A review of literature: An examination of the correlation between attachment styles and adolescent girls’ sexual behaviors

ABSTRACT

This literature review examines eight studies of parental attachment styles, sexual behavior, and health outcomes among adolescent girls. The review focuses on studies that analyzed the perceived relationships between parents and their adolescent daughters and whether instabilities of life experiences correlated with risky sexual behaviors and if high-risk sexual behaviors were associated with an increase of sexually transmitted infections, unplanned pregnancies, and other poor health outcomes in adolescent girls. Findings show adolescent girls with insecure parental attachment styles were at a higher risk of sexual behaviors, early pregnancies, and transmission of sexually transmitted infections (STI’s). The most common finding in the studies reviewed was the significant association of how higher parental communication and monitoring may prevent risky sexual behaviors at an earlier age. Recommendations for mental and health care providers include the development of treatment programs to address the importance of parent-attachment relationships and multifaceted health needs of adolescents girls. Programs can be strengthened by involving other family members, improving parent-daughter communication and relationships and emphasizing system-level change (policy, procedure, practice). Adding these elements may ultimately lead to sustained improvements over time. Future research on other family social factors (e.g., divorce and separation of attachment figure, poverty, and single-parent homes) associated with attachment and high-risk behaviors is warranted. More research is needed to exam how secure attachments among adolescent girls may prevent earlier sexual encounters, unplanned pregnancies, and STI’s.     

Educational Differences in Adolescents' Sexual Health: A Pervasive Phenomenon in a National Dutch Sample

Educational level is strongly associated with age of first intercourse and risk of unintended pregnancies. This study examined these associations in a large representative sample of Dutch adolescents and also included associations of educational level with other sexual health aspects. Adolescents aged 12 to 25 (3,926 boys and 3,915 girls) completed an online questionnaire that included measures of romantic and sexual experience; the evaluation of their sexual debut; the risk of sexually transmitted infections (STIs) and pregnancy; and sexual attitudes, satisfaction, self-efficacy, knowledge, victimization, and functioning. The results showed that adolescents on a vocational track or who completed fewer years of education were more at risk of several adverse sexual health outcomes than adolescents on an academic track. They had their first sexual experiences at an earlier age; evaluated these experiences less favorably; had less sexual health knowledge and fewer refusal skills; and had a higher risk of unintended pregnancy, STIs, and victimization. Possible explanations for these consistent differences are discussed. Sex education and services should pay specific and targeted attention to less educated young people and tailor their efforts specifically to the needs, characteristics, and realities of this group.     

Pathways to early coital debut for adolescent girls: a recursive partitioning analysis

This study examined pathways to early coital debut among early to middle adolescent girls in the United States. In a two-year longitudinal study of 104 adolescent girls, recursive partitioning (RP) analyses were conducted to examine the specific factors that were related to engaging in first intercourse by the 10th grade among adolescent girls who had not yet engaged in sexual intercourse by the 8th grade. RP analyses identified subsamples of girls who had low, medium, and high likelihoods of engaging in early coital debut based on six variables (i.e., school aspirations, early physical intimacy experiences, depression, body objectification, body image, and relationship inauthenticity). For example, girls in the lowest likelihood group (3% had engaged in sex by the 10th grade) reported no prior experiences with being touched under their clothes, low body objectification, high aspirations to complete graduate education, and low depressive symptoms; girls in the highest likelihood group (75% had engaged in sex by the 10th grade) also reported no prior experiences with being touched under their clothes, but had high levels of body objectification. The implications of these analyses for the development of female adolescent sexuality, as well as for advances in quantitative methods, are discussed.     

Latino Adolescent Reproductive and Sexual Health Behaviors and Outcomes: Research Informed Guidance for Agency-Based Practitioners

Latinos are the largest and fastest growing minority youth group in the United States. Currently, Latino adolescents experience higher rates of teen pregnancy compared to any other racial or ethnic group and have disproportionately high levels of sexually transmitted infections and HIV. Latino teens are also affected by a number of social problems such as school dropout, poverty, depression and limited access to healthcare, which contributes to disparities in reproductive health outcomes for this population. Relatively few intervention research studies and programs have been dedicated to reducing sexual risk among Latino youth, despite their particular vulnerabilities in experiencing negative reproductive health outcomes. We provide recommendations for identifying the unique reproductive health needs of Latino youth and specific applied strategies so that agency-based social workers and other providers can develop family-based interventions that improve adolescent Latino sexual and reproductive health.     

Is Affluence a Risk for Adolescents in Norway?

Studies suggest that affluence poses a risk for adolescents, but this has rarely been studied outside the United States. We examined the unique and additive roles of family and school affluence for adolescent outcomes among 10th‐grade students (n = 7,203) in Oslo, Norway. Multilevel models were estimated separately by gender. For both boys and girls, school affluence was a risk for alcohol abuse and family affluence was a risk for conduct problems, although for conduct the risk was only at the very highest end of income distribution and adolescents in very poor families were also at risk. There was also a complex pattern of risk for early sexual debut; family affluence posed risk, but school affluence appeared protective.     

Mental Health Conditions Among North Korean Female Refugee Victims of Sexual Violence

The study aims to examine the negative effects of sexual violence on North Korean (NK) female refugees in South Korea. Although the prevalence of sexual violence victimization is extremely high and mental health problems are serious among these refugees, little to no research has been done on the relationship between sexual violence and mental health among these women. The mental health conditions of two groups of women (sexual violence victims and those who have not experienced sexual violence) were compared using ANCOVA analyses. The results show that suicidal ideation and alcohol use are significantly more prevalent in the sexual violence group than in the non‐sexual violence group. The women who had experienced sexual violence in particular should be provided with more professional and sustained treatment and management services. The government must improve the effectiveness of existing policies related to suicide and the drinking culture in South Korea.     

Coital debut: the role of religiosity and sex attitudes in the Add Health Survey

Recent reviews suggest that religiosity is associated with the delay of adolescent coital debut (Rostosky, Wilcox, Wright, Randall, in press; Wilcox, Rostosky, Randall, Wright, 2001). Few studies, however, have examined this association using longitudinal data to test theoretically driven models. We analyzed data from 3,691 adolescents (ages 15-21), testing the hypothesis that adolescent religiosity and sex attitudes (at Wave 1) predict later coital debut (at Wave 2) and that these predictive relationships vary by gender. Findings indicated that beyond demographic factors and number of romantic partners, religiosity reduced the likelihood of coital debut for both males and females. After accounting for the effects of religiosity, anticipation of negative emotions after coital debut (sex attitude factor 1) further reduced its likelihood for females and males. Finally, adolescent girls - but not boys - who anticipated positive emotions following sexual intercourse (sex attitude factor 2) were more likely to debut. While virginity pledge status was associated with coital debut for boys and girls, more conservative beliefs about sex appeared to mediate its effect. Finally, a significant interaction between race and religiosity indicated that African American adolescent males who had either signed a virginity pledge or were more religious were significantly more likely to debut than both White non-Hispanic males and African American males who were less religious and/or who had not signed a pledge. The implications of these results for adolescent pregnancy prevention programming are discussed.     

Coital debut: The role of religiosity and sex attitudes in the add health survey

Recent reviews suggest that religiosity is associated with the delay of adolescent coital debut (Rostosky, Wilcox, Wright, & Randall, in press; Wilcox, Rostosky, Randall, & Wright, 2001). Few studies, however, have examined this association using longitudinal data to test theoretically driven models. We analyzed data from 3,691 adolescents (ages 15–21), testing the hypothesis that adolescent religiosity and sex attitudes (at Wave 1) predict later coital debut (at Wave 2) and that these predictive relationships vary by gender. Findings indicated that beyond demographic factors and number of romantic partners, religiosity reduced the likelihood of coital debut for both males and females. After accounting for the effects of religiosity, anticipation of negative emotions after coital debut (sex attitude factor 1) further reduced its likelihood for females and males. Finally, adolescent girls—but not boys—who anticipated positive emotions following sexual intercourse (sex attitude factor 2) were more likely to debut. While virginity pledge status was associated with coital debut for boys and girls, more conservative beliefs about sex appeared to mediate its effect. Finally, a significant interaction between race and religiosity indicated that African American adolescent males who had either signed a virginity pledge or were more religious were significantly more likely to debut than both White non‐Hispanic males and African American males who were less religious and/orwho had not signed a pledge. The implications of these results for adolescent pregnancy prevention programming are discussed.     

Adolescent Sexuality: Disentangling the Effects of Family Structure and Family Context

Growing up in single‐parent, step‐, cohabiting, or lesbian families has been suggested to have negative effects on adolescent sexual behavior. However, our analysis reveals that, with the exception of girls in single‐parent families, family structure does not significantly influence adolescents' sexual initiation. Rather, the family context—more specifically the mother‐child relationship, their level of interaction, and the mother's attitudes toward and discussion of sex—is associated with adolescent sexual debut. When looking at sexually active teenagers, neither family structure nor family context have an impact on the sexual partnerships of boys, and they explain little in terms of girl's sexual partnering.     

Gender and racial/ethnic differences in predicting adolescent sexual risk: athletic participation versus exercise

Though often conflated, informal physical exercise and organized athletic participation have very different implications for adolescent sexual risk outcomes. The purpose of this research is to disaggregate strenuous exercise from sports, examine how each is associated with sexual risk, and explain the observed differences using the conceptual lens of cultural resource theory. Using a nationally representative sample of over 16,000 public and private high school students, we employ logistic regression to test hypotheses about the gender-specific and race-specific effects of strenuous exercise and athletic participation on adolescent sexual risk behavior. The results show that both forms of physical activity buffer sexual risk for girls. Strenuous exercise is associated with increased odds of sexual risk for boys. Sports and race interact to influence boys' sexual risk outcomes: Athletic participation is associated with lowered odds of sexual risk for white male adolescents, but heightened odds of sexual risk for black male adolescents.     

Adolescent Sexuality and the Risk of Marital Dissolution

This research investigates whether first sexual intercourse during adolescence is associated with increased risk of first marriage dissolution and tests whether the results are consistent with causal or selection explanations. Drawing on a sample of 3,793 ever‐married women from the 2002 National Survey of Family Growth, this study estimated event‐history models of first‐marriage dissolution. Results indicate that wanted sexual debut in later adolescence does not directly increase the risk of marital dissolution but is linked indirectly as a result of subsequent premarital sexual outcomes. Sexual debut that is not completely wanted or that occurs before age 16 is associated with increased risk of marital dissolution. The results suggest that the timing and context of adolescent sexual debut have important implications for marital stability.     

Strategies and cues adolescents use to assess the age of an online stranger

A common risk among adolescents is sexual solicitation, in which an adolescent is asked to provide sexual information, engage in sexual talk, or in sexual activities. Although scholars increasingly address this topic from an intrapersonal perspective, there is little attention to factors of language use and message content. In two focus group studies, we investigated whether adolescent girls consider themselves capable of assessing whether an online stranger is an adult or a peer, the extent to which adolescent girls actually succeed in making this assessment, the strategies they apply to do so, and the content- and language-related cues focused on. Our findings suggest that most of the adolescent girls are confident in their ability to assess whether the stranger is a peer or an adult with possible sexual intentions. However, we also found that only 43% were able to correctly make this assessment. Most of the adolescents seem to apply the passive strategy of uncertainty reduction: They scan the profile page of the stranger, check contact information, and the profile picture. They may choose to apply the interactive strategy to find out more about the online stranger. Important content-related cues that alarm adolescent girls are: ignoring personal questions, showing an exaggerated amount of interest, acting as a friend, and being sexually oriented. Language cues mentioned related to word usage, abbreviations, sentence length, and tone.     

Association of Sexual Abstinence in Adolescence with Mental Health in Adulthood

We examined whether adolescent sexual abstinence predicts better adult mental health. A total of 1,917 adolescents, recruited from middle schools at age 13, were surveyed at ages 13, 18, 23, and 29. In bivariate analyses, adolescent sexual abstinence was associated with better mental health at age 29 for females, but not for males; three adolescent factors, educational prospects, family bonding, and unconventionality, were investigated as explanatory variables of this relationship. The abstinence–mental health relationship was nonsignificant when educational prospects were included in multivariate models, and was marginally significant when family bonding and unconventionality were included; all three explanatory factors accounted for significant proportions of the variance in adult mental health. Girls who are uninvolved in school, have weak family backgrounds, and exhibit unconventionality may have poor adult mental health, whether or not they abstain from sex in adolescence. Interventions that strengthen adolescents' connections to families and schools may reduce risk for long-term mental health problems.     

Association of sexual abstinence in adolescence with mental health in adulthood

We examined whether adolescent sexual abstinence predicts better adult mental health. 1,917 adolescents, recruited from middle schools at age 13, were surveyed at ages 13, 18, 23, and 29. In bivariate analyses, adolescent sexual abstinence was associated with better mental health at age 29 for females, but not males; three adolescent factors, educational prospects, family bonding, and unconventionality were investigated as explanatory variables of this relationship. The abstinence-mental health relationship was nonsignificant when educational prospects was included in multivariate models, and marginally significant when family bonding and unconventionality were included; all three explanatory factors accounted for significant proportions of the variance in adult mental health. Girls who are uninvolved in school, have weak family backgrounds, and exhibit unconventionality may have poor adult mental health, whether or not they abstain from sex in adolescence. Interventions that strengthen adolescents' connections to families and schools may reduce risk for long-term mental health problems.     

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)     

Adolescent sexuality and peer pressure

It appears that adolescents are becoming sexually active at younger ages than in past generations. How much are they influenced by their peers to become sexually active? A study of 89 adolescent girls in a parochial high school in Manhattan showed that adolescent girls are influenced by their peers when they decide to become sexually active; however, they do not see themselves influenced by their peers. Adolescents appear to have internalized their peers opinions. If adolescents are becoming sexually active at younger ages, they need to be given adequate information to allow them to make informed decisions about their behavior; thus balancing the influence of peer groups.     

Adolescent daughters’ perceptions of their fathers’ levels of communication and care: How these variables influence female adolescent sexual behaviors

This study examines the relationship between female adolescents’ perceptions of their fathers’ level of communication and care, and the influence of these variables on their adolescent daughters’ sexual behaviors. Data was extracted from the National Longitudinal Study of Adolescent Health from 1994–2008, which consisted of a sample (N=629) of adolescent girls in grades 7–12 in the United States during the 1994–1995 school year. Study results show fathers’ caring as statistically significant at the .05 level. As fathers’ caring increased, the number of sex partners decreased among adolescent girls. Fathers’ communication was not statistically significant at the .055 level. However, as the daughters’ perception of their fathers’ communication improved, the number of daughters’ sex partners decreased. The high rates of unintended pregnancy, unprotected sex, and sexually transmitted infections (STI’s) among U.S. adolescent females show the need for a greater understanding of how fathers contribute to their daughters sexual risk-taking behaviors. Implications for practice and future research is discussed.     

Sexual at-risk behaviors of sexually abused adolescent girls

The present study investigated sexual at-risk behaviors of sexually abused adolescent girls. Variables of interest were presence of consensual sexual activity, age at first consensual intercourse, number of sexual partners, condom use, and pregnancies. Participants were 125 sexually abused adolescent girls aged 12 to 17 years. Results showed that severity of sexual abuse (e.g., penetration, multiple perpetrators, physical coercion, multiple incidents of abuse) was related to a greater number of sexual at-risk behaviors. For instance, adolescents with a history of sexual abuse involving penetration were 13 times as likely to have been pregnant. Although family characteristics were significantly associated with being sexually active, their effect proved non-significant in the final hierarchical regression. Regression analyses clearly showed that the likelihood of engaging in sexual at-risk behaviors increased as a function of the number of severity factors.     

Differences in psychological health and family dysfunction by sexual victimization type in a clinical sample of African American

We examined levels of sexual victimization among a sample of 249 14‐ to 19‐year‐old African American adolescent women. Victimization was common: 32.1% reported having been raped, 33.7% had experienced sexual coercion, and 10.8% reported an attempted rape. Only 23.4% had never been victimized. We investigated whether levels of psychological health and family dysfunction varied as a function of the type of sexual victimization. Girls who had been raped had lower levels of self‐esteem and mastery and higher levels of depression compared to girls who reported no sexual victimization. Significantly higher levels of family cohesion and significantly lower levels of family support were reported by girls who had been raped versus girls who reported no sexual victimization. These findings are a starting point for future studies by providing evidence that levels of mental health and family dysfunction vary by the type of sexual victimization experienced.     

Parent Marital Quality and the Parent–Adolescent Relationship: Effects on Adolescent and Young Adult Health Outcomes

Although a number of studies examined the implications of marital disruption for adolescent well-being, few studied the implications of marital relationship quality on health outcomes for children in married-couple families. The present study examines how parent marital quality among intact families interacts with the quality of parent–adolescent relationships to predict physical health, mental health, and substance use in middle adolescence and early adulthood. The study uses data from the NLSY97 cohort, a nationally representative sample of adolescents who are being followed into adulthood. Predictors include the quality of the parent marital relationship, the quality of the parent–adolescent relationship, marital structure, and a number of contextual covariates and control variables. Combined parent marital quality and parent–adolescent relationship groups were developed using latent class analyses and were used to predict positive and negative health behaviors during the teen and early adult years. Results indicate that adolescents in families experiencing poor marital quality fared worse on physical health, mental health, and substance use outcomes. In addition, adolescents who reported poor relationships with at least one of their parents fared worse on outcomes. Adolescents whose parents have low-quality relationships and also have poor parent–adolescent relationships tended to fare least well across health measures. Adolescents whose parents have a high-quality relationship and who have a good parent–adolescent relationship with both parents consistently had the best outcomes. Overall, poor relationships consistently undermine mental health, physical health, and substance use. Family religious activities also consistently predict better health outcomes.