{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T11:11:25Z","timestamp":1784459485406,"version":"3.55.0"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Instances of withdrawal, the practice of removing a penis from a vagina before ejaculation to prevent pregnancy, have increased in some US populations over the past two decades. There is a paucity of research, however, on the prevalence and correlates of withdrawal among adolescents and young adults (AYAs). This study sought to determine the prevalence and correlates of withdrawal use in a representative sample of AYAs in the US, highlighting the association between receipt of informal sexuality education and withdrawal use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>We analyzed cross-sectional National Survey of Family Growth data from AYAs surveyed between 2011 and 2019 (15\u201324 years; N\u2009=\u200914,262). Prevalence of withdrawal was determined using different sexual activity time-points (at first sex and ever) and reference periods (past 3 and 12 months). Logistic regression models were used to identify correlates of withdrawal alone and combined with at least one other method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across all waves and reference periods, the prevalence of withdrawal was higher among AYAs who combined it with at least one other method (ever [overall]=15.15, SE\u2009=\u20090.58) compared with those who used it as the only method (ever [overall]=8.32, SE\u2009=\u20090.38). Compared to the 2011\u20132013 wave, those in the 2015\u20132017 wave had greater odds of reporting using only withdrawal in the past 3 months (AOR: 1.50; 95% CI: 1.02, 2.21). The same trend was seen in those who used withdrawal with another method at last sex in the past 3 and 12 months. Withdrawal alone or combined with another method varied by receipt of informal sexuality education topics (e.g., methods of birth control vs STIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Variations in use of withdrawal based on type of informal sexuality education received suggests that different motivations might inform interventions in promoting effective reproductive health practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0340279","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T18:32:41Z","timestamp":1768588361000},"page":"e0340279","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["The role of sex education in withdrawal use: Prevalence and correlates among a nationally representative sample of adolescents and young adults"],"prefix":"10.1371","volume":"21","author":[{"given":"John L.","family":"Ferrand","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur H.","family":"Owora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9004-8047","authenticated-orcid":true,"given":"Alexandra T.","family":"Hughes-Wegner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1690-5352","authenticated-orcid":true,"given":"Eric R.","family":"Walsh-Buhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"pone.0340279.ref001","author":"National Academies of Sciences E, Division H and M, Education D of B and SS and, Board on Children Y, Applications C on the N and S behavioral S of AD and I, Backes EP, et al","year":"2019"},{"key":"pone.0340279.ref002","unstructured":"Adolescent health in the South-East Asia Region [Internet]. 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