First published online:

| DOI: https://doi.org/10.1363/4414812


Between 1995 and 2006–2010, the proportion of U.S. females aged 15–19 who had never had vaginal intercourse increased by 16%, from 49% to 57%.1 The proportion sexually inexperienced was similar across racial and ethnic groups in the latest period, but it had risen more steeply among Hispanics and blacks (29% and 34%, respectively) than among whites (15%). Women aged 15–17 became less likely to report sexual experience over time; for 18–19‐year‐olds, however, no change was evident. Current use of highly effective contraceptives (hormonal methods and IUDs) was more common in 2006–2010 than in 1995 (60% vs. 47% of sexually experienced teenagers), and was more likely among whites (66%) than among Hispanics (54%) or blacks (46%). These trends, based on analyses of data from the National Survey of Family Growth, likely help explain the considerable decline in the teenage birthrate since 1990, according to the Centers for Disease Control and Prevention.

1. Tyler CP et al., Sexual experience and contraceptive use among female teens—United States, 1995, 2002, and 2006–2010, Morbidity and Mortality Weekly Report, 2012, 61(17):297–301.


The rate at which HIV‐infected Canadian women transmit the virus to their newborns has fallen precipitously since 1997, when treatment with highly active antiretroviral therapy (HAART) became the standard of care.1 Data from a national perinatal HIV surveillance program indicate that among infected women who were referred for treatment before conceiving, during pregnancy or within three months after delivering, the rate of vertical transmission dropped from 20% in 1990–1996 to 3% in 1997–2010. Still, HAART has not eliminated the risk: One percent of infants born to women who received HAART in the later period acquired HIV infection. (By contrast, 2% of those whose mothers received other kinds of treatment and 16% of those whose mothers went untreated became infected.) The rate was less than 1% if the woman began receiving HAART more than four weeks before delivery (as the vast majority did) and 9% if she started the regimen later. For women who did not receive HAART, those who delivered by cesarean had a lower risk of passing the virus on to their infants than did those who delivered vaginally; among those who received HAART, type of delivery was unrelated to transmission risk. The findings, the analysts note, underscore the importance of testing women for HIV "as early in pregnancy as possible."

1. Forbes JC et al., A national review of vertical HIV transmission, AIDS, 2012, 26(6):757–763.


Knowledge about medication abortion was noticeably lacking among a sample of adolescent medicine specialists who participated in a 2010 online survey.1 Although only 3% of the 430 respondents provided medication abortion, 53% provided counseling about it. Nearly one in four mischaracterized medication abortion as less than very safe, and two in five mistakenly thought that it was less than 95% effective; three in 10 did not know that the procedure is recommended only at 7–9 weeks’ gestation. Substantial proportions of physicians were unaware that medication abortion is associated with abdominal pain (12%), nausea (36%) and vaginal bleeding (17%); one‐third or more overestimated the incidence of a variety of complications. Levels of knowledge were higher among respondents who provided counseling on the method than among others. Results of the survey, the investigators comment, highlight a need to improve adolescent medicine specialists’ education about medication abortion.

1. Coles MS, Makino KK and Phelps R, Knowledge of medication abortion among adolescent medicine providers, Journal of Adolescent Health, 2012, 50(4):383‐–388.


Data from 16 state and local health departments indicate that 1% of HIV tests conducted in correctional facilities in 2007 identified previously undetected cases of infection, according to analysts from the Centers for Disease Control and Prevention (CDC).1 In one‐third of cases, the individual reported only low‐risk sexual behavior or no risk factors at all. The odds of obtaining a new HIV diagnosis were elevated among women, individuals aged 30 and older, those tested in facilities in the South, men who have sex with men, injection‐drug users and individuals who had never been tested before. In 2006, the CDC issued recommendations encouraging health care settings to offer routine HIV testing of individuals aged 13–64 unless patients decline or the prevalence of previously undiagnosed infection is less than 0.1%. The analysts who reported on the data for correctional facilities suggest that these sites follow the same recommendations.

1. VanHandel M et al., Newly identified HIV infections in correctional facilities, United States, 2007, American Journal of Public Health, 2012, 102(S2):S201–S204.


In a study in which "mystery callers" posing as 17‐year‐olds phoned pharmacies in five ‐cities inquiring about emergency contraceptives, 19% were told that they could not obtain the method under any circumstances, 54% were put on hold during the call and only 2% spoke with someone who identified himself or herself as a pharmacist.1 Eight in 10 callers were told that emergency contraceptives were available that day; 54% of pharmacies that did not have the pills available offered to order them or said they could do so on request, and 20% suggested alternative pharmacies, but 36% provided none of these options. Callers posing as physicians were less likely to be given misinformation or be put on hold, and were more likely to speak with a pharmacist. While acknowledging a number of limitations of their study, the investigators believe it shows that adolescents wishing to obtain emergency contraceptives face "substantial" barriers.

1. Wilkinson TA et al., Pharmacy communication to adolescents and their physicians regarding access to emergency contraception, Pediatrics, 2012, 129(4):624–629.


A large prospective cohort study has confirmed what earlier research has found using retrospective data: Long‐acting reversible contraceptives (the IUD and implant) are more effective than the pill, patch or ring.1 Between 2007 and 2011, the Contraceptive CHOICE Project enrolled sexually active women in the St. Louis area who did not wish to become pregnant within the next year but were not using a contraceptive; participants received their choice of a reversible method free of charge and were followed up via telephone interview for up to three years. Among the first 7,486 women who selected a hormonal method or an IUD, 156 reported an unintended pregnancy while using the method during follow‐up. The contraceptive failure rate was 0.27 per 100 participant‐years among those using long‐acting methods and 4.55 per 100 among those using the pill, patch or ring; the difference was confirmed in analyses controlling for potential confounders. In the cohort overall and among users of the pill, patch or ring, women younger than 21 had higher pregnancy rates than older participants. Pregnancy rates were similar for users of the injectable and users of long‐acting methods.

1. Winner B et al., Effectiveness of long‐acting reversible contraception, New England Journal of Medicine, 2012, 366(21):1998–2007.


An apparent link between IUD use and the incidence of bacterial vaginosis may be explained by the occurrence of irregular vaginal bleeding.1 In a subsample of 153 participants in the Contraceptive CHOICE Project, women who chose any type of IUD had a higher incidence of bacterial vaginosis during the first six months of use than those who opted for combined pills (37% vs. 19%). Multivariate analyses did not bear out an association, but identified two characteristics associated with increased incidence of bacterial vaginosis: a baseline measure of vaginal bacteria just below the threshold considered indicative of the condition (hazard ratio, 3.1) and reports of irregular bleeding during follow‐up (2.6). In the absence of irregular bleeding, the incidence of bacterial vaginosis did not differ between IUD and pill users. Noting that "irregular bleeding is a frequent side effect" of hormonal contraceptive use and that it is especially likely during the first six months of use of levonorgestrel‐containing IUDs, the researchers suggest that their findings "may be important for patient counseling." However, they acknowledge the need for larger studies, with longer follow‐up periods, to explore this issue in greater depth.

1. Madden T et al., Risk of bacterial vaginosis in users of the intrauterine device: a longitudinal study, Sexually Transmitted Diseases, 2012, 39(3):217–222.


Females with coverage from a large health insurance company who begin the three‐part human papillomavirus (HPV) vaccine series have become increasingly unlikely to complete it, and the decline is especially marked at the youngest ages, an analysis of claims data shows.1 Of the more than 250,000 females aged nine and older who received the first injection in 2006–2009, only 38% received the remaining shots within 12 months. Overall, the proportion declined from 51% among those who began the series in 2006 to 21% among those who had their first injection in 2009. Results of multivariate analysis indicate that over time, the odds of completion dropped by 33% among those aged 9–12 at initiation, 16% among 13–18‐year‐olds and 8% among those aged 19–26. Compared with females who got the first injection from a pediatrician, those who got it from an obstetrician‐gynecologist were more likely to receive all three shots, and those who got it from another type of physician, a nurse, or a clinic or other facility were less likely to do so. The analysts urge providers to follow up with patients who begin the vaccine series and emphasize the importance of completing it.

1. Hirth JM et al., Completion of the human papillomavirus vaccine series among insured females between 2006 and 2009, Cancer, 2012, doi:10.1002/cncr.27598, accessed May 4, 2012.


Nordic women who begin having sex at very young ages are more likely than others to engage in risky behaviors later, according to findings from a survey conducted in 2004–2005 among 18–45‐year‐old women.1 Twelve percent of the close to 65,000 participants—women randomly sampled from population registries in Denmark, Iceland, Norway and Sweden—said that they had first had intercourse at age 14 or earlier. Multivariate analyses suggested that these women had elevated odds of reporting several risky behaviors: binge drinking at least monthly (odds ratio, 1.4), having had multiple partners in the preceding six months (1.7), having had an STD (2.0), smoking (2.3) and having had more than 10 partners (3.8). Analyses stratified by age at enrollment, a characteristic that could have affected the findings, yielded essentially the same results. The investigators point out that although the data are cross‐sectional, the risk‐taking measures clearly assessed women's behaviors after first sex. They conclude, therefore, that in these four countries, early first sex is associated with subsequent risk‐taking, and prevention efforts should target the "clustering" of risky behaviors.

1. Olesen TB et al., Young age at first intercourse and risk‐taking behaviours—a study of nearly 65,000 women in four Nordic countries, European Journal of Public Health, 2012, 22(2):220–224.