Showing papers in "Family Planning Perspectives in 1998"

Unintended pregnancy in the United States.

Abstract: Context Current debates on how to reduce the high U.S. abortion rate often fail to take into account the role of unintended pregnancy, an important determinant of abortion. Methods Data from the 1982, 1988 and 1995 cycles of the National Survey of Family Growth, supplemented by data from other sources, are used to estimate 1994 rates and percentages of unintended birth and pregnancy and the proportion of women who have experienced an unintended birth, an abortion or both. In addition, estimates are made of the proportion of women who will have had an abortion by age 45. Results Excluding miscarriages, 49% of the pregnancies concluding in 1994 were unintended; 54% of these ended in abortion. Forty-eight percent of women aged 15-44 in 1994 had had at least one unplanned pregnancy sometime in their lives; 28% had had one or more unplanned births, 30% had had one or more abortions and 11% had had both. At 1994 rates, women can expect to have 1.42 unintended pregnancies by the time they are 45, and at 1992 rates, 43% of women will have had an abortion. Between 1987 and 1994, the unintended pregnancy rate declined by 16%, from 54 to 45 per 1,000 women of reproductive age. The proportion of unplanned pregnancies that ended in abortion increased among women aged 20 and older, but decreased among teenagers, who are now more likely than older women to continue their unplanned pregnancies. The unintended pregnancy rate was highest among women who were aged 18-24, unmarried, low-income, black or Hispanic. Conclusion Rates of unintended pregnancy have declined, probably as a result of higher contraceptive prevalence and use of more effective methods. Efforts to achieve further decreases should focus on reducing risky behavior, promoting the use of effective contraceptive methods and improving the effectiveness with which all methods are used.

Trends in contraceptive use in the United States: 1982-1995.

Abstract: This article uses data from the 1982 1988 and 1995 US National Surveys of Family Growth to describe the major contraceptive use trends between 1982 and 1995 as well as the subgroups responsible for important changes. The article focuses on current use of contraception by women of reproductive age including sterilization and condom use as defined by use of at least one method during the month of the interview. The proportion of women practicing contraception increased from 56% in 1982 to 60% in 1988 and 64% in 1995 with increases in all age ethnic and racial groups. Tables display the characteristics of women at risk of an unwanted pregnancy as well as the percentage distribution and number of contraceptive users 1) by current method; 2) by current method race and ethnicity; 3) of Whites and Blacks by current method according to age; 4) by age marital status education income and intent to have more children by method; 5) of White and Black users by method according to marital status and parity; 6) of White and Black users aged 20-44 by method according to education and income; and 7) the number of women aged 15-44 and percentage currently using specified contraceptive method combinations by age marital status education income parity race/ethnicity and number of male partners in the past year. The major finding was an increase in condom use especially among young Black Hispanic and unmarried women. This increase accompanied a decrease in use of oral contraceptives and the vaginal diaphragm. The data suggest the trends were affected by concerns about HIV/AIDS and sexually transmitted diseases and point the way to further research on contraceptive use trends.

Family communication about sex: what are parents saying and are their adolescents listening?

Abstract: In the US Black and Hispanic adolescents have an increased risk of a number of negative consequences of sexual activity but most studies about parent-adolescent sex communication have been based on White samples have failed to examine specific content of discussions have considered the adolescents perspective only and have focused on whether (but not how) sexual information is transmitted. This analysis used data from interviews with 982 mother-adolescent pairs who took part in the 1993-94 Family Adolescent Risk Behavior and Communication Study. Sexual communication with either parent was measured by 10 questions to adolescents sexual communication with adolescent was measured by rewording these questions for mothers and another 10 questions measured the process of sexual communication. It was found that the topics of HIV/AIDS and sexually transmitted diseases were covered significantly more than other issues. Findings were influenced by the gender of the adolescent and the parent but not by ethnicity. Adolescents of both sexes were more likely to report discussions with mothers than with fathers and parents were more likely to discuss the 10 topics with adolescents of the same gender. As openness in the communication process increased so did the likelihood of a topic being discussed and of mother-adolescent agreement that the discussion took place. It was concluded that educational programs for parents should include the topic of how information is conveyed.

Multiple sexual partners among U.S. Adolescents and young adults

Abstract: This study estimated the prevalence of having multiple sex partners (MSPs) and examined potential risk factors associated with having MSPs among adolescents and youth in the US. Data were obtained from the 1992 National Health Interview Survey and Youth Risk Behavior Survey among a multistage probability cluster sample that was weighted to represent the youth aged 12-21 years. This analysis was based on a limited sample of 4075 youth who were sexually experienced (SE). Initial factor analysis yielded 2 clusters related to first intercourse: substance use and weapon carrying or fighting. Weapons was excluded due to poor internal consistency. Orthogonal rotation revealed 2 cluster factors: alcohol use and illicit drug use. Cross-tabulations were used to identify potential independent predictors. Logistic regression was used to estimate the independent influence of predictors. Findings indicate that most had 2 or more lifetime partners (LPs). The proportion of those with 6 or more LPs rose from 8% at age 14 to 31% at age 21 among females and from 14% to 45% among males. Only 20% of SE females and 13% of SE males reported 1 lifetime partner. Alcohol use illicit drug use and young age at first intercourse were associated with increased odds of females having 2 or more partners in the preceding 3 months. Marriage lowered the odds for both sexes. The same 3 factors in addition to being Black or Hispanic increased the odds for males. Increases in alcohol-related behaviors contributed to increases in adjusted proportions of recent MSPs from 8% to 48% among females and from 23% to 61% among males.

Compliance, counseling and satisfaction with oral contraceptives: a prospective evaluation.

Abstract: Methods: Two months after initiating or resuming oral contraceptive use, a nationwide sample of 943 women completed questionnaires examining their compliance with instructions for proper use, the quality of their interactions with their provider, their satisfaction with the method, and the frequency and costs of visits or calls to their providers because of pill-related side effects. Regression analyses were used to determine the factors associated with compliance difficulties and method dissatisfaction. Results: In all, 47% of users missed one or more pills per cycle, and 22% missed two or more. Women who lacked an established pill-taking routine, who did not read and understand all of the informational material accompanying the pill package, or who experienced spotting or heavy bleeding had increased odds of missing two or more pills per cycle. Method satisfaction was most likely among women who were aware of the pill’s noncontraceptive benefits, were satisfied with their relationship with their provider, had used the pill in the past and experienced few side effects. Some 22% of users called their provider at least once about pill-related side effects, and 9% made at least one visit for this reason; these women spent $25 and $62, respectively, to treat side effects. Conclusions: Improving pill use is a shared responsibility of the provider, the patient and, to a lesser degree, pill manufacturers. Awareness of potential difficulties such as inadequate counseling is a key step in helping women use oral contraceptives effectively. Family Planning Perspectives, 30(2):89‐92 & 104, 1998

Predicting maternal behaviors during pregnancy: does intention status matter?

Abstract: The hypothesis that womens behaviors during pregnancy that have the potential to influence their babys health are influenced by their attitudes toward the pregnancy was examined through use of data from two US surveys: the 1988 National Maternal and Infant Health Survey (n = 9122 births) and the 1988 National Survey of Family Growth (n = 2586 births). Specifically it was explored whether women with unintended (mistimed or unwanted) pregnancies make less use of prenatal care services and conform less closely to recommended practices such as those related to smoking and weight gain than women with planned pregnancies independent of their social and demographic characteristics. Multivariate analysis indicated women with planned pregnancies were 12 percentage points more likely than women with unintended births to recognize their pregnancy in the first 6 weeks 16 percentage points more likely to have initiated prenatal care in the first 8 weeks and 8 percentage points more likely to have adhered to medical advice to quit smoking. Once the effects of social and demographic factors were controlled these differences were reduced by 49% 46% and 32% respectively. Contrary to expectations once prenatal care was initiated women with an unintended pregnancy were as likely to meet the recommended number of visits reduce alcohol consumption take vitamins and gain weight per advice as women with a planned pregnancy. These results indicate a need to pay attention to social and demographic factors that contribute to late recognition of pregnancy delayed entry into prenatal care and continued smoking during pregnancy as well as the wantedness of the pregnancy in the design of maternal-child health programs.

Gender and ethnic differences in the timing of first sexual intercourse.

Abstract: This study estimated the effects of gender and ethnic differences on the risk of first intercourse (FI) among a population-based sample of Los Angeles County youths aged 12-17 years. Longitudinal surveys were conducted during 1992-94 and 1994-95. The sample was of the multistage stratified probability type. The sample included 877 interviewed adolescents in the 1st round and 675 in the 2nd. Almost 50% of respondents were Hispanic. 58% lived with both parents. The median age of intercourse was 16.9 years; 16.6 years for males and 17.2 years for females. Blacks reported the youngest age of FI at 15.8 years. Asian adolescents had the oldest age of FI at 17.6 years. The same pattern occurred for median age at FI. Age at FI did not vary as much by ethnicity for females. White and Black females had younger ages of FI than Asian females. Black males had significantly higher rates of FI than White females. Asian males were less likely than White females to be sexually experienced. Hispanic and Asian females had significantly lower rates of sexual activity than White females. Family structure was significantly associated with risk of sexual activity. With controls for differences in family background rates of FI differed significantly by ethnicity among males but not females. Teenagers living with a single parent or step family had significantly higher rates of transition to first sex than those living with both parents. Family structure may measure the effects of family disruption rather than parenting behaviors. Findings demonstrate that ethnicity and gender are key factors that predict adolescents risk of becoming sexually active.

Teenage childbearing is not so bad after all...or is it? A review of the new literature.

Abstract: W hat are the socioeconomic effects of teenage childbearing for women and their families? A decade ago, the answer seemed clear, and it provided a solid basis for public policy. "Kids having kids," the research literature conclusively showed, was a very serious problem. It exacerbated the already difficult situation of young women from poor families and contributed importantly to the higher incidence of poverty and welfare dependence of these women. The summary in Risking the Future, the 1987 report of the National Research Council, is well known: "Women who become parents as teenagers are at greater risk of social and economic disadvantage throughout their lives than those who delay childbearing."1 President Clinton echoed this perspective in his 1995 State of the Union address, when he declared, with some understandable political hyperbole, that teenage pregnancy is "our most serious social problem." Now the consensus of the research community is much less settled. Research conducted in the decade since Risking the Future has challenged the conventional view, arguing instead that the problem of teenage childbearing has been exaggerated, perhaps substantially. Authors of these studies contend that a teenage birth does not make a young woman's situation very much worse and that it may even have a beneficial effect on her socioeconomic status. These conclusions have gotten a great deal of attention, and they have a lot of researchers and policymakers scratching their heads. What are we to make of all this? Should we be rethinking our public policy about

Young women's degree of control over first intercourse: an exploratory analysis.

Abstract: Context While policymakers and researchers alike often seem to believe that young women's decision to initiate sexual intercourse is conscious and free of ambiguity, the actual degree of control that such young women exert over first intercourse has rarely been explicitly examined. Methods The 1995 National Survey of Family Growth asked all women who had experienced intercourse to rate, on a 1-10 scale, the wantedness of their first intercourse; they were then asked whether the experience was voluntary. Logistic regression analysis of data for women aged 15-24 who had experienced first premarital intercourse was performed to test the effect of background factors and wantedness scores on contraceptive use at voluntary first intercourse. Results Twenty-four percent of women aged 13 or younger at the time of their first premarital intercourse report the experience to have been nonvoluntary, compared with 10% of those aged 19-24 at first premarital intercourse. About one-quarter of respondents who reported their first intercourse as voluntary chose a low value (1-4) on the wantedness scale. Women whose first partner was seven or more years older than themselves were more than twice as likely as those whose first partner was the same age or younger to choose a low value (36% vs. 17%). Women whose partner had been seven or more years older were also less likely than other women to have used contraceptives at first intercourse. After the introduction of controls for demographic and background factors, partner age discrepancy and relationship status, wantedness of voluntary first intercourse was not independently related to the odds of contraceptive use at that intercourse. Conclusion Characterizing women's first intercourse as simply voluntary or nonvoluntary is inadequate. Measures that take into account degrees of wantedness may help elucidate relationships between sexual initiation, contraceptive use and teenage pregnancy. The fact that substantial numbers of young women voluntarily participated in a first sexual experience about which they felt ambivalent or negative deserves the attention of program planners and service providers.

Measuring the extent of abortion underreporting in the 1995 National Survey of Family Growth.

Abstract: Context Induced abortions are often severely underreported in national surveys, hampering the estimation and analysis of unintended pregnancies. To improve the level of abortion reporting, the 1995 National Survey of Family Growth (NSFG) incorporated new interview and self-report procedures, as well as a monetary incentive to respondents. Methods The weighted numbers of abortions reported in the main interview of the 1995 NSFG (Cycle 5), in the self-report and in the two procedures combined are compared with abortion estimates from The Alan Guttmacher Institute. The Cycle 5 estimates are also compared with estimates from previous cycles of the NSFG. Results The self-report produces better reporting than the main interview, but combining data from the two procedures yields the highest count of abortions. For the period 1991-1994, the level of reporting is 45% in the main interview, 52% in the self-report and 59% when the two methods are combined. The level of abortion reporting in the combined data ranges from 40% for women with an income less than the federal poverty level to more than 75% among women who were older than 35, those who were married at the time of their abortion and those with an income above 200% of the poverty level. The completeness of abortion reporting in the main interview of Cycle 5, though indicating a remarkable improvement over reporting in Cycle 4, is comparable to the levels in Cycles 2 and 3. Conclusions The usefulness of the NSFG remains extremely limited for analyses involving unintended pregnancy and abortion.

The Effects of Pregnancy Planning Status On Birth Outcomes and Infant Care

Abstract: Context: The planning status of a pregnancy may affect a woman’s prenatal behaviors and the health of her newborn. However, whether this effect is independent or is attributable to socioeconomic and demographic factors has not been explored using nationally representative data. Methods: Data were obtained on 9,122 births reported in the 1988 National Maternal and Infant Health Survey and 2,548 births reported in the 1988 National Survey of Family Growth. Multiple logistic regression analyses were employed to examine the effects of planning status on the odds of a negative birth outcome (premature delivery, low-birth-weight infant or infant who is small for gestational age), early well-baby care and breastfeeding. Results: The proportion of infants born with a health disadvantage is significantly lower if the pregnancy was intended than if it was mistimed or not wanted; the proportions who receive wellbaby care by age three months and who are ever breastfed are highest if the pregnancy was intended. In analyses controlling for the mother’s background characteristics, however, a mistimed pregnancy has no significant effect on any of these outcomes. An unwanted pregnancy increases the likelihood that the infant’s health will be compromised (odds ratio, 1.3), but the association is no longer significant when the mother’s prenatal behaviors are also taken into account. Unwanted pregnancy has no independent effect on the likelihood of well-baby care, but it reduces the odds of breastfeeding (0.6). Conclusions: Knowing the planning status of a pregnancy can help identify women who may need support to engage in prenatal behaviors that are associated with healthy outcomes and appropriate infant care.

Sex, Contraception and Childbearing Among High-Risk Youth: Do Different Factors Influence Males and Females?

Abstract: Context: The likelihood that adolescents will engage in sexual activity, use contraceptives or become parents is influenced by a range of attitudes and behaviors. These factors may differ for males and females. Methods: Data on female respondents to the 1979‐1992 waves of the National Longitudinal Survey of Youth and the linked 1994 young adult data file on their children provided background information on 959 adolescents who had been born to young mothers. Partial correlation analysis was used to examine the factors related to sexual behavior, contraceptive use and childbirth, controlling for maternal and familial characteristics, in this relatively disadvantaged sample. Results: Youth who are inclined toward risk-taking and those who have run away from home are more likely than others to be sexually active. For young women, having intercourse at an early age, not using contraceptives and having a child are linked with depression, low selfesteem and little sense of control over their lives. The results for young men are less consistent and often in the opposite direction. Young people who have become parents evidence greater maturity than their childless peers; women are less likely to consume alcohol or to spend time with friends who drink, and men are more likely to participate in socially productive work. Conclusions: Although sexual behavior is tied to risk-taking in both adolescent males and females, some noticeable psychological differences are evidenced early. Behaviorally, there is room for optimism, in that young parents appear to adopt more mature traits. Family Planning Perspectives, 1998, 30(4):163‐169

Impaired fecundity in the United States: 1982-1995.

Abstract: CONTEXT The 1995 National Survey of Family Growth (NSFG) provides new nationally representative data to test the accuracy of the commonly held assumption that impaired fecundity has been rising in the United States over the past decade. METHODS Using data from the 1982, 1988 and 1995 rounds of the NSFG, trends in both the proportions and numbers of women with impaired fecundity and of those who received infertility services were examined. Multiple logistic regressions were carried out to estimate the effects of demographic characteristics on the likelihood of currently having impaired fecundity and of ever having received medical help for infertility. RESULTS The proportion of U.S. women aged 15-44 who reported some form of fecundity impairment rose from 8% in 1982 and 1988 to 10% in 1995, an increase in absolute numbers from 4.6 million to 6.2 million women. Although the proportion of fecundity-impaired women who had ever sought medical help did not change between 1988 and 1995 (44%), the absolute numbers of such women grew by nearly 30%, from 2.1 million to 2.7 million. Women who had ever sought help for fertility problems were older and had a higher income than those who had not, and were more likely to be married. CONCLUSION The dramatic increase in the numbers of U.S. women with impaired fecundity occurred because the large baby-boom cohort, many of whom delayed childbearing, had reached their later and less fecund reproductive years. This increase in both rates and numbers occurred across almost all age, parity, marital status, education, income, and race and ethnicity subgroups.

Abortion incidence and services in the United States, 1995-1996.

Abstract: Context In the 1980s, the number of abortion providers in the United States began to decline, and more recently, so has the number of abortions performed. Whether the decline in service providers, which was last documented in 1992, is continuing and whether this influences the availability and number of abortions is of public interest. Methods In 1997, the Alan Guttmacher Institute conducted its 12th survey of all known abortion providers in the United States. The number and location of abortion providers and abortions were tabulated for 1995 and 1996, and trends were calculated by comparing these data with those from earlier surveys. Limited data were also gathered on types of abortion procedures. Results Between 1992 and 1996, the number of abortions fell from 1,529,000 to 1,366,000, and the abortion rate decreased from 26 to 23 per 1,000 women aged 15-44. The number of providers fell 14%, to 2,042, with the greatest decline among hospitals and physicians' offices rather than clinics. Eighty-six percent of counties had no known abortion provider, and 32% of women aged 15-44 lived in these counties. Of the country's 320 metropolitan areas, 89 had no known abortion provider, and for an additional 12, fewer than 50 abortions each were reported. Seventy percent of abortions were performed in specialized clinics and only 7% in hospitals. In the first half of 1997, early medical abortions were being offered in about 160 facilities, virtually all of which were also providers of surgical abortions. Conclusions While abortion services in some areas of the country have declined since 1992 and many women continue to have limited access to providers, other factors have probably had more influence on the level of abortions performed. Early medical abortion methods are too new to be a measurable factor in abortion access.

Sexual behavior among U.S. high school students, 1990-1995.

Abstract: Nationally representative self-reported data from Youth Risk Behavior Surveys conducted in the US in 1990 1991 1993 and 1995 were used to examine levels of sexual experience age at first intercourse current sexual activity and condom use at last intercourse among students in grades 9-12. The surveys sampled students at public and private schools in the 50 states and the District of Columbia; 11631 in 1990 12272 in 1991 16296 in 1993 and 10904 in 1995. Schools with high percentages of Black and Hispanic students were sampled at a higher rate. The proportion of students who reported being sexually experienced remained at 53-54% during 1990-95 while the percentage of sexually active students who used condoms at last intercourse increased from 46% in 1991 to 54% in 1995. Black students were more likely than White students to report being sexually experienced being currently sexually active and having had 4 or more lifetime sex partners. The median age reported for first intercourse was 16.5 years in all years. In 1995 the median age at first intercourse was 15.0 years among Blacks 16.2 years among Hispanics and 16.7 years among Whites. Gender differences in sexual behavior were found more often among Black students than among White and Hispanic students.

Impact of a High School Condom Availability Program on Sexual Attitudes and Behaviors

Abstract: Context While making condoms available in high schools has provoked much debate, evidence on the actual effects of such programs on students' attitudes and behavior is sparse. Methods Prior to implementation of a condom availability program in a Los Angeles County high school, 1,945 students in grades 9-12 (98% of eligible students) completed a self-administered anonymous survey on their sexual behavior and on related knowledge and attitudes; one year later, 1,110 students (59% of eligible students) completed a follow-up survey. Results There was no significant change over time in the percentage of males or females who had ever had vaginal intercourse or who had had vaginal intercourse during the year prior to the survey. The percentage of males who reported using condoms every time they engaged in vaginal intercourse during the past year increased significantly, from 37% to 50%, and the percentage of males who reported condom use at recently initiated first vaginal intercourse increased from 65% to 80%. On the other hand, female respondents showed no significant change in their condom use. The self-reported likelihood of using a condom for vaginal intercourse during the following year did not change significantly for students who had had vaginal intercourse, but it increased dramatically for those who, had never had vaginal intercourse. The students' attitudes toward sex and condom use either remained the same between surveys or changed in a direction favoring less sexual behavior and greater risk prevention. Conclusions The condom availability program appears not to have produced an increase in sexual activity among high school students, and it appears to have led to improved condom use among males. The apparent strong effect on students' intention to use condoms and on males' use at first vaginal intercourse suggests that such programs may have a particular impact on the least sexually experienced adolescents.

School-based sexuality education: the issues and challenges.

Abstract: This commentary on the issues and challenges related to the provision of sex education in US schools opens by using a 1997 action of the Franklin County North Carolina school board as an example of the controversy. In this case the school board ordered the removal of chapters on sex behavior contraception AIDS and sexually transmitted diseases from its 9th grade health text book to comply with a new state law requiring public schools to teach sexual abstinence until marriage. While most US adults approve of sex education in schools the abstinence-only movement has orchestrated a highly organized successful campaign to remove information from schools and has garnered a $250 million commitment from the federal government to promote abstinence until marriage as part of welfare reform efforts. The commentary continues with a review of efforts to undermine sexuality education starting in the 1960s and sketches the current state of sex education efforts. The next section looks at the new strategy used by sex education opponents which led them to refocus efforts on local school boards and state legislatures instead of national policies. Remaining topics include the other tactics used by sex education opponents the heightened fear of teachers to discuss controversial subjects the lack of teacher training to discuss sexuality and the consequences of this situation in the classroom. Recommendations to redress this situation include improving professional training forming local advisory committees encouraging parental involvement and promoting the benefits of comprehensive programs.

Understanding changes in sexual activity among young metropolitan men: 1979-1995.

Abstract: This study examined how attitudes about sex behavior and exposure to AIDS education have affected premarital sexual behavior among urban teenage (Black and non-Black) males aged 17-19 years in 1979 1988 and 1995 in the US. Data were obtained from a 1979 National Survey of Young Men and the 1988 and 1995 National Surveys of Adolescent Males. The weighted pooled data set included 2087 never-married males aged 17-19 years. The percentage of those who had experienced sexual intercourse (SI) rose from 66% to 76% and then declined to 68% in 1995. For Black male youths SI rates remained stable after 1988. The percentage with recent SI in the 4 weeks before the survey rose from 40% to 45% in 1979 and 1988 and then declined to 39% in 1995. The average number of female sexual partners (FSPs) was 4. The average number of FSPs declined among non-Blacks--from 3.8 in 1979 to 2.9 in 1995--and increased among Blacks--from 5.1 in 1979 to 6.9 in 1995. SI frequency during the prior year rose significantly from 14 encounters/year in 1979 to 21 in 1995. Among Black adolescents SI frequency rose from 13 encounters/year in 1988 to 24 in 1995. Approval of nonmarital sex without an intention to marry followed similar increases and declines as for SI. Attitudes about premarital sex were strongly correlated with recent sexual activity. Teenagers who had received education about STDs or AIDS were significantly less likely to report having had recent SI. Birth control education and race were unrelated to sex behavior. Blacks were more supportive of marriage for nonmarital pregnancy in 1979. Black attitudes toward premarital sex grew more conservative. Less sexual activity is attributed in part to prevalence of AIDS education (except for Blacks) and more conservative attitudes with unknown other factors.

Partner-specific sexual behaviors among persons with both main and other partners

Abstract: Having multiple sex partners may increase a persons chance of having sex with someone who is infected with HIV. Moreover a person may have a certain sexual behavior with his or her primary sex partner which differs from that shared with other secondary partners. Sexually transmitted disease (STD) prevention and control programs may therefore need to address individuals differential risk with each partner type. Relationship characteristics partner risk behaviors and sex behaviors were studied among 123 male and 106 female STD clinic patients who had both main and other partners. Among men and women with both main and other frequent partners 48% of men and 41% of women had known their main partner but not their other partners for at least 1 year. These proportions compare to 2% of men and 9% of women who had known their other frequent partners but not their main partner for at least 1 year. Among those with main and casual partners both men and women were more likely to use alcohol or drugs before or during sex with main partners only (15%) than with casual partners only (1-3%). Women with main and casual partners were more likely to have oral sex only with main partners than only with casual partners (37% vs. 3%) and were more likely to use condoms only with casual partners than only with main partners (33% vs. 4%).

Women's Efforts to Prevent Pregnancy: Consistency of Oral Contraceptive Use

Abstract: Avoidance of unwanted pregnancy in the US would be facilitated by a more thorough understanding of the determinants of inconsistent oral contraceptive (OC) use. This issue was investigated in a nationally representative subsample of 1485 OC users 15-44 years old who participated in the 1995 US National Survey of Family Growth. 15% of these women were using another contraceptive method in addition to the pill. Overall 16.4% of OC users were inconsistent (defined as missing 2 or more pills in a 3-month period); this rate was 20.3% among dual method users. Among users of the pill only Hispanic and Black women were at significantly increased risk of being inconsistent OC users (odds ratios (ORs) 2.5 and 2.1 respectively) than were White women. The risk was also elevated among those who began OC use within the past 3-6 months compared with longer-term users (OR 2.7) and women with a history of an unintended pregnancy (OR 1.6). Among dual method users the risk was elevated among women with incomes less than 250% of the federal poverty level (OR 4.3) and women who began OC use within the preceding 3-6 months (OR 4.5). Awareness of these characteristics could help family planning providers identify OC acceptors at risk of inconsistent use. More research is needed however to develop better measures of consistency and to determine the predictors that should be tested in large-scale national databases.

Condom use among women choosing long-term hormonal contraception.

Abstract: Concerns have been raised that women who use long-term hormonal contraceptive methods to prevent pregnancy will fail to protect themselves from sexually transmitted diseases (STDs) including AIDS through concomitant condom use. This possibility was investigated in a prospective (1993-94) multi-site US (Pittsburgh Pennsylvania; Dallas Texas; and New York New York) study of 1073 new users of either contraceptive implants or Depo-Provera. The mean age of study participants was 23 years; 63% were Hispanic 24% Black and 13% White. Overall the proportion of women who always used condoms in the previous 3 months dropped from 21% at the time of method initiation to 11% at follow-up 6-12 months after enrollment. However use increased from 25% to 31% among women with more than 1 sexual partner. Significant predictors of dual method use included previous condom use (odds ratio (OR) 2.5); receipt of AIDS-specific counseling (OR 1.6); the perception at baseline of being at some risk of AIDS (OR 1.4); and more than 1 sexual partner during the study period (OR 5.4). In addition injectable users teenagers and Black women were more likely than other women to use condoms with their hormonal method. These findings have important implications for family planning programs especially the need for counseling on the continued importance of condom use for STD prevention when pregnancy is prevented by non-barrier methods.

Increased condom use among teenage males, 1988-1995: the role of attitudes.

Abstract: CONTEXT: Understanding whether and to what degree changes in young men's attitudes explain increases in condom use over time can be useful in developing more effective disease prevention strategies. METHODS: Data from the 1988 and the 1995 National Survey of Adolescent Males are used to determine changes in attitudes toward condoms, pregnancy prevention and HIV and AIDS. Two-limit tobit models are employed to investigate the association between these attitudes and condom-use behavior and to examine how this relationship may have changed over time. RESULTS: Between 1988 and 1995, young men's attitudes toward partner appreciation of condom use, condom-use embarrassment and pleasure reduction from condom use all changed in a direction suggestive of more consistent condom use. However, attitudes related to pregnancy prevention and AIDS avoidance changed in a direction suggestive of less-consistent condom use. Changes over time in the strength of the relationship between three attitude measures (masculinity, pleasure reduction and partner appreciation) and condom use also were predictive of lower levels of condom-use consistency. Only the strength of the relationship between condom-use embarrassment and consistent condom use changed in a direction corresponding to observed increases in rates of condom use among young men. CONCLUSIONS: Many of the significant changes in young males' attitudes toward condoms do not explain the increase in consistent condom use among adolescent males that occurred between 1988 and 1995. However increasing male contraceptive responsibility and emphasizing the risks and consequences of contracting HIV appear to be viable routes for policymakers to explore. Efforts particularly need to be targeted toward Hispanics.

Contraceptive practices and trends in France.

Abstract: CONTEXT Contraceptive use has been legal in France for the past 30 years, and patterns of use changed substantially from the 1960s to the 1980s. Given the rapidity with which use patterns change and the possible impact of rising concern about infection with HIV and other sexually transmitted diseases, it is important to determine trends of contraceptive practice into the 1990s. METHODS A total of 5,900 French households were selected in 1994 for inclusion in the Fertility and Family Survey. Respondents were questioned about their contraceptive use patterns and family formation status. The results were compared with those of comparable surveys conducted in 1978 and 1988. RESULTS Two-thirds of French women used some form of reversible contraceptive method in 1994. Oral contraceptive use has grown steadily in France: About 40% of women aged 20-44 reported using the pill alone or combined with another method in 1994, compared with 34% in 1988 and 28% in 1978. Condom use has also been on the rise: Nearly 8% of women were using condoms alone or combined with another method in 1994, up from 5% in 1988 and 6% in 1978. IUD use has declined from 19% in 1988 to 16% in 1994, and both male and female sterilizations remain rare. CONCLUSIONS Contraceptive behavior in France appears unique among developed countries, with fairly high levels of oral contraceptive use--even among older women--relatively high levels of IUD use and little reliance on either male or female sterilization. As with other countries, however, condom use has climbed in recent years, and is especially common at first intercourse.

How relationships of U.S. men affect contraceptive use and efforts to prevent sexually transmitted diseases.

Abstract: Findings are reported from an exploration of the effects of attitudes and background characteristics upon contraceptive use for pregnancy prevention and efforts to avoid sexually transmitted diseases (STDs) among men who were married cohabiting or dating. Attitudinal and background data were drawn on 1595 men from the 1991 and 1993 waves of the National Survey of Men (NSM) and subjected to logistic regression techniques. The majority of respondents were 30-40 years old in 1993 White college-educated and Protestant. Their partners were somewhat younger but with similar characteristics. 70% were married 10% were cohabiting and 20% were dating. Although 47% reported having become sexually active by age 16 84% reported having had only 1 sex partner since 1991. 58% of men were using contraceptives to prevent pregnancy and 22% had recently taken protective measures against STDs. The men who were most concerned about a methods ease of use were less likely than others to be using one to prevent pregnancy and STDs. However concerns about a methods risks to the female partner increased the likelihood of method use for both reasons. Couples in which the man expected his partner to take primary responsibility for contraception were 40% as likely to protect themselves against STDs as were couples in which the man felt that he shared or had greater responsibility. Married men were the least likely to be protecting themselves against STDs while men who were dating were the most likely to do so.

Prenatal care, birth outcomes and newborn hospitalization costs: patterns among Hispanics in New Jersey.

Abstract: Vital statistics data linked with hospital discharge files for single live-born infants delivered in New Jersey (US) in 1989-90 were used to examine the effects of Hispanic ethnicity on prenatal care utilization low birth weight infant mortality and newborn hospitalization costs. The findings indicate that disparities by race may be at least as important as variations in birthplace and ethnicity. Puerto Rican White women who gave birth in New Jersey were twice as likely relative to their US-born non-Hispanic White counterparts to have a low-birth-weight infant and to have an infant who died in the first year of life. In addition their newborn hospitalization costs were 25% higher than those of US-born non-Hispanic White women. Women of Puerto Rican descent regardless of whether they were born in the US initiated prenatal care later than all other Whites except the infants born in Mexico and their infants had the highest rates of low birth weight and mortality among all Whites. Although the multivariate results indicated that ethnic Puerto Rican Black women begin prenatal care earlier and have better birth outcomes than non-Hispanic Blacks the descriptive statistics showed that Puerto Rican Blacks and Whites have similar levels of prenatal care use and birth outcomes. Enhanced understanding of the sources of these racial disparities is important for the design of policies to improve birth outcomes. Poor outcomes without concomitant increases in hospitalization costs may be a sign of low access to high-quality neonatal care.

Using pharmacies in Washington state to expand access to emergency contraception.

Abstract: women's awareness and use of emergency contraception by utilizing pharmacists to increase its availability. We also discuss the impact that their expanded role is having on access to emergency contraception, and thereby the potential impact of the program on rates of unintended pregnancy.

Dual-method use among an ethnically diverse group of women at risk of HIV infection.

Abstract: Promotion of condom use among women who use efficient contraception is essential to protect them from sexually transmitted diseases (STDs) including HIV as well as pregnancy. However fear of negative reactions from a male partner may prohibit dual method use among women who are economically dependent on men. To understand the factors that influence dual method use interviews were conducted with 522 low-income US women at risk of HIV who attended 21 public health family planning (FP) and STD clinics or economic assistance centers in Miami Florida (US) in 1994-95. 54% were concerned about both pregnancy and AIDS; 32% were worried about AIDS only and 5% about pregnancy only. 20% of respondents reported dual method use; overall 36% of women used condoms (either alone or along with another method). The rate of dual method use was 16% among Whites 24% among Blacks and 21% among Hispanics. The likelihood of dual method use was significantly enhanced (odds ratio 2.0-3.5) among women who were not married worried about both pregnancy and AIDS had ever had an STD were confident they could refuse sex with a man who would not use a condom and made FP decisions jointly with their partner. Women who regarded condoms as only somewhat effective in preventing HIV infection or who shared economic decision-making with their partner rather than making such decisions alone were least likely to use dual methods. Black and Hispanic women were significantly more likely than White women to use condoms in conjunction with efficient contraception.

Design and operation of the 1995 National Survey of Family Growth

Abstract: This report describes how the 1995 [U.S.] National Survey of Family Growth (NSFG) was designed planned and implemented. The NSFG is a national survey of women 15-44 years of age designed to provide national estimates of factors affecting pregnancy and birth rates and the health of women and infants....About 260 female interviewers were trained for 7 days in January 1995. These interviewers completed a total of 10847 interviews with women 15-44 years of age for a response rate of 79 percent. This report describes how the survey was planned and designed and how the data were collected edited and processed for public use. (EXCERPT)

Breakage and acceptability of a polyurethane condom: a randomized, controlled study.

Abstract: Results: The clinical breakage rate of the polyurethane condom was 7.2%, compared with 1.1% for the latex condom (relative risk of 6.6, 95% confidence interval of 3.5‐12.3). The complete slippage rate (combining incidents during intercourse and withdrawal) of the polyurethane condom was 3.6%, compared with 0.6% for the latex condom (relative risk of 6.0, 95% confidence interval of 2.6‐14.2). Most male users preferred the sensitivity provided by the polyurethane condom to that of the latex condom. Conclusions: The clinical breakage rate of the polyurethane condom is significantly higher than that of the latex condom. However, nearly half of the users preferred the polyurethane condom, which provides an option for couples who have rejected conventional condoms or who cannot use latex products.

A profile of the adolescent male family planning client.

Abstract: Findings are reported from 1780 young male clients of the California Office of Family Plannings Expanded Teen Counseling Programs (ETCP) family planning clinics during 1992-94 on their sexual behavior contraceptive use pregnancy and parenting history and psychosocial characteristics. 37% were Hispanic 30% White 18% Black 12% Asian and 6% members of other racial or ethnic groups. 14% were aged 14 years or younger 50% were aged 15-17 and 36% were aged 18-19. 9% reported having Medicaid insurance and 3% received Aid to Families with Dependent Children. 31% of the young men reported going to the clinic in search of a birth control method 27% to determine whether they were infected with an STD 26% for a physical exam 22% because their partner or girlfriend wanted them to and 15% for information or someone to talk to. 88% reported recent episodes or symptoms of depression and 23% were having problems in school. 86% were currently sexually active with 48% of those sexually active being age 14 or younger when they had their first sexual encounter. 73% reported using a condom at first sexual intercourse while 12% had never used a contraceptive method. 50% reported using a condom the last time they had sexual intercourse 71% of condom users reported being comfortable with the method 21% had impregnated a partner and 8% were parents and 25% reported having 4 or more sex partners during the past 6 months. 9% reported ever having an STD 31% reported being always or sometimes high on alcohol or drugs during sex and 6% reported having been forced or tricked into having sex. The odds were reduced that a client had used an effective method at last intercourse if he was uncomfortable with that method. The likelihood of contraceptive use at last intercourse was increased among males who agreed with their partner about their method and those who had never impregnated a partner.