Parent-child communication about sex has established links to several beneficial outcomes for adolescents—delayed first sex and relatively high rates of contraceptive and condom use, to name a few. Add to the list use of sexual and reproductive health services, according to Kelli Stidham Hall and colleagues. In this issue of Perspectives on Sexual and Reproductive Health (page 6), Hall and her coauthors show that adolescents whose parents talk with them about sexual issues beyond just saying no to sex are more likely than others to seek sexual or reproductive health care from a medical provider. The data, which come from two rounds of the National Survey of Family Growth, also suggest that young people whose parents limit their sex communication to abstinence-only messages have reduced odds of seeking care. Receipt of sex education from formal programs is not associated with adolescents’ likelihood of using services. The authors comment that public health and policy approaches that encourage comprehensive parent-child communication about sexual and reproductive health “may facilitate use of…services and ultimately enhance teenagers’ sexual and reproductive health.”
Also in This Issue
• Julien O. Teitler and coauthors take a step toward learning about the potential impact of prenatal care on subsequent fertility by exploring associations between the timing and adequacy of care before a first birth and the subsequent birth interval among New Jersey women who had their first baby in 1996–2000 (page 13). They find that women who did not get care in the first trimester or whose care was inadequate were at increased risk of having short birth intervals, which are associated with a range of adverse maternal and child health outcomes. Especially given cuts in public funding for family planning, the researchers contend, “providers should capitalize on their limited encounters with women who initiate prenatal care late, or use it sporadically, to ensure that these women receive information about family planning.”
• Emergency contraception is neither as effective nor as affordable as other methods, and it is not intended for repeated use—all of which makes the results of a 2007 survey of Planned Parenthood clients in Utah, presented by Lindsay Melton et al. (page 22), fairly perplexing. Three in 10 women had used levonorgestrel emergency contraception more than twice in the previous year, and six in 10 overestimated its effectiveness. Moreover, perceived effectiveness was the only independent correlate of repeated use. The investigators emphasize the need for future research, including qualitative studies, to assess “why women of all religions, ethnicities and education levels use levonor-gestrel emergency contraception more than occasionally.”
• In a nationally representative sample of young adults surveyed in 2009, one in five women and one in eight men believed that they likely were infertile, Chelsea Bernhardt Polis and Laurie Schwab Zabin report (page 30). Fewer than half of these women based that perception on a doctor’s statement (men were not asked what had led them to this notion), and data from other sources suggest that the perceived levels of infertility exceed actual levels. Perceived infertility was associated with socioeconomic characteristics, but not with recent contraceptive use. However, men who considered themselves infertile were more likely than others to expect to have unprotected sex. Polis and Zabin urge providers to address “both the reproductive fears and the reproductive desires of young adults,” to help them improve contraceptive use and understand their fertility.
• The human papillomavirus (HPV) vaccine has been publicized largely as a way to prevent cervical cancer in women; its effectiveness, and importance, for males has been largely overlooked. Parents’ knowledge and perceptions of it are key to getting preteenage males’ timely vaccination, so Joan R. Cates and colleagues explored what types of promotional materials are most likely to motivate parents in this regard (page 39). Their findings, from focus groups and a quantitative survey among North Carolina parents, show the importance of emphasizing infection risk and not targeting materials to a single racial group. The authors believe that their results can be used to develop materials that promote HPV vaccination “at the ages when it is most effective.”
• Research on variations in age at first birth have focused mainly on social and demographic characteristics, but as Thea van Roode and her coauthors report (page 48), patterns of sexual behavior and reproductive history may also merit attention. In a birth cohort of New Zealanders followed through age 32, age at first intercourse, relationship instability, and history of miscarriage and abortion all were correlated with age at first birth (although findings were not all consistent for men and women, or for different ages at first birth). The results, in the authors’ words, “illustrate the importance of considering proximal factors related to childbearing when attempting to evaluate more distal factors, such as adult socioeconomic status and education.”
• Unintended pregnancy rates vary among states, and an analysis of state-level variables by Kathryn Kost and colleagues (page 57) suggests that financial obstacles to family planning services warrant examination as possible factors in that variation. According to the findings, unintended pregnancy rates were positively associated with the proportion of women in a state who lacked insurance and were inversely associated with the proportion on Medicaid. These associations were stronger than those for measures that reflected states’ demographic makeup, socioeconomic features, and levels of service availability and contraceptive use. Understanding what underlies state-level variation in unintended pregnancy, the authors conclude, is “crucial” to the formulation of effective strategies for preventing unintended pregnancies.