Key Elements of Positive Youth Development: Disparities Among Adolescents Experiencing Early Sexual Debut

1. Key Elements of Positive Youth Development: Disparities Among Adolescents Experiencing Early Sexual Debut This online training is supported by CDC Cooperative Agreement Number 5U58DP000441-04. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

2. Objectives As a result of this presentation, participants will be able to… • Describe why young women in particular are more vulnerable than young men to sexually transmitted infections (STIs) and a number of other adverse physical health effects of early sexual debut; • Identify the disparities between young women and young men who experience early sexual debut in the context of psychological, relational, social, and financial health; and • Understand the scientific and medical literature supporting the benefits of delaying sexual debut for female adolescents.

3. Background: What is Benefits of Delaying Sexual Debut? • Published in 2008: Comprehensive overview of the research supporting delaying sexual initiation for young people. • Conclusions are based on peer-reviewed scientific and medical journals, academic papers, scholarly books, government data, and expert opinions. • Identified common themes of abstinence-centered education and reviewed the evidence behind the following: • Physical health benefits of delaying sexual initiation • Mental/psychological health benefits of delaying sexual initiation • Financial benefits of delaying sexual initiation • Social and relational benefits delaying sexual initiation

4. Why Delay Sexual Debut in Young Women? • Compared to young men, research shows a disparity in the negative physical health outcomes for young women who experience early sexual debut (i.e., STIs/early pregnancy). • Question: If avoiding STIs and early pregnancy were the only positive outcomes of delaying sexual initiation, would this strategy be worthy of consideration by the public health community? • New Framework: Not only does delaying sexual debut prevent STIs and early pregnancy, but it also benefits the emotional, psychological, relational, social, and financial health of young women.

5. Physical Health Benefits for Young Women • According to analysis from the National Survey of Family Growth from Rector et al. (2003), delaying sexual debut reduces the lifetime risk that an adolescent female will have an early pregnancy and STI (see graph on slide 6). • According to an HHS study (2000), the age at first intercourse has a strong association with the number of lifetime sexual partners one has. The more sexual partners, the greater risk of contracting an STI (see graph on slide 7). • Research also finds that young women are more vulnerable to STIs such as Human Papillomavirus (HPV), Chlamydia, and Gonorrhea (Shufford, 2008 at the The Medical Institute for Sexual Health website: http://www.medinstitute.org/public/125.cfm; Kahn et al., 2002; Miller et al.,1999;) • Additionally, a study by Orr et al. (1991) found that young women who have early sex increase their probability for other negative health outcomes, including suicide attempt and substance use (see graph on slide 8)

9. Emotional and Psychological Consequences • “Something about dating and relationships can be toxic to girls’ health” (Dr. Susan Nolen-Hoeksema, professor of psychology, University of Michigan). • “Young women often equate sex with love, and can easily develop the psychological condition of repetition/ compulsion” • quotes from: Meeker, M. (2002). Epidemic: How Teen Sex Is Killing Our Kids, p. 66. Washington, D.C. Regnery Publishing Company. • Adolescents that have early sexual debut are more likely to engage in casual sex (Grello et al., 2006; Regan et al., 1999).  casual sex is associated with elevated levels of depression and suicide in young women. (Waller et al. 2006; Cohen & Shotland, 1996)

10. Emotional and Psychological Consequences Waller et al. (2006) found that depression in boys is associated with high-risk behaviors such as sex combined with substance use (see graph), whileHallfors et al. (2005) concluded that even sexual experimentation may cause depression in girls.

11. Early Sex and Suicide Research finds that compared to those who abstain, sexually active teens are more likely to attempt suicide, and young women are disproportionately affected (Hallfors et al., 2004; Rector et al., 2003; Orr et al., 1991)

12. Early Sex and Suicide

13. Financial Benefits for Young Women • Early parenthood in young women may decrease their educational attainment; Upchurch and McCarthy (1990) found that only 30% of teenage dropout mothers return and graduate high school after childbirth. • Dropout mothers are likely to attain a GED after (Holtz et al. (1997), buthigh school diplomas carry greater weight in future return for earnings (Cameron and Heckman, 1993). • According to the National Campaign to Prevent Teen and Unplanned Pregnancy (Hoffman, 2006), mothers who delay childbearing until the age of 20-21, compared to teenage mothers, earn an average of $84,000 more over the first 15 years of motherhood ($5,600 annually). • Early sex does not necessarily cause poor academic achievement - delaying sex, however, is associated with higher educational aspirations and achieving better grades (Rector & Johnson, 2005). Halpern et al., (2000) actually found that higher intelligence operates as a protective factor against early sexual activity during adolescence.

14. Some evidence but not very compelling… A recent longitudinal study found that abstaining adolescents were more likely to have higher educational goals and academic achievement when compared to those who had initiated sex (Schvaneveldt et al., 2001).

15. Richard Jessor’s “Problem Behavior” Theory Richard Jessor’s Problem Behavior Theory (1977) (Cycle of Cause and Effect) Ream (2006) tested Jessor’s theory and found that youth who engaged in sexual intercourse experienced greater parental problems, reduced religious participation, and decreased school belonging.

16. Relational Consequences • Studies show that dating violence and abuse is more common among adolescent relationships that involve sex – see graphs on slides 18-19 (Kaestle et al., 2005; Siliverman et al., 2004). • Girls are disproportionately affected by dating violence compared to boys; about 1 in 5 girls (Silverman et al., 2001). • According to Guttmacher (1994), girls with substantially older partners are also more likely to be pressured and forced to engage in sex. • A recent study found that young women with an older sex partner are at a higher risk for acquiring STIs (Ryan et al. 2008).

17. Dating and Relationship Violence

18. Dating and Relationship Violence

19. Forced/Involuntary Sex

20. Conclusions • Early sex typically hurts girls more than boys, primarily because of the female biological makeup; pregnancy and STIs disproportionately affect females. • Psychologically, young women tend to make more of an emotional investment in sex, and are more likely to experience depression and suicide ideation/attempts when compared to boys, who typically show mental distress only when combining sexual activity with other high risk behaviors, such as heavy substance use. • Financially, early pregnancy and childbearing affects young women disproportionately, disrupting education and lowering human capital. “Problem behaviors” such as early sex may get in the way of future goals. • Relationally, dating violence is more likely to occur in adolescent relationships that involve sex, with women being far more likely to be abused.

21. For More Information Christopher Doyle Behavioral Research Analyst The Institute for Youth Development 1329 Shepard Drive, Suite 1 Sterling, VA 20164 703-433-1640 ext. 103 cdcta@youthdevelopment.org www.youthdevelopment.org To ORDER Benefits of Delaying Sexual Debut Visit: http://www.youthdevelopment.org/articles/benefitsodelayingsexualdebut.htm This webcast was supported by CDC Cooperative Agreement Number 5U58DP000441-04. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

22. References Kahn, J.A., Rosenthan, S.L., Succop, P.A. Ho, G.Y., & Burk, R.D. (2002). Mediators of association between age of first sexual consensual intercourse and subsequent human papillomavirus infection. Pediatrics, 109, E5. Miller, H.G., Cain, V.S., Rogers, S.M., Gribble, J.N. & Turner, C.F. (1999). Correlates of sexually transmitted bacterial infections among U.S. women in 1995. Family Planning Perspectives, 31, 4-23. The Medical Institute for Sexual Health. Frequently Asked Questions: What makes adolescent females so susceptible to STIs? Retrieved on April 25, 2007 from: http://www.medinstitute.org/content.php?name=faq. Rector, R., Johnson, K., Noyes, L., & Martin, S. (2003) The Harmful Effects of Early Sexual Activity and Multiple Sexual Partners among Women: A Book of Charts, p. 7. Washington, D.C. The Heritage Foundation. U.S. Department of Health and Human Services. (2001). Trends in the Well-Being of America’s Children and Youth, 2000. Office of the Assistant Secretary for Planning and Evaluation.Washington, DC: Author. Orr, D.P., Beiter, M., & Ingersoll, G. (1991). Premature sexual activity as an indicator of psychosocial risk. Pediatrics, 87(2), 141-147. Grello, C.M., Welsh, D.P., & Harper, M.S. (2006). No strings attached: The nature of casual sex in college students. Journal of Sex Research,43( 3), 255-267. Regan, P.C., & Dreyer, C.S. (1999). Lust? Love? Status? Young adult’s motives for engaging in casual sex. Journal of Psychology and Human Sexuality, 11(1), 1-24. Waller, M.W., Hallfors, D.D., Halpern, C.T. Iritani, B.J., Ford, C.A., & Guo, G. (2006). Gender differences in associations between depressive symptoms and patterns of substance use and risky behavior among a nationally representative sample of U.S. adolescents. Archives of Women’s Mental Health, 9(3), 139-150. Cohen, L.L., & Shotland , R.L. (1996). Timing of first sexual intercourse in a relationship; Expectations, experiences, and perceptions of others. Journal of Sex Research, 33, 291-299. Hallfors, D. D., Waller, M.W., Bauer, D., Ford, C. A., & Halpern, C.T. (2005) Which comes first in adolescence – sex and drugs or depression? American Journal of Preventive Medicine, 29(3), 163-170. Rector, R. R., Johnson, K.A., & Noyes, L.R. (2003). Sexually Active Teenagers Are More Likely To Be Depressed And To Commit Suicide. Washington, D.C. The Heritage Foundation. Upchurch, D.M., & McCarthy, J. (1990). The timing of first birth and high school completion. American Sociological Review. Vol. 55(2), 224-234. Hotz, V.J., Mullin, C.H., & Sanders, S.G. (1997). Bounding causal effects using data from a contaminated natural experiment: Analyzing the effects of teenage childbearing. Review of Economic Studies, 64(4), 575-603. Cameron, S., & Heckman, J. (1993). The nonequivalence of high school equivalents. Journal of Labor Economics, 11(1), 1-47. Hoffman, S. D. (2006). By The Numbers: The Public Costs of Teen Childbearing. Washington, DC: The National Campaign to Prevent Teen Pregnancy. Rector, R., & Johnson, K.A. (2005). Teenage Sexual Abstinence and Academic Achievement. Washingon, D.C. The Heritage Foundation. Halpern, C. T., Joyner, K., Udry, R., & Suchindran, C. (2000). Smart teens don’t have sex (or kiss much either). Journal of Adolescent Health, 26(3), 213-225.

23. References (cont.) Upchurch, D.M., & McCarthy, J. (1990). The timing of first birth and high school completion. American Sociological Review. Vol. 55(2), 224-234. Hotz, V.J., Mullin, C.H., & Sanders, S.G. (1997). Bounding causal effects using data from a contaminated natural experiment: Analyzing the effects of teenage childbearing. Review of Economic Studies, 64(4), 575-603. Cameron, S., & Heckman, J. (1993). The nonequivalence of high school equivalents. Journal of Labor Economics, 11(1), 1-47. Hoffman, S. D. (2006). By The Numbers: The Public Costs of Teen Childbearing. Washington, DC: The National Campaign to Prevent Teen Pregnancy. Rector, R., & Johnson, K.A. (2005). Teenage Sexual Abstinence and Academic Achievement. Washingon, D.C. The Heritage Foundation. Halpern, C. T., Joyner, K., Udry, R., & Suchindran, C. (2000). Smart teens don’t have sex (or kiss much either). Journal of Adolescent Health, 26(3), 213-225. Schvaneveldt, P.L., Miller, B.C., Berry, E.H., & Lee, T.R. (2001). Academic Goals, Achievement, and Age at First sexual Intercourse: Longitudinal, Bidirectional Influences. Adolescence, 36: 767-787. Jessor, R., & Jessor, S.L. (1977). Problem behavior and psychosocial development: A longitudinal study of youth. Academic Press, New York. Ream, G.L. (2006). Reciprocal effects between the perceived environment and heterosexual intercourse among adolescents. Journal of Youth Adolescence, 35(5), 771-785. Kaestle, Christine E. Halpern, & Carolyn T. (2005). Sexual intercourse precedes partner violence in adolescent romantic relationships. Journal of Adolescent Health, 36(5), 386-392. Silverman, J.G., Raj, A., & Clements, K. (2004). Dating violence and associated sexual risk and pregnancy among adolescent girls in the united states. Pediatrics, 114(2), 220-225. Silverman, J.G., Ray, A., Mucci L., & Hathaway, J. (2001). Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy and suicidality. Journal of the American Medical Association, 286, 572-579. Ryan, S., Franzetta, K., Manlove, J.S., & Schelar, E. (2008). Older Sexual Partners During Adolescence: Links to Reproductive Health Outcomes in Young Adulthood. Perspectives on Sexual and Reproductive Health, 40(1), 17-26. The Alan Guttmacher Institute. (1994). Sex and America’s Teenagers. New York, NY: Author. National Institutes of Health. (2006). Behaviors may indicate risk of adolescent depression. From Archives of Women’s Mental Health, 9(3), 139-150.