Adolescents who engage in “high-risk” patterns of sexual behavior do not necessarily develop into young adults with poor sexual and reproductive health, Abigail A. Haydon and colleagues report in this issue of Perspectives on Sexual and Reproductive Health (page 218). In analyses using three waves of data from the National Longitudinal Study of Adolescent Health, the researchers compared outcomes among five groups of young adults, defined by the sequence, spacing, timing and variety of their sexual experiences during adolescence. The most prevalent pattern of behavior was initiation of vaginal sex and then, within about two years, another sexual behavior (typically oral sex). Compared with young adults reporting this pattern, those who had begun having oral and vaginal sex in the same year were no more likely to have had an STD (ever or in the past year) or to have recently had concurrent partners or exchanged sex for money; those who had experienced both early first sex and anal sex by age 18 had elevated odds only of reporting concurrent partnerships. The small minority of respondents who had delayed their first sexual experience until late adolescence or beyond had reduced odds of all adverse outcomes.
Haydon and colleagues comment that teenage sexual behavior “is certainly not without risk.” However, they argue that federal policies aimed at promoting abstinence until marriage “reflect strong assumptions about optimal pathways to sexual development that have not been subjected to rigorous empirical tests and…are inconsistent with the vast majority of young people’s experiences.” The task for health care providers and researchers, the authors conclude, is to understand “the diversity of pathways that contribute to healthy sexual development.”
Also in This Issue
•In a study of low-income Latina pill users in El Paso, Texas, a substantial proportion of women wanted no more children, and most of these wished to undergo sterilization. However, as Joseph E. Potter and colleagues report (page 228), few had had the operation by the time of an 18-month follow-up interview, and most of those who had not been sterilized still wanted to be. In qualitative interviews, the investigators learned that barriers to sterilization included procedures pertaining to Medicaid coverage and providers’ “ad hoc criteria” for performing the operation. The findings, according to the authors, offer “insight into structural factors underlying contraceptive inequity” and demonstrate that women’s current contraceptive method is not necessarily their preferred one.
•Close to half of sexually active U.S. 18–29-year-olds are unsure about their pregnancy desires, but men are more likely than women to be ambivalent, Jenny A. Higgins and coauthors find in analyses of nationally representative data from a 2008–2009 survey (page 236). Moreover, among men (but not women), those who are ambivalent are less likely to say that they and their partner use contraceptives than are those who have a clear desire to avoid pregnancy. The investigators “strongly encourage public health practitioners to explore whether helping men as well as women clarify their pregnancy desires…could help improve contraceptive use and reduce unintended pregnancies.”
•Adolescents’ pregnancy desires also call for attention, as Heather Sipsma and colleagues show in a study of young couples expecting a baby (page 244). Half of participants in this clinic-based sample had wanted a pregnancy, and one in fi ve had been unsure. Characteristics positively associated with pregnancy desire included perceptions of partners’ wishes and both life and relationship satisfaction. Males were more likely than females to have wanted a pregnancy and were less accurate in their perception of their partners’ desires. The researchers observe that on the assumption that teenage pregnancies are unwanted, prevention efforts often focus on increasing knowledge and improving contraceptive use. In their view, however, young people’s pregnancy desires need further exploration “and may be an appropriate focus of interventions.”
•In a mixed-methods study of homeless 13–24-year-olds in Los Angeles (page 252), Joan S. Tucker and coauthors uncover a “disconnect” between pregnancy-related attitudes and behaviors: Most youth considered it very important to avoid pregnancy, but substantial proportions— even among those highly motivated to do so—were not using effective contraceptives. Findings from qualitative interviews and a quantitative survey suggest that a number of social issues “may be important to consider” in adapting or developing pregnancy prevention programs for homeless young people: their strong feelings of relationship commitment; their degree of ambivalence about pregnancy; and their links to prosocial peers, such as youth who regularly attend school.
•A study of family planning service providers in California, reported by Heike Thiel de Bocanegra and colleagues (page 262), suggests that Title X support may enable clinics to reduce barriers to care. Title X–funded clinics responding to a 2010 survey were more likely than other public facilities and private ones to offer extended clinic hours, provide outreach to hard-to-reach populations and use technologies that can help streamline clinic operations. “The California experience,” the authors write, “suggests that if health reform provides clinical services for family planning nationwide, Title X funding could provide an opportunity to improve infrastructure and ensure quality of safety net providers, so that they could potentially serve as the providers of choice.”