Laurie Schwab Zabin

Multiple Sexual Partners Among U.S. Adolescents And Young Adults

CONTEXT Because many teenagers and young adults fail to use condoms correctly and consistently, the number of sexual partners they have is an important risk factor for sexually transmitted diseases, including HIV. Identifying factors that are associated with having multiple partners can help in the design of disease interventions. METHODS Data on 8,450 males and females aged 14-22 who participated in the 1992 Youth Risk Behavior Survey were used to examine the prevalence of and factors associated with young peoples having multiple partners. RESULTS In all, 63% of female respondents and 64% of males were sexually experienced. Among those who had had sex during the three months before the survey, 15% and 35%, respectively, had had two or more partners during that period. At each age, the majority of sexually experienced respondents had had more than one lifetime partner; between ages 14 and 21, the proportion who had had six or more rose from 8% to 31% among females and from 14% to 45% among males. In logistic regression analyses, alcohol use, illicit drug use and young age at first coitus were associated with increased odds that females had had two or more partners in the previous three months, and being married lowered the odds; black or Hispanic race or ethnicity, alcohol use and young age at first coitus increased the odds for males, and being married reduced the odds. As the number of reported alcohol-related behaviors increased, the adjusted proportion of respondents who had recently had multiple partners rose from 8% to 48% among females and from 23% to 61% among men. CONCLUSIONS The strong association between alcohol use and having multiple sexual partners underscores the need to educate young people about the effects of alcohol on partner choice and the risk of infection with sexually transmitted diseases.

Evaluation of a pregnancy prevention program for urban teenagers.

This article reports on a school-based program for the primary prevention of pregnancy among US inner-city adolescents that was designed and administered by the staff of the Johns Hopkins School of Medicines Department of Gynecology and Obstetrics. 4 schools in the Baltimore school system--2 junior high schools and 2 senior high schools--participated. The program provided the students attending one of the junior high schools and one of the senior high schools with sex and contraceptive education individual and group counseling and medical and contraceptive services over a period of almost 3 school years. The other 2 schools served as controls. A survey was conducted to ascertain knowledge attitudes and behavior of the students. The junior high school in which the pregnancy prevention program was introduced is a community school serving an all-black inner-city population. At the baseline survey 667 male students and 1033 female students completed the questionnaire. At the final survey nearly 3 years later 506 male students and 695 female students answered the questionnaire. The baseline survey data revealed high levels of sexual activity in both the program and the nonprogram schools. Almost 92% of boys in the 9th grade of the program junior high school were sexually active as were 54% of the comparable girls. More overall improvement would be gained by helping students holding positive attitudes toward pregnancy prevention translate those attitudes into action than by attempting to change the attitudes of the few who do not share that view. A large proportion of both male and female students cited an ideal age for childbearing that was lower than the age they considered ideal for marriage. After exposure to the program the % decreased among the girls but not the boys. The proportion of sexually active students in the program schools who attended a clinic rose at all grade levels for both male and female students. At the baseline survey pill use was found to increase with age. After exposure to the program the % using the pill increased among all grade levels. Use of no contraceptive method at last intercourse was reduced to extremely low levels after exposure to the program. After 20 months of exposure to the program the conception rate fell by 22.5%. The program led to decreases in the pregnancy rates of 9th-12th grade students.

The risk of adolescent pregnancy in the first months of intercourse.

Because of early age at initiation of intercourse and associated nonuse of contraception, half of first premarital pregnancies to teens occur in the first six months after they begin coitus; one-fifth occur in the first month. Programs to prevent adolescent pregnancy will not succeed unless they reach young people before they begin sexual activity.

The Health Consequences of Adolescent Sexual and Fertility Behavior in Sub-Saharan Africa

This article reviews the literature on health consequences of adolescent sexual behavior and child-bearing in sub-Saharan Africa, and the social and cultural context in which they occur. It suggests that, in addressing the most serious health sequelae, sexual intercourse that occurs in early marriage and premaritally must both be considered. Some limitations of the data are noted. Despite the excess risk to which adolescents are exposed, due both to custom and age-related vulnerability, differences between health effects among adult and adolescent women are often differences in degree. They are attributable to behavioral, social, and biological causes, exist in traditional and nontraditional settings, in union and out of union, and are exacerbated by declining ages at menarche, pressures of HIV/AIDS and STDs, and a dearth of appropriate services-especially for young people. Some current interventions are discussed, and the need for policy as well as medical intervention is stressed.

Partner effects on a woman's intention to conceive: 'not with this partner'

CONTEXT Current definitions of pregnancy intention that are useful at aggregate levels are weak at the individual level. This is especially true in social contexts where childbearing and pregnancy often occur within casual or transient relationships. METHODS Extensive data on lifetime partnerships and sexual behaviors, including pregnancies and births, from 250 low-income women who had experienced a total of 839 pregnancies are used to explore correlates of intention to conceive, as well as the extent to which women attribute their intentions to a current partnership. RESULTS Some 57% of reported pregnancies were unintended. Overall, 21% of the women had not wished to conceive at least one of their pregnancies with the partner who impregnated them; that proportion rose to 33% among women who had had only unintended pregnancies. Even among women who had had no unintended pregnancies, 18% had had at least one conception that they had not wanted with their partner at the time of conception. Women were less likely to say they had not wanted to conceive with a particular partner if they were living with that partner than if they were not. The likelihood of not having wanted a pregnancy with a given partner rose with the lifetime number of serious partners. Pregnancies that were not wanted with a particular partner were more than twice as likely to end in abortion as were those that were (33% vs. 14%). CONCLUSIONS Among these women, the desire to avoid childbearing relates more to the couple involved in the conception than to abstract notions of completed family size. It would therefore be useful to include items pertaining to partner relationships in future studies of pregnancy intention.

Substance use and its relation to sexual activity among inner-city adolescents.

A study of inner-city Black and Caucasian males and females in two junior and two senior high schools provided data on sexual knowledge, attitudes and behaviors, and substance use based on over 2500 anonymous, voluntary self-administered questionnaires. Substance use was high among Caucasians, particularly females. Females smoked more cigarettes than males and men drank more alcohol. Marijuana smoking showed only small racial, age, and gender differences. Compared to Blacks, Caucasians used more hard drugs. Using an index scoring types of substances and frequencies of use, sexually active students were higher than virgins in all subgroups, with those who initiated intercourse early appearing highest on the index. A regression model explaining 21% of the variance in substance use showed independent effects of age, race, gender, and sexual activity. The importance of an index for screening early use is discussed, and research on the relationship of low-level youthful experimentation with future dysfunctional use is proposed.

When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy.

A group of 360 black teenage women of similar socioeconomic background who sought pregnancy tests from two Baltimore family planning providers was followed for two years to determine if those who obtained abortions were adversely affected by their abortion experience. After two years, the young women who had terminated their pregnancies were far more likely to have graduated from high school or to still be in school and at the appropriate grade level than were those who had decided to carry their pregnancy to term or those whose pregnancy test had been negative. Those who had obtained an abortion were also better off economically than were those in the other two groups after two years. An analysis of psychological stress showed that those who terminated their pregnancy had experience no greater levels of stress or anxiety than had the other teenagers at the time of the pregnancy test, and they were no more likely to have psychological problems two years later. The teenagers who had obtained abortions were also less likely than the other two groups to experience a subsequent pregnancy during the following two years and were slightly more likely to practice contraception. Thus, two years after their abortions, the young women who had chosen to terminate an unwanted pregnancy were doing as well as (and usually better than) those who had had a baby or who had not been pregnant.

Ambivalent feelings about parenthood may lead to inconsistent contraceptive use--and pregnancy.

Although the concept of pregnancy intention has been widely used in research intention has been measured with a relatively small number of items over the years. As a consequence even when a significant correlation is found between intention and behavior there is generally a fairly large subset of women among whom that correlation is not observed. The paper suggests that measures of intention have been used to predict what can only be predicted in the presence of cogent measures of contraceptive attitudes. A further argument is that data available on the intention status in the US may not represent as serious a failure in contraceptive practice as is often supposed. Central to understanding the relationship between fertility intention and contraceptive use is an understanding of the concept of ambivalence toward both conception and contraception. It is further argued that ambivalent feelings about parenthood may lead to inconsistent contraceptive use. Ambivalence toward birth control methods is implicated in many cases in which an unintended pregnancy occurs. The implications for understanding adolescent childbearing which has been of such public concern in the US are discussed.

Adolescent sexual attitudes and behavior: are they consistent?

Relationships between sexual attitudes and behavior among adolescents were studied in data collected by self-administered questionnaires from approximately 3,500 junior and senior high school students attending four inner-city schools during 1981-1982. An analysis of the results by sex, race and age found that 83 percent of sexually experienced adolescents cite a best age for first intercourse that is older than the age at which they themselves experienced that event, and 43 percent of them report a best age for first coitus older than their current age. In addition, 88 percent of young women who have had a baby say the best age at which to have a first birth is older than the age at which they first became mothers. Thirty-nine percent of the women and 32 percent of the men say that they believe premarital sex is wrong. Among those who are virgins, the proportions are much higher. However, even among those who have had intercourse, approximately 25 percent of both sexes say they believe sex before marriage is wrong. Women desire stronger relationships before having intercourse than do men, and women claim to have had a stronger relationship with their last sexual partner. Very few teenagers believe neither partner is responsible for pregnancy prevention, which tends to be viewed as a joint responsibility. Those who see it as a shared responsibility are slightly more likely than those who assign the responsibility to one or the other partner to have used a method at last intercourse, and they are considerably more likely to have used a method than are those who believe contraception is neither partners responsibility.(ABSTRACT TRUNCATED AT 250 WORDS)

The Baltimore pregnancy prevention program for urban teenagers: I. How did it work?

An experimental pregnancy prevention program for junior and senior high school students consisted of classroom lectures, informal discussion groups and individual counseling in the schools and group education, individual counseling and reproductive health care in a nearby clinic. The structure of the program allowed for extensive individual counseling for students who desired it, and the reported costs are thus considered generous. School-based services utilized 40 percent of a total three-year budget of