Trends in sexual behaviors and contraceptive use in US high school students: 1991-2005: Are positive trends faltering?

Background: Monitoring trends in adolescent sexual behaviors is crucial in understanding risks for pregnancy and sexually transmitted diseases and evaluating public health prevention efforts. While the prevalence of many sexual risk behaviors among high school students decreased between 1991 and 2005, how consistent are these trends over time and across gender, grade, and race/ethnicity?

Methods:We examined sexually-related risk behaviors among US high school students for two time periods (1991-1997 and 1999-2005), using data from the national Youth Risk Behavior Survey. Over 8 rounds of data collection, 103,868 youth were surveyed. Weighted logistic regression in STATA controlled for the clustered sampling method.

Results:Among males, significant improvements from 1991-1997 were found for three indicators of sexual risk (ever sex, multiple lifetime partners, condom use) and increases were found for recent sexual activity. From 1999-2005, only condom use improved. For females, condom and contraceptive use improved in both time periods; other indicators did not change. Improved contraceptive use among females included decreases in use of withdrawal and in nonuse. Ever having had sex among females decreased significantly between 1991 and 2005. Trends by grade and race/ethnicity generally reflected overall change.

Discussion:Although many indicators of sexual risk have improved since 1991, trends were not consistent over time or across gender. The most consistent improvements were found in condom and contraceptive use. Since 1999, national efforts to delay initiation of sex and reduce multiple partners appear to be faltering.