TECHNICAL REPORT Barrier Protection Use by Adolescents During Sexual Activity Laura K. Grubb, MD, MPH, FAAP, COMMITTEE ON ADOLESCENCE Rates of sexual activity, pregnancies, and births among adolescents have abstract continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy Departments of Pediatrics and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, and sexually transmitted infections (STIs). This technical report discusses the Massachusetts new data and trends in adolescent sexual behavior and barrier protection use. Technical reports from the American Academy of Pediatrics benefit Since 2017, STI rates have increased and use of barrier methods, specifically from expertise and resources of liaisons and internal (AAP) and external condom use, has declined among adolescents and young adults. external reviewers. However, technical reports from the American Academy of Pediatrics may not reflect the views of the liaisons or the Interventions that increase availability of or accessibility to barrier methods organizations or government agencies that they represent. are most efficacious when combined with additional individual, small-group, Dr Grubb, along with the Committee on Adolescence, researched, or community-level activities that include messages about safer sex. Continued conceived of, designed, analyzed and interpreted data for, drafted, and revised this technical report and approved the final manuscript as research informs public health interventions for adolescents that increase the submitted. consistent and correct use of barrier methods and promote dual protection of The guidance in this report does not indicate an exclusive course of barrier methods for STI prevention together with other effective methods of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. contraception. All technical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. This document is copyrighted and is property of the American TRENDS IN ADOLESCENT SEXUAL ACTIVITY AND CONSEQUENCES: THE Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of AMERICAN ACADEMY OF PEDIATRICS BRIGHT FUTURES Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Bright Futures: Guidelines for Health Supervision of Infants, Children, and Pediatrics has neither solicited nor accepted any commercial Adolescents, Fourth Edition provides guidance for adolescent visits for ages involvement in the development of the content of this publication. 11 to 21 years, and in this report, we will provide information that DOI: https://doi.org/10.1542/peds.2020-007245 1 includes this age range. Despite recent data indicating sexual activity has Address correspondence to Laura K. Grubb. E-mail: lgrubb@ declined among adolescents, the current rates of sexual activity and health tuftsmedicalcenter.org consequences of sexually transmitted infections (STIs) and pregnancy PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). indicate that these remain significant public health concerns. The Centers Copyright © 2020 by the American Academy of Pediatrics for Disease Control and Prevention (CDC), through its Youth Risk Behavior FINANCIAL DISCLOSURE: The author has indicated she has no financial Surveillance System, reports sexual behaviors in a nationally relationships relevant to this article to disclose. representative sample of high school students surveyed biannually. In the FUNDING: No external funding. most recently available Youth Risk Behavior Survey (YRBS) from 2017, 40% of high school students reported they had ever had sexual intercourse (defined as penile-vaginal penetration), 29% reported they To cite: Grubb LK, AAP COMMITTEE ON ADOLESCENCE. Barrier were currently sexually active, and 10% had sexual intercourse with 4 or Protection Use by Adolescents During Sexual Activity. Pediatrics. 2020;146(2):e2020007245 more partners in their lifetime.2 Downloaded from www.aappublications.org/news by guest on September 24, 2021 PEDIATRICS Volume 146, number 2, August 2020:e2020007245 FROM THE AMERICAN ACADEMY OF PEDIATRICS In 2017, the year for which the most An estimated 50 900 youth had HIV virus from making copies of itself in recent data are available, 456 000 infection in 2016, representing 4% of the body), and concern exists for adolescent and young women all people with HIV infection. Of extensive drug-resistant strains if younger than 20 years became those, an estimated 56% were aware these youth are not taking pregnant; 448 000 of those of their infection, and people 15 to combination antiretroviral therapy pregnancies were among 15- to 19- 24 years of age were the least likely consistently.16 In a prospective cohort year-olds, and 7400 were among to be aware of their infection study of the reproductive health of those 14 years of age and younger.3 In compared with any other age group.9 sexually active female adolescents 2017, the US pregnancy rate among Young people (13–24 years of age) with PHIV, the cumulative incidence 15- to 19-year-olds was at its lowest accounted for an estimated 21% of all of pregnancy at 19 years of age was point in at least 80 years3; however, new HIV diagnoses in the United 21%, and incidence of STIs was the birth rate for US teenagers States in 2018, totaling 7891 people, 26%.17,18 Several studies have remains higher than that for other of whom 87% were natal male youth revealed that adolescents with PHIV industrialized nations, with marked and 13% were natal female youth.10 have higher rates of sexual activity, disparities by race and/or ethnicity The CDC attributed 80% of new HIV multiple partners, and unprotected and geographic area.4 diagnoses among youth to male-to- penetrative intercourse compared male sexual contact and 20% to other with noninfected peers; more New cases of STIs increased 31% in means (vaginal-penile sexual contact, adolescents frequently tested positive the United States from 2013 to 2017, intravenous drug use, dual male-to- for multidrug-resistant HIV and with half of the 2.3 million new STIs male sexual contact, intravenous drug rarely disclosed their HIV status to reported each year among young use, and other). Among young women partners.19,20 people 15 to 24 years of age.3,5,6 The who received an HIV diagnosis, the Adolescents with intellectual and CDC does not publish specific data on CDC attributed 85% of those physical disabilities are an STI rates by modes of transmission. infections to vaginal-penile contact overlooked group when it comes to The rate of reported cases of and 15% to other transmission sexual behavior, but they have similar chlamydia, gonorrhea, and syphilis 10 methods. There is a paucity of data rates of sexual behaviors when increased for both sexes in both the for transgender adolescents, but the compared with their peers without adolescent (15–19 years of age) and results from the National HIV disabilities.20 These youth receive young adult (20–24 years of age) age – Surveillance System 2009 2014 limited sexual education from their groups between 2012 and 2016. For revealed that youth 13 to 19 years of parents and pediatricians because chlamydia and gonorrhea, rates are age accounted for 8% of new HIV many assume they will not engage in consistently highest among diagnoses among transgender sexual behaviors.21 The American adolescent and young women 15 to 10–12 people. The study also revealed Academy of Pediatrics clinical report 24 years of age; however, the rate of that 25% of transgender women were “Sexuality of Children and reported chlamydia in male patients living with HIV infection and that the Adolescents With Developmental increased, whereas the rate in female percentage of transgender people Disabilities” provides additional patients decreased from 2012 to who received a new HIV diagnosis 22 3 information. 2016. Reported cases of syphilis was more than 3 times the national have been consistently higher among average in 2015.13 In 2018, 1252 This information concerning adolescent and young adult men youth received a diagnosis of AIDS.14 adolescent pregnancy, STIs and/or compared with women, and between HIV, and minority youth is provided 2012 and 2016, rates of reported In discussing barrier methods and to emphasize the need for syphilis cases increased substantially risks, it is important to include comprehensive barrier method in both adolescent and young adult information about youth living with counseling and education for all men and women.6 Because HIV acquired through perinatal youth, regardless of stated sexual trichomoniasis (Trichomonas transmission (PHIV). The CDC does orientation, behaviors, gender, or vaginalis infection) is not a reportable not report specific adolescent data, intellectual and/or physical disease, it is difficult to determine the but at the end of 2016, 1814 children differences. prevalence among adolescents. In the were living with PHIV, and 10 101 United States, there are adults and adolescents (13 years of BARRIER METHOD USE approximately 7 million new cases of age and older) were living with Recent Trends in Adolescent Barrier trichomoniasis each year, and PHIV.15 Youth with HIV infection Method