Adolescent Health and Sexuality

The Question
Do virginity pledges result in lower rates of STD (sexually transmitted disease) acquisition among adolescents and young adults?

The Context
In recent years, Congress and the Bush administration have made a priority of sex education programs that emphasize abstinence and the use of virginity pledges as key components. In fact, the No Child Left Behind Act specifically prohibits the use of NCLB funds for sex education programs that do not emphasize abstinence. In 2005, the federal government will spend more than $170 million on abstinence-only programs, and President Bush has requested $206 million for such programs in his 2006 budget, jumping to $270 million by 2008. Although such programs have been shown to delay the first time adolescents have vaginal sex, research indicates that they continue to engage in other sexual activity and may be less likely to use condoms as a protection against STDs. Analysis of abstinence-only programs shows that many include either no information about STDs and condom use, or present inaccurate information. The study covered in this ResearchBrief examines whether adolescents who take virginity pledges (pledgers) have different rates of STD acquisition than their peers who do not take such pledges (nonpledgers).

The Details
Hannah Br?kner and Peter Bearman conducted the study highlighted in this issue of ResearchBrief (see below for full citation). They used data from the National Longitudinal Study of Adolescent Health, a nationally representative study that looked at the health behaviors and outcomes of adolescents in grades 7?12. The study collected individual, family, school, and community data in three phases?the first in 1994, the second in 1996, and the third in 2001 and 2002, when 18- to 26-year-old participants from the previous two phases were reinterviewed to examine the longer term effects of their adolescent experiences. The researchers hypothesized that they would find one of two outcomes: (1) that pledgers would delay their first incidence of vaginal intercourse and so have lower rates of STD acquisition due to less exposure or (2) that pledgers would be less likely to engage in ?safe sex? practices, including condom use, and so would not have lower rates of STD acquisition.

The study included 20,745 respondents in the first phase, 15,170 of whom also participated in the final phase. As part of the study, in each phase, a series of questions were included related to virginity pledges and the sexual activity of respondents. In the final phase, urine samples were gathered from 92 percent of respondents (8 percent refused to participate in the biospecimen collection) and tested for the presence of three STDs?chlamydia, gonorrhea, and trichomoniasis. In addition, 7,000 females were randomly selected to have their urine tested for human papillomavirus (HPV), the most frequently attributed cause of genital warts. Strict protocols were followed in collection of the specimens, and depending on the test, between 4 percent and 10 percent of the samples were discarded because they were not suitable for testing. No significant difference existed in the rate of participation or discarded samples between pledgers and nonpledgers, although pledging males who were 17 years old or older during the first phase were more likely to participate in the final phase. Ultimately, the researchers were able to analyze data from 11,471 respondents.

Researchers analyzed respondents to the survey in three groups related to their pledge status: consistent pledgers (777), inconsistent pledgers (1,622), and nonpledgers (9,072). The researchers had to create the ?inconsistent pledgers? group because some respondents identified themselves as pledgers in one of the early phases but not in later phases (respondents who pledged in a later phase were categorized as consistent pledgers). The researchers next sought to establish the time between pledging and first-time vaginal intercourse, which they were able to do for 93 percent of the pledgers. (This could not be determined for pledgers who reported pledging and having their first incidence of intercourse in the same phase.) Approximately 11 percent of pledgers first pledged after they had already had intercourse.

The researchers found that adolescents who took virginity pledges did delay their first vaginal intercourse experience; however, 88 percent ultimately had sex before they were married (99 percent of nonpledgers had sex before marriage). Pledgers were also significantly more likely to marry early in life: 52 percent of female consistent pledgers were married by age 25 (compared to 40 percent of inconsistent pledgers and 34 percent of nonpledgers), as were 45 percent of male pledgers (compared to 26 percent of inconsistent pledgers and 25 percent of nonpledgers).

No statistically significant difference in STD acquisition rates existed between groups. Overall, pledgers were slightly less likely to test positive for chlamydia, gonorrhea, and trichomoniasis, and slightly more likely to test positive for HPV, but the differences were not statistically significant. Of pledgers who did have sex prior to marriage (88 percent of the pledgers), 7.3 percent had a current STD infection, as compared to 6.9 percent of those who never pledged and 5.5 percent of those who had sex and then later pledged. Pledgers were significantly less likely to use a condom during their first sexual experience and were also more likely to engage in nonvaginal sexual experiences involving the exchange of fluid than were their nonpledging peers.

The Bottom Line
Students who take virginity pledges acquire sexually transmitted diseases at rates similar to nonpledgers, despite having less cumulative exposure to STDs, fewer partners, and fewer nonmonogamous partners. Pledgers were significantly more likely than nonpledgers to engage in unprotected sexual behaviors that involved the exchange of bodily fluids, as well as have unprotected sex during their first incidence of intercourse.

Who's Affected?
This longitudinal study followed a nationally representative population of males and females from grade 7 through age 24.

Caveats
It is notoriously difficult to gather reliable data related to socially sensitive topics like sexuality using surveys. For longitudinal surveys (data are collected over time using the same participant), researchers must also deal with the variability inherent in changing responses over time. For example, the pledge status of participants was not stable across phases, requiring researchers to incorporate ?inconsistent pledgers? into their analysis. Even so, the National Longitudinal Study of Adolescent Health used a generally strong design, particularly for the determination of STD rates, where participants were physically tested for STD infections rather than using self-reported infection rates.

The Study
Br?kner, H., & Bearman, P. (2005). After the promise: The STD consequences of adolescent virginity pledges. Journal of Adolescent Health, 36, 271?278.

Other Resources

The Content of Federally Funded Abstinence-Only Education Programs (PDF file). United States House of Representatives Committee on Government Reform?Minority Staff Special Investigations Division

The National Longitudinal Study of Adolescent Health

Early Sexual Intercourse, Condom Use, and Sexually Transmitted Diseases. The Daily: Statistics Canada