Characteristics of adolescents' sexual partners and their association with use of condoms and other contraceptive methods.

CONTEXT: While a number of studies have examined the association between individuals' characteristics and their contraceptive use, few studies have examined the influence of partners' characteristics on individuals' contraceptive use. METHODS: Using nationally representative data from the National Longitudinal Study of Adolescent Health, multiple logistic analyses were conducted to identify associations between the demographic characteristics of adolescents' heterosexual partners and adolescents' use of condoms or other contraceptive methods. RESULTS: The partners of white and black adolescents were likely to be similar to them, while the partners of Latino adolescents and of adolescents of "other" race or ethnicity were more likely to be of a different racial or ethnic group. Differences in age between adolescents and their partners were notable in all racial and ethnic groups. As adolescents age, the characteristics of their partners become more heterogeneous. The less similar adolescents and their partners are to one another--whether because of a difference in age, grade or school--the less likely adolescents are to use condoms and other contraceptive methods. CONCLUSIONS: Many adolescents have relationships with partners whose characteristics differ from theirs and with whom they are less likely to use condoms or other contraceptive methods. This behavior is more common as adolescents grow older. To provide appropriate counseling, sexuality educators and family planning providers need to consider the ways in which adolescents' relationships change as they age and discuss with them the dynamics of relationships involving partners who differ in age or other characteristics.     

New evidence on the relationship between substance use and adolescent sexual behavior

Policymakers and the public have a clear interest in encouraging teens to delay becoming sexually active or, if they are sexually active, to use birth control. Many researchers have argued that reducing substance use among teens will accomplish both of these goals, yet work in this area has failed to control for unobservables that are potentially correlated with substance use and sexual behavior. Using a variety of estimation techniques and data from National Longitudinal Study of Adolescent Health, we estimate the effects of marijuana and alcohol use on two outcomes: the probability of being sexually active, and the probability of having sex without contraception. Our results highlight the importance of controlling for unobservables and indicate that the link between substance use and sexual behavior is much weaker than previously suggested.     

Impact of HealthWise South Africa on polydrug use and high-risk sexual behavior

This study was designed to evaluate the efficacy of the HealthWise South Africa HIV and substance abuse prevention program at impacting adolescents' polydrug use and sexual risk behaviors. HealthWise is a school-based intervention designed to promote social-emotional skills, increase knowledge and refusal skills relevant to substance use and sexual behaviors, and encourage healthy free time activities. Four intervention schools in one township near Cape Town, South Africa were matched to five comparison schools (N = 4040). The sample included equal numbers of male and female participants (Mean age = 14.0). Multiple regression was used to assess the impact of HealthWise on the outcomes of interest. Findings suggest that among virgins at baseline (beginning of eighth grade) who had sex by Wave 5 (beginning of 10th grade), HealthWise youth were less likely than comparison youth to engage in two or more risk behaviors at last sex. Additionally, HealthWise was effective at slowing the onset of frequent polydrug use among non-users at baseline and slowing the increase in this outcome among all participants. Program effects were not found for lifetime sexual activity, condomless sex refusal and past-month polydrug use. These findings suggest that HealthWise is a promising approach to HIV and substance abuse prevention.     

Reliability of adolescents' self-reported sexual behavior: a comparison of two diary methodologies.

PURPOSE: To evaluate techniques for measuring high-risk sexual behaviors by comparing the reliability and acceptability of two daily sexual behavior diary modes: a written calendar and an automated telephone interview. METHODS: This randomized controlled study included 105 sexually active female adolescents aged 15-19 years recruited from among teens seeking reproductive health care services at a family planning clinic in the San Francisco Bay Area. Participants completed a standardized sexual behavior questionnaire each day for 4 weeks. Contraceptive use by method type was recorded. Reporting differences between the two diary modes were assessed using generalized estimating equations, concordance of diary and retrospective interview responses was evaluated using kappa statistics, and contingency table analysis and Poisson regression models were constructed to examine mode acceptability. RESULTS: Respondents randomized to the telephone diary cohort reported less frequent use of barrier contraceptive methods, specifically less spermicide use (odds ratio 0.27, 95% confidence interval 0.08, 0.95), and decreasing male condom use over time, whereas reports of male condom use increased for written diary respondents (p = .007). Participant characteristics associated with diary acceptability, defined as the frequency of diary completion, were assessed and teens classified as higher risk provided fewer diary reports (p < .01). Regardless of mode completed, 65% of respondents believed the telephone diary would be preferable to the written diary for most teens. CONCLUSIONS: The automated telephone diary offered an acceptable, even preferred, methodologic alternative to the written diary calendar and elicited more accurate reporting of selected contraceptive behavior.     

Specificity of early movie effects on adolescent sexual behavior and alcohol use

Adolescents' movie sex exposure (MSE) and movie alcohol exposure (MAE) have been shown to influence later sexual behavior and drinking, respectively. No study to date, however, has tested whether these effects generalize across behaviors. This study examined the concurrent influences of early (i.e., before age 16) MSE and MAE on subsequent risky sex and alcohol use among a national sample of 1228 U.S. adolescents. Participants reported their health behaviors and movie viewing up to six times between 2003 and 2009 in telephone interviews. The Beach method was used to create a population-based estimate of each participant's MSE and MAE, which were then entered into a structural equation model (SEM) to predict lifetime risky sex and past month alcohol use at ages 18–21. For both men and women, MAE predicted alcohol use, mediated by age of initiation of heavy episodic drinking (HED) and age of sexual debut; MAE also predicted risky sex via age of sexual debut. Among men only, MSE indirectly predicted risky sex and alcohol use. Findings indicated that early exposure to risk content from movies had both specific and general effects on later risk-taking, but gender differences were evident: for men, MSE was a stronger predictor than MAE, but for women, only MAE predicted later risk behavior. These results have implications for future media research, prevention programs for adolescent sex and alcohol use, and movie ratings that can guide parents' decisions as to which movies are appropriate for their children.     

Health care service use and sexual communication: past experience and future intention of high-risk male adolescents.

High-risk male adolescents were surveyed to collect data to be used to develop strategies to enhance communication with their partners about sexually transmitted diseases (STDs). Participants were concerned about acquiring an STD from their partner, and reported an increased likelihood of communicating about STD-related issues when confidential health care was available.     

Developmental relationships between adolescent substance use and risky sexual behavior in young adulthood.

PURPOSE: To examine the developmental relationship between adolescent substance use and risky sexual behavior in young adulthood. A gender-balanced, ethnically diverse urban sample of 808 children in Seattle was surveyed at age 10 years in 1985 and followed prospectively to age 21 years in 1996. Semiparametric group-based modeling was used to determine trajectory groups of binge-drinking, cigarette smoking, marijuana use, and the use of other illicit drugs. Negative binomial regressions and logistic regressions were used to examine whether these trajectory groups predicted the number of sex partners and condom use at age 21 years. Specific forms of adolescent substance use significantly predicted risky sexual behavior at age 21 years, after other substance use and early measures of sexual behavior were controlled. Early binge-drinkers had significantly more sex partners than nonbinge-drinkers. Late onset binge-drinkers and marijuana users had significantly more sex partners and were less likely to use condoms consistently than those who did not binge drink or use marijuana. Experimenters in cigarette smoking, who did not escalate smoking, were more likely to use condoms consistently than nonsmokers. In contrast, the use of other illicit drugs in adolescence did not predict risky sexual behavior at age 21 years. The effects of adolescent substance use on risky sexual behavior at age 21 years differed for youths with developmentally different substance use trajectories in this urban sample disproportionately drawn from high crime neighborhoods. To prevent risky sexual behavior among young adults, attention should be paid to binge-drinking and marijuana use during adolescence.     

Qualitative evaluation of a promotion campaign for the use of condoms in an adolescent and youth population for the Community of Madrid

BACKGROUND: The Program for Standardizing Condom Use has been carrying out different activities to promote condom use among the teenage and young adult population since November 1998. All of these measures have revolved around a specific measure aimed at making condoms more readily available, that is, the sale of condoms to the teenage and young adult population in pharmacies at low prices. The objective of this research was to assess the results from the standpoint of the persuasive effectiveness of these measures as related to modifying unsafe practices. METHODS: The qualitative methodology employed was the customary methodology within the context of market and opinion studies, that is qualitative after-test on the bases of open interviews with pharmacists and youths. A total of 7 interviews were held with pharmacists in addition to 14 interviews with sexually active young people of both sexes within the 17-19 age range residing in unsafe areas from the standpoint of AIDS incidence. RESULTS: Two main risk factors were identified: a) The approaches taken on the part of certain sexually successful males, always within the context of casual sexual relations, of avoiding condom use for the purpose of greater sexual pleasure in view of a prior assessment of the degree of risk involved in the relations in question; the post-coital pill as an alternative means of contraception seems to be involved very often in such approaches. b) The inhibition of purchasing condoms in the pharmacy, which prevents taking due precautions and, therefore, directly gives rise to unsafe situations arising. CONCLUSIONS: The campaign in question has been assessed as being positive from the purely informative standpoint. No aspects have however been encountered which afford the poSsibility of effectively countering the main risk factor detected, the approaches taken of avoiding the use of a condom for the purpose of achieving greater sexual pleasure and the sanctioning of these practices on the part of the group. As regards this second risk factor, that of inhibition regarding purchase, no appreciable effectiveness has been noted as regards the sale of condoms at a low price in pharmacies.     

Ethnic differences and influence of perceived future certainty on adolescent and young adult sexual knowledge and attitudes

This study examined the effects of future certainty (the perceptions an individual has about how positive and certain their future is) on adolescents' and young adults' sexual knowledge and sexual attitudes. This longitudinal study measured sexual knowledge and attitudes one year after an initial measure of future certainty. Ethnic differences among these relationships were also examined for Hispanic, African American and white adolescents in an attempt to explain some of the variability in sexual risk for these ethnic groups. A total of 2900 male and 3081 female youth were drawn from the National Longitudinal Study of Adolescent Health (Add Health), and were measured on four aspects of future certainty: life certainty (e.g., life expectancy), health certainty (i.e., sexually transmitted infection risk), marriage certainty, and college certainty. Results using analysis of variance showed that white youth were less at-risk of perceiving negative and uncertain futures than their peers. Hierarchical multiple regression analyses also showed that the future certainty variables predicted sexual knowledge and permissive sexual attitudes one year later, after controlling for individual and family characteristics. However, the direction of the relationship was dependent on the type of future certainty, and not all relationships held for all three ethnic groups. The study provides important information for intervention research targeting youth who are at-risk for engaging in high risk sexual behaviours.     

Relative influences of perceived parental monitoring and perceived peer involvement on adolescent risk behaviors: an analysis of six cross-sectional data sets.

PURPOSE: To assess: (a) the relative impact of monitoring and peer involvement among six cohorts of African-American youth in their mid-adolescent years, over a decade of research in one urban area, and (b) the consistency of the impact of the two influences over time. METHODS: Baseline data were collected from six cohorts involving 1279 low income African-American youth aged 13 to 16 years involved in community based studies conducted over a decade in an urban area. Self-reported behaviors, and perceptions of parental monitoring and peer risk-involvement were assessed through structured questions. Data were analyzed by frequency distribution, one-way ANOVA, and multiple logistic regression. RESULTS: There was a rapid increase in sexual activity and substance use behaviors during mid-adolescence. Monitoring had a protective influence on substance use behaviors and sexual activity, but had no impact on condom use or drug trafficking. Peer involvement influenced all evaluated risk behaviors. The influences overall did not statistically change over time. CONCLUSIONS: Despite the marked increase in risk behaviors during mid-adolescence, monitoring and peer involvement both influenced adolescent behaviors across each cohort.     

HIV-relevant sexual behavior among a healthy inner-city heterosexual adolescent population in an endemic area of HIV

The AIDS crisis has devastated segments of the population including the gay community and those who use intravenous drugs. HIV has spread to other groups including prostitutes and those with other sexually transmitted diseases. We have been studying adolescents in a major Northeast city where there is a major HIV/AIDS epidemic. Despite high levels of AIDS related knowledge, these adolescents reported high levels of sex risk behaviors. In addition, our data suggests that even moderate alcohol or marijuana use predicts high risk sexual behaviors. These data indicate the urgent need to develop prevention strategies for the spread of HIV among inner-city youth based upon relevant predictors of risk behaviors. The coupling of HIV in inner-city populations with a high frequency of risk behaviors in adolescents demands an immediate public health response.     

Rural adolescents' help-seeking intentions for emotional problems: the influence of perceived benefits and stoicism

Objective: This study explores the factors that influence adolescents' help‐seeking intentions. Specifically, the study investigates the extent to which perceived benefits of help seeking, stoicism, gender and symptoms of psychological distress are associated with intentions to seek professional help for emotional problems. Design and setting: A cross sectional self‐report questionnaire was administered to adolescents recruited from seven high schools in rural towns in the Riverina region of New South Wales. Participants: A total of 778 adolescents were recruited. The sample included 373 male and 404 female participants between 13 and 18 years of age. Main outcome measure(s): Participants completed an anonymous self‐report questionnaire designed to measure help‐seeking intentions in the advent that they were to experience emotional problems, psychological distress symptoms, perceived benefits of help seeking and stoicism. Results: In all, 17% of male participants and 29% of female participants reported they would be likely to seek help from doctors if they were to experience emotional problems. In total, 15% of male participants and 23% of female participants reported they would be likely to seek help from other health care professionals. Multiple regression analysis suggested that adolescents are more likely to seek help from professionals if they perceive help seeking as beneficial (t = 12.91; P < 0.001). Female particpants reported that they were more likely to seek help than male participants (t = 2.69; P = 0.01). Conclusions: Findings suggest that adolescents are reluctant to seek professional help if experiencing emotional problems, because they do not believe professional help seeking is beneficial. Improving adolescents' beliefs about the benefits of professional help seeking might be a key strategy for increasing their use of professional health services to address mental health problems.     

Correlates of smokeless tobacco use in a male adolescent population.

This paper identifies the correlates of smokeless tobacco use in a sample of 1,030 males representative of 7th through 12th grade students of Dane County (Madison), Wisconsin. Variables independently associated with frequent use of smokeless tobacco were: being White; living in other than a two-parent home; performing poorly in school; smoking cigarettes; consuming beer, wine, or hard liquor; and deviant/delinquent behavior. Participation in team sports was associated with some "experimentation" with smokeless products.     

Controlling for the endogeneity of peer substance use on adolescent alcohol and tobacco use

This study examines whether the effects of peer substance use on adolescent alcohol and tobacco use are due to endogeneity of adolescents selecting their peer group. We analyzed data collected for a longitudinal analysis of a drug-use prevention programme for upper elementary school students. We used a two-step probit regression to control for the potentially endogenous explanatory variable peer substance use. Rigorous tests of endogeneity and the validity of the instrumental variables showed that controlling for the endogeneity of peer substance use to reduce bias is not worth the reduction in mean squared error in these data. Peer substance use has a positive and significant effect on adolescent substance use for both drinking and smoking. These results imply that peer influence is empirically more important than peer selection (endogeneity) in our sample of adolescents in grades 6–9. Living in a single-parent family was by far the strongest predictor of adolescent drinking and smoking. © 1998 John Wiley & Sons, Ltd.     

Getting a high response rate of sexual behavior survey among the general population in Japan: three different methods of survey on sexual behavior.

The purpose of this study was to specify the most accurate, reliable and valid technique for a general sexual behavioral survey in Japan. This pilot study was conducted to assure a high response rate and to keep respondents' privacy confidential by using an anonymous questionnaire survey technique. The sample (360 potential respondents) was selected randomly from basic resident registers in two geographically different areas. From the registries, 90 residents, aged 20 to 49 years old, were randomly selected to represent each sex from each area. The subjects were randomly assigned to three groups each having a different procedure of requesting the completion of the survey and providing the questionnaires: (1) Postal Group, (2) Telephone Group, and (3) Face-to-face Group. The survey was carried out from October 1995 to February 1996. Effective response rates for the above mentioned three groups were 69.2%, 69.2% and 55.8%, respectively. It is difficult to determine the best method when only considering the effective response rates. However, judging from our effort and expense, the mail survey is the best possible procedure and would be a reasonable method for a national sexual behavior survey.     

High school athletic participation, sexual behavior and adolescent pregnancy: a regional study.

PURPOSE: To determine whether high school athletic participation among adolescents in Western New York was associated with reduced rates of sexual behavior and pregnancy involvement. METHODS: A secondary analysis of data from the Family and Adolescent Study, a longitudinal study of a random sample of adolescents (ages 13-16 years) from 699 families living in households in Western New York. A general population sample was obtained with characteristics closely matching the census distributions in the area. Interview and survey methods provided data on athletic participation, frequency of sexual relations during the past year, and risk for pregnancy. Bivariate correlations were used to examine relationships among athletic participation, demographic and control variables, and measures of sexual behavior and pregnancy rates. Next, path analyses were done in order to test for hypothesized relationships between athletic participation, sexual behavior, and pregnancy involvement while controlling for age, race, income, family cohesion, and non-athletic forms of extracurricular activity. Variables that were significantly associated with sexual behavior and/or pregnancy involvement were presented for both sexes within the resulting multivariate models. RESULTS: Lower income and higher rates of sexual activity were associated with higher rates of pregnancy involvement for both sexes. Family cohesion was associated with lower sexual activity rates for both sexes. For girls, athletic participation was directly related to reduced frequency of sexual behavior and, indirectly, to pregnancy risk. Male athletes did not exhibit lower rates of sexual behavior and involvement with pregnancy than male non-athletes. Boys who participated in the arts, however, did report lower rates of sexual behavior and, indirectly, less involvement with pregnancy. CONCLUSIONS: Female adolescents who participated in sports were less likely than their non-athletic peers to engage in sexual activity and/or report a pregnancy. Among male adolescents, athletic participation was unrelated to sexual behavior and pregnancy involvement. Teen pregnancy prevention efforts for girls should consider utilizing sport as a strategic tool.     

Girls' schooling and the perceived threat of adolescent sexual activity in rural Malawi

Despite its relative infrequency, pregnancy is perceived by parents in rural Malawi as a leading cause of school dropout among female students. This paper explores parents' beliefs about adolescent sexual activity and schoolgirl pregnancy and how these perceptions frame parents' aspirations and expectations about girls' schooling. In-depth interviews were collected in rural Malawi from 60 adults aged 25-50 who were the parent of at least one school-aged child. Four themes emerged from the data: how expectations about sexual activity frame parental expectations about schooling duration and dropout, the loss of parental control, the negative influence of classmates and schools as unsafe environments. These concerns frame how parents consider a daughter's schooling prospects and are active even for parents whose daughters are not sexually active or who are not yet old enough to have gone through puberty. Although all parents aspire for their children to attend secondary school, these perceptions of daughters' relative risk weaken parents' motivation to encourage daughters to remain in school.     

风险决策同伴影响抵抗对青少年问题网络使用预测效应的随访研究

探讨同伴影响抵抗和风险决策对青少年问题网络使用的预测效应,为早期发现青少年网络成瘾高危人群及制定有针对性干预措施提供参考依据.方法 在广州和沈阳两市分别抽取5所和3所初中.每所初中选取初一年级全体学生为研究对象,对其随访调查12个月.采用同伴影响抵抗问卷(RPIS)和风险决策问卷(YDMQ)评价青少年同伴影响抵抗和风险决策水平及其对问题网络使用的影响.结果 基线调查2 103名青少年,问题网络使用发生率为14.3%.1 a后随访1 853名,失访率为11.9%.新发PIU为307名(16.6%),持续PIU为150名(8.1%),116名(6.3%)青少年在基线时报告PIU,1 a随访后报告无PIU(终止组).与对照组相比,PIU新发组和持续组风险决策得分高、同伴影响抵抗得分低(P值均<0.01).Logistic回归模型中控制基线PIU、性别、地区、父母文化程度和家庭经济后,风险决策高、同伴影响抵抗低均是随访PIU和新发PIU的危险性预测因素(B值分别为0.904,0.650,0.936,0.741,P值均<0.01),同伴影响抵抗高是PIU中止的保护性预测因素(B=-0.625,P<0.05).结论 同伴影响抵抗能力较差和风险决策较高的青少年可作为健康危害行为早期筛查和干预的重点人群.