Last week, two surveys on teen sexual behavior were released by different divisions of the Centers for Disease Control and Prevention (CDC). These surveys which are conducted at regular intervals provide a snapshot of what today’s teens are doing and a way of tracking trends over time.
So the big news of these two studies is, well, that there is no big news. In recent years, there have been very few changes in the behaviors that we track such as whether teens have ever had sex, whether they are currently sexually active, and if they used condoms or contraception the last time they had sex.
The first of the studies, the Youth Risk Behavior Surveillance Summaries (YRBS) conducted by the CDC’s Division of Adolescent and School Health (DASH), surveys high school students every two years. The results released last week were from the 2009 survey. It found that 46 percent of all high school students report ever having had sexual intercourse. This does not represent a statistically significant change from the 2007 results. And while there has been a decrease since the survey started in 1991 (when 54 percent of high school students reported ever having had sexual intercourse), it has been hovering around the 46 percent mark since 2001.[i]
The second study, released by the National Center for Health Statistics, is a report on teens ages 15 to 19 who participated in the most recent National Survey of Family Growth (NSFG). The NSFG surveys women and men ages 15 to 44 and asks questions regarding “family life, marriage and divorce, pregnancy, infertility, use of contraception, and men’s and women’s health.” The report, Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, National Survey of Family Growth 2006–2008, is among the first bits of data to be released from the most current survey.[ii] Again, this study found that there was very little change in sexual activity among teens; 42 percent of never-married females and 43 percent of never-married males ages 15 to 19 reported having ever had sexual intercourse which is not significantly different from the numbers found in the 2002–04 survey. Like the YRBS, the NSFG noted long-term decreases (in 1988 for example, 51 percent of 15 to 19 year olds had had sex), but the numbers have been holding steady for awhile.
Interestingly, few organizations on either side of the sex education debate commented on the results of these studies. Those that did, tended to lump teen sex in with other numbers (such as teen pregnancy and contraceptive use) and suggest that the stagnation we are seeing represents a failure to properly address the issues. While I am in complete agreement that we are failing to properly address the issues, I wonder if one of the reasons is that we are asking the wrong questions and looking for the wrong results.
Trends over time are interesting but when it comes to educating today’s teens they aren’t all that enlightening. For one thing teens change over time. In 1988, the year the NSFG notes as having the highest teen sex rate, I was in high school. I’m not quite ready to collect social security, but let’s face it, there is no definition on this planet that includes me, at 37, as a young person.
Maybe it’s time we stop looking at the percentage of teens who had sex as a number that needs to go down every year and start accepting that about half of all teens aren’t going to have sex and half are. If we start there, we can use our time and resources to make sure that those who do become sexually active as teens do so safely, without consequences (such as unintended pregnancy and STDs) or regrets. To do this successfully, however, we have to change our most basic attitudes toward teen sex, overcome some misperceptions about what teens are doing, and start asking better questions.
We Changed our Message and Tone (and Not for the Better)
I came into the field of sexuality education at what I now see was an interesting time, a crossroads of sorts. It was 1998 and the initial panic over the HIV/AIDS epidemic that had brought sex education into many classrooms (including my own) was dying down. The public health messages that told young people and adults alike how important it was to use condoms were under attack. And, the abstinence-only-until-marriage movement was gaining momentum both financially and politically.
Still, when I first began I don’t remember a consensus in belief or message that teen sex in-and-of-itself was bad. In fact, one of the first workshops I presented (at a CDC–DASH conference nonetheless) examined the concept of adolescent sexual health and suggested that “responsible adolescent intimate relationships, like those of adults, should be based on shared personal values and should be: consensual; non-exploitative; honest; pleasurable; and protected against unintended pregnancies and sexually transmitted diseases; if any type of intercourse occurs.”[iii]
As the years went by, however, even those of us who strongly supported comprehensive sexuality education began to approach this topic in a different way and shied away from using phrases like “responsible adolescent intimate relationships.” The shift was certainly understandable given the political realities of the last decade. The end result, however, seemed to be that both sides of the sex education debate began to start with the premise that “teens shouldn’t be having sex” or at least “we wish teens weren’t having sex.” The abstinence-only-until-marriage side would go on to say “and that’s why we have to give them a strict message about abstaining,” whereas advocates and educators who believed in a comprehensive approach would finish that sentence by saying something like “…but many teens are or will so we have to provide them with good education to help protect them against pregnancy and disease.”
While this approach was, as I said, politically necessary, it limited the conversation to at best one about risk avoidance and disaster prevention. Instead of fostering a comprehensive view of teen sex, it suggested that our goal was simply to ensure that all young people made it to their 20th birthday without getting pregnant, getting someone pregnant, or contracting an STD.
Such an approach to teen sex is very evident in how we ask teens about their sexual behavior. The CDC describes the YRBS as “monitoring priority risk behaviors that contribute to the leading causes of death, disability and social problems among young adults in the United States.” The handful of questions about sex are flanked on either side by questions about whether teens wore a helmet while bike riding, always used their seatbelt, got in a car with a drunk driver, or ever carried a gun.
We can’t get past this disaster-prevention approach until we stop treating all teen sex as a disaster. Instead of just focusing on, as a colleague of mine used to say, “who put what where, when, and how often,” we could really help young people navigate the world of sexuality if we were to look at their motivations, thoughts, and feelings.
Misperceptions About Teen Sex
The root of our society’s negative attitudes about sex is something that sexuality educators, psychologists, and historians have and will continue to debate for many moons. My husband once glibly explained it by saying, “What do you expect from a nation founded by people so uptight they were kicked out of England?”
Whatever the global source, I think some of the fear and judgment surrounding teen sex stems from simple misperception of what teens are doing. Here, the surveys that came out this week can help set the record straight.
It’s Not the Youngest Ones
One of the problems when we talk about teen sex is that our minds automatically turn to the youngest of teenagers; those 13 and 14 year olds whose playground days are not far behind. I would venture to guess that most, if not all, adults agree that these teens are too young to be having sex. Moreover, research shows us that earlier initiation of sexual activity increases one’s risk, in particular one’s risk for STDs. Some of this is just logical; the earlier someone has sex, the more time they have to accumulate partners, and multiple partners can certainly lead to more exposure to STDs. Some of it may have more to do with the characteristics and circumstances of those teens who do have sex early.
The good news is that, for the most part, 13 and 14 year olds are not having sex; according to the YRBS, 6 percent of high school students report having had sex before age 13. Not surprisingly, the percentage of teens who have had sex goes up steadily with age. If you look at the YRBS, this number jumps from 32 percent of ninth graders to 62 percent of high school seniors. Similarly, the NSFG found that among never-married males only 29 percent of those ages 15 to 17 had had sex compared to 65 percent of those ages 18 and 19. Among never-married females, 28 percent of those ages 15 to 17 had ever had sex compared to 60 percent of those 18 and 19.
Not everyone agrees that pre-marital sex is okay at any age, but I think few people find it alarming when 19-year-olds, many of whom are in college or living on their own under other circumstances, are having sex. So, perhaps instead of focusing on the total numbers of teens having sex and declaring all teen sex to be bad, morally wrong, or something to be eliminated, we can look at it as a fact of life that as teens age toward 20, the majority of them will have sex. Then, we can focus our efforts of reduction on those younger teens who have plenty of time to grow up.
Our society likes to categorize people, women in particular, as either pure and saintly or slutty and promiscuous. While used on adults as well, this image is even stronger when it comes to young people. In our minds and our media, there seem to be either responsible, studious young people with hopeful futures who remain abstinent or their less virtuous peers who lose their virginity in high school and proceed to hop into bed with any and everyone they meet.
Well, it turns out that sexually active teens really aren’t boffing like irresponsible bunnies. They are doing what many single adults do; entering into a small number of selective sexual relationships. Both the YRBS and the NSFG found that only about 14 percent of young people had had more than 4 partners in their lifetime. Among never-married, teen males and females, 2 partners was most likely according to the NSFG. And, as much as we hear about hook up culture, it is not true that teen sex is all about friends with benefits and one night stands. In fact, according to the NSFG the most common first sexual partner (for 72 percent of females and 56 percent of males) is someone with whom they were “going steady.”
We should also note that while many teens are sexually experienced far fewer remain continuously sexually active. The YRBS found that only 34 percent of high school students had had sex in the three months prior to the survey. And, the NSFG found that of those never-married teens who had ever had sex only 38 percent (of males and females) had done so in the last year and only 28 percent of males and 30 percent of females had done so in the last three months. This suggests that sexually active teens, like adults, are being selective about when and with whom they choose to have sex.
When it comes to responsible sexual behavior, one of the most telling signs is contraceptive use, and though there is certainly room for improvement, the statistics show us that sexually experienced teens are capable of protecting themselves against pregnancy and STDs.
The NSFG found that 95 percent of sexually experienced, never-married teens had used a condom at least once and that the majority of them (79 percent) used a contraceptive method the first time they had sex. This is even more important than you might think because research has shown that using a contraceptive method at first sex is a good indicator of future use. In fact, the NSFG found that teen females are almost twice as likely to have a birth before reaching age 20 if they did not use a contraceptive method at their first sex.
The YRBS asked sexually active teens (which it defines as those who had sex in the 3 months prior to the survey) if they used condoms the last time they had sex and 61% of them said they had. This is somewhat disappointing because the numbers had steadily gone up between 1991 and 2003 and have not changed since, but it does suggest that with a little prompting and education, teens will protect themselves. Similarly, the NSFG found that among those never-married teens who had had sex within the month prior to the survey only 51 percent of females and 71 percent of males used condoms 100 percent of the time. (I say only because we’d want that number to 100 percent, but 71 percent of teen males using condoms every time they had sex is pretty impressive and definitely flies in the face of the irresponsible “boys will be boys” image that comes to mind when we think of teen guys and sex.)
In fact, when it comes to contraception, teens behave roughly the same way as adults (and sometimes better). According to the NSFG, 89 percent of all women at risk of an unintended pregnancy were using contraception in the month of the interview. (The NSFG includes most women who had had intercourse in the past 3 months as “at risk” whether or not they were using contraception. The only women who are considered “not at risk” are those who were currently pregnant, trying to get pregnant, sterile for health reasons, had never had intercourse, or had not had intercourse in the last 3 months.) When looking just at teen women, this went down slightly to 81 percent of teens at risk of an unintended pregnancy.[iv] Again, not the 100 percent number we would want, but clearly not a generation of young women who are unwilling or unable to take the necessary precautions.
Looking at the facts from these surveys (rather than inaccurate perceptions of what teens are doing) suggests that it’s time to stop telling our young people that they are too immature and irresponsible to understand or engage in sexual activity, give them some credit for what they are doing right, and help them improve those behaviors that still place them at risk.
Getting to the Heart of the Matter
The NSFG does ask some questions that take us out of the pure public health and risk assessment range, and give us a brief glimpse of what we can and should be asking young people and how we can help them think critically about sexual behavior.
For example, the NSFG asks sexually experienced teens how they felt about the first time they had sex. Most never-married, females (47 percent) said they had mixed feelings about the first time they had sex “part of me wanted it to happen at the time and part of me didn’t” though a similar number (43 percent) said they “really wanted it to happen at the time.” Not surprisingly, the older a teen was when she first had sex, the more likely she was to say she really wanted it to happen. And, though, never-married, teen males were more likely to report they “really wanted it to happen” (62 percent), the same trend holds true for guys; those who waited until they were at least ages 15 to 17 were more likely to say this.
As a sexuality educator, I think this information is incredibly valuable. If we change our goal from preventing teen sex to preventing sex that teens will regret later, we can work to make sure that all teens wait until the right experience (the one that they “really wanted to happen at the time”) comes along. We can do this by engaging teens in conversations and skills-building exercises that help them understand their own beliefs and feelings, negotiate sexual situations, and communicate with partners.
Such critical thinking exercises will likely also improve condom and contraceptive use. While the good news is that among those never-married teens who had had sex in the 3 months prior to the survey, 96 percent of females and 86 percent of males felt there was a “pretty good or almost certain chance” that they or their new partner would appreciate it if they used a condom, some teens (10 percent of females and 8 percent of males) still found the subject of condoms embarrassing to discuss with a new partner. Moreover, many teens (14 percent of females and 36 percent of males) felt there was a “pretty good or almost certain chance” that they would feel less physical pleasure if they used condoms. Interestingly, teens who had used a condom at last sex were less likely to say this. This suggests that education about condoms designed to overcome both embarrassment and misperceptions about pleasure could go a long way in increasing the number of teens who use condoms regularly.
Unfortunately, one of the most telling and alarming statistics to come out of this most recent NSFG has to do with young people’s attitudes toward teen pregnancy. The survey found that 14 percent of females and 18 percent of males ages 15 to 19 would be “a little pleased” or “very pleased” if they got (a partner) pregnant. This implies that avoiding pregnancy is not the motivator many of us had hoped it would be when it comes to helping teens either delay sexual activity or use contraception. In fact, among those never–married teens who had never had sexual intercourse, only 18 percent of females and 12 percent of males cited avoiding pregnancy as their main motivator.
Still we don’t ask enough of these questions, at least in part because there is a fear that doing so will send an unwitting message of acceptance or put ideas in young people’s heads. I don’t understand either of these fears; when the YRBS asks about drunk driving we don’t fear that teens will think we’re in favor of it and I can’t imagine an idea about sex that would come from a survey before it would come from say, Gossip Girl or Maxim magazine.
Let’s Change Again
I remember having lunch a number of years ago with a Dutch graduate student who shared some of his research with me and a few colleagues. He had at his fingertips the average age that young people in his country had their first open-mouth kiss, how long it took them to go from that to other sexual behaviors like petting and oral sex, and from there to sexual intercourse. He also knew whether these behaviors took place with the same partners or different partners.
My colleagues and I already knew that European attitudes were more understanding of teen sex than we are in the United States and we had long been jealous of their model of sexuality education (not to mention their statistics on teen pregnancy and STDs which have always been much lower than ours). Still, faced with this wealth of information, we were envious. Not only do we in the United States limit our conversations and data collection to risk behaviors, we almost exclusively collect data on penile-vaginal intercourse. While some researchers and pollsters have looked at other sexual behaviors like oral sex as well as relationships other than those between heterosexual youth, such data are sparse at best.
We dreamed of having this kind of information and talked about all of the ways we could use it to help teens. We could remind them there are pleasurable experiences other than intercourse, such as kissing and petting, that pose no risk for pregnancy and minimal risk of STDs. We could help them understand that sexual behavior is not necessarily linear and scripted; you don’t have to have intercourse with someone this week just because you had oral sex with them in the last month. We could use it simply to understand the realities of sex for today’s teens.
Well folks, we are at another crossroads. The abstinence-only-until-marriage movement is waning having lost much of its financial, political, and public support. While it has not been completely defunded, as many of us had hoped, far less money is going to these programs. Moreover, the federal government has put aside some money to fund more comprehensive approaches to sexuality education. Though this funding does primarily take a disaster-prevention approach, it is an important start.
I’m hopeful, though, that we can use this moment to make an even more significant change in how we think about, talk about, and teach about teen sex. We have to start by changing our attitude and approach to teen sex from one of disapproval and risk to one of understanding and critical thinking, and by collecting more and better information from teens.
Sure some things about sex, love, and relationships never change, but others do. None of us know, for example, what it’s like to have deal with sex as a teen in the age of the internet, bullies with blogs, facebook, or cell phones with cameras. So, let’s use these surveys to find out what the teens of this moment are thinking, feeling, and doing. Because when it comes to teen sex I don’t believe there is ever no news.
Surveillance Summaries, Morbidity and Mortality Weekly Report, vol. 59, no. SS-5 (4 June 2010), accessed 4 June 2010, http://www.cdc.gov/HealthyYouth/yrbs/index.htm.
[ii] Unless otherwise cited, all statistics from NSFG from: JC Abma, et al, “Teenagers in the United States: Sexual Contraceptive Use, and Childbearing, National Survey of Family Growth,” National Center for Health Statistics, Vital Health Stat 23 (30). 2010.
[iii] This presentation was based on Facing Facts; Sexual Health for America’s Adolescents, a report written by the National Commission on Adolescents, edited by Debra W. Haffner, and published by SIECUS, the Sexuality Information and Education Council of the United States in 1995.
[iv] W.D. Mosher & J. Jones, “Use of Contraception in the United States: 1982-2008,” National Center for Health Statistics, Vital Health Stat 23 (29), 2010.