1. Beyond Abstinence and Risk: A New Paradigm for Adolescent Sexual Health Amy Schalet, Ph.D. University of Massachusetts at Amherst

2. A New Paradigm for Adolescent Sexual Health Develop Autonomy of Sexual Self Develop Autonomy of Sexual Self Build Good Romantic Relationships Build Good Romantic Relationships Maintain Connectedness between Maintain Connectedness between Adolescents and Care Providers

4. Age of First Sex Median Age U.S.Netherlands Girls1717 Boys1818 Sources: Graaf et al., 2005; United Nations, 2003

5. Age of First Marriage Median Age U.S.Netherlands Women2529 Men2731 Sources:Abma et al., 2004; United Nations, 2003 Sources: Abma et al., 2004; United Nations, 2003

6. Percentage of Women Who Have Sexual Intercourse Before Age 20 Sources: Darroch et al., 2001; Graaf et al., 2005; Mosher et al., 2005

7. Public Health Outcomes Source: Schalet, 2004

9. Source: Advocates for Youth, 2001

10. Contraceptive Use at First Intercourse HormonalContraceptionCondom Hormonal + Condom Dutch Females 647546 American Females 266717 Source: Abma et al., 2004;Graaf et al., 2005 Source: Abma et al., 2004; Graaf et al., 2005

11. USBoysUSGirlsNLGirls/Boys Wished Had Waited Longer to Have Sex* 63%69% 8% 8% Experienced First Sex as Really Wanted* 59%33%88% Subjective Experience of Adolescent Sexuality * See Notes Sources: Abma et al., 2004;Albert, 2004; Graaf et al., 2005 Sources: Abma et al., 2004; Albert, 2004; Graaf et al., 2005

12. Sexual Experience Dutch Adolescents Sexual Experience Dutch Adolescents Felt in Control of Timing of First Sexual Experiences Enjoyed First Sexual Experiences Experienced First Intercourse as Mutually Desired and Decided Engages in Current Sexual Activity within Steady Relationship Feels in Love with Current Sexual Partner

13. Data Collection Data Collection Interview Period: 1991-2000 Interviewees: White, Secular and Moderately Religious Middle Class Interview Type: Semi-structured In-depth Interviews 72 Interviews with Boys and Girls, Ages 15-17 58 Parent Interviews (Mothers and Fathers) Interview Content: Variety of Topics Interviews: 1-2 hours, Taped, Transcribed, and Analyzed with N5

14. Raging Hormones Out of Control DRAMATIZATION Battle of the Sexes “Not Under My Roof” Adolescent Sexuality in the United States

15. Readiness and (Self) Regulation NORMALIZATION Relationship Between the Sexes Normal and Non- Secretive Sexuality Adolescent Sexuality in the Netherlands

16. Sex as Risk-Taking Dramatization Love as Extraordinary Sex as Secret Teenagers in the United States

17. Sex as Preparation Normalization Love as Normal Sex as Negotiation Teenagers in the Netherlands

18. Existing Paradigms: The Abstinence (or No Sex) Paradigm Makes sex an “either or” thing Makes sex an “either or” thing Provides a code, not empowerment Provides a code, not empowerment Gives no tools for navigating relationships Gives no tools for navigating relationships Makes sex hard to discuss when it does happen Makes sex hard to discuss when it does happen

19. Existing Paradigms: The “Sex-as-Risk-Taking” Paradigm Makes sex a disease rather than part of life Makes sex a disease rather than part of life Does not distinguish really risky from not so Does not distinguish really risky from not so Instills fear, not sense of mastery/control Instills fear, not sense of mastery/control Leaves out the relational contexts of sexuality Leaves out the relational contexts of sexuality

20. A New Paradigm for Adolescent Sexual Health Develop Autonomy of Sexual Self Develop Autonomy of Sexual Self Build Good Romantic Relationships Build Good Romantic Relationships Maintain Connectedness between Maintain Connectedness between Adolescents and Care Providers

21. Another Paradigm, Another “A” Develop Autonomy of Sexual Self Develop Autonomy of Sexual Self Own and control sexual decision-making process Own and control sexual decision-making process Recognize and articulate own wishes and boundaries Recognize and articulate own wishes and boundaries Or: know when and how to say “yes” and “no” Or: know when and how to say “yes” and “no” Anticipate and adequately prepare for sexual activity Anticipate and adequately prepare for sexual activity Strive for pleasure and enjoyment of sexual contact Strive for pleasure and enjoyment of sexual contact

22. Another Paradigm, Another “B” Build Good Romantic Relationships Build Good Romantic Relationships Get to know each other Get to know each other Build trust over time Build trust over time Deal well with conflict Deal well with conflict Strive for power equality Strive for power equality Enjoy each other’s company Enjoy each other’s company

23. Another Paradigm, Another “C” Maintain Connectedness between Adolescents and Care Providers Maintain Connectedness between Adolescents and Care Providers Honesty and integrity in relationship with parents Honesty and integrity in relationship with parents Honesty and integrity in relationship with professional care providers Honesty and integrity in relationship with professional care providers Educators Educators Medical Professionals Medical Professionals Members of the Clergy Members of the Clergy

24. Another Paradigm, Another ABC Develop Autonomy of Sexual Self Develop Autonomy of Sexual Self Own and control sexual decision-making process Own and control sexual decision-making process Recognize and articulate own wishes and boundaries Recognize and articulate own wishes and boundaries Anticipate and adequately prepare for sexual activity Anticipate and adequately prepare for sexual activity Strive for sexual pleasure and enjoyment of sexual contact Strive for sexual pleasure and enjoyment of sexual contact Build Good Romantic Relationships Build Good Romantic Relationships Get to know each other Get to know each other Build trust over time Build trust over time Deal with conflict Deal with conflict Strive for power equality Strive for power equality Enjoy each other’s company Enjoy each other’s company Maintain Connectedness Between Teenagers and Care Providers Maintain Connectedness Between Teenagers and Care Providers Honesty and integrity in communication with parents Honesty and integrity in communication with parents Honesty and integrity in communication with professional care providers Honesty and integrity in communication with professional care providers (Educators, Medical Professionals, Members of the Clergy, etc.) (Educators, Medical Professionals, Members of the Clergy, etc.)

25. Sources: Abma, J.C., G.M. Martinez, W.D. Mosher, and B.S. Dawson. "Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002." National Center for Health Statistics. Vital and Health Statistics 23 (24). Hyattsville, MD: Centers for Disease Control and Prevention, 2004. Abma, J.C., G.M. Martinez, W.D. Mosher, and B.S. Dawson. "Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002." National Center for Health Statistics. Vital and Health Statistics 23 (24). Hyattsville, MD: Centers for Disease Control and Prevention, 2004. Advocates for Youth. “Adolescent Sexual Health in Europe and the U.S.-Why the Difference?” 2nd Edition. Washington, DC, 2001. Advocates for Youth. “Adolescent Sexual Health in Europe and the U.S.-Why the Difference?” 2nd Edition. Washington, DC, 2001. Albert, Bill. "With One Voice: America's Adults and Teens Sound Off About Teen Pregnancy." Washington, DC: National Campaign to Prevent Teen Pregnancy, 2004. Albert, Bill. "With One Voice: America's Adults and Teens Sound Off About Teen Pregnancy." Washington, DC: National Campaign to Prevent Teen Pregnancy, 2004. Darroch, Jacqueline E., Susheela Singh, and Jennifer J. Frost. "Differences in Teenage Pregnancy Rates among Five Developed Countries: The Roles of Sexual Activity and Contraceptive Use." Family Planning Perspectives 33, no. 6 (2001): 244-50 & 81. Darroch, Jacqueline E., Susheela Singh, and Jennifer J. Frost. "Differences in Teenage Pregnancy Rates among Five Developed Countries: The Roles of Sexual Activity and Contraceptive Use." Family Planning Perspectives 33, no. 6 (2001): 244-50 & 81. Graaf, Hanneke de, Suzanne Meijer, Jos Poelman, and Ine Vanwesenbeeck. "Seks Onder Je 25ste." Utrecht/Amsterdam: Rutgers Nisso Group/Soa Aids Nederland, 2005. Graaf, Hanneke de, Suzanne Meijer, Jos Poelman, and Ine Vanwesenbeeck. "Seks Onder Je 25ste." Utrecht/Amsterdam: Rutgers Nisso Group/Soa Aids Nederland, 2005. Mosher, W.D., A. Chandra, and J. Jones. "Sexual Behavior and Selected Health Measures: Men and Women 15- 44 Years of Age, United States, 2002." In Advance Data from Vital and Health Statistics; no 362. Hyattsville, MD: National Center for Health Statistics, 2005. Mosher, W.D., A. Chandra, and J. Jones. "Sexual Behavior and Selected Health Measures: Men and Women 15- 44 Years of Age, United States, 2002." In Advance Data from Vital and Health Statistics; no 362. Hyattsville, MD: National Center for Health Statistics, 2005. Schalet, Amy. "Must We Fear Adolescent Sexuality?" Medscape General Medicine 6, no. 4 (2004). Schalet, Amy. "Must We Fear Adolescent Sexuality?" Medscape General Medicine 6, no. 4 (2004). United Nations. Trends in Europe and North America: The Statistical Yearbook of the Economic Commission for Europe. New York, 2003. United Nations. Trends in Europe and North America: The Statistical Yearbook of the Economic Commission for Europe. New York, 2003.

26. My contact info: Amy Schalet, schalet@soc.umass.edu “Must We Fear Adolescent Sexuality” at: www.medscape.com/viewarticle/494933