Helen P. Koo

Two good reasons: women's and men's perspectives on dual contraceptive use

In the US, continued high rates of unintended pregnancy, combined with increases in heterosexual transmission of HIV to women, have sharply magnified concern about the factors leading to or barring the use of contraceptive methods to protect concurrently against both risks. This paper reports on results of focus group research among African-American women participating in a longitudinal study and African-American men who are either partners of the women or are of similar socio-economic status as their partners. We found a high level of agreement between men and women on the issues and problems that both sexes face. People felt that regardless of a womans use of other contraceptive methods, a condom should always be used for protection. This belief, however, differed markedly from actual practice. Although we attempted to discern the relative salience of concern about pregnancy versus STIs, we conclude that people may not separate these two concerns in their resolve to use two methods. Furthermore, they recognized the need for dual protection, but expected conflict with their partners from using condoms as a second method because of high levels of distrust regarding sexual fidelity. Thus people are caught in a bind: distrust further increases the sense of a need for dual methods, but using condoms exacerbates the problems people have with achieving trust in relationships.

Mothers, fathers, sons, and daughters: gender differences in factors associated with parent-child communication about sexual topics

BackgroundIn the United States, nearly half of high school students are sexually active, and adolescents experience high rates of unintended pregnancy and sexually transmitted diseases. Parents can have an important influence on their childrens sexual behaviour, but many parents do not talk with their children about sexual topics. Research has shown significant differences in parent-child communication about sexual topics depending on the gender of both the parent and the child. Little is known, however, about the reasons for these gender differences. The purpose of this paper is to describe how factors associated with parent-child communication about sexual topics differ by gender.MethodsData are from a nationwide online survey with 829 fathers and 1,113 mothers of children aged 10 to 14. For each of the four gender groups (fathers of sons, fathers of daughters, mothers of sons, mothers of daughters), we calculated the distribution of responses to questions assessing (1) parent-child communication about sex-related topics, and (2) factors associated with that communication. We used chi-square tests to determine whether the distributions differed and the false discovery rate control to reduce the likelihood of type I errors.ResultsWith both sons and daughters, fathers communicated less about sexual topics than mothers did. Fathers also had lower levels of many characteristics that facilitate communication about sex (e.g., lower self-efficacy and lower expectations that talking to their children about sex would have positive outcomes). Compared with parents of sons, parents of daughters (both mothers and fathers) talked more about sexual topics, were more concerned about potential harmful consequences of sexual activity, and were more disapproving of their child having sex at an early age.ConclusionsUsing a large national sample, this study confirms findings from previous studies showing gender differences in parent-child communication about sexual topics and identifies gender differences in factors that may influence parent-child communication about sexual topics. Interventions designed to support parent-child communication about sexual topics should emphasize to both mothers and fathers the importance of talking to sons as well as daughters. Fathers need particular support to overcome the barriers to communication they encounter.

Effects of Children on Women's Remarriage Prospects

LIFE table analyses of data for white women from the 1975 Current Population Survey showed that the effects of the number of children women had at divorce on their remarriage probabilities depended on the womens age at divorce. Among women divorcing before age 25, being childless increased the likelihood of remarriage; but among women divorcing at 35 or older, having no children decreased it. For women divorcing at age 25 to 34, there was no effect. The failure of previous studies to take into account this interaction between children and age of woman at divorce, along with other problems discussed and corrected in the article, may explain the conflicting results obtained by earlier research.

Associations Between Low-Income Women's Relationship Characteristics and Their Contraceptive Use

CONTEXT Womens relationship context likely influences both their ability and their motivation to use contraceptives. No recent studies, however, have examined associations between womens relationship characteristics and use of different methods. METHODS Data were collected in a longitudinal study of 839 low-income women at risk of unintended pregnancy who visited public family planning and postpartum clinics and maternity wards in two Southeastern cities. Simulated probabilities calculated from multivariate analyses assessed associations between a wide range of relationship characteristics and the use of no method, condoms, withdrawal, female methods or dual methods. RESULTS Women who had had a child with their partner had an increased likelihood of contraceptive nonuse and use of withdrawal, and a decreased likelihood of using any female method. Respondents who were in a relationship for a relatively long time had an elevated likelihood of nonuse and use of female methods, but a lowered likelihood of condom use. Furthermore, married or cohabiting women were less likely than others to use dual methods. Respondents who had good communication with their partner had an elevated likelihood of using condoms. In addition, women who expected to receive a lot of emotional support from their partner if they became pregnant were more likely than others to report any condom use or dual method use, and less likely to report contraceptive nonuse. CONCLUSIONS When counseling family planning clients, providers should consider women in the context of their relationships. Future research exploring factors associated with contraceptive method use should examine variables related to the establishment, quality and expectations of their relationships.

Relationships of Pubertal Development Among Early Adolescents to Sexual and Nonsexual Risk Behaviors and Caregivers’ Parenting Behaviors

Using a school-based sample of fifth graders (mean age = 10.38, SD = 0.66) and their parents (N = 408) from Washington, D.C., the authors examine associations of pubertal development with early adolescents’ sexual and nonsexual risk behaviors and their caregivers’ parenting behaviors and of these risk behaviors with parenting behaviors. Results indicate that youths reporting signs of pubertal development were more likely to engage in these risk behaviors than were students reporting no signs. Pubertal development is not related to parenting behaviors; however, parents of youths who reported multiple nonsexual risk behaviors reported more parent–child communication about sexual topics. These results highlight the need to begin risk prevention efforts early, prior to pubertal development. Research is needed to understand how parents can help youths better cope with pubertal development to avoid involvement in sexual and nonsexual risk behaviors.

The multistate life table method: An application to contraceptive switching behavior

In many demographic behaviors (e.g., those relating to marriage, contraception, migration, and health), people change among multiple statuses through time, sometimes leaving and then returning to the same status. Data on such behaviors are often collected in surveys as censored event histories. The multistate life table (MSLT) can be used to properly describe, in a single analysis, these complex transitions among multiple states measured in such data, but MSLT is rarely applied in the demographic literature because practical guidance is lacking on how to compute MSLTS with such data. We provide methods for computing MSLT quantities using censored event-history data: namely, transition intensities and probabilities, “state occupancy” probabilities and standard errors, average time spent in specified states, and average number of visits to specified states. Applying these methods to contraceptive use, we find high levels of switching back and forth, particularly between barrier methods and non-use, resulting in high rates of unintended pregnancy.

A Computerized Family Planning Counseling Aid: A Pilot Study Evaluation of Smart Choices

CONTEXT Resource constraints may make it challenging for family planning clinics to provide comprehensive contraceptive counseling; technological tools that help providers follow recommended practices without straining resources merit evaluation. METHODS A pilot study using a two-group, posttest-only experimental design evaluated Smart Choices, a computer-based tool designed to help providers offer more patient-centered counseling and enable patients to participate proactively in the counseling session. In two North Carolina family planning clinics, 214 women received usual counseling in March-May 2013, and 126 women used Smart Choices in May-July 2013. Exit interviews provided data for the evaluation. Multivariate Poisson and multinomial logistic regression analyses were performed to examine group differences in counseling outcomes. RESULTS Three of 12 hypotheses tested were supported: Compared with controls, women in the intervention group knew more contraceptive methods (adjusted mean, 11.1 vs. 10.7); discussed more topics related to sexual health during counseling (1.2 vs. 0.9 among those reporting any discussion); and rated counseling as more patient-centered, an indication of how well they felt providers understood their family planning circumstances and ideas (3.9 vs. 3.7 on a scale of 1-4). Contrary to another hypothesis, controls were more likely than women in the intervention group to choose IUDs and implants. CONCLUSIONS Computerized counseling aids like Smart Choices are in an early stage of development. Future research is warranted to develop tools that lead to more productive and individualized clinic visits and, ultimately, to more effective contraceptive use and reduced levels of unintended pregnancy.