The potential protective effects of youth assets from adolescent sexual risk behaviors.

PURPOSE: To examine the relationship among individual youth assets and adolescent sexual risk behaviors. METHODS: Cross-sectional, in-home interview data from randomly selected inner-city neighborhood teenagers (N = 1253) and their parents (N = 1253) were analyzed. Demographic information (e.g., age, parental income, family structure) was statistically controlled for while investigating the relationships among youth asset and sexual activity outcomes using logistic regression analyses. Potential interactions between the demographic variables and the assets were also examined. The five sexual risk behaviors included "never had sexual intercourse," current sexual activity, number of lifetime sexual partners, current use of birth control, and age at first intercourse. RESULTS: Youth mean age was 15.4 (+/- 1.7) years; 52% were female; 49% were Non-Hispanic Caucasian, 23% Non-Hispanic African-American, 19% Hispanic and 10% Non-Hispanic Native American. Sixty-three percent reported never having had sexual intercourse. Multiple logistic regression analyses indicated that, after controlling for the demographic variables and the other significant assets, Non-Parental Adult Role Models, Peer Role Models, Use of Time (Religion), and Future Aspirations were independently significantly related (p <.05) to whether or not youth had ever participated in sexual intercourse. Individual multiple logistic regression analyses indicated that, after controlling for the demographic variables, Peer Role Model and Family Communication assets were each significantly associated with birth control use by sexually active youth (p <.05). CONCLUSIONS: Specific youth assets may have a protective effect from certain sexual risk behaviors.     

Youth assets and sexual abstinence in Native American youth

Compared with youth of other races/ethnicities, Native American youth (ages 15-19 years) are more likely to have participated in sexual intercourse, thus placing them at greater risk for sexually transmitted diseases (STDs) and unintended pregnancies. This study's purpose was to investigate relationships among protective factors (assets) and sexual intercourse in a Native American youth population. Data were collected from Native American youth and their parents (N=126 youth/parent pairs) living in randomly-selected households using in-person, in-home interview methods. Nine youth assets were the independent variables and never had sexual intercourse was the dependent variable. Data were analyzed using logistic regression. One significant (p<.05) asset main effect and one asset by youth age interaction were found. Youth with the Non-Parental Adult Role Models asset were 3.8 times more likely to have never had sex compared with youth without the asset. Further study of the influence of protective factors among Native American youth is warranted.     

The association between multiple youth assets and sexual behavior

PURPOSE: To investigate the possible positive cumulative effects that youth assets may have on youth sexual behaviors. DESIGN: Cross-sectional data were collected from a randomly selected population by in-home, in-person interviews. Mantel-Haenszel chi-square test and logistic regression were conducted to determine the potential cumulative effects that youth assets may have on youth sexual behaviors and to test for significant asset by sexual risk behavior trends. SETTING: Racially diverse inner-city neighborhoods in two midwestern cities. Subjects. Teenagers (n = 1350; mean age = 15.2 years) and parents of the teenagers (n = 1350). The response rate was 51%. MEASURES: Demographic factors, nine youth assets, and five sexual behavior outcomes. RESULTS: Significant (p < .05) trends and odds ratios (ORs) were found for three of the five youth sexual behavior outcomes. Youths with more assets were more likely to have never participated in sexual intercourse (OR = 1.32). Of sexually active youths, those with more assets were more likely to have delayed first intercourse until at least 17 years of age (OR = 1.47) and to have used birth control at last sexual intercourse (OR = 1.18). Nonsignificant (p > .05) results were found for current sexual activity and number of sexual partners. CONCLUSIONS: The results generally support the notion that the more assets adolescents possess, the more likely they are to engage in positive behavior. Practitioners planning asset-based teenage pregnancy prevention programs might consider promoting several specific youth assets.     

A matched case-control study: investigating the relationship between youth assets and sexual intercourse among 13- to 14-year-olds

BACKGROUND: The number of teenagers engaging in sexual intercourse has consistently changed over the past several years. This can become a major challenge when trying to determine why teens continue to have sex. The purpose of this paper was to investigate the relationship between youth assets and sexual intercourse among 13- to 14-year-olds. METHODS: Cross-sectional data were collected using in-person at-home interviews from a random sample of inner-city neighbourhood 13- to 14-year-old teenagers (n = 64 matched pairs; 36% 13-year-olds, 53% female, 45% white, 28% African-American, 16% Hispanic and 11% Native American). Nine individual youth assets were analysed using conditional logistic regression (matching for several demographic variables) to assess the association between assets and abstinence in younger teens. RESULTS: Conditional logistic regression analyses showed that two assets, positive Peer Role Models [odds ratios (OR) = 4.67, 95% confidence intervals (CI) = 1.93, 11.27] and Use of Time (Religion) (OR = 2.20, 95% CI = 1.04, 4.65), were significantly related (P < 0.05) to younger teens never having engaged in sexual activity. CONCLUSION: These findings suggest, when considering abstinence behaviour, involvement in religious activities and having positive peer role models appear to be protective factors related to delaying sexual intercourse among teens aged 13-14 years.     

Using the Information-Motivation Behavioral Model to Predict Sexual Behavior Among Underserved Minority Youth

BACKGROUND: Testing, refining, and tailoring theoretical approaches that are hypothesized to reduce sexual risk behaviors among adolescent subpopulations is an important task. Relatively little is known about the relationship between components of the information-motivation-behavior (IMB) model and sexual behaviors among underage minority youth. Using the IMB model, this study examines predictors of risky sexual behavior among underserved Hispanic and African-American youth. METHODS: This cross-sectional study was conducted with a sample of 380 youths aged 11–17 years recruited in Los Angeles, California, and utilized latent variable models to examine interrelationships and predictive relations among IMB model variables associated with risky sexual behavior. RESULTS: Sixty percent of the participants aged 15–17 and 1 out of 10 participants aged 11–12 reported prior sexual intercourse. Of the sexually active, more than half reported having unprotected sex and 11% had sexual intercourse with 4 or more partners. Results of the structural equation model indicated that older age and attitudes against sexual activities had significant, direct impacts on risky sexual behaviors. Behavioral refusal skills, positioned as an intervening variable, also significantly predicted less risky sex. Knowledge, attitudes against sexual activities, and perceived peer pressure against sexual behavior predicted sexual refusal skills. Additionally, there were significant indirect effects on risky sexual behavior mediated through behavioral refusal skills. CONCLUSION: A large number of disadvantaged minority urban youth are engaged in risky sexual behaviors. Intervention programs, particularly those targeting preadolescents, should focus on building long-lasting behavioral skills that emphasize the reduction of peer pressure and normative influences on risky sexual behaviors. Components of the IMB model clearly have a role in the design of efficacious interventions.     

Factors influencing sexual initiation, multiple partners and condom use among male slum youth in Pune, India

This study examines the factors that influence sexual behaviours among young unmarried males living in urban slums in India, a population characterised by high vulnerability to STI and HIV infections. Data were collected from 600 unmarried male slum youth to examine the relationships between three outcomes of heterosexual behaviour (age at sexual initiation, number of sexual partners and condom use at first intercourse) and factors within the family/household social environment, peer environment and individual level during the respondents' formative years. Regression analyses found factors within the family and peer-level domains such as growing up in a two-parent household, having adequate levels of parental supervision, experiencing violence in the home and having peers who drank significantly impact the age of sexual debut and the subsequent number of lifetime partners. Condom use at first intercourse appears to be significantly influenced by age of sexual debut and type of sexual partner. These findings indicate that in low-resource urban settings, the influence of family and friends as role models can play an important role in determining the initiation of sexual behaviour among male youth and in making behaviour choices that result in favourable health outcomes.     

Sexual intentions of black preadolescents: associations with risk and adaptive behaviors

CONTEXT: Adolescent sexual activity in the United states is prevalent and occurring increasingly early, particularly among minority groups. Other risk behaviors (e.g., alcohol consumption) often co-occur with sexual behavior. By examining the association of risk and adaptive behaviors with precursors of sexual behavior--specifically, sexual intentions--it may be possible to identify preadolescents who are at increased risk for early sexual initiation. METHODS: Data from 1,090 black fourth and fifth graders and their parents from the Parents Matter! Program were used in logistic regression analyses to assess covariation between preadolescents' risk and adaptive behaviors, and their intentions to initiate sexual intercourse in the next year. RESULTS: Risk and adaptive behaviors, as reported by both preadolescents and parents, were associated with sexual intentions; the findings were not qualified by youth's gender. Alcohol consumption and having been in trouble with the police were the primary youth-reported risk behaviors associated with the odds of intending to have intercourse (odds ratios, 2.3 and 1.8); the preadolescent's being in trouble at home was the primary parent-reported risk behavior (2.1). In both sets of reports, performing well on schoolwork was associated with reduced odds of intending to engage in sex (0.5 - 0.6). CONCLUSIONS: Risk and adaptive behaviors are markers of sexual intentions among black preadolescents. Prevention programs can use these behaviors to identify black youth who may be at high risk for early sexual initiation.     

Factors influencing sexual initiation,multiple partners and condom use among male slum youth in Pune,India

Abstract

This study examines the factors that influence sexual behaviours among young unmarried males living in urban slums in India, a population characterised by high vulnerability to STI and HIV infections. Data were collected from 600 unmarried male slum youth to examine the relationships between three outcomes of heterosexual behaviour (age at sexual initiation, number of sexual partners and condom use at first intercourse) and factors within the family/household social environment, peer environment and individual level during the respondents’ formative years. Regression analyses found factors within the family and peer-level domains such as growing up in a two-parent household, having adequate levels of parental supervision, experiencing violence in the home and having peers who drank significantly impact the age of sexual debut and the subsequent number of lifetime partners. Condom use at first intercourse appears to be significantly influenced by age of sexual debut and type of sexual partner. These findings indicate that in low-resource urban settings, the influence of family and friends as role models can play an important role in determining the initiation of sexual behaviour among male youth and in making behaviour choices that result in favourable health outcomes.     

Friends' influence on adolescents' first sexual intercourse

CONTEXT: Social-psychological theories of health behavior suggest that adolescents' sexual behaviors are influenced by the sexual attitudes and behaviors of their friends. METHODS: Data on 2,436 participants in the National Longitudinal Study of Adolescent Health (Add Health) who were sexually inexperienced at Wave 1 (1994-1995) were analyzed to examine whether friend-related variables predicted initiation of vaginal intercourse by Wave 2 (1996). Analyses also assessed whether predictive relationships varied by level of involvement with friends. Odds ratios were generated by logistic regression analysis. RESULTS: In the 9-18 months between Waves 1 and 2, 18% of participants initiated intercourse. In analyses controlling for gender, family structure and romantic relationships, the higher the proportion of a youth's friends who were sexually experienced, the greater the odds of sexual debut (odds ratio, 1.01); the odds also were elevated among youth who believed that they would gain their friends' respect by having sex (1.2). Relationships between friend variables and sexual initiation did not vary by level of involvement with friends. CONCLUSIONS: To maximize the likelihood of success, programs focused on delaying teenage sexual intercourse should address norms for sexual behavior among adolescents' close friends as well as the perceptions, skills and behaviors of individual youth.     

Patterns of initiation of sex and drug-related activities among urban low-income African-American adolescents.

PURPOSE: To examine the pattern of adolescent's involvement in drug-related behaviors and sexual initiation, and its relationship with: (a) age and gender, (b) sensation- seeking, (c) perceptions of peer and family risk involvement, and (d) involvement in high-risk sexual behavior. SUBJECTS: Two hundred and sixty-one urban African-American youth, aged 9 to 15 years at baseline, who were sexually experienced by the end of the 4-year study interval. The longitudinal assessment (4 years) was focused on: (a) alcohol use, illicit drug use, and drug trafficking; (b) high-risk sex; (c) propensity to sensation seeking; and (d) perceived peer and family risk involvement. RESULTS: Involvement increased over the 4-year study interval such that over half of the adolescents reported use of alcohol and/or use of marijuana in the final assessment period. For each of the three drug-related activities examined, the largest proportion of youth who engaged in sexual intercourse never engaged in drug-related activity, and the next largest proportion initiated sexual involvement before drug use. Sensation-seeking scores, which were relatively stable across time, were lower among girls, and also were lower among youth who remained uninvolved in drug-related behaviors. For all three drug-related behaviors, rates of high-risk sex were higher among youth who initiated both sex and drugs, and were lower among youth who reported engaging only in sex. Although youth who did eventually initiate drug use had higher perceived levels of family and peer drug use compared to those who remained uninvolved, these perceptions did not contribute directly to high-risk sexual behavior. CONCLUSIONS: Youth who will become both sexually active and involved with drugs during adolescence are especially vulnerable to involvement in high-risk sexual behavior.     

Youth assets, aggression, and delinquency within the context of family structure

OBJECTIVE: To identify youth assets associated with reduced aggressive and delinquent behavior of youth residing in 1-parent households but not of youth residing in 2-parent households. METHODS: Data were collected from inner-city youth and their parents (N = 1,277 youth-parent pairs) using in-home, in-person interviews. Logistic regression analyses, stratifying by 1- and 2-parent household status, were conducted. RESULTS: Several assets were significantly associated with reduced risk behavior only for youth residing in 1-parent households. CONCLUSIONS: There appear to be specific assets (eg, Family Communication, Responsible Choices) that are more important for youth living in 1- versus 2- parent households.     

Recency of immigration, substance use, and sexual behavior among Massachusetts adolescents

OBJECTIVES: This study examined the relationships between recency of immigration, substance use, and sexual behavior. METHODS: Surveys were conducted with 2635 Massachusetts 8th and 10th graders that allowed comparisons of health behaviors and risk and protective factors among students living in the United States "always," more than 6 years, or 6 years or less. RESULTS: Compared with lifetime residents, immigrant youths (particularly those living in the United States 6 years or less) reported lower lifetime and recent alcohol and marijuana use (P < .001); sexual intercourse rates were similar across groups. However, recent immigrants were most likely to report peer pressures to engage in, and less parental support to avoid, risk behaviors (P < .001). CONCLUSIONS: A window of opportunity exists to provide primary prevention programs in schools to immigrant youths that may reduce adolescent health risk behaviors.     

School-related assets and youth risk behaviors: alcohol consumption and sexual activity

BACKGROUND: Two risk behaviors, alcohol consumption and early initiation of sexual intercourse (ISI), can have devastating consequences for youth. The purpose of this study was to determine the association of school connectedness and school‐related behaviors (eg, academic performance, skipping school, getting into trouble at school) with these 2 risk behaviors. METHODS: The Youth Asset Survey (YAS) was administered to 1117 youth/parent pairs in their homes using Computer‐Assisted Personal/Self‐Interviewing (CAPI/CASI). The YAS measures 17 youth assets and risk behaviors including alcohol consumption and sexual activity. RESULTS: The mean age of the sample was 14.3 years; 53% were female; and 70% were from 2‐parent homes. Five school‐related behaviors were positively associated with no ISI. Four school‐related behaviors were positively associated with reporting no alcohol consumption in the past 30 days, including the School Connectedness asset (only among 12‐ to 13‐year‐olds), not skipping school (only among non‐Hispanic Caucasians), staying out of trouble, and paying attention. CONCLUSIONS: School is very much a part of the lives of youth and therefore the relationship they have with their school experience is important and may influence their involvement in risk behaviors. Feeling connected to school is a positive asset that can protect youth from such risky behaviors as sexual initiation and alcohol consumption.     

Correlates of sexual experience among a nationally representative sample of alternative high school students

Little is known about risk and protective factors associated with sexual experience among alternative school students that might prove useful in targeting and guiding early interventions to prevent onset of sexual risk behavior. Researchers analyzed data from the national Alternative High School Youth Risk Behavior Survey. Principal components analysis identified six risk and protective factors: weapon carrying; tobacco use; cocaine, inhalant, and needle use; alcohol and marijuana use; participation in sports; and fighting. Composite variables with significant bivariate relationships to sexual experience, as well as demographic variables, were entered into a logistic regression analysis to determine independent effects of these correlates on students' sexual experience (N = 6.037). Nearly 90% of students reported having sexual intercourse. In multivariate analysis, significant demographic correlates of sexual experience included female gender (58% more likely than males to report ever having sex), African American race (2.83 times more likely than non-Hispanic Whites), and age (28% more likely with each advancing year). Attending school in a rural or suburban region corresponded to a 31% decrease and 46% decrease, respectively, in the odds of ever having sex. Weapon carrying, and cocaine, inhalant, and needle use, were associated with a 35% and 46% increase, respectively, in the odds of ever having sex. Students reporting they had ever used alcohol or marijuana, and those reporting recent fighting behavior, were 2.7 and 1.6 times more likely, respectively, to report sexual experience. Most alternative school students have had sexual intercourse, with those students engaging in substance use, weapon carrying, and fighting behaviors being at greater risk for sexual experience. Prevention programs for high-risk youth attending alternative high schools need to consider how to promote continued abstinence among the small but important minority of alternative school students not yet sexually experienced.     

成都地区未婚流动青年性避孕行为及影响因素分析

目的:了解未婚流动青年对性相关行为的态度、性行为和避孕措施使用情况及其影响因素。方法:在成都地区抽取工厂和服务场所15～24岁未婚外来务工青年进行匿名问卷调查。结果:有效调查780人。50%以上调查对象能接受未婚性行为,40%以上不在意配偶婚前是否是处女或处男;49.4%有过性交行为;发生性交行为时能够每次使用避孕措施者仅12.7%,7.5%从不使用避孕措施,其余为不规律使用。男性、外出打工年龄小、从事服务行业工作以及能接受未婚性行为者发生性交行为的可能性更大。文化程度低、不与家人同住者更有可能在发生性交行为时不是每次都使用避孕措施。结论:需根据未婚流动青年的性别、年龄等特点,长期、持续、有针对性地开展性与生殖健康知识、避孕知识与技巧的教育和培训。     

Trends in Sexual Risk Behaviors,by Nonsexual Risk Behavior Involvement,U.S. High School Students, 1991–2007

BackgroundAdolescent health risk behaviors often occur together, suggesting that youth involvement with one risk behavior may inform understanding of other risk behaviors. We examined the association between involvement in nonsexual risk behaviors and trends among sexual behaviors.MethodsWe analyzed 1991–2007 data (n = ～125,000) from the Youth Risk Behavior Survey, a nationally representative survey of high school students in the United States. We categorized students into groups based on lifetime (Lifetime Risk Scale) and recent involvement (Recent Risk Scale) in nonsexual risk behaviors, such as smoking and drug use. We examined each group's prevalence of and trends for four sexual behaviors: ever having had sexual intercourse, having four or more lifetime partners, current sexual activity, and use of contraception at last sex. Data were examined for linear and quadratic (U-shaped) change using logistic regression.ResultsSexual behaviors varied considerably between youth engaged in no risk behaviors and those in the highest risk behavior groups: sevenfold for ever having had intercourse (13% vs. 87% in 2007) and threefold for four or more lifetime sexual partners (19% vs. 57%). Despite these differences, trends in sexual risk behaviors among youth engaged in multiple nonsexual risk behaviors and those engaged in few or no risk behaviors were remarkably similar. In contrast, sexual behaviors demonstrated a very different pattern of change from that found or nonsexual behaviors: sexual experience and having multiple sexual partners declined into the early 2000s and then increased, whereas nonsexual behaviors increased over time, peaked in the late 1990s, and then declined.ConclusionsYouth who engaged in little risk taking and those who engaged in considerable risk taking showed similar trends over time. However, the pattern of changes in sexual and nonsexual risk behaviors were remarkably different, raising questions about the potential impact of interventions that would reduce sexual risk taking by reducing nonsexual risk behaviors. Recent increases in sexual risk behaviors may have ominous implications for prevention of unplanned pregnancy and sexually transmitted infections among youth.     

Parental investment, club membership, and youth sexual risk behavior in Cape Town.

This study examines whether parental investment and membership in social clubs are associated with safer sexual behaviors among South African youth. Participants comprised 4,800 randomly selected adolescents age 14 to 22 living in the Cape Town area in 2002. Logistic regression was used to examine associations between measures of parental investment and associational membership with reported condom use at first and most recent sexual intercourse, net of effects of HIV knowledge, age, education, population group, parental co-residence, and household income. Interaction terms were used to examine gender differences in associations between risk behavior and parental investment and between risk behavior and group membership. Participation in clubs and community groups is associated with safer behaviors. A mother's financial support (for clothing, school fees and uniforms, and pocket money) is negatively associated with condom use, particularly among young women, suggesting that material need impels vulnerability to higher risk behaviors. Social resources in households and communities mediate HIV risk behaviors among youth in Cape Town.     

Family Environment and Premarital Intercourse in Bandjoun (West Cameroon)

Family environment is one of the most influential factors on youth sexual behavior but has received little investigation in sub-Saharan Africa. Yet, a comprehensive understanding of family influences could improve the efficiency of reproductive health (RH) interventions. Using retrospective data from a population-based survey, life-table analysis was utilized to compute the median age at premarital intercourse among 1,182 youth aged 12–24 years. Discrete-time hazard models were used in multivariate analysis to estimate the effects of family structures and parent–child interactions on premarital intercourse. Overall, 42% of participants had a premarital intercourse, and the median age at first sex was 16.9 years. Participants in nuclear two-parent families had the highest median (17.7) compared with those in nuclear one-(16.7), extended one-(16.5), extended two-parent families (16.9) or other relatives (16.8). Youth from monogamous families had the highest median (16.9) compared to those from polygamous (16.3) and other families (16.0). Orphans and youth reporting family transitions were more likely to initiate first sex at an earlier age compared with non-orphans and non-movers, with a median of 16.1 and 16.9 years, respectively. Multivariate results showed that living in extended families, being orphaned, and family transitions significantly increased the risk of premarital intercourse. Polygamy showed marginal effects. Stronger parent–child relationships and higher levels of parental control decreased the risk of premarital intercourse. Unexpectedly, parent–child communication was significantly associated with a higher risk of sexual debut. Programmatically, family environment is an important resource that needs to be promoted when designing RH interventions in sub-Saharan Africa.     

Adverse childhood experiences and sexual risk behaviors in women: a retrospective cohort study

CONTEXT: Adverse childhood experiences such as physical abuse and sexual abuse have been shown to be related to subsequent unintended pregnancies and infection with sexually transmitted diseases. However, the extent to which sexual risk behaviors in women are associated with exposure to adverse experiences during childhood is not well-understood. METHODS: A total of 5,060 female members of a managed care organization provided information about seven categories of adverse childhood experiences: having experienced emotional, physical or sexual abuse; or having had a battered mother or substance-abusing, mentally ill or criminal household members. Logistic regression was used to model the association between cumulative categories of up to seven adverse childhood experiences and such sexual risk behaviors as early onset of intercourse, 30 or more sexual partners and self-perception as being at risk for AIDS. RESULTS: Each category of adverse childhood experiences was associated with an increased risk of intercourse by age 15 (odds ratios, 1.6-2.6), with perceiving oneself as being at risk of AIDS (odds ratios, 1.5-2.6) and with having had 30 or more partners (odds ratios, 1.6-3.8). After adjustment for the effects of age at interview and race, women who experienced rising numbers of types of adverse childhood experiences were increasingly likely to see themselves as being at risk of AIDS: Those with one such experience had a slightly elevated likelihood (odds ratio, 1.2), while those with 4-5 or 6-7 such experiences had substantially elevated odds (odds ratios, 1.8 and 4.9, respectively). Similarly, the number of types of adverse experiences was tied to the likelihood of having had 30 or more sexual partners, rising from odds of 1.6 for those with one type of adverse experience and 1.9 for those with two to odds of 8.2 among those with 6-7. Finally, the chances that a woman first had sex by age 15 also rose progressively with increasing numbers of such experiences, from odds of 1.8 among those with one type of adverse childhood experience to 7.0 among those with 6-7. CONCLUSIONS: Among individuals with a history of adverse childhood experiences, risky sexual behavior may represent their attempts to achieve intimate interpersonal connections. Having grown up in families unable to provide needed protection, such individuals may be unprepared to protect themselves and may underestimate the risks they take in their attempts to achieve intimacy. If so, coping with such problems represents a serious public health challenge.     

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.