Prevalence and type of contraception use among US college students: A needed update.

Abstract

While rates of unintended pregnancy are declining among adolescents and young adults in the United States (US), rates remain higher than other industrialized nations and are associated with both educational and economic challenges. Studies examining young adult contraceptive practices are dated and limited in scope. Understanding current contraceptive use of young adults is critical to ensure intentional pregnancies. We used the American College Health Association-National College Health Assessment III 2022-2023 national dataset to examine contraceptive use patterns among 30,568 sexually active 18- to 24-year-old college students at 4-year institutions. Differences based on students' biological sex, race/ethnicity, year in school and number of sexual partners in the last 12 months were examined. Prevalence estimates with confidence intervals were calculated; chi-square tests were used to assess initial bivariate differences and t-tests were used to determine significant pairwise comparisons. Bonferroni correction set the significance level to p<.001219. Most sexually active college students were using contraception (87.6%); however, there were significant differences among students based on demographic characteristics. Black, Latinx, and multiracial students and students with more than one sexual partner in the last 12 months were less likely to use contraception (ps < 0.001). There were also differences in the types of single and dual contraceptive methods used among students based on demographics. Significant differences based on race/ethnicity occurred across all methods and combinations of methods. Results indicated less consistent patterns of differences for sex, year in school, and number of sexual partners for single and dual use. This study provides a critical update on contraceptive use among US college students. The findings indicate which subgroups may be more at risk for an unintended pregnancy due to lower overall contraceptive use and use of methods that are less effective. Differences in race/ethnicity regarding contraceptive use continue to exist, and students with fewer years of education emerged as another essential group deserving attention. Improved awareness of methods and access to birth control are potential strategies to increase uptake. College health professionals and other clinical providers who work with US college students can use these findings to inform discussions with students who may need additional information about all available options. Rates of unintended pregnancy among young adults in the United States (US) have been decreasing, but rates are still higher than other industrialized countries. Current information about contraceptive use among college students, a large segment of the young adult population nationally, is limited; this study fills that gap. Using a national dataset (2022–2023 American College Health Association-National College Health Assessment III), this study examines sexually active college students’ contraceptive use to prevent pregnancy the last time they had vaginal sex. Most students (87.6%) used some type of contraceptive method, but there were differences in using a method or not, what type of single method was used, and what type of dual methods were used among different groups of students. Patterns varied between different group of students, but some notable findings include: Students with one sexual partner in the last 12 months or those who were Asian or White were more likely to use contraception compared to students with more than one partner and other racial groups. Students in higher years of college were more likely to use more effective methods – like the IUD (intrauterine device), shot, patch or ring. Overall, the findings show that contraceptive use among US college students varies among different groups. Healthcare providers need to discuss the variety of available contraceptive options and engage in outreach to those with lower use to ensure students are aware of all methods and can select what is best for their individual circumstances.