Social and Emotional Consequences of Refraining From Sexual Activity Among Sexually Experienced and Inexperienced Youths in California

Abstract

Objectives. We examined the social and emotional consequences among adolescents of refraining from sexual activity (oral or vaginal sex) and whether these consequences differed over time and by gender and sexual experience.

Methods. Adolescents (N=612; 58% female) recruited from 2 schools were assessed at 4 time points separated by 6-month intervals, beginning in fall of ninth grade.

Results. The percentage of adolescents who reported only positive consequences (e.g., they felt responsible, friends were proud) dramatically decreased over time, whereas the percentage that reported negative consequences (e.g., they felt left out, partners became angry) steadily increased. Adolescent girls and sexually experienced adolescents were more likely to report both positive and negative consequences than were adolescent boys and sexually inexperienced adolescents. Adolescents who began the study with sexual experience were more likely to report positive consequences of refraining from sexual activity by the end of the study than those who initiated sexual activity later.

Conclusions. Sexual education programs should address how adolescents can cope with or prevent negative consequences of refraining from sexual activity, so that decisions to abstain are rewarding and decisions to engage in sexual activity are motivated by maturity and readiness.

Numerous prevention efforts are aimed at convincing adolescents to abstain from or delay the onset of sexual behavior.1^,2 These efforts are motivated, in part, by research that has shown that the early initiation of sexual behavior is associated with greater sexual risk taking and related health outcomes among adolescents, including having a greater number of lifetime sexual partners, being under the influence of alcohol or other substances during the most recent sexual experience, experiencing an unintended pregnancy, and contracting a sexually transmitted infection.3^,4 Bearman and Bruckner estimated that more than 2.5 million adolescents had taken public “virginity” pledges to abstain from sexual activity until marriage,5 yet such pledges have been hard for adolescents to keep. For example, data from the National Longitudinal Survey of Youth (Add Health) showed that roughly half of adolescents who pledged to refrain from sexual behavior still initiated it during high school.6

Clearly, it is not easy for adolescents to refrain from sexual activity. It is normal for adolescents to experience sexual desire.7 Adolescents face continual choices about whether to engage in sexual activity, and as with all choices, each course of action may have potential positive and negative consequences.8 Although previous research has examined the positive and negative consequences that adolescents perceive will occur or that they actually experienced after engaging in sexual activity,9^–16 little research has examined the consequences of refraining from sexual activity. This research is critical to understanding why adolescents choose a given course of action with respect to sexual activity and whether they maintain this choice over time.

Traditional health models developed to explain adult risk behavior, such as the Theory of Planned Behavior,17 Health Belief Model,18 Protection Motivation Theory,19 and Stages of Change Model,20 have considered both positive and negative consequences of health behavior. However, when applied to adolescent sexual behavior, empirical tests of these models as well as intervention efforts tend to emphasize the negative health consequences of sexual behavior (e.g., sexually transmitted infections). Halpern-Felsher et al.11^,21 have argued that it is equally important to consider social and emotional consequences,9^–12 including positive consequences, of sexual behavior.9^,10^,12^,16

Positive and negative consequences of engaging in sexual activity represent only half of the equation with respect to sexual decision-making. Adolescents’ experience of positive and negative consequences of refraining from sexual activity is also of conceptual importance in understanding choices adolescents make about sexual activity, yet, surprisingly, no quantitative research has examined adolescents’ experienced consequences of refraining from sexual activity. Some research has examined the motivations adolescents have for refraining from sexual activity. These studies have concentrated on fear-based concerns (e.g., pregnancy) and value-based concerns (e.g., religious edicts against premarital sexual activity).22^,23

In a study by Michels et al., which employed qualitative interviews of sexually experienced and inexperienced adolescents, social and emotional concerns (e.g., disappointing one’s family by engaging in sexual activity) were discussed by adolescents who chose not to engage in sexual activity.11 At least 1 qualitative study has examined adolescents’ perceived consequences of refraining from sexual activity, including positive consequences (e.g., protecting one’s reputation) and negative consequences (e.g., being ashamed of one’s virginity).24 The authors did not assess whether consequences had been experienced by participants as a result of refraining from sexual activity, however.

Estimates of negative social and emotional consequences of refraining from sexual activity (e.g., they felt left out, partners became angry) among adolescent populations are important to identify, because they may increase the likelihood that adolescents will consider engagement in sexual behaviors with which they might initially have felt uncomfortable. Negative consequences of refraining from sexual activity are of particular importance if they occur at higher rates than do positive consequences.

Certain subgroups of adolescents may be at particular risk for experiencing negative consequences of refraining from sexual activity. As they age, adolescents may be more likely to experience negative social and emotional consequences of refraining from sexual activity, because the percentage of their peers who are sexually experienced increases over time.25 Similarly, adolescents who have previously engaged in sexual activity may be at risk for experiencing negative consequences, because they may experience greater external and internal pressures to continue engaging in sexual activity. It is unclear whether aging and previous sexual experience might be associated with adolescents’ reports of positive consequences of refraining from sexual activity.

Gender is another factor that may influence consequences. Girls may be more likely than boys to experience both positive and negative consequences of refraining from sexual behavior, because they are more likely than are boys to encounter societal pressures to restrict sexual behavior,24^,26 yet may also experience more overt pressure to engage in sexual activity from opposite-sex partners.24^,27 Because boys’ sexuality and sexual behavior is generally accepted26 and they appear to experience less overt pressure to engage in sexual activity from opposite-sex partners,24^,27 boys may be less likely than girls to experience positive and negative consequences of refraining from sexual activity.

We examined the consequences of refraining from sexual activity among a sample of adolescents followed throughout the ninth and 10th grades. We sought to determine (1) the extent to which adolescents experienced positive and negative consequences of refraining from sexual activity, and (2) whether social and emotional consequences of refraining from sexual activity differed over time and by gender and sexual experience.

METHODS

Participants

This study was part of a larger investigation on adolescents’ perceptions of and engagement in sexual behavior. Data were collected every 6 months during the ninth and 10th grades between late 2002 and early 2004.

Participants were recruited from mandatory ninth grade classes in 2 California public high schools. Researchers introduced the study to all students in the fall of 2002, when students were in the ninth grade. On the day of recruitment, 1180 students were in attendance and received consent packets to share with their parents. Of this number, 665 students (56%) returned signed parental consent forms, and 637 students (96% of the eligible sample) completed surveys at the first wave of data collection. Participants did not differ from the overall population of students in their school in terms of race/ethnicity or socioeconomic status.

At the first assessment, during the fall of ninth grade, 612 adolescents provided information about their sexual experience and the consequences they may have experienced as a result of refraining from sexual activity, defined as oral or vaginal sex (25 of the original 637 did not provide this information). During the spring of ninth grade, 575 (94% of 612) completed surveys. The percentages who completed surveys during the fall and spring of 10th grade were both 84% (512 and 516 adolescents during the fall and spring, respectively). Participants who completed fewer surveys were more likely to be boys, sexually experienced, have parents who had separated or divorced, have lower grades, and have lower educational goals compared with participants who completed more surveys (all P< .01). Reports of parental education, employment, and religiosity did not vary by number of surveys completed.

In the fall of ninth grade, the mean age of the adolescents (N = 612) was 14 years (SD = 0.5) and 58% were girls. Participants reported diverse racial/ethnic backgrounds: 40% White, 17% Latino, 22% Asian/Pacific Islander, 3% African American, and 18% multiethnic or other ethnicity. Participants’ reports of their mothers’ education varied: professional or graduate degree (9%), 4-year college degree (19%), 2-year college degree (10%), some college education (19%), high school degree (19%), did not graduate from high school (8%), less than a ninth grade education (4%), unknown (12%).

After we obtained institutional review board approval, written parental permission, and adolescent assent, students completed self-administered surveys in the fall and spring of academic years 2002–2003 and 2003–2004.

Measures

Sexual experience.

At each time point, we asked participants whether they had ever engaged in vaginal or oral sex. Adolescents were considered to be sexually experienced if they had ever engaged in either type of sexual activity. We computed a categorical variable to reflect history of sexual activity: sexually inexperienced throughout the study (N = 344; 56% of 612), sexually experienced at the start of the study (report of sexual activity at time point 1 [N = 135; 22% of 612]), and sexually experienced by the end of the study (first report of sexual activity at time points 2, 3, or 4 [N = 133; 22% of 612]).

Consequences of refraining from sexual activity.

At each time point, participants indicated whether they had experienced a number of consequences of refraining from sexual activity (Table 1 ▶). Standardized measures of social and emotional consequences of refraining from sexual activity have not yet been developed. The positive and negative consequences assessed in this study were chosen after qualitative interviews with a small set of adolescents who were asked about types of outcomes adolescents might experience after engaging in or refraining from sexual activity. Similar consequences have been assessed in other studies that examined the consequences of engaging in sexual activity.9^,12 Some consequences were assessed on a 6-point scale, ranging from “none” to “5 times or more,” which used the lead-in, “During your entire life, about how many times have you . . .” Other consequences were assessed by asking adolescents whether or not the consequence had ever occurred (yes or no), by using the lead-in, “Have you ever . . .”

TABLE 1—

Percentage of Adolescents Who Reported Positive and Negative Consequences of Refraining From Sexual Behavior, by Sexual Experience and Time Point: California, 2002–2004

	Sexually Inexperienced Throughout Study				Sexually Experienced at Start of Study				Sexually Experienced by End of Studya
	Time 1	Time 2	Time 3	Time 4	Time 1	Time 2	Time 3	Time 4	Time 1	Time 2	Time 3	Time 4
Total, no.	344	333	297	299	135	109	89	90	133	133	126	127
Overall experience of consequences, %
Only positiveb,c,d	46	34	28	24	37	31	22	8	40	37	16	6
Both positive and negativeb,d	8	14	17	18	30	34	47	44	22	31	45	27
Only negativeb,c,d	1	1	3	5	9	7	14	27	2	4	10	33
No reported consequences	45	51	51	53	24	28	17	21	36	28	29	33
Any positive consequence,b,c,d %	54	48	45	42	67	64	70	52	62	68	61	33
Had a good reputationd	40	41	33	36	35	43	42	38	40	50	37	25
Friends were proudd	45	42	39	39	48	44	51	47	48	52	45	29
Felt responsible	22	19	20	NA	48	42	55	NA	39	39	47	NA
Any negative consequence,b,c,d %	8	15	21	23	38	42	61	70	24	34	56	60
Partner became angryb,c,d	6	10	11	10	36	35	46	53	22	31	41	41
Had a bad reputationb	2	6	6	7	6	12	11	17	6	10	5	10
Felt regretb	NA	NA	4	9	NA	NA	33	39	NA	NA	28	33
Felt left out	NA	NA	8	10	NA	NA	22	18	NA	NA	24	22
Felt like you let your partner down	NA	NA	NA	7	NA	NA	NA	25	NA	NA	NA	20

Note. Time 1 = fall, ninth grade; Time 2 = spring, ninth grade; Time 3 = fall, 10th grade; Time 4 = spring, 10th grade; NA = not assessed.

^aAdolescents reported being sexually inexperienced at Time 1 but later reported sexual experience.

^bWhen we used Cochran’s Q test of the difference between 4 related dichotomous outcomes (P < .05), reports of this consequence significantly differed over time among adolescents who were sexually inexperienced throughout the study. Cochran’s Q test tests the hypothesis that several related dichotomous variables have the same mean. The variables can be measured on the same individual over time. Data from all time points are included in derivation of the test statistic.

^cWhen we used Cochran’s Q test, reports of this consequence significantly differed over time among adolescents who were sexually experienced at the start of the study.

^dWhen we used Cochran’s Q test, reports of this consequence significantly differed over time among adolescents who were sexually experienced by the end of the study.

In our study, all consequences were examined as dichotomous (yes or no) variables. Positive consequences assessed at all time points included “had a good reputation” and “had your friends proud of you.” “Felt responsible” was assessed at time points 1 through 3. Negative consequences assessed at all time points included “had a partner get angry” and “had a bad reputation.” A few consequences not assessed in the first 2 waves of data collection were added in subsequent waves. “Felt regret” and “felt left out of your group of friends” were assessed at time points 3 and 4, and “felt like you let your partner down” was assessed at time point 4. Through discussions with adolescents as the longitudinal study progressed,11 it became clear that these emotionally and socially relevant consequences were salient to youths and should be included in the study. All items were followed by phrases such as “because you did not have sex” or “for not having sex.”

We created composite variables to reflect whether adolescents reported any positive or negative consequence as a result of refraining from sexual activity at each time point (yes or no), as well as adolescents’ overall experience of consequences (Table 1 ▶).

Plan of Analyses

The percentage of adolescents who reported positive and negative social and emotional consequences of refraining from sexual activity were examined within sexual experience group and time point. Cochran’s Q test of the difference between related dichotomous outcomes was used to examine whether consequences differed over time among adolescents within each sexual experience group. Logistic regression analyses of composite outcomes within time point were used to test whether reports of consequences differed according to gender and sexual experience. Gender and previous sexual experience were entered in models simultaneously. Simple contrasts were used to test whether sexual experience groups reported different consequences from one another.

RESULTS

Positive and Negative Consequences of Refraining From Sexual Intercourse

The percentages of adolescents who reported positive and negative social and emotional consequences of refraining from sexual activity are shown in Table 1 ▶. Regardless of sexual experience, reports of only experiencing positive consequences of refraining from sexual activity dramatically declined over time. The percentage of adolescents who reported only positive consequences dropped from 46% to 24% from the fall of ninth grade to the spring of 10th grade among adolescents who remained sexually inexperienced throughout the study. The comparable figures dropped from 37% to 8% among adolescents who were sexually experienced at the start of the study and from 40% to 6% among adolescents who initiated sexual activity by the end of the study.

Regardless of sexual experience, reports of any positive consequences of refraining from sexual activity decreased over time, whereas reports of any negative consequences of refraining from sexual activity increased over time. When analyses of any positive consequences and any negative consequences were limited to those consequences assessed at all time points, the pattern of results was similar, although differences over time reached significance only among specific subgroups. Reports of any positive consequences decreased over time among adolescents who became sexually experienced by the end of the study, whereas reports of any negative consequences increased over time among adolescents who remained sexually inexperienced throughout the study and among adolescents who became sexually experienced by the end of the study (all P< .001 with Cochran’s Q test).

Among adolescents who remained sexually inexperienced throughout the study, report of having a bad reputation and feeling regret as a result of refraining from sexual activity increased over time (Table 1 ▶). Regardless of sexual experience, reports of a romantic partner’s becoming angry as a result of their refraining from sexual activity increased over time. Among adolescents who became sexually experienced by the end of the study, report of having a good reputation and friends being proud as a result of their refraining from sexual activity decreased over time.

Consequences, by Gender and Sexual Experience

Table 2 ▶ shows that at each time point, girls were more likely than were boys to report positive and negative consequences of refraining from sexual activity. Odds ratios showed that girls were 4 to 5 times as likely as boys to report positive consequences of refraining from sexual activity and roughly twice as likely to report negative consequences of refraining from sexual activity. At each time point, girls were also more likely than were boys to report having experienced only positive consequences of refraining from sexual activity. All effects were independent of adolescents’ sexual experience.

TABLE 2—

Odds Ratios (ORs) for Consequences of Refraining From Sexual Behavior Among Adolescents, by Gender and Sexual Experience: California, 2002–2004

	Female vs Male Gender, OR	Sexually Experienced at Start of Study vs Sexually Inexperienced Throughout Study, OR	Sexually Experienced by End of Studya vs Sexually Inexperienced Throughout Study, OR	Sexually Experienced at Start of Study vs Sexually Experienced by End of Study,a OR
Time 1: fall, ninth grade
Any positive consequences	4.60***	2.33***	1.64*	1.42
Any negative consequences	1.69*	9.04***	4.30***	2.10**
Only positive consequences	2.74***	0.76	0.83	0.92
Time 2: spring, ninth grade
Any positive consequences	4.05***	2.33**	2.66***	0.87
Any negative consequences	2.12**	4.04***	3.00***	1.34
Only positive consequences	2.27***	0.93	1.22	0.77
Time 3: fall, 10th grade
Any positive consequences	5.53***	3.08***	2.23**	1.38
Any negative consequences	2.58***	6.29***	5.26***	1.20
Only positive consequences	2.77***	0.70	(2.12)**	1.48
Time 4: spring, 10th grade
Any positive consequences	5.90***	1.52	0.70	2.16*
Any negative consequences	1.59**	7.67***	5.02***	1.53
Only positive consequences	8.63***	(3.99)**	(4.63)***	1.16

Note. Gender and sexual experience were entered simultaneously in logistic regressions models. Effects in parentheses are opposite in direction to that indicated in the column header.

^aAdolescents reported being sexually inexperienced at Time 1 but later reported sexual experience.

*P < .05; **P < .01; ***P < .001.

Independent of gender, sexually experienced adolescents were more likely than were sexually inexperienced adolescents to report any positive consequences of refraining from sexual activity during the ninth grade and fall of 10th grade (Table 2 ▶). At all time points, sexually experienced adolescents were more likely than were sexually inexperienced adolescents to report any negative consequences of refraining from sexual activity. Differences increased over time such that by the fall of 10th grade, sexually experienced adolescents were 2 to 3 times as likely as sexually inexperienced adolescents to report any positive consequences of refraining from sexual activity, and by the spring of 10th grade, they were 5 to 7 times as likely to report any negative consequences of refraining from sexual activity. By the end of the study, adolescents who remained sexually inexperienced throughout the study were more likely than were sexually experienced adolescents to report having only experienced positive consequences as a result of refraining from sexual activity.

Two differences emerged in the consequences reported by adolescents who were sexually experienced at the start of the study and those who became sexually experienced by the end of the study (final column of Table 2 ▶). Adolescents who were sexually experienced at the start of the study were twice as likely to report any negative consequences of refraining from sexual activity during the fall of 9th grade (the first assessment period) as adolescents who became sexually experienced by the end of the study. However, by the spring of 10th grade (the final assessment period), adolescents who were sexually experienced at the start of the study were twice as likely to report any positive consequences of refraining from sexual activity as were adolescents who became sexually experienced by the end of the study.

DISCUSSION

Our goals for this longitudinal survey study were to determine the extent to which adolescents experienced positive and negative consequences of refraining from sexual activity and whether these consequences differed over time and by gender and sexual experience. Adolescents’ reports of negative social and emotional consequences of refraining from sexual activity steadily increased as time progressed from the fall of ninth grade to the spring of 10th grade, such that by the end of the study, nearly one quarter of sexually inexperienced adolescents and more than half of sexually experienced adolescents reported negative consequences of refraining from sexual activity. By contrast, reports of having experienced only positive consequences of refraining from sexual activity dramatically decreased over time, such that by the spring of 10th grade, fewer than a quarter of the adolescents reported only having experienced positive consequences. These results support the idea that adolescents’ experience of positive and negative consequences after refraining from sexual activity are of conceptual importance in understanding the choices adolescents make about sexual activity.

As expected, reports of positive and negative consequences of refraining from sexual activity differed by gender and sexual experience. Independent of sexual experience, girls were more likely than were boys to report both positive and negative consequences of refraining from sexual activity. This is consistent with research that has shown that girls are encouraged by society to restrict sexual behavior,24^,26 yet girls also experience more overt pressure from opposite-sex partners to engage in sexual behavior.24^,27 By contrast, boys’ sexuality and sexual behavior are generally accepted,26 and data suggest that they experience less overt pressure from opposite-sex partners to engage in sexual behavior.24^,27

Independent of their gender, sexually experienced adolescents were more likely to report having experienced any negative consequences of refraining from sexual activity than were sexually inexperienced adolescents. Sexually experienced adolescents were also more likely to report any positive consequences of refraining from sexual activity. One explanation of this finding is that sexually experienced adolescents may have greater difficulty refraining from sexual activity than their sexually inexperienced peers and, thus, feel more responsible when they do refrain from sexual activity. Another explanation is that sexually experienced youths may have more opportunities to refrain from sexual activity and, therefore, more opportunities to experience positive consequences.

One difference in the reports of consequences between adolescents who had initiated sexual activity by the start of the study and those who had initiated by the end of the study highlights a possible developmental process with respect to sexual activity. At the final assessment, adolescents who began the study with sexual experience were more likely to report positive consequences of refraining from sexual activity than were their peers who became sexually experienced at later time points. One explanation for this finding is that sexually experienced adolescents may become more reflective about their past experiences as time progresses and come to value selectivity about their sexual partners or occasions for engaging in sexual activity. Although this process may eventually occur among all adolescents regardless of the age of sexual activity initiation, it is also possible that adolescents who initiate sexual activity at an earlier age are more likely to become involved in harmful relationships that highlight the benefits of refraining from sexual activity.

Future longitudinal research should examine the different sexual experiences adolescents may have depending on age of sexual activity initiation. This is consistent with calls for research to study differences among sexually experienced adolescents rather than purely focusing on how they differ from sexually inexperienced adolescents.28

Strengths and Limitations

Limitations of our study included the assessment of adolescents from 1 region of California, which may not be generalizable to other regions of the country. We began assessments in the ninth grade and, thus, did not capture initiation of sexual activity among one fifth of our sample (i.e., the 135 adolescents who reported being sexually experienced at the first assessment). We were unable to recruit 44% of ninth grade youths into our study, and sexually experienced youths completed fewer surveys, which may have affected estimates; girls were also slightly overrepresented. We assessed a limited number of consequences of refraining from sexual activity, which may not describe adolescents’ full experiences. Our assessment of a greater number of potential negative consequences as time progressed may have increased the likelihood that adolescents reported experiencing any negative consequences.

An additional limitation is that we do not know whether all adolescents who remained sexually inexperienced throughout the study did so because of choice or whether some adolescents wished to engage in sexual activity but lacked opportunity. We also relied on adolescents’ self-report. However, adolescents were assured of confidentiality, and a positive rapport was established with the participants, likely serving to increase reliability.

Strengths included our assessment of more than 600 adolescents who were racially/ethnically and socioeconomically diverse. To our knowledge, this is the first quantitative study to systematically examine the positive and negative social and emotional consequences that adolescents reported as a result of refraining from sexual activity and to examine whether these consequences differed as a function of time, gender, and sexual experience.

Conclusions

Our findings suggest that adolescents may choose not to abstain from sexual activity or may reverse an original decision to abstain in part because they experience more negative and fewer positive social and emotional consequences of refraining as they age. Sexually experienced adolescents are an important subgroup for intervention because they are especially vulnerable to experiencing negative consequences of refraining from sexual activity.

We do not know whether the sexually experienced adolescents in our study consciously decided to abstain from sexual activity for an extended period of time or whether they selectively rejected opportunities to engage in sexual activity within the context of a sexually active relationship. It is likely that both types of abstinence situations occur among sexually experienced adolescents, and each scenario may require a special set of skills. Although abstinence-based programs encourage secondary abstinence, or discontinuation of sexual activity among those who are already sexually experienced,29 it is unclear whether the needs of adolescents who wish to selectively refrain from sexual activity (i.e., selectively engage in sexual activity) are being met by such programs. In addition, qualitative research suggests that some adolescents view abstinence as synonymous with virginity,24 which may cause sexually experienced adolescents to think that abstinence-based programs do not apply to them.

Our study may aid in the design of sexual education and health promotion interventions. Prevention efforts may have the greatest success if adults openly acknowledge that both positive and negative consequences may occur as a result of adolescents’ refraining from sexual activity. Discussion about how to cope with negative consequences may lead some adolescents to delay the onset of sexual activity or to refrain from continued sexual activity.

Given that many adolescents choose not to refrain from sexual activity, it is critical for sexual education and health promotion programs to provide medically accurate and complete information about sexuality and contraceptives to adolescents.30 Findings from our study suggest that this information should be provided to adolescents before the ninth grade, because one fifth of adolescents had initiated sexual activity by the fall of ninth grade.

Our results support the recommendation of Cooper et al. that adolescent sexual behavior should be considered from a dynamic relationship perspective rather than from a purely “disease model” perspective.13 Sexual behavior does not only have physical consequences but also emotional and social consequences. Our study demonstrated an equally important point: refraining from sexual behavior has emotional and social consequences. A comprehensive approach to educating adolescents about sexuality includes discussion of social, emotional, and physical aspects of sexuality and sexual decisionmaking. It also provides medically accurate and complete information about contraceptives and prophylactics, so that adolescents who decide to engage in sexual activity can do so safely. A comprehensive approach to educating adolescents about sexuality may promote decisions to refrain from sexual activity that feel rewarding, and decisions to engage in sexual activity that are based on maturity and perceived readiness.