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Article Excerpt
The majority of pregnancies among unmarried teenagers are unintended. (1) Most adolescents do not want to become pregnant, although some are not opposed to becoming pregnant and others have ambivalent attitudes. (2) A number of explanations of why adolescents' attitudes toward pregnancy vary exist in the literature; however, less often considered is whether these attitudes are associated with pregnancy risk and contraceptive use.
Questions about the relevance of attitudes are important because attitudes may mediate the often-observed association between socioeconomic disadvantage and pregnancy risk. For this reason, social policy is often oriented toward shaping attitudes. Many researchers and advocates have argued that teenage pregnancy prevention programs should target attitudes toward pregnancy. (3) One reason for the attention to pregnancy attitudes has been that interventions that increase the availability of contraceptives have experienced uneven success in reducing teenage pregnancy rates. (4) Many experts have concluded that adolescents have access to the means to avoid pregnancy but do not use them or use them inefficiently because they do not appreciate the consequences of pregnancy. (5)
Actors in the social policy domain may also focus on teenagers' attitudes because they seem easier to change than the social and economic conditions in which those attitudes develop. For example, poverty is associated with teenage initiation of sex, nonuse of condoms at first intercourse and accidental pregnancy, (6) but pregnancy intervention programs are not well suited to end poverty. They may, however, be well suited to shape attitudes. But which attitudes? In the current political climate, supporting programs designed to shift attitudes about pregnancy is easier than supporting programs designed to shift attitudes about contraception. In this article, we address whether sexually experienced adolescents' attitudes toward pregnancy influence their risk of becoming pregnant.
Adolescent Contraceptive Use and Pregnancy
An extensive literature documents the determinants of adolescent contraceptive behavior. Critical factors associated with contraceptive use include social and demographic characteristics (e.g., age, race and income), family-related characteristics (e.g., parental education and closeness with parents) and individual characteristics (e.g., cognitive ability, educational achievement and expectations, self-esteem, age at first sex, history of pregnancy and attitudes toward contraception). (7) The impact of religiosity on contraceptive use is less clear, and the literature contains mixed results about the effects of adolescents' knowledge of sex, fertility and contraception.
With respect to pregnancy, the literature reports similar critical determinants. (8) Social and demographic predictors include age, race, income and parental education; family-related predictors include family structure and relationship with parents; and individual predictors include low cognitive ability, low educational expectations and achievement, negative attitudes toward school, lack of involvement in school clubs and problem behaviors. Popularity at school does not predict adolescent females' risk of pregnancy, but the characteristics of their friends do. Finally, number of partners, age at onset of sexual activity and contraceptive behavior are strong predictors of pregnancy risk.
Most studies that are concerned with attitudes toward pregnancy rely on small convenience samples or on retrospective accounts of pregnant adolescents' attitudes, which may be colored by the pregnancy. Jaccard et al. examined the role of attitudes toward pregnancy prospectively with a representative sample of sexually experienced and inexperienced adolescent females, and found a robust association between positive attitudes and subsequent pregnancies. (9) However, attitudes toward pregnancy are likely to be strongly correlated with attitudes toward having sex, which were not controlled for in the study's multivariate model. Thus, the finding maybe due to this omitted variable or to other factors that are correlated with pregnancy attitudes and delay in sexual debut.
We expand on the prior research in several ways. First, we limited our sample to sexually experienced young women, which allows us to assess the role of pregnancy attitudes in the absence of factors associated with the timing of sexual debut but not pregnancy risk. Because the majority of adolescents will become sexually active between the ages of 15 and 19, it is important for educators and policymakers to know whether attitudes toward pregnancy are associated with pregnancy risk among sexually experienced adolescents. Second, we explore whether contraceptive use is the behavioral mechanism that links attitude and outcome. It has been argued that ambivalence toward pregnancy is a risk factor for pregnancy because it leads to inconsistent contraceptive use, (10) but few studies have directly tested this idea.* (11) Finally, we examine the antecedents of attitudes toward pregnancy, paying special attention to the characteristics of adolescent women who lack a clear opinion.
METHODS
Data
We used data from the National Longitudinal Study of Adolescent Health (Add Health) because of its significant advantages over competing data sets. First, researchers have argued for the need to analyze prospective measures of pregnancy attitudes. (12) Exploiting the prospective features of Add Health allows us to rule out a reverse effect of behaviors (such as becoming pregnant) on attitudes. Second, the range of Add Health data allows us to include in our multivariate models detailed measures of well-established antecedents of both adolescent attitudes toward contraception and pregnancy, and adolescent contraceptive use and pregnancy risk. Finally, Add Health is a nationally representative study; adolescents are not selected on the basis of failed contraceptive use, as is the case in many clinic-based studies.
Add Health utilizes a multistage clustered sample design, and for this study, we used data drawn from its in-home components. (13) From May through December 1995, Wave 1 in-home interviews were administered to 20,745 adolescents. The interviews took 90 minutes to complete, on average, and collected detailed information about risk behaviors, romantic partnerships, family dynamics, aspirations, attitudes and activities. Eighty percent of adolescents in the initial sample completed a Wave 1 interview. Audio computer-assisted self-interviewing technology was used for questions covering sexual and other sensitive health behaviors. Between April and September 1996, re-interviews with Wave 1 respondents, excluding high school seniors, were conducted. Some 88% of eligible respondents participated in Wave 2, yielding a sample of 14,738 adolescents who completed both interviews.
Female respondents aged 15-19 who participated in both in-home interviews were eligible for inclusion in our analyses; we excluded those younger than 15 because they were not asked the questions about pregnancy attitudes. Also, we excluded 44 respondents who were married at Wave 1 or got married between waves, and 138 who were missing information on pregnancy attitudes or sexual history. The final sample consisted of 4,877 adolescent females.
Measures
* Attitudes toward pregnancy In the Wave 1 interviews, adolescents were asked how they would feel if they be came pregnant To measure pregnancy attitudes, we used five survey items that assessed adolescents' perceptions of the consequences of pregnancy: "if you got pregnant, it would be embarrassing lot your family"; "If you got pregnant, it would be embarrassing...
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