Changes in Adolescent Heterosexual Behaviors from the 1980s to the Present in Various Western Countries: A Systematic Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

A well written paper but there are limitations that need addressing.

 

1.  Why only focus on heterosexual studies?  Please discuss theoretical, public policy, political justification for this decision?

 

2.  What is the country scope of the review?   is there diversity or similarities  in the laws towards sexuality across these countries?  Can you describe the implications of this sample of countries?

 

3.  Can you offer a more robust discussion about the limitations of the study design used in the studies?

 

4.  What new insights are revealed by your paper? 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Overall assessment:

The paper is generally well-written and nicely structured with clear aims, methodological stringency and relevant data selection/presentation.

 

Specific comments:

Introduction: The authors might want to consider providing more explicit arguments for the exclusive focus on heterosexual behaviors. Thus, it would have been informative to include temporal trends in same-sex behaviors among adolescents (might this, for example, explain part of the generally increasing heterosexual debut age?).

 

P. 2 (line 46): Knowledge about adolescent sexuality is not just “intended to enhance education and sexual health programs”, but also (in more restrictive settings) used to justify abstinence-only programs.

 

P. 2 (lines 47ff): Legal changes (e.g., the shift towards a consent-based rape legislation seen in Scandinavian countries) might be also listed.

 

P. 2 (line 53): For ignorant readers, it might be emphasized that Simon & Gagnon’s scripting theory was launched in the 1970’ies.

 

P. 2 (lines 66-67): “far-right political movements” are mentioned as operative – but norm-critical (sometimes far-left) woke/queer movements might just as well be introduced here.

 

P. 2 (and elsewhere): Hiv/aids is mentioned several times throughout the paper, but it should be remembered that this infection is very rare among adolescents, and that it is currently non-lethal and non-contagious, if properly treated.  

 

P. 4 (Eligibility Criteria): There is no reason to mention a criterion under both Inclusion and (with reversed sign) Exclusion. Did the authors include all study designs and sample types/sizes?

 

P. 6 (section 3.1.): How can “heterosexual contacts occur in childhood”? Are the authors referring to sexual abuse situations? And given the paper’s age span of 12-19 years, it is hardly true that the study focused on “sexual motivation that occurred after puberty”.

 

Ibidem: The wording “… in the context of an affectionate relationship …” and “… as the relationships themselves develop” seems highly normative and a bit off in this context.    

 

P. 10 (section 3.2). Please observe, that age at first intercourse is difficult to estimate at group level, since both mean and median values might be applied. I would therefore expect that the included studies calculate sexual debut age differently. Also, the very definition of “first sexual intercourse” might differ from study to study (i.e., does oral sex, anal sex and hand sex count?). Numerous percentages are listed and compared – it would be nice, if the authors noted, whether reported differences were statistically significant.    

 

Ibidem: This study from Denmark might be relevant, when discussing temporal trends in sexual debut age:

 

[The age at first intercourse has been stable since the 1960s, and early coital debut is linked to sexual risk situations] - PubMed (nih.gov)

https://pubmed.ncbi.nlm.nih.gov/25294037/

 

Pages 10ff: Is there a particular reason why sexual risk situations (i.e., sexual abuse) were not included as a study outcome? This might have given interesting results.

 

Page 12: It might perhaps be mentioned that mental ill-health among adolescents (which is, most likely, on the rise in the Western world) is a well-established risk factor for sexual inactivity and might therefor account for part of the increasing age at first intercourse:

 

Sexuality among young Danes treated for mental health problems: Baseline findings in a nationwide cohort study - PubMed (nih.gov)

https://pubmed.ncbi.nlm.nih.gov/37952403/

 

P. 13 (lines 175ff): Is this really a “generalizable trend across nearly all studies”? Do (nearly) all of the included studies really address this inherently complex issue?  

 

Finally: This Danish study has for some reason not been retrieved. Perhaps it might further add to the discussion:

 

[Sexual knowledge, attitudes and behavior among young Danes. A questionnaire study] - PubMed (nih.gov)

https://pubmed.ncbi.nlm.nih.gov/12407891/

 

Finally, you might find this article about developments in school-based sex education curricula interesting, as sex ed in schools is possibly an operationally factor in the behavioral trends of adolescents:

 

The research landscape of school-based sexuality education: Systematic mapping of the literature

• February 2018
• Health Education 118(2):00-00

• DOI: 10.1108/HE-05-2017-0030

Comments on the Quality of English Language

No comments.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Your revisions have improved the paper and addressed my earlier comments.