Community health nurses' knowledge of, attitudes toward, and involvement with adolescent contraceptive services

A national sample of community health nurses were surveyed to assess their knowledge of, attitudes toward, and involvement with reproductive health services. Results indicated that slightly more than half of the nurses provided or administered contraceptive services to adolescents, although 73% worked in settings where contraceptive services were provided to adolescents. However, only 3.6% indicated that adolescents were their primary client population. The majority (64.3%) stated that they felt as prepared to work with adolescents as they did with adult clients. While 98% were aware that most adolescents are sexually active before seeking family planning services, a minority correctly answered questions about pregnancy and contraception among adolescents. Ninety-five percent agreed that contraceptives should be available to adolescents, and 90% agreed that parental consent should not be required for adolescents seeking contraceptive services. Yet only 21.5% were aware of the implications of the Adolescent Family Life Act.     

Adolescents' values, sexuality, and contraception in a rural New York county

75 male and 88 female high school students in a rural county of New York completed a questionnaire asking about personal values and sexual experiences. Religiosity was not likely to affect the incidence of intercourse or effectiveness of contraceptive use. Students with more liberal premarital sexual and profeminist standards usually became more sexually intimate with their dates than did conservative students, but these standards did not predict coital frequency or effective contraceptive use. Different groups exhibited remarkably homogeneous sexual and contraceptive behavior. Nonvirgins had coitus sporadically or on the average of only twice a month. In addition, regardless of their values, most nonvirgins were contraceptive risk takers, partly for fear of interfering with pleasure, and partly because sporadic sex was not perceived by the adolescents to be risky. Rejecting the most, reliable methods available (e.g. birth control pills and IUDs), the condom was the most effective contraceptive used by the majority (57%) and 21% of the nonvirgins relied exclusively on such ineffective contraceptives as withdrawal, trusting in luck, and douching. Younger adolescents may be at particular risk, being more impulse motivated and egocentric, and less likely to seek adult-furnished family planning, especially in a rural community where anonymity is more difficult to protect. Given the uniformity of contraceptive behavior among younger adolescents, and the increasing likelihood of contraceptive use with increasing age of 1st coitus, future study will be needed on the impact of cognitive and emotional maturity, as well as that of environment and family planning resources on young adolescents' contraceptive use.     

Sex role development and teenage fertility-related behavior

Data from a 1975 survey of 369 females and 325 males aged 16-17 were analyzed to shed light on the relationship between the maturity of adolescent women and their sexual behavior and contraceptive practice. A straightforward decision-making process was found among males, but more complicated influences exist for females. When the data were submitted to regression and chi-squared analyses, it was found that whereas sexually active adolescents had more liberal sexual attitudes than virgins, their sex role attitudes were more stereotypical than virgins. Then the 2 groups were subdivided into virgins who did not intend to have premarital intercourse (20%); virgins who planned or considered premarital intercourse (40%); adolescents who experienced intercourse prior to age 16 (20%); and those who experienced intercourse after age 16 (20%). It was found that the virgins who did not intend to have premarital intercourse held the most stereotypical sex role attitudes, followed by sexually active women, and that virgins planning or considering intercourse held the least stereotypical views of all. It is suggested that this occurred because these adolescents were more mature and had resolved sexual identity problems earlier without resorting to intercourse. Birth control use was found to be more effective among the adolescents who experienced intercourse after age 16. Further studies are underway to test the hypotheses that the more mature a woman is when she experiences intercourse, the more likely it is that her development will be enhanced and that her contraceptive behavior will be effective.     

Predicting intended contraception in a sample of ethiopian female adolescents: The validity of the theory of planned behavior

Abstract

The purposes of the study were threefold. First, to test the validity of Ajzen's (1991) theory of planned behavior (TPB) in predicting intended contraception in the Ethiopian cultural setting. Second, to examine the additional predictive roles of past behavior and perceived pregnancy risk in the TPB model. Third, to identify the salient contraceptive beliefs influencing intended contraception. Data stemmed from a community sample of 354 sexually active female adolescents aged 15 to 19 years. The findings of the study supported TPB as a robust model in Ethiopian cultural setting, with subjective norm being the strongest predictor of intended contraception. In addition, both past contraceptive behavior and perceived pregnancy risk demonstrated to have significant contributions in predicting intention over and above that explained by attitude, subjective norm and perceived behavioral control elements of the TPB. Moreover, the study also identified salient and important contraceptive beliefs that need to be addressed in family life education and counseling programs designed for adolescents and the youth.     

Parents' behavioral norms as predictors of adolescent sexual activity and contraceptive use

The influence of parental factors on adolescent sexual behavior and contraceptive use has been examined previously, and findings have been contradictory. Previous studies, which found little relationship between parental norms and adolescent sexual activity, have been limited by their failure to recognize developmental differences in the relative weight of parent and peer influences between younger and older teens and by use of selected samples, resulting in a restriction of range. The current study differs in that it utilizes a clustered sample household survey of 329 males and females, aged 14 to 17, and 470 of their parents. Using multiple regression analysis, it was found that parents' reported behavioral norms account for 5% of the variance in whether adolescents have had intercourse, and for 33% of the variance in use of contraception at last intercourse. The study suggests that while parents' normative beliefs have limited effect in the decision to become sexually active, they have considerable impact on later contraceptive use.     

Predicting male and female contraceptive behavior: a discriminant analysis of groups high, moderate, and low in contraceptive effectiveness

An exploratory, multivariate study was carried out to assess (a) whether three contraceptive-effectiveness groups (high, moderate, and low) could be differentiated on the basis of variables that have been theoretically and empirically associated with contraceptive behavior and (b) whether an identified set of discriminating variables could accurately classify sexually active college students into these groups. Three hundred sixty-five sexually active, never-married college students (211 males and 154 females) completed instruments measuring variables related to contraception. Four separate discriminant analyses were performed, one for each sex for both their initial sexual encounter and their current sexual interactions. Discrimination and classification of the three contraceptive groups for both males' and females' initial sexual experience was not very successful. Moderate discrimination was achieved for the female current sexual activity subsample and good discrimination and classification was made for the currently sexually active male subsample. The results are discussed in terms of the implications of the findings for understanding contraceptive behavior of males and females, problems with the dependent variable of contraceptive use, and the mounting evidence that emotional orientation to sexuality influences contraceptive behavior.     

Parent-child communication about sex and young adolescents' sexual knowledge and attitudes

Previous studies indicate that adolescents whose parents talk to them about sex tend to be less sexually active and more likely to use an effective means of contraception. This study sought to determine the relationship between parent-child communication about sex and young adolescents' reproductive and contraceptive knowledge and sexual attitudes. Twenty-two 12- to 14-year-olds and their parents completed sexual-knowledge, sexual-attitude, and contraceptive-choice questionnaires. Families were divided into high-communication and low-communication groups. There were no significant differences in the sexual knowledge, attitudes, or contraceptive choices of the children in the two groups, but the correlation between parents' and children's sexual attitudes in the high-communication group was significantly higher than that of the low-communication group. Although this was a correlational study, it seems likely that the similarity in sexual values was the result of parent-child discussion about sex.     

Prospective Associations Among Youth Religiosity and Religious Denomination and Youth Contraception Use

This study prospectively investigates associations among youth religiosity, religious denomination, and contraception use. Associations between youth religiosity and religious denomination, and type of contraceptive used and consistent contraceptive use among sexually active youth (N = 757) were analyzed using multinomial and binomial logistic regression. Identifying with a religious denomination was a predictor of dual contraceptive use relative to using no method of contraception (AOR = 2.17). There was no association between youth religiosity and type of contraceptive use or contraceptive consistency. Religious leaders and public health practitioners should collaborate to develop strategies to engage in conversations with sexually active youth about contraceptive use.

     

Birth control practices and conservatism

This study examined the relationship of conservatism to reports of contraceptive usage, reasons for nonusage of a particular birth control method, and knowledge of birth control information. The never married high conservative subjects who were sexually experienced revealed that they had (a) a lower frequency of usage as well as a lower variety of contraceptive methods; (b) endorsed the beliefs that it was morally wrong and that it was unnatural to use a given birth control method significantly more often as reasons for not using contraceptive techniques; and (c) less knowledge of birth control methods than did low conservative subjects who were sexually experienced. Results were interpreted to support the notion that the fear of loss of control of one's impulses and hence the basis for conservative attitudes are determinants of contraceptive usage.     

Birth Control Practices and Conservatism

This study examined the relationship of conservatism to reports of contraceptive usage, reasons for nonusage of a particular birth control method, and knowledge of birth control information. The never married high conservative subjects who were sexually experienced revealed that they had (a) a lower frequency of usage as well as a lower variety of contraceptive methods; (b) endorsed the beliefs that it was morally wrong and that it was unnatural to use a given birth control method significantly more often as reasons for not using contraceptive techniques; and (c) less knowledge of birth control methods than did low conservative subjects who were sexually experienced. Results were interpreted to support the notion that the fear of loss of control of one's impulses and hence the basis for conservative attitudes are determinants of contraceptive usage.     

Sexual activity and contraceptive use among low-income urban black adolescent females.

A modified form of Nathanson and Becker's (1983) Health Belief Model Questionnaire and other measures designed to assess cognitive processing were administered to low-income black adolescent female clients of an inner-city comprehensive health care clinic. The purpose of the study was to explore determinants of sexual activity and contraceptive use. Subjects were classified as not sexually active (n = 50), sexually active/noncontracepting (n = 20), or sexually active/contracepting (n = 72). Not sexually active subjects tended to be younger, more career motivated, to have a father at home, to be more influenced by family values, and to have more conservative attitudes regarding adolescent sexuality than did sexually active subjects. Sexually active/noncontracepting subjects tended to report fewer benefits and more barriers to the use of contraception. Level of cognitive processing did not differ among the three groups, but was at a lower-than-expected level for age. Finally, inconsistent contraceptive use was common to both sexually active groups.     

Adolescents’ Exposure to Sexually Explicit Internet Material and Sexual Satisfaction: A Longitudinal Study

The aim of this study was to investigate, within a social comparison framework, the causal relationship between adolescents’ use of sexually explicit Internet material (SEIM) and their sexual satisfaction. In addition, we tested which adolescents were most susceptible to a potential influence of SEIM on sexual satisfaction. Between May 2006 and May 2007, we conducted a three‐wave panel survey among 1,052 Dutch adolescents aged 13–20. Structural equation modeling revealed that exposure to SEIM consistently reduced adolescents’ sexual satisfaction. Lower sexual satisfaction (in Wave 2) also increased the use of SEIM (in Wave 3). Moderator analyses showed that the negative effect of SEIM on sexual satisfaction was stronger for adolescents who had no or limited sexual experience as well as for adolescents who perceived the majority of their peers to be sexually inexperienced. The effect of exposure to SEIM on sexual satisfaction did not differ among male and female adolescents.     

Risk taking as a predictor of adolescent sexual activity and use of contraception

A hypothesis of high-risk behaviors associated with adolescent sexual activity and lack of contraceptive use was tested in a longitudinal random sample of both male and female youths. The data were part of the Rutgers Health and Human Development Project. 1380 subjects were ascertained by random telephone calling were given self-report questionnaires and personality profiles including the Zuckerman's Sensation Seeking Scale, and Jackson's Personality Research Form in 1979 and 1981. Incidence of sexual activity and use of contraceptives increased with age from age 12-21. Cohort effects were apparent with use of some contraceptive methods. Of the variables indicating risk- taking, disinhibition, impulsivity and experience seeking, there were significant associations between sexual activity and disinhibition and experience seeking, for females. There were no significant associations between these variables and sexual activity in males. Contrary to the hypothesis, there were no relationships between either consistency of birth control use or reliability of the method used and behavioral indicators of risk-taking. Thus this 1st study in the field that included both males and females from the general population, as opposed to college students, found that sexually active adolescents were higher risk-takers than virgins, but no relationship between risk-taking and effectiveness of contraception was observed.     

Adolescent sexuality and public policy

In recent decades, various attempts have been made to determine the level of sexual activity among adolescents. This information has been used in the planning and evaluation of sex-related programs. However, there is a flaw in using only the initial estimates of the behavior--that a sexually active person is defined as one who has had sexual intercourse. This narrow definition distorts the perception of adolescent sexual behavior. Sexual activity can more accurately be designated by focusing on the actual frequency with which teenagers have sex. In this research report, adolescents were considered sexually active if they had had sex within the last four weeks. Using this definition, adolescents were found to be substantially less sexually active than has been previously reported. This finding was then used to look at various policy decisions in the areas of sex education, family planning, and sexually transmitted disease prevention.     

Improving adolescent contraceptive use: evaluation of a theory-driven classroom-based intervention

The aim of the research was to evaluate the impact of intervention materials, designed to enhance self-efficacy and anticipated regret, on contraceptive behaviour and antecedents of contraceptive use in a sample of adolescents. It was hypothesised that materials designed to enhance self-efficacy and anticipated regret would lead to improvements in outcome measures compared with controls. A 4(intervention condition) × 3(time) mixed design was used to assess the impact of intervention materials. Participants (N = 414) were recruited from five secondary schools in the north of England. They were assigned to an active control group, an anticipated regret (AR) manipulation, a self-efficacy (SE) manipulation or both AR and SE manipulations. Outcome measures included psychological antecedents of contraceptive behaviour change, intentions and behaviour. Multivariate analysis of variance (MANOVA) revealed increases across several outcome measures over time (F[14,287] = 8.99, P < 0.001, η(p)(2) = 0.305) including intentions, but these did not differ by condition (F[42,852] = 1.35, P = 0.07, η(p)(2) = 0.062). There was evidence that the questionnaires may have caused reactivity in participants. Amongst sexually active participants with relatively low levels of intention to use contraception at the outset, increases in several outcome measures including intention and behaviour were observed (F[3,35] = 10.359, P < 0.001, η(p)(2) = 0.47). Findings support the potential for effective delivery of behaviour change theory-driven interventions in classroom settings. The possibility that the questionnaires may have acted as a form of intervention contributes to recent discussion of this issue in the literature, and the findings also strengthen the case for post-decisional and behavioural skills interventions to enhance behaviour amongst those already motivated to use contraception.     

Factors Affecting HIV Contraceptive Decision-Making Among Women

We examined contraceptive decision-making among African American, Latina, and European American women ages 18–50 years. Logistic regressions examined relationships between demographic and religious factors, unintended pregnancies, sexually transmitted diseases (STDs), reasons for sex, and contraceptive decision-making. Women who were older, single, African American, used pregnancy prevention, and had histories of STDs and unintended pregnancies made contraceptive decisions alone. Older and African American women were more likely to choose no contraception. Among contraceptive users, African Americans used effective methods of pregnancy, but not disease, prevention. Women with STD histories, and younger, more educated women were more likely to use methods that prevent against both pregnancy and disease. Theoretical implications about contraceptive choices among ethnically diverse women are discussed.     

Adolescent males' sexual behavior and contraceptive use: implications for male responsibility

A recent US survey of single 17-21 year old men, indicated that 17.1% used a condom at 1st intercourse and 15.5% used a condom at the most recent intercourse. Withdrawal is also used: 10.0% and 7.4% respectively. Condom use was correlated with being older at 1st intercourse, having a higher educational level, closer association to partner, and sense of male contraceptive responsibility. The data used for this analysis was taken from a sub-sample of 624 sexually active males in 1979. The mean age at 1st intercourse was 14.8 years and mean age at most recent was 18.9 years. The pill was also used at 1st intercourse (8.8%) and a total of 43.5% used some method of contraception. In the most recent intercourse cases, 64.7% used some method of birth control and the pill was used 26.5% , condom 15.5%, and withdrawal 7.4%. Conclusions from this data indicate that male methods are important in teen contraception. Condom use at 1st and most recent intercourse was related to both positive and negative characteristics. It appears that males show some contraceptive responsibility initially but later give the responsibility to females. The declining use of condoms indicates it to be a transitional form of birth control. Programs should promote continued use of condoms since use of the pill is low and unwanted pregnancy risk is high. Communication on contraception should be encouraged, so both partners are aware if neither one is contracepting. With the acquired immunodeficiency syndrome epidemic, condom use takes on a whole new context in relation to the decline in use by adolescents.     

Dominance-popularity status, behavior, and the emergence of sexual activity in young adolescents

In this paper, we investigated the sexual activity levels of several subtypes of middle adolescents (age 14-15 years). The subtype profiles were based on dominance-popularity status and a range of behaviors associated with dominance and popularity. In addition, gender differences in behavioral profiles were examined among dominant-popular, sexually active young adolescents. Results showed that socially dominant and popular young adolescent boys who exhibited a highly aggressive profile were more sexually active than their low-status and non-aggressive male peers; dominant-popular girls who were very attractive and gossips were more sexually active than their female peers. The results are discussed from an evolutionary psychological framework.