Risky Teen Sex: Blame Social Pressures

Nov. 2, 2006 - Young people's sexual behavior is largely determined by social influences -- and around the globe, these influences are strikingly similar.

The finding comes from an analysis of more than 250 studies of teen and young-adult sexual behavior by Cicely Marston, PhD, and Eleanor King, MSc, of the London School of Hygiene and Tropical Medicine.

Young people aged 15 to 24 get about half of the world's new HIV infections. We often blame them for being ignorant, for their notoriously bad judgment, and for their impulsivity. Or we let them off the hook for lack of access to condoms and lack of sex education.

Yet Marston and King find that social influences are what really determine young people's sexual behavior. These influences, they find, fall into seven key themes. And the same themes are seen in every culture in the world.

"Worldwide, not only is sexual behavior strongly shaped by social forces, but those forces are surprisingly similar in different settings, with variations of the extent to which each theme is present rather than of kinds of themes," they report.

The themes are:

• Young people decide whether to have risky sex based on whether they see their partner as "clean" or "unclean." This determination is largely based on social position and behavior perceived as socially appropriate.
• The nature of a young person's sexual partnership influences not just their condom use, but their sexual behavior in general.
• Condoms are stigmatizing and associated with a lack of trust.
• Gender stereotypes determine social expectations and behavior. For example, men are expected to be sexually experienced while women are expected to be innocent -- yet women also are expected to be responsible for pregnancy prevention.
• Society offers both penalties and rewards for sex. For example, an unmarried pregnancy can stigmatize a woman -- yet it can also offer escape from her parents' home.
• Reputations and social displays of sexual activity or sexual abstinence are important.
• Social expectations hamper communication about sex.

Marston and King argue that simply handing out condoms, or providing sex education, is not enough to change sexual behavior. They say four things are needed:

• Understanding what makes young people deviate from socially expected behaviors.
• Understanding details about sexual behavior. For example, this would mean moving beyond asking, "Why don't kids use condoms?" to asking, "What makes kids who use condoms in long-term relationships different from those who don't?"
• Asking new questions, such as exploring the relation between pleasure and sexual behavior or exploring men's attitudes toward pregnancy.
• Analysis not just of sexual behavior, but of the social forces that drive sexual behavior.

"Social expectations, especially ideas about how men and women should behave are a powerful influence on behavior," Marston and King conclude. "The influence of sexual partners is also considerable, as are young people's ideas about stigma and risk; and social pressures make it difficult to communicate clearly with partners, which makes safer sex unlikely."

The study appears in the Nov. 4 issue of The Lancet.