Teen Sexuality and Pregnancy - Early Sexual Activity

The Centers for Disease Control and Prevention (CDC) reported in its 2003 Youth Risk Behavior Survey that almost half of high school students (46.7%) had had sexual intercourse, down from the 54% who were reported as sexually active in 1991. (See Table 7.1 and Figure 7.1.) Almost one in seven (14.2%) had had sex with four or more partners. Girls (45.3%) were slightly less likely than boys (48%) to have had intercourse, and African-American students (67.3%) were more likely than Hispanics (51.4%) or white students (41.8%) to be sexually active.

The proportion of students who had intercourse rose with age; 27.9% of ninth graders, 43.1% of tenth graders, 53.1% of eleventh graders, and 62.3% of twelfth graders had had intercourse at the time of the survey. (See Table 7.1.) Many youth were sexually active before age thirteen; 7.4% had had intercourse at age twelve or younger.

Risk Factors for Early Sexual Activity

In "Early Adolescent Sexual Activity: A Developmental Study," Les B. Whitbeck and his colleagues noted that "the main predictors of early intercourse were age, association with delinquent peers, alcohol use, opportunity, and sexually permissive attitudes" (Journal of Marriage and the Family, November 1999). Family conflict has also been linked to early sexual activity among poor urban African-American adolescents (Cami K. McBride et al., "Individual and Familial Influences on the Onset of Sexual Intercourse among Urban African American Adolescents," Journal of Consulting and Clinical Psychology, February 2003). Another study of poor African-American children found that those who reported high levels of monitoring from parents were less likely to have sex before adolescence (at age ten or earlier) and had lower rates of sexual initiation in their teen years as well (D. Romer et al., "Parental Influences on Adolescent Sexual Behavior in High Poverty Settings," Archives of Pediatrics and Adolescent Medicine, 1999). A 2004 study of inner-city seventh graders found that peer norms about refraining from sex were strongly correlated with seventh and eighth graders abstaining; drug or alcohol use, on the other hand, increased the risk of early sexual activity (John S. Santelli et al., "Initiation of Sexual Intercourse among Middle School Adolescents: The Influence of Psychosocial Factors," Journal of Adolescent Health, vol. 34, March 2004).

Reasons Given for Not Delaying Sex

A number of studies have reported that both sexes consider social pressure the major factor in engaging in early sexual activity. Peer pressure and a belief that "everyone is doing it" have often been cited as explanations. But a recent study found that most female adolescents (78% of the studied group) felt that they had been "too young" at their first sexual experience (Sian Cotton et al., "Adolescent Girls' Perceptions of the Timing of Their Sexual Initiation: 'Too Young' or 'Just Right'?" Journal of Adolescent Health, vol. 34, May 2004).

Figure 7.2 shows that in the 1990s both adults and teens overestimated the percent of teens who were sexually experienced by age fifteen. In addition, some more recent research has challenged the theory that social pressure is the strongest influence on teenagers' sexual decisions. A survey commissioned by Students Against Destructive Decisions (SADD) and the Liberty Mutual Group in January 2002 (Teens Today) asked students in grades six through twelve what factors had most influenced their decisions about sexuality. The most common reasons teenagers gave were to feel good, to have fun, and to please one's partner. The most commonly mentioned reasons not to have sex were fear of pregnancy, fear of sexually transmitted diseases, and not being in a relationship or in love.

The Media and Teen Concepts of Sexuality

In February 2003 the Kaiser Family Foundation released the results of its latest biennial study of sexual

TABLE 7.1

Percentage of high school students who engaged in sexual behaviors, by sex, race, ethnicity, and grade, 2003
*Non-Hispanic.
SOURCE: Adapted from "Table 42. Percentage of High School Students Who Engaged in Sexual Behaviors, by Sex, Race/Ethnicity, and Grade," and "Table 44. Percentage of High School Students Who Were Currently Sexually Active and Who Used a Condom during or Birth Control Pills before Last Sexual Intercourse, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance–United States, 2003," Centers for Disease Control and Prevention Surveillance Summaries: Morbidity and Mortality Weekly Report, vol. 53, no. SS–02, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed September 16, 2004)
	Ever had sexual intercourse			Had first sexual Ever had sexual intercourse			Had ≥4 sex partners during lifetime
Category	Female %	Male %	Total %	Female %	Male %	Total %	Female %	Male %	Total %
Race/ethnicity
White*	43.0	40.5	41.8	3.4	5.0	4.2	10.1	11.5	10.8
Black*	60.9	73.8	67.3	6.9	31.8	19.0	16.3	41.7	28.8
Hispanic	46.4	56.8	51.4	5.2	11.6	8.3	11.2	20.5	15.7
Grade
9	27.9	37.3	32.8	5.3	13.2	9.3	6.4	14.2	10.4
10	43.1	45.1	44.1	5.7	11.2	8.5	8.8	16.4	12.6
11	53.1	53.4	53.2	3.2	7.5	5.4	13.4	18.6	16.0
12	62.3	60.7	61.6	1.9	8.8	5.5	17.9	22.2	20.3
Total	45.3	48.0	46.7	4.2	10.4	7.4	11.2	17.5	14.4
	Currently sexually active			Condom use during last sexual intercourse			Birth control pill use before last sexual intercourse
Category	Female %	Male %	Total %	Female %	Male %	Total %	Female %	Male %	Total %
Race/ethnicity
White*	33.1	28.5	30.8	56.5	69.0	62.5	26.5	17.3	22.3
Black*	44.2	54.0	49.0	63.6	81.2	72.8	11.7	4.4	7.9
Hispanic	35.8	38.5	37.1	52.3	62.5	57.4	12.1	10.3	11.2
Grade
9	18.3	24.0	21.2	66.1	71.2	69.0	11.6	6.6	8.7
10	31.2	30.0	30.6	66.4	71.8	69.0	13.5	11.8	12.7
11	42.9	39.2	41.1	55.5	66.7	60.8	24.1	14.8	19.6
12	51.0	46.5	48.9	48.5	67.0	57.4	27.2	17.5	22.6
Total	34.6	33.8	34.3	57.4	68.8	63.0	20.6	13.1	17.0

messages on television (Dale Kunkel et al., Sex on TV 3: Content and Context). Of the twenty shows most popular with teenagers during the 2000–01 television season, five out of every six episodes (83%) included some sexual content, as compared with the average of 64% for television programs overall. One-fifth (20%) of the episodes reviewed included a portrayal of sexual intercourse, but nearly half (45%) of those included a reference to sexual risk or responsibility. The study's authors noted that while "the effect of viewing sexual content is not thought to be direct and powerful, with a single exposure to a particular program leading a viewer to think or act in any given way," television clearly does influence teenagers' decisions about sex, or their "sexual socialization."

Sexual Activity and Substance Use

Over the years, a number of studies have suggested a link between substance use and sexual activity. Researchers have found that both sexual activity and a history of multiple partners correlated with some use of drugs, alcohol, and cigarettes. However, the 2003 Youth Risk Behavior Survey found that among sexually active students, only one-fourth (25.4%) reported they had used alcohol or drugs at the time of their last sexual experience. (See Table 7.2.) Males (29.8%) were more likely than females (21%) to report this behavior; African-Americans (19.5%) were somewhat less likely than Hispanics (24.1%) or whites (26.8%) to report using alcohol or drugs during sexual activity.

A 2002 report in the Journal of Adolescent Health (J. Guo et al., "Developmental Relationships between Adolescent Substance Use and Risky Sexual Behavior in Young Adulthood," vol. 31, no. 4) noted a link between adolescent binge drinking and marijuana use and risky sexual behavior. Young people who used marijuana or binge drank in high school were more likely at age twenty-one to have had more sexual partners and to use condoms inconsistently.

In Substance Abuse and Risky Sexual Behavior (February 2002), the Kaiser Family Foundation reported on a

FIGURE 7.1

survey of almost a thousand teens and young adults from November 2001 through January 2002. More than a quarter (29%) of sexually active fifteen- to seventeen-year olds surveyed said that alcohol or drugs had influenced their sexual decisions. (See Figure 7.3.) More than one in ten (12%) sexually active fifteen- to seventeen-year-olds reported having had unprotected sex while under the influence of drugs or alcohol. Two out of five of these (41%) said their peers drank or used drugs before having sex "a lot" of the time.

VOLUNTARY AND NONVOLUNTARY EXPERIENCES. The 1995 National Survey of Family Growth asked women whether their first sexual experience was voluntary. Nearly one out of every ten women ages fifteen to twenty-four (9%) reported that their first premarital inter-course was nonvoluntary (reported as either "not voluntary" or "rape"). The first experience for 24% of females who had sexual intercourse by age fourteen was described as not voluntary, compared with 10% of women whose first sexual experience occurred at nineteen to twenty-four years of age (Family Planning Perspectives, January/February 1998). Frequently these girls were coerced into having unwanted relations by a date. Other girls were raped, either by an acquaintance or a family member.

Additionally, in a study of four thousand high school students, almost a third of the girls (30.2%) and a tenth of the boys (9.3%) reported having been sexually abused. Sexually abused females were twice as likely to engage in early sexual intercourse and other risky sexual behaviors as girls who had not been abused (A. Raj et al., "The Relationship between Sexual Abuse and Sexual Risk among High School Students: Findings from the 1997 Massachusetts Youth Risk Behavior Survey," Maternal and Child

FIGURE 7.2

Health Journal, vol. 4, 2000). A study published in 2004 corroborated evidence of the increased sexual risks taken by sexually abused youth (Elizabeth M. Saewyc et al., "Teenage Pregnancy and Associated Risk Behaviors among Sexually Abused Adolescents," Perspectives on Sexual and Reproductive Health, vol. 26, May/June 2004).

Moreover, according to Child Trends, a Washington, D.C.-based nonprofit research organization dedicated to improving the lives of children, early sexual initiation for teenage girls has been linked to a higher risk of becoming the victim of rape or sexual assault at some later time during their adolescence. The October 1997 publication Facts at a Glance indicated that more than half (54%) of females fourteen or younger at first sexual intercourse reported experiencing non-voluntary sex at some point during their teen years. Early sexual initiation has also been linked to domestic violence and verbal abuse later in life (Vaughn I. Rickert, "The Relationship among Demographics, Reproductive Characteristics, and Intimate Partner Violence," American Journal of Obstetrics and Gynecology, October 2002) and to depression and low self-esteem (B. C. Miller, B. H. Monson, and M. C. Norton, "The Effects of Forced Sexual Intercourse on White Female Adolescents," Child Abuse and Neglect, vol. 19, 1995).