A longitudinal examination of risk and protective factors associated with drug use and unsafe sex among young African American females

This study prospectively examined associations among multiple theoretically informed risk (e.g., depression, sexual sensation seeking, and risky peers norms) and protective factors (e.g., social support, STI knowledge, and refusal to have sex self efficacy) on unsafe sex among 715 African American adolescent females aged 15–21 who participated in an STI/HIV prevention intervention. Generalized estimating equation models were used to assess associations between baseline characteristics and sexual risk over a 12-month follow-up period. Overall risk in this population was high: at baseline, nearly a third of women reported sex under the influence of alcohol or substances; ≥ 2 partners for vaginal sex, and casual sex partners in the 60 days prior to baseline, and nearly 75% of those reporting vaginal sex used condoms inconsistently. In multivariable analysis, when risk and protective factors were simultaneously considered, higher levels of sexual sensation seeking were associated with having multiple sex partners and inconsistent condom use. Greater perception of risky peer norms was associated with a higher risk of having sex under the influence of alcohol or drugs. In addition, higher sex refusal self-efficacy was protective against having multiple; casual; and concurrent sex partners. Incorporating these salient factors into prevention programs may be critical to the development of targeted interventions for this population.     

Sensation Seeking and Impulsivity: Combined Associations with Risky Sexual Behavior in a Large Sample of Young Adults

Although prior studies have shown that sensation seeking and impulsive decision-making are related to sexual risk-taking, it is still unclear whether these personality traits operate independently or synergistically. The purpose of this study was to elucidate the joint contribution of these personality traits to HIV and sexually transmitted disease (STD) risk behaviors using data from a large sample of sexually active young adults (N = 2,386). Regression modeling indicated that both sensation seeking and impulsive decision-making were consistently associated with sexual risk behaviors across 11 risk-related outcomes. Results further indicated that sensation seeking and impulsive decision-making operated synergistically with respect to the outcome variables of sex acts using drugs, acts with a partner using alcohol, and acts with a partner using drugs. In contrast to this, sensation seeking and impulsive decision-making operated independently with respect to the other sexual risk outcomes. Theoretical implications, as well as implications for HIV/STD prevention among high sensation seekers and impulsive decision-makers, are discussed.     

Barrier versus oral contraceptive use: a study of female college students

Although they provide birth control and are easier to use, oral contraceptives (OCPs) are not the preferred approach to preventing sexually transmitted disease (STD). Do the knowledge, attitudes, and experiences of oral contraceptive users place them at greater risk for STDs than those who employ barrier methods? This study examined differences between sexually active female college students (ie, those who reported ever having had vaginal intercourse) who used OCPs and those who employed barrier methods of contraception at the time of their most recent intercourse. The authors analyzed HIV- and other STD-related knowledge, attitudes, and behaviors from three consecutive annual health surveys of young women about to begin their first year of college. Findings showed barrier and OCP users to be comparable in knowledge about the effectiveness of various contraceptive methods in protecting them against STDs, perceived personal susceptibility to HIV, and experiences with alcohol before sexual intercourse. Oral contraceptive users, compared with those in the group who used barrier methods, reported a greater number of recent partners (p less than .03) and greater perceived vulnerability to STDs (p less than .03). Student healthcare providers must develop creative educational strategies to encourage simultaneous use of both oral contraceptives and barrier methods to protect students against STDs and pregnancy.     

Will It Help? Identifying Socialization Discourses That Promote Sexual Risk and Sexual Health Among African American Youth

Because much of the existing research examining sexual communication to African American youth focuses on demographic and parental factors predicting sexual risk behaviors, less is known about factors predicting sexual health, and little is understood about the contributions of peer communications. The current study aimed to expand existing approaches by assessing which socialization discourses communicated by parents and peers contribute to sexual risk and health outcomes (sexual assertiveness, positive sexual affect, and condom self-efficacy). Participants were 631 African American undergraduates (73% female) who indicated the extent to which they had received from their parents and peers each of 28 messages representing four cultural discourses: abstinence, relational sex, sex positive, and gendered sexual roles. As expected, parents were perceived to emphasize relational sex and abstinence messages more than peers, and peers were perceived to communicate sex-positive and gendered sex role messages more than parents. Greater exposure to abstinence messages predicted lower levels of sexual experimentation, whereas exposure to sex-positive messages predicted higher levels. In addition, exposure to relational sex and sex-positive messages predicted higher levels of sexual assertiveness and positive sexual affect. Implications are discussed concerning sexual communications that could help Black youth develop healthy sexual perspectives.     

Risk Factors of Sexual Harassment by Peers: A Longitudinal Investigation of African American and European American Adolescents

The present research explores risk factors for, and longitudinal associations of, sexual harassment by peers during adolescence. Eight‐hundred and seventy‐two African American and European American adolescents (65.4% African American, 51.1% females) were assessed during the summer after the eighth grade (mean age=14.2 years) and then again in the 11th grade (mean age=17.1 years). At the first assessment, adolescents were asked about their experiences with sexual harassment, their psychological reactions to sexual harassment, and also about their peer relationships, perceived pubertal timing, problem behavior, and mental health. At the second assessment, adolescents reported on their problem behavior and mental health. In general, youth who associated with peers who were involved in problem behavior were at risk for victimization. Among females, those who perceived themselves to be experiencing early pubertal development were also at risk. Additionally, for some adolescents, sexual harassment predicted later adjustment difficulties.     

Physical Abuse in Early Childhood and Transition to First Sexual Intercourse among Youth in Cape Town,South Africa

This study examined the relationship of physical abuse in early childhood and timing of first sexual intercourse among young South Africans aged 14 to 22 in Cape Town. Using the Cape Area Panel Survey and applying log-normal models, time ratios were estimated to show how rapidly or slowly youth experience first sexual intercourse. Results indicated that boys who experienced physical abuse in early childhood had faster timing to first sex. Boys and girls with violent school environments had faster timing to first sex. Race moderated the effects of physical abuse. Compared to Blacks, Coloreds who experienced higher levels of physical abuse in early childhood had faster timing to first sex. Youth with greater knowledge about HIV/AIDS and those with greater risk perception of contracting HIV/AIDS delayed first sex. On the basis of these findings, policy makers are encouraged to consider the early childhood experiences of youth when designing policies toward HIV/AIDS prevention in South Africa.     

Physical abuse in early childhood and transition to first sexual intercourse among youth in Cape Town, South Africa

This study examined the relationship of physical abuse in early childhood and timing of first sexual intercourse among young South Africans aged 14 to 22 in Cape Town. Using the Cape area panel survey and applying log-normal models, time ratios were estimated to show how rapidly or slowly youth experience first sexual intercourse. Results indicated that boys who experienced physical abuse in early childhood had faster timing to first sex. Boys and girls with violent school environments had faster timing to first sex. Race moderated the effects of physical abuse. Compared to Blacks, Coloreds who experienced higher levels of physical abuse in early childhood had faster timing to first sex. Youth with greater knowledge about HIV/AIDS and those with greater risk perception of contracting HIV/AIDS delayed first sex. On the basis of these findings, policy makers are encouraged to consider the early childhood experiences of youth when designing policies toward HIV/AIDS prevention in South Africa.     

Socialization Influences on Early Adolescents' Cognitive Susceptibility and Transition to Sexual Intercourse

This study examined the relationship between perceived socialization from parents, school, peers, and media and adolescents' cognitive susceptibility to initiating sexual intercourse and transition to intercourse 2 years later. Baseline and follow‐up in‐home Audio‐Computer Assisted Self Interview surveys were completed by 854 Black and White male and female adolescents who, at baseline, were 12–14 years old and had not engaged in sexual intercourse. Results showed that stronger connections to parents and schools and less exposure to permissive sexual norms from peers and media were associated with less susceptibility and sexual behavior, especially among White adolescents. Susceptibility mediated 38–64% of the relations between parent and school socialization and sexual intercourse behavior, and mediated 28–53% of the peer and media socialization links to behavior. Findings provide support for social cognitive models of adolescents' behavior and suggest potential strategies for successful interventions to delay initiation of sexual intercourse.     

Relations Between Substance Use and Personal Dispositions Towards Out-of-Control Sexual Behaviors Among Young Adults

ABSTRACT

This paper examines the extent of associations between the two personal dispositions “sexual sensation seeking” and “sexual compulsivity,” and use of alcohol and stimulants in a sample of 539 young adults. Men scored higher on measures of sexual compulsivity and sexual sensation seeking than women. Stimulant drug use was associated with a high level of sexually compulsive behaviors. Strong positive associations were also found between sexual sensation seeking and alcohol use, and stimulant drug use was also nearly significantly associated with sexual sensation seeking. Relationships between addictive behaviors, and their implications for health promotion programs targeted at college students need to be investigated using longitudinal and qualitative research methods.     

EFFECTS OF OVERWEIGHT ON RISKY SEXUAL BEHAVIOR OF ADOLESCENT GIRLS

We use data from the National Longitudinal Survey of Adolescent Health to estimate effects of adolescent girls' overweight on their propensity to engage in risky sexual behavior. We estimate single equation, two‐stage, and sibling fixed‐effects models. We consider both absolute weight and weight relative to other girls in the individual's school. We focus on vaginal intercourse without a condom, any type of sexual activity while under the influence of alcohol, and anal intercourse. Our findings confirm previous research indicating that overweight or obese girls are less likely than their recommended‐weight counterparts to be sexually active. As a result, they are less likely to have vaginal intercourse without a condom. However, overweight or obese girls are not less likely to have sex under the influence of alcohol, and once they have had vaginal intercourse, their consistency of condom use is no different from that of their recommended‐weight peers. The most striking finding is that overweight or obese girls are at least 15% more likely than their recommended‐weight peers to have ever had anal intercourse regardless of whether they have ever had vaginal sexual intercourse. The results from this study underscore the importance of using multifaceted and contemporary measures of risky sexual behavior and have implications for the health and well‐being of adolescent girls. (JEL I12, J13)     

A comparison of risk factors for sexual victimization among gay, lesbian, bisexual, and heterosexual homeless young adults

Although high rates of sexual victimization have been reported among homeless youth, less is known about whether the risk factors vary for gay, lesbian, and bisexual youth compared to heterosexual youth. Based on a sample of 172 homeless young adults ages 19 to 26, results revealed that depressive symptoms, prostitution, and having friends who traded sex were significantly associated with higher levels of sexual victimization. Gay, lesbian, and bisexual young adults experienced more sexual victimization compared to heterosexual young adults. A test for interactions revealed that the effect of sexual orientation on sexual victimization was moderated by trading sex and having friends who traded sex. Finally, there is support for partial mediation of the effects of sexual abuse, neglect, and depressive symptoms on sexual victimization through other risk factors.     

Self‐Efficacy About Sexual Risk/Protective Behaviors: Intervention Impact Trajectories Among American Indian Youth

For adolescents, normative development encompasses learning to negotiate challenges of sexual situations; of special importance are skills to prevent early pregnancy, HIV, and other sexually transmitted diseases. Disparities in sexual risk among American Indian youth point to the importance of intervening to attenuate this risk. This study explored the impact of Circle of Life (COL), an HIV prevention intervention based on social cognitive theory, on trajectories of self‐efficacy (refusing sex, avoiding sexual situations) among 635 students from 13 middle schools on one American Indian reservation. COL countered a normative decline of refusal self‐efficacy among girls receiving the intervention by age 13, while girls participating at age 14 or older, girls in the comparison group, and all boys showed continuing declines.     

Letters to the editor

Relatively little attention has been paid to the use and importance of labels used by men who have sex with men to describe insertive or receptive sexual behavior during intercourse. This study examines sexual self‐labels, sexual behavior, HIV transmission risk, and psychological functioning among 205 HIV‐seropositive men who have sex with men. The majority of participants (88%) identified as a “top, “ a “bottom, “ or “versatile. “ Tops were more likely to engage in insertive anal intercourse than bottoms, and bottoms were more likely to engage in receptive anal intercourse than tops, with versatiles reporting intermediate rates of both behaviors. Although the results suggest preliminary evidence regarding the predictive utility of self‐labels, sexual behaviors of self‐label groups were greatly overlapping. Differences were found among self‐label groups in gay self‐identification, internalized homophobia, sexual sensation seeking, and anxiety. Results suggest an added value in assessing self‐labels in addition to asking about sexual behavior.     

The Adolescent Sexual Development of African American Gay Men with AIDS: Implications for Community-Based Practice

ABSTRACT

This qualitative study describes the adolescent sexual development of ten African American gay men living with AIDS. The informants retrospectively describe the challenges of being a gay adolescent in a mostly heterosexist and homophobic environment. They report unsupportive homophobic and heterosexist family members, community members and school officials. They also describe their burgeoning sexual orientation, sexual initiation as well as consensual and non-consensual sexual experiences with their peers. Additionally, several informants describe seeking sexual experiences with adult men. Later they suggest the adult men became their primary sources of emotional and psychological support. Implications for community practice, intervention and research with both African American gay adolescents and adult men living with AIDS are discussed.     

Factors influencing condom use and STD acquisition among African American college women

To identify factors that influence condom use and the risk of acquiring sexually transmitted diseases (STDs) among African American college women, the authors surveyed a sample of 123 sexually experienced undergraduate women at a state university. The college women who were older, had initiated sex earlier, or had more recent sexual partners were more likely than others in the study to report a history of an STD. The findings have implications for prevention and intervention programs for African American college women.     

Factors Influencing Condom Use and STD Acquisition Among African American College Women

Abstract

To identify factors that influence condom use and the risk of acquiring sexually transmitted diseases (STDs) among African American college women, the authors surveyed a sample of 123 sexually experienced undergraduate women at a state university. The college women who were older, had initiated sex earlier, or had more recent sexual partners were more likely than others in the study to report a history of an STD. The findings have implications for prevention and intervention programs for African American college women.     

Correlates of Engaging in Survival Sex among Homeless Youth and Young Adults

Using a sample of 1,625 homeless youth and young adults aged 10 to 25 from 28 different states in the United States, this study examines the correlates of having engaged in survival sex. Findings suggest that differences exist based on demographic variables (gender, age, race, and sexual orientation), lifetime drug use (inhalants, Valium?, crack cocaine, alcohol, Coricidin?, and morphine), recent drug use (alcohol, ecstasy, heroin, and methamphetamine), mental health variables (suicide attempts, familial history of substance use, and having been in substance abuse treatment), and health variables (sharing needles and having been tested for HIV). In addition to replicating previous findings, this study's findings suggest that African American youth; gay, lesbian, or bisexual youth; and youth who had been tested for HIV were significantly more likely to have engaged in survival sex than White, heterosexual youth, and youth who had not been tested for HIV, respectively. Implications for interventions with youth and suggestions for future research are discussed.     

‘Belonging’ and ‘Otherness’: Sex Equality in Banking in Turkey and Britain

The struggle for sex equality at work has largely been achieved in the developed world, it is claimed. The number of well‐qualified young women entering white‐collar employment and achieving promotion to first‐line and middle management positions now matches or exceeds their male peers. Many young women have high career aspirations and argue that sex discrimination no longer exists. However, this perception is over‐optimistic. Major sex inequalities persist at senior management level in the salaries and benefits offered to female and male staff and in access to certain favoured occupations and sectors of employment. Questionnaires, interviews and documentary evidence from three Turkish and six British banks and high street financial organizations showed that their claimed commitment to equal opportunities by sex was not matched by their practices. Members of managerial elites (who were almost exclusively male) held firm views about the characteristics of ‘the ideal worker’, which informed organizational ideologies, including human resource policies and practices concerning recruitment and promotion. They also permeated organizational cultures, which affected employees’ working practices and experiences. The outcome of these internal negotiation processes was to differentiate between a favoured group of staff seen as fully committed to the companies’ values, who were promoted and rewarded, and an ‘out’ group, whose members were denied these privileges. This distinction between ‘belonging’ and ‘otherness’ is gendered not only along the traditional lines of class, age, sexual orientation, religion and physical ability, but also along the new dimensions of marriage, networking, safety, mobility and space. Despite local and cross‐cultural differences in the significance of these factors, the cumulative disadvantage suffered by women staff seeking career development in the industry was remarkably similar.     

Sex-Related Alcohol Expectancies Among African American Women Attending an Urban STI Clinic

African American women are disproportionately affected by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and sexually transmitted infections (STIs). Alcohol use is a significant risk factor for HIV/STI acquisition. Sex-related alcohol expectancies (SRAEs) may partially account for alcohol-related risky sexual behaviors. Using qualitative interviews we explored the link between alcohol use and risky sex among 20 African American women attending an STI clinic who had consumed four or more alcoholic drinks per drinking day (binge drinking) and/or reported vaginal or anal sex while under the influence of alcohol. Four SRAEs emerged, which we named drink for sexual desire, drink for sexual power, drink for sexual excuse, and drink for anal sex. While the desire SRAE has been documented, this study identified three additional SRAEs not currently assessed by expectancy questionnaires. These SRAEs may contribute to high-risk sex when under the influence of alcohol and suggests the importance of developing integrated alcohol–sexual risk reduction interventions for high-risk women.