This examination of changes in adolescent fertility emphasizes the changing social context within which adolescent childbearing takes place.

Today, one third of all American babies are born to unmarried mothers—a startling statistic that has prompted national concern about the consequences for women, children, and society. Indeed, the debate about welfare and the overhaul of the federal welfare program for single mothers was partially motivated by the desire to reduce out of wedlock births. Although the proportion of births to unwed mothers has stopped climbing for the first time since the 1960s, it has not decreased, and recent trends are too complex to attribute solely to policy interventions. What are these trends and how do they differ across groups? Are they peculiar to the United States, or rooted in more widespread social forces? Do children of unmarried mothers face greater life challenges, and if so what can be done to help them? Out of Wedlock investigates these questions, marshalling sociologists, demographers, and economists to review the state of current research and to provide both empirical information and critical analyses. The conflicting data on nonmarital fertility give rise to a host of vexing theoretical, methodological, and empirical issues, some of which researchers are only beginning to address. Out of Wedlock breaks important new ground, bringing clarity to the data and examining policies that may benefit these particularly vulnerable children.

Experts estimate that nearly 60 percent of all U.S. pregnancies--and 81 percent of pregnancies among adolescents--are unintended. Yet the topic of preventing these unintended pregnancies has long been treated gingerly because of personal sensitivities and public controversies, especially the angry debate over abortion. Additionally, child welfare advocates long have overlooked the connection between pregnancy planning and the improved well-being of families and communities that results when children are wanted. Now, current issues--health care and welfare reform, and the new international focus on population--are drawing attention to the consequences of unintended pregnancy. In this climate The Best Intentions offers a timely exploration of family planning issues from a distinguished panel of experts. This committee sheds much-needed light on the questions and controversies surrounding unintended pregnancy. The book offers specific recommendations to put the United States on par with other developed nations in terms of contraceptive attitudes and policies, and it considers the effectiveness of over 20 pregnancy prevention programs. The Best Intentions explores problematic definitions--"unintended" versus "unwanted" versus "mistimed"--and presents data on pregnancy rates and trends. The book also summarizes the health and social consequences of unintended pregnancies, for both men and women, and for the children they bear. Why does unintended pregnancy occur? In discussions of "reasons behind the rates," the book examines Americans' ambivalence about sexuality and the many other social, cultural, religious, and economic factors that affect our approach to contraception. The committee explores the complicated web of peer pressure, life aspirations, and notions of romance that shape an individual's decisions about sex, contraception, and pregnancy. And the book looks at such practical issues as the attitudes of doctors toward birth control and the place of contraception in both health insurance and "managed care." The Best Intentions offers frank discussion, synthesis of data, and policy recommendations on one of today's most sensitive social topics. This book will be important to policymakers, health and social service personnel, foundation executives, opinion leaders, researchers, and concerned individuals. May

Bias analysis quantifies the influence of systematic error on an epidemiology study’s estimate of association. The fundamental methods of bias analysis in epi- miology have been well described for decades, yet are seldom applied in published presentations of epidemiologic research. More recent advances in bias analysis, such as probabilistic bias analysis, appear even more rarely. We suspect that there are both supply-side and demand-side explanations for the scarcity of bias analysis. On the demand side, journal reviewers and editors seldom request that authors address systematic error aside from listing them as limitations of their particular study. This listing is often accompanied by explanations for why the limitations should not pose much concern. On the supply side, methods for bias analysis receive little attention in most epidemiology curriculums, are often scattered throughout textbooks or absent from them altogether, and cannot be implemented easily using standard statistical computing software. Our objective in this text is to reduce these supply-side barriers, with the hope that demand for quantitative bias analysis will follow.