An Event-Level Analysis of Condom Use as a Function of Mood,Alcohol Use,and Safer Sex Negotiations

Daily self-reports of condom-protected intercourse were analyzed as a function of emotional states, alcohol consumption, and safer sex negotiations in a sample of single, low-income Hispanic students. The sample included 15 women and 17 men who reported a minimum of four sexual episodes as well as inconsistent condom use over a 3-month self-reporting period. The analyses focused on 829 days out of 2,586 daily self-reports on which sexual intercourse was reported. Hierarchical linear modeling was used to predict condom-protected intercourse as a function of mood states, substance use, and safer sex negotiations. Safer sex negotiation was the strongest positive predictor of condom use. Contrary to expectation, unprotected intercourse was less likely to occur in episodes characterized by greater negative affect and more likely in episodes in which greater positive mood was reported. No main effect of alcohol consumption on safer sex was observed; however, an interaction between alcohol consumption and positive mood emerged, indicating that unprotected intercourse was most likely to occur when positive mood was combined with alcohol consumption. The results contradict the assumption that emotional distress predicts engagement in more risky sexual behavior and indicate that safer sex negotiations are likely to outweigh any effects of mood or alcohol consumption on subsequent condom use.     

When do online sexual fantasies become reality? The contribution of erotic chatting via the Internet to sexual risk-taking in gay and other men who have sex with men

Seeking sexual partners online is associated with sexual risk-taking among men who have sex with men (MSM), but it is not well understood how this use of the Internet is implicated in potential sexual risks. The present study explores whether fantasizing about unprotected anal intercourse (UAI) during online chatting is associated with UAI with partners met online. An online survey of 2058 MSM in France included assessments of UAI with partners met online, responses to erotic chatting about UAI, intentions to use condoms, attitudes regarding UAI, practicing UAI with casual partners, alcohol and drug use with sex and biographical characteristics. While intentions to use condoms with casual partners were high, one-third (32.1%) of respondents reported UAI with partners met online. Responding positively to online chatting about UAI was significantly associated with UAI with partners met online, controlling for intentions, attitudes, behavior and biographic characteristics. These findings suggest that, while MSM may not go online to seek UAI, some engage in online fantasizing about UAI that is associated with possible sexual risk-taking. This speaks critically to the assumption that online fantasizing has no behavioral implications, and underscores the importance of human immunodeficiency virus prevention that addresses the dynamics of online chatting.     

Condom use among high-risk adolescents: anticipation of partner disapproval and less pleasure associated with not using condoms

OBJECTIVE: We determined the association of demographic, psychosocial, and contextual factors with condom use among a large community sample of at-risk adolescents recruited from four locations in the U.S. METHODS: We enrolled 1,410 adolescents/young adults between the ages of 15 and 21 with a history of unprotected sex in the past 90 days at four study sites. Subjects completed an audio-assisted, computerized assessment that gathered information about sexual behavior and its contexts, substance use, and relevant risk and protective attitudes. RESULTS: Nearly two-thirds of adolescents did not use condoms at the time of last intercourse and adolescents reported a mean of 15.5 (median = 5) unprotected intercourse occasions in the past 90 days. Controlling for relevant demographic variables, not using condoms was associated with the perception that condoms reduce sexual pleasure, the perception that partners will not approve of condom use, and less discussion with partners about condoms. CONCLUSIONS: Even across racial/ethnic groups, gender, and geographic locations, several important correlates of adolescents' sexual risk reduction were identified. Many adolescents may feel that condoms reduce their sexual pleasure and fear partner reactions if they initiate condom use. These attitudes may be malleable through clinical and community-based interventions.     

Substance use and HIV-related sexual behaviors among US high school students: are they related?

OBJECTIVES. This study was undertaken to examine whether use of alcohol, cigarettes, marijuana, cocaine, and other illicit drugs is related to the likelihood of sexual behaviors that increase risk for human immunodeficiency virus (HIV) infection among youth. METHODS. The 1990 national Youth Risk Behavior Survey was used to collect self-reported information about a broad range of health risk behaviors from a representative sample of 11,631 high school students in the United States. RESULTS. Students who reported no substance use were least likely to report having had sexual intercourse, having had four or more sex partners, and not having used a condom at last sexual intercourse. Adjusted for age, sex, and race/ethnicity, odds ratios for each of these sexual risk behaviors were greatest among students who had used marijuana, cocaine, or other illicit drugs. Students who had used only alcohol or cigarettes had smaller but still significant increases in the likelihood of having had sexual intercourse and of having had four or more sex partners. CONCLUSIONS. HIV prevention programs for youth should recognize that substance use may be an important indicator of risk for HIV infection and acquired immunodeficiency syndrome through its association with unsafe sexual behaviors.     

The role of mother-daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: a prospective study.

PURPOSE: To prospectively examine the relationship between mother-daughter communication about sex and selected sexual risk behaviors among inner-city adolescent females. METHODS: Participants were 219 sexually experienced females, 12 to 19 years of age, recruited from an inner-city adolescent medicine clinic in Philadelphia, PA, and randomly assigned to the control group of an HIV-risk reduction intervention study. Analyses were limited to data from control group participants to avoid confounding intervention effects. Poisson regression was employed to model three self-reported sexual risk behaviors: number of male sexual partners, number of episodes of sexual intercourse, and number of episodes of unprotected intercourse. Mediation effects were evaluated using variables from the Theory of Planned Behavior. Data were analyzed using Poisson regression. RESULTS: Higher levels of mother-daughter sexual risk communication were associated with fewer episodes of sexual intercourse and unprotected intercourse at 3-month follow-up. There was evidence that the relationship of communication to unprotected intercourse was mediated by condom use self-efficacy. Mother-daughter sexual risk communication was not significantly associated with adolescents' reports of numbers of male sexual partner. CONCLUSIONS: This prospective study supports the notion that mothers who communicate with their daughters about sex can affect their daughters' sexual behaviors in positive ways. These findings lend support for the design and implementation of family-based approaches to improve parent-adolescent sexual risk communication as one means of reducing HIV-related sexual risk behaviors among inner-city adolescent females.     

Predictors of risky sexual behavior among young African American men who have sex with men

This study examined the prevalence and correlates of unprotected anal intercourse among 758 young African American men who have sex with men. A quarter of the sample reported unprotected anal intercourse in the past 3 months; nonsupportive peer norms and not carrying condoms predicted risky sexual behavior. Effective interventions are needed that promote the use of condoms by changing peer norms and encouraging carrying condoms.     

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.     

Relationship between number of sexual intercourse partners and selected health risk behaviors among public high school adolescents.

PURPOSE: To examine the relationship between number of sexual partners and selected health risk behaviors in a statewide sample of public high school students. METHODS: The Centers for Disease Control and Prevention Youth Risk Behavior Survey was used to secure usable sexual risk-taking, substance use, and violence/aggression data from 3805 respondents. Because simple polychotomous logistic regression analysis revealed a significant Race x Gender interaction, subsequent multivariate models were constructed separately for each race-gender group. Odds ratios and 95% confidence intervals was calculated from polychotomous logistic regression models for number of sexual intercourse partners and their potential risk behavior correlates. RESULTS: An increased number of sexual intercourse partners were correlated with a cluster of risk behaviors that place adolescents at risk for unintended pregnancy, human immunodeficiency virus/acquired immunodeficiency syndrome, and other sexually transmitted infections. For Black females, alcohol, tobacco, marijuana use, and dating violence behaviors were the strongest predictors of an increased number of sexual partners; white females had similar predictors with the addition of physical fighting. For white males, alcohol, tobacco, marijuana use, physical fighting, carrying weapons, and dating violence were the strongest predictors of an increased number of sexual intercourse partners. Black males had similar predictors with the addition of binge alcohol use. CONCLUSION: Prevention of adolescent sexual and other health risk behaviors calls for creative approaches in school and community settings and will require long-term intervention strategies focused on adolescent behavior changes and environmental modifications.     

Substance Use and HIV Risk Behavior among Men Who Have Sex with Men: The Role of Sexual Compulsivity

The relationship between substance use, sexual compulsivity and sexual risk behavior was assessed with a probability-based sample of men who have sex with men (MSM). Stimulant, poppers, erectile dysfunction medication (EDM), alcohol use, and sexual compulsivity were independently associated with higher odds of engaging in any serodiscordant unprotected anal intercourse (SDUAI). The association of sexual compulsivity with SDUAI was moderated by poppers and EDM use. Behavioral interventions are needed to optimize biomedical prevention of HIV among substance using MSM.     

Differences by gender and sexual experience in adolescent sexual behavior: implications for education and HIV prevention

Researchers examined individual characteristics and peer influences related to adolescents' sexual behavior, taking gender and sexual experience into account. As part of a larger, longitudinal study investigating youth health awareness, 8th, 9th, and 10th graders reported their intentions to engage in sexual activity and use condoms in the next year, the amount of pressure they felt to engage in sexual activity, and their perceptions about the number of their peers engaging in sexual activity. Findings suggest intentions to engage in sexual behavior and use condoms, feelings of pressure to have sex, and perceptions about the number of friends engaging in sexual intercourse differ by gender and sexual experience status. Implications of these findings for health and sexuality education, as well as HIV prevention programs targeted at adolescents, are discussed.     

Associations of depression, self-esteem, and substance use with sexual risk among adolescents

BACKGROUND: Adolescents are the population at highest risk for acquiring sexually transmitted diseases (STDs). Previous research has suggested that mental health problems, including depression and low self-esteem, may play an important role in the development and maintenance of sexual risk behaviors. METHODS: National Longitudinal Study of Adolescent Health data from baseline interviews of 7th-12th graders reporting sexual intercourse in the preceding year were analyzed. Using logistic regression, associations of depressive symptoms, self-esteem, and substance use with condom nonuse at last sexual intercourse and with ever having had an STD were explored separately for each gender. RESULTS: Among boys (N = 3,192), depressive symptoms were associated with an increased risk of condom nonuse at last sexual intercourse. The association between depressive symptoms and STD appeared to be mediated by alcohol and marijuana use. For girls (N = 3,391), depressive symptoms were associated with a history of STD, but not with condom nonuse. Self-esteem was not significant in any model that included depressive symptoms. CONCLUSIONS: Adolescents with depressive symptoms are at risk for not using a condom and for having an STD. Further research is needed to elucidate the relationship among depression, substance use, and sexual risk to optimize STD prevention strategies for adolescents.     

Increased High Risk Sexual Behavior After September 11 in Men Who Have Sex with Men: An Internet Survey

Numerous studies on the mental health effects of terrorist attacks have been published, with some reporting increases in smoking and drug and alcohol use. None have reported on changes in sexual behavior. To investigate the impact of the September 11 attacks on sexual and drug- and alcohol-using behaviors of men who have sex with men (MSM), an anonymous Internet survey was conducted to obtain information retrospectively on behavior during three month periods before and after the attacks. A total of 2,915 MSM from all 50 U.S. states completed the survey. Men who were exposed to the attacks were not differentially targeted for the survey since the online banner ad used to recruit did not mention September 11. Exposure to the attacks varied: 11.4% lost a friend or relative; 5% witnessed the attacks in person; and nearly all saw the attacks on television within one hour of their occurrence. Nearly equal proportions of men reported increases and decreases in the number of sex partners following September 11. Small, statistically significant increases in unprotected anal intercourse and alcohol use, but not illicit drug use, were found when behavior after September 11 was compared to that before the attacks. Men who lost a friend or relative in the attacks were significantly more likely to report unprotected anal intercourse, an increased number of sex partners, and increased alcohol use after September 11 than those who did not. Counseling about substance abuse and risky sexual behavior should be incorporated into trauma-related programs for adolescents and adults.     

Alcohol,Helping Young Adults to Have Unprotected Sex with Casual Partners: Findings from a Daily Diary Study of Alcohol Use and Sexual Behavior

PurposeTo examine the event-level association between alcohol consumption and the likelihood of unprotected sex among college-age young adults considering contextual factors of partner type and amount of alcohol consumed.MethodsA 30-day, Web-based, structured daily diary was used to collect daily reports of sexual behaviors and alcohol use from 116 sexually active young adults, yielding 2,764 diary records. Each day we assessed the prior evening's behavior regarding alcohol consumption, opportunities for sex, sexual intercourse, condom use, and contextual factors including type of sexual partner.ResultsBased on multilevel models, drinking proximal to events of sexual intercourse increased the likelihood of unprotected sex with casual but not steady partners. For women there was a positive association between number of drinks and a greater likelihood of unprotected sex with casual partners but a negative association with steady partners. Drinking during situations involving opportunities for sex with casual partners increased the likelihood of sex. For women especially, drinking more increased the likelihood of sex occurring regardless of partner type.ConclusionsFailure to assess the contextual determinants of the alcohol—unprotected sex association may result in underestimates of the magnitude of this association. These data highlight an important area for intervention with young adults: reducing alcohol-involved sexual risk behavior with casual partners, especially among women.     

Contextual factors associated with sexual behavior among Brazilian adolescents

PurposeThere are few studies about the influence of the context on sexual behavior among adolescents in developing countries, such as Brazil. Adolescent pregnancy and the high incidence of sexually transmitted disease (STDs) among Brazilian youngsters are a public health problem. The object of this study was to investigate whether factors from family and school contexts are associated with sexual behavior among Brazilian adolescents.MethodsThis study used data from 60,973 adolescent participants in the National Survey of School Health. The response variable was sexual behavior, described in three categories (never had sexual intercourse, had protected sexual intercourse, had unprotected sexual intercourse). The explanatory variables were grouped into sociodemographic characteristics, number of risk behavior factors (regular use of alcohol, smoking, and experimenting with illicit drugs), and family and school context. Variables associated with having protected and unprotected sexual relations in each context were identified by means of multinomial logistic regression. The reference was "never had sexual intercourse."ResultsApproximately one fourth of adolescents have already had sexual intercourse, most frequently boys. Among the adolescents who declared sexual initiation, the most part had their first sexual relation with age of 13 years or younger. Almost 21% did not use protection the last time they had sex. The greater the number of risk factors involved, the higher the incidence of protected and unprotected sex. In the family context, living with only one or with neither parent and low parental supervision increased the frequency of protected and unprotected sex. Never eating meals with the parents augmented the incidence of unprotected sex (odds ratio [OR], 1.60). In the school context, students from private schools were less likely to have had protected and unprotected sex (OR, 0.58 and 0.68). Not receiving instructions at school about pregnancy prevention increased the frequency of protected and unprotected sex (OR, 1.33 and 1.74, respectively).ConclusionsFamily and school context factors are associated with sexual behavior. These associations are generally stronger for unprotected sex. Information about the prevention of pregnancy and STDs/AIDS has to be disseminated very early owing to the young age of sexual initiation.     

Correlates of sexual experience among a nationally representative sample of alternative high school students

Little is known about risk and protective factors associated with sexual experience among alternative school students that might prove useful in targeting and guiding early interventions to prevent onset of sexual risk behavior. Researchers analyzed data from the national Alternative High School Youth Risk Behavior Survey. Principal components analysis identified six risk and protective factors: weapon carrying; tobacco use; cocaine, inhalant, and needle use; alcohol and marijuana use; participation in sports; and fighting. Composite variables with significant bivariate relationships to sexual experience, as well as demographic variables, were entered into a logistic regression analysis to determine independent effects of these correlates on students' sexual experience (N = 6.037). Nearly 90% of students reported having sexual intercourse. In multivariate analysis, significant demographic correlates of sexual experience included female gender (58% more likely than males to report ever having sex), African American race (2.83 times more likely than non-Hispanic Whites), and age (28% more likely with each advancing year). Attending school in a rural or suburban region corresponded to a 31% decrease and 46% decrease, respectively, in the odds of ever having sex. Weapon carrying, and cocaine, inhalant, and needle use, were associated with a 35% and 46% increase, respectively, in the odds of ever having sex. Students reporting they had ever used alcohol or marijuana, and those reporting recent fighting behavior, were 2.7 and 1.6 times more likely, respectively, to report sexual experience. Most alternative school students have had sexual intercourse, with those students engaging in substance use, weapon carrying, and fighting behaviors being at greater risk for sexual experience. Prevention programs for high-risk youth attending alternative high schools need to consider how to promote continued abstinence among the small but important minority of alternative school students not yet sexually experienced.     

Adolescent sexual behavior and associated variables

Proportionally more adolescents are having sexual intercourse and at younger ages. It has been reported that 11.6 million teens in the US between ages 13-19 years have had sexual intercourse. Many, however, do not use contraception, even though the prevalence of condom use has increased over the last ten years. The authors analyzed survey data to identify sexual activity among adolescents by grade, gender, number of partners, and contraceptive use, and to determine the association of intercourse with condom use, alcohol consumption, smoking, and AIDS/HIV education. 56.8% of 568 9th-12th grade respondents reported having had sexual intercourse: 33.5% in 9th grade, 58.9% in 10th grade, 68.5% in 11th grade, and 71.6% in 12th grade. Although more males than females reported having had sexual intercourse, no significant difference was found between males and females in each grade level on the number of lifetime sex partners or sex partners for the previous three months. 25% reported using alcohol during last sexual intercourse, 5% indicated using both alcohol and other drugs, and 22% reported that no contraception was used or that they were not sure if anything was used. Sexually active respondents were significantly more likely to consume alcohol and to smoke. The authors also found no significant difference for use of condoms between those who had AIDS/HIV education and those who had not, except that those who had AIDS/HIV education were less likely to have multiple partners. 42.5% of all sexually active respondents reported using a condom. Only 38.5% of those exposed to AIDS/HIV education in schools reported using a condom during last intercourse compared to 30% of those not exposed to such education.     

Substance use, sexual intercourse, and condom nonuse among depressed adolescents and young adults

PurposeTo examine daily- and event-level associations of substance use with occurrence of sex and condom nonuse among depressed youth.MethodsDepressed, sexually active outpatients aged 15–22 years reported alcohol use, marijuana use, and sex on a personal digital assistant for 2 weeks. If they reported sex, participants indicated partner type and condom use. Data were analyzed for participants who reported both substance use and sex events (N = 39) using generalized estimating equations. Daily-level models compared the likelihood of sex and of condom nonuse between days on which participants did or did not use substances. Event-level models examined the likelihood of sex in the 2, 6, and 12 hours after substance use and the likelihood of condom nonuse if substances were used in the preceding 2, 6, and 12 hours.ResultsParticipants reported 307 sex events (180 unprotected) and 391 substance use events on 572 days. Substance use was associated with increased odds of sex on the same day, but not after adjusting for weekend. Depressed youth were less likely to have sex within 2 hours after substance use and more likely to have sex within 12 hours after marijuana use. There was no main effect of substance use on condom nonuse; however, there was a significant interaction such that on weekdays, condom nonuse was less likely when substances were used within 6 hours before sex.ConclusionsThe findings from this small, predominantly female sample suggest that contextual factors, not intoxication, influence associations of substance use with sexual behavior in depressed youth.     

Effectiveness of abstinence-only intervention in middle school teens

OBJECTIVES: To examine effectiveness of abstinence-until-marriage curriculum on knowledge, beliefs, efficacy, intentions, and behavior. METHODS: Nonrandomized control trial involving 2069 middle school students with a 5-month follow-up. RESULTS: Intervention students reported increases in knowledge and abstinence beliefs, but decreases in intentions to have sex and to use condoms. Intervention did not influence sexual initiation or condom use; however, intervention students who had sex during the evaluation period reported fewer sexual episodes and fewer partners than did controls. CONCLUSIONS: Abstinence-until-marriage interventions can influence knowledge, beliefs, and intentions, and among sexually experienced students, may reduce the prevalence of casual sex. Reduction in condom use intentions merits further study to determine long-term implications.     

Community trauma as a predictor of sexual risk,marijuana use,and psychosocial outcomes among detained African-American female adolescents

Social determinants contribute to health disparities. Previous research has indicated that community trauma is associated with negative health outcomes. This study examined the impact of community trauma on sexual risk, marijuana use and mental health among African-American female adolescents in a juvenile detention center. One hundred and eighty-eight African-American female adolescents, aged 13–17 years, were recruited from a short-term detention facility and completed assessments on community trauma, sexual risk behavior, marijuana use, symptoms of posttraumatic stress disorder and psychosocial HIV/STD risk factors. Findings indicate that community trauma was associated with unprotected sex, having a sex partner with a correctional/juvenile justice history, sexual sensation seeking, marijuana use, affiliation with deviant peers and posttraumatic stress disorder symptoms at baseline and longitudinally. Findings reinforce the impact of community-level factors and co-occurring health issues, particularly in high-risk environments and among vulnerable populations. Structural and community-level interventions and policy-level changes may help improve access to resources and improve adolescents’ overall health and standard of living in at-risk communities.     

Predictors of sexual risk behaviors among adolescent mothers in a human immunodeficiency virus prevention program

PurposeThe purpose of this study was to determine the following: (1) whether adolescent mothers in a human immunodeficiency virus (HIV) prevention program had significantly greater perceived self-efficacy and perceived behavioral control to use condoms, and more favorable outcome expectancies and subjective norms regarding condom use than those in a health education control group, 3 months after intervention; and (2) the impact of the 3-month postintervention theoretical variables on intentions to use condoms at 3 months and sexual risk behaviors at 6 months.MethodsStructural equation modeling with latent variables was used to assess the influence of theoretical variables and treatment condition using data from 496 participants (78% Latinas, 18% African-Americans) who completed questionnaires at baseline and at 3- and 6-month follow-up evaluations.ResultsSubstantial improvements were shown by both groups, with a slight advantage for the HIV prevention group, on all theoretical variables between pretest and the follow-up evaluations. In the predictive model, the intervention group reported significantly fewer sex partners. By using intentions to use condoms as a mediator, greater self-efficacy, hedonistic beliefs, positive subjective norms, and less unprotected sex predicted intentions to use condoms, which, in turn, predicted less unprotected sex. Lower subjective norms modestly predicted multiple partners. Significant indirect paths mediated through intentions to use condoms were observed.ConclusionsThese data support a relationship among several constructs from social cognitive theory and the theory of reasoned action, and subsequent sexual risk behaviors. HIV-prevention programs for adolescent mothers should be designed to include these theoretical constructs and to address contextual factors influencing their lives.