National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitudes and Experiences 

Introduction

The past decade has produced an increased use of condoms among sexually active young people and a small but significant decline in teen birth rates. This good news is offset by the fact that 10 percent of girls between 15 and 19 become pregnant, nearly two-thirds of high school seniors have had sex, and an alarming percentage of sexually active adolescents and young adults engage in unsafe sexual behaviors. Nearly one in four sexually active young people contract a sexually transmitted disease (STD) every year, and one-half of all new HIV infections in this country occur among people under the age of 25.

These facts indicate that there is much more yet to be known about the sexual behavior of today’s young people, their knowledge about sex and sexual health risks, and the social pressures and influences they experience around sexual issues. The Henry J. Kaiser Family Foundation’s National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitudes and Experiences takes a new approach to studying the problems and choices that today’s young people face by moving beyond standard questions about sexual behavior (e.g., “Are you sexually active? Do you practice safe sex?”) and tapping directly into the minds of America’s young people with detailed questions about their knowledge and attitudes toward sex and sexual health (e.g., “Do you feel pressure to have sex? Do you think condoms are effective in preventing STDs and HIV/AIDS?”).

The survey builds on a nationally representative sample of more than 1,800 young people in three key age groups – young adolescents (ages 13-14), adolescents (ages 15-17), and young adults (ages 18-24) – and representative over samples of racial and ethnic subgroups. Parents, educators, health professionals, policymakers, the media and the public can use this survey as a comprehensive national index of what young people know about sex and decisions they are making about important sexual health issues so that we can effectively address the needs and concerns of a generation at risk. To keep the nation attuned to changing patterns in sexual knowledge, attitudes, and behavior among the nation’s young people, this survey will be updated periodically.

The report’s key findings reveal that young people are more concerned about sex and sexual health than any other health issues in their lives. Young people also feel great pressure to have sex, with a majority saying that while putting off sex may be a “nice idea, nobody really does.”

Moreover, many young people are misinformed about the health risks associated with unprotected sexual activity. While three-fourths of sexually active adolescents engage in oral sex, one-fifth of adolescents are unaware that STDs can be transmitted through this activity. Many young people have misperceptions about the health risks associated with STDs and HIV/AIDS and have incomplete information on safer sex practices, the relative effectiveness of condoms versus other forms of birth control in preventing disease, and the frequency and availability of testing for STDs and HIV.

While America’s teen birth rate has declined, a significant percentage of young people are still having unprotected sex and engaging in other dangerous risk behaviors. Three in five sexually active young people report that they or a partner have had a pregnancy scare, one in six say that sex without a condom once in a while is not a “big deal,” and one in five say that they have had unprotected sex after drinking or taking drugs.

The survey reveals that young people want to know more about how to use condoms, how to recognize the signs of STD and HIV infection, what STD and HIV testing involves, and where they can go to get tested. Young people also want more instruction on communicating effectively with partners about sensitive sexual concerns and relationship issues. More specific details about the results of the survey may be found in the Summary of Key Findings and in the main text of the report.

Due to the sensitive nature of some questions – specifically those that ask participants to discuss their own sexual experiences – young adolescents did not participate in certain parts of the survey. The analysis reported here thus focuses on young people between the ages of 15 and 24, an age range that corresponds with higher rates of sexual activity. There is also a special section focusing on the knowledge and attitudes of young adolescents. Complete toplines for adolescents and young adults, accompanied by the exact wording of each survey question, are provided at the end of this report.

Summary of Key findings

More young people say that sexual health issues – namely STDs, HIV/AIDS, and unintended pregnancy – are “big concerns” for people their age than any other issue. And perhaps more importantly, four in five adolescents and young adults – including 79 percent of those who are not sexually active – say they are personally concerned about how sexual health issues may affect them.

Across the age spectrum, young people report considerable pressure to have sex. For both adolescents and young adults pressure to have sex is exceeded only by pressure to drink, and nearly a third of adolescents say that they have experienced pressure to have sex. These pressures are even greater among those who are sexually active, and adolescent males report experiencing more pressure to have sex than their female peers.

The pressures that young people feel in regard to sex maybe reflected in the attitudes they hold toward sexual activity, what they report about their own sexual behavior, and the health risks they take. Three in five adolescents and young adults state that while delaying sex may be a “nice idea, nobody really does,” and 9 percent of sexually active adolescents say that they were 13 or younger when they first had sexual intercourse.

The survey also indicates that oral sex plays an important role in the sexual lives of America’s young people and suggests that many adolescents and young adults are unaware of the serious health risks associated with this type of sexual contact. While a third of adolescents (including three-fourths of sexually active adolescents) say they have engaged in oral sex, one in five does not know that STD transmission can occur through oral sex and two in five considers oral sex to be “safer sex.” About a quarter of sexually active adolescents also report engaging in oral sex as a strategy to avoid sexual intercourse. And more than two in five do not consider it to be as big of a deal as sexual intercourse.

Despite recent declines in teen birth rates, the report shows that pregnancy and pregnancy scares remain a big concern for adolescents and young adults. The survey data show that seven in 10 sexually active young adults and four in 10 sexually active adolescents have had a pregnancy test or have had a partner who took a pregnancy test, and nearly two in five young adults and 8 percent of adolescents report that they or a partner have been pregnant. Furthermore, females were twice as likely as males in both age groups to report that they had faced a pregnancy.

The divergence in pregnancy reporting between females and males underscores the fact that many adolescents and young adults feel extremely uncomfortable talking about essential issues related to sex and their sexual health even though open discussions with partners, parents, and healthcare providers could yield great benefits for their personal health and emotional well-being. While a majority of adolescents and young adults report having discussions with their partners about contraception and their comfort level with specific types of sexual activity, fewer have engaged in dialogue about STDs and HIV/AIDS. Females are much more likely to take the lead in initiating dialogue with their male partners about a broad range of sexual issues, but it is important to note that a third of respondents say they have been in relationships where sexual activity has moved forward faster than they wanted.

Another significant challenge to communication and decision-making in regard to sex is the strong role that alcohol and drugs play in sexual activity. This report shows that four out of five adolescents believe that people their age usually drink or use drugs before having sex. It also reveals that almost third of young adults have “done more” sexually under the influence of alcohol and drugs than they planned while sober and more than one in five sexually active young people report having engaged in unprotected sex while intoxicated.

While three-quarters of adolescents and young adults say they know at least “something” about STDs and HIV/AIDS and one-quarter say they know “a lot,” half of those surveyed did not know that 25 percent of sexually active young people contract an STD, and one-third were unaware that people their age account for 50 percent of all new HIV infections. And while most adolescents and young adults are aware that STDs can cause serious health problems, between one-fifth and three-fifths of those surveyed do not know the specific complications of certain diseases. There are also dangerous gaps in young people’s knowledge of STD transmission; one-fifth of young people believe they would simply “know” if someone else had an STD even if they were not tested, and one-sixth believe that STD transmission can only occur when obvious symptoms are present.

While nine out of 10 adolescents and young adults regard sex with a condom as “safer sex”, 71 percent consider sex with other forms of birth control safer sex despite the fact that many other contraceptive measures do not offer protection from STDs. Also, more than one-third regard oral sex as safer sex even though STDs can be transmitted through this activity. One-fifth consider “pulling out” prior to ejaculation or sex during a woman’s menstrual cycle safer sex despite the fact that these methods do not provide adequate protection against either pregnancy or STD transmission.

While half of sexually active young people say they have been tested for STDs and HIV, the virus that causes AIDS, three in10 mistakenly believe these tests are a standard feature of routine medical exams. One in 10 young adults and two percent of adolescents disclosed that they had contracted an STD. These figures are significantly lower than national estimates for STD incidence among young people. While the gap in reporting may reflect discomfort with revealing personal information, it may also indicate that a significant number of young people are unaware that they have contracted an STD.

Nine out of 10 sexually active adolescents report using birth control or protection at least most of the time and 70 percent say they use birth control or protective measures every time. However, a significant percentage of young people – one-fifth of adolescents and only slightly fewer young adults– believe that condoms are “not effective” in preventing the transmission of STDs and HIV/AIDS. Many young people are also seriously misinformed about the type of protection they receive from birth control pills. One in five young people believe that birth control pills offer protection from STDs and HIV/AIDS.

Adolescents and young adults have some mixed feelings about the importance of using condoms. While more than three-quarters of those surveyed say that sex without a condom is not worth the risk, one-sixth believe that sex without out a condom once in a while is “not that big of a deal” and one in 10 say that “unless you have a lot of sexual partners you do not need to use condoms.” Males are twice as likely as females to say that unprotected sex occasionally is no “big deal.”

While nine out of 10 adolescents say that using condoms is a sign of respect, caring, and responsibility, about half of those surveyed also say that bringing up the subject of condoms can raise suspicions about one’s own sexual history or suggest that one is suspicious of a partner’s sexual history. The discomfort associated with talking about and buying condoms may also pose hurdles. More than a third of adolescents and young adults say that buying condoms is embarrassing and a similar number say that it is hard to “bring up” the subject of condoms.

Among adolescents, the top three sources of information are sex education in school, friends, and parents. These sources are followed closely by media sources like television, the movies, magazines, and the Internet. For young adults, sex education plays a much less prominent role – possibly because many last had sex education sometime during their high school career. Young adults also stress the importance of friends, the media, and boyfriends and girlfriends as their most important sources of information.

More than three-quarters of adolescents and young adults express a need for more information about sexual health topics. They are especially concerned with how to recognize STDs and HIV/AIDS infection, what STD and HIV testing involves, and where they can go to get tested. Two in five young people also want more information on how to communicate more effectively with partners about sensitive sexual concerns and issues. And one-quarter of those surveyed say they need more information on how to use condoms.

The survey found that even among 13- and 14-year-olds –the majority of whom are not yet sexually active – there is strong concern about sex and relationships. Four in five say they are personally concerned about sexual health issues, and three-quarters say they have concerns about sexual violence or other physical violence in relationships.

Kaiser Family Foundation. National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitudes and Experiences.

Menlo Park, CA. 2003.
To access the entire report, please visit the Kaiser Family Foundation.