Does Early Adolescent Sex Cause Depressive Symptoms?

Joseph J. Sabia

Abstract
A recent study by the Heritage Foundation (Rector, Johnson, & Noyes, 2003) found evidence of a positive relationship between early sexual intercourse and depressive symptoms. This finding has been used to bolster support for funding abstinence-only sex education. However, promoting abstinence will only yield mental health benefits if there is a causal link between sexual intercourse and depression. Using the National Longitudinal Study of Adolescent Health (Add Health), I carefully examine the relationship between early teen sex and several measures of depression. Controlling for a wide set of individual-level and family-level observable characteristics, cross-section estimates consistently show a significant positive relationship between early sexual activity for females and three measures of adverse mental health: self-reported depression, a belief that one’s life is not worth living, and serious thoughts of suicide. However, differencein-difference estimates reflect no evidence of a significant relationship between early teen sex and depressive symptoms. These findings suggest that the positive association observed by Rector et al. (2003) can be explained by unmeasured heterogeneity. Thus, promoting abstinence among adolescents is unlikely to alleviate depressive symptoms.© 2006 by the Association for Public Policy Analysis and Management. INTRODUCTION A 2003 study by the Heritage Foundation (Rector, Johnson, & Noyes, 2003) splashed across the mainstream and conservative media implying evidence of a causal link between early teen sexual activity and depression. The authors of the Heritage study claimed that their findings bolstered the need for abstinence-only sex education programs in public schools. Several media outlets—including USA Today (Peterson, 2003), National Review (Pardue & Rector, 2004), and the Washington Times (Wetzstein, 2003)—gave extensive coverage to the Heritage study.1 The authors themselves contributed opinion pieces, implying a causal link between adolescent sex and depression. Writing in National Review Online, Melissa Pardue and Robert Rector argued:
The dangers of early sexual activity are well documented. It leads to higher levels of child and maternal poverty, elevates the risk of sexually transmitted diseases, and often leaves teenage girls depressed, even suicidal. (NRO, January 16, 2004)
1 Moreover, several conservative media outlets, such as World Net Daily, TownHall.com, and World Magazine, reported the Heritage findings.

Journal of Policy Analysis and Management, Vol. 25, No. 4, 803–825 (2006) © 2006 by the Association for Public Policy Analysis and Management Published by Wiley Periodicals, Inc. Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/pam.20209

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In comments appearing in a June 2003 issue of USA Today, Rector was more cautious, stating that the Heritage study did not definitively find a causal link between sexual activity and depression. However, he also noted that “[a causal relationship] is really impossible to prove.” That is, without a randomized experiment, unmeasured heterogeneity may confound the relationship between early teen sex and depression. Still, the authors of the Heritage report argued that their study controls for sufficient observables to conclude that “early sexual activity leads to emotional stress and reduces teen happiness” (Rector et al., 2003). While Rector and colleagues did control for a few observable characteristics that could confound the relationship between teen sex and depression, they did not adequately address the potential problems associated with unmeasured heterogeneity. One might expect a positive relationship between early teen sex and depression for several reasons. First, as Rector and colleagues (2003) suggest, early teen sex may cause psychological trauma, as adolescents struggle with the complicated emotions of physical intimacy at such an early age. However, it is also plausible to imagine that causality runs in the opposite direction. The onset of psychological trauma or depression may cause teens to engage in sexual intercourse in order to escape feelings of hopelessness. Finally, it may be that there is no causal link between sexual intercourse and depression, but rather a positive association due to unobserved heterogeneity. Adolescents who have the highest unobserved propensity for depression—for instance, those who have had particular childhood experiences—may be those who are most likely to engage in sexual activity. Obtaining credible estimates of the impact of adolescent sexual intercourse on emotional health is not merely an empirical exercise. The conclusions of the Heritage study have been used by supporters of abstinence-only sex education to lobby for additional funding for such programs. However, recent work by Sabia (2006a) suggests that typical school-based sex education programs have little affect on adolescent sexual behaviors and health. Because empirical evidence on the impact of abstinence programs on teen pregnancy and sexually transmitted disease (STD) transmission is, at best, mixed (for a further review of the sex education literature, see Kirby, 2001), some proponents of abstinence programs have seized on the link between early teen sex and emotional harm as a key rationale for their policy position. Concerned Women for America (CWA)—an influential women’s public policy organization dedicated to “bring[ing] Biblical principles into all levels of public policy”—has cited the link between teen sex and adverse mental health in its lobbying efforts:
Besides failing to protect from the physical health risks of STDs, “safe sex” does not protect teenagers’ mental and emotional health. In fact, it harms their mental and emotional well-being. Dr. Janice Crouse, senior fellow of Concerned Women for America’s Beverly LaHaye Institute, said, “We are seeing dramatic increases in adolescent depression, suicides, and sexual assaults; these negative trends track the increase in sexual promiscuity among adolescents. Indeed, the sexualization of our culture is robbing our adolescents of their childhood and innocence.” (Anderson, 2005)

The vast majority of evangelical or born-again Christians concur with the CWA’s view. A 2004 national poll by National Public Radio (NPR), the Kaiser Family Foundation, and Harvard’s Kennedy School of Government found that 78 percent of evangelical or born-again Christians believe that “sexual activity outside of marriage is likely to have harmful psychological and physical effects,” compared to 46 percent of non-evangelicals. Socially conservative media outlets have trumpeted the

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idea that early teen sex has adverse mental health effects. National Review and Human Events, two of the most influential conservative magazines in the country, have published op-ed pieces focusing on this link. Conservative public opinion on abstinence-only sex education has led to important public policy decisions by leading national lawmakers. President Bush’s Fiscal Year (FY) 2007 budget includes a request to increase federal funding for abstinenceonly sex education by 15 percent, to $204 million.2 Total federal monies on such programs will top the $1 billion mark next year, with most dollars allocated under (i) Title V, Section 510 of the Social Security Act, passed as part of the 1996 welfare reform package, (ii) the Adolescent Family Life Act (AFLA), and (iii) the Special Programs of Regional and National Significance (SPRANS) Community-Based Abstinence Education program. The federal definition of abstinence-only sex education includes language on the “psychological gains” from abstinence. Section 510(b) of Title V of the Social Security Act, P.L. 104-193 states that abstinence education must have “as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity” and must “teach that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects.”3 In addition to federal funding of abstinence-only sex education through block grants to states, several states have adopted their own regulations on the type of sex education that is taught in their classrooms. Twenty-nine (29) states require abstinence to be covered in sex education courses, with 20 states requiring abstinence before marriage to be stressed (Alan Guttmacher Institute, 2001).4 These state regulations appear to be quite influential. A national survey of school superintendents found that superintendents most frequently cited “state directives” (74 percent) as the factor most influencing the type of sex education taught in schools (Landry, Kaeser, & Richards, 1999). A 1999 survey of secondary sex education teachers found that 23 percent of teachers taught abstinence as the only way to avoid pregnancy (Darroch, Landry, & Sucheela, 2000).
2 However, federal funding for comprehensive sex education still outpaces funding for abstinence-only sex education. In FY 2002, $653 million was allocated by the federal government for comprehensive sex education. 3 The full text of the federal definition of abstinence education in Section 510(b) of Title V of the Social Security Act, P.L. 104-193 appears below: For the purposes of this section, the term “abstinence education” means an educational or motivational program which: A. has as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity; B. teaches abstinence from sexual activity outside marriage as the expected standard for all school-age children; C. teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems; D. teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of sexual activity; E. teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects; F. teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child’s parents, and society; G. teaches young people how to reject sexual advances and how alcohol and drug use increase vulnerability to sexual advances;, and H. teaches the importance of attaining self-sufficiency before engaging in sexual activity. 4 States requiring abstinence to be stressed in sex education courses include AL, AZ, AS, CA, HI, IL, IN, LA, MD, MS, MO, NC, OK, OR, RI, SC, TN, TX, UT, and WV.

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Thus, support for abstinence-only sex education is strong among many conservatives, and these views have led to significant public policy action. However, promoting abstinence will only improve the emotional well-being of adolescents if there is a causal link between early teen sex and depression. Providing credible empirical evidence on this question will be the central task of this paper. Using the National Longitudinal Study of Adolescent Health (Add Health)—the same dataset employed by Rector et al. (2003)—I examine how sensitive the association between adolescent sex and adverse mental health is to unmeasured heterogeneity. Three measures of adolescent mental health are used in the analysis: (i) selfreported depression, (ii) frequent feelings that life is not worth living, and (iii) serious thoughts of suicide. Each of these measures is expected to capture a dimension of mental health and is similar to the outcomes measured by Rector et al. (2003). Using a cross-section sample of adolescents in the 1994–95 academic year, I confirm the findings of Rector et al. (2003). Controlling for a wide set of observables, OLS estimates suggest evidence of a significant positive relationship between engaging in sexual activity and depressive symptoms, particularly for adolescent females. However, these cross-section estimates will only yield unbiased estimates of the effect of teen sex on adolescent mental health if, conditional on observable characteristics, the mean depressive symptoms of virgins is equivalent to what the mean depressive symptoms of sexually active girls would have been had they remained virgins. This assumption is not reasonable in the presence of unobserved heterogeneity. For example, if adolescents who have had particular childhood experiences report greater depression and also choose to enter into sexual activity earlier in life, and this measure of past childhood experiences is unobserved, then cross-section estimates will be upwardly biased. To test the sensitivity of the relationship between teen sex and depression to unobserved heterogeneity, I exploit the longitudinal nature of the Add Health data to estimate individual fixed effects models. Difference-in-difference estimates suggest that the strong, positive relationship observed in the cross-section can be largely explained by selection on unobservables. I find no evidence of a statistically significant relationship between losing virginity and changes in reported depressive symptoms. This finding casts serious doubt on the hypothesis that teen sex has a causal impact on mental health. Rather, the evidence suggests that the types of adolescents who select into early teen sex are those who are most likely to be depressed. In summary, the findings of this paper suggest that while there may be other health or non-health-related benefits of delaying first intercourse, depressive symptoms are unlikely to be improved by policies and programs designed to promote abstinence. Taken together with Sabia (2006a), these results provide important evidence that recent cross-section studies of the causes and consequences of early teen sex often lead to naïve and erroneous policy conclusions. Literature A significant body of sociological literature has shown that adolescent depression is associated with adverse mental health outcomes, lower human capital accumulation, and greater relationship problems in later life. Empirical studies have found that teen depression is correlated with lower self-esteem (Owens, 1994), more suicidal thoughts (Mazza & Reynolds, 1998), more suicide attempts (Rector et al., 2003; Mazza & Reynolds, 1998), more academic problems (Compas, Wagner, Slavin, & Wannatta, 1986), more personal problems (Joyner & Udry, 2000; Compas et al., 1986), a greater likelihood of depression in adulthood, and greater marital

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dissatisfaction (Gotlib, Lewinson, & Seeley, 1998; Kandel & Davies, 1986). Thus, from both a public health perspective and a human capital perspective, there may be reason to identify and ameliorate the causes of adolescent depression. Theoretically, teen sex may adversely affect mental health for several reasons. Sexual relationships may change existing relationships between friends and parents, causing an increase in stress (Aneshensel & Gore, 1991; Douvan & Adelson, 1966; Gray & Steinberg, 1999). Also, the dissolution of relationships involving teen sex may cause significant stress and depression, thereby negatively impacting assessments of net worth and self-esteem (Larson, Clore, & Wood, 1999; Sprecher, 1994). However, there is also a theoretical reason to believe that teen sex could have mental health benefits, if only in the short run. Engaging in sex may increase one’s social acceptance among peers and may yield relationship-specific benefits. The empirical literature exploring the relationship between early teen sex and adolescent mental health has been thin. The Heritage study (Rector et al., 2003) is the highest-profile examination. It finds that among sexually active teenage girls aged 14 to 17, 25.3 percent reported being depressed, compared to just 7.7 percent of their virgin counterparts. After controlling for race, income, and age, Rector et al. (2003) still found a positive and statistically significant relationship between teen sex and depression, with the strongest association for adolescent girls. However, the identification assumptions underlying these cross-section estimates are suspect. In order for the Heritage estimates to be unbiased estimates of the true impact of sexual intercourse on depression, it must be the case that had sexually active girls remained virgins, their mean depression levels would have been equal to the mean depression levels of virgins (conditional on observables). But selection on unobservable characteristics makes this identification assumption unlikely to hold. For example, it may be the case that the types of girls who are depressed are also those likely to have sex early in life, perhaps in an attempt to “escape” from the problems in their lives. If this is the case, then the Heritage estimates will be upwardly biased. While the role of unobserved heterogeneity in the relationship between teen sex and adolescent depression has not been adequately explored in the literature, a recent study has attempted to account for this type of selection in estimating the relationship between entrance into romantic or romantic-like relationships and depression.5 Joyner and Udry (2000) observe that rates of depression are much higher for females than males and posit that one reason for this is the heterogeneous impact of entering into romantic relationships. Using two waves of the National Longitudinal Study of Adolescent Health, Joyner and Udry present both cross-section and fixed effects estimates of the affect of entrance into romantic relationships on teen depression. Difference-in-difference models control for individual-level time-invariant unobserved heterogeneity. For adolescent females, crosssection estimates show evidence of a significant positive relationship between being in a romantic relationship and the probability of depression. After controlling for selection on time-invariant unobservables, the authors still find a significant positive relationship between entering into a romantic relationship and adolescent depression. This suggests more convincing evidence of a causal link between entrance into relationships and depression. In addition to entrance into sexual activity and romantic relationships, several demographic characteristics are theoretically hypothesized to be associated with
5 The Add Health data includes self-reported information on whether the adolescent is in a romantic or romantic-like relationship. The answer to this question is independent of sexual activity.

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adolescent depressive symptoms. One of the most frequently studied correlates of adolescent depression is familial relations (Field et al., 2001; Hoffman & Su, 1998; Pike & Plomin, 1996; Rey, 1995). Poor relationships with parents and siblings are associated with higher rates of depression. Persistent conflict between parents and lengthy household-level economic hardship are also found to be important contributors to adverse adolescent mental health (see, for example, Amato & Keith, 1991; Emery, 1982, 1988; Wertlieb, 1991). Single-parent households are predicted to add emotional and psychological stress to teenagers (Aseltine, 1996). Physical health has been found to be strongly correlated to mental health. Those who rate themselves in poorer physical health tend to be more depressed (see, for example, Enns, Cox, & Martens, 2005). Being overweight may also impact mental health. Obesity has been found to be correlated with lower self-esteem of white women (Averett & Korenman, 1996), but with higher self-worth and stability for black and Hispanic women, who perceive additional weight as providing additional status and power (Stearns, 1997). Moreover, drinking has been consistently found to be positively correlated with depression (see, for example, Joyner & Udry, 2000; White & Labouvie, 1989). There are several “protective” factors identified in the literature, believed to mediate the effects of stressors on adolescent depression. Intelligence (IQ) is one such protective factor. Several studies have found that having a higher IQ is associated with positive mental health outcomes because adolescents with higher IQs can better cope with life’s stressors (Horowitz & Garber, 2003; Masten & Coatsworth, 1998; Tiet, Bird, & Davies, 1998; Werner, 1989). Religiosity is also viewed as a potential protective factor, with several studies showing a positive relationship between religiosity and psychological well-being of both adults (Donahue & Benson, 1995; Koenig, 1997; Payne, Mergin, Bielema, & Jenkins, 1992; Sherkart & Reed, 1992) and adolescents (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; Levin, Markides, & Ray, 1996; Wright, Frost, & Wisecarver, 1993). The literature also suggests that while lower socioeconomic status may contribute to an increased likelihood of depression (Goodman et al., 2003), some cultural traits of historically disadvantaged racial communities can protect individuals from depression. For example, strong community relations among African Americans—along with strong social stigmas against suicide—may protect adolescents against depression and suicide (Gibbs & Hines, 1989; Nettles & Pleck, 1994) and promote healthy coping mechanisms (Morrison & Downey, 2000). This study contributes to the empirical literature by providing more credible estimates of the impact of teen sex on depressive symptoms. Using difference-in-difference estimates to control for fixed individual-level unobserved heterogeneity, I am able to present more credible evidence of the nature of the relationship between losing virginity and depressive symptoms. While not achieving the internal validity of a welldesigned social experiment, difference-in-difference models will produce estimates with more reasonable identification assumptions than have previously been presented in the literature. Obtaining credible estimates is critically important in informing a key piece of the public policy discussion over abstinence-only sex education. DATA This analysis uses data from the National Longitudinal Study of Adolescent Health (Add Health) to estimate the relationship between teen sex and depressive symptoms. This is the same dataset used by Rector et al. (2003). The Add Health survey is a school-based nationally representative longitudinal survey that collected infor-

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mation from adolescents, parents, and school administrators in the 1994–95 academic year (wave 1) and again in the 1995–96 academic year (wave 2). The first wave of data is used to conduct the cross-section analysis, and waves 1 and 2 are used to conduct the difference-in-difference analysis. In the first wave, students from seventh to twelfth grade were asked questions about their mental health, personality, sexual activity, family, romantic relationships, peer groups, neighborhoods, and other health behaviors. Similar questions were posed in wave 2. Parents (mostly mothers) were also interviewed and asked about their relationships with their children, their families, and information on their backgrounds. Weighted means and standard deviations of the dependent variables and independent variables used in the analysis are presented in Table 1A, by age. Means of the dependent variables and the key independent variable are presented by gender and age in Table 1B. Three measures of mental health are constructed for use as dependent variables in this analysis. First, a measure of depression, DEPRESS, is used. Adolescents were asked the following question in both waves of data collection: “These questions will ask about how you feel emotionally and about how you feel in general. How often was [this statement] true during the past seven days: You felt depressed?” DEPRESS was coded as equal to 1 if the adolescent responded that she felt depressed “a lot of the time,” or “most of the time or all of the time.” The variable was coded as 0 if the adolescent responded that she was depressed “never or rarely” or only “sometimes.” This is the same coding used in the Heritage study (Rector et al., 2003). I find that 3.7 percent of adolescent males and 7.6 percent of adolescent females aged 13–14 report being depressed. The percentages rise with age for males, to 4.7 percent of those aged 15–16 and 9.6 percent of those aged 17–18. For adolescent females, the percentages are 12.4 percent of 15–16-year-olds and 12.7 percent of 17–18-year-olds. Second, I construct a measure of the adolescent’s perceived value of life. In both waves of data, adolescents were asked, “[During the past week], how often did you feel that your life was not worth living?” Given the severity of this question, I code the variable NOTWORTH equal to 1 if the adolescent reports that she felt her life were not worth living “sometimes,” “a lot of the time,” or “most or all of the time.” This variable was coded to 0 if the adolescent responded “never” or “rarely.” 6.1 percent of males and 10.9 percent of females aged 13–14 reported that their life was not worth living. As with depression, the percentage rose with age for males to 8.3 percent of 15–16-year-olds, and 11.3 percent of 17–18-year-olds. For females, the percentage rose to 13.8 percent of 15–16-year-olds, and then fell to 11.6 percent of 17–18-year-olds. Finally, I construct a measure of the adolescent’s suicidal tendencies, SUICIDE. Adolescents were asked, “During the past 12 months, did you ever seriously think about committing suicide?” The responses for this question were a simple “yes” and “no.” 7.9 percent of males and 14.4 percent of females aged 13–14 reported that they had contemplated suicide.6 This number rose with age for males (to 9.5 percent of 15–16-year-olds to 13.3 percent of 17–18-year-olds) and rose and fell for females (to 18.3 percent of 15–16-year-olds to 15.5 percent of 17–18-year-olds). The central right-hand side variable of interest is whether the teenager had ever engaged in sexual intercourse, INTERCOURSE. The survey item asks, “Have you ever had sexual intercourse? When we say sexual intercourse, we mean when a male inserts his penis into a female’s vagina.” 15.4 percent of 13–14-year-olds, 39.1 percent
6

Approximately 32 percent of those who reported seriously contemplating suicide reported actually attempting suicide.

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Table 1A. Weighted means and standard deviations. Age 13–14 Age 15–16 0.057 (0.232) 0.086 (0.281) 0.112 (0.315) 0.086 (0.280) 0.112 (0.315) 0.139 (0.346) 0.110 (0.312) 0.115 (0.319) 0.143 (0.350) Age 17–18

Dependent Variables DEPRESS Adolescent reports feeling depressed a lot of the time, most of the time, or all of the time during past seven days NOTWORTH Adolescent reports life not worth living sometimes, a lot of the time, most of the time, or all of the time during past seven days SUICIDE Adolescent has seriously thought about committing suicide during last year

Independent Variables INTERCOURSE Had Sexual Intercourse

FEMALE

Female

BLACK

Black

HISPANIC

Hispanic

AHPVT

Add Health Picture and Vocabulary Test Score

GPA

Math-English Grade Point Average

DRINK

Adolescent reports drinking alcoholic beverages

SUICIDEFAM

Family member attempted suicide in last year

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SUICIDEFRD

Friend attempted suicide in last year

BIRTHWGT

Adolescent Birthweight (kg)

OVERWGT

Adolescent perceives himself or herself to be overweight

BADHEALTH

Adolescent reports being in poor physical health

ROMANTIC

Had a Romantic or Romantic-Like Relationship

0.135 (0.342) 0.531 (0.499) 0.137 (0.344) 0.110 (0.313) 101.80 (14.19) 2.82 (0.938) 0.309 (0.462) 0.043 (0.202) 0.185 (0.389) 4.75 (0.199) 0.313 (0.464) 0.068 (0.251) 0.401 (0.490)

0.378 (0.485) 0.503 (0.500) 0.160 (0.367) 0.119 (0.324) 101.71 (14.12) 2.65 (0.956) 0.513 (0.500) 0.049 (0.216) 0.191 (0.393) 4.75 (0.200) 0.315 (0.465) 0.062 (0.241) 0.568 (0.495)

0.582 (0.493) 0.471 (0.477) 0.176 (0.381) 0.128 (0.334) 100.42 (14.47) 2.58 (0.939) 0.606 (0.489) 0.050 (0.218) 0.177 (0.382) 4.75 (0.219) 0.308 (0.462) 0.085 (0.279) 0.676 (0.468)

FIGHT

NOTCARE

NOTGALONG

OLDERSIB

Parent reports fighting frequently with spouse or partner (“a lot” or “some” of the time) Adolescent believes mother cares not at all, very little, or only somewhat about him/her Parent reports getting along with adolescent “seldom” or “never” Older sibling in household

AFDC

Household Receiving AFDC

MOMDRINK

Mother frequent alcohol user

MOMUNHAPPY

Mother reports frequent unhappiness

COLLEGEGRAD

Mother a college graduate

SINGLEPAR

Single-parent household

RELIGIONWK

Attend religious services at least once per week

RELIGIONMO

Attend religious services about once per month

RELIGIONYR

Attend religious services about once per year

RURAL

Rural location

SUBURBAN

Suburban location

WEST

Western region

MIDWEST

Midwestern region

SOUTH

Southern region

N1

0.216 (0.412) 0.019 (0.138) 0.010 (0.098) 0.432 (0.495) 0.143 (0.350) 0.067 (0.250) 0.040 (0.194) 0.206 (0.405) 0.326 (0.469) 0.433 (0.496) 0.193 (0.394) 0.142 (0.350) 0.142 (0.349) 0.603 (0.489) 0.166 (0.372) 0.317 (0.466) 0.387 (0.487) 3,712

0.200 (0.400) 0.025 (0.155) 0.011 (0.103) 0.401 (0.490) 0.131 (0.337) 0.069 (0.253) 0.033 (0.179) 0.196 (0.397) 0.363 (0.481) 0.372 (0.483) 0.187 (0.391) 0.181 (0.385) 0.169 (0.374) 0.583 (0.493) 0.181 (0.385) 0.169 (0.374) 0.583 (0.493) 5,622

0.195 (0.396) 0.023 (0.149) 0.014 (0.118) 0.323 (0.468) 0.122 (0.328) 0.060 (0.237) 0.039 (0.194) 0.177 (0.382) 0.396 (0.489) 0.314 (0.464) (0.196) (0.397) 0.204 (0.403) 0.192 (0.394) 0.550 (0.498) 0.153 (0.360) 0.345 (0.475) 0.374 (0.484) 3,294

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1Sample

used in OLS regression for depression.

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Table 1B. Means and standard deviations of key variables, by sex and age. Females Age 13–14 Age 15–16 Age 17–18 DEPRESS NOTWORTH SUICIDE INTERCOURSE N 0.076 (0.263) 0.109 (0.324) 0.144 (0.357) 0.116 (0.326) 1,972 0.124 (0.330) 0.138 (0.346) 0.183 (0.386) 0.366 (0.482) 2,874 0.127 (0.333) 0.116 (0.321) 0.155 (0.362) 0.578 (0.494) 1,575 Males Age 13–14 Age 15–16 Age 17–18 0.037 (0.185) 0.061 (0.257) 0.079 (0.266) 0.154 (0.390) 1,740 0.047 (0.211) 0.083 (0.276) 0.095 (0.294) 0.391 (0.488) 2,748 0.096 (0.293) 0.113 (0.317) 0.133 (0.340) 0.585 (0.493) 1,719

of 15–16-year-olds, and 58.5 percent of 17–18-year-old males reported having had sexual intercourse. The percentages are fairly similar for females (11.6 percent, 36.6 percent, and 57.8 percent, respectively). One important limitation of this paper is that the measures of adolescent mental health are self-reported and not validated. However, self-reported measures of depression from the Center for Epidemiologic Studies—Depression (CES-D) have been validated in a number of populations (Radloff, 1977). Moreover, recent studies (Joyner & Udry, 2000; Rector et al., 2003) have used self-reported measures of mental health from the Add Health data and concluded that these measures are reasonable proxies of true mental health outcomes. Table 1A also contains means of the control variables used in the analysis. I discuss a few of these key control variables below.7 In this study, it is important to disentangle the effects of being in a relationship on mental health from the effects of sexual intercourse on mental health. As described above, the literature suggests that entrance into romantic relationships may be associated with increased depression, especially for females (Joyner & Udry, 2000). Hence, I include a variable measuring whether or not the adolescent reports being in a romantic or romantic-like relationship, ROMANTIC. The percentage of adolescent males and females in such a relationship rose with age, from around 40 percent of 13–14-year-olds to 68 percent of 17–18-year-olds. Attempted suicides of family members (SUICIDEFAM) or friends (SUICIDEFRD) are also expected to impact an adolescent’s mental health. Family suicide attempts may reflect biological-based depression, an important correlate of adolescent depression (see, for example, Shiner & Marmorstein, 1998). Moreover, suicide attempts by family or friends can lead to greater stress and anxiety, thus increasing the likelihood of depression. Approximately 4 percent of adolescents reported having a family member attempt suicide in the last year; 18.5 percent reported that a friend had attempted suicide. Obesity may also be correlated with mental health, especially for females. Averett and Korenman (1996) find that being overweight is associated with lower selfesteem for white females, while Stearns (1997) finds that black and Hispanic obese women associate being overweight with greater perceived stability and strength. I include a measure of whether the adolescent perceives himself or herself to be overweight (OVERWGT) as a measure of obesity and as a proxy for attractiveness to
7

Means of control variables by gender are available upon request.

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peers. Approximately 30 percent of individuals in the sample report that they believe themselves to be overweight. Family environment may also impact adolescents’ mental health (Rey, 1995; Pike & Plomin, 1996; Hoffman & Su, 1998; Field et al., 2001). Teens with parents that frequently fight (FIGHT) or do not get along with their children (NOTGETALONG) may be more likely to be stressed and depressed. Approximately 20 percent of mothers reported frequent arguing with their spouses or partners. Adolescents who believe that their parents do not care (NOTCARE) about them are also more likely to be depressed. Other observable characteristics theoretically believed to be linked with adolescent depression are also listed in Table 1A. These variables include race (BLACK, HISPANIC), intelligence (AHPVT), academic performance (GPA), alcohol consumption (DRINK), general health (BADHEALTH, BIRTHWGT), household demographics (OLDERSIB, AFDC, COLLEGEGRAD, SINGLEPAR), mothers’ depression (MOMUNHAPPY, MOMDRINK), religiosity (RELIGION), and location effects (Amato & Keith, 1991; Aseltine, 1996; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; Emery, 1982, 1988; Enns, Cox, & Martens, 2005; Gibbs & Hines, 1989; Horowitz & Garber, 2003; Joyner & Udry, 2000; Levin, Markides, & Ray, 1996; Masten & Coatsworth, 1998; Morrison & Downey, 2000; Nettles & Pleck, 1994; Tiet, Bird, & Davies, 1998; Werner, 1989; Wertlieb, 1991; White & Labouvie, 1989; Wright, Frost, & Wisecarver, 1993). METHODOLOGY This study compares two estimators to examine the sensitivity of the relationship between teen sex and self-reported mental health to unobserved heterogeneity. First, I estimate a cross-section model similar to the one estimated by Rector et al. (2003) using wave 1 of the Add Health data. Each of the measures of adverse mental health is regressed on a set of individual-level and family-level observable characteristics as well as an indicator variable measuring whether the adolescent has engaged in sexual intercourse. Cross-section estimates are estimated via linear probability model.8 Second, to control for selection into sexual activity based on unobservable characteristics, I exploit the longitudinal nature of the Add Health data to estimate individual fixed effects models. Adolescents are interviewed in consecutive academic years (wave 1 and wave 2) and are asked questions about their sexual experiences and depressive symptoms.9 The difference-in-difference model is similar to that estimated by Joyner and Udry (2000) and uses a within-person identification strategy. In order for the fixed effect estimate to yield an unbiased estimate of the effect of losing virginity on depression, there must be no time varying unobservables correlated with both changes in sexual behavior and with changes in depressive symptoms. The principle benefit of the difference-in-difference model is that it controls for fixed individual-level unobserved characteristics that may be associated with both sexual activity and depressive symptoms. The possible cost of this methodology is that it may reduce the amount of identifying variation available to detect significant
8 9

Probit and logit estimates produce results similar to those presented here. The sample is restricted to those who have non-missing observations in both waves 1 and 2 for the dependent variable, virginity status, and time-varying observable characteristics described below. Moreover, less than 4 percent of the sample was composed of so-called “born-again virgins,” reporting that they were not virgins in wave 1, but that they were virgins in wave 2. These individuals are dropped from the sample. However, their exclusion does not change the findings presented here.

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relationships. If there is not sufficient within-person variation in sexual activity and depressive symptoms, then this model will lack power. Table 2 presents the means of the measures of mental health and teen sex in each wave as well as the variability between waves. The descriptive evidence in Table 2 suggests the presence of significant between-wave variation in sexual activity and depressive symptoms.10 Approximately 10 percent of females and 8 percent of males report becoming sexually active between periods t and t 1. Moreover, 10 to 18 percent of females reported changes in a depressive symptom between waves 1 and 2. A smaller, but significant, percentage of males (6 to 13 percent) reported changes in depressive symptoms. This descriptive evidence suggests that a difference-in-difference methodology can be credibly utilized to identify the effects of entrance into sexual intercourse on changes in depression. Taken together, a comparison of OLS and fixed effects estimates will allow us to examine whether fixed individual-level unobserved heterogeneity upwardly biases cross-section estimates. Difference-in-difference estimators are likely to produce more credible estimates of the effect of early teen sex on adolescent mental health. Obtaining credible estimates is especially important in the context of the public policy debate over abstinence-only sex education.11 RESULTS The main results of this study are presented in Tables 3–5. All regression models are weighted and control for Add Health’s clustered sample design.12 OLS Estimates Table 3 presents OLS estimates of the relationship between teen sex and adolescent mental health, by age, using wave 1 of the Add Health data. These cross-section estimates include controls for a wide set of individual-level and family-level observables, as suggested in the theoretical literature. Because the focus of this study is on the relationship between teen sex and mental health, the coefficients on the control variables will not be discussed in the text. However, the findings on the control variables are consistent with the previous literature and are available in Table 3.

Note that the sample in Table 2 is smaller than that in Table 1 because Table 2 information includes only those observations that had non-missing information on observable characteristics in each wave of data collection. 11 An alternative estimation strategy that could be used to identify the effects of early sexual intercourse on mental health is instrumental variables (IV). This would require finding measures that are strong predictors of teenage sexual activity that are uncorrelated with adolescent mental health. I attempted an IV strategy using such exclusion restrictions as perceived parental disapproval of sex, the presence of sex education in school, adolescent perceptions of pregnancy probabilities, and state welfare policies. While the IV estimates obtained from these models are consistent with the difference-in-difference models presented here, the instruments do fail the Sargan overidentification test in several specifications, suggesting that the identification assumptions may not be valid. This finding is not especially surprising given that parenting styles, adolescent attitudes, and community sentiment may be directly correlated with teenage mental health. IV estimates are available upon request of the author. 12 The OLS sample requires only non-missing observations on the dependent variable and on virginity status in wave 1. To avoid losing thousands of observations (and significant power) due to missing values for some right-hand-side (RHS) variables, I include dummy variables for each of these missing values. Estimates of the relationship between teen sex and adolescent mental health are not sensitive to the treatment of missing data on RHS variables. In an alternative specification where I exclude all observations for which there are missing data on any RHS variable, the main findings of the study are unchanged.

10

Journal of Policy Analysis and Management DOI: 10.1002/pam Published on behalf of the Association for Public Policy Analysis and Management

Table 2. Means and variation in adolescent depression and sexual intercourse across data waves, by gender and age. Females Age 15–16 Wave 1 Wave 2 Age 17–18 Wave 1 Wave 2 0.569 0.652 (0.495) (0.476) 0.151 0.225 (0.358) (0.418) 0.385 0.470 (0.487) (0.499) Age 13–14 Wave 1 Wave 2 0.361 0.498 (0.480) (0.500) Males Age 15–16 Wave 1 Wave 2 Age 17–18 Wave 1 Wave 2 0.581 0.664 (0.494) (0.472)

Age 13–14 Wave 1 Wave 2

SEX

0.108 0.208 (0.310) (0.406)

DEPRESS

% btw waves % 0 to 1 % 1 to 0

0.067 0.061 (0.250) (0.240) 10.2% 5.3% 4.9%

0.118 0.088 (0.322) (0.283) 14.6% 5.8% 8.8%

0.118 0.097 (0.323) (0.296) 14.9% 6.4% 8.5%

0.036 0.032 (0.186) (0.176) 5.5% 2.8% 2.7%

0.045 0.038 (0.208) (0.192) 6.7% 3.0% 3.7%

0.088 0.067 (0.284) (0.250) 10.2% 4.0% 6.2%

NOTWORTH

% btw waves % 0 to 1 % 1 to 0

0.116 0.116 (0.320) (0.321) 14.3% 7.1% 7.2%

0.132 0.100 (0.339) (0.330) 13.3% 5.0% 8.3%

0.107 0.086 (0.310) (0.280) 11.4% 4.6% 6.8%

0.062 0.065 (0.243) (0.247) 8.7% 4.5% 4.2%

0.087 0.090 (0.283) (0.286) 12.0% 6.1% 5.9%

0.105 0.096 (0.307) (0.294) 13.3% 6.2% 7.1%

SUICIDE

% btw waves % 0 to 1 % 1 to 0 2,709 1,479

0.146 0.161 (0.354) (0.367) 17.5% 9.5% 8.0%

0.173 0.131 (0.379) (0.338) 17.2% 6.5% 10.7%

0.147 0.092 (0.354) (0.290) 13.9% 4.2% 9.7%

0.075 0.062 (0.264) (0.241) 9.5% 4.1% 5.4% 1,663

0.100 0.089 (0.300) (0.284) 11.6% 5.3% 6.3% 2,694

0.125 0.097 (0.331) (0.295) 11.7% 4.4% 7.3% 1,642

N

1,854

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Note: “% 0 to 1” refers to the percentage of individuals who reported no adverse mental health in wave 1 and adverse mental health in wave 2. “% 1 to 0” refers to those who reported adverse mental health in wave 1, but no adverse mental health in wave 2. “% btw waves” refers to the percentage of adolescents who reported a change in mental health status between waves.

Table 3. OLS estimates of association between sexual intercourse and mental health, by age1,2.
Age 13–14 (2) Not Worth (3) Suicide (4) Depress (6) Suicide (7) Depress (9) Suicide Age 15–16 (5) Not Worth Age 17–18 (8) Not Worth

(1) Depress

INTERCOURSE

FEMALE

BLACK

HISPANIC

AHPVT

GPA

DRINK

SUICIDEFAM

SUICIDEFRD

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Journal of Policy Analysis and Management DOI: 10.1002/pam Published on behalf of the Association for Public Policy Analysis and Management

BIRTHWGT

OVERWGT

BADHEALTH

ROMANTIC

0.046*** (0.018) 0.032*** (0.009) –0.002 (0.011) –0.017 (0.020) –0.000 (0.0004) –0.012* (0.006) 0.025** (0.012) 0.061 (0.045) 0.021* (0.012) 0.004 (0.023) 0.022* (0.012) 0.083*** (0.024) 0.032*** (0.009)

0.052** (0.026) 0.053*** (0.010) 0.005 (0.023) 0.033 (0.027) –0.002*** (0.001) –0.028*** (0.008) 0.038*** (0.013) 0.117** (0.054) –0.003 (0.015) –0.000 (0.025) 0.018 (0.012) 0.088*** (0.027) 0.022** (0.011)

0.050** (0.022) 0.059*** (0.013) –0.006 (0.019) –0.023 (0.026) 0.001 (0.001) –0.029*** (0.010) 0.111 (0.015) 0.0175*** (0.052) 0.065*** (0.019) 0.022 (0.025) 0.025* (0.015) 0.026 (0.028) 0.033** (0.013)

0.023** (0.011) 0.063*** (0.009) –0.017 (0.015) –0.013 (0.015) –0.001*** (0.0004) –0.008 (0.006) 0.029*** (0.011) 0.038 (0.030) 0.018 (0.015) –0.018 (0.030) 0.045*** (0.012) 0.046* (0.026) 0.026** (0.010)

0.048*** (0.014) 0.038*** (0.013) –0.012 (0.017) 0.024 (0.017) –0.003*** (0.001) –0.004 (0.006) 0.013 (0.012) 0.044 (0.035) 0.062*** (0.015) 0.011 (0.035) 0.071*** (0.013) 0.032 (0.029) 0.008 (0.012)

0.034* (0.017) 0.054*** (0.013) –0.023 (0.0015) 0.007 (0.020) 0.000 (0.001) –0.010 (0.008) 0.051*** (0.013) 0.142*** (0.031) 0.141*** (0.021) 0.008 (0.034) 0.066*** (0.016) 0.088*** (0.032) 0.014 (0.012)

0.013 (0.019) 0.015 (0.015) 0.017 (0.019) –0.013 (0.020) –0.001 (0.001) –0.006 (0.008) 0.036*** (0.014) 0.017 (0.041) 0.042** (0.019) –0.027 (0.040) 0.018 (0.019) 0.152*** (0.033) 0.025 (0.018)

–0.004 (0.017) –0.012 (0.016) 0.029 (0.022) 0.031 (0.022) –0.002*** (0.001) –0.020* (0.010) –0.011 (0.017) 0.043 (0.038) 0.055** (0.027) –0.032 (0.038) 0.053*** (0.016) 0.115*** (0.036) 0.003 (0.019)

–0.001 (0.026) –0.005 (0.016) 0.027 (0.026) –0.031 (0.023) 0.001** (0.0005) –0.003 (0.009) 0.035* (0.018) 0.064 (0.045) 0.190*** (0.023) –0.002 (0.041) 0.075*** (0.019) 0.072* (0.038) 0.012 (0.020)

FIGHT

NOTCARE

NOTGALONG

OLDERSIB

AFDC

MOMDRINK

MOMUNHAPPY

COLLEGEGRAD

RELIGIONWK

RELIGIONMO

RELIGIONYR

RURAL

SUBURBAN

0.030*** (0.014) 0.192*** (0.071) 0.059 (0.069) 0.004 (0.010) 0.015 (0.015) 0.023 (0.022) 0.035 (0.035) –0.008 (0.011) 0.016 (0.010) 0.015 (0.015) 0.023 (0.020) 0.007 (0.013) 0.003 (0.011) 3,770 3,757 5,622 5,732 5,701 3,294 3,372 3,358

0.016 (0.012) 0.204*** (0.061) 0.015 (0.048) 0.009 (0.011) 0.023 (0.027) 0.021 (0.029) –0.003 (0.035) –0.004 (0.010) –0.008 (0.011) –0.021 (0.017) 0.010 (0.016) 0.036 (0.024) 0.003 (0.015)

0.001 (0.014) 0.184*** (0.063) –0.084 (0.055) 0.002 (0.013) –0.018 (0.022) –0.016 (0.028) –0.037 (0.033) 0.018 (0.015) –0.025 (0.016) –0.046** (0.019) –0.025 (0.020) 0.015 (0.023) –0.004 (0.014)

0.010 (0.013) 0.031 (0.036) 0.089 (0.094) –0.003 (0.010) –0.009 (0.017) 0.023 (0.024) –0.004 (0.029) –0.011 (0.011) –0.013 (0.012) –0.013 (0.016) –0.018 (0.014) 0.026** (0.012) 0.004 (0.019)

0.017 (0.015) 0.150*** (0.051) 0.016 (0.061) 0.016 (0.010) –0.050** (0.20) 0.065** (0.027) 0.045 (0.040) 0.005 (0.012) –0.003 (0.015) –0.018 (0.018) –0.031 (0.021) –0.012 (0.017) –0.010 (0.013)

0.005 (0.013) 0.140** (0.058) 0.075 (0.086) 0.002 (0.012) –0.028 (0.018) 0.049* (0.030) 0.042 (0.032) 0.026 (0.016) –0.043** (0.018) –0.054*** (0.020) –0.040** (0.018) 0.019 (0.021) –0.003 (0.012)

0.012 (0.019) 0.127** (0.059) 0.271** (0.121) 0.004 (0.018) 0.032 (0.026) –0.022 (0.028) 0.010 (0.040) –0.022 (0.016) 0.000 (0.020) –0.028 (0.020) 0.024 (0.020) (0.011 (0.019) 0.001 (0.015)

0.028 (0.019) 0.208*** (0.076) 0.325*** (0.110) 0.019 (0.016) 0.047* (0.029) 0.025 (0.035) 0.005 (0.046) –0.035** (0.016) 0.001 (0.021) –0.030 (0.021) 0.016 (0.025) –0.036 (0.022) –0.017 (0.019)

0.042* (0.023) 0.121 (0.077) –0.019 (0.077) –0.008 (0.018) 0.027 (0.031) 0.057 (0.049) –0.016 (0.040) –0.017 (0.024) –0.007 (0.023) –0.015 (0.025) 0.010 (0.028) –0.010 (0.018) –0.004 (0.015)

N

3,712

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*** Significant at 1% ** Significant at 5% * Significant at 10% level. 1All models include an age dummy for the omitted age group as well as region dummies. 2Marginal effects presented, with all models estimated after taking into account design effect.

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Table 4. OLS estimates of relationship between sexual intercourse and mental health, by sex and age1,2. Females (1) (2) (3) Age 13–14 Age 15–16 Age 17–18 DEPRESS N NOTWORTH N SUICIDE N 0.092*** (0.029) 1,972 0.081** (0.033) 2,018 0.063* (0.033) 2,012 0.046** (0.020) 2,874 0.050** (0.020) 2,959 0.049** (0.025) 2,949 0.018 (0.043) 1,575 -0.026 (0.029) 1,622 –0.015 (0.031) 1,619 Males (4) (5) (6) Age 13–14 Age 15–16 Age 17–18 0.014 (0.020) 1,740 0.022 (0.028) 1,752 0.038 (0.029) 1,745 0.002 (0.011) 2,748 0.047** (0.020) 2,773 0.017 (0.020) 2,752 0.001 (0.024) 1,719 0.022 (0.018) 1,750 0.004 (0.038) 1,739

*** Significant at 1%; ** Significant at 5%; * Significant at 10% level. 1All models control for the same set of observable characteristics described in Table 2. 2Marginal effects presented, with all models estimated after taking into account design effect.

Models 1–3 present estimates of the relationship between adolescent sexual intercourse and three measures of self-reported depression for those aged 13–14. I find evidence of a strong positive relationship between engaging in sexual intercourse and the likelihood of depression (model 1), feelings that one’s life is not worth living (model 2), and serious thoughts of suicide (model 3). The coefficient estimates suggest that sexual intercourse is associated with a 5 percentage-point higher probability of each of these outcomes. For 15–16-year-olds (models 4–6), the relationships persist. Teen sex is associated with a 2.3 percentage point higher probability of depression, a 4.8 percentage point higher probability of feeling life is not worth living, and a 3.4 percentage point higher probability of having serious suicidal thoughts. However, for the oldest teens (aged 17–18), I find no evidence of a significant relationship between teen sex and mental health after controlling for observables. The findings in Table 3 are consistent with Rector et al. (2003) and suggest evidence of a link between teen sex and depression.13 Rector et al. (2003) find that the magnitude of the association between teen sex and mental health is largest for adolescent females. This is consistent with the positive and statistically significant coefficients on the FEMALE variable in models 1–6. To allow sexual activity to have heterogeneous effects on males and females, separate models are estimated by gender in Table 4. Each coefficient in Table 4 comes from a separate regression model, controlling for the previously discussed control variables.14 The first three columns present results for females. I find robust evidence of a significant positive relationship between sexual activity and adverse mental health for females. Sexual intercourse is associated with a 6.9 higher percentage-point probability of self-reported depression for 13–14-year-old females (column 1) and a 4.7 higher percentage-point probability of depression for 15–16-year-old females. Moreover, sexual intercourse is
13

These findings are also consistent with Joyner and Udry (2000), who find a strong positive association between adolescents entering into a romantic relationship and an increased probability of depression. 14 Coefficient estimates on the control variables for these models are available upon request of the author.

Journal of Policy Analysis and Management DOI: 10.1002/pam Published on behalf of the Association for Public Policy Analysis and Management

Does Early Adolescent Sex Cause Depressive Symptoms? / 819

associated with higher probabilities of feeling life is not worth living for 13–14-yearolds (8.1 percentage-points) and 15–16-year-olds (5.0 percentage-points). Finally, there is a positive relationship between having sexual intercourse and the probability of having serious suicidal thoughts in the last year (6.3 percentage points for 13–14-year-old females and 4.9 percentage points for 15–16-year-old females). For the oldest teenage females (aged 17–18), there is no evidence of a significant relationship between sexual intercourse and adverse mental health after controlling for observable characteristics. For teenage males (columns 4–6), I find little evidence of a significant relationship between sexual intercourse and depressive symptoms. Only for 15–16-year-old males, do I find that engaging in sexual intercourse is associated with a higher probability of feeling life is not worth living. Taken together, the findings in Table 4 confirm the central findings of the Heritage study by Rector et al. (2003). Fixed Effects Estimates Table 5 presents difference-in-difference estimates of the effect of exiting virginity on depressive symptoms.15 The difference-in-difference models control for the following time-varying covariates: whether the adolescent is in a romantic relationship, whether a family member has attempted suicide, whether a friend has attempted suicide, whether the adolescent feels that her parents don’t care about her, whether the teen perceives herself to be overweight, whether the family attends weekly religious services, whether the adolescent consumes alcohol, the adolescent’s annual school grade point average, and the adolescent’s perceived loneliness. The differencein-difference models are estimated with a smaller sample than used in Table 4 because observations on the dependent variable and each of the independent variables are required in each of the two time periods. Thus, in Table 5, I also present cross-section estimates of the relationship between sexual activity and mental health using the fixed effects sample to ensure that any differences between cross-section and difference-in-difference estimators are not due to changes in the sample. OLS estimates on the fixed effects sample produce findings similar to those observed in Table 4. Controlling for observables, sexual activity is associated with higher probabilities of depression, feelings that one’s life is not worth living, and suicidal thoughts for adolescent females aged 13–14 and aged 15–16. As before, for females aged 17–18 and all males, there is little evidence of a significant relationship between sexual intercourse and adverse mental health. For adolescent females, difference-in-difference estimates suggest consistent evidence that OLS estimates of the relationship between sexual intercourse and adverse mental health are upwardly biased due to fixed individual-level unobserved heterogeneity.16 After controlling for individual-level unobservables, I find no significant relationship between losing virginity and depressive symptoms for adolescent females. These insignificant relationships are not simply driven by larger standard errors in the fixed effects (FE) models relative to the OLS models; the magnitudes of the coefficients fall dramatically.
15

Approximately 3.6 percent of adolescents in the sample report that they had engaged in sexual intercourse in wave 1, but in wave 2, they responded that they had never engaged in sexual intercourse in their lives. I code these individuals as having been sexually active. The results presented here are robust to dropping this small subsample of adolescents. 16 Difference-in-difference estimates of the relationship between losing virginity and depressive symptoms is robust to the inclusion or exclusion of a wide set of observable time-varying characteristics.

Journal of Policy Analysis and Management DOI: 10.1002/pam Published on behalf of the Association for Public Policy Analysis and Management

Table 5. OLS and FE estimates of relationship between sexual intercourse and mental health, by age.1,2. Females Age 15–16 (3) (4) OLS FE Age 17–18 (5) (6) OLS FE Age 13–14 (7) (8) OLS FE Males Age 15–16 (9) (10) OLS FE Age 17–18 (11) (12) OLS FE

Age 13–14 (1) (2) OLS FE

DEPRESS

N 0.048** (0.020) 2884 –0.008 (0.019) 2884 –0.022 (0.029) 1582 0.039 (0.038) 1582 0.027 (0.028) 1694 0.007 (0.033) 1694 0.045** (0.020) 2700

0.069*** (0.028) 1854

0.038 (0.038) 1854

0.047** (0.021) 2709

–0.009 (0.025) 2709

0.005 (0.043) 1479

0.048 (0.037) 1479

0.026 (0.021) 1663

–0.031 (0.026) 1663

0.002 (0.011) 2694

–0.014 (0.025) 2694 0.011 (0.035) 2700

0.007 (0.024) 1642 0.027 (0.017) 1708

0.017 (0.043) 1642 –0.013 (0.034) 1708

NOTWORTH 0.072** (0.035) N 1958

0.029 (0.049) 1958

SUICIDE

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Journal of Policy Analysis and Management DOI: 10.1002/pam Published on behalf of the Association for Public Policy Analysis and Management

N

0.059* –0.111*** 0.051** (0.033) (0.043) (0.026) 1955 1955 2882

–0.051* (0.027) 2882

–0.016 (0.032) 1583

–0.077** (0.039) 1583

0.054* (0.029) 1694

0.009 (0.036) 1694

0.019 (0.020) 2692

–0.013 (0.029) 2692

–0.003 (0.038) 1707

0.006 (0.031) 1707

*** Significant at 1% ** Significant at 5% * Significant at 10% level. 1 Fixed effects models include the following time-varying independent variables: whether in a romantic relationship, whether family member has attempted suicide, whether a friend has attempted suicide, whether the adolescent feels that her parents don't care about her, whether aspire to college, whether perceived overweight, whether attend religious services once/week, whether drinking alcohol, GPA, physical health status, and perceived loneliness. OLS models include identical set of observables as described in Table 2. 2 Marginal effects presented, with all models estimated after taking into account design effect.

Does Early Adolescent Sex Cause Depressive Symptoms? / 821

For 13–14-year-old females, the coefficient estimate in the OLS model is 0.069 and is statistically significant at the 1 percent level. After controlling for unobserved heterogeneity, the coefficient falls to 0.038 and becomes insignificant. For 15–16year-old females, the OLS estimate is positive and significant (0.047); however, the fixed effects estimate is negative and insignificant. The findings for the NOTWORTH outcome are similar. For 13–14-year-old females, the OLS estimate is positive and significant (0.072), while the FE estimate is 60 percent smaller in magnitude and is insignificant. Moreover, while the OLS estimate of the relationship between sexual activity and feeling that life is not worth living is positive and significant for females aged 15–16, the FE estimate is negative and insignificant. Most starkly, while OLS estimates of the relationship between sexual activity and serious thoughts of suicide are positive and significant for 13–14-year-old and 15–16-year-old females, difference-in-difference estimates are actually negative and significant. Entrance into sexual activity is associated with an 11.1 percentage point decline in suicidal thoughts for 13–14-year-old females, a 5.1 percentage point decline in suicidal thoughts for 15–16-year-olds, and a 7.7 percentage point decline in suicidal thoughts for 17–18-year-olds. For adolescent males, difference-in-difference estimates of the relationship between sexual intercourse and mental health are statistically insignificant across all specifications, with a few positive OLS signs becoming negative after controlling for unobserved heterogeneity. The findings of this study suggest that it is inappropriate to infer a positive causal relationship between entrance into early teen sex and depression. Rather, certain types of adolescents—those with unobserved psychological traits or childhood experiences—are simply more prone to both depression and early sexual experience. Thus, the results presented here suggest little support for the hypothesis that promoting abstinence-only sex education will ameliorate depressive symptoms. CONCLUSIONS Taken together with Sabia (2006a), this study suggests that recent claims about the causes and consequences of early teen sex have been overstated. Naïve interpretations of poorly designed studies have suggested that comprehensive school-based sex education programs have adverse health effects and that abstinence-only sex education can improve depressive symptoms. In fact, the evidence presented in each of these papers suggests otherwise. This study presents consistent evidence that early entrance into sexual intercourse is not the cause of depression, but rather is an observable indicator of depression. This finding has important policy implications. In order to conclude that the adoption of abstinence-only sex education programs will improve (or hasten the onset of) adolescents’ depressive symptoms, one must show (i) convincing empirical evidence that entrance into sexual intercourse causes depression, and (ii) abstinence-only sex education increases the proportion of students who abstain from sex. While the evidence on (ii) is mixed, this study suggests that it is inappropriate to infer a causal link between early teen sex and depressive symptoms. Thus, even if abstinence-only sex education did increase the proportion of students who abstained, depressive symptoms would not improve unless such a program had a direct effect on depression, independent of its effect on virginity, a claim that has not yet been advanced by abstinence-only education proponents.

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While the findings of this study suggest that prolonging virginity will not improve common measures of adolescent mental health, this does not preclude the presence of other health or non-health benefits to abstinence. There may be sexual, spiritual, or religious benefits to abstinence. Moreover, recent work that carefully addresses unobserved heterogeneity suggests that early teen sex might have negative educational spillovers (Sabia, 2006b). Thus, a more complete understanding of the costs of teen sex decisions would contribute to both the adolescent sex literature as well as the public policy debate over sex education. Both this study and the proceeding study (Sabia, 2006a) shed light on important methodological and substantive shortcomings in the existing empirical literature on early teen sex. Each of these new studies suggests that recent claims about the adverse health effects of sex education and the depression-related consequences of early teen sex are exaggerated. In the context of an increasingly polarized ideological debate about how public policy could or should affect adolescents’ sexual decisions, obtaining credible estimates of the causes and consequences of teen sex is critical to better informing this discussion. JOSEPH J. SABIA is Assistant Professor in the Department of Housing & Consumer Economics at the University of Georgia. ACKNOWLEDGMENTS
This paper has benefited from helpful guidance from Elizabeth Peters, Kara Joyner, and Don Kenkel. I wish to thank Maureen Pirog, Jan Blustein, and two anonymous referees for useful comments and suggestions. This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by grant P01-HD31921 from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC 27516-2524 (http://www.cpc.unc.edu/addhealth/ contract.html).

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