Trends in Sexual Activity, Condom Use, and Use of Pregnancy Prevention Methods Among Female Adolescents: United...

Objectives. To examine trends in sexual behaviors, condom use, and pregnancy prevention methods among female adolescents. Methods. We analyzed national and state Youth Risk Behavior Surveillance System data (2007-2023) among US female high school students (≥ 14 years). Outcomes included current sexual activity, condom use, and use of pregnancy prevention methods. We estimated weighted prevalence and trends overall and by region, age, and race/ethnicity and examined adolescent birthrates using Centers for Disease Control and Prevention data. Results. The proportion of respondents who were currently sexually active declined (2007-2011: 35.1%; 2019-2023: 23.8%; P < .01). Among those sexually active, nonuse of condoms increased (45.8% to 52.4%; P < .01), whereas nonuse of moderately or highly effective pregnancy prevention decreased (73.0% to 63.0%; P < .01), reflecting increased uptake of effective methods. The proportion using no pregnancy prevention method remained stable. Declines in sexual activity reduced population-level sexual risk indicators. Racial/ethnic disparities persisted. Birthrates declined substantially. Conclusions. Declines in adolescent birthrates are driven largely by reduced sexual activity, whereas condom use has declined and disparities in contraceptive use persist, indicating uneven improvements in sexual health behaviors. Public Health Implications. Efforts should strengthen comprehensive sexual health education and access to effective contraception and condoms, with targeted strategies for younger adolescents, the South, and non-Hispanic Black and Hispanic populations. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308511).