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Declines in Pregnancies among U.S. Adolescents from 2007 to 2017: Behavioral Contributors to the Trend

  • S.M. Goodreau
    Correspondence
    Address correspondence to: Steven M. Goodreau, Department of Anthropology, University of Washington. Campus Box 353100, Seattle, WA 98195; Phone +1 (206) 685-3870; Fax +1 (206) 543-3285.
    Affiliations
    Department of Anthropology, University of Washington, Seattle, Washington

    Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington
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  • E.D. Pollock
    Affiliations
    Department of Anthropology, University of Washington, Seattle, Washington

    Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington
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  • L. Wang
    Affiliations
    Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • J. Li
    Affiliations
    Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • M.V. Aslam
    Affiliations
    Program and Performance Improvement Office, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • D.A. Katz
    Affiliations
    Department of Global Health, University of Washington, Seattle, Washington
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  • D.T. Hamilton
    Affiliations
    Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington
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  • E.S. Rosenberg
    Affiliations
    New York State Department of Health, Corning Tower, Empire State Plaza, Albany, New York

    Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York
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      ABSTRACT

      Study Objectives

      Adolescent pregnancies and births in the United States have undergone dramatic declines in recent decades. We aimed to estimate the contribution of changes in 3 proximal behaviors to these declines among 14- to 18-year-olds for 2007-2017: 1) delays in age at first sexual intercourse, 2) declines in number of sexual partners, and 3) changes in contraceptive use, particularly uptake of long-acting reversible contraception (LARC).

      Design

      We adapted an existing iterative dynamic population model and parameterized it using 6 waves of the Centers for Disease Control and Prevention's Youth Risk Behavior Survey. We compared pregnancies from observed behavioral trends with counterfactual scenarios that assumed constant behaviors over the decade. We calculated outcomes by cause, year, and age.

      Results

      We found that changes in these behaviors could explain pregnancy reductions of 496,200, 78,500, and 40,700 over the decade, respectively, with total medical and societal cost savings of $9.71 billion, $1.54 billion, and $796 million. LARC adoption, particularly among 18-year-olds, could explain much of the improvement from contraception use. The 3 factors together did not fully explain observed birth declines; adding a 50% decline in sex acts per partner did.

      Conclusions

      Delays in first sexual intercourse contributed the most to declining births over this decade, although all behaviors considered had major effects. Differences from earlier models could result from differences in years and ages covered. Evidence-based teen pregnancy prevention programs, including comprehensive sex education, youth-friendly reproductive health services, and parental and community support, can continue to address these drivers and reduce teen pregnancy.

      Key Words

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