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BACKGROUND
THE United States has experienced a decrease in the incidence of teen pregnancy over the past decade. From 1991 to 2.001, the teenage birth rate declined significantly across the country, with all States, the District of Columbia, and the territory of Virgin Islands reporting annual declines in the birth rate for teens 15-19 years of age (1). During that same decade, 1991-2001, vital statistics data show the percentage of U.S. high school students who ever had sexual intercourse and the percentage who had multiple sex partners also decreased (2).
It is tempting to think that these trends reflect an increase in responsible sexual behavior among adolescents. However, a broader perspective reveals that the United States still has much work to do. The United States continues to have the highest teen pregnancy rate of all industrialized nations, and its teen pregnancy rate has declined less steeply than in other developed countries during the past 30 years (3). Among currently sexually active high school students, the prevalence of condom use has reached a plateau since 1999 (4). The percentage of students who used alcohol or drugs before last sexual intercourse has also increased (5). Such behaviors place these teens at increased risk for unintended pregnancy and STIs.
One limitation of this information about teen sexual intercourse and pregnancy rates is the absence of data regarding other aspects of teen sexuality. Although disputed by some experts, anecdotal reports suggest that when teens delay intercourse, they may replace it with oral sex and other sexual behaviors (6). Data on teen sexual behavior is incomplete and difficult to obtain (7). However, a study of tenth graders found that they were likely to report oral sex more frequently than intercourse, to have more oral sex partners than intercourse partners, and to refrain from STI protection during oral sex (8).
Because of these trends, promoting responsible teen sexuality is still an important public health initiative. Responsible sexual behavior is one of the Health People 2.010 Ten Leading Health Indicators for the nation, and is the focus of the Surgeon General's Public Health Priorities (9). How to achieve this goal has been the center of a long and heated public debate.
Many experts agree that teen sexual activity is driven by a...