1
|
Palmeira-de-Oliveira R, Oliveira AS, Rolo J, Tomás M, Palmeira-de-Oliveira A, Simões S, Martinez-de-Oliveira J. Women's preferences and acceptance for different drug delivery routes and products. Adv Drug Deliv Rev 2022; 182:114133. [PMID: 35104506 DOI: 10.1016/j.addr.2022.114133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
To use or not to use, that is the first decision to take regarding a drug product. This mandatory step for adherence dictates product efficacy. The determinants for such decision do not only rely on the priority of the therapeutic or preventive strategy, but are related to a complex network of perceptions, preferences, personal and cultural backgrounds, and results from previous experiences. Women's preferences for dosage forms and even for drug delivery routes have been mainly studied in the fields of contraception and HIV prevention (and their related multipurpose approaches). Much less attention has been devoted to other therapeutic or preventive strategies. In a time when patient-centred approaches and shared decisions are increasingly valued, considering women's preferences and their main determinants is essential for product development and selection. Such products will be more likely to be chosen and used as intended, increasing efficacy, and reducing the overall costs related with these treatments. This knowledge shall be integrated in early stages of product development. This article reviews the state of the art related with women's preferences and acceptance for different dosage forms and drug delivery routes involved in women's health. The methodologies used for collecting these data and their major drawbacks are discussed. Results obtained from acceptability studies and the main determinants for selection of preventive and treatment drug products are discussed as tools for new developments in the field.
Collapse
Affiliation(s)
- Rita Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal.
| | - Ana Sofia Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Joana Rolo
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
| | - Mariana Tomás
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Ana Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Sérgio Simões
- CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - José Martinez-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
| |
Collapse
|
2
|
Zaveri T, Powell KA, Guthrie KM, Bakke AJ, Ziegler GR, Hayes JE. Qualitative exploration of intrinsic and extrinsic factors that influence acceptability of semisoft vaginal suppositories. BMC Womens Health 2018; 18:170. [PMID: 30342510 PMCID: PMC6195955 DOI: 10.1186/s12905-018-0657-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/30/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Vaginal microbicides are a promising means to prevent the transmission of HIV and other sexually transmitted infections, by empowering women to initiate use prophylactically when they perceive themselves to be at risk. However, in clinical trials, microbicides have shown mixed results, with the consistent finding that effectiveness varies substantially as a function of user adherence. METHODS Based on the assumption that adherence is driven, at least in part, by product properties that influence acceptability, we used softgel technology to develop vaginal drug delivery systems in the intermediate texture space between solids and liquids to overcome potential shortcomings of current dosage forms. Here, we used focus groups and surveys to determine women's initial reactions (i.e., acceptance and willingness-to-try) for semisoft vaginal suppositories intended for HIV and STI prevention, with a specific focus on how perception of and preferences for vaginal suppositories may be influenced by product characteristics such as size, shape, and firmness. RESULTS Via focus groups, we identified intrinsic and extrinsic factors relevant to acceptability of semisoft suppository prototypes. Willingness-to-try depended on factors like intended functionality, anticipated leakage, type of sex, recommended frequency of use, type of sexual partner, and perceived risk. When handled ex vivo, shape, size, and firmness of suppositories communicated information about ease of imagined insertion and handling, perceived effectiveness, anticipated awareness and comfort of the product in the body. These impressions were partly based on prior experience with vaginal products. CONCLUSIONS Sensory attributes appear to play a substantial role in women's preferences and willingness to try the semisoft suppositories. Using these methods during preclinical development should help efficiently optimize a final product that is both biologically efficacious and preferred by women, toward a goal of enhancing adherence and effectiveness.
Collapse
Affiliation(s)
- Toral Zaveri
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
| | - Kimberly A Powell
- College of Education, The Pennsylvania State University, University Park, PA 16802 USA
- College of Arts and Architecture, The Pennsylvania State University, University Park, PA 16802 USA
| | - Kate M Guthrie
- Centers for Behavioral & Preventive Medicine, the Miriam Hospital, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02906 USA
| | - Alyssa J Bakke
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
| | - Gregory R Ziegler
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
| | - John E Hayes
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
| |
Collapse
|
3
|
Higgins JA, Smith NK. The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept. JOURNAL OF SEX RESEARCH 2016; 53:417-56. [PMID: 26954608 PMCID: PMC4868075 DOI: 10.1080/00224499.2015.1134425] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
How contraceptives affect women's sexual well-being is critically understudied. Fortunately, a growing literature focuses on sexual aspects of contraception, especially hormonal contraception's associations with libido. However, a more holistic approach to contraceptive sexual acceptability is needed to capture the full range of women's sexual experiences. We conducted a narrative literature review of this topic, working with an original sample of 3,001 citations published from 2005 to 2015. In Part 1, we draw from a subset of this literature (264 citations) to build a new conceptual model of sexual acceptability. Aspects include macro factors (gender, social inequality, culture, and structure), relationship factors (dyadic influences and partner preferences), and individual factors (sexual functioning, sexual preferences, such as dis/inhibition, spontaneity, pleasure, the sexual aspects of side effects, such as bleeding, mood changes, sexual identity and sexual minority status, and pregnancy intentions). In Part 2, we review the empirical literature on the sexual acceptability of individual methods (103 citations), applying the model as much as possible. Results suggest contraceptives can affect women's sexuality in a wide variety of positive and negative ways that extend beyond sexual functioning alone. More attention to sexual acceptability could promote both women's sexual well-being and more widespread, user-friendly contraceptive practices.
Collapse
|
4
|
Mahan ED, Zaveri T, Ziegler GR, Hayes JE. Relationships between perceptual attributes and rheology in over-the-counter vaginal products: a potential tool for microbicide development. PLoS One 2014; 9:e105614. [PMID: 25188244 PMCID: PMC4154878 DOI: 10.1371/journal.pone.0105614] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 07/26/2014] [Indexed: 12/11/2022] Open
Abstract
Vaginal microbicides are believed to have substantial potential to empower women to protect themselves from HIV, although clinical trials to date have had mixed results at best. Issues with patient adherence in these trials suggest additional emphasis should be placed on optimizing acceptability. Acceptability is driven, in part, by the sensory properties of the microbicide, so better understanding of the relationships between sensory properties and the physical and rheological properties of microbicides should facilitate the simultaneous optimization of sensory properties in parallel with the biophysical properties required for drug deployment. Recently, we have applied standard methods to assess the potential acceptability of microbicide prototypes ex vivo and to quantify the sensory properties of microbicide surrogates. Here, we link quantitative perceptual data to the rheological properties of 6 over-the counter (OTC) vaginal products used as ex vivo microbicide surrogates. Shear-thinning behavior (n) and tan δ (10 rad/s) showed no relationship with any perceptual attributes while shear storage modulus, G’ (10 rad/s) was correlated with some attributes, but did not appear to be a strong predictor of sensory properties. Conversely, the storage loss modulus, G” (10 rad/s) and the consistency coefficient, K, were correlated with several sensory attributes: stickiness, rubberiness, and uniform thickness for G’’ and stickiness, rubberiness, and peaking for K. Although these relationships merit confirmation in later studies, this pilot study suggests rheological principles can be used to understand the sensory properties evoked by microbicide surrogates assessed ex vivo. Additional work is needed to determine if these findings would apply for microbicides in vivo.
Collapse
Affiliation(s)
- Ellen D. Mahan
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Toral Zaveri
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Gregory R. Ziegler
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - John E. Hayes
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- * E-mail:
| |
Collapse
|
5
|
Best C, Tanner AE, Hensel DJ, Fortenberry JD, Zimet GD. Young women's contraceptive microbicide preferences: associations with contraceptive behavior and sexual relationship characteristics. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2014; 46:15-22. [PMID: 24325312 PMCID: PMC4183361 DOI: 10.1363/46e0114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
CONTEXT In time, microbicides may provide women with dual prevention against pregnancy and STDs. Although several microbicide dimensions have been evaluated, little is known about women's preferences for contraceptive microbicides and correlates of these preferences. METHODS Acceptability of a hypothetical contraceptive microbicide cream or jelly was examined among a -clinic-based sample of 266 women in Indianapolis from 2004 (when participants were aged 14-22) to 2008. Group conjoint analyses and individual conjoint analyses were used to compare preferences with respect to four microbicide -dimensions: contraceptive ability, efficacy in relation to condoms, timing of use and texture. Pearson's product moment correlations were used to examine the relationship between preferences for a contraceptive microbicide and selected characteristics of the women. RESULTS Overall, the top-rated microbicide dimensions were efficacy in relation to that of condoms and contraceptive ability (importance scores, 40.0 and 35.4 out of 100.0, respectively). When all dimension levels were compared, contraceptive ability was the most strongly preferred (part-worth utility score, 8.9), and lower efficacy than that of -condoms was the least strongly preferred (-11.9). Preference for contraceptive microbicides was positively -associated with current contraceptive use, sexual agency, partner communication, commitment to avoiding pregnancy and -perceived partner agreement about avoiding pregnancy (coefficients, 0.07-0.18). It was negatively associated with current or past nonuse of contraceptives, seeking pregnancy and perceived partner agreement about seeking -pregnancy (-0.08 to -0.14). CONCLUSIONS Microbicides with dual prevention properties may be attractive to young women. Microbicide development and subsequent clinical trials should incorporate contraceptive microbicides.
Collapse
Affiliation(s)
- Candace Best
- Candace Best is assistant professor, Department of Psychology, Georgia Regents University, Augusta
| | | | | | | | | |
Collapse
|
6
|
Catallozzi M, Williams CY, Zimet GD, Hargreaves KM, Gelber SE, Ratner AJ, Stanberry LR, Rosenthal SL. Attitudes towards microbicide use for bacterial vaginosis in pregnancy. Sex Health 2014; 11:305-12. [PMID: 25140927 DOI: 10.1071/sh14011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/27/2014] [Indexed: 01/11/2023]
Abstract
UNLABELLED Background Bacterial vaginosis (BV) is the most common reproductive tract infection (RTI) and is a significant risk factor for preterm birth. Microbicides could be an option for the prevention and treatment of BV in pregnancy, and understanding use of the product will be crucial. The present study explored attitudes of women in the third trimester of pregnancy regarding topical microbicide use for the prevention and treatment of BV. METHODS Twenty-six women in their third trimester were interviewed regarding their knowledge and beliefs about RTIs during pregnancy and attitudes concerning the use of topical microbicides for prevention and treatment of BV. RESULTS Participants had a mean age of 24.9 years, were largely under-represented minorities and the majority had had past pregnancies. Participants had knowledge and experience with RTIs but not BV. They were open to the use of microbicides for prevention or treatment of BV, but believed that women requiring treatment would be more motivated. Rationales for acceptability were most commonly related to the baby's health. Practical issues that may interfere with use were often, but not always, related to pregnancy. There was a range of attitudes about partner involvement in decision-making and the practicalities of product use. CONCLUSION Pregnant women are knowledgeable about RTIs but not necessarily BV. The women in this study found microbicide use acceptable, particularly for treatment. To improve acceptability and use, education would be needed about BV and possible complications, how to overcome practical problems and the value of involving partners in the decision.
Collapse
Affiliation(s)
- Marina Catallozzi
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
| | - Camille Y Williams
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN 46202, USA
| | - Katharine M Hargreaves
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
| | - Shari E Gelber
- Weill Cornell Medical College, 525 East 168th Street, New York, NY 10065, USA
| | - Adam J Ratner
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
| | - Lawrence R Stanberry
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
| |
Collapse
|
7
|
Tanner AE, Roof KA, Katz BP, Katschke A, Fortenberry JD, Zimet GD. A comparison of young women's actual and assigned timing of use of a microbicide surrogate. Sex Health 2012; 9:299-303. [PMID: 22877587 DOI: 10.1071/sh11063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 10/10/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE This study examined young women's actual timing of use of a microbicide surrogate gel (vaginal moisturiser (VM)) compared with assigned timing conditions. METHODS Participants used a VM with coitus during 4-week cycles over a 3-year period in random timing sequences: 1h before coitus, 10 min before coitus and 10 min after coitus. Daily diaries collected information related to coital behaviours, VM use and timing, and participants' and partners' VM assessments. Descriptive and mixed-effects model analyses were conducted. RESULTS At least three VM timing conditions were completed by 109 women aged 18-22 years old. Of 17?772 diary days collected, coitus was reported on 2128 (1252 with VM use; 59%). Median times between VM application and coitus were: 60 min before coitus (mean=68.2; s.d.=76.9) for the 1-h pre-coital group, 13.5 min before coitus (mean=44.9; s.d.=117.1) for the 10-min pre-coital group and 5 min before coitus (mean=24.5; s.d.=205.1) for the 10-min post-coital group. Women reported that the VM was very easy to use (68%), it was somewhat messy (61%), they were very wet during sex (81%), sex was very good (80%) and their partners liked using the VM (38%). CONCLUSIONS Overall, the VM was rated positively. There was substantial deviation in application time across timing conditions, with significantly greater variability in the post-coital group. These findings contribute to understanding of how VMs are accepted and used, with implications for HIV prevention with microbicides requiring specific application timing.
Collapse
Affiliation(s)
- Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC 27401, USA
| | | | | | | | | | | |
Collapse
|
8
|
Mahan ED, Morrow KM, Hayes JE. Quantitative perceptual differences among over-the-counter vaginal products using a standardized methodology: implications for microbicide development. Contraception 2011; 84:184-93. [PMID: 21757061 DOI: 10.1016/j.contraception.2010.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 09/21/2010] [Accepted: 11/17/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing prevalence of HIV infection among women worldwide has motivated the development of female-initiated prevention methods, including gel-based microbicides. User acceptability is vital for microbicide success; however, varying cultural vaginal practices indicate multiple formulations must be developed to appeal to different populations. Perceptual attributes of microbicides have been identified as primary drivers of acceptability; however, previous studies do not allow for direct comparison of these qualities between multiple formulations. STUDY DESIGN Six vaginal products were analyzed ex vivo using descriptive analysis. Perceptual attributes of samples were identified by trained participants (n=10) and rated quantitatively using scales based on a panel-developed lexicon. Data were analyzed using two-way ANOVAs for each attribute; product differences were assessed via Tukey's honestly significant difference test. RESULTS Significant differences were found between products for multiple attributes. Patterns were also seen for attributes across intended product usage (i.e., contraceptive, moisturizer or lubricant). For example, Options© Gynol II® (Caldwell Consumer Health, LLC) was significantly stickier and grainier than other products. CONCLUSIONS Descriptive analysis, a quantitative approach that is based on consensus lexicon usage among participants, successfully quantified perceptual differences among vaginal products. Since perceptual attributes of products can be directly compared quantitatively, this study represents a novel approach that could be used to inform rational design of microbicides.
Collapse
Affiliation(s)
- Ellen D Mahan
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, 16802, USA
| | | | | |
Collapse
|
9
|
Morrow KM, Hendrix C. Clinical evaluation of microbicide formulations. Antiviral Res 2010; 88 Suppl 1:S40-6. [PMID: 21109067 PMCID: PMC3053029 DOI: 10.1016/j.antiviral.2010.09.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 09/08/2010] [Accepted: 09/14/2010] [Indexed: 11/25/2022]
Abstract
The clinical evaluation of microbicide formulations presents variable and interacting challenges. Specific domains of acceptability, pharmacokinetics, and toxicity interact with each other to potentially inhibit or enhance a microbicide's efficacy. Each of these is further influenced by application and use parameters in the relative presence (or absence) of vaginal and/or seminal fluids, ultimately impacting effectiveness. Historically, acceptability of formulation and use parameters, and their concomitant behavioral influences, have been considered separately from pharmacokinetics and toxicity. While independent evaluation of these elements is necessary in some respects, we must acknowledge that this approach is not sufficient for the successful development of microbicides. Each needs to be considered in an integrated clinical evaluation strategy. This article presents the rationale for such an approach. This article forms part of a special supplement covering two presentations on clinical evaluation of microbicides from the symposium on "Recent Trends in Microbicide Formulations" held on 25 and 26 January 2010, Arlington, VA.
Collapse
Affiliation(s)
- Kathleen M Morrow
- The Miriam Hospital and The Warren Alpert Medical School of Brown University, CBPM, Coro West, 1 Hoppin Street, Providence, RI 02903, USA.
| | | |
Collapse
|
10
|
Verguet S, Young Holt B, Szeri AJ. Increasing the effectiveness of vaginal microbicides: a biophysical framework to rethink behavioral acceptability. PLoS One 2010; 5:e15501. [PMID: 21124931 PMCID: PMC2989916 DOI: 10.1371/journal.pone.0015501] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 10/04/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Microbicide candidates delivered via gel vehicles are intended to coat the vaginal epithelium after application. The coating process depends on intrinsic biophysical properties of the gel texture, which restricts the potential choices for an effective product: the gel first must be physically synthesizable, then acceptable to the user, and finally applied in a manner promoting timely adequate coating, so that the user adherence is optimized. We present a conceptual framework anchoring microbicide behavioral acceptability within the fulfillment of the product biophysical requirements. METHODS We conducted a semi-qualitative/quantitative study targeting women aged 18-55 in Northern California to assess user preferences for microbicide gel attributes. Attributes included: (i) the wait time between application and intercourse, (ii) the gel texture and (iii) the trade-off between wait time and gel texture. Wait times were assessed using a mathematical model determining coating rates depending upon the gel's physical attributes. RESULTS 71 women participated. Results suggest that women would independently prefer a gel spreading rapidly, in 2 to 15 minutes (P<0.0001), as well as one that is thick or slippery (P<0.02). Clearly, thick gels do not spread rapidly; hence the motivation to study the trade-off. When asked the same question 'constrained' by the biophysical reality, women indicated no significant preference for a particular gel thickness (and therefore waiting time) (P>0.10) for use with a steady partner, a preference for a watery gel spreading rapidly rather than one having intermediate properties for use with a casual partner (P = 0.024). CONCLUSIONS Biophysical constraints alter women's preferences regarding acceptable microbicide attributes. Product developers should offer a range of formulations in order to address all preferences. We designed a conceptual framework to rethink behavioral acceptability in terms of biophysical requirements that can help improve adherence in microbicide use ultimately enhancing microbicide effectiveness.
Collapse
Affiliation(s)
- Stéphane Verguet
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
| | | | | |
Collapse
|
11
|
Tanner AE, Fortenberry JD, Zimet GD, Reece M, Graham CA, Murray M. Young Women's use of a microbicide surrogate: the complex influence of relationship characteristics and perceived male partners' evaluations. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:735-747. [PMID: 19224355 DOI: 10.1007/s10508-008-9464-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 03/26/2008] [Accepted: 08/16/2008] [Indexed: 05/27/2023]
Abstract
Currently in clinical trials, vaginal microbicides are proposed as a female-initiated method of sexually transmitted infection prevention. Much of microbicide acceptability research has been conducted outside of the United States and frequently without consideration of the social interaction between sex partners, ignoring the complex gender and power structures often inherent in young women's (heterosexual) relationships. Accordingly, the purpose of this study was to build on existing microbicide research by exploring the role of male partners and relationship characteristics on young women's use of a microbicide surrogate, an inert vaginal moisturizer (VM), in a large city in the United States. Individual semi-structured interviews were conducted with 40 young women (18-23 years old; 85% African American; 47.5% mothers) following use of the VM during coital events for a 4 week period. Overall, the results indicated that relationship dynamics and perceptions of male partners influenced VM evaluation. These two factors suggest that relationship context will need to be considered in the promotion of vaginal microbicides. The findings offer insights into how future acceptability and use of microbicides will be influenced by gendered power dynamics. The results also underscore the importance of incorporating men into microbicide promotion efforts while encouraging a dialogue that focuses attention on power inequities that can exist in heterosexual relationships. Detailed understanding of these issues is essential for successful microbicide acceptability, social marketing, education, and use.
Collapse
Affiliation(s)
- Amanda E Tanner
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Room 733, Baltimore, MD 21205, USA.
| | | | | | | | | | | |
Collapse
|
12
|
Microbicide acceptability and associated factors among female sex workers and male clients in Kaiyuan county, Yunnan province, China. J Acquir Immune Defic Syndr 2010; 53 Suppl 1:S93-7. [PMID: 20104117 DOI: 10.1097/qai.0b013e3181c7de7b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine microbicide acceptability and associated factors among female sex workers (FSWs) and their clients in Yunnan, China. METHODS Kaiyuan County, with high rates of HIV in FSWs, in Yunnan Province was chosen as the study site. Establishments were selected using stratified sampling, and FSWs were recruited using random sampling. Male clients of FSWs were also recruited. In-depth interviews and anonymous questionnaires were used to collect data. An acceptance rate was calculated for each individual variable, and factors associated with acceptability were assessed using multivariate analysis. RESULTS Four hundred FSWs and 200 male clients were recruited. Microbicides were acceptable if they prevented HIV transmission effectively and safely, were lubricating, effective up to 24 hours, and <10 China Yuan (CNY) (US $1.50) per use. Eighty-one percent of participants indicated future intention to use microbicides. Factors associated with potential microbicide use included age, establishment stratum, price, perception of risk behavior, and knowledge of AIDS/sexually transmitted infections. CONCLUSIONS The acceptablitiy of microbmicides is high among FSWs and their clients. Development of effective and affordable microbicides has great potential for controlling sexual transmission of the HIV epidemic in China.
Collapse
|
13
|
Cook RL, Downs JS, Marrazzo J, Switzer GE, Tanriover O, Wiesenfeld H, Murray PJ, Hillier SL. Preferred characteristics of vaginal microbicides in women with bacterial vaginosis. J Womens Health (Larchmt) 2009; 18:1163-7. [PMID: 19630538 DOI: 10.1089/jwh.2008.1067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vaginal microbicides have the potential to reduce HIV/STD acquisition when used consistently. Our objectives were to determine product attributes associated with willingness to use a vaginal microbicide and whether product preferences varied according to participant characteristics. METHODS Women (n = 408) with bacterial vaginosis (BV) were recruited as part of a randomized trial to prevent BV. Participants completed a survey interview that assessed demographic information, sexual history, and douching behavior. To assess microbicide preferences, women rated whether specific product attributes would make them more or less likely to use a vaginal microbicide. Principal components analyses revealed two major groupings for the product attribute items. We determined the relative importance of each group of product attributes and whether the importance of the different groupings varied among subgroups of women. RESULTS The participants' mean age was 24 years (range 14-45), 64% were black, and 74% were unmarried. Overall, participants reported being most likely to use a vaginal product with protection properties (2.54), whereas they were nearly neutral regarding side effects (0.56). The individual product attributes, could prevent BV, could prevent vaginal odor (2.72), and could prevent vaginal itching and burning (2.61), were rated similarly or slightly higher than could reduce the risk of getting an STD (2.58) or could reduce the risk of getting HIV (2.44). In multivariate analyses, protection attributes were rated significantly higher among older women and marginally higher in women with a greater number of lifetime sexual partners. Younger women were most likely to report that side effects would affect their likelihood of using the product. CONCLUSIONS Women with BV rated potential protection features of a vaginal microbicide higher than side effects. A product's personal hygiene aspects were rated equally or more important than the product's ability to prevent HIV/STD infections. Younger women may respond to different factors that influence product acceptability and adherence.
Collapse
|
14
|
Tanner AE, Short MB, Zimet GD, Rosenthal SL. Research on adolescents and microbicides: a review. J Pediatr Adolesc Gynecol 2009; 22:285-91. [PMID: 19616456 PMCID: PMC2739269 DOI: 10.1016/j.jpag.2008.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 08/13/2008] [Accepted: 08/20/2008] [Indexed: 10/20/2022]
Abstract
Adolescents are an important target for microbicide research, as they are disproportionately affected by sexually transmitted infections and currently are underrepresented in the microbicide research literature. Furthermore, adolescents are psychosocially and biologically different from adults, and findings from adult research cannot be assumed to apply universally to adolescents. Adolescents, to date have rarely been included in clinical trials and acceptability research for microbicides, in part because their participation requires attention to unique developmental issues, including parental consent and confidentiality. Despite these challenges, adolescents should be included in microbicide clinical research. If adolescents are ultimately expected to use microbicides, it is essential that we understand the developmental, contextual, and relationship variables that may influence use and acceptability. Accordingly, the goal of this paper was to examine the issues affecting the inclusion of adolescents in microbicide clinical research as well as review the existing adolescent-specific microbicide research, which highlights the various factors that may influence use and acceptability. It is hoped that this review can provide guidance for future work with this important, specialized population.
Collapse
Affiliation(s)
- Amanda E Tanner
- Department of Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | |
Collapse
|
15
|
Short MB, Rosenthal SL, Auslander BA, Succop PA. Relationship context associated with microbicide-like product use. J Pediatr Adolesc Gynecol 2009; 22:313-7. [PMID: 19592280 PMCID: PMC3891042 DOI: 10.1016/j.jpag.2009.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 02/02/2009] [Accepted: 02/11/2009] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE Topical microbicides are being developed to provide an alternative method of prevention of HIV and sexually transmitted infections. Although topical microbicides would be a female-controlled method of prevention, their use is likely to be disclosed to partners. Thus, the characteristics of the partner relationship may play a role in their use. We sought to examine whether qualities of the relationship and of the partner were associated with using a microbicide-like product. DESIGN We studied 166 females (14 to 21 years of age) who were participating in a 6-month study of microbicide-like products (vaginal lubricants). They described partner relationships and characteristics of the partners. RESULTS Of the 166 participants, 118 used the product. In bivariate analyses, those whose relationships were longer, monogamous, more mutual, and more satisfying were more likely to use the product. Further, when sex occurred in the young women's or couples' homes, use also was more likely. There was no relationship between product use and whether the partner had a job or was in school or between the partners' levels of substance use. In a multivariable logistic regression with backwards elimination, only relationship satisfaction remained significant in the model. CONCLUSION Topical microbicides will be used within the context of a relationship, and characteristics of the relationship most likely will influence use. These findings suggest that special attention may have to be given to supporting use in high-risk relationships and that all interventions to enhance uptake should consider the relationship context.
Collapse
Affiliation(s)
- Mary B Short
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas 77555-0319, USA
| | | | | | | |
Collapse
|
16
|
Montandon M, Sahin-Hodoglugil NN, Bukusi E, Agot K, Boland B, Cohen CR. Sexuality, HIV risk and potential acceptability of involving adolescent girls in microbicide research in Kisumu, Kenya. Sex Health 2009; 5:339-46. [PMID: 19061553 DOI: 10.1071/sh08011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 06/19/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Current microbicide clinical trials primarily enroll adult participants; however, females under the age of 18, because of their high rates of HIV acquisition, represent an important population for future microbicide clinical research. We sought to understand the individual, family and community-level factors that may influence the acceptability of microbicide use and research involving adolescent girls. METHODS We conducted 30 interviews with adolescent girls aged 14-17 and nine focus group discussions with adolescent girls, parents and community leaders in Kisumu, Kenya. Participants discussed adolescent sexuality, HIV prevention methods, perceptions about microbicide use and views about microbicide research involving adolescent girls. RESULTS Adolescent sexual activity is stigmatised yet acknowledged to be a natural part of the 'adolescent stage.' Desperation to stop the spread of HIV among youth and support for female-initiated HIV prevention methods led to enthusiasm about microbicides and future microbicide research. Yet concerns about microbicides were numerous and included: difficulty using it in a timely manner due to the rushed, unplanned nature of adolescent sex; a fear of trying experimental products; concerns about microbicide efficacy; and parental worry that supporting microbicide use in youth would defy societal pressures that denounce adolescent sexual activity. CONCLUSIONS Microbicide acceptability for youth in sub-Saharan Africa may be bolstered by desperation for new methods to stop the spread of HIV, yet hindered by misgivings about experimental HIV prevention methods for youth. Understanding and addressing the microbicide's perceived benefits and shortcomings, as well as the broader context of adolescent sexuality and HIV prevention, may facilitate future research and promotion of microbicides in this high-risk group.
Collapse
Affiliation(s)
- Michele Montandon
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94105, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Tanner AE, Zimet G, Fortenberry JD, Reece M, Graham C, Murray M. Young women's use of a vaginal microbicide surrogate: the role of individual and contextual factors in acceptability and sexual pleasure. JOURNAL OF SEX RESEARCH 2009; 46:15-23. [PMID: 19012060 DOI: 10.1080/00224490802398407] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Currently in clinical trials, microbicides have historically been promoted as a woman-controlled (although more recently woman initiated) method of sexually transmitted infection (STI) prevention. The contradicition that exists in this rationale is that women's bodies, specifically the genitals, have been constructed as a negotiated space within sexual interactions. This study qualitatively explored the factors influencing 40 young women's use of a vaginal moisturizer (VM), utilized as a microbicide surrogate. The results indicated that use of the VM was dependent upon product characteristics (i.e., the lubricating qualities affect on sexual pleasure, timing of insertion), individual factors (i.e., reproductive health goals, experiences with side effects of existing contraceptive methods), and contextual factors (i.e., social norms). An understanding of these bodily and social issues may be beneficial in designing targeted educational campaigns and effective instructional materials as well as in facilitating positive dialogue around women's bodies and their sexuality.
Collapse
Affiliation(s)
- Amanda E Tanner
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Tanner AE, Katzenstein JM, Zimet GD, Cox DS, Cox AD, Fortenberry JD. Vaginal microbicide preferences among midwestern urban adolescent women. J Adolesc Health 2008; 43:349-56. [PMID: 18809132 PMCID: PMC2593640 DOI: 10.1016/j.jadohealth.2008.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 01/23/2008] [Accepted: 02/19/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to assess adolescent women's preferences for specific microbicide characteristics including pregnancy prevention, timing of application, potential for side effects, and whether it targeted human immunodeficiency virus (HIV) or other sexually transmitted infections (STI). Potential differences in microbicide preferences by adolescent age group and behavioral patterns including engaging in sexual intercourse and use of hormonal contraception were examined, as it was hypothesized that as adolescents progress into adulthood and gain sexual experience their preferences in microbicide characteristics may shift. METHOD Adolescent and young women (N = 405, 56.0% African American; 24.0% Euro-American) between the ages of 14 and 20 (mean = 17.0, SD = 1.8) were recruited from urban community-based clinics. Video-Audio Computer-Assisted Self-Interviews were conducted with the young women, during which they were asked about their preferences regarding the characteristics of hypothetical vaginal microbicides. Conjoint analysis was utilized to determine adolescent women's relative preferences for each microbicide characteristic and intent-to-purchase microbicides based upon a combination of the selected properties. RESULTS Overall, the results suggest adolescent and young women had an ordered preference for a microbicide with (1) no side effects, (2) pregnancy prevention, (3) postcoital application, and (4) protection against HIV. Age and behavioral group conjoint analyses resulted in the same pattern of preferences as those reported for the entire group. However, women having sex and not using hormonal contraception had a stronger preference for postcoital application. CONCLUSION The findings suggest that young women's ratings of microbicides were sensitive to characteristics such as side effects, pregnancy prevention, and timing of application and should be considered in microbicide development. The conjoint analysis approach is useful in understanding microbicide preferences, and should be utilized with other populations to assess preferences for specific microbicide characteristics.
Collapse
Affiliation(s)
- Amanda E. Tanner
- Indiana University School of Medicine, Section of Adolescent Medicine, Indianapolis, IN
| | - Jennifer M. Katzenstein
- Indiana University Purdue University Indianapolis, Department of Psychology, Indianapolis, IN
| | - Gregory D. Zimet
- Indiana University School of Medicine, Section of Adolescent Medicine, Indianapolis, IN
| | - Dena S. Cox
- Indiana University Purdue University Indianapolis, Kelley School of Business, Indianapolis, IN
| | - Anthony D. Cox
- Indiana University Purdue University Indianapolis, Kelley School of Business, Indianapolis, IN
| | - J. Dennis Fortenberry
- Indiana University School of Medicine, Section of Adolescent Medicine, Indianapolis, IN
| |
Collapse
|
19
|
Auslander BA, Rupp RE, Short MB, Rosenthal SL. Male partners of young women: assessing their attitudes toward topical microbicides. J Adolesc Health 2008; 42:626-8. [PMID: 18486872 PMCID: PMC3889148 DOI: 10.1016/j.jadohealth.2008.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 12/21/2007] [Accepted: 01/08/2008] [Indexed: 11/17/2022]
Abstract
Male partners' attitudes toward microbicide use are important to understand; however, there are challenges in conducting research with adolescent couples. We describe the experience of recruiting male partners of adolescent females enrolled in a microbicide acceptability study. Creative solutions to enrolling partners of young women in studies need to be explored.
Collapse
Affiliation(s)
- Beth A Auslander
- Department of Pediatrics and Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, Texas 77555-0319, USA
| | | | | | | |
Collapse
|
20
|
Short MB, Succop PA, Rupp R, Rosenthal SL. Adolescents' reasons for using a microbicide-like product over time. Int J STD AIDS 2008; 19:115-7. [PMID: 18334065 DOI: 10.1258/ijsa.2007.007155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined the reasons that adolescent girls used a product over time. Adolescent girls (n = 208; 14-21 years) participated in a six-month study in which they completed three face-to-face interviews and 24-weekly phone call interviews. Participants were given microbicide-like products (vaginal lubricants) and encouraged to use them with condoms when they had intercourse. Most of the reasons for use were endorsed by most of the adolescent girls, at some time during the study. Over time, the adolescents were significantly more likely to report the following reasons for use: did not think the product would leak out (z = 2.49; P < 0.01), the product felt comfortable (z = 2.41; P < 0.02) and the product was not messy to use (z = 3.11; P < 0.01). Although it appears that adolescents are interested in microbicides, they may worry about certain characteristics of the product. It will be important to develop anticipatory guidance that focuses on the experience of using the product, making sure adolescent girls continue to use over time.
Collapse
Affiliation(s)
- Mary B Short
- Department of Psychology, University of Houston-Clear Lake, Houston, TX, USA
| | | | | | | |
Collapse
|
21
|
Short MB, Ramos S, Oakes JK, Rosenthal SL. Adolescent girls' communication with partners about microbicide use. Sex Health 2007; 4:243-8. [PMID: 18082067 DOI: 10.1071/sh07044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 07/19/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Topical microbicides could be a female-controlled method of preventing sexually transmissible infections. Despite the possibility of surreptitious use, most women report that they would tell partners, and microbicides may be detectable. The purpose of the present study was to examine communication between adolescent girls and their partners regarding microbicides. METHODS Girls (aged 14-21 years) participated in a 6-month study in which they were given vaginal moisturisers to use when they had intercourse. Data was collected about their demographics, sexual histories and conversations with mothers and partners. Both quantitative and qualitative analyses were conducted. RESULTS Girls (n = 171) were asked about conversations with their partners. Talking with mothers and using the product were significantly related to talking with partners. Reasons for not talking were intrapersonal or interpersonal variables, the context of the relationship did not warrant an explanation and the lack of a decision to communicate. There seemed to be no difference in conversations for those who used or did not use. Girls had conversations with their partners when deciding to be in the study, when they were engaged in study activities or when deciding to use the product. Conversations about using the product focused on needing to use the product because of study demands, the lubricating properties or wanting to experience product use. CONCLUSIONS Most of the girls talked to their partners and had positive conversations. Girls may need help initiating conversations and managing reluctant partners.
Collapse
Affiliation(s)
- Mary B Short
- Department of Psychology, University of Houston - Clear Lake, Houston, TX 77578, USA
| | | | | | | |
Collapse
|
22
|
Short MB, Succop PA, Ugueto AM, Rosenthal SL. Predictors of using a microbicide-like product among adolescent girls. J Adolesc Health 2007; 41:357-62. [PMID: 17875461 PMCID: PMC2040129 DOI: 10.1016/j.jadohealth.2007.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 05/02/2007] [Accepted: 05/02/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE This study examined demographic, sexual history and weekly contextual variables, and perceptions about microbicides as predictors of microbicide-like product use. METHODS Adolescent girls (N = 208; 14-21 years) participated in a 6-month study in which they completed three face-to-face interviews and 24-weekly phone call interviews. Participants were given microbicide-like products (vaginal lubricants) and encouraged to use them with condoms when they had intercourse. RESULTS Of the girls, 75% had had a sexual opportunity to use the product. Using multi-variable logistic regression, the following variables independently predicted ever using the product: length of sexual experience, number of lifetime vaginal partners, and the Comparison to Condoms subscale on the Perceptions of Microbicides Scale. Using a mixed model repeated measure linear regression, the following variables independently predicted frequency of use: week of the study, age, condom frequency prior to the study, and three subscales on the Perceptions of Microbicide Scale: namely, the Comparison to Condoms subscale, the Negative Effects subscale, and the Pleasure subscale. CONCLUSION Most girls used the product, including those who were not protecting themselves with condoms. Girls' initial perceptions regarding the product predicted initial use and frequency of use. Further research should evaluate the best methods for supporting the use of these products by young or sexually less experienced girls.
Collapse
Affiliation(s)
- Mary B Short
- Department of Psychology, University of Houston-Clear Lake, Houston, Texas 77058, USA.
| | | | | | | |
Collapse
|