To whom do inner-city minors talk about their pregnancies? Adolescents' communication with parents and parent surrogates.

A study of 334 black, urban teenagers who sought pregnancy tests in two Baltimore clinics in 1985-1986 explored communication between the teenagers and their parents or parent surrogates before the pregnancy test visit and, among those whose test results were positive, before the final pregnancy outcome decision. Of these young women, 66% had discussed the possibility that they were pregnant with a parent (usually the mother) or parent surrogate before the test; an additional 6% had turned to another adult. At a follow-up interview a year later, 91% of those whose test results had been positive reported that they had consulted a parent or parent surrogate before deciding what to do about the pregnancy, and 4% had confided in another adult. The probability that an adolescent would consult a parent before deciding what to do about her pregnancy was higher if she was younger, if she lived with the parent and if she found the parent easy to talk to. A year after the pregnancy test, 88% of the adolescents who had given birth or had had an abortion were satisfied with their pregnancy outcome. Satisfaction was not related to whether the young woman had discussed her decision with a parent. Dissatisfaction was most likely if the parent did not support the final outcome, if someone other than the young woman had made the final decision, or if the final outcome was different from the adolescent's preference at the time of the pregnancy test.

A comparison of Medicaid and non-Medicaid obstetrical care in California.

The use of prenatal care and rates of low birth weight were examined among four groups of women who delivered in California in October 1983. Medicaid paid for the deliveries of two groups, and two groups were not so covered. The analyses suggest that longer Medicaid enrollment improved the use of prenatal care. The association between prenatal care and birth weight was less clear. For women under Medicaid, measures of infant and maternal morbidity, hospital characteristics, and Medicaid eligibility were all statistically related to charges, payments, and length of stay for the delivery hospitalization.

Differential characteristics of adolescent pregnancy test patients: abortion, childbearing and negative test groups.

Studies of the consequences of adolescent childbearing report many negative sequelae, but the effects of induced abortion are less studied, and most studies lack appropriate controls for preexisting characteristics. This paper uses baseline data from the intake interview into a longitudinal study of 360 innercity black women (less than or equal to 17 years old) presenting for a pregnancy test at two sites in Baltimore to examine baseline differences between three groups: young women who terminated the index pregnancy and, as controls, those who carried to term and those whose tests were negative. They were interviewed before being told the test result. Education aspirations/achievement, economic well-being, sexual/contraceptive history, psychologic characteristics, and desire for a child were compared. Negative test patients often reveal characteristics suggesting a particularly high risk of pregnancy, e.g., more prior pregnancy tests and a greater desire to conceive. Implications are discussed, emphasizing the need to intervene after a negative pregnancy test with counseling to help avert a future undesired conception.

PIP: Studies of the consequences of teenage childbearing have found negative outcomes, but the effects of induced abortion have not been studied as much. More should be found out about the adolescents who choose abortion, and how they compare with those who choose to have the baby; and those who are no pregnant. Most studies do not have "appropriate controls" for preexisting characteristics. This report uses baseline data from the interviews of a longitudinal study of 360 inner city Black teenagers (or= 17 years) who went for a pregnancy test at 2 places in Baltimore, Maryland. Differences between 3 groups were studied: 1) teenagers who had an abortion; 2) those who carried to term; and 3) those who had negative tests. The last 2 were control groups. They were interviewed before being given the test results, and before they chose an outcome. The 2-year longitudinal study followed 360 young women who came for pregnancy tests at Johns Hopkins Comprehensive Child Care Unit; or Planned Parenthood of Maryland. Those who terminated pregnancy numbered 114; those who had a baby numbered 93; and 100 had negative tests. This was their 1st pregnancy. Mean age at entry was 16.1. There was a somewhat greater economic status among those adolescents who chose abortion. Fewer of those who had babies were in school. The abortion group received fewer medical services in the past year. Psychological differences are shown in tabular form, as in the history of sexual, pregnancy, and pregnancy tests. Abortion and childbearing attitudes are given.

When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy.

A group of 360 black teenage women of similar socioeconomic background who sought pregnancy tests from two Baltimore family planning providers was followed for two years to determine if those who obtained abortions were adversely affected by their abortion experience. After two years, the young women who had terminated their pregnancies were far more likely to have graduated from high school or to still be in school and at the appropriate grade level than were those who had decided to carry their pregnancy to term or those whose pregnancy test had been negative. Those who had obtained an abortion were also better off economically than were those in the other two groups after two years. An analysis of psychological stress showed that those who terminated their pregnancy had experience no greater levels of stress or anxiety than had the other teenagers at the time of the pregnancy test, and they were no more likely to have psychological problems two years later. The teenagers who had obtained abortions were also less likely than the other two groups to experience a subsequent pregnancy during the following two years and were slightly more likely to practice contraception. Thus, two years after their abortions, the young women who had chosen to terminate an unwanted pregnancy were doing as well as (and usually better than) those who had had a baby or who had not been pregnant.

The effect of sexual behavior and a pregnancy on contraceptive method switching among black female teens.

Little is known about determinants of contraceptive method switching and few reports use data that can link events that occur close in time. Using retrospective information from the sexual calendars of black female teens who attended a reproductive health clinic, determinants of method switching in four areas were investigated. Method switchers, those who switched from an unprepared to a prepared method (n = 62) and those who switched from a prepared to an unprepared method (n = 18), were matched with nonswitchers who used the same initial method. Associations between switching and changes in the frequency of intercourse, sexual abstinence, and pregnancy were found. It is suggested that abstinence may have a different role in switching from each type of method. Counselors need to emphasize the importance of method continuation, even when sex has not occurred for a short period of time.

PIP: Little is known about determinants of contraceptive method switching and few reports use data that can link events that occur close in time. Using retrospective information from the sexual calendars of black female teens who attended a reproductive health clinic in a US urban center, determinants of method switching in 4 areas were investigated. Method switchers, those who switched from an unprepared to a prepare method (n = 62) and those who switched from a prepared to an unprepared method (n = 18), were matched with nonswitchers who used the same initial method. Associations between switching and changes in the frequency of intercourse, sexual abstinence, and pregnancy were found. It is suggested that abstinence may have a different role in switching from each type of method. Counselors need to emphasize the importance of method continuation, even when sex has not occurred for a short period of time.

The Baltimore pregnancy prevention program for urban teenagers. I. How did it work?

Two teams, each consisting of a social worker and a nurse, delivered the bulk of services in an experimental pregnancy prevention program for junior and senior high school students that combined school and clinic components. In-school components were classroom presentations, informal discussion groups and individual counseling; clinic services consisted of group education, individual counseling and reproductive health care. Eight-five percent of the total student enrollment had contact with at least one component of the program. More males than females were among the 15 percent with no contact. When estimates of chronic absenteeism are taken into account, the program is believed to have reached all students in regular attendance. Approximately 22 percent of staff-student contacts occurred in the classroom, and the remaining 78 percent were voluntary on the part of the student. About 68 percent of contacts occurred within the school, with small group discussions especially popular--they represented 41 percent of all contacts. The proportion of contacts that occurred in the clinic was highest among senior high females (46 percent) and lowest among senior high males (12 percent).

The Baltimore pregnancy prevention program for urban teenagers. II. What did it cost?

An experimental pregnancy prevention program for junior and senior high school students consisted of classroom lectures, informal discussion groups and individual counseling in the schools and group education, individual counseling and reproductive health care in a nearby clinic. The structure of the program allowed for extensive individual counseling for students who desired it, and the reported costs are thus considered generous. School-based services utilized 40 percent of a total three-year budget of $409,250, and clinic services, 60 percent. The average cost per student served was $122, with the average per female student almost four times that per male and the average per senior high student more than twice that per junior high student. Students who utilized more expensive types of services, such as individual counseling and medical services in the clinic, also used other program offerings more frequently. Services to students who attended only class lectures cost an average of $13.20 to deliver, while students who utilized all services cost the program an average of $546 each.

Users of reproductive health clinic services in a school pregnancy prevention program.

Although the potential of school-based programs in the prevention of adolescent pregnancy is well recognized, few have been evaluated. This paper describes the use of a reproductive health care clinic associated with a school pregnancy prevention program which had demonstrated success. The program operated in one junior and one senior high school in a large city during the 3 school years from 1981 to 1984. Three facets of the 818 users of the program clinic are explored: who enrolled in the clinic, why they enrolled and what contraceptive methods they received, and their continuation with the clinic. Chi-square analysis and Student's t-tests were used to test for significant differences between the two school and sex groups. Life table and regression techniques were employed to examine clinic continuation. The main findings are teens of both sexes used the clinic, and junior high males used it in surprisingly large numbers; there were no major school or sex differences in the characteristics of those who enrolled; most students enrolled to obtain a contraceptive method; although many females served by the clinic had previously used another family planning clinic, the majority of them had unmet needs; the rate of clinic continuation was high; and certain factors contributed to clinic continuation. These findings suggest that a clinic in a school-linked setting can successfully attract students to use its services and it may offer certain advantages for reaching sexually active teens in search of contraceptive protection.

Characteristics of infertile women in the United States and their use of infertility services.

National estimates of demographic characteristics are shown for infertile women compared with those who were fecund, women with primary versus secondary infertility, and infertile women who had, and had not, sought infertility services. Overall, 30% of infertile women had primary infertility, and 70% had secondary infertility. Women with primary infertility were twice as likely to seek services as women with secondary infertility. Many demographic characteristics of women with secondary infertility who sought services differed from those of women who had not sought services. There were fewer differences among women with primary infertility. These findings have implications for the generalizability of results from clinic-based studies and suggest that more research is needed on the barriers to service among infertile couples.

Substance use and its relation to sexual activity among inner-city adolescents.

A study of inner-city Black and Caucasian males and females in two junior and two senior high schools provided data on sexual knowledge, attitudes and behaviors, and substance use based on over 2500 anonymous, voluntary self-administered questionnaires. Substance use was high among Caucasians, particularly females. Females smoked more cigarettes than males and men drank more alcohol. Marijuana smoking showed only small racial, age, and gender differences. Compared to Blacks, Caucasians used more hard drugs. Using an index scoring types of substances and frequencies of use, sexually active students were higher than virgins in all subgroups, with those who initiated intercourse early appearing highest on the index. A regression model explaining 21% of the variance in substance use showed independent effects of age, race, gender, and sexual activity. The importance of an index for screening early use is discussed, and research on the relationship of low-level youthful experimentation with future dysfunctional use is proposed.

PIP: A study of inner-city Black and Caucasian males and females in 2 junior and 2 senior US high schools conducted in the period 1981-1984 provided data on sexual knowledge, attitudes and behaviors, and substance use based on over 2500 anonymous, voluntary self-administered questionnaires. Substance use was high among Caucasians, particularly females. Females smoked more cigarettes than males and men drank more alcohol. Marijuana smoking showed only small racial, age, and gender differences. Compared to Blacks, Caucasians used more hard drugs. Using an index scoring types of substances and frequencies of use, sexually active students were higher than virgins in all subgroups, with those who initiated intercourse early appearing highest on the index. A regression model explaining 21% of the variance in substance use showed independent effects of age, race, gender, and sexual activity. The importance of an index for screening early use is discussed, and research on the relationship of low-level youthful experimentation with future dysfunctional use is proposed. The decreased frequency of substance use at age 16 may suggest the importance of the drop-out population, making it especially important to find ways to investigate the hard-to-reach group. An area needing attention is the relationship between older-age partners and school-age females. The incidence of pregnancy was 23.1% for Blacks and 18.9% for Caucasians. Substance use increased with age; among the sexually active it increased more rapidly with age, especially among Caucasians. Substance use was substantially higher among Caucasians than Blacks for both sexes, sexual activity, and age subgroups. Overall substance use was higher among females than among males, at all ages and regardless of race or sexual activity. Substance use was highest among those racial groups whose sexual activity was lowest, and vice versa; at the aggregate level, Caucasian females, with the lowest rate of sexual activity, had the highest rate of substance use. Conversely, Blacks, males even more than females, had higher rates of sexual activity and similarly low rates of substance use.

Adolescent pregnancy-prevention program. A model for research and evaluation.

Despite the increased interest in the effects of adolescent pregnancy-prevention programs, most interventions lack the research design and data essential for evaluation. This article describes a model in which evaluative research was incorporated in program design. The derivation of the model, the selection of measurable parameters, characteristics of the population reflected in baseline and subsequent data, and problems in quantifying and interpreting appropriate variables are discussed. Clinic data and aggregate data from three self-administered surveys is used. The surveys were completed by students in the inner-city junior and senior high schools that cooperated in the education and clinical program. We demonstrate how these two types of data augment one another in assessing program effects. The study explores the evaluation and the timing of change in sexual knowledge, attitudes, and behavior (coital, contraceptive, and clinic) and thus may contribute to the design of measurable, replicable interventions.

Contraceptive method switching among American female adolescents, 1979.

Better knowledge about contraceptive use in adolescents is needed if pregnancy prevention is to be improved. Data from the 1979 National Survey of Young Women were used to examine method switching once contraceptive use had begun among 449 never-pregnant young women who reported premarital intercourse more than once. Bivariate chi2 tests and multivariate logit regression were used to examine factors related to switching in four analyses: overall switching; switching among those with one intercourse partner; and switching from nonmedical and medical methods separately. Frequency of intercourse and type of first method had an interactive effect on switching; length of exposure to switching, type of relationship, and reason for choosing the first method were also significant. These results suggest that providers and educators should consider the circumstances under which contraceptive methods are chosen and used by young women when counseling them as to what method may be best for them.

PIP: Better knowledge about contraceptive use by adolescents is needed if pregnancy prevention is to be improved. Data from the 1979 National Survey of Young Women in the continental US were used to examine method switching once contraceptive use had begun among 449 never pregnant young women who reported premarital intercourse more than once. Bivariate X to the 2nd power tests and multivariate logit regression were used to examine factors related to switching in 4 analyses: 1) overall switching; 2) switching among those with 1 intercourse partner; and 3-4) switching from nonmedical and medical methods separately. The first 2 analyses were also done by race. Analysis of overall switching by race showed that the % of never pregnant young black women who had a switch in either direction was 32.2%, with 39.8% for young white women. With low frequency of intercourse there was no difference in the likelihood of switching between respondents who used a nonmedical and those who used a medical 1st method. For respondents with high frequency, those with a nonmedical 1st method were much more likely to switch than those who used a medical 1st method. Analysis of overall switching for those with 1 sexual partner showed that of the 138 women in this group 29.7% had switched their contraceptive method. Engaged couples were significantly more likely to experience a first switch than those going steady or dating. Analysis of data for switching by type of first method used showed that of the black and white women who used a nonmedical first method, 3992% and 45.9%, respectively, switched from that method. For each race frequency of intercourse and length of exposure were directly related to the likelihood of switching. 21% of all the medical first method users had a contraceptive method switch. Frequency of intercourse and type of first method had an interactive effect on switching; length of exposure to switching, type of relationship, and reason for choosing the first method were also significant. These results show that providers and educators should consider the circumstances under which contraceptive methods are chosen and used by young women when counseling them as to what method may be best for them.

Adolescent sexual attitudes and behavior: are they consistent?

Relationships between sexual attitudes and behavior among adolescents were studied in data collected by self-administered questionnaires from approximately 3,500 junior and senior high school students attending four inner-city schools during 1981-1982. An analysis of the results by sex, race and age found that 83 percent of sexually experienced adolescents cite a best age for first intercourse that is older than the age at which they themselves experienced that event, and 43 percent of them report a best age for first coitus older than their current age. In addition, 88 percent of young women who have had a baby say the best age at which to have a first birth is older than the age at which they first became mothers. Thirty-nine percent of the women and 32 percent of the men say that they believe premarital sex is wrong. Among those who are virgins, the proportions are much higher. However, even among those who have had intercourse, approximately 25 percent of both sexes say they believe sex before marriage is wrong. Women desire stronger relationships before having intercourse than do men, and women claim to have had a stronger relationship with their last sexual partner. Very few teenagers believe neither partner is responsible for pregnancy prevention, which tends to be viewed as a joint responsibility. Those who see it as a shared responsibility are slightly more likely than those who assign the responsibility to one or the other partner to have used a method at last intercourse, and they are considerably more likely to have used a method than are those who believe contraception is neither partner's responsibility.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: Relationships between sexual attitudes and behavior among adolescents were studied in data collected by self-administered questionnaires from approximately 3500 junior ans senior high school students attending 4 inner-city schools during 1981-1982. An analysis of the results by sex, race and age found that 83% of sexually experienced adolescents cite a best age for 1st intercourse that is older than the age at which they themselves experienced that event, and 43% of them report a best age for 1st coitus older than their current age. In addition, 88% of young women who have had a baby say the best age at which to have a 1st birth is older than the age at which they 1st became mothers. 39% of the women and 32% of the men say that they believe premarital sex is wrong. Among those who are virgins, the proportions are much higher. However, even among those who have had intercourse, approximately 25% of both sexes say they believe sex before marriage is wrong. Women desire stronger relationships before having intercourse than do men, and women claim to have had a stronger relationship with their last sexual partner. Adolescents who report that they would have sex only if they were using birth control are more likely to use a method, but almost 25% of those who make this claim say they used no method at last intercourse. Thus, while there is frequently a statistical relationship between the expressed attitude and associated behavior, there is a large minority in each area for whom the behavior and the attitude are clearly at variance.

Contraceptive failure and continuation among married women in the United States, 1970-75.

Using data from the National Survey of Family Growth (NSFG), this study reports differentials in contraceptive use-failure and continuation among married women aged 15-44 years in the United States. Failure rates differed by contraceptive intention. Within categories of intention, these rates differed by method, age, race, and parity. Users of modern methods had higher continuation rates than users of traditional methods. These results indicate that a woman's motivation is an important factor in long-term successful use of available contraceptive methods and that more effective and easier to use methods need to be developed.

PIP: Using data from the National Survey of Family Growth (NSFG), this study reports differentials in contraceptive use failure and continuation among married women aged 15-44 years in the United States. Failure rates differed by contraceptive intention. Within categories of intention, these rates differed by method, age, race, and parity. Users of modern methods (pill, IUD) had higher continuation rates than users of traditional methods. These results indicate that a woman's motivation is an important factor in longterm successful use of available contraceptive methods and that more effective and easier to use methods need to be developed. According to the data, failure levels were 2.5% for the pill (significantly more effective than any of the other methods), 4.8% for the IUD, 9.6% for the condom, 14.4% for the diaphragm, 17.7% for foam, cream, jelly or suppository methods, and 18.8% for the rhythm method. 11.5% of users of other methods such as withdrawal, douche and abstinence, experienced a 1st-year failure. Motivational factors considered include: whether the woman wanted no children (preventers); whether the woman was seeking to postpone a wanted birth (delayers). 4% of preventers had a 1st-year failure compared with 8.3% of delayers. Failure rates for preventers show a strong inverse relationship with age compared to delayers. 27.6% of preventers using the pill were under age 25; only 18.2% of IUD users for prevention were under that age. The rhythm method had the largest difference between preventers and delayers in the likelihood of a 1st-year failure (13.4%), demonstrating the high level of motivation required for effective use of this method. Among white women twice as many delayers as preventers experienced a 1st year failure (8.6% versus 3.9%); black women had the same rate for preventers and delayers (6.2%). Among preventers, black women have a higher failure rate (18.6% versus 9.8%); among delayers, the rate is lower for black women (12.9% versus 17/9%). White women delayers were more likely to use traditional methods than preventers; for black women use of these methods was equally likely for either motivation. Also explored are the continuity of use for each method.

Aryl hydrocarbon hydroxylase activity and microsomal cytochrome content of human fetal tissues.

Aryl hydrocarbon hydroxylase (AHH) and microsomal cytochromes were measured in tissues of human features aborted by prostaglandins. Cytochrome P-450 concentrations and AHH activity were about 4 times higher in adrenal glands than in liver. AHH was present in testes, ovaries, and vagina and uterus at levels equal to or greater than those in the liver. In lung, kidney, and intestines it was present at levels lower than those in the liver. Mean hepatic AHH and hepatic and adrenal cytochromes P-450 and b5 were not significantly different in prostaglandin and hysterotomy abortuses; mean adrenal AHH was significantly lower in prostaglandin abortuses, but the ranges in both groups were overlapping. Neither fetal sex nor maternal cigarette smoking affected hepatic or adrenal AHH activity or microsomal cytochrome concentrations or difference spectra. Hepatic and adrenal AHH activities were concentrated in microsomes and were correlated with microsomal P-450 content. These findings are constant with P-450 mediation of AHH in human fetal tissues. The data demonstrate the utility of prostaglandin abortuses for studies of fetal tissue mixed-function oxidase activity and point to the endocrine glands and target tissues in addition to the liver as potential sites for activating chemical carcinogens and cytotoxins in the human fetus.