Analysis Sexual Health

No News Is Not Necessarily Good News: 2011 YRBS Reveals Little Change in Teen Sexual Behavior

Martha Kempner

The CDC's biennial survey of high school students came out today and once again it found no change in sexual risk behaviors among young people.  This means that after a decade of progress (between 1991 and 2001) nothing has changed in over a decade. Clearly, we could be doing better. 

Forgive me if I used that title already. I vaguely remember writing an article two years ago when the 2009 Youth Risk Behavior Survey (YRBS), the Centers for Disease Control and Prevention’s (CDC’s) biennial survey of high school students, came out with its interminable lists of data on teen behaviors, from wearing bicycle helmets to texting while driving to drinking soda (or pop depending on where you live). Of course, I always flip right to the pages on sexual behavior (this year it’s tables 64 through 76 for others like me) because as much as I want to know whether teens ate a piece of fruit or drank a glass of 100 percent fruit juice every day, I admit that I’m more interested in whether they used a condom the last time they had sexual intercourse.     

The YRBS is an interesting snapshot of what teens are doing when it comes to sex but it is also very limited. First because it only talks to teens who are currently in high school which means that it misses some of the most at-risk teens. Second because it avoids questions of same-sex sexual behaviors (though some states do ask these questions in their surveys). And also, because it asks very specific questions that look at sexual behavior through the lens of risk. This may be understandable given that a few pages before these questions the survey asks about the use of heroin and methamphetamines; but I always wish sex, by virtue of the fact that unlike meth it can be a healthy behavior for teens, could somehow be treated differently. Still, the survey gives us some valuable insight particularly since much the same questions have been asked of teens every two years since 1991.   

Here are some of the highlights about sexual behavior from the 2011 survey.

  • 47.4 percent of high school students (49.2 percent of males and 45.6 percent of females) reported ever having had sexual intercourse.
  • The percent of students who have ever had sexual intercourse increases steadily with grade level—32.9 percent of 9th graders, 43.8 percent of 10th graders, 53.2 percent of 11th graders, and 63.1 percent of 12th graders.
  • 6.2 percent of high school students (9 percent of males and 4.3 percent of females) reported having had sexual intercourse for the first time before age 13.
  • 15.3 percent of high school students (17.8 percent of males and 12.6 percent of females) reported having had 4 or more sexual partners.
  • 33.7 percent of high school students reported being sexually active which is defined as having had sexual intercourse within the three months prior to the survey.

The YRBS also asks currently sexually active students what form of birth control, if any, they had used at last intercourse.  Here is what it found:

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  • 60.2 percent of currently sexually active high school students (67 percent of males and 53.6 percent of females) reported having used a condom the last time they had intercourse. 
  • 18 percent of currently sexually active high school students (13.4 percent of males and 22.6 percent of female) reported that either they or their partner had used birth control pills the last time they had intercourse.
  • 5.3 percent of currently sexually active high school students (3.2 percent of males and 7.5 percent of females) reported that either they or their partner had used Depo-Provera (the shot), Nuva Ring, Implanon (the implant), or an IUD the last time they had sexual intercourse.

In addition to breaking down these behaviors by sex and school year, the YRBS breaks it down by ethnicity. Here is what it found in 2011.

  • The prevalence of having ever had sexual intercourse was higher among black (60 percent) and Hispanic (48.6 percent) than white (44.3 percent) high school students. 
  • The prevalence of having had sexual intercourse before age 13 was higher among black (13.9 percent) and Hispanic (7.1 percent) than white (3.9 percent) high school students.
  • The prevalence of reporting being currently sexually active was higher among black (41.3) than white (32.4 percent) or Hispanic (33.5 percent) high school students.
  • Among currently sexually active students, the prevalence of having used a condom at last intercourse was higher among black (65.3 percent) than Hispanic (58.4 percent) students and higher among black male (75.4 percent) than white male (66.3 percent) and Hispanic male (63.4 percent) high school students.

What is most telling about this year’s YRBS is that there is almost no change in any of these markers of sexual “risk” behavior from the previous survey. As the authors explain, the prevalence of having ever had sexual intercourse decreased during 1991–2001 (from 54.1 percent of high school students to 45.6 percent) but has not changed significantly since 2001. In 2009, 46 percent of high school students reported having ever had sexual intercourse compared to the 47.4 percent in 2011, this slight tick upwards, however, does not represent a significant change. This same trend of seeing improvements between 1991 and 2001 and then stagnation since then is repeated for almost all behaviors with slight variations. For example, the prevalence of condom use increased between 1991 and 2003 (from 46.3 percent to 63 percent) but has remained stagnant since. Similarly, the prevalence of high school students who reported having had sex before age 13 decreased between 1991 and 2005 but has remained the same since. 

The other really interesting thing about this year’s results is the number of places where the authors note wide variations across states and urban school districts. For example, the percentage of students who reported having had sex before age 13 ranges from 3.6 to 11.8 percent across states and from 4.9 to 15.6 percent across large urban school districts. The prevalence of currently sexually active students who used condoms the last time they had intercourse also varied widely across states from 43.9 percent to 70.8 percent and across large urban school districts from 52.1 percent to 75.1 percent. It would be really interesting if we could use these variations to pinpoint what policies and programs may be helping young people protect themselves because it is clear that when looking at the nation as a whole the policies and programs we have in place right now are not working. 

Don’t get me wrong, I am never one who says the sky is falling when it comes to young people and sexual behavior. I think the fact that 60 percent of sexually active young people used a condom the last time they had sex shows us that many high school students (even those who aren’t virgins) can and do behave responsibly. I’m even more impressed that 9.5 percent of currently sexually active high school students reported using dual methods of contraception meaning that even though they were using a hormonal method like the birth control pill, shot, ring, or implant or had an IUD, they also used a condom presumably to protect themselves against STDs. 

Still, the word stagnant is all over this article.  We made progress between 1991 and 2001 – a nice decade in which fewer teens became sexually active and more teens used condoms — but that decade ended over a decade ago. We have to ask ourselves what we have done wrong in the last 10 years to have impeded progress.

The YRBS does not tell us everything we want to know about teen sexual behavior. I, for one, would like to know who their partners were, if there was a difference in their contraceptive use depending on their relationship status, whether they enjoyed their experiences, and why so many students who have had intercourse are not currently sexually active — is it a choice or simply lack of opportunity? I’d like to know if they learned about condoms in school and I would love to see if states where kids learned about condoms in school had better condom usage rates. I could go on and on (and I will in another article, I’m sure). For now though, what the YRBS does tell us is that 12.9 percent of currently sexually active high school students did not use any form of birth control the last time they had intercourse and 26 percent of high school students haven’t even learned about HIV and AIDS in school. What it does tell us is that we have made no progress in recent years. What it does tell us is that we can do better.

Commentary Politics

No, Republicans, Porn Is Still Not a Public Health Crisis

Martha Kempner

The news of the last few weeks has been full of public health crises—gun violence, Zika virus, and the rise of syphilis, to name a few—and yet, on Monday, Republicans focused on the perceived dangers of pornography.

The news of the last few weeks has been full of public health crises—gun violence, the Zika virus, and the rise of syphilis, to name a few—and yet, on Monday, Republicans focused on the perceived dangers of pornography. Without much debate, a subcommittee of Republican delegates agreed to add to a draft of the party’s 2016 platform an amendment declaring pornography is endangering our children and destroying lives. As Rewire argued when Utah passed a resolution with similar language, pornography is neither dangerous nor a public health crisis.

According to CNN, the amendment to the platform reads:

The internet must not become a safe haven for predators. Pornography, with its harmful effects, especially on children, has become a public health crisis that is destroying the life [sic] of millions. We encourage states to continue to fight this public menace and pledge our commitment to children’s safety and well-being. We applaud the social networking sites that bar sex offenders from participation. We urge energetic prosecution of child pornography which [is] closely linked to human trafficking.

Mary Frances Forrester, a delegate from North Carolina, told Yahoo News in an interview that she had worked with conservative Christian group Concerned Women for America (CWA) on the amendment’s language. On its website, CWA explains that its mission is “to protect and promote Biblical values among all citizens—first through prayer, then education, and finally by influencing our society—thereby reversing the decline in moral values in our nation.”

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The amendment does not elaborate on the ways in which this internet monster is supposedly harmful to children. Forrester, however, told Yahoo News that she worries that pornography is addictive: “It’s such an insidious epidemic and there are no rules for our children. It seems … [young people] do not have the discernment and so they become addicted before they have the maturity to understand the consequences.”

“Biological” porn addiction was one of the 18 “points of fact” that were included in a Utah Senate resolution that was ultimately signed by Gov. Gary Herbert (R) in April. As Rewire explained when the resolution first passed out of committee in February, none of these “facts” are supported by scientific research.

The myth of porn addiction typically suggests that young people who view pornography and enjoy it will be hard-wired to need more and more pornography, in much the same way that a drug addict needs their next fix. The myth goes on to allege that porn addicts will not just need more porn but will need more explicit or violent porn in order to get off. This will prevent them from having healthy sexual relationships in real life, and might even lead them to become sexually violent as well.

This is a scary story, for sure, but it is not supported by research. Yes, porn does activate the same pleasure centers in the brain that are activated by, for example, cocaine or heroin. But as Nicole Prause, a researcher at the University of California, Los Angeles, told Rewire back in February, so does looking at pictures of “chocolate, cheese, or puppies playing.” Prause went on to explain: “Sex film viewing does not lead to loss of control, erectile dysfunction, enhanced cue (sex image) reactivity, or withdrawal.” Without these symptoms, she said, we can assume “sex films are not addicting.”

Though the GOP’s draft platform amendment is far less explicit about why porn is harmful than Utah’s resolution, the Republicans on the subcommittee clearly want to evoke fears of child pornography, sexual predators, and trafficking. It is as though they want us to believe that pornography on the internet is the exclusive domain of those wishing to molest or exploit our children.

Child pornography is certainly an issue, as are sexual predators and human trafficking. But conflating all those problems and treating all porn as if it worsens them across the board does nothing to solve them, and diverts attention from actual potential solutions.

David Ley, a clinical psychologist, told Rewire in a recent email that the majority of porn on the internet depicts adults. Equating all internet porn with child pornography and molestation is dangerous, Ley wrote, not just because it vilifies a perfectly healthy sexual behavior but because it takes focus away from the real dangers to children: “The modern dialogue about child porn is just a version of the stranger danger stories of men in trenchcoats in alleys—it tells kids to fear the unknown, the stranger, when in fact, 90 percent of sexual abuse of children occurs at hands of people known to the victim—relatives, wrestling coaches, teachers, pastors, and priests.” He added: “By blaming porn, they put the problem external, when in fact, it is something internal which we need to address.”

The Republican platform amendment, by using words like “public health crisis,” “public menace” “predators” and “destroying the life,” seems designed to make us afraid, but it does nothing to actually make us safer.

If Republicans were truly interested in making us safer and healthier, they could focus on real public health crises like the rise of STIs; the imminent threat of antibiotic-resistant gonorrhea; the looming risk of the Zika virus; and, of course, the ever-present hazards of gun violence. But the GOP does not seem interested in solving real problems—it spearheaded the prohibition against research into gun violence that continues today, it has cut funding for the public health infrastructure to prevent and treat STIs, and it is working to cut Title X contraception funding despite the emergence of Zika, which can be sexually transmitted and causes birth defects that can only be prevented by preventing pregnancy.

This amendment is not about public health; it is about imposing conservative values on our sexual behavior, relationships, and gender expression. This is evident in other elements of the draft platform, which uphold that marriage is between a man and a women; ask the U.S. Supreme Court to overturn its ruling affirming the right to same-sex marriage; declare dangerous the Obama administration’s rule that schools allow transgender students to use the bathroom and locker room of their gender identity; and support conversion therapy, a highly criticized practice that attempts to change a person’s sexual orientation and has been deemed ineffective and harmful by the American Psychological Association.

Americans like porn. Happy, well-adjusted adults like porn. Republicans like porn. In 2015, there were 21.2 billion visits to the popular website PornHub. The site’s analytics suggest that visitors around the world spent a total of 4,392,486,580 hours watching the site’s adult entertainment. Remember, this is only one way that web users access internet porn—so it doesn’t capture all of the visits or hours spent on what may have trumped baseball as America’s favorite pastime.

As Rewire covered in February, porn is not a perfect art form for many reasons; it is not, however, an epidemic. And Concerned Women for America, Mary Frances Forrester, and the Republican subcommittee may not like how often Americans turn on their laptops and stick their hands down their pants, but that doesn’t make it a public health crisis.

Party platforms are often eclipsed by the rest of what happens at the convention, which will take place next week. Given the spectacle that a convention headlined by presumptive nominee (and seasoned reality television star) Donald Trump is bound to be, this amendment may not be discussed after next week. But that doesn’t mean that it is unimportant or will not have an effect on Republican lawmakers. Attempts to codify strict sexual mores are a dangerous part of our history—Anthony Comstock’s crusade against pornography ultimately extended to laws that made contraception illegal—that we cannot afford to repeat.

Commentary Sexual Health

Fewer Teens Are Having Sex, But Don’t Pop the Champagne Yet

Martha Kempner

The number of teens having sex may be less important than the number having protected sex. And according to recent data from the Centers for Disease Control and Prevention, condom use is dropping among young people.

Every two years, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC-DASH) surveys high school students to gauge how often they engage in perceived risky behaviors. The national Youth Risk Behavior Surveillance (YRBS) is wide ranging: It asks about violence, guns, alcohol, drugs, seat belts, bicycle safety, and nutrition. It also asks questions about “sexual intercourse” (which it doesn’t define as a specific act) and sexual behaviors.

Started in 1991, this long-running study can provide both a picture of what high school students are doing right now and a historical perspective of how things have changed. But for more than a decade, the story it has told about sexual risk has been the virtually the same. Risk behaviors continually declined between 1991 and 2001, with fewer high school students having sex and more of them using condoms and contraception. But after the first 10 years, there has been little change in youth sexual risk behaviors. And, with each new release of almost unchanging data, I’ve reminded us that no news isn’t necessarily good news.

This year, there is news and it looks good—at least on the surface. The survey showed some significant changes between 2013 and 2015; fewer kids have ever had sex, are currently sexually active, or became sexually active at a young age. More teens are relying on IUDs and implants, which are virtually error-proof in preventing pregnancy.

In 2015, 41 percent of high school students reported ever having had sexual intercourse compared to 47 percent in 2013. The researchers say this is a statistically significant decrease, which adds to the decreases seen since 1991, when 54 percent of teens reported ever having had sexual intercourse.

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Another change is in the percentage of students who had sex for the first time before age 13. In 2015, 4 percent of high school students reported this compared to almost 6 percent in 2013. This is down from a full 10 percent in 1991. As for number of overall partners, that is down as well, with only 12 percent of students reporting four or more partners during their lifetime compared to 15 percent in 2013 and 19 percent in 1991. Finally, the percentage of students who are currently sexually active also decreased significantly between 2013 (34 percent) and 2015 (30 percent).

These are all positive developments. Delaying sex can often help prevent (at least temporarily) the risk of pregnancy or STIs. Having fewer partners, especially fewer concurrent partners, is frequently important for reducing STI risk. And those teens who are not currently having sex are not currently at risk for those things.

While I want to congratulate all teens who took fewer risks this year, I’m not ready to celebrate those statistics alone—because the number of teens having sex is less important to me than the percentage of teens having sex that is protected from both pregnancy and sexually transmitted infections. And that number is lower than it once was.

Among sexually active teens, there were no significant positive changes in measures of safer sex other than an increase in the number of sexually active high school students using the IUD or implant (up to 4 percent from 2 percent in 2013).

Moreover, some results indicate that today’s teens are using less protection than those who were teens a decade ago. The most telling finding might be the percentage of teens who used no method of contraception the last time they had sex. This decreased between 1991 and 2007 (from 17 percent to 12 percent), inched up to 14 percent in 2013, and stayed the same in 2015 (14 percent). There was also little to no change in the percentage of high school students who say that either they or their partner used birth control pills between 2013 (19 percent) and 2015 (18 percent) or those who say they used the contraceptive shot, patch, or ring (5 percent in 2013 and 2015).

For me, however, the most distressing finding is the backward progress we continue to see in condom use. The prevalence of high school students who used a condom at last sex went up from 45 percent in 1991 to 63 percent in 2003. But then it started to drop. In 2015, only 57 percent of sexually active high school students used condoms the last time they had sex, less than in 2013, when 59 percent said they used condoms.

It’s not surprising that teens use condoms less frequently than they did a decade ago. In the 1990s, the HIV epidemic was still front and center, and condoms were heavily promoted as a way to avoid infection. As this threat waned—thanks to treatment advances that now also serve as prevention—discussions of the importance of condoms diminished as well. The rise of abstinence-only-until-marriage programs may have also affected condom use, because these programs often include misinformation suggesting condoms are unreliable at best.

Unfortunately, some of the negative messages about condoms inadvertently came from public health experts themselves, whether they were promoting emergency contraception with ads that said “oops, the condom broke”; encouraging the development of new condoms with articles suggesting that current condoms are no fun; or focusing on teen pregnancy and the use of highly effective contraceptive methods such as long-acting reversible contraceptives (LARC). The end result is that condoms have been undersold to today’s teenagers.

We have to turn these condom trends around, because despite the decreases in sexual activity, young people continue to contract STIs at an alarming rate. In 2014, for example, there were nearly 950,000 reported cases of chlamydia among young people ages 15 to 24. In fact, young people in this age group represented 66 percent of all reported chlamydia cases. Similarly, in 2014, young women ages 15 to 19 had the second-highest rate of gonorrhea infection of any age group (400 cases per 100,000 women in the age group), exceeded only by those 20 to 24 (489 cases per 100,000 women).

While we can be pleased that fewer young people are having sex right now, we can’t fool ourselves into believing that this is enough or that our prevention messages are truly working. We should certainly praise teens for taking fewer risks and use this survey as a reminder that teens can and do make good decisions. But while we’re shaking a young person’s hand, we should be slipping a condom into it. Because someday soon (before high school ends, for more than half of them), that teenager will have sex—and when they do, they need to protect themselves from both pregnancy and STIs.