Original article
Changing Behavioral Risk for Pregnancy Among High School Students in the United States, 1991–2007

https://doi.org/10.1016/j.jadohealth.2009.04.017Get rights and content

Abstract

Purpose

After dramatic declines in teen births and pregnancies from 1991 to 2005, teen birth rates in the United States increased in 2006 and 2007. We examined behavioral determinants of these trends and the likely direction of future trends.

Methods

Pregnancy risk was estimated based on recent sexual activity, method of contraception used, and method-specific contraceptive efficacy, using data from young women on the national Youth Risk Behavior Survey (N∼125,000). Weighted logistic and linear regression were used to test for linear and quadratic (curved) trends over time.

Results

Between 1991 and 2007, behavioral risk for pregnancy declined, with all of the decline occurring between 1991 and 2003. Improvements in contraceptive use from 1991 to 2003 were found in condom use, nonuse, and use of withdrawal. Recent sexual activity (past 3 months) was unchanged over the entire period, except among black students. Quadratic changes were found in pregnancy risk for black teens and in condom use among all teens and black teens, suggesting that trends had reversed or flattened out. Although no change was found for any behavior between 2003 and 2007, pregnancy risk among sexually active teens demonstrated a borderline increase (p = .06) and small nonsignificant declines were seen for specific contraceptive methods. Pregnancy risk estimated from behavioral data correlated well with actual changes in teen pregnancy rates (1991–2004) and birth rates (1991–2006).

Discussion

After improvement in the 1990s and early 2000s, trends in behavioral risk for pregnancy appear to have stalled or even reversed among certain groups since 2003. These behavioral trends are consistent with the 2006 and 2007 increases in the teen birth rate. They may well portend further increases in 2008.

Section snippets

Methods

The YRBS is a school-based, self-administered, biennial national survey of U.S. private and public high school students [13], [14], [15]. This analysis used nine rounds of data, covering the period from 1991 to 2007. The YRBS uses a three-stage clustered sample (1, county; 2, schools within counties; and 3, classrooms within schools) to obtain cross-sectional data, which, when weighted accordingly, are representative of students in grades 9 to 12 in the 50 states and the District of Columbia.

Validation of the PRI

In general, we found that PRI scores correlated well with pregnancy rates and birth rates for 15- to 19-year-olds in the same year (R2 = .78 and .80 respectively) and lagged year (R2 = .78 and .79, Table 1). We found strong correlations between pregnancy risk and pregnancy and birth rates for non-Hispanic whites (.79–.84) and non-Hispanic blacks (.88–.96). Lower correlations were found for Hispanic teens (.26–.43). Inspection of the data suggested that 1995 was an outlier, with a PRI score that was

Discussion

After major improvement in the 1990s and early 2000s, behavior change related to teen pregnancy risk appears to have stalled or reversed after 2003. Important improvements in contraceptive use and pregnancy risk were found between 1991 and 2007, with improvements generally occurred between 1991 and 2003. Pregnancy risk behaviors did not change significantly after 2003, although contraceptive behaviors appeared to be moving toward greater risk of pregnancy. A single indicator (pregnancy risk

Acknowledgments

Doug Kirby for his advice on methods and policy, Amy Schalet and Theo Sandfort advice on the Dutch experience, and A.J. Melnikas for excellent editorial assistance. This article was funded by the William and Flora Hewlett Foundation.

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