Demographics: Sexual Health

For background and context, see Adolescent Sexual Development and Sexual Health.

Sexual Orientation

Awareness of romantic attraction may begin prior to puberty [1]. Sexual attraction, behavior, and identity are not always aligned: a person primarily attracted to women may also have sexual contact with men and may or may not identify as gay, bisexual, or straight. This fluidity may be true of both adolescents and adults, and is seen more frequently among females [2]. A 2011 study of the nationally representative 2002 National Survey of Family Growth (NSFG) found that 11% of adolescent women and 4% of adolescent men (age 15-21) reported same-sex sexual activity. However, only 6% of adolescent women and 3% of adolescent men identified themselves as gay or bisexual [3].

Most lesbian, gay, bisexual, and/or transgender students experience harassment at school. In 2009, 85% of LGBTQ middle and high school students reported verbal harassment, 40% physical harassment, and 19% physical assault. Boys who are perceived to be gay or feminine are especially likely to face intense stigma [3]. The presence of Gay-Straight Alliance clubs within a school setting has been demonstrated to foster a safer environment [2, 4].

Most lesbian, gay, and bisexual youth achieve health and well-being at levels similar to those achieved by heterosexual youth, though many face higher risks for violence and rejection [2].

Romantic Relationships and Sexual Experience

Half of all teens have dated, and close to one third have been in a relationship they describe as serious [5]. By age 17, 70% report having had a special romantic relationship within the last 18 months [6]. Despite relatively high levels of conflict in adolescent romantic relationships, most adolescents report a sense of equal power, decision making, and emotional support within their relationships [6].

Adolescent sexual behaviors most often occur within romantic relationships [6], or with friends or ex-partners [7]. Most teens age 15-19 have first heterosexual sex with a partner with whom they are "going steady," but the numbers are quite different for girls (70%) and boys (52%) [8]. Sexual activity that goes beyond kissing and other "light" behaviors is associated with depression and other problems in early adolescence when these behaviors are uncommon. However, these problems are not associated with sexual activity in late adolescence within the context of a romantic relationship [6].

The 2006-2010 NSFG found that of youth age 15-19, 43% of females and 42% of males had had heterosexual vaginal intercourse [8]. In 2009, just under half (46%) of high school students reported having had sexual intercourse at some point in their lives [9] (42% in New York State [10]), and 34% were currently sexually active (had sexual intercourse at least once in the three months before taking the survey) [9]. Most youth in the U.S. first have sexual intercourse at age 17 [11]. Over 80% of adolescent women age 15-21 who report lesbian/bisexual identities or same-sex attractions report having had sex with men [3].

Since 1988, there has been a steady decline in the number of teens (15-19) who have engaged in penile-vaginal intercourse [8]; however, this does not necessarily indicate that other forms of sexual activity are decreasing. Oral sex [12] and heterosexual anal intercourse [13], for example, may be increasing. One survey of 9th grade students found that 20% of respondents had had oral sex [14]. A Guttmacher Institute study of the 2002 NSFG indicates that of all adolescents age 15-19, 54% of females and 55% of males have had heterosexual oral sex and 11% have had heterosexual anal sex. Youth who are white or have a higher socio-economic status are more likely to engage in heterosexual oral or anal sex than are youth of other groups [15].

Condoms and Contraceptives

Among sexually active students, condom use at most recent sexual intercourse increased from 46% in 1991 to 61% in 2009 [9] (68% in New York State [10]). Most high school teens use a condom or other form of contraception the first time they have sexual intercourse (79% of sexually experienced females, 87% of males) [11]. Among sexually active students nationally, in 2009, black males reported the highest levels of condom use (73%) [16]. In that same group, 10% of females and 8% of males reported using condoms together with either oral contraceptives or Depo-Provera [17].

Although it carries an especially high level of risk for HIV and STDs, anal sex among adolescents is often unprotected [12], as is oral sex [14].

According to the 2006-2010 NSFG, the most popular form of birth control among teen women age 15-19 is the condom (used at least once by 96% of sexually experienced females), followed by withdrawal (57%) and the pill (56%). Young women also indicated having at some point used the following contraceptive drugs or devices: injectables such as Depo-Provera (used by 20% of sexually experienced women age 15-19), periodic abstinence/rhythm method (15%), emergency contraception (14%), the contraceptive patch (10%), and the contraceptive ring (5%) [8].

Risky Behaviors

Male adolescents are more likely than females to be exposed to or engage in certain risky sexual behaviors, including sexual intercourse before age 13 (as reported by high school students: 8% males and 3% females in 2009), and having four or more sexual partners in their lifetime (16% male high school students; 11% female high school students) [9].

Adolescent Pregnancy, Abortion, and Birth Rates

Adolescent pregnancies are largely, but not entirely, unplanned: 82% are unintended [11]. Between 1990 and 2006, the teen pregnancy rate declined 39%. Black adolescents led the way with a 44% decrease [18]. Pregnancy rates for Latina youth declined 22% in that period; however, Latinas have the highest teen pregnancy and birth rates in the United States [19].

Teens who identify as lesbian, gay, or bisexual have higher rates of pregnancy involvement than heterosexual teens [2].

The teen abortion rate declined by 56% between 1988 and 2005, before rising 1% in 2006 [20]. In New York State, over half of teen pregnancies end in abortion [20]. In 2008, youth under 18 years of age comprised 6.5% of all women who had abortions. While most women (including teens) who have abortions do so in the first trimester of pregnancy, teens are overrepresented among women who have abortions at 13 weeks or later [21].

The teen birth rate peaked in 1957 at 96.3 births per 1,000 teens age 15-19, then dropped fairly steadily until the late 1980s. It rose abruptly between 1988 and 1991, then fell 34% by 2005 [22], a decline that is attributed primarily to better, more effective contraceptive practice, together with some reduction in vaginal intercourse [20]. Between 2005-2007, the birth rate once again increased by 5%, decreasing slightly (2%) in 2008 [22]. In 2009, the teen birth rate fell by 6% to 39.1 births per 1,000 teens, the lowest level ever recorded [23]. That year there were 409,802 births to teens age 15-19 (16,306 in New York) [24].

Sexually Transmitted Diseases (STDs) and HIV

Among the roughly 19 million new STD infections reported every year, nearly half are found among young people (ages 15-24), although this age group makes up only about 25% of people who are sexually experienced [25]. Girls between the ages of 15 and 19 have more reported cases of gonorrhea and chlamydia than any other age or sex group. Racial disparities characterize all three reportable STDs.

Nearly 30,000 youth age 13-24 were living with an HIV diagnosis in 2008 (in the 40 states and five U.S. dependent areas reporting to the CDC). Of the males in this group, 64% were black, 18% Latino, 16% white, 1% Asian, and 1% multiple races. Of the females, 65% were black, 18% Latina, 15% white, 2% multiple races, and less than 1% Asian. African Americans bear a high burden of HIV, especially youth: in recent years (2006-2009) over 60% of new diagnoses have been among black youth age 13-24. While only 17% of youth age 13-19 in the 40 reporting states were black, black youth accounted for approximately 73% of HIV diagnoses in their age group [26].

Gay, bisexual, and other men who have sex with men are at high risk, and the risk is increasing among young men. In 2009, among males age 13-19, male-to-male sexual contact accounted for nearly 91% of new diagnoses [26].

New York State has a particularly high rate of adolescents (age 13-19) living with an HIV diagnosis: 110.3 per 100,000 at the end of 2008 [26].

Endnotes

[1]	Brooks, D. (2010). Gay, lesbian, bisexual, transgender and questioning (GLBTQ) youth. Retrieved October 3, 2011, from Advocates for Youth website advocatesforyouth.org/index.php?option=com_content&task=view&id=4 24&Itemid=177
[2]	Saewyc, E. M. (2011). Research on adolescent sexual orientation: Development, health disparities, stigma, and resilience. Journal of Research on Adolescence, 21, 256-272. doi: 10.1111/j.1532-7795.2010.00727.x
[3]	McCabe, J., Brewster, K. L., & Tillman, K. H. (2011). Patterns and correlates of same-sex sexual activity among U.S. teenagers and young adults. Perspectives on Sexual and Reproductive Health, 43(3), 142-150. doi:10.1363/4314211
[4]	GLSEN. (2010). 2009 National school climate survey. Retrieved October 3, 2011, from glsen.org/cgi-bin/iowa/all/library/record/2624.html?state=researc h&type=research
[5]	Sorensen, S. (2007, July). Adolescent romantic relationships. Research Facts and Findings. Retrieved October 3, 2011, from actforyouth.net/resources/rf/rf_romantic_0707.pdf (PDF: 128K) actforyouth.net/resources/rf/rf_romantic_0707.cfm (accessible format)
[6]	Collins, W. A., Welsh, D. R., & Furman, W. (2009). Adolescent romantic relationships. Annual Review of Psychology, 60, 631-652. doi:10.1146/annurev.psych.60.110707.163459
[7]	Tolman, D. L. & McClelland, S. I. (2011). Normative sexuality development in adolescence: A decade in review, 2000-2009. Journal of Research on Adolescence, 21(1), 242-255. doi:10.1111/j.1532-7795.2010.00726.x
[8]	Martinez, G., Copen, C. E., & Abma, J. C. (2011, October). Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2006-2010 National Survey of Family Growth. Vital Health Statistics 23(31). Retrieved November 28, 2011, from Centers for Disease Control and Prevention website cdc.gov/nchs/data/series/sr_23/sr23_031.pdf (PDF: 723K)
[9]	Centers for Disease Control and Prevention. (2009). Youth online: High school YRBS: United States 2009 Results. Retrieved October 3, 2011, from apps.nccd.cdc.gov/youthonline/App/Results.aspx?SID=HS&LID=XX
[10]	Centers for Disease Control and Prevention. (2009). Youth online: High school YRBS: New York 2009 Results. Retrieved October 3, 2011, from apps.nccd.cdc.gov/youthonline/App/Results.aspx?LID=NY
[11]	Guttmacher Institute. (2011, August). Facts on American teens' sexual and reproductive health. Retrieved October 3, 2011, from guttmacher.org/pubs/FB-ATSRH.html
[12]	Dake, J. A., Price, J. H., McKinney, M., & Ward, B. (2010). Midwestern rural adolescents' anal intercourse experience. Journal of Rural Health. Retrieved November 28, 2011, from onlinelibrary.wiley.com/doi/10.1111/j.1748-0361.2010.00330.x/full
[13]	Lescano, C. M., Houck, C. D., Brown, L. K., Doherty, G., DiClemente, R. J., Fernandez, M. I., . . . Project SHIELD Study Group. (2009). Correlates of heterosexual anal intercourse among at-risk adolescents and young adults. American Journal of Public Health, 99(8), 1352-1352. doi:10.2105/AJPH.2007.123752e
[14]	Halpern-Felsher, B., Cornell, J., Kropp, R., & Tschann, J. (2005). Oral versus vaginal sex among adolescents: Perceptions, attitudes, and behavior. Pediatrics, 115(4), 845-851. doi:10.1542/peds.2004-2108
[15]	Lindberg, L. D., Jones, R., & Santelli, J. S. (2008). Non-coital sexual activities among adolescents [Electronic version]. Journal of Adolescent Health. Retrieved October 31, 2011, from guttmacher.org/pubs/JAH_Lindberg.pdf (PDF: 113K)
[16]	Centers for Disease Control and Prevention. (2009). Youth online: High school YRBS: United States 2009 Results: Used a condom during last sexual intercourse. Retrieved October 31, 2011, from apps.nccd.cdc.gov/youthonline/App/Results.aspx?TT=C&SID=HS&QID=H6 3&LID=XX&LID2=SL&YID=2009&YID2=SY&HT=QQ&LCT=C&COL=S&ROW1=N&ROW2=N &TST=false&SC=DEFAULT&SO=ASC&VA=CI&CS=Y&DP=1&QP=L&FG=1&FR=1&FS=1& TABLECLICKED=1 [select "Race" in Row Variable 1]
[17]	Centers for Disease Control and Prevention. (2009). Youth online: High school YRBS: United States 2009 Results: Dual birth control. Retrieved October 31, 2011, from apps.nccd.cdc.gov/youthonline/App/Results.aspx?SID=HS&QID=QNDUAL& QP=L&VA=CI&CS=Y
[18]	National Campaign to Prevent Teen and Unplanned Pregnancy. (2011, January). Fast facts: Teen pregnancy and childbearing among black teens. Retrieved November 28, 2011, from thenationalcampaign.org/resources/pdf/FastFacts_TPChildbearing_Bl acks.pdf (PDF: 467K)
[19]	National Campaign to Prevent Teen and Unplanned Pregnancy. (2011, February). Fast facts: Teen pregnancy and childbearing among Latino teens. Retrieved November 28, 2011, from thenationalcampaign.org/resources/pdf/FastFacts_TPChildbearing_La tinos.pdf (PDF: 559K)
[20]	Guttmacher Institute. (2010, January). U.S. teenage pregnancies, births and abortions: National and state trends and trends by race and ethnicity. Retrieved October 31, 2011, from guttmacher.org/pubs/2006/09/12/USTPstats.pdf (PDF: 209K)
[21]	Jones, R. K. & Finer, L. B. (2011). Who has second-trimester abortions in the United States? [Author version]. Retrieved December 16, 2011, from www.guttmacher.org/pubs/journals/j.contraception.2011.10.012.pdf (PDF: 4.5M)
[22]	National Campaign to Prevent Teen and Unplanned Pregnancy. (2010). Teen birth rates in the United States, 1940-2008. Retrieved November 28, 2011, from thenationalcampaign.org/resources/pdf/TBR_1940-2006.pdf (PDF: 41K)
[23]	Martin, J. A., Hamilton, B. E., Ventura, S. J., Osterman, M. J. K., Kirmeyer, S., Mathews, T. J., & Wilson, E. (2011, November). Births: Final data for 2009. National Vital Statistics Reports 60(1), 6. Retrieved from Centers for Disease Control and Prevention website cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_01.pdf (PDF: 1.3M)
[24]	The National Campaign to Prevent Teen and Unplanned Pregnancy. (n.d.). State Profiles: New York. Retrieved November 28, 2011, from thenationalcampaign.org/state-data/state-profile.aspx?state=newyo rk
[25]	Centers for Disease Control and Prevention. (2010). Sexually transmitted disease surveillance 2009. 63-71. Retrieved November 29, 2011 from cdc.gov/std/stats09/surv2009-Complete.pdf (PDF: 15M)
[26]	Centers for Disease Control and Prevention. (2011, July 14). HIV surveillance in adolescents and young adults [Slide set]. Retrieved November 29, 2011, from cdc.gov/hiv/topics/surveillance/resources/slides/adolescents/inde x.htm