Adolescent sexuality in the United States

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Main article: Adolescent sexuality

Adolescent sexuality in the United States relates to the sexuality of American adolescents and its place in American society, both in terms of their feelings, behaviors and development and in terms of the response of the government, educators and interested groups.

According to the US Centers for Disease Control and Prevention, in the year 2007, 35% of US high school students were currently sexually active and 47.8% of US high school students reported having had sexual intercourse.^[1] This percentage has decreased slightly since 1991.^[2] While some researchers suggest that teens are increasingly engaging in oral sex,^[3] other studies indicate that there has been little change in either oral sex or vaginal sex among teen opposite-sex partners over the past decade.^[4][5] Some research indicates that teen sexual activity increasingly takes place outside of romantic relationships and in more casual hook ups, which one author calls a "profound shift in the culture of high school dating and sex."^[6]

The American Academy of Pediatrics has identified the sexual behaviors of American adolescents as a "major public health problem",^[7] and there is a strong correlation between early sexual activity and engaging in other risky behaviors. Every year, an estimated 1 in 4 sexually active teens contracts an STD,^[8] and teen pregnancy is 2 to 10 times more prevalent in the United States than in other similarly developed countries.^[9] There is wide debate about the causes of this rate of teen pregnancy, as well as the impacts of this level of sexual activity among teens. Some studies indicate that the media play a role, as some studies have found a direct link between the amount of sexual content adolescents view and their level of sexual activity.^{[7] [10][11]}

The earlier onset of puberty for all children is putting pressure on teens to act like adults before they are emotionally or cognitively ready,^[12] and thus are at risk to suffer from emotional distress as a result of their sexual activities.^[13][14] Some studies have found that engaging in sex leaves adolescents, and especially girls, with higher levels of stress and depression.^[15]

Among sexually active 15- to 19-year-olds, 83% of females and 91% of males reported using at least one method of birth control during last intercourse.^[16] A majority of adolescents have been provided with some information regarding sexuality,^[17] though there have been efforts among social conservatives in the United States government to limit sex education in public schools to abstinence-only sex education curricula.^[18]

Contents 1 Sexual intercourse 1.1 Initial sexual intercourse 1.2 Current sexual activity 2 Abstinence 3 Motivation 4 Oral sex 5 Social aspects 6 Physical effects 6.1 Pregnancy 6.2 Sexually transmitted diseases 7 Psychological effects 7.1 Depression and emotional distress 7.2 Casual sex 7.3 Relationships 7.4 Oral sex 8 Girls 8.1 Physical effects 8.2 Emotional effects 8.3 Casual sex 9 Sexual minorities 10 Contraceptive use 11 Correlation with other risk behaviors 12 Outside influences 12.1 Media 12.2 Family 12.3 Friends 13 Knowledge of sexuality 14 Approaches to adolescent sexual education 14.1 Comprehensive 14.2 Abstinence-only 15 References

[edit] Sexual intercourse

[edit] Initial sexual intercourse

Main article: Virginity

Percent Of Boys, Aged 15-17, Who Claim To Be Virgins^[2]

Year	Percent
1988	50%
1995	57%
2002	69%

Percent Of Girls, Aged 15-17, Who Claim To Be Virgins^[2]

Year	Percent
1988	63%
1995	62%
2002	70%

By the time they are high school seniors, 66% of girls and nearly 63% of boys report they have had intercourse.^[19] Among younger teens, the majority claim to be virgins, and this percentage has risen over time.^[20]

Among sexually active teens, "a majority of boys and nearly three-quarters of girls regard their own initial sexual experience unfavorably—as an event they wish they had avoided",^[21] and studies indicate that the majority of teens who have had sex wish they had waited.^[20][22] Among sexually active girls, two-thirds say they didn't want to lose their virginity when they did or that they had mixed feelings about it.^[23]

The younger an adolescent is when they first have sex, the more partners they are likely to have over their teenage years. Over a quarter of girls aged 15 to 19 who first had sex when they were younger than 15 have had seven or more partners.^[23] Only 6.5% of girls who first had sex between 17 and 19 have had seven or more partners.^[23] For boys, there is an even larger gap. More than 31% of boys aged 17 to 19 who had sex for the first time at age 14 or younger have had seven or more partners, but only 3.8% of boys who waited until they were at least 17 had the same number.^[23]

Percent Of Boys By Age Who Claim To Have Had Sex^[23]

Age	Percent
14	7.9%
15	14.6%
16	25.3%
17	39.4%
18	54.3%
19	65.2%

Percent Of Girls By Age Who Claim To Have Had Sex^[23]

Age	Percent
14	5.7%
15	13.0%
16	26.8%
17	43.1%
18	58.0%
19	70.1%

Sixteen percent of adults first had sex before age 15, while 15 percent abstained from sex until at least age 21.^[24] The proportion of adults who first had sex before age 15 was highest for non-Hispanic blacks (28 percent) compared to 14 percent for both Mexican-Americans and non-Hispanic whites.^[24] Six percent of blacks abstained from sex until age 21 or older, fewer than Mexican-Americans (17 percent) or non-Hispanic whites (15 percent).^[24]

According to the U.S. Department of Health and Human Services, "Early timing of sexual initiation is important for two reasons. First, the younger the age of first sexual intercourse, the more likely that the experience was coercive, and forced sexual intercourse is related to long lasting negative effects."^[25] Before age 15, "a majority of first intercourse experiences among females are reported to be non-voluntary."^[25]

Girls will most likely lose their virginity to a boy who is 1 to 3 years older than they are.^[23] According to one study, almost 14 percent of teens lose their virginity in June, the most common month.^[26] The teen's home, their partner's home or a friend's house is the most common place for virginity to be lost, with 68% of teens losing their virginity in one of those three places.^[26] According to the study author, "Research shows that the likelihood of a first sexual experience happening will increase with the number of hours a day teens spend unsupervised."^[26] This may explain why teens from non-intact homes are more than 50% more likely to have had sexual intercourse.^[23][2]

Factors that increase the likelihood that a teen will become sexual active include:

• "Individual--having a history of sexual abuse, depression, heavy alcohol or drug use.
• Family--living in a single parent or stepparent household, living in a poor household, having parents with permissive values about sexual activity, having little supervision from parents, having siblings who are sexually active, feeling unloved, unwanted, or not respected by parents.
• Community--having friends who are sexually active, having few positive experiences at school, living in a neighborhood with poor neighborhood monitoring."^[27]

[edit] Current sexual activity

The percentage of teenagers who report they are currently sexually active has also been dropping since 1991. In 1997, only 37% of females and 33% of males who reported ever having had sexual intercourse said that they had sex in the past 3 months.^[28] By 2005, the overall percentage of teenagers reporting that they were currently sexually active was down to 33.9%.^[1] A lower number of sexually active teens is "quite positive in terms of their health and their well-being," said Edward Sondik, director of the National Center for Health Statistics.^[29]

Sexually Active Girls Aged 15-19, And Percent Of How Recently They Have Been Sexually Active^[23]

Age at 1st Intercourse	Last 12 months	Last 3 months	Once Ever
14 & under	89.0%	77.3%	5.1%
15-16	89.3%	76.1%	10.6%
17-19	96.3%	73.2%	11.6%

Sexually Active Boys Aged 15-19, And Percent Of How Recently They Have Been Sexually Active^[23]

Age at 1st Intercourse	Last 12 months	Last 3 months	Once Ever
14 & under	80.9%	66.8%	6.5%
15-16	84.9%	68.9%	10.4%
17-19	94.8%	69.4%	10.0%

[edit] Abstinence

Main articles: Sexual abstinence and Chastity

The number of teenage boys and younger teenage girls who have ever had sex has "declined significantly" in recent years and teens are waiting until they are older before they lose their virginity.^[23] According to the National Youth Risk Behavior Survey conducted by the Centers for Disease Control, the percentage of teens who report they have ever had sexual intercourse has been declining since 1991.^[1] The percentage of high school students in the U.S. who reported that they have ever had sexual intercourse dropped from 54.1% in 1991 to 47.8% in 2007.^[1] Teens are waiting until they are older before initiating sexual intercourse.^[23] The number of boys who waited until they were at least into their 20s before they first had sex went up over 18% between 1995 and 2002.^[23]

Both adolescents who have never had sex and those who have chosen to become abstinent after engaging in sexual behaviors cite the negative consequences of sex as reasons why they choose not to have sex.^[30] Girls of all ages and experience levels were more likely than boys to cite the fear of pregnancy and sexually transmitted diseases.^[30] Virgin boys were more likely than girls to say they believed most students did not have sex.^[30]

Boys who practiced secondary abstinence, that is, those who had had sex in the past but had since become abstinent, were more than twice as likely to have caused a pregnancy than boys who were currently sexually active. However, for girls, past pregnancy had little correlation with secondary abstinence.^[30] Fear of pregnancy, wanting to wait until marriage, and not wanting to have sex were cited more often by virgins in the 12th grade than they were by 9th graders.^[30] Of the sexually experienced who are now practicing abstinence, girls were more likely than boys to say a lack of desire, fear of STDs, being afraid of getting caught, the belief that sex wasn't appropriate for someone their age, and that their parents had taught them the advantages of waiting as reasons why they made their decision.^[30]

Adolescents who have received sex education in school or church settings are less likely to be sexually active. For girls, they were 59% less likely and boys were 71% less likely. Epidemiologists at the Center for Disease Control emphasize that for sex education to be effective, it should take place before teens become sexually active.^[31]

Most common reasons male virgins cite for remaining abstinent^[32]

Reason	Percent of 9th graders	Percent of 12th graders
a decision to wait until marriage	43%	47%
fear of STDs	57%	46%
parents would object	56%	43%
belief that sex was not right for a person their age	50%	33%

Most common reasons female virgins cite for remaining abstinent^[32]

Reason	Percent of 9th graders	Percent of 12th graders
fear of pregnancy	82%	77%
fear of STDs	75%	61%
belief that sex was not right for a person their age	70%	51%
a decision to wait until marriage	56%	58%

[edit] Motivation

In a 2003 study, 89% of girls reported feeling pressured by boys to have sex, while 49% of boys reported feeling pressured by girls to have sex. In contrast, 67% of boys felt pressured by other boys, while 53% of girls felt pressured by other girls.^[33]

A 2005 poll commissioned by NBC News and People magazine found that, of the teens surveyed, the reasons they had sexual intercourse for the first time were: ^[17]

	Major reason	Minor reason	Not a reason
Met the right person	62%	20%	18%
Were curious	36%	35%	28%
To satisfy a sexual desire	34%	34%	31%
Hoped it would make relationship closer	28%	28%	44%
Pressure from partner	15%	19%	65%
Wanted to be more popular and accepted	2%	16%	81%

The vast majority of 13- to 16-year-olds, 87%, have not had sexual intercourse, and 73% have not been sexually intimate at all. Three quarters of them have not because they feel they are too young, and just as many say they have made a conscious decision not to.^[17] Girls are more likely than boys to say they have made a conscious decision to wait (81% vs. 67%) and are more likely to believe they are too young (82% vs. 67%). Girls who date or hang out with older boys are "more likely to be pressured into having sex, more likely to get a sexually transmitted disease, and more likely to experience an unwanted pregnancy,"^[34][35] and also have a higher risk for substance abuse and a combination of sex and drug use.^[36]

According to one study, laws that require parental notification or consent before a minor can obtain an abortion "raise the cost of risky sex for teenagers."^[37] The study found that states which have enacted such laws have seen lower gonorrhea rates among teens than states that do not have such laws. The study's researchers believe these laws lower the gonorrhea rate because teens reduce the amount of sexual activity they have and are more fastidious in the use of birth control.^[37]

According to another study, girls who participate in girls-only activities are far less likely to experience a teenage pregnancy and less likely to be sexually active in general.^[38] Participating in competitive sports has also shown to have an effect for girls. A study published in 1999 found that female adolescents who participated in sports were less likely than their non-athletic peers to engage in sexual activity and/or report a pregnancy.^[39] Males interested in arts are also less likely to be involved in a pregnancy situation. It is unclear whether these correlations are causal or the reflection of the underlying bias of the considered population. The study that reported these findings did not take into account the sexual orientation of the subjects.^[39]

[edit] Oral sex

The National Center for Health Statistics has reported that half of all 15- to 19-year-olds have had oral sex, with the percentage rising to 70% by the time they turn 19, and equal numbers of boys and girls participating.^[40] A 2007 Guttmacher Institute study found that slightly more than half (55%) of 15– to 19-year-olds have engaged in heterosexual oral sex, 50% have engaged in vaginal sex and 11% have had anal sex, and that the prevalence of both vaginal and oral sex among adolescents has remained steady over the past decade.^[5]

This data indicates that many teens, particularly those from middle- and upper-income white families, don't consider oral sex to be as significant or meaningful as older generations do.^[40] Almost half of boys (47%) and fewer girls (38%) believe that oral sex is "not as big of a deal as intercourse", and 55% of teens believe that it is "very important" to be in love before engaging in oral sex. Despite this, "there is discrepancy when it comes to willingness to perform oral sex [with] 22% of sexually active girls say[ing] their partner never performs oral sex on them, while only 5% of boys say their partner never does."^[17][3]

Researchers at the University of California, San Francisco believe that some teens, and particularly girls, engage in oral sex as a way to avoid vaginal intercourse.^[41] However, Dennie Hughes cautions, "We need to move away from the idea that girls who engage in oral sex but not intercourse are "technical" virgins -- that you're not having sex because no one's penetrating you. Let girls know that every time you do something like that, you compromise yourself and give up some of your power."^[42] A study released in 2008 by the Guttmacher Institute disputed this substitution theory. "There is a widespread belief that teens engage in nonvaginal forms of sex, especially oral sex, as a way to be sexually active while still claiming that technically, they are virgins," says study author Laura Lindberg. Their "research shows that this supposed substitution of oral sex for vaginal sex is largely a myth."^[43]

While New York Times columnist David Brooks has written, "Reports of an epidemic of teenage oral sex are .. greatly exaggerated"^[44], the National Center for Health Statistics has found a quarter of 15-year-old girls have performed it, and more than half of all 17-year-old girls have.^[3] About 12% of teens aged 13-16 have had oral sex, and 13% of the same teens have had sexual intercourse.^[17] Researchers believe that oral sex may have become more popular than intercourse for adolescents because teens believe it carries fewer physical and emotional risks,^[45][46][40] a claim one study supports.^[41]

[edit] Social aspects

In a 2002 US News & World Report article that quoted multiple experts, reporter Anna Mulrine states that "nearly everyone agrees" that risky sexual behaviors that involve "anything but intercourse," as well as sexually transmitted diseases, are "rampant" among teenagers.^[47] However, more recent research, including a study released in 2008 by the Guttmacher Institute,^[5] indicates that teenage sexual activity has either held flat or declined in recent years, and New York Times columnist David Brooks, calls such reports "greatly exaggerated".^[44] According to one study, more than half of sexually active teens have had sexual partners they are not dating.^[48][17] Atlantic Monthly social critic Caitlin Flanagan calls this a "a genuine and puzzling change in teen sexual behavior."^[3] Alexandra Hall, senior editor at Boston magazine, terms it a "profound shift in the culture of high school dating and sex."^[6]

Mark O'Connell, an instructor in clinical psychology at Harvard Medical School, has opined that "Sexual behaviors and attitudes change from generation to generation, but the explosion of sex without meaning or substance signifies more than yet another generation's effort to stake its claim by shocking its parents (in this case, parents often too jaded to be shocked)."^[14] Despite their behaviors, 90% of adolescents "agree that most young people have sex before they are really ready".^[33] At a summit called "Sex, Lies and Older Guys," there were girls who were "being raped and feeling powerless to do anything afterward, blocked by a sexual irrevolution that has made feelings irrelevant and intercourse the new dating. They feel that these encounters are their fault, and they are ashamed to tell anyone," the Detroit Free Press reported.^[49]

Claire Brindis, professor of pediatrics at the University of California at San Francisco, has noted that casual attitudes towards oral sex have made it so common that "we're talking about a major social norm. It's part of kids' lives."^[40]

Of adolescents age 12-16, 83% believe a person is still a virgin after engaging in genital touching, and 70% said they believed one retained their virginity after having oral sex. However, only 44% believed that one was abstinent after genital touching and 33% believed one could have oral sex and still remain abstinent. Of anal and vaginal sex, 14% believed you could engage in the former and 12% said you could participate in the latter while still remaining abstinent.^[50] According to a 2007 study published by the Pacific Institute for Research and Evaluation, "A large proportion of young people believe even an intimate level of sexual contact is abstaining from sex and being a virgin."^[51] If an adolescent engaged in a particular behavior they were more likely to believe that they were still a virgin.^[50]

Seventh and eighth graders who do well in school (A's and B's) are less likely to initiate sexual activities than those who perform average or poorly. In addition, among those seventh and eighth graders, those with personal and perceived peer norms that encourage adolescents to refrain from sex are less likely to engage in it. Students in these grades who use drugs and alcohol are also more likely than non users to begin having sex at this young age.^[52]

[edit] Physical effects

The American Academy of Pediatrics has identified the sexual behaviors of American adolescents as a major public health problem.^[7] The Academy is concerned about the prevalence of sexually transmitted diseases in sexually active teenagers and about the very high rate of teenage pregnancy in the United States compared to other developed countries.

Adolescents and young adults have difficulty predicting the consequences their actions will bring and thus often underestimate their risk for adverse consequences.^[53] Research into adolescents' sexual behavior in situations outside traditional dating situations, commonly referred to as hooking up, shows that adolescents underestimate the risk involved in such situations.^[54][55] With all the issues and problems relating to adolescent sex, "ideally, they [adolescents] won’t be having sex", according to LuAnn Moraski, assistant clinical professor of Pediatric Internal Medicine at the Medical College of Wisconsin.^[56]

Early sex poses a greater physical threat for girls than for boys.^[57] Compared with adults, a teenage girl "with an immature cervix, is more likely to catch an STD, triggering problems like smoldering pelvic inflammatory disease that can silently take away fertility, tubal pregnancies, cervical and even throat cancer, and transmission of disease to offspring at birth," Healy stated in US News & World Report.^[57][58]

[edit] Pregnancy

Main article: teen pregnancy

Teen pregnancies in the United States decreased 28% between 1990 and 2000, from 117 pregnancies per every 1,000 teens to 84 per 1,000.^[8] However, a 2007 report showed 3% increase in the teen birth rate from 2005 to 2006, to nearly 42 births per 1,000.^[59]

International comparisons conducted over the years typically place US teen pregnancy and teen birth rates among the highest in the developed world. For example, a 2001 study by UNICEF found that the US teenage birth rate was the highest among 28 OECD nations in the review;^[9] in a 1999 comparison by the Guttmacher Institute, U.S. teen pregnancy and teen birth rates were the second-highest among the 46 developed countries studied.^[60][61] In 2002, the U.S. was rated 84th out of 170 World Health Organization member countries based on teenage fertility rate.^[62]

[edit] Sexually transmitted diseases

Main article: Sexually transmitted diseases

See also: safe sex

Each year, between 8 and 10 million American teens contract a sexually transmitted disease.^[63] According to the U.S. Centers for Disease Control, almost half of the 19 million sexually transmitted diseases reported in the U.S. occur in young people, ages 15 to 24.^[64] Lloyd Kolbe, director of the CDC's Adolescent and School Health program, called the STD problem "a serious epidemic."^[47] The younger an adolescent is when they first have intercourse, the more likely they are to get a STD throughout their teenage years.^[65]

A 2008 study by the CDC found that one in four teen girls, or an estimated 3 million girls, has an STD.^[66] The study of 838 girls who participated in a 2003-04 government health survey found the highest overall prevalence among black girls, nearly half in the study were infected, compared with 20 percent among both whites and Mexican-American teens.^[67] The same study found that, among those who were infected, 15% had more than one STD, and 20% of those who said they had only one sexual partner were infected.^[66]

Human papillomavirus (HPV) is the most common STI among teens as well as adults.^[68] In the CDC study, 18% of teen girls were infected with HPV.^[66] Another study found that HPV infections account for about half of STIs detected among 15- to 24-year-olds each year.^[69] While most HPV infections cause no disease, HPV does cause genital warts and cervical cancer. An HPV vaccine protects women against two HPV types which cause 70% of cervical cancers as well as two types associated with 90% of genital warts.^[64] Ideally the woman should be vaccinated before initial sexual activity, since the vaccine is only effective before exposure to the HPV types.

In the CDC study, 4% were infected with chlamydia, historically the most prevalent of all STDs in the general population. More than a third of all chlamydia cases occur in those aged 15 to 19.^[64]

In the CDC study, 2% were infected with herpes simplex. The herpes infection rate fell between 1988 and 2004 among teens as well as the overall population.^[70] Overall, the number of Americans aged 14 to 49 who tested positive for herpes 2 infection fell by a relative rate of 19 percent between 1988 and 2004 — from 21 percent in the late 1980s and early 1990s to 17 percent 10 years later, the researchers reported. The number of people aged 14 to 19 who tested positive for new herpes simplex 2 infections dropped from 5.8 percent in a 1988-1994 survey to just 1.6 percent 10 years later.^[70]

[edit] Psychological effects

For teens, "having sex changes you. It is emotionally powerful and there are risks involved," Saltz points out.^[71] In one study conducted by the University of California, San Francisco of 273 sexually active California teens, those studied reported both positive and negative consequences of their sexual activity. Among those who had had both oral and vaginal sex, 60% reported at least one negative effect, such as feeling used, getting pregnant, contracting a sexually transmitted infection, or feeling bad about themselves.^[72] According to UCSDF pediatrics Professor Bonnie Halpern-Felsher, "We tend to focus on the health consequences of having sex, like pregnancy and STDs, but we also need to talk to them about all the emotional consequences."^[45] Disease and illness related sexual activity is epidemic, but "the psychological outfall isn’t far behind."^[22]

According to Harvard Medical School's O'Connell, adolescents "often haven't achieved the emotional, even neurological, maturity necessary for making autonomous and self-aware sexual choices."^[14] Psychologist Paul Coleman echoes this assertion: "Teenagers are not mature enough to know all the ramifications of what they're doing."^[13] Emotional, social and cognitive development continues well past adolescence.^[73] With their still-developing brains, teens do not yet possess the ability to either fathom the physical and emotional consequences of sex or to deal with them once they happen.^[47] "Early sexual activity—whether in or out of a romantic relationship—does far more harm than good."^[74]

As the frontal lobe of the brain, which houses complex thinking, understanding cause and effect, controlling impulses, and judgment, is not fully developed until a person is in their 20s, "teens are less prepared to think about 'if I do this today, what will happen to me tomorrow?'" notes psychiatrist Gail Saltz.^[71] "To think that the emotional intimacy and biochemistry of sex can be easily undone is the result of immature cognitive functioning."^[75]

Sex for teens is not "without risk. It can take a toll on the soul, dehumanizing unsuspecting students who tumble too soon into the world of hooking up, not knowing enough about sex or themselves to avoid getting hurt," according to educator and psychologist Pat McDonough.^[75] Despite "societal shifts in sexual standards, human development remains pretty much the same. Kids are still emotionally vulnerable and volatile - more so if they are sexually active," McDonough stated in Newsday.^[75] Stephen G. Wallace, national chairman and chief executive officer of Students Against Destructive Decisions, has cautioned, "There is a lot at stake—a decision about sexual behavior can have lasting physical, social, and emotional consequences."^[22]

[edit] Depression and emotional distress

Longitudinal research has shown "a significant association between teenage sexual abstinence and mental health."^[76] In a broad analysis of data from the National Longitudinal Study of Adolescent Health, researchers found that engaging in sex leaves adolescents, and especially girls, with higher levels of stress and depression.^[15] "Overall, for either gender, teens who are not sexually active are markedly happier than those who are active."^[21] "Depression, anxiety and increased stress accompany the abuse of alcohol and drugs also observed in sexually promiscuous teens."^[75]

Research has found "a dramatic relationship" between sexual activity among adolescents and "multiple indicators of adolescent mental health. Compared to abstainers, membership in any of the risk clusters was associated with increased odds of depression, serious thoughts about suicide, and suicide attempts."^[77] Sexually active girls are more vulnerable to depression, suicidal ideation, and suicide attempt than sexually active boys, but there is little difference between boys and girls who are not sexually active.^[77] Risk for depression is "clearly elevated" for the sexually active of either gender.^[77]

Doctor of adolescent medi­cine Meg Meeker writes, “Teenage sexual activity routinely leads to emotional tur­moil and psychological distress. [Sex­ual permissiveness leads] to empty relationships, to feelings of self-contempt and worthlessness. All, of course, precur­sors to depression.”^[78] According to the Heritage Foundation, boys who have had sex are more than 8 times as likely to attempt suicide (6%) as virgins (0.7%), and sexually active girls are almost three times as likely (14.1% versus 5.1%).^[21]

Experts recommend that sexually active adolescents be screened for depression and be "provided with anticipatory guidance about the mental health risks of these behaviors."^[15][77] Professors at the University of California recommend that parents and health professionals help teens prepare for and cope with the emotions attached to sex.^[45]

Researchers at Brown University have found that cutting is linked to higher levels of risky sex among teenagers.^[79] Psychologist Lori G. Plante states that "habitual cutting is a way of managing intense emotional distress. It makes sense that the level of impulsivity and risk taking would also be higher in these teens." Plante believes that cutting, even once, is "a warning sign that they are overwhelmed in some way."^[79]

[edit] Casual sex

Casual attitudes amongst adolescents toward sex and oral sex in particular "reflect their confusion about what is normal behavior", according to Sabrina Weill, author of The Real Truth About Teens & Sex.^[13] When adolescents engage in casual sexual relationships, they proceed toward adulthood with a lack of understanding about intimacy.^[13] James Wagoner, president of Advocates for Youth, worries that "if we are indeed headed as a culture to have a total disconnect between intimate sexual behavior and emotional connection, we're not forming the basis for healthy adult relationships."^[13] In US News & World Report, physician Bernadine Healy states, "Both as doctor and mother, I can't help but believe that our anything-goes society, in which impulses are immediately satisfied and sex is divorced from love and bonding, is simply not healthy physically, emotionally, or spiritually."^[57]

When taking part in hookups, "the kids don't even look at each other. It's mechanical, dehumanizing", according to psychologist Marsha Levy-Warren.^[80] This impersonality is harmful to both girls and boys; however, girls are especially at risk of becoming victims in casual sexual relationships.^[74]

Studies show "what many teens come to find out on their own: Even if sexual activity seems casual, it often is not", according to Bill Albert, deputy director of the nonprofit National Campaign to Prevent Teen Pregnancy. "A casual hookup on a Friday night might not feel that way a month down the road."^[45] When having causal sex teens are "pretending to say it's just sexual and nothing else. That's an arbitrary slicing up of the intimacy pie. It's not healthy", according to Paul Coleman, psychologist and author of The Complete Idiot's Guide to Intimacy.^[13] Depression, alcohol abuse, anorexia, and emotional disturbance can all afflict adolescents as a result.^[81]

Mark O'Connell has written that the "explosion of sex without meaning" among American teens "is deeply symptomatic. Emotional deadness, disengagement, and constriction are increasingly the norm. (Oral sex is, after all, 'just something to do.') 'Sexual addiction,' our term for moving from sexual experience to sexual experience without ever being satisfied, is prevalent. Meanwhile, for many kids precocious sexuality represents not freedom and experimentation but is a byproduct frequently seen with sexual trauma: compulsively driven activity that both expresses and aims to manage the effects of chronic intrusion and overstimulation."^[14]

[edit] Relationships

Even when teens are in a romantic relationship, sexual activities can become the focus of the relationship. Not only are such relationships less sustained, they are often not monogamous and they have lower levels of satisfaction than relationships that do not have sexual activities as their focus, according to W. Andrew Collins, child psychology professor at the University of Minnesota.^[13]

The "early initiation into sexual behaviors is taking a toll on teens' mental health" with dependency on boyfriends and girlfriends, serious depression around breakups and cheating, and suffering from a lack of goals as possible results.^[47] David Walsh, from the National Institute on Media and the Family, thinks that when adolescents engage in casual sexual relationships they do not develop skills such as trust and communication that are key ingredients in healthy, long-lasting relationships.^[13]

In purely sexual relationships, adolescents pick up "a lot of bad habits" and don't learn "to trust or share or know how to disagree and make up", according to Laura Sessions Stepp, author of Unhooked: How Young Women Pursue Sex, Delay Love, and Lose at Both.^[81] They become jaded and as a result later in life, they have trouble forming adult relationships, according to Levy-Warren.^[80] "They don't learn to build that emotional intimacy before they get physically intimate. In the long term, that develops bad relationship habits. They may grow up not knowing how to connect with a partner on an intimate level", according to adolescent gynecologist Melisa Holmes, author of Girlology: Hang-Ups, Hook-Ups and Holding Out^[82]

Males and females experience sex differently,^[83] and boys are less likely to see sex as connected to an emotional relationship than girls.^[84] Males are more able to shrug off a one night stand, but "girls are more confused afterward... and in general suffer a loss of self esteem," according to Carrie Lukas of the Independent Women's Forum.^[83] However, by the time a young man has reached his early twenties, his girlfriend or his wife will become his primary emotional caregiver.^[84][85] If he cannot establish an emotional relationship with a woman, who does view sex as connected to intimacy, then he is more likely to become depressed, commit suicide or die from illness.^[86]

Experts worry that when teens have sex before they're ready then they undervalue the experience and that leads to a cynical view later on. "I think they can develop a kind of negative attitude about life in general, that things aren't that special and they aren't that wonderful and what's the big deal about a lifelong commitment and a family commitment?" said Linda L. Dunlap, a psychology professor at Marist College. "They're disappointed, probably because they weren't mature enough to understand the meaning of it, and it's kind of made them kind of cold to the idea of commitment in other ways."^[87]

[edit] Oral sex

Teens believe that oral sex is less risky to their emotional and physical well being than vaginal sex,^[46] but experts at the University of California do not believe this conclusion is warranted.^[41] They found that oral sex, as well as vaginal sex, was associated with negative consequences.^[41] "If a substantial number of young people are having oral sex, as these numbers indicate, this is a big concern", said Kristin Moore, president of Child Trends.^[40]

With regards to oral sex, it is almost always the boys who receive it and the girls who give it.^[3][17] When girls provide oral sex "they do so without pleasure, usually to please their boyfriend or to avoid the possibility of pregnancy."^[88] This paradigm has entitled boys and disempowered girls,^[80] putting girls at a disadvantage.^[89] Adolescents who engage in oral sex but not intercourse report fewer problems with sexually transmitted diseases, guilt, and their parents, but also less resulting pleasure, self-confidence or intimacy with their partners.^[45]

Of adolescents engaging in oral sex only, girls were twice as likely as boys to report feeling bad about themselves and nearly three times as likely to feel used.^[45] Boys who engaged in oral sex were more than twice as likely as girls to report feeling more popular and confident.^[45]

[edit] Girls

Researchers at the University of California, San Francisco found that girls are "at particular risk for experiencing negative social and emotional consequences of having any type of sex," including oral sex.^[41] According to Healy, "Early sex is a threat, and it remains a greater threat to girls than to boys."^[57]

The American Psychological Association task force in 2007 found that an early emphasis on sexuality stunts girls' development in other areas.^[90] "When kids are about defining themselves, if you give them this idea that sexy is the be-all and end-all, they drop other things," says Sharon Maxwell, a psychologist who specializes in adolescent sexuality.^[90]

[edit] Physical effects

Girls who have engaged in sexual intercourse are five times more likely than their virgin peers to be the victim of dating violence.^[91] Girls who were intentionally hurt by a date in the past 12 months are at a "significantly elevated risk for a broad range of sexual health concerns and for pregnancy."^[91] Girls who have been victims are also twice as likely to report high levels of multiple sexual partners.^[91]

[edit] Emotional effects

While teens may believe that their sexual activities are fine at the time, Lukas cautions that they may feel very differently in time and may regret the choices they made.^[83] She points to research that shows 2/3 of sexually active girls wish they had waited longer before having sex.^[83] Sex therapists have found that the roots of sexual issues facing adults often date back to regretful teenage experiences.^[45] Of seniors in high school, 74% of girls regret sexual experiences they have had.^[92]

Girls are more than twice as likely as boys to say they felt bad about themselves and more than three times as likely to say they felt used as a result of engaging in sex^[72][75] or hookups.^[45][74] When asked if girls and women really wanted casual sex as much as men did, Dr. Drew Pinsky said he had spoken to them "by the thousands" and that they absolutely did not.^[93] The only reason they engaged in it, he said, was because they thought it was what they need to do in order to get the guy. The current paradigm of casual sex has left females "ambivalent, unhappy and uncomfortable."

For girls, even even modest involvement in sexual experimentation elevates depression risk.^[15] More than 25% of sexually active girls are depressed all of the time, most of the time or a lot of the time, but more than 60% of girls who are not sexually active are never depressed.^[21] Research has also found that adolescent sexual abstinence was associated with better mental health at age 29^[76] and girls who were virgins at age 18 were less likely to have a mental illness at age 40.^[94]

[edit] Casual sex

Benoit Denizet-Lewis, a fellow at the Alicia Patterson Foundation, found in his study of casual sex among adolescents that many girls believe they can have a purely sexual experience with no emotional ties, and they believed it was sexist to assume otherwise. However, he believes that both the girls and the boys who were hooking up often really were depressed and didn't feel very good about themselves.^[95] In his research he found that "all the experts who talk about teen sexuality maintain that... it's impossible" for girls to enjoy meaningless sex as much as boys.^[95] Girls will "inevitably regret what they did."^[95] Speaking on National Public Radio, Lukas noted that girls "particularly are suffering from the new regime [i.e. casual sex] and are having some lasting problems" as a result of it.^[83]

Some research suggests that females are not biologically or evolutionarily equipped to handle casual sex.^[96] According to Washington Post reporter and author Laura Sessions Stepp, the hormone oxytocin, released during sex, affects women differently than men, so that "when women think they can have sex and walk away just like guys do, they're having to suppress thousands of years of evolution that tells them to cuddle, stay in bed, and look forward to tomorrow. When they get up and walk out, they feel depressed and don't know why."^[96] However, attempts to explain differences in how girls and boys perceive sex based on differences in hormone release are speculative.^[97]

[edit] Sexual minorities

According to a study based on a sampling of teenagers in Massachusetts, sexual minority youth, that is, those who identify as gay, lesbian, or bisexual or had any same-sex sexual contact in their lifetimes, were significantly more likely than other students to report lifetime sexual intercourse (72% vs. 44%).^[98] The same study found that sexual minority youth were more likely to report sexual intercourse before age 13 (18% vs. 4%), sexual intercourse with four or more partners in their lifetimes (32% vs. 11%), and recent sexual intercourse (55% vs. 33%). Among students in the Massachusetts study who ever had sexual intercourse in their lifetimes, sexual minority youth were significantly more likely than other students to report "having been or gotten someone pregnant (15% vs. 4%) and having been diagnosed with HIV or another STD (10% vs. 5%)."^[98][99]

Several studies have found that gay youths are represented disproportionately among adolescents who drop out of school, run away from home, abuse alcohol and other drugs, engage in prostitution, or attempt, contemplate and successfully commit suicide.^[100]

[edit] Contraceptive use

Among sexually active 15- to 19-year-olds, 83% of females and 91% of males reported using at least one method of birth control during last intercourse.^[16] Thus, sexually active adolescent women wishing to avoid pregnancy are less likely than those of other ages to use contraceptives (18% of 15- to 19-year-olds used no contraceptives, versus 10.7% average for women ages 15 to 44), according to an analysis of periodic survey data from the National Center for Health Statistics.^[101]

Among adolescents, the most common methods of contraception are birth control pills (used by 43.5% of 15- to 19-year-old women at risk for unintended pregnancy) and condoms (used by 22% of adolescent women).^[101] In 2007, 61.5% of high school students reported using a condom the last time they had sexual intercourse, up from 46% in 1991.^[1] Adolescent women are more likely to use Depo Provera (11% of teens versus 4.8% for women ages 15 to 44) but less likely to use IUDs (0.2% versus 1.9% overall), which require little user action and are thus among the most effective in typical use.^[101]

While 90% of teens surveyed in a poll commissioned by NBC News and People magazine knew they could get an STD from having sexual intercourse, only 67% said that they use protection every time they have sex.^[17] Boys who have received sex education are three times more likely to use contraception than their peers who have not, but for girls there is no difference.^[31] Before the 1980s, 57% of 15- and 16-year-old girls did not use contraception the first time they had intercourse. By 2007, that number fell to 25%.^[2]

Girls who stop using contraception after the first time they have intercourse have been found more likely than those who continue to use it to be less able and willing to plan for sexual intercourse, less apt to believe that pregnancy was likely to occur and less apt to want to remain non-pregnant. They were also more likely to be older and to have been sexually active for at least 6 months. Girls who stopped using contraception were also less likely to have career goals and had more positive expectations themselves about the effects of childbearing on their lives.^[102]

One simulation projected that increasing contraceptive availability among teenagers reduces teen pregnancies in the short run, but may result in more teen pregnancies in the long run. The researchers found "that even well intended contraception policies can be self-defeating."^[103] This study also found that decreasing access to contraception leads to lower rates of sexual activity among teenagers and thus will lower the teen pregnancy rate in the long run.^[103] However, another study outlined the dangers of new laws being enacted that limit adolescents' access to contraceptives, including condoms.^[104]

[edit] Correlation with other risk behaviors

According to a report prepared for the U.S. Department of Health and Human Services,

the younger the age of first sexual intercourse, the greater the risk of unwanted pregnancy and sexually transmitted infections. This is because those who begin having sex at young ages are generally exposed to risk for a longer time, are less likely to use contraception, generally have more sexual partners, and tend to engage in higher risk sexual behaviors such as alcohol or drug use prior to sexual intercourse and having multiple concurrent sexual partners. It must be recognized as well that early intercourse is frequently not voluntary.^[25]

Less than 20% of teens become sexually active at 14 years of age or younger, however if they do they are six times more likely than their peers that self-identify as a virgin to drink alcohol once a week or more, four times more likely to have smoked marijuana and three times more likely to be regular smokers of cigarettes.^[105] Other research also shows that risk behaviors often appear in clusters. If an adolescent is engaging in one risk behavior then there is a strong chance there may be others. For example, many teens are either using drugs or alcohol when they first have sexual intercourse.^[106]

A survey by the National Campaign to Prevent Teen Pregnancy found that "7% of youth used alcohol the first time they had sex, and 6% used alcohol the most recent time they had sex."^[107] Boys will use drugs and alcohol for different reasons than girls. Boys are more likely to use in order to relax and to prevent premature ejaculation.^[108] Girls will often become intoxicated before engaging in sexual activities because it "numbs the experience for them, making it less embarrassing and less emotionally painful."^[109]

Researchers have also found that the younger an adolescent is at the time of their sexual debut, the greater the likelihood that they will engage in delinquent acts later. Adolescents who experience late sexual debut are the least likely to participate in delinquency.^[110] According to one of the study's co-authors, Dana Haynie, adolescents who start having sex at a young age may not be prepared to deal with the emotional, social and behavioral consequences of their actions.^[111] Study coauthor Stacy Armour theorized that adolescents "who waited longer than average may be developing friendships and relationships that can help protect them from potentially troublesome behaviors as they become young adults...The timing of events such as sexual activity can have profound consequences for adolescents, particularly when they occur prematurely...[T]he timing of sexual initiation does matter. Adolescents need to be at a stage when they are developmentally prepared for it."^[111]

[edit] Outside influences

[edit] Media

Although early sexual activity may be caused by a variety of factors, research indicates that the media plays a significant role.^[7] According to journalism professor and media critic Jane Brown, since adolescents see so much sex in the media it is piquing their interest in sex at ages younger than they have traditionally been.^[11] Research has "found a direct relationship between the amount of sexual content children see and their level of sexual activity or their intentions to have sex in the future."^[10][11]

Brown has also found that adolescents whose media diet was rich in sexual content were more than twice as likely as others to have had sex by the time they were 16.^[90] In addition to higher likelihoods that an adolescent exposed to sexual content in the media will engage in sexual behaviors, they are also have higher levels of intending to have sex in the future and more positive expectations of sex.^[112]

Middle school aged boys who watch music videos or pro-wrestling one day a week are 10% more likely to have a higher acceptance rate for rape than boys who do not watch any.^[65] Boys who watch music videos four days a week and pro wrestling 1.7 days a week (the mean exposure rate for boys) have 70% higher odds of endorsing a greater level of rape acceptance.^[65] "Both music videos and pro wrestling shows are popular with youth, combine violent and sexual content, and glorify individuals who behave violently."^[65]

One study found that the relationship between exposure to sexual contact in the media and increased sexual activity among adolescents is more pronounced in white youths than black youths. Black teens are more likely to be influenced by their friends' sexual experiences and their parents' expectations than by what they see in the media.^[113]

According to another analysis, the American media is the most sexually suggestive in the world.^[114] The sexual messages contained in film, television, and music are becoming more explicit in dialog, lyrics, and behavior. In addition, these messages contain unrealistic, inaccurate, and misleading information that young people accept as fact. A 2001 report found that teens rank the media second only to school sex education programs as a leading source of information about sex,^[7] but a 2004 report found that "the media far outranked parents or schools as the source of information about birth control."^[114] Adolescents may turn to the media as a "sexual super peer" when seeking information about sexual norms and adult roles given the lack of information about sexuality readily available to them.^[10] Teens believe the media, as a super-peer, encourages and pressures them to have sex.^[114]

Sex is usually portrayed as 'risk-free' in films, television programs, music and magazines. One media analysis found that sex was usually between unmarried couples and examples of using condoms or other contraception were "extremely rare."^[10] In 2002, only 6% of television scenes that included sexual content had any discussion of risk or responsibility.^[115] In television programing aimed at teens, more than 90% of episodes had at least one sexual reference in it with an average of 7.9 references per hour.^[115]

According to researcher Victor Strasburger, "Teenagers who watch a lot of TV and movies are more likely to accept stereotypical sex roles and to believe that the unusual sexual behavior that is presented on talk shows is realistic."^[114] Strasburger argues that although the average child sees 15,000 sexual references on television alone, missing from these references are the "healthier aspects of human sexuality, such as answers to questions about what it means to be a man or a woman, when is sexual activity appropriate, what a healthy body self-image is, and how pregnancy and sexually transmitted disease can be prevented."^[114] Instead, what teens see is "unrealistic. Sex is depicted most often as a casual pastime, a romp in the hay, with little or no consequences. Most significantly for teenagers, casual sex frequently is shown as being normative behavior: everyone ‘does it.’"^[114] Another study found that teens overestimate how many of their peers are sexually active, a problem contributed to by the media.^[116]

[edit] Family

Researchers at Boston College have found that teens who frequently did “things like eating dinner together as a family or engaging in fun activities or religious activities together” were less likely to have sex, had fewer sexual partners, and had less unprotected sex.^[117] Family activities were "centrally important supports for children, providing opportunities for emotional warmth, communication, and transmission of values and beliefs.”^[117] However, "Negative and psychologically controlling" parenting such as "criticizing the ideas of the adolescents, controlling and directing what they think and how they feel" increased the risk that adolescents would have sex.^[117]

Researchers at the University of Arizona, University of Texas-Austin and Wake Forest University have found that girls who have positive relationships with their fathers wait longer before they have sex. Fathers can explain sex "in a way that mom can't, to let daughter know that for boys teen sex is about conquest, fun and adventure; while for girls, teen sex is about expressing love and affection," according to Dr. Patrick Wanis, a human behavior expert.^[118] Girls who grew up in homes without their father are significantly more likely to have premarital sex than girls who are raised by both parents.^[119] At a summit in Detroit on girls and sexual attitudes it was reveled that some "girls in that same age group [13-16] are 'dating' men as old as 30 because the men can give them things -- love, money, presents -- that their parents cannot."^[120]

[edit] Friends

The perception adolescents have of their best friends' sexual behavior has a significant association with their own oral sex behavior.^[121] Adolescents who reported sexual activity had high levels of reputation-based popularity, but not likeability among peers; however, sex with more partners was associated with lower levels of popularity.^[121]

[edit] Knowledge of sexuality

Most teens (70%) say they have gotten some or a lot of information about sex and sexual relationships from their parents. Other sources of information include friends at 53%, school, also at 53%, TV and movies at 51% and magazines at 34%. School and magazines were sources of information for more girls than boys, and teens "who were sexually active were much more likely to say they got information about sex from their friends and partners."^[17]

Less than half of parents with daughters under 18 talk to their girls about how to say no to boys, and about half talk to them about contraception.^[2] While 78% of parents believe that their daughters can talk to them about any topic, only 54% of girls believe they can discuss any topic with them.^[122]

[edit] Approaches to adolescent sexual education

Main article: Sex education in the United States

Two main forms of sex education are taught in American schools: comprehensive and abstinence-only. Comprehensive sex education covers abstinence as a positive choice, but also teaches about contraception and avoidance of STIs when sexually active. A 2002 study conducted by the Kaiser Family Foundation found that 58% of secondary school principals describe their sex education curriculum as comprehensive.^[123] The difference between these two approaches, and their impact on teen behavior, remains a controversial subject in the United States.

There have been numerous studies on the effectiveness of both approaches, and conflicting data on American public opinion. Public opinion polls conducted over the years have found that the majority of Americans favor broader sex education programs over those that teach only abstinence, although abstinence educators recently published poll data with the totally opposite conclusion.^{[124][125][126]} The poll sponsored by the National Abstinence Education Association and conducted by Zogby International found that:

When parents become aware of what abstinence education vs. comprehensive sex education actually teaches, support for abstinence programs jumps from 40% to 60%, while support for comprehensive programs drops from 50% to 30%. This sharp increase in support of abstinence education is seen across all political and economic groups. The majority of parents reject the so-called "comprehensive" sex education approach, which focuses on promoting and demonstrating contraceptive use. Sixty-six percent of parents think that the importance of the "wait to have sex" message ends up being lost when programs demonstrate and encourage the use of contraception.^[127]

Experts at University of California, San Francisco also encourage sex educators to include oral sex and emotional concerns as part of their curriculum. Their findings also support earlier studies that conclude

that sexual risk-taking should be considered from a dynamic relationship perspective, rather than solely from a traditional disease-model perspective. Prevention programs rarely discuss adolescents’ social and emotional concerns regarding sex.... Discussion about potential negative consequences, such as experiencing guilt or feeling used by one's partner, may lead some adolescents to delay the onset of sexual behavior until they feel more sure of the strength of their relationship with a partner and more comfortable with the idea of becoming sexually active. Identification of common negative social and emotional consequences of having sex may also be useful in screening for adolescents at risk of experiencing more-serious adverse outcomes after having sex.^[41]

[edit] Comprehensive

The American Psychological Association,^[128] the American Medical Association,^[129] the National Association of School Psychologists,^[130] the American Academy of Pediatrics,^[131] the American Public Health Association,^[132] the Society for Adolescent Medicine^[133] and the American College Health Association,^[133] have all stated official support for comprehensive sex education. Comprehensive sex education curricula are intended to reduce sexually transmitted disease and out-of-wedlock or teenage pregnancies.

Proponents of this approach argue that sexual behavior after puberty is a given, and it is therefore crucial to provide information about the risks and how they can be minimized. They hold that abstinence-only sex ed and conservative moralizing will only alienate students and thus weaken the message.

A report issued by the Department of Health and Human Services has found the "most consistent and clear finding is that sex education does not cause adolescents to initiate sex when they would not otherwise have done so."^[25] The same report also found that:

Family life or sex education in the public schools, which traditionally has consisted largely of providing factual information at the secondary school level, is the most general or pervasive approach to preventing pregnancy among adolescents.... Adolescents who begin having sexual intercourse need to understand the importance of using an effective contraceptive every time they have sex. This requires convincing sexually active teens who have never used contraception to do so. In addition, sexually active teens who sometimes use contraceptives need to use them more consistently (every time they have sex) and use them correctly.^[25]

[edit] Abstinence-only

Main article: Abstinence-only sex education

Abstinence-only sex education tells teenagers that they should be sexually abstinent until marriage and does not provide information about contraception. In the Kaiser study, 34% of high-school principals said their school's main message was abstinence-only. Some Christian organizations advocate abstinence-only sex education because it is the only approach they find acceptable and in accordance with their churches' teachings.

Some organizations promote what they consider to be "sexual purity", which encompasses abstaining from not only intercourse before marriage, but also from sexual thoughts, sexual touching, pornography, and actions that are known to lead to sexual arousal. Advocates of abstinence-only sex education object to comprehensive curricula which fail to teach moral behavior; they maintain that curricula should promote conventional (or conservative) morality as healthy and constructive, and that value-free knowledge of the body may lead to immoral, unhealthy and harmful practices.

A comprehensive review of 115 program evaluations published in November 2007 by the National Campaign to Prevent Teen and Unplanned Pregnancy found that two-thirds of sex education programs focusing on both abstinence and contraception had a positive effect on teen sexual behavior. The same study found no strong evidence that programs that stress abstinence as the only acceptable behavior for unmarried teens delayed the initiation of sex, hastened the return to abstinence, or reduced the number of sexual partners.^[134] According to the study author:

"Even though there does not exist strong evidence that any particular abstinence program is effective at delaying sex or reducing sexual behavior, one should not conclude that all abstinence programs are ineffective. After all, programs are diverse, fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs have provided modestly encouraging results. In sum, studies of abstinence programs have not produced sufficient evidence to justify their widespread dissemination."

[edit] References

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