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Sexually Active Young Women Often Underestimate STD Risk

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Duke Health News 919-660-1306

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 judgment, 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 and Group Health Cooperative of Puget
Sound.

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