Adolescent Boys and Young Adult Men: Sexual Behavior and Attitudes

1. Adolescent Boys and Young Adult Men: Sexual Behavior and Attitudes

2. 2 Our presentation covers 3 areas: About the National Campaign and Putting What Works to Work (PWWTW) Sexual behavior and attitudes among teen boys Experiences targeting males in teen pregnancy prevention from states and communities Effective teen pregnancy prevention programs involving both boys and girls

3. 3 The Campaign�s mission is to improve the well-being of children, youth, and families by preventing teen pregnancy. The teen pregnancy rate in 1996 was 96 pregnancies per 1,000 girls aged 15-19. By 2000 it had dropped to 84 pregnancies per 1,000 girls aged 15-19. The goal is to reach 64 per 1,000 by 2005. It looks like we will reach that goal. Our new goal is to reach 43 pregnancies per 1,000 girls aged 15-19 by 2015. which is another 1/3 reduction in the next 10 years. Mention National Campaign resources Web site E-gram (circulating the sign up)The teen pregnancy rate in 1996 was 96 pregnancies per 1,000 girls aged 15-19. By 2000 it had dropped to 84 pregnancies per 1,000 girls aged 15-19. The goal is to reach 64 per 1,000 by 2005. It looks like we will reach that goal. Our new goal is to reach 43 pregnancies per 1,000 girls aged 15-19 by 2015. which is another 1/3 reduction in the next 10 years. Mention National Campaign resources Web site E-gram (circulating the sign up)

4. 4 Putting What Works To Work Cooperative Agreement funded by the Centers for Disease Control and Prevention (CDC). Goal: To enhance the ability of state and local organizations to incorporate science-based approaches into their teen pregnancy prevention efforts.

5. 5 Information from PWWTW Report on Males This presentation uses information from two chapters in a forthcoming report on males and teen pregnancy. Data presented are from chapters written by William Marsiglio and the National Campaign Dr. Sonenstein�s presentation draws from a chapter on co-ed prevention programs in the same volume This presentation will look at recent data from the National Survey of Family Growth (NSFG) and the Youth Risk Behavior Survey (YRBS) about teen boys sexual behavior. In addition, we will use these data to examine trends in boys sexual behavior and we will explore boys attitudes toward sexual behavior. The presentation will then use qualitative data to address some of the challenges in involved young men in teen pregnancy prevention. This presentation will look at recent data from the National Survey of Family Growth (NSFG) and the Youth Risk Behavior Survey (YRBS) about teen boys sexual behavior. In addition, we will use these data to examine trends in boys sexual behavior and we will explore boys attitudes toward sexual behavior. The presentation will then use qualitative data to address some of the challenges in involved young men in teen pregnancy prevention.

6. 6 Why focus on boys? More than 820,000 girls get pregnant each year and they do not do it alone. Half (51%) of males aged 12-19 agree that teen boys often receive the message that sex and pregnancy are not a big deal. There have been changes in boys� sexual behavior. Boys represent the other half of teen pregnancy prevention. The importance of involving adolescent boys and young men in teen pregnancy prevention has become increasingly apparent to researchers, practitioners, parents and others working with youth. The teen pregnancy rate has decreased dramatically in the last several years due in part to changes in the sexual behavior of boys.Boys represent the other half of teen pregnancy prevention. The importance of involving adolescent boys and young men in teen pregnancy prevention has become increasingly apparent to researchers, practitioners, parents and others working with youth. The teen pregnancy rate has decreased dramatically in the last several years due in part to changes in the sexual behavior of boys.

7. 7 Katy will take over slides here. Now let�s take a look at the sexual behavior and attitudes among teen boys.Katy will take over slides here. Now let�s take a look at the sexual behavior and attitudes among teen boys.

8. 8 What do we know about boys and teen pregnancy? The Good News: Fewer boys are having sex Fewer boys are having multiple sex partners When they do have sex more boys are using condoms

9. 9 Fewer Boys (15-19) are Having Sex This graph uses data from the National Survey of Family Growth and the National Survey of Adolescent Males. Important points As you can see from this graph, for never-married boys the percentage who had sexual intercourse decreased dramatically (23%), from 60% in 1988 to 46% in 2002. Unlike previous years, in 2002, the proportion of girls and boys that were sexually experienced was relatively the same. Additional information to use if needed during discussion: Also, among boys from 1988-2002, the percent of 18-19 year olds who had ever had sex decreased 10 percentage points. While for girls aged 18-19 the % who have ever had sex remained relatively the same. According to data from the 2002 NSFG, the median age at first sex for boys is 17.3 Also, I would like to add that the teen pregnancy rate peaked in 1990 and has been decreasing since then. This graph uses data from the National Survey of Family Growth and the National Survey of Adolescent Males. Important points As you can see from this graph, for never-married boys the percentage who had sexual intercourse decreased dramatically (23%), from 60% in 1988 to 46% in 2002. Unlike previous years, in 2002, the proportion of girls and boys that were sexually experienced was relatively the same. Additional information to use if needed during discussion: Also, among boys from 1988-2002, the percent of 18-19 year olds who had ever had sex decreased 10 percentage points. While for girls aged 18-19 the % who have ever had sex remained relatively the same. According to data from the 2002 NSFG, the median age at first sex for boys is 17.3 Also, I would like to add that the teen pregnancy rate peaked in 1990 and has been decreasing since then.

10. 10 Fewer High School Aged Boys are Having Sex Another way to look at the sexual activity is using data from the Youth Risk Behavior Survey (YRBS). The YRBS is a national, school-based survey of youth. The survey asks questions about a variety of topics including: Violence, Alcohol, Tobacco and Drug Use, Dietary behaviors, physical activity and sexual behaviors. Because it has been conducted every 2 years since 1991, it is a great data source for monitoring trends in high school students behaviors. However, it is important to remember that the survey only captures those students that are in school on that day, thus missing students that have dropped out (usually these students are at higher risk of teen pregnancy). This would also miss those teens that have graduated from high school (aged 18 and 19) Important points: This slide shows that the proportion of sexually experienced boys has decreased from 1991 to 2003 for all grades (from 57% in 1991 to 48% in 2003). This is true for all racial and ethnic groups There has been a particularly dramatic decrease in the percent of black males students who report having sex from 88% in 1991 to 74% in 2003. However, the slight increase from 2001 to 2003 is cause for concern. Another way to look at the sexual activity is using data from the Youth Risk Behavior Survey (YRBS). The YRBS is a national, school-based survey of youth. The survey asks questions about a variety of topics including: Violence, Alcohol, Tobacco and Drug Use, Dietary behaviors, physical activity and sexual behaviors. Because it has been conducted every 2 years since 1991, it is a great data source for monitoring trends in high school students behaviors. However, it is important to remember that the survey only captures those students that are in school on that day, thus missing students that have dropped out (usually these students are at higher risk of teen pregnancy). This would also miss those teens that have graduated from high school (aged 18 and 19) Important points: This slide shows that the proportion of sexually experienced boys has decreased from 1991 to 2003 for all grades (from 57% in 1991 to 48% in 2003). This is true for all racial and ethnic groups There has been a particularly dramatic decrease in the percent of black males students who report having sex from 88% in 1991 to 74% in 2003. However, the slight increase from 2001 to 2003 is cause for concern.

11. 11 Fewer High School Aged Boys are Having Multiple Sex Partners Using data from the YRBS we can also look at the percent of students that report having more than 4 lifetime sex partners. Important points: Overall, the percent of male students who have had 4 or more partners decreased from 23% in 1991 to approximately 18% in 2003. The largest decrease was among black male students. For this group the percent who have had 4 or more partners decreased from 63% in 1991 to 42% in 2003 (34% decrease). Although data from 2001 to 2003 indicate that there was a slight increase between these 2 years in the percent of black males that reported 4 or more sexual partners. Cause for concern. Using data from the YRBS we can also look at the percent of students that report having more than 4 lifetime sex partners. Important points: Overall, the percent of male students who have had 4 or more partners decreased from 23% in 1991 to approximately 18% in 2003. The largest decrease was among black male students. For this group the percent who have had 4 or more partners decreased from 63% in 1991 to 42% in 2003 (34% decrease). Although data from 2001 to 2003 indicate that there was a slight increase between these 2 years in the percent of black males that reported 4 or more sexual partners. Cause for concern.

12. 12 Proportion of High School Boys Who Have Had Sex Varies by Race/Ethnicity

13. 13 Teen Boys Who Have Sex Do So with Varying Frequency

14. 14 Feelings about having sex differ among boys and girls: Boys are more willing to have casual sex (sex with people they don�t know very well or sex outside of a relationship) Boys give more favorable reports of their first sexual experience Boys are less likely to report that their first sexual partner was 2 or more years older When dealing with the issue of teen pregnancy it is important to note that often times boys and girls have different ideas about sex, thus prevention strategies must take into account these differences. The data in this presentation indicate that there have been changes in boys sexual behavior. In general more boys are abstaining from sex, and are having fewer partners. However, when dealing with sex and teen pregnancy prevention it is also important to keep in mind boys attitudes about sex. Data suggest that boys have different ideas about sex, particularly when it�s ok to engage in sex and who they engage in sex with as compared to girls. For example: (the slide bullets) Data from the Add Health survey (1995-1996) indicate that only 10% of boys report that their first sexual partner was 2 or more years older compared to 47% of girls.When dealing with the issue of teen pregnancy it is important to note that often times boys and girls have different ideas about sex, thus prevention strategies must take into account these differences. The data in this presentation indicate that there have been changes in boys sexual behavior. In general more boys are abstaining from sex, and are having fewer partners. However, when dealing with sex and teen pregnancy prevention it is also important to keep in mind boys attitudes about sex. Data suggest that boys have different ideas about sex, particularly when it�s ok to engage in sex and who they engage in sex with as compared to girls. For example: (the slide bullets) Data from the Add Health survey (1995-1996) indicate that only 10% of boys report that their first sexual partner was 2 or more years older compared to 47% of girls.

15. 15 Feelings about virginity differ between boys and girls Boys are more likely than girls to view virginity unfavorably and are more likely to be troubled by their virgin status Boys are less likely than girls to report that they are abstinent because their feelings for their partner are not strong enough, or that premarital sex is wrong Also, given that the percent of teen boys who are having sex has decreased, boys� attitudes about virginity are important. Like attitudes toward sex, feelings about virginity differ between boys and girls. Girls more often indicated reasons related to love or relationship status when explaining virginity whereas boys� explanations reflected insecurities, inadequacies or the unavailability of a partner. However, some boys do have a positive view of virginity. However, to illustrate the complexity of attitudes toward sex and virginity, data from the NSFG indicate that in 2002, the main reason both boys and girls had not yet had sex was because it was �against religion or morals�. Thus it is not entirely clear why boys are abstaining. Other studies suggest that fear of STDs and pregnancy is the primary motivating factor for remaining abstinent Also, given that the percent of teen boys who are having sex has decreased, boys� attitudes about virginity are important. Like attitudes toward sex, feelings about virginity differ between boys and girls. Girls more often indicated reasons related to love or relationship status when explaining virginity whereas boys� explanations reflected insecurities, inadequacies or the unavailability of a partner. However, some boys do have a positive view of virginity. However, to illustrate the complexity of attitudes toward sex and virginity, data from the NSFG indicate that in 2002, the main reason both boys and girls had not yet had sex was because it was �against religion or morals�. Thus it is not entirely clear why boys are abstaining. Other studies suggest that fear of STDs and pregnancy is the primary motivating factor for remaining abstinent

16. 16 Ten Percent of High School Boys Report They Had Sex Before Age 13

17. 17 Other Types of Sexual Intimacy Instead of Sex? Given the decrease in sexual intercourse among boys, it is interesting to explore if boys are engaging in other types of intimacy. Using data from the 1995 NSAM and the 2002 NSFG, this graph explores the percent of self reported virgin teens that have engaged in other types of sexual intimacy. There has been a slight increase in these behaviors between 1995 and 2002, however the increase is not statistically significant. Oral sex among virgin boys increased from 19% to 24%. Masturbated by a partner increased from 22% to 25% Given the decrease in sexual intercourse among boys, it is interesting to explore if boys are engaging in other types of intimacy. Using data from the 1995 NSAM and the 2002 NSFG, this graph explores the percent of self reported virgin teens that have engaged in other types of sexual intimacy. There has been a slight increase in these behaviors between 1995 and 2002, however the increase is not statistically significant. Oral sex among virgin boys increased from 19% to 24%. Masturbated by a partner increased from 22% to 25%

18. 18 Factors associated with early sex among boys Race/ethnicity Engaging in �problem� behaviors (i.e. substance abuse) Family structure Some racial/ethnic groups for example, African Americans and Hispanics, are more likely than other racial/ethnic groups to have sex at an early age. Adolescents that engage in other problem behavior such as substance abuse and problems at school are more likely to initiate sex early. Family structure can both promote or delay the initiation of sex. Most studies have found that living in a single parent home is related to early sexual experience as is having an older sibling. However, rule setting in the home has been found to be important for delaying sex. Some racial/ethnic groups for example, African Americans and Hispanics, are more likely than other racial/ethnic groups to have sex at an early age. Adolescents that engage in other problem behavior such as substance abuse and problems at school are more likely to initiate sex early. Family structure can both promote or delay the initiation of sex. Most studies have found that living in a single parent home is related to early sexual experience as is having an older sibling. However, rule setting in the home has been found to be important for delaying sex.

19. 19 More Sexually Active Boys are Using Condoms Now we will explore changes in the use of contraceptives among boys. This is data from the NSAM and NSFG, and indicates the percent of sexually active boys who used a condom at last intercourse. (Sexually active boys are defined as those that have had sex in the past 3 months) Important Points: There has been an increase in the use of condoms by sexually active teen boys from 53% in 1988 to 71% in 2002. This is true for both non-Hispanic White and non-Hispanic Black boys. Additional data if needed for discussion Among sexually experienced boys, in 2002, 70.9% of boys (15-19) reported using a condom at first sex; 9.8% reported using withdrawal at first sex. Non-Hispanic blacks are more likely to report using a condom at first sex (85%) compared to all boys (70.9%) and non-Hispanic whites are more likely to report using withdrawal (13.4%)Now we will explore changes in the use of contraceptives among boys. This is data from the NSAM and NSFG, and indicates the percent of sexually active boys who used a condom at last intercourse. (Sexually active boys are defined as those that have had sex in the past 3 months) Important Points: There has been an increase in the use of condoms by sexually active teen boys from 53% in 1988 to 71% in 2002. This is true for both non-Hispanic White and non-Hispanic Black boys. Additional data if needed for discussion Among sexually experienced boys, in 2002, 70.9% of boys (15-19) reported using a condom at first sex; 9.8% reported using withdrawal at first sex. Non-Hispanic blacks are more likely to report using a condom at first sex (85%) compared to all boys (70.9%) and non-Hispanic whites are more likely to report using withdrawal (13.4%)

20. 20 It is also important to look at the consistency of condom use among boys. Important points Almost 70% of boys who have had sex in the last 4 months used a condom all of the time The use of condoms consistently decreases over a longer period of time Condom consistency can depend on the relationship of the boy with his partner and willingness to discuss protection from pregnancy and STDs For boys who report having had sex in the last 12 months, 48% report using a condom every time compared to 44% who used a condom some of the time and 9% who reported using a condom none of the time. For boys who report having had sex in the last 4 months, 68% reported using a condom all of the time, 5% reported using a condom some of the time and 27% report using a condom none of the time. In 2002, 49% of boys said there was �no chance� they would feel embarrassed if they talked to a partner about condom use.It is also important to look at the consistency of condom use among boys. Important points Almost 70% of boys who have had sex in the last 4 months used a condom all of the time The use of condoms consistently decreases over a longer period of time Condom consistency can depend on the relationship of the boy with his partner and willingness to discuss protection from pregnancy and STDs For boys who report having had sex in the last 12 months, 48% report using a condom every time compared to 44% who used a condom some of the time and 9% who reported using a condom none of the time. For boys who report having had sex in the last 4 months, 68% reported using a condom all of the time, 5% reported using a condom some of the time and 27% report using a condom none of the time. In 2002, 49% of boys said there was �no chance� they would feel embarrassed if they talked to a partner about condom use.

21. 21 Why an increase in condom use? HIV/AIDS, STDs, personal interest and consequence Advocacy and media More cautious attitudes While we cannot be sure why there has been an increase in condom use, some possibilities include the fact that given the spread of HIV/AIDS and STDs, boys now have more of a personal interest in using a condom than when it was primarily a pregnancy prevention tool. Also, there has been increased advocacy and media around condom use, and teens are displaying more cautious attitudes in general which includes not only delaying and abstaining from sex, but also using protection when engaging in sex. While we cannot be sure why there has been an increase in condom use, some possibilities include the fact that given the spread of HIV/AIDS and STDs, boys now have more of a personal interest in using a condom than when it was primarily a pregnancy prevention tool. Also, there has been increased advocacy and media around condom use, and teens are displaying more cautious attitudes in general which includes not only delaying and abstaining from sex, but also using protection when engaging in sex.

22. 22 Boys� Attitudes Towards Condoms 49% of all teen boys say there is no chance it would be embarrassing to discuss using a condom with a partner, while 24% believe there would be a little chance 83% say there is a pretty good or almost certain chance that a new partner would appreciate it if they used a condom One quarter report that wearing a condom would probably decrease pleasure, while only 15% believe that it would not reduce pleasure. While we cannot be sure why there has been an increase in condom use, some possibilities include the fact that given the spread of HIV/AIDS and STDs, boys now have more of a personal interest in using a condom than when it was primarily a pregnancy prevention tool. Also, there has been increased advocacy and media around condom use, and teens are displaying more cautious attitudes in general which includes not only delaying and abstaining from sex, but also using protection when engaging in sex. While we cannot be sure why there has been an increase in condom use, some possibilities include the fact that given the spread of HIV/AIDS and STDs, boys now have more of a personal interest in using a condom than when it was primarily a pregnancy prevention tool. Also, there has been increased advocacy and media around condom use, and teens are displaying more cautious attitudes in general which includes not only delaying and abstaining from sex, but also using protection when engaging in sex.

23. 23 Teen pregnancy and parenting among boys Although data on the number of teen fathers is limited, we have some information from the NSAM and NSFG. The percent of teen boys that report having gotten a partner pregnant, or biologically fathering a child has decreased between 1995 and 2002. In 2002, approximately 13% of boys report getting a partner pregnant and about 4% report fathering a child. These percentages are likely a lower bound estimate because young men might be unaware of their partners� pregnancies, abortions, miscarriages or births. Although data on the number of teen fathers is limited, we have some information from the NSAM and NSFG. The percent of teen boys that report having gotten a partner pregnant, or biologically fathering a child has decreased between 1995 and 2002. In 2002, approximately 13% of boys report getting a partner pregnant and about 4% report fathering a child. These percentages are likely a lower bound estimate because young men might be unaware of their partners� pregnancies, abortions, miscarriages or births.

24. 24 Attitudes Toward Pregnancy and Fatherhood The majority of teen boys (84%) and girls (87%) would feel either very upset or a little upset if they got (a partner) pregnant now. However, boys (51%) are less likely than girls (60%) to report that they would be very upset if they got (a partner) pregnant now. In 2002, 14% of teen boys report that they would be pleased if they got a partner pregnant. Although we have little data on boys attitudes toward being a father, a National Campaign analysis of the 2002 NSFG revealed several interesting facts about boys and girls� attitudes toward pregnancy and childbearing. Please note that these attitudes differ according to age and race/ethnicity. Although we have little data on boys attitudes toward being a father, a National Campaign analysis of the 2002 NSFG revealed several interesting facts about boys and girls� attitudes toward pregnancy and childbearing. Please note that these attitudes differ according to age and race/ethnicity.

25. 25 Cindy will take over here again. Now we will take a closer look at the challenges in involving teen boys and young men in teen pregnancy prevention and some strategies that can be used to overcome these challenges. This section uses qualitative data which was gathered from discussions with practitioners who work with boys and young men as well programmatic materials and other background information.Cindy will take over here again. Now we will take a closer look at the challenges in involving teen boys and young men in teen pregnancy prevention and some strategies that can be used to overcome these challenges. This section uses qualitative data which was gathered from discussions with practitioners who work with boys and young men as well programmatic materials and other background information.

26. 26 What Works for Boys? Overall, the programs that are successful with boys have several notable characteristics: - going beyond the classroom, such as having a service learning component - include a cultural component - extend across at least two years in duration

27. 27 Cindy will take over here again. Now we will take a closer look at the challenges in involving teen boys and young men in teen pregnancy prevention and some strategies that can be used to overcome these challenges. This section uses qualitative data which was gathered from discussions with practitioners who work with boys and young men as well programmatic materials and other background information.Cindy will take over here again. Now we will take a closer look at the challenges in involving teen boys and young men in teen pregnancy prevention and some strategies that can be used to overcome these challenges. This section uses qualitative data which was gathered from discussions with practitioners who work with boys and young men as well programmatic materials and other background information.

28. 28 Challenges to Involving Boys in Teen Pregnancy Prevention Many programs are not inviting to teen boys and young adult men Many boys are not in programs Parents often struggle to talk with their sons about pregnancy and related issues Boys are not all the same Punitive measures may not encourage prevention behavior

29. 29 Strategies to address these challenges: Make programs male-friendly Go to where the boys are Help tongue-tied parents Tailor approaches Emphasize that prevention reduces the need for punitive approaches If running short on time, move ahead to slide 32.If running short on time, move ahead to slide 32.

30. 30 Make programs male friendly More than just changing a pamphlet from pink to blue Suggestions for creating a male-friendly environment: Have male staff Ensure that program goals include language specifically about boys Have male friendly magazines and posters in a waiting room Be sure that program messages include topics that are interesting to boys (i.e. puberty, STDs, peer pressure and fatherhood) Trust is key

31. 31 Go to Where the Boys Are Most boys and young men are not actively seeking or enrolled in teen pregnancy prevention programs Creative strategies for reaching boys include: Using trained outreach workers to connect with boys at community centers, sporting events and other popular gathering places Partnering with juvenile justice, job training, fatherhood and other programs/agencies

32. 32 Help Tongue-Tied Parents Make parental involvement part of prevention initiatives Emphasize the influence that parents can have on their children�both boys and girls Provide guidance and background information so parents can start the conversation with their sons

33. 33 One size does not fit all�Tailor Approaches Messages should be age appropriate Messages should be grounded in cultural tenants that will resonate with the target audience Consider including messages that address other important issues such as school drop out and joblessness

34. 34 Emphasize Prevention Teach young men that being a good father involves more than financial obligations Communicate positive messages about the importance of fathers in their children�s lives and the advantages of waiting until they are older and ready to have children

35. 35 What it all means: Boys are waiting to have sex and are using more contraception Practitioners, community leaders and others that have worked with boys have valuable insights However, few of these male-only programs have been evaluated Dr. Sonenstein will share findings from her analysis of co-ed programs

36. 36 Mention that people should expect an e-gram when the report is published and that it will be available for free from our website. Mention that people should expect an e-gram when the report is published and that it will be available for free from our website.