Reliability of Self-Reported Contraceptive Use and Sexual Behaviors among Adolescent Girls
Sieving, R., Hellerstedt, W., McNeely, C., Fee, R., Snyder, J., Resnick, M., The Journal of Sex Research
Self-report data on contraceptive use and sexual behavior are used to identify adolescents at risk for unintended pregnancy and sexually transmitted diseases (STDs) and to evaluate programs aimed at preventing these outcomes. The most efficient, feasible and commonly used approach to studying sexual behaviors is self-reported recall of those behaviors over some time frame. Errors in self-report can bias prevalence estimates of high-risk behaviors and thus lead to misclassification of individuals at risk, thereby hampering prevention efforts. Important intervention components may be overlooked or overemphasized in situations where measurement error leads to biased estimates of relationships between variables (Catania, Chitwood, Gibson & Coates, 1990). Thus, minimizing error related to the measurement of contraceptive and sexual behaviors is of interest to both adolescent health service providers and researchers.
Many questions related to adolescents' self-reported sexual behaviors and contraceptive use remain unanswered. For example, it is unclear what time intervals adolescents can recall in a reliable fashion (e.g., 3-month period, 6-month period) and whether using partner-specific assessments decreases bias in reporting of sexual and contraceptive behaviors over a given time interval.
Measurement error related to self-reports may stem from respondents themselves or measurement instruments used. Respondent variables that influence the task of providing information include those related to memory and recall (Catania, 1999). The length of the recall period may influence the consistency and accuracy of respondents' reports (Catania et al., 1990). Adolescents may base short-term reports on counts of recent events, but they may use estimation to recall over longer periods of time (McFarlane & St. Lawrence, 1999). Although research consistently documents that reliability of reported sexual behaviors decreases with increasing duration of recall period (Catania et al., 1990; Kauth, St. Lawrence, & Kelly, 1991), few studies have explicitly compared reliability of teenagers' self-reports using short and longer-term recall periods (for an exception, see McFarlane & St. Lawrence, 1999).
The frequency of behaviors being assessed may also influence the consistency and accuracy of adolescents' reports. A study with 12- to 19-year-olds (McFarlane & St. Lawrence, 1999) showed that estimates of yearly behavior based on 2-week, 2-month, or 12-month recall periods produced discrepant conclusions about adolescents' sexual activity. In this study, discrepancies between recall periods were larger with estimates of relatively frequent behaviors, such as condom-protected sexual intercourse, than with infrequent behaviors, such as unprotected oral and anal sex.
Complex patterns of sexual activity may also influence adolescents' ability to recall behavior. For example, individuals in monogamous relationships with a routine pattern of sexual activity may give highly reliable estimates, but adolescents with more complex sexual patterns (e.g., multiple sexual partners and contraceptive use patterns that vary between partners) may have more difficulty in providing overall behavioral estimates. It is assumed that partner-by-partner estimates simplify respondents' task and thus improve the consistency and accuracy of reports, but few studies have examined consistency between adolescents' partner-based estimates and temporal estimates of sexual and contraceptive behavior (Catania et al., 1990).
Another respondent variable that may influence self-reports of sexual activity relates to self-presentation. Fear of reprisal, social desirability, and other personal factors may bias adolescents' reports of sexual behavior. Young people who fear reprisal may under-report sexual activity, or others who want to project an adult image may overestimate sexual activity. Adolescents who seek approval of health care providers may over-report their contraceptive use (Catania, 1999; McFarlane & St. …