Factors Associated with Sexual Risk-Taking Behaviors among Adolescents Author(s): Tom Luster and Stephen A.

Small Reviewed work(s): Source: Journal of Marriage and Family, Vol. 56, No. 3 (Aug., 1994), pp. 622-632 Published by: National Council on Family Relations Stable URL: http://www.jstor.org/stable/352873 . Accessed: 19/03/2013 07:58
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TOMLUSTER Michigan State University

STEPHEN A. SMALL University of Wisconsin-Madison*

Factors Associated with Sexual Risk-Taking Behaviors Among Adolescents

This study examines factors that distinguish between sexually active adolescents who are at risk for pregnancy and for sexually transmitted diseases and sexually active teens who are at lower risk for these outcomes. The study is based on a representative survey of 2,567 teenagers from four rural Midwestern counties. Several characteristics of the adolescents and theirfamilies were found to distinguish between sexual risk takers and those at lower risk for sexually transmitted diseases and teenage pregnancy. During the past two decades, a considerable amount of research has focused on factors related to decisions to have sexual intercourse among adolescents. A growing awareness of the problematic consequences of early childbearing for the teenagers and their children contributed to researchers' interest in this area. Given recent trends, this continues to be an important area of research. The proportion of United States females aged from 15 to 19 who ever had sexual inter-

Department of Family and Child Ecology, Michigan State University, East Lansing, MI 48824-1030. *Department of Child and Family Studies, University of Wisconsin-Madison, Madison, WI 53706. Key Words: adolescence, AIDS, contraception, risk-taking behavior, sexually transmitted diseases, teenage pregnancy.

course rose from 28.6% in 1970 to 51.5% in 1988 (Centers for Disease Control, 1991), and for the past 4 years, the birth rate has increased for 15- to 19-year-old females (Moore, 1993). By age 20, over 80% of males and over 70% of females have had intercourse at least once (Hayes, 1987). Teenage pregnancy and childbearing, however, are not the only problems associated with early sexual activity. Of the 12 million cases of sexually transmitted diseases (STDs) that are estimated to occur annually, adolescents account for one-quarter of those infected (Moore, 1992), and STDs have been increasing among adolescents since the 1970s (Centers for Disease Control, 1992c). As Brooks-Gunn and Furstenberg (1989) noted, "Excluding homosexual men and prostitutes, female teenagers have the highest rates of gonorrhea, cytomegalovirus, chlamydia cervicitis, and pelvic inflammatory diseases of any age group" (p. 254). According to the Centers for Disease Control (1992b), the cumulative number of acquired immune deficiency syndrome (AIDS) cases among adolescents between 13 and 19 years old increased from 127 in January 1987 to 789 in December 1991. Moreover, given that the median incubation period between infection and onset of AIDS is almost 10 years, many of those with AIDS who are in their twenties were infected during adolescence (Centers for Disease Control, 1992b). Unfortunately, research that investigates the problem of sexually transmitted diseases

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Journal of Marriage and the Family 56 (August 1994): 622-632

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Sexual Risk-Taking Behaviors among teenagers is very limited (Brooks-Gunn & Furstenberg, 1989). The present study attempts to shed light on these important matters by examining a large sample of teens residing in the midwestern United States. One objective of this study is to compare adolescents who we will define as sexual risk takers (teens who have had multiple partners and do not use contraception) with teens in two lower risk groups: (a) sexually active but lower risk adolescents (those who have only one partnerand use contraception all the time), and (b) abstainers (those who are not sexually experienced). Teenagers who have multiple partners and do not use contraception are at risk for pregnancy, human immunodeficiency virus (HIV), and other STDs. Thus, they are an important group to try to understand and, currently, one that we know little about. In particular, we are interested in how sexual risk takers differ from other sexually active teens who behave more responsibly. The fact that many adolescents have had several sexual partners has been established by recent, national surveys conducted by the Centers for Disease Control (1992b). Overall, 19% of ninth, 10th, 11lth, and 12th graders who participated in the 1990 Youth Risk Behavior Survey had four or more sex partners during their lifetime. Among males, 20.6% of 10th graders and 38.5% of 12th graders had four or more partners. Fewer females had multiple partners; 9.3% and 17.0% of 10th and 12th graders, respectively, had four or more partners. Although it is well documented that a growing number of adolescents have had multiple sexual partners, there are few studies that have examined factors associated with having multiple partners among adolescents. One exception is the work of Sorensen (1973), who compared adolescents who practiced serial monogamy with adolescents who were labeled sexual adventurers (i.e., those who had frequent changes in sexual partners). In his national sample of adolescents between 13 and 19 years old, 41% of the sexually experienced males and 13% of the sexually experienced females were classified as sexual adventurers. Sexual adventurers differed from serial monogamists in that they had lower grades, were less religious, had less positive relationships with parents, and engaged in other risk-taking behaviors such as smoking marijuana and using alcohol. On attitudinal measures, the sexual adventurers were open to more varied sexual experiences and were more likely to question authority and social norms.

623 Whether these same relationships would hold true over 20 years later is unclear. Ku, Sonenstein, and Pleck (1992) surveyed a nationally representative sample of 15- to 19year-old males in the U.S., and found that older teens, those from more affluent families, and those whose mothers gave birth as teenagers had more heterosexual partnersin the past year. Evangelical and born-again Christians had fewer partners than other Christians in the survey. There is also some evidence that teens are less likely to have multiple partners if they are more knowledgeable about AIDS (Anderson et al., 1990; Ku et al., 1992). Another body of literature germane to this study focuses on factors related to contraceptive practices among adolescents. Because of the tendency to think of teenage pregnancy as a female problem and the relative lack of interest in sexually transmitted diseases in earlier decades, most of the research related to adolescent contraceptive use has focused on females. Although the research is limited, Sonenstein (1986) concluded that the factors associated with use or nonuse of contraception are very similar for females and males. Among the factors associated with irregular or no contraceptive use at the individual level are: low academic skills and educational aspirations, infrequent intercourse and recent initiation to intercourse, being a younger teen, lack of knowledge of sex and contraception, a lack of acceptance of one's own sexual behavior, a fear of side effects from some forms of contraception, and a tendency toward risk-taking behavior generally (e.g., alcohol and other drug use). Family factors associated with irregular contraception include low parental education, a lack of communication about contraception between mothers and daughters, strained relationships between teens and their parents, and parental use of corporal punishment. Extrafamilial influences include not being involved in a committed relationship, and lack of access to free and confidential family planning services. (For reviews of the literature, see Brooks-Gunn & Furstenberg, 1989; Chilman, 1979; Flick, 1986; Hayes, 1987). Of interest in this study is the intersection of the two behaviors discussed above-number of sexual partners and contraceptive use. Only recently have researchers begun to consider the number of sexual partners, birth control practices, and other risk-taking practices (e.g., anal sex, sex for money) simultaneously in their studies of ado-

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624 lescent sexual behavior. Two published studies were found that were concerned with sexual risktaking behaviors; the focus of both these studies was on the relation between sexual risk taking and other problem behaviors in adolescence, particularly substance use. In each study, the measure of sexual risk taking was a composite measure based on the number of sexual risk-taking behaviors that were engaged in. Consistent with studies concerned with number of sex partners, Metzler, Noell, and Biglan (1992) found that sexual risk-taking behavior was correlated with other problem behaviors in adolescence such as cigarette smoking, use of alcohol and other drugs, antisocial behavior, and academic failure. In a study of pregnant adolescents, Gillmore, Butler, Lohr, and Gilchrist (1992) examined the relation between substance use and risky sexual behavior. In the bivariate analyses, significant relations were found between sexual risk-taking behavior and substance use. However, in a hierarchical regression analysis, substance use by the pregnant teens was not related to sexual risk taking when entered in the final step of the analysis. Those who had higher scores on the measure of sexual risk taking had been sexually active for more years, experienced less family closeness, engaged in more delinquent activities, and were more likely to have a partner who used substances during sex than pregnant teens who had lower scores on the index. The literature reviews in each area (i.e., number of partners, birth control use, and sexual risk taking) were consistent in showing that both characteristics of the adolescents and of their families are likely to distinguish between sexual risk takers and those who behave more responsibly. Using this literature as a guide, for the present study we expected sexual risk taking (i.e., multiple partners and irregular contraception use) to be related to a number of individual characteristics including older age, frequent alcohol use, and poor school performance. In addition, we expected poor psychological adjustment, as indexed by suicidal ideations, to be associated with risk-taking behavior. Adolescents who have thoughts of suicide may be less concerned than their peers about their future or the practical consequences of their actions. Family processes that we expected to be predictive of sexual risk-taking behavior were low levels of parental monitoring and parental support, and little or no communication with mothers and fathers about birth control. In addition, we

Journal of Marriage and the Family explored the possibility that a history of abuse (sexual or physical abuse) is related to sexual risk-taking behavior (Boyer & Fine, 1992; Butler & Burton, 1990; Small & Luster, 1994). This study differs from earlier studies of sexual risk taking both in terms of the range of predictor variables assessed, and the way in which the measure of sexual risk taking was constructed. We attempted to define three groups that clearly differed in their level of risk, rather than treating sexual risk taking as a continuous variable. In summary, the central question addressed in this study is: What characteristics of teens and their families distinguish sexual risk takers (i.e., those who have multiple partners and do not use contraception consistently) from teens who engage in more responsible sexual behavior? Past research on adolescent sexual behavior has tended to focus on whether or not adolescents are sexually active. Given that having intercourse before one reaches 20 years of age is now a normative event, it seems equally important for researchers to explore differences between adolescents who engage in sexual behaviors responsibly and their peers who behave less responsibly.
METHOD

Sample The sample consists of 2,567 adolescents who attended schools in four counties in the upper Midwest. They represent 89% of all students who were present on the day the survey was administered. Half of the adolescents are male, and 98% are white. Given our interest in parental influences on sexual behavior, only adolescents who were living with at least one parent were included in the sample. Most of the adolescents (73%) were living with both biological or adoptive parents; 13.2% were living with a parent and stepparent, 12.3% were living with only one parent (9.8% mother only, 2.5% father only), and the remaining adolescents were living with both parents alternately (1.5%). Only adolescents between 13 and 19 years of age were included in the analysis. Specifically, the sample was composed of 498 13-year-olds, 507 14-year-olds, 504 15-year-olds, 508 16-yearolds, 436 17-year-olds, and 114 students who were 18 or 19 years old. The data were originally collected as part of community-based surveys sponsored by several community organizations and local school dis-

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Sexual Risk-Taking Behaviors tricts. The adolescents in this study attended school in 12 different school districts. The primary purpose of the surveys was to provide local program administrators, local policy makers, and parents with information that could be used to guide program development and local policy decisions and to educate parents and other members of the community about the needs, interests, and behaviors of local youth. As part of the parental consent process, parents and students were informed that the survey findings would be shared with them through several outlets, including topical newsletters sent to their homes, community forums and other public presentations, articles in the local and school newspapers, and a community report. Procedure Students were administered a 160-item self-report questionnaire in classroom settings by trained data collectors during scheduled class periods. The survey was anonymous and assessed a variety of attitudes, beliefs, and behaviors as well as basic demographic and scholastic information. Of interest in the present study are measures of adolescent alcohol use, sexual activity, sexual and physical abuse, mental health, grade point average, and family relationships. Measures Number of partners. As part of the survey, teens were asked, "If you have had sexual intercourse, how many different sexual partners have you had?" Possible responses ranged from zero (never had sexual intercourse) to five or more. Birth control use. The consistency with which the teens used birth control was determined by their response to the following question: "If you have sexual intercourse, how often do you and/or your partner use some form of birth control?" A 6point response scale ranging from "never" to "always" was used. Grade point average. Students reported on the grades they usually received in their major subjects at school. Letter grades were converted to their equivalent on a traditional 4-point grading scale. Sexual abuse. Sexual abuse was assessed with the following question: "Have you ever been sexually

625 abused by an adult or someone older than you? (Sexual abuse is when someone in your family or another person does sexual things to you or makes you do sexual things to them that you don't want to do.)" Individuals reporting that they had never been sexually abused were scored as 0; those who reported either current or past abuse were scored as 1. Physical abuse. Physical abuse was determined by responses to the following question, "Have you ever been physically abused by an adult (for example, beat up, hit with an object, kicked, or some other form of physical force)?" Individuals reporting never having been physically abused were scored as 0; those reporting either current or past abuse were scored as 1. Alcohol consumption. The teens were asked how frequently they drank beer and/or wine. A 7-point response scale ranging from "don't use" (0) to "use every day" (6) was employed. Suicidal ideation. The mental health status of the teens was assessed with a single item: "During the past month, have you thought about killing yourself?" Responses ranged from "no" (0) to "yes, all the time" (4). Parental monitoring. This nine-item measure, developed by Small and Kerns (1993), assessed the extent to which parents know the whereabouts of their child, and show an interest in who their youngster spends time with and what the adolescent does in his or her free time. The higher the score, the greater the level of parental monitoring (Cronbach's alpha = .90). Parental support. This six-item measure was adapted from Armsden and Greenberg's (1987) Parent-Adolescent Attachment Inventory. It assesses the adolescents' perceptions of the quality of their relationships with each parent that they live with. The three items for each parent are: (a) My mother/father cares about me, (b) my mother/father is fair when it comes to enforcing family rules, and (c) my mother/father is there when I need her/him. In two-parent families and families with shared custody, the three items for mothers and the three items for fathers were summed and then averaged together. If the adolescent lived with a single mother, only the mother's score was used; similarly, if the adolescent lived only with the father, the father's score was used.

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626 This approach was taken to ensure that adolescents from single-parent families would not be eliminated from multivariate analyses using listwise deletion, and because the correlation between maternal support and paternal support was substantial (r = .59). Discussing birth control with parents. Separate items were used to assess how often adolescents discussed birth control with their mothers and with their fathers. Responses ranged from never (0) to very often (4). The scores of mothers and fathers were not averaged for these items. Past research shows that adolescents are more likely to use birth control if they discuss contraception with their mothers (Flick, 1986; Hayes, 1987); in contrast, little is known about the effects of such discussions with fathers.
RESULTS

Journal of Marriage and the Family ception reliably. The results of these analyses showed that, if anything, those with multiple partners were less reliable users of contraception than those with fewer partners. The correlation between number of sex partners and frequency of contraception use for males was -.09 (p < .05); for females the correlation was -.08 (p < .10). Fifty-four percent of females who had one partner always used birth control, compared with 44% of those with five or more partners. Among males, the comparable figures were 56% and 40%. Factors Associated with Sexual Risk-Taking Behavior The primary purpose of this study was to compare adolescents who were sexual risk takers with adolescents who behaved more responsibly in terms of sexual practices. Three groups were constructed to reflect different levels of risk for HIV, other STDs, and pregnancy. In the first group, known as high-risk, were those who had more than one sexual partnerand rarely or never used contraception. In the second group, designated low-risk, were those who had only one partner and always used contraception. The third group comprised those adolescents who practiced sexual abstinence (sexual abstainers). Adolescents who did not fit into one of these three groups (i.e., those who had multiple partners and always used contraception and those who had only one partnerbut used contraception inconsistently) were not included in the analyses; this was done to ensure that the groups that were being compared clearly differed in terms of where they fell on a risk continuum. To provide baseline information of how these three risk groups differed, a series of one-way ANOVAs was conducted comparing their mean scores on a number of factors; given the exploratory nature of these preliminary analyses, multiple univariate analyses were judged to be the most appropriate analytical approach (Huberty & Morris, 1989). The Scheff6 test was used to determine which groups differed significantly from each other. The findings are presented in Table 2 for females and males respectively. On most measures, high-risk females fared less well than low-risk females and abstainers. High-risk females differed from the other two groups in that they had lower grade point averages (GPAs), contemplated suicide more often, and consumed more alcohol. In addition, 31% of the high-risk females had a history of sexual

Sexual Activity, Number of Sex Partners, and Birth Control Use by Age The relations between sexual activity, number of partners, birth control use, and age of the teens are presented in Table 1 for females and males. Overall, 35.9% of the females and 41.8% of the males who were surveyed were sexually experienced. For both females and males, the chances of being sexually experienced increased markedly through the teen years; over 60% of those 17 and over were sexually experienced, while 16% of females and 27% of males 14 or younger were. Among those who were sexually active in this sample, 44% of the females and 34% of the males had only one partner. However, 16.6% of the females and 28% of the males had five or more partners. Surprisingly, age was unrelated to number of partners among sexually active females (r = .08) and males (r = -.04). The teens were asked about how consistently they used contraception, and for these analyses, respondents were divided into three categoriesthose who never or rarely used contraception, those who used it some of the time to most of the time, and those who always used it. Only half of the females and 43% of the males reported that they always used contraception. Older females were more likely than younger females to use contraception reliably. For males, there was not a clear association between age and contraceptive use. Further analyses were conducted to see if those who had many partners were more likely than those who had fewer partners to use contra-

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TABLE 1. SEXUAL ACTIVITY, NUMBER OF PARTNERS, AND CONTRACEPTIVEUSE BY AGE (IN PERCENTAGES)

Females Age Variable Ever had intercourse Numberof sex partners among all females Zero One Two Three Four Five or more Numberof sex partners among sexually active One Two Three Four Five or more use among sexually active Contraceptive Rarelyor never Sometimes-mostof the time Always aForfemales, n = 508; for males, n = 529. tp>.05. *p<.05. **p<.001. ***p<.0001. Total 35.9 64.1 16.0 7.4 4.0 2.7 6.0 44.4 20.5 11.1 7.4 16.6 26.0 23.9 50.1 13-14 15.7 84.3 8.2 3.1 1.4 1.2 1.8 52.5 20.0 8.8 7.5 11.3 45.2 20.2 34.5 15-16 43.0 57.0 18.8 8.3 6.9 2.4 6.7 43.7 19.2 16.0 5.6 15.5 25.6 25.6 48.9 17+ 61.0 39.0 25.4 13.6 3.7 5.9 12.5 15.79[8]* 41.6 22.3 6.0 9.6 20.5 25.02[4]*** 17.1 23.5 59.4 29.4 27.1 43.4 33.8 24.5 41.7 34.4 18.5 11.9 7.2 28.0 35.9 13.7 9.2 6.1 35.1
x2

Total 41.8 58.2 14.4 7.7 5.0 3.0 11.7

13-14 27.0 73.0 9.7 3.7 2.5 1.6 9.5

192.16[2]** 196.26[10]**

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628

Journal of Marriage and the Family

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Sexual Risk-Taking Behaviors abuse, compared with 15% of the low-risk females and 5% of the abstainers. Similarly, 40% of the high-risk females reported being physically abused, compared with 12% in the low-risk group and 10% of the abstainers. When family characteristics were compared, the results indicated that high-risk females were monitored much less closely by parents, and received lower levels of support from their parents. In addition, high-risk females were less likely to talk with their mothers about birth control than were those in the low-risk, sexually active group. It is noteworthy that on several of the measures-GPA, suicidal ideation, physical abuse, and parental support-the low-risk, sexually active group more closely resembled the sexual abstainers than they did the high-risk females. On most other measures, the scores of the low-risk females fell between the scores of the high-risk group and the sexual abstainers. However, lowrisk females were the most likely to have discussed birth control with their mothers. Similar results were obtained for males. Highrisk males were more likely than males in the two comparison groups to have lower GPAs and higher levels of suicidal ideation. They also consumed alcohol more frequently. Twenty percent of the high-risk males reported being sexually abused, compared with less than 2% of the males in the other two groups. Likewise, 23% of high-risk males had experienced physical abuse, compared with 14% of males in the low-risk group and 7% in the sexual abstainers group. Like their female counterparts,high-risk males were less closely monitored and received less support from parents. However, their parents were as likely (or as unlikely) to have discussed birth control with them as were the parents of low-risk, sexually active males.

629 Consistent with the findings for females, males in the low-risk group did not differ from sexual abstainers on measures of GPA, suicidal ideations, and parental support. On several other measures, the scores of low-risk males fell between the scores of high-risk males and sexual abstainers. Logistic Regression Analyses In the next step in the analyses, logistic regression was used to identify a set of variables that predicted sexual risk taking among the two groups of sexually active adolescents (i.e., the high-risk group with multiple partners and irregular contraceptive use, and the low-risk group with one partner and regular contraceptive use). Logistic regression allows us to identify factors that are related to sexual risk taking when other factors are controlled. In addition, logistic regression provides information on how well group status can be predicted from these variables. All predictor variables on which there were significant mean differences between the two groups on the basis of the Scheff6 procedure were eligible for entry into the analysis (see Table 2). Predictor variables were entered simultaneously. Separate analyses were conducted for females and males. For females, four of the variables were significant predictors of sexual risk taking (see Table 3). The four variables were grade point average, alcohol consumption, discussing birth control with the mother, and parental monitoring. The model chi-square was 85.45 (df = 8, p < .0001). In the classification analysis, 80% of the cases were correctly classified (89% of the lowrisk and 65% of the high-risk females). For males, four variables predicted sexual risk taking in the logistic regression analysis: GPA,

TABLE 3. LOGISTIC REGRESSION ANALYSES FOR FEMALES

Variables GPA Motherdiscusses birthcontrol Alcohol Parentalmonitoring Suicidal ideations Physical abuse Parentalsupport Sexual abuse Constant

p -1.28 -.63 .56 -.10 .17 .32 -.04 .21 3.9964

SE .34 .21 .23 .05 .23 .60 .10 .60 1.74

Wald 14.13 8.91 6.09 4.00 .55 .29 .17 .12 5.26

p Value .0002 .0028 .0136 .0456 .4574 .5914 .6789 .7304 .0218

R -.24 -.18 .14 -.10 .00 .00 .00 .00

Exp (3) .28 .53 1.75 .91 1.19 1.38 1.75 1.23

Note: The dependentvariable is risk status (sexual risk taking versus regularcontraceptiveuse with one partner).The subsamplefor the logistic regression analyses comprises the adolescents who fell into one of these two groups. Results for the model are as follows: -2 log likelihood, X2 = 125.55, df= 154, p = .95; model X2 = 85.45, df= 8, p < .0001; goodness-offit, X2 = 155.75, df= 154, p = .45.

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630

Journal of Marriage and the Family

TABLE 4. LOGISTIC REGRESSION ANALYSES FOR MALES

Variables

SE

Wald

p Value

Exp (3)

Suicidal ideations Sexual abuse GPA Alcohol Parentalsupport Parentalmonitoring Constant

.62 2.74 -.48 .30 -.15 -.02 1.6861

.23 1.10 .21 .15 .08 .03 1.12

7.05 6.21 5.21 3.93 3.53 .42 2.28

.0079 .0127 .0225 .0475 .0601 .5191 .1307

.14 .13 -.12 .09 -.08 .00

1.87 15.54 .62 1.35 .86 .98

Note: The dependentvariable is risk status (sexual risk taking versus regularcontraceptionuse with one partner).The subsamplefor the logistic regression analyses comprises the adolescents who fell into one of these two groups. Results for the model are as follows: -2 log likelihood,X2 = 182.47, df= 168, p = .21; model X2 = 59.16, df= 6, p < .0001; goodness-offit, X2 = 169.64, df= 168, p = .45.

suicidal ideations, alcohol consumption, and sexual abuse (see Table 4). In addition, parental support approached statistical significance (p = .06). The model chi-square was 59.16 (df = 6, p < .0001). Overall, 74% of the males were classified correctly (82% of the low-risk males and 65% of the high-risk males).
DISCUSSION

Recent surveys conducted by the Centers for Disease Control (1992c) have shown that many high school students have had multiple sex partners. Nationally, 9.3% of all 10th grade females (not just those who are sexually active) and 17% of all 12th grade females had four or more partners. Similar results were obtained in the present sample with 9.2% of 10th grade females and 18.6% of 12th grade females having had four or more partners. Among males nationally, 20.6% of 10th graders and 38.5% of 12th graders had four or more partners. The rates for males were lower in this sample-15.8% of 10th graders and 22.2% of 12th graders. Many of those who have multiple partners do not use contraception reliably, and the primary purpose of this study was to compare teens who are sexual risk takers with teens who are at lower risk for pregnancy, HIV, and other STDs. The results revealed that sexual risk takers fared more poorly than abstainers on nearly every variable examined. They also fared less well than more responsible sexually active teens on several measures. Factors associated with sexual risk taking among females included low GPA, frequent alcohol consumption, low levels of parental monitoring, and a lack of communication about birth control with mothers. For males, sexual risk taking was associated with low GPA, frequent alcohol consumption, suicidal ideations, low levels of parental support, and a history of sexual abuse.

Sexual risk takers are exposed to multiple risks. On average, they appear to have more opportunities to engage in risk-taking behaviors (e.g., low levels of parental monitoring) and fewer incentives for avoiding risks (e.g., poor prospects for higher education). When mean scores for the three groups were compared, a particularly striking finding was the poor quality of the relationships sexual risk takers had with their parents and other adults; risk takers had much higher rates of abuse, and lower rates of parental support and monitoring, than their peers in the two comparison groups. Even though we cannot be sure when those discussions occurred, it is worth noting that low-risk females were much more likely than high-risk females to report that they discussed birth control with their mothers. The same trend was not found for males. Although those who had multiple partners and did not use contraception consistently were clearly at high risk, one of the limitations of our study was that we did not know how many of those who used contraception were using condoms. In future studies, clearly there is a need to look at predictors of condom use. Nationally, 49% of males and 40% of females in high school reported using a condom at last intercourse (Centers for Disease Control, 1992b). In the same survey, 78% of males and females reported using some method of contraception at last intercourse. These findings suggest that some of the teens in our sexually active "low-risk" group were still putting themselves at risk for HIV and other STDs, although they were at lower risk for pregnancy if they were using a reliable form of contraception. The Centers for Disease Control survey (1992b), however, shows that some teens use contraceptive methods that are not very effective at preventing pregnancies (e.g., withdrawal). Other limitations of the study that should be noted are that only cross-sectional data were

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Sexual Risk-Taking Behaviors available, and the sample was predominantly white and from a rural area. Because the data are cross-sectional, no information is available about the temporal ordering of events. For example, it is not clear whether the mothers of low-risk females discuss birth control with their daughters before they become sexually active or in response to their daughters' sexual activity. Sample characteristics need to be considered in assessing the generalizability of the results; further research is needed to determine if similar results would be obtained with adolescents from urban areas and adolescents from other ethnic groups. Finally, it is important to consider the implications of these findings. What can be done to reduce the incidence of teen pregnancy, HIV, and other STDs? Obviously there is a continuing need for public education around these matters. In the 3 years that the Centers for Disease Control has been conducting their Youth Risk Surveys (1989-1991) there has been an increase in the percentage of students who receive HIV instruction in school, from 54% to 83% (Centers for Disease Control, 1992a). There was also an increase in the percentage of students who talked with a parent or other adult in the home about AIDS or HIV (54%-61%); students were particularly likely to discuss such matters with their parents if there was HIV instruction in the schools. Although it is too early to be certain, there is some evidence that this public education campaign is having some positive effects on behavior (Anderson et al., 1990; Ku et al., 1992). The Centers for Disease Control (1992a) reported that there was a decline in the percentage of teens who reported having intercourse from 1989 to 1990 (59% to 54%), but not from 1990 to 1991. There was also a decline in the number of teens having four or more partners from 1989 to 1990 (24% to 19%), but again, not the following year. Condom use remained fairly stable over that time period, with the exception of those under 15, who became more likely to use condoms. Schools and the media can do much to increase public awareness of the problem, but the findings from this study also suggest that parents need to play a role in reducing the risks among their adolescent children. Parents can directly reduce the risks their children face by doing such things as encouraging their adolescents to avoid unprotected intercourse and by monitoring their children's activities. They also can indirectly affect risks by influencing other factors associated with sexual risk taking such as poor school per-

631 formance and alcohol use. Adolescents who are sexual risk takers, however, are more likely than others to have troubled relationships with their parents. Other adults may need to reach them if they are to alter their behaviors. Reducing barriers to contraceptive use is also essential. One national health objective for the year 2000 is to increase the use of condoms to 60%-75% among sexually active, unmarriedpersons aged between 15 and 19 years during last intercourse (Public Health Service, 1991). This will require a 50% increase in the use of condoms among high school students (Centers for Disease Control, 1992c). There is little reason to believe that we will achieve this national goal unless teens receive an unambiguous message about responsible sexual practices from parents and other influential adults, and have access to affordable and confidential family planning services. Our best hope for changing the practices of sexual risk takers may be to change the overall climate in the U.S. regarding contraceptive use by adolescents so that not using contraception no longer seems like a viable option.
NOTE

The authorsare gratefulto Peter R. Kerndt,M.D., of the County of Los Angeles HIV Epidemiology Prowiththis project. gram,for his assistance
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