As children become teenagers, their friendship patterns change, and the nature of their relationships shifts. Gender becomes less of a barrier in the formation of social circles, and age differences are blurred; hanging out gives way to dating and going steady, often accompanied by sexual activity, sometimes including intercourse. What can be said about the path from childhood friendships to relationships involving intercourse? To what extent does a young person's friendship history influence the initiation of intercourse? These are the questions that Elizabeth C. Cooksey and coauthors address in the lead article (see article) of this issue of Perspectives on Sexual and Reproductive Health.
Using data from the National Longitudinal Survey of Youth (NLSY), Cooksey and colleagues find that most teenagers had friends predominantly of their gender and grade level at ages 11-12, and these youth are less likely to date regularly during adolescence than are the minority who moved in more mixed circles as preteenagers. Overall, the gender mix of a youth's preteenage friends is not associated with the likelihood of sexual initiation during adolescence, but for males whose friends were mostly female, the findings hint at elevated odds of early sexual debut. Furthermore, young people whose friends were mostly in higher grades are significantly more likely than others to begin having intercourse by ages 15-16. To the researchers, these findings suggest that young people who follow "nonnormative paths" should be considered the "object of special concern."
Cooksey and coauthors also find important relationships between dating patterns and sexual initiation. Only three in 10 teenagers report having dated at ages 13-14, but more than half of these report going steady. And while it is questionable what young people mean by "dating" or "going steady," it is abundantly clear that those who report going steady have significantly elevated odds of becoming sexually experienced during adolescence. Steady dating, then, "may represent a red flag in terms of predicting midadolescent sexual initiation."
In a related contribution, also based on analyses of NLSY data, Lauren M. Rich and Sun-Bin Kim (see article) add to a growing literature suggesting possible detrimental effects of adolescent employment. They find an elevated risk of first intercourse associated with both current employment and cumulative months of employment; the relationship is particularly strong for white women. Teenagers who work more than 120 hours a month also have an elevated risk of early sexual debut. Current employment is associated with an increased risk of a nonmarital pregnancy among black teenagers and a reduced risk among Hispanics; it has no association with white teenagers' risk.
What is one to make of these findings? Rich and Kim acknowledge that it is impossible to determine whether employment attracts young women seeking autonomy or increases teenagers' autonomy. But they suggest that program planners be aware of the association between employment and early sexual activity, particularly if interventions include the provision of employment opportunities.
Also in This Issue
The remaining authors in this issue address questions related to the methods U.S. women use to control their fertility.
• Research on U.S. women's contraceptive use has rarely focused on the extent to which women switch methods. William R. Grady and colleagues help fill that gap (see article), using data from the National Survey of Family Growth. They find that large proportions of women are unable to identify and adopt a contraceptive method that adequately meets their needs, as evidenced by high rates of switching within two years. In detailed analyses--the first ever to examine this issue on the basis of a nationally representative sample--the researchers highlight specific switching patterns and show how women's choices relate to their concerns about pregnancy, sexually transmitted diseases and contraceptive-related health risks.
• A research note by Karen Ramstrom and coauthors (see article) illuminates the reasons behind contraceptive discontinuation for a group of women who are at high risk for unintended pregnancy: clients at sexually transmitted disease clinics. To their surprise, the researchers find that these women's likelihood of discontinuing a method within one year is unaffected by their experience with side effects but is strongly associated with problems in using a method. Clinicians can lessen the likelihood of discontinuation, the authors write, by actively addressing method-use problems with women in their care.
• In a special report (see article), Rachel K. Jones and Stanley K. Henshaw review the experiences of France, Great Britain and Sweden in providing medical abortions with mifepristone, and reflect on how lessons learned there could translate into wider use of the method here at home. In particular, they contend that the European experience suggests that early medical abortions can be safely performed at later gestations and under simpler protocols than the one approved in the United States. While conceding that not all women prefer medical to surgical abortions, the authors point out that providing women the choice will increase satisfaction levels among those obtaining abortions.
• On a similar note, Jane E. Boggess draws on the experience of California and Washington to argue for one means of expanding women's access to emergency contraception: deregulating it, so that women can obtain it directly from a pharmacist. In a viewpoint (see article), Boggess argues that doing so would offer women "an opportunity to respond to their family planning needs in a private and timely way."