Risk-taking behaviour is more frequent in teenage girls with multiple sexual partners

School Connectedness and Risk for Sexual Intercourse and Nonconsensual Sex in Adolescence

The CDC reports that 30% of high school students have engaged in sexual intercourse. Evidence suggests biological, personal, peer, societal, and family variables affect when a child will initiate sex. The school environment plays an important role in a child's development. Evidence suggests that greater attachment to the school community can modify sexual risk-taking activity in adolescents. Future of Families and Child Wellbeing Study (FFCWS) comprises a cohort of approximately 4,700 families of children born in the U.S. between 1998-2000, over-sampled for non-marital births in large U.S. cities. Adolescents (N = 3,444 of 4,663 eligible) completed the wave six teen survey at approximately age 15. School connectedness was self-reported with four items measuring inclusiveness, closeness, happiness, and safety felt by the adolescent in their school environment. Sexual intercourse and nonconsensual sex were self-reported by the adolescent. Hierarchical regression analyses were conducted examining sexual intercourse, nonconsensual sex, risk factors, and school connectedness. In this sample of adolescents (48% female, 49% Black, 25% Hispanic, ages 14-19), school connectedness appears to reduce boys' risk of nonconsensual sex (OR = 0.29, p < 0.01), and reduce girls' risk of engaging in sexual intercourse (OR = 0.55, p < 0.01). Findings suggest gender differences in the association between school connectedness and sexual practices in adolescents. School connectedness may confer protection for boys' risk of nonconsensual sex, and for girls' risk of engaging in sexual intercourse. Further exploration of the relationship between school connectedness may allow for recommendations into preventative measures for teenage sexual behaviors.

Associations between externalizing behavior problems and risky sexual behaviors in adolescence: Attachment as a mediator

INTRODUCTION

Risky sexual behaviors in adolescence are associated with negative health and psychological functioning outcomes. Although the association between behavior problems and risky sexual behaviors is well established, addressing these problems requires understanding the mechanisms that help explain this association. Adolescent attachment, while related to risky sexual behavior, has not been extensively explored as an outcome of childhood externalizing problems. The two objectives of this study were to explore the links between parental and peer attachment and risky sexual behaviors and to examine the mediating effect of attachment on the links between behavior problems and risky sexual behaviors.

METHODS

Five hundred and ninety-eight French-Canadian adolescents (46.2% girls), Mage at T1 = 13.23; Mage at T2 = 14.28; Mage at T3 = 17.35) participated in this longitudinal study.

RESULTS

The quality of parental attachment at T2 was significantly and negatively associated with risky sexual behaviors 3 years later, at T3. More specifically, a lower quality parental attachment relationship was associated with having nonexclusive partners as well as with inconsistent condom use. Finally, parental attachment (T2) was a significant mediator between behavior problems (T1) and risky sexual behaviors (T3), but only for younger adolescents.

CONCLUSIONS

Findings suggest that in addition to behavior problems in adolescence, the quality of parental attachment relationships may help in understanding risky sexual behaviors in adolescence.

Need for Sexual, Reproductive, and Mental Health Promotion Among Diverse College Students in a COVID-19 Era

In 2020, the COVID-19 pandemic forced unprecedented disruptions in higher education operations. While the adverse mental health effects experienced by college students due to these changes are well documented, less is known about the impact on their sexual and reproductive health (SRH), and the reciprocal relationships between SRH and mental health among adolescents and emerging adults. This position paper reviews existing literature on the effects of the COVID-19 pandemic on SRH, sexual violence, unintended pregnancy, sexually transmitted illness and human immunodeficiency virus rates and highlights issues specific to college-aged males, females, racial/ethnic and sexual minorities, and individuals with disabilities. The need to conceptualize SRH as an integral component of normal development, overall health, and well-being in the context of COVID-19 is discussed. The need to prioritize the design and implementation of developmentally appropriate, evidence-based SRH interventions specifically targeting college students is identified. Furthermore, an intergenerational approach to SRH that includes parents/caregivers and/or college faculty and staff (e.g., coaches, trainers) could facilitate comprehensive SRH prevention programming that enhances sexual violence prevention training programs currently mandated by many colleges. Policies and programs designed to mitigate adverse pandemic-related exacerbations in negative SRH outcomes are urgently needed and should be included in mainstream clinical psychology, not only focused on preventing unwanted outcomes but also in promoting rewarding interpersonal relationships and overall well-being. Recommendations for clinical psychologists and mental health researchers are made.

Looking Within: An Analysis of Intimate Partner Violence Victimization Among Sexual Minority Youth

Sexual minority youth are at increased risk of intimate partner violence (IPV) victimization compared to their heterosexual peers. However, the sexual minority population is not a homogenous group and risk of IPV victimization varies by LGB+ subgroup (e.g., gay/lesbian, bisexual, and unsure). Using two waves of data (2017, 2019) from the National Youth Risk Behavior Survey (YRBS), this study analyzes (a) differences in physical and sexual IPV victimization between heterosexual and sexual minority youth, (b) within group differences among sexual minority youth, and (c) if the relationship between IPV victimization and sexual identity is attenuated after controlling for sociodemographic characteristics and theoretically relevant risk factors. Results indicate that sexual minority youth are at elevated risk of IPV victimization compared to their heterosexual peers. Within-LGB+ analyses show that bisexual youth are more likely than gay/lesbian youth to be victims of sexual IPV. The association between physical and sexual IPV victimization and sexual identity is partially attenuated by sociodemographic variables and observed risk factors. Findings indicate that intervention and prevention programming should be tailored to identify, and treat, the risks and needs of unique, at-risk populations.

Relationship Between Alcohol Consumption and Risky Sexual Behaviors Among Adolescents and Young Adults: A Meta-Analysis

Objectives: Adolescents exposed to alcohol have increased risky sexual behaviors (RSBs); however, the association between alcohol consumption and RSBs has to be systematically and quantitatively reviewed. We conducted a meta-analysis of the literature to systematically and quantitatively review the association between alcohol consumption and RSBs in adolescents and young adults. Methods: We searched for qualified articles published from 2000 to 2020 and calculated pooled odds ratios (ORs) using the random-effect model. We also conducted meta-regression and sensitivity analyses to identify potential heterogeneity moderators. Results: The meta-analysis of 50 studies involving 465,595 adolescents and young adults indicated that alcohol consumption was significantly associated with early sexual initiation (OR = 1.958, 95% confidence interval (CI) = 1.635-2.346), inconsistent condom use (OR = 1.228, 95% CI = 1.114-1.354), and having multiple sexual partners (OR = 1.722, 95% CI = 1.525-1.945). Conclusion: Alcohol consumption is strongly associated with RSBs, including early sexual initiation, inconsistent condom use, and multiple sexual partners among adolescents and young adults. To prevent the adverse consequences of alcohol consumption, drinking prevention programs should be initiated at an early age and supported by homes, schools, and communities.

Examining Sexual Behavior Among U.S. Transgender Adolescents

The health of transgender adolescents (i.e., those identifying with a gender other than their sex assigned at birth) is gaining attention from researchers, yet little work has examined normative sexual behaviors among this population. Self-identified gender minority adolescents, including those identifying as trans boys, trans girls, nonbinary, and questioning their gender identity (age range 14-18, M_age = 16, n = 1,223) from all 50 U.S. states responded to anonymous online surveys. Participants reported on their age of initiation and number of sexual partners for four sexual behaviors ranging in intimacy (i.e., sexual touching, oral sex, vaginal sex, and anal sex). Participants also indicated the gender of their sexual partners and experiences with sexually transmitted infections (STIs), STI tests, and pregnancy. Overall, transgender adolescents' age of initiating sexual behaviors and number of sexual partners are similar to those observed in prior studies of cisgender adolescents. No differences were found between gender identity subgroups on ever engaging, age of initiation, number of partners, and gender of partners across the four sexual behaviors, with some exceptions for anal sex. Participants reported low rates of STIs and pregnancy, but also low rates of STI testing. Implications for sex education and health care are discussed.

Sexual Risk Behaviors during Adolescence: Associations with Childhood and Adolescent BMI

Research examining associations between unhealthy weight and sexual risk behaviors derives primarily from cross-sectional studies conducted at varying ages during adolescence. The present study examined longitudinal associations between adolescent sexual risk behaviors and Body Mass Index (BMI), the latter measured prospectively from childhood through adolescence. Data were drawn from an 8095 individuals between the ages of 14 and 19 at last assessment, including 1768 Hispanic (52% female), 2659 non-Hispanic Black (Black; 50% female), and 3668 non-Hispanic, non-Black (predominantly White; 49% female). Childhood BMI predicted increased sexual risk-taking during adolescence for Black and White youth, and increases in BMI predicted increased sexual risk-taking for White females and Black males. The findings highlight differential patterns of association between BMI and sexual risk behaviors for Hispanic, Black, and White females and males with implications for prevention discussed.

How adverse childhood experiences relate to single and multiple health risk behaviours in German public university students: a cross-sectional analysis

Background

Adverse childhood experiences (ACEs) have been shown to be linked to health risk behaviours (HRBs). This study aims to identify risk factors for ACEs and to examine the associations between ACEs and single and multiple HRBs in a sample of university students in Germany.

Methods

An online-based cross-sectional study was conducted among public university students (N = 1466). The widely applied ACE questionnaire was used and extended to operationalise 13 categories of childhood adversity. First, variables for each type of ACE and HRB were dichotomised (single ACEs and single HRBs), and then used for cumulative scores (multiple ACEs and multiple HRBs). Frequencies were assessed, and (multinomial) logistic regression analyses were performed.

Results

Prevalence rates of ACEs ranged from 3.9 to 34.0%, depending on the type of childhood adversity. Sociodemographic risk and protective factors for single/multiple ACEs varied strongly depending on the outcome. In particular, a high family socioeconomic status seemed to be a consistent protective factor for most ACEs. After adjusting for sociodemographic characteristics, both single and multiple HRBs were associated with single events of ACEs. Moreover, dose-response relationships between multiple ACEs and various single and multiple HRBs were found.

Conclusions

The study provides strong evidence that ACEs are associated with HRBs. The number of ACEs may play a role in single or multiple HRBs. Reducing the number of ACEs could thus decrease HRBs, which account for many of the leading causes of morbidity and death. The findings highlight the importance of trauma-informed health interventions designed to prevent the occurrence of ACEs, and build capacity among children and adults.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5926-3) contains supplementary material, which is available to authorized users.

Prevalence of sexual coercion and its association with unwanted pregnancies among young pregnant females in Kampala, Uganda: a facility based cross-sectional study

BACKGROUND

Sexual coercion is associated with sexually transmitted infections and unwanted pregnancies with consequential unsafe abortions and increased maternal morbidity and mortality. Current literature focuses mainly on its risk factors but less on its resultant deleterious health effects. We conducted a study to determine the prevalence of sexual coercion and its association with unwanted pregnancies among young pregnant women.

METHODS

In a cross-sectional study, four hundred and sixteen (416) consenting pregnant females aged 15-24 years attending antenatal clinics in Lubaga division Kampala district in Uganda were enrolled using systematic sampling. Quantitative and qualitative data on sexual coercion were collected by female interviewers. Adjusted Prevalence Proportion Ratios (Adj. PPRs) of unwanted pregnancy and associated 95 % confidence intervals were estimated by generalized linear models with log link function and Poisson family distribution using robust variance estimator. Quantitative data were analyzed using Stata version 10.0, while qualitative data were analyzed using manifest content analysis.

RESULTS

Prevalence of sexual coercion was 24 % and was higher among those who had non consensual sexual debut (29.0 %) compared with those who had consensual sexual debut (22.6 %). The prevalence of unwanted pregnancy was 18.3 % and was higher among participants who had been sexually coerced relative to their counterparts (p < 0.001). History of sexual coercion in the past 12 months and non consensual sexual debut were associated with unwanted pregnancy [adj.PPR = 2.23, 95 % CI: (1.49-3.32)] and 1.72, 95 % CI: (1.16- 2.54)] respectively. Qualitative results indicated that different forms/contexts of sexual coercion, such as deception, transactional sex and physical force influenced unwanted pregnancies.

DISCUSSION

This study highlights that a quarter of our participants in our quantitative study had experienced sexual coercion in the past twelve months and nearly a third of these, had history of non consensual sexual debut. Unwanted pregnancy was higher among the sexually coerced and those who had non consensual sexual debut.

CONCLUSION

Sexual coercion among pregnant women aged 15-24 years in Kampala, Uganda is high and is significantly associated with unwanted pregnancy. Comprehensive sex education targeting young people (<25 years), along with availability and access to youth friendly centers may be useful in addressing sexual coercion and its negative outcomes.

Understanding Consistent Condom Use Among Homeless Men Who Have Sex with Women and Engage in Multiple Sexual Partnerships: A Path Analysis

Consistent condom use is the main strategy aimed at preventing individuals from acquiring HIV through sexual intercourse. The mechanism of consistent condom use among a high-risk homeless subpopulation-homeless men who have sex with women and also engage in multiple sexual partnerships-remains unclear. This study identified 182 homeless men who engaged in multiple sexual partnerships from a representative sample of homeless men, who self-identified as heterosexual, using meal line services in Downtown Los Angeles' Skid Row area. Information such as participants' condom use psychosocial correlates, sexual risk behaviors, and social network characteristics were collected. Results suggested that condom efficacy is a potential intervening mechanism through which condom attitudes (β = -0.199; p = 0.005) and depression (β = -0.156; p = 0.029) are associated with an individual's consistent condom use. Having more network members with whom participants talked about HIV prevention (β = 0.051; p = 0.006) was also found to be associated with an individual's consistent condom use. HIV prevention programs should focus on increasing their condom efficacy to help reduce HIV risks among this vulnerable homeless subpopulation.

The influence of pornography on sexual scripts and hooking up among emerging adults in college

The explosive growth in access to the Internet has led to a commensurate increase in the availability, anonymity, and affordability of pornography. An emerging body of research has shown associations between pornography and certain behaviors and attitudes; yet, how pornography actually influences these outcomes has not been documented. In two studies (Study 1 N = 969; Study 2 N = 992) we examined the hypothesis that pornography influences potentially risky sexual behavior (hooking up) among emerging adults via sexual scripts. Our results demonstrate that more frequent viewing of pornography is associated with a higher incidence of hooking up and a higher number of unique hook up partners. We replicated these effects both cross-sectionally and longitudinally while accounting for the stability of hook ups over the course of an academic semester. We also demonstrated that more frequent viewing of pornography is associated with having had more previous sexual partners of all types, more one occasion sexual partners ("one night stands"), and plans to have a higher number of sexual partners in the future. Finally, we provided evidence that more permissive sexual scripts mediated the association between more frequent pornography viewing and hooking up. We discuss these findings with an eye toward mitigating potential personal and public health risks among emerging adults.

Adolescents' religious discordance with mothers: is there a connection to sexual risk behavior during emerging adulthood?

This study longitudinally investigates the relationship between adolescent/mother religious discordance and emerging adult sexual risk-taking 6-7 years later. We used Social Control Theory to examine the level and direction of concordance using data from Wave I and Wave III of the Add Health Study, focusing on constructs of religious importance, frequency of prayer, and attendance at religious services. We found that higher levels of adolescent/mother discordance in religious importance were related to increased emerging adult sexual risk-taking compared to those with similar levels adolescent/mother religiosity, but this occurred only when mothers reported higher levels of religious importance than their children. In contrast, adolescents reporting higher frequency of prayer than their mothers reported lower levels of sexual risk-taking than those with similar frequency of adolescent/mother prayer. These findings suggest that the protective effects of family religious socialization can be interrupted. However, this influence of religious difference on sexual risk-behavior operates differently depending on the direction and level of religious difference. Even in emerging adulthood, a period marked by distance from childhood values and institutions, religious difference with a parent remains a meaningful influence.

Contraception matters: indicators of poor usage of contraception in sexually active women attending family planning clinics in Victoria, Australia

BACKGROUND

Unintended pregnancy (mistimed or unwanted) remains an important health issue for women. The purpose of this study was to determine the prevalence of and factors associated with risk of unintended pregnancy in a sample of Victorian women attending family planning clinics.

METHODS

This cross-sectional survey of three Family Planning Victoria Clinics from April to July 2011 recruited women aged 16-50 years with a male sexual partner in the last 3 months, and not intending to conceive. The questionnaire asked about contraceptive behaviours and important factors that influence contraception use (identified from a systematic literature review). Univariate analysis was calculated for the variables of interest for associations with contraceptive use. An overall multivariate model for being at risk for unintended pregnancy (due to inconsistent or ineffective contraceptive use or non-use) was calculated through backward elimination with statistical significance set at <0.05.

RESULTS

1006 surveys were analyzed with 96% of women reporting contraception use in the last 3 months. 37% of women were at risk for unintended pregnancy due to imperfect use (61% inconsistent users; 31% ineffective methods) or never using contraception (8%). On multivariate analysis, women at risk for unintended pregnancy compared with women not at risk were <25 years old (OR 1.8, 95% CI 1.2-2.7); had no university/postgraduate degree (OR 1.7, 95% CI 1.2-2.4); and had >1 partner in the last 3 months (OR 3.2, 95% CI 2.3-4.6). These women were dissatisfied with current contraception (OR 2.5, 95% 1.8-3.5); felt "vulnerable" to pregnancy (OR 2.1, 95% CI 1.6-3.0); were not confident in contraceptive knowledge (OR 2.6, 95% CI 1.5-4.8); were unable to stop to use contraception when aroused (OR 2.1, 95% CI 1.5-2.9) but were comfortable in speaking to a doctor about contraception (OR 2.3, 95% CI 1.1-4.1).

CONCLUSION

Despite reported high contraceptive usage, nearly 40% of women were at risk for unintended pregnancy primarily due to inconsistent contraceptive use and use of ineffective contraception. Strategies for improving consistency of effective contraception use or greater emphasis on long-acting contraception may be needed for certain subpopulations at higher risk for unintended pregnancy.

Maternal models of risk: links between substance use and risky sexual behavior in African American female caregivers and daughters

African American (AA) adolescent girls are at heightened risk for HIV and sexually transmitted infections (STIs), and thus knowledge of factors related to risky sexual behavior in this population is crucial. Using Social Learning Theory (Bandura, 1977), this paper examines pathways from female caregivers' risky sexual behavior and substance use to adolescent girls' risky sexual behavior and substance use in a sample of 214 low-income, urban AA female caregivers and daughters recruited from outpatient mental health clinics in Chicago. Structural equation modeling (SEM) revealed that sexual risk reported by female caregivers was associated with adolescent sexual risk, and illicit drug use reported by female caregivers was related to adolescent-reported substance use, which was in turn associated with adolescent-reported sexual risk behavior. These findings suggest that female caregivers' sexual behavior and substance use both relate to girls' sexual risk. Thus, results emphasize the role of female caregivers in transmitting risk.

Risk behaviors among adolescent girls in an HIV prevention trial

Adolescent girls remain vulnerable to HIV and other sexually transmitted infections. Understanding their sexual and substance use behaviors is essential to designing effective interventions to reduce their risk. In this study, baseline data were analyzed from 738 adolescent girls ages 15 to 19 years in Rochester, New York. Data on sexual behavior and substance use (lifetime, past 3 months, and most recent sexual experience) were collected. Nearly one half of recent vaginal (42%) and anal (45%) sex acts were not condom protected; 39% had a prior sexually transmitted infection (STI) and 12% were currently infected with an STI. Approximately one third (31%) of girls had more than one sex partner in the past 3 months. Girls with multiple partners reported that their recent sexual experiences were more likely to involve drug and alcohol use by themselves and partners. Adolescent girls, particularly those with multiple sexual partners, continue to report high-risk sexual behaviors and need focused risk-reduction interventions.

Associations of diet and lifestyle with headache in high-school students: results from a cross-sectional study

BACKGROUND

Diet and lifestyle are seen as factors which influence headache in adults. However, population-based studies on this issue in adolescents are rare.

OBJECTIVE

Aim of the present study was to investigate associations between diet and lifestyle factors and different types of headache, ie, migraine and tension-type headache (TTH) in adolescents.

METHODS

A total of 1260 adolescents from the 10th and 11th grades of high schools filled in questionnaires on intake of meals, coffee, nonalcoholic and alcoholic drinks, smoking, and physical activity. Type of headache was classified according to the International Classification of Headache Disorders - 2nd edition. Multiple logistic regression models, adjusted for sex and grade, were calculated.

RESULTS

High consumption of cocktails (odds ratio = 3.4; 95% confidence interval 1.9-6.0) and coffee (2.4; 1.3-4.7), smoking (2.7; 1.4-5.1), and lack of physical activity (2.2; 1.3-3.7) were significantly associated with migraine plus TTH episodes, consumption of coffee and physical inactivity particularly with migraine (3.4; 1.6-7.0 and 4.2; 2.2-7.9, respectively) and physical inactivity with TTH (1.7; 1.1-2.7). Skipping of meals or insufficient fluid intake were not associated with any type of headache.

CONCLUSIONS

Adolescents with any type of headache might benefit from regular physical activity and low consumption of alcoholic drinks, while for migraine patients a low consumption of coffee should additionally be recommended. Intervention studies are warranted to assess whether psycho-educational programs conferring knowledge of these associations will influence headache-triggering behavior and headache in adolescents.

Research into the efficacy and cost-effectiveness of brief, free of charge and anonymous sex counselling to improve (mental) health in youth: design of a randomised controlled trial

BACKGROUND

The capacity to form romantic relationships and sexual health of adolescents in the Netherlands are compromised by several factors, including young age of first intercourse and adolescent depression. Several thresholds like own expenses, trust and embarrassment prevent adolescents to seek help for their sexual problems. To overcome these thresholds, brief sex counselling has been developed. It has been used since 2006 within the Rotterdam-Rijnmond Public Health Service, but there is lack of information about the (cost-) effectiveness. In the current study we will evaluate the (cost-) effectiveness of brief sex counselling for sexual problems in adolescents and young adults between 18 and 25 years of age.

METHODS

In a randomised controlled trial we will compare (1) brief sex counselling with (2) intensive sexological treatment, and (3) delayed treatment (waiting list). Embedded in this RCT will be a trial-based economic evaluation, looking at the cost-effectiveness and cost-utility of brief sex counselling versus the two other interventions. Four hundred fifty adolescents (aged 18-25) with sexual problems will be recruited among the persons who visit the Public Health Service (PHS) and through various websites. After a screening procedure, eligible participants will be randomly allocated to one of the three intervention groups. Primary outcome measure of the clinical evaluation is the severity of sexual problems. Other outcomes include psychological distress, especially depression. The economic evaluation will be performed from a societal perspective. Costs will be assessed continuously by a retrospective questionnaire covering the last 3 month. All outcome assessments (including those for the economic evaluation) will take place via the internet at baseline, and at 3, 6, 9, and 12 months after baseline.

DISCUSSION

The proposed research project will be the first study to provide preliminary data about the effect and cost-effectiveness of brief sex counselling in youth in comparison with intensive sexological treatment and delayed treatment. It is anticipated that positive results in (cost-) effectiveness of the proposed intervention will contribute to the improvement of sexual health care for adolescents and young adults.

TRIAL REGISTRATION

The study has been registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (NTR1952).