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The more religious the residents of a state are, the higher the state's teenage birthrate, according to an analysis of federal birth statistics for 2006 and responses to a 2007–2008 survey of Americans' religious beliefs.1 Analysts used responses to eight questions on the survey to calculate a religiosity score for each state; the score reflected the degree to which state residents reported the most conservative religious beliefs and practices (e.g., belief that there is only one way to interpret the teachings of one's religion, praying at least daily). The score showed a high correlation with the teenage birthrate (r=0.7), and the relationship remained significant in analyses controlling for states' median income and teenage abortion rate (which were negatively correlated with religiosity). While emphasizing that state-level data cannot be used to make individual-level inferences, the analysts speculate that conservative religious communities "are more successful" in discouraging their teenage members from using contraceptives than in discouraging them from having sex.

1. Strayhorn JM and Strayhorn JC, Religiosity and teen birth rate in the United States, Reproductive Health, 2009, Vol. 6, <;, accessed Sept. 17, 2009.


Change is afoot in Spain. If a bill approved by the country's cabinet in September makes it through Parliament, abortion will become available on demand during the first 14 weeks of pregnancy, and minors aged 16 and older will not need parental consent to get an abortion.1 The current abortion law, passed in 1985, permits the procedure only if the pregnancy resulted from rape, the fetus has a genetic defect or the woman's health is at stake. Opponents of the bill contend that it does not have widespread popular support. Also in September, emergency contraceptive pills became available without a prescription throughout Spain.2 Women of any age can now get the pills over the counter for less than 20 euros.

1. Kingstone S, Spain unveils abortion law change, BBC news, Sept. 26, 2009, <>, accessed Sept. 29, 2009.

2. Govan F, Spain to allow over-thecounter morning after pill, Sept. 27, 2009, <…;, accessed Sept. 29, 2009.


Only 29% of sexually active black teenagers surveyed in four U.S. cities had ever had an HIV test, and 14% of those who had had one did not know the result.1 Youths' factual knowledge about HIV and AIDS was low, but females did somewhat better than males on knowledge measures; females also considered HIV less stigmatizing, and preventive behaviors easier to engage in, than males. In multivariate analyses, females' likelihood of having had an HIV test was positively associated with a history of STD testing (odds ratio, 88.4) or pregnancy (2.8), self-efficacy for risk reduction (2.3) and STD knowledge (2.3); for males, the predictors were a history of STD testing (38.1), partner communication about testing (3.5) and a low level of religiosity (2.1). Given black youths' disproportionate HIV risk, the researchers stress the need to increase their "HIV testing uptake, receipt of results and HIV/[STD] knowledge." They suggest that this will require the involvement of both the health sector and community-based programs that can offer free or low-cost, convenient and youth-friendly services.

1. Swenson RR et al., Prevalence and correlates of HIV testing among sexually active African American adolescents in 4 US cities, Sexually Transmitted Diseases, 2009, 36(9):584–591.


Teenage mothers experience greater psychological distress than either their childless peers or older mothers, but parenthood does not appear to be the cause.1 Researchers used data from the National Longitudinal Study of Adolescent Health (Add Health) to compare psychological measures between teenage mothers and childless teenagers, and data from the Early Childhood Longitudinal Study–Birth Cohort (ECLS-B) to compare teenage and older mothers; both nationally representative data sets showed differences in the expected directions. The difference persisted at least into young adulthood, according to Add Health—and well into women's 30s, according to the ECLS-B. In further analyses of the Add Health data, the relationship between teenage motherhood and psychological distress was explained by differences between teenage mothers and their childless peers in socioeconomic status, academic achievement, family structure and sexual experience. Additionally, among poor young women, high levels of psychological distress were predictive of adolescent childbearing.

1. Mollborn S and Morningstar E, Investigating the relationship between teenage childbearing and psychological distress using longitudinal evidence, Journal of Health and Social Behavior, 2009, 50(3):310–326.


The recession has had a "profound" impact on U.S. women's fertility-related decisions and behaviors, according to a report on results of an Internet survey conducted in mid-2009.1 One-quarter of the 974 sexually active, nonpregnant women who were included in the analyses said that the economic downturn has made it harder for them to afford birth control; the same proportion reported having put off a gynecologic or family planning visit to save money in the past year. Meanwhile, 44% said that they want to reduce or delay childbearing because of the recession, and 64% said that they cannot afford to have a baby now. Economic concerns have caused some women to take greater care to use contraceptives (29%), but have led others to occasionally forgo method use (8% of those who are not protected by sterilization). Other responses to financial hardship have been to switch to a less expensive provider and consider long-term contraceptives or sterilization. Survey respondents were drawn from a household panel that is representative of the U.S. population older than 13; the women in the analytic sample were 18–34 years old and had annual household incomes of less than $75,000.

1. Guttmacher Institute, A real-time look at the impact of the recession on women's family planning and pregnancy decisions, 2009, <>, accessed Sept. 23, 2009.


With appropriate preparation and support, primary health care providers could play an important role in implementing the federal government's 2006 recommendation of routine HIV testing for individuals aged 13–64 during health care visits; this is the conclusion of an evaluation of six community health centers' efforts to increase testing.1 At the six centers, which received rapid HIV testing kits and technical assistance in providing routine testing, roughly 16,000 patients aged 13–64 were offered HIV tests between March 2007 and March 2008—more than five times the number in the year before the recommendation was implemented. Two-thirds of patients offered tests had one; 39 received a preliminary diagnosis of HIV, and for 17, further testing confirmed the diagnosis. Fourteen patients with a confirmed diagnosis received referrals for care. Individuals younger than 55 had elevated odds of being tested (odds ratios, 1.2–1.8), as did nonwhites (1.3–2.7).

1. Myers JJ et al., Routine rapid HIV screening in six community health centers serving populations at risk, Journal of General Internal Medicine, 2009, doi: 10.1007/s11606-009-1070-1, accessed Aug. 17, 2009.


The Food and Drug Administration has approved use of Gardasil in males aged 9–26 to prevent genital warts caused by human papillomavirus (HPV) types 6 and 11.1 The drug, which is administered in three injections over six months, was approved in 2006 for use in females aged 9–26 to prevent infection with the four strains of HPV that are linked to most cases of cervical and other gynecologic cancers and genital warts. Youths aged 18 and younger may be eligible to receive the vaccine for free under the federally funded Vaccines for Children program; beginning in November, Merck, the manufacturer of Gardasil, plans to provide it at no cost to uninsured 19–26-year-old men who could otherwise not afford it (as the company already does for women in that age-group). In addition, Merck plans to institute a rebate program, under which eligible privately insured 19–26-year-olds can receive partial reimbursement for out-of-pocket charges for the vaccine that are not picked up by their insurance carrier.

1. Merck & Co., FDA approves Gardasil for use in boys and young men, news release, Whitehouse Station NJ: Merck & Co., Oct. 16, 2009, <;, accessed, Oct. 19, 2009.


The proportion of patients undergoing HIV testing at an Amsterdam STD clinic increased substantially after the clinic switched from a policy of having providers offer HIV testing to individuals considered to be at high risk to one of making testing a routine part of care unless patients opt out.1 In 2006, under the old policy, 62% of men who have sex with men, 64% of heterosexuals at high risk and 83% of those at low risk had an HIV test; in 2007, after the opt-out policy went into effect, the proportions were 88%, 94% and 98%, respectively. The proportion of tests that came back positive did not change. By far, the most common reason for opting out of testing was fear—cited by 40% of men who have sex with men and 36–37% of heterosexuals. Heterosexuals' next most common reason was the belief that they were at low risk; for men who have sex with men, a previous HIV test with a negative result was the second most frequently mentioned reason for opting out.

1. Heijman RLJ et al., Opting out increases HIV testing in a large sexually transmitted infections outpatient clinic, Sexually Transmitted Infections, 2009, 85(4):249–255.


If findings from a survey of 141 pediatric residents are any indication, pediatricians' attitudes toward abortion and teenagers' having sex are linked to their intention to provide emergency contraception.1 The more favorable residents' attitude toward abortion, the less likely they were to be characterized as having low intention to provide the method, rather than being ambivalent (odds ratio, 0.5); the more favorable their attitude toward teenage sex, the more likely they were to express high intention rather than ambivalence (1.7). Attitudes toward teenage sexual activity also were positively associated with residents' likelihood of saying that they routinely provide counseling about emergency contraception. Other than attitudinal measures, one of the key predictors of residents' provision of counseling and intention to provide emergency contraception was having had a clinical preceptor who encouraged them to offer this service.

1. Upadhya KK, Trent ME and Ellen J, Impact of individual values on adherence to emergency contraception practice guidelines among pediatric residents: implications for training, Archives of Pediatrics and Adolescent Medicine, 2009, 163(10):944–948.