The proportion of male students who reported having sexual intercourse before age 13 years varied from 5% (San Francisco) to 25% (Memphis, TN); elevated rates among black and Hispanic males

Prevalence of Sexual Initiation Before Age 13 Years Among Male Adolescents and Young Adults in the United States. Laura D. Lindberg, Isaac Maddow-Zimet, Arik V. Marcell. JAMA Pediatr. April 8, 2019. doi:10.1001/jamapediatrics.2019.0458

Key Points

Question: Does the prevalence of sexual initiation before age 13 years among males in the United States vary by race/ethnicity, location, and socioeconomic status?

Findings: This cross-sectional study of 19 916 male high school students and 7739 males aged 15 to 24 years found substantial variation in the rates of sexual onset before 13 years of age across metropolitan areas and by race/ethnicity, with rates as high as 28% among non-Hispanic black males in Memphis, Tennessee.

Meaning: Variation in timing of sexual initiation before age 13 years may have implications for the provision of early, inclusive, and comprehensive sex education as well as sexual and reproductive health care to male children and adolescents.

Abstract
Importance: Despite similar sexual activity rates among male and female adolescents, males are more likely to have their first sexual intercourse before age 13 years. The developmental needs and pathways to healthy trajectories for young males remain unknown.

Objective: To examine the prevalence of sexual intercourse before age 13 years among male adolescents; the variation by race/ethnicity, location, and maternal educational level; and the wantedness of this first sexual experience.

Design, Setting, and Participants: This cross-sectional analysis was conducted from September 2017 to June 2018, using pooled 2011, 2013, and 2015 data from the school-based Youth Risk Behavior Surveillance System (YRBSS) and the 2006 to 2015 data of males aged 15 to 24 years from the household-based National Survey of Family Growth (NSFG). The percentage of males reporting sexual onset before age 13 years was estimated using survey-weighted logistic regression to test for differences by race/ethnicity within each national survey and within metropolitan areas (for YRBSS, high school and middle school samples). Among NSFG survey respondents, differences in wantedness of first sexual intercourse by age at first sexual intercourse were examined, along with the associations between sexual initiation and socioeconomic covariates.

Main Outcomes and Measures: Sexual onset before age 13 years.

Results: Data from a total of 19 916 male high school students (from YRBSS) and 7739 males aged 15 to 24 years (from NSFG) were included in the analysis. The sample was largely composed of non-Hispanic white males: 8789 (57.1%) from the YRBSS and 3737 (58.0%) from the NSFG. Sexual onset before age 13 years was reported nationally by 7.6% (95% CI, 6.8%-8.4%) of male high school students and 3.6% (95% CI, 3.0%-4.2%) of males aged 15 to 24 years. The proportion of male students who reported having sexual intercourse before age 13 years varied across metropolitan sites, from 5% (95% CI, 4%-7%) in San Francisco, California, to 25% (95% CI, 23%-28%) in Memphis, Tennessee, with elevated rates among non-Hispanic black and Hispanic males in most metropolitan areas. In the NSFG data set, respondents whose mothers had a college degree or higher educational level were statistically significantly less likely (OR, 0.31; 95% CI, 0.19-0.49) to report having sexual intercourse before age 13 years compared with those whose mothers did not have a college degree. Among males who reported having their first sexual experience before age 13 years, 8.5% (95% CI, 3.8%-17.8%) described their first sexual intercourse as unwanted.

Conclusions and Relevance: Rates of sexual onset before age 13 years among young males varied by race/ethnicity, location, and maternal educational level, presenting important implications for the provision of early, inclusive, and comprehensive sex education and sexual and reproductive health care to male children and adolescents.

Introduction

First sexual intercourse marks an important transition in an individual’s life,1 and early adolescence is a critical developmental period when experimentation with sexual feelings and behaviors often begins.2,3 During these formative years, expectations to adhere to gender roles and norms intensify. The Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System (YRBSS) tracks sexual intercourse before age 13 years as a core surveillance metric and finds that males are more than twice as likely as females to experience first sexual intercourse before age 13 years.4 Sex education guidelines recommend providing children with comprehensive sex education starting at least by kindergarten, and clinical care guidelines recommend clinicians set time alone with young patients to address confidential care inclusive of sexual health starting during early adolescence.5,6 However, most males start having sex before receiving sex education, and the quality of sexual health care delivery to male adolescents is poor.7-9

Estimates of young males’ transition to first sexual intercourse do not examine the prevalence of sexual activity in early adolescence across the intersecting demographics of sex, race/ethnicity, and location, likely missing important variations.10-12 A nationally representative study of sexual behavior reports it as “rare” among those 12 years and younger.13 Yet this conclusion may miss subgroups of males for whom sexual initiation before age 13 years is more common. Given the higher prevalence of first sexual intercourse before age 13 years among males compared with females, understanding the variation in the timing of sexual onset among adolescent males in the United States is critical to supporting their healthy sexual development.

Males’ experiences with regard to emergent manhood and sexuality are shaped by dimensions of masculinity, race/ethnicity, socioeconomic status, and location. Broad cultural scripts about masculinity and sex hold that men should start having sex early and have sex often.14 For young men of color, particularly black males, racist stereotypes of hypermasculinity may also contribute to expectations of early sexual initiation.15-17 Yet research highlights that males in early and middle adolescence do not necessarily follow such scripts and a later transition to first sexual intercourse may be valued.18-22 Understanding males’ wantedness of the sexual experience may be particularly important for interpreting early sexual activity.23,24

Aspects of adolescents’ communities may also be factors in the transition to first sexual intercourse.25-28 Cultural norms and values associated with masculinity may differ across communities.29 Some studies have found differences in the timing of first sexual intercourse between urban and rural settings.30,31 Even across specific urban areas, young men’s experiences may vary.

The current study examined the prevalence of sexual initiation before age 13 years among adolescent males in the United States and the variation in the timing of their sexual initiation by race/ethnicity, location, and maternal educational level and by their characterization of the wantedness of this first sexual experience. Race/ethnicity, socioeconomic status, and location are not the only factors in the timing of first sexual intercourse, but they inform the context in which these experiences and other correlates occur. We used 2 complementary large-scale representative survey systems to assess the timing of sexual onset among adolescent males in the United States, examine key sociodemographic correlates, and consider how reporting issues may affect estimates.