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Patterns of Contraceptive Use Within Teenagers’ First Sexual
Relationships
Jennifer Manlove, Suzanne Ryan, and Kerry Franzetta
Jennifer Manlove is senior research associate, Suzanne Ryan is research associate and Kerry
Franzetta is senior research assistant, all with Child Trends, Washington, DC.
Abstract
CONTEXT—Teenagers have a high unintended pregnancy rate, in part because of inconsistent use
or nonuse of contraceptives. It is important to determine how partner and relationship characteristics
are related to contraceptive use and consistency within adolescents’ first sexual relationships.
METHODS—Logistic and multinomial logistic regression analyses of data from 1,027 participants
in the first two waves of the National Longitudinal Study of Adolescent Health examined the
influence of relationship and partner characteristics on ever-use and consistent use of contraceptive
methods during teenagers’ first sexual relationships.
RESULTS—Teenagers who had waited a longer time between the start of a relationship and first
sex with that partner, discussed contraception before first having sex or used dual contraceptive
methods had significantly increased odds of ever or always using contraceptives. Adolescents who
had taken a virginity pledge, had an older partner, had a greater number of close friends who knew
their first partner, or reported having a relationship that was not romantic but that involved holding
hands, kissing and telling their partners they liked or loved them had decreased odds of contraceptive
use or consistency. As relationship length increased, teenagers were more likely to ever have used a
method, but less likely to always have used a method.
CONCLUSIONS—Parents and programs should encourage teenagers to delay sexual intercourse,
discuss contraception with partners before initiating sex and be vigilant about contraceptive use,
particularly in long-term sexual relationships and in relationships with older partners.
The prevalence of unintended pregnancy is high in the United Slates, especially among women
in their teens. Despite declines in the past decade. U.S. teenage pregnancy rates and birthrates
are among the highest in the industrialized world.1 Public concern about and efforts aimed at
preventing unintended pregnancies have focused primarily on teenagers because the vast
majority of teenage pregnancies and births are unintended.2
Teenagers may avoid unintended pregnancies by delaying early sexual intercourse and by using
contraceptives consistently and effectively when they do become sexually active.3 Among
sexually experienced teenagers and young adults not actively seeking to become pregnant,
approximately half of unintended pregnancies result from nonuse of contraceptives, and the
other half result from ineffective use.4 Although adolescent contraceptive use appears to be
improving,5 teenagers remain inconsistent contraceptive users.6 However, few national-level
studies have assessed factors associated with contraceptive consistency within sexual
relationships.
Too often, researchers must rely on measures of contraceptive use from a single point in time:
Sexually experienced women and men are classified as either users or nonusers on the basis
Author contact:jmanlove@childtrends.org.
NIH Public Access
Author Manuscript
Perspect Sex Reprod Health. Author manuscript; available in PMC 2006 June 5.
Published in final edited form as:
Perspect Sex Reprod Health. 2003 ; 35(6): 246–255.
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of measures of contraceptive use at first or last intercourse. However, single-time measures
are limited and do not reflect patterns of method use over time. For example, contraceptive use
at first sex is a much weaker predictor of unintended pregnancy than contraceptive consistency
over a 12-month period.7
Extensive research has examined factors associated with the transition to first sexual
intercourse, and this work often has included information on contraceptive use at first sexual
intercourse Teenagers’ first relationship experiences may predict how they will approach
subsequent relationships, but until recently, national-level data available to tie contraceptive
patterns to sexual partners have been limited.8 Those studies that have examined consistency
focus primarily on contraceptive effectiveness for a specified period without taking into
consideration sexual relationships during that period,9 but an adolescent’s contraceptive use
may change when he or she begins a sexual relationship with a new partner.10
The focus of this article is on examining how partner and relationship characteristics are
associated with contraceptive consistency within first sexual relationships. We hypothesize
that contraceptive use must be negotiated within each new sexual relationship, and the
likelihood of sustained contraceptive use depends on the dynamics within sexual relationships.
FACTORS ASSOCIATED WITH USE
Some studies have found that partner and relationship characteristics are associated with
contraceptive use at first sex,11 recent contraceptive use,12 ever-use of contraceptives during
sexual relationship13 and the likelihood of a nonmarital pregnancy.14 These studies suggest
that the type of relationship that teenagers have with their partners influences their
contraceptive use patterns. Adolescent women who have just met their partners at the time of
first sex and consider the relationship nonromantic are less likely than those who are going
steady or in a romantic relationship to use a contraceptive method.15 Also, contraceptive use
may differ in monogamous and nonmonogamous relationships: In one study, inner-city women
who reported having more than one partner were more likely to use a condom in their “other”
relationship than in their main, or regular, relationship.16 Other studies report reduced condom
use in cohabiting relationships or in relationships that eventually resulted in cohabitation or
marriage;17 however, these studies do not indicate whether the female partners used a
contraceptive method other than the condom.
The length of sexual relationships also is related to contraceptive use: As the length of their
relationships increases, teenagers have an increased likelihood of ever using a method,18 but
a reduced likelihood of using condoms consistently.19 It is unclear whether this is because of
switching to hormonal methods, a reduction in perceived sexually transmitted disease (STD)
risk or “contraceptive fatigue” (growing difficulty in sustaining consistent contraceptive use
in longer relationships). In addition, teenagers who were younger at the time of their first sexual
experience were less likely than those who were older to have practiced contraception at first
sex20 or during recent sexual activity.21
Partner characteristics are another possible influence on patterns of contraceptive use: Females
with older partners are less likely to practice contraception,22 and a greater age difference
between partners is associated with reduced contraceptive use, especially among females.23
The type of method used during the first sexual relationship may be associated with
contraceptive consistency. Bivariate analyses of National Survey of Family Growth data
suggest that teenagers relying on coitus-dependent methods use contraceptives less
consistently than teenagers relying on the pill.24 It follows that adolescents using the injectable
or the implant should report the greatest contraceptive consistency. Teenagers using dual
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methods–who tend to be more risk-averse than other sexually experienced teenagers–may also
be more consistent contraceptive users.25
Previous research suggests that family background characteristics, including family structure
and socioeconomic status, are associated with sexual and contraceptive behaviors that affect
the risk of early or unintended childbearing.26 Racial and ethnic minorities have a lower
likelihood of contraceptive use than whites27 and a greater risk of teenage pregnancy and
childbearing.28 Higher grades, test scores and educational expectations, and greater school
attendance are associated with increased adolescent contraceptive use and reduced risk of
pregnancy and childbearing.29 Also, some evidence supports a positive influence of sex
education on contraceptive use among female teenagers.30
Males play a critical role in couples’ sexual decisions and contraceptive patterns. With dramatic
increases in condom use for contraception at first and last sex among teenagers,31 it is
important to understand factors associated with consistent contraceptive use among males as
well as females. One national study of gender differences in contraceptive use suggests that
different factors may influence contraceptive use among males and females.32 In addition,
males and females may choose partners with different characteristics, which may influence
their contraceptive use patterns. For example, female teenagers are more likely than males to
have older partners, which places them at a reduced likelihood of contraceptive consistency.
Our study expands on prior research in several ways: by assessing contraceptive use and
consistency throughout sexual relationships instead of examining contraceptive use only at
first and last sex; by focusing on teenagers first sexual relationships, to provide previously
unavailable detail on the types of partners teenagers choose, characteristics of their
relationships and how these are associated with contraceptive use and consistency over time,
by examining how method choice and dual method use contribute to contraceptive consistency;
and by exploring how the links between partner and relationship characteristics and
contraceptive outcomes differ by gender.
We have four hypotheses. First, characteristics of teenagers’ first sexual partners and
relationships will be associated with contraceptive use and consistency during those
relationships. Second, teenagers’ individual and family background characteristics will also
be associated with contraceptive use and consistency. Third, teenagers using hormonal methods
will use contraceptives more consistently than those using condoms, and teenagers using dual
methods will practice contraception more consistently than those using single methods. Finally,
the associations between partner and relationship characteristics and contraceptive consistency
will differ by gender.
DATA AND METHODS
Data
The National Longitudinal Study of Adolescent Health (Add Health) is a nationally
representative survey of U.S. students who were in grades 7–12 in 1995. Add Health provides
an exceptionally rich data source because it involves multiple waves of in-home interviews
and several data collection components.33 In 1995, more than 90,000 adolescents in 80 high
schools and feeder schools completed a self-administered in-school questionnaire, and data on
each school were collected through a survey completed by a school administrator. In 1995
(Wave 1), more than 20,700 students and their parents completed comprehensive in-home
interviews, answering detailed questions about the teenagers’ health behaviors, friendship
networks, romantic partners and relationships with their parents. Approximately 14,700
students were reinterviewed at home in 1996 (Wave 2).*
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For our study, we relied upon data from both Wave 1 and Wave 2 in-home interviews
Information on contraceptive consistency, sexual relationships and partner characteristics was
drawn from the Wave 2 survey, whereas individual and family background characteristics were
taken from the Wave 1 survey. Add Health data are longitudinal, which allowed us 10 examine
how individual characteristics at Wave 1 influenced contraceptive use between waves.
Our sample consisted of adolescents who participated in both survey waves, initiated their first
sexual relationship between interviews and had valid sample weights.* Some 5,230 adolescents
were excluded because they had initiated sexual intercourse before Wave 1, and 7,212 because
they had never had sexual intercourse before Wave 2. The survey posed questions about the
onset of sexual, activity in several ways, and the teenagers were not always consistent in their
responses. † To account for these inconsistencies, we assumed that teenagers who said they
had ever had sexual intercourse or reported a date of first sex with a partner in Wave 1 were
sexually experienced by the first interview and, therefore, excluded them from our sample.
With these restrictions, the sample included 1.126 adolescents. We eliminated 83 respondents
who gave incomplete information on date of first sex (reported only month or year of partner-
specific first sex) at Wave 2 and who reported a date of first sex that fell after the reported date
of last sex. In addition, we eliminated nine respondents who were married and six who were
missing data on the dependent variable, leaving a final sample of 1,027.‡
Measures
Dependent variables—We derived our dependent variable of contraceptive consistency
from two questions about teenagers’ first sexual relationship: “Did you or [your partner] use
any method of birth control?” and “Did one or the other of you use some method of birth control
every time you and [your partner] had sexual intercourse?” Using responses to these questions,
we constructed a measure with three categories: never used a contraceptive method (nonuse),
sometime used a contraceptive method (inconsistent use) and always used a contraceptive
method (consistent use). A second dependent variable compared teenagers who had ever
practiced contraception at any point during their first sexual relationship with those who had
not.
Demography characteristics—We controlled for a number of individual characteristics:
gender, race and ethnicity (non-Hispanic white, non-Hispanic black, Hispanic and other), and
whether the respondent had received pregnancy and AIDS education in school or had taken a
virginity pledge. We measured cognitive ability by score on a modified Peabody Picture
Vocabulary Test, for which the national average is 100.34 Also, we controlled for two family
characteristics–family structure (two biological or adoptive parents versus all others) and
educational level of the more highly educated parent in the family.
Relationship and partner characteristics—Respondents could identify their first sexual
relationship as being one of three types; romantic, liked (defined in Add Health as relationships
that were not self-identified as romantic, but in which respondents had held hands, kissed and
told their partners they liked or loved them) or nonromantic (neither romantic nor liked).
*Data from a third wave of interviews became available after we completed our analyses.
*Twelve percent of the teenagers who participated in both waves of the survey did not have sample weights because they were not part
of the initial probability sample (source: reference 33).
†Questions asked if the respondent ever had sex, the date of first sexual intercourse and the date of first sexual intercourse with specific
partners. Inconsistent responses were largely random and did not affect substantive conclusions (source: reference 41).
‡When data for the explanatory variable were missing data, we substituted the mean or mode of the nonmissing values. If more than 5%
of respondents had missing data on a particular measure, we also included a measure of missing data in the multivariate models. None
of these measures were significantly associated with contraceptive use or consistency. For the 31 adolescents who reported the same date
of first sex for more than one partner, we randomly selected one partner to include in our analyses.
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Measures describing the first sexual relationship were respondent’s age at first sex, length of
the sexual relationship (in months), and number of months between the start of the relationship
and sexual initiation (for romantic or liked relationships).
Measures of partner’s characteristics were age difference between respondent and partner, the
presence of verbal or physical abuse in the relationship, the number of the respondent’s close
friends who knew the partner before the start of the relationship (for romantic and liked
relationships) and whether the couple had ever discussed contraception prior to first sex (for
romantic and liked relationship). Verbal abuse was defined as name-calling, insults,
disrespectful treatment, swearing or threatening the use of violence; physical violence was
defined as pushing, shoving or throwing dangerous items.
Contraceptive method use—We included two measures of contraceptive method use.
First, we created a four-category measure of the most effective method used during the
relationship: hormonal (i.e., the pill, implant, injectable or contraceptive ring), condoms, other
methods (i.e., IUD, withdrawal, rhythm, vaginal sponge, foam, jelly, cream, suppositories,
diaphragm, contraceptive film or some other method) or no method. (Because only 22
respondents reported using the injectable or implant, we grouped all hormonal methods
together.) Second, for teenagers who reported ever having used a method, we measured dual
contraceptive use–comparing those who always used two or more methods when they practiced
contraception with those who sometimes used dual methods or used only a single method.
(Note that inconsistent contraceptive users could be classified as always using dual methods
as long as they used dual methods every time they practiced contraception.)
Analytic Methods
We used chi-square tests to assess bivariate associations between the three level dependent
variable and characteristics of teenagers’ relationships and sexual partners. For multivariate
analyses, we used logistic regression in examine whether teenagers who ever use
contraceptives differ from those who do not, and multinomial logistic regression to examine
whether teenagers who always use a method differ from those who do so only sometimes,
Using multinomial logistic regression for the latter comparisons allowed us to compare
consistent users with inconsistent users, controlling for nonusers,35 we present only the results
for the comparison of inconsistent and consistent users.4 Although categorical measures were
used in the bivariate analyses, for the multivariate analyses, continuous measures were used
for cognitive test score, age at first sex, length of first sexual relationship, time between start
of relationship and first sex, partner age and number of close friends who knew partner.
Multivariate analyses were conducted both on the full sample of 1,027 teenagers and on a
“romantic” sample of the 953 teenagers in romantic or liked relationships. Analyses restricted
to the second sample allowed us to include measures that were not asked of adolescents in
nonromantic relationships.
We hypothesized that among sexually inexperienced adolescents at Wave 1, those teenagers
who had sex by Wave 2 differed systematically from those who remained sexually
inexperienced. † We tested for potential sample selection effects using Heckman selection
models in Stata. (We used the heckprob command to analyzed probit models adjusted for
selection characteristics, and because we had a three-category outcome variable, we
constructed a series of probit models to compare all the groups with each other). The rho values
for the selection equations were not significant in any models, indicating that adolescents who
†A bivariate comparison showed that compared with teenagers who first had sex between Waves 1 and 2, those who remained sexually
Inexperienced at Wave 2 were younger and more likely to be male, living with both parents and have better educated parents.
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had never has sex and those who had first sex between interviews had similar family and
individual characteristics. (We tested selection models comparing our sample with a sample
of teenagers who had first had sex before Wave 1 and with a sample combining teenagers who
had had sex before Wave 1 and teenagers who had never had sex. We found no evidence of
significant selection effects for any of these comparisons). Overall, we felt confident in using
models that did not adjust for selection.
After examining the main effects models, we constructed logit models comparing only the
consistent and inconsistent contraceptive users to incorporate measures of the type of
contraceptive users to incorporate method users. Finally, we tested for interaction effects by
gender. All analyses were weighted and adjusted for the data’s clustered sampling design by
using survey estimation procedures in Stata 7.0.
RESULTS
Sample Characteristics
Fifty-nine percent of teenagers were female,* and 71% were white (Table 1, page 249). More
than half of adolescents (59%) received an above average score on the Peabody Picture
Vocabulary Test; a significantly greater proportion of males than of females scored above the
mean (68% vs. 53%). The majority (85%) of adolescents reported having received pregnancy
and AIDS education in school. Only 17% had taken a pledge to abstain from sex until marriage;
a significantly greater proportion of females than of males had taken a virginity pledge (21%
vs. 11%). Half of teenagers reported living with two biological or adoptive parents and slightly
more than half (54%) reported that their more highly educated parent had more than a high
school education.
The average age at first sex was 15.8 years; females had a lower mean age than males (15.7
vs. 16.0–not shown). The majority (83%) of adolescents reported that their first sexual
relationship was romantic; 9% reported having had a liked and 9% a nonromantic first sexual
relationship. A significantly greater proportion of females than of males reported that their first
sexual relationship was romantic.
On average, adolescents’ first sexual relationship lasted for 3.8 months and female reported
longer relationships than males (4.2 vs. 3.4–not shown).* Interestingly, a substantial proportion
of teenagers’ first sexual relationships were one night stands. Almost one-quarter (23%) of all
teenagers and 68% of those reporting nonromantic relationships (not shown), said that they
had had sex with their first partner only one time. Among teenagers in romantic or liked
relationship began, 38% waited 1–3 months and 38% waited four or more months.
Twenty-five percent of teenagers were the same age as their first sexual partner, 18% had a
younger partner, and 54% had an older partner. On average, first sexual partners were one year
older than the respondents (not shown); females reported that their partners were 1.8 years
older, and males reported that their partners were 0.1 years younger. Twenty-seven percent of
teenagers had experienced some type of abuse during their first sexual relationship. Sixty
percent of teenagers reported that all or most of their close friends knew their partners at the
*We recognized the implicit ordered nature of our dependent variable and, therefore, tried using an ordered logit model, but it violated
the assumption of proportional odds. An underlying assumption of the ordered logit model is that “the influence of the explanatory
variables is independent of the cutpoint for the cumulative logit” (source: reference 35); however, this does not hold true for our data.
The effect of some predictor variables on the step from the “never” category to “sometimes” is distinct from “sometimes” to “always,”
with some effects in opposing directions.
*The length of the reported first sexual relationships is limited because teenagers could report only relationships that began between
interviews (a period averaging 11.1 months).
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start of the relationship, 33% that one or a few knew, and 7% that one knew or that they did
not have any close friends.
Half (51%) of adolescent had discussed contraception with their partner before having sex for
the first time. For 57% of teenagers, the most effective contraceptive method used during their
first sexual relationships was the condom; 20% used a more effective hormonal method and
2% used some other less effective method. Among teenagers who had ever used a method with
their first partner one-quarter had used two or more every time they practiced contraception–
14% a condom plus a hormonal method, and 11% other combinations (not shown).
Bivariate Analyses
Overall, 63% of teenagers reported always contraceptives in their first sexual relationships,
16% using inconsistently and 21% never using (Table 2). In bivariate analyses of contraceptive
consistency, a significantly greater proportion of males than of females reported always using
a method (69% vs. 59%). White and black adolescents reported higher levels of consistency
contraceptive use (66% each) than did either Hispanic teenagers (54%) or those of other races
(50%). Hispanic teenagers were most likely to report never using a method (36%).
Contraceptive consistency was associated with scores on the Peabody Picture Vocabulary Test.
Sixty-seven percent of those who scored above the mean always used a method, compared
with 58% of those who scored below average. Of note, a greater proportion of teenagers who
had not taken a virginity pledge than of those who had not reported using contraceptives only
sometimes (24% vs. 14%), whereas a greater proportion of those who had not taken a pledge
than of those who had reported always using contraceptives (66% vs. 52%).
The majority (55–64%) of teenagers in all three types of relationships reported always using
contraceptives; however, a smaller proportion of adolescents in romantic relationships (18%)
than in liked (38%) or nonromantic relationships (29%) reported never practicing
contraception. Among teenagers who had sex with the first partners only once, 71% reported
using contraceptives during that episode. Inconsistent contraceptive use increased with the
length of the relationship from 15% among those in a 1–3 month relationship to 26% among
those whose relationship lasted four months or longer. A greater proportion of teenagers who
had experienced abuse in their first sexual relationship than of those who had not reported using
contraceptives inconsistently (21% vs. 14%).
A greater proportion of teenagers who talked about contraception before sex than of those who
did not reported always using a method (67% vs. 60%). Eighty-four percent of those who used
a hormonal method reported consistent contraceptive use, compared with 80% of condom users
and 63% of those who used other methods. Furthermore, a greater proportion of those who
used dual methods during their first sexual relationship than of those who did not reported
always using contraceptives.
Multivariate Analyses
Contraceptive consistency in the full sample—Our logistic regression models
comparing teenagers; who ever and never used a method showed that Hispanics and teenagers
of other races or ethnicities had lower odds than whites of ever using contraceptives (odds
ratio. 0.4 for each–Table 3. page 251). Adolescents who scored higher on the Peabody Picture
Vocabulary Test had slightly greater odds of at least sometimes using a contraceptive method
(1.03).
Certain characteristics of teenagers first sexual relationships were associated with ever using
a contraceptive method. Teenagers who reported being in liked relationships had lower odds
than those in romantic relationships of ever using contraceptives (odds ratio, 0.3). Surprisingly,
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we found no significant differences in contraceptive consistency between teenagers in romantic
and nonromantic relationships. In addition, ever using contraceptives was positively associated
with length of relationship: For each one-month increase in duration of the relationship with,
the odds that teenagers were at least occasional contraceptive users increased by 10%.
Many of the characteristics than were significantly associated with teenagers’ ever using
contraceptives (race and ethnicity, cognitive ability and relationship type) were not significant
in the multinomial model comparing consistent and inconsistent users. One result–for
relationship length–is in the opposite direction of that observed in the first model: For each
additional month in duration of the relationship, the odds that teenagers maintained consistent
contraceptive use decreased 14%.
Three characteristics that were not significantly associated with ever using contraceptives were
significantly associated with always using. Living with two biological or adoptive parents was
associated with more consistent contraceptive use (odds ratio, 1.9). In addition, teenagers who
had taken a virginity pledge were less likely than others to always practice contraception (0.4).
Finally, teenagers who dated older partners had decreased odds of consistent contraceptive use:
For each year a partner was older than the respondent, the odds of always using a contraceptive
method were reduced by 11%.
Contraceptive consistency in the romantic sample—The results for ever-use of
contraceptives among the romantic sample were virtually the same as those among the full
sample, except that the result for length of relationship was only marginally significant. In
addition, two of the measures assessed only for teenagers in romantic or liked relationships
were significantly associated with ever-use. First, the odds of teenagers ever using
contraceptives decreased with an increased number of close friends who knew the teenager’s
sexual partner prior to the relationship (odds rat to, 0.8). Second, teenagers who discussed
contraception with their partners before the first sexual intercourse had more than twice the
odds of those who had not of ever using contraceptives (2.1).
As in the full sample, increased length of sexual relationship in the romantic sample was
significantly associated with reduced odds of always using contraceptives (odds ratio, 0.9). In
addition, for each month that a teenager delayed first sex after the start of a relationship, the
odds of consistent contraceptive use increased by 5%. Family structure and having taken a
virginity pledge were only marginally significant, and partner age difference was non-
significant in the romantic sample
Methods use and contraceptive consistency—Table 4 summarizes the findings of
logistic regression models, based on samples restricted to adolescents who sometimes or
always used contraceptives. These models added two measures to the analyses: most effective
type of method used during the relationship and simultaneous use of dual methods. The table
provides only the odds ratios for these constructs, but the models also included all the measures
shown in Table 3.
Teenagers who had used a hormonal method during their first sexual relationship did not have
increased odds of ever or always using contraceptives compared with those whose most
effective method was the condom. The only significant finding was that among the romantic
sample, dual method users had increased odds of always using a method (odds ratio, 2.5);
results for use of other methods and dual method use were marginally significant among the
full sample.
Interaction effects by gender—For both the full sample and the romantic sample, the
interaction between gender and length of relationship was significantly associated with ever
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use. The odds ratio of 0.9 in each sample indicates that the influence of relationship length on
use was weaker for males than for females (Table 5). In analyses of the main effect of
relationship length for each gender, taking into account the interaction effect, females in longer
relationships had elevated odds of ever using a method: For each additional month that a
relationship lasted, the odds that females took the step from never to at least sometimes using
a contraceptive method increased by approximately 15%. This association was not significant
among males.
The interaction effect of gender and relationship length was only marginally significant in the
comparison of always use with sometimes use of contraceptives among both samples. The
main effects were reduced for males and females, although the reduction was greater for males
than for females (odds ratios, 0.8 vs. 0.9). This suggests that although longer sexual
relationships were associated with reduced contraceptive consistency among both males and
females, the reduction was less among females.
DISCUSSION
This article extends our understanding of factors associated with contraceptive use and
consistency by examining the link between partner and relationship characteristics and
contraceptive use within teenagers’ first sexual relationships. Also, it builds upon previous
research that highlights the importance of understanding sexual, contraceptive and birth
outcomes within the context of sexual relationships.36
Our analyses show that characteristics of teenagers first sexual partners and relationships were
associated with contraceptive use and consistency within that relationship. Factors associated
with greater contraceptive use and consistency included waiting a longer time between the start
of a relationship and first sex, discussing contraceptive with one’s partner before first sex and
using dual contraceptive methods. Taking a virginity pledge, having an older partner and being
in a liked (as opposed to a romantic) relationship were related to decreased odds of
contraceptive use or consistency. Increased relationship length was associated with increased
odds of ever use but decreased consistent use. Our findings for the full sample of teenagers
were similar to those for the romantic sample, except that several significant variables in the
full sample lost significance in the smaller sample, perhaps because the romantic sample was
more homogeneous.
Some relationship characteristics that we hypothesized to be associated with contraceptive
consistency did not show a significant association in our models. In contrast to other studies
that show a link between the type of relationship and contraceptive use at first sex or
contraceptive use during relationships,37 our multivariate analyses did not show an association
between nonromantic sexual partners and contraceptive consistency. However, our data
showed a reduced likelihood of ever using contraceptives in liked relationships. Other
characteristics of teenagers’ partners and relationships measured in these models, such as
relationship length and partner’s age difference, may help explain the bivariate association
between nonromantic relationship and reduced contraceptive consistency.*
One counterintuitive finding was that as the number of close friends who knew a teenager’s
partner at the start of the relationship increased, the likelihood of ever-use of a contraceptive
method declined. This may reflect a reduced concern about contracting STDs among teenagers
who have a greater sense of familiarity with their partners and, therefore, view them as low
risk.
*The analyses included a very small number of nonromantic relationships (66), which may have made it difficult to detect significant
associations. This small sample may be due, in part to underreporting of nonvoluntary sexual experiences.
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Contraceptive methods used in teenagers’ first sexual relationships appear to have an
association with contraceptive consistency. Among teenagers in romantic or liked
relationships, those who reported, dual method use every time they practiced contraception in
their first sexual relationship had more than twice the odds of those who used a single method
or who varied between using single and dual methods of always using a method. This finding
supports the notion that teenagers who use dual methods may be more risk averse than other
teenagers and more likely to use contraceptives consistently. However, the type of method used
during a relationship was not significantly associated with contraceptive consistency:
Teenagers who used hormonal methods were no more likely than those who used condoms to
be consistent contraceptive users. This may reflect that many teenagers use condoms at the
beginning of their sexual relationships but eventually switch to more effective methods.38 One
potential side effect of switching methods is the possibility of a lapse in contraceptive coverage
before hormonal methods become effective.39
Study Limitations
It is important to note some of the study’s limitations. Teenagers provided information on their
sexual activity and contraceptive use retrospectively, on the basis of two questions; ideally, we
would have had them record this information in a daily calendar format. The short duration
between Waves 1 and 2, however, does not allow for as much recall bias as in data files that
require respondents to look back several years to their first relationships.
In addition, because contraceptive use was self-reported, it is possible that not all teenagers
provided reliable responses. For example, males in our sample reported, more consistent
contraceptive use than females, which may reflect their assumption that their partners were
using a method when, in fact, some were not. Note that Add Health incorporated audio
computer-assisted self-interviews to help increase the validity of self-reports of risky or
sensitive behaviors, including sexual activity and contraceptive use.40 Certain populations
(e.g. males) are more likely than others to inconsistently report sexual behaviors; however,
incorporating these inconsistencies with consistent responses does not influence substantive
conclusions about sexual behaviors,41 and Add Health reports of sexual behaviors and STDs
appear to be valid.42 Furthermore, we controlled for social and demographic characteristics
in all models, tested interactions by gender, and found no major differences in the influence of
partner and relationship characteristics on contraceptive use and. consistency for males and
females.
Policy and Program Implications
Our results suggest multiple policy approaches to improving contraceptive consistency and
reducing the risk of unintended pregnancy and STDs among teenagers. Programs should
emphasize waiting to have sex as long as possible within a relationship because teenagers who
delay sexual intercourse with their partners may be more likely to plan their first sexual
encounter and, thus, be more prepared to practice contraception. The majority of sexually
experienced teenagers in romantic or liked relationships, however, initiated sex within three
months of the start of their relationship, indicating that the window of time after relationships
begin during which parents and service providers can intervene to help teenagers delay sexual
intercourse or emphasize using contraceptives consistently is small.43 Thus, pregnancy
prevention services should provide clear messages to teenagers before they initiate romantic
relationships.
Teenagers who discussed contraception with their partners before sexual initiation had twice
the odds of those who did not of at least sometimes using a method. This suggests that leaching
teenagers to be vigilant about and comfortable with such discussions may be an effective way
to improve contraceptive consistency. Indeed, sex education programs that actively engage
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teenagers in role-playing to learn to negotiate contraceptive use have shown positive results.
44
Length of relationship was negatively associated with consistent contraceptive use, a finding
that has also been shown in a study of condom use among males.45 With more episodes of
sexual activity, it is harder to maintain perfect consistency, particularly if teenagers and their
partners are not using a long-acting contraceptive method. Thus, teenagers in longer
relationships represent a group that is at an increased risk of unintended pregnancy. These
adolescents need to hear a clear message that it is important to use a contraceptive method
every time they have sex.
Our findings showed a relationship between having an older partner and reduced contraceptive
use. They did not, however, show any moderating effects by gender, so both males and females
with older partners were less likely than others to use contraceptives consistently. Some
researchers with similar findings suggest that having a much older partner may be associated
with an uneven balance of power that may influence contraceptive use and consistency.46
Consequently, parents and providers should encourage teenagers to choose partners their own
age. Statutory rape laws require service providers to report to legal authorities young teenagers
with much older sexual partners, but parents also should be aware of the risks associated with
their daughter’s or son’s having an older partner.
Sexually experienced teenagers who took a virginity pledge were substantially less likely than
others to consistently use contraceptives. This finding corroborates other research that showed
that although adolescents who took a virginity pledge have a later age at sexual initiation,47
those who break their pledge have reduced odds of practicing contraception at first sex.48
Having taken a pledge, these teenagers do not differ from other adolescents with regard to ever
practicing contraception, however, using contraceptives may be viewed as a concrete sign of
a behavior they pledged to avoid and, therefore, they are not diligent about using a method
every time they have sex. Thus, it is important to accompany abstinence messages with a
message that if and when teenagers do become sexually experienced, they should consistently
use contraceptives to avoid unintended pregnancy and STDs
CONCLUSIONS
Our study indicates that relationship and partner characteristics are important factors associated
with contraceptive use within adolescents’ first sexual relationships, the findings confirm the
importance of assessing factors associated with contraceptive use within sexual relationships.
The policy implications of these findings are that parents, educators and service providers
should be particularly aware of relationships that teenagers are engaged in to help reduce early
sexual activity, contraceptive inconsistency, unintended pregnancy and STDs.
Acknowledgements
The research on which this article is based was funded, in part, by the National Institute of Child Health and Human
Development through grant R01 HD40830-01. The authors thank Constantijn Panis for his methodological advice
and guidance, and Elizabeth Terry-Humen for valuable comments on conceptual design.
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TABLE 1
Percentage distribution of respondents to the National Longitudinal Study of Adolescent Health who first had intercourse between the 1995 and 1996
interviews, by selected characteristics, according to gender
Characteristic All (N=1,027) Female (N=608) Male (N=419)
DEMOGRAPHIC
Gender
Male 41.4 na na
Female 58.6 na na
Race/ethnicity
White 70.5 72.3 68.0
Hispanic 12.2 10.5 14.6
Black 11.6 11.4 11.9
Other 5.6 5.8 5.4
Cognitive test score
Below mean 41.0 47.3 32.2***
Above mean 59.0 52.7 67.9
Received pregnancy/AIDS education in school
Yes 84.7 84.6 84.8
No 15.3 15.4 15.2
Took a virginity pledge
Yes 16.7 20.6 11.2**
No 83.3 79.4 88.8
Lives with two biological/adoptive parents
Yes 50.6 52.3 48.2
No 49.4 47.7 51.8
Parent’s education†
≤high school 45.7 48.2 42.2
>high school 54.3 51.8 57.8
RELATIONSHIP AND PARTNER
Age at first sex
≤14 21.4 23.0 19.1*
15 22.2 25.2 18.0
16 22.8 23.5 21.7
≥17 33.7 28.4 41.2
Type of first sexual relationship
Romantic 82.5 89.0 73.4***
Liked 8.8 5.6 13.2
Nonromantic 8.7 5.4 13.5
RELATIONSHIP AND PARTNER (continued)
Length of first sexual relationship
One-night stand 23.4 21.2 26.5
1–3 months 36.6 35.3 38.5
≥4 months 40.1 43.5 35.1
Time between start of relationship and first sex‡
Same month 24.3 23.2 26.0
1–3 months 37.5 37.2 38.0
≥4 months 38.2 39.6 35.9
First partner’s age vs. respondent’s
≥1 year younger 18.1 7.5 38.1***
Same 25.4 20.2 32.9
1 year older 22.6 24.9 19.4
≥2 years older 31.8 47.4 9.7
Physical/verbal violence during first sexual relationship
Yes 27.0 25.8 28.8
No 63.0 74.2 71.2
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Characteristic All (N=1,027) Female (N=608) Male (N=419)
No. of close friends who knew first partner at start of relationship‡
None/had no close friends 7.0 5.7 9.0
One/a few 32.6 34.0 30.5
Most/all 60.4 60.3 60.5
Talked about contraception before first sex‡
Yes 51.4 54.3 46.9
No 48.6 45.7 43.1
CONTRACEPTIVE USE
Method used in first sexual relationship§
Hormonal 19.9 17.8 23.1
Condom 56.8 57.9 55.9
Other 1.8 1.8 1.8
None 21.0 22.5 19.2
Used dual method in first sexual relationship††
Yes 24.7 22.0 29.7
No 75.3 78.0 70.3
Total 100.0 100.0 100.0
*p<.05,
**p<.01,
***p<.001.
†
Educational level of the more highly educated parent of the family.
‡
Among 953 respondents reporting romantic or liked relationships.
§Most effective method reported.
††
Among 802 respondents who had used a method.
Notes na=not applicable. Significance indicates the difference between males and females.
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TABLE 2
Percentage distribution of adolescents, by consistency of contraceptive use, according to selected characteristics
Characteristic Never Sometimes Always Total
All 21.0 15.6 63.4 100.0
DEMOGRAPHIC
Gender*
Male 19.1 11.9 69.0 100.0
Female 22.4 18.2 59.4 100.0
Race/ethnicity***
White 17.0 17.4 65.6 100.0
Hispanic 36.2 10.2 53.5 100.0
Black 23.3 10.4 66.3 100.0
Other 34.3 15.5 50.3 100.0
Cognitive test score**
Below mean 27.3 14.4 58.3 100.0
Above mean 16.7 16.4 66.9 100.0
Received pregnancy/AIDS education in school
Yes 21.0 15.6 63.4 100.0
No 21.1 15.3 63.7 100.0
Took a virginity pledge*
Yes 24.7 23.7 51.6 100.0
No 20.3 14.0 65.7 100.0
Lives with two biological/adoptive parents
Yes 18.8 13.1 68.2 100.0
No 23.4 18.1 58.5 100.0
Parent’s education
≤high school 20.8 16.1 63.2 100.0
>high school 21.0 14.9 64.2 100.0
RELATIONSHIP AND PARTNER
Age at first sex
≤14 24.0 16.7 59.3 100.0
15 22.1 15.0 62.9 100.0
16 23.6 16.6 59.8 100.0
≥17 16.6 14.5 68.9 100.0
Type of first sexual relationship**
Romantic 18.4 17.3 64.3 100.0
Liked 38.1 7.1 54.8 100.0
Nonromantic 28.5 7.7 63.7 100.0
Length of first sexual relationship***
One-night stand 29.0 0.0 71.0 100.0
1–3 months 22.4 14.5 61.2 100.0
≥4 months 14.5 26.1 59.4 100.0
Time between start of relationship and first sex†
Same month 24.3 18.1 57.5 100.0
1–3 months 20.3 20.7 58.9 100.0
≥4 months 16.4 12.5 71.1 100.0
First partner’s age vs. respondent’s
≥1 year younger 17.9 9.0 73.1 100.0
Same 22.9 12.5 61.9 100.0
1 year older 17.7 17.5 64.8 100.0
≥2 years older 24.1 18.7 57.2 100.0
Physical/verbal violence during first sexual relationship*
Yes 15.8 20.7 63.5 100.0
No 23.0 13.6 63.4 100.0
No. of close friends who knew partner at start of relationship†
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Characteristic Never Sometimes Always Total
None/had no close friends 18.3 17.5 64.2 100.0
One/a few 17.0 13.5 69.5 100.0
Most/all 22.4 17.7 60.0 100.0
Talked about contraception before sex***, †
Yes 12.2 20.8 67.1 100.0
No 29.0 11.6 59.5 100.0
CONTRACEPTIVE USE
Method used in first sexual relationship***, ‡
Hormonal na 16.0 84.0 100.0
Condom na 20.4 79.6 100.0
Other na 37.2 62.8 100.0
None 100.0 na na 100.0
Used dual method in first sexual relationship**, §
Yes na 11.3 88.7 100.0
No na 22.5 77.5 100.0
*p<.05,
**p<.01.
***p<.001.
†
Among 953 respondents reporting romantic or liked relationships.
‡
Most effective method reported.
§Among 802 respondents who had used a method.
Notes: Significance indicates the overall chi square for the association between consistency and the predictor variable.
na=not applicable.
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TABLE 3
Odds ratios from logistic and multinomial logistic regression analyses of the likelihood that teenagers ever and
always used contraceptives in their first sexual relationship, by selected characteristics, according to sample
Characteristic All Romantic/liked
Ever Always‡Ever Always‡
Demographic
Male 1.35 1.28 1.11 1.42
Race/ethnicity
White (ref) 1.00 1.00 1.00 1.00
Hispanic 0.44** 1.45 0.39*** 1.69
Black 1.02 1.61 1.01 1.37
Other 0.37*** 0.82 0.38*0.85
Cognitive test score 1.03*** 0.99 1.03** 0.99
Received pregnancy/AIDS education in
school 0.87 1.05 0.99 1.14
Took a virginity pledge 1.08 0.43*1.11 0.54†
Lives with two biological/adoptive parents 1.26 1.85*1.25 1.64†
Parent’s education 0.94 0.96 0.98 0.97
Relationship and Partner
Age at first sex 1.06 0.93 1.06 0.93
Type of first sexual relationship
Romantic (ref) 1.00 1.00 1.00 1.00
Liked 0.34** 1.55 0.39*1.57
Nonromantic 0.61 1.33 na na
No. of months in first sexual relationship 1.10*0.86*** 1.08†0.87***
No. of months between start of relationship
and first sex§na na 1.00 1.05*
No. of years partner was older than respondent 0.96 0.89*0.92 0.91
Physical/verbal violence during first sexual
relationship 1.41 0.73 1.22 0.78
No. of close friends who knew partner at start
of relationship§na na 0.81*0.90
Talked about contraception before sex§na na 2.12** 0.74
F3.36*** 2.96*** 3.58*** 2.31***
df 17 34 20 40
*p<.05,
**p<.01,
***p<.001,
†
p<.10.
‡
Versus sometimes,
§Among respondents reporting romantic or liked relationships.
Notes: ref=reference category,
na=not applicable.
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TABLE 4
Odds ratios from logistic regression analysis of the likelihood that teenagers who ever used contraceptives in
their first sexual relationship always did so, by selected characteristics, according to sample
Characteristic All Romantic/liked
Most effective method used
Hormonal (ref) 1.00 1.00
Condom 0.76 0.89
Other 0.32†039
Used dual methods‡l.83†2.51**
F2.73*** 2.11**
df 20 23
**p<.01.
***p<.001.
†
p<.10.
‡
Reference group includes both those who used one method only and those who alternated between using single and dual methods.
Note: The model includes all other covariates shown in Table 3.
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TABLE 5
Odds ratios from logistic and multinomial logistic regression analyses of the association between length of
relationship and the likelihood that teenagers ever and always used contraceptives in their first sexual relationship,
by gender, according to sample
All Romantic/liked
Measure Ever Always‡Ever Always‡
Gender × length of
relationship 0.86*0.90†0.85*0.89†
Length of relationship
Males 0.99 0.80*** 0.98 0.80***
Females 1.16** 0.89** 1.14*0.90*
F3.48*** 3.02*** 3.70*** 2.25***
df 18 36 21 42
*p<.05.
**p<.001.
***p<.001
†
p<.10.
‡
Versus sometimes.
Note. The model includes all other covariates shown in Table 3.
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