Risk Behaviors

Adolescent sexuality is often viewed from a negative perspective that focuses primarily on sexual behavior and its association with other high-risk behaviors. Youth are sometimes negatively viewed as sex-crazed, hormone-driven individuals who want the perceived independence of adulthood without the responsibility of adulthood. On the other hand, psychosexual development is a critical developmental process during adolescence. P. B. Koch has identified the need for research identifying healthy psychosexual development in adolescents. As children emerge into adolescence, their developing gender identity shapes whom they interact and associate with, especially peers. Negative media images that appear to promote lustful, irresponsible sexual behavior are often associated with early sexual activity among adolescents. However, it is crucial to identify what protective factors can shape positive psychosexual development, including delaying the onset of sexual activity. Research has yet to identify gender-specific strategies that can promote positive psychosexual development in boys and girls.

Early Sexual Activity

Early sexual activity is a growing issue in adolescent development. According to both the National Survey of Family Growth and the Youth Risk Behavior Survey, adolescents are engaging in sexual activity at earlier ages. In general, older adolescents (age fifteen and older) demonstrate a reduction in early sexual activity, whereas adolescents younger than thirteen demonstrate an increase in sexual activity. In addition, two-thirds of high school students report having sex before graduating from high school. These findings persist in the face of an apparent leveling off of sexual activity in adolescents.

Peer pressure to engage in adult-like activities can encourage adolescents to engage in various levels of sexual experimentation. Adolescents who engage in sexual experimentation are at increased risk for sexually transmitted diseases, including HIV/AIDs, and pregnancy. Moreover, risk for early sexual experimentation is associated with other high-risk behaviors in adolescence, including sexual abuse and drug and alcohol use, and emotional adjustment.

In regard to puberty, early-maturing adolescents are more likely to engage in early sexual experimentation than are later-maturing adolescents. They confront their emerging sexuality at younger ages than their peers do, and are more likely to be pursued by older peers in social settings because they appear physically older than their chronological age.

For both male and female adolescents, adolescence represents, in part, a time for pressure to engage in sexual intimacy. As girls enter adolescence (typically a few years before boys), they begin to grow into womanhood and become sexualized objects. Within the media, images of sexuality and overly thin body images can socialize girls into seeing themselves as sexual objects. On the other hand, boys are pressured to exhibit their manhood through sexual conquests.

Much of the research on early sexual activity in adolescents does not address early patterns of noncoital sexuality. Noncoital sexuality is defined as involvement in sexual contact that does not include the exchange of body fluids. Research suggests that by middle adolescence most youths have begun to engage in sexual experimentation, including kissing, with 97 percent of adolescents experiencing their first kiss by age fifteen. Understanding the onset of noncoital sexuality and factors influencing its timing is vital to delineating patterns of early sexual activity in teenagers.

Adolescent condom use has increased for both males and females. The decline in teenage pregnancy is, in part, attributable to an increase in contraceptive use. However, since psychosexual development is a new challenge faced during adolescence, some youths are ill informed, and even though they may choose to use contraceptives, they may use these methods incorrectly.

Teenage Pregnancy

The association of early sexual activity with teenage pregnancy has been a societal concern for decades. For females, teenage pregnancy can complicate adolescent development and contribute to a troublesome transition to young adulthood, which involves a potential future as a single parent with limited educational and economic opportunities. Since the 1990s the overall teenage pregnancy rate has declined, though, according to the National Campaign to Prevent Teen Pregnancy, four out of ten girls still get pregnant before their twentieth birthday. The United States has the highest teen pregnancy, birth, and abortion rates of any industrialized nation.

Teenage mothers are at risk for poverty and school failure, while their offspring are at risk for low birth-weight, poor access to health care, poverty, and early childhood developmental problems. Programs such as Aid to Families with Dependent Children (AFDC), which were created to support single parent mothers, have been criticized as being an incentive for the birth of children out of wedlock in poor communities. Consequently, poor teen mothers have sometimes been blamed for their circumstances and negatively portrayed within the media and the public arena. Yet the overall decline in teenage pregnancy has occurred across all ethnic groups, including the poor ethnic minority groups that are most likely to be demonized in the media as having excessive teenage pregnancy rates.

A significant risk factor for early sexual experimentation is a history of sexual trauma. This is true for both males and females, though the level of risk is increased for females. Adolescent girls who have a history of sexual trauma during childhood and/or adolescence may try to cope during their adolescent years by being sexually provocative. This coping mechanism is negative; however, victims of sexual abuse may try to control future sexual encounters by initiating sexual contact. This may influence the likelihood of their involvement in prostitution and other sexually exploitative illegal activities.

Girls with a history of sexual trauma are also at great risk for involvement in the juvenile justice system, particularly if they do not have supportive home environments that allow them the opportunity to heal from their traumas. Girls within the juvenile justice system are likely to exhibit runaway behaviors in an effort to get out of abusive home environments. Through these runaway patterns, some girls are introduced to sexual exploitation in their effort to survive on the street. Boys who are victims of sexual abuse are at risk for offending behaviors if they lack supportive home environments, and they are also at risk for involvement in the juvenile justice system.

The use of alcohol and drugs reduces inhibitions, and can therefore influence participation in unprotected sexual activity. Boys and girls with a history of smoking and alcohol use have an increased risk for early sexual activity, in part because the use of these substances can influence the decision making of adolescents in social contexts.

Efforts to conduct sexuality education within the home environment have been found to be insufficient. Parents need to provide supportive learning environments in which children can develop a healthy understanding of their sexuality, particularly during their adolescent years. Adolescence represents a time of fundamental change, as adolescents are introduced to new reproductive capacities that have to be understood cognitively, socially, and emotionally.

Pregnancy Prevention

Adolescents receive most of their information about sexuality from peers, which often leads to misinformation. Adolescents need structured formal and informal learning environments with age-appropriate peers to address issues of sexuality. These programmatic models may be available within school and community-based settings. Most pregnancy prevention programs fall within three categories: knowledge interventions, access to contraception, and programs to enhance life options. Lisa Crockett and Joanne Chopack suggest three categories of programs: programs that focus on sexual antecedents, programs that focus on nonsexual antecedents, and programs that focus on a combination of both sexual and nonsexual antecedents. Programs that focus on sexual antecedents directly target sexual behavior and often focus on reducing sexual activity, minimizing the number of sexual partners, and contraceptive use. Programs that focus on nonsexual antecedents indirectly target sexual activity by focusing on other outcomes, such as academic achievement, youth development (including leadership skills), and service-learning models.

Joy Dryfoss has proposed the need for comprehensive health-promotion models as the best practice within sexuality education. This practice not only seeks to minimize risk, but to provide leadership and prosocial skills development to shape the changing lives of young people. Scholars and activists continue to debate the usefulness of abstinence versus education, including birth control strategies. Abstinence-based models show mixed results when rigorously researched, with a limited demonstrated effect on sexual behavior. Many abstinence-only proponents believe that birth control education increases the likelihood of teen sexual activity; however, the evaluations do not support this notion. Sex education models designed to support the psycho-sexual development of adolescents have been extensively debated, based on religious, moral, family, and community values and attitudes. Educational systems have been permitted to provide abstinence-based education to combat historically high teenage pregnancy rates. Those that propose that birth control education should include life-skills development assert that interventions need to be grounded in the realities of those who are at greatest risk for premature sexual activity and associated negative consequences.

Young people from poor, underserved, innercity communities are at risk for poor access to health care, including health education, which increases their risk of negative developmental outcomes related to early sexuality activity. Programmatic efforts need to take into account the social context of these communities. Young people living in such an environment particularly need increased life options rooted in effective decision making, which may lead to a delay in early sexual activity in the adolescent years. According to Saul Hoffman, author of "Teenage Childbearing Is Not So Bad After All … Or Is It? A Review of the New Literature," teenage pregnancy prevention programs targeting teen mothers in poor, underserved communities may yield indirect effects in addition to reducing teen pregnancy. These programs may represent pathways out of poverty for these poor populations of teen mothers.

Within inner-city communities of color, program models such as the I Have a Future program founded by Dr. Henry Foster provide a supportive learning community for youths residing in economically deprived communities with high rates of multi-generational teen pregnancy and sexually transmitted diseases. Such families often remain trapped in poverty, poor health care systems, and economic deprivation. The I Have a Future model provides comprehensive adolescent health services, prosocial skills development, leadership development, alcohol and drug education, gender and ethnic identity development, and academic support. In addition, participants gain exposure to positive role models within the supportive staff and through community linkages to colleges and universities. This program represents a mixed-gender context in which both males and females adolescents can develop positive decision-making skills regarding delayed sexual activity, and it provides a promising framework for effective interventions for high-risk youth.

Positive psychosexual development is important in making a successful transition through adolescence. Adolescents need safe opportunities to relate to peers and develop meaningful attachments without bringing harm to themselves. Psychosexual development is shaped by media, family, community, and peer contexts, and comprehensive strategies that address these contexts are needed to fully support adolescent development. Media literacy can be incorporated into intervention models in order to increase understanding of gender stereotypes. Girls must confront the overwhelming stereotypes of thin, sexually provocative body images of females, whereas males must confront macho images reinforcing masculine control.

The Role of Parents

Parents need resources to support their vital role in shaping the lives of adolescents. Families, and parents in particular, need help in learning effective ways of supporting their adolescent's psychosexual development. In the face of declining teenage pregnancy rates, it is imperative that research focus on targeted evaluations of promising practices that can influence positive developmental outcomes. Some communities and individual programs are strapped for funds to establish and maintain programming, while evaluation goals are deferred because of limited funding. Academic communities can partner with local communities and health promotion agencies to assist in the development of rigorous research paradigms that can increase knowledge of effective interventions that can be potentially replicated in other communities.

In the face of community efforts to address teenage pregnancy, some parents may be apprehensive about other adults influencing their children regarding personal, sensitive issues. For parents who feel comfortable and equipped in addressing these issues with their children, the National Campaign to Prevent Teen Pregnancy offers several tips for parents, including being aware of their own personal values and attitudes regarding sexuality and how they want their children to be introduced to the sensitive topic of sexuality. Effective parent–child communication regarding love and intimacy, as well as family rules and standards about teenage dating, can provide needed support for adolescents who are confronting the social and emotional challenges related to puberty. Parents are encouraged to introduce the topic of sexuality and sex education early in a child's development. How early this occurs is again influenced by the personal values and attitudes of the parents. Parents can also assist as interpreters of negative media images that foster inconsistent and controversial attitudes toward early sexual activity and promiscuity.

In addition, parents are encouraged to become knowledgeable about their children's social contexts. Monitoring children's activities includes not only knowing where one's children are, but also who are the friends and peer associates of one's children. It is also important to provide life options that provide children with constructive, safe opportunities for personal growth.

Other effective models of service include gender-specific interventions that assist adolescents in understanding positive manhood and womanhood development. Through the development of positive gender identity, adolescents can fully consider their role in relationships with family, peers, and community.

There has been some debate regarding gender-specific versus mixed-gender programs to address the issue of teenage pregnancy. Programs are encouraged to be intentional in their efforts to maximize opportunities for education and life-skills development, whether in same-gender or mixed-gender environments. Same-gender programs can provide safe learning environments in which groups can fully consider the challenges facing adolescents to engage in early sexual activity. In particular, for girls who may have been traumatized by males, it is critical that they have opportunities to voice their concerns and experiences without any perceived threat by male counterparts. On the other hand, in the absence of trauma-related experiences, adolescents may benefit from healthy, mixed-gender programs that focus on the shared responsibility of both sexes in family planning. Otherwise, the burden for safe sex, including contraceptive use, is often perceived as the responsibility of the female. Even though females are more likely to experience pubertal changes earlier than their male counterparts, these females are not necessarily advanced in their emotional maturity to the point that they can assume sole responsibility for sexual behavior.

In order to address premature sexual activity among teenagers effectively, comprehensive community strategies are needed to address the myriad of issues involved and the diversity in social and community contexts. In 2002, thirteen community partnerships within eleven states were implementing comprehensive youth preventive interventions to combat teenage pregnancy. These partnerships distribute the responsibility for sexuality education across the family, community, and school.