The Public's Health: A New Sexual Revolution | Public Health Post

 

Quietly, slowly, there has been a notable change in how young Americans relate sexually with each other. Between 1995 and 2015, the proportion of high school students who report ever having sexual intercourse has fallen from 53.1% to 41.2%, the lowest rate since the 1970s. If these percentages were moving in the opposite direction, the headlines would announce how “discouraged” we were by this next generation putting themselves at risk for pregnancy, infection. Good news does not travel as fast as bad news does. So if you were looking for positive public health reports, this is one.
 
Why has there been a decline? The Centers for Disease Control (CDC) in its write-up of these findings offered no speculation. So here are a few ideas.
 
Perhaps changes in the structures of families have influenced behavior. The rise in the number of children living in single-parent families has nearly doubled since 1980, and maybe today’s teenagers carry a new conservatism, partly in response to the households in which they’ve been raised.
 
The greatest decline in the CDC-reported intercourse rates was seen in 9th and 10th graders. Perhaps sexual health curricula—which vary widely, are left up to individual school districts, and only rarely include topics recommended by the CDC—have multiplied in middle school classrooms and have had a hands-off effect.
 
Perhaps this is a result of the growth of social media. When was the last time you met an American teenager without a cell phone or a computer? More than three-quarters have smart phones. Teenagers have new modes of stimulation—pornography at a click, sexting, six seconds of nudity—and vast new networks of friends (and strangers), offering connection. Maybe social has replaced sexual.
 
The decrease in sexual intercourse has been most dramatic among African American students whose rates have decreased from 67.6% to 48.5%, with much of this change occurring since 2013. What larger change in the health landscape was occurring around that time?

Were federal policies like the Teen Pregnancy Prevention Initiative, first funded a few years ago by the Office of Adolescent Health, having effects? Any connection to the Affordable Care Act and an increase in pediatrician visits? It is difficult to draw causal arrows.
 
Early initiation of sexual activity puts teenagers at risk for sexually transmitted infection and pregnancy. But the decrease in high school student sex, teenage pregnancy rates at record lows, and decreasing rates of abortion, suggest that another sexual revolution may well be underway. That seems like good news for the health of populations.
 
Warmly,
Michael Stein & Sandro Galea