Discussions about Contraception or STDs with Partner Before Sex

1. Discussions about Contraception or STDs with Partner Before Sex Suzanne Ryan Kerry Franzetta Jennifer Manlove Good afternoon. In this project, we examine factors that influence whether or not a teen will discuss contraception or STDs with his or her first sexual partner before having sex for the first time. Specific factors that we focus on include knowledge and sex education, parent-teen interactions, opportunity costs/barriers, and partner and relationship characteristics. The research project I�ll be talking about today was conducted with my co-authors, Kerry Franzetta and Jennifer Manlove. And we would like to thank the Office of Population Affairs for funding this research.Good afternoon. In this project, we examine factors that influence whether or not a teen will discuss contraception or STDs with his or her first sexual partner before having sex for the first time. Specific factors that we focus on include knowledge and sex education, parent-teen interactions, opportunity costs/barriers, and partner and relationship characteristics. The research project I�ll be talking about today was conducted with my co-authors, Kerry Franzetta and Jennifer Manlove. And we would like to thank the Office of Population Affairs for funding this research.

2. Background Motivation: Interest in male involvement in reproductive health decisions Research has linked discussing contraception and STDs prior to sex with a greater chance of using contraception and using it consistently. The association is particularly strong for females. Little research has explored what characteristics of teens, their families, their education, and their relationships are associated with discussing contraception and STDs with partners. Our motivation for this paper comes from an initial interest in understanding more about male involvement in reproductive health decisions.  We chose to focus on discussions about contraception because a conversation between teens about contraception by definition will include male involvement and there is a lack of research on male involvement in couple decisions regarding contraceptive use. An expanding research literature links discussions about contraception and STDS with a greater chance of using contraception and using it consistently, especially among females. Yet, little research has explored what characteristics of teens, their families, their education, and their relationships are associated with discussing contraception and STDs with partners. Our motivation for this paper comes from an initial interest in understanding more about male involvement in reproductive health decisions. We chose to focus on discussions about contraception because a conversation between teens about contraception by definition will include male involvement and there is a lack of research on male involvement in couple decisions regarding contraceptive use. An expanding research literature links discussions about contraception and STDS with a greater chance of using contraception and using it consistently, especially among females. Yet, little research has explored what characteristics of teens, their families, their education, and their relationships are associated with discussing contraception and STDs with partners.

3. Research Questions Our work involved multivariate analyses to answer 2 res questions: 1) What characteristics are associated with whether teens discuss contraception or STDs with their first sexual partners before initiating sex? 2) Are different factors important in determining whether males report discussions about contraception than whether females report such conversations?Our work involved multivariate analyses to answer 2 res questions: 1) What characteristics are associated with whether teens discuss contraception or STDs with their first sexual partners before initiating sex? 2) Are different factors important in determining whether males report discussions about contraception than whether females report such conversations?

4. Data and Sample Add Health data: Used retrospective relationship histories from 1st two waves Wave I in-home survey (1995) Wave II in-home survey (1996) Analyses restricted to respondents: Who had never been married Who were virgins at Wave I Who had first sexual intercourse between Wave I and Wave II n = 1,426 adolescents We used data from W 1 & 2 of the National Longitudinal Study of Adolescent Health (also known as Add Health). Add Health is a nationally representative study of adols in grades 7 through 12 in the US in 1995. We used information from retrospective relationship histories in which teens answered a series of questions about recent romantic or sexual relationships and about the characteristics of their partners and relationships. Our analyses are restricted to 1,426 never-married adolescents: Who were virgins at the W1 interview, and Who had first sexual intercourse between Wave I and Wave II. (This restriction allows us to use Wave 1 measures as predictors.)  We used data from W 1 & 2 of the National Longitudinal Study of Adolescent Health (also known as Add Health). Add Health is a nationally representative study of adols in grades 7 through 12 in the US in 1995. We used information from retrospective relationship histories in which teens answered a series of questions about recent romantic or sexual relationships and about the characteristics of their partners and relationships. Our analyses are restricted to 1,426 never-married adolescents: Who were virgins at the W1 interview, and Who had first sexual intercourse between Wave I and Wave II. (This restriction allows us to use Wave 1 measures as predictors.)

5. Dependent Variable � Discussions about Contraception or STDs Before Sex �You talked about contraception or sexually transmitted diseases.� �You had sexual intercourse.� The dependent variable in our research measures whether or not teens reported that they discussed contraception or STDs with their first sexual partner prior to initiating sexual intercourse. We derived this variable from the W2 survey. In one section of the survey, teens answered a series of questions about recent romantic or sexual relationships and were asked to order chronologically the events that occurred in their relationships. These events include such things as going out on dates, exchanging gifts, meeting friends and family members, physical activities such as holding hands and kissing, discussing contraception or STDs, and sexual intercourse. We compared the ordered events to see where teens placed discussions about contraception and STDs relative to where they placed sexual intercourse. Our dependent variable compares teens who discussed contraception or STDs prior to sex versus those who either did not have such a discussion or who discussed contraception or STDs after initiating sex. It is worth noting that due to the way the survey item is worded, it is not clear whether the respondent or his or her partner initiated the conversation about contraception or STDs.The dependent variable in our research measures whether or not teens reported that they discussed contraception or STDs with their first sexual partner prior to initiating sexual intercourse. We derived this variable from the W2 survey. In one section of the survey, teens answered a series of questions about recent romantic or sexual relationships and were asked to order chronologically the events that occurred in their relationships. These events include such things as going out on dates, exchanging gifts, meeting friends and family members, physical activities such as holding hands and kissing, discussing contraception or STDs, and sexual intercourse. We compared the ordered events to see where teens placed discussions about contraception and STDs relative to where they placed sexual intercourse. Our dependent variable compares teens who discussed contraception or STDs prior to sex versus those who either did not have such a discussion or who discussed contraception or STDs after initiating sex. It is worth noting that due to the way the survey item is worded, it is not clear whether the respondent or his or her partner initiated the conversation about contraception or STDs.

6. Males are less likely to discuss contraception or STDs before initiating sex with their first sexual partner This slide presents the distribution of the dependent variable for our sample of teens. As shown in the graph, approximately one-half of teenagers (49%) reported that they had discussed contraception or STDs prior to initiating sex with their first sexual partner. This also means that one-half of teenagers did NOT discuss contraception or STDs before having sex for the first time. It is also important to note that males were less likely to report discussing contraception or STDs than females (45% for males and 53% for females).This slide presents the distribution of the dependent variable for our sample of teens. As shown in the graph, approximately one-half of teenagers (49%) reported that they had discussed contraception or STDs prior to initiating sex with their first sexual partner. This also means that one-half of teenagers did NOT discuss contraception or STDs before having sex for the first time. It is also important to note that males were less likely to report discussing contraception or STDs than females (45% for males and 53% for females).

7. Knowledge/sex education Parent-teen interactions Opportunity costs/barriers Partner/relationship characteristics Socio-demographic factors Predictor Variables We divided our predictor variables into 5 categories: measures of teens� reproductive health knowledge or sex education, parent-teen interactions, opportunity costs or barriers, partner and relationship characteristics, and socio-demog factors. Partner and relationship characteristics are drawn from Wave II, when the teens in our sample reported on their first sexual experience. All other measures are drawn from Wave I, prior to the teens� first sexual experience. We divided our predictor variables into 5 categories: measures of teens� reproductive health knowledge or sex education, parent-teen interactions, opportunity costs or barriers, partner and relationship characteristics, and socio-demog factors. Partner and relationship characteristics are drawn from Wave II, when the teens in our sample reported on their first sexual experience. All other measures are drawn from Wave I, prior to the teens� first sexual experience.

8. Perceived condom knowledge Received pregnancy and AIDS education in school Knowledge/Sex Education Measures We include two measures of knowledge and sex education because we hypothesized that teens who were more knowledgeable about contraception and STDs would be more likely to discuss these topics prior to sex. The first is perceived condom knowledge, measuring how knowledgeable teens think they are about condom use. And the second is a measure of whether teens received both pregnancy and AIDS education in a class at school. (The survey also included questions to measure teens� actual condom knowledge, but we couldn�t use it because it was only asked of teens who were age 15 and older.) We include two measures of knowledge and sex education because we hypothesized that teens who were more knowledgeable about contraception and STDs would be more likely to discuss these topics prior to sex. The first is perceived condom knowledge, measuring how knowledgeable teens think they are about condom use. And the second is a measure of whether teens received both pregnancy and AIDS education in a class at school. (The survey also included questions to measure teens� actual condom knowledge, but we couldn�t use it because it was only asked of teens who were age 15 and older.)

9. Parent-Teen Interaction Measures Parent-teen closeness Communication about everyday life We hypothesized that teens who were closer to their parents and who had higher levels of communication with parents would be more comfortable discussing contraception or STDs with a partner prior to sex, so we included two measures of interaction between teens and their residential parents. Parent-teen closeness is based on teen reports about parental warmth, satisfaction with communication, overall satisfaction with relationship, and overall closeness. Parent-teen communication is based on teen reports of whether or not he or she talked about his or her social life, personal problems, school and/or grades with a parent in the past month. (if a teen had two residential parents, we took the average of each parent�s closeness or communication score.) We hypothesized that teens who were closer to their parents and who had higher levels of communication with parents would be more comfortable discussing contraception or STDs with a partner prior to sex, so we included two measures of interaction between teens and their residential parents. Parent-teen closeness is based on teen reports about parental warmth, satisfaction with communication, overall satisfaction with relationship, and overall closeness. Parent-teen communication is based on teen reports of whether or not he or she talked about his or her social life, personal problems, school and/or grades with a parent in the past month. (if a teen had two residential parents, we took the average of each parent�s closeness or communication score.)

10. Opportunity Costs/Barriers Measures Rational decision-making Educational aspirations Perceived disease risk Next, we included three measures of opportunity costs/barriers because we hypothesized that teens who anticipate the consequences of their actions would be more motivated to discuss contraception or STDs with a partner prior to first sex. The first item measures teens� decision-making habits. It is based on teen reports of whether he or she gets as many facts as possible or thinks of many different approaches when trying to solve a problem, whether the teen uses a systematic method for evaluating alternatives when making decisions, and whether the teen analyzes what went right and wrong after carrying out a solution to a problem. Our second measure of opportunity costs and barriers gauges how much a respondent wants to go to college. And the third measures teens� perceived disease risk, or what they think their chances are of contracting different STDs (HIV, AIDS, other STD). Next, we included three measures of opportunity costs/barriers because we hypothesized that teens who anticipate the consequences of their actions would be more motivated to discuss contraception or STDs with a partner prior to first sex. The first item measures teens� decision-making habits. It is based on teen reports of whether he or she gets as many facts as possible or thinks of many different approaches when trying to solve a problem, whether the teen uses a systematic method for evaluating alternatives when making decisions, and whether the teen analyzes what went right and wrong after carrying out a solution to a problem. Our second measure of opportunity costs and barriers gauges how much a respondent wants to go to college. And the third measures teens� perceived disease risk, or what they think their chances are of contracting different STDs (HIV, AIDS, other STD).

11. Partner/Relationship Characteristics Partner type Teen-partner similarities Age at first sex with partner Length of pre-sexual relationship Number of pre-sexual dating activities Next, we hypothesized that the characteristics of partners and relationships would influence whether or not teens discuss contraception or STDs prior to first sex, so we include five measures of partner and relationship characteristics. The first is partner type, comparing romantic relationships to liked relationships. (These are relationships the teens did not classify as romantic, but in which they kissed, held hands, or told partner they liked or love them.) We couldn�t include teens in nonromantic relationships because our outcome meas was not asked of those teens. The second is teen-partner similarities. This measures how similar a teen is to his or her first sexual partner in terms of age, race/ethnicity, and social networks. The third is the respondents� age at first sex with their first sexual partner. Fourth is length of pre-sexual relationship, which is calculated as the amount of time between the start of the romantic relationship and first sexual intercourse. Lastly, we use a measure of pre-sexual dating activities, that captures the number of dating-like activities teens did before having sex. These activities may include: Thinking of themselves as a couple Telling others they were a couple Going out together in a group or alone Meeting parents Exchanging presents Exchanging �I love you�s� Spending less time with friends in order to spend more time together Next, we hypothesized that the characteristics of partners and relationships would influence whether or not teens discuss contraception or STDs prior to first sex, so we include five measures of partner and relationship characteristics. The first is partner type, comparing romantic relationships to liked relationships. (These are relationships the teens did not classify as romantic, but in which they kissed, held hands, or told partner they liked or love them.) We couldn�t include teens in nonromantic relationships because our outcome meas was not asked of those teens. The second is teen-partner similarities. This measures how similar a teen is to his or her first sexual partner in terms of age, race/ethnicity, and social networks. The third is the respondents� age at first sex with their first sexual partner. Fourth is length of pre-sexual relationship, which is calculated as the amount of time between the start of the romantic relationship and first sexual intercourse. Lastly, we use a measure of pre-sexual dating activities, that captures the number of dating-like activities teens did before having sex. These activities may include: Thinking of themselves as a couple Telling others they were a couple Going out together in a group or alone Meeting parents Exchanging presents Exchanging �I love you�s� Spending less time with friends in order to spend more time together

12. Individual and Family Characteristics Individual Characteristics Gender Race/ethnicity Cognitive test score  Family Characteristics Parent education 2 biological/adoptive parents Our analyses also include these measures of teens� social and demographic characteristics: Our analyses also include these measures of teens� social and demographic characteristics:

13. Analytic Methods We first ran a series of descriptive analyses to assess the association between each individual measure and whether teens discussed contraception or STDs before first sex. Then, we used multivariate analyses to identify factors associated with whether or not teens discussed contraception or STDs, controlling for all other measures. (This means that the analyses take account of other factors that may interfere with the effects observed in the descriptive findings. For example, is being male really an important factor in determining whether teens talk about sex-related issues? Or is it other characteristics of males � such as lower levels of commun with parents � that is really driving the observed effect?) We tested for gender differences to see whether male reports of involvement in discussions about contraception are influenced by different factors than females. We first ran a series of descriptive analyses to assess the association between each individual measure and whether teens discussed contraception or STDs before first sex. Then, we used multivariate analyses to identify factors associated with whether or not teens discussed contraception or STDs, controlling for all other measures. (This means that the analyses take account of other factors that may interfere with the effects observed in the descriptive findings. For example, is being male really an important factor in determining whether teens talk about sex-related issues? Or is it other characteristics of males � such as lower levels of commun with parents � that is really driving the observed effect?) We tested for gender differences to see whether male reports of involvement in discussions about contraception are influenced by different factors than females.

14. Descriptive Results Next we show a series of figures that illustrate our descriptive findings. These figures describe how teens who did discuss contraception or STDs before sex differ from those who did not. Next we show a series of figures that illustrate our descriptive findings. These figures describe how teens who did discuss contraception or STDs before sex differ from those who did not.

15. Teens who discussed contraception or STDs prior to first sex report greater communication with parents This slide shows the association between parent-teen communication and discussions about contraception. The #s shown represent average communication levels, so a 2 would indicate that teens discussed 2 out of the 4 topics with their parents (topics = social life, personal problems, school and/or grades). Teens who discussed contraception or STDs prior to first sex (the light-colored bar) reported higher levels of communication with parents about everyday life issues than did teens who did not discussion contraception or STDs with their partners before sex (the dark-colored bar). This slide shows the association between parent-teen communication and discussions about contraception. The #s shown represent average communication levels, so a 2 would indicate that teens discussed 2 out of the 4 topics with their parents (topics = social life, personal problems, school and/or grades). Teens who discussed contraception or STDs prior to first sex (the light-colored bar) reported higher levels of communication with parents about everyday life issues than did teens who did not discussion contraception or STDs with their partners before sex (the dark-colored bar).

16. Teens who discussed contraception/STDs report greater rational-decision making skills Two opportunity cost measures were associated with our outcome variable. Teens who discussed contraception or STDs prior to first sex reported higher levels of rational decision-making skills than did teens who did not discussion contraception or STDs with their partners.  Therefore, rational decision-making appears protective, helping motivate teens to discuss issues related to safer sex.Two opportunity cost measures were associated with our outcome variable. Teens who discussed contraception or STDs prior to first sex reported higher levels of rational decision-making skills than did teens who did not discussion contraception or STDs with their partners. Therefore, rational decision-making appears protective, helping motivate teens to discuss issues related to safer sex.

17. Teens who discussed contraception/STDs report lower perceived disease risk Teens who discussed contraception or STDs prior to first sex reported lower levels of perceived disease risk than did teens who did not discuss contraception or STDs with their partners.  Therefore, high perceived disease risk does not appear to help motivate teens to discuss contraception and STDs. Teens who discussed contraception or STDs prior to first sex reported lower levels of perceived disease risk than did teens who did not discuss contraception or STDs with their partners. Therefore, high perceived disease risk does not appear to help motivate teens to discuss contraception and STDs.

18. Teens who discussed contraception/STDs before first sex are more likely to be in romantic relationships Several partner/relat chars were associated with discussions about contraception. We first look at partner type. Teens who discussed contraception or STDs prior to first sex are more likely to be in romantic relationships than did teens who did not discussion contraception or STDs with their partners before sex. 94% of those who discussed contraception or STDs before sex were in romantic relationships, and a smaller proportion (85%) of those who did NOT discuss contraception were in romantic relationships.  Thus, being in a romantic relationship vs a more casual one appears to be a positive influence on whether teens discuss contraception and STDs with their partners.Several partner/relat chars were associated with discussions about contraception. We first look at partner type. Teens who discussed contraception or STDs prior to first sex are more likely to be in romantic relationships than did teens who did not discussion contraception or STDs with their partners before sex. 94% of those who discussed contraception or STDs before sex were in romantic relationships, and a smaller proportion (85%) of those who did NOT discuss contraception were in romantic relationships. Thus, being in a romantic relationship vs a more casual one appears to be a positive influence on whether teens discuss contraception and STDs with their partners.

19. Teens who discussed contraception/STDs report longer pre-sex dating relationships & more pre-sex dating activities # of pre-sex dating activities also were associated with our outcome variable On average, teens who had discussed contraception or STDs engaged in approximately 7 out of 8 dating activities before having sex for the 1st time, compared with 4 dating activities for teens who did not discussion contraception or STDs with their partners before sex (they engaged in just over 4 activities).  Therefore, relationships with more dating activities, appear to be protective. # of pre-sex dating activities also were associated with our outcome variable On average, teens who had discussed contraception or STDs engaged in approximately 7 out of 8 dating activities before having sex for the 1st time, compared with 4 dating activities for teens who did not discussion contraception or STDs with their partners before sex (they engaged in just over 4 activities). Therefore, relationships with more dating activities, appear to be protective.

20. Teens who discussed contraception or STDs prior to first sex were older at first sex Finally, teens who discussed contraception or STDs prior to first sex were, on average, about five months older when they first had sex than teens who did not discussion contraception or STDs. This appears to be only a small difference, but it is statistically significant. (15.4 = 15 yrs, 5 months) (15.8 = 15 yrs, 10 months) Finally, teens who discussed contraception or STDs prior to first sex were, on average, about five months older when they first had sex than teens who did not discussion contraception or STDs. This appears to be only a small difference, but it is statistically significant. (15.4 = 15 yrs, 5 months) (15.8 = 15 yrs, 10 months)

21. Summary of Descriptive Findings Protective factors: Being female Higher cognitive ability Communicating more with parents Being more rational in making decisions Lower perceived disease risk Being in a romantic relationship Having a longer pre-sex dating relationship Engaging in more pre-sex dating activities Being older at first sex To summarize the descriptive findings, the following characteristics were associated with being more likely to discuss contraception/STDs:To summarize the descriptive findings, the following characteristics were associated with being more likely to discuss contraception/STDs:

22. Why Are Males Less Likely Than Females to Discuss Contraception/STDs Before First Sex? Lower levels of communication with parents Higher perceived disease risk Less likely to be in a romantic relationship The descriptive findings also help us understand why males are less likely than females to discuss contraception/STDs before first sex. Males have several characteristics that differentiate them from females: - males are report lower levels of communication with parents than do females - they perceive themselves as having a higher risk of contracting STDs than females - they are less likely to be in a romantic relationship than females And each of these 3 factors is also associated with a lower likelihood of discussing contraception/STDs. Therefore, if males had the same levels of communication, perceived disease risk, and involvement in romantic relats as females, we would expect to see no difference in their likelihood of discussing contraception with partners before sex. The descriptive findings also help us understand why males are less likely than females to discuss contraception/STDs before first sex. Males have several characteristics that differentiate them from females: - males are report lower levels of communication with parents than do females - they perceive themselves as having a higher risk of contracting STDs than females - they are less likely to be in a romantic relationship than females And each of these 3 factors is also associated with a lower likelihood of discussing contraception/STDs. Therefore, if males had the same levels of communication, perceived disease risk, and involvement in romantic relats as females, we would expect to see no difference in their likelihood of discussing contraception with partners before sex.

23. Multivariate Results We now move on to multivariate results, in which we examine associations between each predictor var and the outcome, accounting for all other characteristics of teens. We now move on to multivariate results, in which we examine associations between each predictor var and the outcome, accounting for all other characteristics of teens.

24. Significant Predictors of Discussions about Contraception or STDs This slide shows the results of the 1st model, which only included social and demographic measures. A + indicates a positive effect and a � indicates a negative effect. As you can see, gender and cognitive ability were associated with pre-sexual discussions of contraception or STDs with first sexual partner in this first sex of models. Males are less likely than females to discuss contraception or STDs, and teens with higher cognitive ability are more likely to of discuss contraception or STDs, accounting for all other social & demog chars. This slide shows the results of the 1st model, which only included social and demographic measures. A + indicates a positive effect and a � indicates a negative effect. As you can see, gender and cognitive ability were associated with pre-sexual discussions of contraception or STDs with first sexual partner in this first sex of models. Males are less likely than females to discuss contraception or STDs, and teens with higher cognitive ability are more likely to of discuss contraception or STDs, accounting for all other social & demog chars.

25. Significant Predictors of Discussions about Contraception or STDs In the second stage, we added in the measures of knowledge/sex education, parent-teen interactions, and opportunity costs/barriers to see if they account for any observed effects of socio-demographic characteristics. There are three new significant predictors of discussing contraception or STDs prior to sex in this model: parent-teen communication, rational decision-making, and perceived disease risk. More communication and rational decision-making skills are positively assoc with talking about contra & STDs, while greater perceived disease risk is associated with a lower likelihood of discussing these issues. The addition of these measures caused the effect of being male to lose significance, because as we saw earlier, males are less likely to communicate with their parents and more likely to have greater perceived disease risk. Once these factors are accounted for, the negative effect of being male goes away. In the second stage, we added in the measures of knowledge/sex education, parent-teen interactions, and opportunity costs/barriers to see if they account for any observed effects of socio-demographic characteristics. There are three new significant predictors of discussing contraception or STDs prior to sex in this model: parent-teen communication, rational decision-making, and perceived disease risk. More communication and rational decision-making skills are positively assoc with talking about contra & STDs, while greater perceived disease risk is associated with a lower likelihood of discussing these issues. The addition of these measures caused the effect of being male to lose significance, because as we saw earlier, males are less likely to communicate with their parents and more likely to have greater perceived disease risk. Once these factors are accounted for, the negative effect of being male goes away.

26. Significant Predictors of Discussions about Contraception or STDs Lastly, we added in the partner and relationship characteristics to see if accounting for factors related to the context in which teens did or did not discuss contraception or STDs explained some of the effect of the other predictors. Among the partner/relat characteristics, only one factor is significant. Teens who engaged in more dating-like behaviors before sex (i.e. going out together alone as a couple, meeting each other�s parents, exchanging gifts, etc) are more likely to discuss contraception or STDs before transitioning to first sex. Lastly, we added in the partner and relationship characteristics to see if accounting for factors related to the context in which teens did or did not discuss contraception or STDs explained some of the effect of the other predictors. Among the partner/relat characteristics, only one factor is significant. Teens who engaged in more dating-like behaviors before sex (i.e. going out together alone as a couple, meeting each other�s parents, exchanging gifts, etc) are more likely to discuss contraception or STDs before transitioning to first sex.

27. Significant Predictors of Discussions about Contraception or STDs Also, after adding partner and relationship characteristics (in Model 3), the effect for black became significant and the effect of perceived condom knowledge was strengthened (it was marginally signif in model 2). The effect of being black was suppressed in model 2 by the fact that blacks engage in fewer dating activities, on average, than whites (4.7 and 5.6, respectively). When dating activities were accounted for in model 3, the positive effect of being black became evident. (This suggests that if blacks participated in the same number of pre-sex dating activities as whites, they would actually be more likely than whites to communicate about contraception and STD issues.)  We tested for gender diffs in the importance of each factor and found no effects. This means that the factors associated with discussing contra & STDs do not vary for males and females. All factors shown here are important for both genders. Also, after adding partner and relationship characteristics (in Model 3), the effect for black became significant and the effect of perceived condom knowledge was strengthened (it was marginally signif in model 2). The effect of being black was suppressed in model 2 by the fact that blacks engage in fewer dating activities, on average, than whites (4.7 and 5.6, respectively). When dating activities were accounted for in model 3, the positive effect of being black became evident. (This suggests that if blacks participated in the same number of pre-sex dating activities as whites, they would actually be more likely than whites to communicate about contraception and STD issues.) We tested for gender diffs in the importance of each factor and found no effects. This means that the factors associated with discussing contra & STDs do not vary for males and females. All factors shown here are important for both genders.

28. Summary of Multivariate Findings Risk factors Being male Higher perceived disease risk Protective factors Being black (vs. non-Hispanic white) Higher cognitive ability Greater perceived condom knowledge More parent-teen communication More rational decision-making skills More dating activities before first sex To review the factors that are associated with whether or not teens discussed contraception or STDs before sex, this slide summarizes the risk and protective factors, from mvar analyses: Risk factors� are all associated with a lower likelihood of teens discussing contraception or STDs with their first sexual partner prior to initiating intercourse. Protective factors�. are all associated with a greater likelihood of teens discussing contraception or STDs with their first sexual partner prior to initiating intercourse. (Note: The 3 items listed in gray were important in descriptive findings, but not the final mvar models.) To review the factors that are associated with whether or not teens discussed contraception or STDs before sex, this slide summarizes the risk and protective factors, from mvar analyses: Risk factors� are all associated with a lower likelihood of teens discussing contraception or STDs with their first sexual partner prior to initiating intercourse. Protective factors�. are all associated with a greater likelihood of teens discussing contraception or STDs with their first sexual partner prior to initiating intercourse. (Note: The 3 items listed in gray were important in descriptive findings, but not the final mvar models.)

29. Overall Summary One-half of sexually-experienced teens discussed contraception or STDs with their partners before having sex with them for the first time. Males are less likely to report discussing contraception or STDs than females in descriptive analyses, but not in multivariate analyses. The factors associated with whether or not teens discuss contraception or STDs do not vary for males and females. So, to summarize the findings: READ #1 READ #2 A key limitation, however, is that we do not know the content or extent of these discussions. We cannot differentiate, for example, between conversations that involve simply asking the male if he has a condom versus more in-depth conversations about contraception.  READ #3 As I mentioned earlier, we don�t know which member of the couple initiated these conversations, and this could be why we do not find differences for males and females.So, to summarize the findings: READ #1 READ #2 A key limitation, however, is that we do not know the content or extent of these discussions. We cannot differentiate, for example, between conversations that involve simply asking the male if he has a condom versus more in-depth conversations about contraception. READ #3 As I mentioned earlier, we don�t know which member of the couple initiated these conversations, and this could be why we do not find differences for males and females.

30. Implications Encouraging parents to talk to their teens about a range of issues may be beneficial � it doesn�t have to be conversations about sex to have a positive effect. Teaching teens more about contraception may help because the more knowledge they think they have about condoms, the more likely they are to discuss contraception or STDs before initiating sex. Parents and program providers should encourage teens to engage in more dating behaviors before transitioning to sex. Teens who talk with their parents more about everyday life issues are more likely to discussion contraception or STDs with partners prior to sex. Thus, encouraging parents to talk to their kids about a whole range of issues may be beneficial � it doesn�t have to be conversations specifically about sex to have a positive effect on teens� ability/willingness to communicate with partners about contraception or STDs. Greater perceived condom knowledge is associated with greater likelihood of talking about contraception or STDs with one�s partner. Teaching kids more about contraception may help � because the more knowledge they think they have about condoms, the more likely they are to discuss contraception or STDs before initiating sex. Engaging in more dating behaviors before sex has a positive association with communication about contraception or STDs. Thus, parents and program providers should encourage teens to engage in more dating behaviors first before transitioning to sex. This likely improves teens� level of comfort with their partner and, therefore, their willingness to communicate about topics such as contraception and STDs. Teens who talk with their parents more about everyday life issues are more likely to discussion contraception or STDs with partners prior to sex. Thus, encouraging parents to talk to their kids about a whole range of issues may be beneficial � it doesn�t have to be conversations specifically about sex to have a positive effect on teens� ability/willingness to communicate with partners about contraception or STDs. Greater perceived condom knowledge is associated with greater likelihood of talking about contraception or STDs with one�s partner. Teaching kids more about contraception may help � because the more knowledge they think they have about condoms, the more likely they are to discuss contraception or STDs before initiating sex. Engaging in more dating behaviors before sex has a positive association with communication about contraception or STDs. Thus, parents and program providers should encourage teens to engage in more dating behaviors first before transitioning to sex. This likely improves teens� level of comfort with their partner and, therefore, their willingness to communicate about topics such as contraception and STDs.

31. Implications Parents and program providers should provide teens with resources to approach difficult situations in a rational manner. Teens with the highest perceived disease risk could benefit from interventions aimed to improve their knowledge and motivations to prevent pregnancy and STDs, as well as interventions to help them prevent risky sexual and contraceptive use behavior. Teens with greater rational decision-making tendencies are more likely to talk about contraception or STDs before sex, in part because of their choice of sexual partners. This finding suggests that pregnancy and STD-prevention programs that help provide teens with a systematic approach to negotiating decisions about sexual activity and contraceptive use in relationships may be especially effective. Greater perceived disease risk is associated with a reduced likelihood of discussing contraception or STDs with partners prior to sex, in part because of their choice of risky partners. Thus, these high-risk teens are in the greatest need of interventions to help them prevent risky sexual and contraceptive use behaviors. However, they also may need interventions to improve their knowledge and motivations to prevent pregnancy and STDs Teens with greater rational decision-making tendencies are more likely to talk about contraception or STDs before sex, in part because of their choice of sexual partners. This finding suggests that pregnancy and STD-prevention programs that help provide teens with a systematic approach to negotiating decisions about sexual activity and contraceptive use in relationships may be especially effective. Greater perceived disease risk is associated with a reduced likelihood of discussing contraception or STDs with partners prior to sex, in part because of their choice of risky partners. Thus, these high-risk teens are in the greatest need of interventions to help them prevent risky sexual and contraceptive use behaviors. However, they also may need interventions to improve their knowledge and motivations to prevent pregnancy and STDs

32. Implications A key focus of programs should be teaching teens how to initiate conversations about and feel comfortable communicating about pregnancy and STD prevention. A synthesis of effective pregnancy prevention approaches, conducted by Doug Kirby, finds that role playing and negotiation skills are key components of effective approaches to pregnancy prevention. Yet, one-half of teens do not discuss contraception or STDs before having sex for the first time. Thus, a key focus of pregnancy and STD prevention programs should be to help both male and female teens become comfortable with initiating conversations and communicating about pregnancy and STD prevention. A synthesis of effective pregnancy prevention approaches, conducted by Doug Kirby, finds that role playing and negotiation skills are key components of effective approaches to pregnancy prevention. Yet, one-half of teens do not discuss contraception or STDs before having sex for the first time. Thus, a key focus of pregnancy and STD prevention programs should be to help both male and female teens become comfortable with initiating conversations and communicating about pregnancy and STD prevention.