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The effects of advance provision of emergency contraception on adolescent women's sexual and contraceptive behaviors.

CONTEXT: Advance provision of emergency contraception (EC) may increase timely access and improve effectiveness, but the impact on adolescent sexual and contraceptive behaviors is not known. OBJECTIVE: To determine whether adolescents given advance EC have higher sexual and contraceptive risk-taking behaviors compared to those obtaining it on an as-needed basis. DESIGN AND SETTING: Randomized trial conducted at urban, hospital-based adolescent clinic in Pittsburgh, PA, from June 1997 to June 2002. PARTICIPANTS: 301 predominantly minority, low-income, sexually active adolescent women, age 15-20 years, not using long-acting contraception. INTERVENTIONS: Advance EC vs instruction on how to get emergency contraception. OUTCOME MEASURES: Self-reported unprotected intercourse and use of condoms, EC, and hormonal contraception ascertained by monthly 10-minute telephone interviews for 6 months post-enrollment. Reported timing of EC use after unprotected intercourse. RESULTS: At both 1- and 6-month followup interviews, there were no differences between advance EC and control groups in reported unprotected intercourse within the past month or at last intercourse. At 6 months, more advance EC participants reported condom use in the past month compared to control group participants (77% vs 62%, P=0.02), but not at last intercourse (advance EC 83% vs control 78%, P=0.34). There were no significant differences by group in hormonal contraception use reported by advance EC or control groups in the past month (44% vs 53%, P=0.19) or at last intercourse (48% vs 58%, P=0.20). At the first followup, the advance group reported nearly twice as much EC use as the control group (15% vs 8%, P=0.05) but not at the final followup (8% vs 6%, P=0.54). Advance EC group participants began their EC significantly sooner (11.4 hours vs 21.8 hours, P=0.005). CONCLUSIONS: Providing advance EC to adolescents is not associated with more unprotected intercourse or less condom or hormonal contraception use. In the first month after enrollment, adolescents provided with advance EC were nearly twice as likely to use it and began EC sooner, when it is known to be more effective.

Adolescent↗

Contraceptive behavior among sexually active Hispanic adolescents.

The purpose of this study was to examine those factors associated with the contraceptive behavior of a national representative sample of Hispanic female adolescents. The subjects included all (n = 85) unmarried, sexually active Hispanic women, aged 15 to 19, from the 1982 National Survey of Family Growth. Contraceptive behavior was measured on a normalized scale, ranging from oral contraceptives to no contraception. Mexican/American and Central/South American background females were more likely (p less than 0.031) to use effective birth control than Puerto Rican, Cuban, and other Hispanic background subjects. Twenty additional social, behavioral, and demographic variables were found to be significantly associated (p less than 0.05) with contraceptive behavior. Based on multiple regression analysis, seven of these variables were found to explain 62% (p less than 0.0001) of the variation in the contraceptive behavior of this sample. Poorer contraceptive behavior was associated with noncompliance with the initial birth control method used (33.8%), lower coital frequency (8.3%), older postmenarchial age (5.7%), failure to use birth control at first coitus (4.6%), fewer years dating (4.0%), lower frequency of church attendance (3.3%), and never having experienced a pregnancy scare (2.0%). These findings suggest that the contraceptive behavior of Hispanic female adolescents is a dynamic process that can be understood in the context of previous sexual and contraceptive behavior.

Adolescent↗

Sexual behavior, contraception and unintended pregnancy among young females.

Information about contraceptive usage and sexual experiences was sampled in 1985-86 from 16-20-year-old Danish females admitted for legally induced abortion on Funen (N = 140). In attempts to elucidate the causal relations behind undesired pregnancy among teenagers, data were in the present context compared with answers to the same questions from a representative Danish sample of sexually experienced, non-pregnant females of the same age (N = 201). Of the reference sample, 83.6% were using contraceptives at the time of the interview--mostly oral contraceptives (O.C.). Of the abortion sample, 90.7% said they had used contraception earlier in their reproductive life. Approximately one third conceived in spite of contraception (most frequently the condoms). O.C. was the contraceptive method used most recently (by 43.6%). Thus, a pause in an effective contraceptive often precedes an unintended pregnancy, pointing to the need for follow-up counselling when O.C. is prescribed to teenagers. Only the minority could state the total number of times they had experienced sexual intercourse. Significantly more females in the abortion sample were in an alliance with a male partner with whom they had regular sexual intercourse. However, they also reported a higher average number of different sexual partners, indicating an association between changing sexual relationships and undesired pregnancy. In the abortion sample significantly more pregnancies prior to the index pregnancy were reported during a corresponding period of risk of conception lasting only a few years. Taking the widespread use of contraception into account, it is possible that an increased fecundity might be a co-factor behind unsuccessful contraception.

Adolescent↗

Factors influencing contraceptive behavior of single college students.

This study investigated the premarital contraceptive behavior of 222 male and female college students. Contraceptive practice was examined in relation to dating patterns, level of emotional involvement with the sex partner was heightened, the intercourse was planned, and the individual and prior sexual experience.

Adolescent↗

Women's socioeconomic position and contraceptive behavior in Togo.

Few studies have examined empirically the influence of women's position on contraceptive behavior in sub-Saharan Africa. Using data from the 1988 Togo Demographic and Health Survey, this article explores the linkages between various indicators of women's position and spousal communication about family planning and contraceptive use. The results highlight the importance to their contraceptive behavior of women's economic power and individual control over choice of partner. The likelihood of spousal communication about family planning and modern contraceptive use is significantly higher among women who exercised complete control over selection of partner than among those with arranged marriages. Women who work for cash are significantly more likely than those who do not to communicate with their spouses about family planning, particularly if they participate in rotating credit or savings schemes. Such participation also increases significantly the likelihood of ever using traditional and modern methods of contraception.

Adolescent↗

Adolescent contraceptive behavior: the impact of the provider and the structure of clinic-based programs.

OBJECTIVE: To characterize general trends in research on the impact of provider variables on adolescent contraceptive behavior and to identify useful frameworks for designing clinic-based programs aimed at reducing unintended adolescent pregnancy. DATA SOURCES: A computerized search of Psychological Abstracts, Sociological Abstracts, and MEDLINE identified English-language articles from 1990 to 1995 on adolescent contraceptive behavior in the United States. All relevant citations within these articles also were examined. METHODS OF STUDY SELECTION: Studies were selected that focused on any aspect of provider characteristics as they relate to adolescent contraceptive behavior. TABULATION, INTEGRATION, AND RESULTS: Based on a conceptual integration of the articles, three general research issues on provider characteristics were identified; 1) the effectiveness of adolescent-based clinic programs and provider variables that discriminate successful versus unsuccessful programs, 2) the effects of parental notification policies on adolescent clinic use, and 3) whether the presence of clinics promotes sexual activity on the part of adolescents. Issues that must be considered in the structuring of provider-based programs include the strategic focus of the program, the target behaviors, the target population, and the structuring of educational materials. CONCLUSION: The effectiveness of adolescent-based clinic programs is mixed. Parental notification of adolescent use of a clinic can, in some cases, decrease the likelihood of clinic use. There is little convincing evidence that the presence of adolescent clinics promotes sexual activity.

Adolescent↗

Sexual and contraceptive behavior on a college campus. A five-year follow-up.

In the spring of 1974, the authors surveyed students on the campus of the University of Hawaii to determine their sexual attitudes, behavior, and contraceptive practice. In 1979 this same survey was repeated to ascertain what, if any, changes had occurred within this five-year span. It was found that sexual activity among single students had increased slightly, with the increase being the same for both males and females. Other findings included an increase in the number of unmarried students living together; however, it was also found that students living in on-campus dorms had less sexual activity than those living off campus. A surprise finding was an increase in sexual activity by Chinese and Japanese students, while there was a decrease in sexual activity by Filipino students. It was found that sexually active students were using less contraception in 1979. The reason mentioned most frequently for not using contraception was fear of side effects. The number of students who had been pregnant increased slightly, and it was found that there was also a slightly higher incidence of intentional termination.

Abortion, Induced↗

Sexual behavior, contraceptive practice, and reproductive health among Nigerian adolescents.

In the context of a high and increasing incidence of unwanted pregnancy among Nigerian adolescents, a sample survey of never-married residents of the Ibadan area, aged 14 to 25 years, was conducted in 1982 to learn about their perceptions and practices relating to reproductive health. A substantial proportion of the young unmarried population is sexually active, and despite comparatively high contraceptive prevalence among that proportion, many are still engaging in sexual relations without benefit of contraceptive protection. Nearly half of the female students interviewed at both the secondary and university levels have been pregnant, as have two-thirds of those not currently enrolled in school. Among those respondents who had been pregnant, almost all reported that they voluntarily terminated their pregnancies. Existing and needed contraceptive services for the adolescent population are discussed.

Abortion, Illegal↗

Sexual and contraceptive behavior in young unmarried women.

The psychological determinants of sexual and contraceptive behavior among young women are complex, variable over time, and individually unique. While the approach of an individual clinician or clinical program can be shaped by certain common developmental sequences, a given individual's behavior is determined by many factors which come together in a unique way at a given point in time, and thus the most successful encounter will be that which involves face-to-face, one-to-one contact between client and practitioner.

Abortion, Therapeutic↗

Predicting contraceptive behavior from attitudes: a comparison of within- versus across-subjects procedures.

Within- versus across-subjects procedures for predicting behavior from attitudes were contrasted. Each procedure requires a comparison among attitudes in order to generate a prediction; the comparison is either among the same attitudes held by different people (across subjects) or among different attitudes held by the same person (within subject). It was hypothesized that the within-subject model provides a more adequate explanation of behavior from attitudinal constructs and, hence, more accurate prediction of behavior from attitudes than does the across-subjects model. To test this view, a sample of 349 married couples was administered a questionnaire containing measures of three attitudinal components--affect, cognition, and conation--toward each of four contraceptive methods--oral contraceptives, IUD, diaphragm, and condoms. Contraceptive behavior was assessed 1 year later. In support of the hypothesis, the within-subject predictions bore a significantly stronger relation to the behavioral criteria than did the across-subjects predictions. This effect was consistent for each of the three components of attitude, for the prediction of behavior and behavioral intention, for male and female respondents, and for a variety of contraceptive behaviors. In addition, both the within- and the across-subjects analyses demonstrated a clear rank ordering in the predictive validity of the three attitudinal components: Conation was a better predictor of behavior than was affect, which, in turn, was better than cognition.

Affect↗

Social networks, ideation, and contraceptive behavior in Bangladesh: a longitudinal analysis.

Longitudinal survey data from a panel of married women in Bangladesh is used to estimate the impact of a social network approach to family planning field worker communication and to test a theoretical model of behavior change that explains why women adopt modern contraceptives. Government field workers were trained to organize group discussions with women in the homes of opinion leaders located at central points in each village's social network. A set of intervening variables, referred to collectively as 'ideation', are derived from diffusion of innovation and social network theory to explain how the social network approach affects contraceptive behavior. The rate of increase in modern contraceptive use was found to be five times greater among women in the social network approach than among women who were visited by field workers at home. The impact of the social network approach on modern contraceptive use was almost double that of conventional field worker visits after controlling for the effects of prior contraceptive use and intention, prior home visits, and selected socio-demographic characteristics. Both approaches had the same degree of impact on ideation. The results confirm the influence of ideation on fertility change and suggest that family planning programs would benefit from training field workers to use a social network approach.

Adolescent↗

Contraceptive behaviors in adolescents.

A wide range of factors influence adolescents' contraceptive behaviors, from personal characteristics to family context to social support to knowledge about and access to contraception. Improving knowledge about contraception and counseling about successful contraceptive use can be helpful in decreasing the remarkably high US rates of adolescent pregnancy. Encouraging the postponement of sexual activity until an individual adolescent is developmentally capable of participating in a mature, healthy, mutually respectful relationship that incorporates effective contraception clearly is a goal that most clinicians, parents, teachers, and other responsible adults can support. Contraceptive technologies that incorporate delivery systems that are "user-friendly" and long-acting also will help to further lower US adolescent pregnancy rates that, while improving, are currently among the highest in the world.

Abortion, Induced↗

How do family planning workers' visits affect women's contraceptive behavior in Bangladesh?

In Bangladesh, family planning workers' visits reduce the costs of contraception and may increase the demand. If visits increase demand or if workers are targeting their visits, past visits by family planning workers should have a positive and significant effect on later probabilities of adopting contraceptive methods. Longitudinal data show that past visits are not significant in hazard models for adoption of contraceptive methods, whereas visits in the current round are significant. Therefore family planning workers' visits affect women's contraceptive behavior by decreasing the costs of contraception. Results of contraceptive discontinuation hazard models further support this hypothesis.

Adult↗

The initiation of adolescent sexual and contraceptive behavior during changing times.

This paper examines changes in the initiation of adolescent sexual and contraceptive behavior in the United States between 1978 and 1988. Since a number of contextual changes occurred during this time period including a focusing of public attention on adolescent pregnancy along with the widespread publicity surrounding AIDS, we expected that the response to these events not only would change over time, but would also vary across social groups. Using data from Cycles III and IV of the National Survey of Family Growth, we find that the overall population patterns of earlier initiation of sexual intercourse and increased use of condoms at first intercourse are not found in all segments of the population. In general, the effects of race, religion, mother's education, and age changed during this time period. The long-term trend of younger age at first intercourse was halted for Blacks, and reversed for White, fundamentalist Protestants, but continued for all other Whites. Overall, patterns throughout the decade suggest that pressures from parents, religious groups, and others either lead to a later age at first intercourse, or use of contraception, but not both. A notable exception is that increased maternal education leads to both a later age at first intercourse and a higher likelihood of using contraception at first intercourse.

Adolescent↗

Contraceptive behavior in college-age males related to Fishbein model.

Fishbein's Belief-Attitude-Intention-Behavior model states that behavior is predicted on intention, intention is predicated on attitudes, and attitudes are predicated on beliefs. Path analysis was used to test the model with respect to the contraceptive behaviors of 54 college males. In spite of the heterogeneity of the sample, the data supported the model, suggesting that nursing interventions may need to be directed toward beliefs rather than behaviors.

Adolescent↗