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Sexual Health of Adolescents and Young Adults in the United States

The share of adolescents engaging in sexual activity has declined over the past few decades. Despite the growing attention to prevention and health education, recent data indicate that the rates of unintended pregnancy and sexually transmitted infections (STI) remain higher for young adults than older adults and higher than the rates in most developed nations. This fact sheet provides key data on sexual activity, pregnancy, contraceptive use, prevalence of STIs among teenagers and young adults, and access to reproductive health services.

Sexual Activity

  • Nearly half (47%) of all high school students report ever having had sexual intercourse in 2011, a decline from 54% in 1991.  Males are slightly more likely than females to report having had sex (49% vs. 46%).1
  • There are racial/ethnic differences in sexual activity rates.  Black high school students are more likely to have had intercourse (60%) compared to White (44%) and Hispanic students (49%). More Black high school students (14%)2 and Latino students (7%) initiated sex before age 13 compared to White students (4%).1
  • 26% of female teens and 29% of male teens had more than one sexual partner in their lives. The percentage of high school students who report having had four or more sexual partners declined from 18% in 1995 to 15% in 2011.1
  • Almost one-quarter (22%) of sexually active high school students reported using alcohol or drugs during their most recent sexual encounter, with males having a higher percentage (26%) compared to females (18%), and White males (28%) higher than Black males (19%).1
  • One in ten high school students reported having experienced dating violence.  Eight percent of students have been physically forced to have sexual intercourse, with females (12%) more likely than males (5%) to report this experience.1
  • Young women experience the highest rates of rape and sexual assault. More than 1 in 5 (22%) college women have been victims of physical abuse, sexual abuse, or threats of physical violence.3
  • “Sexting” is the exchange of explicit sexual messages or images by mobile phone. 13% of 14-24 year olds report having shared a naked photo or video of themselves via digital communication such as the internet or text messaging.4

    Pregnancy, Birth, and Abortion Rates Among Teens Have Been Steadily Declining in the U.S.

    Figure 1: Pregnancy, Birth, and Abortion Rates Among Teens Have Been Steadily Declining in the U.S.

Pregnancy

  • The pregnancy rate among female teens ages 15-19 in 2008 was 67.8 per 1,000, a drop of 58% since the peak in 1990.5 Despite the decline in this rate over the past decade, the U.S. continues to have among the highest teen pregnancy, birth, and abortion rates in the developed world.6
  • Following a long-term decline, the teen birth rate has decreased significantly between 2007 and 2011, dropping 10 percent from 42 to 31.3 per 1,000 females (Figure 1).7
  • Although birth rates have fallen for teens of all races and ethnicities, the rates for African American, Hispanic and Native American teens are over twice the rates of White and Asian American youth (Figure 2).
  • The vast majority of t­­een pregnancies are unplanned.  These pregnancies comprise a fifth of total unintended pregnancies annually in the US.8 Approximately 18% of women having abortions in the U.S. are teens and 33% are between the ages of 20 and 24.9
  • In 2010, the teen birth rate in rural counties was nearly one-third higher than the rest of the country, regardless of age or race/ethnicity.10 Teen birth rates have been declining in rural areas, but not nearly as quickly as in suburban and urban areas.

    Teen Birth Rates Have Been Declining for All Groups, but Racial and Ethnic Disparities Still Exist

    Figure 2: Teen Birth Rates Have Been Declining for All Groups, but Racial and Ethnic Disparities Still Exist

Contraception

  • Among adolescents, 53% of females and 45% of males talked about contraception or STIs with their partner before their first time having sex.11
  • In a nationally representative survey high school students, 67% of males and 54% of females said they had used a condom at last sexual intercourse.1
  • Only 18% of currently sexually active high school students report that they or their partner used birth control pills to prevent pregnancy at last sexual intercourse.  White students (31%) were more likely to use birth control pills compared to Black (10%) and Hispanic (11%).1
  • 21% of teen females and 13% of teen males did not use contraception at first intercourse. Research has shown that those who reported condom use at their sexual debut were more likely than those who did not to engage in subsequent protective behaviors.12
  • Emergency contraception (EC) can prevent pregnancy when taken within a few days of unprotected intercourse.  EC is available with a prescription for minors, and over-the-counter for those aged 18 and older. In 2006-2008, 11% of sexually experienced female teens had used Plan B, the first major method of EC in the U.S.
  • In 2012, the American College of Obstetricians and Gynecologists (ACOG) formally recommended long-acting reversible contraceptives (LARCs), such as intra-uterine devices, for adolescents.13 LARC utilization rates have been low, especially among teenage and young women, but utilization rates have been increasing. Approximately 4.5% of women aged 15-19 used a LARC in 2009. 

Sexually Transmitted Infections (STIs) and HIV/AIDS

Most New Cases of Sexually Transmitted Infections Occur in Youth and Young Adults

Figure 3: Most New Cases of Sexually Transmitted Infections Occur in Youth and Young Adults

  • Compared to older adults, sexually active teens and young adults are at higher risk for acquiring STIs, due to a combination of behavioral, biological and cultural factors. Though they make up 25% of the sexually active population, they account for nearly half of new STI cases (Figure 3).14
  • HPV is the most common STI among teens, with some estimates reaching an infection rate of 35% of 14-19 year olds.14 Currently, there are two vaccines (Gardasil and Cervarix) that protect against strains of HPV associated with cervical cancer and genital warts. The CDC recommends that all girls and women up to age 26 receive a vaccination, as well as all boys up to age 21.15
  • Girls and women 15 -19 years old had the largest number of reported cases of Chlamydia and Gonorrhea in 2011 of any age group. Females are at greater risk of acquiring infection, and the consequences can include pelvic inflammatory disease, pregnancy complications, and infertility.16
  • Research has found that STI screening rates vary among youth. One study estimates that 37% of young men and 70% of young women had an STI test in the past year.17
  • Over 34,000 young people, ages 13 to 24, were estimated to be living with HIV in the U.S in 2009.18  This age group accounts for 26% of new HIV infections.  Most young people with HIV/AIDS were infected by sexual contact.18
  • In 2009, 30% of young adults ages 19 to 29 reported that they had been tested for HIV in the past 12 months.19 In 2011, 84% of high school students reported that they had been taught about AIDS or HIV infection in school.1

Access to Services

  • Today, 38 states require some level of parental involvement in a minor’s decision to have an abortion, up from 18 states in 1991. Twenty-one states require parental consent, 12 require parental notification, and 5 require both.20
  • Health insurance coverage and the ability to pay for services affect teen access to reproductive health care.  Approximately 28% of young adults 19-25 years old were uninsured and 14% were covered by Medicaid in 2011. Six in ten (61%) young adults lives in a low-income household (below 200% of the federal poverty level).21
  • The Federal Title X program provides confidential contraceptive services and STI screening and treatment for low-income teens and young adults by funding approximately 4,400 clinics, public health departments and hospitals, available in 72% of US counties.22
  • Currently, Medicaid funds 75% of public family planning services in the U.S.23  Family planning is a mandatory service under Medicaid and states are not permitted to charge cost-sharing for family planning services.
  • Confidentiality affects youth access to health services.  Twenty-one states and DC have policies that explicitly allow minors to consent to contraceptive services, 25 allow consent in certain circumstances, and 4 have no explicit policy.24
  • The Affordable Care Act (ACA) requires private insurance plans that offer dependent coverage to children to extend that coverage to young adults up to age 26. An estimated 3 million young adults have already gained or retained insurance coverage because of this provision.25
  • The ACA requires insurance coverage of STI/HIV counseling and screenings, as well as contraception, without cost-sharing.

Fact Sheet: March 2013 (.pdf)

Endnotes
  1. CDC, Youth Risk Behavior Surveillance System: US, 2011. MMWR, 61(-4). 2012.

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  2. CDC, The National Survey of Family Growth 2006-2010, National Center for Health Stats, Vital Health Stats, 2010.

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  3. The White House, “1 is 2 Many: Take Action Against Abuse.”

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  4. AP/MTV Digital Abuse Study, 2011 (http://www.athinline.org)

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  5. Guttmacher Institute, U.S. Teenage Pregnancies, Births and Abortions, 2008: National Trends by Age, Race and Ethnicity, 2012

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  6. Guttmacher Institute, Teen Pregnancy and Lessons Learned, 2002.

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  7. CDC, Births: Preliminary Data for 2009, National Vital Statistics Reports,59(3)2010.

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  8. Finer LB et al. "Disparities in rates of unintended pregnancies in the US." Perspectives on Sexual and Reproductive Health, 2006, 38(2):90–96.

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  9. Guttmacher Institute, Characteristics of U.S. Abortion patients, 2008, 2010.

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  10. The National Campaign to Prevent Teen and Unplanned Pregnancy, Teen Childbearing in Rural America, 2013.

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  11. Ryan, S. “Discussions About Contraceptions or STDs with Partners Before First Sex.” PSRH, 39(3):149–157, 2007.

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  12. Shafii T. "Association between condom use at sexual debut and subsequent sexual trajectories: A longitudinal study using biomarkers." AJPH, 97(6). 2007.

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  13. ACOG, Committee on Adolescent Health Care: Long-Acting Reversible Contraception Working Group, 2012.

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  14. CDC, Sexually Transmitted Disease Surveillance, 2012.

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  15. CDC, HPV Vaccine Information for Clinicians- Fact Sheet, 2012.

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  16. CDC, STDS, 2012

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  17. Cunningham, S. “Relationships Between Perceived STD-Related Stigma STD-Related Shame and STD Screening Among a Household Sample of Adolescents.” PSRH, 2009.

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  18.  CDC, HIV/AIDS Surveillance in Adolescents and Young Adults, 2012.

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  19. Kaiser Family Foundation, 2009 Survey of Americans on HIV/AIDS, 2009.

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  20. Guttmacher Institute, "Parental Involvement in Minors’ Abortions", State Policies in Brief, 2013.

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  21. KFF Unpublished analysis of Urban Institute tabs of 2011 ASEC supplement to CPS, 2012.

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  22. HHS Office of Population Affairs: Family Planning, Title X Family Planning.

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  23. Guttmacher Institute, The Central Role of Medicaid in the Nation’s Family Planning Effort,2012.

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  24. Guttmacher Institute, "Minors’ access to contraceptive services", State Policies in Brief, 2013.

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  25. HHS, Young Adults Gaining Insurance Due to the Affordable Care Act Now Tops 3 Million, 2012.

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