Current Trends Premarital Sexual Experience Among Adolescent Women -- United States, 1970-1988

The initiation of sexual intercourse early in life is associated with an increased number of sex partners and a greater risk for sexually transmitted diseases (STDs). This report describes trends in age at first premarital sexual intercourse for adolescent women (15-19 years of age) in the United States during 1970-1988 and indicates an accelerated increase in the proportion having had premarital sex from 1986 to 1988.

Data for this analysis were obtained from interviews with 8450 women* 15-44 years of age who participated in the National Survey of Family Growth (NSFG) conducted by CDC's National Center for Health Statistics (NCHS) in 1988. The women were part of a subsample from a nationally representative sample of households interviewed in the National Health Interview Survey of 1986 (NCHS, unpublished data). The NSFG provided specific information on age and marital status of participants at first sexual intercourse, as well as detailed information on other factors, such as childbearing experiences, use of family-planning services, and knowledge of and experience with STDs.

Proportions were calculated for adolescent women in each year of age from 15 through 19 who reported having had premarital sexual intercourse by March 1 in 1970, 1975, 1980, 1985, and 1988.** For all ages combined for each of these periods, the proportion of adolescent women who reported having had premarital sexual intercourse increased steadily (from 28.6% in 1970 to 51.5% in 1988 (Table 1)). For each 5-year period from 1970 to 1985, the amount of increase declined (i.e., during 1970-1975, 7.8 percentage points; during 1976-1980, 5.6; and during 1981-1985, 2.1). However, from 1985 through 1988, the proportion increased 7.4 points, or approximately one third of the increase in premarital sexual experience among adolescent women for the entire period 1970-1988. This trend persisted even after adjustment for the influence of changing age composition by comparing age-adjusted proportions.

For each year of age during 1970-1988, the proportion of adolescent women who reported having had premarital sexual intercourse increased at least 55% (Table 1). The largest relative increase occurred among those 15 years of age (from 4.6% in 1970 to 25.6% in 1988). The cumulative absolute effect of these changes was greatest among women 18 and 19 years of age.

Although the proportion of black adolescents who reported having had premarital sexual intercourse was consistently higher than the proportion of white adolescents who reported having had premarital intercourse, the difference narrowed substantially over time because of a greater relative increase among white adolescents (24 percentage points among whites compared with 13 percentage points among blacks) (Figure 1). For white adolescents, this represents an increase in the number of sexually experienced females from 2.2 million in 1970 to 3.7 million in 1988, and for black adolescents, from 0.6 million to 0.8 million.

In 1988, adolescents who had had sexual intercourse earlier in life reported greater numbers of sex partners. Among 15- to 24-year-olds who initiated sexual intercourse before age 18, 75% reported having had two or more partners, and 45% reported having had four or more partners; among those who became sexually active after age 19, 20% reported having had more than one partner, and 1%, four or more partners. Among women aged 15-24 years who had been sexually active for the same length of time ( less than 24 months), 45% of 15- to 17-year-olds reported having had two or more partners, compared with 40% of 18- to 19-year-olds and 26% of those greater than or equal to 20 years of age. Reported by: Family Growth Survey Br, Div of Vital Statistics, National Center for Health Statistics; Div of STD/HIV Prevention, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: The NSFG data show that the proportion of adolescent women who reported having had premarital sexual intercourse increased through the 1970s and 1980s, and first sexual experiences occurred at younger ages. Among the 9 million adolescent women in 1988, almost 4.9 million (52%) may have had premarital sexual intercourse.

Information on the premarital sexual experience of adolescent women in the United States was first provided in a series of National Surveys of Young Women (NSYW) conducted in 1971, 1976, and 1979 (1). Based on these studies, the proportion of adolescent women in metropolitan settings experiencing premarital sexual intercourse increased from 30% in 1971 to 50% by 1979. This trend was confirmed by the 1982 NSFG, although the increase was less pronounced (1). The NSFG estimates for 1976 and 1979 were lower than those from the NSYW studies, but the differences were not statistically significant.

Increased sexual activity among adolescents has several health consequences. For several reasons, adolescents are at higher risk for sexually transmitted infection than are persons in other age groups (2). Compared with older age groups, adolescents have higher rates of gonorrheal and chlamydial infections (3) (Chlamydia trachomatis causes more lower genital tract infections among teenagers than does gonorrhea (4)). In addition, by their late teens, about 4% of whites and 17% of blacks have been infected with herpes virus type 2 (5). The consequences of these infections are most severe later in life. If untreated, gonorrheal and chlamydial infections of the cervix may progress to pelvic inflammatory disease (PID); acute PID increases risk for recurrent PID, infertility, and ectopic pregnancy. Each year, greater than 1 million U.S. women experience an episode of PID, with 16%-20% of cases occurring among teenagers (3,5,6). Age-specific rates of PID are highest for adolescent females (based on appropriate adjustments for sexual activity) (7). In a prospective evaluation of the risk for cervical cancer after cytologic evidence of human papillomavirus (HPV) infection, women less than 25 years of age had increased risk of progression (8).

The association between early age of sexual intercourse and greater numbers of both recent and lifetime sex partners represents a behavioral link to higher levels of STDs. Females and males who have multiple sex partners over a specified period (e.g., several months) are at increased risk for gonorrhea, syphilis, chlamydia, and chancroid (9). Increased numbers of sex partners over a lifetime is associated with a greater cumulative risk for acquiring viral infections such as hepatitis B, genital herpes, HPV, and human immunodeficiency virus (9). Efforts to prevent the adverse health outcomes of sexual activity in adolescents should include 1) innovations for early detection and treatment of STDs among teenagers, 2) specialized training for clinicians providing health services for adolescents, 3) school education coupled with accessible clinical services, and 4) behavioral interventions to prevent exposure to and acquisition of sexually transmitted infections.

References

1. Hofferth SL, Kahn JR, Baldwin W. Premarital sexual activity among U.S. teenage women over the past three decades. Fam Plann Perspect 1987;19:46-53.

2. Cates W Jr. The epidemiology and control of sexually transmitted diseases in adolescents. In: Schydlower M, Shafer M-A, eds. AIDS and the other sexually transmitted diseases: adolescent medicine--state of the art reviews. Philadelphia: Hanley and Belfus, 1990;1(3):409-27.

3. Shafer M-A, Sweet RL. Pelvic inflammatory disease in adolescent females: epidemiology, pathogenesis, diagnosis, treatment, and sequelae. Pediatr Clin North Am 1989;36:513-32.

4. Batteiger BE, Jones RB. Chlamydial infections. Infect Dis Clin North Am 1987;1:55-81.

5. Johnson RE, Nahmias A, Magder LS, et al. A seroepidemiologic survey of the prevalence of herpes simplex virus type 2 infection in the United States. N Engl J Med 1989;321:7-12.

6. Washington AE, Sweet RL, Shafer M-AB. Pelvic inflammatory disease and its sequelae in adolescents. J Adolesc Health Care 1985;6:298-310.

7. Bell TA, Holmes KK. Age-specific risks of syphilis, gonorrhea, and hospitalized pelvic inflammatory disease in sexually experienced U.S. women. Sex Transm Dis 1984;11:291-5.

8. Mitchell H, Drake M, Medley G. Prospective evaluation of the risk of cervical cancer after cytological evidence of human papillomavirus infection. Lancet 1986;1:573-5.

9. Aral SO, Holmes KK. Epidemiology of sexual behavior and sexually transmitted diseases. In: Holmes KK, Mardh PA, Sparling FP, et al., eds. Sexually transmitted diseases. New York: McGraw-Hill, 1990.

• Sufficient data were available to provide stable estimates only for blacks and whites.

** Because some women in each age group will have premarital sexual intercourse for the first time after March 1 but before reaching their next birthday, the proportions do not represent true age-specific rates. However, time comparisons are valid because the proportions are similarly computed for each comparison year.

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