Adolescent sexuality in the United States

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Main articles: Adolescent sexuality and Adolescent sexual behavior

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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 a report prepared for the U.S. Department of Health and Human Services in 2001, by the time American adolescents turn 18, slightly more than half of females and nearly two-thirds of males will have had intercourse.^[1] While this percentage has dropped over the last twenty years,^[2] teens are increasingly engaging in oral sex.^[3][4] Sexual activity is also increasingly taking place outside of romantic relationships and in more causal hook ups, a "profound shift in the culture of high school dating and sex."^[5] Gay and lesbian youth are significantly more likely to have had sex, and are twice as likely to be diagnosed with HIV or another sexually transmitted disease.^[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]}

Many psychologists believe that adolescents are physically ready for sex 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]

Almost all teens used some form of contraception the last time they had sex with condoms being the most popular form.^[8] A majority of adolescents have been provided with some information regarding sexuality,^[16] 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.^[17]

Contents 1 Social aspects 2 Loss of virginity 3 Frequency 4 Motivation 4.1 Oral sex 5 Effects of sexual activity 5.1 Pregnancy 5.2 Sexually transmitted diseases 5.3 Psychological health 5.3.1 Casual sex 5.3.2 Relationships 5.3.3 Oral sex 6 Correlation with other risk behaviors 7 Influence of media 8 Knowledge of sexuality 9 Gay and lesbian youth 10 Contraceptive use 11 Approaches to adolescent sexual education 11.1 Comprehensive 11.2 Abstinence-only 12 References

[edit] Social aspects

More than half of sexually active teens have had sexual partners they are not dating.^[18][16] 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."^[5] Mark O'Connell, a professor 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]

Risky sexual behaviors that involve "anything but intercourse", as well as sexually transmitted diseases, are "rampant" among teenagers.^[19] Ninety per cent of adolescents "agree that most young people have sex before they are really ready".^[20]

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.^[21] This data shows 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.^[21] Claire Brindis, professor of pediatrics at the University of California at San Francisco, has noted that these causal attitudes towards oral sex has made it so common that "we're talking about a major social norm. It's part of kids' lives."^[21] Joe McIllhaney Jr., chairman of the Medical Institute for Sexual Health, questions how much girls enjoy oral sex, however. He says he would like to see more data on how much pressure is put on them by boys before coming to any conclusions.^[21]

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.^[22] 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."^[23] If an adolescent engaged in a particular behavior they were more likely to believe that they were still a virgin.^[22]

[edit] Loss of virginity

Main article: Virginity

According to a report prepared for the U.S. Department of Health and Human Services in 2001, by the time a person turns 18, slightly more than half of females and nearly two-thirds of males will have had intercourse.^[1] However, they find, "one thing is also very clear: most teens who have sex wish they had waited. In fact, whether you ask boys or girls, older teens or younger teens, a large majority say they wish they had waited."^[24] Of 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.^[25]

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%

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.^[25] 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.^[25]

Adolescents who have received sexual 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.^[26]

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 dropping since 1991.^[27] 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 46.8% in 2005.^[27][28] Girls will most likely lose their virginity to a boy who is 1 to 3 years older than she is.^[25]

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 7 or more partners.^[25] Only 6.5% of girls who first had sex between 17 and 19 have had 7 or more partners.^[25] 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 the age of 14 or younger have had 7 or more partners, but only 3.8% of boys who waited until they were at least 17 had the same number.^[25]

Percent Of Boys By Age Who Claim To Have Had Sex^[25]

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^[25]

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.^[29] 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.^[29] Six percent of blacks abstained from sex until age 21 or older, fewer than Mexican-Americans (17 percent) or non-Hispanic whites (15 percent).^[29] Before age 15, "a majority of first intercourse experiences among females are reported to be non-voluntary."^[1][25]

According to one study, almost 14 percent of teens lose their virginity in June, the most common month.^[30] 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.^[30] 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."^[30] This may explain why teens from non intact homes are more than 50% more likely to have had sexual intercourse.^[25][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."^[31]

[edit] Frequency

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.^[32] By 2005, the overall percentage of teenagers reporting that they were currently sexually active was down to 33.9%.^[27] 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.^[33]

Sexually Active Girls Aged 15-19, And Percent Of How Recently They Have Been Sexually Active^[25]

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^[25]

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] 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.^[20]

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: ^[16]

	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 13-16 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.^[16] 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

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."^[16][3] Researchers at the University of California, San Francisco believe that that some teens, and particularly girls, engage in oral sex as a way to avoid vaginal intercourse.^[40]

While New York Times columnist David Brooks has written, "Reports of an epidemic of teenage oral sex are .. greatly exaggerated"^[41], 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.^[16] Researchers believe that oral sex may have become more popular than intercourse for adolescents because teens believe it carries fewer physical and emotional risks.^[42][43][21]

[edit] Effects of sexual activity

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.^[44] 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.^[45][46] 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.^[47]

[edit] 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.^[48] According to the World Health Organization, the U.S. is rated 84th out of 170 countries based on teenage fertility rate, based on 2002 figures.^[49] According to an international comparison conducted by the Guttmacher Institute, U.S. teen pregnancy and teen birth rates are the second-highest among 46 countries in the developed world.^[50]

[edit] Sexually transmitted diseases

Between 8 and 10 million American teens contract a sexually transmitted disease each year.^[51] 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.^[52] Lloyd Kolbe, director of the CDC's Adolescent and School Health program, called the STD problem "a serious epidemic."^[19]

A 2008 study by the CDC found that one in four teen girls, or an estimated 3 million girls, has an STD.^[53] 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.^[54] 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.^[53]

The CDC study corrorobated other research indicating that human papillomavirus (HPV) is the most common STD among teens. In the CDC study, 18% were infected with HPV.^[53] Another study found that HPV infections account for about half of STDs diagnosed among 15- to 24-year-olds each year.^[55] In June 2006, an HPV vaccine was licensed for use in the U.S. The vaccine provides protection against both high-risk types associated with cervical cancer as well as low-risk types associated with genital warts.^[52]

In the CDC study, 4% were infected with chlamydia, historically the most prevalent of all STDs in the general population. Other research by the CDC has indicated that those aged 15 to 19 years accounted for more than a third of all chlamydia cases.^[52]

In the CDC study, 2% were infected with herpes simplex. This corroborates a 2007 study indicating that the herpes infection rate among teens as well as the overall population is falling.^[56] 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.^[56]

[edit] Psychological health

Adolescents "often haven't achieved the emotional, even neurological, maturity necessary for making autonomous and self-aware sexual choices."^[14] Thus, for teens, "having sex changes you. It is emotionally powerful and there are risks involved."^[57] According to University of California San Francisco 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."^[42] Disease and illness related sexual activity is epidemic, but "the psychological outfall isn’t far behind."^[58]

According to psychologist Paul Coleman, "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.^[59] 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.^[19] Because the frontal lobe of the brain, which houses judgment and consequences, 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?'"^[57]

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] For girls, even even modest involvement in sexual experimentation elevates depression risk.^[15] 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.^[40]

Experts at the University of North Carolina at Chapel Hill recommend that sexually active adolescents be screened for depression and be "provided with anticipatory guidance about the mental health risks of these behaviors."^[15] Professors at the University of California recommend that parents and health professionals help teens prepare for and cope with the emotions attached to sex.^[42]

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.^[60] Girls were 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 having sex^[60] and many feel bad about themselves after hooking up.^[61]

Males and females experience sex differently,^[61] and boys are less likely to see sex as connected to an emotional relationship than girls.^[62] 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."^[61] However, by the time a young man has reached his early twenties, his girlfriend or his wife will become his primary emotional caregiver."^[62][63] If he can not 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.^[64]

Sex therapists have found that the roots of sexual issues facing adults often date back to regretful teenage experiences.^[42] Of seniors in high school, 74% of girls regret sexual experiences they have had.^[65] While teens may believe that their sexual activities are fine at the time, Carrie Lukas, the Director of Policy for the Independent Women's Forum, cautions that they may feel very differently in time and may regret the choices they made.^[61] She points to research that shows 2/3 of sexually active girls wish they had waited longer before having sex.^[61]

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."^[1] On the other hand, a journalist, Judith Levine, believes that sexual activity is a normal part of adolescence and that it is not harmful. Her book Harmful to Minors discusses why she believes the stigma and taboo surrounding adolescent sexual activity has spiraled out of control.^[66]

[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]

When taking part in hookups, "the kids don't even look at each other. It's mechanical, dehumanizing", according to psychologist Marsha Levy-Warren.^[67] This impersonality is harmful to both girls and boys; however, girls are especially at risk of becoming victims in casual sexual relationships.^[68] Girls are far more likely to feel used and abused than boys are after a typical hook up.^[42][68] The Independent Women's Forum has found that girls "particularly are suffering from the new regime [i.e. casual sex] and are having some lasting problems" as a result of it.^[61]

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 a lot really were depressed and didn't feel very good about themselves.^[69] 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.^[69] Girls will "inevitably regret what they did."^[69]

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."^[42] 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.^[70]

Harvard Medical School's Dr. 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] According to Leonard Sax, author of Why Gender Matters, "Early sexual activity — whether in or out of a romantic relationship — does far more harm than good."^[68]

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.^[19] 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.^[70] They become jaded and as a result later in life, they have trouble forming adult relationships, according to Levy-Warren.^[67] "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^[71]

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."^[72]

[edit] Oral sex

Teens believe that oral sex is less risky to their emotional and physical well being than vaginal sex,^[43] but experts at the University of California do not believe this conclusion is warranted.^[40] They found that oral sex, as well as vaginal sex, was associated with negative consequences.^[40] "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.^[21]

With regards to oral sex, it is almost always the boys who receive it and the girls who give it.^[3][16] When girls provide oral sex "they do so without pleasure, usually to please their boyfriend or to avoid the possibility of pregnancy."^[73] This paradigm has entitled boys and disempowered girls,^[67] putting girls at a disadvantage.^[74] 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.^[42]

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.^[42] Boys who engaged in oral sex were more than twice as likely as girls to report feeling more popular and confident.^[42]

[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.^[1]

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.^[75] 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.^[76]

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."^[77] 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.^[78] 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."^[79]

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.^[80] 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.^[81] 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."^[81]

[edit] Influence of media

Although early sexual activity may be caused by a variety of factors, the media are believed to play a significant role.^[7] According to journalism professor and media critic Jane Brown, since adolescents see so much sex in the media it is peaking 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] 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.^[82]

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.^[83]

According to another analysis, the American media is the most sexually suggestive in the world.^[84] 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."^[84] 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.^[84]

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.^[85] 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.^[85]

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."^[84] 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."^[84] 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.’"^[84] Another study found that teens overestimate how many of their peers are sexually active, a problem contributed to by the media.^[86]

[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."^[16]

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.^[87]

[edit] Gay and lesbian youth

Gay and lesbian youth are "significantly more likely than other students to report lifetime sexual intercourse (72% vs. 44%), 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 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%)."^[6][88]

Gay youths are far more likely than their straight peers to drop out of school, run away from home, abuse alcohol and other drugs, engage in prostitution, or attempt, contemplate and successfully commit suicide.^[89]

[edit] Contraceptive use

Of U.S. teens aged 15-19 that are having sexual intercourse, almost all (98%) have used at least one form of contraception. The most popular form, at 94% usage, are condoms and the combined oral contraceptive pill is second at 61%.^[8] 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.^[16] 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.^[26] 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.^[90]

One study found 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."^[91] 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.^[91] Another conflicting study outlined the dangers of new laws being enacted that limit adolescents' access to contraceptives, including condoms.^[92]

[edit] Approaches to adolescent sexual education

Main articles: Sex education in the United States and Abstinence-only sex education

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.^[93] 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.^[94][95][96] 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.^[97]

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.^[40]

[edit] Comprehensive

The American Psychological Association,^[98] the American Medical Association,^[99] the National Association of School Psychologists,^[100] the American Academy of Pediatrics,^[101] the American Public Health Association,^[102] the Society for Adolescent Medicine^[103] and the American College Health Association,^[103] 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."^[1] 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.^[1]

[edit] Abstinence-only

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 have propagated the idea that sexual abstinence is the approach to take, in accordance with the Christian values of waiting for marriage before having sexual intercourse, or sexual intimacy.

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.^[104] 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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