Perceived neighborhood partner availability, partner selection, and risk for sexually transmitted infections within a cohort of adolescent females

Investigating the Relative Influence of Romantic Sex Partners and Close Friends on Adolescent Alcohol and Marijuana Use

A large body of research has identified peer exposure as a key factor driving adolescent substance use. However, findings on the role of sex partners are less robust and mixed. This study aims to fill this gap by examining the independent contribution of close friends' and sex partners' alcohol and marijuana use on adolescents' use of these substances. A secondary data analysis of social network data collected in 2000-2002 from a household sample of African American youth (14-19 years old) in the Bayview and Hunter's Point neighborhoods of San Francisco was conducted. Index participants and their nominated close friends and romantic sex partners (N = 104 triads) self-reported recent alcohol and marijuana use (defined as any use in the past 3 months). Generalized estimated equations were used to estimate the independent association between adolescent's recent substance use and their friend's and sex partner's use. Adolescents with a marijuana-using romantic sex partner had a nearly six-fold higher odds of using marijuana compared to adolescents with a non-using partner, controlling for close friend's marijuana use and other confounders [OR:5.69, 95%CI: 1.94, 16.7]; no association with close friend's marijuana use was found. A similar pattern was observed for alcohol use. Adolescents with an alcohol-using romantic sex partner had increased odds of using alcohol compared to adolescents with a non-using partner, controlling for close friend's alcohol use and other confounders [OR:2.40, 95%CI: 1.02, 5.63]; no association with close friend's alcohol use was found. Romantic sex partners may play a unique and significant role in adolescent substance use. Peer-focused interventions may be more effective if they consider romantic sex partners. Future research should consider the role of romantic sex partners in changing social context related to substance use from adolescence to young adulthood.

Sexual Concurrency Among Adolescent Women With Multiple Partners: A Daily Diary Study

PURPOSE

Sexual partnerships that overlap in some period of time (i.e., concurrent) are a key factor in sexually transmitted infection (STI) transmission. Research examining concurrency among adolescents typically uses person-level, cross-sectional, and/or retrospective data, obscuring factors that manifest on any given occasion of concurrency. We used sexual diaries to examine: (1) daily prevalence of vaginal sex concurrency when two partners are reported by adolescent women; and (2) individual, relational, and behavioral attributes that impact the likelihood of sex with neither partner, with one partner or the other, or with both partners on any given day.

METHODS

Daily diaries were drawn from a large longitudinal cohort study examining sexual relationships, behaviors, and STIs among adolescent women. Participants contributed 280,844 partner-associated diary entries, of which (27.9%; n = 78,356) indicated multiple partners. All two-partner diary entries were retained for analysis (N = 323; Mage = 17.55; 90% African American). Random intercept mixed-effects multinomial logistic regression was used to evaluate the impact of predictor variables on odds of having sex with one or the other, both, or neither partner.

RESULTS

Most two-partner days (93.5%) involved no sex with either partner. Few reports (.2%) indicated same-day sexual concurrency. Older age, greater partner support, and higher sexual interest increased the likelihood of sex with both partners on the same day.

CONCLUSIONS

Individual, relational, and behavioral factors predict concurrency in ways that challenge assumptions that secondary partnerships constitute negligible relationships. Programs targeting partner concurrency in adolescents may find success tailoring messaging around these findings.

Perceptions of Sexual Risk and HIV/STI Prevention Among Black Adolescent Girls in a Detention Center: an Investigation of the Role of Parents and Peers

Black American adolescent girls constitute approximately one third of the US youth legal system population. Their overrepresentation in the youth punishment system is an indicator of significant physical, sexual, and/or behavioral health needs. Since less is known about perceptions of HIV/STI risk among Black girls with juvenile justice histories, we used intersectionality theory to explore the following: (1) how a sample of Black girls in detention endorse their perceptions of sexual safety given the multiple intersections of their race, gender, and SES and (2) how their endorsements align with interlocking systems of social inequality for system-involved Black at the social structural level. We examined relational and behavioral factors associated perceived HIV/STI risk. Among a sample of 188 Black girls (ages 13-17 years), we examined parent and partner sexual communication, fear of condom negotiation, a positive STI test, and partner risk profile as significant correlates. Major findings indicated that greater partner communication was associated with higher perceived HIV/STI risk, whereas having had a risky sexual partner, fear of condom negotiation, and having had a positive STI test were correlated with lower perceived risk. The significant factors identified in this study can be the focus of STI prevention and intervention programs for Black girls with youth punishment histories.

Adolescent and Young Women's Daily Reports of Emotional Context and Episodes of Dating Violence

PURPOSE

To investigate same day, previous day, and next day associations between trust, closeness, commitment, jealousy and provision of instrumental support with dating violence victimization and perpetration.

METHOD

A convenience sample of young women, 16-19 years, in a heterosexual dating relationship with at least one act (past month) of physical or psychological victimization or perpetration, were recruited from urban public locations. Participants answered questions daily via text continuously for four months on dating violence and partner-specific emotions. Daily surveys asked about trust, closeness, commitment for their partner, jealousy, perceptions of partner's jealousy and provision of instrumental support to and from partner, and dating violence victimization and perpetration. Multilevel modeling examined within-relationship associations over time.

RESULTS

Mean (sd) age for the full sample was 18.1 (1.1) years. Same-day emotional context (trust, closeness, commitment, jealousy and provision of instrumental support) was more strongly associated with victimization and perpetration compared to previous day emotions. Strongest same-day positive associations were with partner's perpetration, both partner's jealousy, and females' instrumental support. Partner's jealousy and increased trust were best predictors of next day victimization. Closeness, commitment and trust went down on the day of violence. Perpetration was positively associated with next day commitment. Victimization was positively associated with next day trust.

CONCLUSIONS

This event-level analysis demonstrates the role and timing that emotional aspects of adolescent relationships - including positive feelings - have surrounding episodes of dating violence. This granular understanding of the emotional context of dating violence has the potential to facilitate development of effective, developmentally appropriate interventions.

The Impact of Relationship Stressors on Trust and Prorelationship Behavior Within Adolescent Romantic Relationships: A Systems Approach

PURPOSE

Trust is an essential component of romantic relationships. It is not understood how youth respond to a relationship stressor, which may impact trust, such as perceiving to be at risk for a sexually transmitted infection or their partner has other sex partners. We used a system science approach to examine feedback between trust and prorelationship behaviors within adolescent relationships.

METHODS

A prospective cohort of clinic-recruited young women (N = 122), aged 16-19 years, completed daily questionnaires on partner-specific feelings and risk perceptions for 18 months. Relationship stressor defined as either perceiving the risk of sexually transmitted infection from a partner or partner had other sex partners. Prorelationship behaviors were more time spent with partner, sex with partner, and/or gift from partner. Time-lagged generalized estimating equation models were used to examine whether a relationship stressor is associated with a decrease in trust and whether prorelationship behaviors changed following the stressor.

RESULTS

Experiencing a stressor was associated with threefold increased odds of having a decrease in trust in the same week (odds ratio [OR] = 3.30, 95% confidence interval [CI]: 2.30-4.72). Trust increased significantly the week following the stressor (OR = 2.09, 95% CI: 1.54-2.85). An increase in trust relative to the week of the stressor was associated with a 65% increase in prorelationship behavior in the week following the stressor (OR = 1.65, 95% CI: 1.20-2.26).

CONCLUSIONS

Data uniquely show that trust is impacted following a relationship stressor and that youth increase prorelationship behaviors following a drop in trust. The findings suggest that adolescents prioritize maintaining trust, which may impact engagement in protective health behaviors.

The role of dispersal and school attendance on reproductive dynamics in small, dispersed populations: Choyeros of Baja California Sur, Mexico

Individuals from small populations face challenges to initiating reproduction because stochastic demographic processes create local mate scarcity. In response, flexible dispersal patterns that facilitate the movement of individuals across groups have been argued to reduce mate search costs and inbreeding depression. Furthermore, factors that aggregate dispersed peoples, such as rural schools, could lower mate search costs through expansion of mating markets. However, research suggests that dispersal and school attendance are costly to fertility, causing individuals to delay marriage and reproduction. Here, we investigate the role of dispersal and school attendance on marriage and reproductive outcomes using a sample of 54 married couples from four small, dispersed ranching communities in Baja California Sur, Mexico. Our analyses yield three sets of results that challenge conventional expectations. First, we find no evidence that dispersal is associated with later age at marriage or first reproduction for women. For men, dispersal is associated with younger ages of marriage than those who stay in their natal area. Second, in contrast to research suggesting that dispersal decreases inbreeding, we find that female dispersal is associated with an increase in genetic relatedness among marriage partners. This finding suggests that human dispersal promotes female social support from genetic kin in novel locales for raising offspring. Third, counter to typical results on the role of education on reproductive timing, school attendance is associated with younger age at marriage for men and younger age at first birth for women. While we temper causal interpretations and claims of generalizability beyond our study site given our small sample sizes (a feature of small populations), we nonetheless argue that factors like dispersal and school attendance, which are typically associated with delayed reproduction in large population, may actually lower mate search costs in small, dispersed populations with minimal access to labor markets.

Rethinking Urban Female Adolescents' Safety Net: The Role of Family, Peers, and Sexual Partners in Social Support

PURPOSE

To examine how interpersonal factors are associated with family, peer, and partner social support among urban female adolescents in sexual relationships.

DESIGN

Secondary data analysis of cross-sectional data.

SETTING

Two urban health clinics and community sites in Baltimore, Maryland.

PARTICIPANTS

One hundred sixteen female adolescents (ages 16-19) with 131 heterosexual relationships from the Perceived Risk of Sexually Transmitted Diseases cohort.

MEASURES

Interpersonal factors included parental monitoring, friend-partner connectedness, and feelings of intimacy for partner. Social support was measured using the Multidimensional Scale of Perceived Social Support with family, peer, and partner subdomains.

ANALYSIS

Multivariable linear regression models using baseline data and accounting for clustering of partners.

RESULTS

Adolescents perceived high levels of family, peer, and partner support, with the greatest coming from partners (range: 1-5; family mean: 4.0 [95% confidence interval, CI: 3.83-4.18]; peer mean: 4.2 [95% CI: 4.05-4.33]; partner mean: 4.5 [95% CI: 4.36-4.60]). Parental monitoring and friend-partner connectedness were significantly associated with greater family (b = 0.11, standard error [SE] = 0.03, P = 0.001; b = 0.15, SE = 0.06, P = .02) and peer support (b = 0.06, SE = 0.02, P = .01; b = 0.29, SE = 0.07, P < .001). Feelings of intimacy for partner was significantly associated with greater partner support (b = 0.08, SE = 0.03, P = .02).

CONCLUSION

Feeling connected to one's social network and having a connected network is an important contribution to social support for urban female adolescents in sexual relationships. Future research targeting interpersonal factors is warranted, as it may result in increased social support and promote positive sexual health behaviors in an urban female adolescent population.

Individual and Neighborhood Factors Associated With Sexual Behavior Classes in an Urban Longitudinal Sample

BACKGROUND

This study aimed to increase understanding of the clustering of sexual behaviors in an urban sample of emerging adults, and the individual and neighborhood factors associated with sexual behavior patterns to provide insight into reducing the disproportionate burden of poor sexual outcomes among urban African Americans.

METHODS

We draw on 2 cohorts of urban, predominantly African American youth first assessed at age 6 years and follow-up to emerging adulthood (mean age, 20 years; n = 1618). Latent class analyses by gender identified co-occurrence of sexual behavior.

RESULTS

We found 3 classes for both males and females: high-risk (13% of males, 15% of females), low-risk (54% of males, 56% of females) and no-risk (33% of males, 29% of females). Membership in the high-risk class was associated with school dropout, a substance use disorder diagnosis, having a criminal arrest, pregnancy, and sexually transmitted diseases for both males and females. High-risk females also had higher rates of depression. Low-risk males and females also had elevated risk of pregnancy and parenthood. Neighborhood factors distinguished the high- and no-risk classes for males and females, including the neighborhood environment scale, which assessed poverty, safety, drug activity, and crime/violence in the neighborhood. Neighborhood religiosity was inversely associated with membership in the high-risk class compared with the no-risk class for females only. Neighborhood racism distinguished those in the high-risk class compared with the no-risk class for males.

CONCLUSIONS

Future work should take into account the clustering of sexual risk behaviors. Specific neighborhood factors could be addressed to reduce sexual health disparities.

Sexual mixing in opposite-sex partnerships in Britain and its implications for STI risk: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Background

The extent to which individuals are similar to their sexual partners influences STI-transmission probabilities, yet there is a dearth of empirical data, especially those representative of the population.

Methods

Analyses of data reported by 10 759 sexually active people aged 16–74 y interviewed for a British national probability survey undertaken in 2010–12. Computer-assisted self-interviews asked about partner numbers and characteristics of participants’ three most recent partnerships (MRPs). Opposite-sex MRPs were weighted to represent all such partnerships in the past year (N = 16 451). Estimates of disassortative age mixing (≥±5-y difference), ethnic mixing (partner of a different ethnic group) and geographical mixing (partner from a different region/country when they first met) were calculated, stratified by gender, age group and partnership status (casual/steady). Multivariable regression examined how these disassortative mixing measures were associated with STI-risk measures: condom use at first sex together at the partnership-level and, at the participant-level, STI-risk perception and reporting STI diagnoses.

Results

Disassortative age mixing occurred in around one-third of opposite-sex partnerships, with men ≥5 y older in most cases, although this proportion varied by participant’s gender and age group. Ethnic mixing occurred less frequently (11.3% of men’s and 8.6% of women’s partnerships) as did geographical mixing (14.1 and 16.3%, respectively). Disassortative mixing was more common among casual vs steady partnerships. Condom use at first sex was less likely in women’s partnerships that were age-disassortative [adjusted odds ratio (AOR): 0.79, 95% confidence interval (CI): 0.69–0.95], whereas men reporting disassortative ethnic mixing were more likely to perceive themselves at STI risk (AOR: 1.76, 95% CI: 1.23–2.52) and report STI diagnoses (AOR: 2.37, 95% CI: 1.22–4.59).

Conclusions

Disassortative mixing, although uncommon among opposite-sex partnerships in Britain, is independently associated with STI risk, warranting consideration in STI-prevention efforts.

Precocious and Problematic? The Consequences of Youth Violent Victimization for Adolescent Sexual Behavior

PURPOSE

Violent victimization is concentrated in adolescence and is disruptive to both the timing and sequencing of key life course transitions that occur during this developmental stage. Drawing on recent work establishing the interpersonal consequences of youth victimization, we examined the effect of violent victimization on adolescents' timing of sexual debut and involvement in additional sexual risk behaviors (multiple sexual partnering and inconsistent contraceptive use).

METHODS

This study relied on secondary data analysis of 10,070 youth from four waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health). To predict sexual debut and subsequent sexual risk-taking, analyses were limited to youth not yet sexually active at their wave I interview.

RESULTS

Findings from Cox proportional hazards models, negative binomial regression, and repeated measures ordinal logistic regression showed that adolescent victims of violence initiated sex sooner than non-victims and accumulated more sexual partners, but patterns varied by age at victimization. Youth victimized in late adolescence displayed an accelerated trajectory of sexual activity while youth victimized in early adolescence were less likely to debut or engage in other sexual risk behaviors (although younger victims were more likely to engage in other deviant activities).

CONCLUSION

Sexual activity is a normative part of adolescent development, yet this study finds that violent victimization may disrupt the timing of this life course task, exacerbating deviant risk-taking and undermining youths' subsequent well-being. This study also highlights the importance of life course criminology's attention to timing in lives, given that the consequences of victimization varied by the age when it occurred.

Does the Sex Risk Quiz Predict Mycoplasma genitalium Infection in Urban Adolescents and Young Adult Women?

BACKGROUND

Mycoplasma genitalium (MG) is a common sexually transmitted infection (STI), but there are limited strategies to identify individuals at risk of MG. Previously, a sex risk quiz was used to predict STIs including Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis. The original quiz categorized individuals 25 years or younger as at risk of STIs, but the Centers for Disease Control and Prevention identifies females younger than 25 years as at risk of STIs. In this study, the quiz was changed to categorize females younger than 25 years as high risk. The objective was to determine if the age-modified risk quiz predicted MG infection.

METHODS

A cross-sectional analysis of a prospective longitudinal study was performed including female adolescents and young adults (AYAs) evaluated in multiple outpatient clinics. Participants completed an age-modified risk quiz about sexual practices. Scores ranged from 0 to 10 and were categorized as low risk (0-3), medium risk (4-7), and high risk (8-10) based on the STI prevalence for each score. Vaginal and/or endocervical and/or urine specimens were tested for MG, T. vaginalis, C. trachomatis, and N. gonorrhoeae using the Aptima Gen-Probe nucleic amplification test.

RESULTS

There were 693 participants. Most participants reported having 0 to 1 sexual partners in the last 90 days (91%) and inconsistent condom use (84%). Multivariable logistic regression analysis controlling for race, education, and symptom status demonstrated that a medium-risk score predicted MG infection among AYAs younger than 25 years (adjusted odds ratio, 2.56 [95% confidence interval, 1.06-6.18]).

CONCLUSION

A risk quiz may be useful during clinical encounters to identify AYA at risk of MG.

Weekly variations in feelings of trust predict incident STI within a prospective cohort of adolescent women from a US city

OBJECTIVES

Feelings of intimacy, perceptions of partner concurrency (PPC) and perceptions of risk for an STD (PRSTD) are meaningful and dynamic attributes of adolescent sexual relationships. Our objective was to examine whether variations in these STI-associated feelings and perceptions predicted incident Chlamydia trachomatis and/or Neisseriagonorrhoeae infection within a prospective cohort of urban adolescent women.

METHODS

A cohort of clinic-recruited women aged 16-19 completed daily surveys on feelings and risk perceptions about each current sex partner on a smartphone continuously for up to 18 months. Urine was tested for C. trachomatis and N. gonorrhoeae every 3 months. Daily responses were averaged across the week. As overall means for trust, closeness and commitment were high, data were coded to indicate any decrease in feelings from the previous week. PRSTD and PPC were reverse coded to indicate any increase from the previous week. An index was created to examine the cumulative effect of variation in these feelings and perceptions. Generalised linear models were used to account for correlation among repeated measures within relationships.

RESULTS

For each week that there was a decrease in trust, there was a 45% increase in the risk of being infected with an STI at follow-up (relative risk (RR) 1.45, 95% CI 1.18 to 1.78, P=0.004). Neither a decrease in closeness or commitment, nor an increase in PRSTD or PPC was associated with an STI outcome. Cumulatively, the index measure indicated that a change in an additional feeling or perception over the week increased the odds of an STI by 14% (RR 1.14, 95% CI 1.02 to 1.29, P=0.026).

CONCLUSIONS

A decrease in feelings of trust towards a main partner may be a more sensitive indicator of STI risk than PRSTD, PPC or commitment. The next generation of behavioural interventions for youth will need strategies to address feelings of intimacy within adolescent romantic relationships.

Factors Associated with HIV Testing among African American Female Adolescents in Juvenile Detention Centers

BACKGROUND

Little is known about sexual and psychosocial factors associated with HIV testing among detained African American female adolescents-an understudied group at risk for HIV.

METHODS

188 detained African American female adolescents completed assessments on HIV testing, sexual risk behaviors, and psychosocial factors.

RESULTS

Unprotected vaginal sex, history of STI-positivity or pregnancy, higher STI knowledge, and lower partner availability were associated with a higher likelihood of ever being tested for HIV.

DISCUSSION

HIV testing is the gateway to important services for high-risk HIV-positive and HIV-negative adolescents. More research is needed to address barriers and to inform programmatic changes to increase testing among youth.

More like him, me, or us: the impact of trait similarity on adolescent women's sexual risk behaviors in relationships

Ideal partner traits and how they relate to a young woman's current partner and relationship is a knowledge gap in the literature. The objectives of this study were 1) to assess any differences in interpersonal characteristics between a young woman or her partner and relationship and 2) to examine the impact of this difference on sexual monogamy, condom use and frequency of vaginal sex. Study participants (n=387, 14-17 years at enrollment, 90% African American) were recruited from three primary care adolescent health clinics serving areas with high rates of unintended pregnancy and sexually transmitted infection (STI); data were drawn from a longitudinal cohort study of sexual relationships and behaviors among young women. Nineteen interpersonal characteristics, including physical, financial, communication and personal characteristic variables, were found to have varying influences on relationships and sexual behaviors with 'like him' and 'like us' as referents. Monogamy increased as a male partner wanted to get somewhere in life [OR 5.41, (1.25, 23.52, p<0.05)], was intelligent [OR 3.42, (1.09, 10.76, p<0.05)] and had money [OR 1.55, (0.272, 0.595, p<0.001)] in a partnership; monogamy similarly increased when a partner wanted to get somewhere in life [OR 6.77, (1.51, 30.36, p<0.01)], was intelligent [OR 4.02, (1.23, 13.23, p<0.05)], and had money [OR 2.41, (1.51, 3.84, p<0.001)] compared to the young woman. The likelihood of using a condom at last sex increased when the male partner had a nice body [OR 1.42, (1.02, 1.99, p<0.05)], was popular [OR 1.60, (1.12, 2.29, p<0.01)], cared for others [OR 3.43, (1.32, 8.98, p<0.01)], was good at sports [OR 1.35, (1.06, 1.73, p<0.05)] and expressed his feelings [OR 2.03, (1.14, 3.60, p<0.01)]. The condom use ratio increased when the male partner was able to take care of himself [OR 0.076, (0.017, 0.136, p<0.01)], was cute [OR 0.190, (0.082, 0.30, p<0.001)], and had a nice body [OR 0.044, (0.001, 0.09, p<0.05)] in a dyad; the condom use ratio also increased when a male partner could take care of himself [OR 0.091, (0.014, 0.168, p<0.05)], was cute [OR 0.194, (0.077, 0.311, p<0.001)] compared to the young woman. Coital frequency increased when the male partner was described as being able to take care of himself [OR 3.33, (0.138, 6.52, p<0.05)]. Such influences are important in discussions with young women regarding personal and partner choices in sexual health as partners, behaviors and motivations for choice frequently change.

Monitoring knowledge among family, sexually transmitted infections, and sexual partnership characteristics of African American adolescent females

Among 284 African American girls aged 14 to 17 years, frequent family monitoring knowledge was associated with a reduced likelihood of sexually transmitted infections (STIs) and having a casual sex partner but was not associated with other partnership characteristics. Family monitoring may offer an additional STI prevention opportunity for this vulnerable population.