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New data emerge on teen sexual health
By Anita Brakman, MS, Education & Research Manager and Kaiyti Duffy, MPH, Director of Education and Research Physicians for Reproductive Choice and Health New York City
Melanie Gold, DO, FAAP, FACOP Clinical Associate Professor of Pediatrics University of Pittsburgh School of Medicine Staff Physician University of Pittsburgh Student Health Service
Morbidities and mortalities among adolescents often are the result of risk-taking behaviors. By tracking behavioral trends, clinicians can provide more tailored education, counseling, and screenings to adolescents. To enhance sexual health services for young people, the National Survey of Family Growth (NSFG) and Youth Risk Behavior Survey (YRBS) recently released new data on a wide range of behaviors including sexual activity, contraception, and condom use.1, 2
Both surveys use nationally representative samples. YRBS surveys high school students on a variety of behaviors and relies on a written questionnaire given in classrooms. In 2009, 16,460 questionnaires were completed in 158 schools. NSFG focuses solely on reproductive and sexual topics, targets individuals ages 15-44, and gathers data through face-to-face interviews conducted in households nationwide. The data just released is based on 13,495 interviews conducted between 2006 and 2008, including 2,767 teens.
Adolescents' overall rates of sexual activity are stable, remaining similar to rates found in the 2002 NSFG and 2007 YRBS. In the 2009 YRBS, 46% of female and male students report having ever had sex, and 26% of females and 33% of males report having sexual intercourse within the last three months. NSFG 2006-2008 data from never-married participants ages 15-19 years report a slightly smaller percentage of adolescents having ever had sex (42% females, 43% males). A slightly larger percentage of female participants (30%) and smaller percentage of males (28%) reported sexual activity within three months. Results from both surveys reflect an overall trend of declining adolescent sexual activity since the surveys began, in 1991 for YRBS and 1988 for NSFG.
Many sexually active teens are taking steps to protect themselves against pregnancy and sexually transmitted infections (STIs). According to NSFG, 99% of sexually experienced females ages 15-19 years reported ever using contraception. At first sex, 79% of females used contraception, with 68% using a condom and 15% using birth control pills. This does not reflect a significant change since 2002.
Among males, 87% report they had used some method at first intercourse, with condoms being most common at 82%. This is a significant increase over the 71% reported in the 2002 NSFG. Males also reported a significant change in using dual contraceptive methods at first intercourse, increasing from 11% in 2002 to 19% in 2009. Examining contraceptive use at first sex might be especially important because of NSFG findings that females who report using contraceptives at first intercourse are less likely to report experiencing births before age 20.
The YRBS does not measure reported condom or contraceptive use at first intercourse, but does measure these behaviors at most recent or last intercourse. YRBS found no change in reported condom use at last intercourse in 2009 (61%) compared to 2007 (62%) or over time since 2003 (63%). Until 2003, data showed a positive trend of increasing condom use ever since the 1991 low of 46%. YRBS reports 23% of sexually active students used birth control pills or Depo-Provera at last intercourse in 2009, a significant increase over 19% in 2007.
Sexual activity eyed
NSFG also assesses the context within which teens engage in sexual activity. For example, among 18-24 year olds whose first intercourse occurred before age 20, 14% of females' and 25% of males' first intercourse was with someone as "just friends." A larger group reported "going steady" (72% females, 56% males).
In regard to how much first intercourse was wanted, 47% of females in this category reported mixed feelings, 43% really wanted it at the time, and 10% really didn't want it to happen. Women whose first intercourse was at age 14 years or younger, or whose partner was at least three years older than they were at the time, were more likely to report not really wanting first intercourse. Women whose first male partners were older by three years or more also were more likely than peers to report experiencing nonvoluntary first intercourse (12.8%). Males were more likely to report wanting first intercourse at the time it occurred, and there were no correlations between age of first intercourse or age of partner and how much sex was wanted by males.
NSFG also explores why some teens delay sex. In 2006-2008, NSFG found the most common reason reported by sexually inexperienced teens ages 15-19 to delay sex is that such behavior is "against religion or morals," with 41% of females and 35% of males giving this response. This is consistent with 2002 findings. The only significant change since 2002 in sexually inexperienced teens' reasons for delaying sex was a decrease in young males reporting they "do not want to get a female pregnant right now" from 25% to 12%. Eighteen percent of females reported avoiding pregnancy as their main reason for delay. The least popular reason for delay was preventing STIs, cited by just 6% of females and 7% of males.
The low priority of STI prevention found in NSFG data is concerning when compared to the data on HIV/AIDS education from YRBS. In 2009, 13% of students reported never being taught about AIDS or HIV infection in school, a significant increase over 10% in 2007. While such education was on the rise from 1991-1997, it has been declining ever since then.
The data highlight which risk and protective behaviors teens are engaged in, and underscore the importance of taking a comprehensive sexual health history and providing medically accurate counseling on sexually transmitted infections, condom use, and contraception.1-2