Regression Mixture Models of Alcohol Use and Risky Sexual Behavior Among Criminally-Involved Adolescents

Adolescents involved with the criminal justice system engage in high levels of both risky sexual behavior and alcohol use. Yet a strong relationship between the two constructs has not been consistently observed, possibly due to heterogeneity in the data. Regression mixture models were estimated in the current study to address such potential heterogeneity. Criminally-involved adolescents (n = 409) were clustered into latent classes based on patterns of the regression of two measures of risky sexual behavior, condom use and frequency of intercourse, on alcohol use. A three-class solution emerged where alcohol use did not significantly predict either risky sex outcome for approximately 25% of the sample; alcohol use negatively predicted condom use and positively predicted frequency of intercourse for approximately 38% of participants; and alcohol use negatively predicted condom use but not frequency of intercourse for the remaining participants. These classes were then distinguished on the basis of five covariates previously found to influence either alcohol use, risky sexual behavior, or the relationship between the two: self-esteem, gender, participant age, relationship status, and impulsivity/sensation-seeking. High self-esteem, being female, being older, and being in a relationship predicted membership in the class with no observed relationship of alcohol use to risky sex, relative to the other classes. Implications of the present findings are discussed in terms of exploring different risky sex and alcohol use patterns within criminally involved adolescents, as well as understanding the effectiveness of interventions for subgroups of individuals.     

Sexual Behavior,Pregnancy, and Schooling Among Young People in Urban South Africa

This study examines transitions in schooling, sexual activity, and pregnancy among adolescents and young adults in urban South Africa. Data are analyzed from the Cape Area Panel Study (CAPS), a recently collected longitudinal survey of young adults and their families in metropolitan Cape Town. We find that teen pregnancy is not entirely inconsistent with continued schooling, especially for African (black) women. More than 50 percent of African women who were pregnant at age 16 or 17 were enrolled in school the following year. We estimate probit regressions to identify the impact of individual and household characteristics on sexual debut, pregnancy, and school dropout between 2002 and 2005. We find that male and female students who performed well on a literacy and numeracy exam administered in 2002 were less likely than those who performed more poorly to become sexually active and less likely to drop out of school by 2005. Surprisingly, 14–16‐year‐olds who had completed more grades in school in 2002, conditional on their age, were more likely than those who had completed fewer grades to have become sexually active by 2005, a potential indicator of peer effects resulting from the wide dispersion in age per grade in South African schools. Overall, this study shows the importance of accounting for a measure that reflects the knowledge and skills of young people in an examination of their transitions to adulthood.     

Relations Between Trait Impulsivity,Behavioral Impulsivity,Physiological Arousal,and Risky Sexual Behavior Among Young Men

The current study examined how impulsivity-related traits (negative urgency, sensation seeking, and positive urgency), behavioral measures of risk taking and reward seeking, and physiological reactivity related to three different risky sexual behaviors in sexually active undergraduate men (N = 135). Regression analyses indicated that sensation seeking and behavioral risk-taking predicted unique variance in number of sexual partners. These findings suggest that, for young men, acquisition of new partners is associated with need for excitement and reward and willingness to take risks to meet those needs. Sensation seeking, behavioral risk-taking, and skin conductance reactivity to arousing stimuli was related to ever having engaged in sex with a stranger, indicating that, for men, willingness to have sex with a stranger is related not only to the need for excitement and risk-taking but also with innate responsiveness to arousing environmental triggers. In contrast, regression analyses indicated that young men who were impulsive in the context of negative emotions were less likely to use condoms, suggesting that emotion-based impulsivity may be an important factor in negligent prophylactic use. This study adds to the current understanding of the divergence between the correlates of risky sexual behaviors and may lend utility to the development of individualized HIV prevention programming.     

The Association Between Substance Use and Risky Sexual Behaviors Among Incarcerated Adolescents

Objectives: The purpose of this study is to examine the relationships between substance use and risky sexual behaviors and having acquired a sexually transmitted disease. Methods: The sample consisted of 210 incarcerated adolescents ages 12–17. Data were collected through 40-min interviews administered by trained research assistants. Multivariate analysis was used to examine the relationship between risky sexual behaviors and substance use when adjusting for other covariates. Results: Almost three-quarters (70.6%) of these incarcerated adolescents regularly use one or more substances. Inconsistent condom use and sex with multiple partners (>2) was reported by approximately 70% of those surveyed. The regular use of substances elevated the odds of having sex with multiple partners (OR = 11.88), exchanging sex for money or drugs (OR = 4.64), and inconsistent condom use (OR = 3.06). Conclusion: Given strong associations between risky sexual behavior and substance use, interventions should be more multiproblem-focused. Health interventions should attempt to address common causes of both behaviors. Effective interventions will be those that can successfully demonstrate effects on outcomes that measure both the intervention effects on substance use and risky sexual behaviors.     

青少年性知识态度和行为的性别差异

目的　系统分析中学生性知识、态度及行为的性别差异 ,为开展青少年性教育提供一定的参考依据。　方法对陕西省西乡县高中一、二年级的学生进行问卷调查。　结果　男生知识总分高于女生。男女生知识获得的主要途径基本相同 ,大多数来自医学书刊和生理卫生课。男生知识来源较女生广泛 ,尤其来源于录像和街头广告明显多于女生 ;女生知识来源于家庭明显多于男生。除了在中学生谈恋爱上男女均持较宽容的态度外 ,在其它性态度上 ,男生明显比女生开放。男女生性行为的发生率无显著性差异 ( 4 .5 %和 2 .4 % ) ,但其它与性有关的行为男生多于女生。　结论　青少年在性知识、态度和行为以及对性教育的需求上确实存在性别上的差异 ,在对青少年进行性教育的过程中应考虑到这一点     

Risky Sexual Practice among Street Dwelling People in Southern Ethiopia: A mixed-Method Study

BackgroundThe number of street dwellers in major cities in Ethiopia is rapidly increasing. However, their sexual health needs are not that much studied. Hence, this study assessed risky sexual practice and associated factors among street dwelling people in southern Ethiopia.MethodsA cross-sectional study employing a mixed method was conducted. For the quantitative part, a snowball sampling technique was made to conduct face-to-face interviews among 842 respondents. In-depth interviews among street dwellers and key informant interviews among stakeholders were conducted to collect qualitative data.A pre-tested and structured interviewer-administered questionnaire was used to collect data. The collected data were entered using Epidata and exported to SPSS for analysis, and qualitative data analyzed by thematic analysis approach.ResultsAbout one third, 266(31.6%), of the participants had risky sexual practices within the last year of the study period. Sexual violence such as gang rape and same-sex practice were reported qualitatively. Male respondents (AOR: 3.24, 95%CI: 2.09–5.02) had a more likelihood of risky sexual practice than females. Living in Dilla (AOR: 9.62, 95%CI: 4.49–20.58) and Wolaita Soddo towns (AOR: 14.35, 95%CI: 6.29–32.69) had also a more likelihood of risky sexual practice than living in Hawassa. Moreover, the daily average income of 21–50 Birr (AOR: 0.52, 95%CI: 0.29–0.92) had a less likelihood of risky sexual practice compared to those with a daily average income of 5–20 Birr.ConclusionRisky sexual practice among street dwelling people is found high. The Federal Ministry of Health and other stakeholders should work to cut risky sexual practices among street dwelling people.     

Forced Intercourse,Individual and Family Context,and Risky Sexual Behavior Among Adolescent Girls

PurposeThis study tested the hypothesis that individual and family factors associated with adolescent risky sexual behavior (RSB) operate differently in their relationship to RSB among girls who have experienced forced sexual intercourse (FSI), as compared to those girls who have not.MethodsData were collected from 3,863 eighth-grade girls from a larger statewide sample. Different subgroups of participants received different sets of questions, so 655–2,548 students were included in each analysis. Multilevel modeling was used to examine relationships of individual (social negotiation skills, personal safety, depression, and sensation-seeking personality) and family factors (sibling deviance, parental monitoring, and quality of family relationships) to RSB. FSI was examined as a predictor of RSB and as a moderator of the relationship between individual and family variables and sexual risk.ResultsIn the case of individual predictors, social negotiation skills were associated with lower RSB for all girls, but these skills had a stronger relationship to RSB among girls who had experienced FSI. Depression and sensation-seeking tendencies had small positive relationships to RSB for all girls. In the case of family predictors, for girls without a history of FSI, parental monitoring was associated with lower RSB. However, among girls who had experienced FSI, parental monitoring was not significantly related to RSB, but sibling deviance was associated with lower RSB.ConclusionsResults suggest that social negotiation skills and parental monitoring may warrant further attention in research and intervention.     

Understanding Sexual Coercion Among Young Adolescents: Communicative Clarity, Pressure, and Acceptance

Young people's understanding of sexual coercion was studied. Boys and girls (N = 191) were asked to rate scenarios depicting sexual situations according to their perceptions of communicative clarity, the extent of pressure being applied to one partner, and the acceptability of the behaviors. Judgments of communicative clarity were given more readily when there was consent rather than dissent to sex. Clear communication was readily inferred even when there were no cues that this was the case. Boundaries of behaviors that were defined as constituting pressure were influenced by the outcome, that is whether sex did or did not occur, as well as the behavior itself. Ratings of acceptability closely followed those of pressure, although the relationships between perceptions of pressure and acceptability were stronger for girls than for boys. In general, there were few gender differences in perceptions of pressure and communicative clarity. Of concern was the finding that, for some respondents, pressure and acceptability were unrelated to the use of either physical or emotional force.     

Sexual Behavior and Practices Among Adolescents with Disabilities in Southwest Nigeria

Adolescents with disability like other adolescents engage in sexual relationship to express their sexuality without adequate knowledge and skill to cope with the consequences of their actions. A Cross sectional study conducted among 140 adolescents with physical disabilities in four handicapped schools in Osun state South West, Nigeria had 56.4?% male and 43.6?% female respondents. Mean age is 16?years. Poor knowledge of sexuality issues such as: unprotected sex, teenage pregnancy, STIs/HIV/AIDS and contraceptive awareness were evident. Age of sexual debut is 15?years, 54.6?% had sexual intercourse, and commonest source of sexuality information is friend, while the most preferred source is parents who are ill-equipped to play their role as educators. 70.1?% had at least one boy/girlfriend and 29.9?% had multiple sexual partners at a time and engage in multiple sexual relationships. 12.8?% do not take any action to prevent pregnancy, those who do, use male condom. 24.6?% have been forced into sex by different categories of persons with different outcomes; teenage pregnancy, abortion and life birth. A few exchange sex for gifts from strangers. No access to HIV counseling and testing, hence treatment of HIV among this group is difficult and thus posing significant public health concern.     

Association of Depressive Symptoms and Substance Use With Risky Sexual Behavior and Sexually Transmitted Infections Among African American Female Adolescents Seeking Sexual Health Care

Objectives. We examined how depression and substance use interacted to predict risky sexual behavior and sexually transmitted infections (STIs) among African American female adolescents.Methods. We measured depressive symptoms, substance use, sexual behavior, and STIs in 701 African American female adolescents, aged 14 to 20 years, at baseline and at 6-month intervals for 36 months in Atlanta, Georgia (2005–2007). We used generalized estimating equation models to examine effects over the 36-month follow-up period.Results. At baseline, more than 40% of adolescents reported significant depressive symptoms; 64% also reported substance use in the 90 days before assessment. Depression was associated with recently incarcerated partner involvement, sexual sensation seeking, unprotected sex, and prevalent STIs (all P < .001). In addition, adolescents with depressive symptoms who reported any substance use (i.e., marijuana, alcohol, Ecstasy) were more likely to report incarcerated partner involvement, sexual sensation seeking, unprotected sex, and have an incident STI over the 36-month follow-up (all P < .05).Conclusions. African American female adolescents who reported depressive symptoms and substance use were more likely to engage in risky behavior and acquire incident STIs. This population might benefit from future prevention efforts targeting the intersection of depression and substance use.Although self-exploration and identity seeking are healthy aspects of adolescence, certain adverse behaviors, such as substance use and risky sexual behavior, have also been associated with adolescence. HIV, other sexually transmitted infections (STIs), and adolescent pregnancy are significant contributors to female adolescents’ morbidity and mortality in the United States.1 Adolescents aged 15 to 24 years account for approximately 50% of new STI cases each year,2 and it is estimated that 24.1% of adolescent girls aged 14 to 19 years have 1 of 5 commonly reported STIs (herpes simplex virus, trichomonaisis, chlamydia, gonorrhea, and human papilloma virus).3 Minority adolescents are disproportionately at higher risk for HIV and other STIs relative to their White counterparts.4 For example, African American adolescents account for 65% of HIV diagnoses among individuals aged 13 to 24 years.5 Among African American female adolescents aged 14 to 19 years, a national study found that 44% had at least 1 STI.3 Because African American female adolescents are at heightened risk for engaging in risky sexual behavior and STI acquisition, it is important to gain a better understanding of factors that may be associated with these risks. Two such factors are depressive symptoms and substance use or abuse.6–15In a national survey, 4.3% of youths, aged 12 to 17 years, reported current depression, and girls, regardless of age, were more likely to report depression than boys (6.7% vs 4.0%).16 In addition, 1 study found that among adolescents in mental health treatment, girls were more likely to use condoms inconsistently and were more than 9 times likely to contract an STI than were boys.17 The National Longitudinal Study of Adolescent Health found that 19.7% of African American female adolescents reported recent and chronic depressive symptoms compared with 13% among White female adolescents.18 Other studies found rates of depressive symptoms ranging from 40% to 55% among African American female adolescents.6,7,19 Previous research among African American female adolescents reported that depressive symptoms were associated with inconsistent condom use,6,10,12 multiple sexual partners,7,9,10 risky male sexual partners,6 sexual contact while high on alcohol or drugs,6,7,9,11 low frequency of sexual communication,6,7 fear of communication about condoms,6,7 self-reported previous or current STI,7,8,10 and biologically confirmed STIs.6With regards to substance use, a national survey revealed that among African American female 9th to 12th graders, 31.3% reported current alcohol use (vs 35.7% for White and 39.7% for Hispanic), 11.5% reported 5 or more drinks in a sitting (vs 21.1% for White and 22.6% for Hispanic), 27.1% reported current marijuana use (vs 18% for White and 27.4% for Hispanic), and 2.1% reported ever using Ecstasy (vs 4.6% for White and 10.1% for Hispanic).20 Another study found that approximately 27% of African American female adolescents reported having 3 or more drinks in a sitting.13 Substance use often co-occurred with sexual risk behaviors,20 placing adolescents at increased risk for less condom use. Among young African American women, substance use was associated with inconsistent condom use,13,15 sexual sensation seeking,13 multiple sexual partners,13,15 risky sexual partners,15 having sexual intercourse while high on alcohol or drugs,13 and STIs.13–15Previous studies established the relationship between depression, substance use, and risky sexual behavior, and although limited, some studies examined the longitudinal effects of depressive symptoms and substance use on sexual risk-taking among African American female adolescents.7,11–13,15 However, to our knowledge, there is scant research available on the interaction of depressive symptoms and substance use to longitudinally predict sexual risk-taking and STIs among this population. A previous study found that substance use mediated the relationship between depression and substance use, but this effect was only significant for male adolescents and not for female adolescents.8 In addition, this previous study sample included adolescents from multiple ethnicities; thus, the findings might not be applicable to African American adolescents.Because of the impact of these 2 factors on sexual risk-taking, combined with increased HIV/STI vulnerability among African American female adolescents, we aimed to expand upon the existing literature on depression, substance use, and risky sexual behavior in African American female adolescents. To advance the current knowledge and inform HIV/STI prevention efforts among this group, we examined the longitudinal effects of depression and substance use on risky sexual behavior and STI contraction, as well as the interaction between these 2 factors among a clinic-based sample of African American female adolescents over an extended period (36-month follow-up).     

Alcohol Consumption and Risky Sexual Behavior Among Persons Attending Alcohol Consumption Venues in Gaborone,Botswana

Alcohol use is a known key risk factor associated with risky sexual behavior that contributes to HIV transmission. This cross-sectional study used time location sampling to investigate alcohol use and risky sexual behaviors that occurred after ingesting alcohol among 609 patrons of alcohol venues in Gaborone, Botswana. Alcohol Use Disorders Identification Test (AUDIT) scores were categorized as low (1–7), medium (8–15), and high (16+) for analysis. Logistic regression models stratified by gender assessed the association between alcohol use and condom use at last sex after drinking alcohol. Among females, the odds of condom use during last sex after drinking alcohol were significantly lower for high compared to low AUDIT scores (AOR?=?0.17, 95 % CI 0.06–0.54). Among males, factors significantly associated with condom use at last sex after alcohol use were low levels of education (primary level compared to university and above AOR?=?0.13; 95 % CI 0.03–0.55) and beliefs that alcohol use did not increase risky sexual behaviors (AOR?=?0.26; 95 % CI 0.11–0.62). HIV prevention interventions should target females and emphasize sexual risks associated with alcohol use.     

Cell Phone Internet Access,Online Sexual Solicitation,Partner Seeking,and Sexual Risk Behavior Among Adolescents

Archives of Sexual Behavior - Online partner seeking is associated with sexual risk behavior among young adults (specifically men who have sex with men), but this association has yet to be explored...     

Age-Concordant and Age-Discordant Sexual Behavior Among Gay and Bisexual Male Adolescents

There is evidence that risks for HIV and sexually transmitted infections among adolescent females are higher for those with older male sexual partners. Yet, little empirical research has been conducted with male adolescents who engage in sexual activity with older men. In this article, we summarize in a number of ways the range of sexual activity reported by an ethnically diverse sample of 200 gay and bisexual male youth (15–22 years old) in Chicago and Miami. A general pattern of progression from oral sex with men to both receptive and insertive anal sex with men appeared to characterize the sample during their adolescence. Further, there appeared to be a high degree of “versatile” positioning among the sexually active gay and bisexual young men, in both age-discrepant and age-concordant dyads. Risk analysis revealed having primarily age-concordant partners to be a significant predictor of sexual risk behavior. HIV risk among young gay and bisexual men engaging in sexual activity with older men may occur not only within a distinct biological context from their heterosexual counterparts, but also in a social context that may not as rigidly bound to traditional assumptions about age, gender, and power. The significant associations among participants with partners who were the same age and the risk behavior measures in this analysis have implications for HIV prevention efforts.     

Everything's Better in Moderation: Young Women's Gender Role Attitudes and Risky Sexual Behavior

PurposeThis study examines the association between gender role attitudes and risky sexual behavior among young women. Previous studies have posed seemingly contradictory arguments: that either traditional attitudes or egalitarian attitudes are associated with riskier behavior.MethodsData are based on the children of the National Longitudinal Survey of Youth, representing 520 sexually active 18–19-year-old women. Propensity radius matching was used to assess differences in rates of multiple sexual partners and sex outside of a committed relationship.ResultsRelative to moderate gender role attitudes, both egalitarian gender role attitudes and traditional gender role attitudes are associated with higher rates of risky sexual behavior. Both women with egalitarian role attitudes and those with traditional role attitudes have about a 10% higher prevalence of risky behavior compared to women with more moderate gender role attitudes.ConclusionExisting, seemingly contradictory contentions about the relationship between gender role attitudes and risky sexual behavior may be more coherent than they seem. By shifting focus from risk to protection, the results suggest that moderate gender role attitudes are protective against risky sexual behavior. Future studies should investigate the causal mechanisms and intervention implications of this protective relationship.     

Food Insecurity,Substance Use,and Sexual Transmission Risk Behavior Among People Living with HIV: A Daily Level Analysis

People living with HIV in poverty have limited tangible and mental resources coupled with competing demands for these resources. Competing demands require individuals to make choices that may be beneficial to them in the short term but not in the long term. Past research has shown that food insecurity is related to sexual risk behaviors among people living with HIV. Individuals who are food insecure may sell sex in order to obtain food or lack of food may lead to a depletion of mental resources to negotiate safe sex. Substance use may also create additional constraints on these already limited resources. The current study tested the relation between food insecurity and day-level sexual risk behavior and the possible mediating role that alcohol/substance use may play. Men and women living with HIV were enrolled in a 28-day prospective study between October 2012 and April 2014 in which they completed daily text message surveys regarding their sex behaviors and substance/alcohol use in the context of sex. A total of 796 participants reported sex on 3894 days. On days in which sex occurred, baseline food insecurity was negatively associated with daily condom use. There was also a significant effect of substance use in the context of sex on the rates of change in condom use over time, and this interaction between substance use and time was a partial mediator of the relation between food insecurity and condom use. Gender did not moderate this mediation. Situation-specific alcohol and drug use should be integrated into interventions that target food insecurity and HIV prevention.     

Off-Premise Alcohol Sales Policies, Drinking, and Sexual Risk Among People Living With HIV

Drinking among HIV-positive individuals increases risks of disease progression and possibly sexual transmission. We examined whether state alcohol sales policies are associated with drinking and sexual risk among people living with HIV. In a multivariate analysis combining national survey and state policy data, we found that HIV-positive residents of states allowing liquor sales in drug and grocery stores had 70% to 88% greater odds of drinking, daily drinking, and binge drinking than did HIV-positive residents of other states. High-risk sexual activity was more prevalent in states permitting longer sales hours (7% greater odds for each additional hour). Restrictive alcohol sales policies may reduce drinking and transmission risk in HIV-positive individuals.More than 1 million people in the United States are living with HIV,¹ and about 56 000 people are newly infected each year.² Approximately one half of those who have had positive test results for HIV drink alcohol; about 1 in 6 regularly binge drinks.³ Drinking in this population is associated with poor treatment adherence,^4,5 disease progression,^6–8 and spread of the virus through risky sexual activity.^9–12Thus, reducing drinking and problem drinking among HIV-positive individuals is an important public health goal. Alcohol sales policies may be 1 tool for accomplishing this. Research has linked geographic variations in off-premise alcohol sales practices (e.g., regulations regarding the sale of alcohol in stores) to drinking and drinking problems in the general population.¹³ Other types of alcohol regulation have been linked to sexual health.^14–16 Sales policies may influence drinking and sexual activity by making purchases inconvenient or affecting where and when people drink.^17–20 We investigated (1) whether findings linking off-premise sales policies to drinking extend to those living with HIV (who have unique demographic characteristics, drinking patterns, and life circumstances) and (2) whether off-premise sales policies predict sexual risk behavior in this group.     

家庭因素对青少年婚前性行为及危险性行为的影响

目的:探索家庭因素对未婚青少年首次性行为以及危险性行为的影响。方法:采用多阶段抽样方法抽取上海市15～24岁青少年进行匿名电子问卷调查。结果:调查的6023名未婚青少年中12.7%有过性行为(男16.8%、女8.7%),其中首次性行为发生在≤18岁、首次性行为未使用安全措施、有过商业性行为、与陌生人、与吸毒人员发生过性行为的比例分别为29.9%、55.2%、4.3%、12.2%和0.5%;多因素分析结果显示,出生年代越早、与父母同住、青春期早期家庭支持评分较高及父母反对婚前性行为的青少年发生婚前性行为的可能性和危险性行为评分均较低;家庭因素对性行为的影响存在性别差异,女性性行为的发生受家庭因素的影响比较大,而男性更多地受人口学特征的影响。结论:青少年婚前性行为的发生趋于年轻化。家庭因素可能影响青少年的婚前性行为及危险性行为的发生,并且这种影响作用存在性别差异。