Perceptions of Peer Contraceptive Use and its Influence on Contraceptive Method Use and Choice among Young Women and Men in Kenya: A Quantitative Cross-Sectional Study

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Calhoun, Anastasia Mirzoyants, Sylvia Thuku, Lenka Benova, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-434547/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Jan, 2022 Read the published version in Reproductive Health → Version 1 posted 11 You are reading this latest preprint version Abstract Background Prior research has established that an individual’s social environment may influence his or her reproductive behaviors, yet less is known about peer influence on contraceptive use among young people (ages 15–24). In Kenya, the site of this study, 15% of adolescents ages 15–19 have begun childbearing and 45% of sexually active young women report current use of a modern contraceptive method. This highlights the need to better understand what factors influence young people to use contraception. The objective of this study is to explore the relationship between the perception of peers’ use of contraceptives and contraceptive use and method choice among young men and women in Kenya. Methods This study utilizes a nationally representative sample of women and men aged 15–24 years from the 2018 and 2019 cross sectional Shujaaz State of the Kenyan Youth annual surveys. Among the sample of sexually experienced young people (59%), multivariable multinomial logistic regression was used to explore the association between the perception of peers’ use of contraceptives and the respondent’s contraceptive method choice: non-user, condom use or use of any other modern method. Results are presented separately for young men and young women. Results Our results show that sexually experienced young men and women who perceive that their peers are using contraceptives are more likely to report current use of modern contraception. Among women and men, the perception that their peers use contraceptives is associated with higher use of condoms compared to being a nonuser; they are also more likely to use condoms than another modern method of contraception. Young women are more likely to use another modern method (not including condoms) than be a nonuser when they perceive that their peers use contraceptives. Conclusions The results of this study highlight the important role of peer influence on young people’s contraceptive choices. These findings can be used to develop programs that encourage behavior change communication activities in Kenya that focus on providing information on the full range of contraceptive methods as well as normalizing contraceptive use among peer groups of sexually experienced young people. Obstetrics & Gynecology Sexual & Reproductive Medicine Contraceptives youth social norms peer condom Kenya Plain English Summary In Kenya, about 15% of women age 15–19 have already had a birth and approximately one third of these women did not want to have a child at that time. Yet about 45% of sexually active women ages 15–24 report that they currently use family planning (FP). Among young people, friends and peers are an important influence on behaviors. This study focused on a representative sample from Kenya of female and male youth (ages 15–24) who ever had sex. Men and women were asked questions about use of FP, if they think their peers use FP and about characteristics such as age and education. The results show that young women and men who believe their peers use FP are more likely to use FP themselves. Also, young men and women who believe that peers use FP are more likely to use condoms than not use any FP and more likely to use condoms than to use another modern method of FP. Young women who think their peers use are more likely to use another modern method (not including condoms) than to be a nonuser of FP. Programs targeting young people should include information on a range of FP methods and aim to include groups of peers and encourage open discussion. Background Family planning (FP) is widely recognized for its role in reducing maternal and infant mortality as well as enabling women, men and couples to choose when and if they would like to have children [ 1 ]. Yet, about 218 million women of reproductive age in low- and middle- income countries (LMIC) report that they would like to avoid a pregnancy but are not using a modern family planning method, a concept commonly referred to as unmet need for modern contraception [ 1 ]. Unmet need is high among young people in sub-Saharan Africa (SSA) and as a result, approximately 37% of pregnancies among adolescent girls ages 15–19 and 27% of pregnancies among women ages 20–24 in SSA are unintended [ 1 , 2 ]. To address these issues, the global community has recognized the importance of ensuring that the sexual and reproductive health needs of young people are met through enabling access to high quality family planning care for all [ 3 , 4 , 5 , 6 ]. Given that young people often experience many key life transitions between ages 15–24, such as initiation of sexual activity, marriage and childbearing [ 7 , 8 , 9 ], it is critical that they have access to information and services to meet their evolving reproductive health needs in this period [ 3 , 4 , 5 ]. Kenya, the site of this study, has been the focus of international attention in recent years due to concerns about high levels of teenage pregnancy, recently considered to be exacerbated by the global COVID-19 pandemic [ 10 , 11 ]. The 2014 Kenya Demographic Health Survey (KDHS) shows that 15% of young women ages 15–19 have already begun childbearing and 3% were pregnant with their first child [ 12 ]. Kenyan women and men typically have their first sexual experience in their teenage years and women’s median age for first birth is 20.3 years [ 12 ]. These overall estimates mask differences by region, wealth status and education level, with sexual initiation and age at first birth occurring earlier for young people living in rural areas, of lower wealth status and with less education [ 7 , 8 , 9 , 12 ]. Additionally, the adolescent and youth years are characterized by evolving family planning needs depending on age, relationship status, life goals and fertility desires [ 13 , 14 ]. Modern contraceptive use in Kenya among young women ages 15–24 who are in union is almost 10 percentage points higher than that of unmarried sexually active young women (56% vs. 48%) [ 9 ]. Further, contraceptive method mix among young women in union is dominated by injectables and implants whereas unmarried, sexually active young women use a similar set of methods with highest use of injectables, followed by implants and condoms [ 9 ]. Contraceptive use and method mix are often not reported for men, though some studies have shown that young men report using predominantly condoms for dual prevention of pregnancy and sexually transmitted infections [ 15 , 16 ]. It is well established, both globally and in Kenya, that a woman’s social environment, inclusive of her family, peers and community, plays an important role in influencing reproductive behaviors [ 17 , 18 , 19 , 20 , 21 , 22 ]. An individual’s behavior can be influenced through interactions with her or his social network, whereby broader social networks can serve as a source of new information and ideas and have been shown to be associated with contraceptive use [ 21 , 23 , 24 ]. Additionally, behavior can be influenced by social norms which guide social conduct and dictate what individuals should and should not do [ 25 ]. There is growing interest in exploring the role of social norms on FP behaviors, including modern contraceptive use [ 26 , 27 , 28 , 29 , 30 ]. In a review by Costenblader and colleagues (2017), the authors demonstrated that in all 17 included studies, which spanned the globe, there was a significant relationship between social norms supportive of contraceptive use and increased contraceptive use [ 26 ]. Yet few studies examined the role of social influences on contraceptive method choice, that is, not just the decision to use or not to use a method, but also the choice of method type. A study undertaken in Thailand in 1994 found that women with a more extended social network, defined as having more extended kinship ties, were more likely to use modern contraceptives and further, predicted use of oral pills, intrauterine device (IUD) and injectables increased as the number of kinship ties increased [ 24 ]. Using social network analysis, studies in Cameroon [ 31 ] and Bangladesh [ 32 ] found that there was a relationship between the method used by the respondent and the methods used by members of her social network, in that women were frequently connected to others who used similar methods. These studies reflect that a woman’s own contraceptive method choice is sensitive to the methods that her network members use. The global community has long recognized the importance of including men in programs and research on FP, in part because spouses or partners are important decision makers regarding reproductive behaviors. Men have been shown to positively and negatively influence contraceptive use through couple communication, procurement of contraceptive methods, reinforcement of myths and stereotypes about contraceptive users and contraceptive methods and even restricting their partner from using contraceptives [ 33 , 34 , 35 , 36 ]. Qualitative research from rural Malawi shows that social influences function differently for men and women, with men making conclusions about contraceptive use in their community based on their own observations whereas women relied on direct conversations with their social network to inform their conclusions [ 37 ]. Further, a longitudinal study from rural Kenya has shown that men’s social networks may be more influential on men’s contraceptive use decisions as compared to the influence of women’s social networks on their contraceptive use [ 22 ]. This points to the need for more research on social influences on contraceptive use and choice among men. Overall, the role of social influences on contraceptive use and method choice is understudied among young people in sub-Saharan Africa. This gap is notable given that adolescence and young adulthood is the time when social influences, particularly peers, are important and influential [ 38 , 39 ]. Peers may play both a positive and negative role in influencing behaviors, as they have been shown to be a trusted source of information about family planning and at times model positive behaviors, but yet have also been found to share incorrect information, perpetuate myths and reinforce social norms that dictate when and if young people, particularly young women, should engage in sexual activity [ 33 , 35 , 40 , 41 ]. Existing evidence among young people supports that peers influence contraceptive use [ 33 , 35 ] and specifically condom use [ 42 , 43 , 44 , 45 ], but given that Kenya’s contraceptive method mix among young people includes a range of methods, including implants, injectables and condoms, it is important to better understand if social influences are associated with method use and choice, including commonly used hormonal methods. In this context of high teenage pregnancy and substantial evidence on the role of social influences on contraceptive use among women of reproductive age, it is important to understand the role of social influences on contraceptive method choice among both young women and men. This knowledge can inform programmatic strategies seeking to provide full, accurate information to young people and their peers to support young people’s use of the method of their choice. This paper aims to address these gaps by utilizing data from young women and men ages 15–24 years in Kenya. Using rich data collected in 2018 and 2019, this paper explores the influence of perceptions of peers’ use of contraceptives on contraceptive method use and choice among sexually experienced young women and men. Methods Data The data for this paper come from consolidating the 2018 and 2019 cross-sectional, nationally representative Shujaaz State of the Kenyan Youth annual surveys. Shujaaz, Inc. (formerly Well Told Story) is an East African network of social ventures, whose mission is to deliver social and economic value to youth by producing insight-driven experience, consistent positive influence, and information that result in large scale social and behavior change among the Shujaaz, Inc. target audience. One of its ventures, Shujaaz media, is comprised of a monthly comic, daily engagements through digital channels, and events; all media are free to the audience. As part of routine audience research and program monitoring and evaluation, Shujaaz, Inc. undertakes collection of big data, qualitative and quantitative studies, including an annual household survey of young women and men in Kenya. These surveys include males and females ages 15–24 years. In each round, a new sample of female and male youth was selected. A multi-stage sampling procedure was used to achieve the nationally representative sample of youth aged 15–24 years for each round. First, all counties in Kenya were divided into two strata -- urban and rural. Then, target districts were selected within each stratum using a probability proportional to population size approach. The same approach was used to select enumeration areas (EA) within each selected district for a total of 202 EAs. In each selected EA, 10 households were selected using the random walk from a landmark chosen with the help of a Kish Grid. Households were eligible if they had at least one member age 15–24; if the selected household did not have at least one young person, a new household was selected based on a predefined formula. When there were multiple 15–24 year olds in the household, only one youth was selected using a Kish Grid. If the selected respondent was not at home at the time of the interview, an interviewer would make up to 3 call backs and then replace the respondent or the household using a predefined formula. Upon giving consent for participation at the time of the survey (parental/guardian consent and adolescent assent in the case of minors aged 15–17), respondents were asked about sociodemographic characteristics, use and access to media, family planning use, agriculture activities and tobacco use. Study questionnaires were designed based on standardized surveys (e.g. DHS or PMA2020) and previous qualitative research by Shujaaz, Inc. and used a combination of youth-defined terms (including Sheng, a youth dialect), and asked questions in a way that resonated with young people, including several open-ended questions that aimed to build rapport between the interviewer and respondent. The sample size in 2018 was 2,020 (1,009 males and 1,011 females) and 2,020 in 2019 (1,023 males and 997 females). The datasets from 2018 and 2019 were combined in order to increase the sample size for analysis purposes. Population The main outcome of interest is contraceptive use and method choice among sexually experienced young men and women aged 15–24 years. This analysis was limited to the 59% of young women (n = 1,191) and 63% of young men (n = 1,279) who reported that they ever had sex by the time of survey. Dependent variable The dependent variable for this analysis is current contraceptive use and choice. Young men and women were asked if they had ever tried any contraceptive method in any relationship, which includes sexual encounters, dating relationships and marriage. If so, the interviewer listed each type of contraceptive method and asked the respondent to say if they had ever tried the contraceptive method or not for each method on the list. Those who had ever tried a method were asked to describe their current use of that method. Response options included “I use this in all or almost all sexual encounters, I always have it with me”, “I use it occasionally when I happen to have it with me”, “I use it occasionally, mostly when a partner has it with them”, “I use it as a back-up when another preventive method fails”, “I never use it”, “Other”, “Don’t know/Refused”. We coded respondents who selected “I use this in all or almost all sexual encounters, I always have it with me” as current contraceptive users. The small number of respondents who reported concurrent use of more than one method (n = 45) were coded as using whichever method was the most effective; the majority of the respondents who were concurrently using more than one method used a male condom and a hormonal method (n = 28 or 1.13% of the analysis sample). A categorical contraceptive use variable was created separately for males and females. Respondents who reported using traditional methods or non-use were coded as ‘0’ or “non-users of modern contraceptives”; those who used male condoms were coded ‘1’; those who reported that they or their partner used implants, intrauterine devices (coil/IUD), injectables, oral pills, female condoms and emergency contraceptives were coded ‘2’ as “All (or any) other modern method users”. Independent variable The questionnaire was designed to examine respondents’ perceptions of a descriptive norm: the perception of peer contraceptive use. This variable was based on two questions: 1) “How many of your friends use contraception to protect from pregnancy/sexually transmitted infections (STIs)?” and 2) “How many people your age, who are not your friends, use contraceptives to protect from pregnancy/STIs?”. Separate variables for friends and peers were created with the response options “All” and “Most” coded ‘1’ and “Some”, “None”, and “Don’t know/refused” coded ‘0’. The separate variables for friends and peers were found to be correlated at 0.59, and therefore, a combined measure was created which we refer to as ‘perceptions of peers’ use of FP’. If the respondent answered “All” or “Most” to either of the separate questions, the key independent variable was coded ‘1’. All others were coded ‘0’. Analysis Descriptive statistics (proportions and means) were used to better understand differences between perceptions of peers’ use of FP and contraceptive method use and choice. Statistically significant differences were assessed using the Pearson chi-square tests and t-tests to compare continuous variables. Multinomial logistic regression models explored the influence of the key independent variable on current contraceptive use and choice separately among sexually experienced young women and men. The results are presented as relative risk ratios. Multivariate analyses adjust for the clustering in the sample at the EA level and also adjust for demographic characteristics. Based on previous evidence demonstrating the relationship between demographic factors and contraceptive use [ 46 , 47 ], the following variables were included as covariates in the multivariate analyses: age in years (continuous); education (none/some primary, primary completion, secondary completion, college or vocational school); number of children (none, one or more children) and residence status (urban, rural). Relationship status at the time of survey was also included as a covariate with the following categories: dating, have a boyfriend or girlfriend; single, do not have a boyfriend or girlfriend; and ever married/in union. A total of 17 young men and 17 young women reported that they were widowed or divorced; these 34 respondents were coded as “ever married” along with the respondents who were currently married. Additionally, the respondent’s reported average monthly earnings in Kenyan shillings (KES) was also included as a covariate (2018–2019 conversion rate of 1 KES is approximately US $ 0.00980). We also adjusted for survey wave (2018, 2019) to control for secular time trends. Despite the decision to include the covariates as a priori confounders, we checked multicollinearity across independent variables in both multivariate models and did not find evidence of multicollinearity. In both models, all variance inflation factors were less than five which suggests that there is some moderate correlation between covariates but not substantial enough to require changes to the model. In both models, the values for tolerance were all 0.2 or greater. In addition, interaction terms between the relationship status dummies and the peer influence exposure variable were created to explore if there were differences in peer influence by relationship status. The interaction terms were not significant and therefore are not presented. All analyses were performed using Stata version 16. Ethics On behalf of Shujaaz Inc, Research Guide Africa, the subcontractor for data collection, obtained all required study permits from the National Commission for Science, Technology and Innovation (NACOSTI). This secondary analysis study was assessed by the University of North Carolina Institutional Review Board and determined exempt from further review (Study #21–0593). Results Table 1 presents the characteristics of sexually experienced young women and men ages 15–24 who participated in the 2018 and 2019 Shujaaz State of the Kenyan Youth annual surveys. Young women and men had similar levels of education, average age at the time of survey, and residence status. A higher percentage of young men reported that they had a girlfriend at the time of the survey as compared to young women reporting to have a boyfriend (59.0% vs. 38.8%) whereas a higher percentage of young women reported being ever married as compared to young men (35.5% vs 8.8%). A higher percentage of young women than men had one or more children. About 42% of young women and men reported that they thought all or most of their peers use FP to avoid pregnancy or protect from STI. Current contraceptive use and choice patterns were different for young women and men, though there were similar percentages of non-users of modern methods among both women and men (57%-59%). About 15% of young women reported current use of the male condom and about one quarter reported current use of any other modern method. Conversely, about 40% of young men reported using condoms and only 3% reported that their partner currently used another modern method. Table 1 Descriptive characteristics of sexually experienced young men and women ages 15–24 surveyed in 2018 and 2019, Kenya Young men (n = 1,279) Young women (n = 1,191) Total (N = 2,470) Age (years), mean (median) 20.37 (20) 20.63 (21) 20.50 (21) Education (%) None/some primary 12.3 15.7 13.9 Primary completion 38.7 41.7 40.2 Secondary completion 35.6 32.3 34.0 College or vocational training 13.5 10.2 11.9 Relationship status at time of survey (%) Single, do not have a boyfriend or girlfriend 32.2 25.7 29.1 Dating, have a boyfriend or girlfriend 59.0 38.8 49.3 Ever married or in union 8.8 35.5 21.7 Number of children (%) None 89.9 51.3 71.3 One or more 10.1 48.7 28.7 Reported average monthly earnings (KES), mean (median) 6939.33 (4000) 4437.14 (2500) 5732.81 (3000) Residence status Rural 67.1 65.9 66.6 Urban 32.9 34.1 33.5 Survey wave 2018 54.7 52.3 53.6 2019 45.3 47.7 46.4 Current contraceptive use and choice a Non-user of a modern method 56.5 58.9 57.7 Male condoms 40.4 15.8 28.5 All other modern methods b 3.1 25.4 13.8 a Current contraceptive use is based on the respondent’s current use of the most effective method mentioned. Only ~ 1% of the sample report dual use of a hormonal method and a condom. Our measure of current contraceptive use does not capture periodic use of a secondary method. b This category includes current users of implants, IUDs, injectables, oral pills, emergency contraceptive and the female condom. Table 2 presents the cross tabulation of perceptions of peers’ use of FP by current contraceptive use and choice among sexually experienced young men and women. Among male users of condoms, 54% believed all or most of their peers use FP whereas only 36% of users of any other modern method and 35% of nonusers perceived that all or most of their peers use FP. Among young women, 57% of condom users, 50% of other modern method users, and 35% nonusers perceived that all or most of their peers use FP. Based on Pearson chi-square tests, we did not find a significant association (p < 0.001) between perceptions of peers’ FP use and current contraceptive use and choice among young men and women. Table 2 Perception of peers’ use of FP by current contraceptive use and choice a among sexually experienced young men and women ages 15–24 in 2018 and 2019, Kenya Young men (n = 1,279) Young women (n = 1,191) Non-use/traditional method Male condom All other modern methods b Total (%) Non-use/traditional method Male condom All other modern methods b Total (%) Total (n) 723 517 39 517 188 302 How many of your peers use contraception to protect from pregnancy or STI? All/Most 34.9 54.2 35.9 42.7 54.2 57.5 50.0 42.3 Some/none/don’t know 65.2 45.8 64.1 57.3 45.8 42.6 50.0 57.7 100% 100% 100% 100% 100% 100% 100% 100% χ 2 = 46.67, p ≤ 0.000 χ 2 = 40.52, p ≤ 0.000 a Current contraceptive use is based on the respondent’s current use of the most effective method mentioned. Only ~ 1% of the sample report dual use of a hormonal method and a condom. Our measure of current contraceptive use does not capture periodic use of a secondary method. b This category includes current users of implants, IUDs, injectables, oral pills, emergency contraceptive and the female condom. Table 3 presents the multivariate multinomial logistic regression results of the association between perceptions of peers use of FP and current contraceptive use and choice among sexually experienced young men ages 15–24 years. The results show that young men who perceived that most or all their peers use contraceptives were significantly more likely to use condoms than be non-users of a modern method, compared to those who perceived that few or none of their peers use contraception (RRR = 2.12, p < 0.001). In addition, young men who perceived that all or most of their peers use contraceptives were also more likely to report condom use as compared to reporting current use of another modern method (RRR = 2.13, p = 0.034). Table 3 also shows that young men who were in a dating relationship (i.e., they have a girlfriend) and those who were single as compared to those who were ever married were more likely to use condoms as compared to being a non-user of a modern method (RRR = 3.20, p < 0.001 and RRR = 2.14, p = 0.016, respectively). Similarly, young men who were single, meaning that they did not have a girlfriend, as compared to those who were ever married were more likely to report current use of a male condom as compared to use of another modern method (RRR = 6.90, p = 0.021). Young men with one or more children compared to those with no children were less likely to use a condom than another modern method (RRR = 0.17, p < 0.001) and more likely to report use of another modern method as the current method than be a non-user of a modern method (RRR = 4.89, p = 0.001). No associations were found by age, level of education, or place of residence. Table 3 Multinomial logistic regression results for the association between perceptions of peers’ use of FP and current contraceptive use and choice a among sexually experienced young men ages 15–24 in Kenya (n = 1,279) Male condom vs. non-user of modern method All other modern methods b vs. non-user of modern method Male condom vs. All other modern methods b RRR SE p-value RRR SE p-value RRR SE p-value All or most peers use contraception to protect from pregnancy or STI (ref: some/none/don’t know) 2.12 0.26 < 0.001 1.00 0.36 0.992 2.13 0.76 0.034 Age (continuous) 1.01 0.03 0.859 1.08 0.09 0.346 0.93 0.08 0.386 Education (ref: college/vocational school) None/some primary 0.71 0.19 0.206 0.98 0.74 0.977 0.73 0.53 0.661 Primary completion 0.86 0.17 0.449 1.41 0.90 0.588 0.61 0.37 0.415 Secondary completion 0.99 0.18 0.961 2.08 1.29 0.239 0.48 0.28 0.205 Relationship status (ref: ever married) Dating, have a girlfriend 3.20 1.00 < 0.001 1.37 0.70 0.539 2.33 1.21 0.103 Single, do not have a girlfriend 2.14 0.68 0.016 0.31 0.26 0.156 6.90 5.79 0.021 One or more children (ref: none) 0.85 0.21 0.496 4.89 1.96 < 0.001 0.17 0.08 < 0.001 Reported average monthly earnings (KES) (continuous) 1.00 0.00 0.870 1.00 0.00 0.227 1.00 0.00 0.174 Urban (ref: rural) 0.84 0.13 0.267 0.75 0.26 0.412 1.12 0.40 0.749 2019 Survey wave (ref: 2018) 1.06 0.14 0.668 0.95 0.34 0.884 1.11 0.39 0.761 a Current contraceptive use is based on the respondent’s current use of the most effective method mentioned. Only ~ 1% of the sample report dual use of a hormonal method and a condom. Our measure of current contraceptive use does not capture periodic use of a secondary method. b This category includes current users of implants, IUDs, injectables, oral pills, emergency contraceptive and the female condom. RRR- Relative risk ration. SE – standard error Table 4 presents the multivariate multinomial logistic regression results for the association between perceptions of peers use of contraceptives and current contraceptive use and choice among sexually experienced young women ages 15–24 years. The results show that young women who perceived that all or most of their peers use contraceptives were significantly more likely to report current use of condoms or another modern method as compared to being a non-user of a modern method than those who reported that few or none of their peers used contraception (RRR = 2.59, p < 0.001 and RRR = 1.51, p = 0.020, respectively). Similarly, young women who perceived that all or most of their peers use contraceptives were significantly more likely to currently use condoms as compared to another modern method (RRR = 1.71, p = 0.014). Among this sample of young women, those who were older and who had one or more children were more likely to currently use any other modern method as compared to being a non-user of a modern method (RRR = 1.12, p = 0.005 and RRR = 4.53, p ≤ 0.001, respectively) whereas young women who were dating/had a boyfriend or single/no boyfriend were less likely to use any other modern method compared to being a non-user of a modern method (RRR = 0.46, p ≤ 0.001 and RRR = 0.29, p < 0.001, respectively). Young women who were in a dating relationship as compared to those who were ever married were more likely to use condoms compared to being a non-user of modern methods (RRR = 2.54, p ≤ 0.001) as were women with one or more children (RRR = 0.55, p = 0.004). Young women who were dating/had a boyfriend or single/no boyfriend compared to ever married were more likely to use condoms compared to use of another modern method (RRR = 5.46, p ≤ 0.001 and RRR = 3.85, p < 0.001, respectively) and those with one or more children were less likely to use condoms compared to current use of another modern method (RRR = 0.12, p < 0.001). No associations were found by age, level of education, or place of residence. Table 4 Multinomial logistic regression results for the association between perceptions of peers’ use of FP and current contraceptive use and choice a among sexually experienced young women ages 15–24 in Kenya (n = 1,191) Male condom vs. non-user of modern method All other modern methods b vs. non-user of modern method Male condom vs. All other modern methods b RRR SE p-value RRR SE p-value RRR SE p-value All or most peers use of contraception to protect from pregnancy or STI (ref: some/none/don’t know) 2.59 0.48 < 0.001 1.51 0.27 0.020 1.71 0.37 0.014 Age (continuous) 0.96 0.05 0.339 1.12 0.04 0.005 0.85 0.05 0.004 Education (ref: college/vocational school) None/some primary 0.52 0.24 0.150 1.22 0.50 0.620 0.42 0.24 0.130 Primary completion 1.05 0.33 0.884 1.19 0.43 0.623 0.88 0.39 0.767 Secondary completion 0.78 0.24 0.410 1.41 0.54 0.360 0.55 0.24 0.176 Relationship status (ref: ever married) Dating, have a boyfriend 2.54 0.65 < 0.001 0.46 0.09 < 0.001 5.46 1.56 < 0.001 Single, do not have a boyfriend 1.11 0.33 0.729 0.29 0.07 < 0.001 3.85 1.44 < 0.001 One or more children (ref: none) 0.55 0.11 0.004 4.53 0.97 < 0.001 0.12 0.03 < 0.001 Reported average monthly earnings (KES) (continuous) 1.00 0.00 0.155 1.00 0.00 0.898 1.00 0.00 0.187 Urban (ref: rural) 1.13 0.22 0.525 1.23 0.23 0.253 0.92 0.20 0.697 2019 Survey wave (ref: 2018) 1.23 0.22 0.246 1.23 0.21 0.223 1.00 0.22 0.999 a Current contraceptive use is based on the respondent’s current use of the most effective method mentioned. Only ~ 1% of the sample report dual use of a hormonal method and a condom. Our measure of current contraceptive use does not capture periodic use of a secondary method. b This category includes current users of implants, IUDs, injectables, oral pills, emergency contraceptive and the female condom. RRR- Relative risk ration. SE – standard error Discussion Using data from a survey of sexually experienced young women and men in Kenya, this study builds on previous research about social influences on reproductive behaviors in Kenya [ 20 , 22 , 33 ] and found that perceptions of peers’ use of FP was related to young peoples’ current contraceptive use and choice. This is the first study to our knowledge to use household survey data from young women and men in Kenya to explore this topic. Among both sexually experienced young women and young men, the perception that their peers used contraceptives was associated with use of condoms over being a nonuser as well as over use of another modern method of contraception. One distinction between young women and men was that young women were more likely to report current use of any other modern method than nonuse when they perceived their peers used contraceptives but we did not find the same among the sample of sexually experienced young men. The lack of a comparable male finding may reflect the small sample of males who reported current use of a non-condom modern method in their relationships, potentially due to young men not knowing what method their partner uses. These findings highlight the important role that perceptions of peer behavior can play on a young person’s reproductive behaviors. Our findings are consistent with studies in Kenya which found that there was a positive relationship between perception of community approval of contraceptives and an individual’s own use of contraception among both women and men of reproductive age [ 18 ]; this was also shown qualitatively among adolescent girls [ 33 ]. Conversely, a 2020 quantitative study by Shakya and colleagues did not find a significant relationship between the perception of friends’ approval of family planning and use of contraceptives among married adolescent girls in Niger [ 27 ], yet these findings may not be relevant for the Kenyan context given significant contextual differences between the two countries including higher overall FP use in Kenya. Interestingly, our findings suggest that there may be normative behavior within peer groups that is supportive of contraceptive use, including use of hormonal methods by sexually experienced young women. This finding is particularly interesting in a context where there are embedded social norms at the community level that restrict young people from engaging in sexual activity [ 40 ], yet recent research from an unnamed country in SSA suggested that there may be changing attitudes towards young people using contraception [ 48 ]. Our study extends this existing research on social influences on contraceptive use and provides more substantial evidence on this relationship for young women and men in Kenya. The finding that perception of peers' use of contraceptives was associated with use of male condoms over current use of another modern method for both young men and women reflects a choice between method types which may be related to the dual protection against pregnancy and STI afforded by condoms, both of which might be discussed among young people and their peers. Global evidence from several LMIC highlights that women of reproductive age make decisions about their own family planning use based on interactions with their social network, often through direct conversations [ 17 , 37 ], and are more likely to use the methods their social network members use [ 31 , 32 ]. Yet evidence from Kenya has shown that men’s social networks may be more influential on men’s contraceptive use than the networks of women on women’s contraceptive use [ 22 ]. Further, as shown in Malawi, men may make decisions about contraceptive use based on their observations of their network’s behaviors rather than through direct conversations [ 37 ]. For young men, they may not discuss their partner’s use of a hormonal method with their peers either because they are unaware their partner is using a method or due to discomfort discussing their partner’s contraceptive use with others. With nearly one third of our sample reporting current use of condoms alone (rather than in combination with other methods), this is likely the method most discussed among young people for its ability to protect against pregnancy and STI. With the current survey questions, we are unable to know which methods are being discussed among peers. Our study found that there was a preference for condoms among sexually experienced young men and women. This may be due to several factors. Overall, knowledge of contraceptive methods is high among Kenyan youth, with one survey of unmarried, sexually active Nairobi youth reporting that 98.5% of the sample knew of at least one contraceptive method [ 15 ]. High knowledge of condoms among young people may be due, in part, to significant efforts to prevent STIs and HIV through social and behavioral change interventions [ 49 ]. Yet, in the sample of Nairobi youth, only about 4 out of 10 could correctly answer questions comparing efficacy between the condom and oral pills or the condom and IUD suggesting knowledge gaps still exist [ 15 ]. Targeted messaging about STI and HIV appears to have reached young people, as concerns about STI and HIV transmission were high among the sample of Nairobi youth with 55.8% of unmarried, sexually active young men and 28.8% of unmarried, sexually active young women who said they always use a condom [ 15 ]. In addition, young people may face fewer barriers to accessing condoms over other modern methods due to providers restricting access to hormonal methods and a wider range of sources for condoms, including pharmacies and shops, which are frequently more accessible, more convenient, and provide privacy and confidentiality [ 12 , 50 , 51 , 52 ]. These factors contribute to condoms frequently being an entry point to contraceptive use for young people and may further contribute to normalizing condom use amongst this population [ 53 ]. This study has a number of strengths and limitations. Among the strengths is that this study focuses on a nationally representative sample of young people from Kenya, including a sample of young men who are often not included in similar studies. Few studies specifically target young people for data collection because of challenges in receiving approval from ethical review boards to interview young people on sensitive topics, obtaining informed consent or assent, or difficulties identifying an appropriate location for the interview [ 54 ]. Moreover, surveys that include young people such as the Demographic and Health Survey rarely attempt to modify survey tools in order to take into consideration appropriate and accurate terminology for young people, a simplified sentence structure on par with reading and comprehension levels of young people and a youth-friendly questionnaire flow [ 55 ]. In an effort to address these issues, this study utilized a nonstandard, novel survey tool which was designed to solicit more accurate, honest responses from young people. Building rapport and asking questions in a familiar manner helps to make the respondent more comfortable and is particularly important given the focus of this study on sexual and reproductive health. When comparing estimates of modern contraceptive use for all women ages 15–24 from this study (24% in 2018, 26% in 2019) with other nationally representative household surveys from Kenya, such as the DHS (24% in 2014) or PMA2020 (26% in 2018), the results are nearly identical [ 9 , 12 ]. This suggests that the nonstandard questions for contraceptive use utilized in this study produce estimates that are comparable to other more commonly collected data sources but the study design also permitted including novel, youth-specific questions that would be challenging to ask in larger demographic surveys. This study also has some limitations. Many studies that explore social factors and contraceptive use create aggregated community level variables using individual responses to reflect community norms and values [ 46 , 47 ]. Given the sample size and sampling strategy, there were not enough observations to create community average variables for the questions on perceptions of peers’ use of contraceptives. In addition, existing literature has shown that the size of an individual’s social network as well as other contextual factors are important to understand the underlying mechanisms of how social factors influence behaviors and how the effects may differ among young women and men [ 21 ]. In this analysis it was not possible to measure or provide further information on the size of the respondents’ social network or any other community-level contextual factors. In addition, the independent variables only capture perceptions of contraceptive use and do not include more specific mention of methods or types of methods. There were several key variables, such as the age of the partner and unmet need for modern contraception, that were not measured and may introduce some residual confounding. Additionally, this analysis is focused on a measure of current contraceptive use. Therefore, this analysis does not take into account infrequent or occasional use of a second method, such as condoms or emergency contraception, which are coitally specific methods. In addition, young men may not be aware that their partners are using a hormonal method of contraception, and therefore, there is likely underreporting of use of hormonal methods by the young men in this study. Finally, cross-sectional data were used for this analysis which allowed for the examination of associations between variables but does not permit an assessment of the direction of causality. It is possible that given the dynamic nature of young people’s lives, the association we have identified is to some extent also due to reverse causality; meaning that the onset of sexual activity and need for contraceptives lead to creation of peer networks which are similar to the respondent; rather than the other way around. Conclusion In the 2019 Kenya Census, approximately 60% of the population was under 25 years of age [ 56 ]. Meeting the contraceptive needs of this growing, young Kenyan population is critical to ensure that young people are able to attain their life goals. Being able to plan and manage fertility is critical during this time period as young people are building themselves – through education, employment, and transitioning to adulthood. Thus, having the means to avoid an unintended pregnancy through information and access to a full range of contraceptive methods is important to support young people’s growth and development. This study highlights the importance of perceptions of peers’ contraceptive behaviors on young women and men’s contraceptive use. Future studies could include collection of social network data among young women and men to better understand dynamics within peer groups and how contraceptive method choice by one network member may affect the choice of others. Additionally, in-depth qualitative data may be useful to better understand how and why peers’ use influences contraceptive method choice. Given the important role that peers play during the adolescent and young adult years, it is pertinent to develop strategies that ensure that young people have accurate and relevant information to support one another’s healthy reproductive health behaviors. With this in mind, programs should work to disseminate and share information about contraceptive methods broadly through various strategies including social media, mass media, outreach workers, and drama events. Behavior change communication activities that engage young women and men will help to promote positive norms among young people, including males, based on factual information about all available methods. This may include the promotion of positive deviants through these media channels, such as some of the characters in the Shujaaz comic books, which provide entertaining, relatable content to educate the reader while also normalizing positive contraceptive behaviors ( https://www.shujaazinc.com/ ). In addition, youth leaders within communities can be identified to hold discussion groups with other youth to share information about family planning methods. These groups could include younger and older female and male youth who can share experiences about contraceptive methods and which methods may suit young people at different points in the life course. Activities that work to create positive social norms amongst sexually experienced young women and men regarding contraceptive method choice are critical to ensuring that young people are able to avoid unintended pregnancies and plan and manage their fertility. Abbreviations FP family planning HIV human immunodeficiency virus IUD intrauterine device LMIC low- and middle- income countries SSA sub-Saharan Africa STI sexually transmitted infection Declarations Ethics approval and consent to participate: The Shujaaz State of the Kenyan Youth annual surveys receive appropriate ethical approvals prior to country implementation, including all required study permits from the National Commission for Science, Technology and Innovation (NACOSTI). Additionally, all respondents voluntarily consent to participate in the survey. This secondary analysis study was also assessed by the University of North Carolina Institutional Review Board and determined exempt from further review (Study#21-0593). Consent for publication: Not applicable. Availability of data and materials: De-identified data is available upon request. Competing interests: The authors declare that they have no competing interests. Funding: This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation [INV-009814]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. We also received general support from the Population Research Infrastructure Program through an award to the Carolina Population Center (P2C HD050924) at the University of North Carolina at Chapel Hill. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CPC or the Bill & Melinda Gates Foundation. Authors’ contributions: LMC led the analysis and writing of the manuscript for publication. AM and ST were coinvestigators on the Shujaaz State of the Kenyan Youth annual surveys and provided scientific background on the design of the study. LMC, AM, LB, TD, TvdA, CM and ISS participated in the conceptualization of the study and contributed to the analysis and interpretation of the results. All authors read and approved the final manuscript. Acknowledgements: We would like to acknowledge Elizabeth Knippler for her review and contributions to an earlier version of this manuscript. References Sully EA, Biddlecom A, Darroch JE, et al. Adding It Up: Investing in Sexual and Reproductive Health, 2019. New York: Guttmacher Institute; 2020. https:// www.guttmacher.org/report/adding-it-upinvesting-in-sexual-reproductive-health-2019 . Ameyaw EK, Budu E, Sambah F, et al. Prevalence and determinants of unintended pregnancy in sub-Saharan Africa: a multi-country analysis of demographic and health surveys. PLoS One. 2019;14(8):e0220970. Yinger N. Policy Brief: Meeting the Need, Fulfilling the Promise: Youth and long-acting reversible contraceptives. Population Reference Bureau. 2016;(Policy Brief):1–7. 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Cite Share Download PDF Status: Published Journal Publication published 21 Jan, 2022 Read the published version in Reproductive Health → Version 1 posted Editorial decision: Major revision 07 Oct, 2021 Review # 2 received at journal 12 Sep, 2021 Review # 1 received at journal 30 Jun, 2021 Reviewer # 2 agreed at journal 20 Jun, 2021 Reviews received at journal 09 Jun, 2021 Reviewer # 1 agreed at journal 09 Jun, 2021 Reviewers invited by journal 05 Jun, 2021 Submission checks completed at journal 03 May, 2021 Editor invited by journal 03 May, 2021 Editor assigned by journal 19 Apr, 2021 First submitted to journal 16 Apr, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-434547","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":25199542,"identity":"5ff8532f-5d66-4957-8a36-faf4daec01ed","order_by":0,"name":"Lisa M. 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Yet about 45% of sexually active women ages 15\u0026ndash;24 report that they currently use family planning (FP). Among young people, friends and peers are an important influence on behaviors.\u003c/p\u003e \u003cp\u003eThis study focused on a representative sample from Kenya of female and male youth (ages 15\u0026ndash;24) who ever had sex. Men and women were asked questions about use of FP, if they think their peers use FP and about characteristics such as age and education.\u003c/p\u003e \u003cp\u003eThe results show that young women and men who believe their peers use FP are more likely to use FP themselves. Also, young men and women who believe that peers use FP are more likely to use condoms than not use any FP and more likely to use condoms than to use another modern method of FP. Young women who think their peers use are more likely to use another modern method (not including condoms) than to be a nonuser of FP.\u003c/p\u003e \u003cp\u003ePrograms targeting young people should include information on a range of FP methods and aim to include groups of peers and encourage open discussion.\u003c/p\u003e"},{"header":"Background","content":" \u003cp\u003eFamily planning (FP) is widely recognized for its role in reducing maternal and infant mortality as well as enabling women, men and couples to choose when and if they would like to have children [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Yet, about 218\u0026nbsp;million women of reproductive age in low- and middle- income countries (LMIC) report that they would like to avoid a pregnancy but are not using a modern family planning method, a concept commonly referred to as unmet need for modern contraception [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Unmet need is high among young people in sub-Saharan Africa (SSA) and as a result, approximately 37% of pregnancies among adolescent girls ages 15\u0026ndash;19 and 27% of pregnancies among women ages 20\u0026ndash;24 in SSA are unintended [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. To address these issues, the global community has recognized the importance of ensuring that the sexual and reproductive health needs of young people are met through enabling access to high quality family planning care for all [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Given that young people often experience many key life transitions between ages 15\u0026ndash;24, such as initiation of sexual activity, marriage and childbearing [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], it is critical that they have access to information and services to meet their evolving reproductive health needs in this period [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eKenya, the site of this study, has been the focus of international attention in recent years due to concerns about high levels of teenage pregnancy, recently considered to be exacerbated by the global COVID-19 pandemic [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The 2014 Kenya Demographic Health Survey (KDHS) shows that 15% of young women ages 15\u0026ndash;19 have already begun childbearing and 3% were pregnant with their first child [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Kenyan women and men typically have their first sexual experience in their teenage years and women\u0026rsquo;s median age for first birth is 20.3 years [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These overall estimates mask differences by region, wealth status and education level, with sexual initiation and age at first birth occurring earlier for young people living in rural areas, of lower wealth status and with less education [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, the adolescent and youth years are characterized by evolving family planning needs depending on age, relationship status, life goals and fertility desires [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Modern contraceptive use in Kenya among young women ages 15\u0026ndash;24 who are in union is almost 10 percentage points higher than that of unmarried sexually active young women (56% vs. 48%) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Further, contraceptive method mix among young women in union is dominated by injectables and implants whereas unmarried, sexually active young women use a similar set of methods with highest use of injectables, followed by implants and condoms [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Contraceptive use and method mix are often not reported for men, though some studies have shown that young men report using predominantly condoms for dual prevention of pregnancy and sexually transmitted infections [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is well established, both globally and in Kenya, that a woman\u0026rsquo;s social environment, inclusive of her family, peers and community, plays an important role in influencing reproductive behaviors [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. An individual\u0026rsquo;s behavior can be influenced through interactions with her or his social network, whereby broader social networks can serve as a source of new information and ideas and have been shown to be associated with contraceptive use [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Additionally, behavior can be influenced by social norms which guide social conduct and dictate what individuals should and should not do [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. There is growing interest in exploring the role of social norms on FP behaviors, including modern contraceptive use [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In a review by Costenblader and colleagues (2017), the authors demonstrated that in all 17 included studies, which spanned the globe, there was a significant relationship between social norms supportive of contraceptive use and increased contraceptive use [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Yet few studies examined the role of social influences on contraceptive method choice, that is, not just the decision to use or not to use a method, but also the choice of method type. A study undertaken in Thailand in 1994 found that women with a more extended social network, defined as having more extended kinship ties, were more likely to use modern contraceptives and further, predicted use of oral pills, intrauterine device (IUD) and injectables increased as the number of kinship ties increased [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Using social network analysis, studies in Cameroon [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] and Bangladesh [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] found that there was a relationship between the method used by the respondent and the methods used by members of her social network, in that women were frequently connected to others who used similar methods. These studies reflect that a woman\u0026rsquo;s own contraceptive method choice is sensitive to the methods that her network members use.\u003c/p\u003e \u003cp\u003eThe global community has long recognized the importance of including men in programs and research on FP, in part because spouses or partners are important decision makers regarding reproductive behaviors. Men have been shown to positively and negatively influence contraceptive use through couple communication, procurement of contraceptive methods, reinforcement of myths and stereotypes about contraceptive users and contraceptive methods and even restricting their partner from using contraceptives [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Qualitative research from rural Malawi shows that social influences function differently for men and women, with men making conclusions about contraceptive use in their community based on their own observations whereas women relied on direct conversations with their social network to inform their conclusions [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Further, a longitudinal study from rural Kenya has shown that men\u0026rsquo;s social networks may be more influential on men\u0026rsquo;s contraceptive use decisions as compared to the influence of women\u0026rsquo;s social networks on their contraceptive use [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This points to the need for more research on social influences on contraceptive use and choice among men.\u003c/p\u003e \u003cp\u003eOverall, the role of social influences on contraceptive use and method choice is understudied among young people in sub-Saharan Africa. This gap is notable given that adolescence and young adulthood is the time when social influences, particularly peers, are important and influential [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Peers may play both a positive and negative role in influencing behaviors, as they have been shown to be a trusted source of information about family planning and at times model positive behaviors, but yet have also been found to share incorrect information, perpetuate myths and reinforce social norms that dictate when and if young people, particularly young women, should engage in sexual activity [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Existing evidence among young people supports that peers influence contraceptive use [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and specifically condom use [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], but given that Kenya\u0026rsquo;s contraceptive method mix among young people includes a range of methods, including implants, injectables and condoms, it is important to better understand if social influences are associated with method use and choice, including commonly used hormonal methods. In this context of high teenage pregnancy and substantial evidence on the role of social influences on contraceptive use among women of reproductive age, it is important to understand the role of social influences on contraceptive method choice among both young women and men. This knowledge can inform programmatic strategies seeking to provide full, accurate information to young people and their peers to support young people\u0026rsquo;s use of the method of their choice.\u003c/p\u003e \u003cp\u003eThis paper aims to address these gaps by utilizing data from young women and men ages 15\u0026ndash;24 years in Kenya. Using rich data collected in 2018 and 2019, this paper explores the influence of perceptions of peers\u0026rsquo; use of contraceptives on contraceptive method use and choice among sexually experienced young women and men.\u003c/p\u003e "},{"header":"Methods","content":" \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData\u003c/h2\u003e \u003cp\u003eThe data for this paper come from consolidating the 2018 and 2019 cross-sectional, nationally representative Shujaaz State of the Kenyan Youth annual surveys. Shujaaz, Inc. (formerly Well Told Story) is an East African network of social ventures, whose mission is to deliver social and economic value to youth by producing insight-driven experience, consistent positive influence, and information that result in large scale social and behavior change among the Shujaaz, Inc. target audience. One of its ventures, Shujaaz media, is comprised of a monthly comic, daily engagements through digital channels, and events; all media are free to the audience. As part of routine audience research and program monitoring and evaluation, Shujaaz, Inc. undertakes collection of big data, qualitative and quantitative studies, including an annual household survey of young women and men in Kenya. These surveys include males and females ages 15\u0026ndash;24 years. In each round, a new sample of female and male youth was selected. A multi-stage sampling procedure was used to achieve the nationally representative sample of youth aged 15\u0026ndash;24 years for each round. First, all counties in Kenya were divided into two strata -- urban and rural. Then, target districts were selected within each stratum using a probability proportional to population size approach. The same approach was used to select enumeration areas (EA) within each selected district for a total of 202 EAs. In each selected EA, 10 households were selected using the random walk from a landmark chosen with the help of a Kish Grid. Households were eligible if they had at least one member age 15\u0026ndash;24; if the selected household did not have at least one young person, a new household was selected based on a predefined formula. When there were multiple 15\u0026ndash;24 year olds in the household, only one youth was selected using a Kish Grid. If the selected respondent was not at home at the time of the interview, an interviewer would make up to 3 call backs and then replace the respondent or the household using a predefined formula.\u003c/p\u003e \u003cp\u003eUpon giving consent for participation at the time of the survey (parental/guardian consent and adolescent assent in the case of minors aged 15\u0026ndash;17), respondents were asked about sociodemographic characteristics, use and access to media, family planning use, agriculture activities and tobacco use. Study questionnaires were designed based on standardized surveys (e.g. DHS or PMA2020) and previous qualitative research by Shujaaz, Inc. and used a combination of youth-defined terms (including Sheng, a youth dialect), and asked questions in a way that resonated with young people, including several open-ended questions that aimed to build rapport between the interviewer and respondent. The sample size in 2018 was 2,020 (1,009 males and 1,011 females) and 2,020 in 2019 (1,023 males and 997 females). The datasets from 2018 and 2019 were combined in order to increase the sample size for analysis purposes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cp\u003eThe main outcome of interest is contraceptive use and method choice among sexually experienced young men and women aged 15\u0026ndash;24 years. This analysis was limited to the 59% of young women (n\u0026thinsp;=\u0026thinsp;1,191) and 63% of young men (n\u0026thinsp;=\u0026thinsp;1,279) who reported that they ever had sex by the time of survey.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDependent variable\u003c/h2\u003e \u003cp\u003eThe dependent variable for this analysis is current contraceptive use and choice. Young men and women were asked if they had ever tried any contraceptive method in any relationship, which includes sexual encounters, dating relationships and marriage. If so, the interviewer listed each type of contraceptive method and asked the respondent to say if they had ever tried the contraceptive method or not for each method on the list. Those who had ever tried a method were asked to describe their current use of that method. Response options included \u0026ldquo;I use this in all or almost all sexual encounters, I always have it with me\u0026rdquo;, \u0026ldquo;I use it occasionally when I happen to have it with me\u0026rdquo;, \u0026ldquo;I use it occasionally, mostly when a partner has it with them\u0026rdquo;, \u0026ldquo;I use it as a back-up when another preventive method fails\u0026rdquo;, \u0026ldquo;I never use it\u0026rdquo;, \u0026ldquo;Other\u0026rdquo;, \u0026ldquo;Don\u0026rsquo;t know/Refused\u0026rdquo;. We coded respondents who selected \u0026ldquo;I use this in all or almost all sexual encounters, I always have it with me\u0026rdquo; as current contraceptive users. The small number of respondents who reported concurrent use of more than one method (n\u0026thinsp;=\u0026thinsp;45) were coded as using whichever method was the most effective; the majority of the respondents who were concurrently using more than one method used a male condom and a hormonal method (n\u0026thinsp;=\u0026thinsp;28 or 1.13% of the analysis sample). A categorical contraceptive use variable was created separately for males and females. Respondents who reported using traditional methods or non-use were coded as \u0026lsquo;0\u0026rsquo; or \u0026ldquo;non-users of modern contraceptives\u0026rdquo;; those who used male condoms were coded \u0026lsquo;1\u0026rsquo;; those who reported that they or their partner used implants, intrauterine devices (coil/IUD), injectables, oral pills, female condoms and emergency contraceptives were coded \u0026lsquo;2\u0026rsquo; as \u0026ldquo;All (or any) other modern method users\u0026rdquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variable\u003c/h2\u003e \u003cp\u003eThe questionnaire was designed to examine respondents\u0026rsquo; perceptions of a descriptive norm: the perception of peer contraceptive use. This variable was based on two questions: 1) \u0026ldquo;How many of your friends use contraception to protect from pregnancy/sexually transmitted infections (STIs)?\u0026rdquo; and 2) \u0026ldquo;How many people your age, who are not your friends, use contraceptives to protect from pregnancy/STIs?\u0026rdquo;. Separate variables for friends and peers were created with the response options \u0026ldquo;All\u0026rdquo; and \u0026ldquo;Most\u0026rdquo; coded \u0026lsquo;1\u0026rsquo; and \u0026ldquo;Some\u0026rdquo;, \u0026ldquo;None\u0026rdquo;, and \u0026ldquo;Don\u0026rsquo;t know/refused\u0026rdquo; coded \u0026lsquo;0\u0026rsquo;. The separate variables for friends and peers were found to be correlated at 0.59, and therefore, a combined measure was created which we refer to as \u0026lsquo;perceptions of peers\u0026rsquo; use of FP\u0026rsquo;. If the respondent answered \u0026ldquo;All\u0026rdquo; or \u0026ldquo;Most\u0026rdquo; to either of the separate questions, the key independent variable was coded \u0026lsquo;1\u0026rsquo;. All others were coded \u0026lsquo;0\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics (proportions and means) were used to better understand differences between perceptions of peers\u0026rsquo; use of FP and contraceptive method use and choice. Statistically significant differences were assessed using the Pearson chi-square tests and t-tests to compare continuous variables.\u003c/p\u003e \u003cp\u003eMultinomial logistic regression models explored the influence of the key independent variable on current contraceptive use and choice separately among sexually experienced young women and men. The results are presented as relative risk ratios. Multivariate analyses adjust for the clustering in the sample at the EA level and also adjust for demographic characteristics. Based on previous evidence demonstrating the relationship between demographic factors and contraceptive use [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], the following variables were included as covariates in the multivariate analyses: age in years (continuous); education (none/some primary, primary completion, secondary completion, college or vocational school); number of children (none, one or more children) and residence status (urban, rural). Relationship status at the time of survey was also included as a covariate with the following categories: dating, have a boyfriend or girlfriend; single, do not have a boyfriend or girlfriend; and ever married/in union. A total of 17 young men and 17 young women reported that they were widowed or divorced; these 34 respondents were coded as \u0026ldquo;ever married\u0026rdquo; along with the respondents who were currently married. Additionally, the respondent\u0026rsquo;s reported average monthly earnings in Kenyan shillings (KES) was also included as a covariate (2018\u0026ndash;2019 conversion rate of 1 KES is approximately US\u003cspan\u003e$\u003c/span\u003e0.00980). We also adjusted for survey wave (2018, 2019) to control for secular time trends. Despite the decision to include the covariates as \u003cem\u003ea priori\u003c/em\u003e confounders, we checked multicollinearity across independent variables in both multivariate models and did not find evidence of multicollinearity. In both models, all variance inflation factors were less than five which suggests that there is some moderate correlation between covariates but not substantial enough to require changes to the model. In both models, the values for tolerance were all 0.2 or greater. In addition, interaction terms between the relationship status dummies and the peer influence exposure variable were created to explore if there were differences in peer influence by relationship status. The interaction terms were not significant and therefore are not presented. All analyses were performed using Stata version 16.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eEthics\u003c/h2\u003e \u003cp\u003eOn behalf of Shujaaz Inc, Research Guide Africa, the subcontractor for data collection, obtained all required study permits from the National Commission for Science, Technology and Innovation (NACOSTI). This secondary analysis study was assessed by the University of North Carolina Institutional Review Board and determined exempt from further review (Study #21\u0026ndash;0593).\u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the characteristics of sexually experienced young women and men ages 15\u0026ndash;24 who participated in the 2018 and 2019 Shujaaz State of the Kenyan Youth annual surveys. Young women and men had similar levels of education, average age at the time of survey, and residence status. A higher percentage of young men reported that they had a girlfriend at the time of the survey as compared to young women reporting to have a boyfriend (59.0% vs. 38.8%) whereas a higher percentage of young women reported being ever married as compared to young men (35.5% vs 8.8%). A higher percentage of young women than men had one or more children. About 42% of young women and men reported that they thought all or most of their peers use FP to avoid pregnancy or protect from STI. Current contraceptive use and choice patterns were different for young women and men, though there were similar percentages of non-users of modern methods among both women and men (57%-59%). About 15% of young women reported current use of the male condom and about one quarter reported current use of any other modern method. Conversely, about 40% of young men reported using condoms and only 3% reported that their partner currently used another modern method.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDescriptive characteristics of sexually experienced young men and women ages 15\u0026ndash;24 surveyed in 2018 and 2019, Kenya\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYoung men (n\u0026thinsp;=\u0026thinsp;1,279)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYoung women\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1,191)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;2,470)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge (years), mean (median)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20.37 (20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20.63 (21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20.50 (21)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducation (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone/some primary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary completion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary completion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCollege or vocational training\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship status at time of survey (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle, do not have a boyfriend or girlfriend\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDating, have a boyfriend or girlfriend\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e59.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e49.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEver married or in union\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of children (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e89.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e51.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOne or more\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReported average monthly earnings (KES), mean (median)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6939.33 (4000)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4437.14 (2500)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5732.81 (3000)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eResidence status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRural\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e67.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUrban\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSurvey wave\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e52.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e53.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e46.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCurrent contraceptive use and choice\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-user of a modern method\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e56.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e57.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale condoms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAll other modern methods\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003e Current contraceptive use is based on the respondent\u0026rsquo;s current use of the most effective method mentioned. Only\u0026thinsp;~\u0026thinsp;1% of the sample report dual use of a hormonal method and a condom. Our measure of current contraceptive use does not capture periodic use of a secondary method.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003e\u003csup\u003eb\u003c/sup\u003e This category includes current users of implants, IUDs, injectables, oral pills, emergency contraceptive and the female condom.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the cross tabulation of perceptions of peers\u0026rsquo; use of FP by current contraceptive use and choice among sexually experienced young men and women. Among male users of condoms, 54% believed all or most of their peers use FP whereas only 36% of users of any other modern method and 35% of nonusers perceived that all or most of their peers use FP. Among young women, 57% of condom users, 50% of other modern method users, and 35% nonusers perceived that all or most of their peers use FP. Based on Pearson chi-square tests, we did not find a significant association (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) between perceptions of peers\u0026rsquo; FP use and current contraceptive use and choice among young men and women.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePerception of peers\u0026rsquo; use of FP by current contraceptive use and choice\u003csup\u003ea\u003c/sup\u003e among sexually experienced young men and women ages 15\u0026ndash;24 in 2018 and 2019, Kenya\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eYoung men (n\u0026thinsp;=\u0026thinsp;1,279)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eYoung women (n\u0026thinsp;=\u0026thinsp;1,191)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNon-use/traditional method\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMale condom\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAll other modern methods\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNon-use/traditional method\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMale condom\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAll other modern methods\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal (n)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e723\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e517\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e517\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e188\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e302\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\" align=\"left\"\u003e\n\u003cp\u003eHow many of your peers use contraception to protect from pregnancy or STI?\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAll/Most\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSome/none/don\u0026rsquo;t know\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;46.67, p\u0026thinsp;\u0026le;\u0026thinsp;0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;40.52, p\u0026thinsp;\u0026le;\u0026thinsp;0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\"\u003e\u003csup\u003ea\u003c/sup\u003e Current contraceptive use is based on the respondent\u0026rsquo;s current use of the most effective method mentioned. Only\u0026thinsp;~\u0026thinsp;1% of the sample report dual use of a hormonal method and a condom. Our measure of current contraceptive use does not capture periodic use of a secondary method.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\"\u003e\u003csup\u003eb\u003c/sup\u003e This category includes current users of implants, IUDs, injectables, oral pills, emergency contraceptive and the female condom.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e presents the multivariate multinomial logistic regression results of the association between perceptions of peers use of FP and current contraceptive use and choice among sexually experienced young men ages 15\u0026ndash;24 years. The results show that young men who perceived that most or all their peers use contraceptives were significantly more likely to use condoms than be non-users of a modern method, compared to those who perceived that few or none of their peers use contraception (RRR\u0026thinsp;=\u0026thinsp;2.12, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, young men who perceived that all or most of their peers use contraceptives were also more likely to report condom use as compared to reporting current use of another modern method (RRR\u0026thinsp;=\u0026thinsp;2.13, p\u0026thinsp;=\u0026thinsp;0.034). Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e also shows that young men who were in a dating relationship (i.e., they have a girlfriend) and those who were single as compared to those who were ever married were more likely to use condoms as compared to being a non-user of a modern method (RRR\u0026thinsp;=\u0026thinsp;3.20, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and RRR\u0026thinsp;=\u0026thinsp;2.14, p\u0026thinsp;=\u0026thinsp;0.016, respectively). Similarly, young men who were single, meaning that they did not have a girlfriend, as compared to those who were ever married were more likely to report current use of a male condom as compared to use of another modern method (RRR\u0026thinsp;=\u0026thinsp;6.90, p\u0026thinsp;=\u0026thinsp;0.021). Young men with one or more children compared to those with no children were less likely to use a condom than another modern method (RRR\u0026thinsp;=\u0026thinsp;0.17, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and more likely to report use of another modern method as the current method than be a non-user of a modern method (RRR\u0026thinsp;=\u0026thinsp;4.89, p\u0026thinsp;=\u0026thinsp;0.001). No associations were found by age, level of education, or place of residence.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultinomial logistic regression results for the association between perceptions of peers\u0026rsquo; use of FP and current contraceptive use and choice\u003csup\u003ea\u003c/sup\u003e among sexually experienced young men ages 15\u0026ndash;24 in Kenya (n\u0026thinsp;=\u0026thinsp;1,279)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMale condom vs. non-user of modern method\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eAll other modern methods\u003csup\u003eb\u003c/sup\u003e vs. non-user of modern method\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMale condom vs. All other modern methods\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRRR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRRR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRRR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAll or most peers use contraception to protect from pregnancy or STI\u003c/strong\u003e (ref: some/none/don\u0026rsquo;t know)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.992\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.034\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge (continuous)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.859\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.346\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.386\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e (ref: college/vocational school)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone/some primary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.206\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.977\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.661\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary completion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.449\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.588\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.415\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary completion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.961\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.239\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.205\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship status\u003c/strong\u003e (ref: ever married)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDating, have a girlfriend\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.539\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.103\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle, do not have a girlfriend\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.156\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.021\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOne or more children\u003c/strong\u003e (ref: none)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.496\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReported average monthly earnings (KES)\u003c/strong\u003e (continuous)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.870\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.227\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.174\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUrban\u003c/strong\u003e (ref: rural)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.267\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.412\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.749\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2019 Survey wave\u003c/strong\u003e (ref: 2018)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.668\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.884\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.761\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"10\"\u003e\u003csup\u003ea\u003c/sup\u003e Current contraceptive use is based on the respondent\u0026rsquo;s current use of the most effective method mentioned. Only\u0026thinsp;~\u0026thinsp;1% of the sample report dual use of a hormonal method and a condom. Our measure of current contraceptive use does not capture periodic use of a secondary method.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"10\"\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e This category includes current users of implants, IUDs, injectables, oral pills, emergency contraceptive and the female condom.\u003c/p\u003e\n\u003cp\u003eRRR- Relative risk ration. SE \u0026ndash; standard error\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e presents the multivariate multinomial logistic regression results for the association between perceptions of peers use of contraceptives and current contraceptive use and choice among sexually experienced young women ages 15\u0026ndash;24 years. The results show that young women who perceived that all or most of their peers use contraceptives were significantly more likely to report current use of condoms or another modern method as compared to being a non-user of a modern method than those who reported that few or none of their peers used contraception (RRR\u0026thinsp;=\u0026thinsp;2.59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and RRR\u0026thinsp;=\u0026thinsp;1.51, p\u0026thinsp;=\u0026thinsp;0.020, respectively). Similarly, young women who perceived that all or most of their peers use contraceptives were significantly more likely to currently use condoms as compared to another modern method (RRR\u0026thinsp;=\u0026thinsp;1.71, p\u0026thinsp;=\u0026thinsp;0.014). Among this sample of young women, those who were older and who had one or more children were more likely to currently use any other modern method as compared to being a non-user of a modern method (RRR\u0026thinsp;=\u0026thinsp;1.12, p\u0026thinsp;=\u0026thinsp;0.005 and RRR\u0026thinsp;=\u0026thinsp;4.53, p\u0026thinsp;\u0026le;\u0026thinsp;0.001, respectively) whereas young women who were dating/had a boyfriend or single/no boyfriend were less likely to use any other modern method compared to being a non-user of a modern method (RRR\u0026thinsp;=\u0026thinsp;0.46, p\u0026thinsp;\u0026le;\u0026thinsp;0.001 and RRR\u0026thinsp;=\u0026thinsp;0.29, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). Young women who were in a dating relationship as compared to those who were ever married were more likely to use condoms compared to being a non-user of modern methods (RRR\u0026thinsp;=\u0026thinsp;2.54, p\u0026thinsp;\u0026le;\u0026thinsp;0.001) as were women with one or more children (RRR\u0026thinsp;=\u0026thinsp;0.55, p\u0026thinsp;=\u0026thinsp;0.004). Young women who were dating/had a boyfriend or single/no boyfriend compared to ever married were more likely to use condoms compared to use of another modern method (RRR\u0026thinsp;=\u0026thinsp;5.46, p\u0026thinsp;\u0026le;\u0026thinsp;0.001 and RRR\u0026thinsp;=\u0026thinsp;3.85, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively) and those with one or more children were less likely to use condoms compared to current use of another modern method (RRR\u0026thinsp;=\u0026thinsp;0.12, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No associations were found by age, level of education, or place of residence.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultinomial logistic regression results for the association between perceptions of peers\u0026rsquo; use of FP and current contraceptive use and choice\u003csup\u003ea\u003c/sup\u003e among sexually experienced young women ages 15\u0026ndash;24 in Kenya (n\u0026thinsp;=\u0026thinsp;1,191)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMale condom vs. non-user of modern method\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eAll other modern methods\u003csup\u003eb\u003c/sup\u003e vs. non-user of modern method\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMale condom vs. All other modern methods\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRRR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRRR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRRR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAll or most peers use of contraception to protect from pregnancy or STI\u003c/strong\u003e (ref: some/none/don\u0026rsquo;t know)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.014\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge (continuous)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.339\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.004\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e (ref: college/vocational school)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone/some primary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.150\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.620\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.130\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary completion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.884\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.623\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.767\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary completion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.410\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.360\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.176\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship status\u003c/strong\u003e (ref: ever married)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDating, have a boyfriend\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle, do not have a boyfriend\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.729\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOne or more children\u003c/strong\u003e (ref: none)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.004\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReported average monthly earnings (KES)\u003c/strong\u003e (continuous)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.155\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.898\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.187\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUrban\u003c/strong\u003e (ref: rural)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.525\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.253\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.92\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.697\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2019 Survey wave\u003c/strong\u003e (ref: 2018)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.246\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.223\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.999\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"10\"\u003e\u003csup\u003ea\u003c/sup\u003e Current contraceptive use is based on the respondent\u0026rsquo;s current use of the most effective method mentioned. Only\u0026thinsp;~\u0026thinsp;1% of the sample report dual use of a hormonal method and a condom. Our measure of current contraceptive use does not capture periodic use of a secondary method.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"10\"\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e This category includes current users of implants, IUDs, injectables, oral pills, emergency contraceptive and the female condom.\u003c/p\u003e\n\u003cp\u003eRRR- Relative risk ration. SE \u0026ndash; standard error\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":" \u003cp\u003eUsing data from a survey of sexually experienced young women and men in Kenya, this study builds on previous research about social influences on reproductive behaviors in Kenya [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and found that perceptions of peers\u0026rsquo; use of FP was related to young peoples\u0026rsquo; current contraceptive use and choice. This is the first study to our knowledge to use household survey data from young women and men in Kenya to explore this topic. Among both sexually experienced young women and young men, the perception that their peers used contraceptives was associated with use of condoms over being a nonuser as well as over use of another modern method of contraception. One distinction between young women and men was that young women were more likely to report current use of any other modern method than nonuse when they perceived their peers used contraceptives but we did not find the same among the sample of sexually experienced young men. The lack of a comparable male finding may reflect the small sample of males who reported current use of a non-condom modern method in their relationships, potentially due to young men not knowing what method their partner uses. These findings highlight the important role that perceptions of peer behavior can play on a young person\u0026rsquo;s reproductive behaviors.\u003c/p\u003e \u003cp\u003eOur findings are consistent with studies in Kenya which found that there was a positive relationship between perception of community approval of contraceptives and an individual\u0026rsquo;s own use of contraception among both women and men of reproductive age [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; this was also shown qualitatively among adolescent girls [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Conversely, a 2020 quantitative study by Shakya and colleagues did not find a significant relationship between the perception of friends\u0026rsquo; approval of family planning and use of contraceptives among married adolescent girls in Niger [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], yet these findings may not be relevant for the Kenyan context given significant contextual differences between the two countries including higher overall FP use in Kenya. Interestingly, our findings suggest that there may be normative behavior within peer groups that is supportive of contraceptive use, including use of hormonal methods by sexually experienced young women. This finding is particularly interesting in a context where there are embedded social norms at the community level that restrict young people from engaging in sexual activity [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], yet recent research from an unnamed country in SSA suggested that there may be changing attitudes towards young people using contraception [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Our study extends this existing research on social influences on contraceptive use and provides more substantial evidence on this relationship for young women and men in Kenya.\u003c/p\u003e \u003cp\u003eThe finding that perception of peers' use of contraceptives was associated with use of male condoms over current use of another modern method for both young men and women reflects a choice between method types which may be related to the dual protection against pregnancy and STI afforded by condoms, both of which might be discussed among young people and their peers. Global evidence from several LMIC highlights that women of reproductive age make decisions about their own family planning use based on interactions with their social network, often through direct conversations [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], and are more likely to use the methods their social network members use [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Yet evidence from Kenya has shown that men\u0026rsquo;s social networks may be more influential on men\u0026rsquo;s contraceptive use than the networks of women on women\u0026rsquo;s contraceptive use [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Further, as shown in Malawi, men may make decisions about contraceptive use based on their observations of their network\u0026rsquo;s behaviors rather than through direct conversations [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. For young men, they may not discuss their partner\u0026rsquo;s use of a hormonal method with their peers either because they are unaware their partner is using a method or due to discomfort discussing their partner\u0026rsquo;s contraceptive use with others. With nearly one third of our sample reporting current use of condoms alone (rather than in combination with other methods), this is likely the method most discussed among young people for its ability to protect against pregnancy and STI. With the current survey questions, we are unable to know which methods are being discussed among peers.\u003c/p\u003e \u003cp\u003eOur study found that there was a preference for condoms among sexually experienced young men and women. This may be due to several factors. Overall, knowledge of contraceptive methods is high among Kenyan youth, with one survey of unmarried, sexually active Nairobi youth reporting that 98.5% of the sample knew of at least one contraceptive method [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. High knowledge of condoms among young people may be due, in part, to significant efforts to prevent STIs and HIV through social and behavioral change interventions [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Yet, in the sample of Nairobi youth, only about 4 out of 10 could correctly answer questions comparing efficacy between the condom and oral pills or the condom and IUD suggesting knowledge gaps still exist [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Targeted messaging about STI and HIV appears to have reached young people, as concerns about STI and HIV transmission were high among the sample of Nairobi youth with 55.8% of unmarried, sexually active young men and 28.8% of unmarried, sexually active young women who said they always use a condom [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In addition, young people may face fewer barriers to accessing condoms over other modern methods due to providers restricting access to hormonal methods and a wider range of sources for condoms, including pharmacies and shops, which are frequently more accessible, more convenient, and provide privacy and confidentiality [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. These factors contribute to condoms frequently being an entry point to contraceptive use for young people and may further contribute to normalizing condom use amongst this population [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has a number of strengths and limitations. Among the strengths is that this study focuses on a nationally representative sample of young people from Kenya, including a sample of young men who are often not included in similar studies. Few studies specifically target young people for data collection because of challenges in receiving approval from ethical review boards to interview young people on sensitive topics, obtaining informed consent or assent, or difficulties identifying an appropriate location for the interview [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Moreover, surveys that include young people such as the Demographic and Health Survey rarely attempt to modify survey tools in order to take into consideration appropriate and accurate terminology for young people, a simplified sentence structure on par with reading and comprehension levels of young people and a youth-friendly questionnaire flow [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. In an effort to address these issues, this study utilized a nonstandard, novel survey tool which was designed to solicit more accurate, honest responses from young people. Building rapport and asking questions in a familiar manner helps to make the respondent more comfortable and is particularly important given the focus of this study on sexual and reproductive health. When comparing estimates of modern contraceptive use for all women ages 15\u0026ndash;24 from this study (24% in 2018, 26% in 2019) with other nationally representative household surveys from Kenya, such as the DHS (24% in 2014) or PMA2020 (26% in 2018), the results are nearly identical [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This suggests that the nonstandard questions for contraceptive use utilized in this study produce estimates that are comparable to other more commonly collected data sources but the study design also permitted including novel, youth-specific questions that would be challenging to ask in larger demographic surveys.\u003c/p\u003e \u003cp\u003eThis study also has some limitations. Many studies that explore social factors and contraceptive use create aggregated community level variables using individual responses to reflect community norms and values [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Given the sample size and sampling strategy, there were not enough observations to create community average variables for the questions on perceptions of peers\u0026rsquo; use of contraceptives. In addition, existing literature has shown that the size of an individual\u0026rsquo;s social network as well as other contextual factors are important to understand the underlying mechanisms of how social factors influence behaviors and how the effects may differ among young women and men [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In this analysis it was not possible to measure or provide further information on the size of the respondents\u0026rsquo; social network or any other community-level contextual factors. In addition, the independent variables only capture perceptions of contraceptive use and do not include more specific mention of methods or types of methods. There were several key variables, such as the age of the partner and unmet need for modern contraception, that were not measured and may introduce some residual confounding. Additionally, this analysis is focused on a measure of current contraceptive use. Therefore, this analysis does not take into account infrequent or occasional use of a second method, such as condoms or emergency contraception, which are coitally specific methods. In addition, young men may not be aware that their partners are using a hormonal method of contraception, and therefore, there is likely underreporting of use of hormonal methods by the young men in this study. Finally, cross-sectional data were used for this analysis which allowed for the examination of associations between variables but does not permit an assessment of the direction of causality. It is possible that given the dynamic nature of young people\u0026rsquo;s lives, the association we have identified is to some extent also due to reverse causality; meaning that the onset of sexual activity and need for contraceptives lead to creation of peer networks which are similar to the respondent; rather than the other way around.\u003c/p\u003e "},{"header":"Conclusion","content":" \u003cp\u003eIn the 2019 Kenya Census, approximately 60% of the population was under 25 years of age [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Meeting the contraceptive needs of this growing, young Kenyan population is critical to ensure that young people are able to attain their life goals. Being able to plan and manage fertility is critical during this time period as young people are building themselves \u0026ndash; through education, employment, and transitioning to adulthood. Thus, having the means to avoid an unintended pregnancy through information and access to a full range of contraceptive methods is important to support young people\u0026rsquo;s growth and development. This study highlights the importance of perceptions of peers\u0026rsquo; contraceptive behaviors on young women and men\u0026rsquo;s contraceptive use. Future studies could include collection of social network data among young women and men to better understand dynamics within peer groups and how contraceptive method choice by one network member may affect the choice of others. Additionally, in-depth qualitative data may be useful to better understand how and why peers\u0026rsquo; use influences contraceptive method choice. Given the important role that peers play during the adolescent and young adult years, it is pertinent to develop strategies that ensure that young people have accurate and relevant information to support one another\u0026rsquo;s healthy reproductive health behaviors.\u003c/p\u003e \u003cp\u003eWith this in mind, programs should work to disseminate and share information about contraceptive methods broadly through various strategies including social media, mass media, outreach workers, and drama events. Behavior change communication activities that engage young women and men will help to promote positive norms among young people, including males, based on factual information about all available methods. This may include the promotion of positive deviants through these media channels, such as some of the characters in the Shujaaz comic books, which provide entertaining, relatable content to educate the reader while also normalizing positive contraceptive behaviors (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.shujaazinc.com/\u003c/span\u003e\u003c/span\u003e). In addition, youth leaders within communities can be identified to hold discussion groups with other youth to share information about family planning methods. These groups could include younger and older female and male youth who can share experiences about contraceptive methods and which methods may suit young people at different points in the life course. Activities that work to create positive social norms amongst sexually experienced young women and men regarding contraceptive method choice are critical to ensuring that young people are able to avoid unintended pregnancies and plan and manage their fertility.\u003c/p\u003e "},{"header":"Abbreviations","content":" \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003efamily planning\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehuman immunodeficiency virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIUD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eintrauterine device\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elow- and middle- income countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esub-Saharan Africa\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esexually transmitted infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Shujaaz State of the Kenyan Youth annual surveys receive appropriate ethical approvals prior to country implementation, including all required study permits from the National Commission for Science, Technology and Innovation (NACOSTI). Additionally, all respondents voluntarily consent to participate in the survey. This secondary analysis study was also assessed by the University of North Carolina Institutional Review Board and determined exempt from further review (Study#21-0593).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDe-identified data is available upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported, in whole or in part, by the Bill \u0026amp; Melinda Gates Foundation [INV-009814]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. We also received general support from the Population Research Infrastructure Program through an award to the Carolina Population Center (P2C HD050924) at the University of North Carolina at Chapel Hill. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CPC or the Bill \u0026amp; Melinda Gates Foundation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLMC led the analysis and writing of the manuscript for publication. AM and ST were coinvestigators on the Shujaaz State of the Kenyan Youth annual surveys and provided scientific background on the design of the study. LMC, AM, LB, TD, TvdA, CM and ISS participated in the conceptualization of the study and contributed to the analysis and interpretation of the results. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge Elizabeth Knippler for her review and contributions to an earlier version of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSully EA, Biddlecom A, Darroch JE, et al. Adding It Up: Investing in Sexual and Reproductive Health, 2019. New York: Guttmacher Institute; 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps:// www.guttmacher.org/report/adding-it-upinvesting-in-sexual-reproductive-health-2019\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmeyaw EK, Budu E, Sambah F, et al. 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The role of individual and community normative factors: a multilevel analysis of contraceptive use among women in union in Mali. Int Fam Plan Perspect. 2008;34(2):79\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSedlander E, Rimal RN. Beyond individual-level theorizing in social norms research: how collective norms and media access affect adolescents\u0026rsquo; use of contraception. J Adolesc Health. 2019;64(4S):31\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValente TW, Watkins SC, Jato MN, et al. Social Network Associations with Contraceptive Use among Cameroonian Women in Voluntary Associations. Soc Sci Med. 1997;45(5):677\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGayen K, Raeside R. Social networks and contraception practice of women in rural Bangladesh. Soc Sci Med. 2010;71:1584\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOchako R, Mbondo M, Aloo S, et al. Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study. BMC Public Health. 2015;15:118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOchako R, Temmerman M, Mbondo M, Askew I. Determinants of modern contraceptive use among sexually active men in Kenya. Reproductive Health. 2007; 14(56).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKann Sanchez E, Speizer IS, Tolley E, et al. Influences on seeking a contraceptive method among adolescent women in three cities in Nigeria. Reprod Health. 2020;17(1):167.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMwaisaka J, Gonsalves L, Thiongo M, et al. Exploring contraception myths and misconceptions among young men and women in Kwale County, Kenya. BMC Public Health. 2020;20(1):1694.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaz Solden VA. How family planning ideas are spread within social groups in rural Malawi. Stud Fam Plann. 2004;35(4):275\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerndt TJ. Developmental changes in conformity to peers and parents. Dev Psychol. 1979;15:608\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinberg L, Monahan KC. Age differences in resistance to peer influence. Dev Psychol. 2007;43:1531\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVelonjara J, Crouthamel B, O\u0026rsquo;Malley G, et al. Motherhood increases support for family planning among Kenyan adolescents. Sex Reprod Healthc. 2018;16:124\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTavrow P, Karei EM, Obbuyi A, Omollo V. Community norms about youth condom use in western Kenya: is transition occurring? African Journal of Reproductive Health. 2012;16(2):241\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarrison A, Smit J, Hoffman S, Nzama T, Leu CS, Mantell J, Stein Z, Exner T. Gender, peer and partner influences on adolescent HIV risk in rural South Africa. Sexual Health. 2012;9(2):178\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiles M, Liddell C, Bydawell M. Condom use in African adolescents: the role of individual and group factors. AIDS Care. 2005;17(6):729\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Leary A, Jemmott JB, Jemmott LS, Bellamy S, Ngwane Z, Icard L, Gueits L. Moderation and mediation of an effective HIV risk-reduction intervention for South African adolescents. Ann Behv Med. 2012;44(2):181\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEggers SM, Aaro LE, Bos AER, Mathews C, de Vries H. Predicting condom use in South Africa: a test of two integrative models. AIDS Behav. 2014;18(1):134\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhinkorah BO. Predictors of modern contraceptive use among adolescent girls and young women in sub-Saharan Africa: a mixed effects multilevel analysis of data from 29 demographic and health surveys. Contraception and Reproductive Medicine. 2020; 5(32).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMutumba M, Wekesa E, Stephenson R. Community influences on modern contraceptive use among young women in low and middle income countries: a cross-sectional multi-country analysis. BMC Public Health. 2018;18:(430).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSenderowicz L. \u0026ldquo;I was obligated to accept\u0026rdquo;: A qualitative exploration of contraceptive coercion. Social Science \u0026amp; Medicine. 2019; 239.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMichielsen K, Chersich MF, Luchters S, et al. Effectiveness of HIV prevention for youth in sub-Saharan Africa: systematic review and meta-analysis of randomized and nonrandomized trials. AIDS. 2010;24(8):1193\u0026ndash;202.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandra-Mouli V, Akwara E. Improving access to and use of contraception by adolescents: what progress has been made, what lessons have been learnt, and what are the implications for action? Best Pract Res Clin Obstet Gynaecol. 2020;66:107\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTumlinson K, Okigbo C, Speizer I. Provider barriers to family planning access in urban Kenya. Contraception. 2015;92(2):143\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonsalves L, Wyss K, Cresswell JA, et al. Mixed-methods study on pharmacies as contraception providers to Kenyan young people: who uses them and why? BMJ Open. 2020;10:e034769.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMandal. and Calhoun, unpublished work.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBassett R, Beagan BL, Ristovski-Slijepcevic S, Chapman GE. Tough teens: the methological challenges of interviewing teemagers as research participants. J Adolesc Res. 2008;23(2):119\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOmrani A, Wakefield-Scurr J, Smith J, Brown N. Survey development for adolescents aged 11\u0026ndash;16 years: a developmental science-based guide. Adolescent Research Review. 2019;4:329\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKenya National Bureau of Statistics. Kenya Population and Housing Census. Volume III: Distribution of Population by Age and Sex. December 2019. Nairobi: Kenya National Bureau of Statistics; 2019.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Contraceptives, youth, social norms, peer, condom, Kenya","lastPublishedDoi":"10.21203/rs.3.rs-434547/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-434547/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePrior research has established that an individual\u0026rsquo;s social environment may influence his or her reproductive behaviors, yet less is known about peer influence on contraceptive use among young people (ages 15\u0026ndash;24). In Kenya, the site of this study, 15% of adolescents ages 15\u0026ndash;19 have begun childbearing and 45% of sexually active young women report current use of a modern contraceptive method. This highlights the need to better understand what factors influence young people to use contraception. The objective of this study is to explore the relationship between the perception of peers\u0026rsquo; use of contraceptives and contraceptive use and method choice among young men and women in Kenya.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study utilizes a nationally representative sample of women and men aged 15\u0026ndash;24 years from the 2018 and 2019 cross sectional Shujaaz State of the Kenyan Youth annual surveys. Among the sample of sexually experienced young people (59%), multivariable multinomial logistic regression was used to explore the association between the perception of peers\u0026rsquo; use of contraceptives and the respondent\u0026rsquo;s contraceptive method choice: non-user, condom use or use of any other modern method. Results are presented separately for young men and young women.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOur results show that sexually experienced young men and women who perceive that their peers are using contraceptives are more likely to report current use of modern contraception. Among women and men, the perception that their peers use contraceptives is associated with higher use of condoms compared to being a nonuser; they are also more likely to use condoms than another modern method of contraception. Young women are more likely to use another modern method (not including condoms) than be a nonuser when they perceive that their peers use contraceptives.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe results of this study highlight the important role of peer influence on young people\u0026rsquo;s contraceptive choices. These findings can be used to develop programs that encourage behavior change communication activities in Kenya that focus on providing information on the full range of contraceptive methods as well as normalizing contraceptive use among peer groups of sexually experienced young people.\u003c/p\u003e","manuscriptTitle":"Perceptions of Peer Contraceptive Use and its Influence on Contraceptive Method Use and Choice among Young Women and Men in Kenya: A Quantitative Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-05-07 15:07:38","doi":"10.21203/rs.3.rs-434547/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-10-08T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-09-13T00:00:00+00:00","index":2,"fulltext":"Recommendation: Major Revision\nForm responses:\n---\n\nComments to Author:\n---\nI. Summary\n\nThis study builds on existing literature that shows that social networks are associated with family planning behavior. Authors state that less is known about how peer perceptions of contraceptive use affect young people (their contribution to the literature) and how perceptions of peer contraceptive use affect method choice (condoms versus other modern method - also a contribution as most studies focus on use or non-use). Using a cross-sectional, Shujazz State of the Kenyan Youth annual survey, they examined associations between perception of peer use and contraceptive method of choice, distinguishing between non-users, condom use, and any other modern method. Results were reported separately for men and women, finding that for both genders, perception that their peers used contraceptives was associated with use of condoms over being a nonuser or using other modern methods of contraception. Additionally, young women who perceived that their peers were using contraceptives were more likely to use modern contraceptive methods other than condoms than be nonusers, however, the same did not hold for men. Authors state that this discrepancy could be due to men not knowing what contraceptive method their partner uses, while the preference for condoms may be related to its dual protection against pregnancy and STIs.\n\nII. Minor Revisions\n\n Abstract\nThe abstract is well written and generally clear.\no Results:\n (45-50): Somewhat confusing phrasing, I suggest adding the percentages as you did in the results.\no Conclusion:\n (52-55): This paper seems to be more focused on peer influence and social norms than education regarding the \"full range of contraceptive methods.\"\n Background\no (102-105): The phrasing of this sentence makes it sound like there is a notable difference between contraceptive method mix among married and unmarried women, however they are quite similar.\no (147-152): It would be helpful to include why hormonal methods are important (often falsely linked to infertility.)\no (156-159): This could be phrased more objectively\n \"cross-sectional\" data vs. \"rich\"\n \"specific contraceptive method\" vs. \"choice\" to better reflect dependent variable.\n Measurement\n (203-206): Phrasing of dependent variable (current contraceptive use) options seems illogical given the research question: (1. \"I use this in all or almost all sexual encounters, I always have it with me\", 2. \"I use it occasionally when I happen to have it with me\", 3. \"I use it occasionally, mostly when a partner has it with them\", 4. \"I use it as a back-up when another preventive method fails\", 5. \"I never use it\", 6. \"Other\", 7. \"Don't know/Refused\") The way this is worded, makes it seem more relevant to women, since men can only use condoms. If you wanted to include both men and women, it would have been phrased as \"you or your partner.\" Other studies have written family planning questions designed for both men and women: \"Are you or your partner currently using medical methods of family planning to delay or avoid having a child?\"\n\nFurthermore, options 2 and 3 seem only relevant to condoms. You don't happen to have injectables, IUDS, etc. with you. Also, these options seem more focused on condoms. If there was a regular female injectable user, how would they answer this? \"I use this in all or almost all sexual encounters, I always have it with me?\" These responses were not designed with this research question in mind and this is a secondary data analysis so I'm not sure that it makes sense in this context. Authors state, \"This is reflected in men's low reported use of contraceptive methods other than condoms (3% among men compared to 40% among women.).\" Was there any cognitive interviewing to test the questions? I don't see how men would answer this for their partners and I don't really see how women who are not using condoms would logically answer this. Of course, this makes me question the results as this is the most important variable to measure.\n\no (221-226): It would be interesting to disaggregate \"friends\" vs. \"peers\" and compare the two rather than combining.\no (234-235): I suggest using a Huber-White command to better account for clustering. Also, can you please state why you chose to use a relative risk ratio?\n Results\no (356-357): Why do you think young women who perceive that their peers use contraceptives are more likely use condoms than other modern contraceptive methods?\nOne thought is the way that the dependent variable options are phrased will encourage or bias people to think about condoms.\n\nIII. Major Revisions and Reflections\n\nThis is a well written and important study. My biggest concern is how the outcome variable is measured. It doesn't seem logical given the research question. It seems biased towards condoms and it doesn't seem relevant towards men (except condom use). These biases may have affected the results (e.g., 3% of men reported a contraceptive use other than condoms), so while this is a well written and important paper, I do not suggest accepting it in its current form. If the research question was focused on condoms, given the way \"current user\" was defined, that would work but that's a different research question. However, given that all contraceptive methods were included, I do not suggest accepting this paper in its current form. I suggest the authors remove men from the analysis altogether given that the question is asked about their own contraceptive use (not them and their partner) so only condoms are applicable. I also suggest acknowledging a major limitation around the way the phrasing maybe have been interpreted given that the response options seem to be related to condoms (the primary form of birth control that you have with you or don't). Also, I suggest explaining why authors decided to report on condoms and then all other methods separately. What was the rationale behind this decision? In sum, more justification as to why male condoms are singled out as their own category. One reason may be (that I hope they acknowledge in the limitations) is that the questions were written about condoms initially, but they expanded it for this secondary analysis. I wish the authors luck in their revisions - this is an incredibly important topic to the field.\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons after the final decision on the manuscript has been made. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Level of interest: **An article whose findings are important to those with closely related research interests**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: **\nI agree to the open peer review policy of the journal**\n"},{"type":"editorInvitedReview","content":"","date":"2021-07-01T00:00:00+00:00","index":1,"fulltext":"Recommendation: Minor Revision\nForm responses:\n---\n\nComments to Author:\n---\nThank you for the opportunity to read this interesting manuscript. This research on social network influence is an important topic in contraceptive dynamics but current evidence is mostly qualitative, so it was nice to see the use of survey data to explore this. I particularly liked how you expanded the focus beyond the female perspective by including male perspective as well. Although you noted some limitations in capturing male contraceptive use, there are some key takeaways that open questions for further research. Some specific feedback on the manuscript below:\n\nMethods:\n-When enumerators visit the 10 selected households in each EA, do they first do a household listing to identify eligible members age 15-24 and who do they interview for the household listing? Line 177 states \"Households were eligible if they had at least one member aged 15-24\" but does not explain the steps enumerators take to determine eligibility.\n-Minors aged 15-17 needed parental/guardian consent. Was this also the case for married minors?\n-For the dependent variable, the answer options for \"current use\" of method look like they only apply to females. For males, I can only see them responding with these answer options for condoms. Are there specific instructions for males to answer to the best of their knowledge regarding their partner's contraceptive use? It seems like they would mostly select \"mostly when a partner has it with them\" when the method is for female users only.\n\nDiscussion:\n-Line 397 \"potentially due to young men not knowing what method their partner uses\". I think you can expand on this by showing the proportion of \"don't know\" responses in the male sample. Table 2 shows that non-use/traditional method and all other modern methods among the young men have a higher percentage of \"some/none/don't know\" than among the young women, but male condom is approximately the same between the two samples. \n\nLimitations:\n-Do you think the way contraceptive use is captured and categorized in this study is a limitation, such that \"always have it with me\" is categorized as use, whereas \"use it occasionally\" is categorized as non-use. This could overestimate nonuse. Did you do a cross-tabulation between the current use response options and contraceptive methods? Because I wonder if women using injectables, for example, would respond a certain way, because injectables are only administered once for protection of a few weeks. Although they are protected during a sex, would they consider it as \"I use this in all or almost all sexual encounters\"?\n-Did you look at aggregates of reported contraceptive use to look at community level contraceptive use? I wonder if respondents may be perceiving their peers as contraceptive users because contraceptive use in the community in general is already high?\n\nWording:\nLine 102: \"Further, contraceptive method mix…\" I think this sentence needs to be rephrased. It was a bit unclear if you're highlighting the difference or showing that their method mix is similar.\n\nThe discussion section highlights really well the strengths and limitations of the analysis and suggests some areas that can be explored further with additional data.\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons after the final decision on the manuscript has been made. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Level of interest: **An article whose findings are important to those with closely related research interests**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). 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