1 No glove, no love: Why California’s ethnic youth report using contraception Shelly Koenemann, MPH Marlena Kuruvilla, MPH/MSW Michelle Barenbaum, MPH Claire Brindis, DrPH Bixby Center for Reproductive Health Research and Policy University of California, San Francisco

2 Objectives Identify contraceptive motivation as a key focal point when promoting contraceptive use among youth. Compare and contrast contraceptive motivation and behaviors among ethnic groups participating in California’s Teen Pregnancy Prevention (TPP) program. Discuss how findings on contraceptive motivation across ethnic groups can inform teen pregnancy and STI prevention efforts.

3 Teen Pregnancy Trends Since 1991, teen birth rates: In the U.S. have declined steadily in every age and racial/ethnic group. In California have decreased 44% and are now below the national average. National data show that: In 2000, birth rates for African American teens were the lowest in 40 years. Rates for Latino teens remain the highest for any population group.

4 Maternal Race/Ethnicity of Teen Births (n=50,201) & Percent of Teen Population [n=1,222,477]) for Females Aged years, California, 2002 California Department of Health Services Sources: Teen births: State of California, Department of Health Services: Birth Statistical Master File. Teen population: Special Tabulation of County Characteristics, Population Estimates for California (CADHS) Vintage 2002; Population Division, U.S. Census Bureau. Release Date: September 18, 2003 (from 2000 census). Prepared by: California Department of Health Services, Maternal and Child Health Branch, April Latino 68% (represent 40% of teens) White 17% (represent 38% of teens) Asian/Pacific Islander 4% (represent 11% of teens) African American 8% (represent 7% of teens) American Indian 1% (represent.6% of teens) 2 or More Races 2% (represent 3% of teens) Teen Pregnancy by Race/Ethnicity: California

5 Reasons for Decline in Teen Pregnancy Researchers attribute at least half of the recent decline in teen pregnancy to an increase in contraceptive use. An increase in abstinence among teens is the other key factor contributing to a reduction in teen pregnancies.

6 California’s Teen Pregnancy Prevention (TPP) Program TPP is funded at $22 million per year by California’s Department of Health Services. Funds are given to public agencies and community-based organizations serving communities throughout California where teen birth rates are higher than the state average. TPP programs are supported through three different funding sources: Community Challenge Grant Information & Education Male Involvement Program TPP Evaluation includes a quantitative survey administered to program participants before and after prevention education intervention.

7 Methods

8 Sub-study Sample: Survey Age Range: years Mean: 16 years Gender 40% Female 60% Male Race/Ethnicity 87% Non-white Most prevalent groups include Latino (54%), White (13%), African American (12%) TPP Evaluation sample (n=7075) Sub-study sample of sexually active youth (n=2168)

9 Contraceptive Motivation and Ethnicity Ethnicity Beliefs, Skills to Abstain Contraceptive Use Socioeconomic, Cultural, & Other Factors Beliefs, Skills to Use Contraception Abstinence Decline in Teen Pregnancy

10 Reasons Against Using Condoms We asked youth how true each of the following reasons to NOT to use condoms are (or would be) for them: I’m only having sex with one person. I don’t think I will get a disease or give my partner a disease. I didn’t expect to have sex; it was not planned. I can’t convince my partner to use a condom. I don’t feel comfortable talking to my partner about using a condom. We’re using a hormonal method (like the pill or patch) so we don’t need condoms. Sex won’t feel as good with a condom.

11 Reasons for Using Contraception We also asked youth how true each of the following reasons for using contraception are (or would be) for them: I respect myself. I respect my partner. If I am having sex, I want to be responsible. I don’t want to get pregnant or get someone pregnant. I don’t want to get a disease, like HIV.

12 Results

13 Reasons Against Using Condoms by Ethnicity Latinos were significantly more likely than other ethnic groups to report the following as “very true” reasons NOT to use condoms: Only having sex with one person (44% vs. 37%)*  This was the top reason Latinos reported for not using condoms. Sex was unplanned (30% vs. 26%)* Discomfort talking to partner about condoms (12% vs. 9%)* Condoms reduce pleasure (39% vs. 32%)* *All results significant at p<0.05

14 Reasons Against Using Condoms by Ethnicity (cont.) African Americans were significantly less likely than other ethnic groups to report the following as “very true” reasons NOT to use condoms: Inability to convince their partner to use condoms (8% vs. 12%)* Condoms reduce pleasure (29% vs. 37%)* *All results significant at p<0.05

15 Reasons for Using Contraception by Ethnicity African Americans were significantly more likely than other ethnic groups to report self-respect as a “very true” reason for using contraception (87% vs. 78%)*. *All results significant at p<0.05

16 Contraceptive Use by Ethnicity Latinos were significantly less likely than others to report using: reliable contraception at last sex (64% vs. 72%)* contraception every time they had sex in the last month (35% vs. 50%)* African Americans were significantly more likely than others to report using: reliable contraception at last sex (76% vs. 65%)* contraception every time they had sex in the last month (52% vs. 39%)* *All results significant at p<0.05

17 Conclusion Upon examination of contraceptive use and motivation by ethnicity, two groups stood out: Latinos were less motivated and less likely than others to use effective and consistent contraception. African Americans were more motivated and more likely than others to use effective and consistent contraception.

18 Conclusion (cont.) Motivation to use contraception differs across ethnic groups and is an important focal point for teen pregnancy prevention efforts. For example: The belief that monogamous couples do not need to use contraception could put Latino teens at higher risk of unintended pregnancy. A strong sense of self-respect may protect African American teens against unintended pregnancy.

19 Discussion

20 Study Limitations No measures of sociocultural factors Use of terms “condoms” and “contraception” Reliance on self report Recall bias Selection bias Generalizability of findings

21 Discussion Question 1 In your research or program experience, have you noted differences in attitudes or skills relating to teen pregnancy in ethnic groups you study/serve? How would you compare and contrast these findings to your own community’s teens?

22 Discussion Question 2 Why do you think contraceptive motivation and use differs between ethnic groups? What factors such as acculturation and poverty level influencing ethnic groups might be responsible for these differences?

23 Discussion Question 3 What strategies could teen pregnancy prevention programs use to address risky beliefs, for example, that monogamy is safe or that condoms reduce pleasure?

24 Discussion Question 4 Self-respect seems to be a key in this study to increased contraceptive use among African Americans. What might be responsible for this high level of self-respect (culture, program effects)? How can programs increase self-respect among youth, or work with parents so that they can nurture self-esteem in their children?

25 Discussion Question 5 What other ways can we translate findings such as these into practice (for example, program activities) to increase contraceptive motivation and use?

26 Implications A greater awareness of how contraceptive motivation and behaviors differ across ethnic groups can allow programs to tailor their prevention efforts: To be more culturally appropriate To address factors influencing contraceptive motivation

27 Questions? Shelly Koenemann (415)