On kidsdata.org, indicators of teen sexual health include rates of sexually transmitted infections  (i.e., chlamydia and gonorrhea) among young people ages 10-19, and the percentage of adolescents ages 14-17 who report that they have not had sex.

There is much pressure, biological and social, for young people to be sexually active, yet sexual activity can have serious negative consequences including sexually transmitted infections (STIs). Even though youth ages 15-24 represent only 25% of the sexually active population in the U.S., they account for almost half of the 19 million new STI cases each year and are at increased risk for HIV infections (1). Chlamydia and gonorrhea are the most frequently reported bacterial STIs in the U.S., with the highest rates among girls ages 15-19 (2). If untreated, chlamydia and gonorrhea can lead to pelvic inflammatory disease and, in the long term, to infertility and adverse pregnancy outcomes (1, 2).

Many teens lack the information and cognitive skills needed to make informed decisions about sexual activity and how to prevent STIs (1). Once an STI is contracted, detection and treatment can be difficult because the majority of chlamydia and gonorrhea cases in women are asymptomatic (2). For this reason, education and routine screening are crucial. However, the Centers for Disease Control and Prevention (CDC) reports that STI screening occurs for less than half of those who should be screened (3).

STIs also have serious economic consequences. A 2004 study estimated the lifetime medical costs of STIs among American youth ages 15-24 to be $6.5 billion (4). In 2010, the CDC estimated that, overall, STIs cost the U.S. health care system about $17 billion annually (3).

For more information on teen sexual health, see kidsdata.org’s Research & Links section.

Sources for this narrative:

1. Guttmacher Institute. (2011). Facts on American teens’ sexual and reproductive health. Retrieved from: http://www.guttmacher.org/pubs/FB-ATSRH.html
2. Centers for Disease Control and Prevention. (2011). Sexually transmitted disease surveillance 2010. Atlanta, GA: Department of Health and Human Services. Retrieved from: http://www.cdc.gov/std/stats10/default.htm
3. Centers for Disease Control and Prevention. (2011). STD trends in the United States: 2010 national data for gonorrhea, chlamydia, and syphilis. Atlanta, GA: Department of Health and Human Services. Retrieved from: http://www.cdc.gov/std/stats10/trends.htm
4. Chesson, et al. (2004). The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspectives on Sexual and Reproductive Health, 36(1), 11-19.

Teens need accurate information and access to health care to make safe choices about sexual activity and to receive appropriate care. California law prevents withholding information about contraception if sex education is offered in schools, and requires that factual information provided be medically accurate and free of gender, racial, and ethnic bias (1). But sex education itself is not required. Of course, families also play an important role in teen sexual health; teens who grow up in stable families with good parent-child relationships (including communication about sex) are more likely to delay sexual intercourse and use contraception (2).

California youth have the right to talk to their doctor confidentially about sexual health (with limitations regarding sexual assault and statutory rape), but some teens, their doctors, and parents may not fully understand those rights (3). Insurance coding and reimbursement can reveal the nature of the doctor visit, and thus challenge confidentiality, or create disincentives for medical providers to conduct assessments related to teen sexual health or safety.

According to research and subject experts, policy options to influence teen sexual health include:

• Requiring comprehensive health education in schools, including specific skills-based information about reproductive health and contraception (4, 5)
• Informing health care providers and youth about state confidentiality laws concerning sexual health and contraception (3)
• Expanding insurance reimbursement to cover comprehensive psychosocial assessments (often known as a HEEADSSS exam) as a separate service (6)
• Adapting public health and reimbursement policies to encourage broader screening of youth for chlamydia and other sexually transmitted diseases (7)

For more policy ideas and research on this topic, see kidsdata.org’s Research & Links section, or visit The National Campaign to Prevent Teen and Unplanned Pregnancy, or The Guttmacher Institute. Also see Policy Implications on kidsdata.org under Teen Births, Dating and Domestic Violence, and Health Care.

Sources for this narrative:

1. California Adolescent Health Collaborative. (n.d.). Teen pregnancy & sexually transmitted infections. Retrieved August 11, 2011 from: http://www.californiateenhealth.org/pregnancy_sti_overview.asp
2. Child Trends. (2010). Sexually experienced teens. Retrieved from: http://www.childtrendsdatabank.org/?q=node/316
3. Duplessis, V., et al. (2010). Understanding confidentiality and minor consent in California: A module of the adolescent provider toolkit. Adolescent Health Working Group, California Adolescent Health Collaborative. Retrieved from: http://www.californiateenhealth.org/download/toolkit-rri-Web.pdf
4. Mueller, T. E., Gavin, L. E., & Kulkarni, A. (2008). The association between sex education and youth’s engagement in sexual intercourse, age at first intercourse, and birth control use at first sex. Journal of Adolescent Medicine, 42(1), 89-96. Retrieved from: http://www.jahonline.org/article/PIIS1054139X07003254/fulltext
5. Ball, V., & Moore K. A. (2008). What works for adolescent reproductive health: Lessons from experimental evaluations of programs and interventions. Child Trends Fact Sheet, 2008-20. Retrieved from: http://www.childtrends.org/Files/Child_Trends-2008_05_20_FS_WhatWorksRepro.pdf
6. Goldenring, J. M., & Rosen, D. S. (2004). Getting into adolescent heads: An essential update. Contemporary Pediatrics, 21(1), 64-90. Retrieved from: http://www.aap.org/pubserv/PSVpreview/pages/Files/HEADSS.pdf
7. Fiscus, L. C., et al. (2004). Infrequency of sexually transmitted disease screening among sexually experienced U.S. female adolescents. Perspectives on Sexual and Reproductive Health, 36(6), 233-238. Retrieved from: http://www.guttmacher.org/pubs/journals/3623304.html

About 81% of California teens ages 14-17 reported in 2009 that they had not had sex, similar to previous years. These data come from the California Health Interview Survey, and should be considered estimates.

Some teens who engage in sexual activity contract infections, such as chlamydia and gonorrhea. While those infections sometimes go unreported, many of them are documented. In California, chlamydia rates increased by almost 20% over a 10-year period, from 635.1 per 100,000 youth ages 10-19 in 2000 to 756.7 in 2010. The state’s rate of gonorrhea infection among teens, which is lower than the chlamydia rate, fluctuated over the last decade and was 94.9 per 100,000 in 2010. In the state and in most counties, many more females than males are diagnosed with gonorrhea and chlamydia. Teens ages 15-19 are diagnosed with sexually transmitted infections at a higher rate than youth ages 10-14.

• Center for Research on Adolescent Health and Development, Public Health Institute
• Guttmacher Institute: Adolescents
• Journal of Adolescent Health
• Pediatrics Journal
• Sexual Risk Behavior, Centers for Disease Control and Prevention
• Teen Sex and Pregnancy, Child Trends
• The National Campaign to Prevent Teen and Unplanned Pregnancy

• 14 and Younger: The Sexual Behavior of Young Adolescents, 2003, National Campaign to Prevent Teen Pregnancy, Albert, Brown, & Flanigan (Eds.)
• Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy, 2007, Journal of Adolescent Health, Kohler, Manhart & Lafferty
• Dating Violence and Associated Sexual Risk and Pregnancy Among Adolescent Girls in the United States, 08/2004, Pediatrics, Silverman, Raj & Clements
• Discussions about Contraception or STDs Prior to Sex, 04/2008, Child Trends, Holcombe, Ryan & Manlove
• School Connectedness: Strategies for Increasing Protective Factors Among Youth, 2009, Department of Health and Human Services, Centers for Disease Control and Prevention
• Sex Between Young Teens and Older Individuals: A Demographic Portrait, 09/2005, Child Trends, Manlove et al.
• Sexual and Reproductive Health Behaviors Among Teen and Young Adult Men, 10/2008, Child Trends, Manlove et al.
• Sexual Health Disparities Among African American Youth and the Need for Early Prevention Approaches: Parenting and Youth Development Programs as Strategies for Pre-Risk Prevention, 11/2009, Journal of Equity in Health, Miller et al.
• Sociocultural Determinants of Teenage Childbearing Among Latinas in California, 2010, Maternal and Child Health Journal, Dehlendorf et al.
• State Disparities in Teenage Birth Rates in the United States, 10/2010, Centers for Disease Control and Prevention, Mathews et al.
• Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2006–2010 National Survey of Family Growth, 2011, National Center for Health Statistics, Vital and Health Statistics 23(31), Martinez et al.
• Trends and Recent Estimates: Contraceptive Use Among U.S. Teens and Young Adults, 12/2011, Child Trends, Welti et al.
• Trends in HIV- and STD-Related Risk Behaviors Among High School Students- United States, 1991—2007, 08/01/2008, Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report
• Youth Assets and Sexual Risk Behavior: The Importance of Assets for Youth Residing in One-Parent Households, 2005, Perspectives on Sexual and Reproductive Health, Oman, Vesely & Aspy

• 2011 Community Assessment: Health and Quality of Life in San Mateo County, 2011, The Healthy Community Collaborative of San Mateo County
• A Portrait of Preteens in Santa Clara and San Mateo Counties, 2006, Lucile Packard Foundation for Children's Health, Public/Private Ventures
• Key Issues for Low-Income Latino Preteens in Santa Clara County, 12/2005, Lucile Packard Foundation for Children's Health, The Aguirre Group
• San Francisco Bay Area Asian American, Native Hawaiian and Pacific Islander Youth Health Status Report, 12/2007, Asian and Pacific Islander Bay Area Health Council, Asian and Pacific Islander Health Forum
• The 17th Annual Report on the Conditions of Children in Orange County, 2011, Orange County Children's Partnership (OCCP), Center for Community Collaboration, California State University, Fullerton, Orange County Board of Supervisors, Children and Families Commission of Orange County
• The Developmental Assets Survey: Young People Talk About Growing Up in Silicon Valley, 2011, Project Cornerstone
• Tulare County Children’s Report Card 2010, 2011, Children's Services Network

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