Koray Tanfer

The sexual behavior of men in the United States.

A nationally representative study of the sexual behavior of men aged 20-39 in the United States shows that the prevalence and frequency of sexual acts (vaginal, anal and oral) and sexual orientation vary by social and demographic characteristics. Analysis of data from 3,321 respondents to the 1991 National Survey of Men reveals that 95% of men have had vaginal intercourse; among them, 23% have had 20 or more vaginal sex partners in their lifetime. About one-fifth of never-married and formerly married men had four or more partners over a recent 18-month period. However, 41% of never-married men and 32% of formerly married men did not have coitus during the four weeks preceding the interview. Only 20% of men have ever engaged in anal intercourse. Among these, 51% had not done so during the previous 18 months, and 90% had not done so during the previous four weeks. Seventy-five percent of men have performed oral sex and 79% have received oral sex, although 53% of men who ever performed oral sex had not done so during the four weeks prior to interview, and only 11% had done so six or more times. The frequency of receiving oral sex is similar. Only 2% of sexually active men aged 20-39 have had any same-gender sexual activity during the last 10 years, and only 1% reported being exclusively homosexual during this interval.

Men's Perceptions of Their Roles and Responsibilities Regarding Sex, Contraception and Childrearing

Data from the 1991 National Survey of Men examine mens perceptions about their roles in relation to those of women in a couples decision-making about sex, contraception and the rearing of children. A majority of men (61%) perceive that there is gender quality in sexual decision-making, and more than three-quarters (78%) believe that men and women share equal responsibility for decisions about contraception. However, men are three times as likely to say that women play a greater role in a couples decisions about sex as they are to believe that men have the greater voice (30% compared with 9%). In contrast, men are more than twice as likely to perceive than men have a greater responsibility in contraceptive decisions as they are to say that women do (15% compared with 7%). Finally, 88% of men strongly agree that a man has the same responsibilities as a woman for the children they have together.

Contraceptive Use, Pregnancy and Fertility Patterns Among Single American Women in Their 20s

Eighty-two percent of never-married American women aged 20-29 have had sexual intercourse; black women are somewhat more likely than white women to have had intercourse. In all, 53 percent of never-married women in this age-group had intercourse at least once in the four weeks preceding the 1983 National Survey of Unmarried Women. Black women are more likely than white women to have done so (62 percent compared with 51 percent). Nearly all of the women who ever had intercourse have used a contraceptive method at some time; 78 percent practiced contraception at the time of their most recent intercourse. A high proportion did not start using birth control until some time after first intercourse, however: On average, the delay between first coitus and first contraceptive use was eight months, and one-fifth of the respondents said that they began using a method only after their first pregnancy. Most of the women who did use a method at the time of first intercourse relied on the condom or withdrawal; in contrast, about two-thirds of white women and three-quarters of black women now rely on the pill, IUD or sterilization. Eighty-six percent of the women who had intercourse in the four weeks before the interview were current users--88 percent of the white women and 77 percent of the black women. Catholic women are no less likely than others to have ever had intercourse, to be currently sexually active or to be using contraceptives. However, Catholic women who receive communion at least once a week are less likely to be sexually active and substantially less likely to use medical contraceptive methods. Women who consider themselves very religious are less likely to be sexually active, but the sexually active among them are about as likely as others to use contraceptives. Better-educated women are much more likely than less-educated women to practice contraception, and women who work outside of the home are more likely than those who do not to use contraceptives. Thirty-three percent of unmarried 20-29-year-olds have had at least one pregnancy (about 40 percent of those who have ever had intercourse). Thirty-two percent of sexually active white women have been pregnant, compared with 70 percent of comparable black women. Furthermore, whereas 14 percent of white 20-29-year-olds have had an out-of-wedlock birth, 62 percent of black women have done so.(ABSTRACT TRUNCATED AT 400 WORDS)

Condom breakage and slippage among men in the United States.

Data on condom breakage and slippage from a nationally representative survey show that the average condom breakage rate experienced by 20-39-year-old men who have used a condom in the preceding six months was 2.7%, and that 1.9% of all condoms used during that time broke. Comparable condom slippage rates are 2.7% and 2.0%, respectively. Condom breakage and slippage appear to be 4-5 times higher among black men than among men of other races. Levels of breakage and slippage are also elevated among low-income men and those who used condoms relatively infrequently in the six months before the survey. The data also indicate that men who engage in high-risk sexual behavior, such as having multiple partners and engaging in anal intercourse, are more likely to experience condom breakage and slippage.

Gender, Race, Class and Self-Reported Sexually Transmitted Disease Incidence

Multivariate analysis of data from two nationally representative surveys of adult men and women indicates that the likelihood of a self-reported sexually transmitted disease (STD) infection varies by gender, race and socioeconomic status, even after accounting for differences in sexual and health care behaviors. Women and black respondents are more than three times as likely to report an STD infection as men and white respondents; men and women with 12 or fewer years of education are about 30% less likely than those with more schooling to report having had an STD. Income, welfare status and access to health care have no significant association with self-reported STD incidence, but sexual behavior is strongly related. Men and women who have engaged in anal intercourse, have paid for sex or have had one-night stands are significantly more likely than those who avoid these behaviors to report an STD. Further, the likelihood of an STD dramatically increases with the lifetime number of sex partners reported: Compared with men and women who have had only one partner, those who report 2-3 partners are five times as likely to have had an STD; the odds are as high as 31:1 for those who report 16 or more partners.

Determinants of contraceptive choice among single women in the United States.

Data from the 1983 National Survey of Unmarried Women are used to analyze characteristics that affect contraceptive decision-making among single women aged 20-29 who are exposed to the risk of pregnancy. Factors found to affect whether these women use a relatively effective method such as the pill or the IUD, use coitus-dependent methods or use no method include family structure at age 15, educational level, work status, religious affiliation, fertility relative to desired fertility, and past contraceptive failure. Bivariate analyses revealed notable differences between whites and blacks in contraceptive behavior. Multivariate analyses showed that while the decision to use a contraceptive method was somewhat affected by race, method choice was not. Overall, contraceptive decision-making was relatively unaffected by race, length of the relationship and current living arrangement.

Condom use among U.S. men 1991.

A 1991 study of a nationally representative sample of men aged 20-39 finds that 27% of sexually active men had used a condom in the four weeks before interview. Black men are more likely than white men to report condom use (38% vs. 25%), and men younger than 30 are more likely to do so than are those older than 30 (36% vs. 19%). Among white men, condom use increases with years of education; among black men, however, those with 12 years of education are much less likely to report condom use than are those with more or less than 12 years (28% vs. 43-50%). Condom use is positively related to number of partners. Men who have engaged in anal intercourse, those who have had a one-night stand and those who are bisexual or homosexual are also more likely to report condom use. Among those who reported using a condom in the previous four weeks, 55% of whites and 18% of blacks had done so only for birth control and 7% of whites and 9% of blacks had done so only for protection against infection with the human immunodeficiency virus and other sexually transmitted organisms; the remainder had used a condom for both reasons.

Perceptions of AIDS risk and severity and their association with risk-related behavior among U.S. men.

According to a nationally representative sample of 3,321 men aged 20-39 surveyed in 1991, men appear well aware of the severity of AIDS: Nearly all know that AIDS destroys the immune system and that there is no cure for the disease, but a substantial minority do not think that AIDS will necessarily result in pain and death. Mens perceptions of the diseases severity seem to have little impact on their sexual behavior, with no clear relationship between mens knowledge of AIDS and their recent number of sex acts, their condom use or their participation in anal or casual sex. Mens perceptions of the general risk of human immunodeficiency virus (HIV) transmission also appear to have little impact either on their concerns about AIDS or on their behavior, but their perceptions about the AIDS rate in their local community do affect their concerns and behavior. Men know that certain kinds of behavior place them at risk, and their prior behavior significantly influences their perceptions of their own HIV risk. However, speculation about their own HIV status is only moderately related to their recent sexual behavior.

Why are U.S. women not using long-acting contraceptives?

CONTEXT Given the level of unintended pregnancy in the United States, it is somewhat surprising that hormonal implants and injectables-methods that are long-acting, reversible, highly effective and convenient--have not attained the popularity enjoyed by other medical methods. Knowing the reasons why women have so far spurned these methods might lead to the design and implementation of interventions and targeted social marketing to promote their use. METHODS Data from the 1993 and 1995 rounds of the National Survey of Women are used to examine the reasons women gave for not having used the implant or injectables, whether they intended to use these methods and how their attitudes toward them may influence their decision to use such methods in the future. Logistic regression models were used to identify the social and demographic characteristics that influence womens decisions not to use these methods. RESULTS Fewer than 2% of women who were at risk of an unintended pregnancy in 1995 were using the implant, and under 3% were using the injectable. Women gave three major reasons for not using either of these methods: lack of knowledge; fear of side effects or health hazards; and satisfaction with the method they were currently using. Age, education, marital status, parity and current contraceptive method strongly predicted fear of side effects, lack of knowledge and satisfaction with the current method as reasons for not using the implant or the injectable. For example, women aged 30 or older and those with a college education were half as likely as younger women and those with no college education to mention fear of side effects as their main reason for not using the implant. Likewise, single women, women with one or more children and those using a barrier method were 2-3 times as likely as married women, childless women and those using a medical method to attribute nonuse to the implants side effects. Few women said they intended to use these methods in the next 12 months: 5% for the implant and 10% for the injectable. Single women, women with no college education, women with children, women wanting to have a child (or another child) and women with positive attitudes toward the effect of using an injectable were significantly more likely to say they intended to use the injectable. Nevertheless, substantial proportions of women reported quite negative attitudes about these methods. CONCLUSIONS The low prevalence of use and the low level of use intention for the implant and for injectables raise questions about the promise for the future of these methods. Each method seems to appeal to certain subgroups of women, however. Thus, if proper interventions and social marketing are targeted to such groups, they may be disabused of misperceptions regarding these methods and possibly become more willing to try them.

National survey of men: design and execution.

The National Survey of Men (NSM-I) was conducted in 1991 to examine issues related to sexual behavior and condom use among noninstitutionalized US men aged 20-39, intended as the baseline survey for a longitudinal study. A total of 20,086 housing units were canvassed, 2434 were excluded, and 16,414 of the remaining 17,652 housing units were successfully screened for eligibility. The main sample of the general population contained 1062 listing areas and an oversample contained 153 listing areas designated as black listing areas. The probability of selection of a listing area in the main survey sample was 1 in 10,511, while the probability in the black oversample was 1 in 1164. The questionnaire consisted of personal particulars; sexual initiation and current exposure; current wife or partner; previous marital relationships; other nonmarital sexual partners; nonsexual partners; health and risk-taking behavior; attitudes, perceptions, and knowledge of health-related and contraception related issues; reasons for using or not using condoms; follow-up information; interviewer observations; and self-administered questions. Data collection and processing was carried out by the Institute for Survey Research at Temple University, Philadelphia. A total of 206 interviewers and 9 regional field coordinators were recruited for the field work; of these, 189 interviewers and 7 coordinators worked on the survey. The response rate of 70% was considered respectable, given the highly sensitive nature of the questions. Standard errors for various estimated percentages were provided separately for the white and the black samples. After the survey was completed, the final sample was weighted to reflect differential sampling rates, as well as to account for multiple households, multiple eligibility, and differential nonresponse. The final weight consisted of sampling weight, screening weight, eligibility weight, nonresponse weight, and poststratification weight. Scaled to the sample size, it produced a self-weighing sample with a mean weight of 1.00 and a standard deviation of 1.16. The minimum and maximum values of the final weight were .07 and 11.40, respectively.