Ready,Set,Go

Abstract

Understanding of preadolescent sexuality is limited. To help fill this gap, we calculated frequencies, percentages, and confidence intervals for 1,096 preadolescents’ reports of sexual thoughts, intentions, and sexual behavior. Cochran-Armitage trend tests accounted for age effects. Findings show that 9-year-olds are readying for sexual activity, with sexual readiness increasing between ages of 9 and 12. Sexual thoughts increased with age (p < .001): 46% of 9-year-olds and 70% of 12-year-olds were ready to learn about sex, and 14% of 9-year-olds and 41% of 12-year-olds thought about having sex. Few 9-year-olds anticipated sexual debut, but this increased with age (p < .05): 25% of 12-year-olds were ready for sex, and 20% anticipated initiating sex within a year. Our results indicate that preadolescents are initiating dating relationships and anticipating intercourse, and some have engaged in risk behaviors. Thus preadolescence is a critical time to implement prevention programs.

Keywords

sexual behavior sexual development transitions

Introduction

The burden of HIV/AIDS on African Americans is consistently disproportionate compared with other racial/ethnic groups (Centers for Disease Control and Prevention [CDC], 2009). Of particular concern is the impact of HIV/AIDS on African American youth. In 2006, persons aged 13 to 29 accounted for the largest number of new HIV infections, and within this age group African Americans had the highest rates of new HIV infections (CDC, 2008a). Although African American adolescents represent only 17% of the U.S. teenage population, they account for 70% of new HIV cases among youth aged between 13 and 19 years (CDC, 2008b). Similar disparities exist in sexually transmitted infection (STI) rates. Chlamydia, gonorrhea, and syphilis rates among African American youth (ages 15-19) are 8, 19, and 20 times higher, respectively, than rates of these infections among White adolescents (CDC, 2008c). A 2008 study estimates that nearly half of African American adolescent girls between the ages of 14 and 19 are infected with at least one of the most common STIs compared with 20% of White adolescent girls (Forhan et al., 2008).

This sexual health crisis that is occurring among African American youth has life-threatening effects. In 2005, HIV/AIDS was the fourth leading cause of death for African Americans aged 25 to 34 (CDC, 2005), and given the long latency period from HIV infection to the development of AIDS or death from it, it is likely that many of these young adults were infected during adolescence. These findings indicate the urgent need to expand effective sexual risk reduction strategies for African American youth to include primary prevention strategies that target youth before they become sexually active. This prerisk approach requires a better understanding of the sexual development process and when to best provide prevention messages.

The most recent survey data on African American youth’s sexual risk behaviors (2003 Middle School Youth Risk Behavior Survey [MSYRBS] and the 2007 High School Youth Risk Behavior Survey [YRBS]) show that many African American youth initiate intercourse in their preadolescent years. Nationally, 16.3% of African American high school students (26.2% of boys, 6.9% of girls) reported first sexual intercourse before age 13 (CDC, 2008d). Despite these data, only a few studies examine sexuality among preadolescents. In general, this literature suggests that boys begin their sexual trajectory earlier than do girls (Butler, Miller, Holtgrave, Forehand, & Long, 2006), and more preadolescent boys intend to engage in sexual behaviors and have engaged in sexual behaviors than do girls (Browning, Leventhal, & Brooks-Gunn, 2004; Kinsman, 1998; O’Donnell et al., 2006; Rose et al., 2005). Findings from the few studies that explore behaviors beyond intercourse suggest that sexual thoughts, intentions, and precoital behaviors (such as kissing, breast fondling, and genital contact) are precursors to intercourse debut and that preadolescence is a time when youth begin to view sexuality in a self-relevant way (Butler et al., 2006; O’Sullivan & Brooks-Gunn, 2005). Furthermore, the majority of preadolescents have engaged in such precoital behaviors (O’Donnell et al., 2006; O’Sullivan & Brooks-Gunn, 2005).

Clearly, preadolescence is a critical period of sexual development, and these early sexual experiences signal the beginning of a sexual trajectory leading to higher risk sexual behaviors; however, the process of sexual initiation is not well understood (di Mauro, 1995) . To intervene effectively before sexual risk behaviors are established, we need to improve our understanding of preadolescent sexuality. The current study helps to fill this gap. Using a sample of African American fourth and fifth graders between the ages of 9 and 12, we examine their sexual thoughts, intentions, and behaviors and test whether increasing age is associated with differences in these precursors to intercourse and sexual risk behaviors.

Method

We use the baseline data of an intervention trial, the Parents Matter! Program (PMP; Dittus, Miller, Kotchick, & Forehand, 2004; Forehand et al., 2007), funded by the CDC, to estimate percentages of African American youth between ages 9 and 12 with sexual thoughts, intentions, and behaviors. Athens, Georgia, and its surrounding counties—Atlanta, Georgia; and Little Rock, Arkansas—served as study sites. Both parents and their children completed assessments that included sexual attitudes and beliefs and parent–child communication about sexuality, and children reported on their sexual thoughts, intentions, and behaviors.

Participants

A community sample of 1,127 African American parent–child dyads was recruited. To be eligible to participate in PMP, the parent must have been either the biological parent or legal guardian of the child and have lived continuously with the target child for at least 3 years prior to the baseline assessment. In addition, the target child was required to be in the fourth or fifth grade at the time of baseline assessment and between the ages of 9 and 12. The parent had to self-identify as being African American, and both parent and child had to speak English. From the original 1,127 pairs, 31 were excluded from this study as they did not meet the eligibility criteria. Thus, these analyses included 1,096 participants.

Procedure

Families were primarily recruited through community leaders and agencies (e.g., schools, churches, recreation programs) as well as through community advertising, appearances at community events (e.g., health fairs, PTAs), and participant referrals. Once prospective participants were identified, they were screened to determine whether they met eligibility requirements using a standardized screening form. If the prospective participant family agreed to participate, an appointment to secure formal consent and to complete the baseline assessment was scheduled. Consent of participating dyads was secured by an African American interviewer.

When completing the computerized assessment, parents and children were situated at opposite ends of a room or in different rooms to ensure confidentiality of responses and increase comfort during the assessment process. All questions were delivered both visually on the computer screen and orally by a computerized voice over headphones. To ensure confidentiality, interviews were completed individually and assigned an identification number rather than the participant’s name. Child assessments lasted approximately 30 min. Parents were paid US$25 to cover expenses, their time, and their child’s time (US$15 intended for the parent, US$10 intended for the child).

All methods and measures for the current study were reviewed and approved by institutional review boards at each site and at the CDC.

Measures

The PMP survey instruments were assessed for cultural relevance, readability, and comprehension through qualitative pilot research with members of community advisory boards and elementary school teachers with experience teaching this population (Ball, Pelton, Forehand, Long, & Wallace, 2004). It contained questions related to a wide range of individual, family, and peer-related characteristics as well as child’s reports of their sexual thoughts, intentions, and behaviors.

Basic background information was obtained from the child and participating parent including child’s report of their gender, age, and school grade and parent’s report of their marital status, education level, employment status, and household income.

The variables examined related to child’s sexual thoughts, intentions, and behaviors were based on children’s reports. Children were asked all sexual behavior questions in terms of whether they willingly engaged in the behavior, where willingly was defined for them: “Willingly means you gave permission or said it was OK, and that you did it because you wanted to, and not because someone made you.” They were not asked about nonconsensual behaviors. In addition, based on community advisory board recommendations and internal review board restrictions, “gate questions” were used before explicit questions about sexual behaviors and intentions were asked to avoid asking sexually inexperienced children questions about sexually explicit behaviors. If participants reported they had never thought about sex or engaged in certain sexual behaviors, they were not asked the more explicit sexual questions.

As indicated below, all variables were dichotomized and the explicit sexual questions were combined with corresponding gate questions to create a measure that represented the entire sample. For example, only children who reported “ever touching private parts on purpose” were asked if they ever engaged in oral sex. Thus, those participants who stated that they never touched a boyfriend’s or girlfriend’s private parts on purpose were automatically coded as never having engaged in oral sex. We grouped each sexual thought, intention, and behavior variable into one of three stages in the trajectory to sexual risk behaviors: ready, set, and go.

Ready: The “ready” stage was characterized by preadolescents’ readiness to think about sex in a self-relevant way. Four questions were employed in defining the ready stage:

“I feel that I am ready to learn about sex” (0 = not at all true; 1 = a little true OR very true)

“How many times have you thought about having sex with a boyfriend or girlfriend?” (0 = I’ve never thought about it OR I’m not sure or don’t know; 1 = I’ve thought about it once or twice OR I’ve thought about it some OR I’ve thought about it lots of times)

“Have you ever had a boyfriend or girlfriend?” (0 = no; 1 = yes)

“Have you ever kissed a boyfriend or girlfriend?” (0 = no; 1 = yes)

Set: The “set” stage was characterized by preadolescents’ expressed beliefs, intentions, and precoital behaviors that indicate they are on a trajectory toward intercourse. Six questions were used in defining the “set” stage:

“I think I am ready to have sex” (0 = never thought about sex OR not at all true; 1 = a little true OR very true). This question was asked only of participants who answered affirmatively to Question 2 in the “ready” stage.

“. . . how likely is it that you will or will not have sex in the next year?” (0 = never thought about sex OR I am sure I won’t have sex in the next year OR I probably won’t have sex in the next year; 1 = there’s an even chance that I will or will not have sex in the next year OR I probably will have sex in the next year OR I’m sure that I will have sex in the next year). This question was asked only of participants who answered affirmatively to Question 2 in the “ready” stage.

Based on two questions: “Have you ever willingly let a boyfriend or girlfriend put his or her hands under your clothes?” and “Have you ever willingly put your hands under a boyfriend’s or girlfriend’s clothes?” (0 = no to both questions; 1 = yes to at least one question).

Based on two questions: “Have you ever willingly touched a boyfriend’s or girlfriend’s private parts or let a boyfriend or girlfriend touch your private parts?” and “Did you do this by accident or on purpose?” (0 = never touched OR touched by accident; 1 = touched on purpose).

Go: The “go” stage was characterized by preadolescents’ active participation in oral or vaginal sex. Three questions were used in defining the “go” stage and were only asked of participants who answered affirmatively to Question 4 in the “set” stage:

“Have you ever willingly put your mouth or lips on a boyfriend’s or girlfriend’s private parts?” and “Have you ever willingly let a boyfriend or girlfriend put his or her mouth or lips on your private parts?” (0 = never purposely touched private parts OR no to both questions; 1 = yes to at least one question).

“Have you ever willingly had sexual intercourse with a boyfriend or girlfriend? Sexual intercourse is when a boy or man puts his penis in a girl or woman’s vagina” (0 = never purposely touched OR no; 1 = yes).

Analysis

Simple percentages were computed for all demographic characteristics. Number and percentage (with 95% confidence intervals) of child participants who reported sexual thoughts, intentions, and behaviors were tabulated by age groups and gender. Cochran-Armitage trend tests were conducted for each age group to investigate differences in percentages by age. Percentages are reported for the entire sample, not just for those participants who were asked the questions even though some participants were not asked explicit sexual questions if they reported not having thought about sex or not engaging in certain sexual behaviors. In addition, the small number of missing data due to refusing to answer (<0.5% for all variables) were included in the percentage calculations and treated as if the child reported never engaging in the thought, intention, or behavior.

Results

Fifty-five percent of the preadolescents were female, and preadolescents were closely split between the fourth and fifth grade (46% and 54%, respectively). Ages ranged from 9 to 12 years, with the median being 10 years; only 4% were aged 12. Most (97%) had a female parent participating in the study. A majority (76%) of parents participating in the study had at least a high school degree, and 38% were currently married. Half of these parents were employed full-time, 40% reported monthly family income below US$999, and 30% reported an income between US$1,000 and US$1,999.

Ready

A considerable percentage of 9-year-olds were readying for sexual relationships (see Table 1). For example, 46% (44% of boys and 48% of girls) reported being ready to learn about sex; 14% (17% of boys and 13% of girls) had thought about having sex; 51% (66% of boys and 42% of girls) reported ever having a boyfriend or girlfriend; and 15% (25% of boys and 8% of girls) reported ever kissing a boyfriend or girlfriend. For each variable in the ready stage, the percentages increase as age increases (all p values < .001). For 12-year-olds, 70% (80% of boys and 63% of girls) reported being ready to learn about sex; 41% (50% of boys and 33% of girls) reported having thought about sex; 82% (90% of boys and 75% of girls) reported ever having a boyfriend or girlfriend; and 36% (55% of boys and 21% of girls) reported ever kissing a boyfriend or girlfriend.

Table 1.

Baseline Percentages and Values of Child Sexual Interest, Preparation, and Behaviors by Age and Gender for 1,096 African American Preadolescents Enrolled in the Parents Matter! Program, 2001

	Age (years)
	9 (N = 268)		10 (N = 511)		11 (N = 273)		12 (N = 44)		All ages (N = 1,096)
Variable	n	% [95% CI]	n	% [95% CI]	n	% [95% CI]	n	% [95% CI]	n	% [95% CI]
Ready to learn about sex***	124	46 [40, 52]	300	59 [54, 63]	177	65 [59, 70]	31	70 [55, 83]	632	58 [55, 61]
Boy	48	44 [35, 54]	128	55 [48, 61]	84	66 [57, 74]	16	80 [56, 94]	276	56 [52, 61]
Girl	76	48 [40, 56]	172	62 [56, 68]	93	64 [56, 72]	15	63 [41, 81]	356	59 [55, 63]
Ever thought about having sex	38	14 [10, 19]	117	23 [19, 27]	65	24 [19, 29]	18	41 [26, 57]	238	22 [19, 24]
Boy	18	17 [10, 25]	76	32 [27, 39]	41	32 [24, 41]	10	50 [27, 73]	145	30 [26, 34]
Girl	20	13 [8, 19]	41	15 [11, 20]	24	17 [11, 24]	8	33 [16, 55]	93	15 [13, 19]
Ever had a boyfriend or girlfriend***	138	51 [45, 58]	37	66 [62, 70]	95	71 [66, 77]	36	82 [67, 92]	706	64 [62, 67]
Boy	72	66 [56, 75]	182	78 [72, 83]	8	84 [77, 90]	18	90 [68, 99]	380	77 [73, 81]
Girl	66	42 [34, 50]	155	56 [50, 62]	87	60 [52, 68]	18	75 [53, 90]	326	54 [50, 58]
Ever kissed boy or girl***	39	15 [11, 19]	23	24 [20, 28]	73	27 [22, 32]	16	36 [22, 52]	251	23 [20, 26]
Boy	27	25 [17, 34]	80	34 [28, 41]	55	43 [34, 52]	11	55 [32, 77]	173	35 [31, 40]
Girl	12	8 [4, 13]	43	16 [11, 20]	18	12 [8, 19]	5	21 [7, 42]	78	13 [10, 16]
Ready to have sex***	11	4 [2, 7]	43	8 [6, 11]	23	8 [5, 12]	11	25 [13, 40]	88	8 [6, 10]
Boy	7	6 [3, 13]	28	12 [8, 17]	16	13 [7, 20]	5	25 [9, 49]	56	11 [9, 15]
Girl	4	3 [1, 6]	15	5 [3, 9]	7	5 [2, 10]	6	25 [10, 47]	32	5 [4, 7]
Anticipate sex in next year^a,***	12	4 [2, 8]	36	7 [5, 10]	25	9 [6, 13]	9	20 [10, 35]	82	7 [6, 9]
Boy	6	6 [2, 12]	24	10 [7, 15]	19	15 [9, 22]	4	20 [6, 44]	53	11 [8, 14]
Girl	6	4 [1, 8]	12	4 [2, 7]	6	4 [2, 9]	5	21 [7, 42]	29	5 [3, 7]
Put or allowed hands under clothes*	9	3 [2, 6]	43	8 [6, 11]	19	7 [4, 11]	6	14 [5, 27]	77	7 [6, 9]
Boy	7	6 [3, 13]	31	13 [9, 18]	14	11 [6, 18]	4	20 [6, 44]	56	11 [9, 15]
Girl	2	1 [0, 4]	12	4 [2, 7]	5	3 [1, 8]	2	8 [1, 27]	21	3 [2, 5]
Touched private parts*	3	1 [0, 3]	19	4 [2, 6]	4	1 [0, 4]	6	14 [5, 27]	32	3 [2, 4]
Boy	2	2 [0, 6]	13	6 [3, 9]	3	2 [0, 7]	3	15 [3, 38]	21	4 [3, 6]
Girl	1	1 [0, 3]	6	2 [1, 5]	1	1 [0, 4]	3	13 [3, 32]	11	2 [1, 3]
Oral sex^b	1	0 [0, 2]	7	1 [1, 3]	3	1 [0, 3]	0	0 [0, 7]	11	1 [1, 2]
Boy	0	0 [0, 3]	5	2 [1, 5]	2	2 [0, 6]	0	0 [0, 15]	7	1 [1, 3]
Girl	1	1 [0, 3]	2	1 [0, 3]	1	1 [0, 4]	0	0 [0, 13]	4	1 [0, 2]
Vaginal sex^b	3	1 [0, 3]	7	1 [1, 3]	2	1 [0, 3]	3	7 [1, 19]	15	1 [1, 2]
Boy	2	2 [0, 6]	6	3 [1, 6]	2	2 [0, 6]	1	5 [0, 25]	11	2 [1, 4]
Girl	1	1 [0, 3]	1	0 [0, 2]	0	0 [0, 2]	2	8 [1, 27]	4	1 [0, 2]

Only asked of participants who reported ever having thought about having sex, due to community advisory board recommendations and institutional review board restrictions. Those that were not asked the question were coded as a “no” response.

Only asked of participants who reported ever having purposely touched private parts, due to community advisory board recommendations and institutional review board restrictions. Those that were not asked the question were coded as a “no” response.

Armitage trend test: *p < .05. **p < .01. ***p < .001.

Set

A small percentage of 9-year-olds were setting the stage for sexual debut (see Table 1): 4% (6% of boys and 3% of girls) reported they were ready to have sex; 4% (6% of boys and 4% of girls) anticipated initiating sex in the next year; 3% (6% of boys and 1% of girls) reported ever putting or allowing hands under clothes; and 1% (2% of boys and 1% of girls) reported touching private parts. For each variable in the “set” stage, the percentages increase as age increases (all p values < .05). For 12-year-olds, a quarter of both boys and girls reported they were ready to have sex; 20% (20% of boys and 21% of girls) anticipated initiating sex in the next year; 14% (20% of boys and 8% of girls) reported putting or allowing hands under clothes; and 14% (15% of boys and 13% of girls) had touched private parts.

Go

Relatively few preadolescents across all age groups reported engaging in oral or vaginal sex (see Table 1). Of note, however, among 9-year-olds, one girl reported oral sex and three participants reported vaginal sex (two boys and one girl). Overall, 11 (1%) of the participants aged 9 to 12 reported engaging in oral sex and 15 (1%) in vaginal sex. Cochran-Armitage trend test results did not suggest the percentages were different by age group for these behaviors.

Discussion

This study was conducted to examine the sexual thoughts, intentions, and behaviors of African American fourth- and fifth-grade students between the ages of 9 and 12. The data presented here show that 9-year-olds are thinking about sex in a self-relevant way and readying for sexual activity and that sexual readiness increases between the ages of 9 and 12. For example, among 9-year-old participants, 14% had thought about having sex with a boyfriend or girlfriend and 6% of boys and 4% of girls anticipated sexual initiation in the next year, whereas 41% of 12-year-olds had thought about having sex with a boyfriend or girlfriend and 20% anticipated sexual initiation in the next year. As at least two studies have demonstrated the link between intention to have sex and subsequent sexual behavior in adolescents (Kinsman, 1998; Stanton et al., 1996), these findings suggest that for many adolescents, intervention should occur between the pivotal ages of 9 to 12 to interrupt progression from intention to behavior, and perhaps even earlier to delay formation of intention.

The data presented here are supported by large, representative data that survey older youth retrospectively about age of sexual initiation and sexual behavior. Both the YRBS and MSYRBS show that sizeable proportions of youth report having initiated sexual intercourse prior to age 13 (CDC, 2008d; Whalen et al., 2005). Early age of sexual debut has been identified as a significant predictor of both initial and subsequent sexual risk behaviors and sexual health outcomes (Kotchick, Shaffer, Forehand, & Miller, 2001), however, very little is known about the process of sexual initiation among adolescents (di Mauro, 1995; Miller & Moore, 1990). This study examined this process by exploring the sexual thoughts, intentions, and behaviors of preadolescent African American youth. Our results indicate that there are distinguishable patterns of sexual readiness among preadolescents, with a considerable percentage ready to learn about sex and setting the stage for sexual relationships, a trend that increased with age. These findings underscore the need to provide youth with the tools they require to form healthy behaviors. This includes implementation of programs at the late elementary and middle school ages to delay or mitigate the consequences of early sexual activity (Clark, Miller, & Nagy, 2005; Forehand et al., 2007; Jemmott, Jemmott, & Fong, 1998).

Several limitations of this work should be noted. First, these data are from a nonrepresentative convenience sample and the generalizability of findings to other groups is unknown. Additional research in other African American populations, other racial and ethnic groups, and other geographical regions is needed. Second, many of the preadolescents were not asked many of the questions about precoital and sexual behaviors due to a number of skip patterns embedded in the questionnaire. Descriptive data were generated by coding responses for those preadolescents not surveyed on precoital and sexual behavior questions as never engaging in the behavior. Likewise, the small amount of missing data was coded as if the preadolescent had never engaged in the behavior. Thus there may be an underestimate of the incidence of reported behaviors. Third, these are self-reported data and although careful consideration of survey items, pretesting of items, and consistency checks of the data were performed, the data may not reflect actual behaviors.

Our findings, coupled with the YRBS and MSYRBS data, clearly indicate that to equip youth with the sexual health tools they need prior to onset of sexual behaviors, programming needs to start early. Research shows that it is easier to prevent risk behaviors before their onset than to change established behavioral patterns (Botvin, Baker, Dusenbury, Tortu, & Botvin, 1990). Research examining sexual risk outcomes has found that behavior at sexual debut is an important determinant of subsequent behavior; for example, condom use at first penile–vaginal intercourse is associated with a 20-fold increase in lifetime regular condom use (Miller, Levin, Whitaker, & Xu, 1998). This suggests that during the early adolescent years, we have the opportunity not only to reduce sexual risk during the initial acts of sexual behaviors but also to help youth establish lifelong patterns of safe, healthy sexual behaviors.

In addition, many youth are unequipped with information to prevent pregnancy and STIs, including HIV. National surveys found that only one out of three sexually experienced Black males, and fewer than half of sexually experienced Black females, had received instruction about contraception before the first time they had sex (Duberstein, Santelli, & Singh, 2006), and 16% of sexually active female adolescents and 21% of sexually active male adolescents never received formal instruction on how to say no to sex (Abma, Martinez, Mosher, & Dawson, 2004).

Research efforts examining the psychosocial context in which sexual risk-taking behaviors occur suggest that adolescent sexual behavior is determined by factors from several systems of influence (e.g., individual, family, peers, community), all of which play a role in shaping and maintaining risk or protective behaviors (see Kotchick et al., 2001, for a review). To ensure that youth receive necessary sexual risk prevention programming at an early age, we must enlist the support of youth-serving medical providers, parents, and schools. Research findings such as those presented here can help raise awareness of the relevancy and importance of sexual health for preadolescents. Pediatricians can talk to parents about children’s readiness to learn about sex at an early age, encourage parents to start a dialogue with their preadolescent about sexuality, and provide parents resources to help them effectively communicate about sexual health. Parents can communicate information about sexuality to their preadolescents early and often and advocate for comprehensive sex education programs in their school systems. Schools need to use the best data available to help prioritize effective sexual health education efforts to meet the sexual health needs of their students. The time between ages 9 and 12 is a critical opportunity to reach youth with the knowledge and skills they need to engage in safe and healthy behaviors—before they initiate intercourse. We must invest in the health and development of our youth to prepare them for a safe and healthy tomorrow.

Footnotes

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

The authors declared no potential conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.

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