Teenagers' sexual behavior might become more risky if parents had to know of family planning clinic visits.

Most U.S. teenagers younger than 18 who use clinic-based sexual health services do so with their parents' knowledge, according to an analysis of data from 79 family planning clinics across the country. (1) If parental notification were legally mandated, 59% of young women say they would go to a clinic for prescription contraceptives; however, 13% would use rhythm or withdrawal, and 6% would have sex without contraceptives. Only 7% would stop having sex. The strongest predictor of continued clinic attendance is having parents who know about current attendance.

A random sample of publicly funded clinics participated in the study. Staff distributed a questionnaire to women younger than 18 who were seeking sexual health services (other than abortion or pregnancy care) in 2003-2004. Respondents were asked about their demographic characteristics, sexual experience, contraceptive use and parents' knowledge of their clinic visit, and about what they would do if clinics were legally required to notify parents when teenagers got prescription birth control. The final sample comprised 1,526 adolescents. Researchers used t tests and logistic regression to assess relationships between adolescents' background characteristics and three outcomes: whether their parents knew they used the clinic for sexual health services, whether they would attend a clinic for birth control if a parental notification law were enacted and whether they would engage in unsafe sex (i.e., use withdrawal, rhythm or no method) in the case of such a mandate.

Most respondents (73%) were aged 16 or 17; 56% were white, 23% were black, 15% were Hispanic, and 7% reported other races and ethnicities. Twenty percent had mothers who were college graduates, 43% lived in two-parent households and 44% lived with a mother only. Nine percent had never had sex. Among sexually experienced young women, 90% had used a contraceptive at last intercourse; of these, just under half (45%) had used a hormonal method. Five percent of respondents had ever given birth, and 58% had gone to a clinic for contraceptive services in the past 12 months.

Parental Knowledge

Sixty percent of respondents said that a parent or guardian knew they came to the clinic. Moreover, 56% had told a parent voluntarily or had come at a parent's suggestion; 5% said that parents had found out some other way. The most common explanation for parents' ignorance of clinic attendance was not wanting parents to know about sexual activity (25%).

Bivariate analyses suggested that a number of factors were related to decreased levels of parental knowledge: being aged 15 or older, stating a race or ethincity other than black, having a family structure other than mother only, having never given birth, not having used hormonal contraceptives at last sex or having never had sex, and having gone to a clinic for contraceptive services fewer than two times in the past year.

Multivariate analyses revealed that respondents aged 16 and 17 were significantly less likely than those younger than 15 to report parental knowledge (odds ratios, 0.5 and 0.3, respectively). The odds ratios were significantly lower among Hispanics and "other" racial and ethnic groups than among blacks (0.3-0.4); among adolescents whose mothers were college graduates than among those whose mothers were high school graduates (0.5); and among respondents who lived with both parents or a nonparent than among those who lived with their mother only (0.5 and 0.6). Adolescents who had used a condom only or withdrawal at last sex were significantly less likely than those who had used a hormonal method to report parental knowledge (0.5 for both). Reporting fewer than two contraceptive visits in the past year was significantly associated with a decreased likelihood of parental knowledge (0.4-0.6), and having ever given birth was linked to an increased likelihood (2.5).

Responses to Parental Notification Laws

Of all respondents, 59% said they would still visit a clinic for birth control if parental notification were legally required. Forty-six percent would use over-the-counter methods, 18% would go to a private doctor for prescription birth control, 13% would use rhythm or withdrawal, and 6% would have unprotected sex (multiple responses were allowed). Seven percent would stop having sex, though only 1% indicated that this would be their only reaction.

At the bivariate level, a number of background characteristics were significantly associated with continued clinic attendance; four of these relationships persisted in multivariate analyses. Adolescents whose parents did not know they came to the clinic or had found out on their own had a significantly decreased likelihood of reporting continued attendance (odds ratios, 0.1 and 0.4, respectively). The likelihood was also significantly lower among respondents of "other" races and ethnicities than among blacks (0.5) and among respondents whose mothers had graduated from college than among those whose mothers were high school graduates (0.6).

Bivariate analyses revealed a range of indicators that adolescents might have unsafe sex in response to parental notification laws. When these factors were examined in multivariate analyses, the likelihood of indicating unsafe sex was significantly elevated among adolescents who were at the clinic without their parents' knowledge (odds ratio, 2.6); said that their parents had found out against their wishes (3.2); were Hispanic or an "other" race or ethnicity (2.2 and 2.4); had a mother with some college education (2.2); had ever given birth (1.9); and had used withdrawal or no method at last sex (3.9 and 2.2).

The researchers acknowledge that their sample does not represent all U.S. adolescents and that respondents' actual behavior may not replicate their reported intentions. They emphasize that "while a majority of all teenagers attending clinics expected that they would use clinic-based contraceptive services in the face of mandated parental involvement, this response was the majority only among adolescents with parents who already knew they were at the clinic." Laws requiring parental involvement, they conclude, "would discourage few teenagers from having sex and would likely increase rates of adolescent pregnancy and STDs."

REFERENCE

(1.) 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.