Journal of Pediatric Psychology, Vol. 28, No. 4, 2003, pp. 243-249
© 2003 Society of Pediatric Psychology
Adolescent Oral Sex, Peer Popularity, and Perceptions of Best Friends' Sexual Behavior
Yale University
All correspondence should be sent to Mitch Prinstein, Yale University, Department of Psychology, P.O. Box 208205, New Haven, Connecticut 06520-8205. E-mail: Mitchell.Prinstein{at}Yale.edu.
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Objective To provided initial descriptive information regarding adolescents' engagement in oral sex and to investigate adolescents' perceptions of their best friends' sexual behavior and peer-reported popularity as two social mechanisms that may influence engagement in oral sex. Methods A total of 212 tenth graders reported their engagement in oral sex and intercourse, number of sexual partners, and use of sexually transmitted infection (STI) protection, as well as perceptions of their best friends' sexual behaviors. Sociometric assessment yielded peer-reported measures of adolescents' preference- and reputation-based popularity. Results Adolescents were more likely to report engagement in oral sex than intercourse, report more oral sex partners than intercourse partners, and were unlikely to report use of STI protection during oral sex. Perceptions of best friends' behavior were significantly associated with adolescents' own oral sex behavior, but not intercourse. Adolescents who reported sexual activity had high levels of reputation-based popularity, but not likeability among peers; however, sex with more partners was associated with lower levels of popularity. Conclusions Implications for prevention programs are discussed.
Key words: sexual behavior; peer relations; sexually transmitted infection..
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Introduction |
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The rate of sexually transmitted infections (STIs) among adolescents is increasing at an unprecedented rate. Currently, over three million American teenagers become infected with one or more STIs each year (Centers for Disease Control and Prevention [CDC], 2000
), including both bacterial (e.g., gonorrhea,
chlamydia) and viral infections (e.g., herpes, HIV). Recent concern has
focused on noncoital sexual behaviors that may pose a risk for STIs among
adolescents. For instance, public attention has focused on the surprisingly
high percentage of high school adolescents (i.e., grades 9 through 12) who
report engagement in oral sex. Although the topic is rarely investigated
empirically, extant data suggest that approximately 33%–59% of high
school teens and, more specifically, 7%– 24% of adolescent virgins
report that they have either given or received oral sex
(Breakwell & Fife-Schaw,
1992; Gates & Sonenstein,
2000; Haas, 1979;
Newcomer & Udry, 1985;
Schuster, Bell, & Kanouse,
1996). Yet little is known about adolescents' potential for
contracting an STI by engaging in oral sex or about psychological factors that
may influence adolescents' decision to engage in this type of behavior.
Is oral sex a risk behavior worthy of empirical investigation? Certainly,
the risk of acquiring an STI through engagement in oral sex is substantially
less than for other sexual behaviors (e.g., vaginal or anal intercourse).
However, recent reviews have suggested that oral sex is a viable and perhaps
significant mode of transmission for several bacterial and viral infections,
including gonorrhea, herpes, and chlamydia (Edwards & Carne,
1998a,
1998b). Although controversial,
some reports also have documented cases of HIV infection probably incurred
during oral-genital contact (e.g., Keet et
al., 1992). In this investigation, we have elected to examine
adolescents' engagement in oral sex, and peer correlates, for three reasons.
First, it may be that adolescents engage in oral sex to avoid the risks
associated with other sexual behaviors. If so, the study of social influences
and social benefits associated with this behavior would be important for
prevention efforts. Second, if oral sex presents any health risk at all, the
substantial proportion of teens that report engagement in this behavior
suggests potential concern from a public health perspective. Third, no data
are currently available on adolescents' use of STI protection during oral sex
or the number of adolescents' oral sex partners; it is therefore difficult to
determine whether many adolescents engage in this behavior in a manner that
may pose some risk. This initial study offers some preliminary descriptive
statistics on adolescents' engagement in oral sex, as well as the study of
peer correlates, in an effort to encourage future research in this area.
A main goal of this study was to examine potential social influences and
social benefits in the peer milieu that may be associated with adolescents'
engagement in oral sex. Several theoretical models suggest that social factors
may influence decisions to engage in health risk behaviors. For instance, the
theory of reasoned action (Fishbein &
Ajzen, 1975) and the information–motivation–
behavioral skills models (Fisher &
Fisher, 1992) emphasize the role of social norms in guiding teens'
intentions and motivations regarding health behaviors. In addition to family,
community, and media influences, social norms may be guided by adolescents'
perceptions of their best friends' behavior; however, this has been examined
rarely. Indeed, friends are adolescents' most available and relevant reference
group and the most likely source of information for teens on the practices,
norms, and risks associated with sexual behavior (e.g.,
Graber, Britto, & Brooks-Gunn,
1999). Adolescents are also likely to evaluate the risks
associated with specific sexual behaviors through social comparisons with
their best friends. We therefore hypothesized that perceptions of best
friends' behavior would be associated with adolescents' own sexual behavior.
Past research has demonstrated that teens' beliefs regarding their friends'
engagement in risky sexual behavior may be associated with their own reported
engagement in risk behavior (Walter et
al., 1992). Moreover, past work suggests that preadolescent girls
with friends who engaged in sexual intercourse before high school are more
likely to initiate sexual intercourse behavior in early adolescence than girls
with virgin friends (Billy & Udry,
1985).
Adolescents may also associate oral sex with specific social benefits in
the peer context, such as high status and popularity among peers. The belief
that engagement in oral sex may help maintain or elevate an individual's level
of status among peers may be one factor that influences adolescents' decisions
to engage in this behavior (i.e., see the AIDS risk reduction model,
Catania, Kegeles, & Coates,
1990; health belief model,
Janz & Becker, 1984). This
belief would be partially supported if, indeed, adolescents who reported
engagement in oral sex were also most likely to be nominated by peers as well
liked or popular. Both preference- and reputation-based measures of popularity
were examined in this study to test this hypothesis. Preference-based
sociometric measures evaluate the extent to which adolescents are liked or
disliked by peers (see Coie & Dodge,
1983). Three prior investigations have examined likeability among
peers in childhood as a predictor of teenage pregnancy in adolescence
(Feldman, Rosenthal, Brown, & Canning,
1995; Miller-Johnson et al.,
1999; Underwood, Kupersmidt,
& Coie, 1996), yielding mixed, inconclusive results.
Reputation-based measures of popularity (i.e., "peer-perceived
popularity") are based on adolescents' nominations of most- and
least-popular peers, identifying adolescents with the greatest levels of
power, dominance, and status in the peer group. Adolescents who are high in
peer-perceived popularity are not necessarily well liked by their peers but
may be nevertheless envied and emulated within the peer context
(Parkhurst & Hopmeyer,
1998). No prior study has examined associations between
reputation-based measures of popularity and adolescents' sexual behavior. We
hypothesized that, compared to others, adolescents who report sexual behavior
would be regarded as more popular (i.e., higher levels of peer-perceived
popularity) but not necessarily more well liked among peers, indicating that
high-status teens may attract greater sexual interest and thus have more
opportunity to engage in sexual behavior.
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Methods |
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Participants
Participants included 212 adolescents (86 boys, 40.6%; 126 girls, 59.4%) in the tenth grade at a suburban New England high school. Participants' ages ranged between 15 and 17 years (M = 16.31; SD = .50). The ethnic distribution of the sample was 76.4% white/Caucasian; 9.9% African American; 3.8% Latino American, and 9.9% other/mixed ethnicity within a city of fairly homogeneous, middle-class socioeconomic status (SES). According to school records, approximately 22.3% of students were eligible for free or reduced-price lunch. All tenth grade students were recruited for participation, with the exception of students in self-contained special education classes. Consent forms were returned by 70% of families (n = 255); of these, 92% of parents gave consent for their child's participation (n = 235). Data from students absent on one of the days of testing (n = 23) were excluded from analyses.
Measures
Sexual Behavior. Adolescents' sexual behavior was assessed
using items from existing health-risk behavior instruments (e.g., Youth Risk
Behavior Surveillance) (CDC,
1998; La Greca, Prinstein,
& Fetter, 2001). Adolescents were asked to report "the
number of partners you had oral sex with in the past year"; responses
were used to determine adolescents' oral sex activity in the past
year (yes or no) and also to index their number of oral sex partners.
Adolescents who reported at least one oral sex partner were also asked,
"How often did you or your partner use STD protection when giving or
receiving oral sex during the past year?" (Never, Once in a while, About
half the time, Most times, Every time) as a measure of protected oral
sex. Adolescents responded to the same questions regarding their
sexual intercourse activity, the number of sexual intercourse
partners, and their use of STI protection or birth control during sexual
intercourse in the past year ("protected sexual
intercourse"). Comparisons between measures of STI protection
during oral sex and intercourse should be made with extreme caution, given the
differences in the definitions of protection used for these items (i.e.,
protected intercourse referred to the use of STI or pregnancy protection);
data therefore are reported for descriptive purposes only. Pilot testing and
focus groups with adolescents from this school indicated that the wording of
these items on oral sex and intercourse were appropriate and sufficient to
ensure teens' comprehension of the constructs of interest.
Psychometric properties for these items have been demonstrated in prior
studies using this measure (e.g., La Greca
et al., 2001). Items on unprotected sex had co-efficient alphas of
.73 and .77 in two independent samples
(Biglan et al., 1990). Biglan
et al. also found that high-risk sexual behavior was significantly related to
antisocial behavior (r = .21), cigarette use (r = .43),
alcohol use (r = .34), and illicit drug use (r = .39).
Perceptions of Friends' Sexual Behavior. Adolescents
identified their best friend from a roster of classmates and reported their
perceptions of their friend's sexual behavior using a parallel set of
questions to those described, including perceptions of their friend's oral sex
behavior (i.e., friend's oral sex activity, number of friend's oral sex
partners, friend's protected oral sex), and sexual intercourse behaviors
(i.e., friend's sexual intercourse activity, number of friend's sexual
intercourse partners, friend's protected sexual intercourse). This
procedure is consistent with established methodologies for assessing
perceptions of friends' health-risk behavior (e.g., alcohol use, cigarette
use), including sexual behavior (e.g., La
Greca et al., 2001).
Sociometric Measures. Using alphabetized rosters of all
grade mates, adolescents nominated an unlimited number of peers for four
sociometric items. The order of names was counterbalanced on each roster to
control for possible effects of alphabetization on nominee selection.
Nominations were used to compute one measure of preference-based peer status
(i.e., social preference) and one measure of reputation-based peer
status (i.e., social reputation). Social preference was computed as a
standardized difference between standardized responses to two sociometric
items, "Who do you like to spend time with the most?" (likemost)
and "Who do you like to spend time with the least?" (like-least),
with higher scores indicating greater likeability among peers
(Coie & Dodge, 1983).
Social reputation was computed as a standardized difference between
standardized responses to two different sociometric items (i.e., "Who is
most popular?" and "Who is least popular?"), with greater
scores indicating that adolescents were perceived by their classmates to have
higher levels of popularity (Parkhurst
& Hopmeyer, 1998).
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Results |
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Oral Sex: Descriptive Information
Table I lists frequencies and percentages of adolescents who engaged in each form of sexual behavior. There were no significant differences in boys' and girls' reports of sexual behavior. Adolescents were significantly more likely to engage in oral sex as compared to sexual intercourse,
2(1) = 62.62, p <
.0001. Sexually active teens reported a significantly greater number of oral
sex partners than sexual intercourse partners, paired t (96) = 4.42,
p < .0001. Most adolescents who reported engagement in oral sex
indicated that they had never used STI protection (see
Table I).
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Perceptions of Best Friends' Sexual Behavior
Overall, a significant majority of adolescents reported that their best
friends' oral sex behavior was similar to their own oral sex behavior. For
instance, of the 86 adolescents who reported engagement in oral sex, 56.5%
reported that their best friend had also engaged in oral sex in the past year,
2(1) = 34.84, p < .0001. Of the 126 teens who did
not engage in oral sex activity, 82.5% reported that their best friend also
did not engage in oral sexual activity. However, there was no significant
association between adolescents' reports of engagement in sexual intercourse
and their perceptions of their best friend's engagement in sexual intercourse,
2(1) = 1.03, ns.
Pearson correlations were conducted to examine correspondence between adolescents' reported number of sexual partners and their perceptions of the number of their best friends' sexual partners. A significant association was revealed for oral sex partners, r = .57, p < .001, however, no significant association was revealed for sexual intercourse partners, r = .14, ns. Thus, the association for oral sex partners was significantly stronger than the association for sexual intercourse partners, Williams's t (38) = 2.23, p < .05.
Preference- and Reputation-Based Sociometric Measures of Status
A 2 (Oral Sex; yes/no) x 2 (Gender) MANOVA analysis was conducted to
compare adolescents who reported that they did/did not engage in oral sex on
the two continuous measures of peer status, entered as a set of dependent
variables (i.e., social preference and social reputation). A multivariate main
effect for Oral Sex was revealed, Wilks' F(2, 207) = 9.95, p
< .0001, which was significant at a univariate level for social reputation
only, F(1, 208) = 13.45, p < .0001. Adolescents who
reported engagement in oral sex were rated by peers as more popular (social
reputation M = .27; SD = 1.04) than adolescents who did not
engage in oral sex (M = –.31; SD = 1.08). No
significant interaction effect was revealed.
A parallel set of analyses was conducted to examine preference- and reputation-based peer status for adolescents who reported that they did/did not engage in sexual intercourse. A similar pattern of results emerged. A multivariate effect for sexual intercourse, Wilks' F(2, 206) = 10.11, p < .0001, was significant at a univariate level for only social reputation, F(1, 207) = 6.23, p < .0001. Adolescents who reported engagement in sexual intercourse received higher social reputation scores (M = .29; SD = 1.03) than other adolescents (M = –.23; SD = 1.09). No significant interactions involving gender were revealed, nor any significant effects for social preference.
Pearson correlations were conducted to examine associations among social preference, social reputation, and the number of adolescents' reported oral sex and sexual intercourse partners. Among adolescents who reported engagement in oral sex, a significant correlation was revealed between the number of reported oral sex partners and social reputation (r = –.23, p < .05), but not for the association between the number of adolescents' reported oral sex partners and social preference (r = –.21, p = .06). Overall, these results suggest that adolescents' reported engagement in oral sex with multiple partners was generally associated with lower popularity among peers. No significant associations were revealed between the number of adolescents' reported sexual intercourse partners and their social preference (r = –.04, ns) or social reputation (r = .00, ns) among peers.
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Discussion |
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Although the risk of obtaining an STI through oral sex is certainly lower than the risk of infection through sexual intercourse, research has indicated that oral transmission is an important health concern, particularly because some adolescents and adults erroneously view oral sex as a risk-free behavior (Remez, 2000
). In this study,
adolescents reported that they are significantly more likely to engage in oral
sex than in intercourse and engage in oral sex with significantly more
partners than for intercourse. Adolescents also reported that they are
unlikely to use STI protection during oral sex. In other words, adolescents'
behavior may place them at maximum risk for oral transmission of STIs. This study examined social mechanisms that might influence adolescents' engagement in sexual behavior. Results suggested that perceptions of friends' behaviors were more strongly associated with adolescents' engagement in oral sex than in sexual intercourse, suggesting that oral sex may be more amenable to social influence or intervention. Indeed, not only was adolescents' reported engagement in oral sex related to their perceptions of their best friends' oral sex but also the number of adolescents' reported oral sex partners was associated with their perceptions of the number of their friends' partners. In contrast, no such pattern of results was found for sexual intercourse. Although adolescents may be likely to imitate some of their best friends' behaviors, peer influence may be attenuated for behaviors considered risky and dangerous (i.e., intercourse). Unfortunately, this also suggests that less risky behaviors, such as oral sex, may ultimately pose a greater threat to adolescents' health because they are more strongly influenced and reinforced by perceptions of peers' behavior. Adolescents' perceptions of friends also may be influenced by their own behavior, suggesting that adolescents may be invested in the belief that their peers engage in behaviors in a manner that would match and validate their own decisions.
This study also examined potential social benefits that may be associated
with sexual behavior, specifically the associations between oral sex and peer
popularity. Findings suggested that adolescents' reports of oral sex and
intercourse were significantly associated with peer-perceived popularity but
not likeability among peers. These results indicate either that sexually
active adolescents enjoy higher status among peers or perhaps that popular
adolescents feel more pressured or inclined to report that there are sexually
active. Adolescents may believe that sexual activity best matches a prototype
of popular, high-status adolescents. Reputation-based measures of peer status
identify those individuals who best match this prototype of popularity;
indeed, only this measure of status was associated with sexual behavior. The
desire to engage in, or simply report, sexual activity may reflect
adolescents' motivation to imitate that prototype (e.g.,
Gibbons & Gerrard,
1995).
It appears, however, that if adolescents' peers afford higher status to
those who report engagement in sexual behavior, they do so only for those
adolescents who report behaving in a relatively safe manner (i.e., with fewer
partners). Greater numbers of adolescents' reported sexual partners were
associated with lower levels of popularity and, to some extent, with lower
peer acceptance. This is good news for psychologists interested in health
prevention efforts because it suggests that the peer culture may be somewhat
supportive of safer sexual behavior. This finding also offers important
perspectives for the identification of adolescents engaging in risky behavior.
Although past work has typically indicated that children rejected (i.e.,
disliked) by peers are most at risk for negative psychological outcomes
(Parker & Asher, 1987),
these results suggest that intervention efforts should target popular teens,
particularly those who are especially susceptible to the belief that their
closest friends are engaging in risk behavior.
In addition to implications for the identification of potentially at-risk adolescents, the results offer directions for intervention efforts. The findings suggest that a significant proportion of teens may be engaging in oral sex in a manner that potentially poses health risk, even within this community (i.e., not clinically referred) sample. Is it reasonable to expect that teens will begin to use STI protection during oral sex? Recent efforts have attempted to make the use of STI protection during oral sex less aversive for teens (e.g., by providing flavored condoms). However, substantial changes in attitudes and social norms may be required before there are noticeable differences in teens' use of protection for this relatively low-risk sexual behavior. Indeed, many teens may purposefully engage in oral sex to avoid the greater risks associated with other sexual behaviors. Perhaps an initial step for prevention would be increased education for adolescents concerning the reduced but still significant risks associated with oral sex. This information would help adolescents make informed decisions about their engagement in and use of protection during oral sex.
Peer education efforts may be especially fruitful to address possible
misperceptions of peers' behavior and apparent status differences among
adolescents who are or are not reporting engagement in sexual behavior.
Indeed, enlisting popular, high-status adolescents may help to address
possible stereotypes regarding sexual behavior in adolescence. Actively
manipulating social norms and adolescents' perceptions of the social benefits
associated with sexual behavior may also prove to be effective prevention
strategies. For instance, research has demonstrated that simply educating
teens about the tendency to misperceive others' behavior (i.e., pluralistic
ignorance) can be an effective strategy to reduce risk behaviors
(Schroeder & Prentice,
1998). Prevention strategies may also encourage teens to view
safer sex as normative (i.e., "Most kids your age use protection")
or dispel adolescents' misperceptions regarding their peers' approval of
sexually risky behavior (i.e., "Kids who engage in risky behavior are
less popular among their peers")
(Rotheram-Borus & Koopman,
1991; Rotheram-Borus, Mahler,
& Rosario, 1995).
Future research should address some of the limitations of this initial investigation on the correlates of oral sex. Investigations of ethnically and economically diverse samples may reveal different proportions of sexually active adolescents and different social norm influences. The use of a self-report assessment may have influenced adolescents' report of sexual behavior; however, this procedure is typical in this type of research and few alternative methods of assessment are currently available. Future work using alternate assessment strategies may determine whether certain adolescents may be motivated to over- or underreport their engagement in sexual behaviors and how this response tendency may further reflect social pressures and perceptions of norms. Assessment of best friends' actual sexual behavior may reveal important information regarding the accuracy of adolescents' perceptions. Last, future research would greatly benefit from longitudinal studies that can examine prospective associations between social factors and future sexual behavior and begin to determine possible directions of effect.
Overall, this research offers important preliminary data on adolescents' oral sex behavior. Although this particular type of sexual behavior has been relatively neglected in past research and in public education health messages, compelling evidence suggests that adolescents' casual engagement in oral sex may pose potential risk to teens' health. The results clearly indicated that adolescents' engagement in sexual behavior is associated with social influences in a manner that preventionists could used to promote safer sexual behavior.
Received January 25, 2002; revision received June 6, 2002; accepted July 22, 2002
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