Risk and protective factors associated with the transition to a first sexual relationship with an older partner

Drinking alcohol raises the chance of premarital sex by four folds among secondary school adolescent students in Jima Arjo, Southwestern Ethiopia, 2018: a school-based cross-sectional study

Background

Premarital sexual practice is sexual intercourse performed before formal marriage. Pre-marital sexual practice increases adolescents’ risk for having multiple sexual partners, (sexually transmitted disease) STDs, and unintended pregnancy.

Objective

The study aimed to assess the prevalence of premarital sexual practice and associated factors among secondary school (9–12 grade) students in the Jima Arjo district.

Methods

Institutional-based cross-sectional study design was conducted among adolescent students from May 1st to 15th using a pre-tested and structured questionnaire. A systematic random sampling technique was employed to select study participants. The collected data was cleaned and entered into(statistical package for social science) SPSS version 20. Factors associated with the pre-marital sexual practice were identified by multiple logistic regression analyses.

Results

The over all premarital sexual practice in this study area was 24.4%. Being alcoholdrinker(AOR[95%CI] = 3.78[1.49,22.08]),havingaboy/girlfriend(AOR[95%CI] = 5.07[3.74,26.47]), (being male) (AOR[95%CI] = 2.9[1.78,37.8]); urban residence (AOR[95%CI] = 6.44 [1.95,25.84]).

Conclusions

The study revealed that a significant proportion of adolescent students in this study area practiced premarital sex. Being male sex, urban residence, using alcohol use and having a boy/girlfriend significantly affect premarital sexual practice. Therefore, school and community-based sexual health education, and communication need to be intensified to reduce premarital sex and further health consequences.

Lover, Mentor, or Exploiter: Retrospective Perspectives of the Older Person Following Sexual Relationships with Adults During Adolescence

Sexual relationships between an adolescent and an older person are considered controversial and in many countries are conceptualized under the legal definition of statutory relationship/rape. Despite the consensus regarding their potential negative implications, little is known about how adolescents perceive and construct them. To address this lacuna, the current exploratory study examined how individuals who have experienced sexual relationships with an adult while growing up perceived the older person and the meaning they ascribed to the age gap (M age gap, 7.78 years; range, 2-18 years). A qualitative thematic methodology was incorporated in analyzing in-depth semi-structured interviews with 28 individuals (M age, 29.89 years) who had experienced sexual relationships with an (at least 2 years) older person during adolescence (M age, 14.78 years). Participants described five different perceptions of the older persons: romantic partner; sexual partner; authority figure; complex/unstable figure; and exploiter. Subsequent analysis, focusing on the role participants assigned to age when describing these different images of older persons, shed additional light on their subjective perceptions; namely, for each image, age had a particular meaning. This paper may contribute to the understanding of individuals' experiences of sexual relationships with an older person by emphasizing the complexity of such relationships, as reflected in the participants' construction of the older person's image, potentially providing important information that can inform best practice for professionals working with this population. Findings highlight the need to address diversity and ambiguity rather than the uniform dichotomy that characterizes the legal framing of automatically constructing these relationships as statutory. Further implications for research, policy, and practice are discussed.

Romeo, Juliet, and Statutory Rape

Statutory rape is an important yet understudied topic. There is broad public support for the prosecution of older adults who engage in sexual relationships with minors regardless of perceptions of consent by either party. However, some scholars worry that expansive definitions within these laws have led to the widespread involvement of the justice system in the lives of similarly aged teenagers engaging in relatively normal sexual behavior, so called "Romeo and Juliet" liaisons. This, in turn, has called into question the legitimacy of national policies, such as sex offender registration, because of the presumption that registries are likely filled with these kinds of cases which may not represent the intent of legislatures and the public. Despite the importance of these debates, there is little research assessing the prevalence of Romeo and Juliet cases in official crime statistics or that analyze differences in characteristics of statutory rape as a function of victim-offender age differences. Drawing on more than 20 years of police data from over 6,000 police departments in the United States, this study found statutory rape cases were rare and Romeo and Juliet cases were even rarer. Multivariate models showed several distinctions between statutory rape cases as a function of the age differences between victim and offender. Of note, the odds that additional forms of sexual aggression occurred in the incident grew as the age difference expanded.

SURVEY OF SEXUAL ACTIVITY AND CONTRACEPTIVE USE AMONG UNMARRIED YOUNG SCHOOL AND COLLEGE DROP-OUTS IN A DEFINED NIGERIAN POPULATION

This study sought to characterize sexual behaviour, contraceptive use and contributory upbringing factors among young people who had dropped out of school or college in a Nigerian setting. A community-based, cross-sectional sexual survey of 161 young people aged between 15 and 35 who had dropped out of school or college was performed in Ado-Ekiti, south-west Nigeria, in April 2015. One hundred and nineteen of the respondents (73.9%) had had sexual intercourse. Mean age at sexual debut was 19.08±3.5 years. Of those with sexual experience, 79 (66.4%) had their sexual debut with a previous boy/girlfriend and 33 (27.7%) had it in their current relationship. Three (2.5%) respondents had first sex with a stranger. About 90% were still having sexual intercourse within 12 months of the survey; more males had had sex than females (81.1% versus 67.8%). Around 80% of those with sexual exposure practised a form of contraception, mainly use of the male condom, but fewer than 25% were all-time contraceptive users. Coming from a single-parent family (p=0.04) or from a family of poor economic status (AOR: 7.41; 95% CI: 0.69-0.83) were found to be associated with sexual debut by the age of 19 and premarital sex, respectively, in these young people. Unprotected sexual intimacy was found to be high among young school/college drop-outs in this region of Nigeria. This group of young people need targeted reproductive health intervention as they represent a potent route for HIV transmission in the region.

Recalled Explanations for Adolescent Girls' Engagement in Age-Discordant Sexual Relationships

Age-discordant sexual relationships are associated with negative sexual health outcomes for adolescent females. We were particularly interested in females' motivations for engaging in these relationships, and in contextual factors that increase receptivity to age-discordant relationships in the United States (U.S.). However, recent research addressing this topic in the U.S. has been sparse. To address this gap in the literature, we recruited 15 women (Mdn age = 26 years; 93 % African American) from an urban, publicly funded sexually transmitted disease clinic to qualitative interviews. Reasons given by women for their involvement in age-discordant sexual relationships as adolescents included: (a) desire for an actively engaged father figure, (b) to obtain material support, (c) to escape from a troubled home life, and (d) to express independence and maturity. Thus, familial, economic, and developmental factors motivate socioeconomically disadvantaged adolescent females to enter into age-discordant sexual relationships. Efforts to reduce females' participation in these relationships will need to address socioeconomic vulnerability and family relationships.

Older Sexual Partners and Adolescent Females' Mental Health

CONTEXT

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Relationship characteristics and contraceptive use among dating and cohabiting young adult couples

CONTEXT

Contraceptive decision making occurs in the context of relationships. Although many individual-level characteristics have been linked to youths' contraceptive use, less is known about associations between contraceptive use and relationship-level characteristics.

METHODS

Data from the 2001-2002 romantic pair subsample of the National Longitudinal Study of Adolescent Health were used to describe characteristics of 322 dating relationships and 406 cohabiting relationships among young adults aged at least 18 years. Logistic regression was employed to assess associations between these characteristics and hormonal or long-acting contraceptive use and condom use. Data from both partners allowed discordance in reports between partners in some measures to be examined.

RESULTS

Cohabiting couples were less likely than dating couples to have used condoms (19% vs. 37%) and hormonal or long-acting methods (40% vs. 57%) at last sex. In dating relationships, couples reporting discordant levels of intimacy and couples in which neither partner reported a high level of intimacy had greater odds of condom use than couples in which both partners reported high intimacy (odds ratios, 4.5 and 3.3, respectively); mistrust and male problem drinking were negatively associated with condom use (0.3 for each). For cohabiting couples, frequency of sex was negatively associated with condom use and hormonal method use (0.8 for each).

CONCLUSIONS

At least for dating couples, contraceptive use is linked to multiple dimensions of relationships, particularly measures reflecting relationship quality-both positive and negative.

BIOSOCIAL CORRELATES OF AGE AT FIRST SEXUAL INTERCOURSE: THE CASE OF GRADE 9 AND GRADE 11 PUPILS IN THE NORTH WEST PROVINCE OF SOUTH AFRICA

Survival analysis – specifically the actuarial life-table method and the Cox Proportional Hazards model – was used to assess Bronfenbrenner's bio-ecological model with regards to the onset of sexual intercourse in a random sample of 1697 grade 9 and grade 11 pupils in the North West Province of South Africa. Data were collected in July and August 2007. Of the contextual factors examined, only academic performance and community disorganization were found to be statistically significantly associated with age at first sexual intercourse amongst girls. High academic performance by girls is positively associated with age at first sexual intercourse, while girls who live in disorganized communities initiate sexual intercourse earlier than their counterparts in other communities. Age is negatively associated with the timing of first sexual debut among both girls and boys. Males initiate sexual intercourse earlier than females, while youths with at least one sexual partner are much more likely to initiate sexual intercourse earlier than those without sexual partners.

Characteristics of the Social Support Networks of Maltreated Youth: Exploring the Effects of Maltreatment Experience and Foster Placement

Little is known about the social support networks of maltreated youth or how youth in foster care may compare with those who remain with their parent(s). Social network characteristics and perceived social support were examined between (1) maltreated and comparison youth, (2) maltreated youth who remained with their biological parent, those with a foster parent, or a those with a kin caregiver, and (3) youth in stable placements and those who have changed placements. Data came from a sample of 454 adolescents (241 boys, 9-13 years old at enrollment) who took part in a longitudinal study of child maltreatment. Participants completed three assessments approximately 1 year apart. Results showed that on average, maltreated adolescents named significantly fewer people in their network than comparison adolescents. At Time 2, comparison adolescents reported more same-aged friends. In the maltreatment group, youth with a foster parent reported significantly more older friends than maltreated youth with a kin caregiver. Fewer maltreated youth named a biological parent on the social support questionnaire at all three time points. More youth in kinship care described their caregiver as supportive than those in foster care. These findings indicate that despite heterogeneous placement histories, social support networks among maltreated youth were very similar.

Relationship types and contraceptive use within young adult dating relationships

CONTEXT

Although expanding research has found that relationship characteristics can shape contraceptive use among young adults, limited research has examined how relationship characteristics intersect to form distinct types of relationships and how relationship types are linked to contraceptive use.

METHODS

Data from the 2002-2005 rounds of the National Longitudinal Survey of Youth 1997 cohort were used to examine contraceptive use in 3,485 young adult dating relationships. Latent class analysis was employed to develop a typology of relationships using measures of relationship structure (duration) and quality (intimacy, commitment and conflict). Multinomial logistic regression analyses were used to estimate associations between relationship type and contraceptive use and method choice at last sex.

RESULTS

Four types of relationships were identified, two shorter term and two longer term, differentiated by levels of intimacy, commitment and conflict. Young adults in longer term relationships with greater conflict and lower intimacy and commitment were less likely than those in other long-term relationships to use hormonal and dual methods versus no method (relative risk ratios, 0.6-0.7). Hormonal method use, versus no method use or condom use, was more prevalent in short-term relationships with greater intimacy and commitment and lower conflict than in other short-term relationships (1.7 and 1.9, respectively).

CONCLUSIONS

Classifying short-term relationships as "casual" or long-term ones as "serious" may ignore heterogeneity within these categories that may have implications for contraceptive use. Future qualitative research could provide a better understanding of relationship types and couples' fertility intentions and access to and use of contraceptives.

Sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong

BACKGROUND

Little is known about sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong. It is of public health importance to investigate this topic to inform sex education, policymaking, and prevention and intervention programs.

METHODS

Based on the Youth Sexuality Survey conducted by Hong Kong Family Planning Association (FPAHK) in 2011, this study explored the characteristics of sexual knowledge, attitudes, and high-risk sexual behaviors among 1,126 unmarried youth aged 18 to 27 years. Multiple logistic regressions were performed to examine factors associated with unmarried youth's premarital sex, casual relationships, multiple sex partners, and premarital pregnancy.

RESULTS

Unmarried youth in Hong Kong had adequate sex knowledge, but contraceptive knowledge was deficient. The majority of unmarried youth (63.8%) held liberal attitudes toward premarital sex and about half held liberal attitudes toward any form of sexual activity and premarital pregnancy. Around 60% held conservative attitudes toward causal sex relationships and multiple sex partners. Males tended to hold more liberal attitudes toward high-risk sex behaviors than female youth. Approximately 41.5% of unmarried youth reported having engaged in premarital sex, whereas less than 10% engaged in high-risk sexual behaviors. Males also reported higher amounts of premarital sex, casual sex relationships, and multiple sex partners. Females reported higher levels of sexual coercion. Logistic regressions indicated that being older, coming from a divorced family, out of school status and liberal attitudes toward risky sex behavior were more likely to engage in premarital sex or high-risk sex behaviors, and being female, being better educated and being immigrants were less likely to engage in premarital sex. However, being immigrants was more likely to engage in casual relationship and to have multiple partners.

CONCLUSIONS

Premarital sex is becoming more prevalent among unmarried youth in Hong Kong, and a small proportion of young adults are engaging in high-risk sexual behaviors. Sex education and HIV prevention programs should equip them with adequate knowledge on contraception and condom use. Intervention programs can start with their attitudes toward sex.

Racial and ethnic differences in the transition to a teenage birth in the United States

CONTEXT

Rates of teenage childbearing are high in the United States, and they differ substantially by race and ethnicity and nativity status.

METHODS

Data from the National Longitudinal Survey of Youth 1997 cohort were used to link characteristics of white, black, U.S.-born Hispanic and foreign-born Hispanic adolescents to teenage childbearing. Following a sample of 3,294 females aged 12-16 through age 19, discrete-time logistic regression analyses were used to examine which domains of teenagers' lives were associated with the transition to a teenage birth for each racial and ethnic group, and whether these associations help explain racial and ethnic and nativity differences in this transition.

RESULTS

In a baseline multivariate analysis controlling for age, compared with whites, foreign-born Hispanics had more than three times the odds of a teenage birth (odds ratio, 3.5), while blacks and native-born Hispanics had about twice the odds (2.1 and 1.9, respectively). Additional controls (for family environments; individual, peer and dating characteristics; characteristics of first sexual relationships; and subsequent sexual experience) reduced the difference between blacks and whites, and between foreign-born Hispanics and whites, and eliminated the difference between U.S.-born Hispanics and whites. Further, if racial or ethnic minority adolescents had the same distribution as did white teenagers across all characteristics, the predicted probability of a teenage birth would be reduced by 40% for blacks and 35% for U.S.-born Hispanics.

CONCLUSIONS

Differences in the context of adolescence may account for a substantial portion of racial, ethnic and nativity differences in teenage childbearing.

The Protective Influence of Family Bonding on Smoking Initiation in Adolescents by Racial/Ethnic and Age Subgroups

Using data from the National Longitudinal Study of Adolescent Health, this study examined the associations among family bonding factors and the initiation of smoking by race/ethnicity and age group among nonsmokers at Wave 1. Overall, 18% of the sample initiated smoking by Wave 2. For younger African American and Hispanic youth, high maternal satisfaction with the relationship was significantly protective of smoking initiation. For older Hispanics, high parental presence and high parent-family connectedness were protective against smoking initiation while lack of awareness about the adolescent's whereabouts was a risk factor for initiation in both younger and older Caucasians, and in the older Hispanics. Our results underscore the importance of maintaining high levels of family bonding with the adolescent throughout early and late adolescence in order to decrease tobacco initiation.

Do high-risk urban youth also have older friends?

PURPOSE

The purpose of this study was to explore how behavioral, intrapersonal, and socio-environmental factors were associated with the likelihood of having at least one older friend.

METHODS

Participants included 3,709 ethnically diverse eighth grade students in the Project Northland Chicago intervention trial. Socio-demographic characteristics included gender, family composition, language spoken at home, race/ethnicity, and age. Behavioral factors included cigarette, alcohol, and marijuana use, depressed feelings, willingness to wear alcohol-branded merchandise, and violent and delinquent behavior. Intrapersonal factors included low refusal self-efficacy, and outcome expectations and expectancies. Socio-environmental factors included alcohol offers and access, normative estimates and expectations, and peer alcohol use. Having an older friend was defined as having at least one friend aged 16 years or older (students' mean age = 14.2). Logistic mixed-effects regression models were used and controlled for gender, race/ethnicity, treatment status, and age.

RESULTS

Adolescent girls and older eighth graders were significantly more likely to have at least one older friend. Students who scored higher on all the behavioral, intrapersonal, and socio-environmental risk factors were significantly more likely to have at least one older friend. Significant gender interactions were found for several of the relationships.

CONCLUSION

Overall, this study showed that multiple risk-related factors are associated with having older friends in eighth grade. Particularly important factors appear to be cigarette, marijuana and alcohol use, having friends who use alcohol, having increased alcohol offers, and being willing to wear or use alcohol-branded merchandise.

Adolescent overweight, social relationships and the transition to first sex: gender and racial variations

CONTEXT

Being overweight influences adolescents' relationships by increasing their likelihood of experiencing social alienation and discrimination. Its role in sexual development is relatively understudied, as are potential mechanisms through which weight may influence early sexual activity.

METHODS

Data from the National Longitudinal Study of Adolescent Health were used in discrete-time event history analyses investigating the association between body weight, social relationships and timing of sexual debut among 8,197 respondents who were in grades 7-12 in 1994-1995 (Wave 1) and were young adults in 2001-2002 (Wave 3). Subgroup analyses explored gender and racial and ethnic variations in the association.

RESULTS

Overweight adolescents were less likely than their normal-weight peers to report first intercourse between Waves 1 and 3 (odds ratio, 0.9). Characteristics reflecting social alienation, including having relatively few close friends and no experience with romantic relationships, were negatively associated with first intercourse among overweight youths. Results differed by gender and race and ethnicity. Overweight females had a lower likelihood than normal-weight females of experiencing first intercourse (0.8), but no such association was evident among males. Similarly, overweight white youths--but not those from other racial and ethnic groups--had reduced odds of sexual debut (0.7).

CONCLUSIONS

Future studies should seek to understand the broader implications of adolescent weight status for social relationships and subsequent development, and practitioners should apply this knowledge to prevention programs. Postponement of sexual activity may benefit youths, but potential benefits and risks may depend upon the social processes involved.

Associations between religious involvement and behavioral risk factors for HIV/AIDS in American women and men in a national health survey

BACKGROUND

Acquired immunodeficiency syndrome (AIDS), caused by human immunodeficiency virus (HIV), is a leading cause of death.

PURPOSE

We tested the hypothesis that religious variables would be inversely associated with prevalence of HIV/AIDS risk factors.

METHODS

A 2002 national survey included 9,837 individuals aged 15-44 years with complete data on religious involvement, sexual, and drug use behaviors.

RESULTS

Women who never attended services had over two times greater odds of reporting HIV risk factors than those attending weekly or more after adjusting for age and race/ethnicity (p < 0.0001) and over 60% greater after adjusting for multiple confounders, but no significant association was seen in men. Mainline Protestants had lower odds of reporting risk factors than those with no affiliation. No significant independent associations were found with importance of religion.

CONCLUSIONS

Women with public religious involvement had lower prevalence of any HIV risk factors while only affiliation was so associated in men.

Socioeconomic differences in obesity among Mexican adolescents

OBJECTIVE

We investigate socioeconomic disparities in adolescent obesity in Mexico. Three questions are addressed. First, what is the social patterning of obesity among Mexican adolescents? Second, what are the separate and joint associations of maternal and paternal education with adolescent obesity net of household wealth? Third, are there differences in socioeconomic status (SES) gradients among Mexican boys and girls, rural residents and non-rural residents?

METHODS

Using data from the Mexican National Health Survey 2000 we examined the slope and direction of the association between SES and adolescent obesity. We also estimated models for sub-populations to examine differences in the social gradients in obesity by sex and non-rural residence.

RESULTS

We find that household economic status (asset ownership and housing quality) is positively associated with adolescent obesity. High paternal education is related to lower obesity risk, whereas the association between maternal education and obesity is positive, but not always significant.

CONCLUSION

The household wealth components of SES appear to predispose Mexican adolescents to higher obesity risk. The effects of parental education are more complex. These findings have important policy implications in Mexico and the United States.

Connectedness as a predictor of sexual and reproductive health outcomes for youth

To review research examining the influence of "connectedness" on adolescent sexual and reproductive health (ASRH). Connectedness, or bonding, refers to the emotional attachment and commitment a child makes to social relationships in the family, peer group, school, community, or culture. A systematic review of behavioral research (1985-2007) was conducted. Inclusion criteria included examination of the association between a connectedness sub-construct and an ASRH outcome, use of multivariate analyses, sample size of >or=100, and publication in a peer-reviewed journal. Results were coded as protective, risk, or no association, and as longitudinal, or cross sectional. Findings from at least two longitudinal studies for a given outcome with consistent associations were considered sufficient evidence for a protective or risk association. Eight connectedness sub-constructs were reviewed: family connectedness (90 studies), parent-adolescent general communication (16 studies), parent-adolescent sexuality communication (58 studies), parental monitoring (61 studies), peer connectedness (nine studies), partner connectedness (12 studies), school connectedness (18 studies), and community connectedness (four studies). There was sufficient evidence to support a protective association with ASRH outcomes for family connectedness, general and sexuality-specific parent-adolescent communication, parental monitoring, partner connectedness, and school connectedness. Sufficient evidence of a risk association was identified for the parent overcontrol sub-construct of parental monitoring. Connectedness can be a protective factor for ASRH outcomes, and efforts to strengthen young people's pro-social relationships are a promising target for approaches to promote ASRH. Further study regarding specific sub-constructs as well as their combined influence is needed.

Neighborhood poverty and early transition to sexual activity in young adolescents: a developmental ecological approach

This study examined how the link between neighborhood poverty and the timing of sexual initiation varies as a function of age, gender, and background characteristics. A sample of N = 2,596 predominately White Canadian adolescents from the National Longitudinal Survey of Children and Youth was used. Sexual initiations occurring between 12 and 15 years old were considered. Results showed that younger adolescent females who lived in poor neighborhoods and who had a history of conduct problems were more likely to report early sexual activity. Peer characteristics partly accounted for this susceptibility. Among adolescent males, no direct neighborhood effects were found, but those who had combined risks at multiple levels appeared more vulnerable. The theoretical and practical implications of these findings are discussed.

Rethinking Timing of First Sex and Delinquency

The relation between timing of first sex and later delinquency was examined using a genetically informed sample of 534 same-sex twin pairs from the National Longitudinal Study of Adolescent Health, who were assessed at three time points over a 7-year interval. Genetic and environmental differences between families were found to account for the association between earlier age at first sex and increases in delinquency. After controlling for these genetic and environmental confounds using a quasi-experimental design, earlier age at first sex predicted lower levels of delinquency in early adulthood. The current study is contrasted with previous research with non-genetically informative samples, including Armour and Haynie. Results suggest a more nuanced perspective on the meaning and consequences of adolescent sexuality than is commonly put forth in the literature.

Older sexual partners during adolescence: links to reproductive health outcomes in young adulthood

CONTEXT

Sex at a young age with an older partner has been linked to poor reproductive health outcomes during adolescence, but minimal research has examined the influence of teenagers' having an older sexual partner on reproductive health outcomes during the transition to young adulthood.

METHODS

Logistic regression and contrast analyses of three waves of data from the National Longitudinal Study of Adolescent Health were used to examine whether individuals who had had sex before age 16 with a partner at least three years their senior were at increased risk of becoming teenage or unmarried parents or of contracting an STD by young adulthood.

RESULTS

Ten percent of females and 2% of males had had early sex with an older partner. These females were more likely to acquire an STD as young adults than were those whose riskiest relationship was before age 16 with a similar-aged partner (odds ratio, 2.1) or at age 16 or later with a similar-aged or older partner (2.4 and 2.6, respectively). For males, having sex before 16, regardless of partner age, was associated with an elevated STD risk (odds ratio, 1.9), although controlling for relationship history characteristics attenuated the association.

CONCLUSIONS

Adolescents, particularly young adolescents, should be made aware of the potential risks associated with having older sexual partners. In particular, program providers should be alerted that females who engage in early sexual activity with older partners are at especially high risk of experiencing adverse reproductive health consequences.

Sexual attitudes, pattern of communication, and sexual behavior among unmarried out-of-school youth in China

Background

In recent years, more adolescents are engaging in premarital sex in China. However, only a limited number of studies have explored out-of-school youth's sexual attitudes and behaviors, critical for prevention intervention development.

Methods

Using data from the baseline survey of a comprehensive sex education program that was conducted in a suburb of Shanghai in 2000–2002, this study describes sexual attitudes, patterns of communication on sexual matters, and premarital sexual behavior among 1,304 out-of-school youth. Multivariate logistic regression analysis was conducted to examine the factors associated with youth's premarital sexual intercourse.

Results

The majority (60%) of out-of-school youth held favorable attitudes towards premarital sex. Males were more likely to have favorable attitudes compared with females. Male youth generally did not communicate with either parent about sex, while one-third of female youth talked to their mothers about sexual matters. Both males and females chose their friends as the person with whom they were most likely to talk about sexual matters. About 18% of the youth reported having engaged in sexual intercourse. One-fifth of sexually active youth had always used a contraceptive method, and one-quarter had been pregnant (or had impregnated a partner). There were no gender differences in rate of premarital sex or frequency of contraceptive use. Multivariate analysis revealed that age, education, family structure, parent's discipline, attitudes towards premarital sex, pattern of communication and dating were significantly associated with youth premarital sex.

Conclusion

A substantial proportion of out-of-school youth engage in risky sexual behaviors. Prevention programs that empower communication and sexual negotiation skills, and promote condom use should be implemented for this vulnerable group.