Parents, Peers, and Pressures: Identifying the Influences on Responsible Sexual Decision-Making
Sexual health is an essential part of good overall health and well-being. Sexuality is a part of human life and human development. Good sexual health implies not only the absence of disease, but the ability to understand and weigh the risks, responsibilities, outcomes, and impacts of sexual actions, to be knowledgeable of and comfortable with one's body, and to be free from exploitation and coercion. Whereas good sexual health is significant across the life span, it is critical in adolescent health.
Adolescence signifies the onset of physical/sexual maturation and reproductive capacity. Young people have a need and a right to know about their bodies and to be educated and informed about their sexual health, yet they face many social, political, and community barriers to receiving and gaining access to the right information. Sex is often a challenging and difficult issue for both youths and adults to discuss. The consequences of not talking about sex, however, can be severe:
- Every hour of every day, two American young people contract HIV, 96 become pregnant, and nearly 350 more contract a sexually transmitted disease (U.S. Public Health Service, 2001).
- Although national overall rates of teenage pregnancy have declined, nearly 1 million teenagers become pregnant every year (AGI, 1999). Although women, regardless of age, income, race, and ethnicity, experience unintended pregnancy, a disproportionate number of them are low-income African American and Latina teenagers.
- One-quarter of all new HIV infections in the United States are estimated to occur in young people under the age of 21 (Advocates for Youth, 1998). Sixty-four percent of adolescents ages 13 to 19 reported with HIV are females, and 84 percent are ethnic minority youths (CDC, 2000).
Social workers' involvement with youths and families often is related to a sexual health issue, including maternal and child health, unintended pregnancy, sexual abuse and assault, or other problematic behaviors that occur with youths individually or with their family and community system. Our proactive involvement on the issue is critical to help youths navigate the barrage of conflictual messages about sex.
UNDERSTANDING THE INFLUENCES IN SEXUAL DECISION–MAKING
Making good decisions and responsible choices about sexual activity during the teenage years can have immediate and lasting implications for overall health outcomes. How teenagers make decisions about relationships, abstaining or participating in sex, and protecting themselves and others from sexually transmitted diseases and pregnancy is influenced by numerous factors. Parents, peers, the media, access to education and services, and a host of other factors influence decisions and subsequent health outcomes. Understanding the context of decision making and the social influences provides significant insight for effective health interventions. It gives instructive guidance for social workers' individual work with youths and families, as well as programmatic and policy implications. Young people, sexually active or not, are influenced by a range of individual and social factors:
The Role of Parents and Family Dynamics
The role of parents in the lives and decision-making processes of youths is often underestimated. Although the transition to greater independence is the hallmark of this developmental phase, parents clearly have a role and exert significant influence in the choices young people make about sex.
- Teenagers are most likely to seek sexual information from their friends (61 percent). Although they are least likely to seek information from their parents (32 percent), a significant number of teenagers (43 percent) express a strong desire to have more information on how to talk to their parents about sex and relationships (Kaiser Family Foundation, 2000a).
- Nearly 80 percent of teenagers indicate that what their parents have told them and what their parents might think influence their decisions about sex and relationships (Kaiser Family Foundation, 2000b).
- The more that teenagers are satisfied with the mother–child relationship, the less likely they are to be sexually experienced (Advocates for Youth, 1997). Conversely, poor communication with parents about sex and safe sex practices, and parental substance abuse are also linked with risky sexual behaviors (Fraser, 1997).
- Poor parent–child relationships are associated with depression in adolescents. For young men, this may lead to more frequent use of alcohol, which is strongly linked with early sexual activity.
- For young women, estrangement at home often leads them to seek and establish intimate relationships outside the family, seeking the warmth and support they lack at home. Also, girls experiencing sexual abuse in the family are linked to increased risk of teenage pregnancy (U.S. Public Health Service, 2001).
The Role of Peers
The peer group is an important factor in adolescent development and has some bearing on teenagers' decisions about sex.
- Adolescents (ages 13 to 18) report that they are most likely to get information about sexual health issues from their peers (Kaiser Family Foundation, 2000a).
- Pressure to engage in sex increases during middle adolescence (Fraser, 1997). Peer group attitudes about sex influence the attitudes and behaviors of teenagers.
Youths who resist engaging in sexual activity tend to have friends who are abstinent as well. They also tend to have strong personal beliefs in abstinence and the perception of negative parental reactions. Youths who are sexually active tend to believe that most of their friends are sexually active as well, that rewards outweigh the costs of sexual involvement, that sex overall is rewarding, and that it is all right for unmarried adolescents over age 16 to engage in intercourse (Advocates for Youth, 1997).
The Role of the Media
The images that pervade the media (television, music videos, the Internet, and the like), are increasingly more explicit in sexual content.
- More than half (56 percent) of all television shows contain sexual content—averaging more than three scenes with sex per hour. For shows with sexual content, just 9 percent include any mention of the possible risks of sexual activity, or any reference to contraception, protection, or safer sex (Kaiser Family Foundation, 1999).
- Among young people 10 to 17 years of age who regularly use the Internet, one-quarter had been exposed to unwanted pornography in the past year, and one-fifth had been exposed to unwanted sexual solicitations or approaches (U.S. Public Health Service, 2001).
- Although media images of sex and sexuality may be socially defined as a negative influence on teenage sexual decision-making, there is considerable potential for the use of media in conveying messages about responsible sexual behavior. For example, more than one-half of high school boys and girls indicate learning about birth control and pregnancy prevention from television (U.S. Public Health Service, 2001).
The Role of Communities, Schools, and Social Policy
The circle of influence on sexual decision-making extends beyond the individual and family system. Key considerations of these extended influences include:
- Impoverished communities that lack sufficient employment and educational opportunities, access to providers and medical services, and overall social disintegration are associated with higher sexual risk taking (Fraser, 1997).
- Schools have unique opportunities to provide education and information, as well as structured activities that discourage unhealthy risk taking. Greater involvement in schools is related to decreased sexual risk taking and later initiation of sex, pregnancy, and childbearing (U.S. Public Health Service, 2001).
- Young women who were the least successful in high school are the most likely to become pregnant (National Association of Social Workers [NASW], 2000). Substance use and abuse are also factors in sexual decision making. One-quarter of sexually active high school youths reported using alcohol or drugs during their most recent sexual encounter (Kaiser Family Foundation, 2000c).
- Youths often encounter barriers in obtaining needed information and services regarding their sexual health. Policies on medical confidentiality, parental involvement and consent, as well as the nature of sex education available to youths are important considerations in sexual health outcomes.
- The political focus abstinence-only sexuality education has greatly impacted the nature and scope of information and services available to youth. This focus on abstinence-only until marriage however, contradicts the beliefs of the majority of Americans who favor comprehensive sexuality education that includes abstinence as well as information on contraception, pregnancy prevention, STDs, and HIV/AIDS (Advocates for Youth & SIECUS, 1999).
IMPLICATIONS FOR SOCIAL WORK PRACTICE
Defining Responsible Sexual Behavior: Individual and Community Responsibility
The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior (2001), has helped to frame the dialogue on sex and sexuality in a manner that highlights the importance of good sexual health and identifies core components of responsible sexual behavior that will positively impact individual and public health goals. Social workers working on behalf of health, youths, and families can use these concepts in a manner that promotes prevention and positive youth development.
Individual responsibilities include
- understanding and awareness of one's sexuality and sexual development
- respect for one's self and one's partner
- avoidance of physical or emotional harm to either oneself or one's partner
- ensuring pregnancy occurs only when welcomed
- recognition of tolerance and diversity of sexual values.
Community responsibility includes assurance that individuals have
- access to appropriate sexuality education
- access to sexual and reproductive health care and counseling
- the latitude to make appropriate sexual and reproductive choices
- respect for diversity and freedom from stigmatization and violence on the basis of gender, race, ethnicity, religion, or sexual orientation.
This framework can serve as the basis for workshops, counseling sessions, prevention programs, and other related services.
Getting the Boys Involved
Much of the attention to adolescent sexual health is dominated by teenage pregnancy prevention. Although this focus is laudable, it is equally important to address the multiplicity of issues that lead young people to early experiences with sex and potential parenthood. In addition, it is important that young people who need services and assistance be able to gain access to systems of care and help before a pregnancy, which is often when young girls are identified.
Assisting all youths in establishing and maintaining good sexual health requires a focus on the appropriate socialization and behaviors of both females and males.
- Gender roles that accord higher permissiveness for males and passivity for females can negatively impact the sexual and overall health of young girls and women, if they are unable to protect themselves against unintended pregnancy and sexually transmitted diseases (U.S. Public Health Service, 2001).
- Young men are more likely than young women to become sexually active at younger ages, 12 percent and 4 percent, respectively. Males are more likely than females to report having had four or more sexual partners (Kaiser Family Foundation, 2000c).
- Not all men involved in teenage pregnancies are teenagers themselves, especially when very young teenagers or coercive sex is involved. Whereas 63 percent of sexually active females ages 15 to19 have partners who are within two years (older or younger), the younger the girl is when she has sex the first time, the greater the average age difference is likely to be between her and her partner (Kaiser Family Foundation, 2000c).
- Studies show that programs that provide direct counseling and role models for boys can delay the onset of sexual activity, lead to effective use of birth control, and involve fathers in effective fatherhood practices (NASW, 2000).
Helping young people establish healthy relationships and communication with their peers and partners, to be mutually respectful of one another, and to support greater equity in relationships and sexual decision making can make a difference in health outcomes.
MENTAL HEALTH CONSIDERATIONS
Because of our unique roles and diversified practice areas, social workers have the opportunity to bring to bear more contemporary understanding of youth sexual behavior and subsequent outcomes. Issues of mental health, depression, low self-esteem, and feelings of hopelessness may encourage adolescent participation in intimate relationships. The need for intimacy and connection, coupled with the mortality rates of young men, particularly African American men, are important concepts to consider, particularly as they relate to teenage pregnancy.
Additional Ways To Become Involved In Helping Youths and Communities Achieve Responsible Sexual Behavior:
- In school settings, share information with other staff and health professionals on evidence-based intervention models. Approaches that have been effective include community-based programs, school-based programs, clinic-based and religion-based programs (U.S. Public Health Service, 2001).
- Understand the connection between the psychosocial aspects of sexual decision making as a point of intervention. This helps to expand the connection of issues beyond the use of contraception.
- Be knowledgeable about health education and health services access in your local community.
- Have resources and referral information available for youths and families in your community.
- Advocate for policies that protect the confidentiality of youths seeking health care services.
- Work with youths and families to facilitate communication about responsible sexuality.
- Be knowledgeable about the reporting policies in your state (on, for example, statutory rape or suspected sexual exploitation of children). The fathers of babies born to teenage mothers are likely to be older than the mothers: about one in five infants born to unmarried minors are fathered by men five or more years older than the mother (AGI, 1999).
Advocates for Youth. (1997). Factsheet on Adolescent Sexual Behavior: II. Socio-psychological Factors.
Advocates for Youth, (1998). Factsheet on Adolescents, HIV/AIDS, and other STDs.
Advocates for Youth and the Sexuality Information and Education Council of the United States. Poll on America's Attitudes toward Sexuality Education. Conducted by Hickman-Brown Research for Advocates and the Council between February 23 and March 3, 1999. Washington, DC: Hickman-Brown, 1999.
Alan Guttmacher Institute (AGI), 1999. Factsheet on Teen Sex and Pregnancy.
Centers for Disease Control and Prevention (2000). (National Center for HIV, STD and TB Prevention). HIV/AIDS Surveillance in Adolescents.
Fraser, M. (1997). Risk and resilience in childhood: An ecological perspective. Washington, DC: NASW Press.
Kaiser Family Foundation, Sex Education in America, 2000a.
Kaiser Family Foundation, Decision-Making about Sex: SexSmarts, 2000b.
Kaiser Family Foundation, Factsheet on Teen Sexual Activity, 2000c.
Kaiser Family Foundation, Sex on TV: A Biennial Report to the Kaiser Family Foundation, 1999.
National Association of Social Workers. (2000). Adolescent Pregnancy and Parenting. Social work speaks: National Association of Social Workers policy statements 2000–2003 (pp. 15). Washington, DC: NASW Press.
U.S. Public Health Service, The Surgeon General's Call To Action To Promote Sexual Health and Responsible Sexual Behavior. Washington, DC: 2001.
Shelia Clark, MSW
Senior Staff Associate