Update on pregnancy, condom use, and prevalence of selected sexually transmitted diseases in adolescents

Abstract

Adolescent pregnancy and its consequences continue as major sources of morbidity in the United States. A teenager who becomes a parent is at a significant disadvantage in becoming a contributing adult, both psychosocially and economically. The physician who cares for adolescents has the responsibility of helping parenting teens to find needed support so that they will be able to overcome this significant hurdle. Attention from public agencies has focused on increasing condom use as one approach to adolescent pregnancy prevention. The major advantage of using condoms is that they also prevent transmission of sexually transmitted diseases. Of note is that level of knowledge about condoms is not related to their use, and engaging in high-risk behaviors is related to a decreased likelihood of condom use. With rates of condom use estimated at less than 50%, rates of sexually transmitted disease remain high, as reported in recent surveys.

PIP: Sexual activity among adolescents had increased in the US over the past 20 years. Surveys suggest that 14-44% of males and 7-30% of females under age 15 have had sexual intercourse. Risk factors for early sexual activity include low socioeconomic status, low future achievement orientation, and peer and media influence. Surveys indicate, however, that less than 50% of youths use condoms when having intercourse. Both pregnancy and sexually transmitted disease (STD) rates are therefore elevated in these populations in the US. 40% of female American adolescents are impregnated before turning 20 years old; approximately 75% of these pregnancies are unplanned. Of the more than 1 million annual adolescent pregnancies, 400,000 are aborted, 470,000 are born to term, and the rest result in spontaneous miscarriage. Only 5% of those ultimately born are turned over for adoption. The US public annual monetary cost of these unwanted and unplanned pregnancies is estimated to be $20 billion. Teen mothers usually do not finish their education, do not support themselves financially, have failed marriages, produce babies with relatively more health problems, and have more babies grouped close together by age. US adolescents and youths are simply not using contraception effectively. Condoms are especially appropriate and recommended within this age group due to the often sporadic nature and multiplicity of their sexual contacts, as well as the ability of condoms to reduce the risk of both pregnancy and STD transmission. Physicians need to teach and counsel their young clients, and advocate that they receive services targeted to their needs. Finally, any such interventions should be developed with the understanding that the level of knowledge about condoms is not related to their use, and that high- risk sex behavior is related to a decreased likelihood of condom use. Risk prevention efforts should reach young adolescents before they initiate and become accustomed to sexual risk-taking, and aim to change attitudes toward peer beliefs and behaviors; decrease perceived costs; and increase attitudes about the effectiveness of condoms in preventing STDs.