Teenage Sexual Behavior and
Contraceptive Use: An Update
Joyce Abma
National Center for Health Statistics, Centers for
Disease Control and Freya L. Sonenstein The Urban
Institute April 28, 1998
Acknowledgments: Funding for some of
the analyses presented in this paper comes from NICHD
Grant Number RO1 HD30861. We would like to thank John
Marcotte for his statistical consultation and Sean
Williams for the extensive help he has provided
conducting the data analyses. The opinions expressed are
the authors views and do not reflect the position
of the Urban Institute, the National Center for Health
Statistics, or the funders of the surveys.
Teenage Sexual Behavior and
Contraceptive Use: An Update
Concern about the reproductive behavior
of teenagers in the United States has permeated public
policy discussion for the last two decades. Commencing
with the recognition of the serious personal and social
costs of teen childbearing in the 1970s and more
recently, the severe health consequences of STDs
especially HIV, policy makers and program administrators
have wrestled with how to reduce sexual risk behaviors of
teens in the U.S. Crucial to informed public policy and
program development are good data.
Since 1971 periodic household surveys
have interviewed young women ages 15-19 to obtain
information about their sexual activity, contraceptive
use, pregnancies and births. This tracking began with the
National Surveys of Young Women in 1971, 1976 and 1979
conducted by Kantner and Zelnik at Johns Hopkins
University. Later the National Survey of Family Growth
(NSFG) conducted by the National Center for Health
Statistics took over collecting this information for
teenagers, and older women too, in surveys conducted in
1982, 1988 and 1995. Information about male behavior is
not as complete. With the exception of a male component
added to the 1979 survey by Kantner and Zelnik, data for
males were not collected in the 1970s or early 1980s. But
in 1988 the National Survey of Adolescent Males (NSAM)
was begun as a separate study initiated by academic
investigators to collect parallel information from
teenage males. As a result, comparable data are now
available for both male and female teenagers for 1988 and
1995. This paper is an initial effort to pull together
the results of the 1988 and 1995 surveys of male and
female teenagers, to describe the levels of reproductive
risk and to explore trends over time. We are particularly
interested in using the larger combined samples of males
and females to study whether the levels of sexual risk
taking among teenagers are significantly lower in 1995
and whether shifts in behavior are concentrated among
particular subpopulations.
Before we turn to the results
themselves, it is useful to examine how the two surveys
are comparable. Both surveys use in-person interviews
supplemented by self administered instruments to collect
information from samples of female and male teenagers
selected to be representative of the U.S. population ages
15-19. Black and Hispanic teens are oversampled so that
racial and ethnic differences can be examined and trends
over time within subgroups can be studied. In order to
facilitate comparisons with the 1988 data from male
teenagers, the analyses are limited to never-married
males and females ages 15-19.
In designing the instruments for the
surveys, efforts were made to use parallel items. However
we note that there are sometimes differences between the
male and female surveys in the ways the questions are
posed or where they are placed in the instrument. We will
describe these differences as we provide the results. The
data presented in this paper come from interviewer
administered questions. Since the measures involve self
reports of sensitive behaviors, they may be subject to
some intentional and unintentional reporting
errors.
Comparisons of survey data from male
and female samples naturally lead to comparisons of the
consistency of the answers between the two groups.
However we caution readers that the males and females in
our samples do not necessarily draw from the 15-19 year
old population for their sexual partners. In 1995 for
example, the average age of the most recent partner of an
19 year old male was 18.7, while an 19 year old
females most recent partner was 20.7.
The results presented in
this paper are weighted to compensate for the probability
of selection and nonresponse and are poststratified to
align with Census data. The standard errors in the
statistical tests of differences in proportions have been
adjusted because of the complex sampling designs of the
surveys. Results
Sexual Experience Levels
For the first time since national
surveys started tracking levels of sexual experience
among teenagers, the data indicate no increase between
1988 and 1995 in the proportion of males or female
teenagers who have ever had sexual intercourse. Levels of
sexual experience appear to have plateaued or even turned
downwards in the period, as shown in chart 1. In 1995
almost half (49 percent) of teenage females and just over
half (55 percent) of teenage males report that they have
had sex at least once. In 1988 the proportion of teenage
females who were sexually experienced was roughly
comparable. Among males the levels of sexual experience
appear to have fallen marginally, by 5 percentage points
from 1988. Since the shifts for both groups were in the
same direction, we tested for the significance of the
difference between 1988 and 1995 for the male and female
samples combined. The results indicate that the modest
decrease observed in the levels of sexual experience
among U.S. teenagers is statistically
significant.
Chart 2 puts the recent survey results
into a longer term perspective. It indicates that since
1971 the proportion of females ages 15-19 who have ever
had sexual intercourse steadily increased up to 1988. For
males, fewer data points are available for a more
restricted cohort but the trend is similar. The share of
metropolitan males ages 17-19 who were sexually
experienced rose between 1979 and 1988 and decreased
between 1988 and 1995. Although these data show a
decline, it is also important to note that the proportion
of teens who are sexually experienced remains high
compared to patterns among females in the early
1970s.
Early Initiation of Sex
The news is not all good, however.
Chart 3 shows the proportion of teens reporting that they
initiated sexual intercourse before they reached the age
of 15. Among females the proportion reporting early
initiation of sexual intercourse appears to have risen
significantly and substantially from 11 percent to 19
percent. Among males the proportion of early initiators
remains stable at 21 percent. The share initiating before
age 15 has risen among Hispanic, white and black women.
Hispanic males also report a marginally significant
increase from 19 to 28 percent. Thus although the
aggregate levels of sexual experience among teens appear
to have gone down, there is a substantial group of high
risk teens--approximately 1 in 5--who are initiating sex
before age 15 and this group has become larger since
1988. The share of younger members of the female sample
who initiated sex before age 15 has increased
significantly, signaling that the leveling off of sexual
experience levels seen between 1988 and 1995 may be
temporary. A lot of attention is paid to the young women
initiating sex at early ages, we note that the share of
males is comparably high, albeit not rising
overall.
Currently Sexually Active
Many teenagers have sex sporadically.
Thus they may be counted as being sexually experienced,
but they may not currently be at risk because they have
not had intercourse recently. To measure current risk we
have calculated the proportion of teenagers who had sex
in the last 3 months before the interview. Although 55
percent of males and 49 percent of females were
categorized as sexually experienced in 1995, the
proportion who were currently sexually active was
substantially lower at 37.8 percent for males and 37.5
percent for females as shown in Chart 4. Among both male
and female teenagers there has been a significant
decreases between 1988 and 1995 in the share of teens who
have had sex recently. However there are disparities by
race/ethnicity. Among males the decrease in risk appears
concentrated among white youth, among females decreases
are registered among white and black young women but the
shift among black teens is marginally significant. In
stark contrast, Hispanic youth show a very troubling
reversal of this trend. Male and female Hispanic youth
report marginally significant increased levels of
recent sexual activity .
Further evidence that the reduction of
risk in concentrated in particular subpopulations is
shown by the finding that suburban youth are more likely
than central city or rural youth to have lower levels of
current sexual activity in 1995 compared to 1988. This
pattern is shown in Chart 5. Male and female teenagers
living in the suburbs are significantly less likely to
have had sex in the last 3 months in 1995 compared to
1988. In Chart 6 we look more closely at the trends for
black, Hispanic and white youth by community of
residence. Here we have pooled the males and female
samples together to preserve adequate sample sizes. Among
central city residents, black and white teens show no
difference in levels of current sexual activity between
1988 and 1995. Hispanic youth show the same rise we noted
earlier (p<.05). Among suburban youth white teens show
significant decreases in the proportion who have had sex
in the last 3 months. It is worth noting that white teens
in the central cities and black teens living in the
suburbs also appear to have marginally lower levels of
current sexual activity in 1995 compared to 1988 (
p<.20).
Contraceptive Use at Most Recent
Intercourse
If teenagers are sexually active, the
use of certain contraceptive methods may provide
protection against unintended pregnancy and STD
transmission. So we turn to examining trends in the use
of contraceptive methods among teenagers who have had sex
recently, that is, in the past 3 months.
Between 1988 and 1995 there has been
little change in the proportion of currently sexually
active teens reporting that they used no method of
contraception at last intercourse (Not shown in Charts).* Only a small proportion of teens report using
no methods at all. In 1995 the proportions were 16
percent for females and 18 percent for males. However, a
notable trend can be seen among black females. In 1988
one third of black teenage females reported using no
method of contraception at last intercourse, but by 1995
the proportion had dropped to 14 percent (Not shown in
Charts).
Among those using contraceptive
methods, there have been marked changes in the types of
methods selected. Condom use at last intercourse has
risen substantially and significantly among both male and
female teenagers. Chart 7 illustrates this point. Among
males who had intercourse recently, the proportion using
condoms at last intercourse rose from 53 to 64 percent.
Among like females the proportion rose from 27 percent to
36 percent. Broken down by race/ethnicity, the chart
shows increases in condom use among all groups of males
and for white and black females. Hispanic females show a
worrisome trend in the opposite direction, towards
significantly lower use of condoms.
Condom use at first intercourse
has also risen. This indicator is an important measure of
how well teens anticipate and plan for protection at the
initiation of sexual activity, when they experience
intercourse at their youngest age. Among women 15-44
years of age who had premarital first intercourse, 54
percent of those whose first intercourse occurred between
1990 and 1995 used the condom, while among those whose
first intercourse was before 1980 only 18 percent did so
(Not shown in charts).1
There are substantial differences
between the overall levels of condom use that the males
and females report. A number of national surveys have
found similar differences, with male teenage respondents
reporting higher levels of condom use than females. This
is primarily due to the fact that the most recent
partners of the teenage girls in the sample tend to be 2
years older than they are, on average. Condom use has
been found to decrease as teenage males grow older.2 Another possible source of differences could
involve socially desirable responding: that is, males may
report in a way consistent with societys view of
responsible behavior. However, higher reporting among
males was first noted in a 1982, before the appearance of
public concern about HIV and condom protection,
suggesting that social desirability may not be the entire
explanation for higher reports among males.3 A final possible source of variation is
question wording. The NSAM survey posed two questions
about each partners use of contraception, while the NSFG
posed a single question referencing both partners. The
most important point regarding condom use remains that
while the absolute levels may differ between males and
females, the pattern of substantially increased use
prevails for both sexes.
While condom use has risen among most
teenagers, the use of oral contraceptives has dropped
dramatically, as shown in Chart 8. Among currently
sexually active females the use of oral contraceptives at
last intercourse fell from 42 percent to 23 percent.
Among males, who may be less accurate reporters of oral
contraceptive use than females, the proportion reporting
the use of pills decreased from 37 percent to 28 percent.
Reductions in the use of oral contraception are evident
across black, Hispanic and white teenagers of both
sexes.
Some of the reduction in oral
contractive use is counteracted by the adoption of new
methods of contraception like Norplant and DepoProvera
(not shown in charts). In 1995, seven percent of female
teens overall used these methods. They were most widely
used among black female teens: 16 percent reported using
Norplant or DepoProvera at last intercourse. In terms of
risk, therefore, the relatively widespread use of these
effective methods among black females may partially
compensate for their decrease in the use of oral
contraceptives.
Other Changes
There are many different sources of
influence on teens sexual and contraceptive
behavior, ranging from the individual to the societal
level. One likely source of influence is sex education.
Findings from a recent analysis of trends in male sexual
activity levels from 1979 to 1995 corroborate this
notion: reductions in sexual activity were significantly
associated with increases in sex education among white
males.4 Analyses have also shown that receiving formal
instruction on contraception increases the likelihood a
teen female will use contraception at first intercourse.5
A larger percentage of todays
teens, both male and female, are receiving instruction
during early adolescence in the areas of birth control
methods, how to prevent AIDS, and abstinence, or how to
say "no" to sex. Most female teens receive
formal instruction on birth control methods. As shown in
Chart 9, 88 eight percent received such instruction in
1995 compared to 72 percent in 1988. This is also common
among male youth: 79 percent received instruction on
contraceptives in 1995, up slightly from the 1988 level.
Almost all teens now receive instruction on how to
prevent AIDS using safe sex practices: 92 percent of
males and 94 percent of females. Equally common among
females is receipt of instruction on how to say
"no" to sex: 93 percent received such
instruction in 1995. Among males such education is also
common, although not as widespread as among the females:
three quarters of males received abstinence education, up
from 63 percent in 1988.
Summary of the Trends in
Reproductive Behaviors
- The share of teenagers who ever
had sex plateaued or declined in the 1990s.
- Recent sexually activity among
teens dropped, primarily among white suburban
teens.
- This trend does not translate to
fewer teens reporting early initiation of sex;
indeed the proportion among females having sex
before age 15 rose substantially
- Condom use at last sex rose
significantly, suggesting more protection from
STD transmission.
- Oral contraceptive use declined,
suggesting greater vulnerability to unintended
pregnancy if other hormonal methods or consistent
condom use are not employed.
- Most teenagers are receiving sex
and AIDS education about delaying sexual onset
and using contraception.
Overall sexual risk levels appear to
have gone down among U.S. teens between 1988 and 1995.
The decline in levels of sexual experience is
particularly heartening because it is the first evidence
that we have that reductions are possible among teens.
Prior to these 1995 data, higher and higher levels of
sexual activity had been reported in every survey since
the early 1970s. The steady rise in condom use is also
important, but this trend has been observed since 1982.
However there is plenty of room for further improvement.
Inner city teens of color are not showing reductions in
levels of sexual activity, neither are rural teenagers.
The trends among Hispanic youth are particularly
troubling because of their increases in sexual activity
for both males and females and drops in condom use, seen
among the females. The evidence about increases in the
proportion of female teens initiating sex before age 15
does not bode well for the future. It suggests that the
current reductions in sexual activity may be temporary
and that the levels of sexual experience among teenagers
could rise in future.
* The
converse of "no method" is "any
method", and these include methods that provide only
minimal protection against pregnancy and no protection
against STD transmission. Therefore there are teens among
the group using "any method" who are at
virtually the same risk as those using "no
method", although the former teens are distinct in
that they displayed motivation to contracept.
1. Abma J, A.
Chandra, W. Mosher, L. Peterson, and L. Piccinino,
"Fertility, Family Planning, and Womens
Health: New Data from the 1995 National Survey of Family
Growth," Vital and Health Statistics, 1997, Series
23, No. 19.
2. Sonenstein
FL, Ku L., and Pleck JH, "Why Young Men Dont
Use Condoms: Factors Related to the Consistency of
Utilization." in Why Some Men Dont Use
Condoms: Male Attitudes about Condoms and Other
Contraceptives. DJ Besharov, FH Stewart, KN Gardiner
and M Parker (Eds) Menlo Park, CA: The Henry J. Kaiser
Foundation, 1997.
3. Mott, F.
"Fertility-related Data in the 1982 National
Longitudinal Survey of Work Experience of Youth: An
Evaluation of Data Quality and Some Preliminary
Analytical Results." Ohio State University,
1983.
4. Ku L,
Sonenstein FL, Lindberg LD, Bradner CH, Boggess S, and
Pleck JH. "Understanding Changes in Teenage
Mens Sexual Activity: 1979 to 1995," Presented
at the annual meeting of the Population Association of
America, Chicago, IL, April 4, 1998..
5. Mauldon J,
and K Luker. "The Effects of Contraceptive Education
on Method Use at First Intercourse." Family Planning
Perspectives, 1996, 28(1).
Abma and Sonenstein Slides
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