Gender, Contraceptive Attitudes, and Condom Use in Adolescent Romantic Relationships: A Dyadic Approach

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.

Consistent Condom Use and Associated Factors among sexually active Military Personnel in Eastern Ethiopia: Cross-Sectional Study Design

Background

A condom is a latex-based device used to prevent pregnancy and sexually transmitted infections (STIs). Despite condom availability and promotion for use in STI prevention, consistent condom use remains too low in Ethiopia. A significant proportion of Ethiopian military personnel had multiple sexual partners, with lower rates of condom use with non-regular sexual partners. As a result, determining the pattern of condom use and the factors associated with it among military personnel is critical.

Objective

The purpose of this study was to evaluate consistent condom use and associated factors among sexually active military personnel in Eastern Ethiopia from February 1 to 28, 2020.

Methods

A cross-sectional study was conducted among 327 sexually active military personnel. To select the study participants, a systematic sampling technique was used. The data were entered into EpiData and exported to the Statistical Package for Social Sciences version 20 for analysis. To identify factors associated with condom use, bivariate and multivariable logistic regression analysis were used, and the strength of the association was measured using odds ratio and 95% confidence interval (CI), with P-values less than 0.05 considered statistically significant.

Results

The overall prevalence of consistent condom uses over one year by the respondents was 59.9% (95% CI: 54, 65). Study participants with an age of 30–35 years old (AOR = 3.12; 95% CI: 1.43, 11.38), above 35 years old (AOR = 2.42; 95% CI: 1.83, 9.30), college and above in educational status (AOR = 1.52; 95% CI: 1.20, 5.43), Officer in military rank (AOR = 3.12; 95% CI: 1.14, 10.15) and other military ranks (AOR = 3.08; 2.33, 8.52) were factors facilitate the use of condom consistently.

Conclusion

In this study, two in every five military personnel use condoms inconsistently. Designing appropriate intervention and behavioral change strategies, as well as increasing the accessibility and availability of condoms around military camps, will undoubtedly have a significant impact on consistent condom utilization.

Sexual Communication between Adolescent Partners: A Scoping Review and Directions for Future Research

Sexual communication between adolescent partners is an important component of sexual health and wellbeing. Over 40 years of research on adolescent sexual communication has yielded rich information, yet there remain gaps in our understanding of the communication process. The purpose of this scoping review was to synthesize the body of research on adolescent sexual communication to identify how communication has been conceptualized, how researchers have measured communication, and what theoretical frameworks have been applied across the literature. We identified 198 assessments of sexual communication across 119 quantitative studies. This work included 127,489 adolescents (M_age = 15.97) from 15 countries (81.5% U.S.-based). Most studies relied on self-reports (93.4%) and surveyed only one member of a couple (97.5%). The definition of sexual communication was highly varied across the literature: in half of assessments (52.0%) sexual communication was operationalized as a behavior-the verbal or nonverbal exchange of messages about sex-whereas the remaining half of assessments captured social-cognitive aspects of communication (e.g., communication self-efficacy, fear/anxiety). There was also a tendency for investigators to create their own idiosyncratic instruments: half of studies (48.9%) used instruments created by the research team with limited or no discussion of reliability/validity. Regarding the topic of communication, a third of assessments (33.8%) focused exclusively on condom communication and another quarter (24.0%) focused on other safer-sex issues (e.g., STDs, abstinence). Notably absent were studies focused on communication surrounding consent or sexual pleasure. Also absent was a guiding conceptual model or theory that could unify this body of work. Overall, results highlight gaps and inconsistencies in how partner sexual communication has been conceptualized, measured, and theorized about in previous work. We provide several recommendations for future theory-building efforts as well as rigorous, multimethod empirical investigations of adolescent sexual communication that would further our understanding of this important aspect of adolescent sexual wellbeing.

Multilevel Barriers to Sexual Health Behavior Among Vulnerable Adolescent Girls in the USA

Introduction

Most sexual health interventions focus on individual-level predictors of sexual behavior. Given the considerable influence of environmental factors on adolescent girls' sexual health, current interventions may be insufficient to promote safer sex. In this study, we aimed to understand adolescent girls' anticipated barriers to engaging in safer sex behavior after completing a brief, web-based sexual health intervention called HEART.

Methods

This study used qualitative interviews with 50 adolescent girls who were recruited from community-based organizations that serve vulnerable youth. All participants were 12 to 19 years old (mean age=15.62, SD=1.83), and identified with a marginalized racial/ethnic group (58% Black; 18% Latinx; 24% Asian, biracial, or multiracial). Further, 24% identified as LGBTQ+, and 58% were sexually active.

Results

Guided by the social ecological model, we delineate six unique barriers to safer sex discussed by adolescents: partner manipulation, slut shaming, unclear sexual values, present time orientation, embarrassment, and access to sexual and reproductive health services.

Discussion

We conclude with recommendations for addressing these barriers to optimize adolescent girls' sexual health.

More than the sum of their parts: A dyad-centered approach to understanding adolescent sexual behavior

BACKGROUND

Research has documented multiple levels of influences on adolescent sexual behavior, but has generally focused less on the relational nature of this behavior. Studies with dyadic data have provided important findings on relationship process, including the role of gender in different-sex dyads. However, both of these bodies of literature typically utilize a variable-centered approach, which examines average influences of particular variables on sexual behavior. This study expands upon this research by presenting a dyad-centered approach to adolescent sexual behavior that can identify types of couples based on patterns of multidimensional risk and protective factors.

METHODS

I demonstrate the dyad-centered approach using data from different-sex dyads in the National Longitudinal Study of Adolescent to Adult Health to uncover profiles marked by individual, parent, peer, and religion predictors for both male and female partners.

RESULTS

Analyses uncovered five classes of dyadic influences, four of which were marked by relative similarity between partners and one marked by lesser approval of sex for women compared to men. Dyads marked by both partners intending to have sex and being in a context that is more approving of sex were more likely to engage in sexual intercourse.

CONCLUSIONS

Findings demonstrate the heterogeneity of influences and intentions to have sex among adolescent couples, and identify profiles of dyads who are more likely to engage in sexual intercourse. This approach can explicate dyadic processes involved in sexual behavior and the types of couples that exist in a population, leading to more tailored and efficacious interventions.

Contraception in Adolescents

Adolescents are at risk for unwanted pregnancy when they become sexually active, and contraception is an important part of mitigating this risk. Use of contraceptive methods, and long-acting reversible contraceptive methods such as implants and intrauterine devices in particular, has increased among adolescents. Although sexual activity has declined and contraceptive use has increased among adolescents in the United States in recent years, the unintended pregnancy rate remains high. All of the currently available contraceptive methods are safe and effective for adolescents to use; however, adolescents may have specific concerns about side effect profiles and unscheduled bleeding that should be addressed during contraceptive counseling. Healthcare providers should prioritize adolescents' needs and preferences when approaching contraceptive counseling, and also consider the unique access and confidentiality issues that adolescents face when accessing contraception.

Rate of condom use among sexually active adolescents: a nationwide cross-sectional study in Taiwan from 2012 to 2016

OBJECTIVE

Adolescents' sexual behaviours are associated with sexually transmitted infections and unwanted pregnancies. This study aimed to estimate the sexual intercourse and condom use rates at first and last sex among Taiwanese adolescents in grades 7-12.

DESIGN

A secondary data analysis of the Taiwan Global School-Based Student Health Survey's 2012-2016 data. The survey was anonymous, cross-sectional and nationwide.

SETTING

Taiwan high school students (grades 7-12).

PARTICIPANTS

The sample comprised 27 525 students from junior high schools (grades 7-9), and senior high schools, comprehensive schools, vocational high schools and night schools (grades 10-12).

MAIN OUTCOME MEASURES

The rate of ever having had sexual intercourse; the rates and factors of condom use at first and last sex.

RESULTS

The sexual intercourse rate in each school type (in ascending order) was junior high school (1.62%), senior high school (4.14%), comprehensive school (9.08%), vocational high school (14.03%) and night school (41.09%). Condom use rate decreased from 57.07% (95% CI=54.31% to 59.83%) at first sex to 25.72% (95% CI=23.34% to 28.10%) at last sex (p<0.0001). The condom use rate (in ascending order) was junior high school (first sex: 37.67%, last sex: 19.76%), night school (55.83%, 22.62%), vocational high school (61.13%, 25.78%), comprehensive school (62.83%, 28.61%) and senior high school (68.38%, 34.96%). Older age at sexual debut was associated with condom use at first and last sex, and having one sexual partner was associated with condom use at last sex, as revealed by logistic regression analysis.

CONCLUSIONS

This study highlights an urgent need to instil a proper understanding of protected sex while adolescents are still in their formative years. Despite the low sexual intercourse rate (4.95%), there is lower condom use at last sex than at first sex, which indicates that many sexually active adolescents are not practising protected sex, especially among junior high school students.

Egalitarian Values and Sexual Behavior-The Role of Country Level Values in Shaping Individual Level Behaviors in Africa, South America and Asia

Objective The aim of this study is to investigate the relationship between country level egalitarian values (broadly speaking emancipatory values/structural gender equality) and sexual behavior among youth. Methods: Comparative individual level data on sexual activity and condom use were collected from the Global School-based Student Health Survey, resulting in a final sample of 23 countries, analyzed utilizing multilevel logistic regression analysis. Results: Egalitarian values were significantly associated with sexual activity and condom use. Conclusions: Egalitarian values have a relationship with adolescents' sexual activity and condom use, and thus contribute to sexual health and well-being in Africa, South America and Asia.

Partner Type and Young Women's Sexual Behavior: A Qualitative Inquiry

The incidence of sexually transmitted infections (STIs) has increased over recent years, particularly among young women. Partner type is believed to influence women's STI risk. However, researchers often restrict partner type to "casual" versus "committed," labels that can mask risk variability. Therefore, in this study, we identified and explored a range of sexual partner types in order to understand how young women's perceived risk and condom use intentions vary by partner type. Data were obtained during six focus groups of young women (N =25) who were recruited from a community reproductive healthcare clinic. Women described a range of monogamous and non-monogamous partner types that were distinguished based on partner regularity (i.e., whether the sexual partnership was ongoing) and personal relationship (i.e., degree of involvement outside of the sexual relationship). Women's perceived STI risk was higher and condom use intentions stronger with new partners, particularly unfamiliar partners (i.e., "one-night stand," "fuck boy"). Women identified potential harm from condom negotiation with all but the "friends with benefits" partners. However, the nature of this harm differed by partner type. Clinicians and researchers should consider how to support women in advocating for safer sexual behaviors across these partner types by understanding how partner regularity, degree of personal relationship, and emotional attachment differentially impact couples' condom use decisions.

Associated factors and sex differences in condom non-use among adolescents: Brazilian National School Health Survey (PeNSE)

Background

Condom non-use among sexually active adolescents is a major cause of unintended pregnancy and sexually transmitted infections. In order to promote condom use, it is essential to understand factors associated with condom non-use.

Aim

Our aim was to evaluate sex differences and associated factors of condom non-use based on the nationally representative Brazilian National School Health Survey.

Methods

The study participants were 100,962 adolescents 13–18 years old, 9th graders from both public and private schools throughout Brazil. The following factors were considered as explanatory group variables for the outcome of condom non-use among adolescents: school and health service, sexual behavior, substance use, and self-reported body and health perception. Poisson regression model was performed.

Results

Of the total students, 28% (n = 28,157) had had sexual intercourse at least once. (boys, 37.1%; girls, 19.5%). Of these, 69.2% had used condoms the last time they had intercourse (girls: 68%; boys: 69.9%). The variables associated with condom non-use for both sexes were not having accessed a health service or approached a health professional for health-related care; not having received pregnancy prevention counseling or guidance on AIDS or STI prevention at school; early sexual initiation; no additional contraception method; substance use; feeling alone; not being satisfied with their own body; feeling fat or thin; and poor self-reported health. The number of sexual partners was also associated with condom non-use; however, contrasting behavior was indicated between sexes. A higher number of sexual partners indicated less use of condoms among girls, while for boys, a higher number of sexual partners indicated higher condom use.

Conclusion

High condom non-use appears to be associated with lack of health care access and sexual health education, poor sexual practices, substance use, and poor self-perception, indicating areas for health promotion programs.

Sexual health practices of 16 to 19 year olds in New Zealand: an exploratory study

INTRODUCTION New Zealand sexual health surveillance data suggest that young people aged 15-19 years are at considerable risk of contracting sexually transmitted infections. Although there is an established body of international research around sexual behaviours and sexual health practices among teenagers, there is a dearth of local research focusing on this age group. AIM The aim of this study was to explore the sexual repertoires and sexual health practices among teenagers in New Zealand with a view to better understanding levels of risk in this age group. METHODS This study comprised a cross-sectional online survey designed to ask questions about sexual behaviours. A convenience sample of young people (n=52) aged 16-19 years living in New Zealand completed the survey. RESULTS Most participants (71.2%) were sexually active, reporting engagement in a range of sexual practices. The most commonly reported sexual behaviours were penis-in-vagina sex (86.5%) and oral sex with a person-with-a-penis (81.1%). Infrequent and inconsistent use of barrier protection across all types of sexual behaviour was also reported. DISCUSSION The findings of this study highlight the importance of ensuring that young people have access to sexual health education that routinely includes health information and advice addressing the full range of sexual practices, regardless of the identity classifications they may use, or that may be attributed to them.

Dual-Method Contraception Among Adolescents and Young People: Are Long-Acting Reversible Contraception Users Different? A Qualitative Study

STUDY OBJECTIVE

The purpose of this study was to understand the factors and influences that affect dual-method contraception in adolescent and young adult women using long-acting reversible contraception (LARC) and whether these are unique to LARC users.

DESIGN

Qualitative semistructured interview study.

SETTING AND PARTICIPANTS

Adolescents and young women aged 14-24 years using LARC methods, adolescents and young women aged 14-24 years using short-acting reversible contraception (SARC), and men aged 14-30 years.

INTERVENTIONS

Interviews were conducted until thematic saturation was reached.

MAIN OUTCOME MEASURES

The team used a grounded theory approach to identify common themes relating to dual-method contraception.

RESULTS

Interviews were conducted with 20 LARC users, 26 SARC users, and 13 men. There were no differences in dual-method contraception use between LARC users and SARC users. Most participants used condoms primarily for pregnancy prevention rather than sexually transmitted infection (STI) prevention. Relationship context played an important role in dual-method contraception among all 3 groups; participants were less likely to use condoms in a long-term or monogamous relationship than with new or casual partners. Most participants perceived themselves to be at low risk for STI acquisition, although even those who identified themselves to be at risk did not consistently use condoms. Immediate availability of condoms was a determinant of condom use in all 3 groups, whereas knowledge, access, and negotiation of condom use were not.

CONCLUSION

LARC users are similar to SARC users in their decision-making about condom use. Relationship factors and STI risk assessment are important components to be included in contraceptive counseling.

HIV/STI Prevention Among Heterosexually Active Black Adolescents With Mental Illnesses: Focus Group Findings for Intervention Development

Heterosexually active Black adolescents with mental illnesses are at increased risk for sexually transmitted infections (STIs), including HIV. However, few HIV/STI prevention interventions exist for this demographic. We held seven focus groups (N = 33) to elucidate social, cultural, and psychological factors that influence HIV/STI risk-related sexual behaviors in this understudied population. Seven themes emerged: (a) Blackness and media portrayals, (b) Blackness as a source of cultural resilience and pride, (c) psychosocial determinants of condom use, (d) consequences of engaging in sexual activity, (e) attitudes and beliefs toward sexual behaviors, (f) benefits of sexual activity, and (g) coping mechanisms. Participants also supported the feasibility of and interest in HIV/STI prevention programs integrated with mental health treatment. Transportation, potential breaches of confidentiality, and time were noted barriers to participation. Psychoeducational, skills-based programs are needed to address the sequelae of mental illnesses as they relate to the sexual decision-making process in adolescents.

Systematic Mapping of Relationship-Level Protective Factors and Sexual Health Outcomes Among Sexual Minority Youth: The Role of Peers, Parents, Partners, and Providers

Sexual minority youth (SMY) experience elevated rates of adverse sexual health outcomes. Although risk factors driving these outcomes are well studied, less attention has been paid to protective factors that potentially promote health and/or reduce negative effects of risk. Many factors within interpersonal relationships have been identified as protective for the sexual health of adolescents generally. We sought to systematically map the current evidence base of relationship-level protective factors specifically for the sexual health of SMY through a systematic mapping of peer-reviewed observational research. Articles examining at least one association between a relationship-level protective factor and a sexual health outcome in a sample or subsample of SMY were eligible for inclusion. A total of 36 articles reporting findings from 27 data sources met inclusion criteria. Included articles examined characteristics of relationships with peers, parents, romantic/sexual partners, and medical providers. Peer norms about safer sex and behaviorally specific communication with regular romantic/sexual partners were repeatedly protective in cross-sectional analyses, suggesting that these factors may be promising intervention targets. Generally, we found some limits to this literature: few types of relationship-level factors were tested, most articles focused on young sexual minority men, and the bulk of the data was cross-sectional. Future work should expand the types of relationship-level factors investigated, strengthen the measurement of relationship-level factors, include young sexual minority women in samples, and use longitudinal designs. Doing so will move the field toward development of empirically sound interventions for SMY that promote protective factors and improve sexual health.

Factors influencing college women's contraceptive behavior: An application of the integrative model of behavioral prediction

OBJECTIVE

This study investigated variables within the Integrative Model of Behavioral Prediction (IMBP) as well as differences across socioeconomic status (SES) levels within the context of inconsistent contraceptive use among college women.

PARTICIPANTS

A nonprobability sample of 515 female college students completed an Internet-based survey between November 2014 and February 2015.

METHODS

Respondents were asked about their contraception use, knowledge and information sources, demographic information, and IMBP factors, including attitudes, norms, and perceived behavioral control (PBC).

RESULTS

While overall attitudes, norms, PBC, and intentions for contraceptive use were high, only 46.8% of women used contraception consistently. Data also revealed only moderate levels of knowledge about contraception. While there were no differences across SES levels for attitudes, PBC, norms or knowledge, SES levels did differ in sources used to acquire contraceptive information.

CONCLUSIONS

This study highlights the need to consider where college women acquire contraceptive information which is associated with SES.

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.

Providing Contraception to Adolescents

Adolescents have high rates of unintended pregnancy and face unique reproductive health challenges. Providing confidential contraceptive services to adolescents is important in reducing the rate of unintended pregnancy. Long-acting contraception such as the intrauterine device and contraceptive implant are recommended as first-line contraceptives for adolescents because they are highly effective with few side effects. The use of barrier methods to prevent sexually transmitted infections should be encouraged. Adolescents have limited knowledge of reproductive health and contraceptive options, and their sources of information are often unreliable. Access to contraception is available through a variety of resources that continue to expand.

[Effects of a contraceptive counselling intervention in adolescents from deprived neighbourhoods with a high proportion of immigrants]

OBJECTIVE

To evaluate the effectiveness of a contraceptive counselling intervention among adolescents by sex and origin.

METHODS

A pre-post study with a 3-month follow-up was conducted in adolescents from three disadvantaged neighbourhoods. Participants received a counselling session at a community centre. Contraception use at last intercourse and knowledge, beliefs and self-efficacy before and after the intervention were compared with χ(2) and McNemar tests, stratified by sex and origin (autochthonous or immigrant).

RESULTS

A total of 138 (76%) participants completed the follow-up. Fifty-five percent of the participants were girls, 85% were aged 16-19 years and 71% were immigrants. Knowledge and several self-efficacies increased after the intervention. Condom use increased by 5.4% and the proportion not using any method declined by 7.7%.

CONCLUSIONS

Contraceptive counselling in the community setting increased the use of contraception and improved psychosocial determinants, especially in immigrant adolescents.

Healthy sex and sexual health: new directions for studying outcomes of sexual health

Sexual behavior is an important aspect of adolescent development with implications for well-being. These chapters highlight important perspectives on studying sexual health from a normative, developmental perspective, such as viewing a range of sexual behaviors as life events; considering potentially positive physical health, mental health, social health, and identity outcomes; examining both intraindividual and interindividual differences in outcomes; recognizing the romantic relationship context of sexual behavior; and understanding how sexual media may impact sexual health outcomes. We suggest new directions for studying sexual health outcomes, such as studying behaviors beyond vaginal sex and condom use, new methodologies such as latent class analysis, sophisticated longitudinal designs, and collection and analysis of dyadic data. We recommend research on populations underrepresented in sexual health research such as late adolescents who do not attend traditional universities and adolescents from ethnic/racial minorities. Finally, we consider future directions for sexuality education and prevention efforts.