Contextual influences on school provision of health services.

PURPOSE: To examine contextual factors that may facilitate or impede the provision of school health services. METHODS: Using a composite database derived primarily from the National Longitudinal Study of Adolescent Health, we used logistic regression to examine how selected characteristics of communities, schools, and state-level policies are related to the provision of specific health services by high schools. RESULTS: Schools whose students experienced more health risks were generally more likely to provide related services than schools whose students experienced fewer risks. State policies and requirements for health-related programs and services were associated with greater school-based provision of services. Availability of health care services within the community was associated with a reduced likelihood that schools provided similar services on-site; however, for some health services, the reverse was true. In general, more affluent communities were more likely to provide school health services than less affluent communities. Public schools were more likely to offer health services than private schools. CONCLUSIONS: Certain characteristics of communities, schools, and state-level policies are associated with the provision of school health services. These contextual factors appear to operate by creating a demand for services and by creating the opportunity for schools to provide health services.

Men's behavior change following infection with a sexually transmitted disease.

An analysis of data on 20-39-year-old men participating in the 1991 National Survey of Men finds that of 466 respondents who had ever had a sexually transmitted disease (STD), 25% had sex while infected. However, 85% of these men informed their partner of their infection before having intercourse. Black men were significantly less likely than whites to have had sex while infected. Overall, 29% of men with an STD did not modify their sexual behavior or condom use. Blacks, married men and men who were affiliated with a religious group were less likely than whites, single men and those with no religious affiliation to maintain the same behavior subsequent to the diagnosis of an STD infection as before. Black men were more likely than whites to start using condoms; blacks, religious men, less-educated men and those who were older when they had their first sexual experience were the most likely to stop having sex with casual partners once they learned that they were infected with an STD.

PIP: The effects of individual characteristics on the likelihood that a man will modify risk-related sexual behaviors once he learns he is infected with a sexually transmitted disease (STD) were investigated through use of data from the 1991 US National Survey of Men. Of the 3321 men 20-39 years of age (1238 Blacks and 2083 Whites) interviewed for the survey, 494 (15%) reported ever having had an STD; 298 men had gonorrhea. 25% of men with an STD (13% of those with gonorrhea) had had sex while they were infected, but 85% (86% of men with gonorrhea) informed their partners in advance of intercourse that they had an STD. 70% of those with infection (76% of those with gonorrhea) returned to the clinic to be retested for the disease. Overall, 29% of men (22% of those with gonorrhea) had not modified their sexual behavior or condom use in response to an STD diagnosis. Black men were significantly less likely than Whites to have had sex while infected--and also less likely to inform their partner they were infected--and more likely to have stopped having sex with casual partners and to have begun condom use. Blacks, religious men, less educated men, and those who were older when they had their first sexual experience were the most likely to stop having sex with casual partners once they learned they were infected with an STD. Overall, Blacks, married men, and those who were affiliated with a religious group were less likely than Whites, single men, and those with no religious affiliation to maintain the same behavior subsequent to diagnosis of an STD. These findings provide a useful starting point for the understanding of the dynamics of STD transmission and the design of prevention programs.

Men's perceptions of their roles and responsibilities regarding sex, contraception and childrearing.

Data from the 1991 National Survey of Men examine men's perceptions about their roles in relation to those of women in a couple's decision-making about sex, contraception and the rearing of children. A majority of men (61%) perceive that there is gender quality in sexual decision-making, and more than three-quarters (78%) believe that men and women share equal responsibility for decisions about contraception. However, men are three times as likely to say that women play a greater role in a couple's decisions about sex as they are to believe that men have the greater voice (30% compared with 9%). In contrast, men are more than twice as likely to perceive than men have a greater responsibility in contraceptive decisions as they are to say that women do (15% compared with 7%). Finally, 88% of men strongly agree that a man has the same responsibilities as a woman for the children they have together.

PIP: Despite the importance of male participation in efforts to prevent pregnancy and sexually transmitted diseases, there has been little research on men's perceptions of their role in decision making about sex and contraception. To address this void, data on the 2526 (958 Black and 1568 White) men who were in a heterosexual relationship at the time of the 1991 US National Survey of Men interview were analyzed. 66% of these men were married and 11% were cohabiting. Respondents were asked to indicate the strength of their agreement with five statements: it is generally the man who decides whether or not the couple will have sex; it is generally the woman who decides whether or not the couple will have sex; it is a woman's responsibility to make decisions about using birth control; it is a man's responsibility to make decisions about using birth control; and men have the same responsibility as women for the children they father. Gender equality was favored by 60.8% of men in decisions about whether the couple will have sex, by 78.2% in decisions about contraception, and by 87% for child raising responsibilities. Men with nonegalitarian orientations were three times as likely to perceive females as opposed to males as dominating decisions about the timing of sex (30% and 9%, respectively). On the other hand, they were twice as likely to believe that men have greater responsibility than women in contraceptive decisions (15% and 7%, respectively). Men who felt women should bear primary responsibility for contraception were significantly more likely to be older, Black, have a Hispanic partner, be less educated, or have a highly educated partner than those with an egalitarian orientation.

Gender, race, class and self-reported sexually transmitted disease incidence.

Multivariate analysis of data from two nationally representative surveys of adult men and women indicates that the likelihood of a self-reported sexually transmitted disease (STD) infection varies by gender, race and socioeconomic status, even after accounting for differences in sexual and health care behaviors. Women and black respondents are more than three times as likely to report an STD infection as men and white respondents; men and women with 12 or fewer years of education are about 30% less likely than those with more schooling to report having had an STD. Income, welfare status and access to health care have no significant association with self-reported STD incidence, but sexual behavior is strongly related. Men and women who have engaged in anal intercourse, have paid for sex or have had one-night stands are significantly more likely than those who avoid these behaviors to report an STD. Further, the likelihood of an STD dramatically increases with the lifetime number of sex partners reported: Compared with men and women who have had only one partner, those who report 2-3 partners are five times as likely to have had an STD; the odds are as high as 31:1 for those who report 16 or more partners.

PIP: Multivariate analysis of data from two nationally representative surveys of adult men and women in the US indicate that the likelihood of a self-reported sexually transmitted disease (STD) infection varies by gender, race and socioeconomic status, even after accounting for differences in sexual and health care behaviors. The data used in this analysis were obtained from the National Survey of Men (NSM) and the National Survey of Women (NSW), both conducted in 1991. The NSM was based on a multistage, stratified, clustered, disproportionate area probability sample of households in the contiguous United States. The sample consisted of 20-39 year old men. In-person interviews were conducted with 3321 men, 70% of the eligible sample. The NSW sample, consisting of 1669 women 20-37 years old comprised 2 subsamples, both based on a multistage, stratified, clustered area probability design. The combined sample used in this analysis included 3321 men (1238 Blacks and 2083 members of other racial groups) and 1669 women (728 Blacks and 941 others). A dichotomous measure of whether or not the respondent has ever had an STD was the principal variable. Women and Black respondents were more than 3 times as likely to report an STD infection as men and White respondents (p 0.01); men and women with 12 or fewer years of education were about 30% less likely than those with more schooling to report having had an STD. Men and women who had engaged in anal intercourse, had paid for sex, or had had one-night stands were significantly more likely than those who avoided these behaviors to report an STD (p 0.01). Additionally, the likelihood of an STD dramatically increased with the lifetime number of sex partners reported: compared with men and women who had had only 1 partner those who reported 2-3 partners were 5 times as likely to have had an STD; the odds were as high as 31:1 for those who reported 16 or more partners.

Condom characteristics: the perceptions and preferences of men in the United States.

Perceptions regarding the consequences of condom use, as well as preferred characteristics of condoms, are examined in a nationally representative sample of 3,321 men aged 20-39. The psychological and interpersonal effect most often cited is that using a condom "shows that you are a concerned and caring person." This is particularly the case among black men and men who are young and have low educational attainments. However, the same men usually agree that using a condom sends unwanted messages to one's partner--for example, that doing so "makes your partner think that you have AIDS" and "shows that you think that your partner has AIDS." In contrast, white men and those who are highly educated tend to cite embarrassment when buying condoms as a frequent consequence of condom use. The device-related consequences cited most often, particularly among black, unmarried, young and poorly educated men, are that using a condom results in reduced sensation, that one must be careful during sex or the condom may break and that one must withdraw quickly after sex or the condom may come off. When purchasing condoms, most men look for those that are easy to put on, have the right amount of lubrication and stay on; these preferences are particularly prevalent among black men. Few men identify color, ribbing and partner's preference for condom type as important.

The sexual behavior of men in the United States.

A nationally representative study of the sexual behavior of men aged 20-39 in the United States shows that the prevalence and frequency of sexual acts (vaginal, anal and oral) and sexual orientation vary by social and demographic characteristics. Analysis of data from 3,321 respondents to the 1991 National Survey of Men reveals that 95% of men have had vaginal intercourse; among them, 23% have had 20 or more vaginal sex partners in their lifetime. About one-fifth of never-married and formerly married men had four or more partners over a recent 18-month period. However, 41% of never-married men and 32% of formerly married men did not have coitus during the four weeks preceding the interview. Only 20% of men have ever engaged in anal intercourse. Among these, 51% had not done so during the previous 18 months, and 90% had not done so during the previous four weeks. Seventy-five percent of men have performed oral sex and 79% have received oral sex, although 53% of men who ever performed oral sex had not done so during the four weeks prior to interview, and only 11% had done so six or more times. The frequency of receiving oral sex is similar. Only 2% of sexually active men aged 20-39 have had any same-gender sexual activity during the last 10 years, and only 1% reported being exclusively homosexual during this interval.

Condom use among U.S. men, 1991.

A 1991 study of a nationally representative sample of men aged 20-39 finds that 27% of sexually active men had used a condom in the four weeks before interview. Black men are more likely than white men to report condom use (38% vs. 25%), and men younger than 30 are more likely to do so than are those older than 30 (36% vs. 19%). Among white men, condom use increases with years of education; among black men, however, those with 12 years of education are much less likely to report condom use than are those with more or less than 12 years (28% vs. 43-50%). Condom use is positively related to number of partners. Men who have engaged in anal intercourse, those who have had a one-night stand and those who are bisexual or homosexual are also more likely to report condom use. Among those who reported using a condom in the previous four weeks, 55% of whites and 18% of blacks had done so only for birth control and 7% of whites and 9% of blacks had done so only for protection against infection with the human immunodeficiency virus and other sexually transmitted organisms; the remainder had used a condom for both reasons.

Perceptions of AIDS risk and severity and their association with risk-related behavior among U.S. men.

According to a nationally representative sample of 3,321 men aged 20-39 surveyed in 1991, men appear well aware of the severity of AIDS: Nearly all know that AIDS destroys the immune system and that there is no cure for the disease, but a substantial minority do not think that AIDS will necessarily result in pain and death. Men's perceptions of the disease's severity seem to have little impact on their sexual behavior, with no clear relationship between men's knowledge of AIDS and their recent number of sex acts, their condom use or their participation in anal or casual sex. Men's perceptions of the general risk of human immunodeficiency virus (HIV) transmission also appear to have little impact either on their concerns about AIDS or on their behavior, but their perceptions about the AIDS rate in their local community do affect their concerns and behavior. Men know that certain kinds of behavior place them at risk, and their prior behavior significantly influences their perceptions of their own HIV risk. However, speculation about their own HIV status is only moderately related to their recent sexual behavior.

The influence of community characteristics on the practice of effective contraception.

An analysis combining individual-level data from the National Survey of Family Growth with aggregate-level information provides evidence that the characteristics of communities influence the contraceptive decisions of currently married white women in the United States. The analysis examined the relationship between the average effectiveness level of the contraceptive methods that a woman used over a three-and-a-half-year period and community characteristics such as employment opportunities, the availability of contraceptive and abortion information and services, and the level of religious adherence in communities. Community characteristics associated with higher levels of contraceptive effectiveness were rapid population growth, high rates of unemployment, elevated levels of religious affiliation, high socioeconomic status, and ready access to family planning information and services. Community liberality was negatively associated with effective contraceptive use. The results support arguments that various community characteristics affect a woman's contraceptive choices by increasing or decreasing the costs of an unintended pregnancy.

Contraceptive switching among currently married women in the United States.

This study examines contraceptive method switching among married women in the US. It enquires first into the effect of method type and women's socioeconomic characteristics on the risk of switching to each of six methods, including no method, and secondly into the previous methods used by women who adopt specific contraceptive means. The results indicate a great deal of circulation among all method types and of movement to unprotected intercourse. The adoption of sterilization is greatest among women not previously using any contraceptive method.

The effect of marital status at first birth on marital dissolution among adolescent mothers.

The sequencing of marriage and first birth was expected to play an important role in the stability of marriage among adolescent mothers. We hypothesized that adolescent women who married prior to conception would have the lowest rates of marital disruption, followed by those who married between conception and birth. Adolescent women who gave birth prior to marriage were expected to suffer the highest rates of marital dissolution. The results provide partial support for our hypotheses. There is little difference in the probability of separation between adolescent mothers who had a postmarital conception and those who had a premarital conception but married before the birth. Having a premarital birth, however, significantly increases the probability of marital dissolution. We also hypothesized that marital status at first birth would have less effect on the probability of marital dissolution for blacks than for whites. This, too, is generally supported by our findings. Among black females, those with a premarital birth are the first to suffer a marital disruption, but by the end of ten years there is little difference in the probability of separation among the three marital status groups. In contrast, among white females, those with a premarital birth are the first to experience a disruption, and this differential persists over all subsequent marriage duration intervals. Thus, the sequencing of marriage relative to birth has similar short term effects for whites and blacks, but the effect for blacks is evident only in the short term. Ten years after the marriage, black adolescent mothers have similar rates of marital stability regardless of the sequencing of marriage. This is consistent with the findings of previous research and with our hypothesis; with the black family pattern of lower rates of marriage, higher rates of illegitimacy and higher divorce rates, the sequencing of marriage has no long lasting consequences on marital stability. Finally, our predicted decline in the effect of marital status at first birth over historical time also finds partial support. For white females there has been a change in the effect of marriage-first birth sequencing on separation over time. In the period encompassed by the women in our study, white adolescent mothers who married subsequent to the birth have been the most likely to experience a separation at all marriage duration intervals, but this differential narrows as age at interview declines. Among black females there has been no change in the effect of a premarital birth over time.(ABSTRACT TRUNCATED AT 400 WORDS)

The effects of the sequencing of marriage and first birth during adolescence.

Whether or not they marry, black adolescent mothers are more likely than whites to attend school following the birth of their first child. Marrying to legitimate a birth reduces the likelihood that a teenager will return to school after childbearing; this impact of marriage is much stronger among black than among white teenagers. The timing of marriage appears to affect school enrollment among white teenagers through its impact on living arrangements. However, the negative impact of marriage on educational achievement does not seem to be a consequence of earlier differences in educational expectations among the teenagers. Teenage mothers appear less likely to separate from their husbands in later years if they marry before the birth than if they marry afterward. Delaying marriage until after the birth has a long-term effect on the probability of separation among white teenage mothers, but has only a short-term impact among blacks. Among teenagers who marry before giving birth, there is little difference in the likelihood of separation between those who marry before becoming pregnant and those who do so afterward. In addition, the effect of the sequence of marriage and first birth among white teenage mothers may have declined in recent years. Adolescent mothers who do not marry before their first birth experience a longer interval between that birth and their second than do those who marry either before or during the pregnancy. These differences are primarily the result of short-term variations in the amount of time they spend married; that is, women who are unmarried when they give birth are less likely to have a second birth soon afterward.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: Data sets from the US National Survey of Family Growth and the National Longitudinal Survey of Youth (1979-1982) are used to analyze marriage patterns, education and pregnancy outcomes of teenage mothers. Whether or not they marry, black adolescent mothers are more likely than whites to attend school following the birth of their 1st child. Marrying to legitimate a birth reduces the likelihood that a teenager will return to school after childbearing; this impact of marriage is much stronger among black than among white teenagers. The timing of marriage appears to affect school enrollment among white teenagers through its impact on living arrangements. However, the negative impact of marriage on educational achievement does not seem to be a consequence of earlier differences in educational expectations among the teenagers. Teenage mothers appear less likely to separate from their husbands in later years if they marry before the birth than if they marry afterward. Delaying marriage until after the birth has a long term effect on the probability of separation among white teenage mothers, but has only a short-term impact among blacks. Among teenagers who marry before giving birth, there is little difference in the likelihood of separation between those who marry before becoming pregnant and those who do so afterward. In addition, the effect of the sequence of marriage and 1st birth among white teenager mothers may have declined in recent years. Adolescent mothers who do not marry before their 1st birth experience a longer interval between that birth and their 2nd than do those who marry either before or during the pregnancy. When differences in marital duration are taken into account, though, there is no substantial variation among whites in the likelihood of a short 2nd-birth interval, although black women who have had a premarital birth are slightly more likely to report a short birth interval than are black women who marry before the birth. Finally, white teenagers who marry before their 1st birth (either before becoming pregnant or during the pregnancy) are less likely to have a low-birth-weight baby than are their unmarried counterparts. Such differences are not seen among the children of black teenage mothers.

Serum androgenic hormones motivate sexual behavior in adolescent boys.

In order to separate hormonal from social effects on adolescent male sexual behavior, serum hormone assays were performed and questionnaire data on sexual motivation and behavior were collected on a representative sample of 102 boys in grades 8, 9, and 10 of a public school system. Free testosterone was a strong predictor of sexual motivation and behavior, with no additional contribution of other hormones. Including measures of pubertal development and age (indexing the effects of social processes) indicated no additional effects. Free testosterone, therefore, appears to affect sexual motivation directly and does not work through the social interpretation of the accompanying pubertal development.

The influence of male and female best friends on adolescent sexual behavior.

Using panel data from a junior high school system in an urban area of Florida, we examine whether adolescents' best same-sex and best opposite-sex friends' sexual intercourse behavior increases the likelihood that respondents who are virgins at round 1 will make the transition to intercourse between rounds of our study. We find no significant influence effects of friends of either sex for black males or females, or white males. In contrast, white females are influenced by the sexual behavior of both their best female friend and best male friend. A virgin white female whose best friends of both sexes were sexually experience at round 1 was almost certain to have sexual intercourse within the two years of our study.

PIP: Using panel data from a Florida junior high school system, this 2 year study examines what effect the sexual intercourse behavior of a white female's male and female best friend has on her transition from virgin to nonvirgin. There was no significant influence found among best friends of either sex for blacks or white males. However, the results for white female adolescents reveals the following: 1) a girl virgin at round 1 is 6 times as likely to make an intercourse transition by round 2 if her best female friend is a nonvirgin, 3 times as likely if her best male friend is a nonvirgin, 2) a virgin at round 1 having at least one nonvirgin best friend of either sex is 2 times as likely to have intercourse by round 2 than if both friends are virgins, and 3) if both male and female best friends are nonvirgins the virgin white female was almost sure to make an intercourse transition. The sexual status of the best male friend, even if influential because of his potential participation in the white female intercourse transition, has an equal effect on the virginity status of the white female as does the best girl friend's sexual status.

Social mobility and fertility.

PIP: This review examines 4 possible causal links between social mobility and fertility: 1) fertility affects social mobility; 2) social mobility affects fertility; 3) fertility and social mobility simultaneously affect each other; and 4) social mobility and fertility are unrelated. Due to the lack of systematic theory guiding the research, conceptualizations and measures of social mobility and fertility vary markedly from study to study, leading to inconsistent findings. The review focuses on theoretical perspectives underpinning the research, causal operators proposed to interpret observed associations, and analytical methods used. The selectivity perspective is based on the contention that a family must be small in order to rise on the social scale. This has found little support, however. In fact, studies suggest that children induce slightly higher levels of status achievement and family responsibilities may stimulate the energy and ambition of some so that they achieve more than they would have done without a family. Most studies have concerned the hypothesis that social mobility affects fertility. 4 theoretical perspectives have emerged: status enhancement; relative economic status; social isolation; and stress and disorientation. At any time in a couple's reproductive life cycle the decision or actual experience of either social mobility or fertility may influence the decision or actual experience of the other variable. Mobility-fertility research has defined an individual's or couple's position in terms of income, education, or occupation with occupation used most often as a single index of social class and indexes of social mobility developed by comparing persons' changes in occupational position. A common theme in much of the research literature is that the existence of an effect of social mobility on fertility depends on the societal conditions of a given population. Most studies through the mid-60s used a common measurement method to assess whether a mobility effect existed. This method compared the reproductive behavior of the upwardly and/or downwardly mobile with that of the nonmobile at origin and/or destination.^ieng

The impact of prenatal care on birth weight. Evidence from an international data set.

The impact of prenatal visits on birth weight in six countries is studied using data from an international collaborative maternity care monitoring project. The analyses presented pertain only to those women having singleton live births and whose pregnancies went to term. Results of the analyses indicate that around the world the number of prenatal visits is significantly related to birth weight. Controlling for other variables known to influence birth weight does not change the relationship. Further, contrary to previous research, there are no significant interactions with other variables.