IN THIS ISSUE
Youngsters with an older sibling who was involved in a pregnancy or became a parent during adolescence have disproportionately high rates of teenage sexual activity, pregnancy involvement and childbearing. To address the needs of these young people, in 1996, California launched the statewide Adolescent Sibling Pregnancy Prevention Program, which offers the brothers and sisters of pregnant and parenting teenagers such services as case management, academic guidance, training in decision-making skills, job placement, self-esteem enhancement, and contraceptive and sexuality education. An evaluation of the program conducted in 1997-1999 shows that interventions like this hold great promise, especially for adolescent women, as Patricia East, Elizabeth Kiernan and Gilberto Chávez report in this issue of Perspectives on Sexual and Reproductive Health (see article).
Two findings are particularly noteworthy: Over the nine-month evaluation period, young women enrolled in the program had both a lower pregnancy rate (4%) and a lower rate of sexual initiation (7%) than their peers in a comparison group, who received no systematic services (7% and 16%, respectively). At the end of the follow-up period, program participants also were more certain that they would remain abstinent in the near future than were young women in the comparison group. Male program participants increased the consistency of their contraceptive use over the course of the evaluation, while males in the comparison group reported less-consistent use at follow-up than initially. For males, receiving group services was correlated with delayed sexual initiation, and for all sexually active youths, receiving services aimed at strengthening psychosocial skills was correlated with increased contraceptive use.
On some measures, program participants fared no better than youths in the comparison group--and in a few cases, program services were correlated with an unfavorable outcome. Nonetheless, East and colleagues conclude that programs like California's could help foster the trend of declining teenage birthrates. "Such programs," they write, "should be considered an integral component of any national pregnancy prevention policy."
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• Family planning service providers are well situated to help women identify their level of risk for acquiring sexually transmitted diseases (STDs) and to adopt measures that will reduce their risk. At one agency in New York City, Joanne E. Mantell and colleagues learned (see article), providers generally view STD prevention as an integral part of family planning counseling and favor routine risk assessment. In practice, however, some providers lack adequate training to offer high-quality comprehensive services or hold negative attitudes toward particular preventive strategies or methods--especially the female condom--that influence their approach to counseling. The authors stress the need for training to enhance family planning providers' STD risk assessment skills, help them counsel women, assist them in identifying (and overcoming) their biases about certain methods and keep them abreast of relevant research.
• A clinical trial of a new nonlatex condom yielded mixed results, as Terri L. Walsh and coauthors report (see article). While the condom rarely broke or slipped, it did so significantly more frequently than did a commercially available latex condom. In six cycles of typical use, the two condoms were associated with similar pregnancy rates, but when they were used consistently, the latex outperformed the synthetic. Despite the nonlatex condom's lower efficacy, the researchers maintain that it is a good option for people who cannot use latex condoms because of allergy or personal preferences.
• For decades, researchers have studied high-risk teenage sexual behavior, and service providers have tried to prevent it--but have research and on-the-ground experience informed each other? Debra Kalmuss and colleagues argue (see article) that they have not. In their comment, they review research findings on the antecedents of risky teenage sexual behavior and identify critical issues that, from providers' perspectives, hinder programs' success. They then suggest a number of research questions that need to be explored to address a program-relevant agenda.
• How a woman describes her pregnancy intentions may reflect, among other things, when she is asked; how she is asked; her community's, her partner's and her own attitudes toward childbearing; and her values regarding relationships and sexuality. An extensive review of the literature leads John Santelli and colleagues (see article) to the conclusion that current measures of intendedness are "reasonable, reliable and predictive at a population level" but are considerably less useful in providing insights into individual women's fertility-related preferences and needs. After outlining the problems with conventional measures, Santelli's group offers recommendations for improving the measurement, and thus clarifying the meaning, of unintended pregnancy.