Prevalence of Early Sexual Debut among Young Adolescents in Ten States of the United States

Abstract

Sexual debut among young adolescents is under-investigated. In this quantitative descriptive study, we examined the 2019 Middle School Youth Risk Behavior Survey (YRBS) data of 66,366 young adolescents aged 10–14 from 10 states to determine the prevalence of early sexual debut among young adolescents. Data analyses used state-level sampling weights as described in the CDC’s 2019 Middle School YRBS user guide. Nearly 8% of the sample reported having had sexual intercourse. Of those who reported age of first sex, 4% had their first sexual intercourse before 13 years of age. Compared to Whites, young Black/African American (13.2% vs. 5.1%, OR = 4.51, 95% CI: 2.78–7.31) and Hispanic adolescents (8.3 % vs. 5.1 %, OR = 1.44, 95% CI = 1.13–1.84) were more likely to report having early sexual intercourse. Males were more likely to report having multiple sexual partners than females (48.1% vs. 36.5%, OR = 1.68, 95% CI = 1.22–2.29) and were more likely to report using condoms during their last sexual intercourse compared to their female counterparts (59.7% vs. 50.8%, OR = 1.43, 95% CI = 1.06–1.94). This study suggests the need for more research on young adolescents’ sexual behaviors and for the development of sexual health interventions that target young adolescents.

1. Introduction

Early sexual debut, which refers to having first sexual intercourse at 14 years old and younger, has adverse sexual and reproductive health implications on adolescent health [1,2]. Early sexual activity among adolescents of both genders is associated with a higher risk of having multiple sexual partners and engaging in unprotected sex, having sex with older partners and under the influence of substances, and experiencing sexual coercion [3]. All these factors predispose young adolescents to early pregnancy and sexually transmitted infections (STIs), including HIV infection and human papillomavirus (HPV) [4]. Currently, half of the 20 million new STIs reported annually in the United States (US) are among people aged 15–24 years [5], and 21% of new HIV infections are among young people 13–24 years old [6]. Additionally, over 4500 young adolescent girls become pregnant in the US every year [7], and their birth rate is estimated at 0.2 per 1000 [7,8], while their abortion rate is estimated at 0.4 per 1000 [9]. Racial disparities in birth rates for young adolescents also exist, with Hispanic and Black girls having higher rates (3.0 per 10,000 and 4.0 per 10,000, respectively) than White girls (1.0 per 10,000). Combined, these rates suggest that high-risk sexual behaviors may start between the ages of 10 and 14 years or earlier. Therefore, more studies are needed to explore the sexual behaviors of young adolescents.

Studies that have explored the sexual behaviors of young adolescents are scarce [10,11,12,13]. Instead, older adolescents, young adults, and adults have been used to inform the understanding of sexual behaviors and risks for early pregnancies, STIs, and HIV among young adolescents. Cavazos-Rehg, Krauss [14] analyzed the High School Youth Risk Behavior Survey (YRBS) data from 1999–2007 of 9th to 12th graders to determine gender and racial/ethnic differences. The results showed that Black/African American males experienced sexual debut earlier than all other groups and Asian males and females experienced sexual debut later than all groups. Lindberg, Maddow-Zimet and Marcell [15] also examined the High School YRBS of 2011, 2013, and 2015 and the National Survey for Family Growth data of 2006–2015 to determine the prevalence of sexual intercourse before the age of 13 years among male adolescents. In this high school sample, the results revealed a national prevalence of sexual debut before age 13 of 7.6%, ranging widely among states (5% to 25%). Sexual behavior among young adolescents in these studies was mostly based on research involving the retrospective recall of high school adolescents and adults, which may be prone to recall bias [16]. Excluding young adolescents from research studies and epidemiological analyses results in missed opportunities for early interventions to prevent adverse sexual health outcomes among young adolescents [17,18].

To our knowledge, this is the first study to examine sexual behaviors reported in the Middle School YRBS. Researchers often avoid investigating the sexual behaviors of young adolescents in part because of the cultural sensitivity of the topic, which makes it difficult to study young adolescents systematically [10,11]. Additionally, ethical considerations with getting approval from institutional review boards pose challenges to studying this population [12,13]. Given that the onset of puberty occurs on average at age 10 and the onset of sexual maturation continues to fall to as low as 7 and 8 years, understanding how common it is for young adolescents to engage in sexual behaviors can guide when to start discussing sexual health with this age group [12,13]. Recent research also shows that the age of menarche is positively correlated with the age of first sexual intercourse [19]. Therefore, this knowledge is essential to inform the development of strategies to prevent early sexual activity and its negative consequences, such as early pregnancies and STIs, including HIV and HPV infections. In this study, we examined the prevalence of early sexual debut among young adolescents in the 2019 Middle School YRBS and described their sexual behaviors. The results are likely to inform future research and interventions, including supportive policies and programs, for young adolescents’ healthy sexual development.

2. Materials and Methods

This study was a secondary data analysis of the 2019 Middle School YRBS from the Centers for Disease Control and Prevention (CDC). The data were downloaded from the CDC’s YRBS website [20]. This dataset includes the majority of weighted states and large urban school district middle school surveys. State-level YRBS use a two-stage cluster sample design to generate representative samples of middles school students in its jurisdiction, while the national YRBS uses a three-stage cluster sample design to collect a nationally representative sample of US students in middle schools in the 50 states [20,21]. The national YRBS is designed to produce estimates that are accurate within ±0.5% at a 95% confidence interval. A detailed description of this multi-stage cluster sample design is described in the methodology guide of the YRBS [21].

State and district YRBS datasets are owned and controlled by the health and education agencies that conducted the surveys. Some states did not assess the items related to sexual behavior, and others did not give the CDC permission to include their data in the published dataset. Given the variability in which sexual health behaviors are surveyed across states, we limited our analysis to states that assessed adolescents’ sexual behaviors, an approach that has been used in previous studies [22]. Appendix A shows that only 10 states assessed the sexual behaviors of interest in the 2019 Middle School YRBS. Given our focus on the sexual behaviors of young adolescents aged 14 and younger, we further restricted our sample to exclude those aged 15 and older. Students who were 10 or younger were also removed because they were not well represented in the data (N = 254). We excluded this age group because ensuring sufficient representation within subgroups is crucial for conducting meaningful subgroup analyses, as having too few participants in a particular subgroup can lead to unreliable results and limit the ability to detect significant differences within that group [23]. Therefore, our analytic sample consisted of data from adolescents aged 11–14 from the 10 states that assessed sexual behaviors. The study was determined to be exempt from our office of subject protection.

2.1. Measures

Our main variables of interest included four items that were used to examine sexual behavior: (1) “Have you ever had sexual intercourse?” (2) “How old were you when you had sexual intercourse for the first time?” (3) “How many people have you had sex with?” (4) “The last time you had sexual intercourse, did you or your partner use a condom?” Appendix B shows the questions that were asked for each variable, the response options and the scales. These sexual health behaviors were assessed and reported on by a varying number of states. Of the 10 states included in our sample, one state (Hawaii) was missing “Ever sexual intercourse”, and four states were missing the age of first sexual intercourse (North Carolina, North Dakota, Rhode Island, and Vermont). Five states included all four sexual health outcomes (Delaware, Kentucky, Maine, Maryland, and New Mexico) (see Appendix A). To avoid potential inconsistencies in measurement across states due to the assessment of different sexual behaviors, we restricted our analyses to the states that assessed sexual behavior. This is the approach that has been used by previous researchers who have analyzed the youth risk behavior survey [22]. Sexual health behaviors were analyzed for differences by gender (1 = female, 2 = male), age (1 = 10 years old and younger, 2–11 years old, 3 = 12 years old, 4 = 13 years old and 5 = 14 years old), and race (1 = White, 2 = Black of African American, 3 = Hispanic or Latino, 4 = all other races). See Appendix B.

2.2. Analysis

Data analyses were conducted using IBM SPSS Statistics [24]. Analyses of the data from YSRB used state-level sampling weights as described in the CDC’s 2019 Middle School YRBS user guide [20]. We computed descriptive statistics that included measures of central tendency to synthesize the data, and we conducted cross-tabulations to describe the sexual behaviors of young adolescents by their age, race, sex, and state. We maximized the sample size for each item by including all states in which the item was collected and reported.

3. Results

Table 1. Sociodemographic characteristics of middle school 11- to 14-year-old adolescents.

Demographics		Unweighted n	Weighted %
Age	11 years old	11,605	15%
	12 years old	21,120	32%
	13 years old	24,047	35%
	14 years old	9594	17%
Sex	female	32,773	49%
	Male	33,170	51%
Grade	6th grade	17,892	31%
	7th grade	24,254	35%
	8th grade	23,849	33%
	Ungraded/other grade	132	<1%
Race/Ethnicity	White	32,193	50%
	Black/African American	7739	20%
	Hispanic/Latino	10,333	19%
	Other	11,536	12%

Overall unweighted N for the sample is 66,366. Proportions are survey-weighted, sample sizes are unweighted, and variance estimates account for the complex survey design.

shows the sociodemographic characteristics of the participants in the sample. Half of the sample was White, and the other half was divided among Black/African Americans, Hispanics, and other races. Overall, 99% of the adolescents were enrolled in 6th, 7th, and 8th grades, and less than 1% were ungraded or in another grade.

3.1. Ever Had Sexual Intercourse

Table 2. Weighted percentages of young adolescents reporting ever having sexual intercourse by sex, age at the time of assessment, and race.

Variable		Reported Having Sexual Intercourse
		Unweighted Sample Size	Sex (Weighted %)			OR/95% CI
			Females	Males	Total
Ever had sex		53,756	5.1	9.8	7.5	2.02 (1.67–2.44) *
Age at the time of assessment	11 years	9200	1.8	3.8	2.8	2.15 (1.19–3.90) *
	12 years	17,177	3.1	7.1	5.1	2.39 (1.60–3.57) *
	13 years	19,672	6.0	10.9	8.6	1.93 (1.36–2.73) *
	14 years	7707	10.3	16.7	13.8	1.74 (1.20–2.52) *
Race	White	29,572	4.1	6.2	5.1	1.54 (1.17–2.04) *
	Black/African American	6280	5.5	20.9	13.2	4.51 (2.78–7.31) *
	Hispanic/Latino	8075	7.0	9.8	8.3	1.44 (1.13–1.84) *
	Other	6555	7.3	10.0	8.7	1.42 (0.92–2.19)

Note. N = 53,756; * p < 0.05, OR = odds ratio, CI = confidence interval. Proportions are survey-weighted, sample sizes are unweighted, and variance estimates account for the complex survey design.

presents the prevalence of sexual intercourse of males and females by age at the time of assessment and by race. The prevalence of sexual intercourse was 7.5% among the whole sample. Males were twice as likely to report having had sexual intercourse than females (9.8% vs. 5.1%; OR = 2.02, 95% CI: 1.67–2.44). As age increased, so did the prevalence of young adolescents reporting having sexual intercourse. Additionally, for each age (11 to 14 years), males were between 1.74 and 2.39 times more likely to have engaged in sexual intercourse than females. As regards race, White youth had the lowest prevalence of sexual intercourse (5.1%). Also, White males were 1.5 times more likely to report ever having sexual intercourse than White females (6.2% vs. 4.1%, OR = 1.54, 95% CI 1.17 to 2.04). Black/African American males reported the highest prevalence of having ever had sex (20.9%) and were over four and a half times more likely to report having ever had sexual intercourse than Black/African American females (5.5%). The situation was similar with Hispanic/Latino males.

3.2. Age of First Sexual Intercourse

Table 3. Weighted percentages of reported age of first sexual intercourse by sex.

Reported Age of First Sexual Intercourse	Unweighted Sample Size	Sex (%)			OR (95% CI)
		Female	Male	Total
Never had sex	37,595	95.2	92.3	93.8	0.60 (0.58–0.61) *
8 years old or younger	392	0.7	1.0	0.9	1.42 (1.33–1.51) *
9 years old	162	0.2	0.5	0.4	2.72 (2.44–3.03) *
10 years old	214	0.3	1.0	0.6	3.78 (3.45–4.14) *
11 years old	319	0.5	0.8	0.7	1.68 (1.56–1.81) *
12 years old	608	1.0	2.0	1.5	2.00 (1.90–2.06) *
13 years old	863	2.1	2.4	2.2	1.13 (1.09–1.18) *

Note. N = 40,153, * p < 0.05, OR = odds ratio, CI = confidence interval. Proportions are survey-weighted, sample sizes are unweighted, and variance estimates account for the complex survey design.

shows the reported age of first sexual intercourse for males, females, and total. Notably, males were nearly four times more likely to report having their first sexual intercourse at 10 years of age than females (OR = 3.78, 95% CI = 3.45–4.14). The pattern was the same for those reporting first sexual intercourse at other ages such that males were more likely to report sexual intercourse than females from age 8 and younger to age 13. Of those who had had sexual intercourse, nearly two-thirds (65%) reported the age of first sex before the age of 13. Males were more likely to engage in sexual intercourse prior to age 13 than females (69.3% vs. 56%, OR = 1.77, CI:1.19–2.63).

Age of First Sexual Intercourse by Race

Table 4. Weighted percentages of reported age of first sexual intercourse by race.

Variable	Reported Age of First Sexual Intercourse	Unweighted Sample Size	Race (%)				OR of Black/African American Youth vs. All Other Races
			White	Black/African American	Hispanic /Latino	Other Races
Age of first sexual intercourse	Never had sex	35,341	95.3	88.7	92.9	94.3	0.45 (0.44–0.46) *
	8 years old or younger	376	0.5	2.0	0.8	1.0	3.01 (2.82–3.22) *
	9 years old	149	0.2	0.8	0.5	0.5	2.67 (2.41–2.96) *
	10 years old	207	0.3	1.7	0.4	0.7	4.06 (3.76–4.39) *
	11 years old	304	0.5	1.0	0.8	0.6	1.71 (1.54–1.86) *
	12 years old	589	1.4	1.8	1.9	1.1	1.24 (1.17–1.32) *
	13 years old	846	1.8	4.0	2.6	1.8	2.08 (1.99–2.17) *

N = 37,812, * p < 0.05, OR = odds ratio, CI = confidence interval. Proportions are survey-weighted, sample sizes are unweighted, and variance estimates account for the complex survey design.

shows the reported age of first sexual intercourse by race. Similar to findings previously described, Black/African American adolescents were more likely to report first sexual intercourse at each reported age than White, Hispanic, or other races.

3.3. Number of Sexual Partners

Table 5. Weighted percentage of young adolescents reporting having multiple sexual partners by age at assessment and race.

Variable	Two or More Sexual Partners
Age at Assessment	Unweighted Sample Size	Sex (%)			OR (95% CI)
		Females	Males	Total
11 years	208	17.2	43.2	32.2	3.66 (1.23–10.95) *
12 years	570	38.6	41.1	40.4	1.11 (0.56–2.21)
13 years	1143	39.5	47.4	44.3	1.38 (0.71–2.56)
14 years	671	35.0	62.2	51.4	3.06 (1.63–5.74) *
Total	2592	36.5	48.1	44.4	1.68 (1.22–2.29) *
Race
White	767	38.1	49.1	44.0	1.57 (0.94–2.62)
Black/African American	567	31.4	50.0	45.6	2.18 (0.76–6.26)
Hispanic/Latino	615	37.0	51.4	45.6	1.80 (1.03–3.14) *
Other	535	36.8	47.3	42.6	1.54 (0.81–2.94)
Total	2484	36.4	49.7	44.6	1.72 (1.25–2.37)

* p < 0.05, OR = odds ratio, CI = confidence interval. Proportions are survey-weighted sample sizes are unweighted, and variance estimates account for the complex survey design.

shows the rates of two or more partners by age of assessment and sex, as well as by race and sex among young adolescents. Analyses of age of assessment by sex revealed that males were over three times more likely than females to report multiple sex partners at ages 11 and 14. No other differences were observed. The prevalence of sex with multiple partners by race and sex revealed that Hispanic/Latino males were 1.8 times more likely than Hispanic/Latina females to report having sexual intercourse with multiple partners. In fact, Hispanic/Latino males reported the highest prevalence of having multiple partners than all other race–sex combinations.

Condom Use in Last Sexual Intercourse Experience

Table 6. Weighted percentage of young adolescents reporting condom use by age at the time of assessment and race.

Variable	Condom Use during the Last Time Had Sexual Intercourse
Age at Assessment	Unweighted n	Sex (%)			OR (95% CI)
		Females	Males	Total
11 years	172	28.7	43.6	36.9	1.92 (0.66–5.61)
12 years	536	45.1	54.1	51.3	1.44 (0.65–3.19)
13 years	1271	54.7	60.3	58.2%	1.26 (0.77–2.04)
14 years	788	53.4	67.1	61.7%	1.78 (0.79–3.98)
Total	2767	50.8	59.7	56.4%	1.43 (1.06–1.94) *
Race
White	1220	55.0%	61.1%	58.3%	1.28 (0.76–2.18)
Black/African American	559	32.3%	55.7%	50.0%	2.64(1.27–5.47) *
Hispanic/Latino	558	58.2%	66.4%	63.2%	1.42 (0.88–2.29)
Other	340	50.3%	59.6%	55.4%	1.46 (0.68–3.12) *
Total	2677	50.9%	60.2%	56.7%	1.46 (1.07–1.98) *

* p < 0.05, OR = odds ratio, CI = confidence interval. Proportions are survey-weighted, sample sizes are weighted, and variance estimates account for the complex survey design.

shows the rates of condom use during the last sexual experience by age at the time of assessment and sex and by race and sex. Analyses of the age at the time of assessment by sex revealed no differences between sex or age. Still, they did reveal an overall sex difference such that males were 1.43 times more likely than females to report condom use during last sexual intercourse. Prevalence of condom use by race and sex revealed that Black/African American females were 2.64 times less likely to report having used condoms during last sexual intercourse than Black/African American males and were 60% less likely to report having used a condom than non-Black females.

4. Discussion

This study provides one of the most recent estimates of sexual initiation and condom use among middle school adolescents aged 11–14 years. Our findings show that 7.5% of young adolescents report engaging in sexual activities during or before the middle school years, which has a bearing on the risk of early and unplanned pregnancies, HIV infection, and other STIs among this population. These findings highlight the need for increased efforts to initiate sexual health conversations and education early and meet the sexual and reproductive health needs of young adolescents in the US. In non-coercive contexts, adolescents make sexual and reproductive health decisions and choices based on their knowledge and availability of such choices [25]. The more knowledgeable young adolescents are, the more likely they are to take responsibility for their sexual health [26]. Comprehensive knowledge about sexuality before adolescents become sexually active is more likely to help them make informed decisions about the sexual behaviors they adopt [25].

However, addressing sexual behavior in this age group requires careful consideration of cultural, social, and ethical barriers that may influence the content and delivery of sexual education. Research suggests that sexual health interventions for adolescents need to be culturally sensitive and tailored to community norms and values, as these factors can significantly impact how messages are received and acted upon by young people and their families [27]. Additionally, ethical concerns regarding parental consent and determining the appropriate level of information to provide to young adolescents further complicate these efforts [28]. While comprehensive sexuality education has been shown to promote responsible sexual behaviors and reduce risky practices [29,30,31], it is crucial to ensure that such programs are delivered in ways that respect cultural contexts and engage parents and communities in the process. By fostering open, age-appropriate discussions and creating environments where young adolescents can access accurate and relevant information, agencies can empower them to make informed decisions about their sexual and reproductive health. Future efforts should not only aim to deliver early education but also work to overcome the sociocultural and ethical challenges that exist with regard to sexual health education for this age group.

Sex and racial differences were also observed regarding sexual initiation. The findings showed that males had a higher likelihood of sexual initiation compared to females, with Black/African American young adolescent boys having a higher prevalence of sexual initiation compared to Whites, Hispanics, and other races. These results are consistent with previous studies that found male Black/African Americans to experience earlier sexual debut [14] and to have elevated rates of early sexual initiation compared to other races [17]. However, while our findings corroborate these studies, it is important to consider that broader social and structural factors, such as economic disparities and access to resources, might also contribute to these observed differences. For example, Black and Hispanic communities often face systemic barriers, such as limited access to comprehensive sex education and health care [32], which could impact sexual health behaviors. In addition, the higher prevalence of early sexual initiation among males compared to females can be explained by the broad cultural understanding of masculinity and sex that men should start having sex early and have sex often [15]. Studies also report that for young men of color, particularly Black males, racist stereotypes of hypermasculinity also contribute to expectations of early sexual initiation [15,33]. Although this notion is not supported by research among young adolescents [34,35], it adds to the critical need to conduct more investigations to understand how young male adolescents are being socialized to sexuality and understand factors associated with male young adolescents’ sexual initiation. Thus, future studies should investigate how these sociocultural factors influence young adolescent males’ decisions regarding sexual initiation and provide evidence-based strategies to counteract harmful stereotypes.

Among those who reported having had sex, 44.4% had had multiple sexual partners. Previous studies align with this finding and show that young people who engage in early sexual activities at a very young age are at a greater risk of having multiple sexual partners. This is concerning because having multiple sexual partners alongside lack or inconsistent condom use increases the risk of contracting HIV and other STIs. In this study, the Hispanic 14-year-old males were over three times more likely to have multiple sexual partners. This finding suggests the need to explore further the relationship between culture and sexual behavior among young adolescents. Previous studies among older Hispanic men have shown the association between machismo (a cultural factor that reflects the expected gender role of Hispanic men) and sexual behavior [36]. Machismo as a norm is believed to perpetuate the message that Hispanic men should have multiple partners and should exhibit certain behaviors, such as sexual dominance to demonstrate masculinity, the need for penetrative sex, and perceptions of low sexual control [4,36]. Moving forward, culturally tailored interventions targeting Hispanic males should address these cultural norms while promoting healthy, respectful relationships and safer sexual practices. For instance, programs can promote positive, non-exploitative expressions of masculinity and challenge harmful cultural norms of sexual behavior. Engaging community leaders and influencers in these programs may increase their effectiveness.

In this study, just over half (56%) of young adolescents who had had sex reported using a condom the last time they had sex. This statistic raises concern given the high prevalence of early pregnancies and STIs among young adolescents [7,8]. Moreover, the young adolescent females, particularly those aged 11 years in this study, were less likely to use condoms. This finding suggests the need for early conversations on condom use among girls because they have a much increased risk of early pregnancies, HIV infection, and other STIs.

We found that as age increased, condom use increased, and males had the highest prevalence of using condoms across all ages and races. Interestingly, Hispanic/Latino males had the highest prevalence of condom use among all races. Overall, the prevalence of condom use among Black/African American females was substantially lower than any other race in condom usage (2.6% lower than Black males). This finding is consistent with research that suggests Black adolescent girls face unique challenges in negotiating condom use, including pressure from partners and gendered stereotypes [37]. These disparities highlight the importance of tailoring sexual health interventions to address the specific barriers faced by Black females. Programs should focus on empowering young Black women to make informed decisions about their sexual health, while also addressing societal factors like racism, sexism, and power dynamics in relationships. Comprehensive sexual education that emphasizes negotiation skills, self-efficacy in condom use, and awareness of power dynamics in relationships is essential. Moreover, the finding that condom use increased with age suggests that early conversations about sexual health including condom use are crucial, particularly for girls. Interventions should begin before young adolescents become sexually active and provide age-appropriate information about the importance of condom use in preventing both pregnancies and STIs. Additionally, addressing societal factors like gendered racism and the adultification of Black girls may reduce pressures leading to early sexual initiation [37,38,39].

It is not known how well these young adolescents used condoms. Correct and consistent condom use is essential if condoms are to be effective in preventing pregnancies and STIs among young adolescents. Condom use has been documented as being 13.0% less effective in preventing pregnancy in the first year of use, which indicates that further investigation is needed among young adolescents to understand condom use practices and their sexual health needs and determine strategies to help them prevent risky sexual behaviors [38,40].

Also, Black females were nearly three times less likely to use condoms compared to males and other races. The finding that Black females were less likely to use condoms is consistent with what Szucs, Lowry [40] reported among Black students, who showed lower condom use during last sexual intercourse. This finding points to the need for improving young adolescents’ access to comprehensive sexual health education and resources to enhance their knowledge and skills to prevent early sexual debut, early pregnancies, HIV infections, and other STIs.

The substantial racial and ethnic disparities observed in sexual initiation, multiple sexual partnerships, and condom use suggest the need for culturally sensitive, developmentally appropriate, and gender-specific interventions. The high prevalence of sexual debut for young Black/African American female adolescents is alarming, as early sexual debut increases the risk of STIs, HIV, and sexual violence. For young Black/African American adolescents, research suggests that factors such as structural racism, discriminatory practices, and stereotypes about hypersexuality contribute to these disparities [37]. Therefore, addressing these structural determinants of health is critical in promoting equitable sexual health outcomes. These findings also indicate the need to better protect young female Black/African American adolescents [39]. Protection includes developing interventions to address stereotype messaging and structural factors (i.e., racism, discrimination, sexual violence, and adultification) at the individual, interpersonal, community, and societal levels [41]. Interventions should also include care that is developmentally sensitive and culturally tailored to meet the needs of young Black/African American adolescents. Such interventions should not only focus on behavior change at the individual level but also address systemic issues like access to health care, comprehensive sexual health education, and community-based resources.

It was noted with concern that only ten states in the US had data on sexual behavior for young adolescents, and one state assessed the prevalence of oral sex. In addition, sexual behavior data were available for only 254 middle school students aged 10 and younger in this survey. These findings show that engagement in sexual health research in this population is suboptimal, consistent with previous studies that showed a lack of research studies among young adolescents and that research on sexual behavior is focused on older adolescents and adults and solicitation on early sexual debut [12,13]. Considering the challenges of recall bias in such studies, the results of this study suggest the need for targeted efforts to increase sexual health research among young adolescents to better understand their experiences and find better ways of helping them prevent risky sexual behaviors. Advocating for the inclusion of culturally relevant and age-appropriate content in school-based sex education programs is crucial. This includes addressing structural inequalities and ensuring that young adolescents from all backgrounds have access to sexual health resources.

Limitations

This study is not without limitations. The Middle School YRBS did not define sexual intercourse. As such, there is a possibility that some young adolescents might have interpreted sexual intercourse in different ways, leading to inconsistencies in reporting. Future studies exploring sexual behavior among young adolescents need to define the meaning of sexual intercourse to reduce inconsistencies. Sexual intercourse can be interpreted in different ways, and for consistency, it should be clearly defined to avoid potentially differing interpretations.

The study did not explore factors associated with the development of sexual behaviors in young adolescents. Further analyses are required to identify factors that might have been associated with the onset of sexual behaviors in young adolescents. Such information is necessary to inform the timing of interventions that can help reduce early sexual initiation among young adolescents. Also, some adolescents reported that their first experience of sexual intercourse was at the age of 8 years or younger, but the information was not available to determine the prevalence of coerced sexual activities or sexual abuse among young adolescents mostly associated with sexual experience in this age group. Therefore, there is a need for further investigations to determine the prevalence of sexual violence involving young adolescents and determine strategies to reduce it. Future research should account for this factor using quantitative and qualitative methods, as not all components of a complex developmental process can be described by quantitative methods alone. Despite these limitations, this study provides valuable information on the prevalence of early sexual initiation and condom use that is foundational to further research and interventions for reducing early sexual debut and preventing early pregnancies, HIV infection, and other STIs.

5. Conclusions

This Middle School YRBS analysis has revealed the prevalence of early sexual debut among young adolescents. The results show that young adolescents are engaging in sexual activities early, but their sexual behaviors and their sexual health needs are under-investigated. This study suggests that to prevent the development of risky sexual behaviors in young adolescents, there is a need for further research and early sexual health interventions. Understanding the prevalence and the experiences of racism that undergird racial differences in the sexual practices of young adolescents can move all health-care providers, families, parents, and youth agencies closer to the goal of protecting young adolescents and empowering them with the knowledge, attitudes, and optimal skills to make informed decisions about their sexual health. Adolescents can avoid risky sexual behaviors at the onset and cease the risky behaviors they might have initiated at an earlier stage of their growth and development. Waiting to teach children about sexual health until later ages can result in additional pregnancies, HIV infections, and other STIs that could otherwise be prevented.