Reported sexual behaviors and self-esteem among young adolescents

Six hundred seventy-seven adolescents in grades 7 through 9 of a blue-collar, midwestern junior high school responded to a survey of sexual behavior and self-esteem. The focus of this study was on the relationship between sexual experience and self-esteem. Fifty-five percent of the students reported having had at least one coital experience; 7% reported having intercourse about once a week. The proportion of sexually experienced adolescents increased with age; 28% of 12-year-olds, 52.7% of 13-year-olds, 60.1% of 14-year-olds, 73.6% of 15-year-olds, and 90% of 16-year-olds reported having intercourse on at least one occasion. More boys of all ages were sexually active than girls. Six percent of students had had, or were suspicious of having had, a sexually transmitted disease; 7.8% were involved in a pregnancy. The average of the self-esteem scores for girls was significantly lower than the average for boys. There was an interaction effect between gender and coital history for self-esteem. Girls who reported having had intercourse had lower self-esteem scores than those who did not. On the other hand, self-esteem of sexually experienced and inexperienced boys did not differ, nor did self-esteem of virginal boys and girls. Boys and girls with a history of sexually transmitted diseases had lower self-esteem than all others. Pregnancy, on the other hand, did not seem to affect self-esteem of the sexually experienced adolescents. This cross-sectional study does not permit determination of whether the lower average self-esteem among certain girls was antecedent to or a consequence of sexual experience.     

Behavioral risk, emotional risk, and child abuse among adolescents in a nonclinical setting

In this replication study of adolescents in a nonclinical setting, the prevalence of reported problem behaviors, emotions, and abuse is evaluated, and the impact of abuse on multivariate emotional and behavioral risk is assessed. A total of 3998 students (69%) in a rural midwestern community in grades 7 to 12 participated in the study. Almost 20% of the students reported some form of physical and/or sexual abuse, with more girls than boys reporting sexual abuse (chi 2 = 48.5, P less than .001). Some problem behaviors (alcohol use) and emotions (trouble sleeping, difficulty with anger) were common among all adolescents and some were strongly associated with a history of abuse (especially, considering or attempting suicide, running away, laxative use, and vomiting to lose weight). Higher emotional and behavioral risk scores among abused students were confirmed. The effects of physical and sexual abuse on risk scores were independent and additive; no interaction was observed. An interaction of gender and sexual abuse on problem behavior was observed, with problem behavior being significantly greater among sexually abused boys. The results confirm increased risk of problem behaviors and negative feelings among abused adolescents when compared with nonabused peers, and better define influences of gender and abuse type on emotional and behavioral risks.     

Prevalence and correlates of pelvic examinations in sexually active female adolescents.

OBJECTIVES: The pelvic examination is an important component of reproductive health services for adolescent girls and is recommended for those who become sexually active. The aims of this study were to describe self-reported rates of pelvic examinations in sexually active adolescent girls and to determine factors associated with having obtained an examination. METHODS: Cross-sectional data from a national self-administered survey of nurses' adolescent daughters were used. Subjects were those girls (N = 635) who reported ever having had sexual intercourse. Bivariate and multivariate analyses were used to identify demographic and psychological variables, preventive health behaviors, and risk behaviors associated with having ever obtained a pelvic examination. RESULTS: Median subject age was 16.0 years (range 12-19 years), and 46% of subjects reported having had a pelvic examination. Variables associated with having obtained an examination were older age (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.09-1.53), cigarette smoking (OR 1.51, 95% CI 1.02-2.24), higher number of sexual partners (OR 1.29, 95% CI 1.14-1.47), and no condom use during last sexual intercourse (OR 1.80, 95% CI 1.19-2.70). CONCLUSIONS: Fewer than half of these sexually active adolescents had ever obtained a pelvic examination. Younger subjects who did not smoke regularly, had fewer partners, and used condoms were less likely to have obtained an examination; these adolescents may not be seeking reproductive health care services or be recognized by parents or providers as being in need of services.     

The relationship of sex and risk behaviours to students' use of school-based health centres in Cape Breton, Nova Scotia

OBJECTIVE:

Among other benefits, school-based health centres (SBHCs) are thought to provide opportunities to identify and help adolescents with risk-taking behaviours. The present study examined the use of SBHCs at three high schools in Cape Breton, Nova Scotia, to determine the extent to which SBHCs reach students at risk, and whether there are sex differences with respect to this reach.

METHODS:

Self-administered surveys of students in grades 10 to 12 at the three high schools were carried out in May 2006.

RESULTS:

The response rate was 70% of registered students. Boys were more often at risk than girls due to substance use, while girls were more often at risk due to sexual activity and suicidal thoughts. More girls visited SBHC nurses than boys (49% versus 10%; P<0.001). After adjusting for age, boys who saw a SBHC nurse were significantly more likely to engage in all risk-taking behaviours than boys who did not see a nurse; girls who saw a nurse engaged in most risk-taking behaviours significantly more often than girls who did not. However, no more than 22% of students with each specific risk behaviour used SBHCs to address those risks, with the exception of girls consulting for sexual health reasons, who made up 59% of all girls in the schools who reported being sexually active.

CONCLUSIONS:

Boys infrequently use SBHCs, and many at-risk students of both sexes do not use SBHCs. If the full potential for these SBHCs to help students with risk behaviours is to be realized, the need to increase reach to students is clear.     

Temporal associations between depressive symptoms and self-reported sexually transmitted disease among adolescents

OBJECTIVE: To examine the longitudinal associations between depressive symptoms and self-reported sexually transmitted disease (STD) diagnosis among adolescents. SETTING AND PARTICIPANTS: National Longitudinal Study of Adolescent Health data were analyzed for 7th through 12th graders who reported having sexual intercourse between baseline (Wave 1) and 1-year follow-up (Wave 2) in-home interviews (N = 4738 [2232 boys, 2506 girls]). The association between level of depressive symptoms at Wave 1 and self-reported diagnosis of STD between Wave 1 and Wave 2 was explored separately for boys and girls using logistic regression that controlled for age, race/ethnicity, virginity, and history of STD at Wave 1. Alcohol and marijuana use were assessed as potential mediators. The association between interval STD diagnosis and subsequent very high levels of depressive symptoms (predictive of major depression) was also examined separately by sex controlling for demographic characteristics and baseline depressive symptoms. MAIN OUTCOME MEASURES: Self-reported STD diagnosis and depressive symptoms. RESULTS: For boys and girls, higher frequency of depressive symptoms at baseline predicted increased risk of being diagnosed as having an STD within 1 year. After adjusting for history of STD, the association was no longer significant for girls. Alcohol and marijuana use did not mediate this association for either sex, although very frequent alcohol use was an independent predictor of STD diagnosis for boys. For boys and girls, being diagnosed as having an STD within 1 year was associated with very high levels of depressive symptoms at the end of that year in both bivariate and multivariate models. CONCLUSIONS: Screening for depressive symptoms in sexually active adolescents, particularly boys, may identify those at risk for STDs. In addition, adolescents who are diagnosed as having STDs should be monitored for depression. These findings suggest that adolescent preventive care needs to include regular, comprehensive assessments of both mental health and STD.     

Cross-sectional study of female students reporting anabolic steroid use

OBJECTIVE: To determine the characteristics of female US high school students reporting anabolic steroid use. DESIGN: Cross-sectional assessment using the 2003 Centers for Disease Control and Prevention national school-based Youth Risk Behavior Survey database. SETTING: Nationally representative sample of US high schools. PARTICIPANTS: Female students in grades 9 through 12 (n = 7544). MAIN OUTCOME MEASURES: Participants' self-reported anabolic steroid use was compared with other health-related behaviors and with sports participation. RESULTS: Prior or ongoing anabolic steroid use was reported by 5.3% of female high school students. Those adolescent girls had a marked increase in other health-compromising behaviors, including past 30-day use of alcohol (odds ratio [OR], 8.83; 95% confidence interval [CI], 5.49-14.20]), cigarettes (OR, 5.14; 95% CI, 3.14-8.42), marijuana (OR, 7.91; 95% CI, 5.20-12.04), cocaine (OR, 10.78; 95% CI, 6.18-18.81), and diet pills (OR, 4.86; 95% CI, 2.98-7.93). They were more likely to carry a weapon (OR, 7.54; 95% CI, 4.83-11.76), have had sexual intercourse before age 13 years (OR, 2.90; 95% CI, 1.58-5.33), and have had feelings of sadness or hopelessness almost every day for at least 2 consecutive weeks (OR, 4.13; 95% CI, 2.57-7.22). They were less likely to play school-sponsored team sports (OR, 0.52; 95% CI 0.34-0.80). Steroid users participating in sports shared the same problem behaviors as steroid users not participating in team athletics. CONCLUSION: Self-reported anabolic steroid use is not confined to adolescent girls in competitive athletics and is an indicator of adolescent girls with a marked increase in a cluster of other health-harming behaviors.     

Prevalence and characteristics of sexual abuse in a national sample of Swedish seventeen-year-old boys and girls

The aims of this study, which was part of a survey on adolescent sexual behaviour, were to investigate adolescents' experience of child sexual abuse and to present possible abuse-related problems. Representative samples of 2% of Sweden's 17-y-old male and female students and school non-attenders were selected in a two-step procedure. In all, 1943 students and 210 school non-attenders answered a self-administered anonymous questionnaire, distributed by school nurses. Six out of 170 questions dealt with personal experiences of child sexual abuse, i.e. age at onset, frequency of abuse and relationship to the offender. Peer abuse was excluded by the definitions used. The overall response rate was 92.2% for students and 44.2% for school dropouts. Among male and female students, 3.1% and 11.2%, respectively, acknowledged sexual abuse, 2.3% and 7.1%, respectively, when exhibitionism was excluded. Mean age at onset was 9.1 y (SD 4.3) for boys and 9.0 y (SD 3.9) for girls; 1.2% of the boys and 3.1% of the girls reported abusive oral, vaginal and/or anal intercourse. Suicide attempts or other acts of self-harm were reported by 33.3% of the male students reporting abuse and by 5.1% (p < 0.001) of those who had not been abused, and by 30.4% of the abused student girls compared to 9.1% of the non-abused (p < 0.001). Sleep and eating disorders, use of alcohol at an early age and/or experimentation with illicit drugs and consensual coitarche before age 15 y was reported significantly more often by abused than non-abused girls (p < 0.001, differences not found among the student boys). Of school non-attenders, 4% of the boys and 28% of the girls reported sexual abuse. Of the abused girls, 49% reported abusive vaginal intercourse and 64% reported self-destructive behaviour or suicide attempts. No abused boys and few abused girls had confided in a teacher, health professional or social worker. Results from the student sample should be interpreted as markers of "minimum prevalence", as female school non-attenders report significantly higher prevalence of sexual abuse. Potential high-risk groups are better included in prevalence investigations of child sexual abuse. The fact that so few adolescents confided in "professionals" about the abuse, despite having severe symptoms and signs of distress, underlines the need to address sexual abuse when recording the social, medical and psychiatric histories of adolescents.     

Incarcerated adolescents' experiences as perpetrators of sexual assault

OBJECTIVES: To identify self-reported characteristics of past sexual assaults perpetrated by incarcerated juveniles and to determine potential precursors of this behavior. PARTICIPANTS AND METHODS: Participants completed an anonymous written questionnaire regarding their experiences of sexual abuse and/or assault as both a victim and a perpetrator. The questionnaire was incorporated into an existing annual survey of gang-related behaviors. RESULTS: A total of 805 adolescents (707 boys, 91 girls, and 7 gender-not-designated) participated. Of these teens, 79 males (11% of the males), 9 females (10% of the females), and 5 (71%) gender-not-designated said they had forced sex on someone (165 did not answer the question). Twenty-eight males (30% of the male perpetrators) and 4 females (44% of the female perpetrators) were both victims and perpetrators. Drugs and/or alcohol were frequently used by both the assailant (58% of the males and 55% of the females) and the victim (56% for the males and 66% for the females). The attributes of adolescent boys at highest risk of becoming perpetrators were all related to violence, including exposure to parents who were violent in the home (adjusted odds ratio, 2.68), being a victim of physical or sexual assault (adjusted odds ratio, 2.83), having parents who encouraged gang membership (adjusted odds ratio, 3.58), and knowing a perpetrator of sexual violence (adjusted odds ratio, 3.83). CONCLUSIONS: Adolescent boys and girls were both victims and perpetrators of sexual assault. Programs that identify and target violence in young children's lives, particularly intrafamilial violence, may reduce the risk of teenagers becoming perpetrators of sexual violence. Anticipatory guidance during teen years, regarding risk and avoidance of sexual exploitation, may be helpful in reducing the chances of sexual assaults.     

Early sexual initiation: the role of peer norms

OBJECTIVE: To elucidate which components of peer norms influence the process of sexual initiation for young adolescents. Design. Prospective cohort study. Setting. Fourteen elementary and middle schools in an urban public school district. Participants. The 1389 sixth-grade students who completed the questionnaire at the beginning (time 1) and at the end (time 2) of the school year comprise the study sample. Mean age at time 1 was 11.7 years. RESULTS: Of students entering the sixth grade, 30% (n = 416) reported having already initiated sexual intercourse, 5% (n = 74) reported initiating sexual intercourse during the sixth-grade school year (initiated group), and 63% (n = 873) reported not having initiated sexual intercourse by the end of the sixth-grade school year (never group). Demographic comparisons revealed that students in the initiated group were significantly more likely than students in the never group to be older (11.9 years vs 11.6 years), male (58% vs 37%), African-American (70% vs 51%), attending a poorer school (87% vs 85%), and living in an area with a high proportion of single-parent families (45% vs 41%). Self-reports and reports of peers' participation in nonsexual risk behaviors were more common for students in the initiated group. Students in the initiated group were more likely than students in the never group to perceive: 1) a high prevalence of sexual initiation among peers; 2) social gains associated with early sexual intercourse; and 3) younger age of peers' sexual initiation. Students in the never group were more likely to believe that sexually-experienced 12-year-old boys would be negatively stigmatized compared with students in the initiated group. Three predictive models were developed to test the relationship between peer norms and the process of initiation. These models demonstrate that the strongest predictor of sexual initiation in sixth grade is having high intention to do so at the beginning of sixth grade. The strongest predictor of high intention is belief that most friends have already had sexual intercourse. Perceptions of social gain and stigma for sexually-experienced 12-year-old boys act independently of intention to decrease risk of early sexual initiation. CONCLUSION: Early sexual intercourse is not an unplanned experience for many teens. Decisions about initiation are strongly bound to social context with peers playing an important role in creating a sense of normative behavior. Specific components of peer norms impact the process of sexual initiation in both positive and negative ways. Interventions aimed at delaying the onset of sexual initiation need to focus on cohort norms as well as on an individual's perceptions and behaviors.     

Violence risk and protective factors among youth held back in school.

OBJECTIVE: To identify risk and protective factors for violence perpetration among youth with a history of grade retention. DESIGN: Longitudinal analysis of in-home interviews of 13,781 adolescents in grades 7 through 12 conducted in 1995 and 1996. METHODS AND MEASURES: Serious interpersonal violence perpetration at time 2 by time 1 independent variables including measures of community and school context, family context, and individual characteristics. RESULTS: The 20% of girls and 28% of boys who had repeated 1 or more grades were more likely than those who had not to be in the top quintile of violence perpetration at time 2 (P <.001). For both girls and boys with a history of grade repetition, predictive risk factors with an odds ratio of 3 or greater (P <.001) included time 1 violence perpetration, violence victimization, weapon carrying, school problems, and alcohol and marijuana use. Although a high grade point average was a significant protective factor against violence perpetration for both girls (odds ratio, 0.36; P <.05) and boys (odds ratio, 0.23; P <.001), performance on a validated measure of verbal knowledge was not associated with violence perpetration over the study period. School connectedness, parent-family connectedness, and emotional well-being were also significant universal protectors against violence perpetration. CONCLUSIONS: Youth who are held back in school are at heightened risk for violence perpetration. Violence-related behaviors and substance use considerably increase the likelihood of this outcome. The findings suggest that schools can participate in violence prevention by providing youth with a positive community and academic experience.     

The relation between physical activity and mental health among Hispanic and non-Hispanic white adolescents

OBJECTIVE: To assess the relation of physical activity (PA) with feelings of sadness and suicidal thoughts and behaviors among Hispanic and non-Hispanic white adolescent boys and girls. DESIGN: Cross-sectional study using a modified 2001 Youth Risk Behavior Survey. PARTICIPANTS: One thousand eight hundred seventy Hispanic and non-Hispanic white adolescents, aged 14 to 18 years, attending high school in Nueces County, Texas. MAIN OUTCOME MEASURE: Logistic regression analysis was used to assess the relation between PA, including moderate and vigorous PAs, strength and toning, total PA, physical education class, and participation in team sports, and the dependent variables feelings of sadness and considering, planning, and attempting suicide. RESULTS: More boys reported participating in PA than girls (P<.001), and more girls than boys reported feelings of sadness and considering and planning suicide (P<.001). Greater attendance in physical education class was inversely related to feelings of sadness (odds ratio [OR], 0.80 [95% confidence interval (CI), 0.68-0.94]); participation in more total PA sessions per week was associated with a lower risk of considering suicide (OR, 0.72 [95% CI, 0.65-0.79]); and higher levels of vigorous PA (OR, 0.73 [95% CI, 0.57-0.93]), total PA (OR, 0.65 [95% CI, 0.48-0.87]), and strength and toning activity (OR, 0.64 [95% CI, 0.42-0.99]) were associated with a lower risk of planning suicide. CONCLUSIONS: These findings are consistent with a beneficial effect of PA on feelings of sadness and suicidal behaviors in Hispanic and non-Hispanic white boys and girls. Physical activity may be considered as part of an intervention strategy to improve adolescent health as a whole.     

Sexually transmitted organisms in sexually abused children

OBJECTIVE: To establish the prevalence of sexually transmitted organisms and other genital organisms in potentially sexually abused children. DESIGN: Prospective study of children attending an inner London department of community paediatrics for evaluation of possible sexual abuse. SUBJECTS: Children under 16 referred for evaluation of possible sexual abuse. OUTCOME MEASURES: Prevalence of sexually transmitted organisms in relation to age, symptoms, and type of abuse. RESULTS: Swabs were taken from 159 of 242 girls evaluated. The overall prevalence of sexually transmitted organisms was 3.7%: three girls were infected with gonorrhoea, four with Trichomonas vaginalis, and two with Chlamydia trachomatis. One girl had all three infections plus mycoplasmas. Mycoplasmas were identified in 22% of girls swabbed. Of 30 boys swabbed, none yielded a sexually transmitted organism. CONCLUSIONS: There is a low prevalence of definitely sexually transmitted organisms in children who might have been abused. Other organisms possibly associated with sexual activity can be identified in this population. Screening for infection should be mandatory in presumed sexually abused girls with vaginal discharge and ideally should be undertaken in all children attending for evaluation of sexual abuse.     

Sexually transmitted diseases in a health maintenance organization teen clinic: associations of race, partner's age, and marijuana use.

OBJECTIVE: To determine the role of sociodemographic risk markers and behavioral risk factors associated with sexually transmitted diseases (STDs) in sexually experienced youth seeking care at an urban, general health maintenance organization teen clinic. DESIGN: Cross-sectional. PARTICIPANTS: A consecutive, racially and ethnically diverse sample of 285 sexually experienced youth who were preponderantly female (58.6%) and who were aged 16.7 years on average. METHODS: All participants completed a self-report questionnaire and were screened for Chlamydia trachomatis using the ligase chain reaction technique and for Neisseria gonorrhoeae and other STDs using conventional methods. RESULTS: Many of these youth were at high risk for STDs, having a self-reported history of sex with multiple partners (49.1%), sex with a new partner (42.5%), inconsistent use of condoms (71.9%), and frequent substance use (24.5% used marijuana 1-2 times per week or more). Sexually transmitted disease screening revealed that 11.6% of the participants had 1 or more STDs. A logistic regression analysis to determine the best model for predicting STDs indicated that youth who are African American (odds ratio, 3.34; 95% confidence interval, 1.52-7.35), had sexual partners who were 2 or more years older (odds ratio, 2.63, 95% confidence interval, 1.22-5.67), and used marijuana 1 to 2 times or more per week (odds ratio, 2.27; 95% confidence interval, 1.01-5.13) were more likely to have STDs at screening. CONCLUSIONS: A brief sociodemographic and behavioral risk assessment that includes these factors may be useful for clinicians in deciding when to screen for STDs in sexually active youth seeking care for reasons not related to reproductive health.     

Exposure to violence and associated health-risk behaviors among adolescent girls.

OBJECTIVE: To examine the relationship between exposure to violence and health-risk behaviors. DESIGN: Cross-sectional survey. SETTING: University-based outpatient family planning clinic. PATIENTS: Sexually active adolescent girls younger than 18 years (N = 517) who presented for contraceptive care. MAIN OUTCOME MEASURES: Prevalence of witnessing or experiencing violence and the associations with health-risk behaviors, including high-risk sexual behaviors, substance use, and self-injury. RESULTS: Compared with adolescents who had not been exposed to violence, those who had only witnessed violence were 2 to 3 times more likely to report using tobacco and marijuana, drinking alcohol or using drugs before sex, and having intercourse with a partner who had multiple partners. Those who had experienced, but not witnessed violence were at increased risk of these same behaviors and were 2 to 4 times more likely than those who had neither witnessed nor experienced violence to report early initiation of intercourse, intercourse with strangers, multiple partners, or partners with multiple partners, tobacco, alcohol and drug use, or to have positive test results for a sexually transmitted disease. Individuals who had both witnessed and experienced violence demonstrated the greatest risk of adverse health behaviors. These adolescents demonstrated 3 to 6 times greater risk of suicidal ideation (odds ratio [OR], 3.1; 95% confidence interval [CI], 2.2-4.0) or suicide attempts (OR, 4.5; 95% CI, 2.2-9.4), self-injury (OR, 5.8; 95% CI, 2.6-12.9), and use of drugs before intercourse (OR, 6.2; 95% CI, 3.0-12.9) than those who had neither witnessed nor experienced violence. CONCLUSIONS: Adolescents exposed to violence are at increased risk of multiple adverse health behaviors. Programs designed to improve health outcomes should target this high-risk group.     

The association between health risk behaviors and sexual orientation among a school-based sample of adolescents

OBJECTIVE: This study is one of the first to examine the association between sexual orientation and health risk behaviors among a representative, school-based sample of adolescents. DESIGN: This study was conducted on an anonymous, representative sample of 4159 9th- to 12th-grade students in public high schools from Massachusetts' expanded Centers for Disease Control and Prevention 1995 Youth Risk Behavior Survey. Sexual orientation was determined by the following question: "Which of the following best describes you?" A total of 104 students self-identified as gay, lesbian, or bisexual (GLB), representing 2.5% of the overall population. Of GLB youth, 66.7% were male and 70% were white (not Hispanic). Health risk and problem behaviors were analyzed comparing GLB youth and their peers. Those variables found to be significantly associated with GLB youth were then analyzed by multiple logistic regression models. RESULTS: GLB youth were more likely than their peers to have been victimized and threatened and to have been engaged in a variety of risk behaviors including suicidal ideation and attempts, multiple substance use, and sexual risk behaviors. Four separate logistic regression models were constructed. Model I, Onset of Behaviors Before Age 13, showed use of cocaine before age 13 years as strongly associated with GLB orientation (odds ratio [OR]: 6.10; 95% confidence interval [CI] = 2.45-15.20). Early initiation of sexual intercourse (2.15; 10.6-4.38), marijuana use (1.98; 1.04-4.09), and alcohol use (1.82; 1.03-3.23) also was associated with GLB orientation. Model II, Lifetime Frequencies of Behaviors, showed that frequency of crack cocaine use (1.38; 1.06-1.79), inhalant use (1.30; 1.05-1.61), and number of sexual partners (1.27; 1.06-1.43) was associated with GLB orientation. Model III, Frequency of Recent Behaviors, showed smokeless tobacco use in the past 30 days (1.38; 1. 20-1.59) and number of sexual partners in the previous 3 months (1. 47; 1.31-1.65) were associated with GLB orientation. Model IV, Frequency of Behaviors at School, showed having one's property stolen or deliberately damaged (1.23; 1.08-1.40) and using marijuana (1.29; 1.05-1.59) and smokeless tobacco (1.53; 1.30-1.81) were associated with GLB orientation. Overall, GLB respondents engaged disproportionately in multiple risk behaviors, reporting an increased mean number of risk behaviors (mean = 6.81 +/- 4.49) compared with the overall student population (mean = 3.45 +/- 3.15). CONCLUSION: GLB youth who self-identify during high school report disproportionate risk for a variety of health risk and problem behaviors, including suicide, victimization, sexual risk behaviors, and multiple substance use. In addition, these youth are more likely to report engaging in multiple risk behaviors and initiating risk behaviors at an earlier age than are their peers. These findings suggest that educational efforts, prevention programs, and health services must be designed to address the unique needs of GLB youth.     

Beyond sexual abuse: the impact of other maltreatment experiences on sexualized behaviors

This study sought to broaden research findings linking maltreatment to sexualized behaviors by investigating whether maltreatment experiences other than sexual abuse predict such behaviors. The sample included 690 children without reported sexual abuse histories who are participants in the LONGSCAN Consortium, a prospective multisite investigation of childhood maltreatment. Child Protective Service reports before age 8 years and caregiver reports on the Child Sexual Behavior Inventory-II at age 8 years were used to examine the relationship between maltreatment timing and type, and sexualized behaviors. Logistic regression analyses suggested that early (< 4) and late (4-8) reports of physical abuse were associated with more sexualized behaviors (odds ratios = 1.9-2.6). The pattern differed by gender, with physical abuse predicting sexual intrusiveness and displaying private parts in boys, and boundary problems in girls. Findings suggest that maltreatment other than sexual abuse, and the developmental periods in which it occurs, may be linked to the development of sexualized behaviors.     

Entry into sexuality and its hazards]

It is estimated that approximately 20% of adolescents (girls and boys) have their first intercourse experience before 15 years of age. Between 17 and 18 years, approximately 50% have had at least one complete sexual intercourse, and more than one-third have developed a long-lasting relationship. Girls often have an affective link associated with sexual activity. This paper deals with adolescent psychosexual maturation, gender differences, and motivations and feelings concerning their first intercourse experiences.     

Associations between health screening questions and sexual risk behaviors in adolescent female clinic patients: identifying a brief question format to yield critical information

This study examines the ability of brief screening questions to identify adolescent girls at high risk for sexually transmitted infections and teen pregnancy. Participants included 103 sexually active 13-year-old to 17-year-old girls recruited from adolescent clinics who (1) were identified as at risk for negative sexual health outcomes through responses to an 8-item Health Screening Survey, and (2) returned to clinic within 2 weeks to complete a self-report survey about sexual risk behaviors and contraceptive use. Analyses examined relationships between girls' total screening scores, individual screening survey items, and 5 self-reported sexual risk behaviors. Higher screening scores correlated with lower levels of refusing unprotected sex and less consistent condom use (P < .05 and P < .01, respectively). High-risk responses to 2 screening items were associated with all 5 sexual risk behaviors. Findings suggest useful questions in routine clinical screening of sexually active adolescent girls to identify those at high levels of sexual risk.     

Abuse, feelings, and health behaviors in a student population

Behavioral sequelae of child abuse are frequently cited, but there are few studies that examine the strength of association between behavioral effect and abuse for children in a nonclinical setting. Seven hundred twelve junior high school students (mean age, 13.5 years) were surveyed for self-report of personal experience with abuse, certain health behaviors, and self-esteem. Physical and/or sexual abuse was reported by 18.3% of students. Both types of abuse were associated with the following behaviors: running away; considering hurting oneself; suicide attempts; and the use of drugs, pot (marijuana), cigarettes, and laxatives. No clinically significant relationships were found between abuse and report of anger, sadness, or self-esteem. These data suggested that some feelings and behaviors were common among all adolescents sampled, while others were more common among abused adolescents. Recognition of strong associations should help direct clinical management. The results of this study confirm findings from some previous reports and indicate the need for further studies of children who are not in a clinical setting.     

Demographic and risk factors associated with chronic dieting in adolescents

A comprehensive, school-based survey was administered to 36,320 Minnesota public school students in grades 7 through 12 during the 1987-1988 school year. Self-reported chronic dieting was much higher in girls than in boys (12.1% of all girls vs 2.1% of boys). For girls, the percentage of chronic dieters was significantly less in grades 7 and 8 (7.8%) than in grades 9 and 10 (13.5%) or grades 11 and 12 (14.3%). There were no differences among urban, suburban, or rural youth. Black girls were less likely to diet compared with white girls. Chronic dieters were more likely than other students to report maladaptive weight-loss techniques, such as self-induced vomiting (relative risk, 9.92 for girls and 9.40 for boys), laxative use (relative risk, 7.18 for girls and 11.00 for boys), ipecac use (relative risk, 8.33 for girls and 11.00 for boys), and diuretic use (relative risk, 7.30 for girls and 13.5 for boys). It is suggested that chronic dieting may serve as a screening marker for more severe eating and weight-loss behaviors.