Long-term influence of sexual norms and attitudes on timing of sexual initiation among urban minority youth

This study assessed whether sexual norms and attitudes expressed during early adolescence by minority youth from economically disadvantaged urban areas produce a sustained influence on the timing of sexual initiation. African American and Latino youth attending three middle schools were enrolled in the Reach for Health study in seventh grade and followed from an average age of 12.2 to 16.1 years. Some 849 respondents answered the question, "Have you ever had sexual intercourse" at four time points: fall seventh, spring seventh, spring eighth, and spring 10th grade. Culturally tailored scales assessed sex norms and outcome expectancies, sexual responsibility, and refusal attitudes at fall seventh grade. Influence of these norms and attitudes in early adolescence on timing of first reported sexual intercourse was examined using ANOVA controlling for gender. At fall seventh grade, 30.7% of boys and 7.7% of girls reported sexual intercourse; by spring 10th grade, the figures were 74.8% and 56.4%, respectively. Those reporting greater peer involvement in sex and more positive sex outcome expectancies were more likely to have initiated sex by fall seventh grade. Through 10th grade, the higher the scores on peer norms (f = 41.08, p < .0001) and outcome expectancies (f = 5.87, p = .002) at entry into seventh grade, the earlier the timing of initiation. Higher scores on sex responsibility at baseline were associated with delayed sexual intercourse (f = 7.36, p < .001), as are refusal attitudes (f = 15.62, p < .0001). Despite significant gender differences in timing of initiation and mean scale scores, these relationships were similar for males and females. Findings suggest the importance of addressing sexual norms and attitudes of minority youth in interventions to delay early sexual initiation in urban environments where this risk is high. Given their sustained influence on timing of sexual initiation, such interventions must begin prior to middle school and continue through mid-adolescence, years when early sexual experience can lead to negative health and social outcomes.     

Early alcohol initiation and subsequent sexual and alcohol risk behaviors among urban youths

OBJECTIVES: We examined relations between early alcohol use and subsequent alcohol and sexual risk behaviors among urban adolescents. METHODS: A total of 1034 African American and Hispanic youths completed surveys assessing alcohol and sexual behaviors at 7th and 10th grade. After we controlled for early sexual initiation, we examined relations between early drinking and subsequent alcohol and sexual behaviors. RESULTS: Early drinking was associated with alcohol and sexual risks through mid-adolescence. Early drinkers were more likely to report subsequent alcohol problems, unprotected sexual intercourse, multiple partners, being drunk or high during sexual intercourse, and pregnancy. Among females, early drinking was also related to sexual initiation and recent sexual intercourse. CONCLUSIONS: Prevention programs should address combined risks of early alcohol use and sexual intercourse, especially where levels of HIV and other sexually transmitted infections are elevated.     

Long-term reductions in sexual initiation and sexual activity among urban middle schoolers in the reach for health service learning program.

PURPOSE: To evaluate the sustained effectiveness of a middle school service learning intervention on reducing sexual initiation and recent sex among urban African-American and Latino adolescents from 7th grade through the 10th grade. METHODS: During the fall of seventh grade and again in eighth grade, students were randomly assigned by classroom to participate either in community youth service (CYS) or not (controls). Service learning is an educational strategy that couples meaningful service in the community with classroom instruction. Students in both intervention and control conditions received classroom health lessons. Surveys were conducted at seventh grade baseline and at the end of 10th grade, approximately 2 years after intervention. Self-reported sexual behaviors of youths who had participated in CYS were compared with those of controls receiving classroom curriculum alone (n = 195). RESULTS: CYS participants were significantly less likely than controls to report sexual initiation (2 years CYS, odds ratio [OR] = 0.32; 1 year, OR = 0.49) as well as recent sex (2 years CYS, OR = 0.39; 1 year CYS, OR = 0.48). Among those who were virgins at seventh grade, 80% of males in the curriculum-only condition had initiated sex, compared with 61.5% who received 1 year of CYS, and 50% who received 2 years. Among females, the figures were 65.2%, 48.3%, and 39.6%, respectively. CONCLUSION: A service learning intervention that combines community involvement with health instruction can have a long-term benefit by reducing sexual risk taking among urban adolescents.     

How to reach sexual minority youth in the health care setting: the teens offer guidance.

PURPOSE: To explore factors sexual minority youth believe make them feel safe in a health care setting. METHODS: Participants in three urban programs serving lesbian/gay/bisexual/transgendered and questioning (LGBTQ) youth engaged in a four-stage process to generate, prioritize, and explain their own ideas. In Stage III, 94 youth, aged 14 to 23 years, completed a survey comprised of the 34 highest rated items generated in earlier stages. Using a Likert scale, they answered, "How important are each of the following ideas in making you feel safe as an LGBTQ youth when you go for health care?" In Stage IV, youth discussed the results in focus groups. The Marginal Homogeneity Test divided the items into priority ranks and the Kruskal-Wallis test explored subgroup differences in item ratings. RESULTS: The 34 items were divided into six ranks. Five items shared the top rank: the clinician maintaining privacy, demonstrating cleanliness, offering respect, being well-educated, and being honest. The second rank was shared by the following: the clinician not talking down to patients, being a good listener, not downplaying patients' fears, being professional, holding a nonjudgmental stance of the LGBTQ lifestyle, and not assuming every LGBTQ youth has HIV. Interspersed among other ranks were items specific to the needs of sexual minority youth: the clinician not assuming LGBTQ sexual behavior was painful or dangerous; the clinician being educated about the gay lifestyle; clinician sensitivity to the needs of same-sex partners; staff sensitivity to the needs of closeted youth; having a choice of an LGBTQ provider; and the clinician not assuming heterosexuality. Youth who had not publicly disclosed their sexuality rated health information being offered in a private place higher (p =.01). CONCLUSIONS: LGBTQ youth value the same clinician characteristics desired by all adolescents: privacy, cleanliness, honesty, respect, competency, and a nonjudgmental stance. They clearly describe what attracts them (e.g., clinicians educated about their lifestyle) and what offends them (e.g., equating their sexuality with HIV). Clinicians need to achieve and convey a higher comfort level in addressing the special needs of sexual minority youth.     

Evaluating methamphetamine use and risks of injection initiation among street youth: the ARYS study

Many Canadian cities are experiencing ongoing infectious disease and overdose epidemics among injection drug users (IDU). These health concerns have recently been exacerbated by the increasing availability and use of methamphetamine. The challenges of reducing health-related harms among IDU have led to an increased recognition that strategies to prevent initiation into injection drug use must receive renewed focus. In an effort to better explore the factors that may protect against or facilitate entry into injection drug use, the At Risk Youth Study (ARYS) has recently been initiated in Vancouver, Canada. The local setting is unique due to the significant infrastructure that has been put in place to reduce HIV transmission among active IDU. The ARYS study will seek to examine the impact of these programs, if any, on non-injection drug users. In addition, Vancouver has been the site of widespread use of methamphetamine in general and has seen a substantial increase in the use of crystal methamphetamine among street youth. Hence, the ARYS cohort is well positioned to examine the harms associated with methamphetamine use, including its potential role in facilitating initiation into injection drug use. This paper provides some background on the epidemiology of illicit drug use among street youth in North America and outlines the methodology of ARYS, a prospective cohort study of street youth in Vancouver, Canada.     

Exploring gender and sexual minority status among street-involved youth

This article compares heterosexual and sexual minority street-involved youth across a number of sociodemographic, risk and current mental health, victimization and delinquency measures with a particular focus on gender differences. The sample consists of 147 homeless and street-involved young men and women aged 16–21 years in Toronto, Ontario, Canada. Bivariate analyses indicate that many of the differences between the heterosexual and sexual minority youth are driven by differences among the young women. Multivariate analyses are then used to test for interactions between gender and sexual minority status alongside controls. The results suggest that gender, sexuality and street involvement intersect to shape outcomes in more complex ways than are acknowledged by the notion of accumulating or multiplying disadvantage common in the literature. The article concludes with a discussion focused on providing a more nuanced view of the experience of youth homelessness at the intersection of gender and sexuality.     

A comparative study of interventions for delaying the initiation of sexual intercourse among Latino and black youth

CONTEXT: Latino and black adolescents are disproportionately affected by STDs, including HIV, and unintended pregnancies. Few parent‐based interventions have targeted these youth, focused on early adolescence and had high participation rates. METHODS: Between 2003 and 2009, a randomized clinical trial was conducted with 2,016 Latino and black mother‐adolescent dyads in New York City. Adolescents were eligible if they were in grade 6 or 7. Dyads were assigned to one of three conditions: a parent‐based intervention, Families Talking Together (FTT); an adolescent‐only intervention, Making a Difference! (MAD); or a combined FTT+MAD intervention. Respondents completed questionnaires at baseline and 12 months later. Single‐degree‐of‐freedom contrasts and logistic regression analysis were used to evaluate differences in outcomes by intervention. RESULTS: The proportion of youth who reported ever having engaged in vaginal intercourse increased over the study period by eight percentage points among those in the MAD group, five points in the FTT group and three points in the combined group; the differences among these increases were not statistically significant. Adolescents in the two FTT groups were significantly more likely than those in the MAD group to indicate that their mother had talked to them about not having intercourse (79% vs. 68%). They also scored higher than youth in the MAD group on measures of communication and perceived maternal attributes, and lower on activities that might lead to risky behaviors. CONCLUSIONS : The proportions of adolescents who initiated intercourse during the study period were not significantly different across groups, implying that the interventions were comparable. Findings suggest that FTT may have led to improved parenting behaviors.     

Perceived racial/ethnic discrimination,problem behaviors,and mental health among minority urban youth

Objectives. We examined perceived frequency and intensity of racial/ethnic discrimination and associations with high-risk behaviors/conditions among adolescents.

Design. With surveys from 2490 racial/ethnic minority adolescents primarily with low socioeconomic status, we used regression analysis to examine associations between racial/ethnic discrimination and behavioral health outcomes (alcohol use, marijuana use, physical aggression, delinquency, victimization, depression, suicidal ideation, and sexual behaviors).

Results. Most adolescents (73%) experienced racial/ethnic discrimination and 42% of experiences were ‘somewhat-’ or ‘very disturbing.’ Adolescents reporting frequent and disturbing racial/ethnic discrimination were at increased risk of all measured behaviors, except alcohol and marijuana use. Adolescents who experienced any racial/ethnic discrimination were at increased risk for victimization and depression. Regardless of intensity, adolescents who experienced racial/ethnic discrimination at least occasionally were more likely to report greater physical aggression, delinquency, suicidal ideation, younger age at first oral sex, unprotected sex during last intercourse, and more lifetime sexual partners.

Conclusion. Most adolescents had experienced racial/ethnic discrimination due to their race/ethnicity. Even occasional experiences of racial/ethnic discrimination likely contribute to maladaptive behavioral and mental health outcomes among adolescents. Prevention and coping strategies are important targets for intervention.     

Health care seeking among urban minority adolescent girls: the crisis at sexual debut

PURPOSE: We wanted to explore the context of help seeking for reproductive and nonreproductive health concerns by urban adolescent girls. METHODS: We undertook a qualitative study using in-depth interviews of African American and Latina girls (n = 22) aged 13 to 19 years attending public high schools in the Bronx, NY. RESULTS: Before the onset of sexual activity, most girls meet health needs within the context of the family, relying heavily on mothers for health care and advice. Many new needs and concerns emerge at sexual debut. Key factors modulating girls' ability to address their health needs and concerns include (1) the strategy of selective disclosure of information perceived to be harmful to close family relationships or threaten privacy; (2) the desire for personalized care, modeled on the emotional and physical care received from mother; and (3) relationships with physicians that vary in quality, ranging from distant relationships focused on providing information to close continuity relationships. Core values shaping these processes include privacy, a close relationship with the mother, and a perception of sexual activity as dangerous. No girl was able to meet her specific reproductive health needs within the mother-daughter relationship. Some find nonmaternal sources of personalized health care and advice for reproductive health needs, but many do not. CONCLUSIONS: Adolescent girls attempt to meet reproductive health needs within a context shaped by values of privacy and close mother-daughter relationships. Difficulty balancing these values often results in inadequate support and care.     

Lifting the curtain on the conditions of sexual initiation among youth in Ethiopia

PurposeDeriving accurate estimates of the level of sexual coercion is challenging because of the stigma that is attached to the experience. This study examines the effectiveness of a nonverbal response-card method to reduce social desirability bias in reports of the conditions of sexual initiation among youth in southwestern Ethiopia.MethodsThe conditions surrounding sexual initiation are examined using data from a pilot survey and a final survey of youth aged 13–24 years. Half of the respondents in each survey were randomly assigned to a nonverbal response-card method for sensitive questions on sexual attitudes and behavior, and the other half of the respondents were assigned to a control group that provided verbal responses. Responses for the two groups to questions regarding the conditions of sexual initiation are compared.ResultsRespondents who used the nonverbal response card were more likely to report pressure from friends or a partner, having sex for money or another gain, and rape as conditions of sexual initiation than those who provided verbal responses. Among sexually experienced youth, 29.3% of respondents who used the card method reported some form of coercion during sexual initiation compared with 19.4% of respondents who gave verbal responses.ConclusionsThe nonverbal response card provides an effective method for reducing social desirability bias when soliciting responses to sensitive questions in the context of an interviewer-administered survey. The analysis also suggests that coerced sexual initiation is underreported by youth in interviewer-administered surveys that use conventional verbal responses.     

Sexual identities and lifestyles among non-heterosexual urban Chiang Mai youth: implications for health

Using quantitative and qualitative data we explore perspectives on and experiences of sexual lifestyles and relationships among more than 1750 young people aged 17–20 years who reside in urban Chiang Mai, Thailand. We focus on respondents' representations and understandings of their sexual/gender identities derived mainly from in-depth interviews and focus group discussions, supplemented with observations and field notes. Our results show that while many young Thais described themselves as heterosexual women or men, others described themselves as gay, kathoey, tom, dii, bisexual or something else. The terms gay, kathoey, tom and dii are commonly used by these Thais to denote a range of sexual/gender identities relating to persons who are sexually or romantically attracted to the same sex. We use case studies to illustrate the distinctive characterisations, sexual lifestyles and relationships of each of these identities, together with possible health implications.