Condom and other contraceptive use among a random sample of female adolescents: a snapshot in time

Adolescence, Winter, 1997 by Diane M. Grimley, Patricia A. Lee

The number of sexually active adolescents has steadily increased in the United States over the past two decades (Creatsas, 1993). More than half of all females aged 15 to 19 have had sexual intercourse (Harlap, Kost, & Darroch Forrest, 1991). As a result, both pregnancy and sexually transmitted diseases (STDs) are at epidemic proportions among this population. For example, 40% of females in the U.S. become pregnant prior to age 17, with approximately 75% of these pregnancies labeled as "unplanned" (Creatsas, 1993). In New York State, nearly 9% of all females aged 15 to 19 give birth each year (Brown, 1991). Among this age group, pregnancy ends in spontaneous or induced abortion nearly as often as it ends in birth (Harlap et al., 1991). In fact, U.S. rates of abortion and unintended childbirth are among the highest in the Western world (Scales, 1987).

STDs are a common public health problem, with serious health consequences for thousands of children and adults (Roper, Peterson, & Curran, 1993). An estimated 12 million cases of STD occur each year in the United States, including 3 million teenagers (American Association of World Health, 1994). Adolescents are particularly vulnerable because they are more likely to have multiple partners and less likely to prevent or recognize STDs (Biro & Rosenthal, 1992). Among heterosexual adolescents, STD rates are higher for females than males, possibly because females are more likely to acquire an STD following a single act of unprotected intercourse with an infected partner: an estimated 50% of women will contract gonorrhea (Potterat, Dukes, & Rothenberg, 1987) and 30% to 40% will contract chancroid, chlamydia, herpes, or syphilis (Harlap et al., 1991). Moreover, sexually active adolescents have to deal with the threat of infection from the human immunodeficiency virus (HIV), which can lead to acquired immunodefiency syndrome (AIDS). The number of women with AIDS has increased rapidly in recent years (Centers for Disease Control and Prevention, 1994), particularly minority women.

This study examined the sexual practices of adolescent females aged 15 to 19 and their readiness to use specific contraceptive methods for birth control and STD prevention. The investigation was based on the stages-of-change construct from the Transtheoretical Model (Prochaska & DiClemente, 1983, 1984).

METHOD

Subjects

Data were collected in New York State as part of a larger study assessing condom and other contraceptive use in approximately 1,100 women between the ages of 15 and 50 (Grimley, Willey, Johnson, et al., 1995). The adolescent subsample consisted of 235 females with a mean age of 16 years. The majority were white (82%), 6% AfricanAmerican, 6% Hispanic, 1% Asian, 1% Native American, and 4% other. The mean number of years of school completed was 11. Total family income averaged $20,000 to $39,999 annually. Almost half (49.6%) were Catholic and 99% were single.

Procedure

The specific aim of this study was to contact at least 200 adolescent females in order to obtain a better understanding of their condom use and other contraceptive behavior. Using a random-digit-dial computerassisted telephone interviewing method, adolescents were asked to complete a one-time assessment of their sexual practices. The trained telephone interviewers had no knowledge of participants' names or addresses, ensuring confidentiality and anonymity. Informed consent was obtained from each adolescent and a parent or guardian. The overall response rate was 42%. Privacy for the participants to respond to sensitive questions was ascertained, and the survey took an average of 20 minutes. If questions regarding birth control methods arose or additional information was requested, subjects were given the toll-free number of the Family Planning office in New York State, which, in turn, could put them in contact with the Family Planning chapter nearest their home.

Measures

Five sets of measures were embedded in a longer questionnaire:

1. Basic demographics. Information on age, ethnicity, years of schooling, religion, and total family income was obtained.

2. Sexual history. Data were obtained on age of sexual onset, current method of birth control, pregnancy history, vaginal intercourse with primary and nonprimary (e.g., casual) partners, concern about STDs, and number of sexual partners since becoming sexually active.

3. Stages of change for specific methods of birth control. The Transtheoretical Model of Behavior Change (Prochaska & DiClemente, 1983, 1984) postulates that individuals pass through five stages of change when modifying unhealthy behaviors (e.g., smoking) or acquiring new healthy behaviors (e.g., consistent condom or other contraceptive use). These stages are: precontemplation - not intending to change in the foreseeable future; contemplation-intending to change sometime within the next 6 months; preparation-intending to change soon (i.e., within the next 30 days); action - actively engaged in the process of changing for less than 6 months; and maintenance - continued behavior change for more than 6 months.