Adolescent Sexual Behavior
In the U.S., the average age at first intercourse for women is 17.1 years with 27% of 15-17 year-old females and 62.7% of 18-19 year-old females reporting they have ever had intercourse (CDC, 2013). Rates of adolescent sexual intercourse are slightly higher in African American females and Hispanic females, 53.4% and 46.9% respectively, as compared to 45.3% of white females (Kann et al., 2014). Though adolescents have continued to delay sexual initiation and use protection at higher rates over the past two decades, with 85.6% of adolescent females now reporting use of contraception at last intercourse compared to 79.9% in 1988, usage rates and reports of risk behavior have stagnated during the two most recent years of data (CDC, 2011). Social factors modify adolescent sexual behavior and may impact subsequent health outcomes. Lower socioeconomic status contributes to risk of earlier sexual initiation (O’Donnell, O’Donnell, & Stueve, 2001). Family structure differing from two biological parents has been documented as a significant factor in earlier sexual initiation, however it does not significantly impact lifetime risk of sexually transmitted infection (STI), concurrent sexual partners, or exchange of sex for money during the last year (O’Donnell et al., 2001; Haydon, Herring, & Halpern, 2012). Obesity is also a risk factor in some groups, particularly White females where it increases the likelihood of having multiple sexual partners and decreases likelihood of condom usage (Leech & Dias, 2012). Early initiators, defined as those with a sexual debut at less than 15 years, are more likely to report multiple sexual partners, pregnancy, and forced intercourse (Magnusson, Masho, & Lapane, 2012; O’Donnell et al., 2001). The educational prospects of early sexual initiators, with a sexual debut prior to age 15, tend to be the most heavily impacted; they
are significantly less likely to graduate from high school, enroll in college, and graduate from college, even sexual initiation before age 18 has also been associated with reduced odds of post-secondary education (Spriggs & Halpern, 2008; Steward, Farkas, & Bingenheimer, 2009). Certain characteristics and behaviors may serve as protective factors that may delay sexual initiation and increase the likelihood that condoms will be used at first sexual intercourse. In a systematic review of the effects of spirituality and social norms on adolescent sexual health, subjective sexual norms (the attitudes, beliefs, or values of survey participants towards sex), perceived sexual norms (the participants’ perception of the norms of others), and religiosity (attendance at services and importance of spirituality) were found to be protective of ever having had sex, use of condom, and
intention to have sex (House, Mueller, Reininger, Brown, & Markham, 2010). Factors previously thought of as protective, such as college aspirations, may not actually mediate likelihood of sexual initiation or unprotected sexual activity, though one study found a significant difference in recent sexual activity between low and high aspiring students (Cubbin, Brindis, Jain, Santelli, & Braveman, 2010; Kirk, Lewis, Lee, & Stowell, 2011). Pledges of virginity have not been found to be effective at delaying onset of sexual activity or to have an effect on STI history and adolescent women who pledge virginity are less likely to report birth control usage at last sex (Rosenbaum, 2009).