Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Driven by political support from social conservatives, federal funding for abstinence-only sex education through the Adolescent Family Life Act, Title V of the Social Security Act, and the Community-Based Abstinence Education program reached $178 million in Fiscal Year 2006. Advocates of abstinence-only programs stress not only their potential benefits in terms of reducing teen pregnancy and sexually transmitted infections, but also the potential emotional and psychological benefits.

A number of studies using cross-sectional data have found that sexually active adolescents are more likely to be depressed (Waller et al. 2006, Hallfors et al. 2004, Rector et al. 2003, Orr et al. 1991), are more likely to suffer from low self-esteem (Spencer et al., 2002), and are more likely to have suicidal thoughts (Hallfors et al. 2004, Rector et al. 2003, Orr et al. 1991) than their peers who delay first intercourse. However, none of these studies treated sexual activity as endogenously determined, although Sabia (2006) and Hallfors et al. (2005) controlled for individual-level unmeasured heterogeneity through panel data estimation techniques. The current study contributes to the literature by using instrumental variables (IV) estimation to examine the relationship between adolescent sex and psychological wellbeing.

Using data from the National Longitudinal Study of Adolescent Health, we estimate the relationship between virginity status and two measures of psychological wellbeing: (1) the Center for Epidemiologic Studies Depression (CES-D) Scale, a continuous measure of depressive symptomatology; and (2) an abridged version of the Rosenberg Self-Esteem Scale. Controlling for observable factors such as age, race, ethnicity and family background, ordinary least squares (OLS) estimates show that adolescents who have had sex are more likely to exhibit the symptoms of depression and are more likely to suffer from low self-esteem than their peers who delay first intercourse.

We use the availability of county-level family planning services and school-district pregnancy policies to identify exogenous variation in teen virginity (first-stage F-stat > 10). Overidentification tests as well as a large set of sensitivity checks suggest that the instruments do not proxy for community-level social norms that could affect adolescent depression. Moreover, a set of falsification tests on a set of outcomes correlated with depression, but that should not be influenced by teen virginity?having a family member who attempted suicide, having run away from home, having engaged in criminal activity, and having engaged in multiple episodes of binge drinking?show no evidence of a causal effect of virginity, lending support to the validity of the instruments.

For males, individual fixed effects (FE) and IV estimates suggest that OLS estimates are spurious correlations. However, when the sample is restricted to females, IV estimates indicate that sex is associated with a substantial increase in CES-D scores. Comparing the CES-D scores of females who used contraception at last intercourse with those of virgins suggests that the effect of sex is ameliorated, but not eliminated, by contraceptive use.