In this issue.

With all of the emphasis on teenage pregnancy prevention and the risks of disease associated with vaginal intercourse, it should come as no surprise that youth engage in other types of sexual behavior. Or that they are largely ignorant of the risks that those behaviors may entail. In this issue of Perspectives on Sexual and Reproductive Health (page 6), Nicole Stone and coauthors report that in a sample of British young people, the practice of oral sex is fairly common, but the use of protection with that behavior is not: More than half of these youth had had oral sex, but only 2% of those who had engaged in fellatio more than once had used a condom every time.

Stone and colleagues' sample is, as they acknowledge, small and not representative of all British youth. Nonetheless, if the findings are any indication, a substantial minority of young people are unaware that STDs can be transmitted via oral sex, and the majority consider it unimportant to use condoms during fellatio. Even among those who use condoms for oral sex, the primary motives for doing so reflect little concern for STD prevention. "Given the prevalence of oral sex and the lack of knowledge about its risks among young people," the authors urge, "it is essential that those charged with teaching youth about sexual issues ... be encouraged to broaden the scope of their coverage."

Also in This Issue

* As any adolescent's parent likely will attest, one of the greatest influences on teenagers' behavior is other teenagers' behavior. Using data from the first two waves of the National Longitudinal Study of Adolescent Health, Renee E. Sieving and her team show that the theory holds for sexual behavior (page 13). In this sample, sexual initiation between survey waves was predicted by the proportion of a youth's friends who were sexually experienced and by teenagers' belief that they gain their friends' respect by having sex. The findings, the researchers observe, point to the need for programs to address not only individual adolescents' skills and behaviors, but also their close friends' norms related to sexual behavior.

* On the other hand, physicians may not be much influenced by other physicians. Using the theory of reasoned action--which posits that intentions to engage in a behavior are most influenced by individuals' attitudes toward and perceptions of norms associated with the behavior--Marjorie R. Sable and her team explored the underpinnings of physicians' intentions to prescribe emergency contraception (page 20). Contrary to the theoretical assumption, in a sample of faculty physicians at four universities, the perception of support by colleagues or professional organizations in general was not associated with intention to prescribe the method. Physicians' own attitudes regarding the method were important, as were their perceptions of specific colleagues' support for prescribing. As the authors note, "understanding provider attitudes and their underlying components could be a ... productive direction to pursue in encouraging physicians to prescribe emergency contraception."

* The "stereotype of Asian Americans as a 'model minority' does not hold for Asian American adolescents in the area of sexual activity," according to Hyeouk Chris Hahm and coauthors (page 28). In a sample of Asian American participants in the National Longitudinal Study of Adolescent Health, one in four women and one in five men who were not sexually experienced at Wave 1 had had intercourse by Wave 2. For young women, a high level of acculturation and a low level of parental attachment were significant predictors of sexual initiation between interviews; substance use was associated with sexual initiation for women and men. With the Asian American population growing rapidly, the authors conclude, "there is a crucial need for preventive programs that are culturally sensitive, inclusive of family and gender-specific."

* The newest contraceptive methods cost more than older ones, health care financing is constantly in flux and a growing number of Americans have no health insurance. What does this all mean for publicly funded family planning agencies? Results of a nationwide survey reported by Laura Duberstein Lindberg and colleagues (page 37) indicate that many agencies offer the newest, highly effective methods, although for some the trade-off is the elimination of older methods that are in less demand. At the same time, agencies are increasingly adopting policies that make it easier for women to obtain oral contraceptives and emergency contraception. Among the funding challenges are potential changes to Medicaid that may make family planning services less affordable for low-income women.

* Direct pharmacy access to emergency contraception seems the ideal way to assure that women can get the method within the relatively small window of its documented effectiveness. In a survey of women obtaining emergency contraception in California, where pharmacists can dispense the method without a prescription, Diana Greene Foster and colleagues found that the full time savings of this approach have not yet been realized because women are largely unaware of it (page 46). Barely four in 10 women had heard about direct pharmacy access from a physician or clinic, and even smaller proportions cited other sources of information; most, however, considered it very important and found their discussions with pharmacists about emergency contraception helpful. The authors press for wider publicity of this option, to increase women's timely access to emergency contraception.--The Editors