According to the US Centers for Disease Control and Prevention (CDC), 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] According to a 1994 study, every year an estimated one in four sexually active teens contracts a sexually transmitted infection (STI).[3] Teenage pregnancy is four times as prevalent in the United States as in the European Union.[4] However, US teen pregnancy rates have been steadily declining for decades, according to the Centers for Disease Control and were at a "record low" as of 2012.[5]
In 1999, a Kaiser Family Foundation study found that 95% of public secondary schools offered sex education programs. More than half of the schools in the study followed a comprehensive approach that included information about both abstinence and contraception, while approximately one third of schools provided students with abstinence-only sex education.[6] In 2002, most Americans favored the comprehensive approach.[6] A 2000 study found that almost all schools included information about HIV, the virus that causes AIDS, in their curricula.[6] There have been efforts among social conservatives in the US government to limit sex education in public schools to abstinence-only sex education curricula.[6] The effectiveness of abstinence-only programs has been an issue of controversy.[7][8]
Sexual activity
Some studies have indicated that approximately half of sexually active teens have had sexual partners they were not dating.[9] This has led to belief in a "hookup culture" in which casual sex is tolerated among teens and young adults. However, other research indicates "hookup culture" is largely a social myth, and that evidence for greater casual sex among the young is lacking.[10] It may even be that news coverage of hookup culture creates a false belief among the young that such activity is occurring even if they themselves are not participating.[11]Self-report surveys suggest that half of all 15- to 19-year-olds have had oral sex. That percentage rises to 70% by the time they turn 19, and equal numbers of boys and girls participate.[12] Research indicating that oral sex is less risky to teens' emotional and physical well being than vaginal sex has been advanced;[13] researchers at the University of California do not believe this conclusion is warranted.[14] They found that oral sex, as well as vaginal sex, was associated with negative consequences.[14] 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.[15] Despite their behaviors, 90% of adolescents "agree that most young people have sex before they are really ready."[16]
The average age of first sexual intercourse in the United States is around 18 for males and around 17 for females,[17][18] and this has been rising in recent years.[19] For those teens who have had sex, 70% of girls and 56% of boys said that their first sexual experience was with a steady partner, while 16% of girls and 28% of boys report losing their virginity to someone they had just met or who was just a friend.[19]
Teens are using birth control (contraceptives) more today when they lose their virginity than they did in the past, and this is in part due to the AIDS epidemic.[19] Of sexually experienced adolescents, 78% of girls and 85% of males used at least one contraceptive when they lost their virginity.[19] A detailed qualitative study of girls' loss of virginity found that their experiences "were almost all quite negative (and, in some cases, horrific)."[20] Before age 15, "a majority of first intercourse experiences among females are reported to be non-voluntary."[21]
Adolescents who are better students generally initiate sexual activity later than those who are poor students. 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.[22]
The percentage of teenagers who report they are currently sexually active has been dropping since 1991.[23] 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 are "quite positive in terms of their health and their well-being."[24]
The condom is the most popular form of contraception used by teenagers.[25] Among sexually active 15- to 19-year-olds, from 2002 to 2010 more than 80% of females and more than 90% of males reported using at least one method of birth control during their last intercourse.[19][26] In 1995, only 71% of girls and 82% of boys reported using contraception the last time they had sex.[19] In 2006–2010, one in five sexually active female teens (20%) and one-third of sexually active male teens (34%) reported having used both the condom and a hormonal method the last time they had sex.[19] Less than 20% of girls at risk for unintended pregnancy were not using any contraceptive method the last time they had sex.[19] Calendar abstinence, or the rhythm method, was used by 17% of female teens in 2006-2008.[25]
Physical effects
The American Academy of Pediatrics has identified the sexual behaviors of American adolescents as a major public health problem.[33] 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.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.[9][34] With all the issues and problems relating to adolescent sex, "ideally, they won’t be having sex."[35]
Pregnancy
Main articles: Teenage pregnancy in the United States and Teen pregnancy
Teen pregnancies—defined as pregnancies in women under the age of 20,
regardless of marital status—in the United States decreased 28% between
1990 and 2000, from 117 pregnancies per every 1,000 teens to 84 per
1,000.[3] The 2008 rate was a record low and represented a 42% decline from the peak rate of 117 per 1,000, which occurred in 1990.[19] From 2009 to 2010, the teen pregnancy rate dropped 9%, the biggest one year drop since the 1940s.[36]Each year, almost 750,000 girls aged 15–19 become pregnant. Two-thirds of all teen pregnancies occur among the oldest teens (18–19-year-olds).[19] Of them, 82% are unplanned, accounting for about 20% of all unintended pregnancies annually.[19] Of pregnancies among 15–19-year-olds girls in 2008, 59% ended in birth, 26% in abortion, and the rest in miscarriage.[19] Overall, 68 pregnancies occurred per 1,000 girls aged 15–19 in 2008. Nearly 7% of 15–19-year-old girls become pregnant each year. Pregnancies are much less common among girls younger than 15. In 2008, 6.6 pregnancies occurred per 1,000 teens aged 14 or younger. In other words, fewer than 1% of teens younger than 15 become pregnant each year.[19] Stillborn and newborn deaths are 50% higher for teen moms than women aged 20–29, and are more likely to have a low birth weight.[37]
Teenage birth rates, as opposed to pregnancies, peaked in 1991, when there were 61.8 births per 1,000 teens, and the rate dropped in 17 of the 19 years that followed.[36] One in four American women who had sex during their teenage years will have a baby before they are married, compared to only one in ten who wait until they are older.[38] Even more will experience a pregnancy. Of women who have sex in their teens, nearly 30% will conceive a child before they are married. Conversely, only 15% of women who don't have sex in their teens will become pregnant before they are married.[38] Of all women, 16% will be teen mothers.[39]
According to a 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.[40] 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.[41] 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.[41]
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."[42] In another study, teens aged 15–19 accounted for 15.5% of abortions in 2009, and patients aged 20–24 made up 32.7%. Together adolescents aged 15–24 made up just under half (48.2%) of the 784,000 abortions reported to the CDC that year.[43]
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."[44] 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 researchers of the study believe these laws lower the gonorrhea rate because teens reduce the amount of sexual activity they have and are more fastidious in their use of birth control.[44] On the contrary, statistics released from the World Health Organization (WHO) indicate that more restrictive laws on abortions do not necessarily mean fewer abortions; the abortion rate one year for Latin America (where, broadly speaking, abortions are generally made illegal) was 32 per 1000 people, whereas the abortion rate for Western Europe (where overall the laws are more relaxed) was 12 in 1000.[45]
Sexually transmitted infections
Main articles: Sexually transmitted disease and Safe sex
Each year, between 8 and 10 million American teens contract a sexually transmitted infection (STI/STD),[note 1] almost half of the 19 million STIs reported for all age groups in the United States.[19][46]Lloyd Kolbe, director of the Center for Disease Control's Adolescent and School Health program, called the STI problem "a serious epidemic."[47] The younger an adolescent is when they first have any type of sexual relations, including oral sex, the more likely they are to get an STI.[48][49]
HPV (Human papillomavirus) is the most common STI among teens (as well as adults).[50] In a CDC study, 18% of teen girls were infected with HPV.[51] Another study found that HPV infections account for about half of STIs detected among 15- to 24-year-olds each year.[19][52] While HPV infections may not cause any disease and is often asymptomatic, it can cause genital warts and even cancer.
After HPV, trichomoniasis and chlamydia are the most common STI diagnoses among 15- to 24-year-olds; combined, they account for slightly more than one third of diagnoses each year.[19] Genital herpes and gonorrhea together account for about 12% of diagnoses. HIV, syphilis and hepatitis B account for less than 1% of diagnoses,[19] however young people aged 13–24 accounted for about 21% of all new HIV diagnoses in the United States in 2011.[19]
Researchers from the CDC have noted that teenagers often do not understand the risks associated with sexual activity. "Research suggests that adolescents perceive fewer health-related risks for oral sex compared with vaginal intercourse. However, young people, particularly those who have oral sex before their first vaginal intercourse, may still be placing themselves at risk of STIs or HIV before they are ever at risk of pregnancy."[49] "Several studies have documented that oral sex can transmit certain STIs, including chlamydia, genital herpes, gonorrhea and syphilis. Teenagers and young adults engaging in sexual activity are at increased risk of STIs or HIV."[49]
A 2008 study by the CDC found that one in four teen girls, or an estimated 3 million girls, has an STI.[51] 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. This is compared with 20% among both whites and Mexican-American teens.[53] The same study found that, among those who were infected, 15% had more than one STI, and 20% of those who said they had only one sexual partner were infected.[51]
In a 2011 study by the CDC, 7.1% of females and 2.1% of males aged 15–24 were infected with chlamydia,[54]:65 historically the most prevalent of all STIs in the general population (after HPV).
Benefits and negative effects
Benefits to teen sex do exist, by extension of data on the benefits of sex: It can relieve pain, burn calories, relieve stress, help the immune system, stimulate the mind and mellow one's mood. Other health benefits have been observed in older men—decreased risk of stroke and heart attack—but the same benefits have not been confirmed in teenage patients.[55]The earlier onset of puberty can produce sexual drives at a time when teens are not yet fully socialized to understand the potential social and emotional consequences of sexual activities.[56][57][58][59][60] Some scholars claim that the risk for depression is "clearly elevated" for the sexually active of either gender.[61]
"We tend to focus on the health consequences of having sex, like pregnancy and STIs, but we also need to talk to [teens] about all the emotional consequences," some experts say.[15]
Some research suggests that two-thirds of sexually active girls wish they had waited longer before having sex.[62] Of seniors in high school, 74% of girls regret sexual experiences they have had.[63]
For girls, even modest involvement in sexual experimentation elevates depression risk.[64] Sexually active teenage girls are more than twice as likely to suffer depression compared to those who are not sexually active.[65]
Sex therapists have found that the roots of sexual issues facing adults often date back to regretful teenage experiences.[15] Research has also found that being abstinent in the teen years was associated with better mental health at age 29.[66] Girls who were virgins at age 18 were also less likely to have a mental illness at age 40.[67]
Girls are "at particular risk for experiencing negative social and emotional consequences of having any type of sex," including oral sex.[14] 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[15] or hookups.[15][68]
In a study of casual sex among adolescents, many girls believed they could have a purely sexual experience with no emotional ties, and they believed it was sexist to assume otherwise. However, the study found that both the girls and the boys who were hooking up often were depressed and didn't feel very good about themselves.[69]
Effects on relationships
When engaging in sexual acts the body produces oxytocin, a chemical produced in the brain to promote feelings of connection and love. Production of oxytocin increases during the adolescent years. It has a larger effect on girls, suggesting it may make them care more about relationships and feel connections with others more intensely than boys.[55][70]Sexual education given to teens
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 use and the avoidance of STIs if the
teen becomes 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.[6]
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.[101][102][103] The poll sponsored by the National Abstinence Education Association and conducted by Zogby International found that:[104]
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.Experts also encourage sex educators to include oral sex and emotional concerns as part of their curriculum. Their findings also support earlier studies that conclude:[14]
...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.
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