Gender attitudes and health risk behaviors in urban African American and Latino early adolescents.

OBJECTIVES: This study examines the association of beliefs about gender differences (frequently termed gender attitudes or attitudes about women in other research) and of beliefs specifically about masculinity to health risk behaviors in minority, urban, early adolescents, in light of the "gender conventionality" hypothesis. METHODS: Data from a self-administered questionnaire assessing gender attitudes and violence-related, substance use, and heterosexual health risk behaviors administered to 587 African American and Latino early adolescents are analyzed. RESULTS: With sociodemographic and family variables controlled, in males violence-related behaviors and substance use are associated with traditional beliefs about masculinity, and heterosexual activity is associated with traditional beliefs about gender differences. In females, being sexually active is positively associated with traditional beliefs about masculinity. CONCLUSIONS: Interventions to reduce health risk behaviors in minority, urban, early adolescents may be more effective if they include greater attention to ways in which gender-related attitudes may play a role in health risk taking.

Understanding changes in sexual activity among young metropolitan men: 1979-1995.

CONTEXT: Changes in the sexual behavior of teenagers can have a significant impact on levels of adolescent pregnancy and transmission of sexually transmitted diseases (STDs). Understanding the role played by attitudes and educational efforts will provide critical prevention information. METHODS: Data on the sexual behavior, sexual attitudes, educational experiences and demographics of 2,087 never-married metropolitan males aged 17-19 from the 1979 National Survey of Young Men and the 1988 and 1995 waves of the National Survey of Adolescent Males were analyzed through multivariate methods to examine factors that predict sexual behavior as well as those that predict sexual attitudes. RESULTS: The percentage of males aged 17-19 who had ever had sex increased from 66% in 1979 to 76% in 1988 and then decreased to 68% in 1995. The frequency of sexual intercourse in the year prior to the survey increased significantly over time, although the lifetime number of sexual partners did not. Acceptance of premarital sex increased significantly from 1979 to 1988, then decreased significantly from 1988 to 1995. Over time, young men were increasingly likely to prefer having and supporting a baby to marriage, abortion or adoption as the resolution to a nonmarital pregnancy. Trends in attitudes were strongly associated with sexual behaviors, with more conservative attitudes predicting less sexual activity. AIDS education, which was nearly universal in 1995, was associated with decreased sexual activity, although not among black youths. CONCLUSIONS: More conservative sexual attitudes and increased exposure to AIDS education are key predictors of decreased sexual activity among adolescent males. However, broader societal factors, such as fear of AIDS and increased awareness of problems associated with teenage pregnancy and STDs, may underlie both attitudinal and behavioral changes.

PIP: This study examined how attitudes about sex behavior and exposure to AIDS education have affected premarital sexual behavior among urban teenage (Black and non-Black) males aged 17-19 years in 1979, 1988, and 1995 in the US. Data were obtained from a 1979 National Survey of Young Men and the 1988 and 1995 National Surveys of Adolescent Males. The weighted pooled data set included 2087 never-married males aged 17-19 years. The percentage of those who had experienced sexual intercourse (SI) rose from 66% to 76% and then declined to 68% in 1995. For Black male youths, SI rates remained stable after 1988. The percentage with recent SI in the 4 weeks before the survey rose from 40% to 45% in 1979 and 1988, and then declined to 39% in 1995. The average number of female sexual partners (FSPs) was 4. The average number of FSPs declined among non-Blacks--from 3.8 in 1979 to 2.9 in 1995--and increased among Blacks--from 5.1 in 1979 to 6.9 in 1995. SI frequency during the prior year rose significantly from 14 encounters/year in 1979 to 21 in 1995. Among Black adolescents, SI frequency rose from 13 encounters/year in 1988 to 24 in 1995. Approval of nonmarital sex without an intention to marry followed similar increases and declines as for SI. Attitudes about premarital sex were strongly correlated with recent sexual activity. Teenagers who had received education about STDs or AIDS were significantly less likely to report having had recent SI. Birth control education and race were unrelated to sex behavior. Blacks were more supportive of marriage for nonmarital pregnancy in 1979. Black attitudes toward premarital sex grew more conservative. Less sexual activity is attributed, in part, to prevalence of AIDS education (except for Blacks) and more conservative attitudes, with unknown other factors.

Changes in sexual behavior and condom use among teenaged males: 1988 to 1995.

OBJECTIVES: This study examines shifts in sexual experience and condom use among US teenaged males. METHODS: Results from the 1988 and 1995 National Surveys of Adolescent Males were compared. RESULTS: The proportion of never-married 15- to 19-year-old males who had had sex with a female declined from 60% to 55% (P = .06). The share of those sexually active using a condom at last intercourse rose from 57% to 67% (P < .01). Overall, the proportion of males who had sex without condoms last year declined from 37% to 27% (P < .001). CONCLUSIONS: Although protective behaviors among teenagers have increased, significant proportions of teenagers--especially Black and Hispanic males--remain unprotected.

Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology.

Surveys of risk behaviors have been hobbled by their reliance on respondents to report accurately about engaging in behaviors that are highly sensitive and may be illegal. An audio computer-assisted self-interviewing (audio-CASI) technology for measuring those behaviors was tested with 1690 respondents in the 1995 National Survey of Adolescent Males. The respondents were randomly assigned to answer questions using either audio-CASI or a more traditional self-administered questionnaire. Estimates of the prevalence of male-male sex, injection drug use, and sexual contact with intravenous drug users were higher by factors of 3 or more when audio-CASI was used. Increased reporting was also found for several other risk behaviors.

Change in job and marital experiences and change in psychological distress: a longitudinal study of dual-earner couples.

Are changes in job quality more closely linked to changes in distress for men than for women? Conversely, are changes in marital quality more closely linked to changes in distress for women than for men? These questions were addressed in a longitudinal analysis of a random sample of 210 full-time employed dual-earner couples. Change over time in job role quality was significantly associated with change over time in distress, and the magnitude of the relationship differed little, if at all, by gender. In contrast, change over time in marital role quality was also associated with change in distress, but the magnitude of the association depended on gender. Among full-time employed married women, change in marital experience was more closely linked to change in distress than among their husbands.

When we use condoms and why we stop.

PIP: A recent follow-up of the 1988 National Survey of Adolescent Men suggests fairly regular patterns of condom use and nonuse. The 1991-92 follow-up survey collected data on 1676 young men who also participated in the first survey round in 1988 when they were 15-19 years old. 59% of the men aged 17-18 used condoms the first time they had sex with a new partner, with 55% reporting using a condom at most recent intercourse. Once they reached 21-22 years old, however, only 45% and 35% reported using condoms at first and most recent intercourse. The prevalence of condom use therefore declined in this sample over the course of a relationship and as young men in the sample grew older. Study findings suggest that condom use does not decline because men lose the habit of using condoms over time, but because the characteristics of partners and the nature of relationships tend to change as men age. More precisely, men spend more time in longer, more committed relationships, in which condom use is more likely to be perceived as unnecessary for disease prevention and more likely to be replaced by the pill for pregnancy prevention. One particularly salient finding is that the men were less likely to report condom use with partners perceived to be at high risk for HIV/AIDS. When asked the main reason for using a condom the last time they had intercourse, 83% of men in the follow-up survey who had used a condom in the previous two years said they did so to prevent pregnancy, 12% did so to prevent diseases, 2% for both reasons, and 3% because of a partner's insistence.^ieng

The dynamics of young men's condom use during and across relationships.

According to data from the 1991 National Survey of Adolescent Males, condom use is likely to be highest at the beginning of relationships and to decline as the relationship continues. The proportion of sexually active men aged 17-22 who used a condom with their most recent partner declined from 53% the first time they had intercourse with that partner to 44% at the most recent episode. Condom use also decreases with age; 59% of 17-18-year-olds used a condom the first time they had intercourse with their most recent partner, compared with 56% of 19-20-year-olds and 46% of 21-22-year-olds. However, the probability that the female partner used the pill the first time that the couple had sex increased with the man's age--from 21% among 17-18-year-olds to 35% among 21-22-year-olds. Young men were more likely to have used a condom if they thought their partner was sexually inexperienced, and less likely to have done so if they suspected their partner was at high risk for an STD.

Factors influencing first intercourse for teenage men.

Analyses of a nationally representative survey of 1,880 15- to 19-year-old men were conducted to examine factors associated with (a) the age when first sexual intercourse occurred and (b) whether a condom or other contraceptive method was used at first intercourse. Discrete time-event history models assessed factors influencing their age until first intercourse. Black males began sexual activity significantly earlier than white or Hispanic males. Males who had been held back in school also began sexual activity earlier. If a respondent's mother had been a teenager when she first gave birth, or if his mother was employed during his childhood, he was more likely to initiate intercourse early. A variety of combinations of AIDS and sex education topics were examined for their association with one's age at the time of first intercourse: two topics were associated with earlier intercourse, and one was associated with delays in first intercourse. Logistic regression models examined correlates of using a condom or any effective male or female method of contraception at first intercourse: having received education about birth control was marginally associated with increased probability of using a condom or any effective male or female contraceptive method at first intercourse. These findings indicate the relevance of integrated approaches to school-based sex and AIDS education in delaying intercourse and promoting use of contraceptive methods.

Young men's risk behaviors for HIV infection and sexually transmitted diseases, 1988 through 1991.

OBJECTIVES: This paper analyzes age- and period-related changes in risk behaviors for human immunodeficiency virus (HIV) infection and sexually transmitted diseases among young men in the United States between 1988 and 1991. METHODS: Data were from the 1988 and 1991 waves of the National Survey of Adolescent Males. The 1988 survey was a nationally representative survey of 1880 males aged 15 through 19 years. The 1991 survey was a longitudinal follow-up of 1676 males aged 17 through 22 years. RESULTS: As they aged, the young men increased their levels of sexual activity and decreased their condom use. Period-related changes between 1988 and 1991 were examined by comparing similar cohorts of 17.5- through 19-year-old men: there were signs that sexual activity and intravenous drug injection increased, but condom use did not change significantly. In 1991 51% of the young men said they were occasionally "high" during sex, a state that is related to reduced condom use. CONCLUSIONS: Early progress in fostering safer behaviors among young men slowed and possibly stopped as the nation entered the 1990s. Prevention efforts need to be renewed and should focus on older youth and young adults.

Changes in adolescent males' use of and attitudes toward condoms, 1988-1991.

Data from more than 1,000 sexually active young males interviewed in 1988 for the National Survey of Adolescent Males at ages 15-19 and reinterviewed in 1990-1991 at ages 17-22 show that as the respondents grew older, their condom use declined. Although respondents' attitudes about the effects of condoms on pregnancy risk, partner appreciation, sexual pleasure and embarrassment became more favorable toward condom use over time, their degree of worry about AIDS and their perceived likelihood of getting AIDS declined. When data on males aged 17.5-19 in each time period were contrasted, the level of condom use was found to be essentially constant. Several condom-related attitudes among this age-group had become more favorable, although their perceived risk of acquiring AIDS had diminished. Multivariate analyses revealed that decreased worry about AIDS and increased denial of the seriousness of AIDS were modestly associated with a decline in condom use. Change in condom use was also affected by change in perceived reduction in sexual pleasure and by female partner's appreciation of condom use.

Men and masculinities: scales for masculinity ideology and masculinity-related constructs.

PIP: 11 instruments for assessing beliefs and attitudes about men or masculinity standards (masculinity ideology) and 6 instruments that assess first-person accounts of gender role conflict, stress, or conformity to masculinity ideology are evaluated in this review. The 17 instruments were all developed in the past 2 decades and peer reviewed, and are readily accessible. An introductory section distinguishes between gender ideology and gender orientation and defines the scope of the first set of 11 scales as indexing the extent to which subjects accept the ideas and beliefs used to justify gender roles and relations. The second set of 6 scales focus on how men individually experience their gender. All scales were systematically evaluated according to whether they include items comparing the sexes or concerning gender relations or items assessing attitudes and beliefs about women. Inclusion of these types of items is noted in a table, along with information on whether the authors assumed one dominant form of masculinity, whether subscales were identified, and the psychometric properties of the scale and subscale. The review suggests that measures of gender orientation and measures of gender ideologies are independent and have differential correlates. Evidence also suggests that gender ideologies about men are distinct from and have differential correlates from gender ideologies about women or about gender relations in general. Items comparing genders should thus be avoided in measures of attitude toward masculinities. Several of the measures have too narrow a definition of masculinity.^ieng

The association of AIDS education and sex education with sexual behavior and condom use among teenage men.

According to a 1988 nationally representative survey, most 15-19--year-old men in the United States have received formal instruction about AIDS (73%), birth control (79%) and resisting sexual activity (58%). Results of multivariate analyses show the receipt of AIDS education and sex education to be associated with modest but significant decreases in the number of partners and the frequency of intercourse in the year prior to the survey. Having received instruction in these topics was also associated with more consistent condom use. Instruction in some topics was associated with increases in knowledge and attitudes about AIDS, but these increases were not always correlated with safer behavior.

PIP: Multivariate and 1 and 2-limit to bit models were used to analyze data from 1880 noninstitutionalized, never-married men 15-19 years of age included in the US 1988 National Survey of Adolescent Males (NSAM). Cross-sectional data are compared in order to assess the levels of sexual behavior and condom use after AIDS and sex education. Condom consistency rates were calculated. Race, age, urban residence, annual family income, family receipt of welfare within the last 12 months, religious denomination, school attendance, the state incidence of AIDS/100,000 population, and confirmation of mother's teenage pregnancy were used to control for confounding factors. AIDS knowledge and attitudes were also obtained. The 1-limit tobit model was used to analyzed the number of partners and acts of intercourse. Condom use was analyzed with a 2-limit tobit model. The findings were that there has been widespread receipt of AIDS education and sex education in topics on AIDs, birth control biology, and resistance skills, which accounted for 77% of the variance in the 8 topics and were significantly correlated. The receipt of AIDS education was associated with decreases in the number of sexual partners, after controlling for race, age, religion, and other background variables. AIDS education was responsible for 1) a 4% increase in the proportion of students with recent sexual partners (within the past 12 months); 2) a mean reduction of .12 partners among those with recent sex partner; 3) a 7% decrease in the proportion who had never used condoms; recently sex partner; 4) a 9% increase in the proportion using condoms 100% of the time; and a mean increase of 2% among all who ever used a condom. Age, ethnic group, religion, urban residence, and presence of a teenage mother were significant variables in the analysis of AIDS education effects, and the relationship is indicated. In the analysis of other sex education, only AIDS, resistance skills, and birth control were analyzed. Each topic was associated with an increase in condom use (t = 1.91=1.98 at p = .05). In the ordinary least squares analysis, the association between instruction and behavior was not mediated by changes in knowledge or attitudes. No topic affected the perceived risk of infection. Resistance instruction has a strong independent association with fewer sexual partners and acts of intercourse. An integrated and comprehensive approach to HIV education and sex education is suggested. Self-reporting and selection biases are discussed as limitations.

Patterns of HIV risk and preventive behaviors among teenage men.

Analyses of the 1988 National Survey of Adolescent Males indicate the prevalence of risk behaviors related to acquired immunodeficiency syndrome, including sexual, contraceptive, and drug use behaviors, among 15- to 19-year-old men. About three-fifths had sexual intercourse, indicating that a majority of teenage men have at least some potential exposure to the human immunodeficiency virus (HIV) or sexually transmitted disease. From a behavioral perspective, the average sexually active teenage man used a condom more than half the time in the 12 months before the interview. Those with most experience with sexual intercourse, however, used condoms least frequently. More important from an epidemiologic perspective, a third of all acts of intercourse in the prior year were protected using condoms. Further, behaviors with the greatest direct risks for HIV infection, such as homosexual intercourse, use of intravenous drugs, and sex with intravenous drug users or prostitutes, appear to be relatively uncommon. Teenage men who demonstrate high-risk behavior, including both sexual and substance abuse, compound their risks, because risks generally are correlated. Condom use is a preventive behavior that is negatively correlated with most risk behaviors; those who have multiple partners, or who are substance abusers, tend to use condoms least. The convergence of risks for multi-problem teenage men indicates the relevance of interventions directed to high-risk youths.

Men's changing social roles in the 1990s: emerging issues in the psychiatric treatment of men.

In the last two decades, men's social roles have changed to incorporate the increasing time they spend with their families, their greater concern about adult children's leaving or returning home, and alternative sexual preferences and life-styles. One related development is the increased amounts of psychiatric distress reported by men in recent years. Mental health professionals should be familiar with these and other complex issues specific to men and with how such issues might manifest themselves in psychotherapy.

Levels of sexual activity among adolescent males in the United States.

Although three-fifths of adolescent males aged 15-19 say they have had sexual intercourse, analyses of data from the 1988 National Survey of Adolescent Males indicate that their level of sexual activity is relatively moderate. The data show that among sexually experienced young men the mean number of partners in the last 12 months is 1.9, and the mean frequency of intercourse in the last four weeks is 2.7 times. Black males have had more partners than white or Hispanic males; however, after the number of years since first intercourse are controlled for, these differences disappear. On average, sexually experienced youth spent six out of the last 12 months with no sexual partner, and only 21 percent of sexually active males had more than one partner in any month in the last year. Comparisons with 1979 data suggest that proportionately more adolescents were sexually experienced in 1988, but fewer non-black males had first intercourse before their 15th birthday. The number of partners since first intercourse and in the past four weeks appears to have decreased, as has the frequency of intercourse in the last four weeks.

PIP: Researchers used data on 1880 never married males aged 15-19 years living in the United States collected during the 1988 National Survey of Adolescent Males (NSAM) to gauge heterosexual activity by the number of partners and the frequency of coitus and, when possible, to compare these data with data collected during the 1979 National Survey of Young Men. In 1988, 60% had sexual intercourse at least once, but most of them did not have any partners for 5.87 months and only 21% had 1 relationship at the same time during the last 12 months. 19.8% of young Black males said they had had sexual intercourse by age 13 compared to 2.9 of White males and 3.9 of Hispanic males (p.001). Indeed the cumulative proportion of Black teenagers who had 1st intercourse continued to be significantly greater than those of White and Hispanic teenagers (p.001 for 13-18 years; p.05 for 19 years). Overall male adolescents had an average of 5.11 lifetime sexual partners. The 17-19 year olds in 1988 (6) had significantly fewer lifetime partners than those in 1979 (7.34; p.001). Further, the number fell between 1979-1988 in each age group, but the decrease was only significant for 19 year olds (p.05). The number of partners actually rose for Blacks (9.34-9.99), but fell greatly for Nonblacks (6.87-5.02; p.01). In 1988, Blacks had a mean of 8.3 partners compared to 4.3 for Whites and 5.2 for Hispanics (p.001). The mean number of sexual partners in the last year was significantly greater for Blacks (2.37) than Whites (1.85) and Hispanics (1.57; p.001). The number of partners in the last 4 weeks fell significantly between 1979-1988 (.96 vs. .72; p.05). This decline was essentially due to the substantial drop in partners for Blacks (1.32 vs. .86; p.01). These results indicated that overall the rate of sexual activity is declining and that serial monogamy is the norm for male teenagers who have had 1 partner in the last year.

Contraceptive attitudes and intention to use condoms in sexually experienced and inexperienced adolescent males.

PIP: The 1988 National Survey of Adolescent Males, conducted by the Institute for Survey Research of Temple University, interviewed 1880 never-married males, aged 15-19, over the period April-November 1988. The sample is representative of the noninstitutionalized, never-married male population aged 15-19 in the contiguous US, with young men in college dormitories, military barracks, prisons, and other group quarters excluded from the sampling frame. The sample was stratified to overrepresent Black and Hispanic respondents such that 676 Black males, 386 Hispanic males, and 755 White, non-Hispanic males, as well as 63 males of other races were interviewed. 1244 of the men had experienced sexual intercourse, 421 had not experienced intercourse but intended to do so in the near future, and 159 were sexually inexperienced and intended to remain so for some time. Sexually inexperienced respondents who did not intend to have sex are omitted from the analysis. 58.3% of the sexually experienced males and 58.0% of the inexperienced males intending to have sex in the next year reported being almost certain that they would use a condom with an hypothetical future partner. Sexually experienced males reported lower perceived costs for condom use related to embarrassment than did the inexperienced males. Experienced males, however, perceive condoms as being more costly in terms of reducing pleasure. The perceived benefits of using condoms in terms of preventing pregnancy and gaining appreciation from the partner, as well as attitudinal endorsement of male responsibility in contraception more generally, are similar for the two groups. Believing that males are responsible for contraception and perceiving condoms to have low costs in terms of reducing pleasure and high benefits in gaining the partner's appreciation influence intent to use a condom. Attitudes discounting the risk of AIDS reduced intended condom use in both groups. For the sexually inexperienced, urban residence, high educational aspirations, and self-esteem were also associated with the intention to use a condom. For experienced respondents, condom use at last intercourse, not being Hispanic, holding religion to be important, liberal attitudes about the male sex role, and worry about AIDS also predict intended condom use.^ieng

Sexual activity, condom use and AIDS awareness among adolescent males.

New data from the 1988 National Survey of Adolescent Males indicate that 60 percent of never-married young men ages 15-19 are sexually active. Among 17-19-year-old males living in metropolitan areas, the rate of sexual activity reported in 1988 was 15 percent higher than that reported in 1979. This increase encompasses a rise of 23 percent among black males and 13 percent among nonblack males. Slightly more than half of the sexually active males in the 1988 survey reported that they had used a condom the last time they had had intercourse. Among both black and nonblack youths aged 17-19 living in metropolitan areas, rates of reported condom use at last intercourse more than doubled between 1979 and 1988. Conversely, reported reliance on ineffective methods of contraception or use of no method at last intercourse was 60 percent lower. When first intercourse occurred within two years of the 1988 survey, the odds of using a condom were increased by 110 percent over the odds when intercourse occurred between 1975 and 1982, after controlling for the effects of age at first intercourse, race and ethnicity. The young men in the sample were very knowledgeable about how the human immunodeficiency virus is transmitted, and over three-quarters of the sample did not dismiss the disease as uncommon, nor did they think that using condoms to prevent the spread of AIDS was too much trouble. The rates of condom use were significantly lower than average, however, among young men who had ever used drugs intravenously or whose partners had done so, young men who had ever had sex with a prostitute and those who had had five sexual partners or more in the past year.

Adolescent males' sexual behavior and contraceptive use: implications for male responsibility.

PIP: A recent US survey of single 17-21 year old men, indicated that 17.1% used a condom at 1st intercourse and 15.5% used a condom at the most recent intercourse. Withdrawal is also used: 10.0% and 7.4% respectively. Condom use was correlated with being older at 1st intercourse, having a higher educational level, closer association to partner, and sense of male contraceptive responsibility. The data used for this analysis was taken from a sub-sample of 624 sexually active males in 1979. The mean age at 1st intercourse was 14.8 years and mean age at most recent was 18.9 years. The pill was also used at 1st intercourse (8.8%) and a total of 43.5% used some method of contraception. In the most recent intercourse cases, 64.7% used some method of birth control and the pill was used 26.5% , condom 15.5%, and withdrawal 7.4%. Conclusions from this data indicate that male methods are important in teen contraception. Condom use at 1st and most recent intercourse was related to both positive and negative characteristics. It appears that males show some contraceptive responsibility initially but later give the responsibility to females. The declining use of condoms indicates it to be a transitional form of birth control. Programs should promote continued use of condoms since use of the pill is low and unwanted pregnancy risk is high. Communication on contraception should be encouraged, so both partners are aware if neither one is contracepting. With the acquired immunodeficiency syndrome epidemic, condom use takes on a whole new context in relation to the decline in use by adolescents.^ieng

AIDS-phobia, contact with AIDS, and AIDS-related job stress in hospital workers.

In a survey of 237 hospital workers involved in the care of AIDS patients at a major AIDS inpatient-care facility, negative attitudes toward AIDS and AIDS patients (AIDS-phobia) and AIDS-related job stress (AIDS-stress) were common. In multivariate analyses, AIDS-phobia is significantly higher among older staff, those having low contact with AIDS patients (AIDS-contact), and those holding homophobic attitudes. AIDS-phobic attitudes and low AIDS-contact can be interpreted as predicting each other. Finally, AIDS-stress is predicted by low contact with AIDS and AIDS-phobic attitudes.