Neighborhoods and racial/ethnic disparities in adolescent sexual risk behavior

Effect of a Randomized Controlled Trial of Housing Vouchers on Adolescent Risky Sexual Behavior Over a 15-Year Period

We examined whether a housing voucher intervention influenced adolescent risky sexual behavior (RSB) across 15 years in the Moving to Opportunity Study. Low-income families in public housing that resided in 5 cities were randomized to one of three treatment groups: a housing voucher to move to low-poverty neighborhoods (i.e., < 10% poverty rate), a Sect. 8 voucher but no housing relocation counseling, or a control group that could remain in public housing. Youth and their caregivers completed baseline surveys, as well as two uniform follow-ups: interim (2001-2002; 4-7 years after baseline) and final (2008-2010; 10-15 years after baseline). Approximately 4,600 adolescents (50.5% female) aged 13-20 years participated at the final timepoint. Adolescents reported on their RSB, including condom use, other contraceptive use, early sexual initiation (< 15 years old), and 2+ sexual partners in the past year. We modeled each indicator separately and as part of a composite index. We tested baseline health vulnerabilities as potential effect modifiers. The low-poverty voucher group and the Sect. 8 voucher group were combined due to homogeneity of their effects. Applying intent-to-treat (ITT) regression analyses, we found no significant main effects of voucher receipt (vs. control) on any RSB. However, we found protective effects of voucher receipt on RSB among youth with health problems that limited activity, and youth < 7 at baseline but adverse effects among females, youth > 7 at baseline, and youth who were suspended/expelled from school. Results highlight the importance of understanding how housing interventions differentially influence adolescent health and behaviors.

Preventing Teen Pregnancy: A Qualitative Study of the Perspectives of Parenting and Expecting Latino Adolescents

STUDY OBJECTIVE

Latino youths in the United States experience disproportionately high rates of teen pregnancy. The aim of this study was to obtain expecting and parenting Latino adolescents' perspectives regarding factors contributing to teen pregnancy and pregnancy prevention.

METHODS

Expecting/parenting Latino adolescents were recruited from high schools with high proportions of Latino youths and teen pregnancy. Participants completed a questionnaire on sociodemographic and background characteristics. Focus groups were stratified by age and gender and audio recorded. Grounded theory was used to identify themes from the transcribed audio recordings.

RESULTS

Thirty-two expecting/parenting Latino adolescents (20 females, 12 males) 14-19 years old participated in four focus groups. Quantitative results revealed that two-thirds of participants at birth had adolescent mothers. Over three-quarters of participants reported that their pregnancies had occurred too soon. Qualitative themes for factors contributing to teen pregnancy included lack of contraceptive knowledge/access, belief of invincibility, influence within relationships, male decisions on contraceptive use, desire to belong among peers, lack of parental support for contraceptive use, lack of parental attention, rebellion, normalization of adolescent parenthood in Latino culture, and media. Themes for pregnancy prevention included time alone with physicians, parenting teens as mentors, reproductive health education, and community pregnancy-prevention programs.

CONCLUSION

Multiple factors contribute to teen pregnancy in Latino youth, including influences from Latino culture, family, peers, partners, and social determinants of health. Pregnancy prevention should incorporate interventions to address these aspects, including disseminating culturally sensitive education materials, providing parenting teens as peer mentors, encouraging time alone with health care providers, and addressing various social determinants of health.

Socially Disadvantaged Community Structures and Conditions Negatively Influence Risky Sexual Behavior in Adolescents and Young Adults: A Systematic Review

Objectives: This review aims to examine the association between community-level factors, namely, community structure and condition, and risky sexual behavior (RSB) including early sexual debut, having multiple sex partners, and unprotected sex, in adolescents and young adults.

Methods: In total, 17 observational studies were identified for review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Among the 11,216 identified articles, excluded articles comprised 8,361 duplicates, 2,855 articles by title screening, 893 by abstract screening, and 667 by full-text screening. Finally, eight additional articles were added by manual search.

Results: The community structural factors included social disadvantage, economic, employment, education status, racial or ethnic composition, residential stability, and physical environment. The current review found that social disadvantage (six studies) and economic status (10 studies) were most frequently examined. Particularly, higher levels of social disadvantage were associated with higher rates of early sexual initiation, inconsistent condom use, and multiple sexual partners.

Conclusion: This study highlights that community structure and conditions in terms of social disadvantages should be addressed to prevent RSB in the young population.

Modeling the impact of a health coaching intervention to prevent teen pregnancy

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Health coaching is an effective intervention to improve adolescent contraceptive use outcome.

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A microsimulation model of teen pregnancy was developed and used to assess the health and economic impact of a health coaching intervention to prevent teen pregnancy.

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Health coaching intervention for adolescent contraceptive use is cost-effective.

Teenage pregnancy is an important public health issue in the United States, presenting significant health and economic risks to adolescents and the society. Health coaching is a potentially effective intervention in preventing teen pregnancy. In 2017, the Children’s Hospital of Philadelphia implemented a health coaching program among sexually active teenage girls, which improved their contraceptive continuation rates. However, the cost-effectiveness of the health coaching program is not clear. We developed a microsimulation model of teen pregnancy that can predict the number of teen pregnancies and related birth outcomes. Model parameters were estimated from the literature and the health coaching program. The teen pregnancy model was used to assess how the program could influence direct health care costs and pregnancy outcomes. Our model projected that the health coaching program could prevent 15 teen pregnancies per 1000 adolescents compared to no intervention. The incremental cost-effectiveness ratio (ICER) for the intervention was $309 per pregnancy prevented, which was less than the willingness-to-pay threshold of $4,206 per pregnancy. Thus, the health coaching intervention was cost-effective. Our study provides promising data on the effectiveness and cost-effectiveness of a health coaching intervention to reduce the burden of teen pregnancies. Health practitioners should consider implementing the program for a longer term and at a larger scale.

Trends in the Incidence of Human Papillomavirus-Associated Cancers by County-Level Income and Smoking Prevalence in the United States, 2000-2018

Human papillomavirus (HPV)-associated cancer burden is rising in the United States. Trends in the incidence by county-level income and smoking prevalence remain undescribed. We used the Surveillance, Epidemiology, and End Results 21 database to ascertain HPV-associated cancers during 2000-2018. Trends were estimated by county-level income and smoking prevalence quartiles. Anal and vulvar cancer incidence among women and anal cancer incidence among men increased markedly in the lowest-income counties, whereas the increases were slower in the highest-income counties (eg, for vulvar cancer, incidence increased 1.9% per year, 95% confidence interval [CI] = 0.9% to 2.9%, in the lowest-income counties vs 0.8% per year, 95% CI = 0.6% to 1.1%, in the highest-income counties). In recent years, cervical cancer incidence plateaued (0.0% per year [95% CI = -0.5% to 0.5%]) in the highest-income counties; in the lowest-income counties, the annual percentage change was 1.6% per year (95% CI = -0.7% to 4.0%). Counties with high smoking prevalence had marked increases in incidence compared with their counterparts (eg, anal cancer among men increased 4.4% per year [95% CI = 2.7% to 6.0%] for those living in counties with the highest smoking prevalence vs 1.2% per year [95% CI = 0.7% to 1.7%] for those living in counties with the lowest smoking prevalence). Improved and targeted prevention is needed to combat the widening disparities.

Duration-Weighted Exposure to Neighborhood Disadvantage and Racial-Ethnic Differences in Adolescent Sexual Behavior

Racial-ethnic disparities in adolescent sexual risk behavior are associated with health disparities during adulthood and are therefore important to understand. Some scholars argue that neighborhood disadvantage induces disparities, yet prior research is mixed. We extend neighborhood-effects research by addressing long-term exposure to neighborhood disadvantage and estimation bias resulting from inclusion of time-varying covariates. Drawing from the Fragile Families and Child Well-Being Study, we compare a point-in-time proximal measure of neighborhood disadvantage with a duration-weighted measure using marginal structural models with inverse probability of treatment weights. Findings indicate that multiracial, non-Hispanic black, and Hispanic youth exhibit significantly higher sexual risk and duration-weighted exposure to neighborhood disadvantage than non-Hispanic white adolescents. Duration-weighted exposure is a better predictor of sexual initiation and number of partners by age 15 than a point-in-time proximal measure of neighborhood disadvantage and accounts for a substantial portion of the race-ethnic differences in sexual risk.

Does a Rising Median Income Lift All Birth Weights? County Median Income Changes and Low Birth Weight Rates Among Births to Black and White Mothers

Policy Points Policies that increase county income levels, particularly for middle-income households, may reduce low birth weight rates and shrink disparities between Black and White infants. Given the role of aggregate maternal characteristics in predicting low birth weight rates, policies that increase human capital investments (e.g., funding for higher education, job training) could lead to higher income levels while improving population birth outcomes. The association between county income levels and racial disparities in low birth weight is independent of disparities in maternal risks, and thus a broad set of policies aimed at increasing income levels (e.g., income supplements, labor protections) may be warranted.

CONTEXT

Low birth weight (LBW; <2,500 grams) and infant mortality rates vary among place and racial group in the United States, with economic resources being a likely fundamental contributor to these disparities. The goals of this study were to examine time-varying county median income as a predictor of LBW rates and Black-White LBW disparities and to test county prevalence and racial disparities in maternal sociodemographic and health risk factors as mediators.

METHODS

Using national birth records for 1992-2014 from the National Center for Health Statistics, a total of approximately 27.4 million singleton births to non-Hispanic Black and White mothers were included. Data were aggregated in three-year county-period observations for 868 US counties meeting eligibility requirements (n = 3,723 observations). Sociodemographic factors included rates of low maternal education, nonmarital childbearing, teenage pregnancy, and advanced-age pregnancy; and health factors included rates of smoking during pregnancy and inadequate prenatal care. Among other covariates, linear models included county and period fixed effects and unemployment, poverty, and income inequality.

FINDINGS

An increase of $10,000 in county median income was associated with 0.34 fewer LBW cases per 100 live births and smaller Black-White LBW disparities of 0.58 per 100 births. Time-varying county rates of maternal sociodemographic and health risks mediated the association between median income and LBW, accounting for 65% and 25% of this estimate, respectively, but racial disparities in risk factors did not mediate the income association with Black-White LBW disparities. Similarly, county median income was associated with very low birth weight rates and related Black-White disparities.

CONCLUSIONS

Efforts to increase income levels-for example, through investing in human capital, enacting labor union protections, or attracting well-paying employment-have broad potential to influence population reproductive health. Higher income levels may reduce LBW rates and lead to more equitable outcomes between Black and White mothers.

Immigrant Youth Resilience: Theoretical Considerations, Empirical Developments, and Future Directions

Resilient adaptation among immigrant youth provides the foundation for healthy and productive adult lives. Great diversity is observed in their adaptation. This diversity has been studied during the past decade from different angles and intellectual traditions. However, the results are disconnected. In this paper, first, we present a resilience conceptual model for understanding immigrant youth adaptation. We argue that its concepts and principles allow us to best pull together what is known and discover what is still unknown. Together with narrower topic-specific conceptual models, it can guide the formulation of hypotheses regarding immigrant youth resilience. Second, we examine comparatively, through the lens of this conceptual model, results of a content analysis on the abstracts of studies on individual differences in immigrant youth adaptation, conducted during the past decade in North American and European countries. Finally, we discuss the meaning of acculturation-related terms which are often used in an inconsistent way.

The Health of Hispanic Children from Birth to Emerging Adulthood

This article summarizes frameworks for understanding Hispanic children's health, sources of national data available to evaluate their health, and variations in health among Hispanic children. Following ecological and life-course perspectives, we organize our review of the literature on Hispanic children's health and development according to three key stages of child development (zero to three, early to middle childhood, and adolescence to emerging adulthood) with attention to how each stage influences the next. Within each stage, we consider how social position (i.e. skin color, social class, gender, and nativity), social contexts (i.e. family, school, and neighborhood), and political and legal contexts influence Hispanic children's health and development. To improve the health and development of Hispanic children, federal, state, and local policies must address social and economic injustices that lead to declines in health across immigrant generations and persistent racial/ethnic health disparities.

Profiles of young women's alcohol and cannabis use linked to risk for sexually transmitted infection highlight the importance of multi-level targeted interventions: Findings from the Pittsburgh girls study

Background: Social ecological models designed to understand disparities in sexually transmitted infection (STI) prevalence highlight understudied structural and community risk factors. Guided by a social ecological model, this study identified profiles based on substance use-related STI risk, and examined associations of the profiles with selected indicators of structural-, community-, and individual-level STI risk factors. Methods: Repeated measures latent class analysis was applied to Pittsburgh Girls Study data (n = 2,138; 58% Black, 42% White) at ages 18-20. Profile indicators included: women's and partner's alcohol and cannabis use, women's sexual risk behavior, and self-reported STI. Profile predictors included racial background, structural-, community-, and individual-level risk factors. Results: Two of the five identified profiles had low STI likelihood: "Low Use" of alcohol and cannabis (25.5%; overrepresented by Black women), and "Alcohol Only" (19.1%; overrepresented by White women). Three profiles, all representing co-use of alcohol and cannabis, had higher STI likelihood: "Co-Use: Increasing Alcohol and Occasional Cannabis use" (16.5%; overrepresented by White women), "Co-Use: Occasional Alcohol and Cannabis use" (26.1%; overrepresented by Black women), and "Co-Use: Frequent Cannabis and Occasional Alcohol use" (12.8%; overrepresented by Black women). Structural STI risk (household use of public assistance at wave 1) was associated with "Low Use" and "Co-Use: Frequent Cannabis and Occasional Alcohol use" profiles. STI risk at multiple levels (structural, neighborhood, individual) was associated with the "Co-Use: Frequent Cannabis and Occasional Alcohol use" profile. Conclusions: Co-use of alcohol and cannabis is an important target for STI prevention efforts. Results also highlight structural- and community-level STI risk factors that disproportionately impact Black women, and the importance of multi-level interventions that are targeted to profile of risk to optimize the effectiveness of interventions.

Neighborhood Disorder and Risk-Taking Among Justice-Involved Youth-The Mediating Role of Life Expectancy

Neighborhood disorder has been linked to perceptions of shorter life expectancies, and shorter life expectancies have been associated with greater risk-taking. Yet, no studies have combined these two pathways. Using data from the longitudinal Crossroads study, the present study assessed whether life expectancy mediates the association between neighborhood disorder and risk-taking-substance use, crime, and risky sex-among 1,093 justice-involved adolescents. Results indicate that neighborhood disorder was linked to lower estimated life expectancy which in turn related to higher rates of cigarette use, binge drinking, illicit drug use, offending, and casual sex. However, life expectancy did not explain the association between neighborhood disorder and marijuana use or inconsistent condom use.

Patterns of sexting and sexual behaviors in youth: A Latent Class Analysis

INTRODUCTION

A sizable minority of youth are sexting; however there are likely large individual differences in sexting and sexual behaviors, yet to be captured. A Latent Class Analysis was used to identify subgroups of youth characterized by differential engagement in sexting and sexual behaviors.

METHODS

Participants were an ethnically diverse sample of 894 youth (55.8% female; Mage = 17.04, SD = 0.77) from a longitudinal survey study in southeast Texas. Latent classes were identified through participants' responses to the following indicator variables: sending, receiving, and requesting sexts, sexual activity, contraception use, ≥ three partners, and substance use prior to sexual activity. Gender, ethnicity, impulsivity, and living situation were analyzed as predictors, and depressive symptoms as an outcome, of class membership.

RESULTS

The analysis revealed four distinct classes: No sexting-Low sex (42.2%), Sexting-Low sex (4.5%), No sexting-Moderately risky sex (28.3%), and Sexting-Moderately risky sex (24.9%). Gender and ethnicity predicted class membership wherein females and ethnic minority youth were less likely to be in groups displaying higher rates of sexting. Impulsivity and living situation predicted class membership, such that youth reporting higher impulsivity and living in a situation other than with two biological parents were less likely to be in classes displaying low sexting and sexual behaviors. Group membership predicted depressive symptoms.

CONCLUSIONS

Results suggest that not all youth who are sexting are having sex, and not all youth who are having sex are sexting. Evidence of individual differences in youth sexual behaviors should inform educational initiatives aimed at teaching youth about sexual and online health.

The role of stress and absence: How household member incarceration is associated with risky sexual health behaviors

Sexual health is a critical indicator of wellbeing with consequences for population health. However, little is known about whether and how household member incarceration affects the sexual health behaviors of young adults. This study seeks to assess the association between household member incarceration and sexual health behaviors and provides an initial test of mechanisms. Drawing upon data from the NLSY97, this study estimates the association between household member incarceration and sexual health behaviors using linear probability models, and then re-estimates these associations using two alternative comparison groups; 1) youth who experienced other forms of stress, and 2) youth who experienced other forms of family absence. Results indicate that household incarceration is positively associated with a higher risk of reporting sexual intercourse with an intravenous drug user net of individual and family characteristics and is negatively associated with condom use net of individual but not family characteristics. The results also show that the associations between household member incarceration and sexual health behaviors may be attributable, at least in part, to the well documented stress associated with incarceration. Yet, the results provide little evidence that absence is a pathway linking household member incarceration to risky sexual health behaviors. It is possible that household member incarceration is linked to deleterious outcomes for youth through different mechanisms than parental incarceration given the differing roles of parents versus other adults in the home. Future research should explore the pathways linking household member incarceration to health risks for youth and consider household member incarceration as a unique family stressor.

The Healthy Young Men's Cohort: Health, Stress, and Risk Profile of Black and Latino Young Men Who Have Sex with Men (YMSM)

Young men who have sex with men (YMSM), especially YMSM of color, are at increased risk for a wide range of threats to their health and well-being. In this study, we recruited and surveyed an urban sample of 448 young African American/Black (Black), Hispanic/Latino (Latino), and multi-racial/ethnic YMSM, ages 16-24 years (mean = 22.3 years), about stressful life events, their health and mental health, their access to and utilization of care, and their involvement in risk-related behaviors. We found that the majority reported experiences of racism (87%) and homophobia (76%). A high percentage reported food insecurity/hunger (36%), residential instability (15%), financial hardship (63%), and conflict with family/friends (62%). The prevalence of risk behaviors was also high, including recent use of tobacco (46%), alcohol (88%), and marijuana (72%), and 41% tested positive for 1+ drugs. Furthermore, 26% tested positive for 1+ sexually transmitted infections (STIs). Over half (56%) reported being worried about their health, 33% reported having a chronic health condition and 31% a mental health condition, and 45% had wanted/needed mental health services during the past year. Further, 17% reported suicidal ideation/had planned a suicide attempt and 26% had ever engaged in self-injurious behaviors. Significant differences by race/ethnicity and HIV status included residential status/food insecurity, type of racism/homophobia, drug use, and STIs. These findings demonstrate how vulnerable this population is with respect to a wide range of structural and social determinants of health that may be important drivers of behavioral, health, mental health outcomes, and potentially long-term health disparities.

Analysis of Pregnancy and Birth Rates Among Black and White Medicaid-Enrolled Teens

PURPOSE

In the United States, black teens overall have higher pregnancy and birth rates than whites, and it is commonly believed that minority race and low income account for this disparity. We examined racial differences in pregnancy and birth rates among teens from low-income households using Medicaid-enrollment as a proxy for low income.

METHODS

This was a retrospective study of Louisiana Medicaid claims data for female teens aged 15-17 years in 2014 (n = 66,069). Pregnancy and pregnancy outcome codes were identified (n = 2,276) and analyzed for differences by black and white race. We conducted validity analyses with different rate definitions and teens' claims status.

RESULTS

The cohort was 36% white and 54% black. More black teens than whites lacked any claims data (15.6% vs. 12.6%; p < .001). Rates calculated as events per 1,000 person-years of Medicaid coverage showed no difference in live birth rates between white and black teens (24.6 vs. 25.8; relative incidence ratio, 1.05; 95% confidence interval, .93-1.18; p = .43); however, pregnancy rates for whites were higher than those for blacks (42.7 vs. 36.1; relative incidence ratio, .85; 95% confidence interval, .77-.93; p < .001).

CONCLUSION

In contrast to national trends, which include teens from diverse racial and socioeconomic backgrounds, Louisiana Medicaid-enrolled teens aged 15-17 years had equal birth rates regardless of black or white race, and whites had higher pregnancy rates. Decreased racial disparities in pregnancy and birth rates among these adolescents highlights socioeconomic influences in sexual health behavior and a need to examine the interplay of risk factors contributing to racial disparities seen among adolescents nationally.

OXTR DNA methylation moderates the developmental calibration of neural reward sensitivity

The Adaptive Calibration Model of Stress Responsivity (ACM) suggests that developmental experiences predictably tune biological systems to meet the demands of the environment. Particularly important is the calibration of reward systems. Using a longitudinal sample (N = 184) followed since adolescence, this study models the dimensions of early life stress and their effects on epigenetic modification of the oxytocin receptor gene (OXTR) and individual differences in neural response to reward anticipation. We first created a latent variable model of developmental context using measures collected when participants were 13 years old. As adults, two subsets of participants completed a reward anticipation fMRI paradigm (N = 82) and agreed to have their blood assayed for (OXTR) DNA methylation (N = 112) at two CpG sites. Three latent constructs of developmental context emerged: Neighborhood Harshness, Family Harshness, and Abuse and Disorder. Greater OXTR DNA methylation at CpG sites -924 and -934 blunted the association between greater Neighborhood Harshness and increased neural activation in caudate in anticipation of rewards. Interaction effects were also found outside of reward-related areas for all three latent constructs. Results indicate an epigenetically derived differential susceptibility model whereby high methylation coincides with decreased association between developmental environment and neural reward anticipation.

Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model

Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.

Neighborhood Disorder, Family Functioning, and Risky Sexual Behaviors in Adolescence

Adolescent risky sexual behaviors can result in negative consequences such as sexually transmitted infection. However, much research effort has been placed on understanding individual characteristics, rather than the role of neighborhood environment. This study addressed the prospective effects of neighborhood and family functioning in preadolescence on risky sexual behaviors. Participants included 4179 youth (Mage = 11.01 years, range 8.64-13.83; 51% female) and their caregivers. Using objective and self-reported measures of neighborhood and family functioning, results from multilevel regression analyses indicated that youth residing in disordered neighborhoods or had poorer family functioning in preadolescence were more likely to initiate sexual intercourse at younger ages 5 years later. Specifically, neighborhood poverty and decay were linked to early sexual initiation, whereas neighborhood social and family processes were protective against early sexual initiation. Males were more likely to engage in risky sexual behaviors in neighborhoods with greater poverty or decay; neighborhood poverty was linked with sexual initiation in White but not African American youth. Finally, parental monitoring moderated relationships between neighborhood social resources and contraceptive use, with neighborhood social resources linked with greater contraceptive use at low levels of parental monitoring, but lower contraceptive use at high levels of parental monitoring. These findings underscore the importance of neighborhood and family contexts in adolescents' risky sexual behavior, suggesting that males and White youth are more vulnerable to the effects of neighborhood poverty and that more research is needed on the possible counterproductive function of parental monitoring in neighborhoods with greater social resources.

Profiles of Risk and Protection for Violence and Bullying Perpetration Among Adolescent Boys

BACKGROUND

Violence and bullying perpetration among boys are major public health problems. We address gaps in the literature by examining: (1) how risk and protective factors co-occur, and (2) how different risk/protection profiles are associated with violence and bullying perpetration among adolescent boys.

METHODS

Data came from the population-based 2016 Minnesota Student Survey. The analytic sample included boys in grades 8, 9, and 11 (N = 63,818). Latent profile analyses identified patterns of 22 behavioral, intrapersonal, family, and school and community risk/protective factors. Logistic regression analyses examined how these patterns related to violence and bullying perpetration.

RESULTS

We identified 5 groups: Class 1: Low risk, high safety, high connectedness; Class 2: Low risk, moderate safety, moderate connectedness; Class 3: Moderate risk, high safety, moderate connectedness; Class 4: High risk, moderate safety, low connectedness; and Class 5: High risk, low safety, low connectedness. Compared to Class 1, Class 5 students had the highest odds of all for violence and bullying perpetration. Class 4 students also demonstrated high odds of violence and bullying, compared to Class 1. Though not as high as Classes 4 or 5, Class 2 and 3 students showed higher odds for both outcomes, compared to Class 1.

CONCLUSIONS

Substantive variations exist in boys who engage in violence and bullying. We highlight cumulative, co-occurring risk factors, connectedness to parents and other prosocial adults (eg, teachers), and school and neighborhood safety as important factors to address in school health programs seeking to prevent violence and bullying perpetration among boys.

Examining neighborhood poverty-based disparities in HIV/STI prevalence: an analysis of Add Health data

PURPOSE

The purpose of the study was to estimate the effect of exposure to neighborhood poverty in adolescence on HIV/STI prevalence in early adulthood.

METHODS

Longitudinal data from three waves of the National Longitudinal Study of Adolescent to Adult Health were analyzed. The primary exposure was living in a high- versus medium/low-poverty neighborhood during wave I. The outcome was having a sexually transmitted infection (STI) or receiving a HIV/STI diagnosis in the past 12 months at wave III. Covariates included sociodemographic, behavioral, and mental health-related factors. Inverse probability weighted marginal structural models were used to estimate neighborhood poverty-based differences in HIV/STI prevalence.

RESULTS

The analytic sample comprised 8232 National Longitudinal Study of Adolescent to Adult Health participants. Of these, 16% and 84% resided in high- and medium/low-poverty neighborhoods, respectively. Eleven percent currently had an STI or HIV/STI diagnosis within the prior 12 months. Accounting for measured potential sources of confounding and selection bias, the HIV/STI prevalence difference (95% confidence limits) for those who grew up in high- versus medium/low-poverty neighborhoods was 0.015 (-0.015, 0.045).

CONCLUSIONS

Strong evidence for neighborhood poverty-based differences in HIV/STI prevalence was not observed. Researchers should continue to investigate the effect of neighborhood-level socioeconomic position measures and, if warranted, identify etiologically relevant exposure periods.

Teen mothers' educational attainment and their children's risk for teenage childbearing

The children of teen mothers are at elevated risk for becoming teen parents themselves. The current study aimed to identify how levels of mothers' education were associated with risk of teenage childbearing for children of teen versus nonteen mothers. Through structural equation modeling, we tested whether children's environmental and personal characteristics in adolescence and subsequent sexual risk behaviors mediated the relationship between their mothers' educational attainment and their risk for teenage childbearing. With multiple-group models, we assessed whether the associations of maternal educational attainment with children's outcomes were similar for the children of teen and nonteen mothers. The sample (N = 1,817) contained linked data from female National Longitudinal Survey of Youth, 1979 (NLSY79) participants and their first-born child (son or daughter) from the NLSY79 Children and Young Adults. The mediating pathways linking higher levels of maternal education to lower risk for teenage childbearing, and magnitudes of the associations, were mostly similar for children of teen and nonteen mothers. However, nonteen mothers experienced greater associations of their high school diploma attainment (vs. no degree) with some of their children's outcomes. Also, the association of earning a high school diploma (vs. a GED) with household incomes was greater for nonteen mothers; there was no significant difference between degree types for teen mothers. Findings provide support for teen mother secondary school support programming, but point to a need for further research regarding the long-term behavioral and social outcomes associated with the high school equivalency certificate for teen mothers and their children. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Prevalence of Sexual Initiation Before Age 13 Years Among Male Adolescents and Young Adults in the United States

IMPORTANCE

Despite similar sexual activity rates among male and female adolescents, males are more likely to have their first sexual intercourse before age 13 years. The developmental needs and pathways to healthy trajectories for young males remain unknown.

OBJECTIVE

To examine the prevalence of sexual intercourse before age 13 years among male adolescents; the variation by race/ethnicity, location, and maternal educational level; and the wantedness of this first sexual experience.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional analysis was conducted from September 2017 to June 2018, using pooled 2011, 2013, and 2015 data from the school-based Youth Risk Behavior Surveillance System (YRBSS) and the 2006 to 2015 data of males aged 15 to 24 years from the household-based National Survey of Family Growth (NSFG). The percentage of males reporting sexual onset before age 13 years was estimated using survey-weighted logistic regression to test for differences by race/ethnicity within each national survey and within metropolitan areas (for YRBSS, high school and middle school samples). Among NSFG survey respondents, differences in wantedness of first sexual intercourse by age at first sexual intercourse were examined, along with the associations between sexual initiation and socioeconomic covariates.

MAIN OUTCOMES AND MEASURES

Sexual onset before age 13 years.

RESULTS

Data from a total of 19 916 male high school students (from YRBSS) and 7739 males aged 15 to 24 years (from NSFG) were included in the analysis. The sample was largely composed of non-Hispanic white males: 8789 (57.1%) from the YRBSS and 3737 (58.0%) from the NSFG. Sexual onset before age 13 years was reported nationally by 7.6% (95% CI, 6.8%-8.4%) of male high school students and 3.6% (95% CI, 3.0%-4.2%) of males aged 15 to 24 years. The proportion of male students who reported having sexual intercourse before age 13 years varied across metropolitan sites, from 5% (95% CI, 4%-7%) in San Francisco, California, to 25% (95% CI, 23%-28%) in Memphis, Tennessee, with elevated rates among non-Hispanic black and Hispanic males in most metropolitan areas. In the NSFG data set, respondents whose mothers had a college degree or higher educational level were statistically significantly less likely (OR, 0.31; 95% CI, 0.19-0.49) to report having sexual intercourse before age 13 years compared with those whose mothers did not have a college degree. Among males who reported having their first sexual experience before age 13 years, 8.5% (95% CI, 3.8%-17.8%) described their first sexual intercourse as unwanted.

CONCLUSIONS AND RELEVANCE

Rates of sexual onset before age 13 years among young males varied by race/ethnicity, location, and maternal educational level, presenting important implications for the provision of early, inclusive, and comprehensive sex education and sexual and reproductive health care to male children and adolescents.

Functional and Structural Brain Correlates of Socioeconomic Status

Socioeconomic status (SES) is a multidimensional construct that includes not only measures of material wealth, but also education, social prestige, and neighborhood quality. Socioeconomic correlates between wealth and cognitive functions have been well established in behavioral studies. However, functional and structural brain correlates of SES remain unclear. Here, we sought to uncover the most likely neural regions to be affected by low SES, specifically associated with age. Using effect size–seed-based d Mapping, we compiled studies that examined individuals with low SES and performed functional magnetic resonance imaging and voxel-based morphometry meta-analyses. The results revealed that as from early to late age, individuals exposed to low SES are less likely to have sustained executive network activity yet a greater likelihood to enhanced activity within reward-related regions. A similar activity was shown for gray matter volume across early to older age. These findings provide the first quantitative integration of neuroimaging results pertaining to the neural basis of SES. Hypoactivation of the executive network and hyperactivation of the reward network in low SES individuals may support the scarcity hypothesis and animal models of the effects of early adversity.

Implementing Adolescent Sexual and Reproductive Health Clinical Best Practice in the Bronx, New York

PURPOSE

Inequitable access to quality adolescent sexual and reproductive health (ASRH) care may contribute to the high rate of teen pregnancy in the Bronx, New York. Bronx Teens Connection (BxTC), a community-wide intervention, sought to increase the number of ASRH best practices implemented and the number of females 12-19 years old receiving services by health centers in the Bronx.

METHODS

To promote best practices, BxTC provided training and technical assistance to partnering health centers from 2011 to 2014. Health center staff completed a 26-item survey annually to document clinic practices and service utilization. Significance of changes was assessed with paired t tests.

RESULTS

BxTC provided 285 hours of training and technical assistance to 12 partnering health centers. Eight health centers consistently completed the survey. Of the possible 31 ASRH best practices, the average number implemented increased from 23 in 2011 to 28 in 2014. Increases in unduplicated female adolescent patients were observed among Hispanics/Latinas (p = .026) and all females aged 15-17 (p = .035). Contraceptive coverage reported by six of the eight health centers increased among Hispanic/Latinas (32%-55%, p = .006), patients ages 15-17 (33%-53%, p = .005), and patients 18-19 (38%-56%, p = .036). The total number of hormonal implants provided to teens increased from two in 2011 to 173 in 2014.

CONCLUSIONS

Other jurisdictions may consider prioritizing clinical linkages in order to improve ASRH outcomes by supporting best practices and expanding access to services in the most disinvested neighborhoods.

Adolescent Substance Use and Effects on the Birth Experience

Depression, violence, and infant complications are recognized risk factors for negative birth experiences. Substance use, which often co-occurs with these risk factors, is unexplored for its role upon the birth experience. The frequency of these risk factors among childbearing adolescents suggests a need for research in this area. This study revealed direct and indirect effects by all risk factors on the adolescent's birth experience. Implications for nursing practice suggest collaboration between maternal child health and mental health nurses in prenatal, hospital, and follow-up healthcare settings to provide essential assessment of risk factors and resources and referrals across the perinatal period.

Using marijuana, drinking alcohol or a combination of both: the association of marijuana, alcohol and sexual risk behaviour among adolescents

Background Although the association between alcohol use and sexual risk behaviour has been well-documented, there is little understanding of whether marijuana use alone or combining marijuana with alcohol use contributes to sexual risk behaviour among adolescents.

METHODS

A diverse sample of sexually active adolescents (n = 616) aged 12-18 years (50.32% Hispanic; 31.17% Black) completed a survey on alcohol use, marijuana use and sexual risk behaviour during a visit to a primary care clinic.

RESULTS

Adolescents were more likely to report having had two or more sexual partners in the past 3 months if they reported using both alcohol and marijuana (OR=3.90, P<0.0001), alcohol alone (OR=2.51, P<0.0001) or marijuana alone (OR=1.89, P<0.001) compared with adolescents who reported no use during the past month. Adolescents were more likely to report having both two or more partners and condomless sex if they used both alcohol and marijuana (OR=3.19, P<0.001) or alcohol alone (OR=3.41, P<0.01) in the past month compared with adolescents who reported using marijuana alone or had no use of either.

CONCLUSIONS

Providers should screen for both alcohol and marijuana use among adolescents and discuss how use of alcohol or alcohol in conjunction with marijuana may be associated with sexual risk behaviours.

The Effects of School-Based Discrimination on Adolescents of Color Sexual Health Outcomes: A Social Determinants Approach

Social inequalities are at the heart of disparities in sexual health outcomes among African American and Latino/a adolescents living in the United States. Schools are typically the largest and primary context in youth development. School characteristics such as peer and teacher discrimination and school performance were examined to determine whether such characteristics predict sexual behavior in adolescents of color. This study utilized a representative sample of high school age students to assess sexual risk behavior. Findings indicate that there was a clear disparity in sexually transmitted infection diagnoses. School characteristics such as teacher discrimination and Grade Point Average were significant predictors to sexual risky behaviors among adolescents of color. The study adds to the literature in examining contextual factors that are associated with adolescent sexual risk behavior, and findings provide implications for future prevention work.

The Influence of Acculturation on Traumatic Stress Following Childbirth Among Hispanic Adolescents

INTRODUCTION

Many studies have explored the role of acculturation on health outcomes; however, no studies to date have examined relationships between acculturation and the traumatic stress of childbirth among Hispanic adolescents.

METHOD

A convenience sample of 66 Hispanic adolescents 13 to 19 years of age completed the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II), a demographic sheet, birth appraisal scale, and the Impact of Event Scale within 72 hours of birth.

RESULTS

Significant associations were found between the ARSMA-II subscales and acculturation proxy variables, excluding language; however, only the Mexican Orientation Subscale and generation proxy variable influenced the birth experience. The study findings showed that Hispanic adolescents reporting a more traumatic childbirth identified closer with the Mexican culture and reported fewer family generations residing in the United States.

CONCLUSION

As an overlooked area of research, our findings support the need for additional research related to the traumatic stress of birth among Hispanic adolescents. Using multiple acculturation measurements, including the ARSMA-II, with larger, more diverse samples of adolescents, equally balanced between all categories of acculturation and placement within the five-tier generation matrix, can provide some insightful information and directed health care.

Ethnicity, gender and risky sexual behaviour among Nigeria youth: an alternative explanation

BACKGROUND

While studies in demography and public health have acknowledged the role of ethnic differences, the influence of ethnicity on youth sexual behaviour in Nigeria has received little or no attention. It is important to know how cultural norms and gender roles, which vary by ethnicity, may promote or prevent risky behaviour. Such information could provide insights into previously undetected sexual behaviour in multi-ethnic situations.

METHODS

The Nigeria Demographic and Health Surveys (NDHS) for 2003, 2008 and 2013 were pooled to examine the relationship between ethnicity and youth sexual reproductive health, proxied by age at sexual debut, multiple sexual partners (MSP) and condom use at last sexual activity, among the 6304 females and 1549 males who reported being sexually active in the four weeks preceding the survey. Multivariate analysis using a Cox proportional hazard regression model was used to determine the risk factors for early sexual activity among young people (15-24). Logistic regression was used to predict condom use at last sexual activity and MSP.

RESULTS

The median age at first sexual activity was 16 for females and 17 for males. 43% of male youths used condoms in their last sexual activity, compared to only 16% among females and a higher number of males (81%) had multiple sexual partners compared to females (35%). For females, elevated risks of first sex was higher among Hausa/Fulanis aged 15-19 and elevated risk of first sex was higher among Yoruba males.

CONCLUSION

This study provides further evidence that in order to promote protective sexual behaviours among youth in Nigeria, social, cultural and gender-specific tactics should be put in place for the prevention of HIV and other STIs.

Social Determinants and Teen Pregnancy Prevention: Exploring the Role of Nontraditional Partnerships

Addressing the social determinants of health (SDOH) that influence teen pregnancy is paramount to eliminating disparities and achieving health equity. Expanding prevention efforts from purely individual behavior change to improving the social, political, economic, and built environments in which people live, learn, work, and play may better equip vulnerable youth to adopt and sustain healthy decisions. In 2010, the Centers for Disease Control and Prevention in partnership with the Office of Adolescent Health funded state- and community-based organizations to develop and implement the Teen Pregnancy Prevention Community-Wide Initiative. This effort approached teen pregnancy from an SDOH perspective, by identifying contextual factors that influence teen pregnancy and other adverse sexual health outcomes among vulnerable youth. Strategies included, but were not limited to, conducting a root cause analysis and establishing nontraditional partnerships to address determinants identified by community members. This article describes the value of an SDOH approach for achieving health equity, explains the integration of such an approach into community-level teen pregnancy prevention activities, and highlights two project partners' efforts to establish and nurture nontraditional partnerships to address specific SDOH.

Lower neighborhood quality in adolescence predicts higher mesolimbic sensitivity to reward anticipation in adulthood

Life history theory suggests that adult reward sensitivity should be best explained by childhood, but not current, socioeconomic conditions. In this functional magnetic resonance imaging (fMRI) study, 83 participants from a larger longitudinal sample completed the monetary incentive delay (MID) task in adulthood (∼25 years old). Parent-reports of neighborhood quality and parental SES were collected when participants were 13 years of age. Current income level was collected concurrently with scanning. Lower adolescent neighborhood quality, but neither lower current income nor parental SES, was associated with heightened sensitivity to the anticipation of monetary gain in putative mesolimbic reward areas. Lower adolescent neighborhood quality was also associated with heightened sensitivity to the anticipation of monetary loss activation in visuo-motor areas. Lower current income was associated with heightened sensitivity to anticipated loss in occipital areas and the operculum. We tested whether externalizing behaviors in childhood or adulthood could better account for neighborhood quality findings, but they did not. Findings suggest that neighborhood ecology in adolescence is associated with greater neural reward sensitivity in adulthood above the influence of parental SES or current income and not mediated through impulsivity and externalizing behaviors.

Mediators of the Relation Between Community Violence and Sexual Risk Behavior Among Adults Attending a Public Sexually Transmitted Infection Clinic

Prior research shows that violence is associated with sexual risk behavior, but little is known about the relation between community violence (i.e., violence that is witnessed or experienced in one's neighborhood) and sexual risk behavior. To better understand contextual influences on HIV risk behavior, we asked 508 adult patients attending a publicly funded STI clinic in the U.S. (54 % male, M age = 27.93, 68 % African American) who were participating in a larger trial to complete a survey assessing exposure to community violence, sexual risk behavior, and potential mediators of the community violence-sexual risk behavior relation (i.e., mental health, substance use, and experiencing intimate partner violence). A separate sample of participants from the same trial completed measures of sexual behavior norms, which were aggregated to create measures of census tract sexual behavior norms. Data analyses controlling for socioeconomic status revealed that higher levels of community violence were associated with more sexual partners for men and with more episodes of unprotected sex with non-steady partners for women. For both men and women, substance use and mental health mediated the community violence-sexual risk behavior relation; in addition, for men only, experiencing intimate partner violence also mediated this relation. These results confirm that, for individuals living in communities with high levels of violence, sexual risk reduction interventions need to address intimate partner violence, substance use, and mental health to be optimally effective.

Prevalence and determinants of adolescent pregnancy in urban disadvantaged settings across five cities

PURPOSE

The impact of pregnancy on the health and livelihood of adolescents aged 15-19 years is substantial. This study explored sociodemographic, behavioral, and environmental-level factors associated with adolescent pregnancy across five urban disadvantaged settings.

METHODS

The Well-Being of Adolescents in Vulnerable Environments study used respondent-driven sampling (RDS) to recruit males and females from Baltimore (456), Johannesburg (496), Ibadan (449), New Delhi (500), and Shanghai (438). RDS-II and poststratification age weights were used to explore the odds associated with "ever had sex" and "ever pregnant"; adjusted odds of pregnancy and 95% confidence interval were developed by site and gender.

RESULTS

Among the sexually experienced, pregnancy was most common in Baltimore (females, 53% and males, 25%) and Johannesburg (females, 29% and males 22%). Heterosexual experience and therefore pregnancy were rare in Ibadan, New Delhi, and Shanghai. Current schooling and condom use at the first sex decreased the odds of pregnancy among females in Baltimore and Johannesburg participants. Factors associated with higher odds of pregnancy were early sexual debut (Johannesburg participants and Baltimore females) being raised by someone other than the two parents (Johannesburg females); alcohol use and binge drinking in the past month (Baltimore participants); greater community violence and poor physical environment (Baltimore males and Johannesburg participants).

CONCLUSIONS

The reported prevalence of adolescent pregnancy varies substantially across similarly economically disadvantaged urban settings. These differences are related to large differences in sexual experience, which may be underreported, and differences in environmental contexts. Pregnancy risk needs to be understood within the specific context that adolescents reside with particular attention to neighborhood-level factors.