OBJECTIVES: We examined how the proportion of adolescents who engaged in early sexual intercourse (before the age of 14) changed between 2002 and 2022 across 37 countries. METHODS: Data of 15-year-old adolescents participating in the 2002, 2006, 2010, 2014, 2018, and 2022 survey rounds of the Health Behaviour in School-aged Children study were analysed (N = 312,702). We used uni- and multivariate multilevel binary logistic regression models to test whether rates of early sexual initiation changed over time. Country, gender, family affluence, parental support and the clustering effect of school were incorporated in the statistical models; linearity was tested by cubic and quadratic terms in the multivariate models. RESULTS: A significant but very small decline over time was found in early sexual initiation across survey years. Girls and less affluent adolescents had lower odds of early initiation. Parental support (and its interaction with time) also had a significant but small protective role. CONCLUSION: Despite a small decrease over time, still 4% of participants reported early sexual initiation in 2022. Concerted and sustained efforts are needed to support adolescent sexual health.

Centre for Educational Research and Evaluation Ministry of Education and Culture Nicosia Cyprus

Department of Interdisciplinary Social Science Faculty of Social and Behavioural Sciences Utrecht University Utrecht Netherlands

Faculty of Health Disciplines Athabasca University Athabasca AB Canada

Health Promotion Research Centre University of Galway Galway Ireland

Institute for Social Medicine Rehabilitation Sciences and Health Services Research Hochschule Nordhausen Nordhausen Thuringia Germany

Institute of Medical Sociology University Hospital in Halle Halle Bavaria Germany

Olomouc University Social Health Institute Olomouc Czechia

School of Psychology Trinity College Dublin Dublin Ireland

Zobrazit více v PubMed

Madkour AS, de Looze M, Ma P, Halpern CT, Farhat T, ter Bogt TFM, et al. Macro-Level Age Norms for the Timing of Sexual Initiation and Adolescents' Early Sexual Initiation in 17 European Countries. J Adolesc Health (2014) 55(1):114–21. 10.1016/j.jadohealth.2013.12.008 PubMed DOI PMC

Boislard M-A, Van de Bongardt D, Blais M. Sexuality (And Lack Thereof) in Adolescence and Early Adulthood: A Review of the Literature. Behav Sci (2016) 6(1):8. 10.3390/bs6010008 PubMed DOI PMC

de Graaf H, ter Schure J, van Liere GAFS. How Old Are Young People when They Start Having Sex? Unravelling the Applicability of Cox Proportional Hazards Regression. J Public Health (2022) 30(8):1873–80. 10.1007/s10389-021-01619-6 DOI

Asare BY-A, Zegeye B, Ahinkorah BO, Ameyaw EK, Seidu A-A, Yaya S. Early Sexual Debut and its Associated Factors Among Young Women Aged 15–24 in Mali: A Multilevel Analysis. Arch Sex Behav (2023) 52(6):2491–502. 10.1007/s10508-023-02591-w PubMed DOI

Humphreys TP. Cognitive Frameworks of Virginity and First Intercourse. J Sex Res (2013) 50(7):664–75. 10.1080/00224499.2012.677868 PubMed DOI

Clarke A, Beenstock J, Lukacs JN, Turner L, Limmer M. Major Risk Factors for Sexual Minority Young People’s Mental and Physical Health: Findings from a County-Wide School-Based Health Needs Assessment. J Public Health (2018) 41(3):e274–82. 10.1093/pubmed/fdy167 PubMed DOI

Durowade KA, Babatunde OA, Omokanye LO, Elegbede OE, Ayodele LM, Adewoye KR, et al. Early Sexual Debut: Prevalence and Risk Factors Among Secondary School Students in Ido-Ekiti, Ekiti State, South-West Nigeria. Afr Health Sci (2017) 17(3):614–22. 10.4314/ahs.v17i3.3 PubMed DOI PMC

McKinnon B, Vandermorris A. National Age-Of-Consent Laws and Adolescent HIV Testing in Sub-saharan Africa: A Propensity-Score Matched Study. Bull World Health Organ (2019) 97(1):42–50. 10.2471/blt.18.212993 PubMed DOI PMC

Doku D. Substance Use and Risky Sexual Behaviours Among Sexually Experienced Ghanaian Youth. BMC Public Health (2012) 12(1):571. 10.1186/1471-2458-12-571 PubMed DOI PMC

Young H, Burke L, Nic Gabhainn S. Sexual Intercourse, Age of Initiation and Contraception Among Adolescents in Ireland: Findings from the Health Behaviour in School-Aged Children (HBSC) Ireland Study. BMC Public Health (2018) 18(1):362. 10.1186/s12889-018-5217-z PubMed DOI PMC

Kastbom ÅA, Sydsjö G, Bladh M, Priebe G, Svedin C-G. Sexual Debut before the Age of 14 Leads to Poorer Psychosocial Health and Risky Behaviour in Later Life. Acta Paediatr (2015) 104(1):91–100. 10.1111/apa.12803 PubMed DOI PMC

Burke L, Nic Gabhainn S, Kelly C. Socio-Demographic, Health and Lifestyle Factors Influencing Age of Sexual Initiation Among Adolescents. Int J Environ Res Public Health (2018) 15(9):1851. 10.3390/ijerph15091851 PubMed DOI PMC

Doran KA, Waldron M. Timing of First Alcohol Use and First Sex in Male and Female Adolescents. J Adolesc Health (2017) 61(5):606–11. 10.1016/j.jadohealth.2017.05.013 PubMed DOI

Finer LB, Philbin JM. Sexual Initiation, Contraceptive Use, and Pregnancy Among Young Adolescents. Pediatrics (2013) 131(5):886–91. 10.1542/peds.2012-3495 PubMed DOI PMC

Cifríková R, Bašková M, Kolarčik P, Škodová Z. Determinants of Risky Behaviour of 15-Year-Old Adolescents in Relation to Early Underage Sexual Initiation in Slovakia. Kontakt (2024) 26(2):138–43. 10.32725/kont.2024.002 DOI

Ma Q, Ono-Kihara M, Cong L, Xu G, Pan X, Zamani S, et al. Early Initiation of Sexual Activity: A Risk Factor for Sexually Transmitted Diseases, HIV Infection, and Unwanted Pregnancy Among University Students in China. BMC Public Health (2009) 9(1):111. 10.1186/1471-2458-9-111 PubMed DOI PMC

Kellogg ND, Hoffman TJ, Taylor ER. Early Sexual Experiences Among Pregnant and Parenting Adolescents. Adolescence (1999) 34(134):293–303. Available from: https://www.proquest.com/docview/195930262. PubMed

Heywood W, Patrick K, Smith AM, Pitts MK. Associations between Early First Sexual Intercourse and Later Sexual and Reproductive Outcomes: A Systematic Review of Population-Based Data. Arch Sex Behav (2015) 44(3):531–69. 10.1007/s10508-014-0374-3 PubMed DOI

Lee RLT, Yuen LA, Hung TTM, Sobel H. A Systematic Review on Identifying Risk Factors Associated with Early Sexual Debut and Coerced Sex Among Adolescents and Young People in Communities. J Clin Nurs (2018) 27(3-4):478–501. 10.1111/jocn.13933 PubMed DOI

Reis LF, Surkan PJ, Atkins K, Garcia-Cerde R, Sanchez ZM. Risk Factors for Early Sexual Intercourse in Adolescence: A Systematic Review of Cohort Studies. Child Psychiatry Hum Development (2023) 55:1677–90. 10.1007/s10578-023-01519-8 PubMed DOI PMC

de Graaf H, Schouten F, van Dorsselaer S, Költő A, Ball J, Stevens GWJM, et al. Trends and the Gender Gap in the Reporting of Sexual Initiation Among 15-Year-Olds: A Comparison of 33 European Countries. J Sex Res (2024) 1–10. 10.1080/00224499.2023.2297906 PubMed DOI

de Graaf H, Verbeek M, Van den Borne M, Meijer S. Offline and Online Sexual Risk Behavior Among Youth in the Netherlands: Findings from “Sex under the Age of 25”. Front Public Health (2018) 6:72. 10.3389/fpubh.2018.00072 PubMed DOI PMC

Magnusson BM, Crandall A, Evans K. Early Sexual Debut and Risky Sex in Young Adults: The Role of Low Self-Control. BMC Public Health (2019) 19(1):1483. 10.1186/s12889-019-7734-9 PubMed DOI PMC

Donahue KL, Lichtenstein P, Långström N, D'Onofrio BM. Why Does Early Sexual Intercourse Predict Subsequent Maladjustment? Exploring Potential Familial Confounds. Health Psychol (2013) 32(2):180–9. 10.1037/a0028922 PubMed DOI PMC

Richter L, Mabaso M, Ramjith J, Norris SA. Early Sexual Debut: Voluntary or Coerced? Evidence from Longitudinal Data in South Africa – The Birth to Twenty Plus Study. South Afr Med J (2015) 105(4):204–7. 10.7196/samj.8925 PubMed DOI

Kushal SA, Amin YM, Reza S, Hossain FB, Shawon MSR. Regional and Sex Differences in the Prevalence and Correlates of Early Sexual Initiation Among Adolescents Aged 12-15 Years in 50 Countries. J Adolesc Health (2022) 70(4):607–16. 10.1016/j.jadohealth.2021.10.027 PubMed DOI

Risley C, Douglas K, Karimi M, Brumfield J, Gartrell G, Vargas R, et al. Trends in Sexual Risk Behavioral Responses Among High School Students between Mississippi and the United States: 2001 to 2019 Yrbss. J Sch Health (2023) 93(6):500–7. 10.1111/josh.13311 PubMed DOI PMC

Kaplan DL, Jones EJ, Olson EC, Yunzal-Butler CB. Early Age of First Sex and Health Risk in an Urban Adolescent Population. J Sch Health (2013) 83(5):350–6. 10.1111/josh.12038 PubMed DOI

Ryu D-H. Trends in Early Sexual Initiation and its Association with Socio-Environmental Factors Among Korean Adolescents. Children (2023) 10(4):613. 10.3390/children10040613 PubMed DOI PMC

Ramiro L, Windlin B, Reis M, Gabhainn SN, Jovic S, Matos MG, et al. Gendered Trends in Early and Very Early Sex and Condom Use in 20 European Countries from 2002 to 2010. Eur J Public Health (2015) 25(Suppl. 2):65–8. 10.1093/eurpub/ckv030 PubMed DOI

Harden KP. Genetic Influences on Adolescent Sexual Behavior: Why Genes Matter for Environmentally Oriented Researchers. Psychol Bull (2014) 140(2):434–65. 10.1037/a0033564 PubMed DOI PMC

Madkour AS, Farhat T, Halpern CT, Godeau E, Nic Gabhainn S. Early Adolescent Sexual Initiation as a Problem Behavior: A Comparative Study of Five Nations. J Adolesc Health (2010) 47(4):389–98. 10.1016/j.jadohealth.2010.02.008 PubMed DOI PMC

Nigatu DT, Seme A, Fituma S, Segni MT. Sexual Initiation and Associated Factors Among Young Women in West Shoa, Ambo Town, Ethiopia: A Community-Based Cross-Sectional Study. BMC Women's Health (2018) 18(1):76. 10.1186/s12905-018-0563-7 PubMed DOI PMC

Krahé B, Bieneck S, Scheinberger-Olwig R. Adolescents' Sexual Scripts: Schematic Representations of Consensual and Nonconsensual Heterosexual Interactions. J Sex Res (2007) 44(4):316–27. 10.1080/00224490701580923 PubMed DOI

Moreau N, Költő A, Young H, Maillochon F, Godeau E. Negative Feelings about the Timing of First Sexual Intercourse: Findings from the Health Behaviour in School-Aged Children Study. Int J Public Health (2019) 64(2):219–27. 10.1007/s00038-018-1170-y PubMed DOI

Moreau C, Li M, Ahmed S, Zuo X, Cislaghi B. Assessing the Spectrum of Gender Norms Perceptions in Early Adolescence: A Cross-Cultural Analysis of the Global Early Adolescent Study. J Adolesc Health (2021) 69(1):S16–S22. 10.1016/j.jadohealth.2021.03.010 PubMed DOI

Pulerwitz J, Blum R, Cislaghi B, Costenbader E, Harper C, Heise L, et al. Proposing a Conceptual Framework to Address Social Norms that Influence Adolescent Sexual and Reproductive Health. J Adolesc Health (2019) 64(4):S7-S9–9. 10.1016/j.jadohealth.2019.01.014 PubMed DOI PMC

Saewyc E. The Next Phase of the Global Early Adolescent Study: Measuring How Gender Norms and Gender Inequality Intensify and Influence Health. J Adolesc Health (2021) 69(1):S1–2. 10.1016/j.jadohealth.2021.04.003 PubMed DOI

Ghosh P, Tu W. Assessing Sexual Attitudes and Behaviors of Young Women: A Joint Model with Nonlinear Time Effects, Time Varying Covariates, and Dropouts. J Am Stat Assoc (2009) 104(486):474–85. 10.1198/jasa.2009.0013 PubMed DOI PMC

Jeremić V, Matejić B, Soldatović I, Radenović S. Early Sexual Initiation and Risk Factors in Serbian Adolescents: Data from the National Health Survey. Eur J Contracept Reprod Health Care (2014) 19(3):211–9. 10.3109/13625187.2014.897320 PubMed DOI

Költő A, de Looze M, Jåstad A, Nealon Lennox O, Currie D, Nic Gabhainn S. A Focus on Adolescent Sexual Health in Europe, Central Asia and Canada: Health Behaviour in School-Aged Children International Report from the 2021/2022 Survey. Regional Office for Europe: World Health Organization; (2024).

Karofsky PS, Zeng L, Kosorok MR. Relationship between Adolescent-Parental Communication and Initiation of First Intercourse by Adolescents. J Adolesc Health (2001) 28(1):41–5. 10.1016/s1054-139x(00)00156-7 PubMed DOI

Longmore MA, Manning WD, Giordano PC, Rudolph JL. Self-Esteem, Depressive Symptoms, and Adolescents' Sexual Onset. Social Psychol Q (2004) 67(3):279–95. 10.1177/019027250406700304 DOI

Guse K, Levine D, Martins S, Lira A, Gaarde J, Westmorland W, et al. Interventions Using New Digital Media to Improve Adolescent Sexual Health: A Systematic Review. J Adolesc Health (2012) 51(6):535–43. 10.1016/j.jadohealth.2012.03.014 PubMed DOI

Brooks F, Zaborskis A, Tabak I, Carmen Granado Alcon M, Zemaitiene N, de Roos S, et al. Trends in Adolescents' Perceived Parental Communication across 32 Countries in Europe and North America from 2002 to 2010. Eur J Public Health (2015) 25:46–50. 10.1093/eurpub/ckv034 PubMed DOI

Gavin A, Költő A, Kelly C, Molcho M, Nic Gabhainn S. Trends in Health Behaviours, Health Outcomes and Contextual Factors between 1998-2018: Findings from the Irish Health Behaviour in School-Aged Children Study. Dublin: Department of Health; (2021). 10.13025/6nf5-pn06 DOI

Inchley J, Currie D, Samdal O, Jåstad A, Cosma A, Nic Gabhainn S, editors. Health Behaviour in School-Aged Children (Hbsc) Study Protocol: Background, Methodology and Mandatory Items for the 2021/22 Survey. MRC/CSO Social and Public Health Sciences Unit. Glasgow, UK: University of Glasgow; (2023).

Heinz A, Költő A, Taylor AB, Chan A. “Are You a Boy or a Girl?”—A Missing Response Analysis. Children (2023) 10(10):1695. 10.3390/children10101695 PubMed DOI PMC

Torsheim T, Cavallo F, Levin KA, Schnohr C, Mazur J, Niclasen B, et al. Psychometric Validation of the Revised Family Affluence Scale: A Latent Variable Approach. Child Indicators Res (2016) 9(3):771–84. 10.1007/s12187-015-9339-x PubMed DOI PMC

Inchley J, Currie D, Young T, Samdal O, Torsheim T, Augustson L, et al. Growing up Unequal: Gender and Socioeconomic Differences in Young People's Health and Well-Being. Health Behaviour in School-Aged Children (HBSC) Study. In: International Report from the 2013/2014 Survey. Copenhagen: WHO Regional Office for Europe; (2016).

Funder DC, Ozer DJ. Evaluating Effect Size in Psychological Research: Sense and Nonsense. Adv Methods Practices Psychol Sci (2019) 2(2):156–68. 10.1177/2515245919847202 DOI

Bell A, Jones K. Age, Period and Cohort Processes in Longitudinal and Life Course Analysis: A Multilevel Perspective. In: Burton-Jeangros C, Cullati S, Sacker A, Blane D, editors. A Life Course Perspective on Health Trajectories and Transitions. Cham, Switzerland: Springer; (2015). p. 197–213. PubMed

Twenge JM, Park H. The Decline in Adult Activities Among U.S. Adolescents, 1976–2016. Child Dev (2019) 90(2):638–54. 10.1111/cdev.12930 PubMed DOI

Atkins DN, Bradford WD. The Effect of State-Level Sex Education Policies on Youth Sexual Behaviors. Arch Sex Behav (2021) 50(6):2321–33. 10.1007/s10508-020-01867-9 PubMed DOI

Henderson M, Butcher I, Wight D, Williamson L, Raab G. What Explains Between-School Differences in Rates of Sexual Experience? BMC Public Health (2008) 8:53. 10.1186/1471-2458-8-53 PubMed DOI PMC

Kirby D. The Impact of Schools and School Programs upon Adolescent Sexual Behavior. J Sex Res (2002) 39(1):27–33. 10.1080/00224490209552116 PubMed DOI

Shoveller JA, Johnson JL, Langille DB, Mitchell T. Socio-Cultural Influences on Young People's Sexual Development. Soc Sci Med (2004) 59(3):473–87. 10.1016/j.socscimed.2003.11.017 PubMed DOI

Caminis A, Henrich C, Ruchkin V, Schwab-Stone M, Martin A. Psychosocial Predictors of Sexual Initiation and High-Risk Sexual Behaviors in Early Adolescence. Child Adolesc Psychiatry Ment Health (2007) 1(1):14. 10.1186/1753-2000-1-14 PubMed DOI PMC

Lund TJ, Dearing E, Zachrisson HD. Is Affluence a Risk for Adolescents in Norway? J Res Adolesc (2017) 27(3):628–43. 10.1111/jora.12304 PubMed DOI

Widman L, Choukas-Bradley S, Noar SM, Nesi J, Garrett K. Parent-Adolescent Sexual Communication and Adolescent Safer Sex Behavior: A Meta-Analysis. JAMA Pediatr (2016) 170(1):52–61. 10.1001/jamapediatrics.2015.2731 PubMed DOI PMC

Ronis ST, O’Sullivan LF, Cormier LA. Vulnerability and Variability: Associations between Various Early Forms of Nonconsensual Sexual Experiences and Later Sexual Experiences of Young Adults. Can J Hum Sex (2022) 31(1):8–17. 10.3138/cjhs.2021-0046 DOI

Goldfarb ES, Lieberman LD. Three Decades of Research: The Case for Comprehensive Sex Education. J Adolesc Health (2021) 68(1):13–27. 10.1016/j.jadohealth.2020.07.036 PubMed DOI

Lameiras-Fernandez M, Martinez-Roman R, Carrera-Fernandez MV, Rodriguez-Castro Y. Sex Education in the Spotlight: What Is Working? Systematic Review. Int J Environ Res Public Health (2021) 18(5):2555. 10.3390/ijerph18052555 PubMed DOI PMC

Astle S, Brasileiro J. Whose Job Is It Anyway? Parents’ Perspectives of Responsibilities for Educating Their Children about Sex. Sex Res Social Policy (2024) 21(2):759–73. 10.1007/s13178-023-00898-w PubMed DOI PMC

Astle SM, Jankovich MO, Vennum A, Rogers AA. Parent-Child Sexual Communication Frequency and Adolescent Disclosure to Mothers about Sexuality: The Moderating Role of Open Communication in a Common Fate Structural Equation Model. J Sex Res (2023) 60(7):1045–54. 10.1080/00224499.2022.2045888 PubMed DOI

Byers ES, O’Sullivan LF, Burkholder C. How Prepared Are Teachers to Provide Comprehensive Sexual Health Education? Am J Sex Educ (2024) 1–24. 10.1080/15546128.2024.2344518 DOI

Trends in sexual initiation and contraception use among Czech adolescents between 2002-2022