Get focused on status of teen sexual health
By Melanie Gold, DO
Clinical Associate Professor of Pediatrics
University of Pittsburgh School of Medicine
Staff Physician, University of Pittsburgh Student Health Service
and Kaiyti Duffy, MPH
Assistant Director of Medical Education
Physicians for Reproductive Choice
New York City
To prevent pregnancy and disease in adolescents, health professionals seek to help teens delay sexual activity and increase condom and contraception use among those who are sexually active. Throughout the 1990s, those efforts appeared successful.
However, in the last several years, these advances have slowed. The most recent Youth Risk Behavior Survey (YRBS) data released in June 2008 reveal that 49% of high school students in 2007 had initiated sexual activity — a percentage that is virtually unchanged since 2001. Since 2003, rates of reported condom use at last intercourse also have remained statistically unchanged (63% in 2003 vs. 62% in 2007). Additionally, between 1997 and 2007, the percentage of high school students who reported being taught about HIV and AIDS in school declined from 92% to 90%. In general, there were no improvements in the percentage of students who reported engaging in sexual risk-taking behaviors (including having had four or more partners and substance use at last sex) between the 2005 and 2007 YRBS data cycles.1 It still is unknown how these recent trends will affect reproductive health outcomes, but researchers remain vigilant.
In August 2008, the Centers for Diseases Control and Prevention released the newest HIV incidence surveillance rates.2 In 2006, 27 per 100,000 young people ages 13-29 became infected with HIV. Men who have sex with men (MSM) were disproportionately represented among those rates, which make it even more important to address this subpopulation in prevention efforts. Male circumcision might not be a useful strategy for decreasing rates of infection in that population as was previously believed. In a study published in October 2008, researchers analyzed the strength of the association between male circumcision and HIV infection and other sexually transmitted infections in MSM.3 The authors concluded that there is insufficient evidence to support the premise that male circumcision protects against HIV infection or other sexually transmitted infections.3
To avert negative reproductive health outcomes, providers need to gain a deeper understanding of the confounding factors that increase adolescents' sexual risk level. In a November 2008 study, researchers examined the impact of viewing sexual content on television on a teen's risk of pregnancy.4 Results indicated that teens who watched high levels of television sexual content (those in the 90th percentile) were twice as likely to experience a pregnancy in the subsequent three years, compared with those who watched lower levels of television (those in the 10th percentile).4
In addition to assessing psychosocial factors that contribute to teen pregnancy, it is essential for providers to help youth successfully use contraception. Intrauterine devices (IUDs) can be pivotal in achieving this goal; however, recent research indicates that young women still are unaware of that contraceptive option.5 Researchers found that only 40% of participants aged 14-24 years had ever heard of the intrauterine device (IUD). Women younger than 18 years old were even less likely to report familiarity with the method. However, after receiving education about IUDs, most young women in study began to view IUDs in a more positive light.5
Providers also can address factors that affect lack of contraceptive adherence among adolescents. A study published in 2008 investigated whether immediate initiation of oral contraceptives would lead to improved continuation rates and subsequent decreased pregnancy rates among 539 adolescents ages 12-17.6 Researchers found that directly observed, immediate initiation of oral contraceptives (OCs), called QuickStart, with adolescents briefly improved continuation, although overall continuation rates were discouraging low. Only 26% of adolescents continued OC use at six months, and 45 pregnancies were identified at follow-up.6
Health care providers could use this simple contraceptive initiation strategy at the time of an office visit when adolescents wish to start oral contraceptives. However, the low six-month OC continuation rate highlights the need to identify novel and more effective ways of facilitating adolescents' successful initiation and consistent use of contraception.
References
- Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance — United States, 2007. MMWR Surveillance Summaries 2008; 57(SS-4):1-131.
- Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA 2008; 300:520-529.
- Millett G, Flores S, Marks G, et al. Circumcision status and risk of HIV and sexually transmitted infections among men who have sex with men. JAMA 2008; 300:1,674-1,684.
- Chandra A, Martino S, Collins R, et al. Does watching sex on television predict teen pregnancy? Findings from a national longitudinal survey of youth. Pediatrics 2008; 122:1,047-1,054.
- Whitaker AK, Johnson LM, Harwood B, et al. Adolescent and young adult women's knowledge of and attitudes toward the intrauterine device. Contraception 2008; 78:211-217.
- Edwards SM, Zieman M, Jones K, et al. Initiation of oral contraceptives — Start now! J Adolesc Health 2008; 43:432-436.
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