annual health surveys of young women about to begin their fist year of college. Findings showed barrier and OCP users to be comparable in knowledge about the effectiveness of various contraceptive methods in protecting them against STDs, perceived personal susceptibility to HIV, and experiences with alcohol before sexual intercourse. Oral contraceptive users, compared with those in the group who used barrier methods, reported a greater number of recent partners (p < .03)and greater perceived vulnerability to STDs (p < .03). Student healthcare providers must develop creative educational strategies to encourage simultaneous use of both oral contraceptives and barrier methods to protect students against STDs and pregnancy. Key Words. AIDS, barrier methods, birth control methods, health beliefs, oral contraceptives, sexually transmitted diseases
generation of young women has been taught that oral contraceptives (OCPs) are the most effective birth control method.’ Although undisputed in their ability to prevent pregnancy when properly used, OCPs offer no protection against sexually transmitted diseases (STDs). Indeed, some evidence suggests that OCP use may increase the risk of acquiring Today, young women a sexually transmitted must weigh the pill’s benefits-in terms of such well-rec~
Susan M. Radius k an associate professor in the Health Sci-
ence Department at Towson State University in Towson, Maryland; A& Joffe irs an associate professor in the Department of Pediatrics at the Johns Hopkins Hospital in Baltimore; and Marilyn J. GaU irs a clinic/numing adminktrator with the Johns Hopkins Student Health Clinic. VOL 40, SEPTEMBER 1991
ognized attributes as ease, unobtrusiveness, and efficacy-against the need to protect themselves against STDs such as Chlamydia trachomatis, human papillomavirus (HPV), and human immunodeficiency virus (HIV). Barrier methods, in contrast, offer differing levels of contraceptive efficacy and can be invoked on an “as needed” basis. Their ability to prevent STD transmission, however, merits renewed attention. This study contrasted the knowledge, experiences, and attitudes of college women using OCPs with those of students using barrier methods. Our interest was in establishing whether OCP users, compared with young women employing barrier techniques, maintained a distinct profile that might place them at increased risk for contracting an STD.
METHOD We obtained data from annual health surveys administered to three cohorts (September 1987, September 1988, and September 1989) of incoming first-year students at an urban, residential university. The survey instruments were approved by the university Committee on the Use of Human Subjects. Questionnaires were distributed during the students’ first weeks on campus, before classes began. Because first-year students are required to live in university housing, residence directors convened meetings and requested that all those attending complete the anonymous questionnaires. We also obtained written informed consent from the students for their participation in the survey. Questions focused on a variety of health-related issues. This study is limited to areas designed to tap STD and contraceptive knowledge, experiences, and attitudes. We drew items from existing surveys regarding AIDS and young adults. The Health Belief Model guided overall survey con~truction.~ According to selected portions of this model, individuals who perceive greater susceptibility to certain illnesses (eg, STDs) or perceive ways of averting the threat of illness are more likely to pursue preventive actions such as using barrier methods 83
COLLEGE HEALTH
for contraception. Although men and women completed all surveys, analyses reported here include only data from those women who reported ever having had vaginal intercourse and who used an effective contraceptive method at the time of the most recent intercourse. We classified those who used a diaphragm or condom at last intercourse as barrier method users, even if they reported simultaneous use of OCPs, and compared them with women using OCPs as their sole method of birth control. Except for one question (see Table l), the comparisons were of items that appeared-in identical form-in all three surveys. We used chi-square analysis and considered findings statistically significant at p < .05.
Downloaded by [Johns Hopkins University] at 03:54 11 January 2015
RESULTS
Overall response rates for the 3 years were 76%, 66%, and 86%. The percentage of women who described themselves as sexually active (ie, having had vaginal intercourse) was comparable (p > .05) for all three firstyear cohorts: 1987, 39% (71 of 182 respondents); 1988, 37% (63 of 170); and 1989, 39% (89 of 227). The groups were also similar in race and parents’ educational levels, and we found no statistically significant differences among the cohorts in terms of contraceptive method at last intercourse: 23% to 25% used OCPs, whereas 49% to 60% reported barrier techinques. Among the barrier group, 94% used condoms. Respondents in 1989 were slightly older than those in earlier years (1989, M = 17.77 years; 1988, M = 17.55; 1987, M = 17.58). Although statistically significant (p < .05), this finding did not indicate any critical developmental differences. The 3 years’ data were therefore merged into one respondent pool. The first study group, OCP users, consisted of 48 women; the second group consisted of 103 who had used a barrier method at last intercourse.
No significant difference existed between OCP and barrier users’ recognition of the ability of various contraceptive methods to reduce STD risk (see Table l), nor did the groups differ in their perceptions of the ability of condoms to decrease their risk of HIV infection. Both groups’ experiences were largely comparable in the proportion who usually had intercourse after drinking, had intercourse when they didn’t want to as a result of drinking, and reported ever having had an STD (see Table 2). OCP users, however, reported relatively more partners in the past 3 months than the barrier group (p < .03). No differences existed in these young women’s assessment of their likelihood of acquiring HIV, or in the degree to which they worried about getting HIV. The OCP group was, however, more likely than the barrier group to view themselves as at risk for STDs other than HIV (p < .03). DISCUSSION
We recognize certain limitations in our study. Three years of data from one institution with distinct sociodemographic characteristics are of restricted generalizability. A sample larger than 48 OCP and 103 barrier users would better support our conclusions. It is also possible that attitudinal or other factors not measured in this data set account for our findings. It may be that OCP users were more sexually experienced, or were active at earlier ages, and were therefore more willing to commit to OCPs. As partial insight into some alternative explanations, we established that, within our groups’ limited age range, older participants were more likely to be OCP users (p < .01). The barrier group may have included students who were more recently sexually active or who had not yet fully acknowledged their sexuality and committed to OCP use. Alternatively, it may be that young women who placed a greater premium on
TABLE 1 STDRelated Contraceptive Knowledge, by Respondent Group
Oral contraceptive (OCP) (n = 48) No Yes (Yo) (Yo)
Barrier method (n = 103) Yes No (%)
(%)
20.20 2.10 6.12 27.37 12.12 16.16 100.00 99.05
79.80 97.90 93.88 72.63 87.88 83.84 00.00 0.95
I Decreases STD risk Diaphragm OCP Douche Foam/jelly Withdrawal Sponge Condomt Condom decreases AIDS risk
11.36 2.27 4.55 19.05 9.30 16.28 100.00 97.73
88.64 97.73 95.45 80.95 90.70 83.72 00.00 2.27
Note: Response options: Yes = strongly agree or agree; No = disagree or strongly disagree.
TI988 and 1989 data only.
84
JACH
CONTRACEPTlVE USE
TABLE 2 STDRelated Contraceptive Experiences and Attitudes, by Respondent Group
Oral (Yo)
Barrier (Yo)
(n = 48)
(n = 103)
Experiences Partners in last 3 months (1 2 2
Downloaded by [Johns Hopkins University] at 03:54 11 January 2015
Ever had STD Never Ever Had sex after drinking though didn’t want tot Yes
No Usually have sex after drinking? Yes No
Attitudes Worry about getting AIDSt Yes No
65.22 34.78
82.86 17.14*
97.73 2.27
100.00 0.00
25.00 75.00
16.13 83.87
13.63 86.36
7.55 92.45
42.55 57.45
51.22 48.78
14.29 85.71
2.83* 97.17
0.00 100.00
0.00 100.00
Likely to get STD other than AIDS$ Yes
No Likely to get AIDS$ Yes No
tResponse options: Yes = a lot or somewhat; No = little or not at all. *Response options: Yes = very likely or likely; No = very unlikely or unlikely. ‘p = .03.
preventing pregnancy than on STD control were more inclined to use OCPs. Our data nonetheless suggest that the OCP users appeared to be as informed about “safer sex” as those who employed barrier methods. Although both groups recognized the effectiveness of condoms in reducing STD risk, relatively few in either group acknowledged any protective effect of diaphragms used with foam or jelly. This finding suggests an area for counseling all young women about contraceptive methods that also decrease STD risk, particularly those methods within the women’s control (eg, diaphragms). Of additional interest and concern was that as many as 9% to 12% in each group indicated that withdrawal can decrease STD risk.
VOL 40, SEPTEMBER 1991
Alcohol was a worrisome presence among both groups: One fourth of OCP users and 16% of the barrier group reported having had unwanted intercourse after drinking. Fourteen percent of the OCP users and 8% of barrier users also indicated that they “usually” had intercourse after drinking. Studies have shown that students are less likely to use condoms when the level of alcohol consumption is higher.’ Even when they use OCPs, thus protecting against pregnancy, the young women who use alcohol can impair their ability to prevent STDs. The only significant experiential difference between the groups was in the number of sexual partners. Among this sample, however, older participants were more likely to report OCP use and to report two or more sex partners within the past 3 months (p < .002). Our analysis cannot disentangle which of these factors preceded the others. It remains true that, if the probability of acquiring an STD increases with more sex partners when a condom is not used each time, OCP users are putting themselves at risk of contracting an STD. That this same group also saw themselves at greater risk for acquiring STDs other than AIDS only reinforces our concern. Whether this perception derived from or preceded OCP users’ wider unprotected sexual experience (in some sense, becoming a self-fulfilling prophesy) cannot be established from our data. In keeping with the Health Belief Model, however, such vulnerability suggests an important opportunity to encourage the use of barrier techniques as an adjunct to OCPs. Although we do not dispute the value of OCPs, our findings suggest a need for continued attention to college women’s contraceptive practices. As health educators, we must make sure that all female students recognize that, because they are vulnerable to HIV and other STDs, they must use both barrier methods and oral contraceptives. Focusing on pregnancy prevention alone is insufficient for protecting the overall health of today’s college women. REFERENCES 1. Shearin RB, Boehlke JR. Hormonal contraception. Pediatr CIin North Am. 1989;36:697-715. 2. Washington AE, Gove S, Schachter J, Sweet RL. Oral contraceptives, Chlamydia trachomatis infection, and pelvic inflammatory disease. JAMA. 1985;253:2246-2251. 3. Wolner-Hanssen P, Eschenbach DA, Paavonen J, et al. Decreased risk of symptomatic chlamydial pelvic inflammatory disease associated with oral contraceptive use. JAMA. 199Oi263:54-59. 4. Janz NK, Becker MH. The Health Belief Model. A decade later. Health Educ Q. 1984;11:1-47.
5 . Hingson RW, Strunin L, Berlin BM, et al. Beliefs about AIDS, use of alcohol and drugs, and unprotected sex among Massachusetts adolescents. A m J Public Health. 1990;80: 295-299.
85
Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
Barrier versus Oral Contraceptive Use: A Study of Female College Students a
b
Susan M. Radius Ph.D. , Alain Joffe MD & Marilyn J. Gall RN, CFNP
c
a
Health Science Department , Towson State University , Towson, Maryland, USA
b
Department of Pediatrics , Johns Hopkins Hospital , Baltimore, USA
c
Johns Hopkins Student Health Clinic , USA Published online: 09 Jul 2010.
To cite this article: Susan M. Radius Ph.D. , Alain Joffe MD & Marilyn J. Gall RN, CFNP (1991) Barrier versus Oral Contraceptive Use: A Study of Female College Students, Journal of American College Health, 40:2, 83-85, DOI: 10.1080/07448481.1991.9936260 To link to this article: http://dx.doi.org/10.1080/07448481.1991.9936260
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Barrier Versus Oral Contraceptive Use: A Study of Female College Students
Downloaded by [Johns Hopkins University] at 03:54 11 January 2015
Susan M. Radius, PhD; Alain Joffe, MD; and Marilyn J. Gall, RN, CFNP
Abstract. Although they provide birth control and are easier to use, oral contraceptives (OCPs)are not the preferred approach to preventing sexually transmitted disease (STD). Do the knowledge, attitudes, and experiences of oral contraceptive users place them at greater risk for STDs than those who employ barrier methods? This study examined differences between sexually active female college students (ie, those who reported ever having had vaginal intercourse) who used OCPs and those who employed barrier methods of contraception at the time of their most recent intercourse. The authors analyzed HIV- and other STD-related knowlege, attitudes, and behaviors from three consecutive annual health surveys of young women about to begin their fist year of college. Findings showed barrier and OCP users to be comparable in knowledge about the effectiveness of various contraceptive methods in protecting them against STDs, perceived personal susceptibility to HIV, and experiences with alcohol before sexual intercourse. Oral contraceptive users, compared with those in the group who used barrier methods, reported a greater number of recent partners (p < .03)and greater perceived vulnerability to STDs (p < .03). Student healthcare providers must develop creative educational strategies to encourage simultaneous use of both oral contraceptives and barrier methods to protect students against STDs and pregnancy. Key Words. AIDS, barrier methods, birth control methods, health beliefs, oral contraceptives, sexually transmitted diseases
generation of young women has been taught that oral contraceptives (OCPs) are the most effective birth control method.’ Although undisputed in their ability to prevent pregnancy when properly used, OCPs offer no protection against sexually transmitted diseases (STDs). Indeed, some evidence suggests that OCP use may increase the risk of acquiring Today, young women a sexually transmitted must weigh the pill’s benefits-in terms of such well-rec~
Susan M. Radius k an associate professor in the Health Sci-
ence Department at Towson State University in Towson, Maryland; A& Joffe irs an associate professor in the Department of Pediatrics at the Johns Hopkins Hospital in Baltimore; and Marilyn J. GaU irs a clinic/numing adminktrator with the Johns Hopkins Student Health Clinic. VOL 40, SEPTEMBER 1991
ognized attributes as ease, unobtrusiveness, and efficacy-against the need to protect themselves against STDs such as Chlamydia trachomatis, human papillomavirus (HPV), and human immunodeficiency virus (HIV). Barrier methods, in contrast, offer differing levels of contraceptive efficacy and can be invoked on an “as needed” basis. Their ability to prevent STD transmission, however, merits renewed attention. This study contrasted the knowledge, experiences, and attitudes of college women using OCPs with those of students using barrier methods. Our interest was in establishing whether OCP users, compared with young women employing barrier techniques, maintained a distinct profile that might place them at increased risk for contracting an STD.
METHOD We obtained data from annual health surveys administered to three cohorts (September 1987, September 1988, and September 1989) of incoming first-year students at an urban, residential university. The survey instruments were approved by the university Committee on the Use of Human Subjects. Questionnaires were distributed during the students’ first weeks on campus, before classes began. Because first-year students are required to live in university housing, residence directors convened meetings and requested that all those attending complete the anonymous questionnaires. We also obtained written informed consent from the students for their participation in the survey. Questions focused on a variety of health-related issues. This study is limited to areas designed to tap STD and contraceptive knowledge, experiences, and attitudes. We drew items from existing surveys regarding AIDS and young adults. The Health Belief Model guided overall survey con~truction.~ According to selected portions of this model, individuals who perceive greater susceptibility to certain illnesses (eg, STDs) or perceive ways of averting the threat of illness are more likely to pursue preventive actions such as using barrier methods 83
COLLEGE HEALTH
for contraception. Although men and women completed all surveys, analyses reported here include only data from those women who reported ever having had vaginal intercourse and who used an effective contraceptive method at the time of the most recent intercourse. We classified those who used a diaphragm or condom at last intercourse as barrier method users, even if they reported simultaneous use of OCPs, and compared them with women using OCPs as their sole method of birth control. Except for one question (see Table l), the comparisons were of items that appeared-in identical form-in all three surveys. We used chi-square analysis and considered findings statistically significant at p < .05.
Downloaded by [Johns Hopkins University] at 03:54 11 January 2015
RESULTS
Overall response rates for the 3 years were 76%, 66%, and 86%. The percentage of women who described themselves as sexually active (ie, having had vaginal intercourse) was comparable (p > .05) for all three firstyear cohorts: 1987, 39% (71 of 182 respondents); 1988, 37% (63 of 170); and 1989, 39% (89 of 227). The groups were also similar in race and parents’ educational levels, and we found no statistically significant differences among the cohorts in terms of contraceptive method at last intercourse: 23% to 25% used OCPs, whereas 49% to 60% reported barrier techinques. Among the barrier group, 94% used condoms. Respondents in 1989 were slightly older than those in earlier years (1989, M = 17.77 years; 1988, M = 17.55; 1987, M = 17.58). Although statistically significant (p < .05), this finding did not indicate any critical developmental differences. The 3 years’ data were therefore merged into one respondent pool. The first study group, OCP users, consisted of 48 women; the second group consisted of 103 who had used a barrier method at last intercourse.
No significant difference existed between OCP and barrier users’ recognition of the ability of various contraceptive methods to reduce STD risk (see Table l), nor did the groups differ in their perceptions of the ability of condoms to decrease their risk of HIV infection. Both groups’ experiences were largely comparable in the proportion who usually had intercourse after drinking, had intercourse when they didn’t want to as a result of drinking, and reported ever having had an STD (see Table 2). OCP users, however, reported relatively more partners in the past 3 months than the barrier group (p < .03). No differences existed in these young women’s assessment of their likelihood of acquiring HIV, or in the degree to which they worried about getting HIV. The OCP group was, however, more likely than the barrier group to view themselves as at risk for STDs other than HIV (p < .03). DISCUSSION
We recognize certain limitations in our study. Three years of data from one institution with distinct sociodemographic characteristics are of restricted generalizability. A sample larger than 48 OCP and 103 barrier users would better support our conclusions. It is also possible that attitudinal or other factors not measured in this data set account for our findings. It may be that OCP users were more sexually experienced, or were active at earlier ages, and were therefore more willing to commit to OCPs. As partial insight into some alternative explanations, we established that, within our groups’ limited age range, older participants were more likely to be OCP users (p < .01). The barrier group may have included students who were more recently sexually active or who had not yet fully acknowledged their sexuality and committed to OCP use. Alternatively, it may be that young women who placed a greater premium on
TABLE 1 STDRelated Contraceptive Knowledge, by Respondent Group
Oral contraceptive (OCP) (n = 48) No Yes (Yo) (Yo)
Barrier method (n = 103) Yes No (%)
(%)
20.20 2.10 6.12 27.37 12.12 16.16 100.00 99.05
79.80 97.90 93.88 72.63 87.88 83.84 00.00 0.95
I Decreases STD risk Diaphragm OCP Douche Foam/jelly Withdrawal Sponge Condomt Condom decreases AIDS risk
11.36 2.27 4.55 19.05 9.30 16.28 100.00 97.73
88.64 97.73 95.45 80.95 90.70 83.72 00.00 2.27
Note: Response options: Yes = strongly agree or agree; No = disagree or strongly disagree.
TI988 and 1989 data only.
84
JACH
CONTRACEPTlVE USE
TABLE 2 STDRelated Contraceptive Experiences and Attitudes, by Respondent Group
Oral (Yo)
Barrier (Yo)
(n = 48)
(n = 103)
Experiences Partners in last 3 months (1 2 2
Downloaded by [Johns Hopkins University] at 03:54 11 January 2015
Ever had STD Never Ever Had sex after drinking though didn’t want tot Yes
No Usually have sex after drinking? Yes No
Attitudes Worry about getting AIDSt Yes No
65.22 34.78
82.86 17.14*
97.73 2.27
100.00 0.00
25.00 75.00
16.13 83.87
13.63 86.36
7.55 92.45
42.55 57.45
51.22 48.78
14.29 85.71
2.83* 97.17
0.00 100.00
0.00 100.00
Likely to get STD other than AIDS$ Yes
No Likely to get AIDS$ Yes No
tResponse options: Yes = a lot or somewhat; No = little or not at all. *Response options: Yes = very likely or likely; No = very unlikely or unlikely. ‘p = .03.
preventing pregnancy than on STD control were more inclined to use OCPs. Our data nonetheless suggest that the OCP users appeared to be as informed about “safer sex” as those who employed barrier methods. Although both groups recognized the effectiveness of condoms in reducing STD risk, relatively few in either group acknowledged any protective effect of diaphragms used with foam or jelly. This finding suggests an area for counseling all young women about contraceptive methods that also decrease STD risk, particularly those methods within the women’s control (eg, diaphragms). Of additional interest and concern was that as many as 9% to 12% in each group indicated that withdrawal can decrease STD risk.
VOL 40, SEPTEMBER 1991
Alcohol was a worrisome presence among both groups: One fourth of OCP users and 16% of the barrier group reported having had unwanted intercourse after drinking. Fourteen percent of the OCP users and 8% of barrier users also indicated that they “usually” had intercourse after drinking. Studies have shown that students are less likely to use condoms when the level of alcohol consumption is higher.’ Even when they use OCPs, thus protecting against pregnancy, the young women who use alcohol can impair their ability to prevent STDs. The only significant experiential difference between the groups was in the number of sexual partners. Among this sample, however, older participants were more likely to report OCP use and to report two or more sex partners within the past 3 months (p < .002). Our analysis cannot disentangle which of these factors preceded the others. It remains true that, if the probability of acquiring an STD increases with more sex partners when a condom is not used each time, OCP users are putting themselves at risk of contracting an STD. That this same group also saw themselves at greater risk for acquiring STDs other than AIDS only reinforces our concern. Whether this perception derived from or preceded OCP users’ wider unprotected sexual experience (in some sense, becoming a self-fulfilling prophesy) cannot be established from our data. In keeping with the Health Belief Model, however, such vulnerability suggests an important opportunity to encourage the use of barrier techniques as an adjunct to OCPs. Although we do not dispute the value of OCPs, our findings suggest a need for continued attention to college women’s contraceptive practices. As health educators, we must make sure that all female students recognize that, because they are vulnerable to HIV and other STDs, they must use both barrier methods and oral contraceptives. Focusing on pregnancy prevention alone is insufficient for protecting the overall health of today’s college women. REFERENCES 1. Shearin RB, Boehlke JR. Hormonal contraception. Pediatr CIin North Am. 1989;36:697-715. 2. Washington AE, Gove S, Schachter J, Sweet RL. Oral contraceptives, Chlamydia trachomatis infection, and pelvic inflammatory disease. JAMA. 1985;253:2246-2251. 3. Wolner-Hanssen P, Eschenbach DA, Paavonen J, et al. Decreased risk of symptomatic chlamydial pelvic inflammatory disease associated with oral contraceptive use. JAMA. 199Oi263:54-59. 4. Janz NK, Becker MH. The Health Belief Model. A decade later. Health Educ Q. 1984;11:1-47.
5 . Hingson RW, Strunin L, Berlin BM, et al. Beliefs about AIDS, use of alcohol and drugs, and unprotected sex among Massachusetts adolescents. A m J Public Health. 1990;80: 295-299.
85
