|
Article Excerpt
Although the proportion of U.S. teenagers who have ever had sexual intercourse has declined in the past decade, almost half of high school-age teenagers in 2003 were sexually experienced. (1) In addition, despite recent dramatic declines, (2) U.S. teenage pregnancy rates and birthrates are much higher than those of other industrialized countries, (3) and most teenage pregnancies are unintended. (4) Unintended pregnancies among sexually experienced teenagers are due to contraceptive nonuse and contraceptive failure. A better understanding of factors associated with consistent contraceptive use can help researchers, policymakers, program administrators and service providers to identify strategies that potentially could further reduce rates of unintended pregnancy and childbearing among adolescents.
BACKGROUND
An emerging body of research suggests that teenagers make decisions about contraceptive use in the context of individual sexual relationships. For example, characteristics of teenagers' sexual partners and relationships influence their likelihood of using contraceptives consistently. Findings on a link between relationship type and contraceptive use have been mixed. Some studies have found that teenagers who define their relationship as romantic or their partner as someone they are "going steady" with are more likely to use condoms or other contraception than are those in nonromantic or more casual relationships. (5) Yet other studies have found increased condom use and consistency in more casual or "lower quality" relationships (6) or in relationships not involving a main partner. (7) However, these studies have not addressed whether less condom use in more serious relationships may be accompanied by increased use of more effective methods.
Other measures that may reflect the perceived seriousness of a sexual relationship also have possible implications tot contraceptive use and consistency. On average, the more "couple-like" activities teenagers engage in before having intercourse-including thinking about themselves as a couple; going out together, alone or in a group; and meeting their partner's parents--the more likely they are to discuss contraception with their partner. (8) Teenagers who discuss contraception with their first partner before having sex are more likely than others to use contraception at first sex (9) and in their first relationship, (10) which may reflect teenagers' individual motivations to use contraception and their ability to express their needs in their relationships. Adolescents who have relatively little familiarity with their partner when the relationship begins are less likely to use contraceptives with that partner than other teenagers who have a more familiar partner are with theirs, possibly because they are less comfortable discussing sex and contraception. (11) In fact, females who are more comfortable communicating with men in general report higher levels of contraceptive use than other female youth. (12)
As the age difference between teenagers and their partners increases, their odds of contraceptive use and consistency in first relationships, in current relationships and over time are reduced for males and females. (13) Having an older partner may reflect reduced power in a sexual relationship and reduced control over contraceptive decision-making. Some studies have found an association between physical violence in a dating relationship (an indicator of extreme power differentials) and nonuse of condoms. (14)
Compared with teenagers who have sex relatively early in a dating relationship, those who wait are more likely to use contraceptives consistently, (15) but they are no more likely to have used a condom at their most recent sex. (16) In addition, although teenagers are more likely to ever use contraceptives in longer relationships, maintaining consistent use becomes increasingly difficult as the duration of the relationship increases. (17)
In addition to being influenced by, relationship and partner characteristics, teenagers may have an underlying propensity toward consistent or inconsistent contraceptive use. For example, in one study, consistent condom use at one time was strongly associated with condom use later, and an increased lifetime number of sexual relationships was associated with reduced odds of condom use. (18) Moreover, an association has been shown between younger age at first sexual experience and reduced contraceptive use and consistency. (19)
Contraceptive method choice in relationships may influence consistency of use. Teenagers using coitus-dependent methods are, on average, less consistent users than are those who use the pill. (20) Teenagers using dual methods (21) or hormonal methods in their first sexual relationship (22) are more consistent users than are teenagers using other methods.
Several individual-level factors are associated with contraceptive use. Racial and ethnic minorities, especially Hispanic teenagers, report lower levels of contraceptive use than non-Hispanic white teenagers do; moreover, higher test scores and better self-reported grades are associated with greater use and consistency. (23) Formal sex education may be linked to increased contraceptive use. (24) Moreover, although more frequent attendance at religious services and stronger religious beliefs are associated with delaying sexual initiation, (25) when more religious teenagers become sexually experienced, they often are less likely than other teenagers to use contraception. (26) Family characteristics are also important: Living with two biological parents and having parents with higher educational levels are associated with increased use among teenagers. (27)
Although males may play an important role in sexual and contraceptive decision-making in relationships, few studies, have examined gender differences in factors associated with contraceptive use and consistency. Meanwhile, different factors may be important lot males and females. For example, females with positive self-perceptions and high levels of communication report increased contraceptive use, as do males reporting high relationship quality and those with relatively nontraditional attitudes regarding gender roles. (28)
OBJECTIVES AND HYPOTHESES
This article builds on prior research on contraceptive use in several ways. First, we examine contraceptive use and consistency throughout teenagers' most recent sexual relationship instead of examining only contraceptive use at most recent sex. Second, we examine how characteristics of teenagers' relationships and sexual partners influence contraceptive use and consistency. Third, we test whether contraceptive use in teenagers' first sexual relationship and other characteristics of their sexual history are associated with current use, net of most recent partner and relationship factors. Fourth, we compare factors associated with contraceptive use among males versus females. Finally, we test for potential sample selection bias.
We examine five hypotheses: that characteristics of fine most recent sexual relationship and partner are associated with contraceptive use in that relationship: that contraceptive use and consistency in first relationships will be associated with contraceptive use in most recent relationships and that as teenagers' number of sexual relationships increases, their consistency' of use decreases: that users of hormonal methods and dual methods are more consistent users than those who rely' on other methods and single methods are: that family and individual characteristics are associated with contraceptive use and consistency: and that predictors of contraceptive use and consistency will differ by gender.
METHODS
Data Source
Data for this study come from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative school-based survey of U.S. adolescents in grades 7-12 in 1995. (29) Add Health has involved three waves of in-home interviews and several data collection components. At Wave 1, in 1995, more than 20,700 adolescents and their parents completed in-home interviews, answering a wide range of detailed questions about health behaviors, relationships and parent-child interactions. Approximately 14,700 students were reinterviewed for Wave 2 in 1996, and 15,200 at Wave 3, in 2002.
For this study, information on participants' contraceptive use and characteristics of their most recent sexual relationship was drawn from the Wave 2 survey; individual and family background characteristics came from the Wave 1 survey. Characteristics of teenagers' first sexual relation ships came from either Wave 1 or Wave 2, depending on the timing of the respondent's first sex. The longitudinal nature of the Add Health data allowed us to examine how first sexual relationships, as well as individual characteristics and partner and relationship characteristics, are associated with contraceptive use in teenagers' most recent relationship,
Sample
We drew our sample from 5,023 unmarried, sexually experienced adolescents who participated in both survey waves and had valid sample weights and partner-specific information about sexual relationships. We excluded 1,658 teenagers with only one lifetime sexual partner, because we were interested in teenagers with multiple lifetime partners: in addition, we excluded 1,612 whose first sexual relationship had occurred more than 18 months before the interview, because Add Health did not collect partner-specific information for their first relationship. To include independent variables measured before the most recent sexual relationship, we excluded 151 teenagers with at least two sexual partners before, but not since, the Wave 1 interview. Furthermore, we excluded 125 teenagers with incomplete or inconsistent partner-specific information on dates of first sex in their relationships; this allowed us to conclusively identify respondents' first sexual partner. * The 1,468 adolescents in our sample reported 2 10 lifetime sexual partners. ([dagger]) We examined characteristics only from participants' first and most recent sexual partnerships.
Measures
* Dependent variables. Our dependent variables were de rived from two questions about...
|
