Rural Mexican-American Adolescent Sexual Risk Behavior

CONTEXT: There is a need for community-based, culturally sensitive, cognitive-behavioral interventions to reduce sexual risk behavior among minority adolescents. Studies of adolescent risk and protective behaviors have focused on identifying modifiable psychosocial variables that predict differential outcomes for subsequent intervention efforts. Research has been scarce in studies of rural minority adolescent women. PURPOSE: To examine the protective and risk behaviors of these rural Mexican-American adolescent women and their relationship to physical or sexual abuse. METHODS: Mexican-American adolescent women aged 14-19 years were recruited through a rural health clinic and administered a self-report assessment for protective and risk behavior and sexual, physical, and psychological abuse. FINDINGS: Rural minority adolescent women endured high levels of psychological distress and many risk behaviors yet experienced few protective behaviors. Barriers to health care included access and confidentiality. Physically or sexually abused adolescents endured relatively greater risk and fewer protective behaviors than nonabused. CONCLUSIONS: Rural Mexican-American adolescent women may benefit from confidential identification and assessment of abuse history and risk and protective behaviors so that appropriate psychological treatment can accompany accessible medical treatment. The prevalence of risk behaviors and abuse among these women presents a need for development of behavioral interventions for risk reduction and promotion of health protective behaviors.     

Measurement of Sexual Risk Taking Among College Students

Current measures of sexual risk taking are either too narrowly focused to be used with college students or do not have adequate psychometric properties. The goal of the current study was to develop a broad and psychometrically sound measure of sexual risk taking. A total of 613 undergraduate students (302 men, 311 women) at a mid-sized Midwestern university in the U.S. were surveyed to develop and gather reliability and validity information on a new measure of sexual risk, the Sexual Risk Survey (SRS). The measure was found to be multifactorial with five factors. The measure was found to have good internal consistency and test–retest reliability. The SRS also demonstrated evidence of convergent and concurrent validity by its relationships with reported number of sexual partners and history of infidelity as well as measures of sensation seeking, sexual desire, substance use, sexual excitation and inhibition, and sexual health consequences. Social desirability was not found to be related to sexual risk taking scores and threat of sexual disclosure was only weakly related. An investigation of sex differences revealed that men reported greater intentions to engage in sexual risk behaviors and greater overall sexual risk taking behavior compared to women. The SRS provides researchers with a valid and comprehensive measure of sexual risk taking that can be used to clarify inconsistent findings in the literature and to assess outcome in programs designed to prevent and reduce sexual risk behaviors among college students.     

The Sexual Double Standard in African American Adolescent Women's Sexual Risk Reduction Socialization

ABSTRACT

This study explored the sexual double standard (SDS) (in which males are afforded more freedom and power than females in heterosexual interactions) in African American mothers' sexual messages to sons and daughters. We used a convenience sample of 129 African American adolescents, aged 14 to 17 years, and their mothers who reported SDS attitudes. Qualitative analyses revealed gender differences based on an SDS in mothers' sexual risk reduction socialization. Mothers typically took a proactive approach with sons and a neutral or prohibitive approach with daughters. Findings provide directions for socially relevant programs for African American parents, schools, and communities.     

Sexual Risk Behaviors in Adolescent Sexual Minority Males: A Systematic Review and Meta-Analysis

Although adolescent sexual minority males (ASMM) are at increased risk for human immunodeficiency virus (HIV) in the United States (US), studies that estimate sexual risk behaviors that contribute to HIV risk in ASMM are limited. We completed a systematic review and meta-analysis to compile available data and estimate the prevalence of risk behaviors in this population. We searched four databases for key terms related to ASMM, defined as males aged 14 through 19 who identified as gay or bisexual, reported sex with a male in their lifetime, and/or were considered sexual minority by the study. Articles eligible for inclusion were in English, from US studies, and reported quantitative data on sexual risk behaviors among ASMM. We extracted data from eligible articles and meta-analyzed outcomes reported in three or more articles using random effects. Of 3864 articles identified, 21 were eligible for data extraction. We meta-analyzed nine outcomes. Sixty-two percent of adolescent males self-identifying as gay or bisexual ever had sex with a male, and 67% of participants from ASMM studies recently had sex. Among ASMM who had sex in the last 6 months or were described as sexually active, 44% had condomless anal intercourse in the past 6 months, 50% did not use a condom at last sex, and 32% used alcohol or drugs at their last sexual experience. Available data indicate that sexual risk behaviors are prevalent among ASMM. We need more data to obtain estimates with better precision and generalizability. Understanding HIV risk in ASMM will assist in intervention development and evaluation, and inform behavioral mathematical models.     

Feelings About Risk and the Epidemic Diffusion of Adolescent Sexual Behavior

Rapid initiation of sexual risk behavior in adolescents can be explained by diffusion processes similar to those used to model epidemics. These models suggest that novel behavior can spread to all individuals exposed to the behavior. An alternative interpretation places greater emphasis on developmental changes in feelings toward risk behavior that can explain or limit the diffusion process. This research examined the initiation of sexual behavior in adolescents living in high-poverty urban environments. A cross-section of African American youth (N = 355) ages 9–17 living in public housing were interviewed using privacy-enhancing talking computers. Sexual risk behavior (unprotected sexual intercourse) was assessed along with perceived sexual behavior of friends and personal feelings about sexual intercourse and condom use. Age trends in both peer-group perceptions and personal feelings displayed increasing attraction toward risky sex. Diffusion processes were strongly related to sexual initiation and condom use even after controlling for changes in personal feelings. Nevertheless, feelings toward sexual risk behavior moderated the diffusion process. Adolescents with less favorable feelings toward sex were less susceptible to the diffusion of sexual initiation and those with more favorable feelings toward condoms were more likely to use them consistently. Interventions that focus on adolescents' feelings toward risk behavior can help to limit the diffusion of risk behavior in high-risk urban environments.     

Social Support and Its Effects on Adolescent Sexual Risk Taking: A Look at Vulnerable Populations in Baltimore and Johannesburg

Introduction

We seek to understand whether and how much social support affects adolescent sexual risk-taking in disadvantaged urban environments.

Using Sibling Differences to Estimate Effects of Parenting on Adolescent Sexual Risk Behaviors

PURPOSE: To estimate effects of positive and involved parenting during mid-adolescence on sexual risk behaviors (frequency of intercourse, unprotected intercourse, and number of sexual partners) during late adolescence. Substantial literature suggests that supportive family contexts and parenting behaviors may discourage adolescents from engaging in early and risky sexual activities; yet methodological limitations hamper the conclusions regarding causality and directionality that can be drawn from much existing research. To address such limitations, the current study used a variety of increasingly conservative statistical modeling techniques to help control for unobserved heterogeneity and potential bias and hence to progress toward identifying causal relationships. METHODS: Drawing from a nationally representative longitudinal survey of adolescents (NLSY97; N = 4980), this study used ordinary least squares (OLS) regression models, lagged regression models, and family fixed-effects models to assess whether parental knowledge, parent negativity, and family activities during midadolescence predicted differences in late adolescent sexual risk behaviors. RESULTS: Even after controlling for unobserved heterogeneity across individuals and across families, parenting processes significantly predicted later adolescent sexual risk behaviors. Specifically, more regular family activities and less negative and hostile parenting during mid-adolescence predicted lower sexual risk behaviors during late adolescence. CONCLUSIONS: Results concerning the buffering effects of parenting on adolescent risk behaviors help to inform prevention and intervention efforts. Through the use of more rigorous statistical methodology and large representative samples of youth, this research provides an exemplar of how survey research can seek to move closer to understanding causal processes in the exceedingly complex systems of human development.     

Risk Factors for Adolescent Sexual Behavior, Fertility, and Sexually Transmitted Diseases

Current understanding of the risk factors related to adolescent initiation of sexual activity, use of contraception, pregnancy, and STDs is examined. From recent research on adolescent fertility, findings that have particular relevance to school health or reflect new understandings of adolescent sexuality are summarized. In selected cases, prevention programs that build directly on an understanding of these risk factors are cited.     

Homelessness Experiences,Sexual Orientation,and Sexual Risk Taking Among High School Students in Los Angeles

PurposePrior studies reported homeless adolescents engage in more sexual risk than their housed peers. However, these comparisons are typically made post hoc by comparing homeless adolescent community-based samples with high school probability samples. This study uses a random sample of high school students to examine homelessness experiences and sexual risk behaviors.MethodsA supplemental survey to the Youth Risk Behavior Survey containing questions regarding homelessness and sexual health was administered to Los Angeles high school students (N = 1,839). Multivariate logistic regressions assessed the associations between demographics, past year homelessness experiences (i.e., place of nighttime residence), and being sexually active and condom use at last intercourse.ResultsHomelessness experiences consisted of staying in a shelter (10.4%), a public place (10.1%), and with a stranger (5.6%). Lesbian, gay, bisexual, transgender, questioning (LGBTQ), younger, and male adolescents were more likely to experience homelessness. LGBTQ adolescents were also more likely to report staying with a stranger and less likely to report staying in a shelter. Compared to adolescents who stayed in shelters, adolescents who stayed with strangers and in public places were more likely to engage in unprotected sex at last intercourse.ConclusionsAdolescents who report sexual activity and sexual risk taking are more likely to report homelessness experiences. With regard to sexual health, staying with strangers could be a particularly risky form of homelessness; LGBTQ and black adolescents are more likely to experience this form of homelessness. Efforts to reduce homelessness and sexual risk-taking need to recognize the specific vulnerabilities faced by these populations.     

Reducing Sexual Risk Behavior in Adolescent Girls: Results From a Randomized Controlled Trial

PurposeTeenage girls in low-income urban settings are at an elevated risk for HIV, sexually transmitted infections, and unintended pregnancies. The purpose of this study was to evaluate the efficacy of a sexual risk-reduction (SRR) intervention, supplemented with postintervention booster sessions, targeting low-income, urban, sexually active teenage girls.MethodRandomized controlled trial in which sexually active urban adolescent girls (n = 738) recruited in a midsize northeastern U.S. city were randomized to a theory-based SRR intervention or to a structurally equivalent health promotion control group. Assessments and behavioral data were collected using audio computer-assisted self-interview at baseline, then at 3, 6, and 12 months postintervention. Both interventions included four small-group sessions and two booster sessions.ResultsRelative to girls in the control group, girls receiving the SRR intervention were more likely to be sexually abstinent; if sexually active, they showed decreases in (a) total episodes of vaginal sex at all follow-ups, (b) number of unprotected vaginal sex acts at 3 and 12 months, and (c) total number of sex partners at 6 months. Medical record audits for girls recruited from a clinical setting (n = 322) documented a 50% reduction in positive pregnancy tests at 12 months.ConclusionsTheory-based behavioral interventions tailored to adolescent girls can help to reduce sexual risk and may also reduce unintended pregnancies. Although sexually active at enrollment, many of the girls receiving the intervention were more likely to practice secondary abstinence. Continued refinement of SRR interventions for girls is needed to ensure they are feasible, appealing, and effective.     

Comparison of Substance Use Typologies as Predictors of Sexual Risk Outcomes in African American Adolescent Females

African American female adolescents have a disproportionate risk of sexually transmitted infections (STIs) and other adverse sexual health outcomes. Both alcohol and marijuana use have been shown to predict sexual risk among young African American women. However, no studies have attempted to differentiate alcohol and marijuana typologies use as predictors of sexual risk outcomes exclusively among adolescents who use these substances. This study compared recent alcohol and/or marijuana use as predictors of sexual risk outcomes over 18 months among 182 African American female adolescents. African American females (14–20 years) completed interviews at baseline, 6-, 12-, and 18-months. At each assessment, pregnancy testing was conducted and self-collected vaginal swab specimens were assayed for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae using DNA amplification. Logistic subject-specific random-intercept models compared sexual risk outcomes during follow-up among adolescents who reported recent use of alcohol only (AO), marijuana only (MO) or both substances (A + M) at the baseline assessment. Relative to baseline AO use, baseline MO use predicted condom non-use at last sex. Relative to AO use, A + M use predicted pregnancy. Relative to MO use, A + M use predicted pregnancy and acquisition of T. vaginalis and any STI. The results suggest that African American female adolescents who use A + M may represent a priority population for STI, HIV, and pregnancy prevention efforts.