Reproductive Health Counseling For Young Men: What Does It Do?

Summary

A reproductive health intervention combining a highly explicit half-hour slide-tape program with a personal health consultation was provided to male patients aged 15-18 at a large health maintenance organization. A test of the consultation's impact against a control group provides no support for the argument that highly explicit instruction in contraception encourages early initiation of intercourse. In fact, the consultation may have reduced pressure to become sexually active among young men who had never had sexual intercourse. There is also some evidence that the consultation helped improve the effectiveness of contraceptive practice among the men who were sexually active at follow-up; those exposed to the consultation were more likely than those who were not to report that their last intercourse was protected by the pill and that their main method of contraception in the previous year was the pill. Compared with those in the control group, patients who received the health consultation scored higher on mea sures of fertility knowledge and knowledge of the prevention of sexually transmitted diseases, including AIDS. Furthermore, the young men who had the consultation were more likely to have practiced testicular self-examination. In many cases, however, the positive effects of the consultation were stronger or were only statistically significant among those who had not been sexually active at the time of the baseline survey.

Introduction

Men are increasingly viewed as important targets for services in family planning and prevention of sexually transmitted diseases (STDs), (1) but it is clear that considerably more attention could be given to young men, particularly in the context of routine primary care. Because health care practitioners are highly credible sources of sexual information, (*) their increased attention to young men could have important results. However, no studies have evaluated the benefits that such an approach might have for young men or for their partners. Therefore, this article will present analyses in a population of young men of the effects of a model health consultation that incorporated instruction to improve contraceptive practice, knowledge of fertility, prevention of STDs, practice of testicular self-examination and amelioration of coercive sexual attitudes.

An earlier study conducted in the same environment concluded that routine medical visits, as well as negative pregnancy tests, were excellent opportunities for the screening and referral of young women for contraceptive counseling. (2) Furthermore, a "developmental" counseling approach that considered the psychosocial characteristics of adolescence was found more effective than a traditional approach (one that emphasized medical history and information on contraceptive options) in achieving long-term compliance in contraceptive consultation. The developmental approach was, additionally, adapted in the present study to emphasize highly explicit, directive advice. (3)

The current research literature provides indirect support for expecting that counseling young men may have positive results. Research on sex education in the schools suggests that it will increase knowledge and change attitudes, although effects on actual contraceptive behavior have not been fully demonstrated. (4) Research outside the traditional sex education context offers more optimistic expectations for affecting contraceptive and sexual behavior; for example, direct outreach and the community distribution of condoms may be effective in changing the contraceptive practices of young men. (5) In addition, recent national survey data showing increased condom use by U.S. male adolescents confirm that men's contraceptive practice can be influenced, but it remains unclear what precise factors promote such change. (6)

Much attention has been given recently to the concern that sex education may encourage sexual initiation. One study found such an effect in early adolescence but not in middle or late adolescence; (7) another found that sex education may promote a more accepting attitude toward the sexual practices of others, but it is not at all clear that this leads to early sexual experience. (8) We do not know of any research that has addressed the hypothesis (implicit in many popular beliefs) that explicitness in sexual instruction has permissive consequences. The highly explicit nature of the photography and instruction in the reproductive health consultation tested here provides a chance to study this hypothesis.