IN THIS ISSUE
Think of it as education on demand. Saving Sex for Later is a program designed to help parents guide their preadolescent children through the beginnings of their sexual lives, and participation requires only that parents listen to three CDs, with or without their children, when and where they can: no meetings, no scheduling hassles. In an evaluation of the program presented in this issue of Perspectives on Sexual and Reproductive Health (see article), Lydia O'Donnell and colleagues show that the approach has promise.
Program participants received the CDs, on which fictional families of different racial and ethnic backgrounds grapple with the challenges of puberty, over a period of six months. Three months later, these parents were more likely than those in a control group to say that they were able to communicate with their son or daughter about risky behavior, to feel able to discuss pubertal development with their child and to feel that they had influence over the youngster's behavior. Possible program effects were apparent among the preadolescents as well: Those whose parents had received the CDs were more likely than controls to feel supported by their family, to say that their parents set rules and to report few behavioral risks. Acknowledging the short follow-up and other limitations of the evaluation, O'Donnell and her colleagues nevertheless contend that it "provides evidence of the feasibility and acceptability of the intervention" and urge longer term follow-up with outcomes reflecting teenagers' sexual behavior.
•Russia is in the midst of a raging HIV epidemic, and the official numbers may only hint at the reality. Against this backdrop, Natalia Bobrova and coauthors examine condom use among Muscovites aged 15-29, the age-group with the highest incidence of infection (see article). Their findings, based on data from a 2002 telephone survey, show low levels of consistent condom use among sexually experienced young adults and reveal significant differences associated with gender and with attitudes toward condoms. It is clear, for example, that educational interventions need to get across the message that condoms are effective in preventing both pregnancy and STDs.
•The encouraging news from Kathleen Green-Raleigh and colleagues' study of enrollees in a California health plan (see article) is that women who planned to conceive within the next year avoided certain risky behaviors and engaged in some potentially beneficial ones. However, the same was not true of women who planned to conceive more than a year down the road; these women, in fact, had elevated levels of alcohol consumption, which could have adverse effects on a pregnancy that women are not yet aware of. The authors stress the need "to educate all women about the benefits that healthy behaviors before and during pregnancy may have for their overall health and well-being and, should they become pregnant, for the health of their babies."
•Adoption of a hormonal method of contraception should not be a signal to women—especially those engaged in high-risk sexual behavior—to stop using condoms, but that was all too often the case in a sample of family planning clinic clients surveyed in Texas in 1999-2001. Haleh Sangi-Haghpeykar and colleagues report (see article) that half of women who had been using condoms consistently stopped doing so once they began using the pill or an injectable. Three-quarters of women in nonmonogamous relationships did not use condoms consistently after beginning hormonal contraceptive use, even though many had done so previously. Women's attitudes toward condoms and dual method use, as well as their partner's influence, were important predictors of consistent use. Raising levels of dual method use, the authors conclude, will require ongoing educational efforts that focus on couples and aim at increasing women's negotiation skills.
•By and large, women younger than 18 surveyed in U.S. family planning clinics in 2003-2004 said that they had good relationships with their parents and had talked with them about sex and birth control. So why did only six in 10 say that at least one parent knew of their clinic visit? Exploratory analyses by Rachel K. Jones and coinvestigators (see article) suggest that a young teenager's likelihood of telling her parents about a clinic visit may hinge partly on her perceptions of her parents' attitudes toward her having sex and using birth control: If adolescents think of their parents as disapproving, they may keep the visit to themselves to avoid jeopardizing the relationship. According to the researchers, the findings argue for stepped-up efforts to improve and maintain parent-child relations, rather than for mandated parental involvement in minors' reproductive health care.