An individual teenager’s use of services may depend on perceived need, on knowledge of sexual health and local services, and on the ability to access. This paper presents the first UK large-scale quantitative analysis of these factors, comparing those who use services with those who do not.

5747 15/16-year-olds were questioned about their use of sexual health services in the SHARE trial of a school sex education program in 25 schools in Lothian and Tayside, Scotland, UK. Multilevel statistical models examined the role of different factors on service use.

Proximity to specialist clinics was linked with more generous use, while low spending and high parental monitoring were associated with less use. Teenagers with better knowledge, who rated their school sex education as useful, who were comfortable talking about sex, and who had discussed contraception with peers were more likely to have used services. Differences in use relating to sexual experience, knowledge, feeling comfortable talking about sex, and talking with peers helped explain gender differences in service uptake.

There is potential to influence service use through better knowledge and confidence imparted through school sex education and by improving the links between services and schools.