National Health Statistics Reports, Number 104, June 22, 2017
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National Health Statistics Reports Number 104 June 22, 2017 Sexual Activity and Contraceptive Use Among Teenagers in the United States, 2011–2015 by Joyce C. Abma, Ph.D., and Gladys M. Martinez, Ph.D., Division of Vital Statistics Abstract Introduction Objective—This report presents national estimates of sexual activity and Monitoring sexual activity and contraceptive use among males and females aged 15–19 in the United States in contraceptive use among teenagers 2011–2015, based on data from the National Survey of Family Growth (NSFG). For is important because of the health, selected indicators, data are also presented from the 1988, 1995, 2002, and 2006–2010 economic, and social costs of pregnancy NSFGs, and from the 1988 and 1995 National Survey of Adolescent Males, which was and childbearing among the teen conducted by the Urban Institute. population (1,2). Although teen Methods—NSFG data were collected through in-person interviews with nationally pregnancy and birth rates have been representative samples of men and women aged 15–44 in the household population of declining since the early 1990s and the United States. NSFG 2011–2015 interviews were conducted between September reached historic lows at 22.3 per 1,000 2011 and September 2015 with 20,621 men and women, including 4,134 teenagers females aged 15–19 in 2015 (3), U.S. (2,047 females and 2,087 males). The response rate was 72.5% for male teenagers and rates are still higher than those in other 73.0% for female teenagers. developed countries. For example, Results—In 2011–2015, 42.4% of never-married female teenagers (4.0 million) in 2011, the teen birth rate in Canada and 44.2% of never-married male teenagers (4.4 million) had had sexual intercourse was 13 per 1,000 females aged 15–19, at least once by the time of the interview (were sexually experienced). These levels of which was less than one-half of the sexual experience among teenagers are similar to those seen in 2002 and 2006–2010 U.S. rate (34 per 1,000 females aged data. Longer-term trends, from 1988 to 2011–2015, show declines in the percentage 15–19) in the same year. Also in 2011, of teenagers who were sexually experienced. Female teenagers’ use of a method of the rate in France was 7 and the rate in contraception at first sex increased from 74.5% in 2002 to 81.0% in 2011–2015. Male Germany was 5, both of which were teenagers’ use of a condom at first sex increased from 70.9% in 2002 to 79.6% in less than one-quarter of the U.S. rate 2006–2010 and remained stable at 76.8% in 2011–2015. Overall, in 2011–2015, 5.8% (4). In addition, while declines have of female teenagers had used a long-acting reversible method (intrauterine device or occurred for Hispanic, non-Hispanic implant). black, and non-Hispanic white teenagers, differences between these groups Keywords: adolescents • birth control • teen pregnancy risk • National Survey of persist, and pregnancy rates are at least Family Growth twice as high for non-Hispanic black and Hispanic teenagers as they are for non-Hispanic white teenagers (5). As a result of the concern with these higher rates of teen pregnancy and births, as well as differences by race and ethnicity U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Page 2 National Health Statistics Reports Number 104 June 22, 2017 and other socioeconomic characteristics represents men and women aged 15–44 in the survey. The overall response rate (3,6), a large number of federal, state, in the household population of the United for the 2011–2015 NSFG was 71.0%. and local teen pregnancy prevention States, including persons temporarily The response rate was 73.0% for female programs have been launched over the living away from the household in a teenagers and 72.5% for male teenagers. past few decades. In 2014, the Centers college dormitory, sorority, or fraternity for Disease Control and Prevention (14). Further details on the sample Measurement of sexual (CDC) declared teen pregnancy one of design, variance estimation, and seven “Winnable Battles,” highlighting fieldwork procedures for the most recent activity, contraception, and the importance of reducing teen NSFG surveys were published previously related measures pregnancy and birth rates (7). (14–16). Earlier NSFG surveys presented Sexual activity is measured in In addition, concern remains high here include the 1988, 1995, and 2002 two ways: Whether the respondent has over the incidence of HIV and other periodic surveys and the 2006–2010 ever had sex and whether he or she has sexually transmitted infections (STIs) continuous survey (17). Also presented had sex recently. If a respondent has among young people. Sexually active are statistics from the 1988 and 1995 ever had sexual intercourse, they are adolescents aged 15–19 and young adults NSAM, a national panel survey of never- referred to as “sexually experienced.” aged 20–24 are at higher risk of acquiring married male teenagers conducted by the This is ascertained through a “yes or STIs than adults. Reasons for this include Urban Institute that is administered face- no” question in the male and female behavior, physiology, and factors related to-face and designed to yield information questionnaires that is consistent across to health care access and services (8). parallel to that for female teenagers all survey years. Female respondents Prevalence estimates suggest that one in from NSFG (18). The earliest surveys who had ever been pregnant or had ever four sexually active adolescent females align approximately with the beginning cohabited with or been married to a has an STI, such as chlamydia or human of the decline in teen pregnancy rates. person of the opposite sex are not asked papillomavirus (HPV) (8). According to Because the teen pregnancy rate peaked and are coded “yes” (19). The measures the most recent estimates, the total direct in 1990, after which it fell 50% through capturing recency of sexual intercourse— medical cost of STIs in the United States 2010 (5), it is informative to examine whether a respondent has had sex in the among all ages was $15.6 billion (9). national trends in both sexual activity past 12 months and past 3 months— Women and men aged 15–24 account and contraceptive use among teenagers are based on the reported date of last for a large portion of these costs because during a time period starting as close to sex with the last sexual partner. The they acquire nearly one-half of the 20 the peak as possible. For both NSFG and probability of having had sex by specific million new STIs in the United States NSAM, 1988 is the survey point closest ages is based on a question asking each year. to the peak in teen pregnancy rates. respondents how old they were the first This report presents recent data on Presenting data from the 2002 time they had sexual intercourse with a the sexual activity and contraceptive and 2006–2010 surveys in addition to male or female (presented as probabilities use of males and females aged 15–19 in 2011–2015 allows for examination of of having had sex by each age in the teen the United States, using data from the more recent trends (through the 2000s) years, described in the next section). The 2011–2015 and earlier National Surveys in sexual activity and contraceptive use. relationship with the first sexual partner of Family Growth (NSFG) and the 1988 Monitoring changes in these measures is at first sex was based on a question and 1995 National Surveys of Adolescent important for gauging whether progress is asking respondents to choose from Males (NSAM) (Text Table, Tables 1–9, being made toward the goals of reduction eight different categories to describe and Figures 1–7), updating statistics in pregnancy and STI risk behaviors. the relationship at that time: “had just presented in prior similar reports (10–13). In addition, changes in the overall met,” “just friends,” “going out once in use of contraceptive methods and the use a while,” “going steady,” “cohabiting,” of specific methods are influenced by “engaged,” “married,” or “something Methods frequent changes in the development and else” (19). The measure of “reasons for discontinuation of specific contraceptive not yet having had sex” is based on a Data source methods and their accessibility. question asking respondents who had All respondents were given written This report is focused on combined never had sexual intercourse, “What and oral information about the survey NSFG data from 2011–2013 and would you say is the most important and informed that participation was 2013–2015, resulting in a data file of 4 reason why you have not had sexual voluntary. Adult respondents aged 18–44 years of interviews spanning 2011–2015. intercourse up to now?” and includes the were asked to sign a consent form but These two datasets together contain a response categories “against religion or were not required to do so. For minors total of 20,621 interviews: 11,300 with morals,” “don’t want to get pregnant/ aged 15–17, signed consent was required women and 9,321 with men, all aged get a female pregnant,” “don’t want first from a parent or guardian, and 15–44. These interviews include 4,134 to get a sexually transmitted disease,” then signed assent was required from with teenagers: 2,047 females and 2,087 “haven’t found the right person yet,” “in the minor: If either the parent or the males aged 15–19.