Sexual activity and contraceptive practices among teenagers in the United States, 1988 and 1995.

OBJECTIVES: This report presents national estimates of sexual experience, contraceptive use, and selected aspects of sexual behavior among never-married males and females aged 15-19 years in the United States. Data are presented for the years 1988 and 1995 according to age, race and Hispanic origin, progress in school, and other relevant characteristics. Tables present trends over time as well as comparisons between subgroups. METHODS: Descriptive tables of numbers and percents are presented and interpreted. Data for females are from the National Survey of Family Growth, and data for males are from the National Survey of Adolescent Males. RESULTS: About half of all never-married teenagers, about 17.5 million, had had sexual intercourse at least once in 1995. For male teenagers, this represents a decline since 1988, and for females, the proportion was stable across the two time points. The proportion of teen females who had sex before age 15 years increased. In 1995, 29 percent of females and 19 percent of males had unprotected recent sexual intercourse. About one-quarter of teens used no contraceptives during their first sexual intercourse. The condom remained the most popular method of contraception. Although teenagers' use of oral contraceptives dropped between 1988 and 1995, use of injectable and implant contraceptives began. Teenagers with more highly educated mothers, mothers who delayed their first birth beyond age 19 years, those from two-parent families, and those whose schooling was on schedule, were less likely to engage in sexual risk behaviors. These teenagers, along with those who were Protestant, also experienced the largest improvements across time in sexual risk behaviors.

Heterosexual genital sexual activity among adolescent males: 1988 and 1995.

CONTEXT: Researchers have paid little attention to adolescents' experience with genital sexual activity other than vaginal intercourse, even though oral and anal intercourse expose youth to the risk of sexually transmitted diseases. METHODS: Males aged 15-19 interviewed in 1988 and 1995 as part of the National Survey of Adolescent Males were asked questions about whether they had ever engaged in a series of genital sexual activities. These data were collected in a self-administered questionnaire that respondents completed at the end of the interview. RESULTS: In 1995, 55% of males aged 15-19 reported that they had ever engaged in vaginal intercourse, 53% that they had ever been masturbated by a female, 49% that they had ever received oral sex, 39% that they had ever given oral sex and 11% that they had ever engaged in anal sex. More than three-quarters of males who had had vaginal intercourse reported experience with masturbation or oral sex by a female. Moreover, one in five males who had never had vaginal intercourse reported having been masturbated by a female, and one in seven said they had received oral sex. Between 1988 and 1995, the proportion of males who reported having ever been masturbated by a female increased significantly, from 40% to 53%. There were less sizable shifts in the proportions who had received oral sex: Overall proportions were similar in both years, although levels more than doubled among black teenagers, an increase that brings them in line with levels of oral sex reported by white and Hispanic adolescent males in 1995. CONCLUSIONS: Evidence from the National Survey of Adolescent Males showing that a substantial share of male teenagers engage in genital sexual activity beyond vaginal sexual intercourse underlines the importance of monitoring a broad spectrum of sexual behaviors among teenagers. More detailed data with larger samples of both males and females are needed to determine the frequency and timing of these behaviors. Measuring risk for STD infections among teenagers requires attention to all forms of genital sexual activity.

Understanding changes in sexual activity among young metropolitan men: 1979-1995.

CONTEXT: Changes in the sexual behavior of teenagers can have a significant impact on levels of adolescent pregnancy and transmission of sexually transmitted diseases (STDs). Understanding the role played by attitudes and educational efforts will provide critical prevention information. METHODS: Data on the sexual behavior, sexual attitudes, educational experiences and demographics of 2,087 never-married metropolitan males aged 17-19 from the 1979 National Survey of Young Men and the 1988 and 1995 waves of the National Survey of Adolescent Males were analyzed through multivariate methods to examine factors that predict sexual behavior as well as those that predict sexual attitudes. RESULTS: The percentage of males aged 17-19 who had ever had sex increased from 66% in 1979 to 76% in 1988 and then decreased to 68% in 1995. The frequency of sexual intercourse in the year prior to the survey increased significantly over time, although the lifetime number of sexual partners did not. Acceptance of premarital sex increased significantly from 1979 to 1988, then decreased significantly from 1988 to 1995. Over time, young men were increasingly likely to prefer having and supporting a baby to marriage, abortion or adoption as the resolution to a nonmarital pregnancy. Trends in attitudes were strongly associated with sexual behaviors, with more conservative attitudes predicting less sexual activity. AIDS education, which was nearly universal in 1995, was associated with decreased sexual activity, although not among black youths. CONCLUSIONS: More conservative sexual attitudes and increased exposure to AIDS education are key predictors of decreased sexual activity among adolescent males. However, broader societal factors, such as fear of AIDS and increased awareness of problems associated with teenage pregnancy and STDs, may underlie both attitudinal and behavioral changes.

PIP: This study examined how attitudes about sex behavior and exposure to AIDS education have affected premarital sexual behavior among urban teenage (Black and non-Black) males aged 17-19 years in 1979, 1988, and 1995 in the US. Data were obtained from a 1979 National Survey of Young Men and the 1988 and 1995 National Surveys of Adolescent Males. The weighted pooled data set included 2087 never-married males aged 17-19 years. The percentage of those who had experienced sexual intercourse (SI) rose from 66% to 76% and then declined to 68% in 1995. For Black male youths, SI rates remained stable after 1988. The percentage with recent SI in the 4 weeks before the survey rose from 40% to 45% in 1979 and 1988, and then declined to 39% in 1995. The average number of female sexual partners (FSPs) was 4. The average number of FSPs declined among non-Blacks--from 3.8 in 1979 to 2.9 in 1995--and increased among Blacks--from 5.1 in 1979 to 6.9 in 1995. SI frequency during the prior year rose significantly from 14 encounters/year in 1979 to 21 in 1995. Among Black adolescents, SI frequency rose from 13 encounters/year in 1988 to 24 in 1995. Approval of nonmarital sex without an intention to marry followed similar increases and declines as for SI. Attitudes about premarital sex were strongly correlated with recent sexual activity. Teenagers who had received education about STDs or AIDS were significantly less likely to report having had recent SI. Birth control education and race were unrelated to sex behavior. Blacks were more supportive of marriage for nonmarital pregnancy in 1979. Black attitudes toward premarital sex grew more conservative. Less sexual activity is attributed, in part, to prevalence of AIDS education (except for Blacks) and more conservative attitudes, with unknown other factors.

Changes in sexual behavior and condom use among teenaged males: 1988 to 1995.

OBJECTIVES: This study examines shifts in sexual experience and condom use among US teenaged males. METHODS: Results from the 1988 and 1995 National Surveys of Adolescent Males were compared. RESULTS: The proportion of never-married 15- to 19-year-old males who had had sex with a female declined from 60% to 55% (P = .06). The share of those sexually active using a condom at last intercourse rose from 57% to 67% (P < .01). Overall, the proportion of males who had sex without condoms last year declined from 37% to 27% (P < .001). CONCLUSIONS: Although protective behaviors among teenagers have increased, significant proportions of teenagers--especially Black and Hispanic males--remain unprotected.

Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology.

Surveys of risk behaviors have been hobbled by their reliance on respondents to report accurately about engaging in behaviors that are highly sensitive and may be illegal. An audio computer-assisted self-interviewing (audio-CASI) technology for measuring those behaviors was tested with 1690 respondents in the 1995 National Survey of Adolescent Males. The respondents were randomly assigned to answer questions using either audio-CASI or a more traditional self-administered questionnaire. Estimates of the prevalence of male-male sex, injection drug use, and sexual contact with intravenous drug users were higher by factors of 3 or more when audio-CASI was used. Increased reporting was also found for several other risk behaviors.

Adolescent males' combined use of condoms with partners' use of female contraceptive methods.

OBJECTIVE: Protection from both sexually transmitted diseases and pregnancy is best obtained by the combined use of male condoms and effective female contraceptive methods. This research examines dual contraceptive method use among teenage men. METHOD: Analyzed data from the 1995 National Survey of Adolescent Males, a nationally representative survey of 15 to 19-year-old males. Used bivariate analyses and logistic regression to examine the correlates of combined use of condoms and female methods. RESULTS: At last intercourse, 17% of sexually active males reported use of a condom and a female method of contraception. Condom use, alone and in combination with a female method, was positively associated with talking with the partner about contraception and condoms, believing that males have a responsibility for contraception, and being in an earlier stage of a relationship. Only high levels of worry about sexually transmitted diseases differentially influenced dual method use, increasing the likelihood of using a condom with a female method, but not using condoms alone. CONCLUSIONS: The results suggest that efforts to increase condom use in general should also influence young men's use of condoms when their partner is using a female method. Providing information to young males about the high prevalence and serious consequences of sexually transmitted diseases may increase dual method use among adolescents.

The promise of integrated representative surveys about sexually transmitted diseases and behavior.

BACKGROUND: It has been difficult to conduct representative surveys measuring both sexually transmitted disease prevalence and behavioral data. This article reviews the literature, describes a recent pretest of the feasibility of integrated surveys, and discusses the potential implications. METHODS: Several national surveys are reviewed, including the National Health and Nutrition Examination Surveys, National Health and Social Life Survey, and National Survey of Adolescent Males. The 1994 pretest of the National Survey of Adolescent Males collected urine specimens of male respondents, which were tested for Chlamydia trachomatis using ligase and polymerase chain reaction tests. RESULTS: There have not been any prior national surveys that collect clinical measures of STD infection and detailed behavioral data. In the pretest, 85% of the eligible interview respondents provided a urine specimen. Of those tested, 6% were positive for C. trachomatis. CONCLUSIONS: Combining behavioral surveys with collection of urine specimens for STD testing in representative samples is feasible. However, STD testing adds new operational and ethical challenges to the conduct of household surveys.

Young men's experience with condom breakage.

In a nationally representative sample of men aged 17-22, 23% of those using condoms reported experiencing at least one condom break during the previous 12 months. Of all condoms used, 2.5% had broken. In multivariate analyses, increased experience with condoms reduced the likelihood of experiencing condom breakage. Recent sex education was associated with an almost 80% decrease in the risk of breakage among young men who used condoms infrequently. Young males who had ever had a sexually transmitted disease (STD), or whose sexual partner had had an STD, were almost three times as likely as other respondents to have experienced condom breakage. In addition, young men with a household income of less than $60,000 were 2-3 times as likely to have broken a condom as were those with a higher household income.

PIP: Findings are presented upon the condom breakage experience of 933 sexually active men aged 17-22 years who had used a condom during the 12 months preceding the study survey. Data are drawn from the 1991 follow-up of the National Survey of Adolescent Males. 23% reported experiencing at least one condom break during the previous 12 months and 2.5% of all condoms used had broken. In multivariate analysis, increased experience with condoms reduced the likelihood of experiencing condom breakage, while recent sex education was associated with an almost 80% decrease in the risk of breakage among young men who used condoms infrequently. Young men who had ever had a sexually transmitted disease (STD) or whose sex partner had had a STD were almost three times as likely as other respondents to have experienced condom breakage. Finally, young men with a household income of less than $60,000 were 2-3 times as likely to have broken a condom as were those with a higher household income.

Age differences between minors who give birth and their adult partners.

The role of adult men in adolescent childbearing has received heightened attention in recent years, and a new policy efforts have focused on statutory rape laws as a way to reduce adolescent childbearing. Analyses of the 1988 National Maternal and Infant Health Survey indicate, however, that these policies would not apply to most teenage births. Among mothers aged 15-17 who had a child in 1988, 27% had a partner at least five years older than themselves. In addition, since 23% of minors with older partners were married at the time of the infant's birth, 21% of babies born to unmarried minors were fathered by substantially older men. While births to young mothers and older men raise social concerns, these births make up a small share of all teenage childbearing: Only 8% of all births to 15-19-year-olds are to unmarried minors with a partner five or more years older.

PIP: This study examines the role of older adult men in teenage childbearing in the US. Data were obtained from the 1988-91 National Maternal and Infant Health Survey. The study investigates the role of men at least 5 years older than the adolescent. 34% of the sample were Black, 48% were White or of other race, and 18% were Hispanic. 62% of teenagers aged 15-17 years at delivery did not report their partner's age, while 27% of women aged 18-30 years did so. Findings indicate that 5040 men aged 22-30 years fathered a child in 1988, of which 1.8% had a female partner aged 15-17 years. 27% of mothers aged 15-17 years had a partner 5 or more years older. Many older men fathered children with women in the youngest age group. 40% of girls aged 15 years had a partner at least 20 years of age. Only 8% of all births to 15-19 year olds were to unmarried minors with a partner 5 or more years older. Births to 15-17 year olds comprised about 33% of all teenage childbearing. Having an older partner was not strongly associated with a minor's race or household income. Minors who already had a child were more likely than those with a first birth to have had an older partner. Mothers aged 15-17 years who had used alcohol in the 3 months preceding the pregnancy were nearly twice as likely to have had an older partner than those who did not use alcohol. 23% of young mothers were married at the time of delivery. 21% of births to unmarried minors were fathered by a much older man. 35% of minors with an older partner were cohabiting during the pregnancy, and 49% were cohabiting at the time of the interview that was conducted up to 30 months after the birth. Employment rates prior to the pregnancy were significantly higher among older fathers compared to similarly-aged fathers. Almost 28% of men with a minor partner did not have a high school diploma. A higher percentage of older men with a minor partner were Black and Hispanic.

Reproductive health care delivery. Patterns in a changing market.

Providers of reproductive health services, including clinics and office-based physicians, face new challenges as the American health system progresses toward managed care. Although services for low-income women are often subsidized, the average out-of-pocket payments for reproductive health services are the same for women with incomes below and above 200% of the poverty level. Although many women, especially those classified as low income, use clinics, most say that they would prefer to receive care in a private physician's office and in a place where they can get general health care as well. Multivariate analyses indicate the importance of type of insurance and source of primary health care in affecting a woman's selection of her reproductive health care provider. Specialized providers such as family planning clinics need to consider how they can blend with managed care plans.

PIP: To answer questions about women's experiences with reproductive health care in the US, the 1993 Follow-up of the National Survey of Women was used. Telephone interviews were conducted between February 1 and April 15, 1993. The follow-up rate of those interviewed in 1991 was 65%. Interviews were completed with 1093 women 21-40 years old. In 1993, 80% of women interviewed reported that they had received at least one reproductive health service in the previous year. The most common service received was a gynecologic examination, received by 72% of women interviewed. A third of these women also reported receiving contraceptive services. More than 76% of women reported receiving reproductive care from private physicians, while 15% went to clinics, 7% went to health maintenance organizations (HMOs), and 2% went to other types of health providers. Poor women were much more likely to use clinics and more affluent women to use private physicians. 24% reported that their health insurance covered the full cost of care, and 39% reported that their insurance paid some of the cost for care. Medicaid covered the cost of the visit for 7%, and an additional 7% reported that they had received free care. Women overwhelmingly said that they would prefer to receive birth control and other reproductive health services from private physicians. Only 4% reported that they would prefer HMOs, and 8% said they would prefer clinics. 70% preferred a place that provides general health care, although a substantial minority (28%) preferred a place that provides reproductive health care in addition to birth control. In general, the most important factor affecting where a woman receives her reproductive health services is where she receives her regular primary medical care. The growing trend toward managed care will probably continue to shape women's reproductive health choices. Physicians or clinics that do not or cannot join managed care plans are likely to have diminished access to patients.

Men at family planning clinics: the new patients?

PIP: Using a survey of family planning clinics in the continental United States that received Title X funding conducted by The Urban Institute in 1993, those clinics were identified that had made substantial efforts to serve male clients. The final sample size was 567 clinics. 10% of their clients were men and 31% reported that their male clientele had increased in the previous 5 years. During January through March 1995 follow-up telephone interviews were conducted with 25 selected clinics that reported a 10% male share of clients. The clinics were classified into 5 types: 1) 7 clinics with a family planning focus beginning to provide primary care to attract more men; 2) 7 clinics with a family planning focus using community outreach and the partners of female clients to recruit men for clinic services; 3) 6 primary health care clinics beginning to place more emphasis on male reproductive health; 4) 3 hospital-based clinics providing comprehensive and reproductive health care for young men; and 5) 2 school-based clinics providing sports physicals, primary health care, and reproductive health services. In Type 1 clinics males made up 10-40% of clients. They also screened for testicular cancer, and provided infertility, mental health, and nutrition counseling services. Type 2 clinics had an average of 10% male clients and offered male infertility services, nutrition counseling, and specific STD and HIV services for males in the Hispanic and immigrant communities. Type 3 clinics promoted the male role in family planning decision making and STD prevention. A substantial proportion of the clientele was low-income males, but men who came for vasectomies tended to have higher incomes. Type 4 clinics catered to 20-40% male clients with outreach programs for gay minority men, and sessions on stopping domestic violence, male role in family planning, and responsible parenthood. Type 5 clinics had 40-45% males and provided mental health counseling, HIV risk assessment, and screening for testicular cancer.^ieng

When we use condoms and why we stop.

PIP: A recent follow-up of the 1988 National Survey of Adolescent Men suggests fairly regular patterns of condom use and nonuse. The 1991-92 follow-up survey collected data on 1676 young men who also participated in the first survey round in 1988 when they were 15-19 years old. 59% of the men aged 17-18 used condoms the first time they had sex with a new partner, with 55% reporting using a condom at most recent intercourse. Once they reached 21-22 years old, however, only 45% and 35% reported using condoms at first and most recent intercourse. The prevalence of condom use therefore declined in this sample over the course of a relationship and as young men in the sample grew older. Study findings suggest that condom use does not decline because men lose the habit of using condoms over time, but because the characteristics of partners and the nature of relationships tend to change as men age. More precisely, men spend more time in longer, more committed relationships, in which condom use is more likely to be perceived as unnecessary for disease prevention and more likely to be replaced by the pill for pregnancy prevention. One particularly salient finding is that the men were less likely to report condom use with partners perceived to be at high risk for HIV/AIDS. When asked the main reason for using a condom the last time they had intercourse, 83% of men in the follow-up survey who had used a condom in the previous two years said they did so to prevent pregnancy, 12% did so to prevent diseases, 2% for both reasons, and 3% because of a partner's insistence.^ieng

The dynamics of young men's condom use during and across relationships.

According to data from the 1991 National Survey of Adolescent Males, condom use is likely to be highest at the beginning of relationships and to decline as the relationship continues. The proportion of sexually active men aged 17-22 who used a condom with their most recent partner declined from 53% the first time they had intercourse with that partner to 44% at the most recent episode. Condom use also decreases with age; 59% of 17-18-year-olds used a condom the first time they had intercourse with their most recent partner, compared with 56% of 19-20-year-olds and 46% of 21-22-year-olds. However, the probability that the female partner used the pill the first time that the couple had sex increased with the man's age--from 21% among 17-18-year-olds to 35% among 21-22-year-olds. Young men were more likely to have used a condom if they thought their partner was sexually inexperienced, and less likely to have done so if they suspected their partner was at high risk for an STD.

Factors influencing first intercourse for teenage men.

Analyses of a nationally representative survey of 1,880 15- to 19-year-old men were conducted to examine factors associated with (a) the age when first sexual intercourse occurred and (b) whether a condom or other contraceptive method was used at first intercourse. Discrete time-event history models assessed factors influencing their age until first intercourse. Black males began sexual activity significantly earlier than white or Hispanic males. Males who had been held back in school also began sexual activity earlier. If a respondent's mother had been a teenager when she first gave birth, or if his mother was employed during his childhood, he was more likely to initiate intercourse early. A variety of combinations of AIDS and sex education topics were examined for their association with one's age at the time of first intercourse: two topics were associated with earlier intercourse, and one was associated with delays in first intercourse. Logistic regression models examined correlates of using a condom or any effective male or female method of contraception at first intercourse: having received education about birth control was marginally associated with increased probability of using a condom or any effective male or female contraceptive method at first intercourse. These findings indicate the relevance of integrated approaches to school-based sex and AIDS education in delaying intercourse and promoting use of contraceptive methods.

Young men's risk behaviors for HIV infection and sexually transmitted diseases, 1988 through 1991.

OBJECTIVES: This paper analyzes age- and period-related changes in risk behaviors for human immunodeficiency virus (HIV) infection and sexually transmitted diseases among young men in the United States between 1988 and 1991. METHODS: Data were from the 1988 and 1991 waves of the National Survey of Adolescent Males. The 1988 survey was a nationally representative survey of 1880 males aged 15 through 19 years. The 1991 survey was a longitudinal follow-up of 1676 males aged 17 through 22 years. RESULTS: As they aged, the young men increased their levels of sexual activity and decreased their condom use. Period-related changes between 1988 and 1991 were examined by comparing similar cohorts of 17.5- through 19-year-old men: there were signs that sexual activity and intravenous drug injection increased, but condom use did not change significantly. In 1991 51% of the young men said they were occasionally "high" during sex, a state that is related to reduced condom use. CONCLUSIONS: Early progress in fostering safer behaviors among young men slowed and possibly stopped as the nation entered the 1990s. Prevention efforts need to be renewed and should focus on older youth and young adults.

Changes in adolescent males' use of and attitudes toward condoms, 1988-1991.

Data from more than 1,000 sexually active young males interviewed in 1988 for the National Survey of Adolescent Males at ages 15-19 and reinterviewed in 1990-1991 at ages 17-22 show that as the respondents grew older, their condom use declined. Although respondents' attitudes about the effects of condoms on pregnancy risk, partner appreciation, sexual pleasure and embarrassment became more favorable toward condom use over time, their degree of worry about AIDS and their perceived likelihood of getting AIDS declined. When data on males aged 17.5-19 in each time period were contrasted, the level of condom use was found to be essentially constant. Several condom-related attitudes among this age-group had become more favorable, although their perceived risk of acquiring AIDS had diminished. Multivariate analyses revealed that decreased worry about AIDS and increased denial of the seriousness of AIDS were modestly associated with a decline in condom use. Change in condom use was also affected by change in perceived reduction in sexual pleasure and by female partner's appreciation of condom use.

The association of AIDS education and sex education with sexual behavior and condom use among teenage men.

According to a 1988 nationally representative survey, most 15-19--year-old men in the United States have received formal instruction about AIDS (73%), birth control (79%) and resisting sexual activity (58%). Results of multivariate analyses show the receipt of AIDS education and sex education to be associated with modest but significant decreases in the number of partners and the frequency of intercourse in the year prior to the survey. Having received instruction in these topics was also associated with more consistent condom use. Instruction in some topics was associated with increases in knowledge and attitudes about AIDS, but these increases were not always correlated with safer behavior.

PIP: Multivariate and 1 and 2-limit to bit models were used to analyze data from 1880 noninstitutionalized, never-married men 15-19 years of age included in the US 1988 National Survey of Adolescent Males (NSAM). Cross-sectional data are compared in order to assess the levels of sexual behavior and condom use after AIDS and sex education. Condom consistency rates were calculated. Race, age, urban residence, annual family income, family receipt of welfare within the last 12 months, religious denomination, school attendance, the state incidence of AIDS/100,000 population, and confirmation of mother's teenage pregnancy were used to control for confounding factors. AIDS knowledge and attitudes were also obtained. The 1-limit tobit model was used to analyzed the number of partners and acts of intercourse. Condom use was analyzed with a 2-limit tobit model. The findings were that there has been widespread receipt of AIDS education and sex education in topics on AIDs, birth control biology, and resistance skills, which accounted for 77% of the variance in the 8 topics and were significantly correlated. The receipt of AIDS education was associated with decreases in the number of sexual partners, after controlling for race, age, religion, and other background variables. AIDS education was responsible for 1) a 4% increase in the proportion of students with recent sexual partners (within the past 12 months); 2) a mean reduction of .12 partners among those with recent sex partner; 3) a 7% decrease in the proportion who had never used condoms; recently sex partner; 4) a 9% increase in the proportion using condoms 100% of the time; and a mean increase of 2% among all who ever used a condom. Age, ethnic group, religion, urban residence, and presence of a teenage mother were significant variables in the analysis of AIDS education effects, and the relationship is indicated. In the analysis of other sex education, only AIDS, resistance skills, and birth control were analyzed. Each topic was associated with an increase in condom use (t = 1.91=1.98 at p = .05). In the ordinary least squares analysis, the association between instruction and behavior was not mediated by changes in knowledge or attitudes. No topic affected the perceived risk of infection. Resistance instruction has a strong independent association with fewer sexual partners and acts of intercourse. An integrated and comprehensive approach to HIV education and sex education is suggested. Self-reporting and selection biases are discussed as limitations.

Patterns of HIV risk and preventive behaviors among teenage men.

Analyses of the 1988 National Survey of Adolescent Males indicate the prevalence of risk behaviors related to acquired immunodeficiency syndrome, including sexual, contraceptive, and drug use behaviors, among 15- to 19-year-old men. About three-fifths had sexual intercourse, indicating that a majority of teenage men have at least some potential exposure to the human immunodeficiency virus (HIV) or sexually transmitted disease. From a behavioral perspective, the average sexually active teenage man used a condom more than half the time in the 12 months before the interview. Those with most experience with sexual intercourse, however, used condoms least frequently. More important from an epidemiologic perspective, a third of all acts of intercourse in the prior year were protected using condoms. Further, behaviors with the greatest direct risks for HIV infection, such as homosexual intercourse, use of intravenous drugs, and sex with intravenous drug users or prostitutes, appear to be relatively uncommon. Teenage men who demonstrate high-risk behavior, including both sexual and substance abuse, compound their risks, because risks generally are correlated. Condom use is a preventive behavior that is negatively correlated with most risk behaviors; those who have multiple partners, or who are substance abusers, tend to use condoms least. The convergence of risks for multi-problem teenage men indicates the relevance of interventions directed to high-risk youths.

Levels of sexual activity among adolescent males in the United States.

Although three-fifths of adolescent males aged 15-19 say they have had sexual intercourse, analyses of data from the 1988 National Survey of Adolescent Males indicate that their level of sexual activity is relatively moderate. The data show that among sexually experienced young men the mean number of partners in the last 12 months is 1.9, and the mean frequency of intercourse in the last four weeks is 2.7 times. Black males have had more partners than white or Hispanic males; however, after the number of years since first intercourse are controlled for, these differences disappear. On average, sexually experienced youth spent six out of the last 12 months with no sexual partner, and only 21 percent of sexually active males had more than one partner in any month in the last year. Comparisons with 1979 data suggest that proportionately more adolescents were sexually experienced in 1988, but fewer non-black males had first intercourse before their 15th birthday. The number of partners since first intercourse and in the past four weeks appears to have decreased, as has the frequency of intercourse in the last four weeks.

PIP: Researchers used data on 1880 never married males aged 15-19 years living in the United States collected during the 1988 National Survey of Adolescent Males (NSAM) to gauge heterosexual activity by the number of partners and the frequency of coitus and, when possible, to compare these data with data collected during the 1979 National Survey of Young Men. In 1988, 60% had sexual intercourse at least once, but most of them did not have any partners for 5.87 months and only 21% had 1 relationship at the same time during the last 12 months. 19.8% of young Black males said they had had sexual intercourse by age 13 compared to 2.9 of White males and 3.9 of Hispanic males (p.001). Indeed the cumulative proportion of Black teenagers who had 1st intercourse continued to be significantly greater than those of White and Hispanic teenagers (p.001 for 13-18 years; p.05 for 19 years). Overall male adolescents had an average of 5.11 lifetime sexual partners. The 17-19 year olds in 1988 (6) had significantly fewer lifetime partners than those in 1979 (7.34; p.001). Further, the number fell between 1979-1988 in each age group, but the decrease was only significant for 19 year olds (p.05). The number of partners actually rose for Blacks (9.34-9.99), but fell greatly for Nonblacks (6.87-5.02; p.01). In 1988, Blacks had a mean of 8.3 partners compared to 4.3 for Whites and 5.2 for Hispanics (p.001). The mean number of sexual partners in the last year was significantly greater for Blacks (2.37) than Whites (1.85) and Hispanics (1.57; p.001). The number of partners in the last 4 weeks fell significantly between 1979-1988 (.96 vs. .72; p.05). This decline was essentially due to the substantial drop in partners for Blacks (1.32 vs. .86; p.01). These results indicated that overall the rate of sexual activity is declining and that serial monogamy is the norm for male teenagers who have had 1 partner in the last year.