Adolescent males involved in pregnancy:: Associations of forced sexual contact and risk behaviors

Purpose: To determine whether sexually active adolescent males who report being the victim of forced sexual contact and engaging in health risk and problem behaviors are more likely to report getting someone pregnant.

Methods: In 1995, 4159 students in Grades 9–12 in 59 randomly selected public high schools in Massachusetts were anonymously surveyed using the Youth Risk Behavior Survey (YRBS). Data were analyzed for 824 sexually active males. Demographic variables and indicators of sexual behavior, pregnancy, violence, and suicide were assessed. Data were analyzed with multiple logistic regression.

Results: A total of 12.0% of sexually active males reported having been involved in a pregnancy. The proportion of males who reported getting a partner pregnant increased with age. Of the sample, 8.1% gave a history of having had sexual contact against their will. Of those who reported forced sexual contact, 36.4% reported having been involved in a pregnancy; of the males who did not report a history of forced sexual contact, 9.4% were involved in a pregnancy (CV = 0.23; p < 0.00001). Based on multiple logistic regression, forced sexual contact [odds ratio (OR) 3.56; 95% confidence interval (CI) 1.79–7.09], frequency of weapon carrying on school property (OR 1.39; 95% CI 1.18–1.64), number of cigarettes smoked per day (OR 1.22; 95% CI 1.08–1.38), number of sexual partners in the previous 3 months (OR 1.43; 95% CI 1.25–1.65), and condom nonuse at last intercourse (OR 1.80; 95% CI 1.06–3.02) correctly classified 89.9% of the males who were involved in a pregnancy.

Conclusion: This study highlights the association between health-risk and problem behaviors, forced sexual contact, and involvement in pregnancy among sexually active male high school students. In our analysis, a history of forced sexual contact was associated with a higher risk of high school males’ involvement in pregnancy. These results strongly suggest the importance of screening sexually active males for a history of forced sexual intercourse and health risk and problem behaviors in the effort to prevent teenage pregnancy and childbearing.     

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.     

Associations Between Adolescent Risk Behaviors and Injury: The Modifying Role of Disability

BACKGROUND:  Adolescents with disabilities are at risk for poor health outcomes including injury. The objective of this study was to examine if disability status modifies the association between risk behavior and injury among adolescents.
METHODS:  The cross-sectional Health Behavior in School-Aged Children Survey was administered to a representative sample of 7235 Canadian students (grades 6-10) in 2002. Students who reported at least 1 functional difficulty due to a health condition were classified as having a disability. Engagement in up to 6 individual risk behaviors and a summative multiple risk behavior score were considered the primary exposures. Primary outcomes included medically attended injury experienced during a 12-month period.
RESULTS:  Sixteen percent of students reported a disability. Almost all risk behaviors and all injury outcomes were more common among students with disabilities than in those without disabilities (eg, older age group's smoking: 17.5% vs 8.9%, p = <.01; medically attended injury: 67.4% vs 51.4%, p = <.01). Clear risk gradients were observed between engagement in multiple risk behavior and all injury outcomes. The association between multiple risk behavior and injury was accentuated by disability status among older students, particularly for students with disabilities who engaged in frequent multiple risk behavior (adjusted risk ratio 1.8, 95% CI: 1.6-1.9).
CONCLUSIONS:  Canadian students with disabilities who engage in risk behaviors experience higher risks for medically attended injury than their nondisabled peers who engage in those same risk behaviors. Injury prevention programs that focus on risk-taking behavior should integrate the needs of this high-risk group of adolescents in order to prevent additional disability.     

To Be Seen and Not Heard: Femininity Ideology and Adolescent Girls’ Sexual Health

This study used a feminist developmental framework to test the hypothesis that internalizing conventional ideas about femininity in two domains—inauthenticity in relationships and body objectification—is associated with diminished sexual health among adolescent girls. In this study, sexual health was conceptualized as feelings of sexual self-efficacy (i.e., a girl's conviction that she can act upon her own sexual needs in a relationship) and protection behavior (i.e., from both STIs and unwanted pregnancy). A total of 116 girls (aged 16–19) completed measures of femininity ideology, sexual self-efficacy, sexual experiences, and protection behavior. Results revealed that inauthenticity in relationships and body objectification were associated with poorer sexual self-efficacy and sexual self-efficacy, in turn, predicted less sexual experience and less use of protection. Further, the two components of femininity ideology were associated with different forms of protection. The importance of a feminist developmental framework for identifying and understanding salient dimensions of sexual health for female adolescents is discussed.     

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.     

Sexual Behaviors of Middle School Students: 2009 Youth Risk Behavior Survey Results From 16 Locations

BACKGROUND: The potential negative consequences of engaging in sexual risk behaviors at a young age are well documented. Unfortunately, there is a dearth of information about the prevalence of sexual behaviors among middle school students. This article provides an overview of the sexual risk behaviors of middle school students from 16 districts and states throughout the country, and examines these risks by demographic variables. METHODS: In 2009, 10 states and 6 districts administered the Youth Risk Behavior Survey‐Middle School and included sexual behavior questions. Data were examined using the Centers for Disease Control and Prevention's Youth Online database. Frequencies were run for 4 sexual behaviors and an HIV/AIDS education question for each location. A series of t‐tests were calculated for these 5 items by gender, age, and race for each location. RESULTS: Data show that 5–20% of sixth graders and 14–42% of eighth graders have engaged in sexual intercourse. A concerning percentage of students have also engaged in other sexual risk behaviors and many are not receiving HIV/AIDS education. Additionally, there were significant differences by gender, race, and age. CONCLUSION: Consistent with previous studies, males, minorities, and older students are more likely to engage in sexual risk behaviors. There is also variation in the percentage of students engaging in sexual behaviors across locations. Sexual risk reduction education is important for middle school youth, particularly for minorities, males and those from southern and/or larger, urban cities as those are the populations with generally higher sexual risk behaviors.     

青少年危险行为问卷信效度研究

目的编制青少年危险行为问卷（Youth Risk Behavior Survey Questionnaire,YRBS）中文版,并考察其信度与效度。方法 依据我国具体的文化特征,对美国的2009版本的青少年危险行为问卷进行改编为中文版的青少年危险行为问卷。通过分层整群抽样从2008年汶川特大地震9个极重灾区的110所学校的4～9年级的学生中纳入5 486人进行问卷调查。结果 内部一致,中文版青少年危险行为问卷总量表的Cronbach sα为0.730,10项分量表的Cronbach sα为-0.415～0.857。区分度,11个分量表与总量表分相关系数为0.288～0.641,每个分量表与各自分量表中的条目的相关系数为0.176～0.892,P均为0.000。因子分析：规则安全及暴力行为分量表均提取了2个公因子,其余的8个分量表,均提取1个公因子。内容效度即精神科医师及临床心理学家对该量表的内容进行评估,确保该量表有较好的内容效度。结论 青少年危险行为问卷在地震后幸存的青少年中具有较好的信度与效度,可作为该群体行为问题的一个较好的筛查工具,该结论仍有待进一步的验证及完善。     

School-Based Mental Health Prevention Activities for Homeless and At-Risk Youth

Children who are homeless or who live in poverty face increased exposure to risk factors. Participating in mental health prevention activities may serve as a buffer against stress for these children. Schools are an optimal setting for providing prevention services. In this paper, we describe the implementation of and results from the Empowerment Zone (EZ) project, which involved providing mental health and health prevention services to children during small group and classroom activities. The EZ Project was incorporated into character education activities for a summer school program designed to improve reading and math skills for at risk elementary school age youth. The character education program is a key component in the Baltimore City schools where character traits, such as honesty, are taught through small group and classroom activities. Teachers were trained to implement mental health prevention activities; they also reported on the quality and utility of the program, after watching activities implemented by clinicians in their classrooms. Parents also had opportunities to participate in classes, which focused on teaching discipline techniques and discussing ways to improve parent-child relationships and foster children's socioemotional development. Results were positive, supporting project activities. Future empirical research evaluating the effectiveness of mental health prevention programs delivered in schools is needed.     

Intergenerational Associations Between Parental Incarceration and Children's Sexual Risk Taking in Young Adulthood

Purpose

Research on parental incarceration and the health of offspring is relatively scarce despite studies linking childhood adverse experiences to a range of physical and mental health conditions. This study aimed to estimate the associations between parental incarceration and sexual risk outcomes (early sexual onset, inconsistent condom use, and sexually transmitted infections [STIs]) in young adulthood.

The Relationship Between Sexual Abuse and Sexual Risk Among High School Students: Findings from the 1997 Massachusetts Youth Risk Behavior Survey

Objective: To assess whether adolescents with a history of sexual abuse were more likely than those with no such history to engage in sexual risk behaviors. Methods: Data for this study were obtained through the 1997 Massachusetts Youth Risk Behavior Survey, a self-report questionnaire administered to a representative sample of 9th through 12th graders (N = 4014) to assess a variety of adolescent risk behaviors. Only sexually experienced adolescents (n = 1610; female = 779, male = 831) were included in the present study. Logistic regression models were constructed to examine the relationship of sexual abuse history to sexual risk behaviors. Adolescents were considered as having a history of sexual abuse if they reported ever having had sexual contact against their will. Results: Almost one- third of sexually experienced adolescent girls (30.2%) and one-tenth (9.3%) of adolescent boys reported a history of sexual abuse. After controlling for related demographics and risk behaviors, sexually abused female students were significantly more likely than those without such a history to have had earlier first coitus (OR = 2.2, 95%CI = 1.46–3.47), to have had three or more sex partners ever (OR = 2.5, 95%CI = 1.71–3.68), and to have been pregnant (OR = 1.9, 95%CI = 1.21–2.92). Sexually abused male students were significantly more likely than those without such a history to have ever had multiple partners (OR = 3.2, 95%CI = 1.56–6.57), to have had multiple sex partners in the past 3 months (OR = 2.9, 95%CI = 1.71–3.68), and to have engaged in sex resulting in pregnancy (OR = 3.4,95%CI = 1.53–7.34). Conclusion: Both adolescent girls and boys with a history of sexual abuse report greater sexual risk-taking than those without such a history. However, although sexual abuse is more prevalent among girls than boys, the impact of sexual abuse on sexual risk appears to be even greater for boys. Programs addressing both sexual abuse and sexual risk must be made available to all adolescents.     

Project HOPE: Altering Risk and Protective Factors Among High Risk Hispanic Youth and Their Families

Latino youth in urban centers, and more specifically those in families dealing with the challenges of recent immigration to the United States, have special sources of risk for substance abuse and related problems. Project HOPE focused on such a group: Latino seventh and eighth graders in English as a Second Language (ESL) classes at middle school sites with particularly high concentrations of Latino youth. The overriding goals of the project were: (a) to increase protective factors at the individual, family and school level that are likely to lead to reduced abuse of alcohol and other drugs; and (2) to produce actual reductions in rates of use of alcohol, cigarettes, and marijuana. This report describes the results from the third year of this project. With a general risk-protective model as the starting point, several areas of importance were identified for work with this population: (a) the centrality of the family to Latino youth; (b) the importance of cultural identification during times of rapid acculturation; (c) the need to support families in investing in the school institutions influencing their children's lives and (d) increasing the responsiveness of the school institutions to a culturally different population for which they may not be fully prepared. The result was the implementation of a multi-component intervention that addressed change at youth, family and school levels. The youth component engaged youth through three interventions: (a) a school-based prevention curriculum (12 sessions) that focused on substance abuse and on career development; (b) a peer leadership program that focused on building a positive peer culture for Latino youth through a focus on both individual development and team-building in retreats and after-school activities; and (c) a counseling, referral, and advocacy effort that provided counseling and tutoring sessions by bilingual/bicultural Student Relations Specialists (one at each site). These counselors acted as advocates for the students, and mediated with teachers and parents in order to promote school bonding. The parent component engaged the parents of these youth in two ways: (a) a parenting skills workshop (9 sessions) focused on traditional parenting skills content; and (b) an advocacy skills training component that used home visits and workshops to increase parents' ability to be advocates for their children with the school system. A school intervention aimed at increasing teachers' and administrators' sensitivities to Latino needs was planned but not implemented at the time of the report. The design of the evaluation was quasi-experimental, making use of several kinds of comparisons to strengthen causal inferences in a situation where a conventional comparison group was not feasible. Several important results emerged among the 82 youth from whom we were able to collect pre and post data. In terms of the risk/protective factors seen as intermediate outcomes, feelings of Meaninglessness in Life were reduced significantly in the total sample, and perceptions of the school climate became significantly more positive among eighth graders. In terms of ultimate outcomes, 30 day prevalence of alcohol use was reduced by 42% (p < .07). Dose-response analyses indicated that higher levels of program participation were associated with increased levels of cultural pride (p < .02) and greater school attendance (p < .08). Among the 18 Parents for whom we had pre-post data, there were significant increases in self-reported levels of school contact (p < .001), but also significant decreases in perceived parenting skills (p < .04). Project participation may have led parents to a more honest appraisal of their skills. Perhaps more striking is anecdotal evidence that Latino parents have become the most active participants in PTO activities in the two target schools in the HOPE project. In terms of implications, we conclude that a culturally appropriate multi-component intervention can bring about measurable reduction in alcohol use among high risk Latino Youth. Development of culturally appropriate materials and implementation by a culturally sensitive staff (predominantly Latino and from the same origin cultures as the target population) are valuable aspects of interventions for this target group. Building a positive peer culture, addressing cultural identification, and engaging parents to be more invested in and less intimidated by school institutions seem particularly important mediating factors for this population.     

Patterns of Sexual Risk Behavior Change Among Sexually Transmitted Infection Clinic Patients

Effective interventions to reduce sexually transmitted infection (STI) risk behaviors are most potent in the short term and are not uniformly effective for all people. The present study examined patterns of sexual behavior change among 238 men and 104 women who received risk reduction counseling in a public STI clinic and were followed for 9 months with a 1-year retrospective clinic chart abstraction for newly diagnosed STI. A two-stage, multivariate cluster analysis was performed on four risk behavior difference scores (follow-up - baseline) for 1-month, 3-month, 6-month, and 9-month follow-up frequencies of unprotected vaginal and anal intercourse. Cluster analysis identified three profile subgroups: Subgroup 1 had lower levels of risk behavior at all time points; Subgroup 2 had significant reductions in risk over time; and Subgroup 3 demonstrated significant increases in risk over time. Analyses on variables external to the cluster analysis found that the three profile subgroups differed on numbers of sex partners, substance use, sensation seeking, indicators of risk reduction motivation and behavioral skills, and contracting new STI. STI clinic patients with varying profiles of sexual behavior change were, therefore, differentiated by factors relevant to STI interventions.This revised article was published online in June 2005 with the book reviews as separate articles