In the past year, the Department has continued its commitment to support research related to teen pregnancy. This commitment includes investment in long- term research to follow trends in important areas. With such a commitment, many of the Department's activities reported here are continuations of research initially highlighted in last year's report. Areas of research include:
- Adolescent sexual activity
- Timing of first intercourse
- Use of contraceptives
- Intent to become pregnant
- Adolescent decision making
- Male Involvement
Data Collection. The data sets used to conduct research in the area of teen pregnancy are vital to the Department's mission to prevent teen pregnancy. To conduct quality research, the Department has invested resources to gather and maintain high-quality, comprehensive data. These data serve as a critical foundation for the information we now have with regard to teen pregnancy and for the information we will need in the future. A brief description of each data set is in Appendix IV.
Research Activities. The Department's research activities cover a wide spectrum of topics. Continuing research on the sexual activity of adolescents allows for an understanding of the patterns of sexual behavior. Examinations of whether and which adolescents intend to become pregnant or cause a young woman to become pregnant clarify how adolescents feel about becoming pregnant and have important implications for the decisions they make, their physical and emotional well-being, and potentially for the well-being of their children. Research funding is also spent in designing, implementing and evaluating pregnancy prevention programs, so that resources may be used to replicate programs that are demonstrably effective.
Adolescent decision making impacts on many risk-behaviors, including sexual activity and contraceptive use, and is a vital factor in understanding how and why teens become or make someone pregnant. Knowledge of how adolescents make decisions also enhances the ability to create effective prevention and intervention programs. Research on male involvement in teen pregnancy highlights the role, often ignored, that men have in sexual, romantic, marital and parenting relationships. The couple relationship, as well as peer relationships, have important influences on sexual risk behaviors.
Adolescent Sexual Activity. Research supported by the National Institute of Child Health and Human Development (NICHD) indicates that, between 1988 and 1995, a decrease has occurred in the proportion of teenagers aged 15-19 who had ever had sexual intercourse1. This decline occurred primarily among young men.2-3 Research conducted by the NCHS revealed that the levels for young women remained stable.2-3 These trends are departures from trends since the early 1970s, which had been toward increasing percents of sexually experienced teens.
Young Women's First Intercourse. NCHS and other researchers have found that many teenage girls are ambivalent about their first intercourse. More complete knowledge about adolescents' feelings about their first intercourse may help understand its timing, and clarify relationships between sexual initiation, contraceptive use, and teenage pregnancy.4 Among women who had their first intercourse at age 13 or younger, 24 percent report the experience to have been non-voluntary, compared with 10 percent of those who were between 19-24 at first premarital intercourse. Yet, women's experiences are not simply voluntary or non-voluntary. Women were asked to rate, on a scale of 1-10, how much they wanted their first intercourse to occur. About one-quarter of respondents who reported their first intercourse as voluntary also rated it as more unwanted than wanted.
Contraceptive Use. Research supported by NCHS indicates that the principal trend in contraceptive method choice in 1988-1995 was an increase in condom use, especially among black, Hispanic, or unmarried women under the age of 25. The increase in condom use at first intercourse, which dramatically increased in the 1980s and 1990s, was accompanied by a decrease in use of other methods that do not prevent HIV and STDs.5
Twenty-four percent of all black teens using contraception were using injectable or implant contraception, methods which are very effective against pregnancy.5 The use of injectable and implant contraception may help to explain the decline in the second and higher order birth rates for teen mothers — teens who already had a child. This adoption of injectable and implant contraception and the increase in condom use at first intercourse and afterward may have been important factors in the sharp decline in black teen birth rates.3,6For white teens, declines in current sexual activity as well as the increases in condom use may be significant factors in declines in birth rates.2-5 For further information, please see Appendix I.
Unintended Pregnancies. Research conducted by the NCHS indicates that a large proportion of recent pregnancies to women of all ages in the United States — over 50 percent— are unintended even though contraceptives are widely available and widely used.7 Unintended pregnancies that were wanted, but came too soon, or that were not wanted at all, are associated with a woman's attitudes about her pregnancy at the time it was conceived.
The National Survey of Family Growth (NSFG) (see Appendix IV), which has long been the principal national source of information on intended and unintended pregnancy in the United States, traditionally classifies women's pregnancies as intended, mistimed, or unwanted. To study whether young women were having inconsistent feelings about pregnancy, researchers developed a set of scales to measure these feelings.8 The scales were used to show a woman's positive, negative, or conflicting (ambivalent) feelings about her pregnancy and were compared with the traditional measures of unintended pregnancies. Though she may not have actively wanted to get pregnant at the time she did, the young woman may have felt some attraction to what being pregnant would add to her life, for example, looking forward to the new experiences that having a baby would bring. These results affirm the impressions of many service providers that the strength of the motivation to prevent pregnancy, or ambivalence about preventing it, is a prime determinant of both the likelihood of getting pregnant and how effectively contraceptives are used among young and teenaged unmarried women. By measuring ambivalent feelings, service providers may be able to better address teen's feelings and concerns about pregnancy and contraception.
Many unintended pregnancies are pregnancies toward which the mother's attitude was not entirely negative — as measured in a new series of questions asked of teens and young women under age 25 in the 1995 wave of the NSFG.9 In 1995, as in 1988 and 1982, teenaged women had high levels of unintended pregnancy (about 78 percent of recent pregnancies in 1994).10 Teens 15-19 years of age were also more likely to have lower values on a "happiness to be pregnant" scale, which suggests that they had stronger negative or ambivalent feelings about their pregnancies than young women ages 20-24. Overall, the greatest amount of ambivalence was shown by teen women 15-19 years old.
Adolescent Decision Making. The Office of the Assistant Secretary for Planning and Evaluation (ASPE) funded a workshop in January, 1998 which was convened by the Board on Children, Youth, and Families (a joint activity of the National Research Council and the Institute of Medicine) to explore the role that decision making plays in adolescents' involvement in high-risk behaviors.
The changes associated with adolescence, including physical, cognitive, social, and emotional growth, impact decision making. Cognitive changes create an increased capacity for more complex and abstract reasoning. Social cognition—the way one thinks about one's social world, the people with whom one interacts, and the groups in which one participates—may change from adolescence to adulthood. External factors, such as the media—television, radio, movies, music videos—may influence decision making by helping to set both positive and negative social norms.
Research examined at this workshop can assist those involved in the development of programs designed to prevent health risk behaviors. Research on drug use prevention programs, for example, has found that promising programs: (1) are long term, (2) are designed to counter social influences, (3) begin in elementary or middle school, and (4) are supplemented by booster sessions throughout the high school years. Programs may not explicitly use a decision-making model, yet may incorporate decision-making skills such as providing information that teenagers need for effective decision making in a clear and personalized way; encouraging teenagers to take responsibility for their actions and to analyze their options; and showing adolescents how to discuss decisions in a group setting. The report is available on the web at http://aspe.hhs.gov
Male Involvement. Research on male involvement is another important piece of the Department's research focus on teen pregnancy. Examples of programs in this area are highlighted in the section "Supporting Promising Approaches." Including males in the examination of teen pregnancy means investigating how men feel about their sexuality and sexual relationships, attitudes of males regarding what it means to be a man, and attitudes towards and use of contraceptives. Further, male involvement can incorporate issues not directly involving sexuality such as family relationships and parenting, career and educational goals and opportunities among a host of other issues that directly affect young men in the United States.
One area of research in this area is the expansion of the NSFG (see Appendix IV for details on the current NSFG). The 6th cycle of the NSFG, due to be conducted in 2001 will include, for the first time, a national sample of men 15-49 years of age. It is anticipated that the expanded survey will be done every 3-4 years instead of every 6-7 years to more accurately monitor trends. Future improvements under consideration are to include populations of men who are often excluded from national surveys: the military and prisoners. These improved data can be expected to yield reliable national estimates of male sexual behavior and contraceptive use, attitudes toward marriage, cohabitation and fatherhood, extent to which births are wanted by males, and father-child contact and the father's role in raising his children. Further, these data are expected to allow for examinations of similarities and differences in attitudes and behaviors between men and women and subgroups of men and women.
Attitudes Towards Sexual Activity. Small research projects funded at the NIH are addressing adolescents' attitudes toward sexuality. Data collected under the AddHEALTH project (see Appendix IV) are demonstrating, among other things, that a young person's public profession of an intention to remain virgin does have a strong effect upon that person's abstaining from sex for the next year, even when controlling for other influences such as family structure, religiosity, and school success. Other researchers are able to examine how the strength of young people's sense of connection to school and family protect against initiating health risk behaviors, including early and unprotected sex.