Predictors of sexual debut at age 16 or younger

Prevalence and correlates of sexual intercourse under influence of alcohol among Thai adolescents: lessons from a nationwide school-based survey

OBJECTIVES

Having sex under the influence of alcohol is a risky behavior and this study explored its prevalence and correlates among school-going Thai adolescents.

METHODS

The data from the 2021 Thailand Global School-based Student Health Survey (GSHS), including a nationally representative sample of students in grades 7-12th, was used to extract the relevant variables including demographic, psychosocial, substance use, and risky sex behaviors. Logistic regression was used to assess the odds of engaging in sex while intoxicated across the independent variables while accounting for age and sex differences.

RESULTS

Approximately 30.45 % of respondents reported alcohol intoxication and 37.75 % reported engaging in sexual intercourse while intoxicated at least once. Older adolescents (>14 years), males, and those in 11 and 12 grades were more likely to engage in sexual intercourse while intoxicated. Psychosocial factors such as loneliness and anxiety-induced insomnia were associated with increased likelihood, particularly among females. Substance use, including marijuana and amphetamine use, as well as cigarette smoking, correlated with higher odds of engaging in sexual intercourse while intoxicated. Both genders who engaged in sex while intoxicated reported having multiple sexual partners, with males more likely to use condoms.

CONCLUSIONS

The intricate relationship between poor mental health, substance use, and risky sex behaviors along with their association with sex under alcohol influence emphasizes the need for a holistic approach to address the common risk factors and implement effective school-based screening strategies to identify the risk groups, educate them, and prevent the burden of risky sex under alcohol intoxication.

Comparison of survival analysis approaches to modelling age at first sex among youth in Kisesa Tanzania

BACKGROUND

Many studies analyze sexual and reproductive event data using descriptive life tables. Survival analysis has better power to estimate factors associated with age at first sex (AFS), but proportional hazards models may not be right model to use. This study used accelerated failure time (AFT) models, restricted Mean Survival time model (RMST) models, with semi and non-parametric methods to assess age at first sex (AFS), factors associated with AFS, and verify underlying assumptions for each analysis.

METHODS

Self-reported sexual debut data was used from respondents 15-24 years in eight cross-sectional surveys between 1994-2016, and from adolescents' survey in an observational community study (2019-2020) in northwest Tanzania. Median AFS was estimated in each survey using non-parametric and parametric models. Cox regression, AFT parametric models (exponential, gamma, generalized gamma, Gompertz, Weibull, log-normal and log-logistic), and RMST were used to estimate and identify factors associated with AFS. The models were compared using Akaike information criterion (AIC) and Bayesian information criterion (BIC), where lower values represent a better model fit.

RESULTS

The results showed that in every survey, the Cox regression model had higher AIC and BIC compared to the other models. Overall, AFT had the best fit in every survey round. The estimated median AFS using the parametric and non-parametric methods were close. In the adolescent survey, log-logistic AFT showed that females and those attending secondary and higher education level had a longer time to first sex (Time ratio (TR) = 1.03; 95% CI: 1.01-1.06, TR = 1.05; 95% CI: 1.02-1.08, respectively) compared to males and those who reported not being in school. Cell phone ownership (TR = 0.94, 95% CI: 0.91-0.96), alcohol consumption (TR = 0.88; 95% CI: 0.84-0.93), and employed adolescents (TR = 0.95, 95% CI: 0.92-0.98) shortened time to first sex.

CONCLUSION

The AFT model is better than Cox PH model in estimating AFS among the young population.

Is High-Risk Sexual Behavior a Risk Factor for Oropharyngeal Cancer?

(1) Background: Several lines of evidence established a link between high-risk (HR) sexual behavior (SB), the persistence of human papillomavirus (HPV) DNA in saliva, and the presence of oncogenic HR-HPV subtypes in oropharyngeal squamous cell carcinoma (OPSCC). A highly influential case-control study by D'Souza et al. comparing OPSCC patients and ENT patients with benign diseases (hospital controls) established HR-SB as a putative etiological risk factor for OPSCC. Aiming to replicate their findings in a nested case-control study of OPSCC patients and propensity score (PS)-matched unaffected controls from a large population-based German cohort study, we here demonstrate discrepant findings regarding HR-SB in OPSCC. (2) Methods: According to the main risk factors for HNSCC (age, sex, tobacco smoking, and alcohol consumption) PS-matched healthy controls invited from the population-based cohort study LIFE and HNSCC (including OPSCC) patients underwent interviews, using AUDIT and Fagerström, as well as questionnaires asking for SB categories as published. Afterwards, by newly calculating PSs for the same four risk factors, we matched each OPSCC patient with two healthy controls and compared responses utilizing chi-squared tests and logistic regression. (3) Results: The HNSCC patients and controls showed significant differences in sex distribution, chronologic age, tobacco-smoking history (pack years), and alcohol dependence (based on AUDIT score). However, PS-matching decreased the differences between OPSCC patients and controls substantially. Despite confirming that OPSCC patients were more likely to self-report their first sexual intercourse before age 18, we found no association between OPSCC and HR-SB, neither for practicing oral-sex, having an increased number of oral- or vaginal-sex partners, nor for having casual sex or having any sexually transmitted disease. (4) Conclusions: Our data, by showing a low prevalence of HR-SB in OPSCC patients, confirm findings from other European studies that differ substantially from North American case-control studies. HR-SB alone may not add excess risk for developing OPSCC.

Adding up risks: Sexual debut and substance use among Italian university students

Adolescence and youth are periods of great changes in an individual's life, during which experiencing first events of the transition to adulthood and, sometimes, violating social norms. Literature has identified an association of risk behaviours with timing of first sexual intercourse, but scant information is available about their relationship with the use of protection or the choice of a casual partner. This study focuses on the relation between initiation of risk behaviours (get drunk and drug use) and initiation of intercourse. Using event history analysis - also in their competing risk form - on data on Italian university students collected in 2000-2001 and in 2017, we intend to verify to what extent the initiation and the timing to risk behaviours is associated with the circumstances of first intercourse (timing, use of protection, type of partner), and if and how initiation to risk behaviours interacts differently with age at sexual debut. Our results show that in a country such as Italy, where family and sexual norms are relatively traditional, young people who got drunk, used marijuana or ecstasy at least one time in their life are more likely to experience risky sexual intercourse.

Higher parental socioeconomic status accelerates sexual debut: Evidence from university students in Italy

In this paper we analyze how the timing and type (protected or unprotected) of sexual debut are influenced by parental socioeconomic status (SES). We argue that depending on whether a "parental control" or a "cultural openness" mechanism prevails, one could find a postponing or an anticipating effect of higher parental SES on children's timing of sexual debut. By applying event-history techniques to unique data from the two releases of the Sexual and Emotional Life of Youths survey (2000 and 2017), we found a clear accelerating effect of higher parental SES-parental education and father's social class-on the sexual debut of Italian university students. The effect is partly mediated by family characteristics related to the cultural openness mechanism, such as low parental religiosity, greater communication about sex, and parental permissiveness; on the contrary, we only found weak support for the parental control explanation. Higher parental education is associated with a higher likelihood of protected first sexual intercourse-and especially of condom use-even if more precocious. Our results dispute the North American- and Anglo-Saxon-driven finding that high-SES children postpone their sexual debut.

Pathways and Patterns of Entrance into BDSM

Prior limited research on entrance into BDSM divided paths of entry into external or internal factors (Yosta & Hunter, 2012), while research on age at entry into BDSM has not considered variation by BDSM role identity, gender, sexual orientation, and other demographic differences. In this mixed-methods exploratory study, we contribute to this literature by collecting and analyzing qualitative interviews with 96 self-described practitioners of BDSM to more fully describe distinct pathways into BDSM, adding nuance to prior descriptions of entry. We also collected and analyzed surveys with 2,017 self-described practitioners of BDSM to examine patterns of age at entry into BDSM practices and fantasies, and selection into older or younger age at practice and age at fantasy by BDSM role identity, gender, sexual orientation, and other demographic characteristics. Interview respondents told "constructionist sexual stories" describing introductions to BDSM via popular culture including pornography and other media, the Internet, or a sexual partner that awaked an inherent interest, along with "essentialist sexual stories" which described self-discovery solely attributed to an inherent personality characteristic. Survey data revealed that age at fantasy and onset of behavior varied by social-environmental factors. Pathways and patterns into BDSM behavior and fantasies therefore reflect a combination of idiosyncratic interests, exposure to ideas via the media or partners, and stratified social norms and opportunities related to sexual behavior.

What predicts the early sexual debut among unmarried adolescents (10-19 years)? Evidence from UDAYA survey, 2015-16

INTRODUCTION

The societal norm in India is such that adolescents are expected to respect and follow traditional values and view early sexual debut as undesirable and deviant from the social mores. However, a dramatic shift in attitudes towards sex before marriage has been observed in India. We in this study, aim to study the factors associated with early sexual debut among unmarried adolescents.

MATERIALS AND METHODS

The study used data from the Understanding the lives of adolescents and young adults (UDAYA) survey conducted in 2016 with 15,388 adolescents aged 10-19 years from two Indian states. Bivariate and logistic regression analyses were performed to determine the associated factors.

RESULTS

Adolescent boys (9%) were more prone to early sexual debut compared to girls (4%). Both boys (17.2%) and girls (6%) who were school dropouts had significantly higher chances of early sexual debut. Boys who had rare [OR: 2.28; CI: 1.12-4.64] or frequent media exposure [OR: 2.70; CI: 1.36-5.32] were significantly more likely to report early sexual debut than those who had no media exposure. Further, the likelihood of early sexual debut was significantly higher among boys [OR: 3.01; CI: 2.34-3.87] and girls [OR: 1.87; CI: 1.12-3.12] who had exposure to pornography compared to their counterparts. The odds of early sexual debut were higher among boys [OR: 1.89; CI: 1.19-3.01] and girls [OR: 1.77; CI: 1.30-2.41] who had moderately-severe/severe depressive symptoms compared to their counterparts.

CONCLUSIONS

The results highlight that Indian unmarried adolescents demand the appropriate knowledge to promote safer sexual behavior and lead a responsible and healthy lifestyle. The preventive efforts must be multifaceted with involvement at the individual and parental levels. Especially, interventions appear advantageous to be parents-focused emphasizing family life education that can prevent risky sexual behaviors among adolescent boys and girls. And the public programs should focus on sexual health promotion considering the physical and psychosocial changes during early ages of sex life.

Social Capital and Age at Sexual Debut: Race Differences in South Africa

Literature on social capital has long considered whether and how social capital is protective against various risk behaviors, including age at sexual debut. However, much of this literature uses data from wealthy countries in the Global North and is often cross-sectional, dampening generalizability. In this paper, we employ longitudinal South African data from adolescents in the Cape Area Panel Study to examine the longitudinal link between social capital and age at sexual debut. We first examine the overall relationship between age at sexual debut and social capital and then examine how the relationship differs by race. Results suggest that, on average, each additional activity is associated with an approximate 2 month delay in age at sexual debut. However, we observed steep racial differences. For Africans, the link between social capital and age at sexual debut was not significant, while the results for Coloureds and Whites were. For Coloureds, each additional activity translated into a 3 month delay in sexual debut, while for Whites we found a 4 month delay. We found no evidence of sex differences. Taken together, these results suggest that social capital is not equally efficacious for all South African adolescents. For Africans, social capital does not appear to be linked to age at sexual debut. In contrast, more social capital activities appear to be linked to delayed sexual debut, most particularly for Whites.

Early sexual debut and associated factors among students in Ethiopia: A systematic review and meta-analysis

Students with early sexual debut are exposed to risky sexual behaviours. For effective intervention on early sexual debut and its consequences, determination of its magnitude and identifications of associated factors is important. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence and the associated factors of early sexual debut among students in Ethiopia. Relevant articles were identified through databases such as PubMed, Global Health, HINARI, Google advance search, Scopus, and EMBASE from March 10^th to April 3^rd. The data was extracted using a standardized data extraction form and exported to STATA 11 for analysis. The overall pooled prevalence of early sexual debut among students was estimated using a randomeffects meta-analysis. Presence of association was determined using an odds ratio with a corresponding 95% CI. A total of 9 studies with 4,217 participants were involved in this meta-analysis. The estimated pooled prevalence of early sexual debut among students in Ethiopia was 27.53% (95% CI: 20.52, 34.54). Being female (OR: 3.64, 95% CI: 1.67, 5.61), watching pornography (OR: 3.8, 95% CI: 2.10, 5.50) and having boyfriend or girlfriend (OR: 2.72, 95% CI: 1.24, 5.96) were found to be significantly associated with early sexual debut. More than one fourth of students practiced early sexual debut. The finding suggests the need of strengthening prevention strategies, effective intervention, and programs in educational institutions to reduce early sexual debut and its consequences. Furthermore, special attention should be given to female students and students who watch pornography.

Evaluation of an Online Sexual Health Program among Adolescent Girls with Emotional and Behavioral Difficulties

OBJECTIVES

Adolescent girls with emotional and behavioral difficulties (EBDs) have a heightened risk of negative sexual health, including HIV, other sexually transmitted infections (STIs), and unplanned pregnancy. Few evidence-based sexual health interventions are available for adolescent girls with EBDs. This study tested the feasibility, acceptability, and efficacy of a brief, online sexual health program called HEART (Health Education and Relationship Training).

METHODS

Forty-seven participants (M-age = 15.79; SD = 1.71; 62% Black, 23% Hispanic) recruited from community-based organizations in the southeastern U.S. were compared to a non-equivalent comparison group who received an attention-matched intervention.

RESULTS

Findings support the feasibility of participant recruitment and program administration in community-based settings. Participants completed HEART in 44 minutes and experienced few technological difficulties. HEART was highly acceptable: most participants liked, learned from, and were engaged with the program. Further, 92% would recommend HEART to a friend and 98% would use what they learned in the future. At posttest, intervention participants had significantly higher communication intentions, communication skills, STI/HIV knowledge, sexual self-efficacy, condom attitudes, and condom norms than the comparison group (ps < .003; effect size ds = .38-1.65). Significant improvement in condom intentions was observed when comparing pretest to posttest scores among intervention participants only, t(46) = -3.21, d = 0.47.

CONCLUSIONS

Findings support the feasibility, acceptability, and efficacy of HEART among adolescent girls with EBDs in community-based settings. This study also addresses the growing need for research into the transferability of sexual health interventions to facilitate evidence-based decision-making about program dissemination and implementation.

An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi

BACKGROUND

Teenage pregnancies and childbearing are important health concerns in low-and middle-income countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi.

METHODS

The study used the 2004, 2010 and 2015-16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing.

RESULTS

The teenage pregnancy and childbearing rate averaged 29% (p<0.01) between 2004 and 2015-16. Trends showed a "u-shape" in teenage pregnancy and childbearing rates, albeit a small one (34.1%; p<0.01) in 2004: (25.6%; p<0.01) in 2010, and (29%; p<0.01) in 2016. The calculated concentration indices -0.207 (p<0.01) in 2004, -0.133 (p<0.01) in 2010, and -0.217 (p<0.01) in 2015-16 indicated that inequality in teenage pregnancy and childbearing worsened to the disadvantage of the poor in the country. Additionally, the decomposition exercise suggested that the primary drivers to inequality in teenage pregnancy and child bearing were, early sexual debut (15.5%), being married (50%), and wealth status (13.8%).

CONCLUSION

The findings suggest that there is a need for sustained investment in the education of young women concerning the disadvantages of early sexual debut and early marriages, and in addressing the wealth inequalities in order to reduce the incidences of teenage pregnancies and childbearing.

Prevalence and correlates of sexual intercourse among sexually active in-school adolescents: an analysis of five sub-Sahara African countries for the adolescent's sexual health policy implications

BACKGROUND

Early and unprotected sex with multiple partners among adolescents carries a high risk of acquiring HIV infections, other sexually transmitted infections as well as high rates of teenage pregnancy. Sub-Saharan Africa (SSA) has a higher burden of HIV/AIDS: the leading cause of deaths among adolescents. We estimated the prevalence and examined the correlates of sexual intercourse among in-school adolescents of SSA. The purpose is to inform the public health programs dedicated to tackling the burden of HIV/AIDS.

METHODS

We did a secondary analysis of the Global School-based Student Health Surveys (GSHS) datasets pooled from five SSA countries Benin, Mozambique, Namibia, Seychelles, and Tanzania. Our current analysis included a sample of 15,318 in-school adolescents. The primary independent variables were ever had sexual intercourse and sex with multiple partners, while the dependent variables were smoking cigarettes, alcohol use, use of marijuana and amphetamine, and parental connectedness. We performed descriptive statistics, and multivariate logistic regression stratified by gender using SPSS Complex Sample Statistics. A p-value of less than 0.05 was considered statistically significant at 95% confidence intervals.

RESULTS

Out of 15,318 participants, the overall prevalence of ever had sexual intercourse and sex with multiple partners were 43·5% (6670) and 20·9% (3204), respectively. In overall and across each country, male adolescents had a significantly higher proportion of sex with multiple partners than female adolescents, p < 0·001. The predictors of sexual intercourse with multiple partners in both male and females were smoking cigarettes, alcohol use, and use of marijuana and amphetamine. Female adolescents who smoked cigarettes and used marijuana had a significant likelihood of sex with multiple partners than male adolescents: [aOR 3.6, 95% CI: 2.6-5.1] vs [aOR 2.1, 95% CI: 1.7-2.7] and [aOR 2.4, 95% CI: 1.6-3.7] vs [aOR 1.9, 95% CI: 1·3-2·7], respectively.

CONCLUSIONS

Adolescents sexual intercourse and more especially sex with multiple partners was prevalent and strongly correlated with substance use. However, the correlation was higher among female adolescents than male adolescents. A customized public health intervention that targets multiple risk factors concurrently may benefit adolescents with clustering of sexual and non-sexual risk-taking behaviors.

The Role of Religious Socialization and Religiosity in African American and Caribbean Black Adolescents' Sexual Initiation

This study determined the nature of the associations between religious socialization, religiosity, and adolescent sexual initiation. Data originated from the National Survey of American Life-Adolescent (n = 1170), a nationally representative study of black adolescents. Factor analysis, structural equation modeling, and logistic regression were used to evaluate hypotheses. Results indicated that as black adolescents received more messages about religious beliefs and practices, their religiosity was greater and, in turn, they were less likely to report sexual initiation; findings varied by ethnicity, gender, and age. Findings contribute to understanding religious socialization and its association with sexual initiation.

Correlates of sexual initiation among European adolescents

Background

Sexuality is a physiological component of adolescent development, though early initiation is associated with reproductive health risk. This study aimed at identifying correlates and predictors of sexual initiation in a large multinational cohort of European adolescents.

Methods

A questionnaire addressing socio-demographics, behaviours, mental health and sexual activity, was delivered to 11,110 adolescents recruited from 168 randomly selected schools in 10 European countries between 2009 and 2011. A follow-up questionnaire was delivered after 12 months. The longitudinal association of baseline risk behaviors, psychological attributes and contextual vulnerabilities, with sexual initiation during follow-up was evaluated through simple and multivariable age/sex stratified logistic regression. Multinomial logistic regression measured the association between predictors and sexual initiation with or without coexisting reproductive risk factors, such as multiple partners or infrequent condom use.

Results

Baseline sexual experience was reported by 19.2% of 10,757 respondents (median age 15; IQR 14–15; females 59.6%). This was significantly more frequent among pupils older than 15 (41%) and males (20.8%). Of 7,111 pupils without previous experience who were available at follow-up (response rate 81.8%), 17% reported sexual initiation, without differences between females and males. Baseline smoking (age/sex adjusted odds ratio [aOR] 3.63), alcohol use (aOR 2.95), illegal drugs use (aOR 2.72), and poor sleep (aOR 1.71) predicted sexual initiation. Stratified analyses showed a particularly strong association in case of younger and female pupils, and, among girls, when initiation was reported together with multiple partners and/or infrequent condom use. Externalizing (i.e. conduct and hyperactivity) symptoms independently predicted sexual initiation. Internalizing difficulties (i.e. emotional and peer problems) were negatively associated with early and risky sexual initiation among boys. Significant predictors included also being bullied, fighting, truancy, and low parental involvement.

Conclusions

Adolescent sexual behaviours are related to non-sexual risk behaviours, psychological difficulties and contextual vulnerabilities. While gateway effects explain some associations, a comprehensive model is needed to understand adolescent sexual behaviours, their physical, mental, and social health outcomes, and their potential positive effects on wellbeing. Tailored interventions may need to consider younger girls as a particularly vulnerable group in view of a strong association between non-sexual and sexual behaviors.

Individual- and Family-Level Determinants of Risky Sexual Behavior Among Swedish- and Foreign-Born Young Adults 18-30 Years of Age, Residing in Skåne, Sweden

In Sweden, various public health interventions have been performed to reduce risky sexual behaviors among young people and promote safer and positive approaches to sexuality, while attempting to bridge the gap between the less privileged or more vulnerable young people and their more privileged peers. This study aimed to compare the individual- and familial-level determinants of risky sexual behavior among foreign-born and Swedish-born young adults 18-30 years of age residing in Skåne, the south of Sweden. This was a cross-sectional study that used a questionnaire to collect data from 2968 randomly selected respondents between 18 and 30 years between January and March 2013. The associations were analyzed using chi-square tests, and simple and multiple logistic regression analyses. Younger age, i.e., individual-level factor, and living with only one parent or another person while growing up, i.e., familial-level factor, increased the risk of engaging in sexual risk taking for both Swedish- and foreign-born youth. Male gender was related to a higher risk of engaging in sexual risk-taking behaviors among foreign-born youth but was not as important as influence on sexual risk taking among Swedish-born youth. Parental education level, on the other hand, was significantly associated with sexual intercourse on the "first night" and early sexual debut solely among Swedish-born youth. Condom use was not associated with any family-level factor among both Swedish-born and foreign-born youth. The design of sexual reproductive health and rights messages and interventions to target risky sexual behavior among Swedish youth should take into consideration immigration status (for example, being Swedish-born or foreign-born), individual- and family-level characteristics, as well as the type of behavioral change or outcome desired.

Sexual Networking and Partner Characteristics Among Single, African, Caribbean, and Black Youth in Windsor, Ontario

The disproportionate HIV burden shared by African, Caribbean, and Black (ACB) populations in Canada has not been explained by unique sexual behaviors in this population. This study investigates partner selection and sexual networking as potential contributors to HIV vulnerability. The study examines variations in the characteristics of sexual partners and sexual networking across groups based on differences in ethno-religious identity, gender, and length of Canadian residency among single, 16- to 27-year old, heterosexual-identified, ACB individuals living in Windsor, Ontario, Canada. Respondent-driven sampling maximized the representativeness of the sample of 250 (45 % male; 55 % female) youth with penile-vaginal intercourse experience who completed surveys. Logistic regression and analysis of variance compared groups with respect to number of lifetime partners, concurrency of sexual relationships, non-relational and age disparate partnering, and intra-ethnic sexual networking. For vulnerability associated with number of partners, concurrency and non-relational sex, women, newcomers to Canada, and African-Muslim participants were at lower vulnerability for HIV infection than their comparator groups. For vulnerability associated with sexual networking within a group with higher HIV prevalence, women and newcomers to Canada were at higher vulnerability to HIV infection than their comparator groups. There were insufficient data on age disparate partnering to support analysis. These results point to the importance of considering characteristics of partners and sexual networking both in further research and in developing policies and programs to curtail the spread of HIV and other sexually transmitted infections.

Intergenerational Associations in Sexual Onset: Mediating Influences of Parental and Peer Sexual Teasing and Youth Substance Use

PURPOSE

The prospective intergenerational association between fathers' age of onset of sexual intercourse and their son's or daughter's age of onset of oral sex or intercourse up to 30 years later was examined using survival analyses across child ages 11-12 years to 17-18 years. In addition, novel constructs of parental and peer sexual teasing (at ages 11-12 years) and general risk factors of child substance use onset (alcohol and marijuana) before or concurrent with sexual onset were assessed as predictors of children's sexual onset and mediators of intergenerational associations.

METHODS

Hypotheses were tested using the Oregon Youth Study Intergenerational sample, including 100 fathers and 176 children (46% girls).

RESULTS

Univariate findings indicated that children were at risk for earlier sexual onset, provided their fathers had onset of sex at younger ages; in addition, child alcohol and marijuana onset and parental, but not peer, sexual teasing predicted earlier age of sexual onset for children. Multivariate findings indicated that child alcohol onset fully mediated the intergenerational association in age of sexual onset, whereas parental teasing and child marijuana onset did not explain the intergenerational association.

CONCLUSIONS

Findings of intergenerational associations in risk of sexual onset indicate that mechanisms of this association should be further examined. Substance use onset also confers risk for earlier child sexual onset, with alcohol use onset accounting for intergenerational associations; thus, substance use onset should be a prime target for prevention. Parental sexual teasing warrants further study as a mechanism related to possibly unintended encouragement of youth's early sexual onset.

Adolescent Substance Use in the Context of the Family: A Qualitative Study of Young People's Views on Parent-Child Attachments, Parenting Style and Parental Substance Use

BACKGROUND

Adolescent substance use can place youth at risk of a range of poor outcomes. Few studies have attempted to explore in-depth young people's perceptions of how familial processes and dynamics influence adolescent substance use.

OBJECTIVES

This article aimed to explore risk and protective factors for youth substance use within the context of the family with a view to informing family based interventions.

METHODS

Nine focus groups supplemented with participatory techniques were facilitated with a purposive sample of sixty-two young people (age 13-17 years) from post-primary schools across Northern Ireland. The data were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Three themes emerged from the data: (1) parent-child attachments, (2) parenting style, and (3) parental and sibling substance misuse. Parent-child attachment was identified as an important factor in protecting adolescents from substance use in addition to effective parenting particularly an authoritative style supplemented with parental monitoring and strong parent-child communication to encourage child disclosure. Family substance use was considered to impact on children's substance use if exposed at an early age and the harms associated with parental substance misuse were discussed in detail. Both parent and child gender differences were cross-cutting themes.

CONCLUSION

Parenting programmes (tailored to mothers and fathers) may benefit young people via components on authoritative styles, parental monitoring, communication, nurturing attachments and parent-child conflict. Youth living with more complex issues, e.g., parental substance misuse, may benefit from programmes delivered beyond the family environment, e.g., school based settings.

Assessing elements of a family approach to reduce adolescent drinking frequency: parent-adolescent relationship, knowledge management and keeping secrets

AIMS

To estimate (1) the associations between parent-adolescent relationship, parental knowledge and subsequent adolescent drinking frequency and (2) the influence of alcohol use on parental knowledge.

DESIGN

Path analysis of school based cohort study with annual surveys.

SETTING

Post-primary schools from urban and intermediate/rural areas in Northern Ireland.

PARTICIPANTS

A total of 4937 post-primary school students aged approximately 11 years in 2000 followed until approximately age 16 years in 2005.

MEASUREMENTS

Pupil-reported measures of: frequency of alcohol use; parent-child relationship quality; subdimensions of parental monitoring: parental control, parental solicitation, child disclosure and child secrecy.

FINDINGS

Higher levels of parental control [ordinal logistic odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.78, 0.95] and lower levels of child secrecy (OR = 0.83, 95% CI = 0.75, 0.92) were associated subsequently with less frequent alcohol use. Parental solicitation and parent-child relationship quality were not associated with drinking frequency. Weekly alcohol drinking was associated with higher subsequent secrecy (beta -0.42, 95% CI = -0.53, -0.32) and lower parental control (beta -0.15, 95% CI = -0.26, -0.04). Secrecy was more strongly predictive of alcohol use at younger compared with older ages (P = 0.02), and alcohol use was associated less strongly with parental control among families with poorer relationships (P = 0.04).

CONCLUSIONS

Adolescent alcohol use appears to increase as parental control decreases and child secrecy increases. Greater parental control is associated with less frequent adolescent drinking subsequently, while parent-child attachment and parental solicitation have little influence on alcohol use.

Differences in sexual behavior, health, and history of child abuse among school students who had and had not engaged in sexual activity by the age of 18 years: a cross-sectional study

Background

Empirical research about late sexual debut and its consequences is limited, and further research is needed.

Objective

To explore how students who had not had intercourse by the age of 18 years differed in terms of sociodemographic factors, physical and psychological health, sexual behavior, and history of sexual abuse from those who had.

Materials and methods

This is a cross-sectional survey involving 3,380 Swedish 18-year-olds. Descriptive analyses were used to investigate different types of sexual behavior. Ordinal data concerning alcohol consumption, self-esteem, sexual and physical abuse, parental relationships, sense of coherence, and health were analyzed, and multiple regression was carried out to identify the most important factors associated with no sexual debut.

Results

Just under a quarter of the adolescents had not had oral, anal, or vaginal sex by the age of 18 years, and they comprised the index group. They were characterized by being more likely to have caring fathers, parents born outside Europe, lower pornography consumption, lower alcohol and tobacco consumption, less antisocial behavior, and above all lower sexual desire (sometimes, adjusted odds ratio [aOR] 3.8; never/seldom, aOR 13.3) and fewer experiences of sexual abuse (aOR 25.5). Family structure and culture matters when it comes to the age of sexual debut.

Conclusion

Adolescents with no sexual debut at 18 years of age seemed to live a more stable and cautious life than more sexual experienced peers, exemplified by fewer antisocial acts, less smoking and alcohol/drug consumption, less sexual desire, and less experience of sexual abuse.

Youth with Sickle Cell Disease: Genetic and Sexual Health Education Needs

OBJECTIVES

Assess the need for and interest in a sexual health and sickle cell disease (SCD) inheritance educational program for youth with SCD.

METHODS

Using a cross-sectional approach, qualitative data were collected during interviews of youth with SCD between ages 11-19 years from an urban hospital. Inductive and emergent coding was used to identify themes. Frequencies were recorded and analyzed.

RESULTS

Thirty-five youth patients were approached; 20 (57%) consented and completed interviews. Half of the participants were adolescent girls. The mean age was 16.9±1.8 years (range 13-19). Of the 20 participants, 100% expressed interest in SCD genetic counseling and/or posed questions regarding SCD inheritance. Nineteen (95%) demonstrated deficits in sexual health knowledge and/or requested sexual health education. Seventeen (85%) actively engaged with educational materials. Twelve (60%) reported engaging in sexual activity, 7 (35%) in risky behaviors, and 3 (15%) reported past sexually transmitted infection (STI) diagnosis.

CONCLUSIONS

Youth with SCD demonstrated limited knowledge regarding sexual health and inheritance of SCD. Topics like information-seeking, limited knowledge, and need for social skills training provide evidence for the creation of an educational intervention for this vulnerable population. This program shows initial feasibility for youth with SCD.

EXPERIENCE OF FORCED SEX AND SUBSEQUENT SEXUAL, DRUG, AND MENTAL HEALTH OUTCOMES: AFRICAN AMERICAN AND HISPANIC WOMEN IN THE SOUTHEASTERN UNITED STATES

OBJECTIVES

This cross-sectional study examined African American and Hispanic women's (N = 1,509) self-reports of unwanted forced sex and its association with behavioral and mental health outcomes after the event.

METHODS

Twenty percent of the women had experienced forced sex (1st occurrence at age 15 years or younger for 10%, 1st occurrence at older than 15 years of age for 10%).

RESULTS

Regardless of when forced sex 1st occurred, women were more likely to have engaged in unprotected vaginal and anal sex, to have had multiple unprotected sex partners, to have sexually transmitted infections, to have reported binge drinking and illicit drug use, and to exhibit distress and have received mental health counseling.

CONCLUSIONS

Forced sex may have wide-ranging behavioral and mental health consequences years later.

Maternal risk taking on the balloon analogue risk task as a prospective predictor of youth alcohol use escalation

The transition from late childhood through middle adolescence represents a critical developmental period during which there is a rapid increase in the initiation and escalation of alcohol use. Alcohol use is part of a constellation of risk taking behaviors that increase during this developmental transition, which can be explained by environmental and genetic factors. Social learning theory (SLT) implicates observations of parental drinking in the development of alcohol use in youth. Parental risk taking more broadly has not previously been examined as a factor predictive of alcohol use escalation in youth across adolescence. The current study examined the relative contributions of maternal risk taking on the Balloon Analogue Risk Task (BART) and maternal alcohol use in the prediction of alcohol escalation among youth over three years. Participants were a sample of 245 youth (55.0% male, 49.6% Caucasian) who participated annually between grades 8 and 10, drawn from a larger study of adolescent risk taking. Within our sample, maternal risk taking, as measured by the BART, predicted increases in alcohol use. Interestingly, maternal alcohol use and other youth factors were not predictive of escalations in youth alcohol use. Our findings suggest the importance of considering maternal riskiness more broadly, rather than solely focusing on maternal alcohol use when attempting to understand youth alcohol use across adolescence. These findings emphasize the relevance of maternal risk taking as measured by a behavioral task and suggest a general level of riskiness displayed by mothers might encourage youth to behave in a riskier manner themselves.

Early Sexual Debut: A Risk Factor for STIs/HIV Acquisition Among a Nationally Representative Sample of Adults in Nepal

While early sexual debut is highly prevalent in Nepal, its link to sexually transmitted infections (STIs/HIV) risk factors has not been explored at a national level. The objective of this study was to assess potential association between early sexual debut and risk factors for STIs/HIV acquisition, including sexual risk behaviors, sexual violence, and teenage pregnancy among adults in Nepal. Data were taken from the nationally representative Nepal Demographic Health Survey (2011), which employed a two-stage complex design to collect data. A sample of 12,756 adults (ages 15-49 years) were included. Multivariate logistic models were conducted, adjusted for demographic characteristics, to assess the association between early sexual debut and STIs/HIV-related risk factors. The prevalence of early sexual debut in this sample was 39.2%, with a mean age of coital debut at 17.9 years. After adjusting for potential confounders, individuals with early sexual debut were significantly more likely to report a history of STIs (aOR 1.19; 95% CI 1.06-1.35) and had a significantly higher risk profile, including having multiple sex partner (aOR 2.14; 95% CI 1.86-2.47), inconsistent condom use (aOR 0.72; 95% CI 0.61-0.86), paid for sex (aOR 1.61; 95% CI 1.14-2.27), a history of sexual violence (aOR 1.99; 95% CI 1.63-2.43), and teenage pregnancy (aOR 12.87; 95% CI 11.62-14.26). Individuals who have early sexual debut are more likely to engage in risk behaviors that place them at increased risk of STIs/HIV acquisition. STIs/HIV prevention strategies should aim at delaying sexual debut to decrease the disproportionate burden of adverse health outcomes, including STIs/HIV, among individuals in Nepal.

Developmental investigation of age at sexual debut and subsequent sexual risk behaviours: a study of high-risk young black males

Background The purpose of this study was to identify unmediated associations of early sexual debut (ESD) on the current safer sex practices of young Black men (YBM).

METHODS

A cross-sectional study of YBM (n=697) attending clinics treating sexually transmissible diseases (STIs) in three cities was conducted. ESD was dichotomised at the age of 13 years and under. A series of regression models were used to test the moderating effects of ESD and perceived parental monitoring (PPM). A regression model also tested the effect of years of sexual experience (YSE) on sexual risk behaviours, while controlling for ESD.

RESULTS

Mean age of debut was 13.95 years. ESD results varied with significance for pregnancy (P<0.001), sexual partners (P<0.001), and ever having chlamydia (assessed by self report), but this final association was only found for older males (P=0.03). PPM held no moderating effect on any of the sexual risk outcomes. YSE was correlated with an increase in recent unprotected vaginal sex (AOR=1.19, 95%CI=1.10-1.27) and having a pregnant partner at the time of enrolment (AOR=1.30, 95%CI=1.17-1.43).

CONCLUSIONS

The findings provide mixed evidence for unmediated associations of ESD among young Black males. The study strongly posits that ESD may actually be a mediating variable rather than a causal explanation for sexual risk. The findings also suggest that advancing YSE foster diminishing vigilance in safer sex practices. These outcomes should be utilised to inform intervention development.

Characteristics of youth who report early sexual experiences in Sweden

Early timing of first sex is a common risk factor for adverse sexual and reproductive health (SRH) outcomes. This study explored characteristics and circumstances associated with early sexual experience (at or below age 14) among Swedish youth. Data were drawn from UngKAB09, a national study of youth SRH in Sweden. 24,000 youth 16-28 years were randomly selected for a web-based survey with a response rate of 24%. Post-stratification weights were used to correct for over- and underrepresentation in response. Adjusted logistic regression was used to model associations with early sexual experience, by gender. In the final sample (N = 5,321, 49% girls), 9 in 10 were sexually experienced, of whom 21% reported early first sex. In multivariate analysis, early sex was significantly associated with 7 of the 9 predictor variables selected for the model among boys and 14 of 15 selected factors among girls. Early sex was positively associated with low educational attainment, early pubertal onset, bisexual identity and (girls only) rural residence. For girls, first generation immigrant status, greater religiosity, conservative sexual attitudes and low Chlamydia knowledge decreased the odds of early sex. Early experience was more common if youth had older partners and, among girls, felt that sex was expected. Being in love, feelings of intimacy, alcohol use at first sex, and (girls only) causal sexual partner and wantedness of first sex were inversely associated with early first sex. The findings and implications are discussed in relation to the European and global literature on early sexual experiences.

Childhood behavior problems and age at first sexual intercourse: a prospective birth cohort study

BACKGROUND AND OBJECTIVES

Early first sexual intercourse (FSI) is a risk factor for unplanned teenage pregnancy, sexually transmitted infection, and adverse social, emotional, and physical health outcomes in adolescence and into adulthood. The aim of this study was to examine relationships between internalizing (eg, anxious/depressed, withdrawn) and externalizing (eg, delinquent, aggressive) behavior problems in childhood and age at FSI.

METHODS

We used a large, population-based birth cohort (The Western Australian Pregnancy Cohort [Raine] Study) to address this question. Child behavior was measured by using the Child Behavior Checklist collected from parents at ages 2, 5, 8, 10, and 14 and scores calculated for total, internalizing, and externalizing behavior problems. At age 17, 1200 participants reported sexual behavior.

RESULTS

Participants with clinically significant Child Behavior Checklist scores (T ≥ 60) were at increased risk for earlier first sexual intercourse (FSI) (<16 years). Adjusted odds ratios revealed that total and externalizing behavior problems from age 5 years onward significantly increased the risk of earlier FSI for boys. In girls, externalizing problems from age 10 years increased the risk for earlier FSI. Internalizing problems at ages 8 and 10 were significantly associated with early FSI for boys but not girls.

CONCLUSIONS

Externalizing behavior from as early as 5 in boys and 10 in girls is a significant risk factor for earlier age at FSI. Adolescent sexual health promotion should consider early intervention in children with behavior problems, particularly boys.

Sexual debut before the age of 14 leads to poorer psychosocial health and risky behaviour in later life

AIM

This study investigated the relationship between sexual debut before 14 years of age and socio-demographics, sexual experience, health, experience of child abuse and behaviour at 18 years of age.

METHODS

A sample of 3432 Swedish high school seniors completed a survey about sexuality, health and abuse at the age of 18.

RESULTS

Early debut was positively correlated with risky behaviours, such as the number of partners, experience of oral and anal sex, health behaviours, such as smoking, drug and alcohol use, and antisocial behaviour, such as being violent, lying, stealing and running away from home. Girls with an early sexual debut had significantly more experience of sexual abuse. Boys with an early sexual debut were more likely to have a weak sense of coherence, low self-esteem and poor mental health, together with experience of sexual abuse, selling sex and physical abuse. A multiple logistic regression model showed that a number of antisocial acts and health behaviours remained significant, but early sexual debut did not increase the risk of psychiatric symptoms, low self-esteem or low sense of coherence at 18 years of age.

CONCLUSION

Early sexual debut was associated with problematic behaviours during later adolescence, and this vulnerability requires attention from parents and healthcare providers.

Same-sex sexual attraction does not spread in adolescent social networks

Peers have a powerful effect on adolescents' beliefs, attitudes, and behaviors. Here, we examine the role of social networks in the spread of attitudes towards sexuality using data from the National Longitudinal Study of Adolescent Health (Add Health). Although we found evidence that both sexual activity (OR = 1.79) and desire to have a romantic relationship (OR = 2.69) may spread from person to person, attraction to same sex partners did not spread (OR = 0.96). Analyses of comparable power to those that suggest positive and significant peer-to-peer influence in sexual behavior fail to demonstrate a significant relationship on sexual attraction between friends or siblings. These results suggest that peer influence has little or no effect on the tendency toward heterosexual or homosexual attraction in teens, and that sexual orientation is not transmitted via social networks.

Examining the prospective effects of making a virginity pledge among males across their 4 years of college

OBJECTIVES

The authors examined prospective associations of making a virginity pledge on sexual behaviors among male college students.

PARTICIPANTS

A sample of 795 males was followed for 4 years (2008, 2009, 2010, 2011), with response rates ranging from 72% to 82% across the follow-up years.

METHODS

Males were surveyed at the end of each of their 4 years in college about sexual behavior activities and other risky behaviors.

RESULTS

Multivariate regression analyses indicated that males who made private virginity pledges were significantly more likely to remain abstinent across all 4 years of college and have fewer sexual partners at the end of their third and fourth years of college, even after controlling for age, race, high-risk drinking, impulsivity, and religiosity. Making a pledge was not related to condom use.

CONCLUSION

Findings suggest that abstinence-based messages alone are not sufficient yet should be included as part of comprehensive sex education programs.

Maternal models of risk: links between substance use and risky sexual behavior in African American female caregivers and daughters

African American (AA) adolescent girls are at heightened risk for HIV and sexually transmitted infections (STIs), and thus knowledge of factors related to risky sexual behavior in this population is crucial. Using Social Learning Theory (Bandura, 1977), this paper examines pathways from female caregivers' risky sexual behavior and substance use to adolescent girls' risky sexual behavior and substance use in a sample of 214 low-income, urban AA female caregivers and daughters recruited from outpatient mental health clinics in Chicago. Structural equation modeling (SEM) revealed that sexual risk reported by female caregivers was associated with adolescent sexual risk, and illicit drug use reported by female caregivers was related to adolescent-reported substance use, which was in turn associated with adolescent-reported sexual risk behavior. These findings suggest that female caregivers' sexual behavior and substance use both relate to girls' sexual risk. Thus, results emphasize the role of female caregivers in transmitting risk.

Adolescents of the U.S. National Longitudinal Lesbian Family Study: sexual orientation, sexual behavior, and sexual risk exposure

This study assessed Kinsey self-ratings and lifetime sexual experiences of 17-year-olds whose lesbian mothers enrolled before these offspring were born in the longest-running, prospective study of same-sex parented families, with a 93% retention rate to date. Data for the current report were gathered through online questionnaires completed by 78 adolescent offspring (39 girls and 39 boys). The adolescents were asked if they had ever been abused and, if so, to specify by whom and the type of abuse (verbal, emotional, physical, or sexual). They were also asked to specify their sexual identity on the Kinsey scale, between exclusively heterosexual and exclusively homosexual. Lifetime sexual behavior was assessed through questions about heterosexual and same-sex contact, age of first sexual experience, contraception use, and pregnancy. The results revealed that there were no reports of physical or sexual victimization by a parent or other caregiver. Regarding sexual orientation, 18.9% of the adolescent girls and 2.7% of the adolescent boys self-rated in the bisexual spectrum, and 0% of girls and 5.4% of boys self-rated as predominantly-to-exclusively homosexual. When compared with age- and gender-matched adolescents of the National Survey of Family Growth, the study offspring were significantly older at the time of their first heterosexual contact, and the daughters of lesbian mothers were significantly more likely to have had same-sex contact. These findings suggest that adolescents reared in lesbian families are less likely than their peers to be victimized by a parent or other caregiver, and that daughters of lesbian mothers are more likely to engage in same-sex behavior and to identify as bisexual.

Testing the role of adolescent sexual initiation in later-life sexual risk behavior: a longitudinal twin design

The consistent association between adolescent sexual initiation (ASI) and risky adult sexual behavior (RASB) has generally been assumed to indicate that ASI has a causal effect on RASB; consequently, it is assumed that delaying ASI will reduce RASB. Yet the ASI-RASB association might be better accounted for by some third variable. We evaluated the causal role of ASI (initiation of oral, anal, or vaginal sex at or before age 16) in influencing RASB in a longitudinal sample of 2,173 twins (followed from ages 11 to 24 or from ages 17 to 29) using two methods: the discordant-twin design and the propensity-score design. The former controlled for unmeasured genetic and shared environmental factors, and the latter controlled for measured nonshared environmental factors. We replicated the link between ASI and RASB reported in previous research, but results from the discordant-twin and propensity-score analyses suggested that this association is better explained by common genetic or environmental risk factors than as a causal effect. These findings suggest that preventing ASI is unlikely to reduce RASB.

Pathways to early coital debut for adolescent girls: a recursive partitioning analysis

This study examined pathways to early coital debut among early to middle adolescent girls in the United States. In a two-year longitudinal study of 104 adolescent girls, recursive partitioning (RP) analyses were conducted to examine the specific factors that were related to engaging in first intercourse by the 10th grade among adolescent girls who had not yet engaged in sexual intercourse by the 8th grade. RP analyses identified subsamples of girls who had low, medium, and high likelihoods of engaging in early coital debut based on six variables (i.e., school aspirations, early physical intimacy experiences, depression, body objectification, body image, and relationship inauthenticity). For example, girls in the lowest likelihood group (3% had engaged in sex by the 10th grade) reported no prior experiences with being touched under their clothes, low body objectification, high aspirations to complete graduate education, and low depressive symptoms; girls in the highest likelihood group (75% had engaged in sex by the 10th grade) also reported no prior experiences with being touched under their clothes, but had high levels of body objectification. The implications of these analyses for the development of female adolescent sexuality, as well as for advances in quantitative methods, are discussed.

The relationship between early sexual debut and psychosocial outcomes: a longitudinal study of Dutch adolescents

In a longitudinal dataset of 470 Dutch adolescents, the current study examined the ways in which early sexual initiation was related to subsequent attachment, self-perception, internalizing problems, and externalizing problems. For male adolescents, analyses revealed general attachment to mother and externalizing problems at Wave 1 to predict to early transition at Wave 2. However, there was no differential change in these psychosocial factors over time for early initiators of sexual intercourse and their non-initiating peers. For female adolescents, the model including psychosocial factors at Wave 1 did not predict to sexual initiation at Wave 2. However, univariate repeated measures analyses revealed early initiators to have significantly larger increases in self-concept and externalizing problems than their non-initiating female peers. While the difference between female early initiators and non-initiators were statistically significant, the mean levels of problem behaviors were very low. The findings suggest that, contrary to previous research, early sexual initiation does not seem to be clustered with problem behaviors for this sample of Dutch adolescents.