As someone who writes about teen sexual behavior quite often, I do worry that we spend too much time worrying about (to steal a line from a friend) who puts what where and how often. While it is certainly important to know what teens are doing, it is equally important to know what they are thinking. This week, the National Campaign to Prevent Teen and Unplanned Pregnancy released With One Voice 2012, America’s Adults and Teens Sound Off About Teen Pregnancy. The report reveals the results of a nationally- representative survey of teens (ages 12 to 19) and adults and is the latest in a series of surveys the organization has released since 2001 that ask about sex, contraception, and teen pregnancy. The goals of these surveys are to “regularly assess and report on opinions” and to supplement the behavior data on teen sexuality that is collected by surveys such as the Youth Risk Behavior Surveillance Survey (YRBS) and the National Survey of Family Growth (NSFG).

This survey tells us quite a bit about the roles parents play in the sexual decision-making of young people, how young people and adults feel about sexuality education, what they think about contraception, and the power of the media. 

The Role of Parents  

Adults seem to worry a lot about the negative messages that young people receive from the media and their friends but it turns out that they need not be so concerned. The survey found that when it comes to sexuality, parents are more influential than anyone else including peers, media, religious leaders, and teachers. Moreover, the survey found that teens think it would be easier to avoid pregnancy with their parents’ help and support. Unfortunately, while they think their parents have good intentions, many teens believe them to be unprepared to talk about these issues.  Specifically, teens were asked:

When it comes to your/teens’ decisions about sex, who is most influential?

• 43 percent of teens ages 12 to 14 said parents, 19 percent said friends, 8 percent said the media, 6 percent said religious leaders, 5 percent said siblings, 5 percent said teachers and educators, and 8 percent said someone else.

• 36 percent of teens ages 15 to 19 said parents, 24 percent said friends, 9 percent said the media, 6 percent said siblings, 4 percent said teachers and educators, and 12 percent said someone else.

How much do you agree or disagree with the following statement:  “It would be much easier for teens to postpone sexual activity and avoid pregnancy if they were able to have more open, honest conversation about these topics with their parents.”

• 87 percent of teens (ages 12 to 19) agreed with this statement with 53 percent saying they strongly agreed and 34 percent saying they somewhat agreed.

How much do you agree or disagree with the following statement: “Parents believe they should talk to their kids about sex but often don’t know what to say, how to say it, or when it to start.”

• 90 percent of teens agreed with this statement with 51 percent saying they strongly agreed and 34 percent saying they somewhat agreed. 

Teens’ overall desire to talk to their parents did not surprise the author of the survey who explains that it is in line with “a large body of social science research suggesting that overall closeness between parents and their children, shared activities, parental presence in the home, and parental caring and concern are all associated with a reduced risk of early sex and teen pregnancy.”

Monica Rodriguez, president of the Sexuality Information and Education Council of the United States (SIECUS), is also not surprised by these findings: “This confirms what we’ve known, that teens look to their parents and want to hear from them on these issues and that parents need to be prepared to answers their kids’ questions.”   

The survey suggests that parents really do want to help their teens navigate the tricky waters of sexuality and sexual behavior. For example, 90 percent of adults agreed that talking to parents would help teens delay sexual activity and prevent teen pregnancy. And, contrary to the images we have of parents running out to buy chastity belts at the first sign their teen is sexually active–79 percent of parent of teens said that if their teen were having sex they “would hope they could come talk to [me] so [I] could help ensure they were using birth control” as opposed to just 9 percent who said they would “be angry and try to convince them to stop having sex.” 

Unfortunately, the good intentions and willingness may be lost because of a lack knowledge and comfort with the topic; like teens, 88 percent of adults agreed that parents “often don’t know what to say, how to say it, or when to start.” The author notes that “parents continue to say that they really do need help when it comes to talking to their kids about sex and related topics.”   

Rodriguez says that parents should not be discouraged because there are a lot of resources out there – including books and websites – dedicated to helping them take on this task.  She adds that parents should “look at resources designed directly for kids as well so that they can get a good idea of what is age appropriate.”

The Role of Education

If people only listened to politicians and pundits on the issue of sexuality education it would be easy to believe that there are only two types of programs–one that tells young people to put an aspirin between their knees until they’re married and one that hands them condoms and how-to-manuals and sends them on their way—and that these are totally incompatible. When other people are asked about this topic (both teens and adults), though, it turns out that they take the pretty rational view that abstinence and contraception can and should peacefully coexist. Specifically, when asked:

“Do you wish you/teens were getting more information about abstinence, more information about birth control or protection, or more information about both?”

• 49 percent of teens and 74 percent of adults said both, 7 percent of teens and 13 percent of adults said abstinence, and 13 percent of teens and 9 percent of adults said birth control or protection.

“Do you think the primary message of these [federally funded programs] should be to help teens postpone sex, provide teens with information about birth control or protection, or provide teens with information about postponing sex andbirth control or protection?”

• 65 percent of teens and 62 percent of adults said both, 19 percent of teens and 25 percent of adults said primarily providing information about postponing sex, and 11 percent of teens and 13 percent of adults said primarily providing information on birth control or protection.

According to the author, these findings show that in the real world people do not see sex education as an either-or proposition. He goes on to point out that:

“…the extraordinary progress that the nation has made in reducing teen pregnancy and childbearing in the past two decades has been driven by a combination of less sex and more contraception.” 

Educating young people about both, therefore, is a “common sense approach.” 

One of the other questions about sexuality education also shows common sense but may not be as simple as the survey seems to suggest. When asked if they agree or disagree with this statement, “Federally funded programs should primarily support those programs that have been proven to change behavior related to teen pregnancy,” a clear majority of adults (72 percent) agreed.

I, too, agree at least in theory but I fear this is oversimplified and that without first providing a little more context, the answer is not particularly meaningful. Obviously, we would all like to put our money toward programs that have already been proven to work whether they focus on sex ed or other topics. This is what the Obama administration is doing through its Teen Pregnancy Prevention Initiative which provides funding to organizations across the country to conduct prevention programming. Tier 1 of this program requires grantees to choose an evidence-based program (from a relatively small list of those that have been rigorously evaluated) and replicate programs “with fidelity.” Many educators agree, however, that this is too limiting because we don’t have enough programs that have been proven effective and the ones that have tend to be narrowly focused both in the topics they cover and the audiences they are intended to reach.  Rodriguez says this is why Tier 2 of this program is so important, though it is a much smaller pot of money this funding is going toward innovative approaches and that will hopefully add to our knowledge base about what can be effective. 

To Rodriguez, though, the most alarming finding of the survey when it comes to education, is just how low teachers and educators fell on the scale of influence; they were lower than friends, siblings, religious leaders, and the media with just 5 percent of teens ages 12 to 14 and 4 percent of teens ages 15 to 19 noting them as the most influential people when it comes to sex. Rodriguez believes that: “Educators and school administrators need to do some soul searching about why this is. Is it because we’ve censored ourselves–as a result of restrictive policies or fear of controversy–to the point that young people just don’t see us as a good source of information?”   

The Role of Contraception

The survey’s findings when it comes to contraception are a bit of a study in contradiction. Teens, it seems, think they know everything they need to know in order to protect themselves from unintended pregnancy yet admit they don’t all that much about either the male condom or the birth control pill. Moreover, an alarming number of them believe that contraception is somehow irrelevant to whether they get pregnant.  Specifically:

When asked if they agreed with the statement: “I have all of the information I need to avoid an unplanned pregnancy”

• 75 percent of teens ages 12 to 14 agreed as did 86 percent of teens ages 15 to 19.

When asked, how much they thought they know about male condoms and how to use them

• 6 percent of teens ages 12 to 14 thought they know everything, 27 percent know a lot, 50 percent know a little, and 16 percent know nothing.
• 14 percent of teens ages15 to 19 thought they know everything, 50 percent know a lot, 32 percent know a little, and 4 percent know nothing.

When asked how much they thought they know about birth control pills and how to use them

• 2 percent of teens ages 12 to 14 thought they know everything, 12 percent know a lot, 47 percent know a little, and 38 percent know nothing.
• 6 percent of teens ages 15 to 19 thought they know everything, 30 percent know a lot, 48 percent know a little, and 16 percent know nothing.

When asked how much they agreed or disagreed with the following statement: “It doesn’t matter whether you use birth control or not, when it is your time to get pregnant it will happen”

• 42 percent of teens agreed and 57 percent of teens disagreed.

As I said, these results seem somewhat contradictory. Teens are committed to preventing pregnancy and think they know how but in order to truly know how they would need all of the information about both male condoms and the pill and few teens even pretend they know it all.  (And I’d venture to bet some of the select few who think they do are wrong.)  Obviously, this suggests that we need to provide more information to teens about the ways in which they can protect themselves but I fear that this may not be enough if more than 40 percent of teens think contraception is irrelevant if it’s their “time to get pregnant.”

I think this speaks to a general negative attitude that we have toward contraception in this country; whether it’s abstinence-only-until-marriage programs telling students that using a condom is akin to playing Russian Roulette or Rush Limbaugh telling a law student that asking for contraceptive coverage was proof she was a slut. Providing young people with information about contraception–particularly male condoms which also protect against STIs–is a vital first step but we have to change the tone of the conversation about this topic completely if we’re going to make more progress. 

The good news is that adults seem to understand this and agree that our political dialogue, at least, is missing the mark on this issue. Specifically, 75 percent of adults agreed with the statement, “Policymakers who are opposed to abortion should be strong supporters of birth control.” The author explains this sentiment eloquently, saying:

“Over the past year, much of the public discourse about contraception has been considerably less than enlightening. In particular, the number of public figures and policymakers cynically conflating abortion and birth control has been especially disheartening and puzzling. That men and women of good will disagree about abortion is understandable; the hostility to preventing the unplanned pregnancies that frequently lead to abortion is not.”  

The Role of the Media

The survey also asked parents and adults about the role of the media and though, as I mentioned earlier, few young people referred to this as the strongest influence on their opinions about sexuality, participants readily agreed that the media does play a role. For example 75 percent of teen boys and 84 percent of teen girls agreed with the statement, “When a TV or character I like deals with teen pregnancy it makes me think more about my own risk of causing pregnancy and how to avoid it.” 

Teens and adults were asked specifically about the MTV shows 16 & Pregnant and Teen Moms which have been the source of contention with some viewers thinking they glamorize teen pregnancy and make celebrities out of teen moms and others believing that they show a realistic portrayal of the difficulties of parenting young. Most of the teens who had seen the show fell into this latter category with 77 percent believing it “helps teens understand the challenges of pregnancy and parenting.” Parents of teens though were less convinced with only 53 percent taking that point of view and 48 percent believing it “makes pregnancy and parenting look easy and fun.” 

We sexuality educators talk a lot about “teachable moments” when it comes to media message and often suggest that parents use what they see on TV to start conversations.  Both adults (75 percent) and teens (73 percent) agreed that the television shows or movies can be good launching points for conversations between parents and teens though only 47 percent of teens says this actually happens sometimes or often in their family.  Interestingly, 74 percent of parents of teens said they did use TV to spark conversation sometimes or often. The difference in responses between teens and parents does make one wonder what parents were really saying and what their teens were really hearing.

The authors concluded: “In short, media can, and often is, a force for good on teen pregnancy and related issue.”  I will just add that it is up to those of us in education and public health to reach out to media makers to help them use this power for good and not just salaciousness or profit. 

Keep Asking

The survey is quite extensive and asks many more questions of teens than I can cover here but I do want to touch on the one that I find most disturbing. Teens who have had sexual intercourse were asked if they wish they had waited longer; a majority (78 percent of sexually experienced teens 12 to 14 and 55 percent of sexually experienced teens 15 to 19) said that they did. According to the author, this is consistent with finding from the previous surveys, “In fact, over the years, one of the most consistent findings reported in the With One Voice series has been the regret many teens feel about the timing of early sexual activity.” 

More than any other finding, this suggests to me that we are doing something wrong – though it is not immediately clear where we are missing the mark.  Is it that teens are continually being pressured into having sex before they really want to? If so, what are the key sources of these pressures, how can we help teens handle them, and how do we change those message in the long term? Or, is it that through our very mixed messages about sex, teens are taught that they can have sex but really should feel at least a little bad about it afterward. Either way, we need to do better.  Rodriguez sees it as evidence of the gaps in education: “This is where we are missing the boat about what young people really want from sexuality education. It should be less about plumbing and symptoms and more about the decision making. If we gave young people more opportunities to have honest and real conversations about sex and consider their own feeling and values about it, maybe they would feel better about their decisions.”

Insights like these are why surveys that go beyond who does what, with whom, and how often are important.  This one asks many important questions but, of course, I have many more.  Let’s keep asking so we can understand not just what teens are doing but what they are thinking and feeling in order to make better policies, create better programs, and ensure that teens make decisions they are comfortable with – even after the fact.