Jessica Suggs

Health 639
Lit review
Adolescents’ Behaviors and Attitudes towards Sexual Health

1Protective Role of Health Values in Adolescents’ future intentions to use condoms.

Most adolescents in this day and time are engaging in sexual behaviors at an early age.

With such risky behaviors, increases the chances of transmitting and contracting STD’s. An

intervention constructed in a San Francisco health clinic examined the protective role of health

values of intentions for adolescents to use condoms. The 260 participants chosen for the study

ranged from 14-18 years of age. Of the 260, 24 participants were dropped from the analyses due

to not completing the questionnaires. When demographic characteristics like age, gender, and

race, there were no differences revealed. A portion of the patients were HIV positive and did not

speak English. The hypothesis tested was to determine if health values would act as a protective

factor on decisions made by young people to use condoms. Health values can be defined as a

preference for wanting positive health outcomes.

The measurements of the study used were social desirability, past condom behavior,

history of STD’s, The Theory of Planned Behavior and intentions to use condoms. The

questionnaire consisted of 10 true/false questions about social desirability, which did not give

good results. The past condom Behavior section measured the last sexual intercourse between

main and casual partners. The “yes” or “no” section questioned the participants on STD’S,

whether or not they ever contracted one. The Theory of Planned Behavior Model was used to

globalize condom attitudes and social norms regarding condoms. From the global condom

attitude portion of the study, a scale that ranged from 1-5 help analyze the likelihood of using
condoms only because important people in their lives want them too. Lastly, the TPB model, self

efficacy measured the ability to suggest condom usage in different situations. Also on a 5-point

scale the, people were asked to indicate how likely or not they would use condoms every time

they had sexual intercourse or within the next 6 months.

Results showed that the hypothesis of values proved that there were more intentions to

use condoms based on the belief of the importance of one’s health. Therefore, the participants

believed because they valued their own health, using condoms for both casual and main partners

would have positive health outcomes. This theory was based on those who place greater

importance for healthy behavior regardless of their sexual experiences. Health values played

more of a larger role in casual sex because of the higher risk for negative health outcomes.

Overall, adolescents who do not have an higher value of personal health, will most likely be

influenced by negative consequences of certain sexual behaviors.

Friends’ influence on adolescents’ first sexual intercourse

Many adolescents become pressure to have sex before they are ready by their peers at an

early age. The nature of some teenagers who are trying to figure out their own identity is to rely

on the opinions of their friends. Basically there is a worry about being liked and accepted. It is

believed that adolescents who start having sex at a very young age will less likely use condoms.

It will then pose for a higher risk for STD’s. So therefore the hypothesis of the study was to

understand the influences on early initiations of intercourse from friends. This does not exclude

influences such as environmental and self-factors, but at a young age it can help understand the

initiation of sexual intercourse.

 There were a total of four hypotheses tested. The first hypothesis tested was that

adolescents with many friends who are sexually active are likely to initiate sexual intercourse.

Second, those close friends who hold positive attitudes about sex are more likely to persuade

their friends to have sex. The third hypothesis states that by having sex because of being

influenced by friends will create an amount of respect. Lastly, the adolescents who are involved

with their close friends will become sexually active with them.

Methods- the students complete an in-school and in-home survey. The questions ranged

from sexual attitudes/behaviors, romantic relationships and other personal health behaviors. The

Wave 1 and Wave 2 surveys were done at home which were spread out for 9-18 months. About

42% of participants, who answered the survey, believed they would gain respect from their peers

by having sex at an early age. The higher the percentage of adolescents with friends who were

sexually active are more likely to become sexually active. So this finding supported one of the

hypothesis of relationship with sexually active friends will help initiate sexual intercourse.

In conclusion, the study proposes that interventions can help bring out the positive

behaviors of adolescents. Also the interventional programs can decrease the negative outcomes

such as unintended pregnancies and sexually transmitted diseases. But in delaying sexual

intercourse or risky behaviors, is by choosing the most positive high quality friendships. Positive

friendships will less likely have so much peer pressure on sex. The Theory of Planned Behavior

used subjective norm to express the importance of someone else’s belief and approval of a

behavior which is the sexually active friends accepting others for having sex.

Sexy Media Matter: Exposure to Sexual Content in the music, movies, television and
magazines predicts Black and White Adolescents Sexual Behavior

Teen pregnancy and high STI’s are caused by early initiation of sexual intercourse.

African American men and women tend to have the highest STI rates out of most ethnic groups.

Condom usage is a big issue because most young people fail to use contraceptives. Sex education

should start in the home. The reluctance falls heavily on parent-child conversations about sex.

Instead the media tends to educate young people on sex, but only in a way that can show sex

being more freely and glamorized. Some schools are mandated on sex education, especially

being limited to only speaking about abstinence and negative consequences. This study focused

on the sexual behavior of both black and white adolescents age 12-14 years.

The sexual media diet (SMD) measured sexual content in television, movies, magazines and

music by how the behaviors of black and white adolescents are displayed.

The participants were chosen from 3 public schools in districts of Southeastern United

States. The students took the first survey at home with an audio-assisted program. The topics

were of sexuality and drug use. Two years later in 2004, approximately 1074 of the adolescents

were interviewed again for a follow-up. The content of the four media surveys focused on the

portrayal of pubertal development, nudity exposure, romantic relationships, and sexual

intercourse. The next step was to weigh the frequency of use time of these media outlets during

certain parts of the year. For instance, television and music were calculated by responses of

watching and listening during the week, weekends and summertime. Magazines were assessed

by one item and movie viewing was measured by watching in the theater or at home.

Female and male adolescents answer questionnaires with topics such as precoital sexual
behavior, and age at first sexual intercourse. Some of the questions ranged from kissing the

opposite sex without tongue touching/or with, sexual fondling and actual intercourse. Answers

basically were either a “yes” or “no” response. The questionnaire for “age at first sexual

intercourse” the participants were asked if they ever had sex, if so what month and year.

In the follow-up survey conducted in 2004, about 51% of the teens identified themselves

as being gay or bisexual. About 45% said they were unsure of their sexuality. First, the study

proved that early exposure of sexual content can increase the chance of sexual intercourse. White

males responded to using all the four media that had more sexual content more frequently than

black males. Also, they were more likely to read magazines such as Playboy and Maxim. Black

adolescents were less affected by the media. This was concluded by their responses on the

questionnaire. Also, the study explained that some young people will most likely adopt the

perceptions of sex from the media and make them their own. The study included that black

adolescents tend to be more influenced by their own peer groups when it comes to sex. Also they

are encouraged to have more sexual partners..

In conclusion, for some the media can be an indirect influence and also very powerful

when it comes to decision making. The main reason why is because of the lack of

communication between parents and children. Once again proper sex education for both parents

and young can decrease the chances of negative effects of the media on sex. A component of the

health belief model “cues to action” could be displayed in the study because it’s a outside event.

If sex education is talked about in the home, then the media would be the outlook of sex

education. The media can motivate or encourage adolescents to participate in sexual behaviors

and intercourse. Also self-efficacy is described by how white adolescents whose parents view sex
as wrong before marriage, will not engage in sex. Regardless of sex portrayal in the media both

black and white adolescents can be influenced by their peer groups.

Body image and African American females’ sexual health

For the past decades, a body image is heavily a concern for the American culture.

Recently a study was done to find out the beliefs of African American adolescent females. Most

felt that they were not satisfied with their body image. Before the African American culture

would frown upon thinness. Now the wanting of being thin are becoming very popular in most

cultures around the world and in the African American culture. The hypothesis of the research is

to examine how body image and sexual attitudes are connected among African American

adolescent females. The recruiters screened 1130 female teens form different medical clinics that

came from neighborhoods of highly rated unemployment, violence and high STI’s. Only about

609 of the females participated in the study. The age group consisted of 14-18 year-old teens.

Data was collected by the first survey given in a group setting. The survey consisted of questions

pertaining to body image beliefs, sexuality related attitudes and concerns. Also a face to face

interview with the teens was conducted to question about sexual risk behaviors. For each

individual, their body mass index (BMI) was recorded. The calculations were based on a scale on

that ranged from 12 to 35. If the adolescents image scores were less than 28, then likely they

were less satisfied with their body image. Averaging greater than 29 meant they were more

satisfied with their body image. The survey assessed sexual health concerns such as negotiating

condom use, self-control in relationships, ethnic pride and many others. The face to face

interview asked questions about sexual behaviors such as sexual intercourse, multiple sex

partners and receiving oral sex. The recruiters screened 1130 female teens form different medical

clinics that came from neighborhoods of highly rated unemployment, violence and high STI’s.
Only about 609 of the females participated in the study. The age group consisted of 14-18 year-

old teens. Data was collected by the first survey given in a group setting. The survey consisted of

questions pertaining to body image beliefs, sexuality related attitudes and concerns. Also a face

to face interview with the teens was conducted to question about sexual risk behaviors. For each

individual, their body mass index (BMI) was recorded. The calculations were based on a scale on

that ranged from 12 to 35. If the adolescents image scores were less than 28, then likely they

were less satisfied with their body image. Averaging greater than 29 meant they were more

satisfied with their body image. The survey assessed sexual health concerns such as negotiating

condom use, self-control in relationships, ethnic pride and many others. The face to face

interviews asked questions about sexual behaviors such as sexual intercourse, multiple sex

partners and receiving oral sex. One question left out of the interview was pregnancy. The reason

why is because it’s naturally expected for there to already be self-esteem issues with gaining

weight while pregnant.

Some of the females that were dissatisfied with their body image had no relation to

certain sexual practices. For example, having more sexual partners or receiving oral sex, did not

constitute dissatisfaction with one’s body image. Instead it was linked to less positive ethnic

identity, depression, low self-esteem and sexual stereotypes of women on television and music

videos. The adolescents who had low self-esteem stated they had fewer options for sexual

partners. Also, they reported 1.6 times not likely to use a condom.

In conclusion, the study suggested that negative views on body image will lead to poor

choices in sexual relationships. Also it health programs should implement accepting you body

image and sexual health importance on sex education teachings. The result of doing that will

reduce the risk of certain negative consequences of risk behaviors.

 Oral versus Vaginal Sex among Adolescent: Perceptions, Attitudes and Behavior

Introduction

For the past several decades there has been a concern as to why adolescents are engaging

in oral sex more frequently. This article talks about a study used to investigate the perceptions of

adolescents about oral sex versus vaginal sex. Basically research was done to get a better

understanding on the health, social, and emotional consequences of participating more in oral sex

than vaginal sex and why. The hypotheses of the research were to determine if oral sex was more

beneficial, less risky and more prevalent amongst adolescents. The study was conducted by

having 580 ethnically diverse ninth graders participate with consent from their parents. Of the

population selected, about 58% were female at mean average of 14.55 and 42% were males. All

of the participants had different ethnic backgrounds such as Hispanic, African American, Asian

and many others. The students were surveyed just about every six months. Also included as a

piece of background information was the educational background of their mothers. About 9% of

the mothers had a professional degree or some education after college. There were about 12%

who didn’t graduate from high school and a small percentage of students didn’t know the

information.

Methods/Materials
The participants were first selected from two California public high schools. In order to

participate, the students had to have consent forms signed by their parents. There were

information packets given to the students to look over and understand the study. Part one of the

study included measurements based on the intentions of having oral and vaginal sex within the

following six months. The rating was based on a 5-point scale . The ranges were from 1 to 5,

meaning that the students will definitely not engage in any sexual activity or will engage. In part
two of the study is where attitudes and perceptions of oral and vaginal sex were measured. Once

again a 5-point scale was used to measure from strongly agree to strongly disagree.

Results
The results for part 1 of the study focused on intentions and experience of having or to

have oral and vaginal sex had high responses. There were a greater number of students who’ve

had oral sex first as being their initial experience. Also, it showed more intent to have oral sex in

the next 6 months. For part 2, perceived risks and benefits were measured by variance. This

means that the students chancing positive or negative outcomes of either sexual activity. Included

in this section, measurements were risk behaviors, contracting Chlamydia and HIV, and

becoming pregnant. The benefits were measured under sexual pleasure, being more popular and

having good self esteem.

About 71% of the adolescents felt that as a risk of having vaginal sex they would get in

trouble and 63% felt that oral sex would get them in trouble. As for sex being beneficial, 72%

stated they would experience pleasure more from vaginal sex and 59% felt the same way about

oral sex being more pleasurable. Outside of the scales, the results of perception and attitudes of

why adolescents chose oral sex more than vaginal sex are explained in more detail. The negative

outcomes of sexual intercourse are HIV/STD’s and pregnancy which are viewed as less likely to

occur by having oral sex only. Some felt that by engaging in oral sex more, they wouldn’t get a

bad reputation, contract STD’s or have low self-esteem. One difference that stood out more than

sexual pleasure mainly came from vaginal sex. Also what was found that adolescents who have

experienced or not experienced oral sex still feels that it is less risky and still maintains their

virginity.

“As expected, adolescents believed that having oral sex is more acceptable for their age
groups than vaginal sex (2005).” This statement shows that the students believe that vaginal sex

was considered immoral and not age appropriate. Others believed it is ethically and religiously

wrong. So taking the safer route, oral sex seemed more appropriate. There was a gender

interaction difference. About less than 5% of females believed vaginal sex was ethically wrong

and about 2% of males felt neither oral nor vaginal sex was ethically wrong.

Discussion
A concern that was acknowledged in the study was a small percentage of adolescents

actually believed that there couldn’t be a transmission of Chlamydia and HIV during oral sex.

Adolescents agreed that oral sex is not detrimental to their reputation, health and one’s

relationship with their partner. The students also believed oral sex to be more acceptable in

dating and non-dating situations. The results clearly showed the reason why more engaged in

oral sex, because it was viewed as just being less risky. An important factor states “healthcare

providers should specifically discuss oral sex and other non coital sexual behaviors with

adolescents (2005).” There in that statement suggests that sex education should include more

detail information on health risks from oral sex rather than just sexual intercourse. The reason

why is a prime example of a study such as this where young adults don’t see it being any health

risk. Also most literature on sexual intercourse will leave out a STD that can be transmitted

during oral sex. One last key is that this study shows that possibly more education on sex and

mainly oral sex should be introduced early in elementary rather than just high school.

Critique

First, I want to start by saying that conducting a study with participants in the ninth grade

level is a good start. For future studies, it is a way of opening up the communication lines of

adolescents when talking about sex. It is very informative to learn the perception and attitudes of
younger adolescents’ sexual behaviors. The reason why is because more of the younger

generation are quickly becoming pregnant and falling into peer pressure traps. I would say that

there should have been more of a reason why a section of the study inputted the mothers’

educational background. This study did not elaborate or explain why that information was

necessary or beneficial. To use information such as that would have been better useful if the

mother’s were included on the survey. For instance, could there have been a lack of sex talks or

not with their children. I would have added a question or two in the survey addressing peer

pressure. An example is there more peer pressure to have oral sex more than vaginal sex or is

there any pressure at all? Maybe for the second part of the research where benefits are listed,

condom usage should have been mentioned. Most adolescents may not find it very pleasurable to

use condoms or some may feel that it is much safer to use condoms. I believe that this study was

very informative on learning the perceptions and attitudes of oral sex and why more frequently

it’s happening amongst adolescents at an early age.

Overall Conclusion

Using targeted interventions such as the ones listed in this literature review will help

the understanding why sexual health is important. The information listed can be used to help

identify different strategies on ways to promote sexual health behaviors. Also communication

plays an important role in promoting healthy behaviors. First the communications lines should

always be open between parents and children. Teachers also hold a responsibility in sharing

responsible behaviors and avoiding certain risks. When adolescents receive sexual education

from their peers they are being fed myths. These myths can cause unwanted pregnancies and

diseases. It was important for me to review articles that show different

subtopics of sexual behaviors and attitudes.

 Bibliography

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