Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools

OBJECTIVES: This study compared sexual risk behaviors of gay, lesbian, and bisexual (GLB) and heterosexual adolescents and evaluated associations between gay-sensitive HIV instruction and risk behaviors of GLB youths. METHODS: A random sample of high school students and HIV education teachers completed surveys. Self-reported risk behaviors of heterosexual and GLB adolescents were compared, with control for student and community demographic characteristics. Sexual risk behaviors of GLB youths in schools with and without gay-sensitive instruction were compared. RESULTS: GLB youths reported more substance use, high-risk sexual behaviors, suicidal thoughts or attempts, and personal safety issues than did heterosexual youths (P < .001). Among those who were sexually active, GLB youths reported more lifetime and recent sexual partners than did heterosexuals (P < .001), and more of them reported alcohol use before last sex (P < .01) and a history of pregnancy (P < .001). GLB youths in schools with gay-sensitive instruction reported fewer sexual partners, less recent sex, and less substance use before last sex than did GLB youths in other schools (P < .05). CONCLUSIONS: The findings document increased risk behaviors among GLB youths and demonstrate the potential benefits of providing gay-sensitive HIV instruction in schools.     

School attendance,health-risk behaviors,and self-esteem in adolescents applying for working papers.

Since health-risk behaviors are often encountered in clusters among adolescents, it was hypothesized that adolescents with poor school attendance would be associated with more health-risk behaviors (e.g., substance use, violence) than those who attend school regularly. This study assessed the relationship between poor school attendance and health-risk behaviors, and described health-risk behaviors and self-esteem among adolescents seeking employment. In this cross-sectional study, school attendance (poor vs. regular attendance) was related to health-risk behaviors by asking 122 subjects seen at a New York City Working Papers Clinic to complete both a 72-item questionnaire about their health-risk behaviors and the 58-item Coopersmith Self-Esteem School Form Inventory. Chi-square and Fisher''s Exact Tests were performed. The poor and regular attenders of school differed significantly in only 5 out of 44 items pertaining to health-risk behaviors. Self-esteem measures for the two groups did not differ from one another or from national norms. In this sample, depression "in general" (global) and "at home," but not "at school," were associated significantly with suicidal thoughts/attempts and serious past life events (e.g. family conflict, sexual abuse). There were no significant associations between depression or self-esteem and illicit substance or alcohol use. We found few associations between poor school attendance and health-risk behaviors in this sample of employment-seeking adolescents. The poor and regular attenders of school were similar in most aspects of their health-risk behaviors and self-esteem.     

Aggression, substance use, and suicidal behaviors in high school students.

OBJECTIVES. We sought to analyze the frequency and correlates of suicidal behaviors in a community sample of adolescents. METHODS. Information concerning suicidal thoughts and acts, aggressive behaviors, substance use and physical recklessness were collected with the 70-item self-report Youth Risk Behavior Survey from a statewide sample of 3764 South Carolina public high school students. RESULTS. Seventy-five percent of students reported no suicidal behaviors, 11% reported serious suicidal thoughts, 6.4% reported specific suicidal plans, 5.9% reported attempts not requiring medical care, and 1.6% reported attempts requiring medical care. All types of suicidal behaviors occurred more frequently in females than males. Odds ratios for aggressive behaviors and cigarette use were elevated across all categories of suicide behaviors, increasing in magnitude with severity of reported suicidal behavior. Substance use was associated with some but not all categories of suicidal behaviors. The relationships were most pronounced with the use of potentially more dangerous drugs. CONCLUSIONS. The results suggest that suicidal behaviors are not infrequent occurrences among adolescents and that they often coexist with other high-risk behaviors. Interventions designed to reduce suicidal behaviors should simultaneously address coexisting high-risk behaviors.     

Predictors of suicidal ideation among high school students by gender in South Korea

The purpose of this study was to examine the evidence to determine if there are gender differences in suicidal ideation of adolescents. This study examined the main effect of risk factors from 5 domains and protective factors from 1 domain in relation to suicidal ideation by gender and identified the most important predictors of suicidal ideation for males (N = 654) and females (N = 658). This study was a cross-sectional survey, and data were collected through self-report questionnaires. In the univariate analysis, especially, risk factors from behavioral variables and psychosocial-environmental variables appeared to be gender skewed. For males, all behavioral variables were predictive of suicidal ideation. For the females, unlike the males, Wang-tta or victim of bullying behavior and sexual orientation as behavioral variables were predictive of suicidal ideation. For males, parental divorce and parental alcohol abuse as psychosocial-environmental variables were predictive of suicidal ideation. For the females, again unlike for the males, all the psychosocial-environmental variables were not predictive of suicidal ideation. The most important predictors of suicidal ideation for males as a result of the multivariate analysis were history of suicidal attempt, depression, hostility, smoking, parental alcohol abuse, communication with friends, and self-esteem. The most important predictors of suicidal ideation for females as a result of the multivariate analysis were depression, hostility, sexual orientation, and self-esteem. These results would indicate that an effective suicide screening and prevention program for adolescents should consider gender differences.     

Self-reported abuse history and adolescent problem behaviors. I. Antisocial and suicidal behaviors.

PURPOSE: To examine the associations of self-reported abuse and sexual molestation with self-reported antisocial behavior and suicidal ideation/behavior in a general population of adolescents. METHODS: We used a stratified cluster sampling procedure with replacement to sample 4790 students in Washington State public schools in Grades 8, 10, and 12. Students were asked in a self-administered questionnaire whether they had ever been abused by an adult and whether they had ever been sexually molested. They were also asked about antisocial behavior and suicidal ideation and behavior in the past year. We conducted polytomous logistic regressions, controlling for gender and grade, using Software for the Statistical Analysis of Correlated Data (SUDAAN). RESULTS: Reported abuse history was associated with antisocial behavior and with suicidal ideation and behavior. The associations were stronger for abuse and molestation than for nonsexual abuse or molestation alone, and stronger at higher levels of severity (e.g., suicide attempts vs. suicidal thoughts). For example, adjusted odds ratios and 95% confidence intervals (in parentheses) for abuse and molestation were 4.4 (3.1-6.2) for suicidal thoughts, 6.8 (4.4-10.4) for suicide plan, 12.0 (7.9-18.4) for noninjurious suicide attempt, and 47.1 (23.3-95.3) for injurious suicide attempt. For abuse alone, these figures were 2.3 (1.7-3.2), 3.1 (2.1-4.6), 5.1 (3.3-7.8), and 11.8 (4.4-31.9), respectively. CONCLUSIONS: Efforts to reduce antisocial behavior and suicidal ideation/behavior in adolescence, particularly early or severe manifestations of the behaviors, should consider the possible role of a history of maltreatment, especially the possibility of sexual abuse.     

Situational runaway adolescents. A study on risk factors from a Turkish sample

Drawing on a sample of 726 non-clinical adolescents (aged 17-18 years) from high schools in Ankara, Turkey, this paper primarily aims to identify the risk factors related to situational run away behavior. This study was based on an ecological risk factors model and tried to discover the associations for runaways. Run away behavior is one of the problematic behaviors very commonly seen among Turkish adolescents. Regression analyses revealed that predictors for runaway behavior differed due to gender; while, delinquency, sexual intercourse, substance use, parental separation and suicidal ideation were the significant predictors for girl adolescent runaway behaviors, while lack of parental support and depression were the significant predictors for boy adolescent runaway behavior.     

Suicidal ideation and associated factors among school-going adolescents in Thailand

The aim of this study was to estimate the prevalence and identify associations between suicidal ideation and indicators of psychosocial distress and social-environmental factors in Thai adolescents. Using data from the Thailand Global School-Based Student Health Survey (GSHS) 2008, we assessed the prevalence of suicidal ideation and its associated factors among adolescents (N = 2,758). Overall the prevalence of suicidal ideation in the past 12 months was 8.8% (9.9% males and 7.7% females). Variables influenced the suicidal ideation in multivariable analysis were sadness (Odds Ratio = OR: 6.03; 95% Confidence Interval = CI (3.00-12.14), lack of parental attachment (OR = 2.26, CI = 1.09-4.67), current alcohol use (OR = 2.32, 1.21-4.44), and ever having had sexual intercourse (OR = 4.16, CI = 3.40-7.68). Psychosocial, health-risk behaviours and lack of protective factors appear to effect suicidal ideation in this youth population.     

The Clustering of Risk Behaviors Among Caribbean Youth

Objective: To examine the relationships among risk behaviors for Caribbean youth; and to determine the correlations between initiation of sexual activity and other risk behaviors. Methods: The associations between cigarette smoking, alcohol and marijuana use, early initiation of sexual intercourse, involvement in violence and delinquency were examined using odds ratios on data from the Caribbean Youth Health Survey (n = 15,695). Survival analysis was then used to determine the association between initiation of sexual activity and the risk behaviors. Findings: There were statistically significant relationships between all pairs of risk behaviors for both male and female adolescents. Even though more males than females had engaged in each of the behaviors, the strengths of association were higher for females. From survival analysis, initiation of sexual activity was associated with gang involvement and weapon carrying among young adolescents and even more risk behaviors among the older adolescents. Conclusion: Health compromising behaviors cluster among Caribbean youth with associations being stronger for females. Initiating sexual activity was a predictor of other risk behaviors with the likelihood increasing among older adolescents and females.     

Correlates of Sexual Risk Behaviors Among High School Students in Colorado: Analysis and Implications for School-based HIV/AIDS Programs

Objectives of this study are to examine correlates of antecedent sexual risk exposures associated with HIV/AIDS infection among adolescents participating in the 2005 Colorado Youth Behavioral Risk Survey (CYBRS), and to determine gender differences associated with these exposures since previous studies have produced mixed findings. Variables assessing these relationships were drawn from CYBRS, 2005. We used χ² to assess bivariate relationships and multinomial logistic regression to evaluate associations among dependent variables (sexual risk behaviors, age at first sex, and number of sexual partners in the past 3 months) and independent variables (in-school HIV/AIDS education, use of illegal substances, physically forced sex, and alcohol use). We found no significant effect of having received in-school HIV/AIDS education on all outcome measures. Compared with females, males were more likely to initiate sex at a relatively younger age, report unprotected sex with multiple partners, and drink alcohol before sexual intercourse. Among females, using 2 illegal substances increased the odds of early sexual debut by 12 times, while using ≥3 substances increased the same odds to 44-fold. Likewise, binge drinking was also associated with higher odds of having multiple partners. Hispanic ethnicity and physically forced sex variables were consistently associated with high risk sexual behaviors, early sexual initiation, and increased number of sexual partners. Efforts to control the HIV/AIDS epidemic among adolescents may need to focus on targeted interventions aimed at addressing gender- and racial/ethnic-specific risk exposures among this population group, including risk behaviors linked with lifetime physically forced sex. The need to re-examine the role of in-school HIV prevention programs to build adequate competencies among students, parents and community leaders to reduce risk exposures associated with HIV/AIDS infection among youth is emphasized.     

Adolescent sexual orientation and suicide risk: evidence from a national study

OBJECTIVES: Sexual orientation has been a debated risk factor for adolescent suicidality over the past 20 years. This study examined the link between sexual orientation and suicidality, using data that are nationally representative and that include other critical youth suicide risk factors. METHODS: Data from the National Longitudinal Study of Adolescent Health were examined. Survey logistic regression was used to control for sample design effects. RESULTS: There is a strong link between adolescent sexual orientation and suicidal thoughts and behaviors. The strong effect of sexual orientation on suicidal thoughts is mediated by critical youth suicide risk factors, including depression, hopelessness, alcohol abuse, recent suicide attempts by a peer or a family member, and experiences of victimization. CONCLUSIONS: The findings provide strong evidence that sexual minority youths are more likely than their peers to think about and attempt suicide.     

Health risk behaviors and associated risk and protective factors among Brazilian adolescents in Santos, Brazil.

OBJECTIVE: To describe the prevalence of health risk behaviors and identify risk and protective factors that are associated with several health risk behaviors (cigarette smoking, drug use, onset of sexual intercourse before age 15, pregnancy, gun-carrying, suicidal ideation, and suicide attempts) among adolescents in Brazil, as well as to explore gender differences. METHODS: We estimated prevalence rates, evaluated bivariate associations, and explored multivariate analyses using logistic regression on data from a 1997 survey of adolescent health among 2059 eighth- and 10(th)-grade students in Santos, Brazil. RESULTS: Youth in Santos, Brazil report high rates of gun-carrying, suicidal thoughts and attempts, sexual intercourse, and pregnancy. Factors associated with diminished involvement for nearly all health risk behaviors, for both boys and girls, included having good family relationships, and feeling liked by friends and teachers. Factors associated with increases in nearly all health risk behaviors were: gun-carrying and gun availability in the home, drug use, and sexual abuse. CONCLUSIONS: Factors that are associated with a wide range of health risk behaviors among adolescents in Brazil appear to parallel those found in industrialized countries: access to guns, substance use, and sexual abuse. Likewise, connectedness to family, school, and peers is consistently the protective factor associated with diminished risky behaviors.     

Sexual attitudes and risk-taking behaviors of high school students in Turkey

BACKGROUND: The risk of sexually transmitted diseases is high but opportunities of sexual education for adolescents are limited in Turkey. The aim of this study was to evaluate sexual attitudes and behaviors and to determine the predictors of sexual initiation among adolescents. METHODS: A questionnaire designed by the researchers was administered to 861 senior year high school students in their classrooms. RESULTS: The rates of masturbation and sexual intercourse and the median partner numbers among males were higher than females. The rates of having negative feelings after the first sex among females were higher than males. The rates of having sexual intercourse and the mean age at first sexual intercourse among males were similar to developed countries. However, the use of a condom at first intercourse was low. Lower academic performance and grade repetition experience among males and cigarette smoking among both gender groups were related to having sexual intercourse. CONCLUSIONS: This is one of the first studies about sexual risk-taking behaviors among high school students in Turkey. Differences found between gender groups regarding attitudes and behaviors reflect the social structure in Turkey. These findings may be helpful in producing effective solutions for improving education and preventive health care.     

广东省高中和大学生强迫性交经历与健康危险行为的关系研究

目的分析广东省高中及大学生强迫性交的发生情况以及其与健康危险行为发生的关系,为制订干预计划和措施提供依据。方法采用多阶段整群抽样的方法随机抽取广东3个大城市、5个中小城市、13个县／区共21个监测点,每个监测点随机抽取重点高中、普通高中、中专／职业技术学校各1所;另外,城市监测点增加l所大学,每所学校各年级随机抽取1～2个班整群参加调查。调查采用统一设计的问卷,收集被调查者个人及家庭基本情况、个人性行为情况以及其他健康危险行为情况。采用PearsonХ^2检验及多因素logistic回归分析强迫性交与健康危险行为发生的关系。结果该次调查共回收有效问卷15173份,调查对象中男生7375人、女生7798人,强迫性交发生总人数为314人,强迫性交总发生率为2．1％,男、女生强迫性交发生率分别为2．9％、1．3％,男生高于女生（P〈0．01）;按学习阶段分析,高中生、大学生的强迫性交的发生率分别为2．1％、1．9％（P〉0．05）。多因素logistic回归分析结果显示,无论男、女,与未发生过强迫性交者相比,发生过强迫性交者更有可能发生以下行为：过去30d吸烟日子里每天吸烟超过5支（OR男=2．59,OR女=3．42）、过去7d网络成瘾（OR男=1．60,OR女=2．04）以及过去12个月曾自杀（OR男=2．08,OR女=3．42）。另外,分析结果发现男生发生过强迫性交者更有可能发生过去30d曾经重度饮酒（OR男=1．75）、过去12个月参与过打架及曾做过自杀计划（OR男分别为1．83、4．18）以及过去7d玩游戏机成瘾（OR男=1．67）;而女生发生过强迫性交者更有可能发生过去12个月内至少曾经1次醉酒（OR＋=2．18）以及物质滥用行为（OR女=3．13）。结论强迫性交经历与伤害、物质及精神成瘾行为的发生有关。发生过强迫性交的青少年是这些健康危险行为发生的高危人群,应该及早开展行为和心理干预,防止健康危险行为发生。     

Relationship of sexual orientation to substance use, suicidal ideation, suicide attempts, and other factors in a population of homeless adolescents.

PURPOSE: To explore the relationship of sexual orientation and gender to four sets of factors: (a) family history, (b) incarceration, (c) substance use, and (d) depression and suicide, in a population of homeless adolescents. METHODS: A sample of homeless adolescents was recruited in Portland, Oregon and assessed using semi-structured interviews at baseline, three months and six months. A total of 532 youths (216 females and 316 males) provided data on sexual orientation and other variables. Heterosexual (n = 391) and non-heterosexual youths (n = 141) were compared on all sets of factors, primarily using logistic regressions. RESULTS: 44.9% of females identified as lesbian or bisexual, while only 13.9% of males identified as gay or bisexual. Gay, lesbian, bisexual, and "unsure" (GLBU) youths were less likely to have been in foster care or arrested, but were more likely to have spent time in a locked mental health treatment facility. More than one-third of all participants reported use of injection drugs. GLBU youths were more likely to have recently used amphetamines and to have injected drugs, however, gay-bisexual males were less likely to have recently used marijuana. GLBU status was associated with recent measures of depression and suicidal ideation, but not with lifetime measures. Associations of sexual orientation with several lifetime measures were different than with prospective measures, demonstrating the limitations of using lifetime measures rather than recent or prospective measures. CONCLUSIONS: This population of homeless adolescents appears to be higher in its high rate of injection drug use and the large proportion of females who identify as lesbian or bisexual than found in other studies. The high rates of depression and suicidal ideation, especially among GLBU youth, are of great concern.     

Early sexual initiation and subsequent sex-related risks among urban minority youth: the reach for health study.

CONTEXT: Since the 1980s, the age at which U.S. teenagers, especially minority youth, begin having sex has decreased. There is limited information on the relationship between early sexual initiation and subsequent risky sexual behaviors. METHODS: A sample of 1,287 urban minority adolescents completed three surveys in seventh and eighth grade, and 970 completed a follow-up in 10th grade. Logistic regression was used to test the effects of timing of initiation on 10th-grade sexual behaviors and risks, adjusting for gender, ethnicity and age. RESULTS: At baseline, 31% of males and 8% of females reported sexual initiation; by the 10th grade, these figures were 66% and 52%, respectively. Recent intercourse among males increased from 20% at baseline to 39% in eighth grade; 54% reported recent sex and 6% had made a partner pregnant by 10th grade. Among females, recent intercourse tripled from baseline to eighth grade (5% to 15%); 42% reported recent sex and 12% had been pregnant by grade 10. Early initiators had an increased likelihood of having had multiple sex partners, been involved in a pregnancy, forced a partner to have sex, had frequent intercourse and had sex while drunk or high. There were significant gender differences for all outcomes except frequency of intercourse and being drunk or high during sex. CONCLUSIONS: Minority adolescents who initiate sexual activity early engage in behaviors that place them at high risk for negative health outcomes. It is important to involve parents and schools in prevention efforts that address sexual initiation in early adolescence and that target youth who continue to place themselves and their partners at risk.     

565名大学生儿童期性虐待经历回顾性调查

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