Abstract
Amid national trends in postponed parenthood and more diverse family structures, the fatherhood identity may be important to men’s sexual behaviors. This study examined factors associated with reports of consistent contraceptive use and multiple sexual partners across fatherhood status. Using public data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Wave V (2016–2018), two sexual behaviors were examined among 1,163 men aged 32 to 42 years. Outcomes were two binary indicators: consistent contraceptive use with partner and having multiple (≥2) sexual partners in the past year. Fatherhood status was categorized as nonfather, resident father, and nonresident father. Demographic (e.g., race/ethnicity, education, income, and relationship type) and health-related (e.g., drinking, perceived stress, depressive symptoms, and insurance status) factors were considered. Logistic regression analysis produced odds ratios and 95% confidence intervals and were stratified by fatherhood categories. In the sample, 72% of men were resident fathers, 10% were nonresident fathers, and 18% were nonfathers; 28% reported consistent contraceptive use and 16% reported multiple sexual partners. For nonfathers, relationship type and race were associated with reporting multiple sexual partners. For resident fathers, relationship type was the crucial factor associated with consistent contraceptive use and reporting multiple sexual partners. In nonresident fathers, relationship type, education, and income were important factors to consistent contraceptive use and reporting multiple sexual partners. Key findings suggest that relationship type, income, and education are crucial factors to men’s sexual behavior. Heterogeneous effects were observed across fatherhood status. This study adds to limited research on fatherhood and sexual behavior among men transitioning from young adulthood to middle age.
Introduction
Contraceptive use and number of sexual partners are widely recognized as important sexual behaviors that affect rates of pregnancy, sexually transmitted diseases or infections (STDs or STIs), and HIV (Bowleg et al., 2021; Frost et al., 2007; Mercer et al., 2018). Engaging in multiple sexual partnerships, both concurrent (sexual relationship overlap across time) and consecutive (sequential sexual relationships), have been identified as a key driver for HIV and other STIs (Ashenhurst et al., 2017; Centers for Disease Control and Prevention, 2023; Hock-Long et al., 2013; Pflieger et al., 2013). Nationally, rates of STIs have increased to an all-time high in the past 2 years, with more than 2.5 million cases of chlamydia, gonorrhea, and syphilis being reported in 2019 (Centers for Disease Control and Prevention, 2022). Contraceptive methods, such as male condom use, are known to be effective protection against HIV, STIs, and unintended pregnancy (Gavin et al., 2017). Still, incorrect, inconsistent, and condom nonuse remain common among men who have sex with men and women who have sex with men (Abara et al., 2017; Copen, 2017). To address these sexual behaviors specifically in male populations, Healthy People 2030 included objectives to (a) “increase the proportion of adolescent males who used a condom the last time they had sex,” and (b) “reduce gonorrhea rates in male adolescents and young men” (Office of Disease Prevention and Health Promotion, n.d.). These public health priorities reflect the importance of focusing on men’s sexual behaviors as a critical component of men’s health and well-being.
The vast majority of research and interventions on sexual behaviors, such as contraceptive use and the number of sexual partners, in male populations has disproportionately prioritized adolescent and young adulthood contexts. This aligns with developmental perspectives viewing sexual behaviors through the lens of sexual risk in youth and healthy relationships with advancing age (Ashenhurst et al., 2017; Vasilenko, 2017, 2022). In other words, the prevalence, predictors, and risks associated with sexual behaviors and outcomes vary across life stages (O’Donovan, 2009; Vasilenko, 2022). Significantly, less attention has focused on the meaningful contexts by which male sexual behaviors occur at later life stages, with the exception of sexual orientation (Braithwaite et al., 2015; Chittamuru et al., 2018; Martinez et al., 2017; Sawyer et al., 2018). It may be important to consider fatherhood as an important social identity in shaping men’s sexual behaviors. In 2014, the U.S. Census Bureau reported that 60% (74.7 million) of men aged 15 years and older are fathers (Monte & Knop, 2019). In addition, the age in which men begin fathering children has increased from 27 years to 31 years during the past four decades (Khandwala et al., 2017). Coupled with postponed entry into fatherhood, social policies and norms have evolved to support family structures beyond that of two-parent, married households. For example, in the United States, 65% (80 million) of all births are to unmarried couples and the rate of children living with their father only has rapidly increased from 1.7 million in 1990 to 3.3 million in 2020 (Shipe et al., 2022; U.S. Census Bureau, 2021).
Becoming a father has been linked to a positive expression of masculine identity that can foster health-promoting behaviors and dissuade health-undermining behaviors (Gordon et al., 2013; Griffith et al., 2016). The transition to fatherhood is a pivotal moment in a man’s life that can have significant impacts on his social development, personal growth, and overall well-being (Baldwin et al., 2018; Kotelchuck, 2022a; Ramchandani et al., 2005). This has been attributed to the father role, prompting a shift from individualism toward increased responsibility and care for others (Garfield et al., 2010; White et al., 2012). While most of the literature on fatherhood and health centers health outcomes for children, recent studies highlight the influence of fatherhood on men’s health (Caldwell et al., 2019; Kotelchuck, 2022b; Torche & Rauf, 2021). Fathers who are actively involved in their children’s lives tend to have better mental health, higher levels of self-esteem, and greater life satisfaction compared with those who are not involved (Astone & Peters, 2014). Just as fatherhood can have many positive impacts on men’s health, it can also have effects that are not optimal for men’s health. Research highlights detrimental health effects associated with fatherhood that include sleep disruptions, weight gain, increased stress, and decreased testosterone (Gettler et al., 2017; Saxbe et al., 2018). Garfield and colleagues (2014) used nationally representative longitudinal data to observe changes in depressive symptoms as young men transitioned to fatherhood. They observed that resident fathers had a 68% increase in depressive symptom scores from the time they became a father through their child’s fifth year of life, which could affect child development (Garfield et al., 2014).
Along with the overall family structure, the concept of fatherhood has changed over time, and it is important to note its dynamic nature (Casey et al., 2016; Garfield et al., 2006; Hamm et al., 2018; Lemmons & Johnson, 2019). In the past, fatherhood was associated with being a husband and the family’s financial provider, whereas it is more common for today’s fathers to be single, living outside of their child’s household, and engaging with more caregiving activities. The experience and level of engagement of fathers may be influenced by a range of determinants, including socioeconomic status (SES; for example, education, income, and occupation), family structure, and relationship status. For example, research highlights how fathers’ residential status is associated with their level of involvement with their child (Castillo et al., 2011; Goldberg, 2015). Resident fathers, who live with their child, may have more opportunity for valuable engagement, while nonresident fathers may experience more challenges to the same level of involvement. Relative to fathers who live with their child, nonresident fathers likely experience challenges to child involvement that stem from economic and time constraints as well as navigating co-parenting (Violi et al., 2022). These factors may shape fatherhood experiences and challenges in ways that are unique to their particular circumstances; thus, research is needed that assesses the ways that father identities function across health domains.
There is limited research about the sexual behaviors of men after young adulthood; in particular, there is a dearth of information about the sexual behaviors of fathers. Some evidence has indicated that fathers play an important role in steering children, notably sons, toward positive sexual behaviors (Frye et al., 2013; Grossman et al., 2019; Jones et al., 2017; Randolph et al., 2017). One study identified that young men with involved fathers during childhood were less likely to engage in multiple sexual partnerships than those who did not grow up with involved fathers (Barton et al., 2015). Another study, focused on communication about consistent condom use among Black and Latino father–son dyads, reported that some fathers were unable to effectively communicate with sons because they had knowledge and skills gaps about correct condom use (Guilamo-Ramos et al., 2019). In recent years, emerging evidence indicates that men’s identities as fathers shape their sexual behaviors. In a qualitative study of condom use and concurrent sexual partnerships concurrency among heterosexually active Black men, participants identified fatherhood as a motivation to reduce inconsistent condom use and concurrent sexual partnerships (Frye et al., 2013). In one study, fathers reported that communicating about proper condom use with their son improved their own condom use (Guilamo-Ramos et al., 2019). Although nascent, these findings suggest that fatherhood may benefit sexual behaviors in men. Currently, there are no published studies directly comparing sexual behaviors in men without children and fathers. Thus, our objective was to examine factors associated with men’s contraceptive use and number of sexual partners across fatherhood status. Understanding more about the sexual behaviors of men by fatherhood status could be a means to prevent the spread of STIs to sexual partners, reduce unintended pregnancies, and model positive sexual behaviors to offspring and youth.
Method
Study Data
This study used public data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Add Health follows a nationally representative cohort study of adolescents into adulthood and focuses on social, behavioral, and physical health outcomes across their life span. Add Health used a multistage, stratified, clustered sampling design, where schools were systematically sampled to reflect the diversity of adolescents across census region, urbanicity, school size, and racial composition in the United States (Harris et al., 2019). The first Wave of data (Wave I) surveyed adolescents in Grades 7 to 12 from 1994 to 1995, with follow-up survey interviews conducted 1 year later (Wave II; 1995–1996), 7 years later (Wave III; 2001–2002), 14 years later (Wave IV; 2008–2009), and 23 years later (Wave V; 2016–2018). We focus on men’s fatherhood status and reproductive health in Wave V, when respondents are aged from 32 to 42 years. At this wave, the response rate was 71.8%. As this study involved the secondary analysis of publicly available, de-identified data, it was not considered as human subjects research, as defined by federal regulations, and did not require approval from an ethics committee or institutional review board. Survey weights were applied to account for Add Health’s complex sampling design and ensure representativeness.
Measures
We examined men’s sexual behaviors using two binary outcomes. Consistent contraceptive use was based on the question, “On average, how often do you or your partner use a contraceptive method of birth control or disease prevention?” Available answers included none of the time, some of the time, about half of the time, most of the time, and all of the time. To assess consistent contraceptive use, answers were collapsed into categories where “yes” indicates those who responded all of the time and “no” indicates all other responses. This conceptualization aligns with recommendations set forth by contraceptive services to ensure that clients use contraceptives correctly and consistently (Gavin et al., 2017). Multiple sexual partners in the past year was a measure of whether or not male participants engaged in sexual activity with more than one person in the past year. Participants were asked to consider all types of sexual activity and report the number of male or female partners they have had sex with in the past 12 months, even if only once. Answer options ranged from none to 16 or more. This count measure was dichotomized (0 = 0–1 partner, 1 = 2+ partners). The threshold of two or more female sexual partners has been applied by other researchers to examine the number of opposite-sex sexual partners men had in the same time frame (Copen, 2017; Evans et al., 2017; Vasilenko et al., 2018; Vasilenko & Lanza, 2014). Reports of none or one sexual partner were collapsed into one category because 5% of respondents reported having no sexual partner in the past year.
Fatherhood Status
Fatherhood status was defined using the household roster (reported household members and their relationship) and data on live childbirths (reports on each living child they have fathered) (Garfield et al., 2014, 2016). Men who listed a biological or stepchild in their household roster or living (biological) child were categorized as fathers. Among fathers, residence was based on their household roster. Men who did not live with their child were considered nonresident fathers. Taken together, fatherhood status was coded into three categories: resident fathers, nonresident fathers, and nonfathers (no reports of fathering or living with a child). Nonfathers were the referent group in analysis.
Demographic Variables
Demographic variables included participant’s age when interviewed, race/ethnicity, education, personal income, and relationship type at Wave V. In particular, self-reported race/ethnicity was categorized as non-Hispanic White, non-Hispanic Black, Hispanic, and multiracial. The multiracial category included male participants with self-reports of identifying as some combination of more than one racial and ethnic group. Relationship type was categorized as married, cohabitating with a partner, and single to reflect the increasing prevalence and acceptance of cohabiting couples in the United States.
Covariates
Health-related factors were included as covariates in the analyses to account for confounding effects with sexual behaviors. Weight status (healthy weight, overweight, or obesity), any tobacco use in the past month (0 = no, 1 = yes), frequency of heavy episodic drinking in the past year, perceived stress, depressive symptoms, and insurance status (private insurance, public insurance, or no insurance) were included in the analyses. Frequent heavy episodic drinking measured whether or not participants consumed five or more drinks in a row at least 2 days a month over the past 12 months. At Wave V, Add Health included validated measures of perceived stress and depressive symptoms. Perceived stress was measured using a four-item short version of the original Perceived Stress Scale (Cohen et al., 1983). A sample item was “I felt difficulties were piling up so high that I could not overcome them,” and items were rated in a 0 to 4 scale from never to very often, with scores ranging from 0 to 16 (α = .765). A measure of depressive symptoms consisted of five items that paralleled the Center for Epidemiologic Studies–Depression scale (CES-D) negative affect subscale to measure depressive symptoms (Perreira et al., 2005). A sample item was “In the past 7 days, I felt that I could not shake the blues” and items were rated in a 0 to 3 scale, from never or rarely to most or all of the time, with scores ranging from 0 to 15 (α = .783; Dennis et al., 2022). Higher scores for both measures indicated higher severity of stress and depressive symptoms.
Statistical Analysis
Weighted descriptive statistics were calculated using analysis of variance and χ2 tests to characterize the sample. Because there are no known studies examining correlates by fatherhood status, we stratified descriptive statistics by this variable. In our sample, the prevalence of consistent contraceptive use and multiple sexual partners in the past year were both greater than 10%. Evidence suggests using weighted modified Poisson regression to estimate prevalence ratios when the outcome is greater than 10% (Zou, 2004). However, Akaike information criterion values supported logistic regression fit the data better than modified Poisson regression. Survey-weighted logistic regression models that produced odds ratios (ORs) and corresponding 95% confidence intervals (CI) were run and stratified by fatherhood status. This contributes to emerging understandings of the health protections and risks linked to fathers’ sexual health (Garfield et al., 2010; Hamm et al., 2018; Kotelchuck, 2022a; Lu et al., 2010; Neshteruk et al., 2022). We do not directly compare results from different models but base our conclusions on observed patterns. All p values < .05 were considered statistically significant and all tests were two-sided.
The initial sample included men who participated in Wave V, had a valid sampling weight, were born in the United States, and romantically attracted to women (n = 1,584). Male respondents were excluded from the sample if they had missing data on the outcomes of interest (n = 282). Adoptive and foster fathers (n = 95) and non-Hispanic Asian men (n = 46) were excluded from the sample because sample sizes were not sufficient across fatherhood categories to allow computational analyses. After these exclusions, our analytic sample included 1,163 respondents. Analyses were conducted using STATA Version 16.1 (Stata Corp, 2020).
Results
The distribution of select characteristics for men is shown in Table 1. Of the 1,163 men in the sample, 236 were nonfathers (18%), 836 were resident fathers (72%), and 91 were nonresident fathers (10%). In addition, most of the men in the sample were non-Hispanic White (72%); completed high school, vocational, or technical school (46%); were married (70%); had obesity (41%); no reported tobacco uses in the past month (57%); did not report frequent heavy episodic drinking in the past 12 months (65%); no diagnosis of diabetes or hypertension; and were privately insured (73%). The mean age for the sample was 36.8 years. On average, perceived stress scores were moderate (6.91; range = 0–16) and depressive symptom scores were low (3.21; range = 0–15) in the overall sample. In the sample, 28% reported consistent contraceptive use and 16% reported multiple sexual partners in the past year.
Weighted Descriptive Statistics of Male Participants by Fatherhood Status, Add Health Wave V, 2016 to 2018.
Note. Mean and proportional differences calculated using analysis of variance and χ2 tests.
P value < .05 indicates statistical significance.
With respect to these characteristics, differences by fatherhood status were observed. The mean age was higher in nonresident fathers (37.4 years), relative to nonfathers (36.2 years) and resident fathers (36.8 years).
The smallest proportion of non-Hispanic White men were nonresident fathers (56%), and the smallest proportion of non-Hispanic Black men (11%) were resident fathers. The largest proportion of men reporting less than a high school education (15%) and incomes less than US$30,000 (50%) were nonresident fathers, whereas the largest proportion of men reporting incomes of at least US$75,000 were resident fathers (38%). The largest proportion of married men were nonresident fathers (82%), whereas the largest proportion of single men were nonresident fathers (33%). Nonresident fathers represented the largest proportion of men who reported tobacco use (68%) and frequent heavy episodic drinking (50%). The largest proportion of men with private insurance were resident fathers (77%), and the largest proportion of men with public insurance or no insurance were nonresident fathers (24% and 29%, respectively). The largest proportion of men reporting multiple sexual partners were nonresident fathers (42%). Across fatherhood status, there were similar proportions of men reporting Hispanic or multiracial ethnicity, higher education, overweight and obesity, perceived stress, depressive symptoms, and consistent contraceptive use.
Table 2 reports the association between variables and odds of consistent contraceptive use across fatherhood status. Cohabitating with a partner (vs. being married) was associated with lower odds of consistent contraceptive use among resident (OR = 0.38, 95% CI [0.19, 0.75]) and nonresident (OR = 0.14, 95% CI [0.02, 0.78]) fathers, after adjusting for other factors. In nonfathers, those reporting personal incomes of US$30,000 to US$49,999 (vs. less than US$30,000) had lower odds of consistent contraceptive use (OR = 0.24, 95% CI [0.06, 0.86]) and those without insurance (vs. private insurance) had lower odds of consistent contraceptive use (OR = 0.18, 95% CI [0.03, 0.91]), after adjusting for other factors. In resident fathers, those reporting tobacco use (vs. nonuse) had lower odds of consistent contraceptive use (OR = 0.58, 95% CI [0.39, 0.86]) and those reporting multiple sexual partners in the past year (vs. 0–1 partner) had lower odds of consistent contraceptive use (OR = 0.53, 95% CI [0.28, 0.99]), after adjusting for other factors. In nonresident fathers, going to graduate and professional school (vs. less than high school) was associated with lower odds of contraceptive use (OR= 0.03, 95% CI [0.00, 0.34]), after adjusting for other factors.
Logistic Regression Models Predicting Consistent Contraceptive Use With Partner Among Male Participants, Stratified by Fatherhood Status, Add Health Wave V (2016–2018).
Source. Add Health, Wave V (2016–2018).
Note. Analysis adjusts for complex sampling design.
P value < .05 indicates statistical significance.
Table 3 presents the odds of reporting multiple sex partners in the past year across fatherhood status. In all fatherhood status groups, single men were more likely to report multiple sex partners in the past year, compared with married men. Among nonfathers, being non-Hispanic Black was associated with higher odds of reporting multiple sexual partners in the past year (OR = 7.50, 95% CI [1.70, 33.14]), compared with being non-Hispanic White, after adjusting for other factors in the model. Specific to resident fathers, a 1-year age increase was associated with higher odds of reporting multiple sexual partners in the past year (OR = 1.21, 95% CI [1.03, 1.42]), and cohabiting with a partner (vs. being married) was associated with higher odds of reporting multiple sexual partners in the past year (OR = 2.95, 95% CI = [1.48, 5.89]), after adjusting for other factors. Among nonresident fathers, college education (vs. less than high school) had higher odds of reporting multiple sexual partners in the past year (OR = 14.10, 95% CI [1.47, 134.48]), and a personal income of US$30,000 to US$49,999 (vs. less than US$30,000) had lower odds of reporting multiple sexual partners in the past year (OR = 0.04, 95% CI [0.00, 0.85]), after adjusting for other factors.
Logistic Regression Models Predicting Multiple Sexual Partners Among Male Participants, Stratified by Fatherhood Status, Add Health Wave V (2016–2018).
Source. Add Health, Wave V (2016–2018).
Note. Analysis adjusts for complex sampling design.
P value < .05 indicates statistical significance.
Discussion
The objective of this study was to examine factors associated with reports of consistent contraceptive use and multiple (≥2) sexual partners across fatherhood status. Overall, we found heterogeneous effects between key predictors and sexual behaviors within fatherhood status. For nonfathers, income was associated with lower odds of consistent contraceptive use, while being single and non-Hispanic Black were associated with higher odds of reporting multiple sexual partners. For resident fathers, being in a cohabiting relationship was associated with lower odds of consistent contraceptive use, while being unmarried (i.e., single or cohabiting) was associated with higher odds of reporting multiple sexual partners. Also in this group, consistent contraceptive use was associated with lower odds of reporting multiple sexual partners. For nonresident fathers, more education and being in a cohabitating relationship were associated with lower odds of consistent contraceptive use; more education and being single were associated with higher odds of reporting multiple sexual partners, and more income was associated with lower odds of reporting multiple sexual partners. Taken together, key findings suggest that relationship type, income, and education are important factors to men’s sexual behavior, which are discussed in this section. This study makes an important contribution to the limited knowledge base on men’s sexual behaviors by describing factors associated with two behaviors that are integral to sexual health through men’s father identity, which may become more salient to men’s health with age.
The rise and social acceptance of cohabitation relationships has changed the landscape of relationship formations and may be a determining aspect of men’s sexual behavior as it influences patterns of family development and contraceptive use (Sweeney et al., 2015; Wagner, 2019a). Within our study, both resident and nonresident fathers in cohabiting relationships were less likely to consistently use contraceptives with a partner, compared with their married counterparts. Previous research has explored the reproductive context of cohabitation, with an emphasis on contraceptive use among cohabiting couples (Sweeney, 2010; Sweeney et al., 2015; Wagner, 2019b). In contrast to our finding, research suggests that cohabiting couples are more likely to use effective contraceptive methods compared with their married counterparts. The misalignment between our study and extant evidence may result from research focusing on reports from women and excluding male perspectives. On the contrary, research on contraceptive use among unmarried men observed that cohabiting men had a lower prevalence of using any method of contraception (70.5%) compared with those who were never married (89.3%) (Daniels & Abma, 2017). In understanding the effect of cohabitation on reproductive health behaviors, researchers have described cohabitation as a selective experience that differs significantly from marriage across various demographic characteristics (Copen, 2017; Goodwin et al., 2010; Wagner, 2019b). Thus, cohabiting couples may navigate relationship decisions, such as the uptake of contraceptive use, differently from married couples. Furthermore, this finding indicates the need to include fathers, especially fathers who do not live with their children, in conceptualizations of the male cohabitating partner, and participants in family planning and preconception care services.
We found that more income was negatively associated with consistent contraceptive use in nonfathers and negatively associated with reporting multiple sexual partners in nonresident fathers. Amid the lack of comparative empirical literature, qualitative studies of low-income men—most of whom identified as fathers—offer some explanation for our finding. These studies explored topics such as contraceptive use and fathering intentions and discovered that men’s motivations for contraceptive use were based on views about their ability to financially provide for themselves, a pregnant partner, or child (Campbell et al., 2019; Frye et al., 2013; Hamm et al., 2018). This suggests that finances may influence nonresident fathers’ decision-making on whether to engage in multiple sexual partnerships. In nonresident fathers, we also observed that higher education was negatively associated with reporting consistent contraceptive use and positively associated with reporting multiple sexual partners. This suggests that SES, an interplay between income and education, plays a role in nonresident fathers’ sexual behavior. Evidence suggests that unintended pregnancy is disproportionately reported among low-income, relative to high-income women (Finer & Zolna, 2014; Wright, 2020). If we assume that men pursue sexual relationships with women at similar socioeconomic positions, study findings suggest that SES is a mechanism of nonresident fathers’ engagement in sexual behaviors that may increase or reduce the chances of pregnancy. While literature suggests that men are more ambivalent to pregnancies than women (Higgins et al., 2012), nonresident fathers have firsthand experience of their ability to meet the financial and emotional needs of a child. The confluence of fathering experiences, education attainment, and income among this segment of fathers may promote or dissuade participation in risky sexual behaviors. In this study, results suggest that some combination of fathering experiences, educational attainment, and income influence participation in risky sexual behavior in this segment of fathers. However, the directional associations were not uniform and dependent upon the sexual behavior. More research is needed to understand the extent to which nonresident fathers’ contraceptive use and engagement with multiple sexual partners is a function of SES.
In all fatherhood status groups, we found that single men were more likely to report multiple sexual partners in the past year. This is consistent with previous research that highlights relationship type as an important factor to participation in sexual activity with multiple sexual partners (Ashenhurst et al., 2017). Having multiple sexual partners could mean that men are engaging in sexual relationships consecutively (more than one sexual partner over a time period) or concurrently (more than one overlapping sexual partner during a time period). While there are reported benefits (e.g., increased sexual fulfillment, variety, and pleasure) to having multiple sexual partners (Campos et al., 2016; Frye et al., 2013), there is an added risk. Sex with multiple partners, either consecutively or concurrently, is a risk factor for unprotected sex that can lead to pregnancy and transmitting or contracting STIs, albeit unintended (Ashenhurst et al., 2017; Grabovac et al., 2020; Mercer et al., 2018). Our consistent finding across fatherhood status does not suggest that being a father influences the likelihood of engaging in multiple sexual partnerships among single men; however, the association was strongest among nonresident fathers. We also observed that non-Hispanic Black nonfathers were more likely to report multiple sexual partners. This finding shares some alignment with a research on multiple sexual partners among Black men, which reported that men tend to engage in multiple sexual partnerships due to ego and social expectations or pressures (Frye et al., 2013; Hicks et al., 2017; Jones et al., 2017). To advance men’s sexual and reproductive health, there is a need for unmarried men to receive messages and services aimed at the benefits of negotiating safer sex practices with their partner.
When reviewing these findings, we consider a few limitations. This cross-sectional study allows us to assess associations and not causal relationships. We were unable to assess men’s intentions of having a child in the future. Data were not available to determine the type or effectiveness of the contraceptive method used by men and their partners. This variable could have contextualized or changed key findings. We were also unable to determine whether men’s engagement with multiple sexual partners was concurrent or consecutive. Finally, we acknowledge that self-reported outcomes are subject to information bias, such as social desirability, and recall bias may be present in our study, however, our large study sample minimizes this impact (Stuart & Grimes, 2009). Our study has several strengths. This study is one of the first to explore men’s sexual behaviors across fatherhood status. Of note, our quantitative analysis disaggregated fathers by residential status. This adds to the inclusion of nonresident fathers in research concerning paternal health. We used recent data (2016–2018) from a nationally representative cohort sample, making results generalizable to men transiting from young adulthood and toward middle age in the United States. In addition, our study adds to an emerging area of research by shifting the focus to include men and fatherhood, past young adulthood, in the broader domain on sexual and reproductive health.
Conclusion
To our knowledge, this is the first study to examine men’s sexual behaviors across categories of fatherhood status. We found heterogeneous effects of predictors on sexual behaviors among nonfathers, resident fathers, and nonresident fathers. For nonfathers, relationship type and race were associated with reporting multiple sexual partners. For resident fathers, relationship type was the crucial factor associated with consistent contraceptive use and reporting multiple sexual partners. In nonresident fathers, relationship type, education, and income were important factors to consistent contraceptive use and reporting multiple sexual partners. This observed heterogeneity supports greater appreciation and attention to fatherhood as an important social identity and context in men’s health. These findings provide evidence to inform the inclusion of men’s sexual behaviors into maternal and child health and men’s health programs to benefit men with and without children.
Footnotes
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.
Ethics Statement
This research analyzed publicly available, de-identified data, and did not require approval from an ethics committee or institutional review board.
