Over the past decade, public health officials and advocacy groups have brought attention to the high rates of unwanted pregnancy and sexually transmitted diseases (STDs) among America's adolescents, and outreach programs have been launched to reduce these risks. Newly published research, however, raises questions about how to focus these efforts and interpret their results.

"Promising the Future: Virginity Pledges and First Intercourse," in the January 2001 issue of the American Journal of Sociology (AJS), gives results from a sex survey conducted among 20,000 U.S. students, grades 7 through 12. Authors Peter S. Bearman and Hannah Bruckner report that among teens 17 years-old and younger, a pledge of sexual abstinence delayed the time to first intercourse by an average of 18 months, compared with non-pledging students. Average age at first intercourse among non-pledging teens with a romantic partner was 15 years, six months. For pledging participants the average was 17 years, two months.

Bearman and Bruckner's study might be taken as good news for those who support abstinence efforts out of religious conviction or specifically as a program to lower rates of teenage pregnancy and STDs. Data from the study, however, leave some question as to how well the strategy will work. For one thing, abstinence pledges seemed effective only in schools where there were some, but not too many, pledgers. "Once the pledge becomes normative," write Bearman and Bruckner, "it ceases to have an effect." In addition, the authors report that pledgers were less likely to use contraception once they did initiate intercourse.

The Risk of STDs

Perhaps equally important, some observers have stressed that the virginity pledge study may obscure an underlying problem of sexual behaviors that teens might adopt as alternatives to intercourse. Recently published data from other researchers suggest that teenagers frequently engage in noncoital sexual behaviors (mutual masturbation, oral sex, and anal sex) and that many consider these to be a form of abstinence. While these practices do not in themselves lead to unwanted pregnancy, they do create a risk for sexually transmitted diseases (STDs).

The STD risk associated with noncoital sexual behaviors runs a gamut. The risk from mutual masturbation is relatively low, though some experts regard it as a threshold activity that may place teens in a situation where they are more likely to engage in other, more risky sexual behaviors. Oral sex is another matter. While oral transmission of the AIDS virus is not very likely, other viral and bacterial STDs such as herpes, chlamydia, and gonorrhea can establish oral infections. Some of these, in turn, can be transmitted to another person's genitals by oral-genital contact. Case in point: one third of genital herpes among teenagers is now caused by HSV-1 (the "cold sore" virus), which implies to some experts a fairly pervasive practice of oral sex in this age bracket.

As for the STD risk associated with anal sex, many sexually transmitted diseases, including AIDS, can be acquired through anal sex. In that respect, public health experts regard it as the riskiest sexual behavior of all.

While the data on virginity pledges don't address a number of these issues, two articles in the November/December 2000 issue of Family Planning Perspectives (FPP) explore the topic of noncoital sexual behaviors at some length. The first, "Heterosexual Genital Sexual Activity Among Adolescent Males: 1988 and 1995," shows that many teenagers are engaging in this kind of sexual activity. Authors Gary Gates and Feya Sonenstein report results from the 1995 National Survey of Adolescent Males, which found that 55% of young men (15 to 19 years of age) had engaged in vaginal intercourse; 53% had been masturbated by a female; 49% had received oral sex from a female; 39% had performed oral sex on a female; and 11% had engaged in anal intercourse with a female. The second FPP article, "Oral Sex Among Adolescents: Is it Sex or Is It Abstinence" by Lisa Remez, is an extensive review of news stories and surveys suggesting that teen involvement in noncoital sexual behaviors may be on the increase and that many young people do not regard these behaviors as "having sex."

Defining the Act

"I did not have sexual relations with that woman." Does that ring a bell?

At the height of the Clinton-Lewinsky scandal, the Journal of the American Medical Association (JAMA) published a survey of American college students that asked what the students meant by "having sex." Somewhat revelatory was the finding that 59% of the students said oral-genital contact did not count as having "had sex" with a partner. Even more surprising was that 19% expressed the same opinion about penile-anal sex.

Together, the 1999 college student data published in JAMA and the collection of smaller studies reviewed by Remez raise questions about the true meaning of outreach efforts such as virginity pledges. In a study of 1,101 college freshman and sophomores cited in the Remez article, 47% of respondents considered oral sex to be a form of abstinence, and 61% put mutual masturbation in the same category. "The experts interviewed for this report," concludes Remez, "acknowledge that defining what is meant by abstinence-and accurately communicating that to students-has become a crucial issue."

Whether noncoital sexual activity among teens is on the rise remains to be proved, and research in this area has faced numerous barriers. These include the difficulty of obtaining parental consent to conduct surveys among minor children and political fights over government funding for this type of research. Solid research data from past decades is also in short supply.