Timing of First Sexual Intercourse and Young Adult Health Outcomes

Unpacking the Impact of Early Adverse Childhood Experiences on Early Onset of Sexual Intercourse Among an Urban Birth Cohort of Early Adolescents

PURPOSE

Early adverse childhood experiences (ACEs) predict early onset of sexual intercourse. However, patterns of ACEs identified using latent class analysis (LCA) and their links to early sexual intercourse have been less examined. In this study, we apply LCA to identify ACEs profiles at age five and to examine whether these profiles differentially predict adolescents' sexual initiation.

METHODS

We analyzed data obtained from the Future of Families and Child Wellbeing Study for 3,185 participants (male = 1,638; female = 1,547). This included parental/caregivers' reports of 10 types of ACEs when participants were on average at age five and youth self-report data on sexual intercourse before or at age 15. We used LCA to classify the participants into subgroups and multinomial logistic regressions to examine differences in early sexual initiation among the ACEs subgroups.

RESULTS

LCA showed evidence of four classes for both genders: low adversity (51.8%), socioeconomic adversity (32.0%), family dysfunction (12.0%), and abuse (4.2%). We found class membership differences in early sexual intercourse in all three adversity classes compared to the low adversity group. Pairwise comparison tests further revealed that adolescents in the family dysfunction class had lesser odds of engaging in early sexual intercourse than their counterparts in the socioeconomic adversity and abuse classes.

DISCUSSION

Our findings suggest that LCA could help identify meaningful and distinctive child adversity patterns while accounting for the co-occurrence of ACEs. This is particularly helpful in evaluating who might be at greatest health risk which can further inform more effective and targeted interventions.

Longitudinal Patterns of Multidimensional Violence Exposure and Adolescent Early Sexual Initiation

Early sexual intercourse is associated with sexually transmitted infections, pregnancy, and depressive symptoms, and delay of intercourse allows adolescents opportunities to practice relationship skills (Coker et al., 1994; Harden, 2012; Kugler et al., 2017; Spriggs & Halpern, 2008). Thus, understanding predictors of early sexual intercourse is crucial. Prior research has suggested that violence exposure is associated with early initiation of sexual intercourse in adolescence (Abajobir et al., 2018; Orihuela et al., 2020). However, most studies have looked only at a single type of violence exposure. In addition, little research has examined longitudinal patterns of violence exposure in order to determine whether there are particular periods when the violence exposure may have the strongest impact on sexual behavior. Guided by life history and cumulative disadvantage theories, we use longitudinal latent class analysis and data from the Future of Families and Child Well-being Study (N = 3,396; 51.1% female, 48.9% male) to examine how longitudinal patterns of multiple types of violence exposures across ages 3 to 15 are associated with early sexual initiation in adolescence. Findings suggest that experiencing persistent physical and emotional abuse across childhood was associated with the greatest prevalence of early sexual initiation. Early exposure to violence was not consistently associated with greater likelihood of sexual initiation; instead, early abuse was more strongly associated with sexual initiation for boys, while late childhood abuse was more strongly associated for girls. These findings suggest that gender-sensitive programs are highly needed to address unique risk factors for boys' and girls' sexual behaviors.

Association between early sexual initiation and sexually transmitted infections among Peruvian reproductive-age women

Background

Sexually transmitted infections (STIs) are a serious public health problem worldwide, especially among reproductive-age women. The early sexual onset of sexual intercourse (EOSI) has been suggested as a risk factor, although there is no data at the national level.

Objective

To evaluate the association between EOSI and STIs in Peruvian women of childbearing age.

Methods

Analytical cross-sectional study with secondary data analyzes of the Peruvian Demographic and Family Health Survey 2018. The outcome was the presence of STIs in the last 12 months and the exposure variable was EOSI (age < 15 years at the time of their first sexual experience). To evaluate the association of interest, crude and adjusted prevalence ratios (aPRs) were calculated using generalized linear models with Poisson family and logarithmic link function.

Results

We analyzed data from 31,028 women of childbearing age. The 11.3% reported having STIs in the last 12 months and 20.2% of the participants had an EOSI. After adjusting for potential confounders, we found that EOSI was associated with STIs (aPR: 1.27; 95% CI: 1.08-1.50; p = 0.005). When conducting stratified analysis by area of residence and number of sexual partners, this association was maintained in women living in urban areas (aPR: 1.36; 95% CI: 1.11-1.66; p = 0.003) those who did not report having a history of multiple sexual partners (aPR: 1.27; 95% CI: 1.08-1.51; p = 0.005), and those in the middle (aPR: 1.42; 95% CI: 1.03-1.97; p = 0.034) and highest (aPR: 2.12; 95% CI: 1.33-3.39; p = 0.002) wealth quintiles.

Conclusion

Among reproductive-age women from Peru, EOSI was associated with STIs, especially in women living in urban areas, with no history of multiple sexual partners, and belonging to the middle to higher wealth index. The implementation of measures to prevent EOSI and fostering appropriate sexual health counseling for women with EOSI is advised.

The role of child marriage and marital disruptions on hypertension in women - A nationally representative study from India

Child marriage is associated with negative health trajectories among women in low- and middle-income countries (LMICs). Marital disruptions in LMICs are also associated with adverse socioeconomic and health outcomes in women. Yet, little is known about the compounded health effects of experiencing both child marriage and marital disruptions. Using nationally representative data from India among women aged 18-49 years, we examined the effects of marital age (i.e., marriage before or after 18 years) and martial disruptions (i.e., widowed/divorced/separated) on the odds of having hypertension. Findings suggest that together, marital disruptions and child marriage increase the risk of hypertension. Specifically, women married as children and who experienced marital disruptions were 1.2 (95% CI: 1.2-1.3) times more likely to have hypertension compared to women who married as adults and currently in marriage. Additionally, among women married as children, those who experienced martial disruptions had a higher risk (AOR = 1.1, 95% CI: 1.0-1.2) of hypertension compared to their currently married peers. These results suggest public health strategies must consider contextual effects of being widowed/divorced/separated among women who were married as children. Simultaneously, prevention initiatives should be strengthened to reduce the incidence of child marriage in LMICs and associated downstream health consequences.

Identifying causal associations between early sexual intercourse or number of sexual partners and major depressive disorders: A bidirectional two-sample Mendelian randomization analysis

BACKGROUND

Early sexual intercourse and a greater number of sexual partners have been proved associated with depression. However, the causality of these associations is not clear.

METHODS

To unveil the causal associations between sexual factors and major depression disorder (MDD). The bidirectional, two-sample Mendelian randomization (MR) study was conducted, which used genetic variants associated with two sexual factors (age first had sexual intercourse, n = 406,457; lifetime number of sexual partners, n = 378,882) and MDD (n = 500,199) from the largest genome-wide association studies (GWASs) conducted by the UK biobank and the Psychiatric Genomics Consortium. The two-step MR analysis was applied to assess mediation. The Genetic predictors for five risky behaviors were also obtained from the most up-to-date GWAS conducted by the UK Biobank (ever self-harmed: 117,733; ever attempted suicide: 4933; psychoactive substance abuse, alcohol use, and tobacco use: 463,010).

RESULTS

MR analysis indicated a risky causal effect of age first had sexual intercourse (OR = 0.720, 95 % CI: 0.661-0.784, P = 2.45 × 10^-14) and lifetime number of sexual partners (OR = 1.656, 95 % CI: 1.356-2.022, P = 7.46 × 10^-7) on MDD. Mediation analysis showed the effects were mediated by tobacco use, with a proportion of 34.20 % on age first had sexual intercourse and 22.94 % on lifetime number of sexual partners separately.

LIMITATIONS

The overlap of participants in different traits and unclear gender.

CONCLUSIONS

Robust genetic evidence indicated that premature sexual intercourse and more sexual partners were risks for MDD. Risky behaviors, especially the tobacco use, mediated this effect.

Prevalence of sexual initiation and associated factors in school adolescents in Piauí, Brazil, 2015

OBJECTIVE

to analyze prevalence of sexual initiation and associated factors in adolescents in Piauí.

METHODS

this was a cross-sectional study, with secondary data from the 2015 National Adolescent School-based Health Survey. Hierarchical analysis was performed using robust Poisson regression.

RESULTS

a total of 3.872 adolescents were interviewed. Prevalence of sexual initiation was 24.2%; risk factors for sexual initiation were being male [prevalence ratio (PR) = 2.18; 95% confidence interval (95%CI) 1.90;2.47], being 15 years old or over (PR = 2.49; 95%CI 2.18;2.76), living with mother (PR = 0.68; 95%CI 0.54;0.82), working (PR = 1.82; 95%CI 1.55;2.10), attending a public school (PR = 1.39; 95%CI 1.09;1.75), practicing bullying (PR = 1.50; 95%CI 1.31;1.72), using alcohol (PR = 2.35; 95%CI 2.09;2.64), using cigarettes (PR = 1.46; 95%CI 1.22;1.70) and using illicit drugs (PR = 1.40; 95%CI 1.15;1.66).

CONCLUSION

prevalence of sexual initiation was high and associated with sociodemographic characteristics and vulnerable health behaviors, indicating the need for health promotion strategies.

Sexual Behavior and Health From Adolescence to Adulthood: Illustrative Examples of 25 Years of Research From Add Health

Due to its long-term longitudinal design, the National Longitudinal Study of Adolescent to Adult Health (Add Health) has provided numerous valuable insights into adolescent and young adult sexual behavior. Framed by a conceptual model of sexual behavior and health, I review research using Add Health data to study sexual behavior and health. In this paper, I review research examining both predictors (e.g., neighborhood, family, genetic, individual) and health outcomes (e.g., sexually transmitted infections, mental health) of sexual behavior in adolescents and young adults. Where possible, I focus on long-term longitudinal studies that make use of the unique strengths of the Add Health data. Existing Add Health research has provided considerable information about both the predictors and health consequences of adolescent and young adult sexual behavior. Factors ranging from neighborhoods to genetics predict whether adolescent and young adults engage in sexual behaviors. Findings on long-term outcomes of adolescent sexual behavior suggest that early sexual behavior predicts higher rates of sexually transmitted infections and pregnancy in young adulthood, but not long-term changes to mental health. Unique contributions of Add Health include the ability to examine multidimensional bio-ecological predictors of sexual behavior and to examine long-term effects of sexual behavior and how sexual behaviors and their correlates change across adolescence into adulthood. Future work can leverage these strengths, and in particular the long-term longitudinal nature of the data, to uncover new insights about the developmental course of sexual behavior and health.

Temporal Trends and Differences in Sexuality among Depressed and Non-Depressed Adults in the United States

This study aimed to examine temporal trends and differences in sexuality between depressed and non-depressed adults aged 18-59 in the United States from 2005 to 2016. A total of 21,437 people (5432 with depression) were enrolled in this cross-sectional study. From 2005-2008 to 2013-2016, the average age at first sexual intercourse decreased, while the proportion of normal frequency of sexual activity and heterosexual sexual orientation increased among all the participants. Some differences in sexuality were found between the depressed and non-depressed groups. The average age at first sexual intercourse (p < 0.001), the proportion of normal frequency of sexual activity (p < 0.001), and heterosexual sexual orientation (p < 0.001) were lower in depressed participants, and the differences did not change over time (p_{for trend} = 0.926 of average age at first sexual intercourse, p_{for trend} = 0.823 of normal frequency of sexual activity, p_{for trend} = 0.926 of heterosexual sexual orientation). Moreover, these differences were associated with marital status (p_{for interaction} < 0.001 by average age at first sexual intercourse), employment status (p_{for interaction} < 0.001 by average age at first sexual intercourse), education status (p_{for interaction} = 0.023 by heterosexual sexual orientation) and family income status (p_{for interaction} = 0.013 by average age at first sexual intercourse and p_{for interaction} = 0.017 by normal frequency of sexual activity). In conclusion, the study found that the age at first sexual intercourse decreased and the frequency of sexual intercourse increased in all the participants, and differences in sexuality between depressed and non-depressed participants were present; however, these differences had no further increase or decrease during the 12-year period. These differences were associated with marital status, employment status, education status, and family income status. These findings show differences in sexuality between depressed and non-depressed patients but are somewhat different from previous studies; the results may provide directions for future research and social work.

Early Marriage in Adolescence and Risk of High Blood Pressure and High Blood Glucose in Adulthood: Evidence from India

Adolescence, the transition phase to adulthood, is a critical period for physical and psychological development. Disruptions during this period, such as getting married, could result in various adverse short- and long-term health outcomes. This study aimed to assess the differential risk of two common chronic conditions—high blood pressure and high blood glucose—in adult women (20–49 years) who were married during different stages of adolescence (10–19 years) compared to women who were married in their youth (20–24 years). Using the most recent nationally representative data from India, we separately assessed the odds in favor of having the two chronic conditions for women who were married during early (10–14 years), middle (15–17 years), and late (18–19 years) adolescence. We found that an earlier age at marriage during adolescence was associated with a higher risk of chronic conditions later in life. Women who were married during early adolescence were respectively 1.29 and 1.23 times more likely (p < 0.001) to have high blood pressure and high blood glucose compared to women who were married in their youth. These findings highlight the importance of preventing underage marriage among adolescent females to address the risk of downstream chronic health consequences as adults.

Risky sexual behavior and associated factors among sexually-experienced adolescents in Bangkok, Thailand: findings from a school web-based survey

Background

The risk of sexually transmitted infections (STI) arises when there is unsafe sexual activity. Unsafe sex often begins in the teenage years, and it will persist as long as there is the opportunity for risky sexual activity. The purpose of this study was to assess the sexual risk behaviors and related factors of sexually-active adolescents in educational institutions in Thailand.

Methods

This was cross-sectional survey using an Internet-based application in schools in Bangkok from November 2020 to February 2021 with a total of 6,167 high school and vocational students. The schools were selected by simple random sampling among institutions, and the students were systematically randomly selected, with an equal number of males and females. We used multivariable logistic regression to analyze associations and control confounding variables. Indicators of risky sex include: (1) Not using a condom; (2) Having more than one sex partner; (3) Having sex in exchange for cash or in-kind compensation; and (4) Having sex without consent.

Results

Of a total of 872 sexually-active participants, the mean age was 15.6 years, 66.9% were vocational students, 42.1% were male, 57.9% were female, and 69.5% had sex risk behavior. The multivariate logistic regression analysis identified the following statistically-significant factors related to risky sex: smokes cigarettes (AOR = 1.79; 95% CI 1.12–2.88); uses cannabis (AOR = 2.84; 95% CI 1.23–6.56); gambles (AOR = 1.81; 95% CI 1.28–2.55); has sex without contraception (AOR = 2.74; 95% CI 2.91–3.93); has a history of childhood sex abuse (AOR = 1.60; 95% CI 1.03–2.56).

Conclusions

Our findings suggest that, in designing and implementing sexual risk prevention programs for adolescents in educational settings, there is a need to highlight the role of substance abuse in relation to sexual risk behaviors. Programs should target both male and female students. Teenagers who use marijuana are more likely to be sexually active than those who have never used marijuana. These potential risks should be taken into account with respect to legalization of marijuana and recreational use of this drug.

Risky sexual behavior (RSB) is engaging in sexual practices that may increase vulnerability to a reproductive health problem. This study was conducted to assess the sexual risk behaviors of students living in Bangkok, which has the highest rates of STIs among regions in Thailand. Previous studies of RSB have focused on the general population age 18 years or older. By contrast, there is a dearth of studies on sex behavior among Thais under age 18 years. In addition, the present study aimed to explore the association of substance abuse and adverse childhood experiences (ACEs) with adolescent RSB. In this study, 14.1% of all students in the participating schools had ever had sex before. Using the study criteria, two out of three students in the sample had experienced RSB. The findings from this study may help inform programs and interventions aimed at reducing the negative health impacts associated with RSB, specifically STIs. The findings of the study should be relevant for health program managers, socio-behavioral researchers, and other stakeholders who design reproductive health intervention strategies for in-school adolescents.

Early Sexual Initiation Is Associated with Suicide Attempts among Chinese Young People

This study aimed to investigate the association between early sexual initiation and suicide attempts (SAs) among Chinese young people. Our analysis included 9131 college students who had sexual experience from a national sample of 31 provincial administrative regions. Self-reported age at first intercourse was categorized as ≤15, 15–18, and ≥18 years, and the experience of SAs was recorded and analyzed. Compared with females whose sexual debut age was ≥18 years, those ≤15 years (defined as early sexual initiation) had higher odds of SAs in both the forced debut group (odds ratio (OR) 17.04, 95% confidence interval (CI) 4.87–59.66) and the voluntary debut group (OR 37.63, 95% CI 14.96–94.66). Early sexual initiators who lived in rural areas were more inclined to have SAs (female: OR 65.76, 95% CI 19.80–218.42; male: OR 15.39, 95% CI 1.64–144.19). Early sexual initiators who never had parent–child communication about sex were more likely to report having SAs (female: OR 37.81, 95% CI 12.28–116.46). Sexual debut during adolescence, particularly early sexual initiation, was a crucial risk factor for SAs among both sexes. Comprehensive sexuality education and smooth parental communication about sex will provide a supportive environment for young people and hence reduce the potential risks of SAs.

A perspective review of cannabis use and sexual offenses

Substance abuse is an established risk factor for crime and violence, including sexual violence. Nevertheless, the link between cannabis use and sexual offenses remains poorly understood. Cannabis use has a broad effect on sexual functioning and can have both acute and lasting adverse effects on psychological functioning, which in turn can elevate the risk of sexual offending behavior. Yet there is a scarcity of studies that have examined the link between cannabis use and sexual offending. To help fill the gap, this perspective review investigates the link between substance use and crime with a particular emphasis on cannabis use and its effects on sexual and psychological functioning. It then explores how these mechanisms may contribute to sexual offenses and recidivism, with a final discussion on how cannabis use should be conceptualized as a risk factor for sexual violence.

Knowledge of pelvic floor disorders in young women: a cross-sectional study

Abstract Introduction: Young women’s knowledge about pelvic floor function and dysfunction are poor. Objective: To identify the level of knowledge of young women about pelvic floor muscles (PFM) anatomy and function, pelvic floor muscle dysfunction (PFMD), pelvic organ prolapse (POP), and sexual dysfunction (SD). Methods: This is a cross-sectional study. Two hundred forty-two (242) young women from first to the third year of high school from ten public schools, in geographically disparate areas of a Brazilian county serving economic minority student populations, participated in the study. Data analysis was performed using SPSS 20.0 (SPSS Inc., Chicago, IL). The categorical data were expressed as absolute and relative frequency. Results: Only 28% of the young women knew PFM, and 26% answered to be able to contract these muscles. The prevalence of urinary incontinence was 16%, while 5% reported fecal incontinence. The previous knowledge about POP was similar between bladder and uterus prolapse, 34% and 40%, respectively. SD was known by 48% of the young women. Seventy-seven young women (31.8%) declared to have had sexual intercourse. Ten percent declared difficulties to allow vaginal penetration, and 48% of those who were able to have penetration declared that they experienced pain and discomfort. Conclusion: Young women have little knowledge about the PFM anatomy and function, PFMD, POP, and SD. In addition, they have complaints related to sexual practice, such as difficulty during vaginal penetration and pain.

Emotional Outcomes of Casual Sexual Relationships and Experiences: A Systematic Review

Casual sexual relationships and experiences (CSREs) are common and emotionally significant occurrences. Given the uncommitted, often emotionally complicated nature of CSREs, researchers have asked whether these experiences may have positive and/or negative emotional consequences. We reviewed 71 quantitative articles examining emotional outcomes of CSREs, including subjective emotional reactions (e.g., excitement, regret) and emotional health (e.g., depression, self-esteem). Overall, people evaluated their CSREs more positively than negatively. In contrast, CSREs were associated with short-term declines in emotional health in most studies examining changes in emotional health within a year of CSRE involvement. Emotional outcomes of CSREs differed across people and situations. Women and individuals with less permissive attitudes toward CSREs experienced worse emotional outcomes of CSREs. Alcohol use prior to CSREs, not being sexually satisfied, and not knowing a partner well were also associated with worse emotional outcomes. These findings suggest directions for prevention/intervention related to CSREs. For example, skill-building related to sexual decision-making may help individuals decide whether, and under what circumstances, CSREs are likely to result in positive or negative emotional outcomes. In addition, the limitations of extant research suggest directions for future inquiry (e.g., examining whether verbal and nonverbal consent practices predict emotional outcomes of CSREs).

Birth Order and First Sexual Experience: Do Siblings Influence Sexual Debut in Adolescents?

Birth order may foster specific roles for individuals within the family and set in train a dynamic that influences the development of specific behaviors. In this paper, we explored the relationship between birth order, sex, timing of sexual initiation, and its consequences for risky sexual behavior and sexual health. We conducted a path analysis to simultaneously estimate direct and indirect effects using data from the National Survey of Sexual Attitudes and Lifestyles (NATSAL-3). Whereas women born as only-children were more likely to sexually debut at later ages, middle-child boys were significantly more prone to initiate sexual intercourse earlier compared with first-borns. As expected, early sexual initiation was associated with riskier behaviors and sexual health outcomes. These associations were partially moderated by siblings role as confidants about sexuality. Our findings have implications for preventive programs aimed at promoting healthy sexual debuts and behaviors over the life span.

Association between First Sexual Intercourse and Sexual Violence Victimization, Symptoms of Depression, and Suicidal Behaviors among Adolescents in the United States: Findings from 2017 and 2019 National Youth Risk Behavior Survey

The objective of this study was to investigate the association between first sexual intercourse and sexual violence victimization, symptoms of depression, and suicidal ideation among sexually active adolescents in the United States. Data for this study came from the U.S. 2017 and 2019 iterations of the National Youth Risk Behavior Survey. An analytic sample of 6252 adolescents aged 14–18 years old (49.5% female) who reported ever having sexual intercourse was analyzed using Poisson regression. The outcome variables investigated in this study were sexual violence victimization, symptoms of depression, suicidal ideation, a suicide plan, and suicide attempts, and the main explanatory variables were age at first sexual intercourse and forced sexual intercourse. We also analyzed differences by gender and race. Of the 6252 adolescents who reported ever having sexual intercourse, 7.1% had their first sexual intercourse before age 13, and 14.8% experienced forced sexual intercourse. About 16% of adolescents experienced sexual violence during the past year, 42.6% reported symptoms of depression, 23.9% experienced suicidal ideation, 19.3% made a suicide plan, and 11.1% attempted suicide during the past year. In the regression analysis, early sexual intercourse was significantly and positively associated with suicidal ideation (relative risk (RR) = 1.15, 95% Confidence Interval (CI) = 1.02–1.30), suicide plan (RR = 1.18, 95% CI = 1.00–1.38), and suicide attempts (RR = 1.36, 95% CI = 1.15–1.61). Controlling for the effects of covariates, history of forced sexual intercourse was positively associated with the five outcomes examined with the relative risk ranging between 1.59 and 6.01. Findings of this study suggest that history of early or forced sexual intercourse is associated with poor mental health outcomes among adolescents and underscores the importance of developing interventions that offer psychological support in reducing the adverse impact of early sexual intercourse and forced sexual intercourse on adolescent health.

Physical and Emotional Satisfaction at First Same-Sex Anal Sex in Young Gay and Bisexual Men

Research has focused on adolescents' feelings about their first sexual experiences, but little research has examined this topic in sexual minority adolescents. In this study, we examined how experiencing emotional and physical satisfaction at first same-sex anal sex differed by age of first sex for young gay and bisexual men. We applied the time-varying effect model to data from an Internet survey of men who initiated first sex between ages 14-26 (n = 6401) to examine emotional and physical satisfaction at first same-sex anal sex across continuous age of onset and by partner factors. The majority of men reported satisfaction across all ages; however, satisfaction was generally less likely for men who had first anal sex with a non-relationship partner, an older partner, or a partner they had sex with only once and this was particularly true at earlier ages. Findings suggest that many young gay and bisexual men report satisfaction with their first anal sex and that relationship context can be important in predicting satisfaction, particularly at younger ages.

Initial Engagement in Oral Sex and Sexual Intercourse Among Adolescent Girls With and Without Childhood Attention-Deficit/Hyperactivity Disorder

We investigated initial engagement in oral sex and sexual intercourse, as well as number of sexual partners, among a prospectively followed sample of adolescent girls with and without a thorough childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD). Participants were adolescent girls (ages 12-19) followed longitudinally as part of a study of ADHD in females. A diverse sample of 140 girls with clinician-diagnosed ADHD (47 inattentive, 93 combined) and 88 age- and ethnicity-matched comparison girls were initially recruited and invited to partake in research summer programs. We utilized data on initial engagement in oral sex, sexual intercourse, and number of sexual partners, collected during follow-up interviews conducted 5 and 10 years after baseline participation. Girls with a childhood diagnosis of ADHD engaged in oral sex at a significantly younger age and reported nearly twice as many oral sex partners than their typically developing peers. Post hoc tests revealed that group differences were driven largely by girls with the combined presentation of ADHD (i.e., those with childhood histories of both inattention and hyperactivity/impulsivity). No significant differences emerged with respect to age of initial sexual intercourse or number of male sexual intercourse partners. In sum, adolescent girls with ADHD, particularly those with the combined presentation, were more likely to engage in oral sexual activity at a young age and with a greater number of both male and female partners. Findings highlight the need for longitudinal research that quantifies and distinguishes between various forms of sexual behavior and later reproductive and mental health outcomes.

A multi-country cross-sectional study of self-reported sexually transmitted infections among sexually active men in sub-Saharan Africa

Background

Despite the importance of self-reporting health in sexually transmitted infections (STIs) control, studies on self-reported sexually transmitted infections (SR-STIs) are scanty, especially in sub-Saharan Africa (SSA). This study assessed the prevalence and factors associated with SR-STIs among sexually active men (SAM) in SSA.

Methods

Analysis was done based on the current Demographic and Health Survey of 27 countries in SSA conducted between 2010 and 2018. A total of 130,916 SAM were included in the analysis. The outcome variable was SR-STI. Descriptive and inferential statistics were performed with a statistical significance set at p < 0.05.

Results

On the average, the prevalence of STIs among SAM in SSA was 3.8%, which ranged from 13.5% in Liberia to 0.4% in Niger. Sexually-active men aged 25–34 (AOR = 1.77, CI:1.6–1.95) were more likely to report STIs, compared to those aged 45 or more years. Respondents who were working (AOR = 1.24, CI: 1.12–1.38) and those who had their first sex at ages below 20 (AOR = 1.20, CI:1.11–1.29) were more likely to report STIs, compared to those who were not working and those who had their first sex when they were 20 years and above. Also, SAM who were not using condom had higher odds of STIs (AOR = 1.35, CI: 1.25–1.46), compared to those who were using condom. Further, SAM with no comprehensive HIV and AIDS knowledge had higher odds (AOR = 1.43, CI: 1.08–1.22) of STIs, compared to those who reported to have HIV/AIDS knowledge. Conversely, the odds of reporting STIs was lower among residents of rural areas (AOR = 0.93, CI: 0.88–0.99) compared to their counterparts in urban areas, respondents who had no other sexual partner (AOR = 0.32, CI: 0.29–0.35) compared to those who had 2 or more sexual partners excluding their spouses, those who reported not paying for sex (AOR = 0.55, CI: 0.51–0.59) compared to those who paid for sex, and those who did not read newspapers (AOR = 0.93, CI: 0.86–0.99) compared to those who read.

Conclusion

STIs prevalence across the selected countries in SSA showed distinct cross-country variations. Current findings suggest that STIs intervention priorities must be given across countries with high prevalence. Several socio-demographic factors predicted SR-STIs. To reduce the prevalence of STIs among SAM in SSA, it is prudent to take these factors (e.g., age, condom use, employment status, HIV/AIDS knowledge) into consideration when planning health education and STIs prevention strategies among SAM.

The relationship between early risk-taking behavior and mental health problems among a nationally representative sample of Australian youth

BACKGROUND

Earlier engagement in risk-taking behaviors has been associated with more severe mental health problems across development. However, sex differences in risk-outcome relationships remain underexplored and mental health outcomes spanning both ends of the internalizing and externalizing spectra are rarely considered within the same sample. The present study examined associations between age at initiation of alcohol use, illicit drug use, and sexual intercourse, and symptoms of internalizing, externalizing, depression and self-harm, for males and females.

METHODS

The present study analyzed self-report survey data from a nationally representative sample of Australian adolescents (N=2,950). Logistic regression models were conducted separately for males and females to test the association of early (age 15 or younger) and concurrent (age 16-17) initiation of alcohol use, illicit drug use and sexual behavior with symptoms of internalizing, externalizing, depression and self-harm at age 16-17.

RESULTS

Risk-taking behaviors were associated with all mental health outcomes. Generally, earlier initiation of risk-taking behaviors demonstrated stronger associations with mental health outcomes than concurrent initiation. Associations between risk-taking behaviors and mental health outcomes varied by participant sex and mental health outcome.

LIMITATIONS

Mechanisms underlying the relationship between risk-taking behaviors and mental health problems were not tested and the sample had not yet reached early adulthood.

CONCLUSIONS

Risk-taking behaviors, particularly when initiated early, share links with multiple mental health problems in adolescence. Public health strategies to delay the onset of risk-taking behaviors may therefore incur multiple benefits as might an integrated approach to mental health prevention programs for youth.

Relationships between women's emotional reaction to first coital experience and subsequent sexual risk-taking behaviour

Objectives: The study aimed to consider the affective reactions of young French women to their experience of first sexual intercourse and examine the relationship with subsequent risky sexual behaviours, using cluster profiles.Methods: A descriptive cross-sectional study was conducted among women in France (n = 391) (mean age 22.36 years, standard deviation 3.08). Participants completed a questionnaire with self-reported measures of emotional responses to first sexual intercourse and risky sexual behaviours.Results: Cluster analyses revealed four emotional reaction profiles: Pleasure, Guilty-pleasure, Negative-emotional and Anxiety-unpleasant. The Pleasure group reported overall and higher satisfaction and positive emotions towards first sexual intercourse; this group reported lower condom use. The Guilty-pleasure group felt pleasure tinged with guilt and reported fewer same-sex partners. The Negative-emotional profile group tended to feel major negative emotions related to initial coital experience, reporting lower or no pleasure. The Anxiety-unpleasant group reported little pleasure and major anxiety associated with first sexual intercourse. The latter two groups, respectively, reported a higher number of male sexual partners and higher alcohol consumption prior to sexual intercourse compared with the two pleasure groups.Conclusion: These results suggest that women's emotional reactions to first sexual intercourse may be associated with subsequent healthy versus risky sexual behaviours in young adulthood.

Longitudinal Associations of the Attainment of Developmental Tasks With Psychological Symptoms in Adolescence: A Meta-Analysis

The present meta-analysis integrates results from 310 longitudinal studies on associations of the attainment of 10 developmental tasks with psychological symptoms (e.g., internalizing or externalizing symptoms, anxiety, and depression). Higher initial success with getting access to a peer group, building friendships, preparing for a future career, body acceptance, as well as developing a personal identity, a value system, and socially responsible behavior predicted lower levels of symptoms at follow-up and stronger declines of symptoms over time when controlling for initial symptom levels. Furthermore, higher initial symptom levels predicted lower attainment of these tasks at follow-up as well as lower progress in task attainment. In contrast, more initial romantic/sexual involvement predicted an increase in symptoms over time, while higher initial symptoms were related to an increase in romantic/sexual involvement. Associations with autonomy varied between different forms of autonomy, while acquisition of a gender role was not related with psychological symptoms.

Birth Cohort and Racial/Ethnic Differences in the Age of First Oral and Anal Sex Among U.S. Men Who Have Sex with Men

Earlier age of first sex has potential direct and indirect health effects later in life. Though there are multiple nationwide general population studies on ages of first sex, there is no such nationwide study of first male-male oral or anal sex among men who have sex with men (MSM). This may be important for understanding racial/ethnic disparities in HIV and sexually transmitted infection acquisition among young racial/ethnic minority MSM. Our study examined the birth cohort and racial/ethnic differences in ages of first male-male oral and anal sex using a diverse 2015 U.S. nationwide sample of 10,217 sexually active MSM. The mean age of first male-male oral sex was 18.0 years. Compared with older birth cohorts, those MSM born 1990-2000 were more likely to have younger age of first male-male oral sex. Compared to white MSM, Hispanic MSM and non-Hispanic black MSM were more likely to have younger age of first male-male oral sex with a man. The mean age of first male-male anal sex was 20.3 years. Compared with older birth cohorts, those MSM born 1990-2000 were more likely to have younger age of first male-male anal sex. Compared to white MSM, MSM of all other racial/ethnic groups were more likely to have younger age of first male-male anal sex. These findings emphasize the need for comprehensive and MSM-inclusive sexual health education for young teens and online sexual health resources for young gay, bisexual, queer, and other MSM.

Association between cannabis use and sexual behavior among adolescents aged 12-15 years in 21 low- and middle-income countries

AIMS

To investigate the relationship between cannabis use and two sexual behaviors (ever had sex, multiple partners) in a large representative sample of adolescents aged 12-15 years from 21 low- and-middle income countries.

METHODS

Data from 84,867 adolescents aged 12-15 years participating in the Global School-based Student Health Survey were analyzed. Participants reported lifetime frequency of cannabis use (analyzed as 0, 1-2, 3-19 or ≥ 20 times), whether they had ever had sexual intercourse (yes/no) and, if yes, their lifetime number of sexual partners. We used multivariable logistic regression to analyze associations, adjusting for a range of relevant covariates.

RESULTS

12.7% of the sample reported having had sexual intercourse, and of these adolescents, 53.1% had had multiple sexual partners. The prevalence of lifetime cannabis use of 1-2 times, 3-19 times, and ≥ 20 times were 1.1%, 1.2%, and 0.4%, respectively. Those who reported using cannabis 1-2 times, 3-9 times, and ≥ 20 times had 2.32 (95%CI = 1.47-3.65), 2.34 (95%CI = 1.34-4.07), and 5.45 (95%CI = 2.22-13.40) times higher odds of having had sexual intercourse than those who had never used cannabis. Among those who had ever had sexual intercourse, the respective odds ratios (95%CIs) for having multiple sexual partners were 1.56 (0.93-2.62), 1.70 (0.92-3.14), and 5.66 (2.97-10.82). There were no significant interactions by sex for these associations.

CONCLUSIONS

Adolescents from LMIC who use cannabis are more likely to have ever had sexual intercourse than those who do not. Among those who have had sexual intercourse, those who use cannabis are more likely to have had multiple sexual partners.

Food Insecurity Is Associated With Poorer Mental Health and Sleep Outcomes in Young Adults

PURPOSE

The aim of the study was to determine the association between food insecurity, mental health, and sleep outcomes among young adults. Young adulthood represents an important developmental period when educational and economic transitions may increase the risk for food insecurity; however, little is known about associations between food insecurity and health outcomes in this period.

METHODS

Cross-sectional nationally representative data of U.S. young adults aged 24-32 years from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2018. Multiple logistic regression analysis was conducted with food insecurity as the independent variable and self-reported mental health (depression, anxiety, and suicidality) and sleep (trouble falling and staying asleep) outcomes as the dependent variables.

RESULTS

Of the 14,786 young adults in the sample, 11% were food insecure. Food-insecure young adults had greater odds of mental health problems including a depression diagnosis (1.67, 95% confidence interval [CI] 1.39-2.01), anxiety or panic disorder diagnosis (1.47, 95% CI 1.16-1.87), and suicidal ideation in the past 12 months (2.76, 95% CI 2.14-3.55). Food insecurity was also associated with poorer sleep outcomes including trouble falling (adjusted odds ratio 1.78, 95% CI 1.52-2.08) and staying (adjusted odds ratio 1.67, 95% CI 1.42-1.97) asleep.

CONCLUSIONS

Food insecurity is associated with poorer mental and sleep health in young adulthood. Health care providers should screen for food insecurity in young adults and provide referrals when appropriate. Future research should test interventions to simultaneously combat food insecurity and mental health problems in young adulthood.

Dynamic Change Between Intimate Partner Violence and Contraceptive Use Over Time in Young Adult Men's and Women's Relationships

The negative association between intimate partner violence (IPV) and contraceptive use is well established, but much of this research treats the association as static (e.g., similar across all relationships over development or time). Such studies do not account for individual development of sexual and romantic relationship mental, social, and behavioral well-being, which relate to contraceptive use. These studies are also predominantly woman-focused; such work could be complemented by examining men's associations. The current study examined how associations between sexual and physical IPV and consistent condom and birth control (BC) use changed across up to seven sequential relationships in young adulthood over a five-year period within a nationally representative sample. Results indicated that physical IPV-contraception associations were significant only across earliest or latest relationships. Sexual IPV-contraception associations were significant over more relationships but often changed in valence (negative to positive). There were few significant differences in these associations between men and women. Developmental context (e.g., prior relationship/IPV experience) may be important when considering IPV-contraception associations. In addition, although the IPV-contraception association does not appear to be a unique problem for women, research needs to explore how underlying mechanisms explaining this association may be a result of gendered and nongendered contexts.

Leisure-Time Sedentary Behavior, Alcohol Consumption, and Sexual Intercourse Among Adolescents Aged 12-15 Years in 19 Countries From Africa, the Americas, and Asia

BACKGROUND

The association between sedentary behavior and sexual behavior has not been investigated among adolescents.

AIM

The aim of this study was to: (i) investigate the association between leisure-time sedentary behavior and sexual intercourse, and (ii) test for mediation by alcohol consumption, drug use, physical activity, bullying victimization, parental support/monitoring, loneliness, and depressive symptoms in a large global sample of young adolescents.

METHODS

Data were analyzed from 34,674 adolescents aged 12-15 years participating in the Global School-based Student Health Survey. Participants reported the number of hours spent in leisure-time sedentary behavior on a typical day (<1, 1-2, 3-4, 5-8, and >8 hours). Data on alcohol consumption, drug use, physical activity, bullying victimization, parental support/monitoring, loneliness, and depressive symptoms were considered as potential mediators.

OUTCOME

Participants reported whether or not they had sexual intercourse in the past 12 months (yes/no).

RESULTS

The prevalence of past 12-month sexual intercourse was 11.9%, whereas the prevalence of <1, 1-2, 3-4, 5-8, and >8 hours per day of leisure-time sedentary behavior were 26.7%, 35.6%, 21.4%, 11.5%, and 4.9%, respectively. There was a dose-dependent relationship between sedentary behavior and odds of reporting sexual intercourse: compared with <1 hour/day of sedentary behavior, the odds ratio (95% CI) of sexual intercourse associated with 1-2, 3-4, 5-8, and >8 hours/day of sedentary behavior were 1.12 (0.94-1.33), 1.22 (1.01-1.48), 1.34 (1.08-1.66), and 1.76 (1.37-2.27), respectively. There was no significant interaction by sex. The largest proportion of the association between sedentary behavior and sexual intercourse was explained by alcohol use (% mediated 21.2%), with other factors explaining an additional 11.2%.

CLINICAL TRANSLATION

Interventions to reduce leisure-time sedentary and/or alcohol consumption may contribute to a reduction in the proportion of adolescents engaging in sexual intercourse at a young age. The strengths and limitations of this study are the large, representative sample of adolescents from 19 countries. However, the cross-sectional design means causality or temporal associations could not be established.

CONCLUSIONS

In young adolescents, leisure-time sedentary behavior is positively associated with odds of having sexual intercourse in both boys and girls, in a dose-dependent manner. Alcohol consumption seems to be a key mediator of this relationship. Smith L, Jackson SE, Jacob L, et al. Leisure-Time Sedentary Behavior, Alcohol Consumption, and Sexual Intercourse Among Adolescents Aged 12-15 Years in 19 Countries From Africa, the Americas, and Asia. J Sex Med 2019;16:1355-1363.

Associations of depression and anxiety symptoms with sexual behaviour in women and heterosexual men attending sexual health clinics: a cross-sectional study

Objective

To assess the association of symptoms of depression and anxiety with sexual risk behaviour and history, among women and heterosexual men attending genitourinary medicine (GUM) clinics.

Methods

Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) was a cross-sectional, self-administered questionnaire study recruited from 20 GUM clinics in England, 2013–2014. This analysis included women and heterosexual men. The prevalence of depression and anxiety symptoms was assessed. Modified Poisson regression was used to produce adjusted prevalence ratios (aPR) for the association of t demographic, socioeconomic and lifestyle factors with depression and anxiety, adjusted for gender, age, ethnicity, education level and study region. Among individuals reporting sex in the past 3 months, associations of depression and anxiety with sexual risk behaviour and history were assessed separately by gender, adjusted for age, ethnicity, study region, education and relationship status.

Results

Questionnaires were completed by 676 women and 470 heterosexual men. Depression symptoms were reported by 100 (14.8%) women and 33 men (7.0%). Anxiety symptoms were reported by 79 women (11.7%) and 21 men (4.5%). Among women reporting recent sex, those with depression symptoms were more likely to report condomless sex with a non-regular partner, aPR 1.38 (1.07–1.77) and recent condomless sex with two or more partners, 1.80 (1.25–2.59). Women with anxiety symptoms more likely to report recent condomless sex with two or more partners, 1.68 (1.13–2.50), low self-efficacy for condom use, 1.54 (1.02–2.31) and STI diagnosis in the last year 1.51 (1.04–2.20). Among heterosexual men reporting recent sex, depression and anxiety symptoms were associated with low self-efficacy with condom use, 2.32 (1.29–4.19) for depression and 2.23 (1.26–3.94) for anxiety, but not with measures of condomless sex.

Discussion

The associations between psychological symptoms and sexual risk behaviours highlight the importance of holistic assessment of need by both general and sexual health clinicians. We highlight the challenge in delivering holistic care associated with fragmentation of sexual health services.

First Time Cannabis Use and Sexual Debut in U.S. High School Adolescents

PURPOSE

Use of illicit drugs by adolescents might facilitate or trigger other risky behaviors, including early sexual initiation (ESI), multiple partners, and unprotected sex. This study examines whether the age at which adolescents initiate cannabis use is associated with the age of their first sexual intercourse in the U.S. in 2015.

METHODS

A secondary analysis of data from the 2015 Youth Risk Behavior Surveillance Survey, a cross-sectional, nationally representative survey, was conducted (n = 7,664). Exposure of interest was age of initiation of cannabis use (never used cannabis, age 12 or younger, 13-14 years of age, and age 15 or older) and outcome was ESI (14 years old or younger). Unadjusted and adjusted odds ratios (OR) and their 95% confidence intervals were computed.

RESULTS

Prevalence of ESI was 15.3%. The proportion of cannabis use was 39.9%. Adolescents starting cannabis use before the age of 15 had higher adjusted odds of ESI (OR ranged 4.2-6.7). This association is modified by sex: while in boys using cannabis before 13 years, the OR is 9 (95% CI 5.2-15.6); in girls, it is 2.8 (95% CI 1.7-4.7).

CONCLUSIONS

Our findings suggest that there should be sex and drug education programs instituted before the age of 12 ideally, and no later than by age 15 since this time represents a critical period of initiating both behaviors.

Oral contraceptive use and depression among adolescents

PURPOSE

Depression is a prevalent health problem affecting U.S. women. Oral contraceptive pills (OCPs) are commonly used for pregnancy prevention, and evidence is mixed regarding any increased risk for incident depression among users, particularly adolescents.

METHODS

We examined the relationship between OCP use and depressive disorders among female adolescents using validated, structured interview assessments in a general population sample of adolescents in the National Comorbidity Survey-Adolescent Supplement. Respondents were 4765 female adolescents with no history of pregnancy who reported current OCP use, lifetime OCP use, and age of OCP initiation. Lifetime and current depressive disorders, including major depressive disorder and depressive episodes, were assessed by lay interviewers.

RESULTS

In logistic regression models adjusted for a range of confounders, there was no relationship between ever using OCPs and lifetime depressive disorder (OR 1.10, 95% CI 0.88-1.37), nor current use of OCPs and current depressive disorder (OR 0.82, 95% CI 0.50-1.35). Using survival analysis for age-of-onset data, we found that OCP use is not associated with an increased risk of depressive disorders.

CONCLUSIONS

In sum, use of OCPs in a general population sample of adolescents did not increase the risk of depressive disorders.

Paternal Incarceration and Early Sexual Onset among Adolescents

Despite a growing literature documenting deleterious intergenerational consequences of incarceration, relatively little is known about how exposure to paternal incarceration is associated with risk behaviors in adolescence. In this article, we use data from the Fragile Families and Child Wellbeing Study (N = 3,405)-a cohort of urban children born around the turn of the 21st century and followed for 15 years-to examine the relationship between paternal incarceration and one indicator of adolescent risk behavior, early sexual onset. Results from adjusted logistic regression models show that paternal incarceration is associated with a greater likelihood of initiating sexual activity before age 15, in part resulting from externalizing problems that follow paternal incarceration. We also find that these associations are concentrated among boys living with their fathers prior to his incarceration. Given that paternal incarceration is a stressor concentrated among already vulnerable children, paternal incarceration may exacerbate inequalities in adolescent sexual risk behavior.

Associations between Parental Psychopathology and Sexual Behavior in an Outpatient Psychiatric Sample

Early age of sexual debut is associated with an increase in negative outcomes, including higher incidence of nonconsensual sexual experiences, higher rates of sexually transmitted infections, and risky sexual practices. Little research has examined the role of parental psychopathology as a predictor of adolescent sexual activity, however. The current study aims to close this gap by examining the relationship between parental psychopathology and sexual activity in a longitudinal sample of youth. Participants were 685 adolescents from the Longitudinal Assessment of Manic Symptoms study, the majority of whom were male (67%) and White (65%). Analyses considering likelihood of sexual initiation included the full sample, whereas analyses considering predictors of the age of sexual debut included the 162 participants who reported ever having sexual intercourse (62% male, 51% White) via the Youth Risk Behavior Surveillance-High School version. Cox regression analyses suggested that maternal generalized anxiety disorder predicted decreased likelihood of initiating sex during the 8-year follow-up period, whereas paternal conduct disorder predicted increased likelihood of initiating sex. Multivariate linear regressions also showed that maternal conduct disorder predicted earlier age of sexual debut among those who had initiated, whereas paternal antisocial personality disorder predicted later age of sexual debut. These associations were observed in both male and female adolescents. Furthermore, these effects were largely not explained by the established relationship between youth psychopathology and sexual behavior. Results have implications for interventions aimed at decreasing sexual risk taking in vulnerable youth.

Associations Between Patterns of Sexual Initiation, Sexual Partnering, and Sexual Health Outcomes from Adolescence to Early Adulthood

The goal of this study was to examine, in a nationally representative sample, relationships between various sexual initiation patterns, subsequent sexual partnerships, and related health outcomes from adolescence through early adulthood. Data were from a subset of 6587 respondents from the National Longitudinal Study of Adolescent to Adult Health. Bivariate analyses and adjusted logistic and ordinary least squares regression models were used to determine associations between membership in three sexual initiation classes, lifetime sexual partner counts, and multiple health outcomes, including lifetime sexually transmitted infection or disease (STI/STD) diagnosis, lifetime unintended pregnancy, and romantic relationship quality. Broadly, having fewer lifetime sexual partners was associated with lower odds of STI/STD diagnosis and unintended pregnancy, and better relationship quality; however, findings also indicated both within and between sexual initiation class differences in the relationship between lifetime sexual partners and all three health outcomes. In particular, results showed little variation in health outcomes by sexual partnering among those who postponed sexual activity, but members of the class characterized by early and atypical sexual initiation patterns who had fewer lifetime partners exhibited better health outcomes than most other initiation groups. These results show that while both sexual initiation and partnering patterns add important information for understanding sexual health from adolescence to early adulthood, partnering may be more relevant to these sexual health outcomes. Findings indicate a need for more comprehensive sexuality education focused on sexual risk reduction and promotion of relationship skills among adolescents and adults.

Adolescent Age of Sexual Initiation and Subsequent Adult Health Outcomes

OBJECTIVES

To examine the mechanisms of the association between age of sexual initiation and adult health.

METHODS

Data from the Seattle Social Development Project (n = 808), in Seattle, Washington, included outcomes when participants were in their 30s (2005-2014): substance use disorders, depression, poor health, and obesity. Sexual consequence mediators included sexually transmitted infection, adolescent pregnancy, and a high number of sexual partners. We used linear logistic regression to model main effect and mediated associations.

RESULTS

Age of sexual initiation was related to nicotine and marijuana disorders, physical health, and obesity, but not alcohol disorder or depression. Mediated association with nicotine disorder was not significant; association with marijuana disorder was reduced; significant relationships with poor health and obesity remained.

CONCLUSIONS

The relationship between age of sexual initiation and substance use was largely explained by consequences of sexual behavior. Earlier sexual initiation was linked to poorer physical health outcomes, though the nature of the association remains unclear. Public Health Implications. Prevention approaches need to address multiple risk factors and emphasize contraceptive methods to avoid sexual consequences. For physical health outcomes, broad prevention approaches, including addressing early sexual initiation, may be effective.

Age of sexual initiation and depression in adolescents: Data from the 1993 Pelotas (Brazil) Birth Cohort

BACKGROUND

Studies have shown that sexual initiation at earlier ages increases the risk of depressive symptoms in adolescents. However, little is known about its association with major depressive episode (MDE).

METHODS

The association between age of sexual initiation and MDE at 18 years was assessed in the 1993 Pelotas Birth Cohort using multiple logistic regression. Sexual initiation characteristics (age and type of partner) were assessed at the 15- and 18-years follow-up. The age of sexual initiation was evaluated in categories (11-14, 15-16, 17+ years). The type of partner was categorized into: boyfriend/ girlfriend, casual partner and other. MDE was assessed using the Mini International Neuropsychiatric Interview (MINI).

RESULTS

From the 4027 adolescents assessed, the prevalence of MDE was higher in females (10.1%) than in males (3.4%), and 66.7% of the males and 58.6% of the females reported sexual initiation up to 16 years (p < 0.001). Female adolescents who had sexual initiation <17 years had higher odds of MDE (15-16 years: OR 2.29; 11-14 years: OR 2.23), however no association was found for males. The type of partner in the first sexual intercourse was not associated to depression.

LIMITATIONS

Possibility of recall bias on the age of sexual initiation, and low statistical power for some analyses.

CONCLUSIONS

A positive association between age of sexual initiation and MDE was observed only in females. More investigation is needed to understand the mechanisms through which age of sexual initiation can affect the risk of depression and whether the association persists in adulthood.

Early Sexual Onset and Alcohol Use and Misuse From Adolescence Into Young Adulthood

PURPOSE

Little is known about the longitudinal association between early first heterosexual intercourse (e.g., intercourse before the age of 15 years) and alcohol use during adolescence and young adulthood. This study sought to determine whether early first heterosexual intercourse is associated with (1) frequency of alcohol use at age 16 years, (2) changes in alcohol use from ages 16 to 22 years, and (3) alcohol misuse at age 22 years, while controlling for alcohol use, antisocial behavior, pubertal timing, and parental monitoring in early adolescence.

METHODS

A sample of 289 participants (63% female) was surveyed annually from ages 12 to 22 years.

RESULTS

Latent growth curve modeling indicated that youth who experienced an early first heterosexual intercourse report a higher frequency of alcohol use at age 16 years compared with those who have experienced their first heterosexual intercourse at an "on-time" age. However, timing of first heterosexual intercourse was not related to growth in frequency of alcohol use over time. Hierarchical multiple regression analysis showed that experiencing an early first heterosexual intercourse predicted problematic alcohol use at age 22 years (β = .153, p = .027). These results were found while controlling for confounding individual- and family factor-level variables.

CONCLUSIONS

The effect of early first heterosexual intercourse on adolescent alcohol use appears to be long lasting and is associated with a more problematic use of this substance in young adulthood. Further research should be conducted to uncover the developmental processes involved.

Understanding the "Why" for High-Risk Behavior: Adolescent Girls' Motivations for Sex

Identifying why girls participate in safe and risky sexual behaviors is key to developing successful intervention strategies. This study identified motivations for sex in 738 girls enrolled in the Health Improvement Project for Teens (HIPTeens) randomized controlled trial and analyzed differences in sex motives among at-risk subgroups. Sexually active girls, ages 15-19 years, were recruited from urban community-based settings. Baseline data were collected via audio computer-assisted self-interview surveys including a modified Sex Motives Scale based on six domains (intimacy, enhancement, self-affirmation, coping, peer pressure, and partner approval), assessing drivers of both protective and risk-promoting motivations. Statistically significant motive differences across domains were identified among subgroups with different risk profiles, including mental health issues (depression, drug and alcohol use) as well as demographic group characteristics (race, age, and parental status). Understanding why girls have sex provides an opportunity to address motivation-focused strategies that may augment intervention efficacy.