Older male sexual partner as a marker for sexual risk-taking in adolescent females in Nova Scotia

"I'm not Gonna Die Because of an STD": Female African American Adolescents' Perspectives on how they Protected Themselves from Sexual Risks While in Foster Care

PURPOSE

Youth in foster care are at greater risk for engaging in sexual behaviors that increase their odds of experiencing negative sexual and reproductive health (SRH) outcomes. The purpose of this qualitative study was to describe challenges faced by female African American adolescents in foster care as they tried to protect themselves from SRH risks and protective beliefs and behaviors to avoid these risks.

DESIGN AND METHODS

Semi-structured interviews were conducted with 16 female African American adolescents, ages 18-20 years, with a history of foster care placement during adolescence. Purposive sampling was done to recruit participants from a metropolitan area in Virginia. Transcribed interviews underwent inductive thematic analysis. This paper focuses on the theme of protection from SRH risks and its subthemes of challenges that made it difficult to avoid sexual risks and protective beliefs and behaviors that facilitated avoidance of those risks.

RESULTS

Participants reported yearning for connection, partners' desire to not use condoms, and judgmental caregivers as challenges. Protective beliefs and behaviors included open communication with their caregivers about SRH, abstinence, contraceptive use, and participants' desire to be healthy.

CONCLUSIONS

Study findings shed light on protective beliefs and behaviors female youth in foster care used to safeguard themselves from negative SRH outcomes. Youth at times lacked agency in sexual decision-making and contraceptive use.

PRACTICE IMPLICATIONS

Findings highlight the importance of sexual relationships and partner communication related to contraceptive use, and offering trauma-informed interventions, including culturally sensitive counseling regarding long acting reversible contraception.

Early impact of Ontario's human papillomavirus (HPV) vaccination program on anogenital warts (AGWs): A population-based assessment

INTRODUCTION

This study aimed to evaluate the early population impact of Ontario's school-based human papillomavirus (HPV) vaccination program, implemented in September 2007 for grade 8 females, by comparing anogenital wart (AGW) health care utilization before and after vaccine program implementation, in program-eligible and program-ineligible cohorts, focusing on 15-26year olds.

METHODS

Using a retrospective longitudinal population-based study design, health administrative data were used to identify incident AGWs and total health service utilization (HSU) for AGWs for Ontario residents 15years and older between April 1 2004 and March 31 2014. The study period was divided into two eras: the pre-vaccine program era and the vaccine program era. Negative binomial models were generated to analyze trends across time by age group and sex. We adjusted female rates for routine Papanicolaou (Pap) testing to address spillover effects of Pap smear policy changes on AGW diagnosis.

RESULTS

Between fiscal years 2004 and 2013, AGW incidence decreased 2.6% on average per year in 15-17year old females, and total HSU for AGWs decreased an average of 4.8% and 2.2% per year in 15-17 and 18-20year old females. Comparing the vaccine era to the pre-vaccine era, AGW incidence decreased 6.5% in 18-20year old females, and AGW HSU decreased 13.8%, 11.1%, and 10.0% in 15-17, 18-20, and 21-23year old females respectively. In contrast, male AGW incidence rates increased an average of 4.1%, 2.8%, and 0.9% per year in 15-17, 21-23, and 24-26year old males respectively. AGW incidence rates increased 12.2% in 15-17year old males from the pre-vaccine to vaccine era.

CONCLUSION

The decline in AGW incidence and HSU in program-eligible females suggests the school-based HPV vaccination program has had an early population impact in Ontario. The increasing AGW incidence in males suggests no early evidence of herd effects in males.

Older Sexual Partners and Adolescent Females' Mental Health

CONTEXT

The physical health detriments associated with adolescent females' having older romantic partners are well documented. However, little is known about the relationship between having an older partner and females' subsequent mental health.

METHODS

Two waves of data from 1,440 participants in the National Longitudinal Study of Adolescent Health were analyzed. The sample was restricted to females in grades 7-12 who had not had sex at Wave 1 (1994-1995) and reported at least one romantic relationship by Wave 2 (1996). A lagged dependent variable approach with ordinary least-squares regression measured changes in depression and self-esteem associated with sexual and nonsexual relationships with same-age and older partners. Intimate partner violence was tested as a mediator.

RESULTS

Compared with respondents reporting a nonsexual relationship with a same-age partner, those reporting a nonsexual relationship with an older partner, sex with a same-age partner or sex with an older partner experienced greater increases in depression between surveys; mean predicted depression levels at Wave 2 ranged from 7.7 to 9.0 across these groups (possible range, 0-27). Intimate partner violence explained one-third of the difference between those who had had sex and those who had not had sex with same-age partners. Fewer associations were found for self-esteem, and differences between groups were small.

CONCLUSIONS

Health correlates of adolescent sexual behavior go beyond physical health outcomes. Future research should identify mechanisms through which relationships, especially those with older partners, are associated with declines in mental health.

Sexual risk factors for partner age discordance in adolescent girls and their male partners

AIMS AND OBJECTIVES

To investigate differences in sexual risk factors between adolescent girls reporting similar-aged or older sex partners.

BACKGROUND

Adolescent girls are at significant risk of heterosexual-acquired HIV infection and other long-term reproductive health issues. Sexual partner age discordance in teen girls has been correlated with STIs, lack of protection, multiple partners and earlier age of sexual transition.

DESIGN

A descriptive study comparing girls currently involved with age-discordant partners to those with similar-aged partners. Two-sample t-test for continuous variables and chi-squared test or Fisher's exact test for categorical variables were used to compare groups.

METHODS

Baseline data from 738 sexually active, urban, adolescent girls aged 15-19 were analysed to determine which behaviours were more likely to occur in girls with older partners. Data were collected as part of a gender-specific HIV-prevention intervention in a randomised controlled trial (RCT) tailored to adolescent girls.

RESULTS

Multiple reported sexual risk behaviours were found to significantly differ between the two groups at baseline. Overall, girls with older partners had more episodes of sexual instances (vaginal, anal and oral). Specific sexual risk behaviours were found to be statistically significant between the two groups. Girls with older partners started having sex at earlier ages, had more lifetime sexual partners, higher incidents of STIs and were reluctant to discuss using condoms with their partners. Girls with similar-aged partners were less willing to engage in risky sexual behaviours.

CONCLUSIONS

Findings from this investigation support data from other studies. Relationships with older male partners place adolescent girls at increased risk of HIV/STIs and unintended pregnancy.

RELEVANCE TO CLINICAL PRACTICE

Adolescent girls in age-discordant relationships are at risk of immediate and long-term sexual health morbidities. Identifying girls who are at increased risk by asking tailored questions will enable nurses to recommend appropriate diagnostics for this population and provide age-specific counselling.

What's age got to do with it? Partner age difference, power, intimate partner violence, and sexual risk in urban adolescents

Adolescent girls with older male main partners are at greater risk for adverse sexual health outcomes than other adolescent girls. One explanation for this finding is that low relationship power occurs with partner age difference. Using a cross-sectional, descriptive design, we investigated the effect of partner age difference between an adolescent girl and her male partner on sexual risk behavior through the mediators of sexual relationship power, and physical intimate partner violence (IPV), and psychological IPV severity. We chose Blanc's framework to guide this study as it depicts the links among demographic, social, economic, relationship, family and community characteristics, and reproductive health outcomes with gender-based relationship power and violence. Urban adolescent girls (N = 155) completed an anonymous computer-assisted self-interview survey to examine partner and relationship factors' effect on consistent condom use. Our sample had an average age of 16.1 years with a mean partner age of 17.8 years. Partners were predominantly African American (75%), non-Hispanic (74%), and low-income (81%); 24% of participants reported consistent condom use in the last 3 months. Descriptive, correlation, and multiple mediation analyses were conducted. Partner age difference was negatively associated with consistent condom use (-.4292, p < .01); however, the indirect effects through three proposed mediators (relationship power, physical IPV, or psychological IPV severity) were not statistically significant. Further studies are needed to explore alternative rationale explaining the relationship between partner age differences and sexual risk factors within adolescent sexual relationships. Nonetheless, for clinicians and researchers, these findings underscore the heightened risk associated with partner age differences and impact of relationship dynamics on sexual risk behavior.

Risk of depression and multiple sexual risk-taking behaviours in adolescents in Nova Scotia, Canada

BACKGROUND

Although depression is known to be associated with adolescent sexual risk-taking, Canadian studies are few, many have lacked appropriate controls and none has examined the associations of depression with multiple sexual risk-taking behaviours. We tested associations between multiple sexual risk-taking and risk of depression, controlling for other factors, including social capital, in high school students in Nova Scotia, Canada.

METHODS

We surveyed sexually active male (n=418) and female (n=467) adolescents. Participants were asked about their risk of depression, perceptions of social capital, substance use, sociodemographic factors and sexual behaviours. Multinomial logistic regressions were used to determine associations of risk of depression with various levels of sexual risk-taking.

RESULTS

In unadjusted models, risk of depression was associated with two or more v. no sexual risk behaviours among both males and females. After controlling for other variables, risk of depression remained significantly associated with two or more sexual risks v. no risks for both females and males (relative risk ratios (RRR) of 2.5; 95% confidence interval (CI) 1.4-4.5 and 3.5; 95% CI 1.6-7.82 respectively) and for one v. no risks for females (RRR=1.9; 95% CI 1.1-3.5). One measure of social capital was associated with multiple risks in females.

CONCLUSIONS

The consistent, independent associations of risk of depression with multiple sexual risks should lead health care workers interacting with adolescents to ask about sexual risk behaviours among patients with symptoms of depression. Alternatively, patients who engage in sexual risk-taking might be screened for depression.

Associations of sexual risk-taking with having intercourse before 15 years in adolescent females in Cape Breton, Nova Scotia, Canada

BACKGROUND

This study was carried out to determine whether having first vaginal intercourse before 15 years of age is independently associated with sexual risk behaviours in Canadian female adolescents aged from 15 to 19 years.

METHODS

Self-completion surveys which included questions about sexual risk behaviours were carried out at three high schools in Cape Breton, Nova Scotia, Canada, in May 2006. The survey also contained questions asking about socioeconomic status, substance use and depression. Associations of early intercourse with risk behaviours were assessed using unadjusted and adjusted logistic regression.

RESULTS

The survey response rate was 92.5%. Of the 797 females aged 15-19 years responding, 475 had had vaginal intercourse in the previous year; 132 of these (27.8%) had intercourse before the age of 15 years. In adjusted analysis, early vaginal intercourse was associated with not using a condom at last intercourse (odds ratio (OR) 2.22; 95% confidence interval (CI) 1.40-3.54), unplanned intercourse in the previous year due to substance use (OR 2.45; 95% CI 1.49-4.04), having a casual partner at last intercourse (OR 2.10; 95% CI 1.23-3.56) and having three or more partners for vaginal intercourse in the previous year (OR 5.11; 95% CI 2.86-9.14).

CONCLUSIONS

A history of having first intercourse before 15 years is associated with subsequent sexual risk-taking behaviours in adolescent females. These associations have clinical importance because the occurrence of early intercourse can alert health care providers to the possible presence of these risk behaviours. They also underscore the need to develop and assess programs which can delay the onset of sexual debut.

Partner age differences, educational contexts and adolescent female sexual activity

CONTEXT

Research suggesting that female teenagers who date substantially older males are at increased risk for negative health outcomes supports the need for statutory rape laws. However, prior research has generally ignored the social context of adolescence when examining the risks associated with dating an older partner.

METHODS

Data from Waves 1 (1995) and 2 (1996) of the National Longitudinal Study of Adolescent Health were used to model the occurrence of sexual intercourse within adolescent heterosexual romantic relationships. Logistic regression analyses were used to examine the predictors of sexual intercourse among 4,266 romantically involved female students aged 12-18.

RESULTS

Female students with male partners three or more years their senior had higher odds of engaging in sexual intercourse than female students with partners closer to their age (odds ratio, 1.5). However, the association between having an older partner and the risk of sexual intercourse was nonsignificant for females older than 16. Moreover, when male partners' school status was taken into account, the relationship was no longer significant. Female students with partners who had exited school had elevated odds of having had intercourse compared with females who dated partners in the same school (1.8).

CONCLUSIONS

These findings challenge statutory rape laws' focus on age, given that the association between educational context and sexual risk overrides the association between partner age and sexual risk.

Associations of risk of depression with sexual risk taking among adolescents in Nova Scotia high schools

OBJECTIVE

Several interrelated factors, including depression, influence adolescents' chances of risky sexual behaviour. We examined the relation between depression and sexual risk-taking behaviours in adolescents after accounting for the effects of other variables.

METHOD

We surveyed male (n = 1120) and female (n = 1177) adolescents at 4 high schools in central Nova Scotia, measuring factors known to be associated with sexual risk taking. Risk of depression was assessed using the Center for Epidemiologic Studies Depression Scale. Outcomes were self-reported sexual behaviours. We used logistic regression to assess associations of multiple factors with sexual risk taking.

RESULTS

In univariate analyses, risk of depression was associated with 3 risk-taking behaviours for females (being sexually active, having unplanned sex when using substances, and not using effective contraception at last intercourse) and 2 for males (having unplanned sex when using substances and having more than 1 partner in the previous year). In full multivariate models, risk of depression in females remained significantly associated with unplanned sex and nonuse of effective contraception at last intercourse, but was no longer associated with being sexually active. For males, both associations remained significant.

CONCLUSIONS

Risk of depression is consistently and independently associated with adolescent sexual risk behaviours after adjusting for other variables. Health care providers working with teenagers should screen for risky sexual behaviours and sexually transmitted infections if depression is apparent in their patients.

Depressive symptoms and sexual risk behavior in young, chlamydia-infected, heterosexual dyads

PURPOSE

To examine associations between depressive symptoms and dyad-level sexual risk behavior in young heterosexual dyads with sexually transmitted infection (STI).

METHODS

Chlamydia-positive 14-24-year-old, heterosexually active outpatients and their opposite-sex partners completed an assessment that included demographics, past and recent STI risk behaviors, and the Beck Depression Inventory (BDI). Participants in the top 25% of BDI scores within gender were categorized as depressed. Variables were created to identify dyads in which the female or male partner was depressed, as well as a measure of concordance of depression between partners. Dyad-level STI risk variables were created from the STI risk characteristics reported by each dyad member, and associations between these and the depression variables were analyzed.

RESULTS

The 130 dyads were comprised of young men and women at high STI risk. One-third of dyads had at least one depressed partner. Dyads in which the female partner was depressed had greater partner age difference, greater total number of lifetime partners, and one or more partners reporting substance use within 2 hours before sex, compared with dyads in which the female partner was not depressed. Dyads in which the male partner was depressed were more likely than the nondepressed-male dyads to report substance use before sex. All dyads in which both partners were depressed reported substance use before sex.

CONCLUSIONS

In young, chlamydia-infected, heterosexual dyads, depressive symptoms, especially in women, is related to increased dyad-level STI risk, including greater partner age difference, more partners, and substance use before sex.