1. Richmond Teen Pregnancy Prevention Seminar – May 20, 2010 Benefits of Delaying Sexual Debut Disparities in Health Outcomes Between Genders

2. Background Research review of the health outcomes of delaying sexual initiation for young people; not a meta-analysis or systematic review Identified common themes of abstinence-centered education and reviewed the evidence behind the physical, psychological, financial, and relational health outcomes of youth who delay sex – also looked at what influences early sexual debut and teen sex Conclusions are based on peer-reviewed scientific and medical studies, academic papers, scholarly books, government data, and expert opinions Conclusions are based on studies from youth in the United States; not all data is nationally representative; some outcomes are associations, not necessarily cause and effect

3. Different Learning Styles Auditory Visual Tactile or Kinesthetic

4. What Are They Thinking? Put yourself in the place of a young person – what message would you take from this video? What are they thinking? What gender is more likely to be affected? Play VideoPlay Video Studies show that mass media influences the sexual behavior of young people (Brown, 2008; Ashby et al., 2006; Martino et al, 2006) Mass media does not necessarily cause teens to have sex, but the messages can influence behavior, depending on their gender, how much sex they watch, and what the outcome of the sex is (Tolman et al., 2007)

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

6. Physical Health Benefits for Young Women According to analysis from the National Survey of Family Growth from Rector et al. (2003), delaying sexual debut reduces the lifetime risk that an adolescent female will have an early pregnancy and STI According to an HHS study (2000), the age at first intercourse has a strong association with the number of lifetime sexual partners one has. The more sexual partners, the greater risk of contracting an STI Research also finds that young women are more vulnerable to STIs such as HPV, Chlamydia, Gonorrhea, and HIV (Shufford, 2008; MICH, 2008; Kahn et al., 2002; Miller et al.,1999) Young women are also more vulnerable for some of the indirect physical health risks of early sex, such as dating violence and relationship abuse (Kaestle et al. 2005; Silverman et al., 2004)

11. Take a few minutes to process with those around you: 1) Think back to when you were a teenager. What are the differences between the way you thought back then and the way you think today? 2) How do these changes in the way you think today influence your decision-making processes? How Are They Thinking?

13. Emotional and Psychological Consequences “Young women often equate sex with love, and can easily develop the psychological condition of repetition/ compulsion” (Meeker, 2002) Adolescents that have early sexual debut are more likely to engage in casual sex (Grello et al., 2006; Regan et al., 1999)  casual sex is associated with elevated levels of depression and suicide in young women (Waller et al. 2006; Cohen & Shotland, 1996) Youth who experience early sexual debut and continue to be sexually active (especially girls) are more like to be depressed, think of, and attempt suicide (Hallfors et al., 2004; Rector et al., 2003; Orr et al., 1991)

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

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

19. Richard Jessor’s “Problem Behavior” Theory Richard Jessor’s Problem Behavior Theory (1977) (Cycle of Cause and Effect) 1) Adolescent becomes 1) Adolescent becomes sexually active sexually active 2) Negative response from family, school, church etc. 3) Disconnects From positive supportinginstitutions 4) Turns to sexually active peers for support and affirmation 5) Continued deviant behavior (i.e. sexual activity) A study published in the Journal of Youth Adolescence in 2006 (Ream, 2006) tested Jessor’s theory and replicated these findings

20. Relational Consequences Women who begin to date at younger ages are more likely to have older boyfriends and experience early sexual debut (Sieving et al, 2006; Kaestle et al. 2002; Leitenberg & Saltzman, 2000) Young women are much more likely to experience dating violence and physical abuse than young men; 1 in 5 sexually active young women have experienced physical abuse (Silverman et al, 2001) A recent study found that young women with an older sex partner are at a higher risk for acquiring STIs (Ryan et al. 2008). Oxytocin and sexual attachment is more intense for women, who tend to place more of an emotional investment in sex, especially for her first partner (Townsend et al, 1995; Singer, 1985; Kallen & Stephenson, 1982)  However, no disparity among men and women when it comes to early sex and/or cohabitations with future infidelity and divorce

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

24. T HANK YOU ! Christopher Doyle Behavioral Research Analyst The Institute for Youth Development 1329 Shepard Drive, Suite 1 Sterling, VA 20164 703-433-1640 ext. 103 cdoyle@youthdevelopment.orgcdoyle@youthdevelopment.org www.youthdevelopment.org