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.     

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.     

家庭因素对青少年婚前性行为及危险性行为的影响

目的:探索家庭因素对未婚青少年首次性行为以及危险性行为的影响。方法:采用多阶段抽样方法抽取上海市15～24岁青少年进行匿名电子问卷调查。结果:调查的6023名未婚青少年中12.7%有过性行为(男16.8%、女8.7%),其中首次性行为发生在≤18岁、首次性行为未使用安全措施、有过商业性行为、与陌生人、与吸毒人员发生过性行为的比例分别为29.9%、55.2%、4.3%、12.2%和0.5%;多因素分析结果显示,出生年代越早、与父母同住、青春期早期家庭支持评分较高及父母反对婚前性行为的青少年发生婚前性行为的可能性和危险性行为评分均较低;家庭因素对性行为的影响存在性别差异,女性性行为的发生受家庭因素的影响比较大,而男性更多地受人口学特征的影响。结论:青少年婚前性行为的发生趋于年轻化。家庭因素可能影响青少年的婚前性行为及危险性行为的发生,并且这种影响作用存在性别差异。     

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.     

Disentangling Adolescent Pathways of Sexual Risk Taking

Using data from the National Longitudinal Survey of Youth, the authors aimed to describe the pathways of risk within sexual risk taking, alcohol use, and delinquency, and then identify how the trajectory of sexual risk is linked to alcohol use and delinquency. Risk trajectories were measured with adolescents aged 15–24 years (N = 1,778). Using Latent Class Growth Analyses (LCGA), models indicated that the majority of adolescents engaged in sexual risk and alcohol use. In joint trajectory analyses, LCGA revealed six risk taking classes: sex and alcohol, moderate risk taking, joint risk taking, moderate alcohol, alcohol risk, and alcohol and delinquency experimentation. Editors’ Strategic Implications: School administrators and curriculum designers should pay attention to the study’s findings with respect to the need for prevention programs to target early adolescents and integrate prevention messages about alcohol use and sexual risk taking.     

Childhood Behavior Problems and Adolescent Sexual Risk Behavior: Familial Confounding in the Child and Adolescent Twin Study in Sweden (CATSS)

ObjectivePrevious studies have found associations between childhood behavior problems and adolescent sexual risk behavior. Using a quasi-experimental approach, we examined the extent to which this association may be due to between-family differences (i.e., unmeasured familial confounds) not adequately explored in prior research.MethodsWe used data from a longitudinal, population-based cohort of young twins in Sweden (first assessment: age 9 or 12 years; second assessment: age 15; n = 2,388). We explored the nature of the association between symptom scores for attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) at age 9 or 12 and the likelihood of having had sexual intercourse and number of sexual partners by age 15. Two-level mixed-effects models were used to estimate the effect of symptom score on each outcome after controlling for potential unmeasured familial confounds.ResultsHigher ADHD, ODD, and CD scores were associated with significantly increased likelihood of sexual intercourse by age 15. Higher ADHD and ODD scores were also associated with increased number of sexual partners. After controlling for unmeasured familial confounds, however, behavior problems were no longer significantly associated with either outcome.ConclusionThe association between childhood behavior problems and sexual risk behaviors may be due to characteristics shared within families. Hence, prevention strategies aimed at reducing these behaviors might need to address broader risk factors that contribute to both behavior problems and a greater likelihood of sexual risk behavior.     

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.     

A Longitudinal Study of Sexual Risk Behavior Among the Adolescent Children of HIV-Positive and HIV-Negative Drug-Abusing Fathers

PurposeThis is a longitudinal study of the precursors of sexual risk behavior among a cohort of adolescent children of HIV-positive and HIV-negative drug-abusing or drug-dependent fathers.MethodsIndividual structured interviews were administered to 296 drug-abusing or drug-dependent fathers, 43% of whom were HIV positive, and an adolescent child of each father (mean age = 16.3 years; SD = 2.8). Adolescents were reinterviewed approximately 1 year later, at Time 2.ResultsStructural equation modeling showed multiple direct and indirect pathways from psychosocial factors to adolescent sexual risk behavior (sexually active, number of sexual partners, and frequency of condom use). Greater paternal drug addiction and infection with HIV/AIDS, and the youth's perception of environmental hostility (discrimination and victimization), were both related to increased adolescent maladjustment and substance use. Greater paternal drug addiction and infection with HIV/AIDS also were associated with a weaker father–child mutual attachment, which was linked with increased adolescent maladjustment and substance use. Greater perceived environmental hostility (discrimination and victimization), a weak father–child relationship, and greater adolescent maladjustment and substance use had direct pathways to adolescent sexual risk behavior.ConclusionsFindings suggest complex interrelationships among paternal, environmental, social, personal, and substance use factors as longitudinal predictors of sexual risk behavior in children whose fathers abuse or are dependent upon drugs. The importance of perceived environmental hostility, the father–child relationship, and adolescent maladjustment and substance use may have implications for public policy as well as prevention and treatment programs.     

A Multidimensional Model of Sexual Health and Sexual and Prevention Behavior Among Adolescent Women

PurposeSexual health refers a state of lifespan well-being related to sexuality. Among young people, sexual health has multiple dimensions, including the positive developmental contributions of sexuality, as well as the acquisition of skills pertinent to avoiding adverse sexual outcomes such as unintended pregnancy and sexually transmitted infections (STIs). Existing efforts to understand sexual health, however, have yet to empirically operationalize a multi-dimensional model of sexual health and to evaluate its association to different sexual/prevention behaviors.MethodsSexual health dimensions and sexual/prevention behaviors were drawn from a larger longitudinal cohort study of sexual relationships among adolescent women (N = 387, 14–17 years). Second order latent variable modeling (AMOS/19.0) evaluated the relationship between sexual health and dimensions and analyzed the effect of sexual health to sexual/prevention outcomes.ResultsAll first order latent variables were significant indicators of sexual health (β: 0.192 – 0.874, all p < .001). Greater sexual health was significantly associated with sexual abstinence, as well as with more frequent non-coital and vaginal sex, condom use at last sex, a higher proportion of condom-protected events, use of hormonal or other methods of pregnancy control and absence of STI. All models showed good fit.ConclusionsSexual health is an empirically coherent structure, in which the totality of its dimensions is significantly linked to a wide range of outcomes, including sexual abstinence, condom use and absence of STI. This means that, regardless of a young person's experiences, sexual health is an important construct for promoting positive sexual development and for primary prevention.     

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.     

Family Mediators of Acculturation and Adolescent Sexual Behavior Among Latino Youth

The present study develops and evaluates a theoretical framework of mediators of the relationship between acculturation and adolescent sexual behavior. Four hundred Latino mother–adolescent dyads from the Bronx, New York were interviewed. The study explored the relationship between intentions to have sexual intercourse and explanatory variables such as adolescent romantic relationship status and partner preferences, maternal approval of dating, adolescent perceptions of maternal approval of dating, and maternal and adolescent levels of familismo and acculturation. Findings revealed complex dynamics between acculturation and adolescent sexual behavior. Protective and risk-inducing associations were observed, with important gender differences operating for boys and girls. Implications for the development of applied prevention programs are discussed.     

Male Adolescent Sexual Behavior, The Forgotten Partner: A Review

It is encouraging that after years of focusing attention on the female's ability and responsibility to manage her reproductive behavior, the male is finally beginning to receive notice and attention. Ironically, before the widespread use of the Pill and the IUD, men and male birth control methods played an important role in family planning. Even today, reliance on vasectomies, the condom and withdrawal account for 25% of the contraceptive use among couples and trend statistics point to an increased interest among selected populations in the use of barrier methods that require partner cooperation for effective use. Yet, most small scale and nationwide knowledge, attitudes and practice (KAP) studies focus on the female, particularly the teen-age female. With the exception of fragmentary survey data, pertinent information about male adolescent sexual activity is virtually nonexistent. The growing consensus among researchers and planners is that it is now crucial to research the forgotten partner--the adolescent male.     

Levels of Change in Adolescent Sexual Behavior in Three Asian Cities

Considerable change in the romantic and sexual behaviors of Asian young people may be occurring as traditionally Confucian societies modernize and increase outside contacts. This study explores the dimensions and context of this change in three sites at different stages in the process of modernization: Hanoi (early), Shanghai (intermediate), and Taipei (later stage). A survey was conducted of 17,016 males and females aged 15–24 in urban and rural settings in three large metropolitan areas. Survival analysis and Cox regressions were performed to explore ages of respondents at key transitions and the significance of differences between two age cohorts: 15–19 and 20–24. Significant differences are found in levels of sexual and other transitions, even within the narrow time span reflected by the age cohorts. The findings highlight the differential impact of modernization on adolescent sexual behavior as traditional societies undergo social change, and they underline the importance of context in exploring youthful transitions.     

Predictors of Adolescent Sexual Behavior and Intention: A Theory-Guided Systematic Review

PurposeTo better understand why adolescents initiate sexual activity at early ages, we conducted a systematic literature review guided by eight key elements outlined in an integrative theoretical framework.MethodsUsing the matrix method for literature reviews, we extracted—from 69 published studies—statistically significant and nonsignificant findings (related to the attempted prediction/explanation of adolescents’ sexual behavior and intention) and organized them using the various integrative model elements. We also assessed these publications’ methodological quality including each study’s deployment of theory, appropriate design, and data analytic/reporting techniques.ResultsThree integrative theoretical framework elements—intention, perceived norms, and an environmental constraint variable, time home alone—emerged as stable predictors of sexual behavior outcomes in this body of literature. This analysis revealed, however, a literature that has remained rather stagnant regarding its methodological quality, over time.ConclusionsImplications for adolescent sexual health promotion practice and research are discussed.     

Assessing Reliability of Early Adolescent Girls' Reports of Romantic and Sexual Behavior

Increasing rates of HIV among urban adolescents have raised concerns about their participation in sexual risk behaviors. The accuracy of adolescents' sexual reports is critical to the assessment of risk, which may later guide the development of public policy, interventions, and education efforts. The data presented here are part of a larger study on a range of sexual behaviors and cognitions believed to be important regarding adolescent girls' sexual choices and decision-making. Our goal here was to assess the test–retest reliability of early adolescent girls' reports of their romantic and sexual experiences. This information will contribute to our limited information base regarding sexuality research with early adolescents. Fifty urban African American and Latina girls between the ages of 12 and 14 years were recruited from community settings around New York City. A battery of sexual behavior and sexual cognition measures was administered by interviewers at two time points separated by a 3-week interval. Results indicated that the girls were highly reliable in reporting their sexual experiences, especially those experiences related to age of first romantic and sexual milestone experiences.     

Demographics of Adolescent Sexual Behavior, Contraception, Pregnancy, and STDs

The demographics of fertility-related behavior of youth ages 10-18 are reviewed. Data were collected from U.S. vital statistics, and birth rates, contraceptive use, sexual behavior, number and types of sexual partners, patterns of sexual initiation and sexual intercourse, and sexually transmitted diseases were examined. Despite data limitations, the demographic profile of adolescent sexual intercourse is striking. Age clearly is the single most important predictor of sexual debut.     

Understanding the Link Between Adolescent Same-Gender Contact and Unintended Pregnancy: The Role of Early Adversity and Sexual Risk Behavior

Past research suggests an apparent paradox: Women who engage in same-gender sexual behavior show higher rates of unintended pregnancy than women with exclusive other-gender sexual behavior. Such women also have disproportionate rates of early adversity (both harshness, such as abuse or neglect, and unpredictability, such as father absence). We used the Add Health data (N?=?5,617 cisgender women) to examine the relative contributions of early adversity, adolescent same-gender sexual behavior, and general sexual risk behavior to women’s risks for adult unintended pregnancy. Women who engaged in adolescent same-gender sexual behavior were more likely to report childhood adversity, and both childhood adversity and adolescent same-gender behavior made independent contributions to subsequent rates of unintended pregnancy. The association between adolescent same-gender sexual behavior and adult unintended pregnancy was partially attributable to the fact that women with adolescent same-gender sexual behavior engaged in greater sexual risk behavior more broadly. These findings suggest that same-gender sexual behavior in adolescence may relate to a broader set of sexual risk behaviors that augment future risk for unintended pregnancy, independent of sexual identity. We draw on life history theory to explain this pattern of results and suggest directions for future research.

     

Parenting Practices and Adolescent Risk Behavior: Rules on Smoking and Drinking Also Predict Cannabis Use and Early Sexual Debut

Previous research has provided considerable support for idea that increased parental support and control are strong determinants of lower prevalence levels of adolescent risk behavior. Much less is known on the association between specific parenting practices, such as concrete rules with respect to smoking and drinking and adolescent risk behavior. The present paper examined whether such concrete parental rules (1) have an effect on the targeted behaviors and (2) predict other, frequently co-occurring, risk behaviors (i.e., cannabis use and early sexual intercourse). These hypotheses were tested in a nationally representative sample of 12- to 16-year-old adolescents in the Netherlands. We found that both types of rules were associated with a lower prevalence of the targeted behaviors (i.e., smoking and drinking). In addition, independent of adolescent smoking and drinking behaviors, parental rules on smoking predicted a lower prevalence of cannabis use and early sexual intercourse, and parental rules on alcohol use also predicted a lower prevalence of early sexual intercourse. This study showed that concrete parental rule setting is more strongly related to lower levels of risk behaviors in adolescents compared to the more general parenting practices (i.e., support and control). Additionally, the effects of such rules do not only apply to the targeted behavior but extend to related behaviors as well. These findings are relevant to the public health domain and suggest that a single intervention program that addresses a limited number of concrete parenting practices, in combination with traditional support and control practices, may be effective in reducing risk behaviors in adolescence.