Douching increases the risk of bacterial vaginosis, pelvic inflammatory disease, HIV acquisition and cervical cancer. Given these health risks, why then do women douche? Recently published data from the multi-center Gynecologic Infections Follow-Through (GIFT) Study reported attitudes of 532 women who douched and found that over half had douched for 5 or more years and most initiated the practice on recommendation of female relatives, most commonly mothers, for the reason of hygiene. This study also reported that women who had been advised by a health professional to stop douching were less likely to consider douching healthful and were more likely to have tried to stop. Douching therefore is a risk behavior for significant reproductive health problems that is clearly modifiable. In Baltimore, which ranks among the top 5 cities in the U.S. for gonorrhea, chlamydia and HIV, douching is a common practice. Recent data collected from almost 300 African American women attending the STD clinic found that 70 percent actively douche. We hypothesize that model-based, structured intervention messages on the adverse health consequences associated with douching that are directed to personal determinants of douching practices will be successful in decreasing or stopping vaginal douching when delivered to young women and their mothers. In order to develop an educational intervention targeting adolescents in Baltimore, we propose to perform qualitative interviews and focus group sessions among teens between 14 and 17 years of age, as well as among their mothers or female relatives, to investigate issues and personal and cultural determinants that impact on their choices to practice vaginal douching and douching practices. After developing and pilot testing the intervention, we will recruit 550 mother/teen dyads from our Adolescent Medicine Clinic and randomized them to receive a three-session, one-hour cognitive behavioral intervention mother/teen) or a similar control program on career opportunities. We will use an experimental design for the intervention phase with a pre-intervention, 3-month and 6-month post intervention A-CASI questionnaire. In analysis, we propose to determine the effectiveness of this cognitive-behavioral intervention on douching behaviors among teens; measure beliefs, intention to douche, and perception of mothers' beliefs about douching as an effect of intervention on douching behaviors among teens; and evaluate the effects of change in douching behaviors on bacterial vaginosis and incident gonorrhea, chlamydia and trichomonas infections among teens.
|Mark, Hayley; Sherman, Susan G; Nanda, Joy et al. (2010) What has changed about vaginal douching among African American mothers and daughters? Public Health Nurs 27:418-24|