Advances in Contraception 7 (1991) 165-171 © 1991 Kluwer Academic Publishers. Printed in the Netherlands
Female university students in Sweden: sex, contraception and STDs T. TYDi~N (1), S. OLSSON (1) AND C. BJORKELUND-YLANDER (2)
(1) Department of Obstetrics and Gynecology, Universityof Uppsala, S-751 85 Uppsala, Sweden (2) Student Health Center, Uppsala, Sweden Abstract
Female university students (n = 241) visiting the Student Health Center participated in a study concerning sexual behavior (study I). A randomized postal survey (study II) with similar questions was also performed to verify the findings in the first study (n = 137). The mean age was 23 years in both studies. Sexual experience was reported by 96% in study I and 87% in study II. Mean age at first intercourse and mean number of partners were similar; 17.6 years and 6 partners, respectively. Change of contraceptive type was frequent, and about one third had done so within the past two years. A common reason for adopting a new method was a change in social life. More than half the women were afraid of using oral contraceptives. Twenty-six percent of the students in study I and 29% in study II had had at least one sexually transmitted disease (STD). Forty-three percent claimed to have changed their sexual behavior as a result of AIDS publicity but condoms were used by less than 50% at the first intercourse with a new partner. Although this group of intelligent young people have access to information, many of them were risk-takers with respect to both unwanted pregnancies and STD. Misconceptions were frequent concerning the safety of OCs. It is clear that new approaches must be made to educate them about safe sexual practices.
Introduction
An increasing incidence of sexually transmitted diseases (STDs) was noted during the 1970s and 1980s [1]. As sexually transmitted diseases can impair fertility, much effort is thus spent today on treating sequelae of STDs [2].
This paper is based on a presentation given at the Seventh International Meeting of the Scoiety for the Advancement of Contraception, which was held in Singapore on 4-11 November, 1990.
166
Tyd6n et al.
Prevention programs directed towards minimizing the spread of STDs, and HIV in particular, have recently been undertaken in most Western countries. Emphasis has been placed on reducing the risk of infection by adopting a monogamous relationship or by use of a condom. Information campaigns promoting the use of condoms, together with the debate about the potential risk of breast cancer in women who have used combined oral contraceptives (OC) for long periods, have probably been the two main reasons behind a decreased use of OCs in Sweden during this period [3]. The increase in the abortion rate which has been evident in Sweden since 1985 may well reflect the rejection of a more effective contraceptive method, such as the pill, for another less effective method like the condom. Adolescent sexual behavior is known to be associated with the risk of STDs and unwanted pregnancies [4]. University students are known to be a sexually active group [5,6] as they are in a period of life when they are trying to find a partner with whom they can establish a more permanent relationship. A program to improve knowledge and promote awareness about contraception and STDs among university students was commenced in 1989 by health workers from the Student Health Center, Uppsala, Sweden. The first step was to interview students by means of a written questionnaire offered to those visiting the Student Health Center. The purpose of the survey was to equip counsellors with relevant information about the sexual behavior and experience of students, their knowledge of and attitudes to STDs, including AIDS, and their use of contraceptive methods [7]. A high degree of risk-taking behavior was found in this group. These findings were validated in a postal survey of a randomized group of students (from the whole population of students in Uppsala) using an almost identical questionnaire. This evaluation was performed before the final planning of a targeted educational intervention program for students. The intervention has recently been launched and the evaluation of its success will be the final step of this project. In the present paper we report about contraceptive methods in relation to sexually transmitted diseases among female students participating in the two surveys.
Materials and methods
University students (n =379; 275 females) visiting the Student Health Center were asked to participate in a study concerning sexual behavior (study I). This outpatient facility serves about 20,000 students at the two universities in Uppsala, and about 4000 patients are seen during the academic year. Approximately 50% of patient visits are related to contraceptive counselling and other gynecologic care, and are seen by a midwife and gynecologist, respectively. Women with with acute and chronic disorders are seen by GPs, and the remainder are concerned with psychological care. The investigators of this study were associated with the Student Health Center as general practitioner, gynecologist and family planner (nurse/midwife). The students were offered a brief look at the questionnaire. If they were interested, a questionnaire and a stamped envelope were delivered, which made completion in the privacy of their own homes possible. This procedure also guaranteed their anonymity. A total of 90% (n = 343) agreed to participate, 102 males
Female UniversityStudents in Sweden
167
and 241 females. In the randomized postal survey (study II), 400 students received the questionnaire and 239 forms were returned (including 137 females). The written questionnaires issued to students, were devised to compile information about demographic characteristics, sexual behavior and experience, knowledge of and attitudes to STD including AIDS, and the use of contraceptives. They were only minor differences between the questionnaires for study I and study II (see below). The questions were also designed to investigate disparities in their perceived and actual sexual behavior in regard to their risk of exposure to STDs. One question was repeated in different wording in order to check for inconsistencies. The questionnaire was tested on 20 stude~ats before the final version was adopted. Information concerning age at first intercourse, the total number of sexual partners, the number of recent sexual partners (defined as those in the past year) and STD experience were requested of the students. Personal experience of abortion was added in the postal survey (study II). Six questions were formulated around previous and current use of contraceptives. The postal survey had one question about the preferred contraceptive while the other survey required detailed information about recent changes in contraceptive use and the reason for change. Specific questions investigated beliefs about oral contraceptives. Ninety-five percent of the questions were answered in both surveys. The project was approved by the local ethics committee at the Faculty of Medicine, University of Uppsala.
Results
Two hundred and forty-one females participated in the first survey (study I) and 137 females in the postal survey (study II). The number of students from each faculty participating in the survey was proportional to the overall distribution of students within faculties. The mean age of the 241 females in study I was 23.2 _+ 2.8 years (mean _+ SD) and 23.4 + 2.8 in study II. Two hundred and twenty-eight females in study I (96%) were sexually experienced compared with 119 (87%) in study II. Students were asked at which age they wanted to have their first child. Their estimated mean desired age for the birth of the first child was also identical (29.0 + 2.4 years). In study II, 11% (n -- 13) had had an abortion. The mean age at first intercourse was identical: 17.6 with a range from 13 (11, study II) to 25 years. The total number of partners was also identical in both studies (6 partners; range 1-50). The mean number of recent partners, defined as the number of partners in the past 12 months, was similar: 1.7 and 1.4 with a range from 0-9 (0-5, study II) partners in study I and study II, respectively. Thirty-four percent of the women in studies I and II had had two or more partners during the last year. The contraceptive methods used at first intercourse, most recent intercourse and with a new partner are shown in Table 1. A substantial proportion of students either did not use any contraceptives or practiced coitus interruptus (around 40%) at their first coitus and as many as 12-20% did not use safer methods later on. The
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Tyddn et aL
percentage of students using condoms did not reach 50%. However, this was the most common contraceptive method at first intercourse. OCs were the preferred method later on and were used by 58% of the women in study I at their most recent intercourse. Less than 5% from both studies combined OC with condom when changing partners. Table 1 Use of different contraceptives at first coitus, most recent coitus and first coitus with a new partner in the Health Center survey and the postal survey. The number of respondents within each category are given, together with percentages (of total responders) in brackets
First coitus
Most recent coitus
First coitus with a new partner
Study I
Study 11
Study I
Study 1I
Study I
Study 11
No contraceptives or interrupted
90 (40)
51 (43)
27 (12)
19 (16)
45 (20)
18 (15)
Diaphragm
Female university students in Sweden: sex, contraception and STDs T. TYDi~N (1), S. OLSSON (1) AND C. BJORKELUND-YLANDER (2)
(1) Department of Obstetrics and Gynecology, Universityof Uppsala, S-751 85 Uppsala, Sweden (2) Student Health Center, Uppsala, Sweden Abstract
Female university students (n = 241) visiting the Student Health Center participated in a study concerning sexual behavior (study I). A randomized postal survey (study II) with similar questions was also performed to verify the findings in the first study (n = 137). The mean age was 23 years in both studies. Sexual experience was reported by 96% in study I and 87% in study II. Mean age at first intercourse and mean number of partners were similar; 17.6 years and 6 partners, respectively. Change of contraceptive type was frequent, and about one third had done so within the past two years. A common reason for adopting a new method was a change in social life. More than half the women were afraid of using oral contraceptives. Twenty-six percent of the students in study I and 29% in study II had had at least one sexually transmitted disease (STD). Forty-three percent claimed to have changed their sexual behavior as a result of AIDS publicity but condoms were used by less than 50% at the first intercourse with a new partner. Although this group of intelligent young people have access to information, many of them were risk-takers with respect to both unwanted pregnancies and STD. Misconceptions were frequent concerning the safety of OCs. It is clear that new approaches must be made to educate them about safe sexual practices.
Introduction
An increasing incidence of sexually transmitted diseases (STDs) was noted during the 1970s and 1980s [1]. As sexually transmitted diseases can impair fertility, much effort is thus spent today on treating sequelae of STDs [2].
This paper is based on a presentation given at the Seventh International Meeting of the Scoiety for the Advancement of Contraception, which was held in Singapore on 4-11 November, 1990.
166
Tyd6n et al.
Prevention programs directed towards minimizing the spread of STDs, and HIV in particular, have recently been undertaken in most Western countries. Emphasis has been placed on reducing the risk of infection by adopting a monogamous relationship or by use of a condom. Information campaigns promoting the use of condoms, together with the debate about the potential risk of breast cancer in women who have used combined oral contraceptives (OC) for long periods, have probably been the two main reasons behind a decreased use of OCs in Sweden during this period [3]. The increase in the abortion rate which has been evident in Sweden since 1985 may well reflect the rejection of a more effective contraceptive method, such as the pill, for another less effective method like the condom. Adolescent sexual behavior is known to be associated with the risk of STDs and unwanted pregnancies [4]. University students are known to be a sexually active group [5,6] as they are in a period of life when they are trying to find a partner with whom they can establish a more permanent relationship. A program to improve knowledge and promote awareness about contraception and STDs among university students was commenced in 1989 by health workers from the Student Health Center, Uppsala, Sweden. The first step was to interview students by means of a written questionnaire offered to those visiting the Student Health Center. The purpose of the survey was to equip counsellors with relevant information about the sexual behavior and experience of students, their knowledge of and attitudes to STDs, including AIDS, and their use of contraceptive methods [7]. A high degree of risk-taking behavior was found in this group. These findings were validated in a postal survey of a randomized group of students (from the whole population of students in Uppsala) using an almost identical questionnaire. This evaluation was performed before the final planning of a targeted educational intervention program for students. The intervention has recently been launched and the evaluation of its success will be the final step of this project. In the present paper we report about contraceptive methods in relation to sexually transmitted diseases among female students participating in the two surveys.
Materials and methods
University students (n =379; 275 females) visiting the Student Health Center were asked to participate in a study concerning sexual behavior (study I). This outpatient facility serves about 20,000 students at the two universities in Uppsala, and about 4000 patients are seen during the academic year. Approximately 50% of patient visits are related to contraceptive counselling and other gynecologic care, and are seen by a midwife and gynecologist, respectively. Women with with acute and chronic disorders are seen by GPs, and the remainder are concerned with psychological care. The investigators of this study were associated with the Student Health Center as general practitioner, gynecologist and family planner (nurse/midwife). The students were offered a brief look at the questionnaire. If they were interested, a questionnaire and a stamped envelope were delivered, which made completion in the privacy of their own homes possible. This procedure also guaranteed their anonymity. A total of 90% (n = 343) agreed to participate, 102 males
Female UniversityStudents in Sweden
167
and 241 females. In the randomized postal survey (study II), 400 students received the questionnaire and 239 forms were returned (including 137 females). The written questionnaires issued to students, were devised to compile information about demographic characteristics, sexual behavior and experience, knowledge of and attitudes to STD including AIDS, and the use of contraceptives. They were only minor differences between the questionnaires for study I and study II (see below). The questions were also designed to investigate disparities in their perceived and actual sexual behavior in regard to their risk of exposure to STDs. One question was repeated in different wording in order to check for inconsistencies. The questionnaire was tested on 20 stude~ats before the final version was adopted. Information concerning age at first intercourse, the total number of sexual partners, the number of recent sexual partners (defined as those in the past year) and STD experience were requested of the students. Personal experience of abortion was added in the postal survey (study II). Six questions were formulated around previous and current use of contraceptives. The postal survey had one question about the preferred contraceptive while the other survey required detailed information about recent changes in contraceptive use and the reason for change. Specific questions investigated beliefs about oral contraceptives. Ninety-five percent of the questions were answered in both surveys. The project was approved by the local ethics committee at the Faculty of Medicine, University of Uppsala.
Results
Two hundred and forty-one females participated in the first survey (study I) and 137 females in the postal survey (study II). The number of students from each faculty participating in the survey was proportional to the overall distribution of students within faculties. The mean age of the 241 females in study I was 23.2 _+ 2.8 years (mean _+ SD) and 23.4 + 2.8 in study II. Two hundred and twenty-eight females in study I (96%) were sexually experienced compared with 119 (87%) in study II. Students were asked at which age they wanted to have their first child. Their estimated mean desired age for the birth of the first child was also identical (29.0 + 2.4 years). In study II, 11% (n -- 13) had had an abortion. The mean age at first intercourse was identical: 17.6 with a range from 13 (11, study II) to 25 years. The total number of partners was also identical in both studies (6 partners; range 1-50). The mean number of recent partners, defined as the number of partners in the past 12 months, was similar: 1.7 and 1.4 with a range from 0-9 (0-5, study II) partners in study I and study II, respectively. Thirty-four percent of the women in studies I and II had had two or more partners during the last year. The contraceptive methods used at first intercourse, most recent intercourse and with a new partner are shown in Table 1. A substantial proportion of students either did not use any contraceptives or practiced coitus interruptus (around 40%) at their first coitus and as many as 12-20% did not use safer methods later on. The
168
Tyddn et aL
percentage of students using condoms did not reach 50%. However, this was the most common contraceptive method at first intercourse. OCs were the preferred method later on and were used by 58% of the women in study I at their most recent intercourse. Less than 5% from both studies combined OC with condom when changing partners. Table 1 Use of different contraceptives at first coitus, most recent coitus and first coitus with a new partner in the Health Center survey and the postal survey. The number of respondents within each category are given, together with percentages (of total responders) in brackets
First coitus
Most recent coitus
First coitus with a new partner
Study I
Study 11
Study I
Study 1I
Study I
Study 11
No contraceptives or interrupted
90 (40)
51 (43)
27 (12)
19 (16)
45 (20)
18 (15)
Diaphragm
