Not Who You Are, But Who You Are With: Re-examining Women's Less Satisfying Sexual Debuts.

Gender differences in appraisals of first intercourse are among the largest in sexuality research, with women indicating less satisfying "sexual debuts" than men. Dispositional or "actor-level" explanations for this gender gap are pervasive, yet research has largely examined heterosexual debuts in which actor gender and partner gender are confounded. We assessed whether women's less satisfying sexual debuts are better explained by actor gender or partner gender, comparing experiences of women who debuted with men (WDM) with those of men and women who debuted with women (MDW, WDW). Retrospective accounts of sexual debut were collected from 3033 adults. At first intercourse, we found that WDW had equal physical and emotional satisfaction to MDW, and more satisfaction than WDM, suggesting satisfaction gaps owing to partner gender, not actor gender. This pattern did not extend to a comparison event (first masturbation), where WDW and WDM had similar satisfaction, but less satisfaction than MDW, suggesting an actor gender gap. To identify sources of satisfaction gaps, we probed for corresponding differences in the circumstances of sexual debut. Sexual circumstances were more strongly implicated than nonsexual ones, with relative deprivation of glans stimulation explaining relative dissatisfaction at first intercourse, but not first masturbation, and orgasm explaining it at both. Findings challenge the view that the satisfaction gap at first intercourse reflects an inherent difference between genders. Indeed, they demonstrate similarities when partner gender does not differ and suggest strategies for ensuring equal sexual satisfaction-and equal sexual rights realization-at (hetero) sexual debut.

Changes in psychological distress after first vaginal intercourse in late adolescence.

INTRODUCTION: Although early sexual intercourse may be associated with increased depressive symptoms, little research has examined whether first intercourse in late adolescence is associated with changes in mental health. METHODS: This paper uses 3 years of longitudinal data from previously sexually abstinent late adolescent students at a large state university in the northeastern United States (N = 144, 53.5% male, M age = 18.5 years old, 47.2% White, 26.4% Asian/Hawaiian/Pacific Islander, 20.1% Hispanic/Latino, 18.1% Black/African American) to examine whether levels of psychological distress changed after first intercourse. RESULTS: Students' distress decreased after first intercourse, although this effect was only significant two or more semesters after first intercourse. There were no gender differences in these associations. CONCLUSIONS: Findings suggest first intercourse was, on average, associated with decreased psychological distress for both male and female late adolescents.

Age at first intercourse, number of partners and sexually transmitted infection prevalence among Danish, Norwegian and Swedish women: estimates and trends from nationally representative cross-sectional surveys of more than 100 000 women.

INTRODUCTION: Sexual behavior at the population level impacts on public health. Recent representative sexual behavior data are lacking. MATERIAL AND METHODS: Cross-sectional surveys in 2005 and 2012 on women age 18-45 years randomly selected from the general population in Denmark (n = 40 804), Norway (n = 30 331) and Sweden (n = 32 114). RESULTS: Median (interquartile range) age at first intercourse was 16 (15-18) years in Denmark, 17 (16-18) years in Norway, and 17 (15-18) years in Sweden. Women in the most recent birth cohort had sexual debut at the lowest age, and were most likely to have sexual debut before the legal age of consent. Proportions with debut age ≤14 years among women born 1989-1994 vs 1971-1976, odds ratio (95% confidence interval) were: 18.4% vs 10.9%, 1.95 (1.74-2.18) in Denmark, 12.9% vs 6.3%, 2.38 (2.01-2.82) in Norway, 17.8% vs 11.4%, 1.75 (1.55-1.98) in Sweden. Median (interquartile range) number of lifetime sexual partners was 6 (3-10) in Denmark, 5 (2-10) in Norway, and 6 (3-11) in Sweden. The proportion of women reporting >10 sexual partners was also highest in the most recent survey. The percentage with odds ratio (95% confidence interval) in 2012 vs 2005 surveys were: 24.9% vs 22.8%, 1.13 (1.07-1.18) for Denmark; 23.8% vs 19.8%, 1.27 (1.19-1.34) for Norway; and 28.3% vs 23.8%, 1.31 (1.24-1.38) for Sweden. Similarly, the proportion of women reporting ever having had a sexually transmitted infection among women age <30 years were: 29.4% vs 26.4%, 1.21 (1.13-1.31) in Denmark, 28.9% vs 25.0%, 1.20 (1.10-1.31) in Norway, and 29.4% vs 22.2%, 1.45 (1.33-1.58) in Sweden. CONCLUSIONS: Scandinavian women reported lower age at first intercourse in younger birth cohorts. Moreover, they reported more lifetime sexual partners and a higher prevalence of ever having a sexually transmitted infection in 2012 than in 2005. Our findings may inform the interpretation of trends in outcomes associated with sexual health, and public health policies.

Positive and negative perceived consequences of first intercourse among middle and high school students in Puebla, Mexico.

Relatively little is known about young people's interpretations of sexual behaviour in Latin America. In this study, we examine the most commonly perceived consequences of first sexual intercourse among Mexican middle and high school students, how perceived consequences differ by gender, and factors that may predict experiencing more positive or negative consequences. Sexually active Mexican students aged 12-19 years (n = 268) reported whether they had experienced each of 19 consequences following first intercourse. Both positive consequences, such as physical satisfaction and closeness to partner, and negative consequences, such as worry about STDs and pregnancy, were common. Sex with a non-relationship partner was associated with fewer positive and more negative consequences, with the effect for positive consequences being stronger for young women. Pressure to have sex was associated with fewer positive consequences of first intercourse, and pressure to remain a virgin was associated with more positive and negative consequences. These findings suggest that young people often report mixed feelings about their first sexual intercourse and that relationship context and sexual socialisation influence their perceptions of the event.

Premarital first births: The influence of the timing of sexual onset versus post-onset risks in the United States.

Motivated by long-standing debates between abstinence proponents and sceptics, we examine how socio-economic factors influence premarital first births via: (i) age at first sexual intercourse and (ii) the risk of a premarital first birth following the onset of sexual activity. Factors associated with an earlier age at first intercourse will imply more premarital first births owing to increased exposure to risk, but many of these same factors will also be associated with higher risks of a premarital first birth following onset. Our analyses confirm previous findings that women from disadvantaged backgrounds are younger at first intercourse and have higher premarital first-birth risks than women from more advantaged backgrounds. However, differences in onset timing have a strikingly smaller influence on premarital first-birth probabilities than do differences in post-onset risks. Our findings thus suggest that premarital first births result primarily from differences in post-onset risk behaviours as opposed to differences in onset timing.

Limited detraditionalization of intimacy: Growing socioeconomic differences in contraceptive use at first intercourse in Italy.

This paper investigates links between social inequality and reproductive behavior. It complements the extensive research on the stratification of young adults' life chances in education and the labor market by considering changes over time in the stratification of contraceptive use at first intercourse by parental background. We seek to understand detraditionalization trends in young people's sexually intimate behavior by investigating whether these trends were driven by particular social groups and how they were supported by policy initiatives. We study Italy from 1950 to 2006, which shows strong regional and socioeconomic disparities, and comparatively slow changes in religiosity and gender norms. Data from the "Survey on Italians' Sexual Behavior" (2006) and macro indicators on family planning centers are used. The findings show a steep increase in contraceptive use at first sexual intercourse over time, stratified by parental background, but only for condom use. We did not find that family planning centers intervened in these relationships.

Contraception use: is everything played at first intercourse?

OBJECTIVES: The rate of condom and other contraception use varies depending on social, personal and sexual characteristics. We present a study covering various contraceptive means, considering sexual orientation and considering a large panel of co-variables among Swiss resident young adults. METHODS: Data were obtained from a self-administrated national survey on sexual behavior. Participants (N=4703, 49% males) were divided into three groups based on the mean of contraception used at last intercourse: CONDOM (55.1, 54.3% males), CONTRACEPTIVE (34.3, 43.1% males) and NON-USE (10.5, 50.7% males). By gender, groups were compared on sociodemographic and personal characteristics, contraception used at first intercourse (FI) and sexual life. RESULTS: Globally, 90% of participants used a reliable contraception at last intercourse. Compared to the CONDOM group, participants in the CONTRACEPTIVE group were more likely to have already used a contraceptive at FI, and individuals in the NON-USE group were more likely to have had a non-use or to have used a contraceptive only at FI. CONCLUSIONS: Contraception at FI seems to have a considerable impact on the further use of contraception. It seems thus essential to make all necessary efforts in order to promote the best contraception and protection at FI.

Early sexual initiation and multiple sexual partners among Vietnamese women: analysis from the Multiple Indicator Cluster Survey, 2011.

INTRODUCTION: Under current HIV transmission mechanisms operating in Vietnam, women are seen as victims of their male partners. Having multiple sexual partners is one of the well-known risk factors for HIV infection. However, little is known about women's risky sexual behaviour and their vulnerability to HIV in Vietnam. This study aims to explore association between early sexual initiation and the number of lifetime sexual partners in Vietnamese women. Although the Vietnamese culture is socially conservative in this area, identifying women's risky sexual behaviour is important for the protection of women at risk of HIV and other sexually transmitted diseases. DESIGN: A total of 8,791 women, who reported having had sexual intercourse, were included in this analysis of data from the 2011 Multiple Indicator Cluster Survey in Vietnam. Data were collected using two-stage strata sampling, first at the national level and second across six geographical regions (n=8,791). Multivariable logistic regressions describe association between early initiation of a sexual activity and lifetime multiple sexual partners. RESULTS: Early sexual intercourse was significantly associated with having lifetime multiple sexual partners. Women who were aged 19 or younger at first sexual intercourse were over five times more likely to have multiple sexual partners, compared with women whose first sexual intercourse was after marriage; aged 10-14 years (OR=5.9; 95% CI=1.9-18.8) at first intercourse; and aged 15-19 years (OR=5.4; 95% CI=4.0-7.2) at first intercourse. There was significant association with having multiple sexual partners for women of lower household wealth and urban residence, but the association with educational attainment was not strong. CONCLUSIONS: The study results call for health and education policies to encourage the postponement of early sexual activity in young Vietnamese women as protection against risky sexual behaviour later in life.

Oral human papillomavirus infection, sexual behaviors and risk of oral squamous cell carcinoma in southeast of China: A case-control study.

BACKGROUND: The causal association between human papillomavirus (HPV) and oral squamous cell carcinoma (OSCC) remains controversial. Most of previous studies did not consider the potential modification effect of sexual behaviors when evaluating the role of HPV infection in OSCC risk. OBJECTIVES: To explore the independent and joint effects of oral HPV infection and sexual behaviors on OSCC in Chinese population. STUDY DESIGN: A case-control study was conducted from September 2012 to September 2015 in Fujian, China. HPV DNA genotypes were detected in tumor tissues of 178 OSCC patients and oral exfoliated cells of 189 frequency-matched controls using flow-through hybridization and gene chip. Epidemiologic data were collected with a structured questionnaire by face-to-face interviews. Odds ratios (ORs) and 95% confidence interval (CI) were estimated with unconditional logistic regression models. RESULTS: The overall HPV prevalence was 14.04% in OSCC patients and 3.17% in controls. HPV-18 was the most prevalent type in cases and controls (10.67% vs. 2.12%). Oral HPV infection was strongly associated with an increased risk of OSCC: the ORs were 7.21 (95% CI: 2.61-19.88) for HPV16/18 and 7.59 (95% CI: 2.34-24.64) for HPV-18. Moreover, the significant associations were only observed in females, young adults, married population, merchants, non-smokers, non-alcohol drinkers and non-tea drinkers. Additionally, the first intercourse below 22years of age and oral sex practice did not show an association with OSCC. But there was a significantly multiplicative interaction between HPV 16/18 and age at first intercourse for OSCC (Pinteraction<0.001). CONCLUSIONS: Oral HPV infection (specifically type 18) is an independent risk factor for OSCC in Fujian area. Furthermore, there might be a combined effect of HPV 16/18 and age at first intercourse on OSCC.

Associations between source of information about sex and sexual health outcomes in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

OBJECTIVES: To examine variation in source of information about sexual matters by sociodemographic factors, and associations with sexual behaviours and outcomes. DESIGN: Cross-sectional probability sample survey. SETTING: British general population. PARTICIPANTS: 3408 men and women, aged 17-24 years, interviewed from 2010-2012 for third National Survey of Sexual Attitudes and Lifestyles. MAIN OUTCOME MEASURES: Main source of information (school, a parent, other); age and circumstances of first heterosexual intercourse; unsafe sex and distress about sex in past year; experience of sexually transmitted infection (STI) diagnoses, non-volitional sex or abortion (women only) ever. RESULTS: Citing school was associated with younger age, higher educational level and having lived with both parents. Citing a parent was associated, in women, with lower educational level and having lived with one parent. Relative to other sources, citing school was associated with older age at first sex (adjusted HR 0.73 (95% CI 0.65 to 0.83) men, 0.73 (0.65 to 0.82) women), lower likelihood of unsafe sex (adjusted OR 0.58 (0.44 to 0.77) men, 0.69 (0.52 to 0.91) women) and previous STI diagnosis (0.55 (0.33 to 0.91) men, 0.58 (0.43 to 0.80) women) and, in women, with lower likelihood of lack of sexual competence at first sex; and experience of non-volitional sex, abortion and distress about sex. Citing a parent was associated with lower likelihood of unsafe sex (0.53 (0.28 to 1.00) men; 0.69 (0.48 to 0.99) women) and, in women, previous STI diagnosis. CONCLUSIONS: Gaining information mainly from school was associated with lower reporting of a range of negative sexual health outcomes, particularly among women. Gaining information mainly from a parent was associated with some of these, but fewer cited parents as a primary source. The findings emphasise the benefit of school and parents providing information about sexual matters and argue for a stronger focus on the needs of men.

Change in sexual behaviour and decline in HIV infection among young pregnant women in urban Uganda.

OBJECTIVE: To describe sexual behaviour that may partly explain a decline in HIV seroprevalence in pregnant women in urban settings in Uganda, East Africa. SETTINGS: Two major urban districts in Uganda. METHODS: Repeated population-based behavioural surveys in 1989 and 1995, and repeated HIV serological surveys in consecutive pregnant women attending antenatal clinics from 1989 to 1995. RESULTS: During the study period, a 2-year delay in the onset of sexual intercourse among youths aged 15-24 years and a 9% decrease in casual sex in the past year in male youths aged 15-24 years were reported. Men and women reported a 40% and 30% increase in experience of condom use, respectively. In the same study area, over the same period, there was an overall 40% decline in the rates of HIV seroprevalence among pregnant women attending antenatal clinics. It can be hypothesized that the observed declining trends in HIV correspond to a change in sexual behaviour and condom use, especially among youths. CONCLUSIONS: This is the first report of a change over a period of 6 years in male and female sexual behaviour, assessed at the population level, that may partly explain the observed decline in HIV seroprevalence in young pregnant women in urban Uganda. This result should encourage AIDS control programmes to pursue their prevention activities.

PIP: Repeated serologic surveys conducted in consecutive pregnant women attending antenatal clinics in three urban sites--Nsambya, Rubaga, and Jinja--in Uganda in 1989-95 documented substantial declines (27-47%) in HIV prevalence. Multiple population-based behavioral surveys conducted in urban Uganda in 1989 and 1995 suggest this decline in HIV prevalence among pregnant women may be a result of three key changes in sexual practices: a 2-year delay in the onset of sexual intercourse among young people 15-24 years of age, a 9% decrease in the practice of casual sex among males 15-24 years old, and increases in the experience of condom use of 40% among males and 30% among females. Proportions of male and female youth reporting they had never had sexual intercourse increased from 31% and 26%, respectively, in 1989 to 56% and 46%, respectively, in 1995. The prevalence among men in the past year of sex outside relationships that had lasted more than 12 months declined from 22.6% in 1989 to 18.1% in 1995. The proportion of men and women who reported exchanging sex for money dropped by almost 50%. Finally, the proportion of sexually active respondents who reported ever-use of condoms increased from 15.4% to 55.2% among men and from 5.8% to 38.7% among women from 1989 to 1995. In two of the three urban areas, the decline in HIV prevalence was sharpest among pregnant women in the youngest age group (15-24 years), suggesting a true decrease. The finding of substantial changes in the sexual behavior of urban Ugandan youth confirms the efficacy of AIDS prevention and control interventions.

Results of a model AIDS prevention program for high school students in the Philippines.

OBJECTIVES: To describe the sexual practices of high school students; to describe the process of development of a school-based AIDS prevention program; and to evaluate the effect of this program on students' AIDS-related knowledge, attitudes and AIDS-preventive behaviors. SUBJECTS AND METHODS: A cluster-randomized, controlled trial with pretest/post-test evaluation was conducted in four demographically similar public high schools in a semi-urban district of Metro Manila, the Philippines. Of 845 high school students who participated in the baseline survey, 804 (95%) completed a postintervention questionnaire. INTERVENTION: An AIDS prevention program was developed by public high school teachers together with local AIDS experts, social scientists and health educators. The teacher-led AIDS program was designed to provide students with accurate information about AIDS, particularly in dispelling misconceptions about casual contagion, to foster positive attitudes towards people with AIDS and to develop skills aimed at clarifying values and assessing intended behavior. RESULTS: At baseline, 11% of students (20% of males and 4% of females) reported ever having had sexual intercourse (mean age 14 years). Among these, condom use was low (24%). After implementation of the AIDS prevention program, statistically significant effects favoring the intervention group were observed in knowledge and attitudes towards people with AIDS. While there was no statistically significant overall effect on intended preventive behavior, the program appeared to delay the students' intended onset of sexual activity. CONCLUSIONS: A sizable number of Filipino high school students are sexually active but condom use is low. School-based AIDS prevention programs can be developed and implemented in developing countries with the assistance of school personnel to address sexual issues. Our program was successful in increasing AIDS-related knowledge and improving attitudes towards people with AIDS. Supplementation with other preventive activities may be needed to achieve lasting changes in students' risk-taking behavior.

PIP: The objectives were to describe the sexual practices of high school students; to describe the process of development of a school-based AIDS prevention program; and to evaluate the effect of this program on students' AIDS-related knowledge, attitudes and AIDS-preventive behaviors by means of self-administered questionnaires. A cluster-randomized, controlled trial with pretest/post-test evaluation was conducted in 4 demographically similar public high schools in a semi-urban district of Metro Manila, the Philippines. Of 845 high school students who participated in the baseline survey, 804 (95%) completed a postintervention questionnaire. An AIDS prevention program was developed by public high school teachers together with local AIDS experts, social scientists, and health educators to provide students with accurate information about AIDS, dispel misconceptions about casual contagion, to foster positive attitudes towards people with AIDS, and to develop skills aimed at assessing intended behavior. At baseline, 80 (11%) of 804 students reported ever having had sexual intercourse (mean age 14 years). 66 were male and 14 were female (p 0.001). Among these, condom use was low (24%). Reasons for failure to use condoms were: use of other method (26%) and loss of sensitivity (25%). After implementation of the AIDS prevention program, the intervention group was more likely to answer correctly that HIV cannot be transmitted by mosquito bites (p 0.01), through a cough or sneeze (p 0.01), or by shaking hands with an infected person (p 0.01). Students who had attended the AIDS education program were less likely to avoid people with AIDS and were more compassionate toward them (p = 0.01). Changes in knowledge about modes of HIV transmission were associated with improvements in preventive knowledge (p 0.001). While there was no statistically significant overall effect on intended preventive behavior, the program appeared to delay the students' intended onset of sexual activity. The program was successful in increasing AIDS-related knowledge and improving attitudes toward people with AIDS.

Sexual risk factors for cervical cancer among rural Indian women: a case-control study.

BACKGROUND: The association between sexual behaviour and cervical cancer is well established. Despite a high incidence of cervical cancer in India, its role has not been widely investigated in Indian women among whom the rate of sexual promiscuity is known to be very low. A hospital-based case-control study was carried out to investigate the role of sexual risk factors in cervical cancer among rural Indian women. METHODS: A case-control design was used in which a total of 268 subjects, comprising 134 women with invasive cervical cancer as cases and 134 control women were studied. A multiple logistic regression model was used to analyse the data. RESULTS: The risk factors found to be associated with cervical cancer were early age at first coitus, extramarital sex partners of women and the time interval since first exposure. In a multiple logistic regression model, independent effects were observed for early age at first coitus, showing maximum risk in women who reported their first intercourse at < 12 years of age, compared to that of women at > or = 18 years (odds ratio [OR] = 3.5. 95% confidence interval [CI]: 1.1-10.9). Increased risk was also seen for women who had extramarital sex relationships (OR = 5.5, 95% CI: 1.5-19.5). The significant effect of early age at first coitus persisted after adjustment for latency period which also showed its independent risk association with cervical cancer in the multivariate analysis. CONCLUSION: These findings confirm the association between early age at first coitus and cervical cancer in women with a low rate of sexual promiscuity and define the role of these risk factors in cervical carcinogenesis among rural Indian women.

PIP: The association between sex behavior and cervical cancer was investigated among rural Indian women known to have very low levels of promiscuity. 134 women with invasive cervical cancer were matched with 134 controls and analysis performed using a multiple logistic regression model. Risk factors associated with cervical cancer were early age at first coitus, extramarital sex partners of women, and the time interval since first exposure. Independent effects were observed for early age at first coitus, with maximum risk among women who reported their first intercourse at younger than age 12 years compared to that of women at age 18 years or older. Increased risk was also seen for women who had extramarital sex relationships. The significant effect of early age at first coitus persisted after adjustment for a latency period which also showed its independent risk association with cervical cancer in the multivariate analysis.

Contraception and prevalence of sexually transmitted diseases among adolescents and young adults in Uganda.

The study is aimed at (i) exploring the knowledge and attitudes of adolescents (15-19 years old) and young adults (20-24 years old) towards sex and contraception (condoms) and (ii) determining their level of knowledge and attitudes towards sexually transmitted diseases (STD) as well as the prevalence of the latter among the sexually active adolescents and young adults. A sample of 4510 respondents (1545 males and 2965 females) aged 15-24 years from urban and rural areas were interviewed. The majority of adolescents and young adults surveyed have a negative attitude towards the use of condoms although most of them agreed that they prevent STD. Over 95% of the respondents have heard about STD and their level of knowledge is relatively high; slightly higher for urban residents and for young males. Approximately 21% of the male and 8% of the female respondents admitted having ever contracted STD. The gap between contraceptive knowledge and practice is rather wide. Only a small proportion of the respondents were using condoms at the time of the survey.

PIP: Between 1988 and 1990, researchers conducted the Adolescent Fertility Survey in the districts of Jinja, Kampala, Masaka, Kabale, Hoima, and Mbale in Uganda among 4510 15-24 year old urban and rural youth to examine their knowledge and attitudes toward sex, contraception, and sexually transmitted diseases (STDs). Males were more likely to experience 1st sexual intercourse at an earlier age than females. Many youth experienced their 1st sexual intercourse before age 15 and they had had more sexual partners than females. 83.9% of males and 87% of females used no contraception. Overall knowledge of condoms was high (78.2% for males and 56.6% for females) except among rural females (31.1%), especially among urban males (85.8%). Almost everyone was knowledgeable about STDs (96.1% males, 93.5% females). They tended to agree that condoms prevent STDs (urban males, 80.2%; urban females, 76%; rural males, 89.8%; and rural females 83.7%). Despite these high knowledge levels and positive attitude toward condoms, condom use levels were low, e.g., only 12.7% of males and 0.4% of females who were familiar with condoms used them. 40% of all respondents knew about the 3 most common STDs: gonorrhea, syphilis, and AIDS. Urban males were a bit more knowledgeable about these 3 STDs than were the other groups (48.8% vs. 41.2% for urban females, 41.3% for rural males, and 41.6% for rural females). In addition, STD prevalence was quite high especially among males (21.4% for males vs. 7.8% for females). The unsafe sexual practices revealed in this study indicated the need for sex education earlier than it is presently being offered in the school system and the establishment of health clinics geared toward adolescent needs.

Psychosocial predictors of delay of first sexual intercourse by adolescents.

This investigation predicted adolescents' delay of intercourse onset from attitudes, social norms, and self-efficacy about refraining from sexual intercourse. Age, gender, ethnicity, and parental education were also examined as predictors and moderators of the relationships among the 3 psychosocial determinants and onset. The participants (N = 827), part of a cohort initially surveyed in the 9th grade, reported at baseline that they had never engaged in intercourse. The multivariable proportional hazards regression model suggested that adolescents with more positive attitudinal and normative beliefs, as well as those with a parent who graduated from college, were less likely to engage in intercourse in the follow-up period (up to approximately 2 years). Interventions that include an objective to delay onset may benefit from addressing psychosocial determinants, especially attitudes and norms about sexual intercourse.

PIP: This study predicted adolescent's delay of intercourse onset from attitudes, social norms, and self-efficacy about refraining from sexual intercourse. Age, gender, ethnicity, and parental education were also examined as predictors and moderators of the relationships among the three psychosocial determinants and onset. The longitudinal data for the study were obtained from 827 participants in the US who were part of a cohort initially surveyed in the 9th grade. These participants reported at baseline that they had never engaged in intercourse. Utilizing the multivariable proportional hazards regression model, findings suggested that adolescents with more positive attitudinal and normative beliefs were less likely to engage in intercourse in the follow-up period (up to approximately 2 years). This was also the case for those students with a parent who graduated from college. Attitudes and norms were the most robust predictors of intercourse. In addition, a relatively modest increase in either scale was predictive of a 30% reduction in the onset of future intercourse in the most conservative analytic model. Interventions that include an objective to delay onset may benefit from addressing psychosocial determinants, especially attitudes and norms about sexual intercourse.

Female adolescents and onset of sexual intercourse: a theory-based review of research from 1984 to 1994.

PURPOSE: To review a decade of research on the correlates of early onset of sexual intercourse among female adolescents in the United States, using Social Cognitive Theory as a framework for classification. METHODS: Forty-nine studies published in peer-reviewed journals between 1984 and 1994 were reviewed and their findings coded by two independent coders. RESULTS: Findings indicate that most of the studies emphasized quantitative methodologies, using cross-sectional designs and univariate statistical analyses. Many studies lacked a theoretical framework or conceptual model to guide their investigations. When evaluating empirical findings, 61% of the studies found environmental correlates and 47% found biological factors (e.g., age and pubertal development) to be significantly associated with early initiation of sexual intercourse. CONCLUSION: These findings raise important questions about the quality of research on adolescent sexuality, as well as its relationship to the development of risk-reduction programs which tend to focus mainly on intrapersonal factors (such as attitudes, knowledge, and expectancies.

PIP: A comprehensive review of the recent research literature on the onset of sexual intercourse among female adolescents in the US was conducted, with emphasis on concepts included in Social Cognitive Theory. Of the 49 studies published in peer-reviewed journals in 1984 to 1994, 59% used cross-sectional sampling strategies and 35% used a longitudinal design. Coding of empirical results indicated that 61% of studies identified environmental correlates and 47% found biologic factors to be significantly related to early age (under 18 years) at first intercourse. Notable was a general absence of scientifically established theoretical frameworks or conceptual models to serve as a basis for data collection and analysis. Also widespread was a view of onset of sexual activity as an isolated, single, dependent variable rather than a multifaceted, multidetermined behavior. Despite the importance of personal meanings assigned to sexual activity, few studies used qualitative methods. Also revealed were gaps between research and practice. Despite the demonstrated centrality of environmental determinants of premarital sexual activity, the main focus of educational programs remains individual behavioral change.

Influences on adolescents' decision to postpone onset of sexual intercourse: a survival analysis of virginity among youths aged 13 to 18 years.

BACKGROUND: Previous research has focused on risk factors associated with early onset of sexual intercourse among adolescents. This study hypothesizes that protective factors identified for other health compromising behaviors are also protective against early onset of sexual intercourse. The study sample included 26,023 students in grades 7-12 (87.5% white, 52.5% male) who did not report a history of sexual abuse in a statewide survey of adolescent health in 1988. METHODS: Bivariate analyses were stratified into early (13-14 years), middle (15-16 years) and late (17-18 years) adolescence and by gender. Cox proportional hazards survival analysis, stratified by gender, was used to determine risk and protective factors associated with delayed onset of sexual intercourse. RESULTS: Variables showing a significant bivariate association with lower levels of sexual activity across all age groups and genders were: dual-parent families, higher socioeconomic status (SES), better school performance, greater religiosity, absence of suicidal thoughts, feeling adults or parents cared, and high parental expectations. High levels of body pride were associated with higher levels of sexual activity for all age and gender groups. In the multivariate survival analyses, variables significantly associated with delayed onset of sexual activity for both males and females included: dual-parent families, higher SES, residing in rural areas, higher school performance, concerns about the community, and higher religiosity. High parental expectations were a significant protective factor for males but not for females. CONCLUSION: While many protective factors are not subject to intervention, the present analyses indicate that teen pregnancy prevention may be enhanced by addressing family and educational factors.

PIP: This study examines the probability of identified protective factors of other health-compromising behaviors as protective factors against early onset of sexual intercourse based on previous research. Using a bivariate analysis, a sample of 26,023 students in grades 7-12 (87.5% White, 52.5% male) who completed a statewide adolescent health survey in 1988 without a reported sexual history were evaluated. The sample was stratified according to early (age 13-14), middle (age 15-16), and late (age 17-18) adolescence and by gender. On the other hand, the use of Cox proportional hazards survival analysis determines the risk and protective factors associated with delayed onset of sexual intercourse. Variables associated with non-initiation of sexual intercourse among genders included dual-parent families, higher socioeconomic status, rural residency, better school performance, greater religiosity, absence of suicidal thoughts, feeling that adults and parents care, and high parental expectancy. Furthermore, high parental expectations were found to be a more significant protective factor among males than females. Higher levels of sexual activity across all ages and gender groups were noted to be associated with high levels of body pride. This study concludes that the enhancement of family and educational programs would be beneficial in the prevention of teen pregnancy.

The determinants of sexual intercourse before age 16.

PURPOSE: To identify risk and protective factors for initiation of sexual intercourse before age 16 years at the level of the individual, family, and school. METHODS: A longitudinal study based on a cohort of 1020 people born in Dunedin, New Zealand in 1972/73 and followed up to age 21 years. Demographic characteristics of the sample were similar to the New Zealand population of that age, except that a smaller proportion (3%) were Maori or Pacific Island Polynesian. Information on individual, family and school factors was collected by interview with parents at ages 3, 5, 7 and 9 years and then by postal questionnaire two-yearly up to 15 years. Subjects were assessed two-yearly from age 3 years and interviewed about their behaviours and ambitions at ages 11, 13, and 15 years. Questions about age at first intercourse were asked by computer at age 21 years. Multivariate logistic regression was used to model associations with age of first intercourse less than 16 years. RESULTS: Data on age at first intercourse were available for 926/1020 (91%) of surviving members of the cohort assembled at age 3 years. Overall 27.5% of males and 31.7% of females reported sexual intercourse before age 16 years. In multivariate analyses the independent predictors for early sexual initiation for males were: not having outside home interests at age 13 years, no religious activity at age 11 years, not being attached to school at age 15 years, a low reading score, and a diagnosis of conduct disorder in early adolescence. For females, independent predictors were: socioeconomic status in the middle range, mother having her first child before age 20 years, IQ in the middle range, not being attached to school, being in trouble at school, planning to leave school early, cigarette smoking and higher self-esteem score. CONCLUSIONS: Individual and school factors appear to be more important than family composition or socioeconomic status in the decision to have sexual intercourse before age 16 years. The lowering of age at first intercourse may be partly a cohort effect related to high rates of teenage childbearing in the mothers' generation, and to changes in social acceptability of early sexual behaviour.

The sexual practices of Asian and Pacific Islander high school students.

PURPOSE: To describe the sexual behaviors, beliefs, and attitudes of Asian and Pacific Islander California high school students and to compare them to other racial/ethnic groups. METHODS: Data were collected from an anonymous self-administered survey of 2026 ninth to 12th graders in a Los Angeles County school district; 186 of the respondents described themselves as Asian and Pacific Islander. The survey was conducted in April 1992. RESULTS: A higher percentage of Asian and Pacific Islander adolescents (73%) compared with African-American (28%, p < .001), Latino (43%, p < .001), white (50%, p < .001), and other (48%, p < .001) adolescents had never had vaginal intercourse. Asian and Pacific Islander adolescents were less likely than other adolescents to report having engaged in heterosexual genital sexual activities during the prior year, including masturbation of or by a partner, fellatio with ejaculation, cunnilingus, and anal intercourse. Few students in any group reported homosexual genital sexual activities. Asians and Pacific Islanders who had had vaginal intercourse were more likely than most other groups to have used a condom at first vaginal intercourse, but Asians and Pacific Islanders had not used condoms more consistently over the prior year. Asians and Pacific Islanders were more likely to expect parental disapproval if they had vaginal intercourse and less likely to think that their peers had had vaginal intercourse. CONCLUSIONS: Asian and Pacific Islander high school students in one California school district appear to be at lower sexual risk than other racial/ethnic groups. However, a large minority are engaging in activities that can transmit disease and lead to unwanted pregnancy. Therefore, current efforts to develop culturally sensitive clinical and community-based approaches to sexual risk prevention should include Asians and Pacific Islanders.

PIP: Findings are reported from a study conducted to describe the sexual behaviors, beliefs, and attitudes of Asian and Pacific Islander California high school students, and to compare them with other racial/ethnic groups. Data were collected from an anonymous self-administered survey in April 1992 of 2026 9th-12th graders in a Los Angeles County school district. 186 of the respondents described themselves as Asian and Pacific Islander. 73% of Asian and Pacific Islander students had never had vaginal sexual intercourse, compared to 28% of African-American students, 43% of Hispanics, 50% of Whites, and 48% of others. Asians and Pacific Islanders were less likely than other adolescents to report having engaged in heterosexual genital activities during the preceding year. Few students in any racial/ethnic group reported engaging in homosexual genital sexual activities. Asians and Pacific Islanders who had had vaginal intercourse were more likely than students in most other groups to have used a condom at first vaginal intercourse, but they had not used condoms more consistently during the previous year. Furthermore, Asians and Pacific Islanders were more likely to expect parental disapproval if they had vaginal intercourse and were less likely to think that their peers had had such intercourse.

Durations of adolescent sexual relationships before and after conception.

PURPOSE: To explore durations of young couples' relationships between meeting and first intercourse, before first conception and for two years following conception and the associations between these durations; to describe the association between these durations and the young women's perceptions of the nature of these relationships. METHODS: Three hundred and seven adolescent women were enrolled in a prospective study while presenting for pregnancy tests (the index event); they were followed for two years in three groups--those with negative tests, those who terminated the pregnancy and those who bore a child. Retrospective information about durations of relationships with first partners and partners at the index event was obtained at baseline; follow-up data was obtained on continuing relationships with the index partner. RESULTS: Durations of relationships between adolescent females and their partners in this sample, both before and after conception, are rarely brief; the median duration of a girl's prior relationship with a partner with whom she conceives is almost two years. Similarly, almost half of the sample is still in a relationship at two years following the index event, a proportion that rises to two-thirds among those who bore a child together. CONCLUSIONS: Contrary to common belief or practice, there may be sufficient time and commitment to include many male partners in intervention programs before, and in parenting programs after, a first conception--a practice which could have positive implications for both adolescent partners and, potentially, for their child.