An extensive body of research documents factors associated with the start of U.S. teenagers' sexual lives and their contraceptive use at particular times (mainly first or most recent intercourse) or over particular periods. Understanding young people's contraceptive practice within the context of specific relationships would add a new and valuable dimension, but limitations of available national-level data have largely precluded such study. Many of those limitations, however, are being eliminated by the availability of information from successive waves of the National Longitudinal Study of Adolescent Health—better known as Add Health. In this issue of Perspectives on Sexual and Reproductive Health (see article), Jennifer Manlove and coauthors use Add Health data to explore teenagers' contraceptive use within what might well be their most formative sexual relationship: their first one.
The key findings of Manlove and colleagues' analyses—which are based on responses from 1,027 young people who were interviewed in 1995 and again in 1996, and who had intercourse for the first time during the intervening year-highlight the importance of partner and relationship characteristics to teenagers' contraceptive use. Overall, teenagers are less likely to use contraceptives at some point in their first relationship if they think of the relationship as an affectionate rather than a romantic one. The longer a first sexual relationship lasts, the more likely the couple are ever to practice contraception, but the less likely they are to do so every time they have intercourse; the likelihood of consistent use also declines as the age gap between a teenager and an older partner grows. Other factors associated with increased contraceptive practice are use of dual methods of protection and talking to a partner about contraception before having sex.
As the authors note, their findings suggest a number of directions for policy, program and even parental efforts to improve teenagers' contraceptive use. Young people need to receive a clear message that it is important to delay first intercourse and, when they become sexually active, to talk to their partners about protection and maintain consistent use, especially if they are in long-term relationships or are involved with older partners.
Also in This Issue
•Addressing Hispanic women's high rates of unintended pregnancy requires understanding the factors that motivate them to use, and to stop using, effective contraceptives. In a sample of Hispanic women studied by Jennifer Kerns and coauthors (see article), roughly one-quarter of those who obtained birth control pills from a clinic discontinued use within one month. Women who said that their partner was unaware of their intention to use the pill were significantly more likely than those whose partner knew to stop taking the pill after a month or less. The researchers suggest that a man's unawareness of his partner's contraceptive intention may reflect any of several factors that could affect the couple's contraceptive behavior—poor communication within the relationship, a lack of supportiveness or a low level of commitment. Women who seemed ambivalent about pill use and those who planned to use the method for a fairly brief time also were at increased risk of early discontinuation, while older women were less likely than their younger counterparts to quit within a month.
•David J. Landry and coinvestigators report (see article) that half of high school sex education teachers provide the "comprehensive" instruction that advocates believe best prepares youth to embark on their sexual lives, instructing them that it is best to delay intercourse but that if they choose not to, they can take measures that will help them avoid unintended pregnancy and sexually transmitted disease. Slightly more than one in 10 teach what the federal government prefers: They tell students that abstinence is the only proper behavior, and they either do not discuss preventive methods or present them as ineffective. The remaining teachers offer a mix of these approaches. Moreover, both the overall approach and the content of sex education vary substantially by region of the country and characteristics of the school and district. Results of the researchers' nationwide survey reveal that teachers in the South and, to some extent, the Midwest are less likely than Northeasterners to provide instruction about many important skills and services that young people need to lead healthy sexual lives.
•It has been around for more than 150 years, it is easy for women to use without their partner's knowledge, it causes no side effects and it does not interfere with sexual pleasure. But the diaphragm has a lousy rap and is used virtually not at all in the United States. S. Marie Harvey and colleagues argue (see article) that health care providers and women alike unfairly malign this "old-fashioned" method. Part of the problem, they believe, may be simply that people are no longer familiar with the method and what they see as its many benefits. In their viewpoint piece, they press for a reintroduction of the diaphragm, not only because of its advantages as a contraceptive but also because of its potential to offer protection against sexually transmitted diseases.