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FAMILY PLANNING PERSPECTIVES, JANUARY-FEBRUARY 1999, VOL. 31, N? 1
Miller, Heather G.; Cain, Virginia S.; Rogers, Susan M.; Gribble, James N.; Turner, Charles F.
Correlates of sexually transmitted bacterial infections among U.S. Women in 1995.
Context: Sexually transmitted diseases (STDs) of bacterial origin such as gonorrhea and chlamydial infection can lead to pelvic inflammatory disease (PID) and infertility. Identifying behaviors and characteristics associated with infection may assist in preventing these often asymptomatic diseases and their sequelae.
Methods: Data from 9,882 sexually active women who participated in the 1995 National Survey of Family Growth describe the characteristics of women who report a history of infection with a bacterial STD or of treatment for PID. Multivariate analysis is used to determine which demographic characteristics and sexual and health-related behaviors affect the likelihood of infection or the occurrence of complications.
Results: Overall, 6% of sexually active women reported a history of a bacterial STD, and 8% reported a history of PID. Women who first had sexual intercourse before age 15 were nearly four times as likely to report a bacterial STD, and more than twice as likely to report PID, as were women who first had sex after age 18. Having more than five lifetime sexual partners also was associated with both having an STD and having PID. PID was more common among women reporting a history of a bacterial STD (23%) than among women who reported no such history (7%). In multivariate analyses, age, race, age at first intercourse and lifetime number of sexual partners had a significant effect on the risk of a bacterial STD. Education, age, a history of IUD use, douching and a history of a bacterial STD had a significant impact on the risk of PID, but early onset of intercourse did not, and lifetime number of partners had only a marginal effect.
Conclusions: The pattern of characteristics and behaviors that place women at risk of infection with bacterial STDs is not uniform among groups of women. Further, the level of self-reported PID would suggest higher rates of gonorrhea and chlamydial infection than reported.
(UNITED STATES, SEXUALLY TRANSMITTED DISEASES, INFERTILITY, SEXUAL BEHAVIOUR, WOMEN).
English - pp. 4-9 & 23.
H. G. Miller, V. S. Cain, S. M. Rogers, J. N. Gribble and C. F. Turner, Research Triangle Institute, Washington, DC, U.S.A.
***
Brackbill, Robert M.; Sternberg, Maya R.; Fishbein, Martin.
Where do people go for treatment of sexually transmitted diseases?.
Context: Major public health resources are devoted to the prevention of sexually transmitted diseases (STDs) through public STD clinics. However, little is known about where people actually receive treatment for STDs.
Methods: As part of the National Health and Social Life Survey, household interviews were performed from February to September 1992 with 3,432 persons aged 18-59. Weighted population estimates and multinomial response methods were used to describe the prevalence of self-reported STDs and patterns of treatment utilization by persons who ever had a bacterial or viral STD.
Results: An estimated two million STDs were self-reported in the previous year, and 22 million 18-59-year-olds self-reported lifetime STDs. Bacterial STDs (gonorrhea, chlamydia, nongonococcal urethritis, pelvic inflammatory disease and syphilis) were more common than viral STDs (genital herpes, genital warts, hepatitis and HIV). Genital warts were the most commonly reported STD in the past year, while gonorrhea was the most common ever-reported STD. Almost half of all respondents who had ever had an STD had gone to a private practice for treatment (49%); in comparison, only 5% of respondents had sought treatment at an STD clinic. Respondents with a bacterial STD were seven times more likely to report going to an STD clinic than were respondents with a viral STD--except for chlamydia, which was more likely to be treated at family planning clinics. Men were significantly more likely than women to go to an STD clinic. Young, poor or black respondents were all more likely to use a family planning clinic for STD treatment than older, relatively wealthy or white respondents. Age, sexual history and geographic location did not predict particular types of treatment-seeking.
Conclusions: The health care utilization patterns for STD treatment in the United States are complex. Specific disease diagnosis, gender, race and income status all affect where people will seek treatment. These factors need to be taken into account when STD prevention strategies are being developed.
(UNITED STATES, SEXUALLY TRANSMITTED DISEASES, EPIDEMIOLOGY, PUBLIC HEALTH, MEDICAL CARE).
English - pp. 10-15.
R. M. Brackbill, M. R. Sternberg and M. Fishbein, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, U.S.A.
***
Darroch, Jacqueline E.; Frost, Jennifer J.
Women's interest in vaginal microbicides.
Context: Each year, an estimated 15 million new cases of sexually transmitted diseases (STDs), including HIV, occur in the United States. Women are not only at a disadvantage because of their biological and social susceptibility, but also because of the methods that are available for prevention.
Methods: A nationally representative sample of 1,000 women aged 18-44 in the continental United States who had had sex with a man in the last 12 months were interviewed by telephone. Analyses identified levels and predictors of women's worry about STDs and interest in vaginal microbicides, as well as their preferences regarding method characteristics. Numbers of potential U.S. microbicide users were estimated.
Results: An estimated 21.3 million U.S. women have some potential current interest in using a microbicidal product. Depending upon product specifications and cost, as many as 6.0 million women who are worried about getting an STD would be very interested in current use of a microbicide. These women are most likely to be unmarried and not cohabiting, of low income and less education, and black or Hispanic. They also are more likely to have visited a doctor for STD symptoms or to have reduced their sexual activity because of STDs, to have a partner who had had other partners in the past year, to have no steady partner or to have ever used condoms for STD prevention.
Conclusions: A significant minority of women in the United States are worried about STDs and think they would use vaginal microbicides. The development, testing and marketing of such products should be expedited.
(UNITED STATES, SEXUALLY TRANSMITTED DISEASES, WOMEN, PREVENTIVE MEDICINE, METHOD ACCEPTABILITY).
English - pp. 16-23.
J. E. Darroch and J. J. Frost, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
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Anderson, John E.; Wilson, Ronald; Doll, Lynda; Jones, T. Stephen; Barker, Peggy.
Condom use and HIV risk behaviors among U.S. adults: Data from a national survey.
Context: How much condom use among U.S. adults varies by type of partner or by risk behavior is unclear. Knowledge of such differentials would aid in evaluating the progress being made toward goals for levels of condom use as part of the Healthy People 2000 initiative.
Methods: Data were analyzed from the 1996 National Household Survey of Drug Abuse, an annual household-based probability sample of the noninstitutionalized population aged 12 and older that measures the use of illicit drugs, alcohol and tobacco. The personal behaviors module included 25 questions covering sexual activity in the past year, frequency of condom use in the past year, circumstances of the last sexual encounter and HIV testing.
Results: Sixty-two percent of adults reported using a condom at last intercourse outside of an ongoing relationship, while only 19% reported using condoms when the most recent intercourse occurred within a steady relationship. Within ongoing relationships, condom use was highest among respondents who were younger, black, of lower income and from large metropolitan areas. Forty percent of unmarried adults used a condom at last sex, compared with the health objective of 50% for the year 2001. Forty percent of injecting drug users used condoms at last intercourse, compared with the 60% condom use objective for high-risk individuals. Significantly, persons at increased risk for HIV because of their sexual behavior or drug use were not more likely to use condoms than were persons not at increased risk; only 22% used condoms during last intercourse within an ongoing relationship.
Conclusions: Substantial progress has been made toward national goals for increasing condom use. The rates of condom use by individuals at high risk of HIV need to be increased, however, particularly condom use with a steady partner.
(UNITED STATES, CONDOM, AIDS, BEHAVIOUR, SEXUAL BEHAVIOUR, DRUG ADDICTION).
English - pp. 24-28.
J. E. Anderson, Department of Sociology, L. Doll, Behavioral Intelligence Research Branch, T. S. Jones, Department of Science, all at the Division of HIV/AIDS Prevention-Intervention, Research and Support, CDC, Atlanta, U.S.A.; R. Wilson, National Center for Health Statistics, CDC, Hyattsville, MD, U.S.A.; P. Barker, Office of Applied Studies in the Substance Abuse and Mental Health Services Administration, Rockville, MD, U.S.A.
***
Kahn, James G.; Brindis, Claire D.; Glei, Dana A.
Pregnancies averted among U.S. teenagers by the use of contraceptives.
Context: The personal and social costs associated with teenage pregnancy in the United States concern many policymakers and researchers, yet the role of contraception in preventing these pregnancies has not been adequately quantified.
Methods: Published estimates of contraceptive effectiveness were applied to 1995 National Survey of Family Growth data on sexual and contraceptive practices in order to estimate the number of pregnancies averted through the use of contraceptives by U.S. teenagers. Four scenarios of contraceptive access--from current levels of access to highly restricted access--and teenagers' sexual and contraceptive practices in response to such restrictions are used to project the potential impact on pregnancies among teenagers.
Results: Current levels of contraceptive use averted an estimated 1.65 million pregnancies among 15-19-year-old women in the United States during 1995. If these young women had been denied access to both prescription and over-the-counter contraceptive methods, an estimated one million additional pregnancies (ranging from 750,000 to 1.25 million) would have occurred, assuming some decrease in sexual activity. These pregnancies would have led to 480,000 live births, 390,000 abortions, 120,000 miscarriages, 10,000 ectopic pregnancies and 37 maternal deaths.
Conclusions: Contraceptive use by teenage women prevents pregnancies and negative pregnancy-related health consequences that can disrupt the lives of adolescent women and that have substantial societal costs. Continued and expanded access to contraceptives for adolescents is a critically important public health strategy.
(UNITED STATES, ADOLESCENT PREGNANCY, CONTRACEPTIVE EFFECTIVENESS, CONTRACEPTIVE USAGE, CONTRACEPTION DISTRIBUTION).
English - pp. 29-34.
J. G. Kahn, Department of Epidemiology and Biostatistics and Institute for Health Policy Studies, C. D. Brindis, Department of Pediatrics, Division of Adolescent Medicine and Institute for Health Policy Studies, both at University of California, San Francisco, U.S.A.; D. A. Glei, Office of Population Research and the Department of Sociology, Princeton University, Princeton, NJ, U.S.A.
***
FAMILY PLANNING PERSPECTIVES, MARCH-APRIL 1999, VOL. 31, N? 2
Fu, Haishan; Darroch, Jacqueline E.; Haas, Taylor; Ranjit, Nalini.
Contraceptive failure rates: New estimates from the 1995 National Survey of Family Growth.
Context: Unintended pregnancy remains a major public health concern in the United States. Information on pregnancy rates among contraceptive users is needed to guide medical professionals' recommendations and individuals' choices of contraceptive methods.
Methods: Data were taken from the 1995 National Survey of Family Growth (NSFG) and the 1994-1995 Abortion Patient Survey (APS). Hazards models were used to estimate method-specific contraceptive failure rates during the first six months and during the first year of contraceptive use for all U.S. women. In addition, rates were corrected to take into account the underreporting of induced abortion in the NSFG. Corrected 12-month failure rates were also estimated for subgroups of women by age, union status, poverty level, race or ethnicity, and religion.
Results: When contraceptive methods are ranked by effectiveness over the first 12 months of use (corrected for abortion underreporting), the implant and injectables have the lowest failure rates (2-4%), followed by the pill (9%), the diaphragm and the cervical cap (13%), the male condom (15%), periodic abstinence (22%), withdrawal (26%) and spermicides (28%). In general, failure rates are highest among cohabiting and other unmarried women, among those with an annual family income below 200% of the federal poverty level, among black and Hispanic women, among adolescents and among women in their 20s. For example, adolescent women who are not married but are cohabiting experience a failure rate of about 47% in the first year of contraceptive use, while the 12-month failure rate among married women aged 30 and older is only 8%. Black women have a contraceptive failure rate of about 20%, and this rate does not vary by family income; in contrast, overall 12-month rates are lower among Hispanic women (16%) and white women (11%), but vary by income, with poorer women having substantially greater failure rates than more affluent women.
Conclusions: Levels of contraceptive failure vary widely by method, as well as by personal and background characteristics. Income's strong influence on contraceptive failure suggests that access barriers and the general disadvantage associated with poverty seriously impede effective contraceptive practice in the United States.
(UNITED STATES, CONTRACEPTION FAILURES, ESTIMATES, SOCIO-ECONOMIC DIFFERENTIALS, POVERTY, CONTRACEPTIVE METHODS).
English - pp. 56-63.
H. Fu, United Nations Development Programme, New York, NY 10017, U.S.A.; J. E. Darroch, T. Haas and N. Ranjit, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
***
Trussell, James; Vaughan, Barbara.
Contraceptive failure, method-related discontinuation and resumption of use: Results from the 1995 National Survey of Family Growth.
Context: Half of all pregnancies in the United States are unintended. Of these, half occur to women who were practicing contraception in the month they conceived, and others occur when couples stop use because they find their method difficult or inconvenient to use.
Methods: Data from the 1995 National Survey of Family Growth were used to compute life-table probabilities of contraceptive failure for reversible methods of contraception, discontinuation of use for a method-related reason and resumption of contraceptive use.
Results: Within one year of starting to use a reversible method of contraception, 9% of women experience a contraceptive failure--7% of those using the pill, 9% of those relying on the male condom and 19% of those practicing withdrawal. During a lifetime of use of reversible methods, the typical woman will experience 1.8 contraceptive failures. Overall, 31% of women discontinue use of a reversible contraceptive for a method-related reason within six months of starting use, and 44% do so within 12 months; however, 68% resume use of a method within one month and 76% do so within three months. Multivariate analyses show that the risk of contraceptive failure is elevated among low-income women and Hispanic women. Low-income women are also less likely than other women to resume contraceptive use after discontinuation.
Conclusions: The risks of pregnancy during typical use of reversible methods of contraception are considerably higher than risks of failure during clinical trials, reflecting imperfect use of these methods rather than lack of inherent efficacy. High rates of method-related discontinuation probably reflect dissatisfaction with available methods.
(UNITED STATES, CONTRACEPTION FAILURES, CONTRACEPTIVE METHODS, CONTRACEPTION CONTINUATION).
English - pp. 64-72 & 93.
J. Trussell and B. Vaughan, Office of Population Research, Princeton University, Princeton, NJ, U.S.A.
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Glei, Dana A.
Measuring contraceptive use patterns among teenage and adult women.
Context: Measures of contraceptive use at one point in time do not account for its changing nature. A measure that addresses the pattern of method use over time may better predict the cumulative risk of unintended pregnancy.
Methods: Women at risk of unintended pregnancy were selected from the 1995 National Survey of Family Growth, and their contraceptive use patterns were compared across age-groups. Survival analysis was used to validate women's long-term use pattern as an indicator of pregnancy risk, and multivariate regression analyses were used to explore potential covariates of current patterns of contraceptive use.
Results: More than two-thirds of women aged 15-19 report long-term uninterrupted contraceptive use, but they are more likely to report sporadic use and less likely to report uninterrupted use of a very effective method than are women aged 25-34. Compared with women aged 25-34, women aged 20-24 have higher rates of sporadic use and lower rates of effective uninterrupted use. Among teenagers, nonusers are 12 times as likely as uninterrupted effective users to experience an unintended pregnancy within 12 months at risk. Women in less stable relationships, those having more infrequent intercourse and women who have recently experienced nonvoluntary intercourse for the first time are more likely than others to have a high-risk contraceptive pattern. Women aged 17 and younger whose current partner is more than three years older are significantly less likely to practice contraception than are their peers whose partner is closer in age.
Conclusions: Long-term contraceptive use pattern is a valid predictor of unintended pregnancy risk. Policies aimed at reducing unintended pregnancies should target women who do not practice contraception and those who are sporadic users. Women in unstable relationships, those having infrequent sex and women who experience sexual coercion need access to methods, such as emergency contraception, that can be used sporadically or after unprotected intercourse.
(UNITED STATES, CONTRACEPTIVE USAGE, METHODOLOGY, MEASUREMENT, WOMEN, AGE EFFECT, UNWANTED PREGNANCY).
English - pp. 73-80.
D. A. Glei, Office of Population Research, Princeton University, Princeton, NJ, U.S.A.
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Frezieres, Ron G.; Walsh, Terri L.; Nelson, Anita L.; Clark, Virginia A.; Coulson, Anne H.
Evaluation of the efficacy of a polyurethane condom: Results from a randomized, controlled clinical trial.
Context: Condoms made of latex are not comfortable or appropriate for all consumers. Polyurethane condoms may provide a needed alternative.
Methods: In a double-masked study, 805 monogamous couples were randomized to use either the polyurethane condom or the latex condom for six months. Couples recorded the frequency of intercourse, of condom use and of breakage and slippage throughout the trial in coital diaries and in detailed reports on the first five uses. Breakage and slippage rates were determined, and typical-use and consistent-use pregnancy rates were calculated using life-table analysis, adjusted for use of emergency contraception.
Results: The six-month pregnancy rate during typical use (adjusted for use of emergency contraception) was 4.8% for the polyurethane condom and 6.3% for the latex condom. Similarly adjusted pregnancy rates during consistent use over six completed menstrual cycles--2.4% for the polyurethane condom and 1.1% for the latex condom--did not differ significantly. Clinical failure rates (including breakage and slippage occurring during either intercourse or withdrawal) were 8.5% for the polyurethane condom and 1.6% for the latex condom. In general, male participants were more satisfied with the latex condom, and users of latex were significantly less likely to drop out of the study for condom-related reasons than were users of polyurethane.
Conclusions: Although polyurethane and latex condoms provide equivalent levels of contraceptive protection, the polyurethane condom's higher frequency of breakage and slippage suggests that this condom may confer less protection from sexually transmitted infections than does the latex condom.
(CONDOM, TECHNOLOGY, EXPERIMENTATION, PREGNANCY RATE, USE-EFFECTIVENESS, COMPARATIVE ANALYSIS).
English - pp. 81-87.
R. G. Frezieres, T. L. Walsh, Research Division, California Family Health Council, Los Angeles, U.S.A.; A. L. Nelson, Department of Obstetrics and Gynecology, Harbor-University of California, Los Angeles, U.S.A.; V. A. Clark and A. H. Coulson, School of Public Health, UCLA, Los Angeles, U.S.A.
***
Stevens-Simon, Catherine; Kelly, Lisa; Singer, Dena.
Preventing repeat adolescent pregnancies with early adoption of the contraceptive implant.
Context: Even in intensive, adolescent-oriented programs, in which access to highly effective contraceptives is guaranteed, repeat adolescent pregnancies commonly occur.
Methods: To assess whether adoption of the contraceptive implant would lower the rate of repeat pregnancy, contraceptive use and pregnancy outcomes were tracked among 309 adolescent mothers--171 "early" implant users who began use within six months of delivery and 138 who either adopted another method or had used no method. Participants were interviewed at delivery and at six-month intervals through the second year postpartum. Multivariate logistic regression analyses were conducted to ascertain the likelihood of a repeat pregnancy within the first and second year postpartum.
Results: During the first year postpartum, although 7% of the early implant users had their implants removed, pregnancy rates were significantly (p<.0001) lower among early implant users (less than 1%) than among the other adolescent mothers in the sample (20%). By the end of the second year postpartum, 37% of early implant users had discontinued use. Nevertheless, their two-year pregnancy rate (12%) remained significantly lower (p<.0001) than that of the other adolescent mothers (46%). The multivariate analysis showed that early implant use was the only independent predictor of a repeat pregnancy within the first year postpartum, while early use, parity and number of risk factors for repeat pregnancy were independently associated with the likelihood of another pregnancy in the second year postpartum.
Conclusions: Although early implant insertion significantly decreased the rate of rapid, repeat adolescent pregnancies, the rates of removal and of pregnancy by the end of the second year postpartum were high. Thus, health care providers need to address the motivational components of adolescent pregnancy even among those who accept ostensibly long-term methods.
(UNITED STATES, ADOLESCENT PREGNANCY, REPEATED PREGNANCY, CONTRACEPTIVE IMPLANTS, USE-EFFECTIVENESS).
English - pp. 88-93.
C. Stevens-Simon, L. Kelly and D. Singer, Department of Pediatrics, Division of Adolescent Medicine, University of Colorado Health Science Center, Denver, U.S.A.
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FAMILY PLANNING PERSPECTIVES, MAY-JUNE 1999, VOL. 31, N? 3
Marquis, M. Susan; Long, Stephen H.
Medicaid eligibility expansion in Florida: Effects on maternity care financing and the delivery system.
Context: In July 1989, the income limit on Medicaid eligibility for pregnant women in Florida was increased from 100% to 150% of the poverty level. This change may have led to substantial shifts in the financing of pregnancy-related care, and also may have had distinct effects on different providers in the health care delivery system.
Methods: Matched birth and death certificates, hospital discharge abstracts, Medicaid eligibility records and encounter records from county public health departments were used to estimate changes in the flows of funds and services by major payer groups during the period preceding the expansion (July 1988-June 1989) and for calendar year 1991. A total of 188,793 births in the first period and 193,292 in the second were examined.
Results: The number of births financed annually by Medicaid in Florida increased by 47% following the eligibility expansion, from 47,400 in 1988-1989 to 69,600 in 1991. This increase stemmed largely from covered births to women who otherwise would have been uninsured. Seventy-three percent of the additional 22,200 deliveries funded through Medicaid in 1991 are attributed to women who were eligible as a result of the expansions. The additional prenatal care financed by Medicaid was delivered almost entirely by county public health departments, which increased their capacity by more than 100%, from 177,000 visits in 1988-1989 to 433,000 in 1991. Medicaid payments for maternity care increased 39%, from $135 million to $187 million, while payments made by the uninsured dropped by 29%. These changes resulted in a 5% rise in hospital revenues, despite little change in the number of admissions.
Conclusions: The Medicaid expansion benefited low-income pregnant women and hospitals in Florida. It is unknown whether the private delivery system would have accommodated the increased demand in the absence of the public health system response.
(UNITED STATES, STATE, SOCIAL SECURITY, HEALTH CARE, FINANCING, PRENATAL CARE, PUBLIC SERVICES).
English - pp. 112-116 & 121.
M. S. Marquis and S. H. Long, RAND, Washington, DC, U.S.A.
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Whitaker, Daniel J.; Miller, Kim S.; May, David C.; Levin, Martin L.
Teenage partners' communication about sexual risk and condom use: The importance of parent-teenager discussions.
Context: Teenagers' communication with their partners about sex and their use of condoms may be influenced by the discussions teenagers have with their parents about sex. However, little is known about the process of parent-teenager communication on this topic. Understanding both what parents discuss with their children and how they discuss it may lead to a greater understanding of teenagers' sexual behavior.
Methods: Interviews were conducted with 372 sexually active black and Hispanic youth aged 14-17 from Alabama, New York and Puerto Rico. Regression analyses were used to examine parent-teenager discussions about sexuality and about sexual risk, and parental communication skills as predictors of teenagers' discussions about sexual risk with a partner and teenagers' condom use.
Results: Parent-teenager discussions about sexuality and sexual risk were associated with an increased likelihood of teenager-partner discussions about sexual risk and of teenagers' condom use, but only if parents were open, skilled and comfortable in having those discussions. Teenagers' communication with their partner about sexual risk also was associated with greater condom use, but the relationship between parent-teenager communication and teenagers' condom use was independent of this association.
Conclusions: The influence on teenagers of parent-teenager discussions about sexuality and sexual risk depends on both what parents say and how they say it. Programs that foster parent-teenager communication about sexuality and sexual risk must emphasize both of these aspects.
(UNITED STATES, ADOLESCENTS, WORD-OF-MOUTH COMMUNICATION, SEXUAL BEHAVIOUR, CONDOM, CONTRACEPTIVE USAGE, PARENTS).
English - pp. 117-121.
D. J. Whitaker, K. S. Miller, Centers for Disease Control and Prevention, Atlanta, U.S.A.; D. C. May, School of Public and Environmental Affairs, Indiana University-Purdue University, Fort Wayne, IN, U.S.A.; M. L. Levin, Department of Sociology, Anthropology and Social Work, Mississippi State University, Mississippi State, MS, U.S.A.
***
Darroch, Jacqueline E.; Landry, David J.; Oslak, Selene.
Pregnancy rates among U.S. women and their partners in 1994.
Context: When rates of pregnancy, birth and abortion are calculated only for the women involved, men's role in reproduction is ignored, resulting in limited understanding of their influence on these outcomes.
Methods: Data from the 1995 National Survey of Family Growth and from the 1994-1995 Alan Guttmacher Institute Abortion Patient Survey were combined with national natality statistics to estimate pregnancy rates in 1994 for women and their male partners, by age and marital status at the time of conception.
Results: Nine percent of both men and women aged 15-44 were involved in conceiving a pregnancy in 1994 (excluding those resulting in miscarriages). Pregnancy levels were highest among women aged 20-24 and among male partners aged 25-29. Men younger than 20 were involved in about half as many pregnancies as were women this age (9% compared with 18%). In contrast, men aged 35 and older were involved in roughly twice as many pregnancies as were similarly aged women (19% compared with 9%). Three out of every four pregnancies in 1994 resulted in a birth. However, 47% of pregnancies involving men younger than 18 ended in abortion, compared with about 34% of those involving men aged 40 and older. In comparison, 31% of pregnancies among women younger than 18 resulted in abortion, while 39% of those among women aged 40 and older were terminated.
Conclusion: The overall rate at which men were involved in causing a pregnancy is similar to the pregnancy rate among women. Men are typically older than women when they are involved in a pregnancy, however. This implies that men may bring more experience and resources to the pregnancy experience.
(UNITED STATES, PREGNANCY RATE, WOMEN, MEN, MEN?S ROLE, AGE).
English - pp. 122-126 & 136.
J. E. Darroch, D. J. Landry and S. Oslak, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
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Saewyc, Elizabeth M.; Bearinger, Linda H.; Blum, Robert Wm.; Resnick, Michael D.
Sexual intercourse, abuse and pregnancy among adolescent women: Does sexual orientation make a difference?.
Context: Although a limited amount of research has retrospectively explored the childhood and adolescent heterosexual experiences of lesbians, little is known about the prevalence of heterosexual behavior and related risk factors or about pregnancy histories among lesbian and bisexual teenagers.
Methods: A secondary analysis was conducted using responses from a subsample of 3,816 students who completed the 1987 Minnesota Adolescent Health Survey. Behaviors, risk factors and pregnancy histories were compared among adolescents who identified themselves as lesbian or bisexual, as unsure of their sexual orientation and as heterosexual.
Results: Overall, bisexual or lesbian respondents were about as likely as heterosexual women ever to have had intercourse (33% and 29%, respectively), but they had a significantly higher prevalence of pregnancy (12%) and physical or sexual abuse (19-22%) than heterosexual or unsure adolescents. Among sexually experienced respondents, bisexual or lesbian and heterosexual women reported greater use of ineffective contraceptives (12-15% of those who used a method) than unsure adolescents (9%); bisexual or lesbian respondents were the most likely to have frequent intercourse (22%, compared with 15-17% of the other groups). In the sample overall, among those who were sexually experienced and among those who had ever been pregnant, bisexual or lesbian women were the most likely to have engaged in prostitution during the previous year.
Conclusions: Providers of reproductive health care and family planning services should not assume that pregnant teenagers are heterosexual or that adolescents who say they are bisexual, lesbian or unsure of their sexual orientation are not in need of family planning counseling. Further research should explore the interactions between adolescent sexual identity development and sexual risk behaviors.
(UNITED STATES, STATE, HOMOSEXUALITY, ADOLESCENTS, ADOLESCENT PREGNANCY, SEXUAL RELATIONSHIPS).
English - pp. 127-131.
E. M. Saewyc, School of Nursing and Division of Adolescent Medicine, University of Washington, Seattle, U.S.A.; L. H. Bearinger, School of Nursing, R. Wm. Blum and M. D. Resnick, Division of General Pediatrics and Adolescent Health, School of Medicine, University of Minnesota, Minneapolis, U.S.A.
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Dietz, Patricia M.; Adams, Melissa M.; Spitz, Alison M.; Morris, Leo; Johnson, Christopher H.; The PRAMS Working Group.
Live births resulting from unintended pregnancies: Is there variation among states?
Context: States need data on live births resulting from unintended pregnancies in order to assess the need for family planning services; however, many states do not collect such data. Some states may use extrapolated rates from other states.
Methods: Pregnancy Risk Assessment Monitoring System (PRAMS) data were assessed to explore the feasibility of extrapolating data on the percentage of live births resulting from unintended pregnancies from states that collect these data to states that do not. Data on women who had live births between 1993 and 1995 were examined for eight states: Alabama, Florida, Georgia, Michigan, New York (excluding New York City), Oklahoma, South Carolina and West Virginia. Logistic regression was used to determine state variation in the odds of delivering a live birth resulting from an unintended pregnancy after adjustment for maternal race, marital status, age, education, previous live birth and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Results: The percentage of live births resulting from unintended pregnancy ranged from 33% in New York to 49% in Alabama, Georgia and South Carolina. Compared with women in Alabama, women in Oklahoma were more likely to deliver a live birth resulting from an unintended pregnancy (odds ratio of 1.2, confidence interval of 1.11.3) and women in New York State were less likely (odds ratio of 0.7, confidence interval of 0.60.8) to have such a birth. However, unmarried white women in New York had lower odds of having a live birth resulting from an unintended pregnancy and married black women in Michigan had higher odds of having a live birth resulting from unintended pregnancy than their counterparts in Alabama. Although the percentages varied, in all eight states women who were black, were unmarried, were younger than 20 years of age, had less than 12 years of education or had more than one child had higher percentages of live births resulting from unintended pregnancy than women with other demographic characteristics.
Conclusions: Data on which women have the greatest risk of delivering a live birth resulting from an unintended pregnancy may be extrapolated from one state to another, but the rate of such births may overestimate or underestimate the problem from one state to another.
(UNITED STATES, STATE, LIVE BIRTHS, UNWANTED PREGNANCY, COMPARATIVE ANALYSIS).
English - pp. 132-136.
P. M. Dietz, M. M. Adams, A. M. Spitz, L. Morris, C. H. Johnson, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, U.S.A.; The PRAMS Working Group.
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Linnehan, Mary Jane E.; Groce, Nora Ellen.
Psychosocial and educational services for female college students with genital human papillomavirus infection.
Context: College-age women have a high risk of acquiring human papillomavirus (HPV) infection, which may have substantial psychosocial and physical effects. Young women who become infected need information and support from health care professionals, but little is known about providers' attitudes toward or provision of interventions for helping women cope with HPV.
Methods: A survey of 73 nurse practitioners and 70 physicians in college-based health clinics explored their perceptions of the need for psychosocial and educational interventions and their practices regarding such services for HPV patients. Analysis of variance and chi-square testing were used to examine differences by providers' type and gender.
Results: At least 86% of providers agree that HPV infection has a variety of psychosocial effects on young women, but only 54% spend at least 10 minutes providing education and counseling to all of their HPV patients. Roughly 80-90% routinely take a sexual history, explain the potential of HPV recurrence and discuss the risk of cancer with HPV patients; however, fewer than half always offer a variety of other interventions that could help patients cope with the diagnosis and promote preventive behaviors. Female providers are more aware of the psychosocial impact of HPV and the need for support than are male providers. However, nurse practitioners provide counseling and educational interventions more frequently than do physicians, even when gender is controlled for.
Conclusions: College-based health providers need to improve the content of the counseling and education they offer to women with HPV, as well as the consistency with which they deliver those interventions. When they are unable to provide services, they should be able to refer patients elsewhere.
(UNITED STATES, WOMEN, COLLEGE STUDENTS, VIRAL DISEASES, COUNSELING, HEALTH EDUCATION, MEDICAL PERSONNEL).
English - pp. 137-141.
M. J. E. Linnehan, Newark Beth Israel Hospital School-Based Youth Program, Newark, NJ, U.S.A.; N. E. Groce, School of Public Health, Yale University, New Haven, CT, U.S.A.
***
FAMILY PLANNING PERSPECTIVES, JULY-AUGUST 1999, VOL. 31, N? 4
Darroch, Jacqueline E.; Landry, David J.; Oslak, Selene.
Age differences between sexual partners in the United States.
Context: Researchers have examined the age of partners of young women at first intercourse and of young women who have given birth, but little is known about the age of partners of young women in current sexual relationships or young women who have had an abortion.
Methods: Data from the 1995 National Survey of Family Growth (NSFG) were used to examine age differences between women and their current partner and women's use of contraceptives at last intercourse, by marital status and by the age difference between women and their partner. Data from the NSFG and the 1994-1995 Alan Guttmacher Institute Abortion Patient Survey, with supplemental information from other sources, were used to estimate 1994 pregnancy rates for women by their age and marital status, according to the age difference between the women and their partner.
Results: Among all sexually active women aged 15-44, 10% had a partner who was three or more years younger, 52% a partner who was within two years of their age, 20% a partner who was 3-5 years older, and 18% a partner who was six or more years older. In contrast, 64% of sexually active women aged 15-17 had a partner within two years of their age, 29% a partner who was 3-5 years older, and 7% a partner who was six or more years older. Among women younger than 18, the pregnancy rate among those with a partner who was six or more years older was 3.7 times as high as the rate among those whose partner was no more than two years older. Among women younger than 18 who became pregnant, those with a partner who was six or more years older were less likely to have an unintended pregnancy (70%) or to terminate an unintended pregnancy (21%) than were those whose partner was no more than two years older (82% and 49%, respectively). Among women younger than 18 who were at risk of unintended pregnancy, 66% of those who had a partner who was six or more years older had practiced contraception at last sex, compared with 78% of those with a partner within two years of their own age. Young women who were Catholic and those who had first had sex with their partner within a relatively committed relationship were less likely to be involved with a man who was six or more years older than were young women who were Protestants and those who first had sex with their partner when they were dating, friends or had just met. Young women who had ever been forced to have sex were twice as likely as those who had not to have a partner who was 3-5 years older.
Conclusion: Although the proportion of 15-17-year-old women who have a much older partner is small, these adolescents are of concern because of their low rate of contraceptive use and their relatively high rates of pregnancy and birth. Research is needed to determine why some young women have relationships with an older man, and how their partner's characteristics affect their reproductive behavior.
(united states, mate, age, contraceptive usage, pregnancy rate, adolescents, differential fertility).
English - pp. 160-167.
J. E. Darroch, D. J. Landry and S. Oslak, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
***
Grady, William R.; Klepinger, Daniel H.; Nelson-Wally, Anjanette.
Contraceptive characteristics: The perceptions and priorities of men and women.
Context: Despite the fact that choosing a contraceptive method is often a decision made by couples, little is known about how men and women differ in their perceptions of the characteristics of various method types, and in the importance that they attach to those characteristics when choosing a contraceptive method.
Methods: The data analyzed here are subsets from two companion surveys conducted in 1991--1,189 men aged 20-27 who were surveyed in the National Survey of Men and 740 women aged 20-27 who were surveyed in the National Survey of Women. Multivariate ordered logit analysis is used to examine how gender is related to both the importance that individuals assign to seven specific contraceptive characteristics when choosing a method, and to perceptions about the extent to which five common method types possess each of these characteristics.
Results: Women rank pregnancy prevention as the single most important contraceptive characteristic when choosing a method, with 90% citing it as "very important." The health risks associated with particular methods and protection from sexually transmitted diseases (STDs) are rated as the second most important characteristics by women (each mentioned as "very important" by 77%). In contrast, men consider STD prevention for themselves and their partner to be just as important as pregnancy protection (each mentioned as "very important" by 84-86%), and they rank STD prevention as more important than other health risks (by 72%). Women, but not men, rank both ease of use and the need to plan ahead as being more important characteristics than a method's interference with sexual pleasure. Both men and women have an accurate understanding of the strengths and weaknesses of particular methods, but differ enough in their perceptions to alter the relative attractiveness of each method. In particular, women have more favorable perceptions than men about the pill, being somewhat more likely than men to believe that the pill is "very good" at preventing pregnancy (75% vs. 67%) and to say that it is very good at not interfering with sexual pleasure (82% vs. 76%). In contrast, women have generally less favorable perceptions than men about other reversible methods, including the condom: Women were less likely than men to consider the condom very good at pregnancy prevention (29% vs. 46%) or at having no need for advance planning (22% vs. 38%). Gender differences in perceptions about the specific characteristics of contraceptive methods often vary by marital status.
Conclusions: Men and women have somewhat different priorities when choosing a contraceptive method. Despite many similarities between women and men in their perceptions about the characteristics of each method type, numerous differences between them may have an important influence on how couples make their method choices.
(united states, contraceptive methods, choice, sex differentials).
English - pp. 168-175.
W. R. Grady, D. H. Klepinger and A. Nelson-Wally, Battelle Centers for Public Health Research and Evaluation, Seattle, U.S.A.
***
Benson Gold, Rachel; Sonfield, Adam.
Family planning funding through four Federal-State Programs, FY 1997.
Context: The maternal and child health (MCH) and the social services block grants have long played an important role in the provision of family planning services in the United States. The extent to which states have incorporated family planning services into the newer federally funded, but state-controlled, programs--Temporary Aid to Needy Families (TANF) and the State Children's Health Insurance Program (CHIP)--has yet to be identified.
Methods: The health and social services agencies in all U.S. states, the District of Columbia and five federal jurisdictions were queried regarding their family planning expenditures and activities through the MCH and social services block grants and the TANF program in FY 1997. In addition, the states' CHIP plans were analyzed following their approval by the federal government. Because of differences in methodology, these findings cannot be compared with those of previous attempts to determine public expenditures for contraceptive services and supplies.
Results: In FY 1997, 42 states, the District of Columbia and two federal jurisdictions spent $41 million on family planning through the MCH program. Fifteen states reported spending $27 million through the social services block grant. Most of these jurisdictions indicated that they provide direct patient care services, most frequently contraceptive services and supplies. Indirect services--most often population-based efforts such as outreach and public education--were reported to have been provided more often through the MCH program than through the social services program. MCH block grant funds were more likely to go to local health departments, while social services block grant funds were more likely to be channeled through Planned Parenthood affiliates. Four states reported family planning activities funded under TANF in FY 1997, the first year of the program's operation. Virtually all state plans for the implementation of the CHIP program appear to include coverage of family planning services and supplies for the adolescents covered under the program, even when not specifically required to do so by federal law.
Conclusions: Joining two existing--but frequently overlooked--block grants, two new, largely state-controlled programs are poised to become important sources of support for publicly funded family planning services. Now more than ever, supporters of family planning services need to look beyond the traditional sources of support--Title X and Medicaid--as well as beyond the federal level to the states, where important program decisions are increasingly being made.
(UNITED STATES, FAMILY PLANNING POLICY, FINANCING, GOVERNMENT POLICY, HEALTH SERVICES, MATERNAL AND CHILD HEALTH, SOCIAL WELFARE).
English - pp. 176-181.
R. Benson Gold and A. Sonfield, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
***
Paine-Andrews, Adrienne; Harris, Kari Jo; Fisher, Jacqueline L.; Lewis, Rhonda K.; Williams, Ella L.; Fawcett, Stephen B.; Vincent, Murray L.
Effects of a replication of a multicomponent model for preventing adolescent pregnancy in three Kansas communities.
Context: A significant amount of attention has been devoted to the complex issue of teenage pregnancy and to programs for reducing pregnancy among adolescents. Careful evaluations of such programs are needed to ascertain what strategies will be most effective at reducing teenage pregnancy.
Methods: A pretest-posttest comparison group design was used to analyze the effects of a comprehensive multicomponent school and community intervention on estimated pregnancy rates and birthrates among young people in three Kansas communities: Geary County, Franklin County and selected neighborhoods of Wichita.
Results: There were high levels of program activity in all three communities during the intervention period, including teacher training and sexuality education for students. Survey respondents rated highly such project interventions as the extension of school-linked clinic hours to accommodate student schedules and support groups established in middle schools. Between 1994 and 1997, the proportions of adolescents reporting that they had ever had sex decreased significantly among all ninth and 10th graders in Geary County, from 51% to 38% among females and from 63% to 43% among males. In Franklin County, more males in grades 11 and 12 reported using condoms in 1996 (55%) than had done so in 1994 (39%). Age at first intercourse remained relatively stable in Franklin and Geary counties during the intervention period. The estimated pregnancy rate among adolescents aged 14-17 decreased between 1994 and 1997 in Geary Country, while it increased in comparison areas. The estimated pregnancy rates among 14-17-year-olds decreased in both Franklin County and its comparison communities. The birthrate declined both in one target area of Wichita and in its comparison area from 1991-1993 to 1994-1996. Over the same time period, the birthrate increased in a second target area of Wichita, while it decreased in the comparison community.
Conclusions: This evaluation of a comprehensive multicomponent program for adolescent pregnancy prevention contributes to our understanding of this model and its replicability in diverse communities. Ongoing program evaluation is important for developing initiatives and for refining strategies so they respond to local conditions.
(UNITED STATES, STATE, ADOLESCENT PREGNANCY, PROGRAMME EVALUATION, METHODOLOGY).
English - pp. 182-189.
A. Paine-Andrews, J. L. Fisher, S. B. Fawcett, Work Group on Health Promotion & Community Development, University of Kansas, Lawrence, KS, U.S.A.; K. J. Harris, Department of Preventive Medicine, University of Kansas School of Medicine, Kansas City, KS, U.S.A.; R. K. Lewis, Department of Psychology, Wichita State University, Wichita, KS, U.S.A.; E. L. Williams, National Immunization Program, Kansas City, MO, U.S.A.; M. L. Vincent, Department of Health Promotion and Education, School of Public Health, University of South Carolina, Columbia, SC, U.S.A.
***
Lindsay, Jo; Smith, Anthony M. A.; Rosenthal, Doreen A.
Conflicting advice? Australian adolescents' use of condoms or the pill.
Context: Teenagers are exposed to two potentially conflicting sexual health messages, one emphasizing the prevention of sexually transmitted diseases (STDs) and the other stressing pregnancy prevention. To protect teenagers from both STDs and unwanted pregnancy, it is important to know what method choices they make and why.
Methods: Data from a 1997 national survey of 3,550 Australian secondary school students were used to examine teenagers' method choice and patterns of advice-seeking about contraception and STD prevention. Logistic regression analyses were conducted to identify factors associated with the exclusive use of condoms or the pill.
Results: Virtually all 961 currently sexually active students were using at least one contraceptive method--primarily condoms (78%) or the pill (45%). Some 31% were using condoms exclusively, and 10% were using the pill exclusively. Older students and those who had sought contraceptive advice had elevated odds of using the pill rather than condoms exclusively (odds ratios, 4.4 and 2.6, respectively), while those who had had only casual partners in the last year had a reduced likelihood of exclusive pill rather than condom use (0.1). Furthermore, the more students believed that their peers used condoms, the less likely they were to report exclusive pill use (0.4). Parents were the most frequent source of advice about contraception, followed by physicians and teachers. The most common sources of advice about HIV and other STDs were parents, teachers and then physicians.
Conclusions: Young people must be educated about the distinction between safer sex and contraception, and about how to prevent both STDs and pregnancy. Providing parents with current sexual health information may help to improve young people's sexual health.
(AUSTRALIA, ADOLESCENTS, SEXUAL BEHAVIOUR, CONTRACEPTIVE METHODS, CHOICE, COUNSELING, SEX EDUCATION, SEXUALLY TRANSMITTED DISEASES).
English - pp. 190-194.
J. Lindsay, A. M. A. Smith and D. A. Rosenthal, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.
***
Danielson, Ross; Barbey, Anita; Cassidy, Donna; Rosenzweig, Julie; Chowdhury, Durre.
Couple-friendly services in a metropolitan sexually transmitted disease clinic: Views of clients and providers.
Context: Clients making clinic visits related to reproductive health might benefit from participation with their partner. There is little information available, however, on whether either clients themselves or clinic staff would feel comfortable with such a possibility.
Methods: The Multnomah County Health Department Sexually Transmitted Disease Clinic in Portland, Oregon, conducted a survey of 237 new clients in June 1994 to assess clients' and providers' responses to the idea of offering couple visits.
Results: Twenty-six percent of female clients and 16% of male clients were accompanied by their partner on their visit to the clinic. Eighty-seven percent of all clients favored the clinic's offering couple visits, 5% opposed the concept and 8% were undecided. Fifty-four percent would have wanted their partner to be with them during their present visit if this choice had been offered, and 62% would want their partner to join them in follow-up couple visits if this were recommended by their provider. Seventy-one percent had already discussed with their partner the reason for their immediate clinic visit, and 88% expected to discuss the visit with their partner afterward. Attitudes toward couple services were similar for male and female clients and did not vary by race or ethnicity. For more than one-fifth of clients, clinic staff reported that they would not recommend couple visits; however, many of these clients reported that they would prefer being accompanied by their partner.
Conclusions: Appropriately designed couple-friendly options are likely to be generally accepted and moderately utilized by clients of varying backgrounds. Clinic staff may be more reluctant to involve clients' partners than the clients are themselves, however.
(UNITED STATES, SEXUALLY TRANSMITTED DISEASES, COUPLE, CLINICS, CLIENTS, STAFF, ATTITUDE).
English - pp. 195-199.
R. Danielson, Northeast Health Resource Center, Portland, OR, U.S.A.; A. Barbey, D. Cassidy, Multnomah County Health Department HIV Clinic, Portland, OR, U.S.A.; J. Rosenzweig, School of Social Work, Portland State University, Portland, OR, U.S.A.; D. Chowdhury, Faculty of Medicine, Department of Community Medicine, Jordan University of Science and Technology, Irbid, Jordan.
***
FAMILY PLANNING PERSPECTIVES, SEPTEMBER-OCTOBER 1999, VOL. 31, N? 5
Singh, Susheela; Darroch, Jacqueline E.
Trends in Sexual Activity Among Adolescent American Women: 1982-1995.
Context: The formulation of policies and development of programs regarding adolescent sexual and reproductive health requires up-to-date information on levels of and trends in teenage sexual activity.
Methods: Analysis of three NSFG surveys, carried out in 1982, 1988 and 1995, allows examination of the sexual behavior of teenage women over a 13-year time period, using comparable data for the entire time period.
Results: The proportion of adolescent women who ever had sexual intercourse increased somewhat during the 1980s, but this upward trend stabilized between the late 1980s and the mid-1990s. Throughout the period, there has been little change in the proportion currently sexually active: In each of the surveys, about 40% of all 15-19-year-olds had had sexual intercourse in the last three months. The average number of months in the past year in which sexually experienced teenagers had had intercourse declined during the 1980s, with no change in the continuity of sexual intercourse taking place between 1988 and 1995, when the mean remained at 8.6 months. Differences in teenage sexual behavior across poverty and racial and ethnic subgroups were large in the early 1980s, but narrowed over the 13-year period.
Conclusions: Only continued monitoring will tell whether the patterns observed during 1988-1995 signify a temporary leveling off in the trend toward increasing adolescent sexual activity, stability in behavior or the beginnings of a decline. Nevertheless, the sustained level of initiation of sexual activity during adolescence is by now a recognized pattern of behavior, and is an important characteristic of the transition to adulthood in the United States.
(UNITED STATES, ADOLESCENTS, WOMEN, SEXUAL BEHAVIOUR, TRENDS).
English - pp. 212-219.
S. Singh and J. E. Darroch, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
***
Williams, Lindy; Abma, Joyce; Piccinino, Linda J.
The Correspondence Between Intention To Avoid Childbearing and Subsequent Fertility: A Prospective Analysis.
Context: Retrospective studies of pregnancy intendedness have revealed some characteristics that can help identify which women are more likely than others to experience an unintended birth. A comparison of these findings with those from a prospective analysis may shed greater light on the characteristics associated with unintended pregnancy.
Methods: Data were taken from the 1988 National Survey of Fertility Growth and a telephone reinterview of respondents conducted in 1990. Separate analyses were conducted of women intending to postpone childbearing for at least three years and of women intending to forgo all future childbearing. Logistic regression models were used to identify the effects of social and demographic characteristics, as well as change in marital status and certainty of intentions, on the odds of experiencing a birth in the interval between interviews.
Results: Only 10% of women intending to postpone pregnancy for more than three years and 8% of respondents seeking to forgo future childbearing had a birth in the interval between interviews. (These births, referred to as unpredicted births in this article, are roughly analogous to those labeled unintended in retrospective analyses.) Women with incomes below the poverty level were 2-3 times as likely as women with incomes between 100% and 199% of poverty to experience an unpredicted birth. Race was not a significant factor among women intending to avoid future childbearing, and became nonsignificant among those intending to postpone when change in marital status and contraceptive status were taken into account. Women aged 35 and older who wanted no more children were significantly less likely than women aged 20-29 to have an unpredicted birth. Women aged 30-34 who wanted to postpone childbearing were roughly 70% less likely than women aged 20-29 to experience an unpredicted birth. Overall, women who were at risk for a pregnancy but not practicing contraception were 2-3 times more likely than women using an effective method to have an unpredicted birth.
Conclusions: There are at least two potential explanations for instances where the correlates of unintended births in the prospective analysis differ from those identified in retrospective studies. Certain subgroups of women may be more likely to classify births as wanted when they are asked retrospectively; alternatively, they may be more likely to experience changes in their living conditions that alter their fertility intentions.
(UNITED STATES, UNWANTED PREGNANCY, FAMILY PLANNING, UNPLANNED PREGNANCY, SOCIO-ECONOMIC DIFFERENTIALS).
English - pp. 220-227.
L. Williams, Population and Development Program, Department of Rural Sociology, Cornell University, Ithaca, NY, U.S.A., J. Abma, and L. J. Piccinino, Reproductive Statistics Branch of the National Center for Health Statistics, Hyattsville, MD, U.S.A.
***
Finer, Lawrence B.; Darroch, Jacqueline E.; Singh, Susheela.
Sexual Partnership Patterns as a Behavioral Risk Factor For Sexually Transmitted Diseases.
Context: Women's and men's number of sexual partners and protective practices such as condom use can have a direct effect on their risk of contracting sexually transmitted diseases (STDs), including HIV.
Methods: The 1988 and 1995 cycles of the National Survey of Family Growth and five rounds of the General Social Survey conducted from 1988 to 1996 are used to examine women's and men's numbers of recent sexual partners. Levels of direct risk for STDs (two or more partners in the past year) and the social and demographic correlates of multiple partnership are analyzed among women and men. In addition, women's indirect risk for STDs (their partners' involvement with other partners in the past year) is used to estimate their overall risk of STDs through multiple partnerships.
Results: At least three-quarters of sexually active U.S. women and men in the late 1980s and mid-1990s had had only one sexual partner in the preceding 12 months. Moreover, there is no indication that the proportion with more than one partner in the past year changed substantially over that period. Nevertheless, combining women's and men's partnership reports suggests that about 17 million women aged 15-44--34% of those sexually active in the past year--were at risk for STDs because of direct exposure to multiple partners (5.4 million), indirect exposure (6.3 million) or both direct and indirect exposure (5.5 million). In all, 21% of women were at direct risk and 23% were at indirect risk. In comparison, among men aged 18-44, 24% were at direct risk for STDs and an unknown proportion were at indirect risk. Multivariate analyses indicated that unmarried individuals, women younger than 40 and men aged 20-29, blacks and women in the South were all at elevated risk for STDs because of multiple partnership. Overall, in 1995, 19% of sexually active women aged 15-44 had used condoms to protect against STDs over the preceding year, and 19% of those sexually active in the three months before the survey were current condom users. Condom use specifically for STD prevention was more common among women reporting both direct and indirect risk for STDs (58%) and among those at direct risk (46%) than among other women; women whose partners put them at indirect risk only were less likely to be current or recent condom users than women who were not at risk or were only at direct risk.
Conclusions: There is a continuing need to educate people regarding their risk for STDs, to increase the use of existing barrier methods and to develop new methods that protect against STD infection. In addition, if we are to develop a better understanding of the extent of STD risk through multiple partnership, the collection of information on number of partners and relationships between partners must be expanded and improved.
(UNITED STATES, SEXUALLY TRANSMITTED DISEASES, SEXUAL BEHAVIOUR, SEX DIFFERENTIALS, MATE, CONDOM).
English - pp. 228-236.
L. B. Finer, J. E. Darroch and S. Singh, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
***
Harvey, S. Marie; Beckman, Linda J.; Sherman, Christy; Petitti, Diana.
Women's Experience and Satisfaction with Emergency Contraception.
Context: If any new contraceptive technology is to become a viable option for decreasing unintended pregnancies, women must be willing to use the method and find it acceptable. However, because emergency contraceptive pills have not been widely used, very little is known about this method's acceptability.
Methods: Telephone interviews were conducted with 235 women who had received emergency contraceptive pills through a demonstration project at 13 Kaiser Permanente medical offices in San Diego to assess women's experience and satisfaction with the pills.
Results: More than two-thirds of the women (70%) were using a contraceptive method prior to their need for emergency contraception, and 73% of these users were relying on condoms. When asked about the situation that led to unprotected intercourse, 45% reported that their condom broke or slipped, while 23% said they had had unplanned sex. More than three-quarters of the sample (81%) experienced at least one side effect. The overwhelming majority were satisfied with emergency contraceptive pills (91%) and would recommend them to friends and family members (97%). Just one-quarter of the sample (28%) believed that emergency contraceptive pills should be dispensed over the counter, and an even lower proportion agreed that they should be available from vending machines (6%).
Conclusions: Because women were overwhelmingly accepting of emergency contraceptive pills, found them easy to use and did not intend to substitute them for regular contraceptive use, this new method is an important addition to the contraceptive options available to women, providing a way to prevent pregnancy after unprotected intercourse or method failure.
(UNITED STATES, WOMEN, POSTCOITAL CONTRACEPTIVE AGENTS, SATISFACTION).
English - pp. 237-240 & 260.
S. M. Harvey, Pacific Institute for Women's Health, Los Angeles, CA, U.S.A., L. J. Beckman, California School of Professional Psychology, Los Angeles, U.S.A., C. Sherman, Pacific Institute for Women's Health, Los Angeles, U.S.A., and D. Petitti, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, U.S.A.
***
Dobie, Sharon A.; Hart, L. Gary; Glusker, Ann; Madigan, David; Larson, Eric H.; Rosenblatt, Roger A.
Abortion services in rural Washington State, 1983-1984 to 1993-1994: Availability and outcomes.
Context: Fewer rural health providers offer abortion services than a decade ago. It is unknown how the reduction in service availability has affected women's pregnancy outcomes, the extent to which they must travel to obtain an abortion or whether abortions are delayed as a result.
Methods: Population, birth and fetal death data, as well as pregnancy termination reports, obtained from Washington State were used to calculate abortion rates and ratios and birthrates for Washington residents in 1983-1984 and in 1993-1994. Residence of abortion patients was classified by county only, and location of providers was recorded as large urban county, small urban county, large rural county or small rural county. Distances that women traveled to obtain an abortion were calculated. Chi-square tests were used to compare urban and rural rates and ratios within time periods, and to compare changes that occurred between time periods.
Results: Birthrates and abortion rates decreased for both rural and urban Washington women between 1983-1984 and 1993-1994, but the magnitude of the decrease was greater for rural women. The rural abortion rate fell 27%, from 14.9 abortions per 1,000 women to 10.9 per 1,000, while the urban rate dropped 17%, from 21.8 to 18.2 per 1,001. The decline in the abortion rate was larger for adolescents than it was for other age-groups. In rural areas, the abortion rate decreased from 16.5 per 1,000 adolescents aged 10-19 in 1983-1984 to 10.8 per 1,000 in 1993-1994, while it declined from 23.3 per 1,000 to 16.9 per 1,000 in urban areas. From the earlier to the later time period, rural women traveled on average 12 miles farther each way to obtain an abortion, and the proportion who obtained the procedure in a rural county decreased from 25% to 3%. In the earlier time period, 62% of rural women traveled 50 miles or more to obtain an abortion, compared with 73% in 1993-1994. From 1983-1984 to 1993-1994, the proportion of rural women who traveled out of state for an abortion increased from 8% to 14%. The proportion of rural women terminating their pregnancy after the first trimester increased from 8% in 1983-1984 to 15% in 1993-1994.
Conclusion: Rural Washington women are traveling farther and more often to urban and out-of-state locations for abortion services, and are obtaining their abortions at a later gestational age, which is associated with a decade-long decline in the number of abortion providers.
(UNITED STATES, STATE, RURAL AREAS, ABORTION, HEALTH SERVICES, SUPPLY, TRENDS).
English - pp. 241-245.
S. A. Dobie, A. Glusker, R. A. Rosenblatt, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, U.S.A.; L. G. Hart, WWAMI Center for Health Workforce Studies, Department of Family Medicine, University of Washington School of Medicine, U.S.A.; E. H. Larson, WWAMI Rural Health Research Center, D. Madigan, Department of Statistics, University of Washington College of Arts and Sciences, Seattle, WA, U.S.A.
***
Trussell, James; Vaughan, Barbara; Stanford, Joseph.
Are all contraceptive failures unintended pregnancies? Evidence from the 1995 National Survey of Family Growth.
Context: The incidence of unintended pregnancy has long been used as a primary indicator of the state of reproductive health. However, the definition--and therefore the measurement--of this indicator has been elusive.
Methods: Data from the 1995 National Survey of Family Growth (NSFG) were used to compare levels of unintended pregnancy among contraceptive users based on two definitions--the standard definition based on women's reports of contraceptive failure, and the NSFG definition based on pregnancy timing (wanted then, wanted later, or not wanted then or in the future). An attitudinal scale was used to examine women's feelings about their unintended pregnancy.
Results: Of pregnancies classified as contraceptive failures under the standard definition, only 68% were unintended pregnancies--94% of those ending in abortion and 60% of those ending in birth. Just 59% of women with a contraceptive failure classified as an unintended pregnancy reported feeling unhappy or very unhappy about their pregnancy, while 90% of those with a failure classified as an intended pregnancy reported being happy or very happy.
Conclusions: Measures of wantedness based on women's feelings about their pregnancy may correlate more closely with important pregnancy outcomes than do traditional measures of intendedness.
(UNITED STATES, CONTRACEPTIVE FAILURES, UNWANTED PREGNANCY, UNPLANNED PREGNANCY).
English - pp. 246-247 & 260.
J. Trussell, B. Vaughan, Office of Population Research, Princeton University, Princeton, NJ, U.S.A.; J. Stanford, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, U.S.A.
***
FAMILY PLANNING PERSPECTIVES, NOVEMBER-DECEMBER 1999, VOL. 31, N? 6
Bankole, Akinrinola; Darroch, Jacqueline E.; Singh, Susheela.
Determinants of trends in condom use in the United States, 1988-1995.
Context: Although overall condom use has increased substantially over the past decade, information is needed on whether dual method use has also become more common. In addition, there is little information on which characteristics of women influence condom use and dual method use, and on whether these characteristics have changed over time.
Methods: Data from the 1988 and 1995 National Surveys of Family Growth are examined to evaluate trends in condom use--either use alone or use with another highly effective method (dual method use). Logistic and multinomial regression analyses are presented to analyze the influence of women's characteristics on condom use.
Results: Current condom use rose significantly between 1988 and 1995, from 13% to 19% of all women who had had sex in the past three months. Dual method use increased from 1% in 1988 to 3% in 1995, still a very low level. In both years, current condom use was higher among women younger than 20 (32-34% in 1995) than among those aged 30 or older (less than 20% in 1995). Likewise, current condom use was most common among never-married women who were not cohabiting in both 1988 (20%) and in 1995 (34%). Multivariate analyses showed that women in the early stage of a relationship (six months or less in duration) were much more likely than those in a long-standing relationship (five years or more in length) to use the condom (odds ratio, 1.5). In both 1988 and 1995, younger women and better educated women were more likely to be currently using the condom than were older or less-educated women. For example, in 1995, women younger than 18 were 1.8 times as likely as 40-44-year-olds to be using condoms, and college graduates were 1.5 times as likely as high school graduates to do so. Further, women who were not in a union and either had never been married or were formerly married were more likely to be current condom users in 1995 than were married women (odds ratios, 1.5-1.9). Poor women were less likely than higher income women to be condom users in 1995 (odds ratios, 0.7-0.8), but poverty had made little difference in 1988. Groups likely to be dual method users were those also likely to be at greater risk of sexually transmitted disease: women in a union of less than six months duration (2.8), women younger than 20 (4.6-6.8), unmarried women (2.8-7.5) and women with two or more partners in the past three months (1.7).
Conclusions: While the increase in condom use, especially among unmarried and adolescent women, is encouraging, condom use overall is substantially less than that needed to protect women and men against sexually transmitted diseases (including HIV). Moreover, steps need to be taken to understand why levels of dual method use are low and how they may be increased.
(UNITED STATES, CONDOM, CONTRACEPTIVE USAGE, CONTRACEPTIVE METHODS, TRENDS).
English - pp. 264-271.
A. Bankole, J. E. Darroch and S. Singh, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
***
Davis, Karen R.; Weller, Susan C.
The effectiveness of condoms in reducing heterosexual transmission of HIV.
Context: It is not established whether the condom is as effective at preventing heterosexual transmission of HIV as it is for preventing conception. An overall estimate of condom effectiveness for HIV prevention is needed.
Methods: Information on condom usage and HIV serology was obtained from 25 published studies of serodiscordant heterosexual couples. Condom usage was classified as always (in 100% of acts of intercourse), sometimes (1-99%, 0-99% or 1-100%) or never (0%). Studies were stratified by design, direction of transmission and condom usage group. Condom efficacy was calculated from the HIV transmission rates for always-users and never-users.
Results: For always-users, 12 cohort samples yielded a consistent HIV incidence of 0.9 per 100 person-years (95% confidence interval, 0.4-1.8). For 11 cohort samples of never-users, incidence was estimated at 6.8 per 100 person-years (95% confidence interval, 4.4-10.1) for male-to-female transmission, 5.9 per 100 (95% confidence interval, 1.5-15.1) for female-to-male transmission and 6.7 per 100 (95% confidence interval, 4.5-9.6) in samples that specified the direction of transmission. Generally, the condom's effectiveness at preventing HIV transmission is estimated to be 87%, but it may be as low as 60% or as high as 96%.
Conclusions: Consistent use of condoms provides protection from HIV. The level of protection approximates 87%, with a range depending upon the incidence among condom nonusers. Thus, the condom's efficacy at reducing heterosexual transmission may be comparable to or slightly lower than its effectiveness at preventing pregnancy.
(UNITED STATES, CONDOM, USE-EFFECTIVENESS, AIDS, CONTRACEPTIVE USAGE).
English - pp. 272-279.
K. R. Davis and S. C. Weller, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, U.S.A.
***
Landry, David J.; Kaeser, Lisa; Richards, Cory L.
Abstinence promotion and the provision of information about contraception in public school district sexuality education policies.
Context: For more than two decades, abstinence from sexual intercourse has been promoted by some advocates as the central, if not sole, component of public school sexuality education policies in the United States. Little is known, however, about the extent to which policies actually focus on abstinence and about the relationship, at the local district level, between policies on teaching abstinence and policies on providing information about contraception.
Methods: A nationally representative sample of 825 public school district superintendents or their representatives completed a mailed questionnaire on sexuality education policies. Descriptive and multivariate analyses were conducted to identify districts that had sexuality education policies, their policy regarding abstinence education and the factors that influenced it.
Results: Among the 69% of public school districts that have a district-wide policy to teach sexuality education, 14% have a comprehensive policy that treats abstinence as one option for adolescents in a broader sexuality education program; 51% teach abstinence as the preferred option for adolescents, but also permit discussion about contraception as an effective means of protecting against unintended pregnancy and disease (an abstinence-plus policy); and 35% (or 23% of all U.S. school districts) teach abstinence as the only option outside of marriage, with discussion of contraception either prohibited entirely or permitted only to emphasize its shortcomings (an abstinence-only policy). Districts in the South were almost five times as likely as those in the Northeast to have an abstinence-only policy. Among districts whose current policy replaced an earlier one, twice as many adopted a more abstinence-focused policy as moved in the opposite direction. Overall, though, there was no net increase among such districts in the number with an abstinence-only policy; instead, the largest change was toward abstinence-plus policies.
Conclusions: While a growing number of U.S. public school districts have made abstinence education a part of their curriculum, two-thirds of districts allow at least some positive discussion of contraception to occur. Nevertheless, one school district in three forbids dissemination of any positive information about contraception, regardless of whether their students are sexually active or at risk of pregnancy or disease.
(UNITED STATES, SEX EDUCATION, SCHOOLS, PUBLIC EDUCATION, SEXUAL ABSTINENCE, CONTRACEPTIVE TRAINING).
English - pp. 280-286.
D. J. Landry, C. L. Richards, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.; L. Kaeser, National Institute of Child Health and Human Development, Bethesda, MD, U.S.A.
***
Cromer, Barbara A.; MCCarthy, Maureen.
Family planning services in adolescent pregnancy prevention: The views of key informants in four countries.
Context: Rates of adolescent pregnancy vary widely in the developed world. The prevention of adolescent pregnancy in the United States might be improved by comparing the provision of family planning services in the United States with that in some other developed countries.
Methods: Face-to-face, semi-structured interviews were conducted with 75 key informants (clinicians, politicians, public health administrators, social and behavioral scientists, and antiabortion activists) in Great Britain, the Netherlands, Sweden and the United States. Inductive, systematic qualitative analysis was performed on verbatim transcripts of these interviews.
Results: Across all four countries, interviewees described optimal family planning services for adolescents as those that include accessible, comprehensive and multidisciplinary care provided in confidence by nonjudgmental staff with good counseling and communication skills. Interviewees in Sweden and the Netherlands described a close liaison between family planning services and local schools, while key informants in the United States reported parental resistance to such coordination. Interviewees in the Netherlands and Sweden observed that family planning staffs in their countries have a clear sense of "ownership" of family planning services and better job-related prestige than did interviewees in Great Britain. Respondents in all countries except Sweden reported that providers are not always comfortable providing confidential care to teenagers. This was a particular concern for family planning providers in Great Britain who have patients younger than 16. Respondents in all countries except the United States thought that a "user-friendly" procedure for contraceptive provision should not require a pelvic examination. Finally, interviewees felt that governmental support in the Netherlands and Sweden seems to have led to adequate financing of family planning services, while in the United States, interviewees reported that there seems to be little governmental, medical or familial support for preventive health care, including family planning services.
Conclusions: As described by key informants, the family planning services available to teenagers in the Netherlands and Sweden have many of the features identified by respondents from all four countries as those that would characterize ideal family planning services for adolescents.
(DEVELOPED COUNTRIES, ADOLESCENT PREGNANCY, FAMILY PLANNING PROGRAMMES, COMPARATIVE ANALYSIS, INTERVIEWS).
English - pp. 287-293.
B. A. Cromer, Department of Pediatrics, Case Western Reserve University, Cleveland, OH, U.S.A.; M. McCarthy, College of Medicine and Public Health, Ohio State University, Columbus, OH, U.S.A.
***
Bender, S?ley S.
Attitudes of Icelandic young people toward sexual and reproductive health services.
Context: Iceland has higher levels of fertility among both adult women and adolescents than many other western European countries. There is a need to make sexual and reproductive health services more accessible to teenagers in Iceland.
Methods: A descriptive, cross-sectional national postal survey was conducted in 1996 to explore the attitudes of 2,500 young people aged 17-20 toward sexual and reproductive health services in Iceland and to determine which factors might be of importance for the development of such services.
Results: Icelandic adolescents want specialized sexual and reproductive health services offered within a broad-based service setting. Half of them would prefer to have these services located in a sexual and reproductive health clinic, and about one-third want such services to be located in community health centers. Having services that are free, that are anonymous and that do not require an appointment are important to teenagers who live in Reykjav?k, but proximity and equal access to services are more highly valued by adolescents who live outside Reykjav?k. Characteristics that young women, in particular, value include close proximity to services, access to a comfortable environment, a friendly staff, absolute confidentiality, and the ability to come with a friend and to have enough time for discussion. Adolescents who have already used contraceptive services mentioned that they need enough time for discussion and that they value high-quality client-provider interaction.
Conclusions: The attitudes of adolescents should be considered when specialized sexual and reproductive health services are developed for young people in Iceland. Specialized services that respond to the unique concerns of adolescents may increase their utilization of contraceptive methods and other reproductive health services.
(ICELAND, ADOLESCENTS, ATTITUDE, SEXUALITY, HEALTH SERVICES, FAMILY PLANNING CENTRES).
English - pp. 294-301.
S. S. Bender, Department of Nursing, University of Iceland, Iceland.
***
FAMILY PLANNING PERSPECTIVES, JANUARY-FEBRUARY 2000, VOL. 32, N? 1
Joyce, Ted; Kaestner, Robert.
The impact of Mississippi's mandatory delay law on the timing of abortion.
Context: Mississippi mandates that a woman seeking an abortion must first receive, in person, information about the fetus and alternatives to abortion. She must then wait at least 24 hours before having an abortion. It is not clear how such mandatory delay requirements affect the timing during pregnancy at which abortion occurs.
Methods: The data for analysis, from the Mississippi Department of Health, are 34,748 abortions obtained by residents in the six-year period surrounding the law's enactment in August 1992 (i.e., from August 1989 through July 1995). The records were stratified by location of the nearest provider, so abortions to women whose nearest provider is in-state comprised the "treatment group" (N=28,975), while abortions to women whose nearest provider is in a neighboring state with no such law comprised the "control group" (N=5,773). Probit regressions were used to assess effects on the likelihood of a second-trimester abortion, and ordinary least-squares regressions were used to determine effects on gestational age at the time of the abortion.
Results: After enactment of the law, the proportion of second-trimester procedures increased by 53% (from 7.5% of abortions to 11.5%) among women whose closest provider is in-state, but it increased by only 8% (from 10.5% to 11.3%) among women whose closest provider is out-of-state. And although the overall abortion rate declined among women in the treatment group over the period (from 11.3 procedures per 1,000 women aged 15-44 to 9.9), the rate of second-trimester procedures increased among these women (from 0.8 per 1,000 women aged 15-44 to 1.1). The law was independently associated with delays in obtaining an abortion: Once the law went into effect and net of all covariates, the proportion of second-trimester abortions increased by nearly three percentage points more among women living closest to an in-state provider than among those living closest to an out-of-state provider. The law increased the mean gestational age of the fetus at the time of the procedure by approximately four days. Women who live closest to abortion providers in other states were relatively unaffected by the law.
Conclusions: The proportion of abortions performed later in pregnancy will probably increase if more states impose mandatory delay laws with in-person counseling requirements.
(UNITED STATES, STATE, INDUCED ABORTION, LEGISLATION, DURATION OF PREGNANCY).
English - pp. 4-13.
T. Joyce and R. Kaestner, Department of Economics, Baruch College, New York, U.S.A.
***
Singh, Susheela; Darroch, Jacqueline E.
Adolescent pregnancy and childbearing: Levels and trends in developed countries.
Context: Adolescent pregnancy occurs in all societies, but the level of teenage pregnancy and childbearing varies from country to country. A cross-country analysis of birth and abortion measures is valuable for understanding trends, for identifying countries that are exceptional and for seeing where further in-depth studies are needed to understand observed patterns.
Methods: Birth, abortion and population data were obtained from various sources, such as national vital statistics reports, official statistics, published national and international sources, and government statistical offices. Trend data on adolescent birthrates were compiled for 46 countries over the period 1970-1995. Abortion rates for a recent year were available for 33 of the 46 countries, and data on trends in abortion rates could be gathered for 25 of the 46 countries.
Results: The level of adolescent pregnancy varies by a factor of almost 10 across the developed countries, from a very low rate in the Netherlands (12 pregnancies per 1,000 adolescents per year) to an extremely high rate in the Russian Federation (more than 100 per 1,000). Japan and most western European countries have very low or low pregnancy rates (under 40 per 1,000); moderate rates (40-69 per 1,000) occur in Australia, Canada, New Zealand and a number of European countries. A group of five countries--Belarus, Bulgaria, Romania, the Russian Federation and the United States--have pregnancy rates of 70 or more per 1,001. The adolescent birthrate has declined in the majority of industrialized countries over the past 25 years, and in some cases has been more than halved. Similarly, pregnancy rates in 12 of the 18 countries with accurate abortion reporting showed declines. Decreases in the adolescent abortion rate, however, were less prevalent.
Conclusions: The trend toward lower adolescent birthrates and pregnancy rates over the past 25 years is widespread and is occurring across the industrialized world, suggesting that the reasons for this general trend are broader than factors limited to any one country: increased importance of education, increased motivation of young people to achieve higher levels of education and training, and greater centrality of goals other than motherhood and family formation for young women.
(DEVELOPED COUNTRIES, ADOLESCENT PREGNANCY, ADOLESCENT FERTILITY, ABORTION, TRENDS, COMPARATIVE ANALYSIS).
English - pp. 14-23.
S. Singh and J. E. Darroch, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
***
Panchaud, Christine; Singh, Susheela; Feivelson, Dina; Darroch, Jacqueline E.
Sexually transmitted diseases among adolescents in developed countries.
Context: Sexually transmitted diseases (STDs) are responsible for a variety of health problems, and can have especially serious consequences for adolescents and young adults. An international comparison of levels and trends in STDs would be useful to identify countries that are relatively successful in controlling the incidence of STDs, as a first step toward improving policies and programs in countries with high or growing STD incidence.
Methods: Incidence data for the past decade on three common bacterial STDs--syphilis, gonorrhea and chlamydia--were obtained for as many as 16 developed countries from official statistics, published national sources or scientific articles, and unpublished government data. Rates of incidence per 100,000 were calculated for adolescents, for young adults and for the total population. (These estimates should be considered conservative, because STDs commonly are underreported.)
Results: The incidence of these three STDs has generally decreased over the last decade, both in the general population and among adolescents. However, the Russian Federation is an important exception: Syphilis has risen dramatically in the 1990s. Except in the Russian Federation and Romania, the syphilis rate in the mid-1990s was quite low, with rates of less than seven reported cases per 100,000 teenagers in most developed countries. Gonorrhea incidence is many times higher than that of syphilis in several countries, and this disease disproportionately affects adolescents and young adults. Gonorrhea rates among adolescents can be as high as 600 per 100,000 (in the Russian Federation and the United States), although in many countries the reported rate among teenagers is below 10 per 100,001. In all countries with good reporting, chlamydia incidence is extremely high among adolescents (between 563 and 1,081 cases per 100,000). The reported incidence of all three STDs is generally higher among female teenagers than among males of the same age; this is especially true for chlamydia.
Conclusion: Prevention programs, active screening strategies and better access to STD diagnosis and treatment services, especially for adolescents and young adults, are necessary to reduce the incidence and the burden of STDs among young people.
(DEVELOPED COUNTRIES, SEXUALLY TRANSMITTED DISEASES, ADOLESCENTS, TRENDS, COMPARATIVE ANLYSIS).
English - pp. 24-32 & 45.
C. Panchaud, S. Singh, D. Feivelson and J. E. Darroch, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
***
Bradner, Carolyn H.; Ku, Leighton; Duberstein Lindberg, Laura.
Older, but not wiser: How men get information about AIDS and sexually transmitted diseases after high school.
Context: As they reach adulthood, young men are less likely to use condoms and are at increased risk for exposure to AIDS and other sexually transmitted diseases (STDs). Little is known about which prevention efforts reach men in their 20s.
Methods: Longitudinal data from the 1988, 1990-1991 and 1995 waves of the National Survey of Adolescent Males are used to identify sources of information about AIDS and STDs among 1,290 young men aged 22-26. Information receipt from four main sources, the topics covered by each source and the personal characteristics associated with getting more information are all explored.
Results: Twenty-two percent of men surveyed discussed disease prevention topics with a health provider in the last year, 48% attended a lecture or read a brochure, 51% spoke to a partner, friend or family member, and 96% heard about AIDS or STDs from the media (e.g., television advertisements, radio or magazine). Excluding media sources, 30% of young men reported getting no STD or AIDS prevention messages in the last year. Being black or Hispanic, having had a physical exam or an AIDS test in the last year, and having had discussions about AIDS or STDs with parents or a health care provider in the past were associated with receiving more information.
Conclusions: Although young men who are at higher risk for STD or HIV infection are more likely than other young men to get information about disease prevention, young adult men are much less likely than adolescents to receive AIDS or STD prevention education. More prevention efforts need to be aimed at young adults.
(UNITED STATES, MEN, AIDS, SEXUALLY TRANSMITTED DISEASES, YOUTH, INFORMATION SOURCES).
English - pp. 33-38.
C. H. Bradner, University of Chicago's Pritzker School of Medicine, U.S.A.; L. Ku and L. Duberstein Lindberg, The Urban Institute, Washington, DC, U.S.A.
***
Schwab Zabin, Laurie; Huggins, George R.; Emerson, Mark R.; Cullins, Vanessa E.
Partner effects on a woman's intention to conceive: "Not with this partner".
Context: Current definitions of pregnancy intention that are useful at aggregate levels are weak at the individual level. This is especially true in social contexts where childbearing and pregnancy often occur within casual or transient relationships.
Methods: Extensive data on lifetime partnerships and sexual behaviors, including pregnancies and births, from 250 low-income women who had experienced a total of 839 pregnancies are used to explore correlates of intention to conceive, as well as the extent to which women attribute their intentions to a current partnership.
Results: Some 57% of reported pregnancies were unintended. Overall, 21% of the women had not wished to conceive at least one of their pregnancies with the partner who impregnated them; that proportion rose to 33% among women who had had only unintended pregnancies. Even among women who had had no unintended pregnancies, 18% had had at least one conception that they had not wanted with their partner at the time of conception. Women were less likely to say they had not wanted to conceive with a particular partner if they were living with that partner than if they were not. The likelihood of not having wanted a pregnancy with a given partner rose with the lifetime number of serious partners. Pregnancies that were not wanted with a particular partner were more than twice as likely to end in abortion as were those that were (33% vs. 14%).
Conclusions: Among these women, the desire to avoid childbearing relates more to the couple involved in the conception than to abstract notions of completed family size. It would therefore be useful to include items pertaining to partner relationships in future studies of pregnancy intention.
(UNITED STATES, WOMEN, MATE, FERTILITY DETERMINANTS, POVERTY, DECISION MAKING, UNWANTED PREGNANCY).
English - pp. 39-45.
L. Schwab Zabin, M. R. Emerson, Department of Population and Family Health Sciences, Johns Hopkins School of Public Health, Baltimore, MD, U.S.A.; G. R. Huggins, Department of Gynecology and Obstetrics, Johns Hopkins Bayview Medical Center, Baltimore, MD, U.S.A.; V. E. Cullins, Technical Resources, AVSC International, New York, U.S.A.
***
FAMILY PLANNING PERSPECTIVES, MARCH-APRIL 2000, VOL. 32, N? 2
Pagnini, Deanna L.; Reichman, Nancy E.
Psychosocial factors and the timing of prenatal care among women in New Jersey's HealthStart Program.
Context: Helping high-risk pregnant women obtain prenatal care early is the main policy goal of most U.S. publicly funded programs aimed at reducing the incidence of low birth weight and infant mortality. It is therefore crucial to understand the factors that influence when women initiate prenatal care.
Methods: The effects of psychosocial and demographic risk factors on the timing of entry into prenatal care were estimated using data on roughly 90,000 Medicaid recipients who participated in New Jersey's HealthStart prenatal care program.
Results: Overall, 37% of women began prenatal care in the first trimester. Multivariate logistic regression indicated that women who lived in poor housing conditions and those who smoked, drank or used hard drugs had a reduced likelihood of entering care early (odds ratios, 0.8-0.9), while those who had clinical depression or who experienced domestic violence or abuse had elevated odds of early entry (1.1-1.2). The risk factor with the greatest impact on the timing of prenatal care was the wantedness of the pregnancy; women whose pregnancy was unwanted had dramatically reduced odds of entering care early (0.4). Separate analyses of women of varying racial and ethnic backgrounds demonstrated the differential effects of risk factors, the importance of including ethnicity with race and the universal impact of wantedness across racial and ethnic groups.
Conclusions: Entry into prenatal care for at-risk women is affected by factors from multiple domains. It is important for prenatal programs to recognize the complexity of the issue as well as the barriers that different subgroups of women face.
(UNITED STATES, STATE, PRENATAL CARE, HEALTH SERVICES, HIGH RISK PREGNANCY, DURATION OF PREGNANCY).
English - pp. 56-64.
D. L. Pagnini, Population Studies Center, University of Pennsylvania, Philadelphia, PA, U.S.A.; N. E. Reichman, Bendheim-Thoman Center for Research on Child Well-being, Princeton University, Princeton, NJ, U.S.A.
***
Martin, Kelly; Wu, Zheng.
Contraceptive use in Canada: 1984-1995.
Context: In every country, contraceptive behavior has important implications for fertility and the prevalence of sexually transmitted diseases (STDs). There has been relatively little attention to contraceptive practices in Canada, however, particularly how patterns of method use may have changed.
Methods: Data on contraceptive use were collected from 5,315 women in the 1984 Canadian Fertility Survey, and from 3,220 women and 3,449 men in the 1995 General Social Survey.
Results: Among Canadian women aged 15-49, current contraceptive use declined from 69% to 60% between 1984 and 1995. Pill use dropped from 19% to 17%, and IUD use declined from 6% to 3%. However, during the same period, condom use increased from 6% to 10%; tubal ligation declined from 24% to 17%, while vasectomy increased. In addition, the proportion of women sterilized for reasons other than contraception rose between 1984 and 1995. Men were less likely to rely on sterilization than were women (31% vs. 40%). Men reported higher levels of condom use (22%), but lower levels of pill use among their partners (9%), than did women (10% and 17%, respectively).
Conclusions: Contraceptive behavior in Canada is unique: The decline in contraceptive use over the last decade has left Canada's overall contraceptive prevalence among the lowest in the industrialized world, and the rate of sterilization among the highest. These changes in contraceptive behavior complicate efforts to plan for social and health needs, particularly policy decisions focusing on reducing infections with STDs.
(CANADA, CONTRACEPTIVE USAGE, TRENDS, CONTRACEPTIVE METHODS, SEXUAL STERILIZATION).
English - pp. 65-73.
K. Martin and Zheng Wu, Department of Sociology, University of Victoria, Victoria, British Columbia, Canada.
***
Klijzing, Erik.
Are there unmet family planning needs in Europe.
Context: The measurement of unmet need for family planning--the discrepancy between individuals' sexual and contraceptive behavior and their stated fertility preferences--has generally focused on developing countries. There has so far been little effort to measure how low unmet family planning needs can go in more developed countries, where contraceptive practice is supposedly (nearly) perfect.
Methods: Data were taken from Fertility and Family Surveys (FFS) conducted in recent years in selected member states of the United Nations Economic Commission for Europe, and minimum and maximum estimates of unmet need were calculated for 10 countries with the requisite data.
Results: The proportion of individuals with an unmet need for family planning (i.e., who have a current unwanted pregnancy or who are fecund, are sexually active, want no more births but are not using contraceptives) is as low as 3% in two European countries and below 10% in most. However, levels of unmet need in countries with economies in transition (13% in Latvia and Lithuania and 23% in Bulgaria) surpass some of the lowest levels observed for developing countries. Considerable within-country variations are seen. For instance, unmet need is more prominent among men than among women in seven of the nine countries for which there are data. Moreover, unmet need increases with family size and with age, suggesting an unmet need for limiting rather than for spacing births. In all of the countries except Hungary, unmet need is higher among those in marital unions than among those in less formal relationships. Level of education is another important dimension of unmet need, with less-educated respondents having the highest level of unmet need in nine of the 10 countries. Multivariate analyses confirm most of these results. Moreover, there is a clear association between unmet need and abortion ratios: Where levels of unmet need are high, the number of abortions per 100 live births is also relatively high.
Conclusions: Data on unmet need, supplemented with information on induced abortion and related issues, could provide countries in Europe with useful inputs for formulating and implementing responsive reproductive health policies and programs.
(EUROPE, FAMILY PLANNING, SUPPLY AND DEMAND, SOCIO-ECONOMIC DIFFERENTIALS, COMPARATIVE ANALYSIS).
English - pp. 74-81 & 88.
E. Klijzing, Faculty of Sociology, University of Bielefeld, Germany.
***
Soler, Hosanna; Quadagno, David; Sly, David F.; Riehman, Kara S.; Eberstein, Isaac W.; Harrison, Dianne F.
Relationship dynamics, ethnicity and condom use among low-income women.
Context: Women's protection against HIV and sexually transmitted diseases (STDs) depends upon their ability to negotiate safer sex. It is important to know how cultural norms and gender roles, which vary by ethnicity, may either constrain or encourage negotiation of condom use.
Methods: Questionnaires were completed by 393 low-income non-Hispanic black, Hispanic and non-Hispanic white women who were sexually active and attending family planning and STD clinics and other public health and social service centers in Miami in 1994 and 1995. Multivariate logit techniques were used to identify ethnic differences in relationship dynamics and to determine couple- and individual-level factors associated with consistent use, occasional use or nonuse of condoms.
Results: Black and Hispanic women reported higher levels of consistent condom use (15-17%) than did white women (4%). Nearly all black and white women (90-95%) said that they were extremely or somewhat comfortable talking about condoms with their partner, whereas 76% of Hispanic women did so. A larger proportion of Hispanic women (55%) reported joint contraceptive decision-making than did black women (26%) or white women (31%). Among women who reported that their partner made contraceptive decisions, 28% used condoms consistently or occasionally, compared with 24% among women who made the decision themselves. When the couple made the decision jointly, 41% of them were condom users. Hispanic women scored the lowest on a scale of condom-related self-efficacy, yet also reported the highest levels of confidence in their condom negotiating skills. Multivariate analysis indicated that, compared with white women, black and Hispanic women were more likely to be consistent condom users than nonusers (odds ratios, 10.2 and 18.9, respectively). Women who shared financial decision-making with their partner were almost 80% less likely to be a consistent condom user, and women who did not participate in financial decisions were more than 90% less likely to do so, than were women who made monetary decisions independently.
Conclusions: HIV prevention and intervention programs should emphasize birth control discussion between partners and the development of condom-related self-efficacy and negotiation skills, and these programs also should customize prevention messages according to ethnicity and social context.
(UNITED STATES, WOMEN, POVERTY, CONDOM, DECISION MAKING, ETHNICITY).
English - pp. 82-88 & 101.
H. Soler, D. F. Sly, K. S. Riehman, I. W. Eberstein, Center for the Study of Population, D. Quadagno, Department of Biological Sciences, and D. F. Harrison, School of Social Work - all at Florida State University, Tallahassee, FL, U.S.A.
***
FAMILY PLANNING PERSPECTIVES, MAY-JUNE 2000, VOL. 32, N? 3
Manning, Wendy D.; Longmore, Monica A.; Giordano, Peggy C.
The relationship context of contraceptive use at first intercourse.
Context: Despite widespread efforts to increase contraceptive use to prevent both pregnancy and sexually transmitted diseases among sexually active adolescents, most prior work examining adolescent contraceptive use does not explicitly recognize that sexual decision-making inherently involves both partners in a couple.
Methods: An analytic sample of 1,593 females who first had intercourse during adolescence (prior to age 18) was drawn from the 1995 National Survey of Family Growth. Logistic regression and multinomial logistic regression techniques were used to model the effects of sexual partners' characteristics and relationship type on contraceptive use at first intercourse and contraceptive method selected at first intercourse.
Results: Approximately 31% of respondents used no contraceptive method at first intercourse. Roughly half (52%) of adolescents who had just met their sexual partner used no method, compared with 24% of those who were going steady. Whereas 75% of teenagers who practiced contraception at first intercourse used a condom, 17% relied on the pill. In multivariate models, net of other variables, adolescents who had just met their partner had 66% lower odds than those who were going steady of practicing contraception at first intercourse. Individual-level factors that influenced contraceptive use at first intercourse were age at first intercourse, race or ethnicity, family type, parents' education, grades in school and receipt of birth control education prior to first intercourse. Differences between respondents and their partner in age and race or ethnicity mostly were not significantly related to method use at first intercourse. One exception was that adolescents who first had sex with a man six or more years older had reduced odds of practicing contraception. Type of relationship was significantly associated with method selection only among adolescents who were just friends with their first partner, who had higher odds of using "other" methods rather than the condom. Variables associated with pill use rather than condom use were age at first sex, race, family type, mother's education and school grades.
Conclusions: Further efforts to understand contraceptive choice among adolescents should focus on relationship features. Research on the decision-making process surrounding contraceptive use may benefit from treating this as a partner decision and not just as a decision made by one member of the couple. Further research examining the qualities of the relationship may provide important clues for understanding adolescent contraceptive choice.
(UNITED STATES, WOMEN, ADOLESCENTS, COITUS, CONTRACEPTIVE USAGE, INTERPERSONAL COMMUNICATION, CONTRACEPTIVE METHODS, DECISION MAKING, COUPLE).
English - pp. 104-110.
W. D. Manning, M. A. Longmore and P. C. Giordano, Department of Sociology, Bowling Green State University, Bowling Green, OH, U.S.A.
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Whitaker, Daniel J.; Miller, Kim S.; Clark, Leslie F.
Reconceptualizing adolescent sexual behavior: Beyond did they or didn't they?
Context: Adolescent sexual behavior is typically studied as a dichotomy: Adolescents have had sex or they have not. Broadening this view would lead to a greater understanding of teenagers' sexual behavior.
Methods: Interview data from 907 high school students in Alabama, New York and Puerto Rico were used to examine the relationships between sexual experience and a variety of social, psychological and behavioral variables. Four groups of teenagers are compared: those who did not anticipate initiating sex in the next year (delayers), those who anticipated initiating sex in the next year (anticipators), those who had had one sexual partner (singles) and those who had had two or more partners (multiples).
Results: Compared with delayers, anticipators reported more alcohol use and marijuana use; poorer psychological health; riskier peer behaviors; and looser ties to family, school and church. Similarly, multiples reported more alcohol and marijuana use, riskier peer behaviors and looser ties to family and school than singles. Risk behaviors, peer behaviors, family variables, and school and church involvement showed a linear trend across the four categories of sexual behavior.
Conclusions: The traditional sex-no sex dichotomy obscures differences among sexually inexperienced teenagers and among adolescents who have had sex. Prevention efforts must be tailored to the specific needs of teenagers with differing sexual experiences and expectations, and must address the social and psychological context in which sexual experiences occur.
(UNITED STATES, ADOLESCENTS, SEXUALITY, SEXUAL BEHAVIOUR, COMPARATIVE ANALYSIS).
English - pp. 111-117.
D. J. Whitaker, K. S. Miller, Center for Disease Control and Prevention, Atlanta, U.S.A.; L. F. Clark, Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, U.S.A.
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Boggess, Scott; Bradner, Carolyn.
Trends in adolescent males' abortion attitudes, 1988-1995: Differences by race and ethnicity.
Context: Studying how adolescent males view abortion and how their attitudes toward abortion have changed over time can improve our understanding of the sexual, contraceptive and abortion behavior of these males and their partners.
Methods: Data from the 1988 and 1995 National Survey of Adolescent Males are used to describe changes in young males' attitudes toward abortion over time, as well as differences in abortion attitudes by race and ethnicity. Multivariate models are used to examine the relationship between religiosity and abortion attitudes.
Results: Between 1988 and 1995, young males' approval of abortion decreased significantly. In 1995, 24% of U.S. males aged 15-19 agreed that it was all right for a women to have an abortion "for any reason," down from 37% in 1988. This decrease was driven almost entirely by non-Hispanic white males; there was little change in the abortion attitudes of non-Hispanic blacks and Hispanics. The decrease in white males' approval of abortion coincides with a significant increase in the self-reported importance of religion and in the proportion of whites who identified themselves as born-again Christians. The proportion of non-Hispanic white males indicating that religion was very important increased from 28% in 1988 to 34% in 1995, while the proportion identifying themselves as born-again increased from 18% to 24%. Multivariate analyses indicate that religiosity was more strongly related to the abortion attitudes of non-Hispanic whites than to those of Hispanics or non-Hispanic blacks.
Conclusions: The large decrease in approval of abortion among white teenage males has closed the racial and ethnic gap in attitudes toward abortion that was evident in 1988, when such youth held significantly more liberal attitudes toward abortion than did either Hispanics or blacks. This trend toward more conservative abortion-related attitudes among whites coincides with increasingly conservative attitudes regarding premarital sex and greater religiosity among white male adolescents.
(UNITED STATES, ADOLESCENTS, MEN, ATTITUDE, ABORTION, ETHNICITY, RACES, TRENDS, RELIGIOSITY).
English - pp. 118-123.
S. Boggess, Department of Demography, Georgetown University, Washington, DC, U.S.A.; C. Bradner, The Urban Institute, Washington, DC, U.S.A.
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Sable, Marjorie R.; Libbus, M. Kay; Chiu, Jing-Er.
Factors affecting contraceptive use in women seeking pregnancy tests: Missouri, 1997.
Context: If the national health objective of reducing unintended pregnancy is to be met, a better understanding is needed of barriers to women's acquisition and use of contraceptives.
Methods: A sample of 311 Missouri women who were seeking pregnancy tests in public health department clinics in 1997 and who said their potential pregnancy was unintended were asked about potential barriers to family planning. Factors affecting contraceptive use among these women were examined by frequency of use, insurance status, education and race.
Results: In general, the women mostly disagreed that particular factors were potential barriers to contraceptive use. For only one item--worry over the potential side effects of the hormonal injectable contraceptive--did a majority agree or strongly agree that it was a barrier to method use in the previous six months. Women who used a contraceptive infrequently were more likely than frequent users to identify 33 factors in nine areas as being potential barriers to contraceptive use. These ranged from factors involving access to services and condom-specific issues to cost-related concerns, social norms, pregnancy denial, embarrassment over discussing or obtaining birth control, worry about side effects and experience with forced sex, among others. Perceived barriers differed somewhat by insurance status in the areas of access, embarrassment, side effects and forced sex. For example, women with no insurance coverage reported a higher level of agreement that transportation problems had hindered their access to a clinic than did women with private insurance. Level of education affected agreement only in the area of side effects, with more-educated women expressing greater concern about side effects than less-educated women. The respondent's race affected agreement in six areas: access, social norms, pregnancy denial, embarrassment, forced sex and other miscellaneous concerns, such as condom use and relationship issues.
Conclusion: Better education and improved access to and delivery of services might address several factors affecting contraceptive use that are associated with unintended pregnancy. Some barriers, however, such as those related to self-efficacy, self-esteem and fatalistic attitudes about pregnancy, would be much harder for family planning providers to resolve.
(UNITED STATES, STATE, WOMEN, CONTRACEPTIVE USAGE, UNWANTED PREGNANCY, SOCIO-ECONOMIC DIFFERENTIALS, ATTITUDE).
English - pp. 124-131.
M. R. Sable, School of Social Work, M. K. Libbus, School of Nursing, and Jing-Er Chiu, Department of Statistics, University of Missouri-Columbia, U.S.A.
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Hervey Stephen, Elizabeth; Chandra, Anjani.
Use of infertility services in the United States: 1995.
Context: Both the demand for and the availability of infertility services in the United States increased during the 1980s and early 1990s. Understanding the factors that are related to service-seeking among women with current fertility problems would aid efforts to better provide services.
Methodology: Data on U.S. women's use of infertility services were taken from the 1995 National Survey of Family Growth, a nationally representative survey of 10,847 women aged 15-44. For the 1,210 women who at the time of the interview reported having fertility problems, multivariate statistical modeling was used to identify the characteristics associated with their use of infertility services.
Results: Of the 6.7 million women with fertility problems in 1995, 42% had received some form of infertility services. The most common services ever received among these women were advice (60%) and diagnostic tests (50%), medical help to prevent miscarriage (44%) and drugs to induce ovulation (35%). The proportions of fertility-impaired women who had ever received infertility services were generally highest among those who were older, who had ever been married, who had graduated from college, who had a high income and who were non-Hispanic white. Multivariate analyses reveal that apparent differences by age and race or ethnicity in the unadjusted analysis disappear once the effects of women's marital status, income and private health insurance coverage are taken into account.
Conclusion: Women who have ever used infertility services continue to represent a select group from among those with impaired fertility. Moreover, the vast majority of women with fertility problems who seek services receive noninvasive treatments that could be considered "low technology" interventions.
(UNITED STATES, WOMEN, INFERTILITY, HEALTH SERVICES).
English - pp. 132-137.
E. Hervey Stephen, Department of Demography, Georgetown University, Washington, DC, U.S.A.; A. Chandra, Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Hyattsville, MD, U.S.A.
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Macaluso, Maurizio; Demand, Michael; Artz, Lynn; Fleenor, Michael; Robey, Lawrence; Kelaghan, Joseph; Cabral, Rebecca; Hook III, Edward W.
Female condom use among women at high risk of sexually transmitted disease.
Context: Whereas the female condom has been evaluated in many hypothetical acceptability or short-term use studies, there is little information about its suitability for the prevention of sexually transmitted diseases (STDs) or HIV over extended periods of time.
Methodology: As part of a six-month prospective follow-up study of 1,159 STD clinic patients, clients were interviewed during their initial visit, exposed to a behavioral intervention promoting condoms, given a physical examination and provided with instructions on completing a sexual diary. Potential predictors of trying the female condom were evaluated using logistic regression, and three condom-use groups (exclusive users of female condoms, exclusive users of male condoms and users of both types of condoms) were compared using multinomial regression.
Results: Among 895 women who reported having engaged in vaginal intercourse during the study period, one-half had sex with only one partner, while one-quarter each had two partners or three or more partners. A total of 731 women reported using the female condom at least once during the follow-up period--85% during the first month of follow-up. Multiple logistic regression analyses indicated that employed women and those with a regular sexual partner at baseline were significantly more likely to try the female condom. By the end of the follow-up period, 8% of participants had used the female condom exclusively, 15% had used the male condom exclusively, 73% had used both types of condom and 3% had used no condoms. Twenty percent of women who tried the female condom used it only once and 13% used it twice, while 20% used 5-9 female condoms and 32% used 10 or more. Consistent condom users (N=309) were predominantly users of both types of condom (75%), and were less often exclusive users of the male condom (18%) or the female condom (7%). According to a multivariate analysis, women who used the female condom exclusively or who mixed condom types were more likely to be black, were more likely to be employed and were more likely to have a regular partner than were users of the male condom.
Conclusions: Women at risk of STDs find the female condom acceptable and will try it, and some use it consistently. Mixing use of female condoms and male condoms may facilitate consistent condom use. The female condom may improve an individual's options for risk reduction and help reduce the spread of STDs.
(UNITED STATES, CONDOM, CERVICAL CAP, SEXUALLY TRANSMITTED DISEASES).
English - pp. 138-144.
M. Macaluso, Department of Epidemiology and International Health, School of Public Health, University of Alabama at Birmingham, U.S.A.; M. Demand, Independence Blue Cross, Philadelphia, PA, U.S.A.; L. Artz, M. Fleenor, Jefferson County Department of Health, Birmingham, AL, U.S.A.; L. Robey, Madison County Health Department, Huntsville, AL, U.S.A.; J. Kelaghan, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, U.S.A.; R. Cabral, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, U.S.A.; E. W. Hook III, Department of Medicine, University of Alabama at Birmingham, AL, U.S.A.
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FAMILY PLANNING PERSPECTIVES, JULY-AUGUST 2000, VOL. 32, N? 4
Santelli, John S.; Duberstein Lindberg, Laura; Abma, Joyce; Sucoff McNeely, Clea; Resnick, Michael.
Adolescent sexual behavior: Estimates and trends from four nationally representative surveys.
Context: Accurate information about trends over time in adolescent sexual behavior is essential to understand changes in adolescent pregnancy and sexually transmitted diseases and to monitor the progress of health promotion activities in the United States
Methods: Estimates from the National Survey of Family Growth (NSFG), the National Survey of Adolescent Males (NSAM), the Youth Risk Behavior Survey (YRBS) and the National Longitudinal Study of Adolescent Health (Add Health) were compared. While methodologies and populations varied by survey, adolescents aged 15-17 who attend high school were a common subpopulation among all four. For each survey, the prevalence of sexual intercourse, contraceptive use and multiple sexual partners was measured in this population.
Results: Trend comparisons fell into four categories. First, some similar significant trends were found across surveys. The proportion of all males and of white males who reported ever having had sexual intercourse decreased significantly, while condom use rose significantly among males in both the NSAM and the YRBS. For such behaviors as ever having had sexual intercourse (among Hispanic males and black females), using the pill and using the condom (among all females) and having four or more lifetime sexual partners (among white males), a significant trend was found in one survey while a similar but nonsignificant trend was found in another. Several trend comparisons were not significant in any survey. Finally, having had intercourse in the past three months (among all males and all females), having had two or more partners in the past three months (for males) and having had four or more lifetime sexual partners (among white females and all males) showed a significant trend in one survey but lacked a parallel nonsignificant trend in another. Prevalence estimates in 1995 differed significantly in at least one comparison of surveys for all behaviors except having four or more lifetime sexual partners (both genders) and having two or more recent sexual partners (females). Gender differences within the YRBS and between the NSFG and the NSAM generally were consistent.
Conclusions: Trends over time and gender differences were similar across surveys, underscoring their value for tracking adolescent sexual behaviors. Differences in prevalence estimates across surveys probably result from differences in question wording, diverse interview settings and modes of data collection, and varying statistical power. These findings suggest a need to increase our understanding of how methodologies influence survey response in research on adolescents.
(UNITED STATES, ADOLESCENTS, SEXUAL BEHAVIOUR, TRENDS, COMPARATIVE ANALYSIS).
English - pp. 156-165 & 194.
J. S. Santelli, Division of Reproductive Health, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, U.S.A.; L. Duberstein Lindberg, Urban Institute, Washington, DC, U.S.A.; J. Abma, Reproductive Statistics Branch, National Center for Health Statistics, Hyattsville, MD, U.S.A.; C. Sucoff McNeely and M. Resnick, University of Minnesota, Minneapolis, U.S.A.
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Manlove, Jennifer; Terry, Elizabeth; Gitelson, Laura; Romano Papillo, Angela; Russell, Stephen.
Explaining demographic trends in teenage fertility, 1980-1995.
Context: The teenage birthrate rose sharply in the late 1980s and early 1990s, and then declined in the 1990s. Attempts to explain these changes have failed to account for the changing environment in which adolescents live.
Methods: Data from the 1995 cycle of the National Survey of Family Growth are used to compare the experiences of three cohorts of teenage females in the 1980s and 1990s. A life-course framework is used to examine trends in characteristics of adolescents and adolescent mothers over time, and event-history analyses are conducted to determine which characteristics are associated with the risk of a teenage birth in each cohort. A comparison of the predicted probabilities from hazard analyses shows how changes in the context of adolescence across the cohorts help explain changes in the probability of a teenage birth over time.
Results: Factors associated with the increase in the teenage birthrate in the 1980s include negative changes in family environments (such as increases in family disruption) and an increase in the proportion of teenagers having sex at an early age. Factors associated with the recent decline in the teenage birthrate include positive changes in family environments (such as improvements in maternal education), formal sex education programs and discussions with parents about sex, stabilization in the proportion of teenagers having sex at an early age and improved contraceptive use at first sex. Sexually experienced teenagers in the mid-1990s were younger, on average, at first sex than were their counterparts in the 1980s, and thus are at an increased risk of a teenage birth. Partner factors, including nonvoluntary first sexual experiences, were not associated with the risk of a adolescent birth in any cohort.
Conclusions: Programs to further reduce the teenage birthrate should take into account the role of family stability, parent-child communication, sex education programs and engagement in school, as well as attempt to reduce the proportion of adolescents having sex at an early age and to improve contraceptive use. The increasing risk levels among sexually experienced teenagers suggest that current programs may be reducing sexual activity among adolescents already at a low risk of a teenage birth, without addressing the needs of those at highest risk.
(UNITED STATES, ADOLESCENT FERTILITY, TRENDS, FERTILITY DETERMINANTS, FAMILY ENVIRONMENT).
English - pp. 166-175.
J. Manlove, E. Terry, L. Gitelson, A. Romano Papillo and S. Russell, Department of Human and Community Development, University of California, Davis, U.S.A.
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Tanfer, Koray; Wierzbicki, Susan; Payn, Betsy.
Why are U.S. women not using long-acting contraceptives?
Context: Given the level of unintended pregnancy in the United States, it is somewhat surprising that hormonal implants and injectables--methods that are long-acting, reversible, highly effective and convenient--have not attained the popularity enjoyed by other medical methods. Knowing the reasons why women have so far spurned these methods might lead to the design and implementation of interventions and targeted social marketing to promote their use.
Methods: Data from the 1993 and 1995 rounds of the National Survey of Women are used to examine the reasons women gave for not having used the implant or injectables, whether they intended to use these methods and how their attitudes toward them may influence their decision to use such methods in the future. Logistic regression models were used to identify the social and demographic characteristics that influence women's decisions not to use these methods.
Results: Fewer than 2% of women who were at risk of an unintended pregnancy in 1995 were using the implant, and under 3% were using the injectable. Women gave three major reasons for not using either of these methods: lack of knowledge; fear of side effects or health hazards; and satisfaction with the method they were currently using. Age, education, marital status, parity and current contraceptive method strongly predicted fear of side effects, lack of knowledge and satisfaction with the current method as reasons for not using the implant or the injectable. For example, women aged 30 or older and those with a college education were half as likely as younger women and those with no college education to mention fear of side effects as their main reason for not using the implant. Likewise, single women, women with one or more children and those using a barrier method were 2-3 times as likely as married women, childless women and those using a medical method to attribute nonuse to the implant's side effects. Few women said they intended to use these methods in the next 12 months: 5% for the implant and 10% for the injectable. Single women, women with no college education, women with children, women wanting to have a child (or another child) and women with positive attitudes toward the effect of using an injectable were significantly more likely to say they intended to use the injectable. Nevertheless, substantial proportions of women reported quite negative attitudes about these methods.
Conclusions: The low prevalence of use and the low level of use intention for the implant and for injectables raise questions about the promise for the future of these methods. Each method seems to appeal to certain subgroups of women, however. Thus, if proper interventions and social marketing are targeted to such groups, they may be disabused of misperceptions regarding these methods and possibly become more willing to try them.
(UNITED STATES, FEMALE CONTRACEPTIVE AGENTS, CONTRACEPTIVE PREVALENCE, CONTRACEPTIVE IMPLANTS, INJECTABLES, DECISION MAKING).
English - pp. 176-183 & 191.
K. Tanfer, S. Wierzbicki and B. Payn, Centers for Public Health Research and Evaluation, Seattle, U.S.A.
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Bentley, Margaret E.; Morrow, Kathleen M.; Fullem, Andrew; Chesney, Margaret A.; Horton, Scott D.; Rosenberg, Zeda; Mayer, Kenneth H.
Acceptability of a novel vaginal microbicide during a safety trial among low-risk women.
Context: The increasing recognition that women who are unable or unwilling to discuss or use condoms with their sexual partners need female-controlled methods for preventing sexually transmitted diseases (STDs), including HIV, has led to considerable focus on the development of vaginal microbicides. While many such products are being tested for safety and effectiveness, clinical trials generally overlook another key factor in a product's impact on infection rates--its acceptability to users.
Methods: A Phase I clinical trial of a microbicidal gel included an assessment of the product's acceptability among 27 low-risk participants. Information on acceptability was gathered from structured interviews, participants' daily diaries and unstructured exit interviews.
Results: Participants reported only minor side effects of product use, such as itching, burning and difficulty urinating; two women developed candida infections while participating in the study. None of the side effects could be conclusively linked to use of the gel. Some women noted product discharge and messiness as drawbacks of the method, but this experience varied according to how often the women applied the gel. For example, one-third of those who used it once daily said that at least some of the time, it was too "wet or drippy," compared with two-thirds of women who inserted the gel twice a day. However, participants considered these "nuisance factors" that could be outweighed by the potential protective characteristics of the product. The majority reported that they would use the product if it were available and proven efficacious, and if they perceived that they were at risk of STD infection.
Conclusions: Additional testing of this product is urgently needed. Furthermore, as other products approach Phase I testing, acceptability assessments should be a key component of clinical trials.
(METHOD ACCEPTABILITY, VAGINAL JELLY, SEXUALLY TRANSMITTED DISEASES, TESTS).
English - pp. 184-188.
M. E. Bentley, Carolina Population Center, University of North Carolina, Chapel Hill, NC, U.S.A.; K. M. Morrow, Brown University School of Medicine, Providence, RI, U.S.A.; A. Fullem, HIV/AIDS Surveillance, Massachusetts Department of Public Health, Boston, U.S.A.; M. A. Chesney, Center for AIDS Prevention Studies, University of California at San Francisco, U.S.A.; S. D. Horton, Fred Hutchinson Cancer Research Center, Seattle, U.S.A.; Z. Rosenberg, HIV Prevention Trials Network, Family Health International, Arlington, VA, U.S.A.; K. H. Mayer, Brown University AIDS Program, Providence, RI, U.S.A.
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Francome, Colin; Freeman, Edward.
British general practitioners' attitudes toward abortion.
Context: Women in Great Britain may obtain abortions only if they meet certain criteria and the procedure is approved by two physicians. Since seeing a general practitioner is typically a woman's first step toward obtaining an abortion, these doctors' attitudes about the procedure are very important.
Methods: In 1999, a random sample of 702 general practitioners participated in a mailed survey regarding their attitudes toward abortion and the British Abortion Act.
Results: Four in five respondents considered themselves broadly prochoice, and three in five believed that the current law should be liberalized to give women the right to obtain an abortion without regard as to reason. Three-quarters of doctors favored government provision of free abortions, and one-quarter thought that the current law places an unreasonable burden on general practitioners. However, physicians' opinions about whether the abortion decision should be the woman's alone depended on the pregnancy's gestation, and three-fifths of respondents said that the law was appropriate. Among doctors who were broadly antiabortion, one-fifth favored women's right to choose, and two-thirds supported the current law; however, nearly half opposed government funding of abortion services, and one-quarter did not feel that physicians need to reveal their antiabortion stance to patients.
Conclusions: Although Great Britain's abortion law is more restrictive than those in many other developed countries, general practitioners have largely positive attitudes toward women's access to abortion and toward the existing law. Their occasionally contradictory views, however, suggest that some areas are potentially problematic.
(UNITED KINGDOM, ABORTION, PHYSICIANS, ATTITUDE, OPINION SURVEYS).
English - pp. 189-191.
C. Francome, Department of the Sociology of Health, Middlesex University, London, U.K.; E. Freeman, Marie Stopes International, London, U.K.
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