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Parent-child relations among minor females attending U.S. family planning clinics.



The extent to which parents should be involved in their adolescent ad·o·les·cent
adj.
Of, relating to, or undergoing adolescence.

n.
A young person who has undergone puberty but who has not reached full maturity; a teenager.
 children's decisions to have sex and use contraceptives is a sensitive issue, as well as one that has policy and programmatic pro·gram·mat·ic  
adj.
1. Of, relating to, or having a program.

2. Following an overall plan or schedule: a step-by-step, programmatic approach to problem solving.

3.
 implications. Positive parent-child In database management, a relationship between two files. The parent file contains required data about a subject, such as employees and customers. The child is the offspring; for example, an order is the child to the customer, who is the parent.

 relations are associated with fewer risk-taking behaviors, delayed sexual activity and fewer births among adolescents. (1) Many adolescent females can access confidential family planning family planning

Use of measures designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family’s access to limited resources.
 and STD (Subscriber Trunk Dialing) Long distance dialing outside of the U.S. that does not require operator intervention. STD prefix codes are required and billing is based on call units, which are a fixed amount of money in the currency of that country.  services, but recent legislative efforts have sought to require parental involvement for minors seeking family planning services at publicly funded clinics. (2) Policymakers and advocates who support confidential reproductive health Within the framework of WHO's definition of health[1] as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene  care for minors contend that such access is essential because some sexually experienced adolescents would avoid seeking contraceptive contraceptive /con·tra·cep·tive/ (-sep´tiv)
1. diminishing the likelihood of or preventing conception.

2. an agent that so acts.
 or STD services if they were required to involve their parents. To date, 21 states and the District of Columbia District of Columbia, federal district (2000 pop. 572,059, a 5.7% decrease in population since the 1990 census), 69 sq mi (179 sq km), on the east bank of the Potomac River, coextensive with the city of Washington, D.C. (the capital of the United States).  have enacted laws that explicitly allow adolescents younger than 18 to consent to contraceptive services. (3) No states require parental consent Parental consent laws (also known as parental involvement or parental notification laws) in some countries require that one or more parents consent to or be notified before their minor child can legally engage in certain activities.  or notification for all minors seeking contraceptive services, though Utah and Texas require parental consent for all adolescents seeking family planning services at clinics that receive certain types of state funding.

Most family planning clinics family planning clinic nclínica de planificación familiar

family planning clinic ncentre m de planning familial

 place priority on providing confidential services to adolescents without parental knowledge or approval, but recognize that parents play a central role in many adolescents' lives. Consequently, many have made efforts to facilitate and improve parental involvement in adolescents' lives. For example, among federally funded family planning agencies, which served 1.9 million adolescents in 2001, 43% had programs or policies intended to enhance parent-child communication. (4)

Almost two-thirds of 15-17-year-old females who obtained a family planning or medical service in the past year did so from clinics. (5) However, little is known about relations between adolescents who use clinic-based sexual health services health services Managed care The benefits covered under a health contract  and their partents. One purpose of this article is to describe communication, connectedness with parents and perceived per·ceive  
tr.v. per·ceived, per·ceiv·ing, per·ceives
1. To become aware of directly through any of the senses, especially sight or hearing.

2. To achieve understanding of; apprehend.
 parental attitudes among females younger than 18 visiting family planning clinics. Furthermore, because most such clients report that parents know they use the clinic for sexual health services, (6) this article also examines associations between adolescents' relationships with parents and parental knowledge of clinic visits.

RESEARCH ON PARENT-CHILD RELATIONS

A substantial body of research has examined parental relationships among the general adolescent population. Three of the more relevant indicators for purposes of this study are levels of parent-child communication about sexuality issues, parent-child connectedness and parental attitudes toward sex and contraception contraception: see birth control.
contraception

Birth control by prevention of conception or impregnation. The most common method is sterilization. The most effective temporary methods are nearly 99% effective if used consistently and correctly.
.

Communication About Sex and Contraception

Over the last two decades, researchers have devoted a significant amount of attention to the extent and quality of parent-child communication about sex. Most recently, the 2002 National Survey of Family Growth (NSFG NSFG National Survey of Family Growth
NSFG Naked Stick Figure Guy
), which gathered information from a representative sample of women (and men) of reproductive re·pro·duc·tive
adj.
1. Of or relating to reproduction.

2. Tending to reproduce.



reproductive

subserving or pertaining to reproduction.
 age, found that a majority of females aged 15-17 have talked to parents about issues such as how to say no to sex (62%), methods of birth control (52%) and STDs (57%); substantial minorities have talked to parents about where to get birth control (39%) and how to use a condom 1. condom - The protective plastic bag that accompanies 3.5-inch microfloppy diskettes. Rarely, also used of (paper) disk envelopes. Unlike the write protect tab, the condom (when left on) not only impedes the practice of SEX but has also been shown to have a high failure  (30%). Twenty-five percent have not talked to a parent about any of these issues. (7)

Likewise, other studies have consistently found that about half of teenagers have talked to parents about sex and birth control, (8) but the current state of communication is hardly ideal--many adolescents express a desire for more information and guidance from parents than they receive on these issues. (9) Also, studies with information from both parents and their adolescent children have found that mothers are more likely to report that they have discussed a given topic than are their children, (10) suggesting that parents are not conveying information as effectively as they think they are.

Parent-Child Connectedness

Parent-child connectedness, defined as "an emotional bond between a parent and a child that is both mutual and sustained over time," (11) has received increasing attention among researchers, policymakers and the popular press. This is partly because research using the National Longitudinal Study of Adolescent Health The National Longitudinal Study of Adolescent Health (also called Add Health) is the first and only nationally-representative study of adolescent sexuality, which has spawned over one thousand peer-reviewed publications on many issues related to adolescent health and  (Add Health), a representative survey of adolescents in school and their parents, has consistently found that connectedness to parents is associated with a decreased likelihood of sexual intercourse sexual intercourse
 or coitus or copulation

Act in which the male reproductive organ enters the female reproductive tract (see reproductive system).
 and risky adolescent behaviors, including pregnancy. (12) Connectedness with parents is typically measured as a composite of several relationship dimensions, such as closeness, satisfaction with the overall relationship, satisfaction with communication, and perceptions of caring and feeling loved and wanted by family members. (13) Most adolescents report high levels of connectedness with parents. A scale measure of mother-child connectedness using data from Add Health ranged from three to 22; the mean score of 19 suggested that on average, a majority of U.S teenagers are highly connected with parents. (14) Similarly, research using a scale to measure parental responsiveness among a sample of high-risk high-risk adjective Referring to an ↑ risk of suffering from a particular condition Infectious disease Referring to an ↑ risk for exposure to blood-borne pathogens, which occurs with blood bank technicians, dental professionals, dialysis unit  minority adolescents suggests that a substantial proportion of this population also are connected to parents (mean, 22; scale range, 8-32). (15)

Parental Attitudes Toward Sex and Birth Control

Parents often disapprove dis·ap·prove  
v. dis·ap·proved, dis·ap·prov·ing, dis·ap·proves

v.tr.
1. To have an unfavorable opinion of; condemn.

2. To refuse to approve; reject.

v.intr.
 of their adolescent children's having sex. One Add Health study found that 87% of mothers strongly disapprove of their daughters' having sex; (16) another study, of high-risk teenagers, found 75% of mothers disapproving dis·ap·prove  
v. dis·ap·proved, dis·ap·prov·ing, dis·ap·proves

v.tr.
1. To have an unfavorable opinion of; condemn.

2. To refuse to approve; reject.

v.intr.
 of sex. (17)

Just as adolescents are less likely than their mothers to recall previous conversations about sex, they perceive per·ceive
v.
1. To become aware of directly through any of the senses, especially sight or hearing.

2. To achieve understanding of; apprehend.
 mothers to be less disapproving than they actually are. While 61% of eighth and ninth graders (males and females) in one study perceived strong maternal MATERNAL. That which belongs to, or comes from the mother: as, maternal authority, maternal relation, maternal estate, maternal line. Vide Line.  disapproval of their having sex, 76% of mothers expressed such disapproval. (18) A similar pattern has also been found among a sample of high-risk teenagers. (19)

Parental attitudes about contraception are not as well documented. Only 21% of mothers in Add Health report that they have recommended a birth control method to their minor daughters, (20) but lack of recommendations does not necessarily mean disapproval. At least one study found that a majority of parents do not object to their adolescent children's having access to contraception. Almost two-thirds of Baltimore Baltimore, city (1990 pop. 736,014), N central Md., surrounded by but politically independent of Baltimore co., on the Patapsco River estuary, an arm of Chesapeake Bay; inc. 1745.  parents registering their children for services at middle and high school-based health clinics indicated that the clinics could, in the future, provide adolescents, and presumably pre·sum·a·ble  
adj.
That can be presumed or taken for granted; reasonable as a supposition: presumable causes of the disaster.
 their own children, with access to condoms and birth control. (21)

ADOLESCENTS ATTENDING FAMILY PLANNING CLINICS

Research findings on parent-child connectedness and communication about sex among the general population may not be applicable to minor clients of family planning clinics. However, a few studies have gathered information from this population.

Most studies have found that a majority of minor adolescents who use family planning clinics report that a parent knows they are at the clinic. (22) Reports of an informed parent are more common among adolescents who are younger, (23) who are black (24) and who have made prior contraceptive visits, (25) and less common among teenagers with college-educated mothers and those who live with both parents. (26)

More than one-third of young women report that they voluntarily informed parents that they used family planning clinic services. (27) However, even teenagers who voluntarily tell their parents of clinic visits may not be discussing broader issues of sexuality with them. A 1984 study found that even though parental awareness of daughters' clinic visits increased over a 15-month period, the proportion of adolescent females who indicated that they "usually" talked about sex and birth control with their mother remained at 37-39%. (28)

For a substantial minority of adolescents who use family planning services, parents are supportive of and actively involved in this aspect of their lives. In various studies, 6-15% of teenagers said they had learned about the clinic from a parent, (29) 24% of young women indicated that a parent had suggested the clinic for sexual health services, (30) and 10-14% of adolescents who made contraceptive visits were accompanied ac·com·pa·ny  
v. ac·com·pa·nied, ac·com·pa·ny·ing, ac·com·pa·nies

v.tr.
1. To be or go with as a companion.

2.
 by a parent, typically the mother. (31) Several studies suggest that black teenagers and younger teenagers are significantly more likely than whites and older adolescents to have parents involved in this aspect of their lives. (32) Parental involvement presumably indicates approval of daughters' contraceptive use, but lack of overt Public; open; manifest.

The term overt is used in Criminal Law in reference to conduct that moves more directly toward the commission of an offense than do acts of planning and preparation that may ultimately lead to such conduct.


OVERT. Open.
 involvement does not necessarily signify sig·ni·fy  
v. sig·ni·fied, sig·ni·fy·ing, sig·ni·fies

v.tr.
1. To denote; mean.

2. To make known, as with a sign or word: signify one's intent.
 disapproval.

A number of research questions about relationships between adolescents attending family planning clinics and their parents remain unanswered. For example, to what extent do adolescent female clinic clients talk to their parents about sex and contraception? What level of connectedness do they report? Are young women seeking sexual health services with parental knowledge and support? Are parent-child connectedness and discussions about sex and birth control associated with whether young women voluntarily inform their parents that they are using family planning services? And which groups of young women who use clinics are the most likely to do so at a parent's suggestion? Our study answers these questions using current, national data from more than 1,500 females younger than 18 obtaining sexual health services in U.S. family planning clinics.

METHODS

Data

We systemically selected a random sample of clinics from a database of all publicly funded family planning clinics in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area.  maintained by the Guttmacher Institute The Guttmacher Institute (formerly The Alan Guttmacher Institute) advances sexual and reproductive health in the United States and globally through an interrelated program of social science research, public education, and policy analysis. . The universe was restricted to facilities that served 200 or more adolescent contraceptive clients in 2001, to maximize the cost-effectiveness cost-effectiveness

pertaining to cost-effective.


cost-effectiveness analysis
a comparison of the relative cost-efficiencies of two or more ways of performing a task or achieving an objective.
 of fielding the survey. We stratified stratified /strat·i·fied/ (strat´i-fid) formed or arranged in layers.

strat·i·fied
adj.
Arranged in the form of layers or strata.
 the universe from which the sample was drawn by adolescent caseload case·load  
n.
The number of cases handled in a given period, as by an attorney or by a clinic or social services agency.


caseload
Noun
 (200-399; 400-749; 750-1,199; 1,200 or more), type of facility (hospital clinic, health department, Planned Parenthood Planned Parenthood

A service mark used for an organization that provides family planning services.
 or other), receipt of Title X funding and whether state law explicitly protects minors' access to contraceptive services. Facilities in Texas and Utah were excluded because at least some minors in state-funded family planning clinics in those states were already required to obtain parental consent for family planning services. The final universe of 2,442 family planning clinics from which the sample was drawn represented 37% of all facilities but served 82% of all adolescent contraceptive clinic clients in 2001.

Participating facilities distributed questionnaires to eligible adolescents for 2-6 weeks. If a facility declined to participate or did not obtain usable USable is a special idea contest to transfer US American ideas into practice in Germany. USable is initiated by the German Körber-Stiftung (foundation Körber). It is doted with 150,000 Euro and awarded every two years.  questionnaires from at least 50% of eligible teenagers seen during the study period, it was replaced by the next clinic in the stratified sample Noun 1. stratified sample - the population is divided into strata and a random sample is taken from each stratum
proportional sample, representative sample
; this procedure ensured that the replacement clinic was similar to the original. Our goal was to gather surveys from minors in 80 clinics. A total of 97 clinics declined to participate, mostly because of understaffing, time and budget constraints A Budget Constraint represents the combinations of goods and services that a consumer can purchase given current prices and his income. Consumer theory uses the concepts of a budget constraint and a preference ordering to analyze consumer choices.  or general lack of interest. An additional 31 clinics agreed to participate, but failed to obtain usable surveys from at least 50% of eligible female clients. Low response rates typically stemmed stemmed  
adj.
1. Having the stems removed.

2. Provided with a stem or a specific type of stem. Often used in combination: stemmed goblets; long-stemmed roses.
 from administrative disorganization disorganization /dis·or·gan·iza·tion/ (-or?gan-i-za´shun) the process of destruction of any organic tissue; any profound change in the tissues of an organ or structure which causes the loss of most or all of its proper characters. , inability of facility staff to keep a complete tally of eligible minors or failure to pass out the survey. Because most clinic refusals and failures were caused by administrative issues, we expect that the adolescent clients in clinics that declined to participate or that were unable to do so successfully did not differ from the adolescents in our sample. Fieldwork field·work  
n.
1. A temporary military fortification erected in the field.

2. Work done or firsthand observations made in the field as opposed to that done or observed in a controlled environment.

3.
 began in May 2003 and lasted until February February: see month.  2004. The final sample of 79 facilities consisted of 28 health department sites, seven hospital clinics, 31 Planned Parenthood affiliates and 13 other clinic types. Clinics from 33 states participated, including several from each of the four major census regions.

Data were collected via a self-administered questionnaire, available in both English 1. English - (Obsolete) The source code for a program, which may be in any language, as opposed to the linkable or executable binary produced from it by a compiler. The idea behind the term is that to a real hacker, a program written in his favourite programming language is  and Spanish Spanish, river, c.150 mi (240 km) long, issuing from Spanish Lake, S Ont., Canada, NW of Sudbury, and flowing generally S through Biskotasi and Agnew lakes to Lake Huron opposite Manitoulin island. There are several hydroelectric stations on the river. . The questionnaire was written at a fifth-grade reading level, and results from pretesting indicated it took approximately 10 minutes to complete. Clinic staff distributed surveys to all clients younger than 18 seeking sexual health services, excluding abortion and prenatal prenatal /pre·na·tal/ (-na´tal) preceding birth.

pre·na·tal
adj.
Preceding birth. Also called antenatal.



prenatal

preceding birth.
 and postnatal postnatal /post·na·tal/ (-na´t'l) occurring after birth, with reference to the newborn.

post·na·tal
adj.
Of or occurring after birth, especially in the period immediately after birth.
 care. Surveys were anonymous and confidential, and respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy.  were given a sealable envelope so that clinic staff could not view their completed questionnaires. The survey instrument and fielding protocol were approved by the Guttmacher Institute's institutional review board as well as external institutional review boards of several study clinics that required separate approval.

Participating clinics saw 2,038 eligible female clients during the survey period, and obtained surveys from 75%. The final data used for these analyses come from 1,526 young women. We constructed weights to represent the universe of adolescent clients using all publicly funded family planning clinics that serve 200 or more adolescents annually. We imputed Attributed vicariously.

In the legal sense, the term imputed is used to describe an action, fact, or quality, the knowledge of which is charged to an individual based upon the actions of another for whom the individual is responsible rather than on the individual's
 missing values In statistics, missing values are a common occurrence. Several statistical methods have been developed to deal with this problem. Missing values mean that no data value is stored for the variable in the current observation.  for key demographic variables using a hot-deck procedure. (33)

Measures

* Communication about sexual health issues. Our measure is based on a question that asked respondents how often they discussed seven topics with a parent: how to say no to sex, how to prevent getting an STD, how to prevent getting HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome , how to prevent pregnancy, how to use condoms, how to know when it is appropriate to have sex and where to get prescription contraceptives. Respondents were provided with four response categories, ranging from "a great deal" to "not at all." The seven items were highly interrelated in·ter·re·late  
tr. & intr.v. in·ter·re·lat·ed, in·ter·re·lat·ing, in·ter·re·lates
To place in or come into mutual relationship.



in
 (Cronbach's alpha Cronbach's (alpha) has an important use as a measure of the reliability of a psychometric instrument. It was first named as alpha by Cronbach (1951), as he had intended to continue with further instruments. , 0.92) and were used to construct an additive additive

In foods, any of various chemical substances added to produce desirable effects. Additives include such substances as artificial or natural colourings and flavourings; stabilizers, emulsifiers, and thickeners; preservatives and humectants (moisture-retainers); and
 scale (range, 7-28), on which a higher score indicated more frequent conversations on more topics. ** We collapsed the scale into a four-category ordinal (mathematics) ordinal - An isomorphism class of well-ordered sets.  variable, with each category containing approximately 25% of respondents, to make discussion of the findings more meaningful and straightforward.

* Parent-child connectedness. Our measure of parent-child connectedness is based on responses from two sets of items, both adopted with minor modification from Add Health. The first assessed communication with parents ("I am satisfied with the way my mother/female guardian and 1 communicate with each other"); the second assessed overall relationships ("Overall, I am satisfied with my relationship with my mother/female guardian"). Parallel items about communication and overall relationship with fathers were also asked. There were five response categories, ranging from "strongly agree" to "strongly disagree," plus "not applicable." For the analyses, we collapsed the response categories of the items so that "strongly agree" and "agree" were considered one response, as were "strongly disagree" and "disagree."

We first constructed a single measure of satisfaction with communication with parents and a single measure of overall relationship with parents. Since approximately one-half of minor females did not live with fathers, we relied primarily on information pertaining per·tain  
intr.v. per·tained, per·tain·ing, per·tains
1. To have reference; relate: evidence that pertains to the accident.

2.
 to mothers, but used information pertaining to fathers when maternal information was missing. The two items were highly related (Cronbach's alpha, 0.92), and were combined to construct a three-category measure of connectedness with parents: satisfied with both communication and overall relationship, satisfied with only one dimension (or neutral on both) and dissatisfied dis·sat·is·fied  
adj.
Feeling or exhibiting a lack of contentment or satisfaction.



dis·satis·fied
 with both. This measure is simpler than measures of parent-child connectedness used in prior research,34 but it captures two of the more important dimensions of this construct.

* Parental attitudes toward sex and contraception. Items assessing adolescents' perceptions of parental attitudes also were adopted with minor modification from Add Health: "How would your mother/female guardian feel about your having sex at this time in your life?" and "How would your mother/female guardian feel about your using birth control at this time in your life (if you were having sex)?" We also asked parallel questions about fathers' attitudes. There were five response categories, ranging from "strongly approve" to "strongly disapprove," plus "don't know Don't know (DK, DKed)

"Don't know the trade." A Street expression used whenever one party lacks knowledge of a trade or receives conflicting instructions from the other party.
." For the analyses, we collapsed "strongly approve" and "approve" into a single category and did the same with "strongly disapprove" and "disapprove." We created one variable for sex attitude and one variable for birth control attitude. Again, we relied primarily on information about maternal attitudes, and used information about fathers' attitudes when information about mothers' attitudes was not provided. We combined our measures of perceived parental attitudes toward sex and toward birth control to construct a four-category measure of parental attitudes: approves of contraception and approves of or is neutral about sex, approves of contraception but disapproves of sex, disapproves of both and a residual Residual

See:Residual value
 category that included other responses (including "don't know"). (We examined other combinations of these two variables, and determined that this categorization scheme was the most efficient and provided the most insights into how perceived parental attitudes are associated with parental knowledge of clinic visits.)

* Parental knowledge of clinic visit. Respondents were asked "Does a parent/legal guardian know you come to this clinic for birth control or other sexual health services?" Teenagers who answered yes were directed to a follow-up follow-up,
n the process of monitoring the progress of a patient after a period of active treatment.


follow-up

subsequent.


follow-up plan
 item asking if they had voluntarily informed their parents, if their parents had recommended the clinic or if their parents had found out through some other means--for example, through an insurance company or another person. We constructed three measures from these questions. We first examined whether young women indicated a parent knew they were at the clinic. Among those whose parents knew, we then examined whether young women had voluntarily informed parents and whether parents had suggested the clinic visit.

* Demographic characteristics. We asked respondents about their age, race and ethnicity ethnicity Vox populi Racial status–ie, African American, Asian, Caucasian, Hispanic , mother's education, living arrangement, number of prior births and, when appropriate, number of months since first intercourse INTERCOURSE. Communication; commerce; connexion by reciprocal dealings between persons or nations, as by interchange of commodities, treaties, contracts, or letters.  and number of contraceptive visits in the last 12 months.

* Missing values. The overwhelming majority of respondents provided usable responses to most items. For example, only 2% did not provide their month and year of birth, one of the first items on the survey, and 6% failed to provide information about mothers' education, one of the last items. Nonresponse and missing values for items pertaining to parents' sex and birth control attitudes were higher than those for other items. When asked how their mothers would feel about their having sex, 7% of young women indicated "don't know"; 3% did not answer the item. Some 75% of these respondents were living with a mother; we hypothesize hy·poth·e·size  
v. hy·poth·e·sized, hy·poth·e·siz·ing, hy·poth·e·siz·es

v.tr.
To assert as a hypothesis.

v.intr.
To form a hypothesis.
 that a response of "don't know" in this circumstance Circumstance or circumstances can refer to:
  • Legal terms:
  • Aggravating circumstances
  • Attendant circumstance
 indicated a lack of communication about these issues and, hence, the inability to provide a response. Therefore, we incorporated "don't know" as a usable response category in assessing young women's perceptions of parental attitudes.

Analytic an·a·lyt·ic or an·a·lyt·i·cal
adj.
1. Of or relating to analysis or analytics.

2. Expert in or using analysis, especially one who thinks in a logical manner.

3. Psychoanalytic.
 Strategy

All analyses use weighted data. We first provide a demographic profile A demographic or demographic profile is a term used in marketing and broadcasting, to describe a demographic grouping or a market segment. This typically involves age bands (as teenagers do not wish to purchase denture fixant), social class bands (as the rich may want  of women younger than 18 attending family planning clinics and, to the extent possible, compare them with the general population of females aged 15-17, as well as those who are sexually experienced, using nationally representative data from the 2002 NSFG. (We do not assess whether differences between the populations are statistically significant.) We next examine descriptive statistics descriptive statistics

see statistics.
 to assess the extent to which young women attending family planning clinics talk to their parents about sex and contraception, levels of connectedness with parents and perceptions of parents' attitudes toward sex and birth control. The next step is to use t tests to assess bivariate bi·var·i·ate  
adj.
Mathematics Having two variables: bivariate binomial distribution.

Adj. 1.
 associations between these three dimensions of teenagers' relationships with parents and our measures of parental knowledge of clinic visits. Our final step, using logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. , is to determine if these associations are maintained once demographic characteristics and sexual behavior sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life.  are taken into account. Stata Stata (Statistics/Data Analysis) is a statistical program created in 1985 by Statacorp that is used by many businesses and academic institutions around the world. Most of its users work in research, especially in the fields of economics, sociology, political science, and  software, version 8, is used to conduct tests of significance that take into account the clustered nature of the sample of clients within clinics.

Given the cross-sectional cross section also cross-sec·tion
n.
1.
a. A section formed by a plane cutting through an object, usually at right angles to an axis.

b. A piece so cut or a graphic representation of such a piece.

2.
 nature of the data, we cannot determine if communication with parents, parent-child connectedness and perceived parental attitudes preceded parental knowledge of clinic visits or had any influence on how parents knew of the visits. Hence, our analyses are more descriptive than explanatory ex·plan·a·to·ry  
adj.
Serving or intended to explain: an explanatory paragraph.



ex·plan


RESULTS

Characteristics of Minors Attending Clinics

Nine percent of minor females who were attending family planning clinics in the United States in 2003 were younger than 15, 18% were 15 years old, 31% were 16 and 42% were 17 (Table 1). *** The majority (56%) were white, 23% were black, 15% were Hispanic Hispanic Multiculture A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race Social medicine Any of 17 major Latino subcultures, concentrated in California, Texas, Chicago, Miam, NY, and elsewhere  and 7% were of some other race or ethnicity Twenty-one twenty-one: see blackjack.  percent of respondents had mothers who were not high school graduates; 20% had mothers who were college-educated. Similar proportions of young women resided with both parents and with a single mother (43% and at4%, respectively). Respondents who were sexually experienced (91%) had been so for an average of 20 months (not shown). Only 5% had given birth, and 58% had made one or more contraceptive visits in the last 12 months.

Adolescents using family planning clinics differed from adolescents nationally (in 2002) on a number of indicators. Black adolescents made up only 16% of the population aged 15-17, and were overrepresented o·ver·rep·re·sent·ed  
adj.
Represented in excessive or disproportionately large numbers: "Some groups, and most notably some races, may be overrepresented and others may be underrepresented" 
 among clinic clients (23%--Table 1). (35) White adolescents were underrepresented un·der·rep·re·sent·ed  
adj.
Insufficiently or inadequately represented: the underrepresented minority groups, ignored by the government. 
 among the clinic population. Minor adolescents using family planning clinics are likely to be somewhat economically ec·o·nom·i·cal  
adj.
1. Prudent and thrifty in management; not wasteful or extravagant. See Synonyms at sparing.

2. Intended to save money, as by efficient operation or elimination of unnecessary features; economic:
 and socially disadvantaged This article or section may contain original research or unverified claims.

Please help Wikipedia by adding references. See the for details.
This article has been tagged since September 2007.
 relative to the larger population of minor adolescents, given that greater proportions of them are black, have mothers with a high school education or less, and do not live with both parents--all characteristics associated with economic disadvantage In policy debate, a disadvantage (abbreviated as DA, and sometimes referred to as a Disad) is an argument that a team brings up against a policy action that is being considered. Structure
A DA usually has four key elements.
.

While sexually experienced adolescents using family planning clinics for reproductive health services were demographically similar to the larger population of sexually experienced minor adolescent females, there were some differences. A lower proportion of minors using family planning clinics than of sexually experienced adolescents nationally were white, and a greater proportion had mothers who had not graduated from high school; there is some indication that living in a two-parent household was more common among clinic clients. Also, a lower proportion of clinic clients had given birth (though this may be because the clinic sample included adolescents younger than 15 as well as teenagers who were not sexually active).

Relations with Parents

Most respondents had talked with a parent about sex and contraception (Table 2). The largest proportions had talked a great deal with parents about how to say no to sex (42%), and had discussed how to prevent getting an STD, how to prevent HIV/AIDS and where to get prescription birth control (32-33%). Fifty percent of young women indicated they did not talk with parents at all about how to use condoms, making it the least commonly discussed of the seven issues. The mean score on the scale that combines all seven items was 17.7, about the midpoint mid·point  
n.
1. Mathematics The point of a line segment or curvilinear arc that divides it into two parts of the same length.

2. A position midway between two extremes.
 (not shown), suggesting that on average, teenagers using family planning clinics have moderate levels of discussion with parents about these issues. Most teenagers had talked about these topics with parents at least a little bit (50-80%), and only 7% had not talked about any of the seven issues with parents (not shown). However, when asked to provide an overall evaluation of these conversations, 29% indicated they were very helpful, and 22% indicated that they were not at all helpful or did not occur.

In general, young women reported positive relations with at least one parent (Table 3). Approximately three-quarters Noun 1. three-quarters - three of four equal parts; "three-fourths of a pound"
three-fourths

common fraction, simple fraction - the quotient of two integers

three-quarters npl
 were satisfied with their overall communication and overall relationship with their mothers, and one in 10 strongly disagreed with either statement (not shown). Young women's evaluation of relationships and communication with fathers was not as positive. Fewer than half were satisfied with communication with their fathers, and slightly more than half were satisfied with the overall relationship.

Our measure combining information on relationships with both mothers and fathers on communication and overall relationship shows that 68% of young women were highly connected with parents (Table 4, page 198). Some 14% were disconnected, insofar in·so·far  
adv.
To such an extent.

Adv. 1. insofar - to the degree or extent that; "insofar as it can be ascertained, the horse lung is comparable to that of man"; "so far as it is reasonably practical he should practice
 as they were dissatisfied on both dimensions.

Young women largely perceived parents to disapprove of their being or becoming sexually active, but felt that parents were more supportive of their using contraceptives (Table 3). More than one-half of young women reported that their mothers disapproved of their having sex, but nearly two-thirds perceived that if they were going to have sex, their mothers approved of their using birth control. Fathers were perceived as having far more negative attitudes; 61% of young women indicated that fathers disapproved of their having sex, and only 36% perceived paternal PATERNAL. That which belongs to the father or comes from him: as, paternal power, paternal relation, paternal estate, paternal line. Vide Line.  approval of birth control.

Combining information from both items on parental attitudes, we found that young women using family planning clinics most commonly perceived parents to approve of birth control and either approve of or be neutral about their having sex (34%--Table 4). Thirty percent perceived parents to approve of their using contraceptives (if they were sexually active) but to disapprove of their having sex. Nineteen percent perceived parents to disapprove of both behaviors.

Parents' Knowledge of Clinic Visits

Sixty percent of young women indicated that a parent knew they were at the clinic for sexual health services (Table 5, page 198). Among these, 66% had voluntarily told parents, and 40% were there at a parent's recommendation. Nine percent indicated that a parent had found out some other way (not shown). **** The three responses were not mutually exclusive Adj. 1. mutually exclusive - unable to be both true at the same time
contradictory

incompatible - not compatible; "incompatible personalities"; "incompatible colors"
, and 13% of those with informed parents indicated that their parents knew of the visits through multiple mechanisms. The most common multiple response (given by 10% of those with informed parents) was that parents had suggested the clinic and young women had told their parents voluntarily In these instances, parents may have recommended the clinic for future health care needs, and upon subsequently accessing services, young women had informed parents.

The bivariate associations suggest that parental relations are associated with whether parents know their daughters are at family planning clinics, but are less consistently associated with how parents learned of the visits. The more young women communicated with parents about sexuality issues, the more likely they were to indicate that a parent knew they were at the clinic. However, among teenagers with informed parents, there was no significant association between level of communication and how parents knew they were at the clinic.

Among adolescents who were most connected with their parents, 71% indicated that a parent knew they were at the clinic; this proportion was significantly higher than the 37% for teenagers who exhibited the lowest levels of connectedness. Notably, 50% of young women whose parents did not know they were at the clinic reported high levels of connectedness (not shown).

Adolescents' perceptions of parental attitudes toward sex and contraception were associated with several aspects of parental knowledge of their clinic visits. Among young women who perceived parents to disapprove of their both having sex and using contraceptives, only 25% indicated a parent knew they were at the clinic; the proportion was significantly higher for every other attitudinal group (49-77%). Some 44% who perceived parents to have disapproving attitudes had voluntarily told parents they were at the clinic, compared with 61-73% for the other attitudinal groups.

Many of the associations between parent-child relations and parental knowledge of clinic visits were maintained even after demographic characteristics were controlled for (Table 6). Among all minors using family planning clinics, discussions about sexuality were strongly associated with parental knowledge of clinic use. Those who reported the highest level of communication had five times the odds of indicating that a parent knew they were at the clinic relative to young women who had the lowest levels. Female adolescents who were most connected with parents had two times the odds of the least connected of indicating that a parent knew they were at the clinic. Minor adolescents who perceived parents to approve of birth control were significantly more likely to indicate that a parent knew they were at the clinic than were young women whose parents disapproved of both behaviors (odds ratios, 5.4 and 4.5 depending on perceived parental attitude toward sex).

Associations between demographic and social characteristics and parental knowledge of the clinic visit confirmed findings from prior research, suggesting that they operate independently of parent-child relations. (36) Relative to 17-year-olds, younger teenagers were more likely to indicate that a parent knew they were at the clinic; the differential was particularly marked for those aged 14 and younger (odds ratio, 3.7). Relative to young women with college-educated mothers, those whose mothers had no more than a high school education were more likely to indicate that a parent knew they were at the clinic. Young women who lived only with their mothers were more likely than those living with two parents to report that a parent knew they attended the clinic. Finally, young women who had made one or no visits for contraception in the past year were less likely to have parents who knew they were at the clinic, and the longer the time since first sex, the more likely were parents to know about the clinic visit.

Among young women whose parents knew they were at the clinic, a second logistic regression model compared those whose parents suggested the clinic with those who voluntarily informed parents; ***** respondents who indicated their parents had found out some other way were excluded from the model. Few of the parental relationship dynamics were associated with how parents knew. The likelihood that a parent had recommended the clinic as opposed op·pose  
v. op·posed, op·pos·ing, op·pos·es

v.tr.
1. To be in contention or conflict with: oppose the enemy force.

2.
 to the adolescent's voluntarily informing parents did not differ by level of connectedness with parents or communication about sexuality issues. Relative to adolescents whose parents disapproved of sex and birth control, only those in the "residual" group (youth who gave inconsistent Reciprocally contradictory or repugnant.

Things are said to be inconsistent when they are contrary to each other to the extent that one implies the negation of the other.
 answers or answers that did not seem meaningful) were significantly less likely to indicate a parent had recommended the clinic (and were more likely to have told parents voluntarily). Because the three measures of parental relations are somewhat interrelated among adolescents with informed parents, we examined models that included each relationship dimension separately and controlled only for demographic characteristics (not shown). Even in those analyses, communication and connectedness were not associated with parent's suggesting the clinic visit.

Finally, several demographic characteristics and sexual behaviors were associated with whether a parent had recommended the clinic. Minor females aged 15 and younger were more likely than 17-year-olds to indicate that a parent had recommended the clinic. Adolescent females who lived with their fathers but not their mothers were less likely than those who lived with both parents to report that a parent had suggested the clinic; those who had had a prior birth were less likely to be there at a parent's suggestion than those who had not given birth. The longer minor female adolescents had been having sex, the less likely they were to indicate that a parent had recommended the clinic.

DISCUSSION

The majority of minor adolescent females attending family planning clinics have good relationships with at least one parent. Most have talked to a parent about a range of issues related to sex and birth control, and most report high levels of connectedness. A majority of young women perceive parents to disapprove of their having sex, but two-thirds perceive that their parents approve of their using contraceptives if they are sexually active. This seemingly seem·ing  
adj.
Apparent; ostensible.

n.
Outward appearance; semblance.



seeming·ly adv.
 inconsistent perception mirrors findings from a public opinion poll indicating that most adults do not approve of teenagers' having sex but support teenagers' having access to contraceptives if they are going to have sex. (37)

It is important not to overlook that one in seven adolescents were "disconnected" from parents. These young females may need support in making responsible decisions about their sexual health.

A majority of minor females indicated that a parent knew they were at the clinic. Young women who had the highest level of communication with their parents about sexual matters, adolescents who were highly connected with parents and those who did not perceive parents to disapprove of sex and contraception were more likely to indicate that a parent knew they were there than those with low levels of communication and connectedness, and those whose parents disapproved of both sex and birth control. Notably, we were unable to establish the causal causal /cau·sal/ (kaw´z'l) pertaining to, involving, or indicating a cause.

causal

relating to or emanating from cause.
 direction of these relationships, and there may be several paths. For some teenagers, high levels of communication may have preceded the clinic visit; for example, discussions about how to prevent pregnancy and where to get birth control may have motivated mo·ti·vate  
tr.v. mo·ti·vat·ed, mo·ti·vat·ing, mo·ti·vates
To provide with an incentive; move to action; impel.



mo
 teenagers to visit the clinic. Alternately al·ter·nate  
v. al·ter·nat·ed, al·ter·nat·ing, al·ter·nates

v.intr.
1.
a. To occur in a successive manner: day alternating with night.

b.
, or in addition, parents may have initiated more discussions about sexual matters such as birth control and STDs after their daughters disclosed that they were obtaining services.

Adolescents using family planning clinics are more likely than U.S. teenagers in general to be economically and socially disadvantaged, though they are demographically similar to the national population of sexually experienced minor teenagers. Interestingly, minors from relatively better-off bet·ter-off
adj.
Being in a better or more prosperous condition: a visit to her better-off relatives.


better-off
Adjective

reasonably wealthy:
 households--for example, those who lived with both parents or whose mothers had college degrees--had reduced odds of indicating that a parent knew they were at the clinic. These adolescents may use family planning clinics, as opposed to private physicians, specifically because they are concerned about confidentiality; future research should explore this issue in more depth.

Parents may learn about their daughters' use of family planning clinics through several mechanisms. Most commonly, adolescents had voluntarily told their parents, but a substantial minority of parents had themselves suggested that their daughters use the clinic. Among young women whose parents knew they were at the clinic, neither communication about sexual issues nor connectedness was associated with whether parents had recommended the clinic.

Expanding on previous research showing that younger adolescents are more likely than older adolescents to report that a parent knows they are at the clinic, (38) we found that those aged 15 and younger were also more likely than older adolescents to be at the clinic at a parent's suggestion. Barriers such as lack of information and misinformation mis·in·form  
tr.v. mis·in·formed, mis·in·form·ing, mis·in·forms
To provide with incorrect information.



mis
 about contraceptives and where to obtain them, (39) limited mobility and restricted financial independence are more pronounced for the youngest adolescents than for older teenagers. Our research suggests that many adolescents aged 15 and younger access family planning services specifically because parents are involved.

Four in 10 adolescent females indicated that a parent did not know they were at the clinic for sexual health services; the proportion was higher among adolescents whose parents disapproved of sex and birth control than among those reporting any other parental attitude. This pattern suggests that some teenagers perceive that they are using sexual health services against parents' wishes. Prior research has found that teenagers whose parents do not know they are at the clinic would be particularly likely to engage in unsafe sex if parental involvement were mandated; the most common reasons adolescents do not tell parents they use family planning clinics are that they do not want parents to know they are having sex (25%) and they are concerned that parents will be disappointed if they find out they are having sex (22%). (40) Given that one-half of teenagers whose parents did not know they were at the clinic were highly connected with parents, we expect that these teenagers would opt to have unsafe sex rather than disappoint dis·ap·point  
v. dis·ap·point·ed, dis·ap·point·ing, dis·ap·points

v.tr.
1. To fail to satisfy the hope, desire, or expectation of.

2.
 parents and jeopardize jeop·ard·ize  
tr.v. jeop·ard·ized, jeop·ard·iz·ing, jeop·ard·izes
To expose to loss or injury; imperil. See Synonyms at endanger.
 their good relations.

Our study has several shortcomings A shortcoming is a character flaw.

Shortcomings may also be:
  • Shortcomings (SATC episode), an episode of the television series Sex and the City
. Even though participating clinics represent a cross section of U.S. family planning providers with large adolescent caseloads, the high number of clinic refusals and survey administration failures may have resulted in a biased sample A biased sample is a statistical sample of a population where some members of the population are less likely to be included than others. An extreme form of biased sampling occurs when certain members of the population are totally excluded from the sample (that is, they have zero , meaning that the findings cannot be extrapolated to all minor females using such clinics. The reading level and length of the survey could have deterred some teenagers from participating or caused them to answer items incorrectly. As is the case among the larger population of adolescents, minor females using family planning clinics may have inaccurate perceptions of parents' attitudes toward sex and birth control. Biased responses are possible if teenagers falsely reported that parents were aware of the visit in order to preserve their access to confidential services. While we refer to our measures as assessments of parent-child relations, the measure we constructed gave primary emphasis to relationships with mothers and incorporated teenagers' evaluations of their relationships with fathers only when information from mothers was not available. This strategy was warranted because a substantial minority of minor adolescent females are not in contact with their fathers. However, relationships with fathers are sometimes associated with young women's reproductive health outcomes, (41) and subsequent research should develop measures that incorporate relationships with both fathers and mothers in ways that do not penalize pe·nal·ize  
tr.v. pe·nal·ized, pe·nal·iz·ing, pe·nal·iz·es
1. To subject to a penalty, especially for infringement of a law or official regulation. See Synonyms at punish.

2.
, or assign lower scores, to young women who live only with their mothers.

Family planning clinic visits provide appropriate opportunities for clinic staff to encourage adolescents to talk to parents about sexual matters, including birth control and prevention of STDs. And a number of clinics have adopted practices and policies to promote parental involvement, (42) typically without compromising adolescent confidentiality (43) Most young women using family planning clinics have good relations with parents. Rather than mandating parental involvement for minors, and potentially jeopardizing parental relationships for the minority of adolescents whose parents do not know they are at the clinic, a more effective strategy for promoting positive parental engagement would be to increase support for activities that clinics have undertaken to improve and maintain these relations.

Acknowledgments See About this product.

The authors thank John Santelli and Lawrence Lawrence.

1 City (1990 pop. 26,763), Marion co., central Ind., a residential suburb of Indianapolis, on the West Fork of the White River. It has light manufacturing.

2 City (1990 pop. 65,608), seat of Douglas co., NE Kans.
 Finer for reviewing early drafts of this article. This research was funded in part by the Annie E. Casey Foundation According to their website, "the Annie E. Casey Foundation has worked to build better futures for disadvantaged children and their families in the United States." The foundation is a regular contributor to public broadcasting, including National Public Radio. . The findings and conclusions presented in this article are those of the authors alone.

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  • Faye Resnick
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a chronological study in epidemiology which attempts to establish a relationship between an antecedent cause and a subsequent effect. See also cohort study.
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(3.) The Alan Guttmacher Alan Frank Guttmacher (1898-1974) was an American physician.

He served as president of Planned Parenthood and vice-president of the American Eugenics Society, founded the Association for the Study of Abortion in 1964, was a member of the Association for Voluntary
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(5.) Mosher A mosher is a person who is crossed between goth/punk/skater they have long hair and listen to music like slipknot and metal music. Some people call them headbangers. At certain music shows they have something called a mosh pit, basically its a fight pit with loads of people bashing each other.  WD et al., Use of contraception and use of family planning services in the United States: 1982-2002, Advance Data from Vital and Health Statistics, 2004, No. 350, Table 17.

(6.) Jones RK et al., Adolescents' reports of parental knowledge of adolescents' use of sexual health services and their reactions to mandated parental notification for prescription contraception, Journal of the American Medical Association, 2005, 293(3):340-348; Nathanson Nathanson is the last name of:
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  • Jeff Nathanson
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Also see Natanson.

This page or section lists people with the surname Nathanson.
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n. 1. (Zool.) A European fish (Pagellus centrodontus); the sea bream or braise.
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Things
  • Torres (board game)
  • Francisco Torres
Places
  • Torres (Rio Grande do Sul)
  • Torres Straits
  • Torres Novas
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American Confederate general who was active at the battles of Shiloh (1862) and Chickamauga (1863). He was a founder and the first leader (1866-1869) of the Ku Klux Klan.
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(7.) Abma JC et al., Teenagers in the United States: sexual activity, contraceptive use, and childbearing child·bear·ing
n.
Pregnancy and parturition.



childbearing adj.
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(8.) McNeely C et al., Mothers' influence on the timing of first sex among 14- and 15-year-olds, Journal of Adolescent Health, 2002, 31(3):256-265; Miller KS et al., Family communication about sex: what are parents saying and are their adolescents listening? Family Planning Perspectives, 1998, 30(5):218-222 & 235; and National Campaign to Prevent Teen Pregnancy, With One Voice: America's Adults and Teens Sound Off About Teen Pregnancy, Washington Washington, town, England
Washington, town (1991 pop. 48,856), Sunderland metropolitan district, NE England. Washington was designated one of the new towns in 1964 to alleviate overpopulation in the Tyneside-Wearside area.
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(9.) National Campaign to Prevent Teen Pregnancy, 2003, op. cir. (see reference 8).

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n. pl. con·gru·en·cies
Congruence.
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Main articles: Human sexual behavior, Adolescence, and Adolescent sexuality
Adolescent sexual behavior refers to the sexual behavior of adolescents.
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Santa Cruz (săn`tə krz), city (1990 pop. 49,040), seat of Santa Cruz co., W Calif., on the north shore of Monterey Bay; inc. 1866.
, CA: ETR ETR Estimated Time of Return/Repair
ETR Early to Rise (health e-zine)
ETR Effective Tax Rate
Etr Etruscan (linguistics)
ETR Eastern Test Range
ETR Express Toll Route
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French socialist politician who served as premier (1936-1937, 1938, and 1946-1947). He was imprisoned (1940-1945) by the Vichy government during World War II.
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n.
The branch of medicine concerned with the treatment of youth between 13 and 21 years of age. Also called ephebiatrics, hebiatrics.
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(13.) Resnick MD et al., 1997, op. cit. (see reference 1); Sieving RW, McNeely CS and Blum RW, 2002, op. cit. (see reference 12); and Whitaker Whitaker is a surname and may refer to:
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  • Benjamin Whitaker, British Labour Party politician
  • Brian Whitaker, British journalist
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(14.) Sieving RW, McNeely CS and Blum RW, 2002, op. cit. (see reference 12).

(15.) Whitaker DJ et al., 1999, op. cir. (see reference 13).

(16.) McNeely C et al., 2002, op. cit. (see reference 8).

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(19.) Jaccard J, Dittus PJ and Gordon VV, 1998, op. cit. (see reference 10).

(20.) McNeely C et al., 2002, op. cit. (see reference 8).

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(23.) Jones RK et al., 2005, op. cit. (see reference 6); Torres A, 1978, op. cit. (see reference 6); and Torres A, Forrest JD and Eisman S, 1980, op. cit. (see reference 6).

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  • Annie Kenney, suffragette
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  • Bill Kenney, American football player
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  • Douglas Kenney, co-founder of National Lampoon
  • Ed Kenney, actor
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(27.) Ibid.

(28.) Furstenberg FF et al., 1984, op. cit. (see reference 10).

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(30.) Jones RK et al., 2005, op. cit. (see reference 6).

(31.) Herceg-Baron R et al., Supporting teenagers' use of contraceptives: a comparison of clinic services, Family Planning Perspectives, 1986, 18(2):61-66; and Nathanson CA and Becker MH, 1986, op. cir. (see reference 6).

(32.) Furstenberg FF et al., 1984, op. cit. (see reference 10); Mosher W and Horn M, 1988, op. cir. (see reference 29); and Nathanson CA and Becker MH, 1986, op. cit. (see reference 6).

(33.) Ford BL, An Overview of Hot-Deck Procedures: Incomplete Data in Sample Surveys, Vol. 2, New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
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(34.) Resnick MD et al., 1997, op. cit. (see reference 1); Sieving RW, McNeely CS and Blum RW, 2002, op. cit. (see reference 12); and Whitaker DJ et al., 1999, op. cit. (see reference 13).

(35.) Special tabulations from the 2002 U.S. National Survey of Family Growth.

(36.) Jones RK et al., 2005, op. cir. (see reference 6); and Nathanson CA and Becker MH, 1986, op. cit. (see reference 6).

(37.) National Campaign to Prevent Teen Pregnancy, 2003, op. cit. (see reference 8).

(38.) Jones RK et al., 2005, op. cit. (see reference 6); Torres A, 1978, op. cir. (see reference 6); and Torres A, Forrest JD and Eisman S, 1980, op. cir. (see reference 6).

(39.) Zabin LS, Stark HA and Emerson MR, Reasons for delay in contraceptive utilization utilization,
n 1. the extent to which a given group uses a particular service in a specified period. Although usually expressed as the number of services used per year per 100 or per 1000 persons eligible for the service, utilization rates may be
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(40.) Jones RK et al., 2005, op. cit. (see reference 6).

(41.) Nathanson CA and Becket beck·et  
n. Nautical
A device, such as a looped rope, hook and eye, strap, or grommet, used to hold or fasten loose ropes, spars, or oars in position.



[Origin unknown.]

Noun 1.
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(42.) Finer LB, Darroch JE and Frost JJ, 2002, op. cit. (see reference 4); and Lindberg LD et al., Specialized spe·cial·ize  
v. spe·cial·ized, spe·cial·iz·ing, spe·cial·iz·es

v.intr.
1. To pursue a special activity, occupation, or field of study.

2.
 services at publicly funded U.S. family planning clinics, unpublished manuscript manuscript, a handwritten work as distinguished from printing. The oldest manuscripts, those found in Egyptian tombs, were written on papyrus; the earliest dates from c.3500 B.C. , New York: Guttmacher Institute, 2005.

(43.) Sugland BW, Leon Leon

Medieval kingdom, northwestern Spain. Leon proper included the cities of León, Salamanca, and Zamora—the adjacent areas of Vallodolid and Palencia being disputed with Castile, originally its eastern frontier.
 J and Hudson Hudson, towns, United States
Hudson.

1 Industrial town (1990 pop. 17,233), Middlesex co., E central Mass., on the Assabet River, in an apple-growing region; settled c.1699, inc. 1866.
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** In all, 95 respondents had missing values on at least one item: Forty did not answer any of the items, and most of the rest (47 of the 55) were missing information on only one or two. To reduce the number of missing cases, if a respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests.  answered at least one item, we assigned as·sign  
tr.v. as·signed, as·sign·ing, as·signs
1. To set apart for a particular purpose; designate: assigned a day for the inspection.

2.
 the response "not at all" to the unanswered items.

*** Demographic characteristics for clients aged 15-17 were virtually identical to those of the population that includes adolescents younger than 15, so we do not provide them separately.

**** We do not include information on this outcome in the analysis because of its infrequency and because there were relatively few substantive Substantive may refer to:

In grammar:
  • a noun substantive, now also called simply noun
  • a verb substantive, a verb like English "be" when expressing existence (in contrast to use as a copula)
In law:
 findings.

***** When respondents indicated both conditions, priority was given to "parent suggested the clinic." We examined logistic regression models that excluded young women who indicated both responses and found that the direction and significance of the associations remained the same.

Rachel Rachel, in the Bible
Rachel (rā`chəl), in the Bible, wife of Jacob and mother of Joseph and Benjamin. She is one of the four Jewish matriarchs. An alternate form is Rahel.
 K. Jones is senior research associate and Susheela Singh For the fictional global crime syndicate, see .
Singh is a Sanskrit word meaning "lion". It is used as a common surname and middle name in North India by many communities, especially by the Sikhs and the Rajputs.
 is vice president of research at the Guttmacher Institute, New York Alison Alison

betrays old husband amusingly with her lodger, Nicholas. [Br. Lit.: Canterbury Tales, “Miller’s Tale”]

See : Adultery
 Purcell is a former research assistant at the Guttmacher Institute.

Author contact: rjones@guttmacher.org See .org.

(networking) org - The top-level domain for organisations or individuals that don't fit any other top-level domain (national, com, edu, or gov). Though many have .org domains, it was never intended to be limited to non-profit organisations.

RFC 1591.
 
TABLE 1. Percentage distribution of minor adolescent
females using family planning clinics, 2003, and of all
minor adolescent females and of those who were sexually
active, nationally, 2002--all by selected characteristics

Characteristic                         2003         2002

                                       clinic
                                       clients      All
                                       (N=1,526)    (N=9,834)

Age
<15                                      8.7         na
15                                      18.3         31.3
16                                      31.4         33.1
17                                      41.6         35.6
Race/ethnicity
White                                   55.9         62.9
Black                                   22.7         15.5
Hispanic                                14.7         15.7
Other                                    6.7          5.9
Mother's education
<H.S.graduate                           20.7         15.3
H.S.graduate                            40.9         34.6
Some college                            18.6         25.1
[greater than or equal to] college      19.8         24.9
Living arrangement
Two parents/guardians                   43.2         50.9 ([dagger])
Mother/guardian only                    44.2          u
Father/guardian only                     6.0          u
Other                                    6.5          u
Ever had sex
Yes                                     91.0         30.3
No                                       9.0         69.7
Ever had birth
Yes                                      5.4          3.3
No                                      94.6         96.7
Prior visits to a clinic for birth
control in last 12 months
0                                       41.9          u
1                                       22.1          u
[greater than or equal to] 22           36.0          u

Total                                  100.0        100.0

Characteristic                         2002

                                       Sexually
                                       experienced
                                       (N=4,598)

Age
<15                                     na
15                                      14.4
16                                      32.2
17                                      53.4
Race/ethnicity
White                                   62.2
Black                                   21.2
Hispanic                                13.0
Other                                    3.7
Mother's education
<H.S.graduate                           14.8
H.S.graduate                            40.6
Some college                            25.9
[greater than or equal to] college      18.7
Living arrangement
Two parents/guardians                   35.4 ([dagger])
Mother/guardian only                     u
Father/guardian only                     u
Other                                    u
Ever had sex
Yes                                    100.0
No                                       0.0
Ever had birth
Yes                                     10.7
No                                      89.3
Prior visits to a clinic for birth
control in last 12 months
0                                        u
1                                        u
[greater than or equal to] 22            u

Total                                  100.0

([dagger]) Item assessed whether respondent had been living with both
biological or adoptive parents since birth. Notes: u=unavailable.
na=not applicable. N for 2003 is the actual number of respondents; Ns
for 2002 are weighted to the population and are in thousands.
Percentages may not total 100 because of rounding. Sources:
2003--Guttmacher Institute survey. 2002--special tabulations from the
2002 National Survey of Family Growth.

TABLE 2. Percentage distribution of minor female adolescent family
planning clinic clients, by responses to questions about communication
with parents about selected sexual health topics

Question                              N        Response option

Frequency of discussion                        Not at all    A little

How to say no to sex                  1,486    24.7          13.9
How to prevent getting an STD         1,486    30.6          16.0
How to prevent getting HIV/AIDS       1,486    32.3          17.5
Where to get prescription birth
  control                             1,486    35.0          14.3
How to know when it is appropriate
  for you to have sex                 1,486    23.9          17.8
How to prevent pregnancy              1,486    20.1          23.4
Howto use condoms                     1,486    50.3          13.9

                                               Not/never
Evaluation of discussion              N        talk          A little
How helpful have these
  conversations been for you?         1,478    21.9          22.0

Question                              Response option

                                                  A great
Frequency of discussion               Somewhat    deal       Total

How to say no to sex                  19.5        41.8       100.0
How to prevent getting an STD         19.9        33.4       100.0
How to prevent getting HIV/AIDS       17.5        32.7       100.0
Where to get prescription birth
  control                             18.8        31.9       100.0
How to know when it is appropriate
  for you to have sex                 28.4        29.9       100.0
How to prevent pregnancy              27.9        28.7       100.0
Howto use condoms                     17.2        18.7       100.0

Evaluation of discussion              Somewhat    Very       Total
How helpful have these
  conversations been for you?         27.5        28.5       100.0

Note: Percentages may not total 100 because of rounding.

TABLE 3. Percentage distribution of minor female adolescent family
planning clinic clients, by responses to questions about communication
and overall relationships with parents and perceptions of parents'
attitudes

Question                           N        Response option

COMMUNICATION AND RELATIONSHIP              Agree      Neither
Satisfied with communication
With mother/guardian               1,457    70.8        9.5
With father/guardian               1,253    46.2       17.5
Satisfied with relationship
With mother/guardian               1,459    76.5        7.6
With father/guardian               1,265    58.4       13.6

PERCEIVED PARENTAL ATTITUDES       N        Approve    Neither

About the minor's having sex
Mother/guardian                    1,486    15.5       22.1
Father/guardian                    1,454     7.4       12.8
About the minor's using birth
control (if she was having sex)
Mother/guardian                    1,477    64.8        9.1
Father/guardian                    1,453    36.1       10.8

Question                           Response option

COMMUNICATION AND RELATIONSHIP     Disagree           Total
Satisfied with communication
With mother/guardian               19.7               100.0
With father/guardian               36.3               100.0
Satisfied with relationship
With mother/guardian               16.0               100.0
With father/guardian               28.0               100.0

PERCEIVED PARENTAL ATTITUDES       Disap-    Don't    Total
                                   prove     know
About the minor's having sex
Mother/guardian                    55.4       7.0     100.0
Father/guardian                    61.3      18.5     100.0
About the minor's using birth
control (if she was having sex)
Mother/guardian                    19.0       7.1     100.0
Father/guardian                    33.5      19.5     100.0

Notes: Percentages may not total 100 because of rounding. The
categories "agree," "disagree," "approve" and "disapprove" include
"strongly" responses.

TABLE 4. Percentage distribution of minor female adolescent
family planning clinic clients, by parent-child connectedness
and perceived parental attitudes toward sex and contraceptive
use

Measure                                          %

Connectedness                                    (N=1,477)

Satisfied with communication and relationship     67.9
Neutral toward or satisfied with only one         17.8
Dissatisfied with both                            14.3

Perceived parental attitudes                     (N=1,485)

Approves of birth control, neutral
  toward or approves of sex                       33.6
Approves of birth control, disapproves of sex     30.0
Disapproves of both                               19.2
Other                                             17.2

Total                                            100.0

TABLE 5. Percentage of minor female adolescent family planning clinic
clients reporting parental knowledge of clinic visits and, among these,
percentage reporting how parents found out by communication about
sexuality issues, connectedness with parents and perceived parental
attitudes

Measure                               All clients

                                      N        Parent
                                               knows
                                               at clinic ([dagger])

Total                                 1,431    60.1

Communication
Low (ref)                               341    34.1
Medium-low                              352    51.1 ***
Medium-high                             334    67.3 ***
High                                    399    85.3 ***

Connectedness
Satisfied with communication
  and relationship                      957    70.7 ***
Neutral toward or satisfied with
  only one                              242    38.7
Dissatisfied with both (ref)            198    37.1
Perceived parental attitudes
Approves of birth control, neutral
  toward or approves of sex             492    77.0 ***
Approves of birth control,
  disapproves of sex                    425    68.2 ***
Disapproves of both (ref)               337    24.7
Other                                    56    49.3 ***

                                      Clients whose parents
Measure                               know ([dagger])

                                      N      Voluntarily    Parent
                                             told           suggested
                                             parents        clinic

Total                                 856    65.6           39.5

Communication
Low (ref)                             122    63.1           35.6
Medium-low                            180    58.4           42.1
Medium-high                           222    69.3           35.7
High                                  332    68.1           42.6

Connectedness
Satisfied with communication
  and relationship                    674    68.4           39.2
Neutral toward or satisfied with
  only one                             91    54.8           43.9
Dissatisfied with both (ref)           77    58.4           37.4
Perceived parental attitudes
Approves of birth control, neutral
  toward or approves of sex           373    71.0 **        36.4
Approves of birth control,
  disapproves of sex                  394    61.0 *         45.6
Disapproves of both (ref)             163    43.6           46.5
Other                                 117    72.5 ***       32.0

* p < .05. ** p <. 01. *** p < .001. ([dagger]) Excludes teenagers who
do not use the clinic for sexual health services. Note: refeference
group.

TABLE 6. Odds ratios from logistic regression models examining
associations between parental knowledge of clinic
visits and selected characteristics of minor female adolescent
family planning clinic clients

Characteristic                       Parent knows    Parent
                                     vs. does not    suggested clinic
                                     know            vs. minor told
                                     (N=1,387)       voluntarily
                                                     (N=757) ([dagger])

PARENTAL RELATIONS
Communication
Low (ref)                            1.00             1.00
Medium-low                           1.54 **          1.14
Medium-high                          2.32 ***         0.89
High                                 5.18 ***         1.07

Connectedness
Satisfied with communication
  and relationship                   2.38 **          0.73
Neutral toward or satisfied
  with only one                      1.01             0.90
Dissatisfied with both (ref)         1.00             1.00

Perceived parental attitude
Approves of birth control, neutral
  toward or approves of sex          5.39 ***         0.53
Approves of birth control,
  disapproves of sex                 4.50 ***         0.72
Disapproves of both (ref)            1.00             1.00
Other                                2.43 **          0.38 *

DEMOGRAPHIC
Age
<15                                  3.72 **          2.10 *
15                                   1.76 *           1.98 **
16                                   1.47 *           1.22
17 (ref)                             1.00             1.00

Race/ethnicity
White (ref)                          1.00             1.00
Black                                1.57             1.26
Hispanic                             0.83             0.93
Other                                0.75             0.95

Mother's education
<H.S.graduate                        1.97 **          1.11
H.S. graduate                        1.59 *           1.16
Somecollege                          1.55             0.72
[greater than or equal to] college
  (ref)                              1.00             1.00

Living arrangement
Two parents/guardians (ref)          1.00             1.00
Mother/guardian only                 1.77 ***         0.98
Father/guardian only                 1.26             0.25 **
Other                                0.98             1.03

SEXUAl/CONTRACEPTIVE BEHAVIOR
Ever had birth
Yes                                  2.00             0.46 *
No (ref)                             1.00             1.00

Prior visits to a clinic for birth control in last 12 months
0                                    0.31 ***         1.20
1                                    0.62 **          0.80
[greater than or equal to] 2 (ref)   1.00             1.00

Months since first sex               1.01 **          0.99 *

* p<.05. ** p<.01. *** p<.001. ([dagger]) Excludes those whose parents
found out some other way. Note: ref=reference group.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:surveys
Author:Purcell, Alison
Publication:Perspectives on Sexual and Reproductive Health
Geographic Code:1USA
Date:Dec 1, 2005
Words:9210
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