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The article below is really a study... a study
that talks about percentages of teens that use protection when having sex & how they "feel" about birth control, getting
pregnant & some other factors...
Ambivalent feelings seem to always be the case
as it's still not a reality to the teen that if they don't use protection - they will get pregnant - that is... if not the
1st time, most likely the 2nd time. Actually, the more you get away with - having unprotected sex - the more you tend to do
it again without protection.
Teens have difficulty believing that "pregnancy" will happen to them! It's just the same as drinking & driving! They will drink & drive - STILL -
even though knowing the consequences is so boldly known - because they never believe that it'll happen to them. Things like that happen to "other teens!"
Ambivalence & Pregnancy: Adolescents’ Attitudes, Contraceptive Use & Pregnancy
The majority of
pregnancies among unmarried teenagers are unintended.1 Most adolescents don't want to become pregnant, although some aren't opposed to becoming pregnant & others have ambivalent attitudes.2
A number
of explanations of why adolescents’
attitudes toward pregnancy vary exist in the literature; however,
less often considered is whether these attitudes are associated with pregnancy risk & contraceptive
use.
Questions about
the relevance of attitudes are important because attitudes may mediate the often-observed association between socioeconomic
disadvantage & pregnancy risk. For this reason, social
policy is often oriented toward shaping attitudes.
Many researchers
& advocates have argued that teenage pregnancy prevention
programs should target attitudes toward pregnancy.3
One
reason for the attention to pregnancy attitudes has been that interventions that increase the availability
of contraceptives have experienced uneven success in reducing
teenage pregnancy rates.4
Many
experts have concluded that adolescents have
access to the means to avoid pregnancy but don't use them
or use them inefficiently because they don't
appreciate the consequences of pregnancy.5
Actors in the social
policy domain may also focus on teenagers’ attitudes because they seem easier to change than the social &
economic conditions in which those attitudes develop. For example, poverty is associated with teenage
initiation of sex, non-use of condoms at first intercourse & accidental pregnancy,6 but pregnancy intervention programs aren't well suited to end poverty.
They may, however, be well suited to shape attitudes. But which attitudes? In the current political climate, supporting programs designed
to shift attitudes about pregnancy is easier than supporting programs designed
to shift attitudes about contraception.
In this article,
we address whether sexually experienced adolescents’
attitudes toward pregnancy influence their risk of becoming pregnant.
Adolescent Contraceptive Use & Pregnancy
An extensive literature
documents the determinants of adolescent contraceptive behavior.
Critical factors associated with contraceptive use include
social & demographic characteristics (e.g., age, race & income), family - related characteristics (e.g., parental education & closeness with parents)
& individual characteristics (e.g.,
cognitive ability, educational achievement & expectations, self-esteem, age at first sex, history of pregnancy & attitudes toward contraception).7
The impact of religiosity on contraceptive
use is less clear & the literature deviate contains
mixed results about the effects of adolescents’ knowledge of sex, fertility & contraception.
With respect to
pregnancy, the literature reports similar critical
determinants.8
Social &
demographic predictors include:
family related
predictors include:
individual predictors
include:
-
low cognitive ability
-
low educational expectations & achievement
-
negative attitudes toward school
-
lack of involvement in school clubs
-
problem behaviors
Popularity at school
doesn't predict adolescent females’ risk of pregnancy,
but the characteristics of their friends do. Finally, number
of partners, age at onset of sexual activity & contraceptive
behavior are strong predictors of pregnancy risk.
Most studies that
are concerned with attitudes toward pregnancy rely on small
convenience samples or on retrospective accounts of pregnant
adolescents’ attitudes, which may be colored by the
pregnancy. Jaccard et al. examined the role of attitudes
toward pregnancy prospectively with a representative sample
of sexually experienced & inexperienced adolescent females
& found a robust association between positive
attitudes & subsequent pregnancies.9
However, attitudes
toward pregnancy are likely to be strongly correlated with
attitudes toward having sex, which weren't controlled for
in the study’s multivariate model.
Thus, the finding
may be due to this omitted variable or to other factors
that are correlated with pregnancy attitudes & delay
in sexual debut. We expand on the prior research in several
ways.
1st, we limited our sample to sexually experienced young women, which allows us to assess the role of pregnancy attitudes in the absence of factors associated with the timing of sexual debut but not pregnancy risk. Because the majority of adolescents will become sexually active between the ages
of 15 & 19, it's important for educators & policymakers
to know whether attitudes toward pregnancy are associated
with pregnancy risk among sexually experienced adolescents.
2nd, we explore
whether contraceptive use is the behavioral mechanism that
links attitude & outcome. It has been argued that ambivalence
toward pregnancy is a risk factor for pregnancy because
it leads to inconsistent contraceptive use,10 but few studies have directly tested this idea.*11
Finally, we examine the antecedents of attitudes
toward pregnancy, paying special attention to the characteristics
of adolescent women who lack a clear opinion.
METHODS
Data
We used data from the National
Longitudinal Study of Adolescent Health (Add Health) because of its significant advantages over competing data sets.
1st, researchers have argued for the need to analyze prospective measures of pregnancy attitudes.12 Exploiting the prospective features
of Add Health allows us to rule out a reverse effect of
behaviors (such as becoming
pregnant) on attitudes.
2nd,
the range of Add Health data allows us to include in our
multi- variate models detailed measures of well-established
antecedents of both adolescent attitudes toward contraception
& pregnancy & adolescent contraceptive use &
pregnancy risk.
Finally,
Add Health is a nationally representative study; adolescents
are not selected on the basis of failed contraceptive use,
as is the case in many clinic-based studies.
Add Health utilizes
a multistage clustered sample design & for this study,
we used data drawn from its in-home components.13 From
May through December 1995, Wave 1 in-home interviews were
administered to 20,745 adolescents.
The interviews took 90 minutes to complete, on
average & collected detailed information about risk behaviors,
romantic partnerships, family dynamics, aspirations, attitudes
& activities. 80% of adolescents in the initial sample
completed a Wave 1 interview.
Audio computer-assisted
self-interviewing technology was used for questions covering
sexual & other sensitive health behaviors. Between April
& September 1996, re-interviews with Wave 1 respondents,
excluding high school seniors, were conducted.
Some 88% of eligible
respondents participated in Wave 2, yielding a sample of
14,738 adolescents who completed both interviews.
Female respondents
aged 15–19 who participated in both in-home interviews
were eligible for inclusion in our analyses; we excluded
those younger than 15 because they weren't asked the questions
about pregnancy attitudes.
Also, we excluded
44 respondents who were married at Wave 1 or got married
between waves & 138 who were missing information on
pregnancy attitudes or sexual history.
The final sample consisted
of 4,877 adolescent females.
Measures
Attitudes toward pregnancy.
In the Wave 1 interviews, adolescents were
asked how they would feel if they became pregnant. To measure
pregnancy attitudes, we used 5 survey items that assessed
adolescents’ perceptions of the consequences of pregnancy:
-
“If
you got pregnant, it would be embarrassing for your family”
-
“If
you got pregnant, it would be embarrassing for you”
-
“If
you got pregnant, you'd have to decide whether or not to have the baby & that would be stressful & difficult”
-
“If
you got pregnant, you'd be forced to grow up too fast”
-
“Getting pregnant at this time is one of
the worst things that could happen to
you.”
Response categories
were strongly agree, agree, neither agree nor disagree,
disagree & strongly disagree.
When the 5 responses
were averaged into a single index of pregnancy attitude
(Cronbach’s alpha=0.72), this measure had relatively little dispersion (standard deviation contains=0.09)
around its mean (2.1).
Most respondents opposed pregnancy, although
some respondents did so more vehemently than others &
still others appeared not to oppose it all. Yet another
group of respondents were unable to form an opinion &
chose “neither agree nor disagree.”
We divided respondents
into 4 groups according to their attitudes toward pregnancy.
Those who strongly agreed with all 5 statements, or strongly
agreed with 4 &
agreed with 1, were classified as having the most unfavorable attitudes
toward becoming pregnant (anti-pregnancy).
Respondents who
disagreed or strongly disagreed with at least 3 statements
were classified as having the most favorable attitudes toward
becoming pregnant (propregnancy).
Those who neither
agreed nor disagreed with at least 2 statements were classified
as having the least defined attitudes toward becoming pregnant
(ambivalent).
We categorized
the 15 respondents who qualified as both ambivalent & propregnancy as propregnancy. The remaining respondents were considered to have mainstream attitudes.
Our analytic strategy
was to define groups outside the mainstream that would be
small enough to be considered extreme in attitude, but large
enough to exhibit sufficient within-group variation. These
group definitions are robust.
Multiple adjustments
to the groups (i.e., restriction & relaxation of the criteria) didn't alter the relationship between
attitudes & contraceptive behaviors or the occurrence
of pregnancy in multivariate analyses.*
Background characteristics.
We controlled
for age, race & ethnicity, maternal education, poverty
status, family structure, closeness with mother, religiosity,
cognitive ability, self-esteem & social isolation (Table 1).
In addition, we created a measure of risk status - adolescents’ orientation
to school, future expectations & non-normative social
behavior - from the cross-classification of two indices,
as was done in a previous study.14
The first index summarizes orientation to
school & includes grade point average, school attachment,
number of extracurricular activities & desire for &
perceived likelihood of attending college.
The
second index summarizes non-normative social behavior &
includes drinking, truancy, delinquency & having trouble
with teachers or other students. We defined respondents
who scored in the bottom quartile on the school orientation
index & in the top quartile on the non-normative social
behavior index as being high-risk & those who scored
in the top quartile on the school orientation index &
in the bottom quartile on the non-normative social behavior
index as being low-risk. The remaining respondents (the
majority) were defined as middle-risk.
Sexual behavior, contraceptive
use & contraceptive knowledge.
We considered respondents sexually experienced if they reported at Wave 1 that they had ever had sexual intercourse. Length of sexual career was measured as the difference between respondents’ age at sexual debut & their age at Wave 2.
We defined respondents’ number of partners as the number of sexual partners they reported having between Waves 1 & 2, excluding any partners who were current at Wave 1.
If a respondent reported at Wave 1 that she had ever been pregnant, she was considered to have
had a prior pregnancy. Only pregnancies that occurred between
waves were used to construct the outcome measure; pregnancies
that had occurred prior to Wave 1 were used as a predictor
of between-wave pregnancy.
We assessed respondents’
knowledge about pregnancy avoidance at Wave 1 by their responses
to nine true or false questions about proper condom usage,
ovulation & pregnancy risk.
In addition, we
used the number of questions that a respondent answered
incorrectly but was certain she had gotten right as a measure
of respondents’ unfounded certainty about pregnancy
avoidance.
The questionnaire
contained 7 items that measured attitudes toward contraception.
We constructed a scale from these items by averaging responses,
which were given on a 5-point Likert scale. Higher values
indicate more positive attitudes toward contraception (Cronbach’s alpha= 0.81).
Contraceptive behavior
was measured retrospectively at Wave 2. Respondents were
asked to report on up to 6 sexual relationships & for
each relationship, whether they used contraceptives, which
methods they used & their contraceptive consistency
(always, sometimes or never).
To make sure that
we measured the independent variables (e.g., attitudes) before the outcome occurred, only sexual relationships initiated between waves were included in the analysis.
For the analysis
of pregnancy, we characterized contraceptive behavior differently
for respondents who didn't get pregnant between waves &
those who did, to allow for the possibility that a pregnant
respondent’s contraceptive behavior was influenced
by her pregnancy.
For respondents
who became pregnant, contraceptive behavior was characterized
by use during the month in which the pregnancy occurred.
To create a similar
“worst-case” measure for respondents who didn't
get pregnant, contraceptive behavior was summarized across
all inter-wave sexual relationships. Respondents were considered
nonusers if they hadn't practiced contraception in at least
1 relationship.
Among respondents
who had practiced contraception in all their relationships, those who had used contraceptives inconsistently in at least one relationship were classified as inconsistent users & those who always used contraceptives in every relationship were classified as consistent users.
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kat's feelings of ambivalence...
In my past, especially throughout my teenage years; I was existing on a continual - nonstop
roller coaster ride of emotions and feelings. Up moods, crashed moods, down moods, extended moods, positive moods, negative
moods, angry moods, brief moments of clarity... never knowing really just what is was that I felt.
I think most teens have an ambivalent relationship with their parents. If I were to describe
the feeling of ambivalence to you in this case it would simply be:
I have a love / hate relationship with my parents. I want them to love me, I want to love
my father, I need to love my father and I need him to love me; but there's this hate aspect that goes hand in hand with it...
It's frustrating and infuriating to experience two opposite emotions at the same time and to not understand why.
My parents would never say that they loved me but they would always say things like:
- I hate the way you look in that outfit.
- I hate the way you always follow your friends around.
- I hate your irresponsibility.
I could mention hundreds of things they hate about me; but I'm
at a loss for what they liked about me.
With my friends & others
at school, I wanted to be included. I would want to hang out with certain cool kids at school & then they would do something
stupid like bash gay kids in school & I'd be disappointed in theml. There... I've said it! OMG it's confusing & I
hate it, but I love the way those cool kids party together!
I wanted to have sex with my boyfriend & yet I didn't
want to. There was this ambivalence I felt about it all. I knew I was needy, emotionally
needy. My parents were having troubles & ignored everything I did. I knew that all the kissing & touching felt good.
I felt like it was my boyfriend's way of telling me he loved me. I wanted to feel loved. Then in my confusion; I found myself thinking sex was love. What a mistaken belief that was!
Ambivalence haunted me. Not knowing what I felt - it was
a constant competition of love/hate - love/hate & I wanted to be sure of something. I wanted to know for sure that someone loved me for who I was & yet I didn't know who I was.
This is a sense of ambivalence.
On the opposite column there's an article about ambivalence. It's what I suspect most teens are thinking when they're getting ready to have sex. Do I use a
condom or not? I know I should, but I don't want to...
- I know I don't want to get pregnant - but having
a baby would be so cool!
- I don't want to get any STD's or AIDS - but using
a condom feels so weird....
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