Condom and Contraceptive Use Among Sexually Active High School Students, 2019

Preventing unintended pregnancy and sexually transmitted diseases (STDs), including HIV, among adolescents is a public health priority. U.S. teen birth rates have fallen to record lows — helped by wider use of IUDs and implants — but remain higher than in comparable Western nations, with wide gaps: in 2018, birth rates among Black (26.3) and Hispanic (26.7) 15- to 19-year-olds were almost twice that of white peers (12.1).

Image from the Centers for Disease Control and Prevention

Why "condom plus" matters

The most effective methods don't prevent STDs, which hit adolescents hardest and are rising. So CDC and medical organizations recommend condoms for STD/HIV protection together with a more effective contraceptive against pregnancy.

The survey

The 2019 Youth Risk Behavior Survey is a nationally representative school survey of students in grades 9–12. 27.4% of students were sexually active (sex in the past 3 months; 3,226 students). Questions asked about condom use and the one main method used to prevent pregnancy the last time they had sex; pregnancy-prevention analyses covered the 2,698 who had had sex with someone of the opposite sex.

What students used last time

• 54.3% used a condom.
• 89.7% used a condom or some pregnancy-prevention method — but 19.8% used only withdrawal or another method, or nothing.

• Only 9.1% used a condom with a more effective method — mostly pills (7.5%); condoms with an IUD, implant, shot, patch or ring were each under 1%.
• Only 31.4% used a highly or moderately effective method at all.

Condom and contraceptive use at last sex, 2019. Image from the Centers for Disease Control and Prevention

Who is least protected

By race and ethnicity

• No method was more common among Black (23.2%) and Hispanic (12.8%) students than white students (6.8%) — and more common among Black than Hispanic students.
• IUD or implant: 2.0% (Black) and 1.6% (Hispanic) vs 6.7% (white); pills: 12.1% and 15.5% vs 29.7%; condom plus a more effective method: 7.5% and 4.8% vs 12.4%.
• Any condom use was lower among Black students (48.2%) than Hispanic (56.2%) or white (55.8%) students.

By grade: younger students relied more on condoms (as the main method, 55.3% in grade 9 vs 37.4% in grade 12); older students more on IUDs or implants (8.2% in grade 12 vs under 1% in grade 9), pills, and condom-plus combinations. Use of no method was the same across grades.

By sex: boys reported more condom use (60.0% vs 49.6%) and less partner use of pills or shots, patches and rings — likely reflecting who uses each method; girls' reports of female-controlled methods are considered more accurate.

With other risks, protection was weaker:

Students with four or more lifetime partners, and those who used alcohol or drugs, were also more likely to use no method (14.7% each, vs 9.2% and 9.6%).

What can help

• Sexual risk reduction education, which works — with more attention to condoms, which have been getting less time in school instruction, and to highly and moderately effective methods as early as middle school.
• Working with communities most affected, to tackle social determinants and structural barriers behind the disparities.
• Community–clinic partnerships through youth-serving organizations, to improve access by referral or integrated services.
• Adolescent-friendly care: for example, same-day IUD or implant placement, and providers counseling teens to use condoms along with a more effective method.

Limitations

Boys' reports of partners' contraception may be inaccurate; the survey can't tell whether condoms were used for pregnancy or STD prevention; students could name only one method, which may understate condom-plus use and the use of more effective methods.

Sources

Based on "Condom and Contraceptive Use Among Sexually Active High School Students — Youth Risk Behavior Survey, United States, 2019," by Leigh E. Szucs, Richard Lowry, Amy M. Fasula and colleagues, MMWR Supplements 69(1), Centers for Disease Control and Prevention; a work of the United States government in the public domain.