Poor compliance with contraceptive regimens 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 follow-ups, 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.

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