Why Some Women Douche and Why Other Women Never Start: Results from a National Survey Lucy Annang, PhD, MPH Diane M. Grimley, PhD UAB School of Public Health Department of Health Behavior 2006 National STD Prevention Conference

Background Vaginal douching has been linked to numerous reproductive health consequences Bacterial Vaginosis (Ness et al., 2002; Schwebke et al., 2004; Cottrell 2006) PID (Jossens et al., 1996; Zhang et al., 1997; Ness et al., 2002) STIs (Scholes et al., 1998; Peters et al., 2000; Foch et al., 2001)

Background (con’t) Despite these relationships, women continue to douche 27% of all females 55% of African American females (NCHS, 1997) Reasons why some women douche and others never initiate the behavior is unclear

Methodology Random-digit-dial CATI English speaking U.S. females ages 18-44 “Women’s health issues” questionnaire measured Demographic characteristics Gynecologic history Douching behaviors Other feminine hygiene product use

Methodology (con’t) Participants not offered incentive Closed and open-ended questions Descriptive analyses of quantitative and qualitative items Full details available: Grimley et al., 2006 MCHJ

Results— Demographic Characteristics (N=2,602) White Black Hispanic 2,081 (79.9) 314 (12.1) 207 (8.0) Age Mean = 32.8 yrs Married 1,476 (56.7) Employed Homemaker 1,688 (64.8) 422 (16.2) Some college High school/GED 791 (30.4) 700 (26.9)

Results— Douching Behavior

Results— Douching Behavior by Race/Ethnicity %

Results— Behavioral Characteristics by Douching Status (%) Current Douchers N=307 Never Douchers N=1,241 From whom do you get your health information? Physicians Nurses Family members Internet 54.2 40.7 33.9 29.3 54.1 39.3 34.2 34.0 STI history* 14.1 6.0 BV history* 10.7 8.9 PID history 3.6 3.1 P < 0.05

Results— Behavioral Characteristics by Douching Status (con’t) (%) Current Douchers N=307 Never Douchers N=1,241 Feminine hygiene product use Wipes* Sprays* Powder* 30.3 24.1 21.8 10.4 2.9 3.4 P < 0.05

Results— Current Douchers’ Reasons for Starting to Douche %

Results— Recommenders of Douching Behavior %

Results— Never Douchers’ Reasons for Never Starting to Douche %

Results— Recommenders of Never Douching %

Conclusions Douching prevalence on the decline Associations with BV and STIs Two major reasons emerged for both current douchers and never douchers Cleanliness and recommendations Unnecessary behavior and recommendations

Conclusions (con’t) Efforts to prevent women from initiating or modifying the frequency of douching should acknowledge these motivational cues

Limitations Low response rate Only English speaking population Representative?

Future Directions Consider motivation for douching (and never initiating) by race/ethnicity

Acknowledgements Terry Hooks, BA ASPH/CDC Grant #S1451 The findings and conclusions in this presentation have not been formally disseminated by the CDC/ATSDR and should not be construed to represent any agency determination or policy. Please note