"In our bicultural household -- I am American, my husband is Swedish -- we are trying to raise our children with the language, cultures and values of both countries. In most cases this isn't difficult. In one area, however, our values differ widely: My husband, reflecting the predominant view in Sweden and much of Western Europe, thinks sex is a normal part of adolescent development. Like many in this country, I disagree, believing it's better for teens to wait -- if not until marriage, at least until they are in an adult, loving relationship.

As a health journalist, I wondered if one way of thinking is demonstrably healthier, physically and psychologically. I resolved to find out.

Among the findings that surprised me: Although prevalent attitudes on teen sex differ in Western Europe and the United States, the views of leading researchers and doctors on both sides of the Atlantic do not. Their opinions lean much closer to the European model. They tend to agree that the mixed message America sends to teens about sex -- authorities say "don't" while mass media screams "What are you waiting for?"-- endanger our children.

The outcome? Levels of teen sexual activity look remarkably similar here and abroad, but U.S. rates of teen pregnancy, childbirth, abortion and sexually transmitted diseases are among the highest of all industrialized nations, despite recent decreases. Read brief accounts of how Western European and American perspectives compare.

In the United States

Of course there is no official U.S. position on teen sex, but a portion of the federal Healthy People 2010 report summarizes a set of carefully balanced goals: reduce unwanted pregnancies; cut the proportion of unmarried teens who have had sex; increase the use of birth control and disease prevention techniques among teens who are sexually active; and make contraception, including emergency contraception, more widely available.

But in practice, teens in our culturally heterogenous American society receive many conflicting messages. Many churches in the United States urge abstinence until marriage. Under government and local citizen pressure, many school sex education programs express disapproval of premarital sex and limit information about contraception. A 1999 Kaiser Family Foundation study found that about a third of U.S. public high schools have sex education programs that advocate strict abstinence until marriage. Experts at the Sexuality Information and Education Council of the United States say the number has since grown, with some states not only accepting federal funds for abstinence education, but also including federal government language in their sex education guidelines.

Mary Stetson is a Fairfax County health and physical education teacher who has taught sex education for 11 years. (State guidelines suggest sex ed should run from kindergarten through 12th grade, but individual school districts can decide whether or not to teach it, and parents can have their kids opt out.) Her course focuses on decision-making and values clarification, with an emphasis on encouraging kids not to have sex until marriage. Students learn the consequences of impulsive and risk-taking behavior. Some of her religiously oriented students take abstinence pledges.

Students' outside-class knowledge of sex tends to vary based on their parents' education and socioeconomic status. "The more education the parent has, the more likely the parents are going to talk to kids about sex," she said.

Poverty alone (the United States is home to a greater proportion of poor teens than Western Europe) doesn't account for the disparity in teen sex behavior here and abroad. According to a 2001 Guttmacher study, the poorest U.S. teens are nearly 80 percent more likely to have a child by 18 than similar teens in Britain.

Outside the classroom, U.S. teens face a barrage of provocation. A study last month in the journal Pediatrics found that the higher the exposure to sexual content in movies, TV, music and magazines, the more likely teens were to have intercourse. The study found "frequent and compelling portraits of sex as fun and risk-free."

This message falls on too many teens who are ill-informed or unprotected, says Robert Blum, chairman of the department of population and family health at the Johns Hopkins Bloomberg School of Public Health.

"We have a very hyper-sexualized media and, concurrent with that, a total aversion to giving clear and consistent messages about how you reduce risk," he says. In a 1995 survey, he asked both teens and their parents if the teens had had sex. Half the parents who said their kids were not sexually experienced were wrong, he said. (According to a 2003 survey by the Centers for Disease Control, nearly half of all U.S. students in grades 9-12 have had sex.)

But many American educators and parents say more permissiveness is not the way to go.

Angela Griffiths, executive director of an abstinence-based sex education program in California called Await & Find, said she sees an attitude among some California educators that teen sex is inevitable. Her program focuses on how condoms and birth control sometimes fail to prevent pregnancy and disease, and on the benefits of postponing sex. She said many educators are unwilling to combat what she called the prevailing media attitude that sex is fine for teens.

Too many teachers "are accepting that this is part of youth," she said.

Jonathan Klein, chairman of the American Academy of Pediatrics Committee on Adolescents, says there is a risk that children's best interests are getting lost in the debate over teen sexuality.

"We have some groups in our country who would like to prevent unintended pregnancy and sexually transmitted diseases, and some groups that would like to prevent people from having sex," Klein said. Both are willing to twist research to support their position, he said.

Regardless of a parent's opinions about teen sex, he said, more open communication is healthier: "Healthy sexual behavior is part of development. From a medical perspective it's important that parents and children and teenagers are well-educated about the implications of normal, psychosocial and sexual development."

But what of the emotional consequences? While a series of decades-old studies tied teen sex to other risky behaviors -- like drug and alcohol use -- many researchers say those findings are not nationally representative. Newer research has linked teen alcohol and drug use to failure to use a condom and more sexual partners, but there's no proof a cause-and-effect relationship exists, or, if it does, which behavior might trigger the other.

"Although advocates of abstinence-only government policy have suggested that psychological harm is a consequence of sexual behavior during adolescence, there are no scientific data suggesting that consensual sex between adolescents is harmful," wrote Columbia University's John Santelli in the January issue of the Journal of Adolescent Health. That's despite several studies that have looked at the psychological impact of sex on teens.

Where mental health problems are associated with early sexual activity, he says, research suggests that the sexual activity is a consequence of the psychological problems, not vice versa.

In research recently published in the Journal of Adolescent Health, Lydia Shrier, an assistant professor of pediatrics at Harvard Medical School and director of clinic-based research for the division of adolescent/young adult medicine at Children's Hospital Boston, showed that sexually active people aged 15 to 21 reported more positive feelings on the days they had sex than on the days they didn't. Shrier said sex education messages should take that into account.

"We have to tailor the messages to reflect our understanding that for many people, sex is not a bad thing or a thing that is ridden with guilt, but as a more positive and less negative experience, for some of these young people, than other things in their lives," Shrier said. ·

In Western Europe

Pierre-Andre Michaud, chief of the Multidisciplinary Unit for Adolescent Health at the University of Lausanne Hospital in Switzerland and a leading researcher in European teen sexuality, dismisses the idea--widely held in the United States--that sex constitutes risky behavior for teens. In an editorial in May's Journal of Adolescent Health, he wrote:

"In many European countries -- Switzerland in particular -- sexual intercourse, at least from the age of 15 or 16 years, is considered acceptable and even part of normative adolescent behavior." Switzerland, he noted, has one of the world's lowest rates of abortion and teen pregnancy. Teens there, like those in Sweden and the Netherlands, have easy access to contraceptives, confidential health care and comprehensive sex education.

A 2001 Guttmacher Institute report, drawing on data from 30 countries in Western and Eastern Europe, concluded: "Societal acceptance of sexual activity among young people, combined with comprehensive and balanced information about sexuality and clear expectations about commitment and prevention childbearing and STDs [sexually transmitted diseases] within teenage relationships, are hallmarks of countries with low levels of adolescent pregnancy, childbearing and STDs." The study cited Sweden as the "clearest of the case-study countries in viewing sexuality among young people as natural and good."

Cecilia Ekéus, a nurse midwife with a PhD in public international health who works with the Institute of Women and Child Health at Karolinska Institute in Stockholm, says Swedish society teaches that sex should occur in a committed relationship "and also that teenagers should use contraceptives, be informed and take responsibility. But in general we are open and positive and think that it's okay."

In Sweden, compulsory sex education starts when children are 10 to 12. Without parental consent, teens can get free medical care, free condoms, prescriptions for inexpensive oral contraceptives and general advice at youth clinics. Emergency contraceptives (the so-called morning-after pill) are available without a prescription.

Religion tends to insert itself less in government policy on sex education, contraception and abortion in Western Europe than in the United States, says Michaud. The Catholic Church exerted minimal influence in Switzerland's AIDS prevention campaign, he said. "All in all, the church has been very tolerant and does not really get involved in sexual matters," Michaud wrote in an e-mail.

Straightforward messages on how to prevent STDs and teen pregnancy help offset the impact on teens of sexually explicit ads, movies and other mass media -- as ubiquitous in Western Europe as in the United States, said Robert Blum, chair of the Department of Population and Family Health at the Johns Hopkins Bloomberg School of Public Health.

Western Europe also attaches more social stigma to teen pregnancy and teen motherhood than do some American sub-cultures, says Bill Albert, spokesman for the National Campaign to Prevent Teen Pregnancy, a U.S. group: "The focus [in Western Europe] is much more on preventing pregnancy and less on sex itself," Albert said.

Although some experts argue that economic, educational and racial diversity in the U.S. distort national figures and invalidate comparisons with more homogenous Western European countries, Michaud said he has studied Swiss teens who have dropped out of high school, used drugs or lived in disadvantaged areas of the country. They tend to use contraception regardless of economic status, he said.

"My feeling is that it is impossible to have a double message toward young people," Michaud said, in a phone interview from his Lausanne office. "You can't say at the same time, 'Be abstinent, it's the only fair, good way, to escape from having HIV . . . and at the same time say, 'Look, if you ever happen to have sex, then please do that and that and that.' You probably have to choose the message."

Abstinence, he said, is not something the Swiss press on teens. "We think it's unfair. It's useless. It's inefficient. We have been advocating the use of the condom . . . and I think that we tend to be successful."

Joan-Carles Surís, head of the research group on adolescent medicine at the University of Lausanne, puts it another way:

"The main difference is that in the States sexual activity is considered a risk. Here we consider it a pleasure."" (Elizabeth Agnvall, The Washington Post, May 16, 2006)