Surveys of risk behaviors have been hobbled by their reliance on respondents to report accurately about engaging in behaviors that are highly sensitive and may be illegal. An audio computer-assisted self-interviewing (audio-CASI) technology for measuring those behaviors was tested with 1690 respondents in the 1995 National Survey of Adolescent Males. The respondents were randomly assigned to answer questions using either audio-CASI or a more traditional self-administered questionnaire. Estimates of the prevalence of male-male sex, injection drug use, and sexual contact with intravenous drug users were higher by factors of 3 or more when audio-CASI was used. Increased reporting was also found for several other risk behaviors.

Adolescence is marked by the emergence of human sexuality, sexual identity, and the initiation of intimate relations; within this context, abstinence from sexual intercourse can be a healthy choice. However, programs that promote abstinence-only-until-marriage (AOUM) or sexual risk avoidance are scientifically and ethically problematic and-as such-have been widely rejected by medical and public health professionals. Although abstinence is theoretically effective, in actual practice, intentions to abstain from sexual activity often fail. Given a rising age at first marriage around the world, a rapidly declining percentage of young people remain abstinent until marriage. Promotion of AOUM policies by the U.S. government has undermined sexuality education in the United States and in U.S. foreign aid programs; funding for AOUM continues in the United States. The weight of scientific evidence finds that AOUM programs are not effective in delaying initiation of sexual intercourse or changing other sexual risk behaviors. AOUM programs, as defined by U.S. federal funding requirements, inherently withhold information about human sexuality and may provide medically inaccurate and stigmatizing information. Thus, AOUM programs threaten fundamental human rights to health, information, and life. Young people need access to accurate and comprehensive sexual health information to protect their health and lives.

Objectives. We explored the relative contributions of declining sexual activity and improved contraceptive use to the recent decline in adolescent pregnancy rates in the United States. Methods. We used data from 1995 and 2002 for women 15 to 19 years of age to develop 2 indexes: the contraceptive risk index, summarizing the overall effectiveness of contraceptive use among sexually active adolescents (including nonuse), and the overall pregnancy risk index, calculated according to the contraceptive risk index score and the percentage of individuals reporting sexual activity. Results. The contraceptive risk index declined 34% overall and 46% among adolescents aged 15 to 17 years. Improvements in contraceptive use included increases in the use of condoms, birth control pills, withdrawal, and multiple methods and a decline in nonuse. The overall pregnancy risk index declined 38%, with 86% of the decline attributable to improved contraceptive use. Among adolescents aged 15 to 17 years, 77% of the decline in pregnancy risk was attributable to improved contraceptive use. Conclusions. The decline in US adolescent pregnancy rates appears to be following the patterns observed in other developed countries, where improved contraceptive use has been the primary determinant of declining rates.

The premise that unintended childbearing has significant negative effects on the behavior of mothers and on the health of infants strongly influences public health policy and much of current research on reproductive behaviors. Yet, the evidence base presents mixed findings. Using data from the U.S. National Survey of Family Growth, we employ a measure of pregnancy intentions that incorporates the extent of mistiming, as well as the desire scale developed by Santelli et al. (Studies in Family Planning, 40, 87–100, 2009). Second, we examine variation in the characteristics of mothers within intention status groups. Third, we account for the association of mothers’ background characteristics with their pregnancy intentions and with the outcomes by employing propensity score weighting. We find that weighting eliminated statistical significance of many observed associations of intention status with maternal behaviors and birth outcomes, but not all. Mistimed and unwanted births were still less likely to be recognized early in pregnancy than intended ones. Fewer unwanted births received early prenatal care or were breast-fed, and unwanted births were also more likely than intended births to be of low birth weight. Relative to births at the highest level of the desire scale, all other births were significantly less likely to be recognized early in pregnancy and to receive early prenatal care.

Updated estimates of adolescents' receipt of sex education are needed to monitor changing access to information. Using nationally representative data from the 2006-2010 and 2011-2013 National Survey of Family Growth, we estimated changes over time in adolescents' receipt of sex education from formal sources and from parents and differentials in these trends by adolescents' gender, race/ethnicity, age, and place of residence. Between 2006-2010 and 2011-2013, there were significant declines in adolescent females' receipt of formal instruction about birth control (70% to 60%), saying no to sex (89% to 82%), sexually transmitted disease (94% to 90%), and HIV/AIDS (89% to 86%). There was a significant decline in males' receipt of instruction about birth control (61% to 55%). Declines were concentrated among adolescents living in nonmetropolitan areas. The proportion of adolescents talking with their parents about sex education topics did not change significantly. Twenty-one percent of females and 35% of males did not receive instruction about methods of birth control from either formal sources or a parent. Declines in receipt of formal sex education and low rates of parental communication may leave adolescents without instruction, particularly in nonmetropolitan areas. More effort is needed to understand this decline and to explore adolescents' potential other sources of reproductive health information.

OBJECTIVE: To investigate the prevalence and correlates of short interpregnancy intervals in the United States. METHODS: We analyzed pregnancy data from a nationally representative sample of 12,279 women from the 2006–2010 National Survey of Family Growth. We limited our sample to second and higher-order births within 5 years of the interview. Interpregnancy intervals were calculated as the interval between the delivery date of the preceding live birth and the conception date of the index pregnancy, with short interpregnancy intervals defined as intervals less than 18 months. We used simple and multivariate logistic regression analyses to examine associations between short interpregnancy intervals and maternal demographic and childbearing characteristics, including pregnancy intention. RESULTS: Among the 2,253 pregnancies in our sample, one third (35%) were conceived within 18 months of a previous birth. After adjusting for sociodemographic and childbearing characteristics, women were significantly more likely to have a short interpregnancy interval if they were aged 15–19 years or married at the time of conception of the index pregnancy, initiated childbearing after age 30 years, or reported the pregnancy as unintended. Short interpregnancy intervals were more likely to be intended among more advantaged women (married, non-Hispanic white, college-educated, or non-Medicaid delivery). We estimate that preventing unintended pregnancies would reduce the proportion of short interpregnancy intervals from 35% to 23%. CONCLUSION: Providing counseling about the potential negative consequences of short interpregnancy intervals and improving women's contraceptive use to reduce rates of unintended pregnancy likely would reduce the proportion of short interpregnancy interval pregnancies in the United States. LEVEL OF EVIDENCE: II