Age of partner at first adolescent intercourse and adult sexual risk behavior among women

Age-disparate relationships at first sex and reproductive autonomy, empowerment, and sexual violence among adolescent girls and young women in Rwanda

Background

Age-disparate relationships (ADR) place adolescent girls and young women (AGYW) at higher risk of unprotected sex and HIV infection; few studies have investigated ADR at first sex in sub-Saharan Africa. This study investigates ADR at first sex and its association with reproductive autonomy, reproductive empowerment, contraception coercion, and consent at first sex among female Rwandan youth.

Methods

Cross-sectional data from a randomized trial (n = 5768) of in-school youth ages 12-19 at enrollment were analyzed with focus on those who reported sexual activity (n = 1319). General estimating equation linear models and Poisson models were used to estimate linear coefficients and prevalence ratios (PR), with 95% confidence intervals (CIs) estimated using robust standard errors.

Results

Females reported a significantly higher average partner age gap than males by 2.43 years (2.90 years vs. 0.46 years, 95% CI: 2.01, 2.86). Overall, 23.4% (n = 102) of sexually active AGYW engaged in an ADR at first sex. The prevalence of non-consensual first sex was 60% higher among AGYW reporting ADR at first sex compared to AGYW reporting similar-aged partners (adjusted PR = 1.59, 95% CI: 1.25, 2.02). No association was found between ADR at first sex and reproductive autonomy, reproductive empowerment, or contraception coercion.

Conclusions

Our results suggest a high prevalence of sexual violence among AGYW engaging in first sex with an age-disparate partner. However, we did not find evidence that ADR at first sex affects reproductive autonomy or empowerment within the first few years of sexual initiation. Further research is needed to explore the impact of ADR at first sex and longer-term trajectories of sexual behavior, empowerment and autonomy.

Assessing Sexual Behavior Patterns among Student Athletes of Senior High Schools in the Upper East Region, Ghana

The purpose of this study was to investigate the sexual behavior patterns of student athletes of senior high schools in the Upper East Region of Ghana and to assess the differences in sexual behavior patterns between male and females. A sample of 400 student athletes using a convenience sampling technique from public senior high schools was drawn to complete a self-designed research study. Descriptive statistics and the Chi-square test tool were used to analyze the collected data. The results showed that student athletes practiced various forms of sexual behaviors such as celibacy, foreplay, vaginal-penile sex, sexual fantasy, masturbation, oral sex, and anal sex. The Chi-square analysis showed significant gender differences in prevalence of masturbation (χ2 (1, n = 400) = 4.6962, probability = 0.030) and sexual fantasy (χ2 (1, n = 400) = 6.8477, probability = 0.009), but not vaginal-penile intercourse (χ2 (1, n = 400) = 1.3197, probability = 0.251) and celibacy (χ2, (1, n = 400) = 0.0721, probability = 0.788). The study concludes that student athletes of senior high schools might be vulnerable to unplanned parenthood and are at risk of STIs, including HIV. Regular health promotion campaigns on sexual risk-taking behaviors are required to help reduce the prevalence of student athletes’ indulgence in risky sexual behavior patterns that can harm their health. It is essential to implement gender-specific interventions (e.g., decision-making skills) when addressing the problems of sexual behaviors among the student athletes in the region.

Parent, partner and individual contexts of very early first sex experiences among young men and their links to subsequent reproductive health outcomes

Research indicates that upwards to 30% of US urban Black male adolescents report first sex younger than age 13; however, there is limited literature on the sexual and reproductive health outcomes and contexts of these early first sex experiences. This exploratory study described sexual and reproductive health histories and explored personal, partner and parent contextual factors associated with first sex experiences occurring at 13 years or younger among a sample of US urban young men aged 15-24. Participants were assessed on their demographics and sexual health histories and a subset of young men were assessed on the contextual factors related to their first sex experience. Pearson chi-squared tests examined factors associated with early first sex and Fisher's exact tests examined associated contextual factors. First sex at 13 years or younger was reported by 29% of young men. A higher proportion of young men who had first sex at 13 or younger than those who had sex onset at 14 or older reported having got someone pregnant, having a "much older" first partner, and relationship satisfaction with their mother (16%) and father (12%). Study findings highlight the need to better understand urban young men's early first sex experiences, including the support needed to promote their healthy sexual development.

Determinants of unintended pregnancies among currently married women in Uganda

BACKGROUND

Unintended pregnancies are no longer bound to teenagers or school-going children, married women in Uganda, as well do experience such pregnancies though little has been investigated on them. This study examines the determinants of unintended pregnancies among currently married women in Uganda.

METHODS

In this study, we used data from the 2016 Uganda Demographic and Health Survey (UDHS) which comprised of 10,958 married women aged 15-49 years who have ever been pregnant. The analysis was done using descriptive analysis, logistic regression, and the generalized structural equation model.

RESULTS

The study showed that 37% of pregnancies among married women were unintended. Young women, living in poor households, staying in rural areas, women in the Eastern and Northern region, Muslim women, lack of knowledge on ovulation period, discontinuation of contraceptives, non-use of and intention for contraceptives, high age at sexual debut, high age at first birth, and high parity were directly associated with a higher risk of unintended pregnancies. Relatedly, discontinuation of contraceptives regardless of the place of residence, region, woman's age, education, household wealth, access to family planning messages were associated with higher odds of unintended pregnancies. Older women and those in rural areas who had more children were also at a higher risk of similar pregnancies. However, having more children while using contraceptives, being educated, living in a wealthier household, and having access to family planning messages significantly lowered the risk of unintended pregnancies.

CONCLUSION

Increased access to family planning messages, empowering women as well as having improved household incomes are key preventive measures of unintended pregnancies. There is a need to provide quality contraceptive counseling through outreaches so that women are informed about the different contraceptive methods and the possible side effects. Having a variety of contraceptive methods to choose from and making them accessible and affordable will also encourage women to make informed choices and reduce contraceptive discontinuation. All these coupled together will help women have their desired family sizes, increase the uptake of contraceptives and significantly reduce unintended pregnancies.

Sexually Transmitted Infections and Associated Factors in Southeast Spain: A Retrospective Study from 2000 to 2014

The World Health Organization estimates that more than one million people acquire a Sexually Transmitted Infection (STI) every day, compromising quality of life, sexual and reproductive health, and the health of newborns and children. It is an objective of this study to identify the factors related to a Sexually Transmitted Infection diagnosis in the province of Granada (Spain), as well as those better predicting the risk of acquiring such infections. In this study, 678 cases were analyzed on a retrospective basis, which were treated at the Centre for Sexually Transmitted Diseases and Sexual Orientation in Granada, between 2000–2014. Descriptive statistics were applied, and by means of binary logistic regression, employing the forward stepwise-likelihood ratio, a predictive model was estimated for the risk of acquiring an STI. Sex, age, occupation, economic crisis period, drug use, number of days in which no condoms were used, number of sexual partners in the last month and in the last year, and number of subsequent visits and new subsequent episodes were associated with an STI diagnosis (p < 0.05). The risk of being diagnosed with an STI increased during the economic crisis period (OR: 1.88; 95%-CI: 1.28–2.76); during the economic crisis and if they were women (OR:2.35, 95%- CI: 1.24–4.44); and if they were women and immigrants (OR: 2.09; 95%- CI:1.22–3.57), while it decreased with age (OR: 0.97, 95%-CI: 0.95–0.98). Identification of the group comprised of immigrant women as an especially vulnerable group regarding the acquisition of an STI in our province reflects the need to incorporate the gender perspective into preventive strategies and STI primary health care.

The “dating game”: age differences at first sex of college students in Italy

Researchers have devoted much attention both to the analysis of the first sexual experience and to how the couple was established, but little is still known about age differences of partners at their first sexual relationship. The availability of two highly comparable waves of a survey on the sexual behavior of college students in Italy (SELFY—Sexual and Emotional LiFe of Youth) carried out in 2000 and 2017 allowed us to study the predictors of age differences between partners at first sex, filling the existing gap on recent research. Results of multivariate analyses show important gender differences on mate selection: women tend to choose an older partner for having their first sexual experience and are less likely as men to be involved in age discordant first sex relationships with a younger partner. Age gaps between partners also influence age at sexual debut, which tends to occur earlier in a relationship with an older partner and later if having first sex with a younger partner. Another important predictor of the age gap is the type of relationship that linked the respondent to its partner at first sex. Our estimations indicate a lower likelihood of having had an older first sex partner for students who had their first sexual experience with the own boy/girl-friend or with a friend compared to those who have had it with a stranger. Finally, we have found a higher likelihood of first sex relationships among same-age partners relative to older partners through SELFY waves and small changes on variables influencing such relationships.

Acceptability and Barriers to HIV Pre-Exposure Prophylaxis in Atlanta's Adolescents and Their Parents

Adolescents aged 13-24 years account for 23% of new HIV infections in Atlanta, indicating need for better HIV prevention strategies in this population. Pre-exposure prophylaxis (PrEP) is now approved for adolescent use. This study aims to understand the acceptability of and barriers to PrEP in adolescents and parents. We administered PrEP acceptability and barrier measures to HIV(-) 13-17 year olds and their parents from January to April 2016 in an adolescent clinic and emergency department in Atlanta, GA, stratifying by adolescent sexual activity. Acceptability scores (AS) and barrier scores (BS) were calculated by averaging survey answers 1-3. For AS, 1 was very unlikely to accept PrEP; concomitantly, BS near 3 indicated fewer barriers. Two-sample hypothesis testing, Pearson correlations, and linear regression were used. Of the 102 adolescent/parent dyads, 67% of adolescents were female, 94% black, with a mean age of 15.7 ± 1.5 years, and 31% were sexually active. Parents were 94% female, 96% black, with a mean age of 42.4 ± 8.9 years. AS averaged between somewhat to very likely to accept PrEP (2.4 ± 0.5 and 2.2 ± 0.6) in adolescents and parents, respectively. BS averaged between unlikely and somewhat likely to perceive barriers to PrEP (2.0 ± 0.4 and 1.9 ± 0.5) in adolescents and parents, respectively. The adolescent/parent dyad is likely to accept PrEP, regardless of sexual activity. Limitations include that nearly 70% of adolescents were not sexually active, and the study was conducted before PrEP approval by the Food and Drug Administration for those who are younger than 18 years. These results support future parent and adolescent education on PrEP.

Associations of Partner Age Gap at Sexual Debut with Teenage Parenthood and Lifetime Number of Partners

CONTEXT

Age at sexual debut and age gap between partners at debut are modifiable characteristics that may be related to risky sexual behaviors. Understanding any such relationships is a necessary first step toward strengthening risk interventions.

METHODS

Age at sexual debut and partner age gap were examined for 3,154 female and 2,713 male respondents to the 2011-2013 National Survey of Family Growth who first had intercourse before age 18. Multivariable logistic regression was used to assess associations between these measures and teenage parenthood and reporting a high lifetime number of partners (i.e., a number above the sample median).

RESULTS

Females' odds of teenage parenthood were elevated if sexual debut occurred at ages 15-17 and involved a partner age gap of 3-4 years (odds ratio, 1.8) or more (2.0); they were reduced if debut occurred before age 15 and the gap was 3-4 years (0.8). Females' likelihood of reporting a high lifetime number of partners was negatively associated with age gap (0.4-0.7, depending on age at debut and length of age gap). Males' likelihood of reporting a large number of partners was positively associated with age gap if sexual debut was before age 15 and the gap was five or more years (1.7) or if debut was at ages 15-17 and involved a 3-4-year gap (2.0).

CONCLUSION

Identifying the mechanisms underlying these associations could inform program design and implementation.

Moving Beyond Age: An Exploratory Qualitative Study on the Context of Young African American Men and Women's Sexual Debut

African American youth continue to be disproportionately affected by HIV. Early sexual debut has been identified as a major determinant of HIV risk. However, emerging research suggests that the overarching context in which first sex occurs may have greater implications for sexual health than simply age alone. The purpose of this exploratory, qualitative study was to better understand the broader context of African Americans' sexual debut. In-depth, semi-structured interviews were conducted with 10 African American men and women aged 18-24 years. Thematic analysis was used to analyze the data. The mean age at sexual debut for the sample was 15.4 (SD = 3.3), and youth framed their sexual debut as positive (50%), negative (30%), and both positive and negative (20%). The majority of youth initiated pre-sex conversations with their partners to gauge potential interest in engaging in sexual activity, and all youth utilized at least one HIV/sexually transmitted infection and pregnancy prevention method. However, most youth failed to talk to their partners prior to sex about their past sexual histories and what the experience meant for their relationship. Key differences emerged between youth who framed the experience as positive and those who framed the experience as negative or both positive and negative in terms of their motivations for initiating sex (i.e., readiness to initiate sex, pressure, and emotionally safety) and post-sex emotions (i.e., remorse and contentment). Findings provide further support for examining the broader sexual context of African American's sexual debut. A more comprehensive understanding of sexual debut will aid in the development and tailoring of sexual risk reduction programs targeting African American youth.

Exploring First Sexual Intercourse, Sexual Orientation, and Sexual Health in Men

In this study the characteristics of the sexual debut of men who have sex with men (MSM) and men who have sex with women (MSW) age 35 or younger (N = 1,201) were compared with one another. We investigated whether these characteristics were associated with sexual health and behavior, and to what extent. Compared to MSW, MSM tended to be older when they had their first sexual intercourse; their first sex partner was older, they felt less ready, and they experienced more pain. We also found that they reported a higher number of lifetime sexual partners and less condom use compared to MSW. Similarities were also ascertained, such as the fact that individuals from both groups do not differ significantly regarding how they experienced their first sexual intercourse emotionally. Many differences between these groups should not always be seen as problematic, whereas others still indicate a need for targeted interventions.

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

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

The impact of social media on the sexual and social wellness of adolescents

For most adolescents in the United States, the use of social media is an integral part of daily life. While the advent of the Internet has enhanced information dispersal and communication worldwide, it has also had a negative impact on the sexual and social wellness of many of its adolescent users. The objective of this review is to describe the role of social media in the evolution of social norms, to illustrate how online activity can negatively impact adolescent self-esteem and contribute to high-risk adolescent behaviors, to elucidate how this activity can result in real-world consequences with life-long results, and to provide guidance regarding social media use for those who care for adolescents. Although research is now aimed at use of social media for positive health and wellness interventions, much work needs to be done to determine the utility of these programs. Adolescent healthcare providers are important contributors to this new field of study and must resolve to stay informed and to engage this up-and-coming generation on the benefits and risks of social media use.

The Emotional Experiences of Early First Intercourse

The experience of the first intercourse at an early age is a well-established sexual risk behavior as it is related to adverse physical and mental health outcomes. However, the diversity within the group of early starters as well as the actual processes that make early first-time intercourse (potentially) more harmful remain understudied. The goal of this research is to understand the mechanisms that make an early experience of the first intercourse either more or less emotionally harmful. Therefore, a combination of quantitative and qualitative data are used. The quantitative data stem from a population survey (ages 14-35 years; N = 705); the qualitative data were gathered by in-depth interviews among 24 young people (ages 16-18 years) with an early first-time intercourse (at age 14 years or younger). Quantitative analyses show that the age at first-time intercourse is positively related to the feeling of readiness. For the male respondents only, it is also positively related to the general experience of the first intercourse. For female respondents, the age at the first intercourse is only related to the general experience of it in interaction with the age difference with the first partner. Qualitative analyses show that much variation goes behind these statistical regularities. Successful early starters can be differentiated from problematic early starters based on relationship characteristics, the preceding sexual trajectory, and the preceding sexual decision making. Practical implications are described, and recommendations for further research are made.

Influence of sexual sensation-seeking on factors associated with risky sexual behaviour among African-American female adolescents

Background The identification of antecedents to sexual risk among youth is critical to the development and dissemination of multilevel interventions. Therefore, the aim of the present study was to examine the effect of sexual sensation-seeking on partner age, partner communication, and the sexual attitudes and behaviours of African-American female youth.

METHODS

This study examined survey data collected by audio computer-assisted self-interviews from 701 young African-American females between 14 and 20 years of age. The survey consisted of items designed to measure adolescents' sexual risk and preventive behaviours.

RESULTS

The results of this study suggest that sexual sensation-seeking is associated with condom use among adolescent African-American females. For adolescents who reported greater sexual sensation-seeking, lower levels of sexual happiness were associated with a decreased likelihood of condom use at last intercourse (β=1.01, P≤0.05). For those reporting lower levels of sexual sensation-seeking, greater sexual enjoyment was associated with a greater likelihood of condom use at last intercourse (β=0.93, P≤0.01). Adolescents with younger sexual partners and lower levels of sexual sensation-seeking reported a higher proportion of condom use in the past 6 months (β=0.70, P=0.01). Higher partner communication self-efficacy and decreasing levels of sexual sensation-seeking were associated with fewer lifetime sexual partners (β=-0.54, P≤0.05).

CONCLUSIONS

Future research should address the impact of these variables on adolescent relationship dynamics and sexual decision-making.

What's age got to do with it? Partner age difference, power, intimate partner violence, and sexual risk in urban adolescents

Adolescent girls with older male main partners are at greater risk for adverse sexual health outcomes than other adolescent girls. One explanation for this finding is that low relationship power occurs with partner age difference. Using a cross-sectional, descriptive design, we investigated the effect of partner age difference between an adolescent girl and her male partner on sexual risk behavior through the mediators of sexual relationship power, and physical intimate partner violence (IPV), and psychological IPV severity. We chose Blanc's framework to guide this study as it depicts the links among demographic, social, economic, relationship, family and community characteristics, and reproductive health outcomes with gender-based relationship power and violence. Urban adolescent girls (N = 155) completed an anonymous computer-assisted self-interview survey to examine partner and relationship factors' effect on consistent condom use. Our sample had an average age of 16.1 years with a mean partner age of 17.8 years. Partners were predominantly African American (75%), non-Hispanic (74%), and low-income (81%); 24% of participants reported consistent condom use in the last 3 months. Descriptive, correlation, and multiple mediation analyses were conducted. Partner age difference was negatively associated with consistent condom use (-.4292, p < .01); however, the indirect effects through three proposed mediators (relationship power, physical IPV, or psychological IPV severity) were not statistically significant. Further studies are needed to explore alternative rationale explaining the relationship between partner age differences and sexual risk factors within adolescent sexual relationships. Nonetheless, for clinicians and researchers, these findings underscore the heightened risk associated with partner age differences and impact of relationship dynamics on sexual risk behavior.

Consequences of sex education on teen and young adult sexual behaviors and outcomes

PURPOSE

This study examined whether formal sex education is associated with sexual health behaviors and outcomes using recent nationally representative survey data.

METHODS

Data used were from 4,691 male and female individuals aged 15-24 years from the 2006-2008 National Survey of Family Growth. Weighted bivariate and multivariate analyses were conducted by gender, estimating the associations of sex education by type (only abstinence, abstinence and birth control, or neither) before first sexual intercourse, and sexual behaviors and outcomes.

RESULTS

Receipt of sex education, regardless of type, was associated with delays in first sex for both genders, as compared with receiving no sex education. Respondents receiving instruction about abstinence and birth control were significantly more likely at first sex to use any contraception (odds ratio [OR] = 1.73, females; OR = 1.91, males) or a condom (OR = 1.69, females; OR = 1.90, males), and less likely to have an age-discrepant partner (OR = .67, females; OR = .48, males). Receipt of only abstinence education was not statistically distinguishable in most models from receipt of either both or neither topics. Among female subjects, condom use at first sex was significantly more likely among those receiving instruction in both topics as compared with only abstinence education. The associations between sex education and all longer-term outcomes were mediated by older age at first sex.

CONCLUSIONS

Sex education about abstinence and birth control was associated with healthier sexual behaviors and outcomes as compared with no instruction. The protective influence of sex education is not limited to if or when to have sex, but extends to issues of contraception, partner selection, and reproductive health outcomes.

Parents, peers and pornography: the influence of formative sexual scripts on adult HIV sexual risk behaviour among Black men in the USA

Black men in the USA experience disproportionately high rates of HIV infection, particularly in the Southeastern part of the country. We conducted 90 qualitative in-depth interviews with Black men living in the state of Georgia and analysed the transcripts using Sexual Script Theory to: (1) characterise the sources and content of sexual scripts that Black men were exposed to during their childhood and adolescence and (2) describe the potential influence of formative scripts on adult HIV sexual risk behaviour. Our analyses highlighted salient sources of cultural scenarios (parents, peers, pornography, sexual education and television), interpersonal scripts (early sex- play, older female partners, experiences of child abuse) and intrapsychic scripts that participants described. Stratification of participant responses based on sexual-risk behaviour revealed that lower- and higher-risk men described exposure to similar scripts during their formative years; however, lower-risk men reported an ability to cognitively process and challenge the validity of risk-promoting scripts that they encountered. Implications for future research are discussed.