Trends in adolescent contraceptive use, unprotected and poorly protected sex, 1991–2003

doi:10.1016/j.jadohealth.2005.07.001

Journal of Adolescent Health

Volume 38, Issue 6, June 2006, Pages 734-739

https://doi.org/10.1016/j.jadohealth.2005.07.001 Get rights and content

Abstract

Purpose

To estimate trends in use and nonuse of effective protection among adolescents 1991–2003, and to assess factors associated with poorly protected sex in 2003.

Methods

We analyzed seven Youth Risk Behavior Surveys (YRBSs) of 9th–12th graders conducted from 1991 through 2003. We estimated trends in use of condoms, effective contraception, withdrawal, and no method, using linear logistic regression models, and evaluated correlates of the use of no method or withdrawal in 2003.

Results

Throughout 1991–2003, about one third of students reported that they had been sexually active in the previous 3 months. Condom use increased significantly throughout 1991–2003, from 46.2% (± 3.3%) in 1991 to 63.0% (± 2.5%) in 2003, and the percentage reporting use of either withdrawal or no method steadily declined, from 32.6% (± 2.7%) to 18.8% (± 2.1%). In 2003, use of withdrawal or no method was greater among females, Hispanics, those who had been pregnant or had caused a pregnancy, and those who reported feeling sad or hopeless or had considered suicide.

Conclusions

Reported unprotected sex decreased, while use of condoms increased. A high-risk group engaging in poorly protected sex was identified, accounting for 6.4% of students.

Section snippets

Methods

The YRBS was conducted in 1991, 1993, 1995, 1997, 1999, 2001, and 2003. Each YRBS survey was designed as an independent sample of 9th- through 12th-grade students representative of all students in the United States; samples of 10,904–16,262 were collected for the seven surveys, with overall response rates of 60–70% [2], [11]. Students completed self-administered paper questionnaires, and entered answers on machine-readable booklets. The questionnaire asked whether students had ever had sexual

Results

In the 2003 YRBS, 34.3% percent of respondents (95% confidence interval [CI], ± 2.1%) reported having sexual intercourse with at least one person in the 3 months before the survey. Among sexually-active students, the data from the seven surveys indicate steadily increasing condom use throughout the 1991–2003 period for both male and female students, a statistically significant linear trend (Table 1). For both sexes, the percent reporting condom use during last sexual intercourse increased from

Discussion

The seven national surveys conducted as part of the YRBS over the 1991–2003 period indicate that during this period when reported sexual experience was declining, among those who were sexually active, there was steadily increasing reported condom and contraceptive use, and a steadily decreasing percentage who reported using no method or withdrawal during last sexual intercourse. Overall hormonal contraceptive use (use of either the pill or Depo-Provera) changed little over time, although a

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Cited by (46)

Sexual addiction
2020, Adolescent Addiction: Epidemiology, Assessment, and Treatment
Behavioral addictions consist of a series of actions that expose one to “mood-altering events” on which one achieves pleasure and becomes dependent, which may alter neurotransmitter function, particularly mesolimbic dopaminergic turnover. Compulsive sexual behavior is a behavioral addiction. Sexual addiction is a pattern of sexual behavior that is initially pleasurable but becomes unfulfilling, self-destructive, and that a person is unable to stop. A pattern of physically or emotionally abusive relationships may facilitate sexual acting out. Adult sexual addicts have been found to report being depressed, low in self-esteem, and feeling alone. There is no consistent set of strategies agreed on to decrease risky sexual behavior among teens. Given that the Internet is becoming a platform for teens to explore their sexuality, and may facilitate sex and Internet addiction among teens, sexual addiction prevention should address ways to minimize exposure to unwanted online sexual material and dependency on the Internet.
Sexuality Education During Adolescence and Use of Modern Contraception at First Sexual Intercourse Among Mexican Women
2019, Journal of Adolescent Health
Mexico has implemented comprehensive sexuality education. We hypothesized that young women who received sexuality education as adolescents would be more likely to report modern contraceptive use at first sexual intercourse.
We used a nationally representative survey of Mexican women aged 20–24 years who were asked about experiences during adolescence. We defined our treatment variable in three mutually exclusive groups: comprehensive sexuality education (receipt of education in nine topics); incomplete sexuality education (receipt of at least one topic in each of three themes); or no sexuality education. Our outcome was use of modern contraception at first sexual intercourse. We included individual- and household-level sociodemographic factors. All presented data used survey weights. We used multivariable logistic regression and predicted probabilities to estimate the association between sexuality education and using modern contraception at first intercourse.
In our sample (n = 2,725; population N = 4,008,722), 60.6% of participants reported receipt of comprehensive, 15.6% of incomplete, and 23.9% of no sexuality education; 62.5% reported utilizing a modern method of contraception at first intercourse. Women who reported receiving comprehensive (adjusted odds ratio: 2.3, 95% confidence interval [CI]: 1.7, 3.2) or incomplete (adjusted odds ratio: 2.4, 95% CI: 1.3, 4.2) sexuality education had higher odds of using contraception at first intercourse compared with no sexuality education. The absolute multivariable probabilities of using modern contraception at first intercourse were 57.5% (95% CI: 55.2%–59.8%), 60.4% (95% CI: 56.0%–64.9%), and 37.6% (95% CI: 33.9%–41.3%) among comprehensive, incomplete, and no sexuality education, respectively.
Sexuality education is associated with contraception use at first intercourse among young women in Mexico.
Adolescents: Their futures and their contraceptive decisions
2014, Journal of Pediatric and Adolescent Gynecology
Pregnancy prevention counseling addresses future goals as a motivator for contraceptive use, but this is often unsuccessful. This study investigated how adolescent females define success and whether they believe teen childbearing will be a barrier to their success.
A racially and ethnically diverse group of 84 nulliparous, high-risk adolescent females in teen clinics completed a survey asking about how they define success, future plans, and barriers to their success and future plans.
Most respondents defined a successful person as one who has a higher education (73%) and/or a good job (73%). Most saw themselves finishing high school (70%), in college (62%), or working at a job (75%) in 3-5 years. Participants who left with a prescription contraceptive method were not more likely to feel that education/career were important for success. Most reported that having a child would have no (52%) or a positive effect (30%) on their education.
The majority felt childbearing would have a negative impact on many aspects of their life. But feeling their finances would be negatively affected was the only predictor of obtaining contraception.
We found that high-risk adolescents did not differ in conventional goals and aspirations regardless of their contraceptive choice. Although most girls felt that education/career was important, many of them felt that childbearing would not be a barrier to or may even improve their educational attainment. This challenges counseling that uses conventional goals as a motivator to remain non-pregnant. Further study of novel motivators for contraceptive use is needed.
A quasi-experimental evaluation of parents as sexual health educators resulting in delayed sexual initiation and increased access to condoms
2011, Journal of Adolescence
Citation Excerpt :
Although this population is generally healthy, they may practice behaviors that negatively affect their future well-being. For example, the lack or inconsistent use of condoms is considered an important factor for both adolescent unplanned pregnancies and the spread of sexually transmitted infections (STIs) (Anderson, Santelli, & Morrow, 2006; Darroch, Singh, Frost, & The Study Team, 2001). In Mexico, the last National Health Survey showed that only 64% of adolescent males and 38% of adolescent females reported using a condom during their first sexual relation and that 30% of males and 57% of females stated not having used any method (Olaiz-Fernández et al., 2006).
To evaluate the effectiveness of an educational intervention for parents of first year high school students in the State of Morelos, Mexico, whose aim was to impact adolescents’ sexual behavior, knowledge and access to contraception.
Quasi-experimental prospective study with eleven control and eleven intervention schools using self-administered questionnaires for parents and adolescents pre- and post-intervention. Parent–child dyads in the control and intervention schools were matched according to parents’ propensity score; the average treatment effect (ATE) was estimated for adolescent’s outcome variables.
At follow-up, we found significant differences for adolescents in the intervention schools: 6.8% delayed initiation of sexual intercourse, 14.4% had correct knowledge about emergency contraception (EC), and 164% reported having received condoms from their parents, when comparing with students in control schools.
Our results suggest that parent-focused interventions could be an innovative and effective strategy to promote adolescents sexual health.
Type of contraception method used at last intercourse and associations with health risk behaviors among US adolescents
2010, Contraception
Citation Excerpt :
Survey year was included in the model to adjust for any differences in outcomes by year. Models were run separately for males and females because there were significant interactions between gender and many of the independent variables and past studies document gender differences in types of contraceptives used and the potential for males to unreliably report their female partners' use of birth control pills or DMPA [11]. Multivariable multinomial logistic regression analyses, an extension of logistic regression for outcomes with more than two levels [12], were performed to identify variables predictive of type of contraceptive use at last sexual intercourse, with condoms only as the reference group because it was the most common contraceptive method used.
This study was conducted to examine associations with contraception methods used at last sexual intercourse among US adolescents.
Data consisted of sexually active adolescents (9th–12th grade, weighted n=24,638) from the 1999–2007 Youth Risk Behavior Surveillance System (YRBSS). We performed multinomial multivariable logistic regression analyses with condom users at last sexual intercourse as the reference group.
Males who used alcohol, cigarettes, marijuana and cocaine were more likely to use no method/unsure of method (OR=2.4, CI=1.7–3.4) or rely on withdrawal (OR=2.6, CI=1.5–4.3). Females with six or more sexual partners were more likely to rely on withdrawal (OR=2.9, CI=2.1–3.9) or contraception methods that offer no STI protection [i.e., birth control pills: OR=1.9, CI=1.4–2.5; and depot medroxyprogesterone acetate (DMPA, marketed as Depo-Provera): OR=2.6, CI=1.6–4.2]. Earlier age of sexual debut was also associated with nonuse.
Prevention efforts should focus on at-risk adolescents including substance-using males, females with six or more sexual partners, and those who initiate sexual intercourse at an early age.
Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States
2010, Journal of Sexual Medicine
Citation Excerpt :
As correct and consistent condom use remains one of the most cost-effective STI/HIV and contraceptive methods, their promotion continues to be a major component of STI/HIV interventions worldwide [5–7]. Prior studies have indicated increasing rates of condom use for HIV/STI and pregnancy prevention purposes among both adolescents [8–13] and adults [14–19] in the general population of the United States. Unfortunately, surveillance of condom use across expansive segments of the U.S. population is less routine as the collection of such data is methodologically complex, time-consuming, and costly [20,21].
Given the efficacy of latex condoms for preventing pregnancy, HIV, and most STI, their promotion remains central to global sexual health efforts. To inform the development of accurate and appropriately-targeted interventions, there is a need for contemporary condom use rates among specific populations.
The purpose of this study was to establish rates of condom use among sexually active individuals in the U.S. population.
Data were collected via a national probability sample of 5,865 U.S. adolescents and adults aged 14 to 94 years.
Condom use was assessed during the most recent partnered vaginal or anal sexual event and over the past 10 vaginal and anal intercourse events.
Condom use by men during past 10 vaginal intercourse events was slightly higher (21.5%) than that reported by women (18.4%), and consistent with rates of condom use reported during most recent vaginal intercourse by men (24.7%) and women (21.8%). Adolescent men reported condom use during 79.1% of the past 10 vaginal intercourse events, adolescent women reported use during 58.1% of the same. Condom use during past 10 anal intercourse events was higher among men (25.8%) than women (13.2%); the same was observed for most recent anal intercourse event (26.5% for insertive men, 44.1% for receptive men, and 10.8% for receptive women). Generally, condom use was highest among unmarried adults, higher among adolescents than adults, and higher among black and Hispanic individuals when compared with other racial groups.
These data indicate clear trends in condom use across age, gender, relationship status, and race/ethnicity. These contemporary rates of condom use will be helpful to those who lead efforts to increase condom use among individuals who may be at risk for sexually transmitted infections or who desire to prevent pregnancy. Reece M, Herbenick D, Schick V, Sanders SA, Dodge B, and Fortenberry JD. Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States. J Sex Med 2010;7(suppl 5):266–276.

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Original articleTrends in adolescent contraceptive use, unprotected and poorly protected sex, 1991–2003

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Adolesc Health

J Adolesc Health

J Adolesc Health

Sex and America’s Teenagers

Youth Risk Behavior Surveillance—United States, 2003

MMWR

Sexual activity and contraceptive practices among teenagers in the United States, 1988 and 1995

Vital Health Stat

Trends in sexual risk behaviors among high school students-United States, 1991–2001

MMWR

Teenagers in the United StatesSexual activity, contraceptive use, and childbearing, 2002

Vital Health Stat

Sexually Transmitted Disease Surveillance, 1993

Sexually Transmitted Disease Surveillance, 2002

Original article
Trends in adolescent contraceptive use, unprotected and poorly protected sex, 1991–2003