In addition, African American heritage and early alcohol use among boys and cigarette smoking among girls were associated with early onset of intercourse. Children who attended church and had friends who attended the same church were less likely to initiate sexual intercourse early.

Studies among college and university students give insight on the extent of sexual activity among young adults. A 1991 survey at in a large Midwestern university showed that 80 percent of male and 73 percent of female students had experienced sexual intercourse and that men reported an average of eight lifetime partners and women had an average of six lifetime partners (Reinisch et al., 1995). A survey of a Hawaiian university population found that a history of an STD was reported by 21 percent of women and 16 percent of men (Hale et al., 1993).

The prevalence of high-risk sexual practices among college students remains high. For example, a major study of female college students who sought gynecological care at a student health center during 1975, 1986, and 1989 examined trends in sexual behavior and practices during this time period (DeBuono et al., 1990). Among sexually active women, the percentage who reported that their partner ''always or almost always" used a condom increased significantly, from 12 percent in 1975, to 21 percent in 1986, to 41 percent in 1989. However, despite the recognition of HIV infection and other STDs during this period, with the exception of increased condom use, there were no significant changes in sexual practices such as number of partners and other high-risk sexual practices among the students surveyed from 1975 through 1989. A follow-up study, however, showed that almost three-quarters of college women reported "always or almost always" using condoms in 1995 (Peipert et al., 1996). Although condom use has increased substantially, absolute rates are still low in many groups.

During the past several decades, the age of entry into marriage has dramatically increased in the United States. For example, approximately 80 percent of men born during the interval 1933-1942 had married by age 27 compared to only 50 percent of men born during the interval 1953-1962 (Laumann, Gagnon et al., 1994). Coupled with the decreasing age at first intercourse during the last several decades, this means that the length of time between first intercourse and marriage has increased greatly. This phenomenon has increased the potential for spread of STDs because single persons tend to have more sex partners than married persons.

Knowledge and Awareness of STDs

Knowledge and awareness of STDs among Americans is poor. In a 1993 national survey of one thousand women from 18 through 60 years of age, almost two-thirds knew nothing or very little about STDs other than HIV/AIDS, and only 11 percent were aware that STDs can be more harmful to women than to men (EDK Associates, 1994). The lack of knowledge among women in high-risk



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