Note to Editors: Despite a plethora of programs and policies designed to protect teenagers’ sexual and reproductive health, the debate continues over what actually influences teenagers’ behavior, and what types of programs can most effectively prevent unintended pregnancy and sexually transmitted diseases. The November/December 2004 issue of Perspectives on Sexual and Reproductive Health contains seven analyses--based on data from the National Longitudinal Study of Adolescent Health (Add Health), a large, nationally representative study of teens and young adults in the United States--that begin to address these questions.

Seven percent of middle and high school-aged adolescents have ever been forced into sexual intercourse, and eight percent of those are revictimized by their early 20s. A number of risk factors, including early sexual intercourse, emotional distress and use of alcohol or drugs, work together to increase teens’ vulnerability and the chances that they will be victimized or revictimized, according to "Sexual Victimization Among a National Probability Sample of Adolescent Women," by Ramesh Raghavan et al. Identifying the behaviors and circumstances that put teens at increased risk for sexual victimization can be useful in developing early interventions and can aid service providers in reaching those teens in need of attention.

In the mid-1990s, only one in five sexually experienced teens received screening for sexually transmitted diseases as recommended by medical experts, even if they had received a routine physical exam; teens with private insurance coverage were less likely to report testing than teens receiving publicly funded care, according to "Infrequency of Sexually Transmitted Disease Screening Among Sexually Experienced U.S. Female Adolescents," by Lynne C. Fiscus et al. This study suggests a need to ensure that health care providers understand the importance of screening, and to encourage teens to get screened annually.

Surprisingly, teens who take the greatest sexual risks are not necessarily the most likely to contract a sexually transmitted disease, according to "Implications of Racial and Gender Differences in Patterns of Adolescent Risk Behavior for HIV and Other Sexually Transmitted Diseases," by Carolyn Tucker Halpern et al. Instead, the authors report, black females are the least likely of all groups to engage in high-risk behavior, yet the most likely to acquire sexually transmitted diseases. This finding highlights the need to investigate relationship patterns and sexual networks to better understand how sexually transmitted diseases are spread.

The more positive teens’ attitudes toward contraception, the more likely they are to use it. In contrast, teens’ attitudes toward becoming pregnant-whether positive or negative-do not impact their risk of pregnancy or their likelihood of using contraception, according to "Ambivalence and Pregnancy: Adolescents' Attitudes, Contraceptive Use and Pregnancy," by Hannah Brückner et al. The authors suggest that pregnancy interventions that focus on attitude change should emphasize positive attitudes toward contraception rather than negative attitudes about pregnancy.

Only a minority of sexually experienced young adults in the United States think that they are at risk of acquiring a sexually transmitted disease, even if they engage in high-risk behaviors or already have an infection, according to "Perceived Risk of Chlamydial and Gonococcal Infection Among Sexually Experienced Young Adults in the United States," by Carol A. Ford et al. This analysis suggests a need to help young adults gauge their risk more accurately, and to raise awareness of the importance of routine testing and treatment among all sexually experienced young men and women.

The characteristics of teens' partners influence whether they use contraception and how consistently. For example, teen girls who did not know their partners before they began dating are less likely to use contraceptives or use them consistently than teens who met their partner through school, friends or church, according to "Contraceptive Use and Consistency in U.S. Teenagers’ Most Recent Sexual Relationships," by Jennifer Manlove et al. Understanding the circumstances that influence teens' decisions to use contraception is crucial to developing pregnancy prevention programs that will teach teens to negotiate consistent contraceptive use in each relationship.

Teens, who delay first sex are less likely to acquire sexually transmitted diseases than teens who are younger than 14 at first intercourse, but the effect is complicated by social contexts, including family, neighborhood and school characteristics, according to "Social and Behavioral Determinants of Self-Reported STD Among Adolescents," by Dawn M. Upchurch et al. To effectively reduce risk, programs that attempt to delay first sex must also take the social and cultural context into consideration.