Contraceptive use and pregnancy risk among U.S. high school students, 1991-2003.
BACKGROUND
Trends in teenagers' contraceptive use have received less attention than trends in adolescent sexual intercourse, despite the importance of contraceptive use to preventing teenage pregnancy.


METHODS
Sexually active high school students' use of contraceptives and risk of pregnancy from 1991 to 2003 were examined using data from the national Youth Risk Behavior Survey and published contraceptive failure rates. Changes in pregnancy risk were assessed using weighted least-squares regression.


RESULTS
Between 1991 and 2003, contraceptive use improved among sexually active U.S. high school students. Improvements among women included an increase in the proportion reporting condom use at last sex (from 38% to 58%) and declines in the proportions using withdrawal (from 19% to 11%) and no method (18% to 12%). Hormonal method use changed little, as a decline in pill use (from 25% to 20%) was offset by use of injectables (5% in 2003). Similar patterns were found among men. Women's risk of pregnancy declined 21% over the 12 years. The largest improvements in contraceptive use and pregnancy risk occurred among ninth graders, and whites and blacks. In 2003, 46% of pregnancy risk resulted from failure to use any method of contraception, and 54% resulted from contraceptive failure.


CONCLUSIONS
Improvement in the use of contraceptives by sexually active high school students during the 1990s is encouraging. To sustain this trend, programs need to encourage contraceptive use among teenagers who do not use it and to stress consistent and correct use among those who do.
Santelli
John S
JS
Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA. js2637@columbia.edu
Morrow
Brian
B
Anderson
John E
JE
Lindberg
Laura Duberstein
LD
D000293:Adolescent; D003267:Contraception / Q000706:statistics & numerical data*; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D018570:Risk Assessment; D014481:United States