Does sexual coercion play a role in the high-risk sexual behavior of adolescent and young adult women?

Gender role attitudes, awareness and experiences of non-consensual sex among university students in Shanghai, China

BACKGROUND

Non-consensual sex (NCS) among young people, an important subject with public health and human rights implications, was less studied in China. This study is to investigate the NCS awareness and victimization of university students in Shanghai, China and whether they were associated with adolescent gender-role attitudes.

METHODS

Gender-role attitudes, awareness and victimization of different forms of NCS were examined among 1099 undergraduates (430 males and 669 females) in four universities in Shanghai using computer-assisted self-interview approach.

RESULTS

University students held relatively egalitarian attitude to gender roles. Gender difference existed that girls desired to be more equal in social status and resource sharing while more endorsed the submissiveness for women in sexual interaction than boys. They held low vigilance on the risk of various forms of NCS, with the mean score on perception of NCS among boys (5.67) lower than that among girls (6.37). Boys who adhered to traditional gender norms were less likely to aware the nature of NCS (β = - 0.6107, p = 0.0389). Compared with boys, higher proportion of girls had been the victims of verbal harassment, unwanted touch, fondling, and penetrative sexual intercourse. Multivariable analysis revealed that girls who held more traditional gender-role attitudes were more vulnerable to physical NCS (OR = 1.41, p = 0.0558).

CONCLUSIONS

The weakening but still existing traditional gender norms had contributions in explaining the gender difference on the low vigilance of NCS and higher prevalence of victimization among university students in Shanghai, China. Interventions should be taken to challenge the traditional gender norms in individual and structural level, and promote the society to understand the nature of NCS better as well as enhance negotiation skills of adolescents and young people that prevent them from potentially risky situations or relationships.

Female Drug Offenders: HIV-Related Risk Behavior, Self-Perceptions and Public Health Implications

One-third of women entering U.S. prisons between 1986 and 1991 were drug offenders (Bureau of Justice Statistics 1993). In turn, between 1991 and 1995, the number of HIV-positive prisoners grew at about the same rate (38%) as the overall prison population (36%) (BJS 1997). This paper describes 188 drug-offending females upon admission to a state prison, with an emphasis on their self-reported HIV-related behavioral histories. We analyze the self-reported health histories, drug and sexual high-risk behaviors, and self-perceptions of risk of these women. We also examine their attitudes toward drugs and alcohol as a personal problem and toward treatment, as compared to property and violent offenders.

We find that drug-offending females have histories of multiple HIV/AIDS-related risk behaviors, yet perceive their HIV infection risk as low. Unlike women incarcerated for property or violent offenses, a significant propor tion of drug offenders with personal drug and alcohol problems is interested in participating in substance abuse treatment. These findings support our contention that correctional administrators have a narrow, yet critical, window of opportunity to provide drug and alcohol treatment, AIDS education, and self-efficacy training to these women during their few years of incarceration.

Predicting Unprotected Sex and Unplanned Pregnancy among Urban African-American Adolescent Girls Using the Theory of Gender and Power

Reproductive coercion has been hypothesized as a cause of unprotected sex and unplanned pregnancies, but research has focused on a narrow set of potential sources of reproductive coercion. We identified and evaluated eight potential sources of reproductive coercion from the Theory of Gender and Power including economic inequality between adolescent girls and their boyfriends, cohabitation, and age differences. The sample comprised sexually active African-American female adolescents, ages 15-21. At baseline (n = 715), 6 months (n = 607), and 12 months (n = 605), participants completed a 40-min interview and were tested for semen Y-chromosome with polymerase chain reaction from a self-administered vaginal swab. We predicted unprotected sex and pregnancy using multivariate regression controlling for demographics, economic factors, relationship attributes, and intervention status using a Poisson working model. Factors associated with unprotected sex included cohabitation (incidence risk ratio (IRR) 1.48, 95 % confidence interval (1.22, 1.81)), physical abuse (IRR 1.55 (1.21, 2.00)), emotional abuse (IRR 1.31 (1.06, 1.63)), and having a boyfriend as a primary source of spending money (IRR 1.18 (1.00, 1.39)). Factors associated with unplanned pregnancy 6 months later included being at least 4 years younger than the boyfriend (IRR 1.68 (1.14, 2.49)) and cohabitation (2.19 (1.35, 3.56)). Among minors, cohabitation predicted even larger risks of unprotected sex (IRR 1.93 (1.23, 3.03)) and unplanned pregnancy (3.84 (1.47, 10.0)). Adolescent cohabitation is a marker for unprotected sex and unplanned pregnancy, especially among minors. Cohabitation may have stemmed from greater commitment, but the shortage of affordable housing in urban areas could induce women to stay in relationships for housing. Pregnancy prevention interventions should attempt to delay cohabitation until adulthood and help cohabiting adolescents to find affordable housing.

Sexual victimization using latent class analysis: exploring patterns and psycho-behavioral correlates

Sexual victimization is prevalent in the United States and overrepresented among adolescents. Research typically assesses victimization on a continuum of severity and rarely examines patterns of victimization within an individual. Using latent class analysis, the present study investigated whether meaningful classes of sexual victimization could be found based on the tactic used and severity of sexual behavior. Personal characteristics and psycho-behavioral outcomes were explored as they related to victimization classes. Peer sexual coercion experiences were examined among 657 racially diverse high school and college students, and four classes were identified: non-victims (54%), manipulated and forced fondle/intercourse (27%), poly-victimization (9.5%), and forced fondling (9.5%). Sexual victimization classes were significantly characterized in regards to childhood sexual abuse, gender, and age. The poly-victimization class (i.e., verbal coercion, substance facilitated, and physical force resulting in completed intercourse) showed the greatest level of psycho-behavioral consequences with significantly lower self-esteem, higher psychological distress, and more sexual risk taking than all other classes. The manipulated and forced class also showed significantly lower self-esteem than non-victims. Findings provide important implications for understanding patterns of sexual victimization and related consequences to help target interventions more effectively.

Sexual Coercion Among Black and White Teenagers

The relations between type of sexual coercion (i.e., verbal, substance-facilitated, physical) and psychological and behavioral health were examined among Black ( n = 107) and White ( n = 114) young women. We also explored the moderating role of sexual stereotypes in understanding the relations between sexual coercion and health. Over half (53%) of the total sample reported experiencing at least one sexually coercive incident. Direct relations were found between sexual coercion type and psychological and behavioral health correlates. Specifically, for both Black and White young women, greater verbal coercion was related to increased risky sexual behaviors. Substance-facilitated sexual coercion was related to lower levels of two indicators of mental health among Black participants (i.e., psychological distress and self-esteem). Endorsement of sexual stereotypes moderated the relations between total sexual coercion experiences and self-esteem for Black young women and between total sexual coercion experiences and psychological distress for White young women.

Experience of sexual coercion and risky sexual behavior among Ugandan university students

Background

Growing worldwide evidence shows that the experience of sexual coercion is fairly prevalent among young people and is associated with risky sexual behavior thereafter. The causal mechanisms behind this are unclear but may be dependent on specific contextual determinants. Little is known about factors that could buffer the negative effects of coercion. The aim of this study was to assess the association between the experience of sexual coercion and risky sexual behavior among university students of both sexes in Uganda.

Methods

In 2005, 980 (80%) out of a total of 1,220 students enrolled in Mbarara University of Science and Technology in Uganda participated in a self-administered questionnaire covering socio-demographic and religious factors, social capital, mental health, alcohol use, and sexual behavior. A validated scale of six items was used to assess the experience of sexual coercion. Logistic regression analyses were applied to control for confounders. Potential buffering factors were analyzed by testing for effect modification.

Results

Fifty-nine percent of those who responded had previously had sexual intercourse. Among the male students 29.0%, and among the female students 33.1% reported having had some experience of sexual coercion. After controlling for age, gender, and educational level of household of origin, role of religion and trust in others sexual coercion was found to be statistically significantly associated with previously had sex (OR 1.6, 95% CI; 1.1-2.3), early sexual debut (OR 2.4, 95% CI; 1.5-3.7), as well as with having had a great number of sexual partners (OR 1.9, 95% CI; 1.2-3.0), but not with inconsistent condom use.

Scoring low on an assessment of mental health problems, reporting high trust in others, or stating that religion played a major role in one's family of origin seemed to buffer the negative effect that the experience of sexual coercion had on the likelihood of having many sexual partners.

Conclusion

The findings of this study suggest that the experience of sexual coercion is common among youth/young adults in Uganda and is subsequently associated with risky sexual behavior in both sexes. The existence of individual and contextual factors that buffer the effects mentioned was also demonstrated. In the Ugandan context, this has implications for policy formulation and the implementation of preventive strategies for combating HIV/AIDS.

Evolving prosocial and sustainable neighborhoods and communities

In this review, we examine randomized controlled trials of community interventions to affect health. The evidence supports the efficacy of community interventions for preventing tobacco, alcohol, and other drug use; several recent trials have shown the benefits of community interventions for preventing multiple problems of young people, including antisocial behavior. However, the next generation of community intervention research needs to reflect more fully the fact that most psychological and behavioral problems of humans are interrelated and result from the same environmental conditions. The evidence supports testing new comprehensive community interventions that focus on increasing nurturance in communities. Nurturing communities will be ones in which families, schools, neighborhoods, and workplaces (a) minimize biologically and socially toxic events, (b) richly reinforce prosocial behavior, and (c) foster psychological acceptance. Such interventions also have the potential to make neighborhoods more sustainable.

Reliability and validity of the sexual pressure scale

The purpose of this study was to develop the Sexual Pressure Scale (SPS) as a valid and reliable measure of gender stereotypical expectations to engage in sexual behavior. Data were collected using audio computer-assisted self-interview in 306 urban women, aged 18 to 29. Exploratory principal components analysis with varimax rotation yielded 19 items consisting of five factors: Condom Fear, Sexual Coercion, Women's Sex Role, Men Expect Sex, and Show Trust, accounting for 62% of the variance. Divergent and convergent validity were supported, respectively, by negative relationships of SPS factors with dyadic trust and positive relationships with sexual victimization and sexual risk behavior. Alpha reliability was .81; factor reliabilities ranged from .63 to .82. A valid assessment of sexual pressure can suggest the extent to which stereotypical gender expectations structure women's freedom to explore partner and condom use choices.

Trading sex: voluntary or coerced? The experiences of homeless youth

This study examined the circumstances surrounding a homeless youth's "decision" to trade sex for food, money, shelter, or drugs. Forty homeless youth in 4 Midwestern states participated in individual in-depth qualitative interviews. Interviewers recruited youth both through service agencies and through street outreach. The findings revealed that approximately 1/3 of the sample had some experience with trading sex, whether it was in the form of having traded sex, having been propositioned to trade sex but having refused, or having friends or acquaintances that had traded sex. Young people's reports indicated that they had traded sex for things they deemed necessary in order to survive (i.e., food, shelter, money, or drugs), and that they did not want to trade sex, but did so because they were desperate and lacked alternatives. Additionally, others were coerced, manipulated, or forced to do so; thus indicating that the decision to trade sex is not always voluntary. We discuss the implications of these findings in terms of cumulative effects on youths' later development. Directions for future research among this population are also discussed.

Depressive symptoms as a longitudinal predictor of sexual risk behaviors among US middle and high school students

OBJECTIVE

The purpose of this study was to examine whether depressive symptoms are predictive of subsequent sexual risk behavior in a national probability sample of US middle and high school students.

METHODS

Sexually active, unmarried, middle and high school students (n = 4152) participated in home interviews in waves I and II of the National Longitudinal Study of Adolescent Health, at an approximately 1-year interval. Associations between baseline depressive symptoms and sexual risk behaviors over the course of the following year were examined separately for boys and girls, adjusting for demographic variables, religiosity, same-sex attraction/behavior, sexual intercourse before age 10, and baseline sexual risk behavior.

RESULTS

In adjusted models, boys and girls with high depressive symptom levels at baseline were significantly more likely than those with low symptom levels to report > or = 1 of the examined sexual risk behaviors over the course of the 1-year follow-up period. For boys, high depressive symptom levels were specifically predictive of condom nonuse at last sex, birth control nonuse at last sex, and substance use at last sex; these results were similar to those of parallel analyses with a continuous depression measure. For girls, moderate depressive symptoms were associated with substance use at last sex, and no significant associations were found between high depressive symptom levels and individual sexual risk behaviors. Parallel analyses with the continuous depression measure found significant associations for condom nonuse at last sex, birth control nonuse at last sex, > or = 3 sexual partners, and any sexual risk behavior.

CONCLUSION

In this study, depressive symptoms predicted sexual risk behavior in a national sample of male and female middle and high school students over a 1-year period.

Differences in psychological health and family dysfunction by sexual victimization type in a clinical sample of African American adolescent women

We examined levels of sexual victimization among a sample of 249 14- to 19-year-old African American adolescent women. Victimization was common: 32.1% reported having been raped, 33.7% had experienced sexual coercion, and 10.8% reported an attempted rape. Only 23.4% had never been victimized. We investigated whether levels of psychological health and family dysfunction varied as a function of the type of sexual victimization. Girls who had been raped had lower levels of self-esteem and mastery and higher levels of depression compared to girls who reported no sexual victimization. Significantly higher levels of family cohesion and significantly lower levels of family support were reported by girls who had been raped versus girls who reported no sexual victimization. These findings are a starting point for future studies by providing evidence that levels of mental health and family dysfunction vary by the type of sexual victimization experienced.

Scope of HIV risk and co-occurring psychosocial health problems among young adults: violence, victimization, and substance use

PURPOSE

This study examines the co-occurrence of sexual risk with violence, victimization, risky substance use, and drug-related problems among young adults.

METHODS

Data were collected from 3392 young adults drawn from California and Oregon as youth, as part of the RAND adolescent panel study. Logistic regression analyses were used to test differences in psychosocial health problems for participants at high, moderate, and low sexual risk, overall, and by gender.

RESULTS

Nearly 80% of young adults exhibited some degree of sexual risk. Both moderate (56%) and high (22%) HIV risks were associated with multiple forms of drug use, drug-related problems, violence and victimization. Males and females had similar relative risk profiles, but females reported higher rates of victimization in the form of partner abuse and sexual coercion. Over 80% of those at high sexual risk exhibited psychosocial health problems in at least 2 other areas.

CONCLUSIONS

Sexual risk-taking is widespread among young adults and typically co-occurs with other psychosocial health problems. Interventions designed for young adults at high sexual risk should take into account their additional psychosocial problems; broad media campaigns may be useful for those at moderate risk.

Relationships of sexual imposition, dyadic trust, and sensation seeking with sexual risk behavior in young Urban women

This study was designed to examine the relationships of sexual imposition, dyadic trust, and sensation seeking with HIV sexual risk behavior in 257 young urban women. Interviews were conducted using Audio Computer-Assisted Self-Interview (ACASI). Hierarchical multiple regression revealed that sexual imposition, dyadic trust, and sensation seeking explained 18.3% of the variance in sexual risk behavior. Although sexual imposition was positively related to sexual risk, pressure to satisfy a male partner sexually was more common than physical coercion. Dyadic trust was negatively related, indicating that women engaged in sexual risk behavior with men they distrusted. Sensation seeking was positively related to sexual risk. Findings suggest the need for enhancing awareness of non-sexually imposing relationship alternatives and incorporating thrill and excitement in health promotion messages.

Sexual initiation: predictors and developmental trends

BACKGROUND

Early initiation of sexual intercourse is associated with increased risk for acquiring sexually transmitted diseases.

GOAL

To examine variables related to sexual initiation and developmental changes in the reasons why adolescent girls have sexual intercourse.

STUDY DESIGN

A longitudinal study of girls recruited from an adolescent medicine clinic was performed.

RESULTS

Logistic regression showed that girls who described their families as being expressive, having a moral-religious emphasis, providing supervision, and having greater maternal education, and who experienced menarche at an older age were older at sexual initiation. On the basis of contingency analyses, younger girls were less likely to report attraction or love, and more likely to report peers having sex as a reason for sexual intercourse at initiation. A generalized estimating equation analysis indicated that girls at younger ages are more likely to report curiosity, a grown-up feeling, partner pressure, and friends having sexual intercourse as reasons for intercourse. Girls at older ages are more likely to report a feeling of being in love, physical attraction, too excited to stop, drunk or high partner, and feeling romantic as reasons for having sexual intercourse.

CONCLUSIONS

Prevention programs should include a focus on familial characteristics and susceptibility to peer norms. They should be conducted with sensitivity to the developmental changes in intimate relationships that occur during adolescence.

Adolescent sexual risk behavior: a multi-system perspective

Adolescents are at high risk for a number of negative health consequences associated with early and unsafe sexual activity, including infection with human immunodeficiency virus, other sexually transmitted diseases, and unintended pregnancy. As a result, researchers have attempted to identify those factors that influence adolescent sexual risk behavior so that meaningful prevention and intervention programs may be developed. We propose that research efforts so far have been hampered by the adoption of models and perspectives that are narrow and do not adequately capture the complexity associated with the adolescent sexual experience. In this article, we review the recent literature (i.e., 1990-1999) pertaining to the correlates of adolescent sexual risk-taking, and organize the findings into a multisystemic perspective. Factors from the self, family, and extrafamilial systems of influence are discussed. We also consider several methodological problems that limit the literature's current scope, and consider implications of the adoption of a multisystemic framework for future research endeavors. We conclude with a discussion of the implications of the available research for practitioners working to reduce sexual risk behavior among adolescents.

Childhood sexual abuse, adolescent sexual coercion and sexually transmitted infection acquisition among homeless female adolescents

OBJECTIVE

To examine the relationship between childhood experiences of sexual abuse, sexual coercion during adolescence, and the acquisition of sexually transmitted infections (STIs) in a population of homeless adolescents.

METHOD

Homeless adolescent females (N = 216) from a northwestern United States city were recruited by street outreach workers for a longitudinal study of STI epidemiology. Baseline data on childhood abuse and recent history of sexual coercion were used to predict physiologically confirmed STI acquisition over the subsequent 6 months.

RESULTS

About 38% of all girls reported a history of childhood sexual abuse (CSA). Girls with a history of CSA were more likely to report recent sexual coercion. In turn, sexual coercion in the last three months was significantly associated with a higher number of sexual partners (but not with a greater frequency of intercourse or with lower rates of condom use). Number of sexual partners significantly predicted the future acquisition of an STI within 6 months.

CONCLUSIONS

Interventions to reduce risky sexual behaviors in homeless adolescent females may need to consider the impact of CSA, particularly on the number of sexual partners during adolescence. However, it also should be noted that engagement in intercourse often results from coercion and is not voluntary in this population.

Sexual coercion among youth and young adults in Lima, Peru

PURPOSE

To determine the prevalence and correlates of sexual coercion in young adults in Lima, Peru.

METHODS

Lifetime sexual coercion and that at first sexual experience were studied in 629 sexually active young people, drawn from representative samples of 611 adolescents and 607 young adults.

RESULTS

Almost half of the young women and a quarter of the young men in the study reported sexual coercion. In multiple logistic regression analyses, men and women who reported having been coerced at heterosexual initiation also reported more lifetime sexually transmitted diseases and a lower age at first sex than those not reporting coercion. Men who reported coercion at heterosexual initiation also reported a lower number of lifetime heterosexual partners and less sexual knowledge than men not coerced.

CONCLUSION

Experiencing heterosexual initiation as coercive appears to be a marker for a riskier sexual career for both genders and for future homosexual behavior in men.

Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women

Developed by Robert Connell, the theory of gender and power is a social structural theory based on existing philosophical writings of sexual inequality and gender and power imbalance. According to the theory of gender and power, there are three major social structures that characterize the gendered relationships between men and women: the sexual division of labor, the sexual division of power, and the structure of cathexis. The aim of this article is to apply an extended version of the theory of gender and power to examine the exposures, social/behavioral risk factors, and biological properties that increase women's vulnerability for acquiring HIV. Subsequently, the authors review several public health level HIV interventions aimed at reducing women's HIV risk. Employing the theory of gender and power among women marshals new kinds of data, asks new and broader questions with regard to women and their risk of HIV, and, most important, creates new options for prevention.

Risky sexual behavior among adolescent women

ISSUES AND PURPOSE

To review the epidemiology and etiology of risky sexual behavior in adolescent women, and to discuss implications for primary prevention.

CONCLUSION

Adolescent women who participate in risky sexual behavior are at risk for sexually transmitted infections, including HIV. Black, Hispanic, and out-of-home adolescent women, however, are at greatest risk. Factors contributing to risky sexual behavior include early initiation of sexual intercourse, inconsistent use of condoms and other barrier contraception, and unprotected sexual intercourse. Identified protective factors for early initiation of sexual activity include the development of healthy sexuality, family and school connectedness, and the presence of caring adults.

PRACTICE IMPLICATIONS

Effective clinical interventions target high-risk adolescent women; incorporate environmental and cognitive-behavioral components; use social learning theories; address differences in regards to culture, developmental stage, and sexual experience; and support family and school involvement.

The Real Controversy About Child Sexual Abuse ResearchContradictory Findings and Critical Issues Not Addressed by Rind, Tromovitch, and Bauserman in Their 1998 Outcomes Meta-Analysis

This article presents a review of all types of child sexual abuse research ignored by Rind, Tromovitch, and Bauserman in their 1998 meta-analytic study. Eight major findings are addressed. Altogether, these findings demonstrate the narrow focus of the Rind et al. meta-analysis. By restricting a supposedly broad meta-analysis to only some of the research and population in question, the conclusions Rind et al. drew regarding this complex topic (primarily, that adult-child sex is not necessarily harmful to children) are invalid.

Date rape among adolescents and young adults

BACKGROUND

Adolescents and young adults are four times more likely to be victims of sexual assault than women in all other age groups. In the vast majority of these cases, the perpetrator is an acquaintance of the victim. Date rape is a subset of acquaintance rape where nonconsensual sex occurs between two people who are in a romantic relationship.

METHODS

We conducted a MEDLINE and Current Concepts search for articles relating to date rape and then systematically reviewed all relevant articles.

RESULTS

Lifetime prevalence of date or acquaintance rape ranges from 13% to 27% among college-age women and 20% to a high of 68% among adolescents. Demographic characteristics that increase vulnerability to date rape include younger age at first date, early sexual activity, earlier age of menarche, a past history of sexual abuse or prior sexual victimization, and being more accepting of rape myths and violence toward women. Other risk factors include date-specific behaviors such as who initiated, who paid expenses, who drove, date location and activity, as well as the use of alcohol or illicit drugs such as flunitrazepam (Rohypnol). Alcohol use that occurs within the context of the date can lead to: the misinterpretation of friendly cues as sexual invitations, diminished coping responses, and the female's inability to ward off a potential attack.

CONCLUSIONS

Longitudinal research designs are needed to further our understanding of sexual violence among adolescents and young adults and the most effective ways to eliminate it. Understanding and comparing research findings would be easier if consensus regarding the definitions of date rape, sexual aggression, and sexual assault was obtained. Finally, primary and secondary date and acquaintance rape prevention programs must be developed and systematically evaluated.