Diane M. Morrison

Adolescent contraceptive behavior: a review.

This review examines the psychologically oriented literature on adolescent contraceptive use. Descriptive studies individual difference studies and theory-based studies from family planning medical and applied journals are covered as well as studies appearing in psychology journals. The findings indicate that many teenagers are startlingly uninformed about basic reproductive physiology. A sizeable proportion of adolescents surveyed believed themselves to be immune to pregnancy or at least very unlikely to become pregnant even though they are unaware of the theoretical probability of pregnancy. 2nd birth control pills are popular with adolescents but condoms remain the only effective method of contraception used with any frequency at 1st intercourse. 3rd adolescents do not like to use contraceptives although it is unclear why. 4th personality variables specifically locus of control and self-esteem are correlated with contraceptive use but their effects are small and situationally limited. 5th contraceptive use increases with chronological age and frequency of intercourse although it is unclear whether these are direct or indirect relations. 6th adolescents nonuse of contraception is not irrational given their level of information beliefs and attitudes. Reasons for not using contraception include underestimating the possibility of pregnancy not having access to contraceptives and not anticipating the need for contraceptives. Moreover these beliefs and attitudes are powerful predictors of contraceptive behavior. A few problems with contraceptive use research include the lack of a standard classification system for birth control methods and vague descriptions of samples. Psychological methods using cognitive emotional and developmental factors have been used to predict and explain these behaviors and they hold promise for future research.

Using Focus Groups to Discuss Sensitive Topics with Children

The Childrens Health Awareness Project is presented as a case study of the use of focus groups for gathering sensitive information from children. General focus group techniques are described, as are the benefits and limitations of focus group methodology for social science applications. Recommendations are offeredfor other investigators planning to use this methodology to gather information from children, especially when sensitive topics are to be addressed.

Racial differences in acceptability and availability of drugs and early initiation of substance use

This paper examines differences among three racial groups in exposure to three risk factors for drug use (availability of drugs, acceptability of drug use, and peer alcohol use), and the relationship of these factors to drug use initiation in a sample of preadolescent urban youths. Tobacco and alcohol initiation rates were highest among Whites, lower among Blacks, and lowest among Asian-Americans. Paralleling these differences, White youths reported the greatest access to marijuana, greatest parental tolerance of substance use, and greatest intentions to use drugs as adults. Blacks somewhat less, and Asian-Americans the least. No racial differences appear in the proportion who reported that their peers used alcohol. Marijuana availability and peer use predicted substance initiation for all three racial groups. However, intentions to use substances as an adult and perceived parental tolerance of substance use predicted drug use only for White and Asian-American youths, while the expectation of punishment for drug use predicted lower drug use only among Black youths. Implications for prevention are discussed.

HIV / STD risk factors for women with violent male partners.

This study compared 167 women, categorized as nonabused, emotionally abused, or physically abused in their primary relationships, on sexual risk factors. Physically abused women differed in several ways: greater STD risk, psychosocial distress, and substance use; more traditional gender role beliefs; lower self-esteem; more likely to have been raped and to engage in sex for pay; and less likely to attend the projects STD/HIV risk reduction groups. Within primary relationships, they differed in amount of decision-making power about safer sex, likelihood of nonmonogamy, use of substances before sex, and self-efficacy about initiating condom use. African American women reported higher rates of emotional abuse than White women, a finding related mainly to their lower socioeconomic status in this sample.

Sexual behavior of American adolescents: Results from a U.S. national survey☆

PURPOSE This paper reports on data from a 1990 U.S. national survey of the sexual behavior of male and female adolescents aged 12-17. METHODS A household survey using a multi-stage area probability sample of the United States was undertaken in 1990. Adolescents were interviewed about sexual history, contraceptive use, and motivations, attitudes, and expectations with regard to sexual behavior and risk. RESULTS The majority of 17-year-olds and about half of 16-year-olds, both male and female, had initiated sexual activity, with males initiating at younger ages than females. Sexual activity was episodic; only half of sexually experienced adolescents reported having sex in the month prior to the interview. Many sexually active respondents expressed less desire to have sex than confidence that they would have sex. Over half of respondents reported using a condom at most recent intercourse, with boys being more likely than girls to report condom use. Condom use at last intercourse was unrelated to perceptions of risk and concern about AIDS. CONCLUSIONS Given the importance of some of the undesirable consequences of sexual activity in adolescents, such as AIDS and unwanted pregnancy, accurate and up-to-date information on sexual behavior of this age group is crucially important. The results of this study underscore the need for in-depth, population-based research on adolescent sexual behavior.

Condom use, frequency of sex, and number of partners: Multidimensional characterization of adolescent sexual risk‐taking

Sexual health research often relies on single risk indicators. However, multi‐variable composites may better capture the underlying construct of risk‐taking. Latent Profile Analysis identified subgroups based on condom use consistency, partner numbers, and sex frequency among 605 adolescents. Three profiles were identified for each of grades 8 to 10 (Condom Users, Few Partners, and Risk‐Takers) and 4 in grades 11 and 12 (Condom Users, One Partner, Two Partners, and Risk‐Takers). Inconsistent condom use groups reported more non‐condom (and often less effective) birth control use and STD and pregnancy histories. Females had greater representation in the Few Partners, One Partners, and Two Partners groups, which also contained increasing proportions of participants in each subsequent year. Males had greater representation in the Risk‐Takers group. A profile approach to measurement has methodological advantages, can add to substantive knowledge, and can inform content, timing, and targets of sexual health interventions.

Comparison of diary and retrospective measures for recording alcohol consumption and sexual activity

This study examines issues in the measurement of HIV risk factors, using daily diaries to collect data on both alcohol use and sexual behavior. Seventy-nine adolescents and young adults recruited from an STD clinic and from a university campus were studied. Participants gave daily reports of their drinking, drug use, and sexual activities for 4 weeks. Respondents then completed a retrospective questionnaire asking about the frequencies of these behaviors during the preceding period. Diary reports of behavior were strongly correlated with retrospective reports. More frequent drinking was reported on the diary measure than the retrospective measure, and this discrepancy was larger for more frequent drinkers. Frequency of sexual activity was overreported on the retrospective measure only among adolescents. Errors in the measurement of alcohol use, sexual behavior, or their co-occurrence could affect estimations of the relationship of alcohol use to sexual behavior. The types of error inherent in these measures may differ, resulting in different tendencies toward over- or underreporting of alcohol use and sexual behavior, depending on frequency of the behavior and the characteristics of the subject population.

Drug use among adolescent mothers: prepregnancy to 18 months postpartum.

PURPOSE Little is known about the substance use patterns of adolescent mothers, particularly in the postpartum period. This study provides descriptive, longitudinal data on the substance use behavior of a cohort of adolescent mothers. METHODS A total of 241 pregnant adolescents, under 18 years old and planning to carry the pregnancy to term, completed the initial interview. Respondents were interviewed again at 1, 6, 12, and 18 months postpartum. The data reported here are based on the 229 respondents who completed all five interviews. RESULTS Use of all substances decreased substantially during pregnancy, but increased steadily in the first 6 months postpartum. A similar pattern was observed for regular use of multiple substances. Regular use before and after the pregnancy, but not during it, was the most common pattern of substance use. CONCLUSIONS The prevalence of substance use among adolescent mothers is significant. To capitalize on the large decreases in use during pregnancy, drug prevention programs for adolescent mothers should target the first 6 months postpartum.

Using research to guide culturally appropriate drug abuse prevention.

Several ways in which research can be an important tool in creating culturally appropriate prevention programs are suggested. To illustrate cultural variability, we present data from a study of 5th-grade African-American and European-American students. These data describe rates of early initiation, levels of exposure to identified risk factors, and degree to which identified risk factors predict substances initiated. Results indicate that European-American Ss have higher rates of tobacco and alcohol initiation, that the same risk factors predict the variety of substances initiated for African-American and European-American Ss, and that several differences exist in the level of exposure to risk factors between the 2 groups. Implications of the findings for developing culturally appropriate drug abuse prevention are discussed.

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.