DEET (N,N-Diethyl-meta-toluamide)

Chemical Technical Summary for Public Health and Public Safety Professionals

Agency for Toxic Substances and Disease Registry
Atlanta, Georgia
December 6, 2004

This summary is designed for use by professionals and assumes basic knowledge of the topics covered. As with any summary, details are left out that may be significant in an individual exposure situation. No observed effects should be ruled out or in based solely on the information presented in this document.

N,N-Diethyl-meta-toluamide is the most widely used insect repellent in the world. It was registered for use by the general public in 1957 and is commonly used to repel mosquitoes and other biting insects as a preventative measure against vector-borne diseases. Its repellency has been demonstrated in many species of insects, especially mosquitoes. DEET is also widely used, with approximately 30% of the U.S. population using DEET each year. DEET is available in a variety of forms including liquids, lotions, sprays, and impregnated materials. Formulations registered for direct application to human skin contain between 4 and 100% DEET. Approximately 230 products containing DEET are currently registered with the U.S. Environmental Protection Agency (EPA). DEET can be absorbed via inhalation, ingestion, or dermal contact. DEET is not readily absorbed dermally, with approximately 5-17% of the applied dose being absorbed in humans. The major route of excretion of DEET in humans following dermal and oral exposures is via the urine. The major metabolites of DEET are four carboxylic acid derivatives. The most common toxicological symptom of DEET exposure is dermatitis. In rare occasions, more serious symptoms include encephalopathy, seizures, and severe skin irritation.

When used according to the recommended usage guidelines, there is a very low probability of toxicity in healthy adults. When DEET is used on children, the guidelines for use must be carefully followed – it should not be used in children under 2 months of age. DEET has been included as one of the chemicals of concern regarding unexplained illnesses among Gulf War veterans, but its exact role in neurological or other symptoms that have arisen in Gulf War veterans is unknown. More studies must be conducted to establish a definite relationship between the observed health effects and DEET use.

CDC

Insect Repellent Use and Safety NEW!

Information on insect repellents

Q. Why should I use insect repellent?

A. Insect repellents can help reduce exposure to mosquito bites that may carry viruses such as West Nile virus that can cause serious illness and even death. Using insect repellent allows you to continue to play and work outdoors with a reduced risk of mosquito bites.

Q. When should I use mosquito repellent?

A. Apply repellent when you are going to be outdoors. Even if you don’t notice mosquitoes there is a good chance that they are around. Many of the mosquitoes that carry West Nile virus bite between dusk and dawn. If you are outdoors around these times of the day, it is especially important to apply repellent. In many parts of the country, there are mosquitoes that also bite during the day, and some of these mosquitoes have also been found to carry West Nile virus.

Q. How often should repellent be reapplied?

A. In general you should re-apply repellent if you are being bitten by mosquitoes. Always follow the directions on the product you are using. Sweating, perspiration or getting wet may mean that you need to re-apply repellent more frequently.

Repellents containing a higher concentration (higher percentage) of active ingredient typically provide longer-lasting protection.

Q. How does mosquito repellent work?

A. Female mosquitoes bite people and animals because they need the protein found in blood to help develop their eggs. Mosquitoes are attracted to people by skin odors and carbon dioxide from breath. The active ingredients in repellents make the person unattractive for feeding. Repellents do not kill mosquitoes. Repellents are effective only at short distances from the treated surface, so you may still see mosquitoes flying nearby.

Active Ingredients (Types of Insect Repellent)

Q. Which mosquito repellents work best?

A. CDC recommends using products that have been shown to work in scientific trials and that contain active ingredients which have been registered with the US Environmental Protection Agency (EPA) for use as insect repellents on skin or clothing. When EPA registers a repellent, they evaluate the product for efficacy and potential effects on human beings and the environment. EPA registration means that EPA does not expect a product, when used according to the instructions on the label, to cause unreasonable adverse effects to human health or the environment.

Of the active ingredients registered with the EPA, CDC believes that two have demonstrated a higher degree of efficacy in the peer-reviewed, scientific literature (See Publications page.). Products containing these active ingredients typically provide longer-lasting protection than others:

• DEET (N,N-diethyl-m-toluamide)
• Picaridin (KBR 3023)

Oil of lemon eucalyptus [active ingredient: p-menthane 3,8-diol (PMD)], a plant- based repellent, is also registered with EPA. In two recent scientific publications, when oil of lemon eucalyptus was tested against mosquitoes found in the US it provided protection similar to repellents with low concentrations of DEET.

Q. How does the percentage of active ingredient in a product relate to the amount of protection it gives?

A. Typically, the more active ingredient a product contains the longer it provides protection from mosquito bites. The concentration of different active ingredients cannot be directly compared (that is, 10% concentration of one product doesn’t mean it works exactly the same as 10% concentration of another product.)

DEET is an effective active ingredient found in many repellent products and in a variety of formulations. Based on a 2002 study:

• A product containing 23.8% DEET provided an average of 5 hours of protection from mosquito bites.
• A product containing 20% DEET provided almost 4 hours of protection
• A product with 6.65% DEET provided almost 2 hours of protection
• Products with 4.75% DEET were both able to provide roughly 1 and a half hour of protection.

These examples represent results from only one study and are only included to provide a general idea of how such products may work. Actual protection will vary widely based on conditions such as temperature, perspiration, and water exposure.

Choose a repellent that provides protection for the amount of time that you will be outdoors. A product with a higher percentage of active ingredient is a good choice if you will be outdoors for several hours while a product with a lower concentration can be used if time outdoors will be limited. Simply re-apply repellent (following label instructions) if you are outdoors for a longer time than expected and start to be bitten by mosquitoes.

Q. Why does CDC recommend certain types of insect repellent?

A. CDC recommends products containing active ingredients which have been registered with US Environmental Protection Agency (EPA) for use as insect repellents on skin or clothing.

All of the EPA-registered active ingredients have demonstrated repellency however some provide more longerlasting protection than others. Additional research reviewed by CDC suggests that repellents containing DEET (N,N-diethyl-m-toluamide) or picaridin (KBR 3023) typically provide longer-lasting protection than the other products and oil of lemon eucalyptus (p-menthane-3,8-diol) provides longer lasting protection than other plant-based repellents. Permethrin is another long-lasting repellent that is intended for application to clothing and gear, but not directly to skin. In general, the more active ingredient (higher concentration) a repellent contains, the longer time it protects against mosquito bites.

People who are concerned about using repellents may wish to consult their health care provider for advice. The National Pesticide Information Center (NPIC) can also provide information through a toll-free number, 1-800-858-7378 or npic.orst.edu

Q. How can you know which active ingredient a product contains?

A. Check the product label if you have questions-–repellents must specify their active ingredients. In some cases you will note the chemical name in addition to/instead of the “common” name:

• DEET is N,N-diethyl-m-toluamide
• Picaridin is KBR 3023, sometimes known as “Bayrepel” outside the US
• The active ingredient in oil of lemon eucalyptus is p-menthane 3,8-diol (PMD)

Q. What is permethrin?

A. Certain products which contain permethrin are recommended for use on clothing, shoes, bed nets, and camping gear, and are registered with EPA for this use. Permethrin is highly effective as an insecticide and as a repellent. Permethrin-treated clothing repels and kills ticks, mosquitoes, and other arthropods and retains this effect after repeated laundering. The permethrin insecticide should be reapplied following the label instructions. Some commercial products are available pretreated with permethrin.

Q. Where can I find these repellents?

A. Most of these repellents are sold at multiple retail, discount and drug stores. A wider selection may be available at “outdoor” stores or in hunting and camping sections. At this time picaridin is not yet registered with the state pesticide programs in NY and CA, and thus is not available in those areas.

Q. Where can I find more information about picaridin?

A. An technical fact sheet covering picaridin is available from EPA (http://www.epa.gov/opprd001/factsheets/picaridin.pdf)

Using Repellents Properly

Q. What are some general considerations to remember when using insect repellents?

A. Always follow the recommendations appearing on the product label.

• Use enough repellent to cover exposed skin or clothing. Don’t apply repellent to skin that is under clothing. Heavy application is not necessary to achieve protection.
• Do not apply repellent to cuts, wounds, or irritated skin.
• After returning indoors, wash treated skin with soap and water. (This may vary depending on the product. Check the label.)
• Do not spray aerosol or pump products in enclosed areas.
• Do not spray aerosol or pump products directly to your face. Spray your hands and then rub them carefully over the face, avoiding eyes and mouth.

Q. What are some reactions to be aware of when using insect repellents?

A. Use of repellents products may cause skin reactions in rare cases. Most products also note that eye irritation can occur if product gets in the eye. If you suspect a reaction to a product, discontinue use, wash the treated skin, and call a poison control center. If product gets in the eyes flush with water and consult health care provider or poison control center. If you go to a doctor, take the product with you.

There is a national number to reach a Poison Control Center near you: 1-800-222-1222.

Q. Can insect repellents be used on children?

A. Repellent products must state any age restriction. If there is none, EPA has not required a restriction on the use of the product.

According to the label, oil of lemon eucalyptus products should NOT be used on CHILDREN UNDER 3 YEARS.

In addition to EPA’s decisions about use of products on children, many consumers also look to the opinion of the American Academy of Pediatrics (AAP). The AAP does have an opinion on the use of DEET in children .AAP has not yet issued specific recommendations or opinion concerning the use of picaridin or oil of lemon eucalyptus for children. CDC will post a link to such information from the Academy when/if it becomes available.

Since it is the most widely available repellent, many people ask about the use of products containing DEET on children. No definitive studies exist in the scientific literature about what concentration of DEET is safe for children. No serious illness has been linked to the use of DEET in children when used according to manufacturer’s recommendations.

The American Academy of Pediatrics (AAP) Committee on Environmental Health has updated their recommendation for use of DEET products on children in 2003, citing: “Insect repellents containing DEET (N,N-diethyl-m-toluamide, also known as N,N-diethyl-3-methylbenzamide) with a concentration of 10% appear to be as safe as products with a concentration of 30% when used according to the directions on the product labels.” AAP recommends that repellents with DEET should not be used on infants less than 2 months old.

Parents should choose the type and concentration of repellent to be used by taking into account the amount of time that a child will be outdoors, exposure to mosquitoes, and the risk of mosquito-transmitted disease in the area.

If you are concerned about using repellent products on children you may wish to consult a health care provider for advice or contact the National Pesticide Information Center (NPIC) through their toll-free number, 1-800-858-7378

Q. What guidelines are available for using a repellent on children?

A. Always follow the recommendations appearing on the product label when using repellent:

• When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children’s eyes and mouth and use it sparingly around their ears.
• Do not apply repellent to children’s hands. (Children may tend to put their hands in their mouths.)
• Do not allow young children to apply insect repellent to themselves; have an adult do it for them.
• Keep repellents out of reach of children.
• Do not apply repellent under clothing. If repellent is applied to clothing, wash treated clothing before wearing again. (May vary by product, check label for specific instructions.)

Q. How else can I protect children from mosquito bites?

A. Using repellents on the skin is not the only way to avoid mosquito bites. Children (and adults) can wear clothing with long pants and long sleeves while outdoors. DEET or other repellents such as permethrin can also be applied to clothing (but is not registered for use on skin), as mosquitoes may bite through thin fabric.

Mosquito netting can be used over infant carriers.

Finally, it may be possible to reduce the number of mosquitoes in the area by getting rid of containers with standing water that provide breeding places for mosquitoes.

Q. Can insect repellents be used by pregnant or nursing women?

A. Other than the routine precautions noted earlier, EPA does not recommend any additional precautions for using registered repellents on pregnant or lactating women. Consult your health care provider if you have questions.

Insect Repellents containing DEET and Sunscreen

Q. Can I use an insect repellent and a product containing sunscreen at the same time? What are the recomendations for combination sunscreen/insect repellent products ?

A. Yes. People can, and should, use both a sunscreen and an insect repellent when they are outdoors. Follow the instructions on the package for proper application of each product. In general, the recommendation is to apply sunscreen first, followed by repellent.

It is recommended NOT to use a single product that combines insect repellent containing DEET and sunscreen, because the instructions for use of insect repellents and use of sunscreen are different. In most situations, insect repellent does not need to be reapplied as frequently as sunscreen. While no recommendations are available at this time regarding products that combine other active ingredients and sunscreen, it is important to always follow the label on whatever product you are using.

To protect from sun exposure and insect bites, you can also wear long sleeves and long pants. You can also apply insect repellent to your clothing, rather than directly to your skin.

CDC

Severe acute respiratory syndrome (SARS)

Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003. Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was contained. This fact sheet gives basic information about the illness and what CDC has done to control SARS in the United States.

The SARS outbreak of 2003
According to the World Health Organization (WHO), a total of 8,098 people worldwide became sick with SARS during the 2003 outbreak. Of these, 774 died. In the United States, only eight people had laboratory evidence of SARS-CoV infection. All of these people had traveled to other parts of the world with SARS. SARS did not spread more widely in the community in the United States. For an update on SARS cases in the United States and worldwide as of December 2003, see Revised U.S. Surveillance Case Definition for Severe Acute Respiratory Syndrome (SARS) and Update on SARS Cases — United States and Worldwide, December 2003.

Symptoms of SARS
In general, SARS begins with a high fever (temperature greater than 100.4°F [>38.0°C]). Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms at the outset. About 10 percent to 20 percent of patients have diarrhea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia.

How SARS spreads
The main way that SARS seems to spread is by close person-to-person contact. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes. Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to 3 feet) through the air and deposited on the mucous membranes of the mouth, nose, or eyes of persons who are nearby. The virus also can spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose, or eye(s). In addition, it is possible that the SARS virus might spread more broadly through the air (airborne spread) or by other ways that are not now known.

What does “close contact” mean?
In the context of SARS, close contact means having cared for or lived with someone with SARS or having direct contact with respiratory secretions or body fluids of a patient with SARS. Examples of close contact include kissing or hugging, sharing eating or drinking utensils, talking to someone within 3 feet, and touching someone directly. Close contact does not include activities like walking by a person or briefly sitting across a waiting room or office.

CDC response to SARS during the 2003 outbreak
CDC worked closely with WHO and other partners in a global effort to address the SARS outbreak of 2003. For its part, CDC took the following actions:

Activated its Emergency Operations Center to provide round-the-clock coordination and response.
Committed more than 800 medical experts and support staff to work on the SARS response.
Deployed medical officers, epidemiologists, and other specialists to assist with on-site investigations around the world.
Provided assistance to state and local health departments in investigating possible cases of SARS in the United States.
Conducted extensive laboratory testing of clinical specimens from SARS patients to identify the cause of the disease.
Initiated a system for distributing health alert notices to travelers who may have been exposed to cases of SARS.
cdc

Adenoviruses

Clinical features: Adenoviruses most commonly cause respiratory illness; however, depending on the infecting serotype, they may also cause various other illnesses, such as gastroenteritis, conjunctivitis, cystitis, and rash illness. Symptoms of respiratory illness caused by adenovirus infection range from the common cold syndrome to pneumonia, croup, and bronchitis. Patients with compromised immune systems are especially susceptible to severe complications of adenovirus infection. Acute respiratory disease (ARD), first recognized among military recruits during World War II, can be caused by adenovirus infections during conditions of crowding and stress.

The viruses: Adenoviruses are medium-sized (90-100 nm), nonenveloped icosohedral viruses containing double-stranded DNA. There are 49 immunologically distinct types (6 subgenera: A through F) that can cause human infections. Adenoviruses are unusually stable to chemical or physical agents and adverse pH conditions, allowing for prolonged survival outside of the body.

Epidemiologic features: Although epidemiologic characteristics of the adenoviruses vary by type, all are transmitted by direct contact, fecal-oral transmission, and occasionally waterborne transmission. Some types are capable of establishing persistent asymptomatic infections in tonsils, adenoids, and intestines of infected hosts, and shedding can occur for months or years. Some adenoviruses (e.g., serotypes 1, 2, 5, and 6) have been shown to be endemic in parts of the world where they have been studied, and infection is usually acquired during childhood. Other types cause sporadic infection and occasional outbreaks; for example, epidemic keratoconjunctivitis is associated with adenovirus serotypes 8, 19, and 37. Epidemics of febrile disease with conjunctivitis are associated with waterborne transmission of some adenovirus types, often centering around inadequately chlorinated swimming pools and small lakes. ARD is most often associated with adenovirus types 4 and 7 in the United States. Enteric adenoviruses 40 and 41 cause gastroenteritis, usually in children. For some adenovirus serotypes, the clinical spectrum of disease associated with infection varies depending on the site of infection; for example, infection with adenovirus 7 acquired by inhalation is associated with severe lower respiratory tract disease, whereas oral transmission of the virus typically causes no or mild disease. Outbreaks of adenovirus-associated respiratory disease have been more common in the late winter, spring, and early summer; however, adenovirus infections can occur throughout the year.

Diagnosis: Antigen detection, polymerase chain reaction assay, virus isolation, and serology can be used to identify adenovirus infections. Adenovirus typing is usually accomplished by hemagglutination-inhibition and/or neutralization with type-specific antisera. Since adenovirus can be excreted for prolonged periods, the presence of virus does not necessarily mean it is associated with disease.

Treatment: Most infections are mild and require no therapy or only symptomatic treatment. Because there is no virus-specific therapy, serious adenovirus illness can be managed only by treating symptoms and complications of the infection.

Prevention: Vaccines were developed for adenovirus serotypes 4 and 7, but were available only for preventing ARD among military recruits. Strict attention to good infection-control practices is effective for stopping nosocomial outbreaks of adenovirus-associated disease, such as epidemic keratoconjunctivitis. Maintaining adequate levels of chlorination is necessary for preventing swimming pool-associated outbreaks of adenovirus conjunctivitis.

CDC

Keeping hands clean

Keeping hands clean is one of the most important steps we can take to avoid getting sick and spreading germs to others. It is best to wash your hands with soap and clean running water for 20 seconds. However, if soap and clean water are not available, use an alcohol-based product to clean your hands. Alcohol-based hand rubs significantly reduce the number of germs on skin and are fast acting.

When washing hands with soap and water:

• Wet your hands with clean running water and apply soap. Use warm water if it is available.
• Rub hands together to make a lather and scrub all surfaces.
• Continue rubbing hands for 20 seconds. Need a timer? Imagine singing “Happy Birthday” twice through to a friend!
• Rinse hands well under running water
• Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet
• Remember: If soap and water are not available, use alcohol-based gel to clean hands.

When using an alcohol-based hand sanitizer:

• Apply product to the palm of one hand
• Rub hands together
• Rub the product over all surfaces of hands and fingers until hands are dry.

When should you wash your hands?

• Before preparing or eating food
• After going to the bathroom
• After changing diapers or cleaning up a child who has gone to the bathroom
• Before and after tending to someone who is sick
• After blowing your nose, coughing, or sneezing
• After handling an animal or animal waste
• After handling garbage
• Before and after treating a cut or wound

CDC

Health benefits of owning a pet

There are many health benefits of owning a pet. But some animals may carry germs that can be transmitted to people. Keep in mind these tips if you own a pet.

Your relationship with your pet enriches your life. However there are a few important tips to keep in mind when you own a pet. Some animals may carry germs that can be transmitted to people. These are called zoonoses.

Pick the Right Pet

Before you purchase or adopt a pet, make sure that it is the right one for you and your family. CDC recommends that households with children under 5 years of age should not own reptiles, and pregnant women should avoid contact with pet rodents to prevent a virus that causes birth defects. Pregnant women should follow other special precautions. Immune-compromised persons and persons with HIV or AIDS should take extra precautions when choosing and handling pets.

Do research about the specific needs of the animal. Some questions to ask are: How much exercise does the pet need? How large will it become? Is the type of animal aggressive? What does the pet eat? How much will it cost for veterinary care? Do I have enough time to properly care for and clean up after the pet? What exactly does this pet need in its habitat to be healthy? Are pets allowed in my apartment or condominium?

Wash Hands Thoroughly after Playing with or Handling Your Pet and Pet Treats
Wash hands after cleaning the cage or aquarium as well as after handling an animal or pet treats. Many pets, such as dogs, cats, reptiles, rodents, and birds carry zoonoses. Be sure to wash your hands before handling food or eating. By keeping your pet healthy, you keep yourself and your family healthy.

Get Your Pet Early, Regular, and Life-long Veterinary Care
Providing regular, life-long care is key to a healthy pet and a healthy family. Keep up with vaccines*, deworming, and flea and tick control. Provide a good diet, fresh water, clean bedding, and exercise. Follow advice from your veterinarian*, who is devoted to your family’s good health as well as your pet’s. Ask questions.

Avoid Ticks on Dogs and Cats
Your pets may carry ticks that can spread diseases like Rocky Mountain spotted fever to people. Consult your veterinarian about ways to prevent ticks on your dogs and cats.

Practice Good Hygiene Around Your Pet
Pick up dog feces and dispose of properly. Keep young children away from areas that may contain dog or cat feces to prevent the spread of roundworms and hookworms. Change the cat litter box daily. Cover sand boxes so cats don’t use them as a litter box. If you are pregnant, have someone else clean the litter box. Cats can carry a parasite that causes toxoplasmosis, a disease that can cause birth defects. Make sure to wash your hands after cleaning up after your pet and before eating or preparing food. Get more information on toxoplasmosis ( 203KB) and birth defects.

Prevent Rabies
Rabies is a deadly disease that can make both you and your pet sick. Get your pets vaccinated for rabies. Make sure your pet gets and wears a tag with its name and your phone number. Keep your pet in a fenced yard or on a leash. See more information about dog bites.

Keep Wildlife Wild
Though they may be cute and cuddly, don’t encourage wild animals such as raccoons, prairie dogs, or wild rodents to come into your home by feeding them. Many wild animals carry zoonoses.

Teach Children How to Appropriately Care for Pets
Children under 5 years old should be supervised while interacting with animals. Teach children to wash their hands after playing with animals. Children under 5 years old should be extra cautious when visiting farms and having direct contact with farm animals, including animals at petting zoos and fairs.

Spay and Neuter
Spaying or neutering your pet is part of responsible pet ownership. It may help prevent some behavioral problems, minimize your or your family’s exposure to unfamiliar animals attracted to a female in heat, and extend your pet’s life.

Enjoy Your Pet!
There are many health benefits of owning a pet. The companionship of pets can help overcome loneliness and depression. Pets can increase your opportunities for exercise and outdoor activities as well as opportunities for socialization. Therefore, regular walking or playing with pets can decrease your blood pressure, cholesterol levels, and triglyceride levels. Remember, healthy pets = healthy people!

CDC

Types of Birth Control

Reversible Methods of Birth Control

Intrauterine Devices (IUDs)

Copper T IUD—An IUD is a small device that is shaped in the form of a “T.” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. This IUD is more than 99% effective at preventing pregnancy.

Mirena intrauterine system (IUS)—The IUS is a small T-shaped device like the IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The IUS stays in your uterus for up to5 years. The IUS is more than 99% effective at preventing pregnancy.

Hormonal methods

Oral contraceptives—Also called “the pill,” it contains the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, or have a history of blood clots, breast cancer, or endometrial cancer, your doctor may advise you not to take the pill. The pill is 92–99% effective at preventing pregnancy.

Mini pill—Unlike the pill, the mini-pill only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. Mothers who breastfeed cause the mini-pill because it will not affect their milk supply. It is a good option for women who can’t take estrogen or for women who have a risk of blood clots. They are 92–99% effective at preventing pregnancy.

Patch—This skin patch is worn on the lower abdomen, buttocks, or upper body. This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. The patch is 92–99% effective at preventing pregnancy, but it appears to be less effective in women who weigh more than 198 pounds.

Hormonal vaginal contraceptive ring— The NuvaRing releases the hormones progestin and estrogen. Your doctor places the ring inside your vagina to go around your cervix (the opening to your womb). You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. It is 92–99% effective at preventing pregnancy.

Injection or “shot”— Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. It is 97–99% effective at preventing pregnancy.

Implant—The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. It is 99 percent effective at preventing pregnancy.

Emergency contraception—Emergency contraception is NOT a regular method of birth control. Emergency contraception should only be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke.

One type of emergency contraception requires you to take two doses of hormonal pills 12 hours apart. You have to take the pills starting within three days (72 hours) after having unprotected sex. They are sometimes referred to as “morning after” pills, even though they can be used up to three days later. The pills are at least 75% effective at preventing pregnancy. Plan B is available over-the-counter for women aged 18 years and older. Plan B is available by prescription for women aged 17 years and younger. (Plan B is the brand name of one product approved by the Food and Drug Administration for use as emergency contraception.)

Another type of emergency contraception is having your doctor insert the Copper T IUD into your uterus within seven days of unprotected sex. This method is 99% effective at preventing pregnancy.

Barrier methods

Male condom—Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy and HIV and other STDs as do the newer synthetic condoms. “Natural” or “lambskin” condoms also help prevent pregnancy, but may not provide protection against STDs, including HIV. Male condoms are 85–98% effective at preventing pregnancy. Condoms can only be used once, and are most effective when used consistently and correctly. You can buy condoms, KY jelly, or water-based lubricants at a drug store. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break.

Female condom—Worn by the woman, the female condom helps keeps sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. It can be inserted up to eight hours before sexual intercourse. Female condoms are 79–95% effective at preventing pregnancy when used consistently and correctly, and may also help prevent STDs.

Diaphragm or cervical cap—Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. The diaphragm is 84–94% effective at preventing pregnancy. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes.

Spermicides—These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. Spermicides alone are about 71–82% effective at preventing pregnancy. They can be purchased in drug stores.

Fertility awareness and abstinence

Continuous abstinence—This method means not having vaginal, anal, or oral sex at any time. It is the only 100% effective way to prevent pregnancy, HIV, and other STDs.

Natural family planning or fertility awareness—Understanding your monthly fertility pattern can help you plan to get pregnant or avoid getting pregnant. Your fertility pattern is the number of days in the month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely, but possible. If you have a regular menstrual cycle, you have about nine or more fertile days each month. If you do not want to get pregnant, you do not have sex on the days you are fertile, or you use a form of birth control on those days. These methods are 75–99% effective at prevention pregnancy.

Permanent Methods of Birth Control

These methods are meant for people who want a permanent method of birth control. In other words, they never want to have a child, or they do not want more children. The methods listed here are more than 99% effective at preventing pregnancy.

Female Sterilization—Tubal ligation or “tying tubes.”— A woman can have her fallopian tubes tied (or closed) to stop eggs from going down to her uterus where they can be fertilized. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately. In the first year after the surgery, your chance of getting pregnant is less than 1%. Over time, the ends of your fallopian tubes could fuse back together, and it may be possible to get pregnant. Failure rates have been reported in women who had their tubes tied earlier in their lives. But these failure rates are lower in women who are older when they have tubal ligation.

Transcervical Sterilization— A thin tube is used to thread a tiny device into each fallopian tube. It irritates the fallopian tubes and causes scar tissue to grow and permanently plug the tubes. It can take about three months for the scar tissue to grow, so use another form of birth control during this time. Return to your doctor for a test to see if scar tissue has fully blocked your fallopian tubes. Research studies followed more than 600 women for one year. None had any pregnancies when the devices were implanted correctly.

Male Sterilization–Vasectomy [va-sec-toe-me]—This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. This operation is simpler than tying a woman’s tubes. The procedure is done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero. It may take a few weeks for that to happen. Another form of birth control should be used until the man’s sperm count has dropped to zero.

Chronic Disease Self-Management Program (CDSMP)

Chronic Disease Self-Management Program (CDSMP) is an effective self-management education program for people with chronic health problems. The program specifically addresses arthritis, diabetes, lung and heart disease, but teaches skills useful for managing a variety of chronic diseases. This program was developed at Stanford University. CDSMP workshops are held in community settings and meet 2 1/2 hours per week for 6 weeks. Workshops are facilitated by two trained leaders, one or both of whom are non-health professionals with a chronic diseases themselves. This program covers topic such as: techniques to deal with problems associated with chronic disease, appropriate exercise, appropriate use of medications, communicating effectively with family, friends, and health professionals, nutrition, and, how to evaluate new treatments. Participants who took CDSMP demonstrated significant improvements in exercise, communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role activities limitations. To find out about availability in your state, you can check with your state arthritis program.

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Arthritis Foundation Self-Help Program (AFSHP)

Arthritis Foundation Self-Help Program (AFSHP) is an effective self-management education intervention for people with arthritis. Developed by Dr. Kate Lorig of Stanford University, the course helps people learn and practice the different techniques needed to build an individualized self-management program and gain the confidence to carry it out. The 6-week course consists of weekly 2-hour sessions guided by two trained instructors who follow a detailed protocol. There is a robust science base that demonstrates the positive impacts of participation in the Arthritis Foundation Self-Help Program: participants report a 20% decrease in pain, and a 40% decrease in physician visits, even 4 years after course participation. To find out about availability in your area you can check with the Arthritis Foundation*.

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Arthritis Basics

Key Public Health Messages
Early diagnosis and appropriate management of arthritis, including self-management activities, can help people with arthritis decrease pain, improve function, stay productive, and lower health care costs. Key self-management activities include the following:

Learn Arthritis Management Strategies—Learning techniques to reduce pain and limitations can be beneficial to people with arthritis. Self-management education, such as the Arthritis Foundation Self Help Program (AFSHP), or the Chronic Disease Self Management Program (CDSMP) help you develop the skills and confidence to manage your arthritis on a day to day basis. For example, AFSHP has been shown to reduce pain even 4 years after participating in the program.

Be Active—Research has shown that physical activity decreases pain, improves function, and delays disability. Make sure you get at least 30 minutes of moderate physical activity at least 3 days a week. You can get activity in 10-minute intervals. Read about the physical activity programs the CDC recommends for people with arthritis.

Watch Your Weight—The prevalence of arthritis increases with increasing weight. Research suggests that maintaining a healthy weight reduces the risk of developing arthritis and may decrease disease progression. A loss of just 11 pounds can decrease the occurrence (incidence) of new knee osteoarthritis.

See Your Doctor—Although there is no cure for most types of arthritis, early diagnosis and appropriate management is important, especially for inflammatory types of arthritis. For example, early use of disease-modifying drugs can affect the course of rheumatoid arthritis. If you have symptoms of arthritis, see your doctor and begin appropriate management of your condition.

Protect Your Joints—Joint injury can lead to osteoarthritis. People who experience sports or occupational injuries or have jobs with repetitive motions like repeated knee bending have more osteoarthritis. Avoid joint injury to reduce your risk of developing osteoarthritis.

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