National Needs of Family Planning Among US Men Aged 15 to 44 Years.

OBJECTIVES: To estimate national need for family planning services among men in the United States according to background characteristics, access to care, receipt of services, and contraception use. METHODS: We used weighted data from the 2006-2010 National Survey of Family Growth to estimate the percentage of men aged 15 to 44 years (n = 10 395) in need of family planning, based on sexual behavior, fecundity, and not trying to get pregnant with his partner. RESULTS: Overall, 60% of men were in need of family planning, defined as those who ever had vaginal sex, were fecund, and had fecund partner(s) who were not trying to get pregnant with partner or partner(s) were not currently pregnant. The greatest need was among young and unmarried men. Most men in need of family planning had access to care, but few reported receiving family planning services (< 19%), consistently using condoms (26%), or having partners consistently using contraception (41%). CONCLUSIONS: The need for engaging men aged 15 to 44 years in family planning education and care is substantial and largely unmet despite national public health priorities to include men in reducing unintended pregnancies.

Family Planning and Preconception Health Among Men in Their Mid-30s: Developing Indicators and Describing Need.

The Centers for Disease Control and Prevention and Healthy People 2020 call for improvements in meeting men's reproductive health needs but little is known about the proportion of men in need. This study describes men aged 35 to 39 in need of family planning and preconception care, demographic correlates of these needs, and contraception use among men in need of family planning. Using data from Wave 4 (2008-2010) of the National Survey of Adolescent Males, men were classified in need of family planning and preconception care if they reported sex with a female in the last year and believed that they and their partner were fecund; the former included men who were neither intentionally pregnant nor intending future children and the latter included men intending future children. Men were classified as being in need of both if they reported multiple sex partners in the past year. About 40% of men aged 35 to 39 were in need of family planning and about 33% in need of preconception care with 12% in need of both. Current partner's age, current union type, and sexually transmitted infection health risk differentiated men in need of family planning and preconception care (all ps < .01) and participants' race/ethnicity further differentiated men in need of preconception care (p < .01). More than half of men in need of family planning reported none of the time current partner hormonal use (55%) or condom use (52%) during the past year. This study identified that many men in their mid-30s are in need of family planning or preconception care.

Men Aged 15-44 in Need of Preconception Care.

OBJECTIVES: Preconception care for men focuses on prevention strategies implemented prior to conception of a first or subsequent pregnancy to improve pregnancy and infant outcomes. Little is known about U.S. men in need of preconception care. This analysis describes the proportion of men in need of preconception care and associations of these needs by background characteristics, related health conditions, access to care and receipt of services. METHODS: Data from men aged 15-44 in the National Survey of Family Growth 2006-2010 were analyzed to describe men in need of preconception care, based on future childbearing intentions and self and partner fecundity status (among sexually experienced only), and associated factors with these needs using weighted bivariate analyses. RESULTS: About 60 % of men are in need of preconception care. Higher prevalence of being in need was observed among men aged 15-29 than older; living in urban than non-urban settings; in school than not in school regardless of working status; not in a coresidential union than married or cohabiting; who were recent immigrants than U.S. born; and reporting never having had a child than ≥1 child(ren). Men in need were overweight/obese (56 %), ever binge drank in the last year (58 %), and have high STI risk (21 %). The majority of men in need reported access to care in the last year (>70 %), but few reported receipt of services including STD/HIV testing (<20 %) or counseling (<11 %). CONCLUSIONS FOR PRACTICE: Findings from this analysis have implications for promoting preconception care among U.S. men.

Union status and sexual risk behavior among men in their 30s.

CONTEXT: Understanding the relationship between union status and men's sexual risk behavior in their 30s is important to ensure appropriate reproductive health services for men in middle adulthood. METHODS: Data from 1,083 men aged 34-41 who participated in the 2008-2010 wave of the National Survey of Adolescent Males were used to examine differentials in sexual risk behaviors by union status, past risk behavior and selected characteristics. Bivariate tabulations were done to assess relationships between current risk behavior and background variables, multinomial regression analysis was conducted to identify associations between union status and past risk behavior, and logistic regression analysis was used to assess associations between current behavior and both union status and past behavior. RESULTS: Eight percent of men in their 30s had had three or more sexual partners in the last 12 months, 10% had had at least one risky partner and 8% had had concurrent partners. Men living outside co-residential unions reported higher levels of these behaviors (24%, 29% and 24%, respectively) than did married men (1-2%) or cohabiting men (7-12%). In multivariate analyses that controlled for past risk behavior, married men were less likely than cohabiting men to have had at least one risky partner or concurrent partners in the last year (odds ratio, 0.2 for each), while men who were not in a co-residential union had an increased likelihood of reporting each risk behavior (2.2-5.3). CONCLUSIONS: Men in their 30s, especially those who are not married, engage in risky sexual behaviors. Further studies are needed to assess what contributes to behavioral differences by union status and what types of services might help men in this age-group reduce their risk.

The Transmission of Parenting from Fathers to Sons.

OBJECTIVE: We address the extent to which parenting practices of fathers and mothers are associated with their sons' parenting behaviors as young adults and whether adolescent behavior explains this association. DESIGN: Data come from 409 young men interviewed in the 2006 Young Adult study of the 1979 National Longitudinal Survey of Youth. RESULTS: Men whose fathers were positively involved with them when growing up report more positive parenting of their own children, a direct effect. Less harsh mothering and more positive fathering are associated with reduced adolescent behavior problems, and positive mothering is associated with positive adjustment of these young men as adolescents. However, neither adolescent problem behavior nor positive adjustment is associated with young men's fathering of their own children, and thus does not explain the association between the fathering young men received and their own fathering behavior. CONCLUSIONS: Men's parenting of their sons can have a long-term direct effect on how their sons parent their own children. Although parenting is associated with both positive and negative behaviors of sons during adolescence, these adolescent behaviors are not directly linked to later parenting behavior when sons have their own children. More research is needed to examine mediation mechanisms for the intergenerational transmission of parenting.

Pathways of early fatherhood, marriage, and employment: a latent class growth analysis.

In the National Longitudinal Survey of Youth 1979 (NLSY79), young fathers include heterogeneous subgroups with varying early life pathways in terms of fatherhood timing, the timing of first marriage, and holding full-time employment. Using latent class growth analysis with 10 observations between ages 18 and 37, we derived five latent classes with median ages of first fatherhood below the cohort median (26.4), constituting distinct early fatherhood pathways representing 32.4% of NLSY men: (A) Young Married Fathers, (B) Teen Married Fathers, (C) Young Underemployed Married Fathers, (D) Young Underemployed Single Fathers, and (E) Young Later-Marrying Fathers. A sixth latent class of men who become fathers around the cohort median, following full-time employment and marriage (On-Time On-Sequence Fathers), is the comparison group. With sociodemographic background controlled, all early fatherhood pathways show disadvantage in at least some later-life circumstances (earnings, educational attainment, marital status, and incarceration). The extent of disadvantage is greater when early fatherhood occurs at relatively younger ages (before age 20), occurs outside marriage, or occurs outside full-time employment. The relative disadvantage associated with early fatherhood, unlike early motherhood, increases over the life course.

Racial and ethnic disparities in sexual risk behaviors and STDs during young men's transition to adulthood.

CONTEXT: Racial and ethnic health disparities are an important issue in the United States. The extent to which racial and ethnic differences in STDs among youth are related to differences in socioeconomic characteristics and risky sexual behaviors requires investigation. METHODS: Data from three waves of the National Survey of Adolescent Males (1988, 1990-1991 and 1995) were used to examine 1,880 young men's history of STDs and their patterns and trajectories of sexual risk behavior during adolescence and early adulthood. Multinomial and logistic regression analyses were conducted to test whether racial and ethnic differences in STDs are due to the lower socioeconomic status and higher levels of risky sexual behavior among minority groups. RESULTS: Young black men reported the highest rates of sexual risk and STDs at each wave and across waves. Compared with white men, black and Latino men had higher odds of maintaining high sexual risk and increasing sexual risk over time (odds ratios, 1.7-1.9). In multivariate analyses controlling for socioeconomic characteristics, black men were more likely than white men to have a history of STDs (3.2-5.0); disparities persisted in analyses controlling for level of risky sexual behavior. CONCLUSIONS: Race and ethnicity continue to differentiate young black and Latino men from their white peers in terms of STDs. Prevention programs that target different racial and ethnic subgroups of adolescent men and address both individual- and contextual-level factors are needed to curb STD incidence.

Associations of Family and Peer Experiences with Masculinity Attitude Trajectories at the Individual and Group Level in Adolescent and Young Adult Males.

Data were drawn from 845 males in the National Survey of Adolescent Males who were initially aged 15-17, and followed-up 2.5 and 4.5 years later, to their early twenties. Mixed-effects regression models (MRM) and semiparametric trajectory analyses (STA) modeled patterns of change in masculinity attitudes at the individual and group levels, guided by gender intensification theory and cognitive-developmental theory. Overall, men's masculinity attitudes became significantly less traditional between middle adolescence and early adulthood. In MRM analyses using time-varying covariates, maintaining paternal coresidence and continuing to have first sex in uncommitted heterosexual relationships were significantly associated with masculinity attitudes remaining relatively traditional. The STA modeling identified three distinct patterns of change in masculinity attitudes. A traditional-liberalizing trajectory of masculinity attitudes was most prevalent, followed by traditional-stable and nontraditional-stable trajectories. Implications for gender intensification and cognitive-developmental approaches to masculinity attitudes are discussed.

Men's Work Efforts and the Transition to Fatherhood.

In this paper we tested three hypotheses: (a) the transition to fatherhood is associated with an increase in work effort; (b) the positive association (if any) between the transition to fatherhood and work effort is greater for fathers who are married at the time of the transition; and (c) the association (if any) is greater for men who make the transition at younger ages. The data are from the National Longitudinal Survey of Youth 1979 Cohort. The transition to fatherhood was associated with an increase in work effort among young unmarried men, but not for married men. Among married men who were on-time fathers, work effort decreased. Among childless men, the marriage transition was associated with increased work effort.

What are the consequences of relying upon self-reports of sexually transmitted diseases? Lessons learned about recanting in a longitudinal study.

PURPOSE: Self-reports are the standard measure of STD history used in survey research. We explored to what extent self-reports of ever having an STD are recanted in a follow-up data collection. METHODS: Using the National Survey of Adolescent Males (NSAM), we assessed consistency over time in self-reports of ever having an STD in a sample of young men transitioning from adolescence to young adulthood (aged 15-26 years), a population in which STDs are particularly prevalent. RESULTS: Approximately 7% of all sexually experienced young men rescinded STD self-reports over time. Thus, self-reports at one point in time likely underestimate true STD history, using earlier self-reports as the criterion. Among men who ever report an STD, 94-98% recant their reports in later waves. CONCLUSIONS: Knowledge of the extent of underreporting can potentially be used to adjust cross-sectional estimates of STDs based on survey self-reports. These study findings move us one step closer to estimating just how much underreporting of STDs in self-reports is.

Changes in sexual risk behavior as young men transition to adulthood.

CONTEXT: Understanding how young men's sexual risk behaviors change during the transition from adolescence to early adulthood is important for the design and evaluation of effective strategies to reduce the transmission of HIV and other STDs. METHODS: Data from three waves of the National Survey of Adolescent Males (1988, 1991 and 1995) were used to categorize 1,880 respondents into clusters according to sexual risk behaviors. Univariate and bivariate analyses were conducted to assess associations between clusters and rates of self-reported STD diagnoses and positive chlamydia tests. RESULTS: Two dimensions of sexual risk-taking defined the clusters: partner characteristics and condom use. More than 50% of men remained in low-risk groups over time. In the first two waves, 24-32% of men reported engaging in high-risk behaviors (risky partners, condom nonuse); these behaviors were associated with elevated levels of STD outcomes. Nearly 40% of men who entered a high-risk group in the first two waves transitioned to a lower risk group by the third wave. Nine percent of men either engaged in increasingly risky behaviors or maintained membership in high-risk groups; elevated STD rates characterized both trajectories. Low condom use combined with having multiple partners during adolescence was associated with elevated STD rates in the year preceding the third wave; high condom use coupled with having risky partners was not. CONCLUSIONS: The prominence of low-risk behaviors over time suggests that most young men avoid sexual risk-taking. Effective strategies to reduce HIV and STD risk in young men must simultaneously address multiple dimensions of sexual behavior.

Mother Involvement as an Influence on Father Involvement with Early Adolescents.

This study hypothesized that father involvement is influenced by mothers' level of involvement as well as by marital conflict, mothers' work hours, and fathers' status as biological or step father. The analysis also tested hypotheses about mother involvement as a potential mediator of the effects of marital conflict and maternal work hours on father involvement, and hypotheses about factors influencing mother involvement. Children aged 10-14 from the NLSY79 who resided with their biological or step father and with their mother reported on each parent's involvement with them. As hypothesized, father involvement was predicted by mother involvement, and the reciprocal influence was not significant. Father involvement was associated with low marital conflict and being a biological father. Mothers' involvement partially mediated the effects of marital conflict on father involvement. If the mediating role of maternal involvement is not taken into account, the effect of marital conflict on father involvement is overestimated.

Masculine beliefs, parental communication, and male adolescents' health care use.

OBJECTIVES: Male adolescents frequently become disconnected from health care, especially as they get older, which limits physicians' abilities to address their health needs and results in missed opportunities to connect them to the health care system as they enter adulthood. In this study we tested the ability of modifiable (beliefs about masculinity, parental communication, sex education, and health insurance) and nonmodifiable (age, race/ethnicity, and region of residence) factors to prospectively predict health care use by male adolescents. PATIENTS AND METHODS: We conducted a prospective analysis of data from 1677 male participants aged 15 to 19 years who completed the National Survey of Adolescent Males, a household probability survey conducted throughout the United States in 1988 (wave 1, participation rate: 74%) and in 1990-1991 (wave 2, follow-up rate: 89%). We present percentages and adjusted relative risks of the factors that predict male adolescents' self-report of a physical examination by a regular provider in the past year measured at wave 2. RESULTS: On average, 1067 (66%) of 1677 male adolescents at wave 2 reported having a physical examination within the last year. Factors associated with a lower likelihood of a physical examination included living in the South, Midwest, and West; being older in age; and holding more traditional masculine beliefs. Factors associated with a higher likelihood of a physical examination included communicating about reproductive health with both parents and being insured. Male adolescents who were sexually active or engaged in > or = 2 other risk behaviors had neither a higher nor lower likelihood of a physical examination. CONCLUSIONS: Efforts to enhance male adolescents' health through health care should include work to modify masculine stereotypes, improve mothers' and fathers' communication about health with their sons, expand health insurance coverage, and identify interventions to connect male adolescents at increased risk for health problems with health care.

Friendship interactions in children with and without depressive symptoms: observation of emotion during game-playing interactions and post-game evaluations.

This observational study supplements the strong and consistent link found between childhood depression and deficits in interpersonal functioning by examining the relationship between a high versus low score on the Children's Depression Inventory (CDI) and children's emotions when interacting with their best friends. High-CDI and low-CDI target children (n=86) were paired for videotaped game-playing with self-reported best friends. Researchers found that although high-CDI target children were not distinguishable from low-CDI peers in their displays of positive and negative emotion. However, the partners of high-CDI target children displayed significantly more negative emotion during the competitive task and significantly less positive emotion during the cooperative task than did partners of low-CDI target children. In addition, high-CDI target children and their partners reported less enjoyment of their interactions than low-CDI target children and their partners. This combination of findings suggests that depressive symptoms were associated with a relative lack of success achieving an optimal friendship interaction even under highly favorable conditions.

Long-term reductions in sexual initiation and sexual activity among urban middle schoolers in the reach for health service learning program.

PURPOSE: To evaluate the sustained effectiveness of a middle school service learning intervention on reducing sexual initiation and recent sex among urban African-American and Latino adolescents from 7th grade through the 10th grade. METHODS: During the fall of seventh grade and again in eighth grade, students were randomly assigned by classroom to participate either in community youth service (CYS) or not (controls). Service learning is an educational strategy that couples meaningful service in the community with classroom instruction. Students in both intervention and control conditions received classroom health lessons. Surveys were conducted at seventh grade baseline and at the end of 10th grade, approximately 2 years after intervention. Self-reported sexual behaviors of youths who had participated in CYS were compared with those of controls receiving classroom curriculum alone (n = 195). RESULTS: CYS participants were significantly less likely than controls to report sexual initiation (2 years CYS, odds ratio [OR] = 0.32; 1 year, OR = 0.49) as well as recent sex (2 years CYS, OR = 0.39; 1 year CYS, OR = 0.48). Among those who were virgins at seventh grade, 80% of males in the curriculum-only condition had initiated sex, compared with 61.5% who received 1 year of CYS, and 50% who received 2 years. Among females, the figures were 65.2%, 48.3%, and 39.6%, respectively. CONCLUSION: A service learning intervention that combines community involvement with health instruction can have a long-term benefit by reducing sexual risk taking among urban adolescents.