Despite the physical, economic, lifestyle, and emotional stress of pregnancy and par – enthood—and despite the availability of birth control today—many sexually active American teenagers do not use contraceptives consistently or effectively (Barclay, 2010; Reece et al., 2010b; Scott et al., 2011). Furthermore, many adolescents do not use any contraception at all the first few times they have sexual intercourse (Centers for Disease Control, 2012b).

A recent national survey revealed that in 2009, 60% of sexually active male teens and 44% of sexually active female teens used condoms during their last intercourse experi­ence (Centers for Disease Control, 2011g). The NSSHB found that adolescent men used condoms during 79% of their last 10 vaginal intercourse experiences whereas only 58% of teen women reported using condoms during their previous 10 involvements in vagi­nal intercourse (Reece et al., 2010b). Findings from the NSSHB do support a consensus among sexologists that there is a definite trend among adolescents to increasingly use con­doms during penile-vaginal intercourse (Fortenberry et al., 2010; Reece et al., 2010b).

For many sexually active teenagers the use of hormonal contraceptive methods (pills or injectables) alone or in combination with condoms remains low (Centers for Disease Con­trol, 2011g). However, recent research provided encouraging evidence that the percentage of male teens who use condoms during their initial experience with intercourse is on the rise—71% in 2006 and 85% in 2010 (National Center for Health Statistics, 2011).

Many teenagers wait months after becoming sexually active to seek birth control advice, and some never seek counsel. Misconceptions about possible health risks associ­ated with some contraceptive methods, fear of the pelvic exam, embarrassment associated with seeking out and/or purchasing contraceptive devices, and concerns about confiden­tiality keep many teenagers from seeking birth control advice (Guttmacher Institute, 2006; Iuliano et al., 2006). In reality, most American obstetrician-gynecologists are will­ing to provide contraceptives to adolescents without notifying their parents (Lawrence et al., 2011a).

Several factors or personal attributes have been found to be associated with ado­lescents’ use or nonuse of birth control. Teenage women who experience infrequent intercourse are likely to be ineffective contraception users (Glei, 1999; Klein, 2005). Furthermore, teenage women whose partners are several years older are significantly less likely to use birth control than are their peers who have partners closer in age (Ryan et al., 2008; Senn et al., 2011). Being involved with an older partner may result in "reduced power in a sexual relationship and reduced control over contraceptive decision-making" (Manlove et al., 2004, p. 265). Adolescents who experience intercourse at an early age are less likely to use contraception than are their peers who delay intercourse onset (Manlove & Terry-Humen, 2007; Ryan et al., 2007).

Research also indicates that sexually active adolescents in close, loving relationships are less likely to use condoms to prevent pregnancies and STIs than those in casual rela­tionships (Reece et al., 2010b). This finding suggests that teens in close relationships may prioritize trust, romance, and love over concerns about unwanted pregnancies and STIs and thus engage in risky sexual behaviors (Zimmerman et al., 2007). Inequities in power within intimate relationships often reduce a teenage woman’s ability to effectively negoti­ate condom use (Silverman et al., 2011). Many sexually active young women believe that they lack the right to communicate about and/or control aspects of their sexual interac­tion with men, and thus lack of sexual assertiveness is often associated with inconsistent contraceptive use (Manlove & Terry-Humen, 2007; Rickert et al., 2002).

Strong parent-child relationships that embrace healthy patterns of communica­tion about everyday life, including sex and contraception, have been positively linked to adolescent contraceptive use (Halpern-Felsher et al., 2004; Manlove & Terry-Humen,

2007) . Experiencing academic success in school and having well-educated parents are also associated with effective use of contraception (Klein, 2005; Manlove & Terry – Humen, 2007). Research also indicates that adolescents raised in families that stress personal responsibility for behavior tend to be effective users of birth control (Whitaker et al., 1999; Wilson et al., 1994). Finally and perhaps most obviously, adolescents who are the most knowledgeable about contraceptives are the most likely to use them consis­tently and effectively (Lagana, 1999).