Psychosocial Correlates of Adolescent Males' Pregnancy Intention
http://www.100md.com
《小儿科》
Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital, Brown University School of Medicine
Departments of Obstetrics and Gynecology and Community Health Women & Infants Hospital, Brown University School of Medicine
Department of Psychiatry, University of California, San Francisco, California
Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
ABSTRACT
Objective.To identify psychosocial differences between sexually experienced male adolescents who indicate intentions to get someone pregnant and those who do not.
Methodology.Cross-sectional study of 101 sexually experienced adolescent males recruited from a sexually transmitted disease clinic in northern California. We used Student's t tests and regressions to examine psychosocial differences between males who reported any intention versus no intention to get someone pregnant in the next 6 months, and we used analyses of variance to examine differences among different combinations of pregnancy plans/likelihood.
Results.Adolescents' reports of their plans for getting someone pregnant differed from their assessments of the likelihood that they would do so (2 = 24.33; df = 1). Attitudes toward pregnancy and participants' mothers' educational attainment differentiated those with clear pregnancy intentions (planning and likely) from those with clear intentions to avoid pregnancy (not planning and not likely)
Conclusions.To reduce the rates of adolescent childbearing, males' pregnancy intentions must be assessed and asked about in multiple ways.
Key Words: adolescent males pregnancy intentions psychosocial variables
Abbreviations: STD, sexually transmitted disease SES, socioeconomic status
Although teen pregnancy rates have dropped in recent years, a sizeable number of girls 15 to 19 years old still become pregnant each year. In 2000, 330000 girls <18 years old became pregnant in the United States, and 166000 gave birth.1 More than 75% of teen pregnancies are considered unplanned or unintended, and 35% of all teen pregnancies end in abortion.2 For adolescents continuing a pregnancy, 40% to 60% of births are considered to be the result of unintended pregnancies.2–6
The vast majority of research studies examining adolescent pregnancy have focused solely on female adolescents' pregnancy attitudes, intentions, and behaviors. However, male partners play a role in determining the frequency of sexual intercourse7 and the use of contraceptives.8–10 Male partners also exert strong influence on female adolescents' intentions to conceive4,11,12 as well as their decisions regarding and adjustment to a pregnancy termination.13 Male pregnancy intentions can also affect the psychological and emotional responses to the children born as a result of a given pregnancy. Research has demonstrated that disagreements in pregnancy intentions between mothers and fathers can affect infants' health and well-being. Such disagreements occur about one fourth of the time.14,15
Studies of adolescent males indicate a range of attitudes toward pregnancy. Some indicate that getting someone pregnant is a marker of manhood,16 and making it known that they have fathered a child can elevate their social standing (even if they take no additional child-rearing actions).15 Others report the potentially negative consequences for their futures17 and recognize the additional responsibilities that they would need to take on.18,19
Understanding male adolescents' motivations for getting someone pregnant and the factors (ie, attitudes, beliefs, and intentions) that characterize those male adolescents who indicate a desire to get someone pregnant may aid in efforts to reduce the negative health consequences of teenage childbearing in the United States. Adolescent pregnancies are often characterized by delayed initiation of prenatal care, poor prenatal health behaviors, and low birth weight infants.20–22 Recent work also suggests that even healthy infants born to teenage mothers are at increased risk of postneonatal death.23
Previous research examining pregnancy intentions among female adolescents and adults has identified inconsistencies in responses to questions posed at different points in time (eg, preconception versus during pregnancy) and assessed in different ways (eg, "intended" versus "planned" versus "wanted").22,24,25 Others have identified ambivalence on the part of adolescents when asked about their pregnancy intentions.26 Our own research found that sexually active female adolescents responded differently to questions of whether they planned to get pregnant and of their perceptions of the likelihood of their getting pregnant. This disconnect was associated with adolescent females' reports of contraceptive use, which suggests the possibility that assessing pregnancy plans may capture desires or intentions regarding pregnancy, whereas assessing perceived likelihood of a pregnancy focuses additionally on how efficacious one feels about what is required to prevent a pregnancy.27
We examine male adolescents' intentions to get someone pregnant (likelihood and planning) in the present study. We hypothesize that, similar to their female counterparts, few sexually experienced adolescent males are expected to report planning to get someone pregnant in the next 6 months, but more will indicate at least some likelihood that they will get someone pregnant in the next 6 months; we also hypothesize that adolescent males who indicate some intention to get someone pregnant in the next 6 months will differ in their reports of psychosocial variables from those who do not intend to get someone pregnant in the next 6 months. In particular, we were interested in determining if the interplay of planning to get someone pregnant and perceiving some likelihood of getting someone pregnant are associated with reports of condom use and intentions to use condoms in the future (because condom use is the only male-controlled contraceptive method). The findings from this study may help to broaden our understanding of pregnancy intentions among adolescent males and identify areas to target in intervention to prevent teenage pregnancies.
METHODS
Participants and Recruitment
Male adolescents (101) from a municipal sexually transmitted disease (STD) clinic in northern California were recruited between June 1996 and June 1998.28 The study's protocol was approved by the institutional review board at the University of California (San Francisco, CA). Adolescents were recruited in the waiting area before their clinician visit. Eligibility criteria included age between 14 and 19 years, English-speaking ability, vaginal or anal intercourse in the preceding 3 months, and residence within the local metropolitan area. The participation rate at the STD clinic was 90% of the 112 adolescents approached to participate.
Administration of Measures
Data were collected as part of a larger study examining perceived risk of STDs, perceived risk of pregnancy, and sexual decision-making.28 After obtaining written informed consent, a research assistant conducted a structured interview with each participant in a private room and filled out corresponding questionnaires with the participants. The interview assessed demographics, perceived risk of STDs, attitudes toward condom use, perceived social norms regarding condom use, condom self-efficacy, and intentions to use a condom. Pregnancy attitudes/intention, perceived risk of pregnancy, and abortion intentions items were included within this interview. Participants were offered compensation of $15 to participate in the interview.
Interviews
Selection of psychosocial variables was guided by the theory of planned behavior.29
Demographics
Participants indicated their age, gender, self-identified racial/ethnic group, and their mother's educational attainment.
Condom Variables
We measured condom attitudes using composite scores calculated by multiplying common expectancies with their corresponding values associated with condom use.30 Four multi-item scales resulted: (1) perceived condom efficacy (2 items, = .92); (2) trust-related issues associated with condom use (4 items, = .71); (3) negative aspects of condom use (6 items, = .84); and (4) positive aspects of condom use (6 items, = .62). Condom self-efficacy was measured with an existing 6-item scale that describes a variety of challenging situations and assessed the participants' confidence that they could insist on the use of a condom in each situation ( = .89).31
Pregnancy Attitudes and Intention
Attitudes toward pregnancy and pregnancy intention were assessed by scales developed for the larger study. Three 5-point Likert scale items assessed how (1) worried, (2) upset, and (3) happy an adolescent would be if he got someone pregnant in the next 6 months. A total pregnancy-attitudes score was calculated by taking the mean of these 3 items ("worried" and "upset" items were reverse scored; = .72). Higher scores on this measure indicated more positive attitudes toward pregnancy. Pregnancy intention was measured by 2 items that assessed (1) how likely he thought it was that he would get someone pregnant in the next 6 months and (2) the degree to which he agreed that he planned to get someone pregnant in the next 6 months. Responses for these items were rated on 5-point Likert scales (ranging from "not at all likely"/"definitely no" to "extremely likely"/"definitely yes").
We measured perceptions of risk of pregnancy using newly developed items that included how likely participants thought they were to get someone pregnant in the next 6 months if (1) their partner used birth control pills every day and (2) they didn't use any form of contraceptive at all.
Participants' abortion intentions were measured by asking them to indicate, if they got someone pregnant in the next 6 months, how likely they would be to encourage her to have an abortion and how sure they were that they would or would not encourage her to have an abortion (2 separate items; = .92). Responses for these items were rated on 5-point Likert scales (ranging from "not at all likely"/"very sure I will not" to "extremely likely"/"very sure I will"). Abortion intentions were included to measure their potential influence on pregnancy intentions.
Intentions to Use Condoms
Four items assessed intentions to use condoms. The items asked participants to indicate, on 5-point Likert scales, (1) how often they would use condoms, (2) how likely it is that they would use condoms every time, (3) how sure they were that they would use condoms every time, and (4) how likely it is that they would not use condoms in the next 6 months (reverse scored). Higher scores indicated greater intention to use condoms ( = .93).
Previous Condom Use
Participants were asked how frequently they or their partners had used condoms in the past 6 months.
Data-Analysis Plan
Responses to pregnancy-plans and pregnancy-likelihood items were dichotomized to contrast those who indicated no intention to get someone pregnant (definitely not planning or not at all likely) from those who indicated any intention to get someone pregnant (indicating any of the other 4 response categories of planning or likelihood) in the next 6 months. We initially chose to examine pregnancy plans separately from pregnancy likelihood to highlight the possible differences associated with assessing pregnancy intention using each of these questions. We then created combination pregnancy-intention groups using cross-tabs of the dichotomized pregnancy intention (plan/likely) items ("planning and likely," "not planning, but likely," "planning, but not likely," and "not planning and not likely"). However, because few males reported "planning, but not likely," this group was dropped from additional analyses. We conducted a series of 1-way analyses of variance to determine psychosocial variables that would differentiate the remaining 3 intention groups. All analyses were conducted by using SPSS 10.0 software.32
RESULTS
The participants ranged in age from 15 to 19 years with an average age of 18.13 years (SD: 1.11). Forty-three percent (43) were black, 15.8% (16) were white, 14.9% (15) were Latino/Hispanic, 10.9% (11) were Asian American, and 13.9% (14) were mixed/other race/ethnicity. More than 17% (16) reported that their mother attended some high school, 34.8% (32) of their mothers had graduated from high school, 16.3% (15) of their mothers had attended some college, 19.6% (18) of their mothers had graduated from college, 6.5% (6) of their mothers had obtained an advanced degree (masters or doctoral), and 2.2% (2) did not know their own mother's educational attainment.
Intentions to Get Someone Pregnant
There were significant differences in responses to the questions on planning versus likelihood (2 = 24.33; df = 1; P < .0001). Although the majority of the sample of 101 (75.2%) indicated no plans to get someone pregnant in the next 6 months, more than half (56.4%) indicated that there was at least some likelihood that they would get someone pregnant in the next 6 months.
Correlates of Intentions to Get Someone Pregnant
Plan
A series of Student's t tests were conducted to identify differences between those who indicated any plans to get someone pregnant and those with no plans to get someone pregnant in the next 6 months (Table 1). Those who indicated any plans to get someone pregnant in the next 6 months reported that their own mothers had lower educational attainment and held both more negative attitudes toward condoms' effects on trust in relationships and less negative attitudes toward getting someone pregnant than did those who indicated no plans to get someone pregnant in the next 6 months.
Likelihood
Those who perceived any likelihood of getting someone pregnant in the next 6 months similarly reported lower educational attainment of their mothers than did those who reported no likelihood of getting someone pregnant in the next 6 months. They also showed less self-efficacy to use condoms in challenging situations, less negative pregnancy attitudes, greater perceived risk of getting someone pregnant who is using birth control pills, and weaker intentions to use condoms in the future.
Combinations of Plan/Likelihood
To determine the interplay between pregnancy plans and pregnancy likelihood, we created pregnancy-intention groups based on the combination of the dichotomized answers to intention items. The resulting groups were (1) those who indicated that they were planning and likely to get someone pregnant ("planning and likely"; n = 24 [23.8%]), (2) those who were not planning but at least somewhat likely to get someone pregnant ("not planning, but likely"; n = 33 [32.7%]), and (3) those who were not planning and not likely to get someone pregnant ("not planning and not likely"; n = 43 [42.6%]). The group of adolescents who were planning but not likely to get someone pregnant (n = 1 [0.9%]) was too small to include in the analyses. In a series of 1-way analyses of variance we compared psychosocial variables that might differentiate the pregnancy-intentions groups. There were significant differences in their mothers' educational attainment (socioeconomic status [SES]), condom attitudes, and pregnancy attitudes (Table 2). Those who indicate a clear desire to get someone pregnant (planning and likely) reported lower educational attainment of their mothers and held less negative pregnancy attitudes than those with a clear desire to avoid getting someone pregnant (not planning and not likely).
DISCUSSION
This study of sexually active male adolescents attending an STD clinic gives us a unique perspective on their beliefs, attitudes, values, intentions, and behaviors surrounding the complex issue of pregnancy intention. Despite a majority of the teens expressing no plans to get someone pregnant in the next 6 months, there was substantial variability in their assessments of the likelihood that they would get someone pregnant in the next 6 months. Although both planning and likelihood have been considered means by which pregnancy "intentions" are measured among adolescent females,5,33,34 it is clear that they do not represent a unitary construct to adolescent males.
The inconsistency in responses between planning to get someone pregnant and perceived likelihood of causing a pregnancy could reflect ambivalence about getting someone pregnant. However, the beliefs associated with the different patterns of planning and likelihood (eg, condom attitude, condom self-efficacy) suggest ambivalence or lack of confidence about one's ability to do what is required to prevent pregnancy. In this view, the "inconsistent" adolescents are not necessarily wanting to get someone pregnant more than the "no planning, no likelihood" group but are cognizant that they or their partner may not be as likely to use contraception for a variety of reasons. Thus, the same behavior (not using contraception effectively) may reflect lack of motivation to avoid pregnancy or lack of commitment to using contraception.
Interpretation of our findings should take into account a number of limitations. We relied on self-report data that can be influenced by social desirability. Additionally, our study sample was an older, sexually experienced group of adolescents who attended an urban STD clinic in an AIDS epicenter; our results may not generalize to other, younger adolescent populations who are not yet sexually active, who have health insurance and access to more health care resources (and therefore would not attend an STD clinic), or who live in other geographical areas. Because the original aims of the larger study did not include a focus on males' pregnancy intentions, per se, we were not able to characterize the adolescents in our sample with respect to all of the issues that might have influenced their intentions to get someone pregnant (eg, their view of fatherhood as positive or negative, past experiences with getting someone pregnant, and/or previously encouraging someone to get an abortion). Because of the cross-sectional nature of our study, we also were unable to relate our psychosocial variables (attitudes, values, and intentions) to subsequent behavior. Future work should address these questions in a longitudinal study in which it would be possible to ascertain whether those adolescent males' with inconsistent intentions to get someone pregnant use condoms and/or contraceptives or if they get someone pregnant. Additionally, because of the relatively small sample size, we may not have had enough power to detect significant differences when they might have existed; several variables approached significance in the expected direction of relationship with pregnancy intentions but did not reach statistical significance. Finally, although we were unable to relate attitudes and intentions to use condoms to future condom-use behaviors, previous research of adolescents suggests significant positive association between attitudes, condom intentions, and subsequent condom use even up to 1 year later.35
CONCLUSIONS
Reproductive health services and discussions with adolescent males regarding their sexual health needs are relatively rare. In 1 study, although 71% of the males aged 15 to 19 years had received a physical examination in the past year, only 39% had received any reproductive health services.36 Discussions with adolescent males regarding their intentions to get someone pregnant are currently not routine in clinical practice but are likely to provide significant information about their intentions to use condoms in the future and can provide clinicians with insight into other sexual and reproductive health attitudes of their adolescent male patients. Targeting discussions particularly to those adolescent males whose mothers have lower educational attainment (a proxy for lower SES) and younger adolescents (who tended to report more inconsistent pregnancy intentions) may be most fruitful.
Given that the responses to questions of pregnancy plan and perceived pregnancy likelihood were not always the same, assessing males' pregnancy intentions by using a number of questions is important to capture the meaning of these different concepts for adolescent boys who are at risk for causing a pregnancy. Clearly, if clinicians or counselors simply ask adolescent boys if they are planning to get someone pregnant, they are likely to be missing important aspects of pregnancy intentions that might be captured in also assessing their perceptions of likelihood regarding pregnancy. By asking both questions, clinicians or counselors may be able to focus their interventions on discussing the realities of how to prepare for a healthy pregnancy and infant (among those with clear intentions to get someone pregnant) or the adolescent male's ability to avoid causing a pregnancy (among those with clear intentions to avoid pregnancy) and a broader discussion of the ambivalence that some adolescent males might feel about their desires for and abilities to prevent impregnating someone.
Interventions to alter intentions to get someone pregnant among adolescent males ought to focus particularly on the modifiable influences on pregnancy plans (ie, attitudes toward condoms and pregnancy) and on perceptions of pregnancy likelihood (ie, self-efficacy to use condoms, attitudes toward pregnancy, perceived risk of pregnancy, and intentions to use condoms). Interventions aimed at enhancing condom self-efficacy and positive attitudes toward condoms and encouraging greater condom use in sexually experienced adolescent males could be effective in reducing the occurrence of adolescent pregnancy.
ACKNOWLEDGMENTS
Dr Rosengard was supported by National Institute of Mental Health grant MH67490-01. The research was supported by National Institute of Allergy and Infectious Diseases grant AI36986 and Maternal and Child Health Bureau Training grant MCJ000978A.
FOOTNOTES
Accepted Mar 30, 2005.
No conflict of interest declared.
REFERENCES
Ventura SJ, Abma JC, Mosher WD, Henshaw S. Estimated pregnancy rates for the United States, 1990–2000: an update. Natl Vital Stat Rep. 2004;52 (23):1–9
Henshaw SK. Unintended pregnancy in the United States. Fam Plann Perspect. 1998;30 :24 –29, 46
Ahluwalia IB, Johnson C, Rogers M, Melvin C. Pregnancy Risk Assessment Monitoring System (PRAMS): unintended pregnancy among women having a live birth. PRAMS Working Group. J Womens Health Gend Based Med. 1999;8 :587 –589
Rubin V, East PL. Adolescents' pregnancy intentions: relations to life situations and caretaking behaviors prenatally and 2 years postpartum. J Adolesc Health. 1999;24 :313 –320
US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. Washington, DC: Government Printing Office; 2000
Toledo-Dreves V, Schwab Zabin L, Emerson MR. Durations of adolescent sexual relationships before and after conception. J Adolesc Health. 1995;17 :163 –172
Dudgeon MR, Inhorn MC. Men's influences on women's reproductive health: medical anthropological perspectives. Soc Sci Med. 2004;59 :1379 –1395
Jorgensen SR. Adolescent pregnancy and parenting. In: Montemayor R, ed. Adolescent Sexuality. Newbury Park, CA: Sage Publications; 1993:103 –140
Stevens-Simon C, Kelly L, Singer D, Cox A. Why pregnant adolescents say they did not use contraceptives prior to conception. J Adolesc Health. 1996;19 :48 –53
Schwab Zabin L, Huggins GR, Emerson MR, Cullins VE. Partner effects on a woman's intention to conceive: "not with this partner. " Fam Plann Perspect. 2000;32 :39 –45
Fischer RC, Stanford JB, Jameson P, DeWitt MJ. Exploring the concepts of intended, planned, and wanted pregnancy. J Fam Pract. 1999;48 :117 –122
Major B, Cozzarelli C, Testa M, Mueller P. Male partners' appraisals of undesired pregnancy and abortion: implications for women's adjustment to abortion. J Appl Soc Psychol. 1992;22 :599 –614
Korenman S, Kaestner R, Joyce T. Consequences for infants of parental disagreement in pregnancy intention. Perspect Sex Reprod Health. 2002;34 :198 –205
Montgomery MR. Comments on men, women, and unintended pregnancy. Popul Dev Rev. 1996;22 :100 –106
Goodyear RK, Newcomb MD, Allison RD. Predictors of Latino men's paternity in teen pregnancy: test of a mediational model of childhood experiences, gender role attitudes, and behaviors. J Couns Psychol. 2000;47 :116 –128
Marcell AV, Raine T, Eyre SL. Where does reproductive health fit into the lives of adolescent males Perspect Sex Reprod Health. 2003;35 :180 –186
Gohel M, Diamond JJ, Chambers CV. Attitudes toward sexual responsibility and parenting: an exploratory study of young urban males. Fam Plann Perspect. 1997;29 :280 –283
Nesmith JD, Klerman LV, Oh MK, Feinstein RA. Procreative experiences and orientations toward paternity held by incarcerated adolescent males. J Adolesc Health. 1997;20 :198 –203
Brown SS, Eisenberg L, ed. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: National Academy Press; 1995
American Academy of Pediatrics, Committee on Adolescence. Adolescent pregnancy—current trends and issues: 1998. Pediatrics. 1999;103 :516 –520
Joyce T, Kaestner R, Korenman S. The stability of pregnancy intentions and pregnancy-related maternal behaviors. Matern Child Health J. 2000;4 :171 –178
Phipps MG, Blume JD, DeMonner SM. Young maternal age associated with increased risk of postneonatal death. Obstet Gynecol. 2002;100 :481 –486
Rosenfeld JA, Everett KD. Factors related to planned and unplanned pregnancies. J Fam Pract. 1996;43 :161 –166
Joyce T, Kaestner R, Korenman S. On the validity of retrospective assessment of pregnancy intentions. Demography. 2002;39 :199 –213
Zabin LS, Astone NM, Emerson MR. Do adolescents want babies The relationship between attitudes and behavior. J Res Adolesc. 1993;3 :67 –86
Rosengard C, Phipps MG, Adler NE, Ellen JM. Adolescent pregnancy intentions and pregnancy outcomes: a longitudinal examination. J Adolesc Health. 2005;35 :453 –461
Ellen JM, Adler NE, Gurvey JE, Millstein SG, Tschann JM. Adolescent condom use and perceptions of risk for sexually transmitted diseases: a prospective study. J Appl Soc Psychol. 2003;32 :648 –663
Ajzen I. From intentions to actions: a theory of planning behavior. In: Beckman J, ed. Action Control: From Cognition to Behavior. Berlin, Germany: Springer-Verlag; 1985:11 –39
Albarracin D, Ho R, McNatt P, et al. Structure of outcome beliefs in condom use. The Project RESPECT Study Group. Health Psychol. 2000;19 :458 –468
Marin BV, Gomez CA, Tschann JM, Gregorich S. Self-efficacy to use condoms in unmarried Latino adults. Am J Community Psychol. 1998;26 :53 –71
SPSS [computer program]. Version 10.0. Chicago, IL: SPSS, Inc; 1999
Kalmuss DS, Namerow PB. Subsequent childbearing among teenage mothers: the determinants of a closely spaced second birth. Fam Plann Perspect. 1994;26 :149 –153
Klerman LV. The intendedness of pregnancy: a concept in transition. Matern Child Health J. 2000;4 :155 –162
Adler NE, Kegeles SM, Irwin CE Jr, Wibbelsman C. Adolescent contraceptive behavior: An assessment of decision processes. J Pediatr. 1990;116 :463 –471
Porter LE, Ku L. Use of reproductive health services among young men, 1995. J Adolesc Health. 2000;27 :186 –194(Cynthia Rosengard, PhD, M)
Departments of Obstetrics and Gynecology and Community Health Women & Infants Hospital, Brown University School of Medicine
Department of Psychiatry, University of California, San Francisco, California
Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
ABSTRACT
Objective.To identify psychosocial differences between sexually experienced male adolescents who indicate intentions to get someone pregnant and those who do not.
Methodology.Cross-sectional study of 101 sexually experienced adolescent males recruited from a sexually transmitted disease clinic in northern California. We used Student's t tests and regressions to examine psychosocial differences between males who reported any intention versus no intention to get someone pregnant in the next 6 months, and we used analyses of variance to examine differences among different combinations of pregnancy plans/likelihood.
Results.Adolescents' reports of their plans for getting someone pregnant differed from their assessments of the likelihood that they would do so (2 = 24.33; df = 1). Attitudes toward pregnancy and participants' mothers' educational attainment differentiated those with clear pregnancy intentions (planning and likely) from those with clear intentions to avoid pregnancy (not planning and not likely)
Conclusions.To reduce the rates of adolescent childbearing, males' pregnancy intentions must be assessed and asked about in multiple ways.
Key Words: adolescent males pregnancy intentions psychosocial variables
Abbreviations: STD, sexually transmitted disease SES, socioeconomic status
Although teen pregnancy rates have dropped in recent years, a sizeable number of girls 15 to 19 years old still become pregnant each year. In 2000, 330000 girls <18 years old became pregnant in the United States, and 166000 gave birth.1 More than 75% of teen pregnancies are considered unplanned or unintended, and 35% of all teen pregnancies end in abortion.2 For adolescents continuing a pregnancy, 40% to 60% of births are considered to be the result of unintended pregnancies.2–6
The vast majority of research studies examining adolescent pregnancy have focused solely on female adolescents' pregnancy attitudes, intentions, and behaviors. However, male partners play a role in determining the frequency of sexual intercourse7 and the use of contraceptives.8–10 Male partners also exert strong influence on female adolescents' intentions to conceive4,11,12 as well as their decisions regarding and adjustment to a pregnancy termination.13 Male pregnancy intentions can also affect the psychological and emotional responses to the children born as a result of a given pregnancy. Research has demonstrated that disagreements in pregnancy intentions between mothers and fathers can affect infants' health and well-being. Such disagreements occur about one fourth of the time.14,15
Studies of adolescent males indicate a range of attitudes toward pregnancy. Some indicate that getting someone pregnant is a marker of manhood,16 and making it known that they have fathered a child can elevate their social standing (even if they take no additional child-rearing actions).15 Others report the potentially negative consequences for their futures17 and recognize the additional responsibilities that they would need to take on.18,19
Understanding male adolescents' motivations for getting someone pregnant and the factors (ie, attitudes, beliefs, and intentions) that characterize those male adolescents who indicate a desire to get someone pregnant may aid in efforts to reduce the negative health consequences of teenage childbearing in the United States. Adolescent pregnancies are often characterized by delayed initiation of prenatal care, poor prenatal health behaviors, and low birth weight infants.20–22 Recent work also suggests that even healthy infants born to teenage mothers are at increased risk of postneonatal death.23
Previous research examining pregnancy intentions among female adolescents and adults has identified inconsistencies in responses to questions posed at different points in time (eg, preconception versus during pregnancy) and assessed in different ways (eg, "intended" versus "planned" versus "wanted").22,24,25 Others have identified ambivalence on the part of adolescents when asked about their pregnancy intentions.26 Our own research found that sexually active female adolescents responded differently to questions of whether they planned to get pregnant and of their perceptions of the likelihood of their getting pregnant. This disconnect was associated with adolescent females' reports of contraceptive use, which suggests the possibility that assessing pregnancy plans may capture desires or intentions regarding pregnancy, whereas assessing perceived likelihood of a pregnancy focuses additionally on how efficacious one feels about what is required to prevent a pregnancy.27
We examine male adolescents' intentions to get someone pregnant (likelihood and planning) in the present study. We hypothesize that, similar to their female counterparts, few sexually experienced adolescent males are expected to report planning to get someone pregnant in the next 6 months, but more will indicate at least some likelihood that they will get someone pregnant in the next 6 months; we also hypothesize that adolescent males who indicate some intention to get someone pregnant in the next 6 months will differ in their reports of psychosocial variables from those who do not intend to get someone pregnant in the next 6 months. In particular, we were interested in determining if the interplay of planning to get someone pregnant and perceiving some likelihood of getting someone pregnant are associated with reports of condom use and intentions to use condoms in the future (because condom use is the only male-controlled contraceptive method). The findings from this study may help to broaden our understanding of pregnancy intentions among adolescent males and identify areas to target in intervention to prevent teenage pregnancies.
METHODS
Participants and Recruitment
Male adolescents (101) from a municipal sexually transmitted disease (STD) clinic in northern California were recruited between June 1996 and June 1998.28 The study's protocol was approved by the institutional review board at the University of California (San Francisco, CA). Adolescents were recruited in the waiting area before their clinician visit. Eligibility criteria included age between 14 and 19 years, English-speaking ability, vaginal or anal intercourse in the preceding 3 months, and residence within the local metropolitan area. The participation rate at the STD clinic was 90% of the 112 adolescents approached to participate.
Administration of Measures
Data were collected as part of a larger study examining perceived risk of STDs, perceived risk of pregnancy, and sexual decision-making.28 After obtaining written informed consent, a research assistant conducted a structured interview with each participant in a private room and filled out corresponding questionnaires with the participants. The interview assessed demographics, perceived risk of STDs, attitudes toward condom use, perceived social norms regarding condom use, condom self-efficacy, and intentions to use a condom. Pregnancy attitudes/intention, perceived risk of pregnancy, and abortion intentions items were included within this interview. Participants were offered compensation of $15 to participate in the interview.
Interviews
Selection of psychosocial variables was guided by the theory of planned behavior.29
Demographics
Participants indicated their age, gender, self-identified racial/ethnic group, and their mother's educational attainment.
Condom Variables
We measured condom attitudes using composite scores calculated by multiplying common expectancies with their corresponding values associated with condom use.30 Four multi-item scales resulted: (1) perceived condom efficacy (2 items, = .92); (2) trust-related issues associated with condom use (4 items, = .71); (3) negative aspects of condom use (6 items, = .84); and (4) positive aspects of condom use (6 items, = .62). Condom self-efficacy was measured with an existing 6-item scale that describes a variety of challenging situations and assessed the participants' confidence that they could insist on the use of a condom in each situation ( = .89).31
Pregnancy Attitudes and Intention
Attitudes toward pregnancy and pregnancy intention were assessed by scales developed for the larger study. Three 5-point Likert scale items assessed how (1) worried, (2) upset, and (3) happy an adolescent would be if he got someone pregnant in the next 6 months. A total pregnancy-attitudes score was calculated by taking the mean of these 3 items ("worried" and "upset" items were reverse scored; = .72). Higher scores on this measure indicated more positive attitudes toward pregnancy. Pregnancy intention was measured by 2 items that assessed (1) how likely he thought it was that he would get someone pregnant in the next 6 months and (2) the degree to which he agreed that he planned to get someone pregnant in the next 6 months. Responses for these items were rated on 5-point Likert scales (ranging from "not at all likely"/"definitely no" to "extremely likely"/"definitely yes").
We measured perceptions of risk of pregnancy using newly developed items that included how likely participants thought they were to get someone pregnant in the next 6 months if (1) their partner used birth control pills every day and (2) they didn't use any form of contraceptive at all.
Participants' abortion intentions were measured by asking them to indicate, if they got someone pregnant in the next 6 months, how likely they would be to encourage her to have an abortion and how sure they were that they would or would not encourage her to have an abortion (2 separate items; = .92). Responses for these items were rated on 5-point Likert scales (ranging from "not at all likely"/"very sure I will not" to "extremely likely"/"very sure I will"). Abortion intentions were included to measure their potential influence on pregnancy intentions.
Intentions to Use Condoms
Four items assessed intentions to use condoms. The items asked participants to indicate, on 5-point Likert scales, (1) how often they would use condoms, (2) how likely it is that they would use condoms every time, (3) how sure they were that they would use condoms every time, and (4) how likely it is that they would not use condoms in the next 6 months (reverse scored). Higher scores indicated greater intention to use condoms ( = .93).
Previous Condom Use
Participants were asked how frequently they or their partners had used condoms in the past 6 months.
Data-Analysis Plan
Responses to pregnancy-plans and pregnancy-likelihood items were dichotomized to contrast those who indicated no intention to get someone pregnant (definitely not planning or not at all likely) from those who indicated any intention to get someone pregnant (indicating any of the other 4 response categories of planning or likelihood) in the next 6 months. We initially chose to examine pregnancy plans separately from pregnancy likelihood to highlight the possible differences associated with assessing pregnancy intention using each of these questions. We then created combination pregnancy-intention groups using cross-tabs of the dichotomized pregnancy intention (plan/likely) items ("planning and likely," "not planning, but likely," "planning, but not likely," and "not planning and not likely"). However, because few males reported "planning, but not likely," this group was dropped from additional analyses. We conducted a series of 1-way analyses of variance to determine psychosocial variables that would differentiate the remaining 3 intention groups. All analyses were conducted by using SPSS 10.0 software.32
RESULTS
The participants ranged in age from 15 to 19 years with an average age of 18.13 years (SD: 1.11). Forty-three percent (43) were black, 15.8% (16) were white, 14.9% (15) were Latino/Hispanic, 10.9% (11) were Asian American, and 13.9% (14) were mixed/other race/ethnicity. More than 17% (16) reported that their mother attended some high school, 34.8% (32) of their mothers had graduated from high school, 16.3% (15) of their mothers had attended some college, 19.6% (18) of their mothers had graduated from college, 6.5% (6) of their mothers had obtained an advanced degree (masters or doctoral), and 2.2% (2) did not know their own mother's educational attainment.
Intentions to Get Someone Pregnant
There were significant differences in responses to the questions on planning versus likelihood (2 = 24.33; df = 1; P < .0001). Although the majority of the sample of 101 (75.2%) indicated no plans to get someone pregnant in the next 6 months, more than half (56.4%) indicated that there was at least some likelihood that they would get someone pregnant in the next 6 months.
Correlates of Intentions to Get Someone Pregnant
Plan
A series of Student's t tests were conducted to identify differences between those who indicated any plans to get someone pregnant and those with no plans to get someone pregnant in the next 6 months (Table 1). Those who indicated any plans to get someone pregnant in the next 6 months reported that their own mothers had lower educational attainment and held both more negative attitudes toward condoms' effects on trust in relationships and less negative attitudes toward getting someone pregnant than did those who indicated no plans to get someone pregnant in the next 6 months.
Likelihood
Those who perceived any likelihood of getting someone pregnant in the next 6 months similarly reported lower educational attainment of their mothers than did those who reported no likelihood of getting someone pregnant in the next 6 months. They also showed less self-efficacy to use condoms in challenging situations, less negative pregnancy attitudes, greater perceived risk of getting someone pregnant who is using birth control pills, and weaker intentions to use condoms in the future.
Combinations of Plan/Likelihood
To determine the interplay between pregnancy plans and pregnancy likelihood, we created pregnancy-intention groups based on the combination of the dichotomized answers to intention items. The resulting groups were (1) those who indicated that they were planning and likely to get someone pregnant ("planning and likely"; n = 24 [23.8%]), (2) those who were not planning but at least somewhat likely to get someone pregnant ("not planning, but likely"; n = 33 [32.7%]), and (3) those who were not planning and not likely to get someone pregnant ("not planning and not likely"; n = 43 [42.6%]). The group of adolescents who were planning but not likely to get someone pregnant (n = 1 [0.9%]) was too small to include in the analyses. In a series of 1-way analyses of variance we compared psychosocial variables that might differentiate the pregnancy-intentions groups. There were significant differences in their mothers' educational attainment (socioeconomic status [SES]), condom attitudes, and pregnancy attitudes (Table 2). Those who indicate a clear desire to get someone pregnant (planning and likely) reported lower educational attainment of their mothers and held less negative pregnancy attitudes than those with a clear desire to avoid getting someone pregnant (not planning and not likely).
DISCUSSION
This study of sexually active male adolescents attending an STD clinic gives us a unique perspective on their beliefs, attitudes, values, intentions, and behaviors surrounding the complex issue of pregnancy intention. Despite a majority of the teens expressing no plans to get someone pregnant in the next 6 months, there was substantial variability in their assessments of the likelihood that they would get someone pregnant in the next 6 months. Although both planning and likelihood have been considered means by which pregnancy "intentions" are measured among adolescent females,5,33,34 it is clear that they do not represent a unitary construct to adolescent males.
The inconsistency in responses between planning to get someone pregnant and perceived likelihood of causing a pregnancy could reflect ambivalence about getting someone pregnant. However, the beliefs associated with the different patterns of planning and likelihood (eg, condom attitude, condom self-efficacy) suggest ambivalence or lack of confidence about one's ability to do what is required to prevent pregnancy. In this view, the "inconsistent" adolescents are not necessarily wanting to get someone pregnant more than the "no planning, no likelihood" group but are cognizant that they or their partner may not be as likely to use contraception for a variety of reasons. Thus, the same behavior (not using contraception effectively) may reflect lack of motivation to avoid pregnancy or lack of commitment to using contraception.
Interpretation of our findings should take into account a number of limitations. We relied on self-report data that can be influenced by social desirability. Additionally, our study sample was an older, sexually experienced group of adolescents who attended an urban STD clinic in an AIDS epicenter; our results may not generalize to other, younger adolescent populations who are not yet sexually active, who have health insurance and access to more health care resources (and therefore would not attend an STD clinic), or who live in other geographical areas. Because the original aims of the larger study did not include a focus on males' pregnancy intentions, per se, we were not able to characterize the adolescents in our sample with respect to all of the issues that might have influenced their intentions to get someone pregnant (eg, their view of fatherhood as positive or negative, past experiences with getting someone pregnant, and/or previously encouraging someone to get an abortion). Because of the cross-sectional nature of our study, we also were unable to relate our psychosocial variables (attitudes, values, and intentions) to subsequent behavior. Future work should address these questions in a longitudinal study in which it would be possible to ascertain whether those adolescent males' with inconsistent intentions to get someone pregnant use condoms and/or contraceptives or if they get someone pregnant. Additionally, because of the relatively small sample size, we may not have had enough power to detect significant differences when they might have existed; several variables approached significance in the expected direction of relationship with pregnancy intentions but did not reach statistical significance. Finally, although we were unable to relate attitudes and intentions to use condoms to future condom-use behaviors, previous research of adolescents suggests significant positive association between attitudes, condom intentions, and subsequent condom use even up to 1 year later.35
CONCLUSIONS
Reproductive health services and discussions with adolescent males regarding their sexual health needs are relatively rare. In 1 study, although 71% of the males aged 15 to 19 years had received a physical examination in the past year, only 39% had received any reproductive health services.36 Discussions with adolescent males regarding their intentions to get someone pregnant are currently not routine in clinical practice but are likely to provide significant information about their intentions to use condoms in the future and can provide clinicians with insight into other sexual and reproductive health attitudes of their adolescent male patients. Targeting discussions particularly to those adolescent males whose mothers have lower educational attainment (a proxy for lower SES) and younger adolescents (who tended to report more inconsistent pregnancy intentions) may be most fruitful.
Given that the responses to questions of pregnancy plan and perceived pregnancy likelihood were not always the same, assessing males' pregnancy intentions by using a number of questions is important to capture the meaning of these different concepts for adolescent boys who are at risk for causing a pregnancy. Clearly, if clinicians or counselors simply ask adolescent boys if they are planning to get someone pregnant, they are likely to be missing important aspects of pregnancy intentions that might be captured in also assessing their perceptions of likelihood regarding pregnancy. By asking both questions, clinicians or counselors may be able to focus their interventions on discussing the realities of how to prepare for a healthy pregnancy and infant (among those with clear intentions to get someone pregnant) or the adolescent male's ability to avoid causing a pregnancy (among those with clear intentions to avoid pregnancy) and a broader discussion of the ambivalence that some adolescent males might feel about their desires for and abilities to prevent impregnating someone.
Interventions to alter intentions to get someone pregnant among adolescent males ought to focus particularly on the modifiable influences on pregnancy plans (ie, attitudes toward condoms and pregnancy) and on perceptions of pregnancy likelihood (ie, self-efficacy to use condoms, attitudes toward pregnancy, perceived risk of pregnancy, and intentions to use condoms). Interventions aimed at enhancing condom self-efficacy and positive attitudes toward condoms and encouraging greater condom use in sexually experienced adolescent males could be effective in reducing the occurrence of adolescent pregnancy.
ACKNOWLEDGMENTS
Dr Rosengard was supported by National Institute of Mental Health grant MH67490-01. The research was supported by National Institute of Allergy and Infectious Diseases grant AI36986 and Maternal and Child Health Bureau Training grant MCJ000978A.
FOOTNOTES
Accepted Mar 30, 2005.
No conflict of interest declared.
REFERENCES
Ventura SJ, Abma JC, Mosher WD, Henshaw S. Estimated pregnancy rates for the United States, 1990–2000: an update. Natl Vital Stat Rep. 2004;52 (23):1–9
Henshaw SK. Unintended pregnancy in the United States. Fam Plann Perspect. 1998;30 :24 –29, 46
Ahluwalia IB, Johnson C, Rogers M, Melvin C. Pregnancy Risk Assessment Monitoring System (PRAMS): unintended pregnancy among women having a live birth. PRAMS Working Group. J Womens Health Gend Based Med. 1999;8 :587 –589
Rubin V, East PL. Adolescents' pregnancy intentions: relations to life situations and caretaking behaviors prenatally and 2 years postpartum. J Adolesc Health. 1999;24 :313 –320
US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. Washington, DC: Government Printing Office; 2000
Toledo-Dreves V, Schwab Zabin L, Emerson MR. Durations of adolescent sexual relationships before and after conception. J Adolesc Health. 1995;17 :163 –172
Dudgeon MR, Inhorn MC. Men's influences on women's reproductive health: medical anthropological perspectives. Soc Sci Med. 2004;59 :1379 –1395
Jorgensen SR. Adolescent pregnancy and parenting. In: Montemayor R, ed. Adolescent Sexuality. Newbury Park, CA: Sage Publications; 1993:103 –140
Stevens-Simon C, Kelly L, Singer D, Cox A. Why pregnant adolescents say they did not use contraceptives prior to conception. J Adolesc Health. 1996;19 :48 –53
Schwab Zabin L, Huggins GR, Emerson MR, Cullins VE. Partner effects on a woman's intention to conceive: "not with this partner. " Fam Plann Perspect. 2000;32 :39 –45
Fischer RC, Stanford JB, Jameson P, DeWitt MJ. Exploring the concepts of intended, planned, and wanted pregnancy. J Fam Pract. 1999;48 :117 –122
Major B, Cozzarelli C, Testa M, Mueller P. Male partners' appraisals of undesired pregnancy and abortion: implications for women's adjustment to abortion. J Appl Soc Psychol. 1992;22 :599 –614
Korenman S, Kaestner R, Joyce T. Consequences for infants of parental disagreement in pregnancy intention. Perspect Sex Reprod Health. 2002;34 :198 –205
Montgomery MR. Comments on men, women, and unintended pregnancy. Popul Dev Rev. 1996;22 :100 –106
Goodyear RK, Newcomb MD, Allison RD. Predictors of Latino men's paternity in teen pregnancy: test of a mediational model of childhood experiences, gender role attitudes, and behaviors. J Couns Psychol. 2000;47 :116 –128
Marcell AV, Raine T, Eyre SL. Where does reproductive health fit into the lives of adolescent males Perspect Sex Reprod Health. 2003;35 :180 –186
Gohel M, Diamond JJ, Chambers CV. Attitudes toward sexual responsibility and parenting: an exploratory study of young urban males. Fam Plann Perspect. 1997;29 :280 –283
Nesmith JD, Klerman LV, Oh MK, Feinstein RA. Procreative experiences and orientations toward paternity held by incarcerated adolescent males. J Adolesc Health. 1997;20 :198 –203
Brown SS, Eisenberg L, ed. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: National Academy Press; 1995
American Academy of Pediatrics, Committee on Adolescence. Adolescent pregnancy—current trends and issues: 1998. Pediatrics. 1999;103 :516 –520
Joyce T, Kaestner R, Korenman S. The stability of pregnancy intentions and pregnancy-related maternal behaviors. Matern Child Health J. 2000;4 :171 –178
Phipps MG, Blume JD, DeMonner SM. Young maternal age associated with increased risk of postneonatal death. Obstet Gynecol. 2002;100 :481 –486
Rosenfeld JA, Everett KD. Factors related to planned and unplanned pregnancies. J Fam Pract. 1996;43 :161 –166
Joyce T, Kaestner R, Korenman S. On the validity of retrospective assessment of pregnancy intentions. Demography. 2002;39 :199 –213
Zabin LS, Astone NM, Emerson MR. Do adolescents want babies The relationship between attitudes and behavior. J Res Adolesc. 1993;3 :67 –86
Rosengard C, Phipps MG, Adler NE, Ellen JM. Adolescent pregnancy intentions and pregnancy outcomes: a longitudinal examination. J Adolesc Health. 2005;35 :453 –461
Ellen JM, Adler NE, Gurvey JE, Millstein SG, Tschann JM. Adolescent condom use and perceptions of risk for sexually transmitted diseases: a prospective study. J Appl Soc Psychol. 2003;32 :648 –663
Ajzen I. From intentions to actions: a theory of planning behavior. In: Beckman J, ed. Action Control: From Cognition to Behavior. Berlin, Germany: Springer-Verlag; 1985:11 –39
Albarracin D, Ho R, McNatt P, et al. Structure of outcome beliefs in condom use. The Project RESPECT Study Group. Health Psychol. 2000;19 :458 –468
Marin BV, Gomez CA, Tschann JM, Gregorich S. Self-efficacy to use condoms in unmarried Latino adults. Am J Community Psychol. 1998;26 :53 –71
SPSS [computer program]. Version 10.0. Chicago, IL: SPSS, Inc; 1999
Kalmuss DS, Namerow PB. Subsequent childbearing among teenage mothers: the determinants of a closely spaced second birth. Fam Plann Perspect. 1994;26 :149 –153
Klerman LV. The intendedness of pregnancy: a concept in transition. Matern Child Health J. 2000;4 :155 –162
Adler NE, Kegeles SM, Irwin CE Jr, Wibbelsman C. Adolescent contraceptive behavior: An assessment of decision processes. J Pediatr. 1990;116 :463 –471
Porter LE, Ku L. Use of reproductive health services among young men, 1995. J Adolesc Health. 2000;27 :186 –194(Cynthia Rosengard, PhD, M)