Peer and sibling substance use: predictors of substance use among adolescents in Mexico.

OBJECTIVE: To examine the extent to which peer drug use and sibling drug use predict alcohol abuse/dependence disorder status and the use of drugs other than alcohol among school-based youth in Mexico. METHODS: Data were collected on 1 203 middle and high school students in northern Mexico in May 1998. Participation was voluntary, and responses were confidential. Logistic regression analyses estimated the association that peer drug use and that sibling drug use had with alcohol abuse/dependence diagnosis and the lifetime use of drugs other than alcohol. RESULTS: Students who had siblings or peers who used alcohol and other drugs were more likely to meet the standard alcohol abuse/dependence criteria defined by the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), and were more likely to have used drugs other than alcohol. Controlling for potentially important confounders, we found that adolescents with the highest level of peer substance use were eight times as likely to meet alcohol abuse/dependence criteria and four times as likely to use other drugs. Youth who had siblings who used drugs were about twice as likely to meet alcohol abuse/dependence criteria and about 2.5 times as likely to use drugs other than alcohol when compared to youth with no sibling substance use. CONCLUSIONS: Consistent with extant findings among youth in the United States of America, peer and sibling substance use are major risk factors for substance use among school-based youth in Mexico. Students in Mexico may benefit from prevention strategies found to be effective among students in the United States.     

A test of factors mediating the relationship between unwanted sexual activity during childhood and risky sexual practices among women enrolled in the NIMH Multisite HIV Prevention Trial

This study examined both the direct and indirect associations between unwanted sexual activity during childhood and HIV-related sexual practices of adult women. The sample consisted of 3,346 women recruited from sexually transmitted disease (STD) clinics and health service organizations. The findings demonstrated that participants who reported unwanted sexual activity as a child (USC) were more likely than women who did not report such experience to indicate that they had problems with alcohol, used drugs, received money or drugs in exchange for sex, had unwanted sex, and used mental health services. The women reporting USC also noted a greater number of unprotected sex acts, a greater number of partners, and a greater proportion of sex acts accompanied by drugs or alcohol in the past 90 days. Mediated analyses showed that drug use, exchange of sex for money/drugs, unwanted sex, and to a lesser extent, problems with alcohol mediated the relationship between USC and unprotected sex acts, number of partners, and sex under the influence of drugs and alcohol. These findings suggest that participation in non-sexual risky behaviors among women who report USC may be a bridge to participation in sexual behaviors that increase their risk of HIV infection.     

Older boyfriends and girlfriends increase risk of sexual initiation in young adolescents

Purpose: To explore the prevalence and impact of older boyfriends or girlfriends on sexual behavior in sixth graders (mean age 11.5 years).

Methods: Students in 19 ethnically diverse middle schools in an urban area were surveyed (n = 2829, response rate 68%). Instrument measured demographics, age of oldest boyfriend or girlfriend, unwanted sexual advances, peer norms, and sexual behavior. Students with older, same-age, or no boyfriend or girlfriend were compared on demographic and psychosocial variables using analysis of variance. Separate multivariate logistic regressions for both boys and girls were used to predict sexual behavior from demographics, psychosocial variables, and age categories of boyfriend or girlfriend.

Results: One-half of the respondents (56%) had never had a serious boyfriend or girlfriend, 35% reported that their oldest boyfriend or girlfriend was <2 years older than they, and 8.5% reported a partner ≥2 years older. Those reporting an older boyfriend or girlfriend were more likely to be Hispanic, were less acculturated, reported more unwanted sexual advances and more friends who were sexually active, and, among girls, were more likely to have experienced menarche. Overall, 4% of students reported ever having had sex. Students with an older boyfriend or girlfriend were over 30 times more likely than those with no boyfriend or girlfriend ever to have had sex (odds RATIO = 33.8 for boys and 44.2 for girls). In the multivariate logistic regressions, peer norms about sexual behavior, having experienced unwanted sexual advances, and having a boyfriend or girlfriend were strongly associated with having had sex.

Conclusions: Having an older boyfriend or girlfriend, although rare, is associated with early sexual onset and unwanted sexual activity in this population of sixth graders.     

A Test of Factors Mediating the Relationship Between Unwanted Sexual Activity During Childhood and Risky Sexual Practices Among Women Enrolled in the NIMH Multisite HIV Prevention Trial

SUMMARY

This study examined both the direct and indirect associations between unwanted sexual activity during childhood and HIV-related sexual practices of adult women. The sample consisted of 3,346 women recruited from sexually transmitted disease (STD) clinics and health service organizations. The findings demonstrated that participants who reported unwanted sexual activity as a child (USC) were more likely than women who did not report such experience to indicate that they had problems with alcohol, used drugs, received money or drugs in exchange for sex, had unwanted sex, and used mental health services. The women reporting USC also noted a greater number of unprotected sex acts, a greater number of partners, and a greater proportion of sex acts accompanied by drugs or alcohol in the past 90 days. Mediated analyses showed that drug use, exchange of sex for money/drugs, unwanted sex, and to a lesser extent, problems with alcohol mediated the relationship between USC and unprotected sex acts, number of partners, and sex under the influence of drugs and alcohol. These findings suggest that participation in non-sexual risky behaviors among women who report USC may be a bridge to participation in sexual behaviors that increase their risk of HIV infection.     

Recalled Sexual Experiences in Childhood with Older Partners: A Study of Brazilian Men Who Have Sex with Men and Male-to-Female Transgender Persons

This study assessed the prevalence of recalled childhood sexual experiences with an older partner among men who have sex with men (MSM) and/or male-to-female transgender persons recruited in Campinas, Brazil. It also analyzed associations between such recalled experiences and sexual risk behavior in adulthood. Participants recruited using respondent driven sampling completed a self-administered, computer-based questionnaire, and underwent HIV testing. For data analysis, raw scores were weighted based on participants’ reported network size. Of 575 participants (85% men and 15% transgender), 32% reported childhood sexual experiences with an older partner. Mean age at first experience was 9 years, partners being, on average, 19 years old, and mostly men. Most frequent behaviors were partners exposing their genitals, mutual fondling, child masturbating partner, child performing oral sex on partner, and child being anally penetrated. Only 29% of the participants who had had such childhood sexual experiences considered it abuse; 57% reported liking, 29% being indifferent and only 14% not liking the sexual experience at the time it happened. Transgender participants were significantly more likely to report such experiences and, compared with men, had less negative feelings about the experience at the time of the interview. No significant associations were found between sexual experiences in childhood and unprotected receptive or insertive anal intercourse in adulthood. Results highlight the importance of assessing participants’ perception of abuse, regardless of researchers’ pre-determined criteria to identify abuse. MSM and transgender people may experience childhood sexual experiences with older partners differently from other populations (e.g., heterosexuals), particularly in countries with different cultural norms concerning sexuality than those prevalent in Europe and the U.S.     

Substance abuse among sexually abused adolescents and their families

The concurrence of substance abuse and history of sexual abuse among adolescents has prompted this study of substance abuse patterns among families of adolescents who report incest or extrafamilial sexual abuse. A total of 3,179 ninth-grade students in a rural midwestern state completed a survey that included questions about individual and family substance abuse. Adolescents who had been sexually abused were more likely to report substance abuse for themselves as well as for members of their immediate families. They were also more likely to report that they used substances because of family problems, school problems, and because they were sad, lonely, or angry. Adolescents reporting a parent with an alcohol or a drug problem were more likely to use cigarettes, marijuana, alcohol, or “speed.” Adolescents experiencing extrafamilial abuse reported more alcohol abuse and more alcohol-related problems than those who experienced incest. There were similar reports of parental and familial alcohol and drug problems among those experiencing incest and those experiencing extrafamilial abuse. Those with drug-abusing parents, however, were most likely to report some kind of sexual abuse history.     

Observations of Adolescent Peer Resistance Skills Following a Classroom-Based Healthy Relationship Program: A Post-intervention Comparison

This study examines peer resistance skills following a 21-lesson classroom-based intervention to build healthy relationships and decrease abusive and health-risk behaviors among adolescents. The Fourth R instructs students in positive relationship skills, such as negotiation and delay, for navigating challenging peer and dating scenarios. Observational data from 196 grade 9 students participating in a larger cluster randomized controlled trial were used to evaluate post-intervention acquisition of peer resistance skills. Pairs of students engaged in a role play paradigm with older student actors, where they were subjected to increasing pressure to comply with peer requests related to drugs and alcohol, bullying, and sexual behavior. Specific and global measures of change in peer resistance responses were obtained from two independent sets of observers, blinded to condition. Specific peer resistance responses (negotiation, delay, yielding to pressure, refusal, and compliance) were coded by research assistants; global peer resistance responses were rated by teachers from other schools (thinking / inquiry, application, communication, and perceived efficacy). Students who received the intervention were more likely to demonstrate negotiation skills and less likely to yield to negative pressure relative to controls. Intervention students were also more likely to use delay than controls; control girls were more likely to use refusal responses; the number of times students complied with peer requests did not differ. Teacher ratings demonstrated significant main effects favoring intervention youth on all measures. Program and research implications are highlighted.     

童年期被虐待经历对大学生恋爱暴力发生的影响

目的 了解大学生恋爱暴力的发生情况及童年期被虐待经历对大学生恋爱暴力发生的影响。方法 采用滚雪球抽样的方法,对北京市7所大学的1 130名大学生进行不记名自填式问卷调查。结果 1 130名大学生中50.8%最近一年有过恋爱经历,其中遭受和实施恋爱暴力的比例分别为16.9%和11.1%。遭受肢体暴力、情感虐待和性暴力的比例分别为14.1%、10.6%和9.9%,实施肢体暴力、情感虐待和性暴力的比例分别为8.0%、7.1%和3.7%。有509名(45.0%)大学生在童年期曾有被父母虐待的经历,其中被用力徒手打、用物品打、在其他人面前遭到羞辱和目睹父母打架或父母打兄弟姐妹的比例分别为41.6%、24.9%、13.1%和24.5%。具有童年期被虐待经历的大学生遭受和实施恋爱暴力的比例均高于童年期没有被虐待经历的大学生,差异具有统计学意义(P=0.005)。结论 大学生恋爱暴力问题不容忽视,童年期遭受父母虐待经历对大学生恋爱暴力的发生具有一定影响。     

565名大学生儿童期性虐待经历回顾性调查

目的 了解大学生中儿童期性虐待发生情况,探讨性虐待经历对大学生心理健康的影响。方法 用自填式问卷,于2003年9月对一所普通高校565名大学生就有关儿童期受性虐待经历进行不记名回顾性调查。结果 在被调查的565名大学生中,有20.0％(32/160)的女生和14.3％(58/405)的男生报告16岁以前曾经历过非身体接触或身体接触的性虐待,其中18名(11.3％)女生和31名(7.7％)男生经历过身体接触的性虐待。儿童期性虐待经历首次发生年龄59.4％的女生、51.7％的男生发生在11岁及以下。与没有儿童期性虐待经历的学生比较,有儿童期性虐待经历的学生抑郁情绪量表得分高;健康状况自我感觉评价得分低;症状自评简表中的躯体症状、敌意、强迫症状和焦虑得分高;有过性交行为及在调查的近一年里考虑过自杀、饮酒醉过的比例高。结论 儿童性虐待问题在中国并非少见。大学生心理健康问题与儿童期性虐待经历相关。亟待开展儿童期性虐待的预防工作及为受害者提供心理健康服务。     

Sexual Regret in College Students

A questionnaire study was conducted to assess the relationship between sexual regret and sexual behaviors and demographic factors among 348 college-aged students prior to attending an educational program about sexual health issues. Analyses conducted on the portion of the sample who were sexually active (n = 270) indicated that the majority (71.9%, n = 194) has regretted their decision to engage in sexual activity at least once. The most cited reasons for regret by students included their sexual decision making as inconsistent with their morals (37%), an acknowledgment that alcohol influenced their decision (31.7%), the realization they did not want the same thing as their partner (27.9%), the lack of condom use (25.5%), feeling pressure by their partner (23.0%), and their desire to wait until marriage to have sex (15.4%). The only significant sex difference was that women reported regret due to feeling pressured by a partner more often than men. Multiple and logistic regression analyses indicated that the only significant predictor of regret regarding one's sexual decisions was the number of sexual partners. These results demonstrate the need for sexual educators to incorporate sexual regret into their curricula as the phenomenon of regret is more common than pregnancy and sexually transmitted diseases, the usual focus of sexuality education.     

Reconceptualizing adolescent sexual behavior: beyond did they or didn't they?

CONTEXT: Adolescent sexual behavior is typically studied as a dichotomy: Adolescents have had sex or they have not. Broadening this view would lead to a greater understanding of teenagers' sexual behavior. METHODS: Interview data from 907 high school students in Alabama, New York and Puerto Rico were used to examine the relationships between sexual experience and a variety of social, psychological and behavioral variables. Four groups of teenagers are compared: those who did not anticipate initiating sex in the next year (delayers), those who anticipated initiating sex in the next year (anticipators), those who had had one sexual partner (singles) and those who had had two or more partners (multiples). RESULTS: Compared with delayers, anticipators reported more alcohol use and marijuana use; poorer psychological health; riskier peer behaviors; and looser ties to family school and church. Similarly, multiples reported more alcohol and marijuana use, riskier peer behaviors and looser ties to family and school than singles. Risk behaviors, peer behaviors, family variables, and school and church involvement showed a linear trend across the four categories of sexual behavior. CONCLUSIONS: The traditional sex-no sex dichotomy obscures differences among sexually inexperienced teenagers and among adolescents who have had sex. Prevention efforts must be tailored to the specific needs of teenagers with differing sexual experiences and expectations, and must address the social and psychological context in which sexual experiences occur.     

Substance use and HIV-related sexual behaviors among US high school students: are they related?

OBJECTIVES. This study was undertaken to examine whether use of alcohol, cigarettes, marijuana, cocaine, and other illicit drugs is related to the likelihood of sexual behaviors that increase risk for human immunodeficiency virus (HIV) infection among youth. METHODS. The 1990 national Youth Risk Behavior Survey was used to collect self-reported information about a broad range of health risk behaviors from a representative sample of 11,631 high school students in the United States. RESULTS. Students who reported no substance use were least likely to report having had sexual intercourse, having had four or more sex partners, and not having used a condom at last sexual intercourse. Adjusted for age, sex, and race/ethnicity, odds ratios for each of these sexual risk behaviors were greatest among students who had used marijuana, cocaine, or other illicit drugs. Students who had used only alcohol or cigarettes had smaller but still significant increases in the likelihood of having had sexual intercourse and of having had four or more sex partners. CONCLUSIONS. HIV prevention programs for youth should recognize that substance use may be an important indicator of risk for HIV infection and acquired immunodeficiency syndrome through its association with unsafe sexual behaviors.     

Comparison of Teenagers' Early Same-Sex and Heterosexual Behavior: UK Data From the SHARE and RIPPLE Studies

PurposeNorth American research finds increased sexual risk-taking among teenagers with same-sex partners, but understanding of underlying processes is limited. The research carried out in the United Kingdom compares teenagers' early sexual experiences according to same- or opposite-sex partner, focusing on unwanted sex in addition to risk-taking, and exploring underlying psychosocial differences.MethodsMultivariate analyses combined self-reported data from two randomized control trials of school sex education programs (N = 10,250). Outcomes from sexually experienced teenagers (N = 3,766) were partner pressure to have first sex and subsequent regret, and sexual risk measures including pregnancy. Covariates included self-esteem, future expectations, substance use, and communication with mother.ResultsBy the time of follow-up (mean age, 16), same-sex genital contact (touching or oral or anal) was reported by 2.3% of teenagers, with the majority also reporting heterosexual intercourse. A total of 39% reported heterosexual intercourse and no same-sex genital contact. Boys were more likely to report partner pressure (Odds ratio [OR] = 2.56, 95% confidence intervals [CI] = 1.29–5.08) and regret (OR = 2.32; 95% CI = 1.39–3.86) in relation to first same-sex genital contact than first heterosexual intercourse, but girls showed no differences according to partner type. Teenagers with bisexual behavior reported greater pregnancy or partner pregnancy risk than teenagers with exclusively opposite-sex partners (girls, OR = 4.51, 95% CI = 2.35–8.64; boys, OR = 4.43, 95% CI = 2.41–8.14), partially reduced by attitudinal and behavioral differences.ConclusionsThis UK study confirms greater reporting of sexual risk-taking among teenagers with same-sex partners, and suggests that boys in this group are vulnerable to unwanted sex. It suggests limitations to the interpretation of differences, in terms of psychosocial risk factors common to all adolescents.     

Alcohol and Drug Use Among Gang Members: Experiences of Adolescents Who Attend School

BACKGROUND: Problems related to gangs have been noted in large cities and in many schools across the United States. This study examined the patterns of alcohol, drug use, and related exposures among male and female high school students who were gang members. METHODS: Analyses were based on the Youth Violence Survey, conducted in 2004, and administered to over 80% of eligible public school students in grades 7, 9, 11, and 12 (N = 4131) in a high-risk, urban school district. The self-administered survey, completed during a class period, included measures of alcohol and drug use and related exposures. Tests of associations were determined using chi-square tests and logistic regression analyses. RESULTS: In this study, 8.8% of students reported gang membership. Students who initiated alcohol use prior to age 13 (OR = 4.90; 95% CI: 3.65–6.58), who drank alcohol 3 or more times per week (OR = 9.57; 95% CI: 6.09-15.03) and who used drugs 3 or more times per week (OR = 6.51; 95% CI: 4.59-9.25) were more likely to report gang membership than students who did not report alcohol or drug use. Boys were more likely than girls to report alcohol-related fighting and drug selling. DISCUSSION: Gang members were significantly more likely than non-gang members to have initiated alcohol early, to have reported a high prevalence of alcohol use, to have engaged in alcohol-related physical fighting, peer drinking, drug use, drug selling, peer drug selling, and having seen drug deals in their neighborhood. Schools may serve as a critically important source for intervention and prevention efforts for gang members, especially those in 7th grade, who still attend school.     

Young gay men who suffer sexual abuse more prone to HIV

A study by Canadian researchers found that young gay men with a history of sexual abuse were twice as likely to have unprotected anal intercourse as gay men who had not been abused. Nearly one third of the 287 gay men in the study sample in Vancouver reported being coerced into having sex. Sexual abuse survivors were more apt to experience depression and self-loathing attitudes, and were more likely than other gay men to use cocaine, tobacco and nitrite inhalants. The findings suggest a vulnerability among male survivors of sexual abuse toward behaviors that place them at risk for HIV infection, and suggest that sexual abuse counseling should be integrated into HIV prevention efforts. Researchers of the study suggest that lingering effects of sexual abuse appear to be a more potent risk factor than the use of either alcohol or drugs.     

Kinsey revisited,part I: Comparisons of the sexual socialization and sexual behavior of white women over 33 years

This research compared data from two studies of women's sexual behavior—one conducted in the 1940s, the other in the 1980s. The first sample included 3952 white women, ages 18 to 36, drawn from the larger sample of women who participated in the original Kinsey study. The second comprised 122 white women, in the same age range, who had taken part in a recent study of sexual socialization and experiences among women in Los Angeles County, CA. Log-linear analyses were used to control for differences between the samples on age, education, and marital status. Comparisons were conducted in the areas of childhood family characteristics; sexual socialization and education; sexual behavior in childhood, adolescence, and adulthood; contraceptive practices; and child sexual abuse. Results tended to reflect changes that have taken place in society and in patterns of sexual behavior. Differences in sexual socialization pointed to the increased role of the media and the schools and to more relaxed attitudes about nudity in the home. Shifts in sexual behavior were particularly dramatic. As compared to women in the Kinsey sample, the newer subjects began intercourse earlier, were less likely to have a fiance or husband as their first partner, reported a higher number of sexual partners, and participated in a broader range of sexual behaviors. Contraceptive practices differed considerably, especially among never-married women. Women in the new study were also more likely to report instances of child sexual abuse. Methodological and social factors contributing to the findings are discussed.This research was supported by the Center for the Prevention and Control of Rape, NIMH, MH 33603 and through a Research Scientist Career Development Award (MH 00269), to the first author.     

First sexual intercourse and subsequent regret in three developing countries

PurposeAdolescents who engage in sex can be affected by a range of negative physical and psychological consequences. We intend to analyze the reasons behind first sex, regret, and the association between reasons and regret.MethodsA questionnaire was implemented to 8,495 high schools students aged 14–18 years residing in the Philippines, El Salvador, and Peru. Sexually active participants responded whether several circumstances were reasons involved in their first sexual relationship. They also responded whether they regretted having already had sexual relationships.ResultsMore than one-third of respondents reported at least one external pressure leading to first sex, and about one-half reported at least one reason implying getting carried away by sexual arousal.More females affirmed they regret having already had sex. Logistic regression shows that reasons for first sex associated with regret were partner insistence, “uncontrolled situations,” and seeing sexual images. These reasons were associated with regret even when love was also reported as related to first sex.ConclusionsAdolescent sexual experience is often motivated by pressure (such as external pressure [because most friends already had sex or because of partner insistence]) and circumstances (such as getting carried away by sexual arousal [through an “uncontrolled situation” or viewing sexual images]) that lower the control over their decisions concerning sex, rather than by mature decisions, and this may result in later regret. Adolescents should be helped by parents, educators, and policy makers to be aware of these characteristics of sexual behavior of adolescents and empowered to make assertive and informed decisions concerning their sexuality.     

Cumulative abuse experiences, physical health and health behaviors

PURPOSE: Our purpose was to investigate the complex relationship between a range of lifetime abuse experiences with current physical health and health behaviors. METHODS: Between October 1998 and May 1999, interviews were conducted with 557 ethnically diverse women seen at two urban primary care centers. Seven forms of abuse were measured: childhood physical and sexual abuse, past physical and sexual intimate partner violence (IPV), and recent emotional, physical, and sexual IPV. Severity was measured for six of these forms. Multiple non-specific physical symptoms were measured with a modified PRIME-MD, and four health behaviors were ascertained. RESULTS: Approximately 10% of women never experiencing abuse reported multiple non-specific physical symptoms, compared with 25.8% to 78.4% of women reporting a range of abuse experiences. Increases in recent IPV, past IPV, child abuse, and economic hardship were associated with increases in reported symptoms. Women who experienced IPV were more likely to report smoking cigarettes, binge drinking, and having poor nutritional habits. CONCLUSIONS: Recent IPV is associated with physical symptoms and risky health behaviors beyond the effects of child abuse, past IPV, and economic disadvantage. Understanding a person's IPV experiences may inform interventions for health behaviors, such as smoking cessation programs.     

Characteristics of pregnant adolescents receiving prenatal care at school-based or hospital-based clinics

This study examines characteristics of adolescent females in prenatal care in a hospital-based teen clinic compared to a school-based teen clinic. Interviews were conducted during 1991-92 among 189 pregnant adolescents, whose mean age was 16.22 years. 48% were African American, 42% were Hispanic, and 2% were Asian or other. 75% of adolescents were single or without a spouse. 30% lived with siblings, 21% lived with their husband, 9% lived with their boyfriend, 10% lived with in-laws, 4% lived with a friend, and the rest lived with their mothers. 48% of adolescents' mothers helped with child care. 27% did not have any help. 57% were enrolled in school, 41% dropped out, and 4% graduated. 63% planned to continue their education. 75% had a parent who served as a mentor. Over 50% lived with someone who smoked cigarettes or drank alcohol. 75% had friends or relatives who smoked. Almost 25% had a sexual partner who sold drugs, and 25% had a sexual partner who had been in trouble with the law. 14% had a partner who used drugs. 62% of adolescents who had smoked before their pregnancy quit smoking. 79% of adolescents who had consumed alcohol before their pregnancy stopped consuming alcohol. Adolescents in both clinics showed no significant differences in family welfare status, initiation of prenatal care, parity, and number of living children. There were differences by clinic type for adolescent ethnic patterns of clinic use, educational status, financial and social support, and family setting. Hispanics and Whites and school dropouts were more likely to use hospital-based care. The school-based adolescents were more likely to be single; to receive support from parents, relatives, and a job; and to have higher exposure to alcohol and substance abuse. Hospital-based adolescents were more likely to live with relatives, not to have help, and to be Spanish speakers. It is recommended that services match the characteristics and needs of clients in each local setting.     

HIV/AIDS knowledge and sexual behavior among high school students

Data from the 1989 Secondary School Student Health Risk Survey indicate that 54 percent of all high school students in the United States had had some form of HIV/AIDS education in school. Responses to a questionnaire on HIV/AIDS knowledge show that nearly all students knew the two main modes of HIV transmission--intravenous drug use and sexual intercourse. Students who had been taught about HIV and AIDS in school gave correct answers to questions about the virus more often than those who had not received instruction. Students who knew more about HIV transmission were less likely to report having had two or more sexual partners and more likely to report consistent condom use.