The Effects of Contraceptive Education on Method Use at First Intercourse by Jane Mauldon and Kristin Luker

The Effects of Contraceptive Education On Method Use at First Intercourse By Jane Mauldon and Kristin Luker

Despite long-standing public support for sex education in the schools, it has been difficult to show were more likely than others to use a method when they first had sexual intercourse. concrete effects of sex education on sexual and contraceptive behavior. Data from the 1988 Na- Behavior at first intercourse is an in- tional Survey of Family Growth indicate that exposure to a formal contraceptive education program formative measure of the value of sex ed- increases the likelihood that a teenage woman will use a contraceptive method at first intercourse. ucation for several reasons. First, for most people, the initiation of sexual activity is According to the results of a multivariate analysis, the odds that a young woman will use any meth- a memorable experience, so reports about od and the odds that she will use a condom increase by about one-third following instruction about contraceptive use at that time should be birth control; the effect on the likelihood of pill use, however, is nonsignificant. If contraceptive edu- relatively reliable. cation occurs in the same year that a teenager becomes sexually active, the odds of any method Second, investigating a respondent’s first opportunity to use a method follow- use and of condom use are increased by 70Ð80%, and the odds of pill use are more than doubled. ing sex education should yield the most ac- The results also suggest that with greater educational efforts, the proportion of teenagers who use curate, and perhaps the highest, estimates condoms at first intercourse could increase from 52% to 59%, while the proportion using no meth- possible of the effect of contraceptive education. Because the respondent was not od might decrease from 41% to 33%. (Family Planning Perspectives, 28:19Ð24 & 41, 1996) sexually active previously, the potential impact of education is not contaminated mericans have long put their faith believe that schools can and should in- by the effects of prior contraceptive be- in education as a remedy for many fluence teenagers’ sexual behavior, in- havior or by intervening sexual episodes. Aof society’s problems, and the cluding their contraceptive behavior, Third, most young people’s contracep- question of how young people should while others fear that contraceptive edu- tive behavior remains fairly consistent for manage their sexuality is no exception to cation encourages sexual activity among at least some months following first in- this generalization. Public support for sex adolescents, and still others think that sex tercourse. For example, among teenage education in the schools is both long- education is largely irrelevant because women interviewed in 1988 who had been standing and high.1 Programs designed “nothing works.” sexually active for about two years, 43% to teach schoolchildren about sex, repro- Although several studies have docu- reported that their contraceptive behav- duction and related issues date back to the mented that sex education programs result ior had been exactly the same at first in- earliest parts of this century.2 in increased knowledge about contracep- tercourse and at most recent intercourse; The content of contemporary sex edu- tion and more favorable attitudes toward another 23% said they had used contra- cation programs ranges from discussions it,5 actual changes in students’ behavior ceptives on both occasions but had aimed at helping students clarify their val- due to sex education have been harder to changed methods.8 Five out of six re- ues or practice decision-making skills, to demonstrate. A 1991 survey of the research spondents who had used a method at first classes stressing abstinence almost exclu- literature summarized the evaluations of intercourse had also used one at most sively, to forthright discussion of contra- several sex education curricula with what recent intercourse. In contrast, one-third ceptive use and availability.3 The AIDS is still the conventional wisdom on the sub- who had used no method initially were epidemic has been an important influence ject: “None of the educational programs still not using one. on state and local educational policies. By evaluated…had any measurable effects on Correlations in behavior between first 1989, virtually all schools included AIDS participants’ sexual activity, contraceptive and most recent intercourse weaken as the education in their curricula, sometimes to- use, or pregnancy rates.”6 period between these events increases, but gether with other sex education topics and In contrast to this pessimistic view, a 1994 the results reported in this article can rea- sometimes separately; AIDS education summary of the findings of 23 published, sonably be thought of as reflecting be- curricula are now strongly recommend- peer-reviewed studies of school-based sex havior early in a young woman’s sexual ed or mandated in all 50 states.4 and AIDS education programs reported life. This is an important time; the conse- Opinions are sharply divided about that some of these programs “did delay the quences of even a few weeks or months whether and how much schools should initiation of intercourse, reduce the fre- of unprotected intercourse can be severe. teach students about condoms and other quency of intercourse, reduce the number One-fifth of all premarital first pregnan- contraceptive methods. Some observers of sexual partners or increase the use of cies among teenagers occur in the first condoms or other contraceptives.”7 The re- months after they become sexually active.9 Jane Mauldon is assistant professor of public policy at the search presented here focuses on the last Researchers investigating the impact of Graduate School of Public Policy, University of Califor- of these outcomes: whether sex education sex education on students’ contraceptive be- nia, Berkeley. Kristin Luker is professor of sociology and increases contraceptive use. More precise- professor in the Jurisprudence and Social Policy Program, havior early in their sexual lives have used Boalt Hall School of Law, University of California, Berke- ly, we investigate whether women who re- two types of data: retrospective reports from ley. The research on which this article is based was sup- ceived formal instruction about contra- nationally representative samples, and data ported in part by a grant from the Spencer Foundation. ception before becoming sexually active generated to evaluate various types of sex

Volume 28, Number 1, January/February 1996 19 Contraceptive Education and Method Use at First Sex

than others to use a method,13 and one tive respondents who were unmarried Table 1. Percentage of women aged 15Ð24 by 14 measures of sexual activity, contraceptive and found that they were less likely to do so. teenagers at first intercourse. sex education, and contraceptive use, accord- For the remaining curricula, results are re- We estimated two multivariate models ing to birth cohort, 1988 National Survey of Fam- ported for all students’ contraceptive use to predict contraceptive use: a binomial ily Growth after the educational exposure. Two of logistic regression predicting the use of Measure 1963Ð 1967Ð 1970Ð these programs had no significant impact any method (excluding rhythm and with- 1966 1969 1972 on contraceptive use,15 while two yielded drawal) at first intercourse; and a multi- (N=947) (N=762) (N=775) improvements in use.16 nomial logit model comparing use of the Ever had sex 89 77 na condom (alone or with spermicide or Before age 14 6 3 5 At age 14Ð15 16 17 20 Data and Methods other methods), the pill and no method. At age 16Ð18 45 46 na† The data used for this article are from the Respondents who used some other meth- >18 or unknown 22 11 na† 1988 National Survey of Family Growth od at first intercourse (35 women) were ex- Had formal contra- (NSFG), a nationally representative sur- cluded from the final model because the ceptive education 70 79 na vey of 8,450 American women aged cell sizes for these women were too small Age 17 <14 13 15 26 15–44. The NSFG data that are relevant for analysis with a multinomial logit 14Ð15 23 31 32 to this analysis are age at first intercourse; model. The models were estimated using 16Ð18 29 29 na† first contraceptive method used (if any); mainframe SAS and fit by the method of Unknown 5 4 3 Timing relative to first sex contraceptive use at first intercourse; maximum likelihood. The regressions and Before 47 56 58 whether, by age 18, the respondent had cross-tabulations were adjusted by the In same year 11 10 7 After 7 8 4 had “any formal instruction on methods sample weights on the tape, scaled by the Unknown 5 4 3 of birth control” or sexually transmitted mean of the weights.† diseases (STDs), and whether she had ever Some selectivity bias is possible, since Had no formal contraceptive education 30 21 28 talked to either of her parents about these our analyses are based on women who Sexually active 26 16 11 topics; and the age at which she first had had become sexually active by the time of Not sexually active 4 5 17 formal instruction about contraception. the survey—about 90% of the oldest co- Other sex education From these data, the relative order of hort (women born in 1963–1966), but only Formal STD instruction 75 81 77 contraceptive education and first inter- 40% of the youngest (those born in Talked to parents about contraception 48 59 58 course could be established for all women 1970–1972). We have tried to correct for Talked to parents except those who had their first contra- this selectivity by controlling for both age about STDs 35 45 52 ceptive education class and first intercourse at and year of first intercourse in the mul- ‡ Contraceptive use at first sex at the same age. We could not establish the tivariate models. Any method 45 51 59 timing relative to first intercourse of STD Exposure to contraceptive education Condom 31 41 52 Pill 11 7 6 education or parent-child conversations prior to first intercourse is a function both Other 3 3 1 about sexual issues; therefore, we do not of the respondent’s behavior (whether she No method‡ 55 49 41 focus much attention on these variables. (In waited to begin sexual activity until re- †Most respondents had not yet reached age 18. ‡In this and sub- many schools, discussions about STDs and ceiving contraceptive education) and of sequent tables, includes use of withdrawal and rhythm. Note: In this and subsequent tables, na=not applicable. about contraception probably were linked her school’s curriculum (whether it in- once concern over the AIDS epidemic had cluded contraceptive education, and at become widespread, since condoms are what grade level). Certain characteristics education curricula. Two studies of the first used for both STD and pregnancy preven- that may prompt a young woman to delay type found that young women exposed to tion.) intercourse until after she has received sex contraceptive education were more likely The first part of the analysis illustrates education may also be correlated with her than others to use a method at first inter- differences between cohorts in the content inclination to use a contraceptive meth- course,10 while one found no such effect on and timing of sex education; the data are od. Similarly, a school may offer contra- young men’s behavior.11 from the 2,484 respondents aged 15–24 at ceptive education in an early grade be- Among seven curriculum-specific eval- the survey date (in the birth cohorts cause many of its students become uations summarized in the 1994 review,12 1963–1966, 1967–1969 and 1970–1973) who pregnant young or because the commu- only three reported results comparing teen- had lived in the United States at age 15 nity it serves is socially liberal. agers who were sexually experienced be- and who provided complete and consis- The controls for respondents’ character- fore receiving sex education with those tent information on the relevant charac- istics included in the multivariate models who were not: Two of these found that stu- teristics.* For the second part, the analy- help to correct for individual-level selec- dents who began having intercourse after ses of contraceptive use, the sample was tivity in exposure to contraceptive educa- receiving sex education were more likely further restricted to the 1,479 sexually ac- tion, but we have no controls for school-

*The residence restriction excluded 2% of otherwise eli- tiply the standard errors by 1.414 (or multiply the variance ages 16–19 may have responded in significantly differ- gible respondents; the data quality restriction excluded by two), and adjust t-ratios accordingly. For most variables, ent ways to contraceptive education than did members another 6%. this procedure would actually be an overcorrection. Gen- of the earlier cohort who similarly delayed initiation of erally, coefficients significant at the 1% level in the analy- intercourse (and are included in the study); we have not †Because of the clustered sampling design of the survey, sis reported here would retain significance at least at the been able to control for this possibly confounding selec- standard errors on the parameters in the regression tend 5% level were a conservative correction of this type applied tivity. When we reran the logistic regression models with to be underestimated. Special software is needed to cor- to the results. The t-ratios and levels of significance reported only the cohorts born before 1970, we found an effect of rect for possible correlations between geographically clus- in Tables 4 and 5 have not been adjusted in this fashion. tered observations, and this software is not readily avail- prior exposure to contraceptive education with the pre- able in a format compatible with multinomial logistic ‡Members of the later cohort who are excluded from this dicted sign, but it did not achieve statistical significance regression. Alternatively, a conservative correction is to mul- analysis because they postponed first intercourse until at the 5% level.

20 Family Planning Perspectives level characteristics.* Consequently, our re- Table 2. Mean age of sexually active respondents at first intercourse and at contraceptive ed- sults may either understate or overstate the ucation, and percentage distribution of sexually active respondents by contraceptive use at impact of early contraceptive education, de- first intercourse, according to type and timing of contraceptive education pending on the characteristics of students Type and timing N Mean age Mean age Contraceptive use at first sex (%) who were most likely to be exposed to it. of education at first at contra- sex ceptive Condom Pill Other None Total Results education Cohort Differences Total 1,479 16.5 14.7 39 9 2 50 100 Had contraceptive education Sex education in the home and at school before first sex*** 681 17.2 14.2 44 10 2 44 100 saw several changes during the late 1970s Had contraceptive education in same and early 1980s. More schools began to year as or after first sex*** 427 15.6 15.7 37 7 1 54 100 No contraceptive education*** 371 16.3 na 33 8 4 55 100 teach students about birth control meth- Talked to parents about contraception 875 16.5 14.6 41 11 2 46 100 ods, and those classes were often given to Did not talk to parents about contraception 604 16.6 14.9 37 6 3 54 100 young teenagers, rather than only to stu- Had contraceptive education before dents nearing completion of high school first sex and talked to (Table 1). Between the 1963–1966 and parents about contraception 454 17.1 14.1 43 12 3 42 100 Had no contraceptive education before 1970–1972 cohorts, the proportion of first sex and did not talk young people having formal education to parents about contraception 379 16.1 na 31 6 4 59 100 about contraception before age 14 in- ***Within these categories, differences in contraceptive use are significant at p<.001. creased from 13% to 26%, and the proportion receiving such instruction at age 14 or 15 grew from 23% to 32%. one and one-half years younger when tercourse and encouraged contraceptive Consequently, while the proportion of they had contraceptive education (14.2 vs. use. On the other hand, conversations respondents who became sexually active 15.7). In short, having had contraceptive with parents might have consisted of re- by age 16 rose modestly (from 22% to 25%) education before first intercourse may be quests to acquire contraceptives and in across the three cohorts, the proportion a consequence of later age at first inter- any case might have occurred after first in- who started having intercourse after learn- course, earlier sex education or both. tercourse. Because of this ambiguity, we ing about contraception grew from 47% to Prior contraceptive education is signifi- have not included conversations with par- 58%. Meanwhile, the proportion who ini- cantly correlated with method use. At first ents as an independent variable in the tiated sexual activity without having re- intercourse, 44% of sexually active respon- multivariate models. ceived contraceptive education dropped dents who had had formal instruction about The striking correlations between con- from 33% to 15%.† contraception used a condom, and 10% used traceptive education and subsequent meth- Other types of sex education also be- the pill. By contrast, among women who od use do not necessarily indicate a causal came more prevalent in the late 1970s and had contraceptive education in the same relationship between the two. Contracep- early 1980s. A substantially larger pro- year as or after they had first intercourse, or tive use among teenagers is influenced by portion of the youngest than of the oldest who had not had formal contraceptive ed- cohort reported having talked with their ucation by the survey date, 33–37% used a *If students attending the same school resemble each parents about contraception or STDs, even condom, and 7–8% used the pill. other in behavior such as age at first intercourse or contraceptive use, and differ from students in other schools, though half of the women born in Talking to parents about birth control then school-specific decisions on the timing and content 1970–1972 were only 15 or 16 years old at is also correlated with using either a con- of sex education will compromise studies that use na- the survey date. dom or the pill, and respondents who nei- tional data to estimate the impact of sex education on sex- At the same time, teenagers’ contra- ther had formal education about contra- ual behavior. For example, if schools attempt to offer contraceptive education classes just before many students ceptive use improved markedly. The pro- ception nor discussed it with their parents initiate sexual activity, then we might expect to find that portion who used a barrier, hormonal or reported the lowest levels of condom and receipt of sex education predicts first intercourse, even spermicidal contraceptive method the first pill use. Respondents who had received in the absence of a real association between them. School- time they had intercourse rose from 45% school-based contraceptive education also level data from randomized trials are probably more ap- of the earliest cohort to 59% of those born tended to have talked to their parents propriate than national data for assessing the impact of contraceptive education on the timing of first intercourse. later. Virtually all of this change can be at- about birth control, suggesting that when tributed to a 21-percentage-point increase young people are in formal contraceptive †The sequence of instruction and first intercourse can- education classes, either they or their par- not be determined for the roughly 10% of the sample who in condom use at first intercourse, while learned about birth control in the same year they became the fraction of respondents relying on the ents may be encouraged to initiate con- sexually active and the 4% who did not report the age at pill or other methods declined.‡ versations about sex. (The correlation which they learned about contraception. Although the Table 2 shows several important dif- might also indicate differential recall: Re- experiences of the youngest cohort are censored, we note ferences between teenagers who had con- spondents who remember having a class that the large majority have had contraceptive education; thus, only 17% were at risk of having intercourse prior traceptive education prior to initiating sex- about contraception may also recall a con- to contraceptive education. Consequently, the increase ual activity, those who had it in the same versation at home about it.) in proportions of teenagers having contraceptive edu- year as or following first intercourse and Although the apparent relationships be- cation before first intercourse will surely still hold once those who had no contraceptive educa- tween parent-child conversations and the experience of the youngest cohort is complete. tion. Women in the first group typically birth control use are tantalizing, the di- ‡Part of the apparent switch between condoms and the were about one and one-half years older rections of causality are not clear, because pill is due to the younger average age at first intercourse than women in the second group when the order of events is unknown. For some among sexually active women in the latest cohort. Women in the 1970–1972 cohort who initiated sexual ac- they started having intercourse (ages 17.2 respondents, a specific conversation about tivity after the 1988 survey may have had higher rates of and 15.6, respectively), and were about birth control might have preceded first in- pill use because they were older at first intercourse.

Volume 28, Number 1, January/February 1996 21 Contraceptive Education and Method Use at First Sex

had used a method at of AIDS) and, perhaps, changing prefer- Table 3. Percentage of sexually active respondents who had contraceptive education, and percentage who used a contraceptive first intercourse. The ences among most young people toward method at first intercourse, by selected characteristics proportions were rough- later and smaller families. These inter- ly the same among black pretations are only speculative, however; Characteristic N Had contraceptive Used a education method women, but were con- we tested some of them using very weak at first siderably lower among indicators for the social factors concerned Ever Before first sex Hispanics—63%, 42% (the best trend data we could locate for sex and 35%, respectively. knowledge of AIDS, legal restrictions on Mother’s education The relationship with contraceptive availability and advertising,

†Calculations exclude the 33 respondents of other racial or ethnic groups. tions were 71% and Prior contraceptive education had a 62%, respectively. moderate, statistically significant effect on contraceptive use. The odds of using any many factors, including the norms about Multivariate Models contraceptive method were estimated to family formation, reproduction and inti- In the following regression models, we in- increase by one-third following contra- macy that young people encounter in their vestigate whether differences in age and ceptive education, with somewhat dif- families and in the broader cultures of timing of first intercourse or in the women’s ferent effects on condom use and on pill which they are members. Table 3 demon- background characteristics reduce or even use: The odds of using a condom over strates that the young women whose back- completely overwhelm the apparent asso- using nothing increased by 35%; the odds ground characteristics, age at first inter- ciation between contraceptive education of using the pill increased by 59%, but this course and calendar year of first sexual and contraceptive use. We report in Table change was not significant.† experience suggest they are likely to have 4 the results of a binomial logistic regres- The coefficients for contraceptive edu- used a contraceptive at first intercourse also sion model predicting contraceptive use at cation before first intercourse imply that tended to have had contraceptive education first intercourse, and in Table 5 a multino- if about 6% of teenagers would use the pill, in school. Likewise, the women from back- mial model predicting probabilities of con- 52% would use a condom and 41% would grounds or cohorts that predisposed them dom use, pill use and no contraceptive use. use nothing (the behavior of the most not to use a method tended also not to have The tables show the odds ratio and its as- recent cohort) without such education, had formal instruction about birth control. sociated t-ratio for each covariate. We re- then with contraceptive education, the Young women whose mother had at port results only for pooled models in- rates for similar teenagers would change least some college education were more cluding women of all races.* to 8% using the pill, 59% using the con- likely than those whose mother had not The statistically significant coefficients dom and 33% using nothing (not shown). graduated from high school to have had on the calendar-year variable in Table 4 and any contraceptive education (79% vs. 71%) the last two columns of Table 5 emphasize Table 4. Odds ratios (and t-ratios) predicting and to have had it before first intercourse the increases in condom (but not pill) use use of a contraceptive method at first inter- (56% vs. 41%); there is a corresponding gap in the 1980s that have been reported by sev- course, by selected characteristics (N=1,479) 18 between these groups in their use of birth eral researchers. Calculations based on the Characteristic Odds ratio control at first intercourse (57% vs. 43%). regression estimates suggest that the odds Calendar year of first sex 1.14*** (5.99) Some 76% of white women had had any of using a condom rather than using noth- Age at first sex 1.14** (2.72) formal birth control education, and 50% had ing at first intercourse increased about four- Age squared 0.99 (Ð0.45) Contraceptive education had it before initiating sexual activity; 52% fold in nine years. Indeed, between the before first sex 1.34* (2.25) mid-1970s and the mid-1980s, the fre- Contraceptive education in same *Because the 1988 NSFG oversampled blacks, other an- quency of condom use at first intercourse year as first sex 1.75*** (3.33) alysts have reported separate models for black women Black 1.14 (0.88) and women of other races. We initially estimated such increased from 21% to 49%, and the fre- Hispanic 0.57** (Ð2.74) models and found the coefficient estimates for white quency of nonuse of any contraceptive Other race 0.83 (-0.56) women to be essentially the same as those we report here method declined from 72% to 41%. Jewish 1.98 (1.03) for the pooled model. The small number of black women, Mainline Protestant† 1.36* (2.38) however, meant that the model for blacks had no statis- These striking changes in contraceptive Mother’s yrs. of education 1.09*** (3.67) tically significant coefficients. (Weighted race-specific use over time were, we suspect, the result Intercept 0.001*** (Ð6.72) models are available from the authors.) of several developments in the 1980s: *p<.05. **p<.01. ***p<.001. †Episcopalian, Lutheran, Methodist †The estimated effect on any contraceptive use is smaller more visible and widely available sales of or Presbyterian. Notes: In this table and Table 5, the reference categories are as follows: no contraceptive education before first sex; than the effect on either condom use or pill use because the condoms, concern about preventing AIDS, white, non-Hispanic; and other or no religion. For age at first in- model predicting any use includes women who used some tercourse, age 15 is set at 0. Mother’s years of education is coded other contraceptive method at first intercourse, and con- fairly candid public discussions about sex- in single years, beginning with 0. traceptive education did not increase their numbers. ual behavior (particularly in the context

22 Family Planning Perspectives These changes are smaller than the ones ly than others to use Table 5. Odds ratios (and t-ratios) predicting pill and condom use we observe in the raw (uncontrolled) data, condoms. at first intercourse, by selected characteristics (N=1,444) but are still substantial. In a different model, Characteristic Pill vs. Condom vs. Condom Having a contraceptive education class we found Catholics sig- no method no method vs. pill in the same year as initiating intercourse nificantly less likely to Calendar year of first sex 1.01 (0.27) 1.18*** (6.93) 1.17*** (3.66) leads to an even higher likelihood of meth- use condoms than other Age at first sex 1.24* (2.37) 1.12* (2.10) 0.90 (Ð1.05) od use; the odds ratios are 1.75 for condom women, but not less Age squared 1.04 (1.41) 0.97 (Ð1.63) 0.99* (Ð2.36) use and 2.38 for pill use. Assuming that likely to use the pill (not Contraceptive education before first sex 1.59 (1.91) 1.35* (2.19) 0.85 (Ð0.65) sex education preceded first intercourse shown). These apparent Contraceptive education in for half of these women and followed first effects of religion prob- same year as first sex 2.38** (2.87) 1.75** (3.16) 0.74 (Ð1.00) Black 2.26*** (3.41) 0.96 (Ð0.22) 0.43*** (Ð3.46) intercourse for half, these results suggest ably are chiefly a conse- Hispanic 0.62 (Ð1.18) 0.61* (Ð2.21) 1.00 (Ð0.01) that learning about birth control imme- quence of other back- Other race 0.61 (Ð0.70) 0.96 (Ð0.12) 1.57 (0.63) Jewish 6.44* (2.39) 1.32 (0.37) 0.20* (Ð2.28) diately before first intercourse greatly in- ground characteristics Mainline Protestant 1.01 (0.03) 1.50** (2.95) 1.49 (1.64) creases the likelihood of using a method. of adherents rather than Mother’s yrs. of education 1.10* (2.31) 1.09*** (3.70) 1.00 (Ð0.09) Race, ethnicity and family background a consequence of theo- Intercept 0.01 (Ð1.37) 0.00*** (Ð7.70) 0.00** (Ð3.05) also influence contraceptive use at first in- logical beliefs. *p<.05. **p<.01. ***p<.001. Note: This sample excludes respondents who used some meth- tercourse. Young black women are much We tested a variety of od other than the pill or condom, as well as women whose method was unknown. more likely than those of other ethnic indicators of social rela- groups to use the pill at first intercourse, tionships and social sta- and are as likely as whites to use condoms. tus that other research has shown to pre- ship persists when confounding variables Hispanic women are much less likely than dict aspects of sexual behavior (region of are held constant. How one reads this others to use condoms. The precise rea- residence, family structure at age 14, moth- striking result depends in large measure sons for these differences await further er’s age at first birth and religiosity), but on how one interprets the contraceptive study; we know that cultural norms sur- found none of them significant at the 5% education variable. The simplest hypoth- rounding sex and fertility, access to med- level when added to this model.* Nor did esis is that formal education about birth ical care, perceptions of the risks and ben- their addition to the model alter the sta- control methods really does change con- efits of different contraceptives and other tistical significance or the general magni- traceptive behavior, at least at first inter- factors vary across these populations.19 tude of the coefficients on the contracep- course. Before pursuing this hypothesis, Mother’s level of education is highly sig- tive education variables. we consider other possible explanations. nificant in the model. (Comparable infor- We also investigated the impact of other One is that since the NSFG data are mation for fathers was not reported.) Four sex education variables in these models, based on retrospective reports, they are af- or five years of additional maternal edu- although since we did not know if this ed- fected by recall bias. For instance, it may cation have the same estimated effect on ucation occurred before or after first in- be that the women who reported having contraceptive use as prior exposure to sex tercourse, these variables were of weak had contraceptive education prior to ini- education. The “real” effect reflected in this theoretical interest and are not included in tiating sexual activity remember it because coefficient may be primarily economic, in the final models reported here. Informa- they used the information when they first that better-educated mothers are also more tion about STDs, whether from school or had intercourse. Women similarly ex- affluent, and teenagers from more afflu- parents, was not associated with contra- posed to contraceptive education who did ent families are more likely to practice con- ceptive behavior. In contrast, talking to not use the information may not remem- traception. Alternatively, the variable may parents about contraception was positively ber having the class or may remember it capture indirectly the aspirations for fur- and significantly related to pill use at first as occurring later than it did. ther education that the respondent inher- intercourse, but had no relationship with Another alternative is that the women ited from her mother, or perhaps better-ed- condom use. This disjuncture suggested who learned about contraception in school ucated mothers teach their daughters to that the conversations with parents may before they became sexually active may have “manage” their first sexual experience suc- have been, in many cases, requests for help differed in unmeasured ways from those cessfully and avoid pregnancy. in acquiring the pill. If so, the variable is who did not. For example, they may have Previous studies have documented a not a cause but a consequence of a young been raised by liberal parents who tolerat- strong relationship between contraceptive woman’s intention to use a contraceptive ed this type of schooling for their daughters, use and religious affiliation. Two analy- and should be excluded from the model. and the home climate in these more liberal ses found fundamentalist Protestants to Finally, we tested for significant interac- families may have independently predis- be relatively unlikely to use a contracep- tions between contraceptive education and posed daughters to use contraceptives. tive at first intercourse,20 but we were un- such variables as age and race or ethnicity, While these competing hypotheses re- able to replicate that result. Rather, we ob- to see whether birth control instruction had main possibilities, the patterns of contra- served that Jews and mainline Protestants different impacts for younger and older ceptive education reported in the survey (Episcopalians, Lutherans, Methodists teenagers, or for black and Hispanic teen- limit their plausibility. First, the data do and Presbyterians) were more likely than agers. None of these explorations yielded not seem particularly skewed by selective others to use a method. Jewish women significant differences between groups. recall. The change over time that appears were much more likely than others to use in respondents’ reports of contraceptive the pill at first intercourse. (This result Discussion education is entirely consistent with in- should be interpreted with skepticism, A significant association exists between however, as it is based on 15 Jewish re- exposure to formal education about con- *Other researchers have found that intact family structure at age 14 predicts condom use (see reference 11). We spondents in the survey.) Mainline Protes- traception and subsequent use of birth found no effect on condom use and a marginally signif- tants, on the other hand, were more like- control at first intercourse. The relation- icant negative impact on pill use (p=.07).

Volume 28, Number 1, January/February 1996 23 Contraceptive Education and Method Use at First Sex dependent evidence that sex education young woman’s education could have an References has become both more prevalent and more impact on her partner’s behavior if it not 1. B. A. Page and R. Y. Shapiro, The Rational Public: Fifty comprehensive. Second, sex education is only taught her about the importance of Years of Trends in Americans’ Policy Preferences, Universi- ty of Chicago Press, Chicago, 1992, pp. 104–115 and Fig- increasingly common for children from di- condoms and how to acquire and use ure 3.12; and W. Mayer, The Changing American Mind: verse backgrounds. Moreover, in our mul- them, but also helped her develop nego- How and Why American Public Opinion Changed Between tivariate models, we have controlled for tiation and assertiveness skills, or even 1960 and 1988, University of Michigan Press, Ann Arbor, some of the differences that predispose skills for choosing boyfriends. 1992, p. 389. teenagers to use contraceptives. The contrasts we observe in teenagers’ 2. M. Imber, “Toward a Theory of Curricular Reform: An We suspect that we are finding effects of contraceptive choices over time should Analysis of the First Campaign for Sex Education,” Cur- sex education where other studies have not alert us to the fact that contraception is a riculum Inquiry, 12:339–362, 1982; and B. C. Gruenberg, High Schools and Sex Education, U.S. Government Print- because the 1988 NSFG did not ask re- multidimensional phenomenon. The pill ing Office, Washington, D.C., 1940. spondents merely “Did you have sex edu- has consistently been a relatively unpop- 3. J. D. Forrest and J. Silverman, “What Public School cation?” but more specifically, “Did you ular means of contraception at first inter- Teachers Teach About Preventing Pregnancy, AIDS and have a formal program of education about course, while use of the condom has in- Sexually Transmitted Diseases,” Family Planning Per- contraceptive methods?” Sex education creased considerably. Young couples who spectives, 21:65–72, 1989. programs that did not discuss contracep- use condoms are choosing a different set 4. Ibid.; and P.O. Britton, D. de Mauro and A. E. Gam- tion would not be included in this measure. of experiences—in the bedroom, in the brell, “HIV/AIDS Education: SIECUS Study on Assuming that contraceptive education health care system and in the market- HIV/AIDS Education for Schools Finds States Make changes the behavior of a substantial place—than are those who rely on the pill. Progress, but Work Remains,” SIECUS Report, Vol. 21, No. 1, pp. 1–8, 1992. number of teenagers, the question arises: One implication for research is that analy- Whose behavior does it affect? Other re- ses focusing only on whether teenagers 5. C. D. Hayes, ed., Risking the Future: Adolescent Sexual- ity, Pregnancy and Childbearing, Vol. 1, National Acade- searchers have found that having sex ed- use contraceptives, and not on the specif- my Press, Washington, D.C., 1987; and U.S. Congress, ucation influences young men’s use of ic method they use, are conflating differ- Office of Technology Assessment, Adolescent Health: Vol- condoms.21 The puzzle here is to under- ent types of behavior, which have differ- ume II—Background and the Effectiveness of Selected Pre- stand how it is that a young woman’s ex- ent meanings for individuals, as well as vention and Treatment Services, U.S. Government Printing perience of sex education might not only different health and reproductive conse- Office, Washington, D.C., 1992. affect her behavior, but more important, quences. 6. U.S. Congress, Office of Technology Assessment, 1992, lead to her partner’s using a condom the How young people assess contraceptive op. cit. (see reference 5), p. 365. first time she has sexual intercourse. methods and how easily they can acquire 7. D. Kirby et al., “School-Based Programs to Reduce Sex- Designers of AIDS prevention and other them are important elements in the story ual Risk Behaviors: A Review of Effectiveness,” Public Health Reports, 109:339–360, 1994. sex education programs wrestle with this we have told. Condoms are sold in many conundrum as they seek to increase rates venues, packaged appealingly, touted in 8. J. Mauldon, “The Effect of Sex Education on Teenagers’ Use of Birth Control,” paper presented at the annual of condom use among sexually active youth-oriented media and even distrib- meeting of the Population Association of America, San young women (or, more precisely, among uted in schools. Since the 1980s, manu- Francisco, Apr. 6–8, 1995. their partners). However, the NSFG data facturers have targeted the female market 9. L. S. Zabin, J. F. Kantner and M. Zelnik, “The Risk of offer no insights: The survey did not gath- in their promotions. Opinion surveys Adolescent Pregnancy in the First Months of Intercourse,” er information about the details of a re- among women of all ages showed favor- Family Planning Perspectives, 11:215–222, 1979. spondent’s contraceptive education (the able assessments of the condom rising 10. D. A. Dawson, “The Effects of Sex Education on Ado- 24 program’s length, type of teacher pro- sharply during the 1980s. Nevertheless, lescent Behavior,” Family Planning Perspectives, 18:162–170, viding instruction, pedagogical style or although some young women carry con- 1986; and M. Zelnik and Y.J. Kim, “Sex Education and course content) or about the young doms and claim that this is “their” meth- Its Association with Teenage Sexual Activity, Pregnan- woman’s first sexual partner. Lacking od of birth control, the most recent na- cy and Contraceptive Use,” Family Planning Perspectives, 14:117–126, 1982. data, one can only speculate. One expla- tional data on teenagers’ contraceptive use nation is simply that contraceptive edu- suggest that among adolescents, males 11. L. C. Ku, F.L. Sonenstein and J. H. Pleck, “Factors Af- fecting First Intercourse Among Young Men,” Public cation curricula have begun to emphasize rather than females typically provide the Health Reports, 108:680–694, 1993. heavily the advantages of the condom. condoms.25 With the advent of AIDS, schools have Important and encouraging changes in 12. D. Kirby et al., 1994, op. cit. (see reference 7). begun to stress the dual function of the the contraceptive behavior of teenagers 13. D. Kirby et al., “Reducing the Risk: Impact of a New condom, as a prophylactic against both have occurred since 1978, in the direction Curriculum on Sexual Risk-Taking,” Family Planning Per- 22 spectives, 23:253–263, 1991; and M. Howard and J. B. Mc- disease and pregnancy. Presumably, in of increased condom use. Although sex Cabe, “Helping Teenagers Postpone Sexual Involve- some cases, a young woman who had education explains very little of the trends ment,” Family Planning Perspectives, 22:21–26, 1990. learned this information in the classroom we observe, it seems to have played a part 14. M. Eisen, G. L. Zellman and A. L. McAlister, “Eval- discussed it with her partner, and the two in influencing adolescent behavior. The uating the Impact of a Theory-Based Sexuality and Con- of them decided to use condoms. discouraging aspect of the story is that traceptive Education Program,” Family Planning Per- But the information included in con- large numbers of teenagers still engage in spectives, 22:261–271, 1990. traceptive education programs is proba- intercourse with no protection against ei- 15. B. H. Thomas et al., “Small Group Sex Education at bly only half of the story. From evaluations ther pregnancy or STDs. But if teenagers School: The McMaster Teen Program,” in B. C. Miller et of specific curricula,23 we know that ef- have changed their behavior with only the al., eds., Preventing Adolescent Pregnancy, Sage Publi- fective sex education programs focus on modest official encouragement from cations, Newbury Park, Calif., 1992, pp. 28–52; D. Kirby et al., 1991, op. cit. (see reference 13); and G. Walker and behavior as well as on information. They school sex education programs common F. Vilella-Velez, Anatomy of a Demonstration: STEP from allow students to practice skills as simple in the 1970s and 1980s, greater change Pilot Through Replication and Postprogram Impacts, as buying condoms or as complex as per- through other types of educational cam- Public/Private Ventures, Philadelphia, 1992. suading a partner to use a condom. A paigns seems achievable. (continued on page 41)

24 Family Planning Perspectives