There exists a strong association between an active sexually transmitted disease and the HIV virus:

The epidemiologic evidence has suggested that a substantial
proportion of adolescents engage in high-risk behavior
associated with the acquisition and transmission of STDs. . .
As recent evidence has indicated that having an active STD
is strongly associated with an increased risk of HIV infection,
this age group appears to be at considerable risk.19

There is little data assessing adolescents' knowledge of AIDS and risk of HIV infection. These findings suggest that a large number of teens who are aware that sexual activity increases the risk of contracting AIDS are not changing their behavior accordingly.20

In short, the research on AIDS prevention programs targeted at teens shows that these programs must be comprehensive in nature i.e., carefully examine the causes of the behavior including the psychological, social, maturational as well as cultural determinants of the behaviors that put teens at risk for HIV. This approach goes beyond the provisions of contraceptive services which is the primary focus of current intervention efforts.21

CHARACTERISTICS OF TEENS WHO ABSTAIN

The most important predictor of sexual activity is the stability of the family.22 Family structure is an important factor in

19

DiClemente, Ralph J., "The Emergence of Adolescents as a Risk Group for Human Immunodeficiency Virus Infection," Journal of Adolescent Research, January 1990, P. 11.

20 ibid.

21 Lyons, John F., Ph.D., "School-Based Health Clinics," Children's Voice, Winter 1992, p. 19.

22 Stiffman, Arlene R., Earls, Felton, Robins, Lee N., Jung, Kenneth G., and Kulbok, Pamela, "Adolescent Sexual Activity and Pregnancy: Socioenvironmental Problems, Physical Health, and Mental Health," Journal of Youth and Adolescence, October 1987.

learning self-restraint. The data indicate that the environment in which a child grows i.e., family, school, community and peers, is an important predictor in the onset of risky behavior:

The protective role of supportive environments during
adolescence must be acknowledged and may be critical in
developing prevention and intervention programs. Family and
peer factors are crucial, with parental behavior and style being
important correlates of onset. Increased parental involvement
appears to prevent the onset of risk behaviors and mitigates
the most negative outcomes of risk behavior.23

The evidence is overwhelming that teenagers who say "No" are healthier physically as well as mentally. As reported in the Journal of Youth and Adolescence, "sexually inactive youths have the lowest rates of mental health problems.'

"24

Our findings here indicate that a truly comprehensive approach to teens and AIDS in America must include support for teens who say "No", as well as a much more in-depth research assessment of those who abstain. There is much to learn from this approach.

Clearly, there is a relationship between sexual activity and the values teens hold. Teens who hold traditional values are more likely to abstain from sexual activity. In a 1990 study reported in Family Planning Perspectives:

Bivariate analysis revealed that religious attendance and
importance of belief were strongly correlated with adolescent
sexuality: Those who attended religious services frequently
and considered religion important in their lives also had more
restrictive attitudes toward premarital sex and reported less
sexual experience.

Both the mothers' attitudes toward premarital sex and the
teenagers' religious attendance had statistically significant

23

Irwin, Charles E., Jr., M.D., "The Theoretical Concept of At-Risk Adolescents," Adolescent Medicine: State of the Art Reviews, February 1990, p. 10.

effects on the adolescents' sexual attitudes and behavior.2
.25

Findings published by the Department of Health and Human Services in 1991 are consistent with the above study:

Women aged 15 through 19 are more likely to be sexually
active if they are not regular church attenders and if they
report that religion is not very important to them.2

26

Discipline, or the values that parents transmit to their children appear to modify the behavior of teens when it comes to sexual activity:

Adolescents who report their discipline received at home as
"not strict at all" are more than twice as likely to participate
in nonmarital intercourse than adolescents who report a
moderate amount of strictness and rules.27

THE STRONGEST MOTIVATION FOR TEENAGE SEXUAL ACTIVITY IS EMOTIONAL NOT PHYSICAL

Recent research, reported by the Journal of Adolescent Health Care, states that:

Teenagers have many motivations for wanting to be sexually
active ranging from psychosocial needs (acceptance, love, peer
pressure) to simple curiosity and experimentation. Recent
research has identified the need to achieve maturity and
acceptance through parenthood as a motivation for sexual
activity among low-income black girls. In general, however,
the strongest motivation for adolescent sexuality is the
emotional and psychological need to love and be loved...
Often, the physical enjoyment of sex is not an important

25 Remez, L., "Adolescents' Attitudes Toward Premarital Sex Affect Religious Activity," Family Planning Perspectives, January/February 1990, p. 42.

26,

Healthy People 2000: National Health Promotion and Disease Prevention Objectives, U.S. Department of Health and Human Services, Public Health Service, 1991, p. 194.

27 ibid.

motivation, particularly among young adolescents.

28

What this research says then is that in meeting the needs of teenagers we will miss our mark if we respond to teenage sexual activity as if nothing else but hormones were driving this behavior.

In a classic work by Professor Armand Nicholi, of Harvard, writing in the American Journal of Psychiatry, referring to the college students he interviewed, he states:

They described their sexual relationships as less than
satisfactory and as contributing little to providing the
emotional closeness they desired. They expressed a profound
loneliness and a "sense of not belonging." Their sexual
behavior by and large appeared to be a desperate attempt to
overcome this loneliness.29

This finding was confirmed in the Journal of the Ohio State Medical Association:

We need to help them develop a sense of awareness, to show
them they can express their new sexuality in ways other than
becoming sexually active -- to let them know they are allowed
to say "No."

n30

Teenagers may behave in a manner that is inconsistent with their own beliefs. In a recent study reported in the American Journal of Preventive Medicine:

Based on results from self-administered questionnaires from
3,500 juniors and seniors at four inner-city high schools, 83%
of sexually experienced adolescents said that the best age to

28 O'Reilly, Kevin R., and Aral, Sevgi O., "Adolescence and Sexual Behavior, Trends and Implications for STD," Journal of Adolescent Health Care, July 1985, p. 267-268.

29 Nicholi, Armand M., "A New Dimension of the Youth Culture," American Journal of Psychiatry, April 1974, p. 397.

30 Porter, Susan, "Sexuality and Pregnancy: A Change in Values," Ohio Medicine,

Journal of the Ohio State Medical Association, March 1987, p. 157.

initiate intercourse is older than their age at initiation, and
approximately 25% of both sexes who have had intercourse
said they believed that sex before marriage is wrong.

31

One interpretation of this finding clearly is that to resolve the inconsistency between behavior and belief structure we need to send teens very clear messages promoting moral conduct. Gary Bauer, president of the Family Research Council, expressed it well:

American society has reached the point at which it must
choose between two fundamentally opposed solutions to the
problem of adolescent sex. We must either make a massive,
and open-ended, commitment of public resources to deal with
the consequences of promiscuity (including illegitimacy,
abortion, venereal diseases, AIDS, teen suicide); or we must
explain to the young, for their own good, one clear standard
of conduct which tells them how to grow up.

32

In a study reported in Family Planning Perspectives (1990), more than 1,000 sexually active girls, aged 16 and younger, were asked what topic they wanted more information on and 84% checked the item "how to say no without hurting the other person's feelings.

133

Peer pressure is a consistent finding in the literature as to why teens are engaging in reckless behavior:

Teenagers report that social pressure is the chief reason why
their peers do not wait until they are older to have sexual

31, Fielding, Jonathan E., M.D., M.P.H., and Williams, Carolyn A., Ph.D, RN "Adolescent Pregnancy in the United States: A Review and Recommendations for Clinicians and Research Needs," American Journal of Preventive Medicine, Vol. 7, Number 1, 1991, p. 48.

32 Bauer, Gary L. The Family: Preserving America's Future, A Report to the

President from the White House Working Group on the Family, December 1986, p. 27.

33 Howard, Marion, and McCabe, Judith B., "Helping Teenagers Postpone Sexual Involvement," Family Planning Perspectives, January/February 1990, p. 22.