Factors Associated With Being Pleased With a Female Partner Pregnancy Among Sexually Active U.S. Adolescent Males

Abstract

Adolescent pregnancy remains a major U.S. public health problem. Little is known about pregnancy attitudes in U.S. adolescent males. The study objective was to identify factors from different domains that are associated with sexually active U.S. adolescent males who would be pleased with a female partner pregnancy (hereafter known as pleased with a pregnancy). The National Survey of Family Growth is a nationally representative survey of those 15 to 44 years old. Bivariate and multivariable analyses were performed of the 2002 and 2006-2010 cycles to examine factors associated with being pleased with a pregnancy among sexually active U.S. males. Among the 1,445 sexually active U.S. adolescent males surveyed, 25% would be pleased with a pregnancy. In bivariate analyses, ever being suspended from school, having sporadic health insurance, age, and ever HIV tested were significantly associated with being pleased with a pregnancy. In final multivariable analyses, sporadic insurance was associated with almost triple the odds, and being older and ever HIV tested with double the odds of being pleased with a pregnancy. Higher educational attainment for both adolescent males and adolescent males’ fathers was associated with reduced odds of a being pleased with a pregnancy. One quarter of sexually active U.S. adolescent males would be pleased with a pregnancy. Adolescent males who have been sporadically insured, are older, and ever HIV tested have higher odds of being pleased with a pregnancy. Targeting these adolescent males for more focused pregnancy-prevention counseling may prove useful in reducing adolescent pregnancy rates.

Keywords

adolescent pregnancy attitudes risk factors adolescent males

Introduction

Despite recent declines, the U.S. adolescent birth rate remains the highest of all industrialized countries (Centers for Disease Control and Prevention, 2011; Hamilton & Ventura, 2012; The National Campaign to Prevent Teen and Unplanned Pregnancy, 2012). Among males 15 to 44 years old, almost 15% have fathered at least one child before the age of 20 (Martinez, Chandra, Abma, Jones, & Mosher, 2006). In the most recent national analyses available, almost 10% of adolescent births to 15- to 17-year-old females were fathered by a male older than 20 years (Lindberg, Sonenstein, Ku, & Martinez, 1997). Studies conducted in Texas demonstrate rates of 20% to 33% of adolescent births were fathered by older males (Agurcia, Rickert, Berenson, Volk, & Wiemann, 2001; Castrucci, Clark, Lewis, Samsel, & Mirchandani, 2010).

Factors from many different domains, including individual, family, and environmental have been identified that are associated with adolescent fatherhood or adolescent males who have impregnated a female partner. Individual factors have been associated with adolescent fatherhood or adolescent males who impregnated a female partner including race/ethnicity, age, academic performance, school grade, alcohol and drug use, forced sexual contact, delinquency, inconsistent condom use, the number of sexual partners, receipt of sex education, sexually transmitted infection (STI) history, employment, being homeless, religion, and attitudes toward premarital births (Elster, Lamb, & Tavare, 1987; Fagot, Pears, Capaldi, Crosby, & Leve, 1998; Greene & Ringwalt, 1998; Hanson, Morrison, & Ginsburg, 1998; Kirby, 2002; Ku, Sonenstein, & Pleck, 1993; Lerman, 1993; Pierre, Shrier, Emans, & Durant, 1998; Resnick, Chambliss, & Blum, 1993; Spingarn & Durant, 1996; Guagliardo, Huang, & D’Angelo, 1999). Family factors include parental marital status, socioeconomic status, family violence, being born to an adolescent father or an adolescent mother, number of children born to mother, early parental separation/divorce, lack of a father figure, parental educational attainment, and mother’s employment status (Gohel, Diamond, & Chambers, 1997; Hanson et al., 1998; Kirby, 2002; Sipsma, Biello, Cole-Lewis, & Kershaw, 2010; Tan & Quinlivan, 2006). Environmental factors include neighborhood disadvantage and U.S. region (Hanson et al., 1998; Lindberg & Orr, 2011).

There has been limited research, however, on adolescent males’ attitudes regarding female partner pregnancy. Research on the fertility intentions of poor adult males demonstrates that, although many of these males do not use contraception, they do not intend to impregnate their partner (Augustine, Nelson, & Edin, 2009). Nonetheless, these males may have ambivalent or positive attitudes regarding a pregnancy. Research suggests that fatherhood can have a positive value in low-income communities, and some males who unintentionally impregnated their partner may gain the social respect of being a father without the full parental responsibilities (Augustine et al., 2009). For inner-city adolescent males, fatherhood for some may serve as mark of manhood and the ability to control females (Anderson, 1994).

Few studies have identified factors associated with attitudes regarding pregnancy. One nationally representative study identified age, current school enrollment, having at least a college degree, and peers’ beliefs toward contraceptive use as associated with negative attitudes regarding a pregnancy with a current partner in young adults (Hayford & Guzzo, 2013). An urban study of African-American and Puerto Rican young adults identified relationship duration, frequency of sex, and cohabitation were associated with a being pleased with a pregnancy (Carter, Kraft, Hock-Long, & Hatfield-Timajchy, 2013). Only one study, however, has specifically examined factors associated with adolescent males’ attitudes regarding a female partner pregnancy (Marsiglio, 1993), but the findings are more than 20 years old and did not examine factors such as the adolescent males’ highest educational attainment, number of female sexual partners in the adolescent males’ lifetime, receipt of formal education on contraception and how to say no to sex, and age of sexual debut.

Given that adolescent males’ attitudes toward a pregnancy are associated with impregnating a female partner (Rocca, 2010), additional research is needed to identify factors associated with adolescent males’ attitudes regarding a female partner pregnancy. Social ecological theory (Concoran, 1999), in which factors from multiple domains (individual, peer/partner, family, etc.) can directly and indirectly influence a behavior, was used as a framework for identifying potential variables that might be associated with being pleased with a pregnancy. It is theorized that factors from the different levels are likely associated with being pleased with a pregnancy, as they are with adolescent pregnancy (Kirby, 2002). Specifically, it is hypothesized that those factors that are positively associated with adolescent pregnancy involvement also would be positively associated with being pleased with a female partner pregnancy in males. Factors associated with adolescent and young adult males being pleased with a female partner pregnancy include race/ethnicity and gender role attitudes (at the individual level), and neighborhood quality (at the environmental level; Hayford & Guzzo, 2013). In adolescent females, socioeconomic status, parental education, and sexual health discussions (at the family level) are associated with being pleased with a pregnancy (Cavazos-Rehg et al., 2013).

Because of their possible relationship with pregnancy involvement and being pleased with a pregnancy among adolescent males, other variables included in the analysis were (1) being sporadically insured, given that sporadically insured children are more likely to have unmet medical needs and access barriers to care, including receipt of preventive care and having a usual source of care, where pregnancy-prevention discussions often occur (Olson, Tang, & Newacheck, 2005); (2) taking a virginity pledge, given that adolescents who take virginity pledges are less likely to use contraception and increasing the risk of pregnancy (Rosenbaum, 2009); (3) timing and source of sex education, given that these two factors are associated with adolescent pregnancy among females (Goldfarb et al., 1977); (4) accompanying a female partner to or receiving services at a family-planning clinic, given that adolescent males may be involved in pregnancy-prevention discussions during these visits, and obtaining contraception was the top reason for adolescent males to attend a family-planning clinic (Brindis et al., 1998); and (5) believing it is difficult to impregnate someone, given that concerns about fertility may cause adolescent males to not take an active role in pregnancy prevention with their female partners (Schwartz, Brindis, Ralph, & Biggs, 2011).

No study, however, has examined whether factors from different domains including sociodemographics, sexual behavior and receipt of sexual education, use of family-planning and medical services, and family and sexual attitudes might be associated with being pleased with a female partner pregnancy (hereafter known as pleased with a pregnancy) in adolescent males. By identifying which factors are associated with being pleased with a pregnancy among adolescent males, it may be possible to identify those adolescent males who are at higher risk for impregnating their female partner and in need of focused family-planning counseling. The study aim was to identify factors in the four different domains that are associated with being pleased with a pregnancy among sexually active U.S. adolescent males 15 to 19 years old.

Method

Data Source

The National Survey of Family Growth (NSFG), a nationally representative survey of U.S. individuals 15 to 44 years old, collects data on sexual activity and related issues, including contraception and pregnancy; adoption, marriage, and divorce; child care; and family and sexual attitudes (Lepkowski, Mosher, Davis, Groves, & Van Hoewyk, 2006). Adolescents 15 to 19 years old comprised 2,271 and 4,662 of the interviews in the 2002 and 2006-2010 cycles (Groves, Mosher, Lepkowski, & Kirgis, 2009). These were the latest cycles of the NSFG available for analysis. Interviews were not conducted between 2003 and 2005. Use of NSFG sample weights provides estimates that generalize to the entire noninstitutionalized U.S. population of adolescents 15 to 19 years old (Lepkowski et al., 2006; Lepkowski, Mosher, Davis, Groves, & Van Hoewyk, 2010).

Parental consent and adolescent assent were obtained for adolescents 15 to 17 years old in the NSFG (Groves et al., 2005; Lepkowski et al., 2013). Consent was obtained from adolescents older than or equal to 18 years old. The adolescent response rate was 81% in the 2002 NSFG, and 77% in the 2006 to 2010 NSFG (Groves et al., 2009; Lepkowski et al., 2013). Detailed information about the NSFG sampling procedures and study design is available elsewhere (Groves et al., 2005; Groves et al., 2009; Lepkowski et al., 2006, 2010).

Institutional review board approval was not required, given that this was a secondary database analysis with no personal identifiers.

Definitions and Variables

The primary outcome—being pleased with a pregnancy—was assessed for all sexually active adolescent males 15 to 19 years old using the following NSFG survey item: “If you got a female pregnant now, how would you feel? Would you be very upset, a little upset, a little pleased, or very pleased?” If the respondent insisted, the response of “would not care” could be entered. The responses “a little pleased” or “very pleased” were categorized as pleased with a pregnancy, and “a little upset” and “very upset” as not pleased with a pregnancy. Sensitivity analyses were performed in which the response “would not care” was classified either as pleased or not pleased with a pregnancy, but neither alternate classification changed the bivariate or multivariable results. In the final analyses, “would not care,” therefore, was classified as being pleased with a pregnancy. The decision is supported by research demonstrating that young adult males who “would not care” if they impregnated a female now, are less likely to use contraception consistently, increasing their partner pregnancy risk (Gohel et al., 1997). Adolescent males were considered sexually active if they ever reported having vaginal sexual intercourse with a female.

The focus of this study was adolescent males 15 to 19 years old, given that most studies examining factors associated with pregnancy attitudes have targeted males older than or equal to 18 years (Carter et al., 2013; Hayford & Guzzo, 2013; Higgins, Popkin, & Santelli, 2012; Rosengard, Phipps, Adler, & Ellen, 2005).

Factors from four domains were analyzed to examine their association with being pleased with a pregnancy. Variables from the different domains are listed below.

Sociodemographics

Variables in this domain include race/ethnicity, country of birth, parents’ marital status, school suspensions, living away from home, working full-time, sporadic insurance coverage, school grade, family income, type of insurance, mother’s age of first child, parental educational attainment, number of children born to mother, ever jailed, religion importance, type of residence, current attendance of religious services, age, always living with parents, male or female presence in home at 14 years old, attendance of religious services at 14 years old, mother’s employment status, and ever lived in a homeless shelter. Race/ethnicity was self-identified by the adolescent. Adolescents who self-identified as Asian/Pacific Islander or American Indian/Alaska Native were combined into an “other” category, because of small sample sizes. As per the NSFG, adolescents were considered to be sporadically insured if they were uninsured for part, but not all, of the past 12 months. An adolescent was classified by the NSFG as having lived away from home if, before 18 years old, the adolescent left home to attend college, serve in the Armed Forces, or take up residence in any other circumstance that did not include time spent at a boarding school, institution, group home, or jail.

Sexual Behavior and Receipt of Sexual Education

Sexual-behavior variables include age of sexual debut, number of female sexual partners in the past 12 months and during the lifetime, age of the first female partner, use of female method to prevent pregnancy, condom use at last sex, use of a male method (condoms, withdrawal, or sterilization) to prevent pregnancy, and whether the male was forced to have vaginal sex with female partner.

Receipt of sexual education included questions on formal education on how to say no to sex, formal education on contraceptives, discussion of sexual education topics with parents, grade at first sexual and contraceptive education, and taking a virginity pledge.

Family Planning and Medical Services

Variables in this domain included testing and diagnoses for different STIs, having a usual source of care, receipt of a physical exam and a testicular exam in the past 12 months, receiving advice about different STIs, receipt of services at a family planning clinic or Planned Parenthood (PP), believing it is difficult to get someone pregnant, accompanying a female partner to a family planning clinic or PP and believing it is physically possible to get someone pregnant.

Family/Sexual Attitudes

Variables in this domain included attitudes on who should work and who should take care of the home, discussions about condom use with partner, unmarried females having children, views regarding a work mother’s relationship with her children compared with a nonworking mother, physical pleasure with condom use, unmarried adults living together, the importance of a man spending time with his family, the appropriate age for sexual intercourse, sexual acts between consenting adults are acceptable, and the rewards of parenting.

Analyses

Data from the two cycles of the NSFG were pooled for analysis. Given that studies demonstrate that adolescent fatherhood is significantly associated with happiness that their partner became pregnant, and that over time, expectant adolescent fathers’ feelings regarding a pregnancy become more positive, only sexually active males 15 to 19 years old who were not parenting or had not recently impregnated a female partner were included in the sample (Gohel et al., 1997; Westney, Cole, & Munford, 1986). The NSFG used regression imputation for certain missing variables that are used frequently in analysis (Lepkowski et al., 2006; Lepkowski et al., 2010). Bivariate analyses were performed using PROC SURVEY procedures in SAS version 9.1 to adjust for the complex sampling design of the NSFG and to produce weighted estimates. SAS code developed for the NSFG was used for the analyses. A detailed description of the development of the weighted variables in the NSFG is beyond the scope of this article; detailed information on NSFG sample weights are described elsewhere (Lepkowski et al., 2006; Lepkowski et al., 2010).

In keeping with published guidelines, Bonferroni adjustments were not performed, given that a specific a priori hypothesis was tested (that sociodemographic characteristics, sexual behavior, and receipt of sexual education, use of family planning and medical services, and family and sexual attitudes are associated with being pleased with a pregnancy among adolescent males), rather than performing analyses without an a prior hypothesis or testing a general hypothesis (Perneger, 1998).

Sociodemographic characteristics were compared for sexually active adolescent males who were pleased versus not pleased with a pregnancy, followed by bivariate analyses to identify associations of sexual behaviors, receipt of sexual education, use of family planning and medical services, and family and sexual attitudes, with a being pleased with a pregnancy. Chi-square and t-tests were used for categorical and continuous variables, respectively. These tests analyze column and row percentages within each variable, and post-hoc analyses were performed to examine pairwise comparisons within categorical variables.

Two-step multivariable analyses were performed to examine adjusted associations of sociodemographic factors, sexual behavior history, receipt of sexual education history, family-planning and medical-services history, and family and sexual attitudes with being pleased with a pregnancy. Variables were checked for collinearity before being entered into multivariable analyses, resulting in some variables, including the mother’s highest level of education, ever being suspended from school, and ever lived away from home not being included in the final multivariable models. All noncollinear variables in the bivariate analyses were simultaneously entered into the first logistic regression analyses. Statistically significant variables (p < .05) from the first logistic regression analysis were then forced into the final logistic regression analysis.

Results

Sample

The mean age of the sexually active U.S. adolescent males in the sample was 17.5 years old (SD ± .04; Table 1). African-American adolescents made up 21% (296) and Latino adolescents made up 18% (255) of the population studied. Over one-quarter (27.3% or 381) of adolescents had an annual family income >400% of the federal poverty level. One-third (33% or 455) of adolescents were publicly insured. More than half (53% or 745) of adolescents had ever been suspended from school. Additional descriptions of the adolescent population studied are available in Table 1.

Table 1.

Selected Sociodemographic Characteristics of Sexually Active U.S. Adolescent Males.

Characteristics	n	Weighted mean (± SE) or proportion (%)
Age, years	1,395	17.5 (±0.04)
Race/ethnicity
White	777	55.7%
African -American	296	21.2%
Latino	255	18.3%
Other	67	4.8%
U.S.-born	1,288	92.3%
Highest school grade attended
≤9th	141	10.1%
10th	198	14.2%
11th	261	18.7%
12th	437	31.3%
At least some college	359	25.7%
Family income
<100% poverty level	190	13.6%
100% to 199% poverty level	102	7.3%
200% to 299% poverty level	360	25.8%
300% to 399% poverty level	363	26.0%
≥400% poverty level	381	27.3%
Type of insurance in last 12 months
Uninsured	93	6.7%
Private	848	60.8%
Public	455	32.6%
Always lived with parents^a	868	62.2%
Ever been suspended from school	745	53.4%

Has the adolescent always lived with his biological/adopted parents.

A total of 1,395 interviews were conducted with sexually active adolescent males 15 to 19 years old; 25% (380) reported being pleased with a pregnancy. Responses frequencies for the question, “If you got a female pregnant now, how would you feel?” were the following: 18% (68) would be very pleased, 6% (23) would be a little pleased, 1% (4) would not care, 37% (141) would be a little upset, and 38% (144) would be very upset.

Bivariate Analysis: Sociodemographic Characteristics

Of the sexually active adolescent males surveyed, 16% (125) of Whites, 33% (97) of African-American 41% (105) of Latinos, and 38% (26) of other races/ethnicities would be pleased with a pregnancy (Table 2). Compared with adolescent males who would not be pleased with a pregnancy, adolescent males who would be pleased with a pregnancy were less likely to be U.S.-born and have married biological parents, and more likely to be ever suspended, ever lived away from home, ever worked full-time for more than 6 months, and have sporadic insurance coverage. Higher proportions of adolescent males who would be pleased with a pregnancy had a lower educational attainment, had a low family income (<300% of the poverty level), were uninsured or publicly insured, had a mother whose age at the birth of her first child was younger than 25 years, had parents with a lower educational attainment, and had mother who gave birth to more than or equal to three children. Compared with adolescent males who would not be pleased with a pregnancy, adolescent males who would be pleased with a pregnancy were more likely to have been jailed. Higher proportions adolescent males who would be pleased with a pregnancy were more likely to state that religion was not important, to rent their residence, and to rarely attend religious services. The following variables were examined and were not significant: age, always living with parents, having a male parent or figure at home at 14 years old, having a female parent or figure at home at 14 years old, religious service attendance, and ever lived in a homeless shelter.

Table 2.

Bivariate Analysis of Association of Sociodemographic Characteristics With Being Pleased With a Pregnancy Among Sexually Active U.S. Adolescent Males 15 to 19 Years Old.

	Pleased with a pregnancy		Not pleased with a pregnancy
	(n = 380)		(n = 1,015)
Characteristic	n	Weighted mean (± SE) or proportion (%)	n	Weighted mean (± SE) or proportion (%)	p
Race/ethnicity					<.01
White	125	16.1%	652	83.9%
African -American	97	32.8%^a	295	67.2%
Latino	105	41.3%^a	255	58.7%
Other^b	26	38.1%	67	61.9%
U.S.-born	312	88.2%	976	94.0%	<.01
Biological parents married	257	67.7%	792	78.0%	<.01
Ever suspended from school	258	67.8%	490	48.3%	<.01
Ever lived away from home	118	18.7%	68	11.6%	<.01
Ever worked full-time >6 months	135	35.6%	158	15.6%	<.01
Sporadic insurance coverage	120	31.6%	132	13.0%	<.01
Highest school grade attended					<.01
≤9th	55	39.2%^c	86	60.8%
10th	70	35.4%^c	128	64.6%
11th	70	26.9%	191	73.1%
12th	96	22.1%	340	77.9%
At least some college	62	17.3%	296	82.7%
Family income					<.01
<100% poverty level	68	35.9%^d	122	64.1%
100% to 199% poverty level	38	37.8%^d	63	62.2%
200% to 299% poverty level	108	29.9%^d	252	70.1%
300% to 399% poverty level	83	22.8%	280	77.2%
≥400% poverty level	50	13.2%	331	86.8%
Type of insurance in last 12 months					<.01
Uninsured	48	51.5%^e	45	48.5%
Private	157	18.5%	691	81.5%
Public	152	33.4%^e	303	66.6%
Mother’s age at first child					<.01
<18 years old	77	32.2%^f	132	67.8%
18-19 years old	87	37.2%^f	157	62.8%
20-24 years old	130	26.8%^f	347	73.2%
25-29 years old	50	14.9%	215	85.1%
≥30 years old	18	9.8%	121	90.2%
Father’s highest educational attainment					<.01
Not high school graduate	103	42.4%^g	125	57.6%
High school graduate or GED^h	138	27.6%	362	72.4%
Some college	56	18.3%	251	81.7%
Bachelor’s degree or higher	41	13.2%	219	86.8%
Mother’s highest educational attainment					<.01
Not high school graduate	85	45.9%^g	100	54.1%
High school graduate or GED	129	25.9%	367	74.1%
Some college	98	24.5%	302	75.5%
Bachelor’s degree or higher	93	12.5%	274	87.5%
Number of children born to mother					.01
1	21	15.7%	114	84.3%
2	105	21.7%	379	78.3%
≥3	225	29.0%^h	551	71.0%
Ever jailed	52	13.7%	71	7.0%	.01
Importance of religion					.01
Very important	31	16.6%	111	83.4%
Somewhat important	140	20.9%	416	79.1%
Not important	119	29.8%ⁱ	283	70.2%
Type of residence					.02
Own	191	22.2%	672	77.8%
Rent	163	30.6%^j	370	69.4%
Frequency of current religious services attendance					.04
>Once weekly	74	23.2%	246	76.8%
≥Once monthly	118	27.2%	315	72.8%
>Several times a year	86	20.4%	335	79.6%
>Rarely or never	77	34.7%^k	145	65.3%
Age, years		17.5 (± 0.05)		17.7 (± 0.05)	.06
Has always lived with parents	225	59.2%	642	63.3%	.28
Male parent or parent-figure in home at 14 years old					.31
Biological father	58	21.3%	174	79.0%
Step father	51	23.8%	134	76.2%
No father figure	95	29.5%	217	70.5%
Other father figure	32	25.3%	83	74.7%
Attendance of religious services at 14 years old					.62
At least weekly	171	26.3%	479	73.7%
At least monthly	76	22.3%	265	77.7%
Few times a year	68	24.9%	206	75.1%
Never	39	30.3%	90	69.7%
Female parent or parent-figure in home at 14 years old					.92
Biological mother	187	24.8%	486	75.2%
Other mother figure	37	26.6%	88	73.4%
No mother figure	12	23.8%	34	76.2%
Mother’s employment status					.96
Full-time	230	25.4%	672	74.6%
Part-time	65	26.1%	186	73.9%
Full-time and part-time	11	27.9%	29	72.1%
Not working	48	23.9%	154	76.1%
Ever lived in homeless shelter	8	2.0%	20	2.0%	.99

Note. GED = general equivalency degree.

p < .05 for pairwise comparison with Whites.

Asian/Pacific Islander and American Indian/Alaska Native.

p < .01 for pairwise comparison with at least some college.

p < .01 for pairwise comparison with ≥400% poverty level.

p < .01 for pairwise comparison with private insurance.

p < .01 for pairwise comparison with ≥30 years old.

p < .05 for pairwise comparison with bachelor’s degree or higher.

p < .01 for pairwise comparison with ≥3 children.

p < .01 for pairwise comparison with religion very important.

p < .05 for pairwise comparison with own residence.

p < .01 for pairwise comparison with weekly current religious service attendance.

Bivariate Analysis: Sexual Behavior and Receipt of Sexual Education

The mean age of sexual debut was slightly lower for adolescent males who would be pleased with a pregnancy (Table 3). The mean number of female sexual partners in the past 12 months and in their lifetime was slightly higher for adolescent males would be pleased with a pregnancy The mean age of their first female sexual partner was slightly lower for adolescent males who would be pleased with a pregnancy. Lower proportions of adolescent males who would be pleased with a pregnancy used a female method to prevent pregnancy at sexual debut or received formal education on how to say no to sex. The following variables were examined and were not significant: condom used with last sex, used male method to prevent pregnancy at last sex, male forced to have vaginal sex, received formal contraceptive education, discussed sexual education topics with parents, grade at first sexual education or contraceptive education, and taking a virginity pledge.

Table 3.

Bivariate Analysis of the Association of Sexual Behavior, Sexual Education, Family Planning and Medical Services, and Family/Sexual Attitudes With Being Pleased With a Pregnancy Among Sexually Active U.S. Adolescent Males 15 to 19 Years Old.

	Pleased with a pregnancy		Not pleased with a pregnancy
Characteristic	n	Weighted mean (±SE) or proportion(%)	n	Weighted mean (±SE) or proportion (%)	p
Sexual behavior history
Age of sexual debut, years		14.3 (±0.13)		14.8 (±0.08)	<.01
Number of female sexual partners in past 12 months		2.3 (±0.2)		2.1 (±0.1)	<.01
Number of lifetime female sexual partners		3.9 (±0.2)		3.3 (±0.1)	<.01
Age of first female sexual partner, years		15.2 (±0.13)		15.4 (±0.08)	.02
Used female method to prevent pregnancy at sexual debut	239	75.3%	538	84.3%	.03
Condom used with last sex	208	71.8%	525	79.2%	.09
Used male method to prevent pregnancy at last sex	299	83.2%	797	88.8%	.10
Forced to have vaginal sex	6	5.9%	16	3.7%	.34
Sexual education history
Received formal education on how to say no to sex	251	70.7%	849	83.7%	<.01
Received formal contraceptive education	144	41.2%	332	33.7%	.09
Sexual education topics discussed with parents	301	86.1%	933	89.6%	.20
Grade of first sexual education					.61
≤6th	124	21.3%	378	78.7%
7th-9th	147	23.2%	433	76.8%
≥10th	25	25.1%	75	74.9%
Grade at first contraceptive education					.66
≤6th	58	21.5%	163	78.5%
7th-9th	144	23.3%	438	76.7%
≥10th	34	25.4%	94	74.6%
Virginity pledge	13	5.0%	39	4.9%	.96
Family planning and medical services
Ever tested for HIV	127	28.6%	186	16.3%	<.01
Usual source of medical care	255	66.4%	791	78.0%	<.01
Physical exam in past 12 months	220	57.8%	686	68.1%	<.01
Diagnosed with herpes	6	1.6%	3	0.3%	.06
Testicular exam in past 12 months	198	52.0%	597	58.8%	.09
Received STI testing past 12 months	99	26.1%	207	20.4%	.13
Diagnosed with chlamydia in past 12 months	16	4.1%	157	15.5%	.15
Diagnosed with syphilis	3	0.8%	2	0.2%	.15
Diagnosed with gonorrhea in past 12 months	206	54.2%	257	25.3%	.16
Diagnosed with genital warts	4	1.0%	3	0.3%	.21
Received STI treatment in past 12 months	23	6.1%	42	4.1%	.28
Received advice about STI	95	25.1%	220	21.7%	.33
History of pregnancy ending in abortion	170	44.7%	339	33.4%	.34
Received advice about HIV	96	25.2%	228	22.5%	.38
Received services at family planning clinic or Planned Parenthood	90	23.6%	268	26.4%	.42
Difficulty getting someone pregnant	8	2.0%	27	2.7%	.62
Gone with female partner to family planning clinic or Planned Parenthood	40	10.4%	121	11.9%	.63
Physically able to get someone pregnant	372	98.0%	993	97.8%	.86
Family/sexual attitudes
Agree that a man should work and the woman should take care of home	188	49.5%	327	32.2%	<.01
Feel comfortable talking with partner about condom use					.01
No chance	212	23.9%	677	76.1%
A little chance	66	23.7%	213	76.3%
50-50 chance	20	20.3%	79	79.7%
A pretty good chance	40	44.6%^a	50	55.4%
Almost certain chance	15	39.1%	23	60.9%
Acceptable for unmarried female to have children	269	70.9%	634	62.5%	.03
Agree that a working mother can have a warm/secure relationship with her children similar to a nonworking mother	288	75.9%	785	77.3%	.26
Feel less physical pleasure with condom					.28
No chance	54	25.0%	166	75.0%
A little chance	89	22.2%	312	77.8%
50-50 chance	107	31.7%	232	68.3%
A pretty good chance	68	23.7%	222	76.3%
Almost certain chance	31	23.0%	106	77.0%
Agree a young couple should not live together unless married	98	25.9%	222	21.9%	.30
Agree that is important for man to spend a lot of time with family	247	65.1%	692	68.2%	.41
Acceptable for unmarried 16-year-olds to have sex	228	59.9%	591	58.2%	.68
Any sexual act between consenting adults is acceptable	326	85.8%	856	84.3%	.71
Agree that with the statement “The rewards of parenting are worth it”	347	91.2%	921	90.7%	.83
Acceptable for unmarried 18-year-olds to have sex	333	87.6%	890	87.7%	.99

Note. STI = sexually transmitted infection.

p < .01 for pairwise comparison with no chance.

Bivariate Analysis: Family Planning and Medical Services

Ever being tested for HIV was associated with higher proportions of adolescent males who would be pleased with a pregnancy. Lower proportions of adolescent males who would be pleased with a pregnancy had a usual source of care and a physical exam in the past 12 months. The following variables were examined and were not significant: testicular exam in the past 12 months; STI testing in the past 12 months; diagnosed with herpes, chlamydia, syphilis, gonorrhea, or genital warts; received treatment for an STI; received advice about an STI or HIV; received services at a family planning clinic or PP; accompanied a female partner to a family planning clinic or PP; believing it physically impossible to impregnate a female; and believing it would be difficult to impregnate a female.

Bivariate Analysis: Family/Sexual Attitudes

For adolescent males, higher proportions of adolescent males who would be pleased with a pregnancy agreed that a man should work and a woman should take care of the home, there was a pretty good chance of feeling comfortable talking with their partner about condom use, and that it was acceptable for an unmarried female to have children. The following variables were examined and were not significant: attitudes regarding a working mother’s relationship with children, less physical pleasure with a condom, unmarried couples living together, men spending time with the family, the age unmarried adolescents can have sex, and the rewards of parenting.

Multivariable Analysis

Of the variables that were significantly associated with being pleased with a pregnancy in bivariate analysis, only seven remained significant in the initial multivariable analyses (Table 4). Socioeconomic status and type of insurance were not significant in the initial multivariable analysis.

Table 4.

Initial Multivariable Analysis of Factors Associated With Being Pleased With a Pregnancy Among Sexually Active U.S. Adolescent Males 15 to 19 Years Old.

Characteristic	Odds ratio (95% confidence inerval) of being pleased with a pregnancy
Sociodemographic
Sporadic insurance coverage	2.6 (1.7, 4.0)
Latino	2.5 (1.7, 3.8)
Age	1.9 (1.4, 2.4)
Ever tested for HIV	1.9 (1.2, 2.9)
African-American	1.6 (1.1, 2.2)
Highest school grade attended	0.5 (0.4, 0.6)
Father’s highest educational attainment	0.7 (0.5, 0.9)
Other	1.9 (0.96, 3.7)
Number of children born to mother	1.3 (0.9, 1.9)
Mother’s age at first child	0.9 (0.8, 1.1)
Attendance of religious services	0.9 (0.7, 1.3)
Importance of religion	0.9 (0.6, 1.3)
Current religious services attendance	0.9 (0.7, 1.3)
Family income	0.9 (0.8, 1.2)
Ever worked full-time >6 months	0.8 (0.7, 1.9)
Has health insurance	0.7 (0.3, 2.1)
Own residence	0.6 (0.7, 1.2)
U.S.-born	0.6 (0.3, 1.4)
Sexual behavior history
Age of first female sexual partner	1.3 (0.9, 1.6)
Age of sexual debut	1.1 (0.8, 1.6)
Number of female sexual partners in the past 12 months	1.1 (0.9, 1.2)
Number of lifetime female sexual partners	0.8 (0.6, 1.1)
Female method to prevent pregnancy at first sex	0.6 (0.3, 1.2)
Sexual education history
Grade at first contraceptive education	1.3 (0.6, 2.6)
Virginity pledge	0.9 (0.1, 10.7)
Sexual education topics discussed with parents	0.5 (0.1, 3.0)
Received formal sexual education	0.7 (0.3, 1.5)
Family planning and medical services
Testicular exam in the past 12 months	1.2 (0.7, 2.0)
Difficulty getting someone pregnant	1.0 (0.6, 1.9)
Gone with female partner to family planning clinic or Planned Parenthood	1.0 (0.8, 1.3)
Family planning and medical services
Usual source of medical care	0.9 (0.7, 1.2)
Physical exam in the past 12 months	0.9 (0.5, 1.4)
Sexual/family attitudes
Any sexual act between consenting adults is acceptable	1.7 (0.6, 4.9)
Acceptable for unmarried female to have children	1.5 (1.01, 2.3)
Acceptable for unmarried 16-year-olds to have sex	1.3 (0.4, 3.8)
Agree young couple should not live together unless married	1.0 (0.3, 3.3)
Feel less physical pleasure with condom	1.0 (0.7, 1.3)
Acceptable for unmarried 18-year-olds to have sex	0.8 (0.2, 4.1)
Feel comfortable talking with partner about condom use	0.8 (0.6, 1.2)
Agree that it is important for man to spend a lot of time with family	0.6 (0.3, 1.6)
Agree that a man should work and the woman should take care of home	0.4 (0.2, 1.1)

In the final multivariable model, only five variables were retained. Sporadic insurance, ever testing for HIV, and older age were associated with higher odds of being pleased with a pregnancy (Table 5). The adolescent males’ highest school grade attended and higher paternal educational attainment were associated with significantly lower odds of being pleased with a pregnancy.

Table 5.

Multivariable Analysis of Factors Associated With Being Pleased With a Pregnancy Among Sexually Active U.S. Adolescent Males 15 to 19 Years Old.

Characteristic	Odds ratio (95% confidence interval) of being pleased with a pregnancy
Sporadic insurance coverage	2.5 (1.6, 3.8)
Ever tested for HIV	2.0 (1.2, 3.1)
Age	1.9 (1.5, 2.4)
Highest school grade attended	0.5 (0.4, 0.6)
Father’s educational attainment	0.7 (0.5, 0.9)

Additional analyses that included all theoretically important variables and interaction terms, including age and education level, did not change the multivariable findings (results not reported).

Analyses comparing only adolescent males who would be very pleased with a pregnancy versus those who would be very upset with a pregnancy, resulted in older age being associated with double the odds of being very pleased with a pregnancy, and highest school grade attended and family income associated with lower odds of being very pleased with a pregnancy (results not reported).

Discussion

Our study findings reveal that one quarter of sexually active U.S. adolescent males 15 to 19 years old would be pleased with a pregnancy. Sporadic health insurance was associated with 2.5 times the odds and ever tested for HIV was associated with double the odds of being pleased with a pregnancy. Paternal educational attainment and older age were associated with reduced odds of a being pleased with a pregnancy.

The percentage of sexually active adolescent males who would be pleased with a pregnancy is surprisingly high, given the efforts on reducing adolescent pregnancy. Most of the emphasis on pregnancy prevention has been placed on adolescent females, however, and involving adolescent males in pregnancy prevention has recently been a priority. The latter is essential, given that boyfriends’ desires about a pregnancy were associated with adolescent females’ desires about pregnancy (Cowley & Farley, 2001; Davies et al., 2003) and an adolescent pregnancy (Crosby, DiClemente, Wingood, Harrington, & Davies, 2002; Rocca, 2010); and happiness about impregnating a current partner in adolescent males are associated with impregnating a female partner within 2 years (Rocca, 2010). For some adolescent males, especially those that are poor, self-esteem can be derived from fatherhood as seen in one study (Marsiglio, 1993). Being pleased with being pregnant or impregnating a partner may reflect the social marginalization of specific adolescent groups, including racial/ethnic minorities, those in foster care, the homeless or runaways, and the impoverished (Healthy Teen Network, 2008). These populations have been reported to have a greater likelihood of being pleased with impregnating a partner in males and adolescent pregnancy in females and males (Cavazos-Rehg et al., 2013; Greene & Ringwalt, 1998; Hayford & Guzzo, 2013; Kearny & Levine, 2012; Marsiglio, 1993; Oshima, Narendork, & McMillien, 2013; Resnick et al., 1993; Tucker et al., 2012).

Sporadic health insurance (but not socioeconomic status) was associated with being pleased with a pregnancy, even after adjustment for relevant confounders, including Latino or African-American race/ethnicity, age, income, and the father’s educational attainment. No prior published study, to our knowledge, has identified an association between sporadic health insurance and being pleased with a pregnancy. It has been demonstrated that children with sporadic insurance have lower odds of preventive visits (Olson et al., 2005) and that preventive counseling, including discussions about sexual health, usually occur during preventive visits (Henry-Reid et al., 2010). Even among sexually active adolescent males who made preventive visits, only one-third discussed STIs, HIV, or pregnancy prevention with their health care provider (Burstein, Lowry, Klein, & Santelli, 2003). Adolescent males, especially those who are sporadically insured, might be pleased with a pregnancy because of a possible lack of counseling regarding pregnancy prevention. The American Academy of Pediatrics recommends that sexual and reproductive health care including discussions of pregnancy prevention and contraception be provided at all clinical visits by adolescent males (Marcell, Wibbelsman, Seigel, & Committee on Adolescence, 2011). This is especially important for adolescent males who are sporadically insured.

Having ever tested for HIV was associated with being pleased with a pregnancy, after controlling for age, an association that has not been reported in the literature. It is possible those adolescent males who have been tested for HIV engage in risky sexual activities, such as unprotected sexual activity. Other studies have demonstrated that HIV testing has been associated with a having more than one sexual partner within the past year and history of STIs in adolescents and young adults (Samet, Winter, Grant, & Hingson, 1997; Tolou-Shams et al. 2007). HIV testing of adolescent males also can be health promoting, by protecting others or providing an assessment of risky sexual behaviors (Wallace, McLellan-Lemal, Harris, Townsend, & Miller, 2011), or may be demanded by potential female partners before entering into a new sexual relationship. HIV testing in some adolescent males may represent a greater belief of the need to be free from all STIs in preparation to procreate; no research exists examining this belief and being pleased with a pregnancy among adolescent males.

Our study indicates that higher paternal educational attainment (but not family income) is associated with reduced odds of being pleased with a pregnancy in adolescent males. This is a noteworthy finding, given that the full model adjusted for income and other relevant confounders. One might hypothesize that fathers with higher educational attainment might be more likely to discuss sexual health topics or the importance of an education with their adolescent sons. Parental education may play a role in adolescent males’ attitudes regarding pregnancy, given that in one study, low maternal education has been reported to be associated with pregnancy intentions in adolescent males (Rosengard et al., 2005).

In our study, older age was associated with being pleased with a pregnancy, yet higher educational attainment was associated with reduced odds of being pleased with a pregnancy in adolescent males. Given that the analyses adjusted for age and age is strongly correlated with grade level, these results suggest that it is older adolescent males with lower educational attainment who have especially high odds of being pleased with a pregnancy. In two studies, a history of ever being expelled or suspended from school, which can result in grade retention or possibly withdrawing from school, and older age for grade have been associated with adolescent fatherhood (Elster et al., 1987; Ku et al., 1993; Stouthamer-Loeber & Wei, 1998).

Certain study limitations should be noted. The NSFG was not a prospective but rather a cross-sectional study. Although certain questions about past events, such as age of sexual debut and frequency of religious attendance at 14 years, may be subject to recall bias in cross-sectional studies, given that the survey items focused on recent experiences of 15- to 19-year-old males, the data provided are likely accurate (Martinez, Copen, & Abma, 2011). The NSFG was conducted only in English and Spanish, so individuals with limited English proficiency who spoke a primary language other than Spanish were excluded. Adolescents required parental consent to participate in the NSFG, which may result in potential selection bias. The prevalence of being pleased with a pregnancy in sexually active adolescent males may actually be higher or lower, given that adolescent males may have selected the response that they viewed as being more socially desirable. It is important to note that not all adolescent males who would be pleased with a pregnancy will end up impregnating a female partner. The high percentage of adolescent males who have been suspended from school may have contributed to the high percentage of adolescent males who would be pleased with a pregnancy. Information was not available on whether adolescents were in the appropriate grade level for their age and had behavioral issues or learning disabilities. Although only one item was used to assess whether adolescent males would be pleased with a pregnancy, this was the identical approach used to assess adolescent males’ pregnancy attitudes in previous studies using nationally representative databases (Carter et al., 2013; Hayford & Guzzo, 2013). The NSFG did not question adolescent males about exposure to domestic violence, or about emotional, physical, or sexual abuse, but did ask about non-voluntary intercourse with a female, which was not associated with pregnancy attitudes in our analysis. Information was not available on adolescent males’ knowledge about contraceptive options, and concern or distrust regarding specific contraceptive methods. Pregnancy desire, timing, and happiness toward a current or previous pregnancy were only asked of adolescent males who recently impregnated a partner or were parenting and could not be examined in our overall study sample.

There are several study strengths. This is the first study, to our knowledge, to examine associations of sociodemographic factors, sexual behavior history, receipt of sexual education history, family planning, and medical service history, and family and sexual attitudes with a being pleased with a pregnancy in a nationally representative study of sexually active U.S. adolescent males. Our study identified variables that were associated with being pleased with a pregnancy that had not been previously associated with adolescent fatherhood including sporadic health insurance and HIV testing. Additionally, the NSFG is a household, not a school-based survey, so adolescents who were and who were not enrolled in school are included.

The study findings have several research, clinical, and policy implications. With the Centers for Disease Control recommendations to offer HIV testing to anyone older than or equal to 13 years (Branson et al., 2006), the relationship between HIV testing and being pleased with a pregnancy in adolescent males may not be relevant. The association of paternal educational attainment with adolescent males being pleased with a pregnancy is an area that requires further study. Longitudinal studies examining academic difficulties, pregnancy attitudes, and pregnancy among adolescent males may be useful for developing a clinical screening tool to identify adolescent males at greatest risk for impregnating a female partner and to guide family-planning efforts. By identifying adolescent males who may be at greatest risk for impregnating a partner, more focused family-planning counseling can occur, which potentially might prevent adolescent pregnancies. Given the high prevalence of U.S. adolescent males who would be pleased with a pregnancy, clinicians might consider asking adolescent males about pregnancy attitudes at every clinical visit, especially those who are sporadically insured, for pregnancy attitudes are associated with pregnancy intentions and female partner pregnancy within 2 years (Rocca, 2010). National and state organizations, including the American Academy of Pediatrics, Centers for Disease Control and Prevention, Society for Adolescent Health and Medicine, The Partnership for Male Youth, and Texas Health Steps have developed webinars, clinical reports, and toolkits for clinicians to effectively discuss sexual and reproductive with adolescent males, particularly when dealing with limited resources and time. The findings also suggest that to prevent adolescent pregnancy, it may be most useful to screen for sporadic insurance in adolescents, provide continuous health insurance coverage for adolescents, and provide sexual and reproductive health care, including discussions regarding pregnancy prevention at every clinical encounter involving adolescent males, especially those that are sporadically insured. Finally, clinicians can play a greater role in preventing adolescent pregnancy by collaborating with, programs, schools, social service organizations, workforce initiatives, and other community organizations to develop interventions and strategies that may alter adolescent males’ positive attitudes regarding a female partner pregnancy, and decrease adolescent pregnancy rates.

Footnotes

Authors’ Note

Presented in part as a platform presentation at the annual meeting of the Pediatric Academic Societies, May 5, 2013, Washington, D.C.; and as a poster at the annual meeting of the Society of Adolescent Health and Medicine, March 15, 2013, Atlanta, GA.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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