This study examines the prevalence of vaginal, oral, and anal inter-course among a population of urban, public middle school students, the characteristics of early sexual initiators, and the sequence of sexual initiation. Such data are limited for early adolescents. A total of seventh-grade students Overall, A small percentage of early adolescents are engaging in multiple sexual behaviors. These findings have implications for early adolescent school-based sexual health education.
Although adolescent pregnancy rates have declined steadily in the United States over the past decade, adolescent births and sexually transmitted infections STIs remain serious public health issues. In , births to mothers aged years increased for the first time since the early s. Early sexual initiation has been associated with an increased risk of pregnancy and STI. In order to develop effective pregnancy and STI prevention efforts for early adolescents aged years , it is important to understand the prevalence of vaginal, oral, and anal intercourse in this age-group and the characteristics of early initiators.
However, public sensitivity regarding sexual behavior surveys among early adolescents, particularly in public school settings, has impeded this research.
Active parental consent is typically required, and parents and school administrators may be reluctant to expose students to explicit questions regarding sexual behavior, particularly those regarding oral and anal sex. Of those students, between 3. Previous studies among older adolescents report contrasting findings regarding the sequence of sexual initiation. Several studies among 9th- and 10th-grade students indicate earlier initiation of oral sex compared to vaginal sex.
Given this lack of detailed information, further epidemiological studies examining sexual behavior among middle school youth are needed to help prioritize effective sexual health education efforts.
The goals of the present study were to 1 examine the prevalence of vaginal, oral, and anal intercourse among a population of urban, public middle school seventh-grade students; 2 to examine the demographic characteristics of those youth who engaged in each type of sexual intercourse, and 3 to examine the sequence of initiation of the 3 types of sexual intercourse.
This information may help to prioritize needs for middle school sexual health education to prevent or mitigate the consequences of early sexual initiation among potentially high-risk youth populations. A total of eighty-nine percent of students were eligible for free or reduced-price lunches, an indicator of low socioeconomic status.
Parental consents were returned by Students classified by the school as learning disabled or as having limited English proficiency ie, had their primary instruction in Spanish were excluded from the study sample, leaving youth eligible for participation. Reasons for nonparticipation included being absent on survey dates or refusal to participate. Data were collected between November and January ; student consent was obtained at the time of the survey. The survey contained multiple items addressing precoital behavior, sexual intercourse, and demographic characteristics.
To mitigate concerns from parents and school personnel regarding exposure of nonsexually experienced seventh-grade students to explicit questions regarding vaginal, oral, and anal sex, 2 precoital items were used to identify and screen for nonsexually experienced youth.
Thus, the precoital items appeared to provide a valid and reliable strategy for avoiding overexposure to sensitive content in this age-group while collecting important information from those youth who were sexually experienced. Only students who indicated participation in 1 or both of these precoital behaviors received items regarding sexual intercourse.
For vaginal and anal sex, students who reported being currently sexually active were also asked about the frequency of intercourse without a condom during the past 3 months. Unfortunately, due to the need to limit the number of items, questions regarding condom use during oral sex were not included. Age was dichotomized as 12 years versus years since the majority of students were 12 years old. Family structure was collapsed into 4 categories: living with 2 biological parents, living with 1 biological parent, living with 1 biological parent and a stepparent or partner, and other which included living with another relative or nonrelative.
Surveys were administered on laptop computers via audio computer-assisted self-interview ACASI during regular school hours. Surveys were conducted in a quiet location such as an empty classroom or library. The use of ACASI systems has been found to be a valid and reliable method for obtaining sensitive information, including sexual risk-taking behavior, as it appears to increase the honesty of reporting over pencil-paper surveys.
It also allowed for an automatic skipping procedure to limit exposure of nonsexually experienced students to sexually explicit items. Prior to analysis, 5 students were removed from the data set due to missing data regarding lifetime intercourse, and 23 students were removed due to small counts for a specific age ages 11, 15, and 16 leaving a total sample of for analysis.
Prevalence estimates of condom use for vaginal and anal sex were computed only for students who were currently sexually active ie, reported having sex in the past 3 months. Multivariate logistic regression analysis was used to examine associations between demographic variables and lifetime intercourse experience.
Among students who had initiated more than 1 type of intercourse, frequencies were calculated to examine the relative age of initiation for each type of sex ie, whether a specific type of sex was initiated at a younger age, the same age, or an older age relative to the other type of intercourse.
Of seventh graders who participated in the study, Prevalence of sexual intercourse is reported in Table 2. Overall, 1 of 7 students Twelve percent of students reported engaging in vaginal intercourse, 7. Among students who were sexually experienced, approximately one quarter reported having 4 or more lifetime sexual partners and approx-imately two thirds reported being currently sexually active ie, they had sex within the past 3 months.
Among students who were currently sexually active, approximately one third reported having had vaginal or anal sex without a condom at least once during the past 3 months. Several differences were reported by gender. Significantly higher percentages of males reported initiation of vaginal, oral, and anal sex. Significantly more males reported initiating vaginal and anal sex before age 11 compared to females. No significant gender differences were reported regarding current sexual activity or condom use.
In other words, among youth who were sexually experienced, Hispanic youth were more likely to be currently sexually active regardless of type of intercourse. With regard to condom use, a greater percentage of Hispanic youth reported having vaginal sex without a condom during the past 3 months compared to their peers. Age was significantly related to initiation of vaginal sex, with higher percentages of to year-olds reporting lifetime engagement compared to year-olds. No significant differences were reported by age in terms of age of sexual debut, current sexual activity, lifetime number of sexual partners, and condom use.
Adjusted odds ratios presented in Table 3 indicate that male and black students were significantly more likely to report having engaged in each type of intercourse compared to female and Hispanic students, respectively. Older students years indicated increased likelihood of engaging in vaginal intercourse.
Students living in nontraditional family structures were almost times more likely to have engaged in vaginal and oral intercourse compared to students living in a 2-biological parent household. Among students who had engaged in more than 1 type of intercourse, vaginal intercourse was the most frequently reported type of sex.
Regarding the sequence of initiation, among students who reported engaging in both vaginal and oral sex, 66 Among students who reported engaging in both vaginal and anal sex, 57 This study was conducted to examine patterns of sexual intercourse among seventh-grade students in an urban public middle school. One of 7 students This estimate is similar to the median percentage For all types of intercourse, students who were sexually experienced were more likely to be male and black, corroborating findings from previous studies.
Similar findings are observed for youth who experience peer victimization in their schools. In this study, vaginal intercourse was the most prevalent type of sexual intercourse reported. Most students who had engaged in both oral and vaginal intercourse, or anal and vaginal intercourse, reported initiating vaginal intercourse either at an earlier age or at the same age.
These results corroborate findings from the NSFG among to year-olds, which indicate that youth who have experienced vaginal sex are more likely to initiate other types of intercourse. Nearly as many students had engaged in anal inter-course 6. Furthermore, Although lifetime experience of anal intercourse was greater among blacks, recent anal activity was greater among Hispanic youth, which contrasts with data from older adolescents.
Approximately two thirds of students who reported being sexually experienced also reported being currently sexually active, that is, they had engaged in sex 1 or more times in the past 3 months. This underscores the need to provide youth with reasons and skills to delay further sexual activity once they become sexually experienced. Among students who were currently sexually active, approximately one third reported having had vaginal or anal sex without a condom at least once in the past 3 months. This emphasizes the need to provide accurate information about condoms for contraceptive and disease prevention purposes.
In addition, students who have been sexually active need to receive information and services related to STI and pregnancy testing, as well as skills training for future abstention or risk reduction if they intend to remain sexually active.
Several aspects of the conduct of this study were important for obtaining approval from parents and school district personnel. Use of ACASI for questionnaire delivery was important for maintaining confidentiality of data and inclusion of precoital screening questions limited exposure of sexually inexperienced students to more explicit questions.
However, several limitations must be also noted with respect to these findings. First, the data were self-reported, which may raise concerns regarding reliability and validity. While use of ACASI has been demonstrated to increase reliability over other types of survey administration, 28 , 29 the data may still reflect under- or overreporting.
However, this potential underreporting would result in more conservative prevalence estimates of sexual intercourse than overestimates, and the methodology still provided important information not otherwise available. Active parental consent was required for this study, which led to a lower response rate than desired. Our response rate is similar, however, to other school-based studies, which have used active parental consent.
The result is that the prevalence estimates in our study would be underestimated. Finally, all schools were recruited from a single school district, which limits external generalization to other urban middle school youth. These findings indicate that a small percentage of early adolescents are engaging in multiple sexual risk behaviors. Effective, culturally sensitive school-based HIV, STI, and pregnancy prevention programs are needed at the middle school level to help reduce problems related to early sexual activity.
Furthermore, open discussion of the risks involved in all types of sexual intercourse by school nurses and health educators is recommended with this age group despite sensitivities surrounding sexual health issues. National Center for Biotechnology Information , U. J Sch Health. Author manuscript; available in PMC Feb Christine M. Addy , MA, c Elizabeth R. Baumler , PhD, d and Susan R. Tortolero , PhD e. Markham a Assistant Professor, ude. Melissa Fleschler Peskin b Assistant Professor, ude.
Robert C. Addy c Data Analyst, ude.