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OBJECTIVES: To describe trends over time in sexual behaviour, condom use, and sexually transmitted infections among female and male adolescents in the United States. METHODS: A review was carried out of published studies using data from six surveys since the 1970s on sexual behaviour and surveillance data on sexually transmitted infections. RESULTS: The proportion of adolescents who have ever had sexual intercourse increased for females and males through the 1980s and then declined for males through the 1990s. Some survey data showed that the level remained unchanged in the 1990s for adolescent females and other sources showed a decline by 2001. Condom use at first sexual intercourse and current condom use have increased over the past two decades for both male and female adolescents. Incidence rates for gonorrhoea and syphilis among adolescents declined over the 1990s and up through 2002, though new diagnoses of HIV/AIDS among adolescents remained relatively constant throughout the 1990s and into the new century. CONCLUSION: Although data sources are difficult to compare over time, trends in sexual behaviour, condom use, and sexually transmitted infections among adolescents from different data sources display generally similar directions towards declines in risk behaviours and outcomes, and increases in protective behaviours.

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This article examines women's covert use of contraceptives, that is, their use of a method without their husbands' knowledge. Three questions are addressed: (1) How is covert use measured? (2) How prevalent is it? and (3) What are the factors underlying covert use? Existing studies are used together with survey and qualitative data collected in 1997 in an urban setting in Zambia from married women and their husbands. Women's covert use of contraceptives is estimated to account for 6 to 20 percent of all current contraceptive use, and it is more widespread when contraceptive prevalence is low. The multivariate analysis indicates that difficult spousal communication about contraception is the strongest determinant of covert use. Husbands' disapproval of contraception works through spousal communication rather than as a direct influence on covert use. Husbands' pronatalism had no significant effect. The article concludes with implications of covert use for reproductive health and family planning programs, especially women's (and men's) needs for confidential services.

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The prevalence of unmet need for family planning is a primary justification for family planning programs, but the causes of unmet need have not been much explored. This article investigates four explanations for unmet need: (1) as an artifact of inaccurate measurement of fertility preferences and contraceptive practice; (2) as a reflection of weakly held fertility preferences; (3) as a result of women's perceiving themselves to be at low risk of conceiving; (4) as due to excessive costs of contraception. The explanations are examined using quantitative and qualitative data collected in 1993 from currently married women and their husbands in two provinces in the Philippines. The results indicate that the preference-behavior discrepancy commonly termed "unmet need" is not an artifact of survey measurement. The most important factors accounting for this discrepancy are the strength of women's reproductive preferences, husbands' fertility preferences, and the perceived detrimental side effects of contraception. Inaccessible family planning services appear to carry little weight in this setting. Modification of services to make them more attentive to other obstacles to contraceptive use would improve their effectiveness in reducing unmet need.

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PIP: This report presents a description of the trends in growth of the elderly population in the Philippines and their health, disability, education, work status, income, and family support. The proportion of elderly in the Philippines is much smaller than in other Southeast Asian countries, such as Singapore and Malaysia. The elderly population aged over 65 years increased from 2.7% of total population in 1990 to 3.6% in 1990. The elderly are expected to comprise 7.7% of total population in 2025. The proportion of elderly is small due to the high fertility rate. Life expectancy averages 63.5 years. The aged dependency ratio will double from 5.5 elderly per 100 persons aged 15-64 years in 1990 to 10.5/100 in 2025. A 1984 ASEAN survey found that only 11% of elderly rated their health as bad. The 1990 Census reveals that 3.9% were disabled elderly. Most were deaf, blind, or orthopedically impaired. 16% of elderly in the ASEAN survey reported not seeing a doctor even when they needed to. 54% reported that a doctor was not visited due to the great expense. In 1980, 67% of men and 76% of women aged over 60 years had less than a primary education. The proportion with a secondary education in 2020 is expected to be about 33% for men and 33% for women. 66.5% of men and 28.5% of women aged over 60 years were in the formal labor force in 1990. Women were less likely to receive cash income from current jobs or pensions. 65% of earnings from older rural people was income from agricultural production. 60% of income among urban elderly was from children, and 23% was from pensions. Family support is provided to the elderly in the form of coresidence. In 1988, 68% of elderly aged over 60 years lived with at least one child. Retirement or nursing homes are uncommon. The Philippines Constitution states that families have a duty to care for elderly members.^ieng

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We use the 1990 National Health Interview Survey supplement on Family Resources to examine the health care utilization patterns of immigrant and native-born adults in the United States. We modify a standard health care utilization framework by including duration of residence in the United States and measures of immigrant adaptation and family health context to model both the probability and number of physician contacts in the previous year. We find that duration of residence has a strong effect. Recently-arrived immigrants are much less likely to have had a contact in the previous year and had fewer contacts than either native-born or longer-term immigrant adults. Once the measures of adaptation--age at immigration and language of survey interview--are included, immigrants who have been in the United States for 10 years or more are not statistically different from the native-born. Family characteristics, including measures of exposure to the formal health care system, slightly reduce the size of the effects but do not alter the basic relationship between duration of residence and health care utilization. These results suggest that, net of socioeconomic characteristics, access to health insurance, and differences in morbidity, recent immigrants are much less likely than both the native-born and those immigrants of longer duration, to receive timely health care.

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Increasing awareness about AIDS is an important step toward the prevention of this disease. The AIDS Knowledge and Attitudes Survey of the National Health Interview Survey shows that more than 80 percent of U.S. adults are familiar with the major modes of AIDS transmission. Despite this, up to one-third still believe that AIDS can be spread by various forms of casual contact. In the three racial/ethnic groups studied, the less educated were less knowledgeable. Further, black and Hispanic adults lagged somewhat behind white adults in certain important aspects of AIDS knowledge. About one-fourth of white, black and Hispanic adults have had the HIV antibody test. While reasons for testing differed, most of the adults were tested in health care sites. Educational counseling that should accompany HIV testing is provided to less than half of those tested. Identifying gaps in knowledge can help to more effectively target AIDS educational efforts.

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We conducted a study to assess the level of AIDS knowledge, testing behavior patterns, and self-assessed risk of contracting AIDS for a representative sample of health care workers in the United States. The study was based on data collected in the 1989 AIDS Knowledge and Attitudes Supplement to the National Health Interview Survey. Health care workers in four occupational groups were compared with other members of the labor force and with one another. The survey included 1,620 respondents identified as health care workers and 25,217 respondents with occupations other than in health care. Health care workers were more knowledgeable about AIDS than were other workers; approximately 55% and 25%, respectively, reported knowing a lot about AIDS. They were also more likely to have been tested (34%) than other workers (24%) and to have done so voluntarily (28% versus 14%). Health care workers also believed they had higher risk of contracting AIDS (8% versus 3%), although they were about equally likely to report being in one of the six high-risk groups. Among health care workers, those in the health diagnosing occupations were the most knowledgeable about AIDS (74% reported knowing a lot) and were the most likely to have been tested (41% were tested at least once). Health service workers were the least knowledgeable; only 38% reported knowing a lot about AIDS and only 26% reported being tested.

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