Adolescent sexuality in the United States

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

According to the US Centers for Disease Control and Prevention, in the year 2007, 35% of US high school students were currently sexually active and 47.8% of US high school students reported having had sexual intercourse.cite web |url=http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbs07_us_sexual_behaviors_trend.pdf |title=Trends in the Prevalence of Sexual Behaviors|accessdate=2008-07-02 |work=The National Youth Risk Behavior Survey (YRBS) 1991-2007 |publisher=US Centers for Disease Control and Prevention |year=2007 |format=PDF] This percentage has decreased slightly since 1991.By the Numbers: Teen Sex in America; January 2007; Scientific American Magazine; page 30; by Rodger Doyle] While some researchers suggest that teens are increasingly engaging in oral sex,Cite web|url=http://www.theatlantic.com/doc/200601/oral-sex|title=Are You There God? It's Me, Monica|accessdate=2007-01-21|publisher=The Atlantic Monthly|year=Jan/Feb 2006|author=Caitlin Flanagan|format=html] other studies indicate that there has been little change in either oral sex or vaginal sex among teen opposite-sex partners over the past decade.cite web |url=http://www.slate.com/id/2148583/ |title=A Cock-and-Bull Story: Explaining the huge rise in teen oral sex |accessdate=2007-12-07 |last=Harford |first=Tim |date=2006-09-02 |work= |publisher=Slate] Some research indicates that teen sexual activity increasingly takes place outside of romantic relationships and in more casual "hook ups", which one author calls a "profound shift in the culture of high school dating and sex."cite journal | author=Alexandra Hall| title=The Mating Habits of the Suburban High School Teenager| journal=Boston Magazine| issue=May 2003| url=http://www.bostonmagazine.com/articles/the_mating_habits_of_the_suburban_high_school_teenager]

The American Academy of Pediatrics has identified the sexual behaviors of American adolescents as a "major public health problem", 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,Cite web|url=http://www.kff.org/youthhivstds/upload/U-S-Teen-Sexual-Activity-Fact-Sheet.pdf|title=U.S. Teen Sexual Activity|accessdate=2007-03-11|publisher=Kaiser Family Foundation|month=January | year=2005|format=pdf] and teen pregnancy is 2 to 10 times more prevalent in the United States than in other similarly developed countries. [http://www.unicef-icdc.org/publications/pdf/repcard3e.pdf A League Table of Teenage Births in Rich Nations] , UNICEF (2001) Retrieved July 7, 2006.] 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.cite journal | title=Sexuality, Contraception, and the Media| journal=Pediatrics| month=January | year=2001| volume=107| issue=1| url=http://aappolicy.aappublications.org/cgi/content/full/pediatrics;107/1/191| pages=191–1994 | doi=10.1542/peds.107.1.191] cite journal | author=Sam Jones| title=Media 'influence' adolescent sex| journal=The Guardian| date=March 22, 2006 |url=http://www.guardian.co.uk/uk_news/story/0,,1736599,00.html]

Among sexually active 15- to 19-year-olds, 83% of females and 91% of males reported using at least one method of birth control during last intercourse.cite web |url=http://www.kff.org/womenshealth/upload/3040-03.pdf |title=Sexual Health Statistics for Teenagers and Young Adults in the United States |accessdate=2008-07-02 |publisher=Kaiser Family Foundation |year=2006| month=September |format=PDF ] A majority of adolescents have been provided with some information regarding sexuality,Cite web| url=http://www.msnbc.msn.com/id/6839072|title=Nearly 3 in 10 young teens 'sexually active'|accessdate=2007-01-21|publisher=MSNBC|year=2005|author=Katie Couric ] 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.cite web |url=http://www.advocatesforyouth.org/PUBLICATIONS/policybrief/pbwaroncondoms.htm |title=The Social Conservatives' War on Condoms |accessdate=2007-12-07 |work=Policy Brief: Advocates for Youth]

exual intercourse

Initial sexual intercourse

Sixteen percent of adults first had sex before age 15, while 15 percent abstained from sex until at least age 21. [http://www.cnn.com/2007/HEALTH/06/22/sex.drug.report.ap/index.html U.S. survey tracks sex behavior, illegal drug use] Associated Press, June 22, 2007] 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. Six percent of blacks abstained from sex until age 21 or older, fewer than Mexican-Americans (17 percent) or non-Hispanic whites (15 percent).

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."Cite web|url=http://aspe.hhs.gov/HSP/cyp/xsteesex.htm|title=Beginning Too Soon: Adolescent Sexual Behavior, Pregnancy And Parenthood|accessdate=2007-03-11|publisher=U.S. Department of Health and Human Services | year=2001] Before age 15, "a majority of first intercourse experiences among females are reported to be non-voluntary."

Girls will most likely lose their virginity to a boy who is 1 to 3 years older than they are. According to one study, almost 14 percent of teens lose their virginity in June, the most common month. [http://hjnews.townnews.com/articles/2007/06/01/news/news02.txt Study says June holds highest rate for teens’ first-time sex] , David Baker, The Herald Journal, Friday, June 01, 2007] 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. 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." This may explain why teens from non-intact homes are more than 50% more likely to have had sexual intercourse.

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."Cite web|url=http://www.ext.vt.edu/pubs/family/350-853/350-853.html|title=Adolescents and Sex|accessdate=2008-04-16|publisher=Virginia Tech|month=November | year=2002 |author=Erin Morgan, Research Associate, Human Development and Angela Huebner, Assistant Professor and Extension Specialist, Human Development; Virginia Tech|work=Publication Number 350-853|format=html]

Current sexual activity

The percentage of teenagers who report they are currently sexually active has also been dropping since 1991. In 1997, only 37% of females and 33% of males who reported ever having had sexual intercourse said that they had sex in the past 3 months. [http://pedsinreview.aappublications.org/cgi/content/extract/23/12/407 Adolescent Sexual Behavior and Sexual Health] , Renee E. Sieving, Jennifer A. Oliphant, and Robert Wm. Blum, Pediatrics in Review 2002 23: 407-416.] By 2005, the overall percentage of teenagers reporting that they were currently sexually active was down to 33.9%. 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.Teen birth rate falls, as does percentage of high schoolers having sex, Associated Press, 7/13/07]

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.

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: The vast majority of 13- to 16-year-olds, 87%, have not had sexual intercourse, and 73% have not been sexually intimate at all. Three quarters of them have not because they feel they are too young, and just as many say they have made a conscious decision not to. 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,"cite book | title=Why Gender Matters| url=http://www.whygendermatters.com| last=Sax, M.D., Ph.D| first=Leonard| year=2005| publisher=Doubleday| isbn = 038551073X page 136.] [See also Mike Males, Adult Liaison in the Epidemic of Teenage Birth, Pregnancy and Venereal Disease, Journal of Sex Research, 29:525-45, 1992.] and also have a higher risk for substance abuse and a combination of sex and drug use. [ [http://www.unc.edu/news/archives/mar07/physicalmaturity031607.html Girls with early puberty, older boyfriends at greater risk for drugs, sex, alcohol] , University of North Carolina Chapel Hill News Release, 2007-03-16, accessed 2007-12-06]

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."cite journal | author=Jonathan Klick, Thomas Stratmann| title=Abortion Access and Risky Sex Among Teens: Parental Involvement Laws and Sexually Transmitted Diseases| journal=FSU College of Law, Public Law Research Paper No. 175| date=October 5, 2005| volume=| issue=| url=http://papers.ssrn.com/sol3/papers.cfm?abstract_id=819304] 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.

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.cite journal | author=Whitbeck, Les, et al| authorlink=http://cyfs.unl.edu/fawhitbeck.htm| title=Early adolescent sexual activity : A developmental study| journal=Journal of marriage and the family| year=1999| volume=61| issue=4| url=http://cat.inist.fr/?aModele=afficheN&cpsidt=1548752| doi=10.2307/354014| pages=934] 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.cite journal | author=Sabo, Donald, et al| title=High school athletic participation, sexual behavior and adolescent pregnancy: a regional study| journal=Journal of Adolescent Health| year=1999| volume=25| issue=3| url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10475497&dopt=Abstract| doi=10.1016/S1054-139X(99)00070-1| pages=207] 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.

Oral sex

The National Center for Health Statistics has reported that half of all 15- to 19-year-olds have had oral sex, with the percentage rising to 70% by the time they turn 19, and equal numbers of boys and girls participating.Cite web|url=http://www.washingtonpost.com/wp-dyn/content/article/2005/09/15/AR2005091500915.html|title=Study: Half of All Teens Have Had Oral Sex|accessdate=2008-04-28|publisher=Washington Post|year=9/16/2005|author=Laura Sessions Stepp|format=html] A 2007 Guttmacher Institute study found that slightly more than half (55%) of 15– to 19-year-olds have engaged in heterosexual oral sex, 50% have engaged in vaginal sex and 11% have had anal sex, and that the prevalence of both vaginal and oral sex among adolescents has remained steady over the past decade.cite web |url=http://www.guttmacher.org/pubs/JAH_Lindberg.pdf |title=Non-coital sexual activities among adolescents |accessdate=2008-06-30 |last=Duberstein Lindberg | first=Laura | coauthors=Rachel Jones, John S. Santelli |publisher=Guttmacher Institute|format=PDF]

This data indicates that many teens, particularly those from middle- and upper-income white families, don't consider oral sex to be as significant or meaningful as older generations do. 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."

Researchers at the University of California, San Francisco believe that some teens, and particularly girls, engage in oral sex as a way to avoid vaginal intercourse.cite journal | author=Sonya S. Brady, PhD and Bonnie L. Halpern-Felsher, PhD| title=Adolescents’ Reported Consequences of Having Oral Sex Versus Vaginal Sex| journal=PEDIATRICS | year=2007| volume=119| issue=2| pages=229–236| doi=10.1542/peds.2006-1727] However, Dennie Hughes cautions, "We need to move away from the idea that girls who engage in oral sex but not intercourse are "technical" virgins -- that you're not having sex because no one's penetrating you. Let girls know that every time you do something like that, you compromise yourself and give up some of your power."Cite web|url=http://www.usaweekend.com/02_issues/020825/020825sexed.html|title=The sex lives of kids|accessdate=2008-09-11|publisher=USA Today Weekend|year=August 25, 2002|author=Dr. Drew Pinsky and Dennie Hughes|format=html] A study released in 2008 by the Guttmacher Institute disputed this substitution theory. "There is a widespread belief that teens engage in nonvaginal forms of sex, especially oral sex, as a way to be sexually active while still claiming that technically, they are virgins," says study author Laura Lindberg. Their "research shows that this supposed substitution of oral sex for vaginal sex is largely a myth." [cite press release |title=Perception That Teens Frequently Substitute Oral Sex For Intercourse A Myth|publisher= |date=2008-05-20 |url=http://www.guttmacher.org/media/nr/2008/05/20/index.html |accessdate=2008-06-30]

While "New York Times" columnist David Brooks has written, "Reports of an epidemic of teenage oral sex are .. greatly exaggerated"cite news |first=David |last=Brooks |title=Public Hedonism and Private Restraint |url=http://www.nytimes.com/2005/04/17/opinion/17brooks.html?ex=1271390400&en=d2a42c3d658dab90&ei=5090&partner=rssuserland&emc=rss |work=Editorials Op-Ed |publisher=New York Times |date=2005-04-17 |accessdate=2007-12-08 ] , 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. About 12% of teens aged 13-16 have had oral sex, and 13% of the same teens have had sexual intercourse. Researchers believe that oral sex may have become more popular than intercourse for adolescents because teens believe it carries fewer physical and emotional risks,cite news |first=Ilene |last=Lelchuk |title=UCSF explores teens' post-sex emotions |url=http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/02/15/BAG6RO4VDQ1.DTL&type=health |publisher=San Francisco Chronicle |date=2007-02-15 |accessdate=2007-12-08 ] [http://www.medicalnewstoday.com/articles/22235.php Teens believe oral sex is safer, more acceptable to peers] , Medical News Today, 2005-04-04] a claim one study supports.

ocial aspects

In a 2002 US News & World Report article that quoted multiple experts, reporter Anna Mulrine states that "nearly everyone agrees" that risky sexual behaviors that involve "anything but intercourse," as well as sexually transmitted diseases, are "rampant" among teenagers. However, more recent research, including a study released in 2008 by the Guttmacher Institute, indicates that teenage sexual activity has either held flat or declined in recent years, and "New York Times" columnist David Brooks, calls such reports "greatly exaggerated". According to one study, more than half of sexually active teens have had sexual partners they are not dating.cite journal | author=Wendy D. Manning, Peggy C. Giordano, Monica A. Longmore| title=Hooking Up: The Relationship Contexts of "Nonrelationship" Sex| journal=Journal of Adolescent Research| year=2006| volume=21| issue=5| url=http://jar.sagepub.com/cgi/content/abstract/21/5/459 | doi=10.1177/0743558406291692 | pages=459] Atlantic Monthly social critic Caitlin Flanagan calls this a "a genuine and puzzling change in teen sexual behavior." Alexandra Hall, senior editor at Boston magazine, terms it a "profound shift in the culture of high school dating and sex."

Mark O'Connell, an instructor in clinical psychology at Harvard Medical School, has opined that "Sexual behaviors and attitudes change from generation to generation, but the explosion of sex without meaning or substance signifies more than yet another generation's effort to stake its claim by shocking its parents (in this case, parents often too jaded to be shocked)." Despite their behaviors, 90% of adolescents "agree that most young people have sex before they are really ready".Cite web|url=http://www.kff.org/entpartnerships/upload/Gender-Rolls-Summary.pdf|title=Gender Roles Summary|accessdate=2007-04-13|publisher=Kaiser Family Foundation|format=pdf] At a summit called "Sex, Lies and Older Guys," there were girls who were "being raped and feeling powerless to do anything afterward, blocked by a sexual irrevolution that has made feelings irrelevant and intercourse the new dating. They feel that these encounters are their fault, and they are ashamed to tell anyone," the Detroit Free Press reported. [ [http://www.freep.com/apps/pbcs.dll/article?AID=/20080818/NEWS05/80818083 Take a breath, then read about teens' normal sex life] ]

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

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.Bersamin, M.M.; Fisher, D.A.; Walker, S.; Hill, D.L.; and Grube, J.W. "Defining virginity and abstinence: Adolescents' interpretations of sexual behaviors", Journal of Adolescent Health, 41:182-188, 2007.] 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." [Bersamin, Melina, [http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/11-01-2007/0004695671&EDATE= Young People Engaging In Sexual Activity Differ on Definitions of Virginity, Abstinence] , Press Release: Pacific Institute for Research and Evaluation, November 1, 2007] If an adolescent engaged in a particular behavior they were more likely to believe that they were still a virgin.

Seventh and eighth graders who do well in school (A's and B's) are less likely to initiate sexual activities than those who perform average or poorly. In addition, among those seventh and eighth graders, those with personal and perceived peer norms that encourage adolescents to refrain from sex are less likely to engage in it. Students in these grades who use drugs and alcohol are also more likely than non users to begin having sex at this young age.cite journal | author=R. MacLean| title=Norms That Encourage Young Adolescents Not to Have Sex Tied to Reduced Odds of Becoming Sexually Active| journal=Perspectives on Sexual and Reproductive Health| volume=36| issue=4]

Physical effects

The American Academy of Pediatrics has identified the sexual behaviors of American adolescents as a major public health problem. 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. [Hall PA, et al. Risky adolescent sexual behavior: a psychological perspective for primary care clinicians. Topics in Advanced Practice Nursing eJournal. 2004;4(1).] 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. [Lescano CM, et al. Condom use with "casual" and "main" partners: what's in a name? J Adolesc Health. 2006;39(3):e1-e7.] [Manning WD, et al. Hooking up: the relationship contexts of "nonrelational" sex. J Adolesc Research. 2006;21:459-483.] 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.Cite web|url=http://healthlink.mcw.edu/article/1031002160.html|title=Close Parental Relationships Could Delay Adolescent Sex|accessdate=2007-03-11|publisher=Medical College of Wisconsin|year=2002-09-13]

Early sex poses a greater physical threat for girls than for boys.Cite web|url=http://health.usnews.com/articles/health/sexual-reproductive/2008/09/03/on-teens-and-sex-wheres-the-love.html|title=On Teens and Sex: Where's the Love?|accessdate=2008-09-07|publisher=US News & World Report|year=September 3, 2008|author=Bernadine Healy M.D.|format=html] Compared with adults, a teenage girl "with an immature cervix, is more likely to catch an STD, triggering problems like smoldering pelvic inflammatory disease that can silently take away fertility, tubal pregnancies, cervical and even throat cancer, and transmission of disease to offspring at birth," Healy stated in US News & World Report.Cite web|url=http://townhall.com/Columnists/DrMiriamGrossmanMD/2008/09/04/what_our_daughters_must_know|title=What Our Daughters Must Know|accessdate=2008-09-08|year=September 04, 2008|author=Dr. Miriam Grossman|format=html]

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. However, a 2007 report showed 3% increase in the teen birth rate from 2005 to 2006, to nearly 42 births per 1,000.cite press release |title=Teen Birth Rate Rises for First Time in 14 Years |publisher=CDC National Center for Health Statistics |date=2007-12-05 |url=http://www.cdc.gov/media/pressrel/2007/r071205.htm |accessdate=2007-12-05]

International comparisons conducted over the years typically place US teen pregnancy and teen birth rates among the highest in the developed world. For example, a 2001 study by UNICEF found that the US teenage birth rate was the highest among 28 OECD nations in the review;UNICEF. (2001). PDFlink| [http://www.unicef-icdc.org/publications/pdf/repcard3e.pdf A League Table of Teenage Births in Rich Nations] |888 KiB . Retrieved July 7, 2006. ] in a 1999 comparison by the Guttmacher Institute, U.S. teen pregnancy and teen birth rates were the second-highest among the 46 developed countries studied. [cite journal|author=Singh S and Darroch JE|url=http://www.guttmacher.org/pubs/journals/3201400.html | title=Adolescent Pregnancy and childbearing levels and trends in developed countries |journal=Family Planning Perspectives |year=2000 |volume=32 |issue=1 |page=14–23] [http://globalis.gvu.unu.edu/indicator.cfm?Country=GB&IndicatorID=127 Indicator: Births per 1000 women (15-19 ys) – 2002] UNFPA, State of World Population 2003, Retrieved Jan 22, 2007.] In 2002, the U.S. was rated 84th out of 170 World Health Organization member countries based on teenage fertility rate.cite web|url=http://www.who.int/whosis/database/core/core_select.cfm|title=Core Health Indicators] According to an international comparison by the Guttmacher Institute, teen pregnancy and childbearing levels are higher in the US largely because of differences in contraceptive use. Sexually active teens in the US are less likely to use any contraceptive method and especially less likely to use highly effective hormonal methods, primarily the pill, than their peers in other countries. The research also found that US teens who become pregnant are less likely to choose abortion, whether due to lack of access, higher levels of antiabortion sentiment, or greater acceptance of teen motherhood. [cite web |url=http://www.guttmacher.org/pubs/tgr/05/1/gr050107.html |title=Teen Pregnancy: Trends And Lessons Learned |accessdate=2008-10-05 |author=Heather Boonstra |date=February 2002 |work=The Guttmacher Report on Public Policy |publisher=Guttmacher Institute]

exually transmitted diseases

Each year, between 8 and 10 million American teens contract a sexually transmitted disease.cite book |title=Your Kids at Risk: How Teen Sex Threatens Our Sons and Daughters |last=Meeker |first=Meg |year=2007 |publisher=Regnery Publishing |location=Washington, DC |isbn=9781596985131] 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. [http://www.cdc.gov/std/stats/toc2006.htm Sexually Transmitted Diseases Surveillance, 2006] Centers for Disease Control, 2006, accessed 2007-12-05] Lloyd Kolbe, director of the CDC's Adolescent and School Health program, called the STD problem "a serious epidemic." The younger an adolescent is when they first have intercourse, the more likely they are to get a STD throughout their teenage years.cite journal | author=Christine E. Kaestle, Carolyn T. Halpern, William C. Miller and Carol A. Ford| title=Young Age at First Sexual Intercourse and Sexually Transmitted Infections in Adolescents and Young Adults | journal=American Journal of Epidemiology| year=2005 | volume=161| issue=8| page=774-780]

A 2008 study by the CDC found that one in four teen girls, or an estimated 3 million girls, has an STD.Cite web|url=http://www.baltimoresun.com/news/health/bal-te.std12mar12,0,707040.story|title=1 in 4 U.S. teen girls infected with STD|accessdate=2008-03-12|publisher="Baltimore Sun"|date=March 12, 2008|author=Stephanie Desmon|format=html] 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. [cite news |first=Lindsey |last=Tanner |title=Nearly 1 in 4 Teen Girls Has STD, CDC Says |url=http://abcnews.go.com/Health/ReproductiveHealth/Story?id=4429246&page=1 |work= |publisher= ABC News|date=2008-03-11 |accessdate=2008-04-15] 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.

Human papillomavirus (HPV) is the most common STI among teens as well as adults.cite journal |author=Dunne EF, Unger ER, Sternberg M, "et al" |title=Prevalence of HPV infection among females in the United States |journal=JAMA |volume=297 |issue=8 |pages=813–9 |year=2007 |pmid=17327523 |doi=10.1001/jama.297.8.813] In the CDC study, 18% of teen girls were infected with HPV. Another study found that HPV infections account for about half of STIs detected among 15- to 24-year-olds each year. [Weinstock H et al., Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000, Perspectives on Sexual and Reproductive Health, 2004, 36(1):6–10.] While most HPV infections cause no disease, HPV does cause genital warts and cervical cancer. An HPV vaccine protects women against two HPV types which cause 70% of cervical cancers as well as two types associated with 90% of genital warts. Ideally the woman should be vaccinated before initial sexual activity, since the vaccine is only effective before exposure to the HPV types.

In the CDC study, 4% were infected with chlamydia, historically the most prevalent of all STDs in the general population. More than a third of all chlamydia cases occur in those aged 15 to 19.cite web| url=http://www.cdc.gov/std/stats/toc2006.htm | title=Sexually Transmitted Diseases Surveillance, 2006| accessdate=2007-12-05]

In the CDC study, 2% were infected with herpes simplex. The herpes infection rate fell between 1988 and 2004 among teens as well as the overall population.Reinberg, Steven, [http://news.aol.com/story/_a/us-herpes-cases-on-the-decline/n20070901021209990016 U.S. Herpes Cases on the Decline] Healthday, 2007-09-01, accessed 2007-12-05] 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.

Psychological effects

For teens, "having sex changes you. It is emotionally powerful and there are risks involved," Saltz points out.Dr. Gail Saltz, Access Hollywood, 12/22/07] 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.Cite web|url=http://www.cbsnews.com/stories/2007/02/06/health/webmd/main2440089.shtml|title=Teen Sex May Take Emotional Toll|accessdate=2008-04-09|publisher=cbsnews.com|date=February 6, 2007] According to UCSDF pediatrics Professor Bonnie Halpern-Felsher, "We tend to focus on the health consequences of having sex, like pregnancy and STDs, but we also need to talk to them about all the emotional consequences." Disease and illness related sexual activity is epidemic, but "the psychological outfall isn’t far behind."Cite web|url=http://www.sadd.org/oped/opedpdfs/HookingUp.pdf | title=Hooking Up, Losing Out: The New Culture of Teen Sex |accessdate=2008-04-09|year=2005|author=Stephen G. Wallace, M.S. Ed.|format=pdf]

According to Harvard Medical School's O'Connell, adolescents "often haven't achieved the emotional, even neurological, maturity necessary for making autonomous and self-aware sexual choices."Cite web|url=http://www.boston.com/news/globe/editorial_opinion/oped/articles/2005/03/09/the_epidemic_of_meaningless_teen_sex/|title=The epidemic of meaningless teen sex|accessdate=2008-04-09|publisher=The Boston Globe|date=March 9, 2005|author=Mark O'Connell] Psychologist Paul Coleman echoes this assertion: "Teenagers are not mature enough to know all the ramifications of what they're doing." Emotional, social and cognitive development continues well past adolescence.cite journal | author=Staci A. Gruber & Deborah A. Yurgelun-Todd| title=Neurobiology and the Law: A Role in Juvenile Justice?| journal=Ohio State Journal of Criminal Law| volume=3| issue=2| url=http://moritzlaw.osu.edu/osjcl/Articles/Volume3_2/Symposium/Gruber-PDF-03-29-06.pdf] 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.cite journal | author=Anna Mulrine| title=Risky Business| journal=U.S. News & World Report| issue=May 27, 2002| url=http://www.usnews.com/usnews/culture/articles/020527/archive_020860.htm] "Early sexual activity—whether in or out of a romantic relationship—does far more harm than good."

As the frontal lobe of the brain, which houses complex thinking, understanding cause and effect, controlling impulses, and judgment, is not fully developed until a person is in their 20s, "teens are less prepared to think about 'if I do this today, what will happen to me tomorrow?'" notes psychiatrist Gail Saltz.Dr. Gail Saltz, Access Hollywood, 12/22/07]

Sex for teens is not "without risk. It can take a toll on the soul, dehumanizing unsuspecting students who tumble too soon into the world of hooking up, not knowing enough about sex or themselves to avoid getting hurt," according to educator and psychologist Pat McDonough. "To think that the emotional intimacy and biochemistry of sex can be easily undone is the result of immature cognitive functioning."Cite web|url=http://www.newsday.com/news/opinion/ny-opmcd055829620sep05,0,2409822.story|title=Parents! Teen sex hookups hit many snags|accessdate=2008-09-06|publisher=NewsDay|year=September 5, 2008|author=Pat McDonough|format=html]

Despite "societal shifts in sexual standards, human development remains pretty much the same. Kids are still emotionally vulnerable and volatile - more so if they are sexually active," McDonough stated in Newsday. Stephen G. Wallace, national chairman and chief executive officer of Students Against Destructive Decisions, has cautioned, "There is a lot at stake—a decision about sexual behavior can have lasting physical, social, and emotional consequences."

Depression and emotional distress

Longitudinal research has shown "a significant association between teenage sexual abstinence and mental health."cite journal | author=Bogart, Laura M., Collins, Rebecca L., Ellickson, Phyllis L., Klein, David J.,| title=Association of Sexual Abstinence in Adolescence with Mental Health in Adulthood| journal=Journal of Sex Research| year=2007| volume=44| issue=3] 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. "Overall, for either gender, teens who are not sexually active are markedly happier than those who are active." "Depression, anxiety and increased stress accompany the abuse of alcohol and drugs also observed in sexually promiscuous teens."

Research has found "a dramatic relationship" between sexual activity among adolescents and "multiple indicators of adolescent mental health. Compared to abstainers, membership in any of the risk clusters was associated with increased odds of depression, serious thoughts about suicide, and suicide attempts."cite journal | author=Denise D. Hallfors, PhD, Martha W. Waller, MA, Carol A. Ford, MD, Carolyn T. Halpern, PhD, Paul H. Brodish, MSPH, Bonita Iritani, MA| title=Adolescent Depression and Suicide Risk: Association with Sex and Drug Behavior| journal=American Journal of Preventive Medicine | year=2004| volume=27| issue=3| page=224-231] Sexually active girls are more vulnerable to depression, suicidal ideation, and suicide attempt than sexually active boys, but there is little difference between boys and girls who are not sexually active. Risk for depression is "clearly elevated" for the sexually active of either gender.

Doctor of adolescent medicine Meg Meeker writes, “Teenage sexual activity routinely leads to emotional turmoil and psychological distress. [Sexual permissiveness leads] to empty relationships, to feelings of self-contempt and worthlessness. All, of course, precursors to depression.”Meeker, Epidemic: How Teen Sex Is Killing Our Kids, p. 64; as quoted in [http://www.heritage.org/Research/Abstinence/cda0304.cfm Sexually Active Teenagers Are More Likely to Be Depressed and to Attempt Suicide] .] According to the Heritage Foundation, boys who have had sex are more than 8 times as likely to attempt suicide (6%) as virgins (0.7%), and sexually active girls are almost three times as likely (14.1% versus 5.1%).

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

Researchers at Brown University have found that cutting is linked to higher levels of risky sex among teenagers.Cite web|url=http://www.webmd.com/mental-health/news/20080612/self-cutting-linked-to-risky-teen-sex|title=Self-Cutting Linked to Risky Teen Sex|accessdate=2008-06-14|publisher=WebMD|year=2008|author=Salynn Boyles|format=html] Psychologist Lori G. Plante states that "habitual cutting is a way of managing intense emotional distress. It makes sense that the level of impulsivity and risk taking would also be higher in these teens." Plante believes that cutting, even once, is "a warning sign that they are overwhelmed in some way."

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". When adolescents engage in casual sexual relationships, they proceed toward adulthood with a lack of understanding about intimacy. 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." In "US News & World Report", physician Bernadine Healy states, "Both as doctor and mother, I can't help but believe that our anything-goes society, in which impulses are immediately satisfied and sex is divorced from love and bonding, is simply not healthy physically, emotionally, or spiritually."

When taking part in hookups, "the kids don't even look at each other. It's mechanical, dehumanizing", according to psychologist Marsha Levy-Warren.cite news |first=Anne |last=Jarrell |title=The Teenage Face of Sex Grows Younger |url=http://query.nytimes.com/gst/fullpage.html?res=9906E3D7133CF931A35757C0A9669C8B63&n=Top/Reference/Times%20Topics/Subjects/S/Sex/Abstinence |work= |publisher=New York Times |date=200-04-02 |accessdate=2007-12-08 ] This impersonality is harmful to both girls and boys; however, girls are especially at risk of becoming victims in casual sexual relationships.cite book | title=Why Gender Matters| url=http://www.whygendermatters.com| last=Sax, M.D., Ph.D| first=Leonard| year=2005| publisher=Doubleday| isbn = 038551073X ]

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." 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". Depression, alcohol abuse, anorexia, and emotional disturbance can all afflict adolescents as a result.Cite web|url=http://www.boston.com/yourlife/relationships/articles/2007/02/13/hooking_up_is_the_rage_but_is_it_healthy/?page=1 |title=Hooking up is the rage, but is it healthy? |accessdate=2007-02-13 |publisher=Boston Globe |date=2007-02-13 |author=Barbara F. Meltz]

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."

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.

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. 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.

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". They become jaded and as a result later in life, they have trouble forming adult relationships, according to Levy-Warren. "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"cite news |first=Sharon |last=Jayson |title=What's up with hookups? |url=http://www.usatoday.com/educate/college/healthscience/articles/20070225.htm |work= |publisher=USA Today |date=2007-02-15 |accessdate=2007-12-08 ]

Males and females experience sex differently,Cite web|url=http://www.npr.org/templates/story/story.php?storyId=1952884|title=Friends with Benefits|accessdate=2008-04-15|publisher=National Public Radio|year=2005|author=Carrie Lukas, Director of Policy, Independent Women's Forum|format=windows media] and boys are less likely to see sex as connected to an emotional relationship than girls.cite book | title=Why Gender Matters| url=http://www.whygendermatters.com| last=Sax, M.D., Ph.D| first=Leonard| year=2005| pages=132| publisher=Doubleday| isbn = 038551073X] Males are more able to shrug off a one night stand, but "girls are more confused afterward... and in general suffer a loss of self esteem," according to Carrie Lukas of the Independent Women's Forum. However, by the time a young man has reached his early twenties, his girlfriend or his wife will become his primary emotional caregiver. [See also cite journal | author=Furman, Wyndol; Wehner, Elizabeth A.| title=Adolescent Romantic Relationships: A Developmental Perspective| journal=New Directions for Child Development| year=Winter 1997| volume=78| url=http://eric.ed.gov/ERICWebPortal/Home.portal?_nfpb=true&_pageLabel=RecordDetails&ERICExtSearch_SearchValue_0=EJ558606&ERICExtSearch_SearchType_0=eric_accno&objectId=0900000b8000e7f1| pages=21–36 ] If he cannot establish an emotional relationship with a woman, who does view sex as connected to intimacy, then he is more likely to become depressed, commit suicide or die from illness.cite journal | title=Becoming Married and Mental Health: A Longitudinal Study of a Cohort of Young Adults| journal=Journal of Marriage and the Family| year=1996| volume=58]

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."Cite web|url=http://www.recordonline.com/apps/pbcs.dll/article?AID=/20080323/NEWS/803230332/-1/NEWS|title=Do teens treat sex with caution?|accessdate=2008-03-24|publisher=Times Herald-Record|date=March 23, 2008|author=Christian Livermore|format=2008]

Oral sex

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

With regards to oral sex, it is almost always the boys who receive it and the girls who give it. When girls provide oral sex "they do so without pleasure, usually to please their boyfriend or to avoid the possibility of pregnancy." [The Body Project: An Intimate History of American Girls, Joan Brumberg, Random House, 1997, p. 190.] This paradigm has entitled boys and disempowered girls, putting girls at a disadvantage.Cite web|url=http://archive.salon.com/mwt/feature/2001/01/10/teen_sex/index.html|title=A teen sex guru speaks|accessdate=2007-01-21|publisher=Salon.com|date=January 10, 2001|author=Amy Benfer|format=html] 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.

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

Girls

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

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

Dating violence

Girls who have engaged in sexual intercourse are five times more likely than their virgin peers to be the victim of dating violence.cite journal | author=Jay G. Silverman, PhD, Anita Raj, PhD, and Karen Clements, MPH| title=Dating Violence and Associated Sexual Risk and Pregnancy Among Adolescent Girls in the United States | journal=PEDIATRICS | year=2004| volume=114| issue=2| page=220-225] Girls who were intentionally hurt by a date in the past 12 months are at a "significantly elevated risk for a broad range of sexual health concerns and for pregnancy." Girls who have been victims are also twice as likely to report high levels of multiple sexual partners.

Emotional effects

While teens may believe that their sexual activities are fine at the time, Lukas cautions that they may feel very differently in time and may regret the choices they made. She points to research that shows 2/3 of sexually active girls wish they had waited longer before having sex. Sex therapists have found that the roots of sexual issues facing adults often date back to regretful teenage experiences. Of seniors in high school, 74% of girls regret sexual experiences they have had. [cite book |title=The Truth about Sex by High School Senior Girls |last=Anderson |first=Kristen |year=2001 |publisher=Kristen Anderson |isbn=0970883102 ]

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 or hookups. When asked if girls and women really wanted casual sex as much as men did, Dr. Drew Pinsky said he had spoken to them "by the thousands" and that they absolutely did not.cite | author=Dr. Drew Pinsky| authorlink=Drew Pinsky| title=Lovline show of 9/10/2008| publisher=KROQ| date=9/10/2008] The only reason they engaged in it, he said, was because they thought it was what they need to do in order to get the guy. The current paradigm of casual sex has left females "ambivalent, unhappy and uncomfortable."

For girls, even even modest involvement in sexual experimentation elevates depression risk. More than 25% of sexually active girls are depressed all of the time, most of the time or a lot of the time, but more than 60% of girls who are not sexually active are never depressed.cite web |url=http://www.heritage.org/Research/Abstinence/cda0304.cfm |title=Sexually Active Teenagers Are More Likely to Be Depressed and to Attempt Suicide |work= |publisher=Heritage Foundation |date=2003-06-03 |accessdate=2008-07-06 ] Research has also found that adolescent sexual abstinence was associated with better mental health at age 29 and girls who were virgins at age 18 were less likely to have a mental illness at age 40.cite journal | author=Finger, R., Thelen, T., Vessey, J. T., Mohm, J. K., & Mann, J. R.| title=Association of virginity at age 18 with educational, economic, social, and health outcomes in middle adulthood| journal=Adolescent and Family Health| year=2004| volume=3| page=164-170]

Casual sex

Benoit Denizet-Lewis, a fellow at the Alicia Patterson Foundation, found in his study of casual sex among adolescents that many girls believe they can have a purely sexual experience with no emotional ties, and they believed it was sexist to assume otherwise. However, he believes that both the girls and the boys who were hooking up often really were depressed and didn't feel very good about themselves.Cite web|url=http://www.npr.org/templates/story/story.php?storyId=1952884|title=Friends with Benefits|accessdate=2008-04-15|publisher=National Public Radio|year=2005|author=Benoit Denizet-Lewis|format=windows media] 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. Girls will "inevitably regret what they did." Speaking on National Public Radio, Lukas noted that girls "particularly are suffering from the new regime [i.e. casual sex] and are having some lasting problems" as a result of it.

Some research suggests that females are not biologically or evolutionarily equipped to handle casual sex.Cite web|url=http://lifestyle.msn.com/Relationships/LoveandRomance/ArticleMC.aspx?cp-documentid=4615497|title=Does Hooking Up Hurt You? You Bet!|accessdate=2008-06-29|publisher=MSN|author=Colleen Oakley|format=html] According to "Washington Post" reporter and author Laura Sessions Stepp, the hormone oxytocin, released during sex, affects women differently than men, so that "when women think they can have sex and walk away just like guys do, they're having to suppress thousands of years of evolution that tells them to cuddle, stay in bed, and look forward to tomorrow. When they get up and walk out, they feel depressed and don't know why." However, attempts to explain differences in how girls and boys perceive sex based on differences in hormone release are speculative.cite journal |author=Bancroft J |title=The endocrinology of sexual arousal |journal=J. Endocrinol. |volume=186 |issue=3 |pages=411–27 |year=2005 |month=September |pmid=16135662 |doi=10.1677/joe.1.06233 |url=http://joe.endocrinology-journals.org/cgi/pmidlookup?view=long&pmid=16135662]

exual minorities

According to a study based on a sampling of teenagers in Massachusetts, sexual minority youth, that is, those who identify as gay, lesbian, or bisexual or had any same-sex sexual contact in their lifetimes, were significantly more likely than other students to report lifetime sexual intercourse (72% vs. 44%).">cite journal | author=Massachusetts Department of Education| title=2005 Youth Risk Behavior Survey | journal=Massachusetts Department of Education Website| month=June | year=2006| url=http://www.doe.mass.edu/cnp/hprograms/yrbs/05/ch8.doc] The same study found that sexual minority youth were more likely to report sexual intercourse before age 13 (18% vs. 4%), sexual intercourse with four or more partners in their lifetimes (32% vs. 11%), and recent sexual intercourse (55% vs. 33%). Among students in the Massachusetts study who ever had sexual intercourse in their lifetimes, sexual minority youth were significantly more likely than other students to report "having been or gotten someone pregnant (15% vs. 4%) and having been diagnosed with HIV or another STD (10% vs. 5%)."cite journal | author=Ethan Jacobs| title=Surprising results from health risk survey for LGB youth | journal=Bay Windows| date=June 21, 2007| url=http://www.baywindows.com/ME2/Audiences/dirmod.asp?sid=008EC9FBCFF24AD18614290016BE1303&nm=Current+Issue&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&AudID=0813BC739F2044E5A03DCF2DE3FDF7C9&tier=4&id=59C560AFCEA14E5AA8FFBB6A41B300BC| format=Dead link|date=June 2008 – ^{[http://scholar.google.co.uk/scholar?hl=en&lr=&q=author%3A+intitle%3ASurprising+results+from+health+risk+survey+for+LGB+youth&as_publication=Bay+Windows&as_ylo=June 21, 2007&as_yhi=June 21, 2007&btnG=Search Scholar search]}]

Several studies have found that gay youths are represented disproportionately among adolescents who drop out of school, run away from home, abuse alcohol and other drugs, engage in prostitution, or attempt, contemplate and successfully commit suicide.cite journal | author=Johnson, Cheri C., Johnson, Kirk A.| title=High Risk Behavior Among Gay Adolescents| journal=Adolescence| year=2000| volume=35| issue=140]

Contraceptive use

Among sexually active 15- to 19-year-olds, 83% of females and 91% of males reported using at least one method of birth control during last intercourse.cite web |url=http://www.kff.org/womenshealth/upload/3040-03.pdf |title=Sexual Health Statistics for Teenagers and Young Adults in the United States |accessdate=2008-07-02 |publisher=Kaiser Family Foundation |year=2006| month=September |format=PDF ] Thus, sexually active adolescent women wishing to avoid pregnancy are less likely than those of other ages to use contraceptives (18% of 15- to 19-year-olds used no contraceptives, versus 10.7% average for women ages 15 to 44), according to an analysis of periodic survey data from the National Center for Health Statistics.National Surveys of Family Growthcite journal | journal = Contraception | title = Reducing unintended pregnancy in the United States | url = http://www.arhp.org/publications-and-resources/contraception-journal/january-2008| author = James Trussell and L.L. Wynn | date = January 2008]

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

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. 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. 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%.

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. [Characteristics of Adolescent Women Who Stop Using Contraception after Use at First Sexual Intercourse; Emily O. Kinsella MSPH, Lori A. Crane PhD, MPH, Lorraine G. Ogden PhD and Catherine Stevens-Simon MD; Journal of Pediatric and Adolescent Gynecology; Volume 20, Issue 2, April 2007, Pages 73-81]

One simulation projected that increasing contraceptive availability among teenagers reduces teen pregnancies in the short run, but may result in more teen pregnancies in the long run. The researchers found "that even well intended contraception policies can be self-defeating." [http://www.econ.duke.edu/~psarcidi/teensex.pdf Habit Persistence and Teen Sex: Could Increased Access to Contraception have Unintended Consequences for Teen Pregnancies?] ; Peter Arcidiacono, Ahmed Khwaja, Lijing Ouyang] 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. However, another study outlined the dangers of new laws being enacted that limit adolescents' access to contraceptives, including condoms.Cite web|url=http://www.guttmacher.org/media/nr/2005/01/18/|title=New studies signal dangers of limiting teen access to birth control information and services|accessdate=2007-05-11|format=html]

Outside influences

Media

Although early sexual activity may be caused by a variety of factors, research indicates that the media plays a significant role. According to journalism professor and media critic Jane Brown, since adolescents see so much sex in the media it is piquing their interest in sex at ages younger than they have traditionally been.Cite web|url=http://www.npr.org/templates/story/story.php?storyId=1952884|title=Friends with Benefits|accessdate=2008-04-15|publisher=National Public Radio|year=2004|author=Jane Brown, Professor in the School of Journalism and Mass Communications, University of North Carolina|format=windows media] 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."

Brown has also found that adolescents whose media diet was rich in sexual content were more than twice as likely as others to have had sex by the time they were 16.Citation | last=Luscombe | first=Belinda| title= The Truth About Teen Girls| periodical =Time| date= 2008-09-11 | url= http://www.time.com/time/magazine/article/0,9171,1840556-2,00.html] 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.Fisher, D.A.; Hill, D.L.; Grube, J.W.; Bersamin, M.M.; Walker, S.; and Gruber, E.L. "Televised sexual content and parental mediation: Influences on adolescent sexuality", November 10, 2006.]

Middle school aged boys who watch music videos or pro-wrestling one day a week are 10% more likely to have a higher acceptance rate for rape than boys who do not watch any.cite journal | author=Christine Elizabeth Kaestle, Carolyn Tucker Halpern, Jane D. Brown| title=Music Videos, Pro Wrestling, and Acceptance of Date Rape among Middle School Males and Females: An Exploratory Analysis| year=2007| volume=40| issue=2| page=101-198] Boys who watch music videos four days a week and pro wrestling 1.7 days a week (the mean exposure rate for boys) have 70% higher odds of endorsing a greater level of rape acceptance. "Both music videos and pro wrestling shows are popular with youth, combine violent and sexual content, and glorify individuals who behave violently."

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.cite journal | author=Jane D. Brown, PhD, MA, Kelly Ladin L'Engle, PhD, MPH, Carol J. Pardun, PhD, MA, Guang Guo, PhD, Kristin Kenneavy, MA and Christine Jackson, PhD, MA| title=Sexy Media Matter: Exposure to Sexual Content in Music, Movies, Television, and Magazines Predicts Black and White Adolescents' Sexual Behavior| journal=Pediatrics| year=2006| volume=117| issue=4| pages=1018–1027| doi=10.1542/peds.2005-1406]

According to another analysis, the American media is the most sexually suggestive in the world.cite journal | author=Victor C. Strasburger, MD| title=Adolescents, Sex, and the Media: Ooooo, Baby, Baby - a Q & A| journal=Adolesc Med| year=2005| volume=16| pages=269–288| doi=10.1016/j.admecli.2005.02.009] 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, but a 2004 report found that "the media far outranked parents or schools as the source of informationabout birth control." 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. Teens believe the media, as a super-peer, encourages and pressures them to have sex.

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." In 2002, only 6% of television scenes that included sexual content had any discussion of risk or responsibility.cite journal | author=Jennifer Stevens Aubrey| title=Sex and Punishment: An Examination of Sexual Consequences and the Sexual Double Standard in Teen Programming| journal=Sex Roles| year=2004| volume=50| issue=7-8| pages=505–514| doi=10.1023/B:SERS.0000023070.87195.07] 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.

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." 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." 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.’" Another study found that teens overestimate how many of their peers are sexually active, a problem contributed to by the media.cite journal | author=S. Liliana Escobar-Chaves, DrPH, Susan R. Tortolero, PhD, Christine M. Markham, PhD, Barbara J. Low, DrPH, Patricia Eitel, PhD and Patricia Thickstun, PhD| title=Impact of the Media on Adolescent Sexual Attitudes and Behaviors | journal=Pediatrics| year=2005| volume=116| issue=1| pages=303–326 | doi=10.1542/peds.2004-2541]

Family

Researchers at Boston College have found that teens who frequently did “things like eating dinner together as a family or engaging in fun activities or religious activities together” were less likely to have sex, had fewer sexual partners, and had less unprotected sex.cite journal | author=Rebekah Levine Coley, Bethany L. Medeiros, Holly S. Schindler, | title=Using Sibling Differences to Estimate Effects of Parenting on Adolescent Sexual Risk Behaviors| journal=Journal of Adolescent Health| year=2008| volume=43| issue=2| page=133-140] Family activities were "centrally important supports for children, providing opportunities for emotional warmth, communication, and transmission of values and beliefs.”

However, "Negative and psychologically controlling" parenting such as "criticizing the ideas of the adolescents, controlling and directing what they think and how they feel" increased the risk that adolescents would have sex. Pinsky has said that "the biggest issue in my mind is surviving our destroyed family system. Kids that come from chaos create chaos."Cite web|url= http://www.wistv.com/Global/story.asp?S=9097278&nav=menu36_13_11|title=Dr. Drew Tackles Teen Sex Talk, with Mom and Dad|accessdate=2008-10-07|publisher=WISTV|year=2008|format=html]

Researchers at the University of Arizona, University of Texas-Austin and Wake Forest University have found that girls who have positive relationships with their fathers wait longer before they have sex. Fathers can explain sex "in a way that mom can't, to let daughter know that for boys teen sex is about conquest, fun and adventure; while for girls, teen sex is about expressing love and affection," according to Dr. Patrick Wanis, a human behavior expert.Cite web|url=http://www.mercurynews.com/opinion/ci_10012863|title=What only a dad can tell a daughter about sex|accessdate=2008-08-26|publisher=MercuryNews.com|year=July 27, 2008|author=Ernest Hooper|format=html]

Girls who grew up in homes without their father are significantly more likely to have premarital sex than girls who are raised by both parents.Cite web|url=http://www.suburbanchicagonews.com/heraldnews/business/1124194,4_3_JO25_CYC_S1.article|title=Center reaches out to help dads support kids|accessdate=2008-08-31|publisher=Joliet Herald News|year=August 25, 2008|format=html] At a summit in Detroit on girls and sexual attitudes it was reveled that some "girls in that same age group [13-16] are 'dating' men as old as 30 because the men can give them things -- love, money, presents -- that their parents cannot."Cite web|url=http://www.freep.com/apps/pbcs.dll/article?AID=/20080818/NEWS05/80818083|title=Take a breath, then read about teens' normal sex life|accessdate=2008-08-31|publisher=Detroit Free Press|year=August 18, 2008|author=ROCHELLE RILEY |format=html]

Friends

The perception adolescents have of their best friends' sexual behavior has a significant association with their own oral sex behavior.cite journal | author=Prinstein, Mitchell J. PhD; Meade, Christina S. MS; Cohen, Geoffrey L. PhD | title=Adolescent Oral Sex, Peer Popularity, and Perceptions of Best Friends' Sexual Behavior. | journal=Journal of Pediatric Psychology| year=June 2003| volume=28| issue=4| page=243-249] Adolescents who reported sexual activity had high levels of reputation-based popularity, but not likeability among peers; however, sex with more partners was associated with lower levels of popularity.

Extracurricular activities

Girls who participate in athletics, artistic, or academic extracurricular activities are less likely to be sexually active than girls who don't participate in any.cite book | title=Contemporary Issues in Sociology of Sport| last=Yiannakis| first=Andrew | coauthors=Merrill J. Melnick| date=2001| pages=109-123| publisher=Human Kinetics] Female athletes have "significantly fewer sex partners, engaged in less frequent intercourse... and began having sex at a later age." For boys, those who participate in sports are slightly more likely to be sexually active, and those who are in artistic activities are considerably less likely.

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."

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. 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.Cite web|url=http://newsblaze.com/story/20080310084620tsop.nb/newsblaze/TOPSTORY/Top-Stories.html|title=You Know Far Less About Your Teen Daughter Than You Think|accessdate=2008-03-10|publisher=Newsblaze.com|year=2007|author=Judyth Piazza|format=html]

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.

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. [National Campaign to Prevent Teen Pregnancy, 14 and Younger: The Sexual Behavior of Adolescents, 2003] 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.cite book | title=The Romance of Risk| last=Ponton| first=Lynn| year=1997| pages=97| publisher=HarperCollins| location=New York]

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."cite web|url=http://www.teenpregnancy.org/resources/reading/pdf/14summary.PDF|title=National Campaign to Prevent Teen Pregnancy, 14 and Younger: The Sexual Behavior of Adolescents, 2003|accessdate=2005-05-11|format=pdf] 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.cite book | title=Why Gender Matters| url=http://www.whygendermatters.com| last=Sax, M.D., Ph.D| first=Leonard| year=2005| pages=128| publisher=Doubleday| isbn = 038551073X] 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." [cite book | title=Why Gender Matters| url=http://www.whygendermatters.com| last=Sax, M.D., Ph.D| first=Leonard| year=2005| pages=128| publisher=Doubleday| isbn = 038551073X See also comments made by Dr. Drew Pinsky on NPR's Fresh Air, September 23, 2003.]

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.cite journal | author=Stacy Armour and Dana L. Haynie|title=Adolescent Sexual Debut and Later Delinquency| journal=Journal of Youth and Adolescence| volume=36| issue=2| url=http://www.springerlink.com.ezp1.harvard.edu/content/415qm4t173260t22/?p=5f9746b9b2be4216b2e5b3990291ff1f&pi=2] 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. [http://www.sciencedaily.com/releases/2007/02/070226131500.htm Early Sex May Lead Teens To Delinquency, Study Shows] , Science Daily, 2007-03-07] 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."

Approaches to adolescent sexual 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.cite web |url=http://www.kff.org/youthhivstds/upload/Sex-Education-in-the-U-S-Policy-and-Politics.pdf |title=Sex Education in the U.S.: Policy and Politics |accessdate=2007-05-23 |year=2002 |month=October |format=PDF |work=Issue Update |publisher=Kaiser Family Foundation ] 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. [cite web |url=http://www.guttmacher.org/pubs/tgr/04/1/gr040109.html |title=Sex Education: Politicians, Parents, Teachers and Teens |accessdate=2007-05-23 |last=Dailard |first=Cynthia |year=2001 |month=February |work=The Guttmacher Report on Public Policy |publisher=Guttmacher Institute] [cite web |url=http://www.siecus.org/policy/public_support.pdf |title=On Our Side: Public Support for Comprehensive Sexuality Education |accessdate=2007-05-23 |format=Fact Sheet |work=SIECUS ] [cite web |url=http://www.abstinenceassociation.org/newsroom/050307_zogby_key_findings.html |title=NAEA Executive Summary of Key Findings |accessdate=2007-05-24 |date=2007-05-03 |work=National Abstinence Education Association ] 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. [http://www.abstinenceassociation.org/newsroom/pr_050307_parents_prefer_2to1.html Parents Prefer Abstinence Education 2 to 1] , National Abstinence Education Association]

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.

Comprehensive

The American Psychological Association, [ [http://www.apa.org/releases/sexeducation.html Comprehensive Sex Education is More Effective at Stopping the Spread of HIV Infection ] ] the American Medical Association, [ [http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/H-170.968.HTM AMA Policy Finder - American Medical Association ] ] the National Association of School Psychologists, [ [http://nasponline.org/about_nasp/pospaper_sexed.aspx NASP Position Statement on Sexuality Education ] ] the American Academy of Pediatrics, [ [http://pediatrics.aappublications.org/cgi/reprint/108/2/498 Sexuality Education for Children and Adolescents - Committee on Psychosocial Aspects of Child and Family Health and Committee on Adolescence 108 (2): 498 - Pediatrics ] ] the American Public Health Association, [ [http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1334 APHA: Policy Statement Database ] ] the Society for Adolescent Medicine and the American College Health Association,Cite web|url=http://www.adolescenthealth.org/PositionPaper_Abstinence_only_edu_policies_and_programs.pdf|title=Abstinence-only education policies and programs|accessdate=2008-03-31|publisher=Journal of Adolescent Health|year=2006|format=html] 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." 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.

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 advocate abstinence-only sex education because it is the only approach they find acceptable and in accordance with their churches' teachings.

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

A comprehensive review of 115 program evaluations published in November 2007 by the National Campaign to Prevent Teen and Unplanned Pregnancy found that two-thirds of sex education programs focusing on both abstinence and contraception had a positive effect on teen sexual behavior. The same study found no strong evidence that programs that stress abstinence as the only acceptable behavior for unmarried teens delayed the initiation of sex, hastened the return to abstinence, or reduced the number of sexual partners. [ [http://www.thenationalcampaign.org/EA2007/ Emerging Answers 2007] The National Campaign to Prevent Teen and Unplanned Pregnancy, November 2007, accessed 2007-12-05] 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."

References

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