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Revealing sexual thoughts or behaviors to the parent that might elicit criticism or punishment. In fact, sex education and parent-child communication about sexuality are associated with delayed sexual activity and more consistent contraceptive use. Parents tend to exclude positive topics associated with sexuality, such as pleasure, love, and healthy relationships, in favor of negative topics and warnings. These conversations lacking positive topics associated with sexuality, pregnancy, sexually transmitted infections STIs , and abuse and exploitation. Parental guidance is needed as adolescents develop, but parents need to have accurate and complete information from medically accurate resources to share with their teens. The purpose of this article is to provide an overview of the best practices, specific tips, and resources that health care providers can use to empower parents. This article is an overview of currently understood best practices related to talking to adolescents about sexuality within the context of contemporary knowledge and broad cultural norms. For the sake of brevity, the authors describe the best practices in relation to major topics in sexuality. Some parents and teens may have discussed sexuality in the past but have not done so recently. An absence of conversation may be an indicator that it is time for parents to check in with their teen.
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Editor's note: This interview contains a homophobic slur. Author Peggy Orenstein knows that talking to your son about sex isn't easy: "I know for a lot of parents, you would rather poke yourself in the eye with a fork than speak directly to your son about sex — and probably he would rather poke himself in the eye with a fork as well," she says. But we don't have "the luxury" to continue avoiding this conversation, she says. Orenstein spent 25 years chronicling the lives of adolescent and teen girls and never really expected to focus on boys. Orenstein notes that society doesn't often give boys "permission or space" to discuss their interior lives. Maybe that's why the young men she spoke to were so eager to open up: "When they had the chance [to talk], when somebody really gave it to them and wasn't going to be judgmental about what they had to say, they went for it. Orenstein says the boys she spoke with felt constrained by traditional notions of masculinity. One interviewee confided that he preferred to partner with girls for school projects because, "It was OK to say you didn't know what you were doing with a girl, and you couldn't do that with a guy. They saw girls as equals and deserving of their place on the playing field and in class and in leadership, and they had female friends. So that had really changed.
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By my third week of college, I was finally embracing the freedom that comes with making new friends. Sure, I loved the old ones, but we'd never had candid conversations about our sexual experiences other than to acknowledge that they existed. College was a clean slate then, a chance to become the type of woman who could talk about lube over lunch. So one day, while my girlfriends and I were at the caf eating away our hangovers, I decided to hit them with what I believed to be my most unpopular sex opinion. I mean, I'll do it. I'm just wondering if it's supposed to suck, or I was met with peels of laughter, shrugs of agreement, and a suggestion: "Maybe you've just been having bad sex. It was entirely possible. I lost my virginity at 15 to a guy with a secret girlfriend she was a secret to me, anyway ; I'd had more sex with my ex-boyfriend post-breakup than while we were together, and it seemed that more bad sex was in my future when my years-long flirtation with another guy ended in a minute flat. With a record like that by 18, it's no wonder I was confused by the contrast between the sex I saw in movies and the sex I actually experienced on the ground not literally.
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References Appendix: Other Studies in Progress. Department of Health and Human Services. The goal of the task order is to develop a working knowledge base about the use of new media such as the Internet, social networking sites, cell phones, online video games, and MP3 players among adolescents and the potential impact on their sexual activity. The literature review presented in this paper has the specific goals of 1 fostering an understanding of the types of new media available to adolescents, outlining both the platforms that adolescents use to access media and the media itself, and 2 illuminating the potential relations between new media and adolescent sexual activity.

Sexual risk behavior among U. Nearly , young women aged years become pregnant in the United States each year, most of them unintentionally, 1 and half of the roughly 19 million new sexually transmitted infections STIs diagnosed each year are among to year-olds. Over the past decade, new research has identified media as having the potential to serve both roles.

But the media landscape is evolving at a startling pace, and a greater diversity of content, new types of media, and new platforms for delivering media are constantly emerging. The number of television channels received in homes has moved from three to well into the three-digits, allowing youth to choose from a much wider variety of programming than in the past. The variety of content available on the Internet is practically limitless and includes what were previously considered "other media," such as music, television, games, and films.

Moreover, content can now be viewed or used on computers, MP3 players, handheld video players, and cell phones, as well as on television sets, regardless of whether it was initially "television" or "Internet" media. This new portability makes it possible to use media in a variety of new settings and, conceivably, throughout the day.

Adolescents are immersing themselves in these and newer media, with social networking sites, cell phones, and instant messaging playing major roles in their everyday lives. Thus, it is critical that researchers begin to systematically study new media and new platforms to determine their influence. Given the emerging evidence linking more traditional media use with initiation of various sexual activities, to the extent that new media contain relevant sexual messages, researchers may find that these media are also linked to developing sexual attitudes and behavior and could affect sexual risk-taking and health in either a positive or negative manner as well.

In this paper, we review the literature linking media use to adolescent sexual attitudes and behavior, focusing primarily on newer media. By "new media," we mean content created and delivered via the Internet, including social networking and other specialized kinds of websites, as well as content delivered on other digital platforms, such as cell phones.

We cover what may be largely unintended effects of exposure to sexual content in these media and review new-media interventions designed to improve adolescent sexual health. Our goal is both to clarify what is already known and to identify where there is the strongest need for further study in this rapidly changing area of adolescent life. We begin with a brief description of the state of adolescent sexual health in the United States. Then, we discuss some of the more prominent theories of media effects on youth, including those that are a particularly good fit with the characteristics of newer media, such as content creation, sharing, and portability.

In the same section, we briefly describe the empirical evidence regarding the relationship between traditional media and adolescent sexual attitudes and behavior. We then discuss what is known about the use of new media among youth: what is used, how often, by whom, and less often for what purpose.

The data show that, as one would expect with newer content and platforms, this is a rapidly shifting landscape. Nonetheless, in that section, we attempt to identify emerging trends and point to media that will play an important role in adolescent lives in the next few years. After that, in a section that makes up the bulk of this paper, we present a detailed review of the small but increasing body of research examining new media content and new media effects as they relate to adolescent sexual health. We focus on associations between the use of content and adolescent outcomes that are unintended by content creators and distributors, or at least not meant as programmatic interventions to improve sexual health.

A subsequent section reviews the latter. Most of the programs that we describe have been evaluated, but because this area is so new, we also include in the appendix an overview of several programs that are planning evaluations that are not yet complete. Finally, we conclude with a discussion of what is known about new media and adolescent sexual health and where there are particularly important gaps in knowledge that suggest priorities for future efforts in this arena.

Sexual intercourse is the most commonly studied form of adolescent sexual behavior, and there is a substantial literature on the determinants of initiation of coitus. For example, studies show the influence of perceived parental 12 and peer 13 norms on adolescent sexual activity and risk-taking. These rates compare to 42 percent among white males and females, who do not differ from each other in terms of the percent who have ever had sex.

Possible explanations of gender differences include the differential consequences of unintended pregnancies and the opportunity costs of sexual activity, as well as differences in parental supervision. Early intercourse appears to be part of a cluster of adolescent problem behaviors.

It correlates with substance use, truancy, and aggression and is also well predicted by indicators of behavioral deviance. But early intercourse initiation poses special risks, with an increase in the odds of both pregnancy and STIs when it occurs at a younger age. As noted at the outset of this paper, rates of pregnancy and STIs are high among U. In comparison to the study of intercourse, researchers have paid little attention to other forms of sexual behavior.

However, carefully conducted surveys of a Los Angeles County high school and a nationally representative group of adolescent males aged years indicate that substantial proportions of adolescents who have not engaged in vaginal intercourse have engaged in other sexual activity involving genital contact, such as mutual masturbation and oral sex.

Many of the factors that predict intercourse initiation also predict these risk behaviors. As noted earlier, nearly , young women aged years become pregnant in the United States each year. Twenty-four percent tested positive for at least one of these infections, and among those who were sexually experienced, the prevalence rate was Among sexually active adolescents in this age group, only 63 percent report that they or their partner used a condom the last time they had sexual intercourse.

The challenge to promoting sexual health in the United States has been to identify addressable risk factors for adolescent intercourse, sex outside of a monogamous ongoing relationship, and unprotected sex that will have maximum impact on a large number of youth. Given its broad reach and the potential to control exposure, media may be one such modifiable risk factor.

For the same reasons, media may also represent a particularly useful tool when employed as part of a sexual health intervention. Both possibilities depend, of course, on whether media use is related to sexual attitudes and behavior. In the next section, we review theories and evidence bearing on this question. According to most theories of media effects, the influence of media depends largely on the content it contains.

Television viewing remains the most common medium and platform, and it makes up the largest chunk of adolescents' media use, accounting for 4. A state-of-the-art content analysis of 1, programs representative of the content airing between 6 a. Mountain Standard Time on 10 channels in the television season found that 70 percent of programs contained sexual content. Among those with such content, there were an average of five scenes with sex in each hour of programming.

However, adolescents use a variety of media32 and increasingly engage with these media on diverse platforms. Looking at television, music, movies, favorite Internet sites, and magazines used by a sample of black and white youth from the Southeastern United States, Pardun and colleagues 34 found that, overall, 11 percent of these media contain sexual content. However, the content is concentrated much more strongly in music 40 percent contained sexual content than in movies 12 percent or television 11 percent.

And only 6 percent of the Internet sites they examined contained sexual content. Other studies might produce different estimates for a given medium. The analysis did not look at a representative sample of each medium, but, rather, focused on the "vehicles" television programs, music artists used by a particular sample of youth.

However, it does provide a rare comparison of multiple media types using the same coding scheme and metric time presented. The wide variability in sexual content across types suggests the importance of understanding the extent and nature of sexual portrayals in newer media as well. While all theories of media effects emphasize the importance of content, they make differing claims about which aspects of content are important to measure.

Social learning theory and its close relation, social cognitive theory, 35 argue that screen-media exposure leads to the cognitive acquisition of behaviors along with their expected social, emotional, and cognitive consequences.

Exposure to portrayals suggesting that a behavior sex will lead to social disapproval or other negative outcomes e. Thus, the content portrayed sexual or not and the specific nature of the content consequences of sex are critical to measure if one wishes to accurately predict subsequent beliefs and behavior.

One of the findings from a RAND study linking television exposure to sexual behavior is illustrative. Overall, teenagers viewing more television sexual content at the time of a baseline survey had a greater likelihood of intercourse initiation and initiation of new noncoital behaviors by one year follow-up relative to those who viewed less.

The Integrative Model of Behavior Change 37 builds on social cognitive theory and integrates it with other theories, such as the Theory of Reasoned Action, 38 to predict that media exposure will influence behavior through shifts in behavioral intentions, which are themselves a function of attitudes, norms, and perceptions of self-efficacy acquired through media and other sources.

Thus, media users learn not only what is likely to be the outcome of sexual activity, but also whether others engage in it or approve of it, and come to see themselves as more or less able to engage in similar activities themselves.

The RAND study 39 also looked at these issues, finding that the relationship between exposure to sexual content on television and intercourse initiation could be explained in whole by shifts in viewers' perceptions of themselves and their ability to negotiate sexual situations safe sex self-efficacy , their perceptions of peer norms regarding sexual activity, and their beliefs about the consequences of engaging in intercourse.

This strongly supports the integrative model's predictions. Closely related to social cognitive theory are script theories of media use. Individuals not only learn whether a behavior is common and whether it will result in positive outcomes, but they are also presented with a series of ordered events describing how and when it is appropriate to enact the behavior i.

These scripts are not always used, but when events or circumstances in the environment trigger them for example, a first date or an unexpected kiss , they may be acted out. Aubrey and colleagues 41 have applied this theory to sexual media, demonstrating correlations between television use and college-aged females' and males' expectations regarding timing and variety of sexual activities respectively.

Others have used script theory to explain the effects of exposure to sexually objectifying portrayals and portrayals of sex as a game, arguing that these lead to the acting out of roles in which boys pursue sex and girls use it as leverage.

Other theories may better predict the effects of new media, which offer a greater opportunity to select the content one prefers and allow the user to create and distribute, as well as receive, content. Furthermore, such content is often discussed and exchanged within social networks. The Media Practice Model 45 argues that media use is selective, with users focusing on content related to the predominant issues of interest to them. Thus, adolescents whose interest in sex is growing as a result of puberty and other forces are more likely to select media with sexual content.

Three studies have confirmed such a relationship empirically. Selective use of media in a social context may also set up the conditions for the "downward spiral" theorized by Slater and colleagues in relation to media violence. This creates homogeneity in user preferences and characteristics, likely to lead to social reinforcement of the messages portrayed.

That is, youth who are becoming interested in sex may encounter other sexually interested youth when they view sexual media online. And these youth are likely to express approval of sexual messages and portrayals. Thus, one might expect greater impact on users in this venue, compared to the same portrayal watched on a television set, particularly if viewers report chatting on the site, engaging in instant messaging, or sharing links with friends. New media are often viewed via portable platforms, such as cell phones and MP3 devices.

As such, there is opportunity for increased exposure, as well as more private exposure. Roberts et al. This is consistent with theories of "parental mediation" of media messages: Parents and other adults can greatly alter the impact of messages when they discuss them with youth.

In a report on young people's media use, the Kaiser Family Foundation found that a total of 10 hours and 45 minutes of exposure are packed into 7. That is, about 30 percent of adolescents' media time is spent using more than one medium simultaneously.

This phenomenon seemed to have been enabled partly by the portability of media, which can now be viewed and used on laptops, cell phones, and other devices that youth carry throughout the day. How might this influence media effects? Message processing theory might predict that multitasking distracts users from sexual information and thus reduces the effects of media exposure. Indeed, Jordan and colleagues 51 found that youth who did homework or other household tasks while using media were less affected by media content.

In contrast, Collins 52 found that exposure to sexual content on television was more strongly related to sexual initiation among those who reported using the Internet at the same time that they watched television. It is possible that the resolution to these conflicting findings lies in what youth are doing when they are online.



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