A young girl-woman, without education, without resources, stressed and
depressed, rears her baby alone and bends like the poplar.
Gentle summer rains nourish the soil … but where do the poplars and the waters
The Scope of the Problem: Teen Pregnancy
The Scope of the Problem: AIDS and Other Sexually Transmitted Diseases
Precursors of Risky Sexual Behavior: Background Characteristics
Box 9.1 Daddy’s Girl
Precursors of Risky Sexual Behavior: Media Influences
Television and Other Media
Internet Pornography, Sexual Solicitation, and Sexting
Positive Media Potential
Box 9.2 A Sexting Tragedy
Consequences of Early Childbearing
Intervention Strategies Focused on Risky Sex
Nonsexual Antecedent Program and Approaches
Sexual Antecedent Programs
Specific Intervention: An Adlerian Model
Purposiveness of Behavior
Goals of Misbehavior
Box 9.3 Lying for Revenge
Corrective Procedures for AGMs
Corrective Procedures for Power
Corrective Procedures for Revenge
Corrective Procedures for Assumed Inadequacy
Natural and Logical Consequences
Problems related to adolescent sexual activity are broad-ranging and complex,
including pregnancy, abortion, sexual identity difficulties, human immunodeficiency
virus (HIV), acquired immunodeficiency syndrome (AIDS), other sexually
transmitted diseases (STDs), childhood molestation and incest, and sex-related
violence. No one chapter can fully attend to the interpersonal, psychological, and
social implications of these issues. We focus on two critical problems related to a
young person’s sexuality, sexual development, and sexual activity: the problem of
“babies having babies” and HIV/AIDS and other STDs. More specifically, in this
chapter we discuss (a) the incidence and frequency of teenage pregnancy, (b)
incidence of AIDS/HIV and other STDs among teens, (c) background factors
associated with risky sex among teens including media influences, (d) the
consequences of risky sex, and (e) prevention and treatment strategies.
THE SCOPE OF THE PROBLEM: TEEN
After steady increases in the teen pregnancy rate in the 1980s, the United States has
made clear progress in reducing it. By 2005, the rate had fallen 41% from its 1990 peak
(Finer, 2010). This decline in teen pregnancy and birthrates is attributed to decreased
sexual activity and increased use of contraceptives; undoubtedly, part of the credit goes
to the many, varied pregnancy and STD/HIV prevention programs that have been
instituted. In 2005, teen birthrates were at their lowest recorded level, although the rate
increased 3% in 2006 and some expect it to continue to rise (Kost, Henshaw, Carlin,
2010). Currently, teenage girls give birth to over 1,200 babies each day.
Even with the reported decreases, over half of U.S. adolescents start having sex during
their teen years, a figure that has been fairly stable over the past decade; 6 out of 10
teens have sex by the time they graduate from high school; 1 in 5 report having sexual
intercourse before age 15, and more than 1 in 3 teenage girls get pregnant before age 20.
Approximately 78% teen pregnancies continue to be unplanned (Kost, Henshaw, Carlin,
2010; National Campaign to Prevent Teen Pregnancy, 2005).
Even with recent declines, the United States still has the highest teen pregnancy and
birthrates among comparable industrialized nations. Teen birthrates in the United
States have declined but remain high, especially among African American, Latino, and
southern state adolescents (Centers for Disease Control and Prevention/CDC, 2011). In
addition, the United States has higher teen pregnancy rates than most developing
nations (Centers for Disease Control and Prevention/CDC, 2011). In countries with
lower teen pregnancy rates, contraceptive services are confidential, widely available, and
very inexpensive or free (Brown & Eisenberg, 1995).
Only 13% of U.S. teens have had sex by age 15; by the time they graduate from high
school, however, about two-thirds of all students have had intercourse (Abma, 2010).
When younger girls first have intercourse, they are more likely to have had involuntary
or unwanted first sex (National Campaign to Prevent Teen Pregnancy, 2001). Regular
use of alcohol, cigarettes, and marijuana by 14- and 15-year-olds is also related to their
engagement in sexual intercourse with boys more likely than girls to have used alcohol
or drugs. Also, European American (28%) and Latino (24%) students are more likely
than African American students (18%) to use alcohol or drugs at sexual intercourse
(Centers for Disease Control and Prevention, 2002).
Although contraceptives can prevent pregnancy, they can be complicated to use and
difficult and expensive to obtain. They may also seem unnecessary to teenagers, even
though a sexually active teenage girl who does not use contraceptives continue to have a
very high chance of becoming pregnant. Teen girls use contraceptives much more
sporadically than older women (AGI, 1999). Teenage contraceptive use at first
intercourse rose from 48% to 65% during the 1980s, mostly due to the doubling in
condom use. By 1995 contraceptive use at first intercourse reached 78% (AGI, 1999).
However, more than 1 in 5 students failed to use condoms at last sexual intercourse,
leaving them at risk for pregnancy and sexually transmitted diseases (Kann et al., 1998).
Meanwhile, consistent contraceptive use has been significantly related to factors such as
high academic expectations, good relationships with both parents, lower rates of
involvement in delinquency and substance use, lower association with deviant peers,
and more frequent attendance of religious services (Costa et al., 1996).
About 33% of students in grades 9 through 12 nationwide reported that they are
currently sexually active (CDCP, 2002), and more than 40% reported that they had not
used a condom during last sexual intercourse. Male African American students were
more likely to report condom use than European American or Latino students. Female
and European American students reported birth control pill use more than male, Latino,
and African American students. Teenage women would experience an estimated
385,800 additional unintended pregnancies annually if publicly subsidized
contraceptive services were not available; therefore, publicly funded contraceptive
services annually avert about 154,700 teen births, 183,300 abortions, and 47,800
miscarriages or spontaneous abortions every year (Forrest & Samara, 1996).
The response of adolescents to pregnancy is changing as well. The teen abortion rate in
the United States declined by 21% between 1991 and 1995, and more teens chose to give
birth rather than to terminate their pregnancies (Henshaw, 1998). Nonetheless,
teenagers receive more than 25% of all the abortions performed in the United States,
giving the United States the highest rate of teen abortion among developed,
industrialized countries (Brown & Eisenberg, 1995). In addition, formal adoption among
teens has declined sharply in recent decades, with less than 1% placing their children for
adoption (Child Trends, 1996). Children of teens in Latino, African American, and
Native American families are often parented or informally adopted by a member of the
extended family. Current trends also suggest that many adolescent girls would rather
have an abortion than carry an unwanted pregnancy to term and relinquish the baby for
Of course, in addition to pregnancy, risky sex also has the potential danger of Sexually
Transmitted Diseases (STDs) including HIV/AIDs. We discuss these problems next.
THE SCOPE OF THE PROBLEM: AIDS AND
OTHER SEXUALLY TRANSMITTED DISEASES
Approximately 9 million new STDs occur among teens in the United States every year
(AGI, 2011). Gonorrhea, genital warts, herpes, and syphilis are all too common. In a
single act of unprotected sex with an infected partner, a teen girl has a 1% risk of
acquiring HIV, a 30% risk of getting genital herpes, and a 50% chance of contracting
gonorrhea. Chlamydia, an infection of the vagina or urinary tract, is the most frequently
diagnosed STD among adolescents.
Each day 54 young people under the age of 20 are infected with HIV. The total number
of reported AIDS cases among 13- to 24-year-olds in the United States exceeded 31,000
in the year 2000, and most of those in the 20- to 24-year-old age group were infected
during their teens. African American and Latino youth are vastly overrepresented in
AIDS cases in the 13- to 19-year-old age group, representing 61% and 21% of new AIDS
cases, respectively (Devieux et al., 2005). Young people are most likely to have
contracted AIDS via sexual contact with men, with only about 10% of reported cases
resulting from intravenous drug injection (CDCP, 2000). Finally, although rates of
contracting AIDS are declining overall, there has not been a comparable decline in HIV
cases among youth (CDCP, 2002). Forty-six percent of a nationally representative
sample of high school students had experienced sexual intercourse, and only 19%
reported condom use. One in six teenagers has had a sexually transmitted infection
(SDI), and half of all new HIV infections in 2001 occurred in those under age 25 (CDCP,
National Center for Health Statistics, 2003).
Knowledge regarding STDs is low among teenagers. For example, one survey found that
only 12% of teens were aware that STDs infect as many as one-fifth of people in the
United States, and 42% of teens could not name a single STD other than HIV/AIDS
(American Social Health Association, 1995). Even more alarming, in a study of sexually
active female adolescents, 81% indicated that they had “never done anything that could
give them a chance of getting AIDS,” and most believed that their chance of contracting
HIV was “very low” (36%) or “nonexistent” (37%). Their reasons for feeling safe
included that they were currently monogamous, they believed their partner was safe and
faithful, they believed that they were good at choosing partners carefully, they used
condoms, and they did not use injection drugs (Overby & Kegeles, 1994). Note that only
one of these reasons, using condoms, is a reliable (though not guaranteed) means of
reducing risk of HIV transmission.
Teens tend to feel invulnerable to something as catastrophic as AIDS—“It can’t happen
to me!” or else “Even if I get it, there will be a cure before it affects me.” That attitude,
coupled with sexual activity, multiple sex partners, and ineffective, sporadic, or no
condom use, makes teenagers very vulnerable for contracting HIV/AIDS. Sexually active
adolescent gay males are particularly vulnerable to HIV infection. When adolescents
experiment sexually with both male and female partners, teenage boys who experiment
with unprotected sex with other males may not see themselves at risk if they do not selfidentify as gay, which many do not (Ryan & Futterman, 1998). Research on young men
who have sex with men indicates high rates of risky activity. Two studies indicated that
38% to 55% or more of respondents reported unprotected anal intercourse (HIV
Epidemiology Program, 1996; Valleroy, MacKellar, & Jacobs, 1996). Sexually
transmitted diseases (STDs) have extremely serious health consequences that may be
irreversible and, in the case of herpes and AIDS, are incurable.
The fluctuations in adolescent risky sexual activity and subsequent STDs, pregnancies,
abortions, and births can be attributed to a variety of factors. We review these next.
PRECURSORS OF RISKY SEXUAL BEHAVIOR:
Family and social issues as well as psychological and interpersonal characteristics
contribute to teen pregnancy. In this section we discuss (a) issues related to adolescent
development; (b) antecedent characteristics that set the stage for teen pregnancy; (c)
interpersonal influences, such as peer relationships and family dynamics; and in the
next section we consider various form of the media that influence risky sexual behavior.
In view of the normal challenges of adolescence, it is not surprising that many teens are
involved in sexual activity or that pregnancy so frequently results. One of the primary
ways in which adolescents attempt to negotiate the transition from childhood to
adulthood is through sexual activity. Even though most teenage parents never expected
or wanted to conceive a child, many teens see sexual activity as a way to develop adult
identity. Teens look to the opposite sex for validation and approval. Sexual behavior also
provides a means of challenging parents on the way toward independence.
Adolescence is an important time in the formation of sexual identity. Experimentation
with sex is often a part of the learning experience. Interestingly, young people engaging
in same-sex activity often do not identify as gay or lesbian. One study of male
adolescents who reported same-sex intercourse found that only 54% identified
themselves as gay (Ryan & Futterman, 1998). Models of gay or lesbian identity
development characterize the process of developing a positive gay, lesbian, or bisexual
(GLB) identity as a series of nonlinear and potentially reoccurring stages (Fassinger,
2000; E. H. McWhirter, 1994). For GLB teens of color, the process of developing a
positive ethnic identity may conflict with the development of a positive sexual identity.
GLB adolescents confront the task of forming a stigmatized identity just at a time when
sameness and affiliation with peers are very important, and they may withdraw from
their peers, stifle expression of their feelings and experiences, or develop a false identity.
All of these strategies create anxiety. Not surprisingly, drug use, running away, family
rejection, and risky sex are significant problems among GLB adolescents.
Preparation for career, marriage or partnership, and family life is part of this
developmental period for all adolescents, and sexual activity serves as a way for young
people to test these future roles. When an unwanted pregnancy occurs, the
developmental process is accelerated. Adolescents must cope immediately with adult
roles: parenthood, finding a job, and dealing with social isolation and loneliness. In
many cases they become dependent on public aid for survival. In addition, these adverse
consequences for mothers and their children impose high public sector costs (Centers
for Disease Control and Prevention/CDC, 2011).
For many girls, pregnancy limits life options. However, if already restricted in
opportunities, having a child may not alter their beliefs about options.
Some personal and demographic characteristics place teens at risk for premature
pregnancy; some serve as protective factors. For example, higher self-esteem decreases
the risk of pregnancy for Latino and African American teens (Berry et al., 2000), but
delinquent activity and alcohol use often precede teen pregnancy (Hockaday et al.,
2000). Among urban African American girls, living in a more disorganized
neighborhood, having low school expectations, holding deviant values, being a gang
member, and engaging in early status offenses are the greatest risk factors for sexual
activity. For these girls pregnancy may represent a source of gratification and
independence (Lanctot & Smith, 2001). Pregnant African American girls are
proportionally more likely to participate in status offenses than their sexually active but
nonpregnant peers (Berry et al., 2000). Teens at risk for pregnancy are also likely to
reject social norms, to have limited knowledge of their own physiology, to have difficulty
using information about birth control, to be biologically mature, and to be less religious
(Brown & Eisenberg, 1995; Haveman & Wolfe, 1994). Finally, a young woman’s
socioeconomic status (Berry et al., 2000), perception of opportunity, and educational
expectations are crucial determinants of pregnancy (Hockaday et al., 2000; National
Campaign to Prevent Teen Pregnancy, 2001).
Teens born to poor and less-educated teenage parents are more likely to bear children
during adolescence (Berry et al., 2000; National Campaign to Prevent Pregnancy, 2001).
Lower educational and career opportunities and coming from a single-parent family or
from a family with marital strife and instability also increase risk. School dropouts are
more likely to start sexual activity earlier, fail to use contraception, become pregnant,
and give birth (Brewster et al., 1998; Darroch, Landry, & Oslak, 1999; Manlove, 1998).
Teens who give birth are much more likely to come from poor or low-income families
(83%) than teenagers who have abortions (61%) or teenagers in general (38%; AGI,
1999). Finally, early childbearing is associated with conduct disorder as well as with
lower IQ, lower educational attainment, and lower SES (Jaffee, 2002).
A teen’s relationship with his or her parents is associated with adolescent pregnancy.
Perceptions of high levels of warmth, love, caring, and connection with parents, as well
as parental disapproval of teen sex, have been associated with delay of sexual activity
among teenagers. Girls, more than boys, talk with their parents about “how to say no to
sex” or about birth control (Martinez, Abma, & Casey, 2010). A close mother–daughter
relationship, in particular, encourages girls to turn to their mothers for nurturance.
Communication between mother and daughter about sexual issues, feelings, and
behaviors can significantly help daughters learn and practice responsible sexual
behavior. Girls who are close to their mothers are more likely to abstain from sex or to
practice birth control (Dittus & Jaccard, 2000). Apparently, a good mother–daughter
relationship provides a girl with a model for responsible sexual behavior and for
maintaining a good relationship with a future partner. However, even though most
parents see it as their responsibility to talk to their children about sexuality, most do not
engage in in-depth discussions with their children about sex (Byers, 2011). In fact, many
teens who have had sexual intercourse have never spoken with their parents about sex
(Centers for Disease Control and Prevention/CDC, 2011).
Families characterized by poor interpersonal relationships, ineffective communication,
and limited problem-solving skills typically encourage teens to turn to peers, which
often leads to risky behavior and irresponsibility. In one study, the only significant
predictor of teenage girls’ attitudes about pregnancy was their boyfriends’ attitudes
toward having children (Cowley & Tillman, 2001). Peers can provide support, fairly
clear norms, and the structure that most adolescents want. Along with the media, peers
are a primary source of information about sex. Unfortunately, adolescents who
confidently share information may lack knowledge and may encourage premature and
irresponsible sexual decisions.
Finally, once a girl becomes pregnant, her mother usually has the most influence on the
outcome, but not always (see Box 9.1). Often the mother pressures her pregnant
daughter to keep the child. In this case, the relationships between mother, daughter,
and baby tend to become confused, with the new grandmother taking on primary
responsibility for the infant. Although these teen mothers may indeed have family
support, the decision to keep the baby in the family often restricts their educational and
occupational. Often this choice places the babies in a similar situation of restricted
future options, and the cycle of “babies having babies” is perpetuated.
BOX 9.1: Daddy’s Girl
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