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• W1998032502 abstract "Teenage pregnancy rates in the United States have fallen substantially since 1991, leading many to ask, “What have we finally done right?” More accurately, we should be asking, “What have teenagers done right?” Santelli and his colleagues from the Centers for Disease Control and Prevention examine this question in an article in this issue of the Journal of Adolescent Health [1Santelli J.S. Abma J. Ventura S. et al.Can changes in sexual behavior among high school students explain the decline in teen pregnancy rates in the 1990s?.J Adolesc Health. 2004; 35: 80-90Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar] by using available U.S. national data sets. Most pregnancies result from a single behavior: engaging in incompletely protected sexual intercourse. Simply put, if this behavior decreases, so do the odds of pregnancy. The reader might therefore ask, “Why are analysts bothering to examine the behavior underlying the recent decline in pregnancy rates among American teenagers?” The answer lies in the fact that a decrease in unprotected sex among teenagers actually involves a number of key decisions that teenagers can make. Each of these decisions carries different chances of pregnancy. Teens can wait until they are older to initiate sex. After sex is initiated, choosing to have sex less frequently can also lower the odds of pregnancy. For males, fewer partners can also reduce the odds. Santelli's research team has calculated how much of the decline in teen pregnancy is associated with reductions in the proportion of teenagers who are sexually experienced, but they cannot factor levels of sexual activity into their estimates because they lack the data. Using contraception also reduces the chance of pregnancy, but the type of contraception matters, and some methods are typically more effective than others. This essential fact is the key element of the analyses reported by the research team. The investigators estimate how much of the decrease in teen pregnancy rates might be attributed to better contraception by examining shifts in the types of method used at last sex combined with the typical failure rates of these methods. This approach to calculating how shifts in contraceptive use might contribute to declines in pregnancy rates has not been used before and improves on previous attempts to estimate the behaviors underlying changing pregnancy rates. Sexual experience levels among 15–17-year-old females in school have fallen from 51% to 43% between 1991 and 2001. Not surprisingly, they have also fallen among male students [2Youth Risk Behavior Surveillance System, Division of Adolescent and School Health, Centers for Disease Control and Prevention. Youth 2001 Online (online database). Available at: http//appsnccdc.gov/ybss/. Accessed May 20, 2004Google Scholar]. More students also report using some form of contraception at last sex, although there has been a shift from reliance on birth control pills to greater reliance on condoms. Data from an earlier period also suggest some improvements in the consistency of method use. This is all good news. The share of teenagers who are exhibiting responsible sexual behaviors has steadily risen across the decade. And teenage pregnancy rates are falling. The analyses presented in Santelli's study estimate that about half of the change is the result of delaying sexual initiation and half is the result of better contraception. Still, we should emphasize that the analyses, though more complete than earlier attempts to address this issue, are based on estimation techniques with less than perfect information. The authors are quick to acknowledge these limitations. The reader should note the very large confidence intervals around the point estimates. Even if the actual estimates had shown that a larger proportion of the change were the result of declines in sexual experience (or alternatively, better contraception), the large confidence intervals around the estimates would not support a conclusion that one behavior has contributed more than the other to declines in teen pregnancy rates. While more teenagers are doing the right thing, adults continue to debate whether the reduction in unintended pregnancies is the result of efforts to promote abstinence or to promote better contraceptive protection. The analyses presented here cannot discern the factors and motives behind reductions in sexual risk taking among teenagers. We can only speculate about why teenagers' behaviors have shifted over time: Are teenagers more fearful of acquiring a sexually transmitted disease? Do teenagers have better access to effective hormonal contraception? Are teenagers responding to the increased emphasis on abstinence? Have changes in welfare reform had an effect on delaying childbearing? The information collected in the Youth Risk Behavior Survey provides little information that could be used to understand this shift. The important point is that more and more teenagers are making good decisions that lead to fewer unintended pregnancies. It is important to support them at each decision point; whether they are considering initiating sex, limiting their sexual activity, or choosing to use contraception. Clinicians can provide this support by making sure that teenagers receive accurate information, encouragement, and validation for decisions that protect their health and future well-being. In this issue of the Journal, the Society for Adolescent Medicine reviews one of the most critical issues in setting the stage for providing adolescents with the critical information that they need to make healthy decisions: confidential care [3Society for Adolescent MedicineConfidential health care for adolescents Position paper of the Society for Adolescent Medicine.J Adolesc Health. 2004; 35: 160-167Abstract Full Text Full Text PDF PubMed Scopus (184) Google Scholar]." @default.
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• W1998032502 date "2004-08-01" @default.
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• W1998032502 title "What teenagers are doing right: changes in sexual behavior over the past decade" @default.
• W1998032502 cites W2012796115 @default.
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• W1998032502 doi "https://doi.org/10.1016/j.jadohealth.2004.05.004" @default.
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