The 130th Annual Meeting of APHA

Abstract #50283

John S Santelli, MD, MPH¹, Joyce Abma, PhD¹, Stephanie J. Ventura, MA², and Laura Duberstein Lindberg, PhD³. (1) Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop K20, Atlanta, GA 30341, 770-488-5611, jfs8@cdc.gov, (2) Division of Vital Statistics, National Center for Health Statistics, 6525 Belcrest Road, Hyattsville, MD 20782, (3) Abt Associates, 2100 M St., NW, Washington, DC 20037

Background: The U.S. teen pregnancy rate declined 19% between 1991 and 1997 and the teen birth rate declined 29% from 1991 through 2000. It is unclear how changes in sexual behavior relate to these changes in outcomes. Methods: The national Youth Risk Behavior Survey provided estimates for students 15-17 years (n=13,500 females, 1991-1997) who had initiated intercourse and contraceptive method(s) used at last intercourse. To calculate overall contraceptive failure rates (CFR), published method-specific rates were multiplied by the percentage of users and added. Results: For blacks, overall CFR declined 19.0% and sexual experience decreased 10.5%; the combined change was 27.9%, closely approximating the change in pregnancy rates. The improvement in the CFR was primarily the result of increases in condom use and a decline in no method use. For whites, sexual experience decreased 5.5% and CFR rose slightly by 1.3%; the combination predicted a decline of 4.3%, underestimating the actual decline. Sensitivity analyses considering either recent sexual activity, using behavioral data from 14-16 year olds, or adding 1999 behavioral data did not provide a better fit to pregnancy rates. First birth rates did not show a better fit to the behavioral data. Discussion: This method found an excellent fit to data for black teens and a poor fit for whites. Sources of error in these estimates include pregnancies occurring to non-students, insufficient power given small changes in sexual behaviors, possible improvements over time in CFR, changes over time in reporting bias, and limitations in national abortion reporting.

Learning Objectives: At the conclusion of this presentation, participants will be able to

• Describe recent trends in adolescent births and pregnancies.
• Identify the two key behavioral factors influencing teen pregnancy rates.
• Identify the three gaps in current surveillance systems for monitoring teenage pregnancy.

Keywords: Adolescent Health, Sexual Behavior

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.