Neighborhood poverty, aspirations and expectations, and initiation of sex

Risky sexual behavior and associated factors among out-of-school youths in Addis Ababa, Ethiopia; mixed methods study

INTRODUCTION

Sexual risky behaviors, as defined by the World Health Organization, encompass a spectrum of sexual activities that heighten the likelihood of negative outcomes related to sexual and reproductive health. Despite the implementation of various healthcare programs and interventions, youths continue to encounter challenges in accessing reproductive health services. Consequently, they remain vulnerable to engaging in high-risk sexual behaviors; 50.36% of adolescents in Ethiopia. Therefore, this study was aimed to determine the prevalence of risky sexual behavior and associated factors among out-of-school Youths in Addis Ababa, Ethiopia; 2023.

METHODS

A community based cross sectional mixed methods study was conducted among 701 youths in Addis Ababa from September 1st to 30th, 2023. The quantitative data were collected through face to face interview using a pre-tested structured questionnaire, while qualitative data were gathered through in depth interviews and focus group discussions. For the quantitative study, the study samples were chosen using systematic sampling. Conversely, purposive sampling was employed for the qualitative study. Variables with P-value ≤ 0.25 in the bivariate analysis were considered as candidates for the multivariable analysis. Statistical significance was declared at a P-value less than 0.05.

RESULTS

The prevalence of risky sexual behavior among out of school students in Addis Ababa was 40.6% (95%CI: 36.8, 44.1). Age 15-19 years (AOR: 2.52; 95%CI: 1.61, 3.94), being female (AOR: 2.84; 95%CI: 1.93, 4.18), fathers who were unable to read and write (AOR: 4.13; 95%CI: 2.04, 8.37), alcohol consumption (AOR: 2.07; 95%CI: 1.33, 3.19), peer pressure (AOR: 2.59; 95%CI: 1.81, 3.72), live together with either of biological parent (AOR: 2.32; 95%CI: 1.52, 3.55), watching pornography (AOR: 2.10; 95%CI: 1.11, 3.97) and parental monitoring (AOR: 0.59; 95%CI: 0.39, 0.90) were factors associated with risky sexual behavior.

CONCLUSION AND RECOMMENDATIONS

A lower prevalence of risky sexual behavior compared to prior research efforts. Age, gender, educational level of the husband, alcohol consumption, peer pressure, living arrangements, exposure to pornography, and family monitoring emerged as significant factors associated with risky sexual behavior. Therefore, government should prioritize strategies to reduce substance use, mitigate the impact of watching pornography, and enhance parent-youth connectedness.

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.

Early Sexual Debut and Neighborhood Social Environment in Latinx Youth

OBJECTIVES

To examine whether social aspects of the neighborhood environment are associated with early sexual initiation in a California agricultural community of predominantly Latinx adolescents.

METHODS

In a prospective cohort study of 599 eighth graders recruited from middle schools in Salinas, California (2015-2019), participants completed five interviews over 2 years. Social environment measures included neighborhood social dynamics (neighborhood disorder, social cohesion, and social network gang exposure); experiences of discrimination; and school connectedness. We estimated associations between baseline social environment and early sexual initiation (<15 years) using Poisson regression with robust standard errors. We compared contraceptive self-efficacy and attitudes by sexual initiation status using ANOVA.

RESULTS

Most youth were Latinx (94%) and age 13 (70%) at enrollment; 53% were female and 49% had a parent employed in agriculture. Additionally, 14% reported first vaginal sex before age 15. Neighborhood disorder (relative risk [RR], 1.13; 95% confidence interval [CI], 1.05-1.21), social network gang exposure (RR, 2.23; 95% CI, 1.49-3.33), and experiences of discrimination (RR, 1.67 [1-2 events versus none], 95% CI, 1.09-2.55; RR, 2.33 [3+ events versus none], 95% CI, 1.07-4.64) were associated with early sexual initiation. School connectedness was protective (RR, 0.44, 95% CI, 0.29-0.69). Youth who initiated sex before age 15 had more negative birth control attitudes and expressed lower motivation to use contraceptives.

CONCLUSIONS

Findings underscore opportunities to promote early adolescent sexual health through strengthening supportive and safe neighborhood environments with the promise of addressing disparities in unintended pregnancy and sexually transmitted infection rates in later adolescence.

Neighborhood and Network Characteristics and the HIV Care Continuum among Gay, Bisexual, and Other Men Who Have Sex with Men

In order for treatment as prevention to work as a national strategy to contain the HIV/AIDS epidemic in the United States (US), the HIV care continuum must become more robust, retaining more individuals at each step. The majority of people living with HIV/AIDS (PLWHA) in the US are gay, bisexual, and other men who have sex with men (MSM). Within this population, there are distinct race- and ethnicity-based disparities in rates of HIV infection, engagement, and retention in HIV care, and viral suppression. Compared with White MSM, HIV-infected Black MSM are less likely to be on anti-retroviral therapy (ART), adhere to ART, and achieve viral suppression. Among MSM living in urban areas, falling off the continuum may be influenced by factors beyond the individual level, with new research identifying key roles for network- and neighborhood-level characteristics. To inform multi-level and multi-component interventions, particularly to support Black MSM living in urban areas, a clearer understanding of the pathways of influence among factors at various levels of the social ecology is required. Here, we review and apply the empirical literature and relevant theoretical perspectives to develop a series of potential pathways of influence that may be further evaluated. Results of research based on these pathways may provide insights into the design of interventions, urban planning efforts, and assessments of program implementation, resulting in increased retention in care, ART adherence, and viral suppression among urban-dwelling, HIV-infected MSM.

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.

Trends in Adolescent Birth Rates in California: Examining the Influence of Community Characteristics Through Geographic and Temporal Analysis

PURPOSE

The aim of the article was to understand community-level factors associated with the decline in the adolescent birth rate (ABR) in California from 2000 to 2014.

METHODS

We consolidated multiple data sources at the level of the Medical Service Study Area (MSSA), a federally recognized subcounty geographic unit (N = 497). We used ordinary least squares regression to examine predictors of change in the ABR at the MSSA level over three periods of notable change in California's ABR: 2000-2002, 2006-2008, and 2012-2014. Variables assessed include geographic density, change in sociodemographic and economic characteristics, and change in the availability of publicly funded sexual health services.

RESULTS

The ABR declined more in urban than rural MSSAs. In the earlier period, growth in the black, Hispanic, and foreign-born populations, unemployment, and receipt of public assistance were associated with smaller declines in the ABR. Growth in the share of married households and high school completion were associated with larger declines in the ABR. In the later period, growth in public assistance receipt was associated with smaller declines in the ABR, whereas growth in high school completion and college attendance were associated with larger declines. Decline in the ABR was steeper in areas that began offering publicly funded long-acting contraception to adolescents. Rural-urban differences were no longer significant after controlling for change in the provision of long-acting contraception.

CONCLUSIONS

Identifying the independent contributions of changes in sociodemographic, economic, and service characteristics to changes in the ABR supports the development of programs and policies that are more responsive to the communities they serve.

Adolescent Sexual Risk Taking: The Distribution of Youth Behaviors and Perceived Peer Attitudes Across Neighborhood Contexts

PURPOSE

Sexual activity is a normative part of adolescent development, yet early sexual debut and sex with multiple partners undermine health and well-being. Both structural (e.g., poverty) and social (e.g., norms) characteristics of neighborhoods shape sexual risk taking, yet scholarship remains focused on urban areas. Thus, this study explores sexually permissive attitudes and sexual risk taking across a wider expanse of neighborhood types.

METHODS

Among 8,337 nonsexually active respondents in Wave I (1994-1995 [ages 11-18]) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a hierarchical linear model and a hierarchical generalized linear model were used to estimate the effect of neighborhood type and permissive sexual climate on youths' sexual debut, age at debut, and lifetime number of sexual partners by Wave III (2001-2002 [ages 18-26]), controlling for individual, familial, and peer factors.

RESULTS

Sexual climates varied in overall permissiveness and internal consistency both across and within neighborhood types and were linked to increased sexual risk taking. Compared with youth from upper middle class white suburbs, the odds of sexual debut and the number of partners were highest among youth from rural (black and white) neighborhoods; youth from almost all other neighborhood types initiated sex earlier.

CONCLUSIONS

Early sexual debut in adolescence is a public health issue with immediate and long-term implications. Adolescence unfolds in neighborhood environments, the characteristics of which may spur youth into such risk taking. Continued scholarship on sexual risks should consider further variations in the geographic distributions of such risks to investigate more fully their consequences.

Place Still Matters: Racial/Ethnic and Geographic Disparities in HIV Transmission and Disease Burden

Neighborhood-level structural interventions are needed to address HIV/AIDS in highly affected areas. To develop these interventions, we need a better understanding of contextual factors that drive the pandemic. We used multinomial logistic regression models to examine the relationship between census tract of current residence and mode of HIV transmission among HIV-positive cases. Compared to the predominantly white high HIV prevalence tract, both the predominantly black high and low HIV prevalence tracts had greater odds of transmission via injection drug use and heterosexual contact than male-to-male sexual contact. After adjusting for current age, gender, race/ethnicity, insurance status, and most recently recorded CD4 count, there was no statistically significant difference in mode of HIV transmission by census tract. However, heterosexual transmission and injection drug use remain key concerns for underserved populations. Blacks were seven times more likely than whites to have heterosexual versus male-to-male sexual contact. Those who had Medicaid or were uninsured (versus private insurance) were 23 and 14 times more likely, respectively, to have injection drug use than male-to-male sexual contact and 10 times more likely to have heterosexual contact than male-to-male sexual contact. These findings can inform larger studies for the development of neighborhood-level structural interventions.

Feelings Matter: Depression Severity and Emotion Regulation in HIV/STI Risk-Related Sexual Behaviors

Human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention models may not address psychological complexities among adolescents with mental illnesses. This study examined contextual factors related to HIV/STI risk among heterosexually active Black adolescents with mental illnesses to inform the development of targeted HIV/STI prevention strategies. Black adolescent males and females (aged 14-17) were recruited from outpatient mental health programs in Philadelphia, PA to complete a computer-assisted personalized interview on sociodemographics, sexual behaviors, and emotion regulation (N = 53). Two sample t-tests, Wilcoxon Rank Sum tests and regression modeling were used to examine differences in the study measures by gender and relationship status. Reports of sexual partner concurrency were high-both while already in a sexual relationship (67.3%) and multiple sexual partners in the same day (42.3%). Boys reported significantly more risk behaviors than girls. Sadness dysregulation predicted currently being in a relationship, older age at first oral sex, fewer vaginal sexual partners and fewer unprotected oral sexual encounters. Coping difficulties predicted a greater number of vaginal and oral sexual partners, and a lower age at first vaginal sex. Increasing depression severity was related to older age at first vaginal sex, fewer vaginal sexual partners and fewer unprotected oral sexual encounters in the past 3 months. This formative work suggests that coping mechanisms should be addressed in HIV/STI prevention research through the inclusion of activities targeted toward emotion regulation and decreasing sexual risk behaviors. Psycho-education and skills building may mitigate the psychopathology that contributes to HIV/STI risk in the target demographic.

Social network recruitment for Yo Puedo: an innovative sexual health intervention in an underserved urban neighborhood—sample and design implications

Most existing evidence-based sexual health interventions focus on individual-level behavior, even though there is substantial evidence that highlights the influential role of social environments in shaping adolescents' behaviors and reproductive health outcomes. We developed Yo Puedo, a combined conditional cash transfer and life skills intervention for youth to promote educational attainment, job training, and reproductive health wellness that we then evaluated for feasibility among 162 youth aged 16-21 years in a predominantly Latino community in San Francisco, CA. The intervention targeted youth's social networks and involved recruitment and randomization of small social network clusters. In this paper we describe the design of the feasibility study and report participants' baseline characteristics. Furthermore, we examined the sample and design implications of recruiting social network clusters as the unit of randomization. Baseline data provide evidence that we successfully enrolled high risk youth using a social network recruitment approach in community and school-based settings. Nearly all participants (95%) were high risk for adverse educational and reproductive health outcomes based on multiple measures of low socioeconomic status (81%) and/or reported high risk behaviors (e.g., gang affiliation, past pregnancy, recent unprotected sex, frequent substance use; 62%). We achieved variability in the study sample through heterogeneity in recruitment of the index participants, whereas the individuals within the small social networks of close friends demonstrated substantial homogeneity across sociodemographic and risk profile characteristics. Social networks recruitment was feasible and yielded a sample of high risk youth willing to enroll in a randomized study to evaluate a novel sexual health intervention.

Change in Population Characteristics and Teen Birth Rates in 77 Community Areas: Chicago, Illinois, 1999-2009

OBJECTIVE

We analyzed community area differences in teen births in Chicago, Illinois, from 1999 to 2009. We analyzed the association between changes in teen birth rates and concurrent measures of community area socioeconomic and demographic change.

METHODS

Mean annual changes in teen birth rates in 77 Chicago community areas were correlated with concurrent census-based population changes during the decade. Census measures included changes in race/ethnicity, adult high school dropouts, poverty or higher-income households, crowded housing, unemployment, English proficiency, foreign-born residents, or residents who moved in the last five years. We included non-collinear census measures with a p<0.1 bivariate association with change in teen births in a stepwise multiple linear regression model.

RESULTS

Teen birth rates in Chicago fell faster than the overall birth rates, from 85 births per 1,000 teens in 1999 to 57 births per 1,000 teens in 2009. There were strong positive associations between increases in the percentage of residents who were black and Hispanic, poor, without a high school diploma, and living in crowded housing, and a negative association with an increase in higher-income households. Population changes in poverty, Hispanic population, and high school dropouts were the only significant measures in the final model, explaining almost half of the variance in teen birth rate changes.

CONCLUSION

The study provides a model of census-based measures that can be used to evaluate predicted vs. observed rates of change in teen births across communities, offering the potential to more appropriately prioritize public health resources for preventing unintended teen pregnancy.

Twenty Years of Neighborhood Effect Research: An Assessment

This paper reviews the magnitude and empirical findings of social epidemiological neighborhood effects research. An electronic keyword literature search identified 1369 empirical and methodological neighborhood effects papers published in 112 relevant journals between 1990 and 2014. Analyses of temporal trends were conducted by focus, journal type (e.g., epidemiology, public health, or social science), and specific epidemiologic journal. Select papers were then critically reviewed. Results show an ever-increasing number of papers published, notably since the year 2000, with the majority published in public health journals. The variety of health outcomes analyzed is extensive, ranging from infectious disease to obesity to criminal behavior. Papers relying on data from experimental designs are thought to yield the most credible results, but such studies are few and findings are inconsistent. Papers relying on data from observational designs and multilevel models typically show small statistically significant effects, but most fail to appreciate fundamental identification problems. Ultimately, of the 1170 empirically focused neighborhood effects papers published in the last 24 years, only a handful have clearly advanced our understanding of the phenomena. The independent impact of neighborhood contexts on health remains unclear. It is time to expand the social epidemiological imagination.

Neighborhoods and racial/ethnic disparities in adolescent sexual risk behavior

Understanding the determinants of racial/ethnic disparities in adolescent sexual risk behavior is important given its links to the differential risk of teen pregnancy, childbearing, and sexually transmitted infections. This article tests a contextual model that emphasizes the concentration of neighborhood disadvantage in shaping racial/ethnic disparities in sexual risk behavior. We focus on two risk behaviors that are prevalent among Black and Hispanic youth: the initiation of sexual activity in adolescence and the number of sex partners. Using data from the 1997 National Longitudinal Study of Youth (N = 6,985; 48% female; 57% non-Hispanic White) evidence indicates that neighborhood disadvantage--measured by concentrated poverty, unemployment rates, and the proportion of female-headed households--partially explains Black and Hispanic disparities from Whites in the odds of adolescent sexual debut, although the prevalence of female-headed households in neighborhoods appears to be the main driver in this domain. Likewise, accounting for neighborhood disadvantage reduces the Black-White and Hispanic-White disparity in the number of sexual partners, although less so relative to sexual debut. We discuss theoretical and practical implications of these findings.

Associations between life contexts and early sexual initiation among young women in France

CONTEXT

Early sexual initiation (before age 16) has been linked to an increased risk of teenage pregnancy and STDs. Most research on correlates of early sexual initiation is from the United States; no similar work has been conducted in France, where the sociocultural environment differs.

METHODS

Cross-sectional data from the 2010 Health Behaviour in School-Aged Children survey were used to examine the relationships of personal, family, peer, school and neighborhood characteristics with early sexual initiation among 1,094 French females in grades 8-10. Two-level logistic regressions were used to identify associations.

RESULTS

Twenty-five percent of respondents had had sex before age 16. Early sexual initiation was primarily -associated with individual-level characteristics. Young women had an elevated likelihood of having initiated sex early if they went out after school at least four times a week (odds ratio, 2.0), had repeated a grade (1.8), lived with a single parent or in a stepfamily (1.8 and 1.5, respectively), perceived a low level of parental monitoring (1.6) or had two or more male friends (2.8). At the environmental level, respondents who attended school in areas with a high proportion of residents who were foreigners had a reduced likelihood of having initiated sex early (0.5-0.6).

CONCLUSIONS

Although early sexual initiation in France was essentially linked to individual-level variables, further research is needed to understand its relationship with neighborhood characteristics. Such studies should include additional environmental variables, test new hypotheses and employ a longitudinal approach.

Neighborhoods and infectious disease risk: acquisition of chlamydia during the transition to young adulthood

Adolescents and young adults have the highest rates of sexually transmitted infections (STIs) in the USA despite national priority goals targeting their reduction. Research on the role of neighborhoods in shaping STI risk among youth has increased in recent years, but few studies have explored the longitudinal effects of neighborhoods on STI acquisition during the adolescent to young adult transition. The aims of this study were to examine: (1) the longitudinal relationships between the neighborhood context (poverty, residential instability, and racial/ethnic concentration) of exposure during adolescence and young adults' acquisition of chlamydia, and (2) the extent to which sexual risk behaviors and depression over the transition from adolescence to young adulthood mediate the relationship between the neighborhood context of exposure during adolescence and young adults' acquisition of chlamydia. A longitudinal observational design was employed using data from the National Longitudinal Study of Adolescent Health (Add Health), waves 1-3 (1994-2002). The sample was composed of 11,460 young adults aged 18 to 27 years. Neighborhood measures during adolescence were derived from the 1990 US Census appended to adolescents' interview data. Chlamydia infection was measured via urine assay at wave 3 and 4.6 % of the young adults in the sample tested positive for chlamydia. Multilevel logistic regression analyses were conducted adjusting for numerous neighborhood and individual risk factors. Multivariate findings indicated exposure to neighborhood poverty during adolescence increased the likelihood of a positive urine test for chlamydia during young adulthood (AOR = 1.23, 95 % CI = 1.06, 1.42), and the association was not mediated by sexual risk behaviors or depression. Further research is needed to better understand the pathways through which exposure to neighborhood poverty contributes to chlamydia over the life course as are comprehensive STI prevention strategies addressing neighborhood poverty.

Structuring the Future: Anticipated Life Events, Peer Networks, and Adolescent Sexual Behavior

While prior research has established associations between individual expectations of future events and risk behavior among adolescents, the potential effects of peers' future perceptions on risk-taking have been overlooked. We extend prior research by testing whether peers' anticipation of college completion is associated with adolescent sexual risk-taking. We also examine whether adolescents' perceptions of the negative consequences of pregnancy and idealized romantic relationship scripts mediate the association between peers' anticipation of college completion and sexual risk-taking. Results from multivariate regression models with data from the National Longitudinal Study of Adolescent Health (Add Health) indicate peers' anticipation of college completion is negatively associated with a composite measure of sexual risk-taking and positively associated with the odds of abstaining from sexual intercourse and only engaging in intercourse with a romantic partner (compared to having intercourse with a non-romantic partner). In addition, perceptions of the negative consequences of pregnancy and sexualized relationship scripts appear to mediate a large portion of the association between peers' anticipation of future success and sexual risk-taking and the likelihood of abstaining (but not engaging in romantic-only intercourse). Results from our study underscore the importance of peers in shaping adolescent sexual behavior.

Disparities in abortion rates: a public health approach

Women of lower socioeconomic status and women of color in the United States have higher rates of abortion than women of higher socioeconomic status and White women. Opponents of abortion use these statistics to argue that abortion providers are exploiting women of color and low socioeconomic status, and thus, regulations are needed to protect women. This argument ignores the underlying causes of the disparities. As efforts to restrict abortion will have no effect on these underlying factors, and instead will only result in more women experiencing later abortions or having an unintended childbirth, they are likely to result in worsening health disparities. We provide a review of the causes of abortion disparities and argue for a multifaceted public health approach to address them.

Alcohol Outlet Density and Young Women's Perpetration of Violence Toward Male Intimate Partners

This paper examines the relationships between alcohol outlet density, alcohol use, and perpetration of intimate partner violence (IPV) among young adult women in the US. Data were from Wave III of the National Longitudinal Study of Adolescent Health (Add Health; N = 4,430 in present analyses). Multinomial logistic regression was used to examine occurrence of past year IPV perpetration toward a male partner based on tract-level on-premise and off-premise alcohol outlet density, controlling for individuals' demographic, alcohol use, and childhood abuse characteristics and neighborhood socio-demographic factors. Higher off-premise alcohol outlet density was found to be associated with young women's perpetration of physical only IPV, controlling for individual-level and ecological factors. Alcohol use had an independent association with IPV perpetration but was not a mediator of the outlet density-IPV relationship. Findings suggest that considering alcohol-related environmental factors may help efforts aimed at preventing young women's use of physical violence toward partners.

A longitudinal study of youth assets, neighborhood conditions, and youth sexual behaviors

PURPOSE

To prospectively determine whether individual, family, and community assets help youth to delay initiation of sexual intercourse (ISI); and for youth who do initiate intercourse, to use birth control and avoid pregnancy. The potential influence of neighborhood conditions was also investigated.

METHODS

The Youth Asset Study was a 4-year longitudinal study involving 1,089 youth (mean age = 14.2 years, standard deviation = 1.6; 53% female; 40% white, 28% Hispanic, 23% African American, 9% other race) and their parents. Participants were living in randomly selected census tracts. We accomplished recruitment via door-to-door canvassing. We interviewed one youth and one parent from each household annually. We assessed 17 youth assets (e.g., responsible choices, family communication) believed to influence behavior at multiple levels via in-person interviews methodology. Trained raters who conducted annual windshield tours assessed neighborhood conditions.

RESULTS

Cox proportional hazard or marginal logistic regression modeling indicated that 11 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for ISI; seven assets (e.g., educational aspirations for the future, responsible choices) were significantly associated with increased use of birth control at last sex; and 10 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for pregnancy. Total asset score was significantly associated with all three outcomes. Positive neighborhood conditions were significantly associated with increased birth control use, but not with ISI or pregnancy.

CONCLUSIONS

Programming to strengthen youth assets may be a promising strategy for reducing youth sexual risk behaviors.

Determinants of sexual health knowledge in adolescent girls in schools of Riyadh-Saudi Arabia: a cross sectional study

Background

There are many social and cultural factors affecting the sexual knowledge of adolescents. This study measured the sexual health knowledge level of adolescents and identified its association with role of parents, friends and school environment in adolescent girls in Riyadh, Saudi Arabia.

Methods

Four hundred and nineteen Saudi female students belonging to intermediate and secondary grades were randomly selected from four public and private girl schools. 255 (69.8%) students were ≤15 years and 164 (39.2%) were >15 years. A self-administered structured questionnaire comprising of socio-demographic information, role of parents and teachers, availability of school curriculum on sexual health was used. Sexual health knowledge was assessed through questions on identification of physical changes during puberty for ≤15 years and separate questions on sexually transmitted infections for >15 years.

Results

54% of ≤15years and 70.7% of >15 years had poor sexual health knowledge. Multivariate analysis found determinants for poor sexual health education in ≤15years are: lower education level of both parents (OR 10.87; 95% CI 2.44–48.38), second birth order or more (OR 2.32; 95% CI 1.24–4.33) and absence of school curriculum on sexual health (OR 0.56; 95% CI 0.33–0.95). Determinants for >15 years of age are : mothers with low literacy (OR 3.08, 95% CI 1.42–6.71), as for sources of poor sexual knowledge : parents (OR 10.10; 95% CI 2.70–37.74), schools (OR 6.95; 95% CI 1.95–24.78) maids (OR 4.57; 95% CI 1.26–16.59) and media (OR 5.12; 95% CI 1.29–20.07) were statistically significant factors.

Conclusion

Government agencies with collaboration of all stake holders should develop policies and programs for implementing and evaluating integrated and comprehensive sexual educational programs for adolescents in Saudi Arabia.

Perpetration of intimate partner violence by young adult males: the association with alcohol outlet density and drinking behavior

OBJECTIVE

This study examined the association between alcohol outlet density and male to female intimate partner violence (IPV).

METHOD

Data were analyzed from a national probability sample of males who reported a current heterosexual relationship (N=3194). Multinomial logistic regression was used to examine the likelihood of having perpetrated IPV.

RESULTS

High alcohol outlet density was associated with having perpetrated physical only IPV (odds ratio [OR]=2.51; 95% confidence interval [CI]: 1.21-5.20). Outlet density was not associated with greater odds of sexual IPV perpetration.

CONCLUSIONS

Alcohol outlet density was found to be associated with perpetration of physical IPV. Developing environmental strategies with respect to alcohol outlets could potentially reduce perpetration of male-to-female physical IPV.

Relationships among alcohol outlet density, alcohol use, and intimate partner violence victimization among young women in the United States

Greater access to alcohol has been widely found to be associated with many negative outcomes including violence perpetration. This study examines the relationship between alcohol outlet density, alcohol use, and intimate partner violence (IPV) victimization among young women in the United States. A direct association between alcohol outlet density in one's neighborhood and the likelihood of IPV victimization was examined. Data were from Wave III of the National Longitudinal Study of Adolescent Health (Add Health), which followed a nationally representative sample of adolescents into adulthood. Participants were young adult females age 18 to 26 at Wave III. Of the 4,571 female respondents who reported a current heterosexual relationship and had IPV data, 13.2% reported having been the victim of physical violence only and 6.5% experienced sexual only or physical and sexual violence in the relationship during the past year. In the regression models tested, there was no significant direct association between neighborhood alcohol outlet density and IPV victimization nor was there an association between outlet density and drinking behaviors, thus eliminating the possibility of an indirect association. Results of fully adjusted models indicate females who drank heavily, whether infrequently or frequently, were at significant risk for experiencing sexual only IPV or sexual and physical IPV. Asians and Native Americans were at significantly greater odds of experiencing sexual only or sexual and physical IPV compared with non-Hispanic Whites, while non-Hispanic Blacks were at significantly greater odds for physical only IPV. We conclude that a continuous measure of alcohol outlet density was not associated with IPV in models controlling for individual and other neighborhood characteristics. Young women who drink heavily, whether infrequently or frequently, have greater odds of experiencing sexual only or sexual and physical compared to abstainers. Similar to previous study findings, young women living with or married to their partner were at far greater risk of experiencing physical only and/or sexual only or sexual and physical IPV. The study adds to the growing body of literature that examines how community characteristics such as outlet density influence the likelihood of IPV.

Violence victimization of young men in heterosexual relationships: does alcohol outlet density influence outcomes?

This study examined whether alcohol outlet density is associated with male physical and sexual victimization by a female partner. Data were from the National Longitudinal Study of Adolescent Health (Add Health). A total of 3,179 young adult men identified a current heterosexual relationship and had complete intimate partner violence (IPV) victimization data. Almost 16% of this sample reported being the victim of physical only IPV in their relationship over the previous 12 months; an additional 6.4% were victims of sexual only or sexual and physical IPV. Multivariate analyses indicated high alcohol outlet density was associated with greater odds of experiencing physical IPV only (odds ratio [OR] = 2.07). Heavy drinkers experienced increased odds of physical and sexual IPV victimization. Alcohol outlet density should be addressed in prevention efforts.