Contraceptive Method Choice among Youth in the United States:
The Importance of Relationship Context
Yasamin Kusunoki, Ph.D., MPH
University of Michigan
and
Dawn M. Upchurch, Ph.D.
University of California, Los Angeles
Population Studies Center Research Report 08-655
Yasamin Kusunoki, University of Michigan, Population Studies Center, Institute for
Social Research, 426 Thompson St., Room 2214, Ann Arbor, MI, 48106-1248,
[email protected].
Dawn M. Upchurch, University of California, Los Angeles, School of Public Health,
650 Charles E. Young Drive South, Los Angeles, CA, 90095-1772,
[email protected].
The research on which this article is based was supported by a pre-doctoral fellowship to Yasamin
Kusunoki from the California Center for Population Research Training Program while she was a graduate
student at the University of California, Los Angeles, which was supported by a grant from NICHD (T32
HD007545) and by two research grants to Dawn M. Upchurch funded by NICHD (R01 HD36993 and
R01 HD41886). An NICHD Postdoctoral Fellowship (T32 HD007339) at the Population Studies Center
at the University of Michigan provided additional support to Yasamin Kusunoki. The authors thank
Jennifer Barber, Sarah Burgard, and David Harding for their helpful comments. An earlier version of this
paper was presented at the Population Association of America Annual Meeting in Philadelphia, March
31-April 2, 2005. This research uses data from Add Health, a program project designed by J. Richard
Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the
Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative
funding from 17 other agencies. Special acknowledgment is due to Ronald R. Rindfuss and Barbara
Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health
should contact Add Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC 275162524 ([email protected]). No direct support was received from grant P01-HD31921 for this analysis.
Contraceptive Method Choice among Youth
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ABSTRACT
Involvement in romantic and sexual relationships increases during adolescence and young
adulthood as does the significance of these relationships. Relationship experiences during this
period are influential for reproductive health outcomes and set the stage for future family
formation choices and behaviors. This study utilizes retrospective sexual relationship histories
of young adults available in the most recent wave (2001-2002) of the National Longitudinal
Study of Adolescent Health to obtain a better understanding of the factors associated with
contraceptive method choice, with a focus on relationship context. Multilevel analysis is
conducted to investigate associations between individual- and relationship-level characteristics
and relationship-specific type of contraceptive method used at last sexual intercourse. Results
indicate that for a given individual, contraceptive method choice varies across relationships as a
function of relationship commitment and couple heterogamy, even accounting for individuals’
own characteristics and prior relationship experiences. The results also confirm the importance
of individuals’ own characteristics and reveal that early perceptions of risk and severity of
negative reproductive health outcomes and contraceptive self-efficacy have enduring effects on
later contraceptive method choices. Furthermore, the patterns of associations between both
relationship and individual characteristics and contraceptive use differ depending on the specific
type of contraceptive method.
Contraceptive Method Choice among Youth
3
INTRODUCTION
Rates of unintended pregnancy and sexually transmitted infections (STIs) among
adolescents and young adults in the United States remain high and there continues to be
considerable variation, with disproportionately higher rates among disadvantaged groups (CDC
2004; Darroch et al. 2001; Henshaw 1998; Weinstock, Berman, & Cates 2004). Use of condoms
and/or other contraceptive methods is a key protective behavior in the prevention of these
negative reproductive health outcomes (IOM 1997). Recent findings from the National Survey
of Family Growth and the National Survey of Adolescent Males indicate that overall
contraceptive use among youth is increasing (Abma et al. 2004; Mosher et al. 2004). However, a
substantial proportion of youth continue to engage in unprotected sex, those who do use
contraception do not do so consistently, and there are persisting differences in use and the type of
method used (Abma et al. 2004; Everett et al. 2000; Glei 1999; Mosher et al. 2004).
Prior research on contraceptive behaviors among adolescents and young adults has
tended to focus on individual- and family-level determinants of this variation. Comparatively
less attention has been placed on the role of youths’ own romantic and sexual relationships. Yet,
involvement in romantic and sexual relationships increases substantially during the early life
course as does the significance of these relationships (Collins 2003; Giordano, Longmore, &
Manning 2001). They provide a significant interpersonal context for psychosocial and sexual
development (Furman, Brown, & Feiring 1999; Giordano et al. 2001; Graber, Brooks-Gunn, &
Petersen 1996). Intimacy and sexuality, which often emerge as these close relationships develop,
are key components of identity formation and the ability to interact with others and with the
social surroundings (Connolly & Johnson 1996; Fischer, Munsch, & Greene 1996; Furman et al.
1999; Miller, Christopherson, & King 1993). Relational patterns and behaviors learned may set
the stage for future relationships formed in later adulthood (Raley, Crissey, & Muller 2007).
And, most importantly, sexual activity and protective practices are often negotiated within the
context of these relationships (Laumann et al. 1994).
The conceptual approach proposed in this study posits that both the context of the
relationship and the individual’s own characteristics influence the type of contraceptive method
that is used in a given relationship. Characteristics of youths’ nonmarital sexual relationships,
specifically relationship commitment and couple heterogamy, are posited to be associated with
contraceptive method choice because they represent the stage and structure of the relationship.
Contraceptive Method Choice among Youth
4
This may determine the attitudes and beliefs that arise as a function of being in the relationship
to ultimately affect contraceptive practices. Individuals’ own characteristics, namely
sociodemographic, family background, psychosocial, and early risk-related experiences, are also
important as they reflect the beliefs and experiences that the individual brings to the relationship.
These not only shape the propensity to use contraception and which method to use regardless of
the particular relationship but also influence partner selection and the types of relationships that
are formed. The conceptual approach also recognizes that prior relationship experiences, such as
having used a hormonal method in a previous relationship, may influence behaviors in
subsequent relationships.
BACKGROUND AND SIGNIFICANCE
Relationship Characteristics and Contraceptive Method Choice
A growing body of literature suggests that contraceptive behavior may indeed vary by the
characteristics of youths’ partners and relationships (Ford, Sohn, & Lepkowski 2001; Howard et
al. 1999; Katz et al. 2000; Ku, Sonenstein, & Pleck 1994; Manlove, Ryan, & Franzetta 2007;
Manning, Longmore, & Giordano 2000; Soler et al. 2000; Upchurch et al. 1991; Wingood &
DiClemente 1998), and highlights two salient dimensions: relationship commitment and couple
heterogamy.
Relationship commitment. Past research has commonly categorized nonmarital
sexual relationships into two general levels of commitment, such as casual versus serious or
nonromantic versus romantic. This distinction is found to explain some variation in
contraceptive practices, although the direction and magnitude of this association has been mixed.
Most studies indicate that new or casual relationships are more likely to use condoms and to do
so consistently, while established or serious relationships are less likely to include condoms and
more likely to include hormonal methods yet not necessarily consistently (Fortenberry et al.
2002; Katz et al. 2000; Ku et al. 1994; Macaluso et al. 2000; Ott et al. 2002; Upchurch et al.
1991). But, some studies also find that any contraceptive use is more common in committed
relationships (Ford et al. 2001; Manlove et al. 2007; Manning et al. 2000). This discrepancy may
be due to two important factors. First, most research has either investigated condom use only or
has examined any use or use at first sex. There are potentially different motivations for using
Contraceptive Method Choice among Youth
5
condoms compared to other methods such as hormonal methods (i.e., prevention of pregnancy,
STIs, or both), and these motivations are likely relationship-specific; focusing on one method at
the exclusion of others or combining methods ignores this variation. Given that youth form a
variety of relationship types, some of which may be only sexual and others that may be
precursors to long-term commitments such as marriage and cohabitation (Manning, Giordano, &
Longmore 2006; Manning, Longmore, & Giordano 2005), it is critical that a more
comprehensive examination of multiple contraceptive methods be conducted. Second, while
useful, simple dichotomous measures of commitment only capture a portion of the overall
meaning of youths’ nonmarital sexual relationship experiences thereby masking potentially
meaningful variability that could have implications for contraceptive method choice. It is more
likely that commitment occurs along a continuum and is intertwined with the strength, duration,
and frequency of interactions within the relationship (Kelley et al. 1983).
The current study proposes that youth form sexual relationships of varying levels of
commitment, and further, that the effect of commitment on contraceptive method choice is
contingent on these other dimensions of relationship-specific interactions. These interactions,
operationalized here as the length of time the partner was known before first sex, duration of the
sexual relationship, and frequency of sexual activity, have also been shown to be independently
associated with differential contraceptive use. Relationships in which the couple has known one
another a greater amount of time before first sex are more likely to use contraception (Manlove,
Ryan, & Franzetta 2003). Contraceptive use, specifically condom use, becomes less consistent
with increased duration of a relationship and is often not used at all after a period of time (Ku et
al. 1994), and individuals in relationships involving more frequent sex are less likely to use
condoms (Katz et al. 2000; Sayegh et al. 2006). What is less clear, however, is the ways in
which level of commitment and these other important features interact and then how the unique
patterns of these characteristics influence contraceptive practices. For example, does knowing
the partner for a longer time before sex despite being in a casual (i.e., less committed)
relationship improve the use of contraception and then if so, for all methods or just condoms?
Does frequency of sex differentiate the type of method used even in serious relationships? This
study characterizes these complexities by developing a relationship typology comprised of
multiple dimensions and investigates the implications of this more nuanced conceptualization for
contraceptive method choice. It is expected that, in general, individuals in casual relationships
Contraceptive Method Choice among Youth
6
are more likely to use condoms whereas individuals in serious relationships are more likely to
use hormonal methods, but that there are gradations of casual and serious that are differentiated
in terms of these other relationship factors and that this diversity results in variation in
contraceptive practices within each of the two general commitment types.
Couple heterogamy. While relationships are often formed between individuals with
similar characteristics (Laumann et al. 1994), relationships in which partners differ by age and
race/ethnicity are not unusual, especially among contemporary American youth (Ford, Sohn, &
Lepkowski 2003). Differences in these key social markers have implications for contraceptive
method choice. For instance, young women who are involved with an older partner are less
likely to report using any contraception (Abma, Driscoll, & Moore 1998; Manning et al. 2000).
Ties between individuals with similar characteristics are more likely to be closer and last for a
longer duration than ties between individuals who are dissimilar, and similarities reflect shared
knowledge and experiences (McPherson, Smith-Lovin, & Cook 2001), which may make
communication about sex and contraception easier. Age and racial/ethnic differences may
reflect differences in maturity, sexual histories and experiences, social and sexual networks,
resources, and status (Ford, Sohn & Lepkowski 2002; Stein et al. 2008). These differences may
contribute to an imbalance in power and/or reveal discrepancies in the couple’s beliefs and
desires for marriage and children. This may then pose challenges in agreement on use and the
type of method used or result in one partner having more control over contraceptive decisionmaking than the other (Abma et al. 1998; Weisman et al. 1991). Relationships that are
heterogamous in terms of age and race/ethnicity are posited to be less likely to involve the use of
contraception. In addition, the negative effect of an age difference is expected to be greater
when the woman is the younger partner because of the potentially greater power differential it
creates. Because the use of condoms requires partner cooperation, an age difference is expected
to be of greater consequence for condom and dual method use than hormonal method use.
Individual Characteristics and Contraceptive Method Choice
Sociodemographic characteristics and family background. Studies
consistently demonstrate differentials in youths’ contraceptive practices by sociodemographic
characteristics and family background factors (e.g., Abma et al. 2004; Jones, Darroch, & Singh
2005; Mosher et al. 2004; Rostosky et al. 2004; Unger & Molina 1998). Sociodemographic
Contraceptive Method Choice among Youth
7
characteristics, such as age, gender, race/ethnicity, nativity status, and religion/religiosity
represent social position and socialization processes that shape youths’ life experiences,
opportunities and resources, social relationships, and the choices they make (Grusky 2001;
Lefkowitz et al. 2004; Lindsey 1997), including sexual and contraceptive choices. Family
background is also relevant because the family is central to the formation of sexual attitudes and
behaviors as it provides a social and economic environment, cultural values, and standards of
sexual conduct for adolescents and young adults (DeLamater 1981; Fox 1981). This study posits
that the effects of familial resources during adolescence carry forward into young adulthood
through their indirect influence on future goals, partner selection, and the types of family
formation behaviors desired.
Psychosocial factors. Psychosocial explanations for differences in individuals’
sexual and protective practices stem from theories of health behavior, which identify a set of
overlapping cognitive variables hypothesized to predict behavior, namely perceived risk,
perceived severity, and self-efficacy (Strecher & Rosenstock 1996). Applied to contraceptive
behavior, individuals engage in protective practices, such as using contraception, if they regard
themselves as susceptible to unintended pregnancy and/or STIs, if they believe these outcomes
have serious consequences, and if they have confidence in their ability to use contraception
despite potential barriers. A number of studies have confirmed these hypothesized associations
(e.g., Colon, Wiatrek, & Evans 2000; Longmore et al. 2003; Sheeran, Abraham, & Orbell 1999;
Soler et al., 2000). However, previous studies tend to focus on condom use and often place less
emphasis on other factors that represent social position and processes, specifically ignoring the
contributions of youths’ sexual relationships. The current study improves upon past research by
accounting for other important individual characteristics and different method types, and by
exploring the extent to which the effects of these psychosocial factors exist net of differences
attributable to the types of relationships youth form. Furthermore, the psychosocial factors
examined in this study are measured during adolescence, thus enabling an investigation of the
potential enduring effects. Higher levels of perceived risk of pregnancy and STIs, perceived
severity of pregnancy, and contraceptive self-efficacy are posited to be associated with an
increased likelihood of using contraception, particularly dual method use, as this method would
be most protective against both pregnancy and STIs.
Contraceptive Method Choice among Youth
8
Early risk-related experiences. Individuals exhibit differential patterns of
behavior depending on the timing and sequencing of critical developmental and transitional
events (Elder 1995). The current study views the age at onset of sexual activity as a key early
risk-related experience, the timing of which may influence later experiences. Age is associated
with cognitive development and decision-making skills (Byrnes 2002; Fischer et al. 1996).
Those who delay sex may be more developed cognitively, socially, and emotionally, and thus
better able to comprehend the potential consequences of their behavior, form safer relationships,
plan for sex, and negotiate protective practices with their current and future partners. Studies
indicate that youth with earlier ages at sexual initiation are less likely to use contraception, tend
to have greater numbers of sexual partners, and may be at higher STI risk (Coker et al. 1994;
Greenberg, Madger, & Aral 1992; Santelli et al. 1998; Upchurch et al. 2004). It is less evident,
however, whether there are enduring effects of this early risk-related experience on later
contraceptive practices adjusting for differences in the characteristics of relationships; this is
examined in the current study.
Methodological Issues
The current study seeks to investigate relationship-specific contraceptive behavior both
within and between individuals. Much of the prior reproductive health research has used a
between person approach. This approach allows researchers to study how people who differ
along certain dimensions behave, or how people in general respond to situational factors (Gable
& Reis 1999). This approach allows for a comparison of relationship experiences across
individuals, but does not account for an important source of variability: individuals have
relationships with different partners. Failing to account for variability across relationships for a
given individual ignores the notion that individuals may behave differently with different
partners. A within person approach can ameliorate this shortcoming as it allows for a
comparison of relationship experiences for each individual. By adopting a within person
perspective, the current study can examine the multiple relationships within which individuals
have functioned. Relationships and individuals are conceptualized at distinct levels, and a
multilevel approach is applied in order to investigate variation in the type of contraceptive
method used attributable to differences in the characteristics of relationships, while also
examining individual characteristics.
Contraceptive Method Choice among Youth
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Summary
The present study builds on previous research examining contraceptive behavior among
adolescents and young adults and extends our understanding of the nonmarital sexual
relationships that are formed during the early life course and the role that these relationships play
in the decisions to use specific contraceptive methods. The current study utilizes a nationally
representative data set of young adults that includes rich retrospective relationship histories
spanning mid-adolescence to early adulthood. This study also develops and investigates a more
detailed characterization of the types of nonmarital sexual relationships that youth form than
previous studies, thereby recognizing that these relationships are multidimensional and should be
conceptualized accordingly. Additionally, multiple contraceptive methods are examined (i.e.,
condom, hormonal method, and dual method) because it is posited that there are potentially
different motivations for using a particular method, and that these motivations vary as a function
of the relationship context. Furthermore, through the use of multilevel modeling techniques, this
study accounts for the multiple relationships that individuals form and is therefore better able to
investigate the extent to which individuals may behave differently in different relationships.
DATA AND METHODS
Study Design and Sample
The data to be used for this study are from Add Health (Harris et al. 2003). The original
sampling frame consisted of 80 high schools, with “feeder schools” (e.g., junior high school) for
each identified high school also being sampled. The student roster constituted the student-level
sampling frame. From that listing, a baseline sample was drawn consisting of a core sample and
several oversamples. The core sample is a probability sample of size 12,105 that is nationally
representative of students enrolled in grades 7-12 during the 1994-1995 academic year. With the
oversamples, the Wave I sample size is 20,745; respondents were 11-21 years old. The Wave II
sample (survey conducted in 1996) includes all adolescents interviewed at Wave I, except for the
deletion of 12th graders and one of the oversamples. The Wave II sample size is 14,738;
respondents were 12-22 years old. In 2001 and 2002, Wave I respondents, now young adults
aged 18-27, were reinterviewed. The Wave III sample size is 15,197. Response rates at each
wave are 78.9%, 88.2%, and 77.4%, respectively.
Contraceptive Method Choice among Youth
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The relationship-level data collected during the Wave III interview is the primary source
of data for this study. At Wave III, respondents were asked to identify all romantic and/or sexual
relationships since Wave I. Respondents then answered a short series of questions pertaining to
each relationship via audio-CASI (Computer Assisted Self-Interview) techniques. Based on the
answers to these screener questions, relationships were determined to be sexual, important,
and/or selected to be part of a couple sample by the Add Health investigators (relationships could
be more than one type). Different additional relationship-specific questions were asked
according to whether the relationship was one or more of these types (e.g., important and sexual
but not part of the couple sample). 1 Because the objective is to understand the ways in which
nonmarital sexual relationships are associated with the type of method used including hormonal
methods, analysis is limited to heterosexual nonmarital relationships in which vaginal sex
occurred (26,948 relationships for 9,203 individuals). In order to examine variation in
contraceptive method choice across individuals’ multiple relationships, the analytic sample is
restricted to respondents who identified more than one such relationship with valid information
on the type of method used (22,740 relationships for 5,832 individuals). Individual-level
information from the Waves I and III interviews are also used for this study. Wave III measures
of gender, race/ethnicity, nativity status, and age at first sex and Wave I measures of religion,
family background, and psychosocial factors are used. Psychosocial factors were only collected
for respondents who were 15 years old or older at Wave I, therefore necessitating the exclusion
of those who were younger than 15 at Wave I. Individuals missing a Wave III weight are also
excluded. Native Americans comprised less than 1% of the Wave III sample; due to this small
cell size, analysis including this racial/ethnic group was not possible. The final analytic sample
includes 4,111 individuals and 16,179 relationships.
Variable Description and Measurement
Dependent variable. Respondents were asked questions regarding contraceptive
use at first and last sex for heterosexual relationships in which vaginal sex had occurred. The
following methods were queried and multiple responses were allowed: a) condom, b)
1
This part of the study design was motivated by the different research interests of the Add
Health investigators, which resulted in different versions of the questionnaire being administered
according to the relationship type (sexual, important, or couple). Refer to the Add Health study
Web site for details (http://www.cpc.unc.edu/projects/addhealth/files/w3cdbk/sect19.zip).
Contraceptive Method Choice among Youth
11
withdrawal, c) rhythm, d) birth control pill, e) vaginal sponge, f) foam, jelly, creme,
suppositories, g) diaphragm, with or without jelly, h) IUD, i) Norplant, j) ring, k) Depo Provera,
l) contraceptive film, and m) some other method. Relationships may change across time thereby
making it difficult to relate an individual’s retrospective description of the relationship to
contraceptive use that occurred at the beginning of a relationship. Individuals’ assessments of
characteristics such as commitment are expected to be more closely aligned with behavior that
occurred during the most recent sexual experience, therefore, the current study examines
contraceptive use at last sexual intercourse. The outcome variable measures the type of
contraceptive method used at last sex and was collapsed into the following mutually exclusive
categories: (1) no method, (2) condom only, (3) hormonal only, and (4) dual method (condom
plus hormonal). For those who mentioned more than one method, priority was given to condom
and/or hormonal methods as these are the most effective methods for STI and pregnancy
prevention (e.g., the condom category also includes those who used a condom and some other
non-hormonal method). Only 1% of relationships used only withdrawal, rhythm, and/or some
other method, which made multilevel analysis for this group difficult; these relationships were
also excluded.
Relationship-level independent variables. Relationship commitment is
operationalized as a multidimensional relationship typology, which characterizes nonmarital
sexual relationships into meaningful and distinct groups according to the unique patterns of the
following four characteristics: 1) relationship type, 2) length of time the respondent knew the
partner before first having sexual intercourse, 3) duration of the sexual relationship, and 4)
frequency of sexual activity (refer to the Appendix for the categories of each measure). The
typology was created by categorizing relationships in terms of their most defining
characteristic(s) as identified by cluster analysis (Aldenderfer & Blashfield 1984). 2 For ease of
discussion, the seven categories of the relationship typology were assigned shortened labels that
summarize the major dimension(s) of importance: 1) casual and knew each other shorter time, 2)
casual and knew each other longer time, 3) moderately serious and less frequent sex, 4)
moderately serious and more frequent sex, 5) serious, longer, and more frequent sex, 6) most
serious and less frequent sex, and 7) most serious and more frequent sex. The moderately
2
Results are available from the authors.
Contraceptive Method Choice among Youth
12
serious and more frequent sex relationships are the reference category. (Refer to the Appendix
for more details on each category.)
Couple heterogamy is operationalized as age and racial/ethnic differences between
partners. Age difference was measured in years and collapsed as follows: (1) partner is three or
more years older, (2) partner is within two years of the respondent’s age, and (3) partner is three
or more years younger. Reference relationships are those in which the partner was within two
years of the respondent’s age. Racial/ethnic difference was constructed by comparing the
respondent’s race/ethnicity to the partner’s race/ethnicity; it was coded 1 if the partner was a
different race/ethnicity and 0 otherwise. This study also controls for whether the relationship
was current (coded 1 if the relationship was ongoing at Wave III and 0 otherwise) and whether
the relationship had involved a pregnancy (coded 1 if a pregnancy had ever occurred in the
relationship and 0 otherwise). 3
Individual-level independent variables. All analyses are stratified by the
respondent’s gender. For race/ethnicity, priority was given to any mention of being Hispanic,
with groups defined as non-Hispanic white, non-Hispanic black, Hispanic, or non-Hispanic
Asian. Non-Hispanic white is the reference group. Nativity status is binary and indicates
whether an adolescent was born in the United States or not. The reference category is U.S. born.
Age is operationalized as the age of the respondent at the beginning of the sexual relationship
and therefore varies across relationships. It was measured in years and then collapsed into the
following categories: (1) 15 years or younger, (2) 16-17 years, (3) 18-19 years, (4) 20-21 years,
and (5) 22 years or older. The reference category is 18-19 years old. At Wave I, respondents
were asked to identify their religious denomination from a list of 28 possible responses that also
included no denomination. For this study, religious denomination was collapsed into the
following categories: (1) no denomination, (2) Catholic, (3) Protestant, (4) Non-Christian, and
(5) other. Protestant is the reference group. A religiosity scale was created using principal
components factor analysis of attendance, importance, and prayer. A low score indicates low
3
Less than 5% of relationships were missing on any relationship variable, and for most of the
relationship variables, the percentage missing on each was less than 1%. Missing values were
imputed using regression models that included all individual- and relationship-level variables
and accounted for clustering of relationships within individuals. Results of models predicting
contraceptive method used at last sex as a function of imputed versions of the relationship
variables did not differ substantially from models that excluded these relationships.
Contraceptive Method Choice among Youth
13
levels of religiosity. Family structure was based on the Wave I household roster and includes:
(1) two biological parents, (2) biological mother with stepfather, (3) biological father with
stepmother, (4) biological mother only, (5) biological father only, and (6) other situations. The
two biological parents category is the reference. Mother’s and father’s education were separately
coded as years of schooling completed. 4 Logged household income in 1994 is also included as a
family background measure. 5 Respondents who were 15 years old or older as of Wave I were
asked questions regarding perceived risk and severity of pregnancy, AIDS, and/or STIs and
contraceptive self-efficacy. Three scales were developed using principal components factor
analysis: perceived risk of pregnancy or AIDS, perceived severity of becoming pregnant,
contraceptive self-efficacy (refer to the Appendix for indicators used in each scale). Low scores
indicate low levels. All respondents in the analytic sample had engaged in vaginal sexual
activity by Wave III (a necessity of the sample selection). Because almost two-thirds had not yet
had sex by Wave I, the Wave III measure of age at first vaginal sex was used. It was measured
in whole years and collapsed as follows: (1) 14 years old or younger, (2) 15-17 years old, and (3)
18 years old or older. The 15-17 year old category is the reference.
This study also accounts for prior relationship experiences. Indicators of this experience
include number of prior relationships, any hormonal method use at last sex in prior relationships,
and any pregnancies in prior relationships. 6 These measures were created based on ordered
information from preceding relationships and therefore vary across relationships. For instance,
for an individual with four relationships, the third relationship would have had two prior
relationships whereas the fourth relationship would have had three prior relationships.
4
Those who were missing on education were assigned the racial/ethnic-specific value. Those
without a parent were coded zero. Any constant would be valid; zero is convenient.
Interpretation of contrasts between family types without a defined parent and family types with
both parents requires post-estimation calculation.
5
Household income was available only from information obtained from the Wave I Parent
questionnaire. About 17,000 of the Wave I respondents had a parent who was also interviewed
at Wave I. For missing cases, log-income was imputed using a regression model that included a
number of family background characteristics as reported by the respondent.
6
Other characteristics of prior relationships (i.e., commitment and heterogamy) were not
significantly associated with contraceptive method choice in subsequent relationships and were
therefore not included in the final models presented.
Contraceptive Method Choice among Youth
14
Analytic Strategy
Descriptive statistics of the sample of young adults and their nonmarital sexual
relationships are provided first. Descriptive analysis was conducted in Stata 8.2/SE (StataCorp
2003). Stata’s survey estimation procedures (-svy-) were used in order to weight and account for
the complex study design of Add Health. Then, a multilevel modeling approach was utilized to
investigate the associations between individual- and relationship-level characteristics and the
type of contraceptive method used at last sex within each relationship; models were stratified by
gender. In the present study, level-1 represents relationships and level-2 represents individuals
(i.e., relationships are nested within individuals). The subscript j is for individuals (j = 1…J) and
the subscript i is for relationships (i = 1… nj). Because the outcome of interest, type of method
used at last sex, is a multicategory nominal variable comprised of four categories (condom,
hormonal method, dual method, and no method), the multilevel multinomial model is as follows:
Level-1:
Qm
η mij = β 0 j ( m ) + ∑ β qj ( m ) X qij , for m = 1,…, M − 1
(1)
β 0 j ( m ) = γ 00( m ) + ∑ γ 0 s ( m )W sj + u 0 j ( m ) , for m = 1,…, M − 1
(2)
q =1
Level-2:
At level-1 or within individuals, η mij is defined as the log-odds of being in the mth category (i.e.,
condom, hormonal method, or dual method) relative to the Mth category, which is the reference
category (i.e., no method), and X represents the set of relationship-level characteristics. At level2 or between individuals, the individual-specific intercepts, β 0 j ( m ) , are modeled as a function of
W, which represents the set of individual-level characteristics and are allowed to vary randomly
across individuals to account for unmeasured individual-level variables that could explain
between-individual variation in contraceptive method choice. The results from three sequential
models are presented. The first model includes relationship-level characteristics only and the
second model adds individual-level characteristics. Prior relationship experiences are accounted
for in the third model. Multilevel analysis was conducted in HLM 6.0 (Raudenbush, Bryk, &
Congdon 2004) and was unweighted.
Contraceptive Method Choice among Youth
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RESULTS
Table 1 presents the weighted descriptive statistics of individual-level characteristics by
the young adults’ gender. Overall, there were few gender differences. The majority of women’s
and men’s relationships began between the ages of 20 and 21. Women’s relationships tended to
begin somewhat earlier than men’s relationships. Over two thirds of both women and men were
white, followed by black, Hispanic and Asian. The average score on early perceptions of risk of
pregnancy or AIDS associated with engaging in unprotected sex during adolescence was higher
for women than men whereas the average score on early perceptions of severity of becoming
pregnant (or getting someone pregnant for men) was lower for women than men. Contraceptive
self-efficacy was higher among women. The average number of sexual relationships for women
and men was about four. Women and men had a similar average number of prior relationships
and similar prior experiences with hormonal method use. Women had higher percentages of any
prior relationships that had involved a pregnancy than did men.
Table 2 presents the weighted distributions of the characteristics of young adults’
nonmarital sexual relationships by the young adults’ gender. The majority of both women’s and
men’s relationships were moderately serious and involved more frequent sex. Men had more
relationships that were casual and involved knowing the partner for a shorter time before first
sex. Women had more relationships that were moderately serious and involved less frequent sex.
Women were more likely to have older partners whereas men were more likely to have younger
partners. Most of women’s and men’s relationships involved a condom only at last sex. Men
had more relationships that did not involve any method at last sex and women had slightly more
relationships that had involved a hormonal method either alone or with a condom.
Tables 3 and 4 present the multilevel multinomial model results in the form of log-odds
for the type of contraceptive method used at last sex among women and men, respectively.
Model 1 includes relationship characteristics only and Model 2 adds individual characteristics.
The results for Model 1 (Table 3) indicate that there is substantial variation in the specific
type of method used at last sex according to the unique characteristics of women’s relationships.
Casual relationships where the partner was known for longer had higher log-odds of using a
condom only versus no method as compared to the reference relationships (i.e., moderately
serious and more sex). Moderately serious relationships that had less sex also had higher logodds of condom use whereas serious relationships that were longer and had more sex had lower
Contraceptive Method Choice among Youth
16
log-odds. The most serious relationships that involved more sex had lower log-odds of condom
use only. All three of the relationships that were more casual than the reference relationships
had lower log-odds of hormonal method use only. Moderately serious relationships that had less
sex had higher log-odds of dual method use whereas the most serious relationships that involved
more sex had lower log-odds. Relationships with a partner who was three or more years older
had lower log-odds of involving any method type relative to no method. Interracial relationships
had higher log-odds of condom use at last sex. As shown in Model 2, the significant associations
between these relationship-level characteristics and type of method did not change substantially
upon accounting for individual-level characteristics.
Several individual-level characteristics were also associated with contraceptive method
choice among women (Model 2). Relationships that began when the woman was between the
ages of 16 and 17 had higher log-odds of condom use only. Relationships that began prior to age
18 had lower log-odds of involving a hormonal method whereas only relationships formed
during early adolescence (i.e., prior to age 16) had lower log-odds of dual method use. Black
women had higher log-odds of condom use with or without a hormonal method but lower logodds of having used a hormonal method only. Hispanic and Asian women had lower log-odds of
hormonal method use, either alone or with a condom. Women who had not identified with any
religion during adolescence had significantly higher log-odds of using any type of method. A
higher level of maternal education was associated with greater log-odds of using a hormonal
method only whereas paternal education was positively associated with using a condom only or a
dual method. Women who had perceived a greater level of risk of pregnancy or AIDS associated
with engaging in unprotected sex during adolescence had higher log-odds of using a dual
method; risk perception was not significantly associated with condom use only or hormonal
method use only. Women who had reported a greater level of perceived severity associated with
becoming pregnant during adolescence had higher log-odds of using any method type at last sex.
Increases in self-efficacy to use contraception were associated with increased log-odds of using a
hormonal method, with or without a condom. Between-individual variation in relationshipspecific contraceptive method choice at last sex remains even after controlling for individual and
relationship characteristics, as evidenced by the significant random variance components.
The results for Model 1 (Table 4) among men also indicate substantial variation in the
specific type of method used at last sex according to the unique characteristics of their
Contraceptive Method Choice among Youth
17
relationships. Moderately serious relationships that involved less sex had higher log-odds of
condom use only whereas serious relationships that were longer and had more sex had lower logodds compared to the reference relationships. All three of the relationships that were more
casual than the reference relationships had lower log-odds of involving a hormonal method
whereas serious relationships that were longer and had more sex had higher log-odds of
involving this method type. The most serious relationships that had less sex had lower log-odds
of involving a hormonal method only. Both types of casual relationships had lower log-odds of
dual method use. Relationships with an older partner had lower log-odds of involving a condom
only whereas relationships with a younger partner had lower log-odds of involving a hormonal
method, either alone or with a condom. As was found among women, the significant
associations between these relationship-level characteristics and the type of method used among
men did not change substantially upon accounting for individual-level characteristics, with two
exceptions. Casual relationships in which the partner was known a shorter time had higher logodds of condom use only and relationships in which the partner was three or more years older
had lower log-odds of involving a hormonal method only.
Individual-level characteristics were also associated with contraceptive method choice
among men (Model 2). Relationships that began when the man was between the ages of 16 and
17 had lower log-odds of involving a hormonal method only whereas relationships that began
during early adulthood (i.e., after age 21) had higher log-odds of involving a hormonal method
only; age at relationship formation was not associated with condom use, either alone or with a
hormonal method. Compared to white men, black and Hispanic men had higher log-odds of
condom use only. Black men had lower log-odds of reporting that their partner used a hormonal
method only while Hispanic and Asian men had lower log-odds of reporting partners’ hormonal
method use, with or without a condom. There were few significant associations with religion
and family background with the exception of maternal education, which was positively
associated with all method types. Men who had perceived a greater level of risk of pregnancy or
AIDS associated with engaging in unprotected sex during adolescence had higher log-odds of
using a condom, with or without a hormonal method. Perceived severity of getting someone
pregnant during adolescence was positively associated with reporting that their partner used a
hormonal method only. Men with higher levels of contraceptive self-efficacy, as measured
during adolescence, had higher log-odds of using any method type. Only the random variance
Contraceptive Method Choice among Youth
18
components for condom and dual method use were significant, suggesting that among men,
differences in their own characteristics and the characteristics of their relationships explained a
substantial portion of the between-individual variation in whether their partner had used a
hormonal method at last sex.
Table 5 presents the results for prior relationship experiences net of all previously
included relationship- and individual-level characteristics, stratified by gender. Recall that these
indicators vary across relationships as they are based on characteristics of relationships that
preceded each relationship. Among women, as the number of prior relationships increased, or in
other words, the more relationship experiences the woman had prior to a given relationship, the
log-odds of condom use and dual method use decreased. Hormonal method use in any prior
relationships was negatively associated with condom use and positively associated with
hormonal and dual method use in a subsequent relationship. Among men, the greater the number
of prior relationships (i.e., more prior experience), the lower was the log-odds of dual method
use in a subsequent relationship. Having had any prior relationships in which a partner used a
hormonal method was associated with increased log-odds of hormonal or dual method use.
Relationships that had occurred after any relationships that involved a pregnancy had lower logodds of involving a hormonal method, either with or without a condom. The patterns of
associations between the previously discussed relationship- and individual-level characteristics
and contraceptive method choice within a relationship did not change upon controlling for
previous relationship experiences (results available from authors). However, the betweenindividual variance components were reduced (particularly for hormonal and dual method use),
suggesting that the remaining variation between individuals in the previous models was
attributable, in part, to individuals’ prior experiences. In other words, while the characteristics of
a specific relationship matter for the method used in that relationship, experiences in earlier
relationships are also important for later relationships.
DISCUSSION
This study examines contraceptive method choice within a multilevel framework thereby
allowing for an investigation of both relationship and individual characteristics. This study
develops and investigates a multidimensional relationship typology that is shown to have
important, yet previously undetected, implications for the type of contraceptive method used.
Contraceptive Method Choice among Youth
19
These findings are noteworthy because they emphasize that contraceptive method choice varies
across relationships for a given individual as a function of the unique characteristics of the
relationship, net of important individual characteristics and prior relationship experiences. The
results also confirm the importance of individuals’ own characteristics and reveal that early
perceptions of risk and severity of negative reproductive health outcomes and contraceptive selfefficacy have enduring effects on later contraceptive method choices. In addition, the patterns of
associations between both relationship and individual characteristics and contraceptive use differ
depending on the specific type of method.
This study investigates a more detailed conceptualization of the casual versus serious
dichotomy and in doing so, not only concurs with the general finding that casual relationships are
more likely to use condoms and serious relationships are more likely to use hormonal methods
(e.g., Fortenberry et al. 2002; Ku et al. 1994; Ott et al. 2002), but further reveals that there is
variation in the type of contraceptive method used within these two general types that may not
have been evident with previous distinctions. For instance, among women, of the three more
serious relationships, those that involved less sex are more likely to have used a condom than the
other two types that involved more sex (calculated by subtracting the coefficients). This is
consistent with the previous finding that condom use is negatively associated with frequency of
sex (Katz et al. 2000; Sayegh et al. 2006), and as the current study further illustrates, even at
similar levels of relationship seriousness. In addition, among women, while the two most casual
relationships do not differ from one another in terms of condom use, casual relationships that
involved knowing the partner for longer before sex are more likely to have reported hormonal
method use than those that involved knowing the partner for a shorter time (calculated by
subtracting the coefficients). Youth who know their partners better are more likely to have
discussed contraception (Kaestle & Halpern 2005), and those who communicate about
contraception are more likely to have used contraception (Manlove et al. 2003; Widman et al.
2006). As revealed here, knowing the partner for longer before sex improved the use of
hormonal methods despite being in a casual relationship; this distinction, however, was not
found for condom use.
For the most part, the patterns of associations between the multidimensional relationship
typology and contraceptive method choice are similar for women and men, with a notable
exception (as confirmed in a pooled model with gender interactions). Women in the most
Contraceptive Method Choice among Youth
20
serious relationships are less likely to have reported a condom or a dual method at last sex; this is
not evident among men. Women in serious relationships tend to trade condoms for hormonal
methods, particularly when pregnancy concern is high and STI risk is assumed to be low (Ott et
al. 2002). However, it may also be that negotiating condom use in a committed relationship is
more difficult for women than men. Research suggests that condom use may not be adequately
integrated into the relational scripts of serious relationships. In other words, individuals in
intimate relationships may not consider using condoms because of normative beliefs about what
should occur in intimate relationships or because they are hesitant to introduce the use of
condoms as it may imply infidelity, signify distrust, or symbolize casual sex (Gilmore,
DeLamater, & Wagstaff 1996; Hynie et al. 1998; Wingood & DiClemente 1998); these issues
may be particularly salient for women as condom use requires partner cooperation.
Similar to other studies (Abma et al. 1998; Manning et al. 2000), the present study finds
that an age difference between partners is negatively associated with the use of contraception,
but further reveals that this differs depending on type of method and type of age difference (i.e.,
having an older versus younger partner). Having an older partner (but not a younger partner) is
detrimental to the use of condoms. Contrary to expectations, this was found for both women and
men. An age difference between partners may create a power differential that makes condom
use difficult to negotiate regardless of whether the older partner is male or female. As an age
difference may also represent differences in sexual experiences and beliefs about contraception,
the older partner may dictate the method used, and as condom use tends to decrease with age (Ku
et al. 1994; Sheeran et al. 1999), condom use may be lower in such relationships. Having a
younger partner was associated with hormonal method use (with or without a condom) among
men only. It may either be that men do not know that their partners are using hormonal methods
and/or because their partners are younger, they are less likely to use this type of method. These
findings suggest that both men and women have difficulty communicating about contraceptive
issues with their partners; this deserves greater attention as communication has been found to
improve use (Manlove et al. 2003; Widman et al. 2006).
Women in interracial relationships are more likely to report that their partner used a
condom. While this is contrary to expectations, there are reasons why it may be plausible.
Interracial relationships tend to be less public and to have less social support from significant
others (Wang, Kao, & Joyner 2004). This may result in the couple spending greater amounts of
Contraceptive Method Choice among Youth
21
time alone in more couple-oriented activities, which may result in better communication,
therefore increasing condom use. This, however, does not explain the gender differential (as
confirmed in a pooled model with gender interactions). Studies indicate that there are
differences in the prevalence of forming interracial relationships that vary by gender and
race/ethnicity (Ford & Lepkowski 2004; Ford et al. 2002; Laumann & Youm 1999). This was
not explicitly explored in the current study but may partially explain this result. For instance,
black men in this sample are much more likely than black women to form interracial
relationships (results not shown). To the extent that the interracial partners of women in this
sample are the men from the racial/ethnic groups that are more likely to use condoms with their
partners, condom use may be easier to negotiate in these relationships.
The findings for individual-level characteristics largely confirm those of past research but
for a large and diverse sample of youth and further, provide new information regarding the
potential longer-term influence of psychosocial factors. Specifically, early perceptions of risk
and severity of negative reproductive health outcomes and contraceptive self-efficacy have
enduring and differential associations with later contraceptive method choices. Both women and
men who perceived higher levels of pregnancy or AIDS risk are more likely to have reported
dual method use. This makes sense given that a dual method would be protective against both
pregnancy and STIs whereas the use of a hormonal method alone would not protect against STIs.
Women who had perceived higher levels of severity associated with becoming pregnant are more
likely to report that any method was used whereas perceived severity is not associated with
condom or dual method use among men. The short- and long-term implications of pregnancy are
arguably of greater consequence for women. Accordingly, the desire to avoid pregnancy may be
greater for women and therefore result in increased use of any method. Men who perceived
higher levels of pregnancy or AIDS risk or who had higher contraceptive self-efficacy are more
likely to have used a condom; neither is associated with using a condom among women. Given
that condoms are controlled by men, if men have greater desires to avoid pregnancy or AIDS and
feel more confident in their ability to use condoms, they may be more likely to make the decision
to use this method. These results are noteworthy because the psychosocial variables were
measured prior to the formation of most of these relationships, indicating that these factors may
have enduring effects through adolescence and into young adulthood.
Contraceptive Method Choice among Youth
22
While this study advances our understanding of the association between the relationship
context and contraceptive method choice, there are limitations. There may be recall or reporting
bias in the reporting of relationship information, thereby creating a select sample of identified
relationships. Individuals may remember and thus report more salient long-term relationships
but overlook more casual short-term relationships. In addition, there may be selection into
certain types of relationships. For instance, individuals who are motivated by intimacy needs
may have fewer partners, have partners who are more familiar, and have closer relationships than
those who are motivated by pleasure-seeking goals (Cooper, Shapiro, & Powers 1998). When
partners are better known, communication concerning contraception may be easier, thus
potentially improving use and the type of method used. In addition, creating a typology is one
approach of several that may be used to better characterize the complexities of youths’
nonmarital sexual relationships. However, the results of this study suggest that the categories of
the typology are substantively meaningful and reflect multiple dimensions of relationships, with
different dimensions being of greater importance for different types of relationships. Also, while
the findings are consistent with those presented in existing literature or those hypothesized based
on theory, the underlying mechanisms are still not well defined and between-individual variation
remains. There may be other relationship factors, most of which were not available for this
sample of relationships, that could explain the associations and the remaining between-individual
variation, such as relationship quality and satisfaction, gender equity, violence, and
communication (Manlove et al. 2003; Manlove et al. 2007; Soler et al. 2000; Widman et al.
2006; Wingood & DiClemente 1998).
An important contribution of this study is the examination of relationship-specific
contraceptive practices within a multilevel framework and the subsequent finding that
individuals may behave differently in different relationships, as evidenced by the significant
patterns of associations between the characteristics of youths’ relationships and contraceptive
method choice, net of a comprehensive set of individual characteristics and prior relationship
experiences. As this is a relatively new area of research, future research endeavors would benefit
from enriching both the content and method of data collection in order to allow for a more
thorough investigation of youths’ partners and relationships and the potential mechanisms by
which relationship context influences contraceptive behavior. Data that include relationship
process measures, such as emotional closeness, are still lacking relative to measures that more
Contraceptive Method Choice among Youth
23
likely represent relationship structure, such as duration. In addition, questions that go beyond
asking about contraceptive use at first and last sex are necessary in order to better understand
change in contraceptive behavior across time within a given relationship.
Contraceptive Method Choice among Youth
24
APPENDIX
Relationship characteristics included in the multidimensional relationship
typology:
Relationship type:
• Only having sex
• Dating occasionally
• Dating frequently but not exclusively
• Dating exclusively
• Cohabiting
Time partner was known before first sex:
• One day or less
• More than a day but less than a week
• One to two weeks
• Two to four weeks
• One to five months
• Six months to a year
• A year or more
Duration of sexual relationship:
• One month or less
• Two to four months
• Five to 12 months
• 13 to 27 months
• 28 months or more
Frequency of sexual activity:
• Sex occurred on only one occasion
• One time per week or less
• Two times per week
• Three times per week
• Four to seven times per week
• Eight or more times per week
More detailed description of the multidimensional relationship typology
categories:
•
•
•
•
•
Sex only and occasionally dating relationships, partner known for two weeks or less
Sex only and occasionally dating relationships, partner known for two weeks or more
Frequently and exclusively dating relationships, sex one or fewer times per week
Frequently and exclusively dating relationships, sex more than one time per week
Exclusively dating and cohabiting relationships, lasted more than a year, sex more than
three times a week
Contraceptive Method Choice among Youth
•
•
25
Cohabiting relationships, sex one or fewer times per week
Cohabiting relationships, sex more than one time per week
Indicators used in psychosocial scales:
Perceived risk of pregnancy or AIDS:
• Chance of becoming pregnant if they had unprotected sex even just once
• Chance of getting the AIDS virus if they had unprotected sex as often as they wanted for
a whole month
Perceived severity of becoming pregnant:
• Getting pregnant (or getting someone pregnant if male respondent) at this time in their
life would be one of the worst things that could happen
• It would be bad if they got pregnant (or got someone pregnant if male respondent) at this
time in their life (reverse coded)
Contraceptive self-efficacy:
• If they wanted to use birth control, how sure they are that they could stop themselves and
use birth control if they were highly aroused or turned on
• How sure they are that they could plan ahead to have some form of birth control available
• How sure they are that they could resist sex if their partner did not want to use some form
of birth control
Contraceptive Method Choice among Youth
26
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Contraceptive Method Choice among Youth
30
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31
Contraceptive Method Choice among Youth
Table 1.
Weighted Descriptive Statistics (Percentages or Means) of Individual
Characteristics by Individual’s Gender, Add Health, Wave III (2001-2002)
Individual Characteristics
Sociodemographic characteristics
Age at the beginning of the relationship*** a
≤ 15 years
16-17 years
18-19 years
20-21 years
≥ 22 years
Race/ethnicity
White
Black
Hispanic
Asian
Nativity status
US born
Foreign born
Religious denomination as of Wave I
No religious affiliation
Catholic
Protestant
Non-Christian
Other
Religiosity as of Wave I*** b
Family background factors
Family structure as of Wave I
Both biological parents
Biological mother/stepfather
Biological father/stepmother
Biological mother only
Biological father only
Other family situations
Parental education as of Wave I
Mother’s education c
Father’s education d
Household income as of Wave I
Psychosocial factors
Perceived risk of pregnancy or AIDS as of Wave I***
Perceived severity of pregnancy as of Wave I*
Contraceptive self-efficacy as of Wave I***
Women
Men
7.5
20.6
27.1
27.5
17.3
5.7
17.0
27.5
30.2
19.6
71.7
17.6
8.0
2.7
73.2
14.1
10.0
2.7
97.2
2.8
96.4
3.6
15.0
22.4
57.0
1.5
4.1
-0.09
16.1
26.1
52.1
2.5
3.2
-0.31
53.3
9.3
1.3
25.5
4.0
6.6
54.8
8.4
2.3
24.8
3.9
5.8
13.33
13.71
$47,208
0.19
0.04
2.13
13.37
13.66
$47,353
-0.19
0.14
-0.08
(continued)
32
Contraceptive Method Choice among Youth
(Table 1, continued)
Women
Individual Characteristics
Early-risk related experiences
Age at first sex as of Wave III
≤ 14 years
15-17 years
≥ 18 years
Number of sexual relationships per individuals
Prior relationship experiences e
Number of prior relationships
Any hormonal use in prior relationships
Any pregnancies in prior relationships***
N (individuals)
Men
20.3
53.5
26.2
3.92
17.5
57.3
25.2
3.92
2.19
28.5
15.9
2.24
27.1
8.5
2,221
1,890
Note: Wave III weights; unweighted Ns. Design-based F-test significance levels conducted for gender
comparisons
a
b
c
d
e
Age of the respondent at the beginning of the relationship varies across relationships.
Among respondents who reported a religious denomination.
Among respondents who reported a residential mother/mother figure.
Among respondents who reported a residential father/father figure.
Prior relationship experience measures vary across relationships.
* p < .05; ** p < .01; *** p < .001
33
Contraceptive Method Choice among Youth
Table 2.
Weighted Descriptive Statistics (Percentages) of Relationship Characteristics
by Individual’s Gender, Add Health, Wave III (2001-2002)
Women
Relationship Characteristics
Relationship typology***
Casual, knew each other shorter time
Casual, knew each other longer time
Moderately serious, less frequent sex
Moderately serious, more frequent sex
Serious, longer, more frequent sex
Most serious, less frequent sex
Most serious, more frequent sex
Age difference***
Partner ≥ 3 years older
Partner within 2 years
Partner ≥ 3 years younger
Racial/ethnic difference
Relationship current
Pregnancy occurred***
Type of method used at last sex***
No method
Condom
Hormonal
Dual method (condom plus hormonal)
N (relationships)
Men
9.7
19.7
21.1
26.5
10.8
5.9
6.3
22.5
17.5
12.7
25.3
11.3
4.7
6.0
36.8
61.4
1.8
20.8
17.9
13.2
11.0
74.1
14.9
19.8
16.8
7.3
27.2
38.3
16.2
18.3
32.3
40.9
13.3
13.5
8,696
7,483
Note: Wave III weights; unweighted Ns. Design-based F-test significance levels conducted for gender
comparisons.
* p < .05; ** p < .01; *** p < .001
34
Contraceptive Method Choice among Youth
Table 3.
Multilevel Multinomial Logistic Regression Results (Coefficients) of Relationship-Specific Type of Contraceptive
Method Used at Last Sex, Effects of Relationship- and Individual-level Characteristics, Add Health, Wave III
(2001-2002), Women
Relationship-level Characteristics
Relationship typology (ref: moderately
serious, more frequent sex)
Casual, knew shorter time
Casual, knew longer time
Moderately serious, less frequent sex
Serious, longer, more frequent sex
Most serious, less frequent sex
Most serious, more frequent sex
Age difference (ref: partner within 2
years)
Partner 3+ years older
Partner 3+ years younger
Racial/ethnic difference (ref: partner
same race/ethnicity)
Partner different race/ethnicity
Current status (ref: past)
Current
Pregnancy history (ref: no)
Yes
Condom
vs.
None
M1
Hormonal
vs.
None
Condom
vs.
None
M2
Hormonal
vs.
None
0.0292
0.2814**
0.6523***
-0.3643**
-0.1244
-0.7852***
-1.2879***
-0.8158***
-0.5646***
0.2169
0.0993
0.1252
-0.1915
-0.1297
0.3292**
-0.2128
0.1102
-0.4178*
0.1192
0.3051**
0.5989***
-0.3906**
-0.0561
-0.6878***
-1.2760***
-0.7879***
-0.5390***
0.2651*
0.0481
0.1002
-0.1594
-0.1198
0.2896*
-0.2206
0.0600
-0.4278*
-0.2266**
-0.2262
-0.2097*
0.0677
-0.3425***
-0.0692
-0.1976**
-0.0871
-0.1669*
0.0834
-0.3173***
0.0095
0.1614*
-0.1376
-0.0376
0.2236**
-0.1023
-0.4849***
1.0639***
-0.0175
-0.4514***
0.9191***
-1.0991***
-1.1273***
-1.1303***
-1.1937***
-0.7833***
Dual
vs.
None
Dual
vs.
None
0.1146
-0.0729
-1.0850***
(continued)
35
Contraceptive Method Choice among Youth
(Table 3, continued)
Condom
vs.
None
Individual-level Characteristics
Age at beginning (ref: 18-19 years)
≤ 15 years
16-17 years
20-21 years
≥ 22 years
Race/ethnicity (ref: White)
Black
Hispanic
Asian
Nativity status (ref: US born)
Foreign born
Religious denomination (ref:
Protestant)
No denomination
Catholic
Non-Christian
Other
Religiosity
Family structure (ref: Two biological
parents)
Biological mother/stepfather
Biological father/stepmother
Biological mother only
Biological father only
Other situations
M1
Hormonal
vs.
None
Dual
vs.
None
Condom
vs.
None
M2
Hormonal
vs.
None
Dual
vs.
None
0.1364
0.2733**
-0.0771
-0.1835
-0.6250**
-0.3366*
0.0983
0.2430
-0.4745**
0.0164
0.0596
-0.1076
0.9314***
0.1240
-0.1578
-0.6822***
-0.7620***
-0.8206**
0.3368*
-0.8275***
-1.0530***
-0.0479
-0.3590
-0.2638
0.3017*
0.3515**
0.7805
0.1583
-0.0255
0.5112**
0.2070
1.0995*
0.1614
-0.0950
0.4200*
0.3932*
0.6738
0.3528
-0.0217
0.2125
-0.3917
0.6866*
0.0856
0.8469*
0.0695
-0.1930
0.2228
0.7817
1.3992**
0.0314
0.2230
0.9692*
0.6024
1.8451***
(continued)
36
Contraceptive Method Choice among Youth
(Table 3, continued)
Condom
vs.
None
M1
Hormonal
vs.
None
Dual
vs.
None
Parental education
Maternal education
Paternal education
(ln) Household income
Age at first sex (ref: 15-17 years)
14 years or younger
18 years or older
Number of sexual relationships
Perceived risk of pregnancy or AIDS
Perceived severity of pregnancy
Contraceptive self-efficacy
Intercept
Random variance component
( τˆ00 ( m ) 00 ( m ) )
0.6422***
1.2988***
-0.4323***
2.5026***
Note: Unweighted results. N=2,221 women and 8,696 relationships.
* p < .05; ** p < .01; *** p < .001
-0.1791
3.5414***
Condom
vs.
None
M2
Hormonal
vs.
None
Dual
vs.
None
0.0152
0.0537*
0.0361
0.0822**
0.0335
0.2037*
0.0549
0.0759*
-0.0782
-0.2982**
0.3079**
-0.0163
0.0501
0.0871*
0.0645
-0.3466*
0.0790
-0.0893***
0.0826
0.1220*
0.2231**
-0.5091**
0.2277
-0.0947***
0.1532*
0.1775**
0.3100***
-0.7780*
1.2488***
-2.1741***
2.3122**
-1.3805**
3.4097***
37
Contraceptive Method Choice among Youth
Table 4.
Multilevel Multinomial Logistic Regression Results (Coefficients) of Relationship-Specific Type of Contraceptive
Method Used at Last Sex, Effects of Relationship- and Individual-level Characteristics, Add Health, Wave III
(2001-2002), Men
Relationship-level Characteristics
Relationship typology (ref: moderately
serious, more frequent sex)
Casual, knew shorter time
Casual, knew longer time
Moderately serious, less frequent sex
Serious, longer, more frequent sex
Most serious, less frequent sex
Most serious, more frequent sex
Age difference (ref: partner within 2
years)
Partner 3+ years older
Partner 3+ years younger
Racial/ethnic difference (ref: partner
same race/ethnicity)
Partner different race/ethnicity
Current status (ref: past)
Current
Pregnancy history (ref: no)
Yes
Condom
vs.
None
M1
Hormonal
vs.
None
0.1673
0.1329
0.5886***
-0.5114***
-0.2964
-0.2456
-1.0812***
-0.8768***
-0.3318*
0.3072*
-0.5611**
0.2185
-0.3181**
-0.1157
-0.0073
-0.1616
-0.7420***
Condom
vs.
None
M2
Hormonal
vs.
None
-0.6327***
-0.4445**
0.0682
-0.1335
0.1779
-0.0045
0.2365*
0.1513
0.5517***
-0.5135***
-0.2694
-0.1974
-1.0983***
-0.9046***
-0.3083*
0.4860**
-0.5824**
0.2442
-0.5662***
-0.4356**
-0.0042
-0.1676
0.0831
-0.0574
-0.2467
-0.2574*
-0.2453
-0.3842**
-0.3179**
-0.0921
-0.2944*
-0.3188*
-0.2596
-0.3974**
-0.2003
-0.0779
-0.0599
0.0648
0.0311
-0.1676
1.0715***
0.2300
1.2126***
-0.9416***
Dual
vs.
None
0.2413*
-0.8947***
-0.7929***
-0.6324***
Dual
vs.
None
-0.9350***
(continued)
38
Contraceptive Method Choice among Youth
(Table 4, continued)
Condom
vs.
None
Individual-level Characteristics
Age at beginning (ref: 18-19 years)
≤ 15 years
16-17 years
20-21 years
≥ 22 years
Race/ethnicity (ref: White)
Black
Hispanic
Asian
Nativity status (ref: US born)
Foreign born
Religious denomination (ref:
Protestant)
No denomination
Catholic
Non-Christian
Other
Religiosity
Family structure (ref: Two biological
parents)
Biological mother/stepfather
Biological father/stepmother
Biological mother only
Biological father only
Other situations
M1
Hormonal
vs.
None
Dual
vs.
None
Condom
vs.
None
M2
Hormonal
vs.
None
Dual
vs.
None
0.0718
0.0877
-0.1134
-0.0615
-0.4860
-0.3055*
0.1945
0.5046**
-0.0773
-0.1613
-0.0238
-0.2504
0.7640***
0.3118*
-0.0167
-1.0495***
-0.6387**
-0.8833**
0.3628
-0.4698*
-0.8692**
-0.2224
-0.4012
-0.7089*
-0.0950
-0.0678
0.3197
0.4460
0.0302
-0.1381
-0.2369
0.5475
-0.1930
0.0441
-0.0546
-0.3069
0.0857
0.4873
0.5067
-0.0918
-0.1555
-0.7683
0.6705
-0.2106
(continued)
0.1767
0.0268
1.2269**
0.1184
0.0826
-0.1286
0.1459
-0.3796
0.7232
0.1997
39
Contraceptive Method Choice among Youth
(Table 4, continued)
Condom
vs.
None
M1
Hormonal
vs.
None
Dual
vs.
None
Parental education
Maternal education
Paternal education
(ln) Household income
Age at first sex (ref: 15-17 years)
14 years or younger
18 years or older
Number of sexual relationships
Perceived risk of pregnancy or AIDS
Perceived severity of pregnancy
Contraceptive self-efficacy
Intercept
Random variance component
( τˆ00 ( m ) 00 ( m ) )
0.5470***
1.8313***
-0.7446***
1.8020*
Note: Unweighted results. N=1,890 men and 7,483 relationships.
* p < .05; ** p < .01; *** p < .001
-0.6120***
3.4123***
Condom
vs.
None
M2
Hormonal
vs.
None
Dual
vs.
None
0.0669**
-0.0199
-0.0146
0.0901**
0.0210
-0.0056
0.0786*
-0.0483
0.0072
-0.2577*
0.1928
-0.0347*
0.1220*
0.0585
0.1250*
-0.1792
0.0693
-0.0495*
0.0047
0.1740**
0.1841**
-0.0799
0.4180**
-0.1063***
0.2212**
-0.0590
0.2178**
-1.7588**
1.6564
0.2727
3.2719***
0.0150
1.7744***
40
Contraceptive Method Choice among Youth
Table 5.
Multilevel Multinomial Logistic Regression Results (Coefficients) of Relationship-Specific Type of Contraceptive
Method Used at Last Sex by Individual’s Gender, Effects of Prior Relationship Experiences, Add Health, Wave
III (2001-2002)
Prior Relationship Experiences
Number of prior relationships
Hormonal use in prior relationships
Pregnancy in prior relationships
Intercept
Random variance component
( τˆ00 ( m ) 00 ( m ) )
Condom
vs.
None
Women
Hormonal
vs.
None
-0.0450*
-0.2821**
-0.0696
0.0038
1.6214***
-0.2434
-0.8617*
1.2524***
-2.3726***
1.0564***
Condom
vs.
None
Men
Hormonal
vs.
None
-0.0922**
1.8906***
-0.0409
-0.0250
0.0226
-0.2581
0.0595
0.8496***
-0.5055**
-0.0819*
1.0894***
-0.5535**
-1.7879***
1.7474***
-0.0265
1.7927***
-1.7487***
1.0714***
-0.3903
2.3461***
Dual
vs.
None
Dual
vs.
None
Note: Unweighted results. Nwomen=2,221 women and 8,696 relationships. Nmen=1,890 men and 7,483 relationships. Results are net of all
relationship- and individual-level characteristics and an indicator for first relationship (i.e., no prior relationships).
* p < .05; ** p < .01; *** p < .001