Risky sexual behavior takes place in the context of couples but has typically been studied in the context of individuals. In this issue of Perspectives on Sexual and Reproductive Health (see article), however, John O.G. Billy and coauthors explore predictors of risky behavior (specifically, anal sex and unprotected anal sex) by analyzing information collected from dating heterosexual couples. They find that power dynamics within relationships—which partner has the higher socioeconomic status, the greater control over sexual and contraceptive decisions, and the stronger commitment to the relationship, for example—may help to explain associations between partners' individual characteristics and the likelihood of risky behavior. In fact, some individual-level predictors of risky behavior are apparent only when power differentials are taken into account; in other words, they are significant only if the individual has enough power to influence the sexual relationship.
The researchers note that couples-based interventions have proven feasible and effective. When "grounded in research that accounts for the many relationship influences forming the context for human sexual behavior and attitudes," they comment, such interventions "may help redress the continuing problem of STD infection in the United States.
Also in This Issue
•Teenage women who engage in risky behavior, have unintended pregnancies or experience pregnancy problems are at increased risk of becoming young adults who are involved in intimate partner violence, Lydia O'Donnell and coauthors report (see article). Three in 10 young women who entered a longitudinal study as middle school students reported during their early 20s that they had recently been victims of intimate partner violence; two in 10 had recently perpetrated such violence. Both experiences were positively associated with aggressive behavior during middle school; lifetime number of sexual partners; and having a history of unintended pregnancy, abortion, miscarriage or fertility problems. The findings, the researchers remark, underscore the importance of early intervention and the potential role of sexual and reproductive health providers in helping to prevent and address intimate partner violence.
•If life imitated art, a lot of teenage men would likely be a lot happier. As it is, Steven C. Martino and colleagues demonstrate (see article), what teenagers see of sex on TV may leave them open to disappointment in the real-life experience. Two-fifths of male teenagers who had intercourse for the first time during the course of a three-year longitudinal study said that they wished they had waited. The likelihood of regret was positively associated with the amount of sexual content the young men viewed on TV; this relationship was partly explained by lowered expectations of sex once youth who saw a lot of sex on television had had their first intercourse. (The feeling of regret was not related to TV viewing for women.) The authors comment that limiting teenagers' exposure to sexual content on TV, ensuring balanced portrayals of sex in the media and helping teenagers think critically about what they see on TV could help young people "make more carefully considered decisions about sexual debut."
•By linking birth certificate data for the period 1993–2002, Susan N. Partington and colleagues (see article) identify repeat births to Milwaukee teenagers and analyze the outcomes of second births, essentially using each mother as her own control. They find a greater likelihood of preterm delivery for second than for first births. Notably, several predictors of poor second-birth outcomes (low birth weight and preterm delivery), as determined in multivariate analyses, are modifiable maternal behaviors: smoking during pregnancy, gaining too little weight while pregnant, having closely spaced pregnancies and receiving inadequate prenatal care. Therefore, the authors reason that "consistent, thorough screening for…these behaviors at the first prenatal visit," along with appropriate follow-up, "could…improve outcomes."
•Although access to emergency contraception is easing for many women, it remains a challenge for some teenagers, even if they live near pharmacies with staff who are certified to provide the method without a prescription. In a study by Olivia Sampson and coinvestigators (see article), only about one-third of phone calls made by researchers claiming to be teenagers in need of emergency contraception to pharmacy-access pharmacies in California were successful—that is, callers were told that they could come right in and get the pills. Calls to pharmacies in rural areas were less likely to be successful than were calls to urban pharmacies, and Spanish-speaking callers were less likely than English speakers to register success. Interviews with pharmacists revealed systemic and attitudinal factors that may impede provision of the method. All of which, according to the authors, proves that "policy changes alone are not enough to guarantee access at pharmacies."
•Does the requirement that teenagers notify their parents when seeking an abortion deter young women from becoming pregnant? Not in Texas, according to Silvie Colman and Ted Joyce (see article). However, Colman and Joyce find, many teenagers who get pregnant 3–4 months before they turn 18 put off having an abortion until after their birthday, when they are no longer subject to the requirement. And for some who wait, the delay may mean the difference between terminating their pregnancy in the first trimester and ending it in the second trimester, when the potential risks and the costs are higher. Viewing their findings in conjunction with those from earlier work showing that some teenagers carry pregnancies to term rather than involve their parents in an abortion decision, the authors observe that parental notification requirements may be detrimental to teenagers' welfare.