Effect of Peer Counselors

on Adolescent
Compliance
in Use of Oral Contraceptives
M. Susan Jay, MD, Robert H. DuRant, MA, Tamsen Shoffitt, RN,
Charles

W. Linder,

From the Departments

Medical

ABSTRACT.

Poor compliance

with

School,

MD,

of Pediatrics,

Stanford,

contraceptive

regi-

Noncompliance
with oral contraceptive
regimens
has been shown
to be an important
antecedent
of
adolescent
pregnancy.
Compliance
has been de-

for publication
June 21, 1982; accepted
April 22, 1983.
in part, at the American
Pediatric
Society
Meeting,
Washington,
DC, May 14, 1982.
Reprint
requests
to (R.H.D.)
Department
of Pediatrics,
Children
and Youth
Clinic,
Medical
College
of Georgia,
Augusta,
GA
30912.
PEDIATRICS
(ISSN
0031 4005).
Copyright
1984 by the
American
Academy
of Pediatrics.

126

Iris F. Liii,
Medical

MD

College of Georgia,

Augusta;

and Stanford

California

mens
has been
shown
to be an important
antecedent
of
adolescent
pregnancy.
The purpose
of this study
was to
test prospectively
the effect
of a peer
v nurse
counseling
program
on adolescent
compliance
with
the use of oral
contraceptives.
Fifty-seven
females
aged
14 to 19 years
from
a lower
socioeconomic
background
were
randomly
assigned
to a peer
(n = 26) or nurse
(n = 31) group.
At
the initial visit and at 1-, 2-, and 4-month
follow-up
visits,
subjects
received
Ortho-Novum
1/35
combined
with
a tablet
marker
and were
counseled
by a nurse
or
peer. Noncompliance
was
measured
using
a Guttman
scale
consisting
of: (1) avoidance
of pregnancy,
(2) appointment
adherence,
(3) pill count,
and
(4) urinary
fluorescence
for riboflavin.
At the first and second followups, the adolescents
counseled
by a peer
had a significantly
(P
.038) lower noncompliance
level than the
nurse-counseled
group.
Adolescents
with
more
frequent
sexual activity
(P
.027),
with one sexual
partner
(P <
.04), and who worried
that
they
might
become
pregnant
(P
.01) had significantly
lower
levels
of noncompliance
when
counseled
by a peer than
by a nurse.
At the fourth
month
follow-up,
adolescents
who expressed
feelings
of
hopelessness
about
the future
had significantly
(P
.036)
higher
levels of noncompliance
when
counseled
by a nurse
than
when
counseled
by a peer.
These
results
suggest
that
incorporating
a peer counselor
into the health
care
team
may be an effective
method
of increasing
adolescent
compliance.
Pediatrics
1984;73:126-131;
peer counselors,
compliance,
oral contraceptives.

Received
Presented,

and

fined as the extent

to which the patients
behavior
coincides
with the clinical
prescription.7
There are
many
reasons
for noncompliance,8
including
the
health
care providers
lack of ability
to describe
the
prescription
to the patient
in terms that the patient
can comprehend,
as well as the patients
inability
to remember
and lack of motivation
to comply
with
the prescription
requirements.
This study was undertaken

in

order

to

investigate

the

impact

of

peer counseling
program
on adolescents
compliance with the use of oral contraceptives.
Peers are an important
source of sexual education
for adolescents,
and as adolescence
progresses,
peer
influence
tends
to become
increasingly
important.9t#{176}Several
schools
and health
centers
have
successfully
established
peer counseling
sessions
in
which young people
are trained
to help peers seeking advice
on dealing
with personal
problems.5
The training
is generally
carried
out in small groups
and covers
a wide range of topics
such as listening
and communication
skills,
family
problems,
academic
motivation,
sexuality,
and
relationships.
Those in training
benefit
by receiving
help in working through
personal
problems
and gaining
experience in helping
others.
Several
peer
counseling
efforts
have
emphasized
health-related
issues
such
as venereal
disease
(VD)16 and smoking,17
but involvement
of adolescent
peer counselors
in sex education
and contraceptive
distribution
has not been
critically
evaluated.
Inasmuch
as the quality
of
interaction
between
a patient
and provider
may
influence
her compliance
with her medical
regimen,
and because
teenagers
can be a powerful
influence
on one another,
their
involvement
in certain
aspects of health
education
may be a positive
factor
in enhancing
adolescent
compliance.
Accordingly,
the present
study
was undertaken
to test prospectively
the effect
of a peer v nurse
counseling
program
on adolescent
compliance
with
oral contraceptives.

PEDIATRICS
Vol. 73 No. 2 February 1984
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METHODS
Subjects
The first 60 adolescent
females
who came to the
adolescent
gynecology
clinic of the Title V Children
and Youth
(C&Y) Project
for the State of Georgia8
were asked
to participate
in the research
project.
Fifty-seven
(95%) of the adolescents
agreed
to participate.
The volunteer
subjects
were compared
with all
adolescent
females
registered
in the C&Y Project
and were found
to be highly
representative
with
regard
to age, race, previous
contraceptive
use, and
previous
pregnancies
and abortions.
In order to be
eligible
for clinic services,
the subjects
had to reside
in one of five federally
funded
housing
projects
in
the city of Augusta.
The 57 subjects
(55 black and
two white)
ranged
in age from 14 to 19 years with
a mean age of 16.6 years.
Peer

Counselors

Five adolescent
females
were selected
from the
C&Y Project
area to serve as peer counselors
based
on their verbal
interaction
skills,
leadership
abilities, and social and sexual maturity.
The peer counsebors were between
17 and 18 years
of age. Peer
counselors
were given organized
training
sessions
in (1) conversational
and interaction
skills, (2) observational
skills,
(3) decision-making,
(4) formal
counseling,
(5) confidentiality,
(6) problem
solving,
and (7) birth control.
The training
included
participation
in role playing
in order to refine counseling
skills prior to participating
in the peer counseling
program.

possible
correlates
with either
contraceptive
noncompliance
or adolescent
pregnancy.
Subjects
were
then
randomly
assigned
to either
peer or nurse
counseling
groups
utilizing
a computer-generated
random
numbers
table.
Thirty-one
(54%) subjects
were assigned
to the nurse counselor
group,
and 26
(46%)
were assigned
to the peer counselor
group.
We would expect
50% (28 or 29) of the subjects
to
be assigned
to each group.
A sampling
error of this
degree was not significant
with a sample
size of 57.
At the initial
visit,
subjects
assigned
to each
group were given one cycle of oral contraceptives
and were instructed
on their proper
use by either
a
peer or nurse
counselor,
according
to the group
to
which they had been assigned.
The oral contraceptives
utilized
were Ortho
Novum
1/35 combined
with 28 mg of riboflavin
as a urinary
marker23
in
00 hard
gelatin
capsules
and packaged
in numbered pill dispensers
(Control
Cube 30, Columbus,
OH). All subjects
were followed
up at 1, 2, and 4
months.
At each
follow-up
appointment
a urine
sample
was obtained,
compliance
was measured,
and the subject
was counseled
and received
oral
TABLE

1.

Sexual His tory For Experim

ental

Nurse-Counseled

Group

(N

Peer-Counseled
Group
(N = 26)

31)

Groups*

16.61.2

16.71.3

9.72.7

10.21.9

12.71.1
3.91.5

12.91.2
3.81.6

14.51.1

14.61.5

partners

0.90.5

0.90.6

of sexual
partners
in last 6 mo

1.10.6

1.10.7

Age (yr)
Parents
education
(grades)

Age at menarche
(yr)
Postmenarchal
age
(yr)

Onset of first sexual

encounter
(age)
No.

of sexual

in last 3 mo
Nurse

Counselors

The three
female
nurses
working
in the C&Y
Project
served
as the nurse counselors.
The nurses
ranged
in age from 26 to 29 years and were experienced in caring
for adolescents.
The nurses
participated
in the same training
program
as the peers.
Experimental

No.

Values

tests,
cally

are means

values
for
significant

these

(P

>

on analysis

variables

.05) from

of variance

were

not

Indicators

for

Nurse-Counseled

Coddington

events

self-conlife

62.1

8.3

62.2

7.5

crisis

320.3

172.4

294.9

208.5

life

change

367.5

236.1

385.2

228.3

1.4

1.4

events scale
Autonomy
scale
Dissatisfaction

Group

scale

Yeaworths

2.0
with

previous medical
care scale
Values are means

tests,

Experi-

Peer-Counseled

Group

Piers-Harris
cept scale

statisti-

one another.

TABLE 2. Social-Psychological
mental Groups*

Design

Each
subject
was administered
a pretest
questionnaire
which
measured
various
demographic
variables,
medical
history,
sexual
activity
and devebopment,
and sociopsychological
variables
(Tables 1 and 2). Included
in the questionnaire
were
Millers
motivation
for seeking
birth control
scale,
factors
for predicting
compliance
as described
by
Litt et al,
an autonomy
scale,9 the Piers-Harris20
self-concept
scale,
the
Coddington2
life crisis
events
scale, and the adolescent
life change
scale of
Yeaworth
et al.22 These
instruments
were chosen
because
they
had previously
been
implicated
as

SD. Based
pretest

values

cally significant

for

these

(P

2.6

1.6 1.7

SD. Based
pretest

>

1.5 1.1

on analysis

variables

were

of variance
not

satisti-

.05) from one another.

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127

contraceptives
from either
a nurse
or peer counselor. The subjects
did not necessarily
see the same
nurse
or peer counselor
at every
follow-up
visit.
However,
continuity
of counselors
was similar
in
both experimental
groups.
Urine
samples
were tested
for the presence
of
riboflavin
by placing
them
in front
of a 375M
ultraviolet
light
source
(Gelman
Instrument
Co,
model 51438).23
The adolescents
urine plus that of
positive
and negative
control
subjects
were evaluated for fluorescence
in a double-blind
fashion
by a
panel of three independent
observers.
Noncompliance

Scale

Noncompliance
was measured
with a four-factor
Guttman
scale that consisted
of the following:
(1)
whether
the subject
became
pregnant
during
the
previous
month,
(2) whether
she missed
her appointment,
(3) whether
she missed
taking
three or
more oral contraceptives
during
the month,
and (4)
absence
of urinary
fluorescence
at the time of follow-up.
Based
on a Guttman
scale analysis,
these
four items
had a coefficient
of reproducibility
of
0.96 and a coefficient
of scalability
of 0.84.24
The
coefficient
of reproducibility
is a measure
of the
extent
to which
a respondents
scale
score
is a
predictor
of ones
response
pattern.
A score
of
greater
than
0.90 is considered
a valid scale. The
coefficient
of scalability
measures
the degree
that
the scale is unidimensional
and cumulative.
This
score should
be well above 0.60.25
Of the 57 subjects
in the study,
26 who were
randomly
chosen
at random
follow-up
periods
had
serum
samples
tested
for the presence
of norethindrone
levels.
Serum
norethindrone
was measured
using a radioimmunoassay
method
by the Endocrinology
Laboratory
at the Medical
College
of Georgia.2m
The 26 subjects
had a mean norethindrone
level of 694.75 46.6; SEM was 23.3 and coefficient
of variation
was 6.7%. The serum
norethindrone
test was used to ensure
that the urinary
fluorescence test was an accurate
measure
of compliance
with
an oral contraceptive
regimen.
Based
on a
Fishers
exact test, a high degree
of association
(P
: .02) was found
between
the serum
norethindrone
test and urinary
fluorescence.3#{176}
Statistical

Analysis

The two experimental

groups
pretest
measurements
were compared
using a one-way
analysis
of
variance
test. The posttest
measurements
at 1-, 2-,
and 4-month
follow-ups
were analyzed
using oneand
two-way
analysis
of variance
tests
with
a
regression
approach.25
The regression
approach
assesses each effect in the analysis
of variance
model

128

PEER

COUNSELORS

AND

after

all

other

been

adjusted.

main

and

interaction

effects

have

RESULTS
There
were no significant
(P > .05) differences
between
the nurse-counseled
and peer-counseled
groups
in any of the pretest
measurements
(Tables
1 and 2). This
suggests
that the subjects
in both
groups
were similar
with regard
to these
variables
prior to the institution
of the treatment
effect (peer
V nurse
counseling).
At the first month
follow-up,
the subjects
in the
peer-counseled
group
had significantly
(P
.038)
lower
noncompliance
than
the
nurse-counselor
group
(Table
3). When
additional
pretest
factors
were entered
into the analysis
of variance
model to
determine
whether
they influenced
the response
to
nurse
v peer counselors,
worrying
about
becoming
pregnant
significantly
(P
.01) interacted
with the
treatment
effect.
Adolescents
in the nurse-counseled group who stated
that they worried
that they
might
become
pregnant
had significantly
higher
levels
of noncompliance.
In the peer
group,
the
difference
between
worriers
and nonworriers
was
not significant.
These
findings
suggest
that peer
counselors
may have a positive
influence
on this
subgroup
of adolescents.
Frequency
of sexual activity
also significantly
(P
.027) interacted
with the treatment
groups
at the
first month
follow-up.
Adolescents
in the nursecounseled
group who had sexual
intercourse
once a
week
or less had slightly
higher
noncompliance
than those adolescents
in the peer-counseled
group
with the same frequency
of sexual
activity.
However, adolescents
who had sexual
intercourse
two
or more times a week and were counseled
by a nurse
had significantly
higher
levels
of noncompliance
than any of the other adolescents.
At the second
month
follow-up,
the nurse-counseled group continued
to have higher
levels of noncompliance
than
the peer-counseled
group.
This
difference
was statistically
significant
when
controlling
for the effects
of number
of sexual partners
(P
.006) and frequency
of sexual
activity
(P
.044).
Similar
to the findings
at the first month
follow-up,
there was little difference
in noncompliance between
nurse-counseled
and peer-counseled
adolescents
having
sex once a week or less. However, among
adolescents
having
sexual
intercourse
two or more times
a week,
those
counseled
by a
nurse
had significantly
(P
.044) higher
levels of
noncompliance
than
those
counseled
by a peer at
the second
month
follow-up.
The number
of sexual
partners
also significantly
(P
.03) interacted
with
the treatment
groups.
Adolescents
with one sexual
partner
had the same level of noncompliance,
re-

CONTRACEPTIVES

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TABLE

3.

Noncompliance

Levels

for ExperimentaiGroups

at Each

1.68t
1.18

(N
(N
1.06 1.11 (N

Total attrition
rate
Values are means

of

P
.001.

4.331,

gardless

which

4.531;
P
8.888;
P
.044 when

counseling

1.22
1.10

with

no

sexual

.038.
.006 when
controlling

group

partners

controlling
for sexual

they

were

not

statistically

in the

preceding

significant

(Table

3).

(P

of the

indicators

of sexual

behavior

interacted

with the treatment.

effect at the fourth
month
follow-up.
Yet,
a social
psychological
indicator
of
hopelessness
significantly
(P
.036) interacted
with the counseling
groups
effect on compliance.
Adolescent
females
in the nurse-counseled
group
who felt it was no use trying
to get anywhere
in life
had significantly
higher
levels of noncompliance
by
the fourth
month
follow-up;
yet, adolescents
with
feeling
of hopelessness
who had been counseled
by
a peer had substantially
lower levels of noncompliance.
DISCUSSION
Prior
subjects

to being
were

assigned
pretested

to treatment
on

(N

0.78 (N

0.98

(N

26)

22)

20)

23%

a variety

groups,
of

the

measures.

The purpose
of this was to ensure
that other factors
previously
implicated
as possible
correlates
with
noncompliance
or adolescent
pregnancy
did not
differ
between
the groups.68922
The subjects
in

of sexual

the

partners;

F ratio

and

peer-counseled

were

physical

the nurse-counseled
group
had signifi.001) higher attrition
(42% v 23%) from
the study
than
the peer-counseled
group
by the
fourth
month
follow-up.
Attrition
was
defined
as
failing
to keep the second
rescheduled
broken
appointment
or discontinuing
the oral contraceptive
regimen.
Unlike
the first and second
month
follow-ups,
none

groups

However,

cantly

1.16

0.95
0.85

both

in.

appeared
to respond
better
to nurse counseling than peer counseling.
The adolescents
in the
nurse-counseled
group
with
two or more
sexual
partners
had the highest
level of noncompliance
at
the second
month
follow-up.
At the fourth
month
follow-up,
the nurse-coiinseled group still had higher
levels of noncompliance
than the peer-counseled
group,
although
the differwere

1.OOt

22)
18)

for number
frequency.

months

ences

31)

SD.

The adolescents
in the peer-counseled
group
with
no sexual partners
in the last 3 months
had significantly
higher
noncompliance
levels than
the adolescents
with
two or more
partners.
In contrast,
the
subjects

=
=

42%

tFratio
:1:F ratio

Peer-Counseled
_____Group

Group

1st mo follow-up
2nd mo follow-up
4th mo follow-up

Period*

__________

Nurse-Counseled

Follow-up

found

and
nurse-counseled
similar
in sexual

be

to

development,

sexual

history,

and

self-concept,

autonomy,
life crisis events,
and satisfaction
with
previous
medical
care.
At the first month
follow-up,
our peer-counseled
group had significantly
lower levels of noncompliance than
our nurse-counseled
group.
Two additional
factors
were found to influence
the effect of
the type of counselor
on noncompliance.
Adolescents
who
stated
that they worried
about becoming
pregnant
had higher
levels of noncompliance
when
counseled
by a nurse
than by a peer. Those
adolescents

who

expressed

pregnant
previous
knew

worry

may represent
sexual
and
that

they

might

oral

that

they

might

girls who,
contraceptive
have

to take

their

higher

risk of becoming

difficulty

contraceptives

become

due to their
experiences,
remembering

and,

in turn,

pregnant.

be at

However,

the

findings

also suggest
that being counseled
by a peer
may
have had a positive
impact
on this subgroup
of adolescents.
In addition,
adolescents
who reported
having
sex two or more
times
a week were
at higher
risk of noncompliance
when counseled
by
a nurse,
but not when counseled
by a peer.
At the second
month
follow-up,
when the effect
of previous
sexual
activity
was
statistically
controlled,
the peer-counseled
group continued
to have
significantly

lower

dition,

two

selors

effect

on

during

the

first

sexual

intercourse

nificantly

levels

factors

of

noncompliance.

interacted

with

compliance.

subjects

than

weekly

levels

of

once

noncompliance

a week
were counseled
by a nurse. However,
difference
between
the groups
that
olescents

having

by

We

a peer.

partners
months

that

month

also

found
her

Adolescents
having
period,

that

only
had

with
one

sexual

the

same

were

the

number

had

in the

response

to
more

having
had

sig-

than

ad-

counseled
of sexual

previous

a peer
stable

partner
level

findings

or less if they
there was little

once

an adolescent

influenced

counselor.
ships,

sex

ad-

of coun-

to the

follow-up,

more

higher

type

Similar

month

In

the

or

relationover

of

ARTIClES

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nurse
a

3-

compliance

129

regardless

of

whether

counseled

by

nurse

or

peer. The adolescent

girls with no sexual
partners
in the 3-month
period
prior to the study who were
counseled
by a peer had significantly
higher
levels
of noncompliance
than similar
subjects
counseled
by a nurse.
In contrast,
subjects
with the most
sexual
experience,
having
two or more sexual
partners,
had extremely
low levels
of noncompliance
when counseled
by a peer, but extremely
high levels
of noncompliance
when counseled
by a nurse.
Both
of the above relationships
suggest
that adolescents
with little sexual
experience
may benefit
from the
experience,
professionalism,
and possible
authority
that a nurse
may demonstrate
during
the initial
months
of contraceptive
use.
However,
among
adolescents

with

more

sexual

and

contraceptive

ex-

perience,
the introduction
of a peer counselor
appeared
to enhance
compliance.
This finding
may be
explained
by the fact that adolescents
with greater
sexual experience
may be more receptive
to positive
role models
such as a peer provider.
At the fourth
month
follow-up,
the nurse-counseled group continued
to have higher
levels of noncompliance
than
the
peer-counseled
group,
although
the differences
were not statistically
significant.
However,
by 4 months
a significantly
higher
proportion
of the adolescents
in the nursecounseled
group than
in the peer-counseled
group
discontinued
taking
oral contraceptives.
During
the
first 2 months
of follow-up,
previous
sexual activity
had the greatest
influence
on how the adolescents
responded
to nurse v peer counseling.
By the fourth
month
a social-psychological
indicator
had an impact on compliance.
We found that among
adolescents
who felt hopeless
or apathetic3
about
their
future,
those counseled
by a peer had significantly
lower levels of noncompliance
than those
who received nurse counseling.
Ryan and Sweeney32
point
out that among
adolescents
who have no hope for
the future,
pregnancy
does not appear
to be a threat
to their
future
life-style
and thus may be an acceptable
alternative.
They
argue
that
until
this
subgroup
of adolescents
are able to have their hopes
for the future
realistically
threatened
by pregnancy,
they
will continue
to seek
personal
fulfillment
through
childbearing.
The findings
from our study
suggest
that
the use of peer
counselors
may be
beneficial
in helping
these
high-risk
adolescents
deal with their hopelessness
by providing
them with
positive
role models.
This,
in turn,
may increase
their compliance
with contraceptive
regimens.
In confirmation
of previous
reports,6
the findings
from our study suggest
that the nature
of the interaction
between
the health
care provider
and the
patient,
combined
with the adolescents
sexual
behavior
and social-psychological
status,
may influence how compliant
she will be with her oral con-

130

PEER

COUNSELORS

AND

traceptive
from

regimen.

our

study

More

that

peer

specifically,

it appears

counselors

can

work

as

adjuncts
to the health
care team in providing
information,
education,
and counseling
in the use of oral
contraceptives.
These
findings
also suggest
that the
impact
of peer counselors
on adolescent
compliance
may
be greatest
during
the first
2 months
after
initiation
of oral contraceptives.
This is significant
as most
of the adolescents
who
do become
noncompliant do so during
the first few months
after taking
oral contraceptives.67
Of three adolescents
who became
pregnant
during
our study,
one pregnancy
occurred
in each group during
the first month
follow-up,
and one additional
pregnancy
occurred
in
the
nurse-counseled
group
during
the
second
month.
We are now aware
that knowledge
of contraceptive
availability
is not enough
to prevent
adolescent
pregnancy,
and other
modalities
must
be used to reach
our adolescent
population.
As
adolescents
seek contraception,
structure
and guidance are needed
and peer counselors
can frequently
fulfill these needs in a nonthreatening
way.
It would have been desirable
to have studied
this
problem
with a larger
sample
size over a longer
follow-up
period.
However,
this prospective
study
was conducted
with greater
experimental
control
and for longer
follow-up
periods
than previous
reports.

In

addition,

inasmuch

as

this

sample

was

drawn
from a lower socioeconomic
population
considered
to be at high risk of adolescent
pregnancy,
it would be beneficial
to test prospectively
the influence
of peer counselors
on compliance
with oral
contraceptive
use in other groups
of adolescents.

ACKNOWLEDGMENTS
This

work

was

funded,

in part,

by

a grant

from

the

Georgia Department
of Human
Resources.
We would like to thank Dr V. B. Mahesh
and J. 0.
Ellegood
for completing
the serum norethindrone
tests
and Kathy Pilcher for assistance
with the manuscript.

REFERENCES
1. McAnarney

ER:

Am J Dis Child
2.

Kantner

women
3. Chilman

Society,
Health,
4. Cvetkovich

formation.

5.

Population
Human
Fustenberg

sequence
6.

JF,

Adolescent

pregnancy:

A national

priority.

1978;132:125
Zelnick

M:

Sexual

experience

of

unmarried

in the United
States.
Fam
CE: Adolescent
Sexuality

Plann Perspect
1972;4:9
in a Changing
American
DHEW Publication
No. (NIA) 79, Department
of
Education,
and Welfare,
1979, chap 7
G,

Grote

Presented

B: Antecedents

at

responsible

a Conference

Division,
Development
FF Jr:

for

family

sponsored
by the
of Child Health
and

National
Institute
(NICHHD),
Bethesda,
MD,
1976
Unplanned
Parenthood:
The Social
Conof Teenage
Childbearing.
New
York,
Free
Press,

1976
Litt IF, Cuskey

for non-compliance
1980;86:742
7. Litt
IF, Cuskey

WR,

Rudd

with
WR:

S: Identifying
contraceptive

Compliance

with

adolescents
at risk
therapy.
J Pediatr
medical

CONTRACEPTIVES

Downloaded from pediatrics.aappublications.org at Indonesia:AAP Sponsored on March 28, 2015

regimens

during
8.

9.

J Adoles

and
Utech

Simon

in Fink
Dysfunction.
DA,

influences
Davis

PJ,

Hoving
on

Soc Psychol
11.

Pediatr
Clin North
Am 1980;27:3
Jay
MS,
Linder
CW,
et al: The
influence
factors
on adolescent
compliance
with

contraceptives.
Gagnon
JH,

ment,
10.

adolescence.

DuRant
RH,
psycho-social

AK,

the

Health

W:

Sex

Care,

Hammett
Philadelphia,
KL:

in press

education

and

of
oral

1984

22.

human

develop-

VBO (eds): Sexual

Function
FA Davis Co, 1968

Patients

decisions

and

peers

of children

as

23.

competing

of different

JM,

Shute

RE:

Positive

peer

ages.
influence

school based prevention.

Health Educ 1977;8:20
12. Nadelson
CC, Notman
M, Gillon JW: Sexual knowledge
attitudes
of adolescents:
Relationship
to contraceptive
Obstet Gynecol
1980;55:340

and
use.

13.

Hamburg

BA,

Varenhorst

ondary
schools:
J Orthopsychiatry
14.

Vriend

T: High

BB:

A community
1972;42:566
performing

Peer

counseling

health

project

inner

city

in the

sec-

for youth.

Am

assist

low

adolescents

performing
peers in counseling
groups.
Personnel
Guidance
J 1969;48:897
15. Baldwin
BA: Moving
from drugs to sex: New directions
for
youth-oriented
peer counseling.
J Am Coil Health
Assoc
16.

1978;27:75
Aiwine
G:

need

love,

come

to

us:

An

overview

of a

19. Cuskey WR: A SystemsApproach

to the Study of DrugAbuse.
National
Institute
on Drug Abuse,
Psychosocial
Branch,
publication
No. (ROl-DA
00813), July 1976
EV,

life

RM,

preg-

MA, et al: The development

change

event

scale.

Adolescence

S: A method
to evaluate
whether
Clin Pediatr
1966;5:239
24. Doby JT: An Introduction
to Social
Research,
ed 2. New
York, Appleton-Century-Crofts,
1967, chap 8
25. Nie NH, Hull CH, Jenkins
JG, et al: Statistical
Package
For
the Social Sciences,
ed 2. New York, McGraw-Hill,
1975, pp
348-430,
532-537
26. Mills TM, Lin TJ, Hernandez-Ayup
5, et al: The metabolic
clearance
rate and urinary
excretion
of oral contraceptive
drugs
1-norethindrone.
Am J Obstet Gynecol
1974;120:764
27.
Parker
CR, Ellegood
JO, Mahesh
VB: Methods
for multiple
steroid
radioimmunoassay.
J Steroid Biochem
1975;6:1
28. Mills
TM,
Lin TJ, Braselton
WE,
et al: Metabolism
of oral
contraceptive
drugs: The formulation
and disappearance
of
take

metabolites

nous

Blackman

prescribed

medication.

of norethindrone

and

oral

administration.

and

mestranol

Am

after

Obstet

intrave-

Gynecol

1976;126:987

Mahesh
VB, Mills TM, Lin TJ, et al: Metabolism,
metabolic
clearance
rate, blood
metabolites,
and blood
half-life
of
norethindrone
and mestranol,
in Garratini
5, Berendes
HW
(eds): Pharmacology
of Steroid
Contraceptive
Drugs.
New
York, Raven Press, 1977, p 117
30. Jay 5, DuRant
RH, Linder CW et al: Reliability
of riboflavin
as an indicator
of compliance
with oral contraceptives.
J
Adoles

31. Smith

1979;68:811

Piers

Silberstein

York J, Hussey

1964;55:91
with adolescent

29.
If you

peer-counseling
program
in a senior
high school.
J Sch
Health
1974;44:463
17. McAlister
AL, Penny
C, Macoby
N: Adolescent
smoking:
Onset
and prevention.
Pediatrics
1979;63:650
18. McNamara
V, King LA, Green MF: Adolescent
perspectives
on sexuality,
contraception,
and pregnancy.
J Med Assoc Ga

20.

Yeaworth
RC,
of an
adolescent
1980;57:92
patients

1969;78:267
Weener

concept
in children.
J Educ Psychol
21. Coddington
RD: Life events associated
nancies.
J Clin Psychiatry
1979;40:180

Harris

DB:

Age

and

other

correlates

of

self-

Care

1982;13:140

TJ: Social integration,

victim1978;16:395
Ryan
GM, Sweeny
PJ: Attitudes
of adolescents
toward
pregnancy
and
contraception.
Am J Obstet Gynecol
1980;
137:358
ization

32.

Health

DL, DuRant
and

anomia.

R, Carter

Criminology

ARTICLES

Downloaded from pediatrics.aappublications.org at Indonesia:AAP Sponsored on March 28, 2015

131

Effect of Peer Counselors on Adolescent Compliance in Use of Oral Contraceptives

M. Susan Jay, Robert H. DuRant, Tamsen Shoffitt, Charles W. Linder and Iris F. Litt
Pediatrics 1984;73;126
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright 1984 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
Online ISSN: 1098-4275.

Downloaded from pediatrics.aappublications.org at Indonesia:AAP Sponsored on March 28, 2015

Effect of Peer Counselors on Adolescent Compliance in Use of Oral Contraceptives

M. Susan Jay, Robert H. DuRant, Tamsen Shoffitt, Charles W. Linder and Iris F. Litt
Pediatrics 1984;73;126

The online version of this article, along with updated information and services, is located on
the World Wide Web at:
http://pediatrics.aappublications.org/content/73/2/126

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,
it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked
by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,
Illinois, 60007. Copyright 1984 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.

Downloaded from pediatrics.aappublications.org at Indonesia:AAP Sponsored on March 28, 2015