IN THIS ISSUE
Despite the lack of scientific evidence supporting the effectiveness of abstinence-only education, federal and state funding for programs taking this approach to reducing risky sexual behavior among teenagers has ballooned since the late 1990s. One result, as Laura Duberstein Lindberg and colleagues report in this issue of Perspectives on Sexual and Reproductive Health (see article), is that young people are becoming increasingly unlikely to receive medically accurate and comprehensive reproductive health information from their schools or other formal sources of education. Furthermore, many do not receive this information when they most need it—before they begin sexual activity. The analyses, based on 1995 and 2002 surveys that included nationally representative samples of youth, highlight the gaps in areas of instruction and inequities in the education provided to various subgroups of youth.
Also in This Issue
•Studies on the consistency of pill use tend to focus on whether women missed at least one pill during a cycle and on the characteristics of users that are associated with their having done so. Using data from a population-based survey of French women, Caroline Moreau and her team take a broader view (see article). They find, for example, not only that 20% of pill users missed at least one pill during their most recent cycle, but that 10% missed at least one pill and did not use contraceptive backup the next time they had intercourse. And the characteristics associated with inconsistent use include situational ones that will, or may, change over time, such as having young children at home and not having a daily routine for taking the pill. The findings bring new light to the potential public health impact of inconsistent pill use and to the questions providers need to explore to help women choose the most appropriate contraceptive method.
•Data from the 2002 National Survey of Family Growth offer an unprecedented opportunity to study the nature and consequences of sexual relationships between young teenagers and older partners. Jennifer Manlove and coauthors find (see article) that 14% of 18–24-year-old women and 6% of men that age—or an estimated two million women and 800,000 men—first had sex before age 16 with a partner at least three years their senior. These young people were at increased risk of involvement in a teenage pregnancy. The analyses also help to identify groups of teenagers at greatest risk of having early sexual relationships with older partners.
•Given the rapid growth of the Latino population in the United States, and the considerably above average birthrate among Latina teenagers, the relationship between acculturation and sexual and reproductive health is of increasing concern. In a review of the literature since 1985 (see article), Aimee Afable-Munsuz and Claire D. Brindis identify 17 studies that explicitly examined this relationship among Latinos aged 25 and younger. Although several of these studies made, in Afable-Munsuz and Brindis' words, "noteworthy contributions" to the literature, their theoretical grounding, designs and definitions of acculturation vary widely; moreover, their findings are largely difficult to generalize and often inconsistent. Drawing on the gaps in the available literature, Afable-Munsuz and Brindis recommend research directions that would help guide policymakers, planners and providers in designing effective interventions for Latino populations.
•"State agencies and local partners can work together effectively to expand women's options for preventing unintended pregnancy." This is the key lesson from Washington State=paragraphs experience with integrating emergency contraception into its health care and social service systems, as described by Marian Weldin and colleagues in their special report (see article). Throughout the process, the two state agencies that spearheaded the effort emphasized the goal of having healthy families and encouraged innovative, community-centered approaches to expanding access to the method. Although laws and practices vary from state to state, the authors believe that Washington's experience can be used as a model for other state-level initiatives.