Types of adolescent sexual relationships and associated perceptions about condom use

The Impact of Relationship Stressors on Trust and Prorelationship Behavior Within Adolescent Romantic Relationships: A Systems Approach

PURPOSE

Trust is an essential component of romantic relationships. It is not understood how youth respond to a relationship stressor, which may impact trust, such as perceiving to be at risk for a sexually transmitted infection or their partner has other sex partners. We used a system science approach to examine feedback between trust and prorelationship behaviors within adolescent relationships.

METHODS

A prospective cohort of clinic-recruited young women (N = 122), aged 16-19 years, completed daily questionnaires on partner-specific feelings and risk perceptions for 18 months. Relationship stressor defined as either perceiving the risk of sexually transmitted infection from a partner or partner had other sex partners. Prorelationship behaviors were more time spent with partner, sex with partner, and/or gift from partner. Time-lagged generalized estimating equation models were used to examine whether a relationship stressor is associated with a decrease in trust and whether prorelationship behaviors changed following the stressor.

RESULTS

Experiencing a stressor was associated with threefold increased odds of having a decrease in trust in the same week (odds ratio [OR] = 3.30, 95% confidence interval [CI]: 2.30-4.72). Trust increased significantly the week following the stressor (OR = 2.09, 95% CI: 1.54-2.85). An increase in trust relative to the week of the stressor was associated with a 65% increase in prorelationship behavior in the week following the stressor (OR = 1.65, 95% CI: 1.20-2.26).

CONCLUSIONS

Data uniquely show that trust is impacted following a relationship stressor and that youth increase prorelationship behaviors following a drop in trust. The findings suggest that adolescents prioritize maintaining trust, which may impact engagement in protective health behaviors.

Weekly variations in feelings of trust predict incident STI within a prospective cohort of adolescent women from a US city

OBJECTIVES

Feelings of intimacy, perceptions of partner concurrency (PPC) and perceptions of risk for an STD (PRSTD) are meaningful and dynamic attributes of adolescent sexual relationships. Our objective was to examine whether variations in these STI-associated feelings and perceptions predicted incident Chlamydia trachomatis and/or Neisseriagonorrhoeae infection within a prospective cohort of urban adolescent women.

METHODS

A cohort of clinic-recruited women aged 16-19 completed daily surveys on feelings and risk perceptions about each current sex partner on a smartphone continuously for up to 18 months. Urine was tested for C. trachomatis and N. gonorrhoeae every 3 months. Daily responses were averaged across the week. As overall means for trust, closeness and commitment were high, data were coded to indicate any decrease in feelings from the previous week. PRSTD and PPC were reverse coded to indicate any increase from the previous week. An index was created to examine the cumulative effect of variation in these feelings and perceptions. Generalised linear models were used to account for correlation among repeated measures within relationships.

RESULTS

For each week that there was a decrease in trust, there was a 45% increase in the risk of being infected with an STI at follow-up (relative risk (RR) 1.45, 95% CI 1.18 to 1.78, P=0.004). Neither a decrease in closeness or commitment, nor an increase in PRSTD or PPC was associated with an STI outcome. Cumulatively, the index measure indicated that a change in an additional feeling or perception over the week increased the odds of an STI by 14% (RR 1.14, 95% CI 1.02 to 1.29, P=0.026).

CONCLUSIONS

A decrease in feelings of trust towards a main partner may be a more sensitive indicator of STI risk than PRSTD, PPC or commitment. The next generation of behavioural interventions for youth will need strategies to address feelings of intimacy within adolescent romantic relationships.

Perceived responsibility for pregnancy and sexually transmitted infection prevention among young African American men: An exploratory focus group study

Poor reproductive health outcomes, including unplanned pregnancies and sexually transmitted infections, continue to disproportionately affect African American teenaged populations. Interventions largely focus on young women, yet young men may play an important role in mitigating these reproductive health outcomes. This study aims to understand African American male teenagers' views on pregnancy prevention responsibility by qualitatively exploring their attitudes around contraception and condom responsibility. We conducted exploratory qualitative focus groups on perceived contraceptive and condom responsibility with 24 African American male high school students, ages 14-19, enrolled in charter schools in the South Side of Chicago. Research domains included relationship type, communication with female partners, perceived responsibility for pregnancy prevention, condom and contraceptive behaviors, and contraceptive knowledge. Data were coded using content analysis revealing several themes: Young men view condom use as important, but actual use of condoms is modified by relationship factors and perception of risk of STIs; Responsibility to prevent pregnancy is a shared- or female-responsibility; and male teenagers had greatest awareness of male-controlled contraceptive methods and limited knowledge or comfort with other non-condom forms of contraception. These adolescents weigh many factors when determining whether to use condoms and/or contraception. Building upon widespread endorsement for condom use and STI prevention offer the most hope for further gains.

Perceived Dual Method Responsibilities by Relationship Type Among African-American Male Adolescents

PURPOSE

To describe the extent to which African-American male adolescents perceive responsibility for contraception and condom use and to understand the perceived importance of dual method use for respondents in casual versus committed relationships.

METHODS

Data were collected using surveys informed by formative focus group sessions. Participants included African-American male high-school students aged 14-19 years from the Chicago's South Side. Respondents were surveyed regarding contraceptive behavioral intentions and perceived importance of dual method use. Responses were compared by relationship type. Logistic regression modeling was used to determine the association between contraception responsibility and perceiving dual method protection as important for each sexual relationship type.

RESULTS

Sample included 348 young men (mean age: 16.1 years; mean age at first sex: 13.8 years). Among those who had heard of condoms (99.4%) and withdrawal (90.4%), most reported liking these methods (83.7% and 53.9%). Participants were more likely to report greater responsibility within a committed relationship for all perceived contraceptive responsibilities (e.g., going with partner to get contraception). Participants were more likely to engage in conversation about pregnancy prevention with a committed partner. Among sexually active respondents, perceived contraceptive responsibility was associated with perceiving dual protection as very important (odds ratio = 1.58; 95% confidence interval = 1.05-2.38).

CONCLUSIONS

Respondents felt partially responsible for pregnancy prevention, particularly within committed relationships, and were open to using dual protection. However, many respondents had low levels of contraception knowledge. These findings indicate that male African-American adolescents might benefit from increased education and support around contraception methods and condom use.

Motivations and Experiences Related to Women's First Same-sex Sexual Encounters

Using women's self-identified sexual identity, the current study compares motivations for first same-sex sexual encounters as well as associated experiential outcomes. We also examine whether relations between sexual motivations and experiential outcomes differ as a function of women's sexual identity status. Participants were women (N=123), ages 18-to-29 (M=21.59, SD=3.33), who self-reported a history of same-sex sexual contact. Approximately 27% of women identified as exclusively heterosexual (i.e., EH), 35% as primarily heterosexual (i.e., 'mostly heterosexual' [MH]), and 38% as exclusively or primarily lesbian/ gay, or bisexual (i.e., LGB). Participants completed an online survey. MH and LGB women reported first same-sex sexual encounters that were more motivated by intimacy and exploration motives, relative to EH women. Compared to MH and LGB women, EH also engaged in fewer sexual activities with their first same-sex partner. Intimacy and exploration motives were related to positive experiential outcomes during first same-sex contact. Associations between motivations and experiential outcomes were not moderated by sexual identity. Findings contribute to understanding motivations and experiences related to women's first same-sex sexual encounters and show that not all women with a history of same-sex sexual contact subsequently identify with a minority sexual identity label.

Hooking Up

More than one half of sexually active teens have had sexual partners they are not dating. However, remarkably little is known about the nature of these sexual relationships. Using survey and qualitative data from the Toledo Adolescent Relationships Study the authors contrast the qualities of dating sexual relationships and sexual relationships that occur out-side the dating context. They find that adolescents having sex outside of the dating context are choosing partners who are friends or ex-girlfriends and/or boyfriends. Moreover, one third of these nondating sexual partnerships are associated with hopes or expectations that the relationship will lead to more conventional dating relationships. Boys and girls who experience sex outside of conventional dating relationships often share similar orientations toward their relationship. Results suggest that a more nuanced view is key to understanding adolescent sexual behavior.

Attitudes Towards Power in Relationships and Sexual Concurrency Within Heterosexual Youth Partnerships in Baltimore, MD

Sexual concurrency may increase risk for HIV/STIs among youth. Attitudes about gender roles, including power balances within sexual partnerships, could be a driver. We examined this association among Baltimore youth (N = 352), aged 15-24. Data were collected from February, 2011 to May, 2013. We examined whether index concurrency in male-reported partnerships (N = 221) and sex partner's concurrency in female-reported partnerships (N = 241) were associated with youth's attitudes towards relationship power. Males with more equitable beliefs about power were less likely to report index concurrency. Females with more equitable beliefs were more likely to report sex partner's concurrency. The relationship was significant in main and casual partnerships among females and main partnerships among males. The strongest associations were detected among middle-socioeconomic status (SES) males and low-SES and African American females. Implementing interventions that recognize the complex relationship between socioeconomic context, partner dynamics, gender, and sexual behavior is an important step towards reducing HIV/STI risk among youth.

Understanding variability in adolescent women's sexually transmitted infection-related perceptions and behaviors associated with main sex partners

BACKGROUND

It is not well understood whether characteristics of adolescent main partnerships differ categorically from one relationship to the next or whether observed differences in sexually transmitted infection (STI)-related perceptions and sexual behaviors between main partnerships results from a failure to capture variability within adolescent main partnerships. The objective of this study was to examine the extent to which female adolescents' STI-related feelings, perceptions, and sexual behavior associated with main sex partners varied over the course of their relationship.

METHODS

A cohort of adolescent women aged 16 to 19 years at baseline, recruited from health clinics or community venues, completed daily diaries on a Smartphone continuously for 18 months. Participants reported daily on their partner-specific feelings of closeness, trust, commitment, perceived risk for acquiring a sexually transmitted disease (PRSTD), perception of partner concurrency (PPC), and condom use for their main sexual partners.

RESULTS

Relationships from 49 participants were used to examine variability over time in STI-related feelings, perceptions, and behavior. Overall, relationships were characterized by high levels of trust, closeness, and commitment and low levels of PPC, PRSTD, and condom use. However, for all but PRSTD, there was more variation (>50%) within than between relationships for each of these measures, although variability of PRSTD was high (47.1%). Residual variability for all perceptions and behaviors remained significant after controlling for trends over time.

CONCLUSIONS

Diary data illustrate wide day-to-day fluctuations in feelings of intimacy, PPCs, PRSTDs, and condom use indicating that these are dynamic attributes of adolescent romantic relationships.

The roles of partner communication and relationship status in adolescent contraceptive use

INTRODUCTION

Because of high rates of pregnancy and sexually transmitted infections among adolescents, factors influencing adolescents' contraceptive use require close examination. This study explores how different types of partner communication relate to contraceptive use among adolescent girls and whether these associations vary by relationship status.

METHOD

Cross-sectional, self-report data from 253 sexually active 13- to 17-year-old girls were used to examine associations between partner communication, relationship status, and contraceptive consistency.

RESULTS

In a multivariate analysis, partner communication specific to contraceptive use (RR = 1.3, p < .001) and "steady" partnership status (RR = 0.65, p < .01) were associated with hormonal contraceptive consistency. In interaction models, the impact of partner communication on hormonal consistency was greater in steady partnerships than in casual partnerships.

DISCUSSION

Findings suggest that clinicians should ask about the nature of adolescent girls' relationships with their sexual partners when encouraging contraceptive use. Early communication with partners about sexual topics should be stressed, especially among girls in steady relationships.

Does perception of relationship type impact sexual health risk?

A sample of 327 men (age, 16-36 years) responded to self-completed questionnaires, which included questions regarding their most recent female sexual partner and specific behaviors pertaining to that partner. Analyses showed significant differences in several variables including condom use and sexually transmitted infection history, among the different relationship types.

The influence of individual, partner, and relationship factors on HIV testing in adolescents

Early identification of HIV by increasing testing is a national priority; however, little is known about HIV testing behaviors in high school age adolescents. We examined the association of individual, partner, and relationship factors with HIV testing using a computer-assisted survey administered from 2003 to 2006 in a community sample of 980 sexually active 14- to 17-year-olds (56% female, 55% Latino, 25% African American) living in a jurisdiction with a high AIDS burden. Twenty percent reported their first sexual encounter as having occurred when they were <13 years of age, 33% had had four or more lifetime sexual partners, 21% reported high partner HIV-risk behavior, and 428 (44%) had been tested for HIV. In our final regression model, independent associations with HIV testing included being female (OR=1.68 [1.23-2.30]), older (OR=1.41 [1.21-1.65]), and having had four or more lifetime sexual partners (OR=2.24 [1.64-3.05]). The strongest independent predictor of HIV testing was having high HIV-related partner communication (OR=3.70 [2.77-4.94]). Being in a serious committed relationship (OR=1.39 [1.02-1.87]) was also independently associated with HIV testing, whereas reporting high worry about HIV/AIDS (OR=0.53 [0.40-0.71]) was independently negatively associated with HIV testing. High HIV/AIDS knowledge, high partner HIV risk behavior, and young age at first sexual encounter were not associated with testing. These findings suggest that, for high school aged adolescents, optimal strategies to promote HIV testing should look beyond increasing HIV/AIDS knowledge and identifying individual risk behaviors to also considering the role of partners and relationships and their influence on testing behavior.

Identification and characterization of adolescents' sexual boundaries

PURPOSE

Adolescents' decisions to have sex may be based on a priori boundaries placed on sex. This study addresses: (1) to what extent adolescents set vaginal sexual boundaries; (2) the types of sexual boundaries most and least likely to be endorsed; and (3) to what extent sexual boundaries vary by sex, race/ethnicity, and sexual experience.

METHODS

A cross-sectional study of 518 students attending 10th grade. Survey measures queried about demographics, ever having sex, and existence of sexual boundaries (e.g., being in love, having an attractive partner) that must be in place before having vaginal sex.

RESULTS

The most frequently endorsed boundaries were maturity, commitment, trust, love, and marriage. These boundaries were more frequently endorsed than having a safer-sex method. Compared with females, males were more likely to choose boundaries based on partner attractiveness (p < .001) and avoiding trouble (p < .04). Compared with Asians and Pacific Islanders, whites were more likely to endorse wanting to be a certain age to have sex (p < .01 and p < .05, respectively); Asians and Pacific Islanders were more likely to choose sexual boundaries based on marriage (p's < .05). Adolescents who were sexually experienced were more likely than inexperienced adolescents to endorse boundaries related to relationship characteristics and partner attractiveness (OR = 2.5), and less likely to endorse boundaries related to feeling mature (OR = .34) and waiting until marriage (OR = .34).

CONCLUSIONS

Identifying adolescents' sexual boundaries should help healthcare professionals better understand under what circumstances adolescents are more or less likely to have sex; and this information should ultimately inform the development of new interventions.

Shared social and emotional activities within adolescent romantic and non-romantic sexual relationships

Typically, "non-romantic" sexual relationships are assumed to be casual; however, the emotional and social distinctions between romantic and non-romantic contexts are not well understood, particularly in adolescence. Data from the National Longitudinal Study of Adolescent Health (Add Health) was used to compare shared emotional (e.g., telling partner that they love her/him) and social (e.g., going out in a group) activities within romantic and non-romantic sexual relationships. Adolescents who reported exclusively romantic sexual relationships (n = 1,891) shared more emotional, but not social, activities with their partners than adolescents who were in non-romantic sexual relationships (n = 315; small effect size, r = .07-.13), akin to adolescents who experienced both relationship types (n = 519; small-to-medium effect size, r = .18-.38). Girls shared more emotional and social activities with their partners than boys when in romantic relationships (small effect size, r = .06-.10); there were no significant gender differences within non-romantic sexual relationships. Findings suggest that gendered scripts remain for sexual relationships that are romantic but not for those that are non-romantic. Notably, for the majority of adolescents, non-romantic relationships still held many emotional and social dimensions typical of romantic relationships and differences between relationship types were small. Although non-romantic relationships were less intimate than romantic sexual relationships, there was remarkable heterogeneity within this relationship type. Caution is advised when working with adolescents engaged in "casual" sexual relationships. Understanding the complexity of adolescent sexual relationships is critical for the advancement of effective sex education programming.

Dual use of long-acting reversible contraceptives and condoms among adolescents

Unintended pregnancy and sexually transmitted infections (STI) continue to be significant public health problems, and adolescents are disproportionately affected by both. With national attention and funding directed toward adolescent pregnancy prevention, promotion of long-acting reversible contraceptive (LARC) use among adolescents is both timely and relevant. However, LARCs provide no protection against STIs, requiring dual-method use of both LARC and barrier methods, most commonly the male latex condom, to address these issues simultaneously. Rates of both LARC and dual-method contraception are low in the United States, but have increased in recent years. Dual-method contraception is highest among younger women and adolescents with multiple or new sex partners. Consistent condom use remains a major barrier to dual-method use, as it necessitates admission of STI risk by both partners, and use is dependent upon two decision-makers rather than a single contraceptive user. Promoting the initiation and maintenance of LARC and condom use across multiple partnered sexual encounters requires understanding of individual, dyadic, and social influences. Successful maintenance of contraceptive and STI prevention behaviors requires individualized, longitudinal reinforcement, and social supports, but can ultimately reduce the burden of unintended pregnancy and STI among adolescents.

Adolescent intimate heterosexual relationships: measurement issues

During adolescence, individuals develop increased ability to have emotionally and physically intimate relationships. The type of intimate relationship will make a difference as to whether the adolescent engages in protective behaviors or avoids risky behaviors. However, in reviewing the literature on the association of relationship type and sexual risk and protective behaviors, four methodological challenges were noted. These challenges limit our understanding of the impact of relationship type. These four challenges are: (a) inconsistent definitional frameworks; (b) lack of adolescent voices; (c) lack of consideration of gender; and (d) poor differentiation between individual and relationship risk. These issues direct the course of future work in this area and are necessary to advance the field of adolescent sexual health, particularly with regard to the development and testing of appropriate interventions designed to reduce untoward outcomes of adolescent sexuality.

Gender-specific relationships between depressive symptoms, marijuana use, parental communication and risky sexual behavior in adolescence

A large body of research has identified correlates of risky sexual behavior, with depressive symptoms and marijuana use among the most consistent psychosocial predictors of sexual risk. However, substantially less research has examined the relationship between these risk variables and adolescent risky sexual behavior over time as well as the interaction of these individual-level predictors with family-level variables such as parenting factors. Additionally, most studies have been restricted to one index of risky sexual behavior, have not taken into account the complex role of gender, and have not controlled for several of the factors that independently confer risk for risky sexual behavior. Therefore, the current study investigated the association between depressive symptoms and parameters of parenting on marijuana use, number of sexual partners and condom usage measured 9 months later for both boys and girls. Participants were 9th and 10th grade adolescents (N = 1,145; 57.7% female). We found that depressive symptoms may be a gender-specific risk factor for certain indices of risky sexual behavior. For boys only, marijuana use at Time 2 accounted for the variance in the relationship between depressive symptoms at Time 1 and number of partners at Time 2. Additionally, strictness of family rules at Time 1 was associated with the number of partners with whom girls engaged in sex at Time 2, but only among those with lower levels of depressive symptoms at Time 1. Results from the current investigation speak to the utility of examining the complex, gender-specific pathways to sexual risk in adolescents. Findings suggest that treatment of mental health and substance use problems may have important implications in rates of risky sexual behavior and, conceivably, controlling the high rates of serious individual and public health repercussions.

Multiple method contraception use among African American adolescents in four US cities

We report on African American adolescents' (N = 850; M age = 15.4) contraceptive practices and type of contraception utilized during their last sexual encounter. Respondents completed measures of demographics, contraceptive use, sexual partner type, and ability to select "safe" sexual partners. 40% endorsed use of dual or multiple contraceptive methods; a total of 35 different contraceptive combinations were reported. Perceived ability to select "safe" partners was associated with not using contraception (OR = 1.25), using less effective contraceptive methods (OR = 1.23), or hormonal birth control (OR = 1.50). Female gender predicted hormonal birth control use (OR = 2.33), use of less effective contraceptive methods (e.g., withdrawal; OR = 2.47), and using no contraception (OR = 2.37). Respondents' age and partner type did not predict contraception use. Adolescents used contraceptive methods with limited ability to prevent both unintended pregnancies and STD/HIV. Adolescents who believed their partners posed low risk were more likely to use contraceptive practices other than condoms or no contraception. Reproductive health practitioners are encouraged to help youth negotiate contraceptive use with partners, regardless of the partner's perceived riskiness.

Always, never, or sometimes: examining variation in condom-use decision making among Black adolescent mothers

Our purpose in this study was to describe Black adolescent mothers' decisions regarding condom use and non-use with their male sex partners, including their children's fathers. Research on partner type and condom use has been insufficiently focused on understanding the specific influence that the biological father of the baby has on condom use among adolescent mothers. We conducted five focus groups and three interviews with 31 predominantly African-American mothers. We found that their decisions to use condoms always, never, or sometimes were based on partner type and on emotional and relationship factors. The "baby daddy" was the only partner with whom they never used condoms. HIV/STI prevention interventions for adolescent mothers must address risk taking with their children's biological fathers.

Developmental changes in condom use among urban adolescent females: influence of partner context

PURPOSE

National surveys have found that the percentage of female adolescents who report condom use at last sex differs by age group. Using longitudinal data, the authors examined whether there are longitudinal changes in condom use and whether these changes are due in part to developmental changes in the types of sexual relationships in which young women are involved.

METHOD

A clinic sample of 298 African American female adolescents aged 14-19 years at enrollment were interviewed every 6 months for a period of 36 months. At each interview, participants were asked to name all their recent sex partners, to classify each partner as main or casual, and to report whether a condom was used at last sex with each of these partners. Hierarchical generalized linear modeling was used to analyze repeated measures within individuals.

RESULTS

On average, there was no statistically significant change in condom use over time. The odds of having a single main partner increased by 4% for each 6 months spent in the study (odds ratio: 1.04%, 95% confidence interval: 1.02-1.05). Stratifying females by longitudinal relationship patterns resulted in three distinct condom use trajectories.

CONCLUSION

Data suggest that longitudinal changes in condom use are a function of developmental changes in relationships, whereby young women trend toward monogamous relationships. As condoms are abandoned within these monogamous relationships, lowering infection rates in sex partners through broader sexually transmitted infections screening or through community-level interventions aimed at sex networks might prove to be a more effective approach to reduce sexually transmitted infections risk in young women.

Event-level marijuana use, alcohol use, and condom use among adolescent women

BACKGROUND

It is widely believed that marijuana use and alcohol use directly intercede on successful condom use. However, measurement differences and inconsistent findings in past research remain unclear whether marijuana and alcohol work directly to influence condom behavior, or spuriously function through other factors that actually reflect an increased likelihood of vaginal sex. The current study prospectively disentangles the association of marijuana and alcohol use on condom behavior among adolescent women.

METHODS

Young women (N=387; 14-17 years) provided daily sexual diaries as part of a longitudinal cohort study (1999-2009) of sexual behavior and sexual relationships. To separate the effects of marijuana and alcohol use on vaginal sex from condom use (when vaginal sex occurs), we estimated a 3-category outcome variable (no vaginal sex, vaginal sex with a condom, vaginal sex without a condom), alternating no sex (Model 1) and sex without a condom (Model 2) as the referent categories. Generalized estimating equation multinomial logistic regression adjusted odds ratios for multiple sexual events from the same young woman over time.

RESULTS

Subjects contributed 14,538 coital events; 30% of these events were condom-protected. Neither marijuana nor alcohol use was directly associated with lower condom use; the strongest effect of condom use (adjusted odds ratio) and nonuse was performance of these behaviors in the past week.

CONCLUSIONS

This study finds no evidence of a relationship between marijuana or alcohol use and condom nonuse. Both condom use and nonuse were identified as consistent behavioral patterns, regardless of the effect of marijuana and alcohol use.

"He cheated on me, I cheated on him back": Mexican American and White adolescents' perceptions of cheating in romantic relationships

A qualitative approach was used to explore the meaning and perceptions of cheating in adolescent romantic relationships. Mexican American and White adolescents (N = 75; 53.3% girls; 56.1% Mexican American), separated by gender and ethnicity into 12 focus groups (three groups per type), discussed personal and peer experiences of cheating in dating relationships as both the victim and perpetrator. Dialogue was coded using inductive content analysis; two broader cheating themes encompassing six sub-themes emerged 1) perceptions of cheating (individual-oriented, peer-oriented, and frequency of occurrence) and 2) consequences of cheating (commitment, emotional responses, and relationship outcomes). Mexican American girls spoke most frequently and strongly about cheating, followed by White girls. The meaning and contexts of cheating by ethnicity and gender has important implications for promoting healthy dating behavior during adolescence.

The relationship between rejection sensitivity and compliant condom use

Those who are rejection sensitive anxiously expect and readily perceive rejection. Rejection sensitivity is hypothesized to predict behavior; however, this link may be more evident in some contexts than others. The current study examined the link between rejection sensitivity and condom use. Australian young adults in romantic (n = 649, 70% female) and casual (n = 144, 76.2% female) relationship contexts completed measures on rejection sensitivity, condom use preferences, and condom use. Regression analysis showed that rejection sensitivity predicted condom use when participants' condom use preferences were at odds with those they thought their partner held. Specifically, highly rejection-sensitive individuals who preferred more frequent condom use reported using condoms less often, if that was what they thought their partners wanted. The results lend support to the model of rejection sensitivity in that individuals comply more with their perceived partner's preferences if they are more rejection-sensitive. The results also highlight the need to take the situational context into consideration when examining links between personality dispositions and behavior.

Women may underestimate their partners' desires to use condoms: possible implications for behaviour

Australian young adults reported how often they wanted to use condoms in both romantic (n = 667) and casual relationship (n = 152) contexts and how often they thought their partners wanted to use condoms. Young adults wanted to use condoms more often than they perceived their partners to in both casual and romantic relationship contexts. Gender interactions showed that this pattern was especially strong among young women. Women seemed to underestimate the frequency at which their male partners wanted to use condoms. Furthermore, both the participants' condom use desires and perceptions of their partners' condom use desires predicted condom use behavior. Results suggest that gendered expectations may play a part in how often individuals perceive their partners to want to use condoms, which, in effect, may determine condom use behavior.

Sexual decision making for the "better than average" college student

OBJECTIVES

to examine the impact of downward social comparison and the "known partner is a safe partner" heuristic on college students' sexual decisions.

PARTICIPANTS

One hundred-eighty heterosexual or bisexual undergraduate college students.

METHODS

participants read dating vignettes that varied on perspective and familiarity and then rated the likelihood the couple would engage in sexual intercourse and use a condom.

RESULTS

there were no differences in rated likelihood based on familiarity, suggesting that the students did not view the 2 partner types as significantly different. Students rated the likelihood of sexual intercourse lower and condom use higher when the vignette was presented from the second person perspective.

CONCLUSIONS

the students' use of downward social comparison is consistent with the "better than average effect," suggesting that the students perceive their own behavior as safe. The implication is that safer sex messages might be most effective if they focus on what students will gain by practicing safer sex behaviors, not just avoidance of a risk behavior.

Relationship dynamics and consistency of condom use among adolescents

CONTEXT

Research on adolescent condom use often focuses on the influence of parents, peers and environmental factors. Although most sexually active teenagers have sex within dating relationships, little is known about associations between the characteristics of these relationships and consistency of condom use.

METHODS

Data on 269 participants in Wave 1 of the Toledo Adolescent Relationships Study who had had sex in their current or most recent dating relationship were analyzed in logistic regression models to examine how positive and negative relationship qualities are associated with consistent condom use.

RESULTS

Among teenagers who had had sex with their dating partner, both negative relationship dynamics (conflict, partner's controlling behavior, mistrust, jealousy, perceived partner inferiority) and positive qualities (love, enmeshment, salience, self-disclosure) were negatively associated with consistent condom use (odds ratios, 0.7-0.9). Asymmetries in partners' age, race and school were not related to consistent condom use. Relationship duration was negatively associated with consistency (0.98-0.99), but the association was explained by feelings of relationship importance. Findings for relationship qualities were similar for males and females, with the exception of conflict, which was positively associated with consistent condom use among females but not males.

CONCLUSIONS

Although the relationship processes associated with consistent condom use are complex, such processes appeared to be more strongly associated with consistent condom use than were social and demographic characteristics. Programs should focus on relationship qualities and dynamics, recognizing that both negative and positive relationship features are associated with consistent condom use.

Comparison of sexual partnership characteristics and associations with inconsistent condom use among a sample of adolescents and adult women diagnosed with Chlamydia trachomatis

BACKGROUND

This analysis compared characteristics of female adolescent and adult sexual partnerships and related these characteristics to inconsistent condom use.

METHODS

Data are from a study of 126 women with prevalent chlamydia infections who reported information about 172 sexual partnerships in the previous 3 months. Characteristics of sexual partnerships included type of partner (main vs. other), duration of sexual relationship (<3 months vs. > or =3 months), partner age difference (<2 years older vs. > or =2 years older), and two scale measures: overlap of social networks (a measure based on how well the participant knew her partner's friends, for example) and intimacy.

RESULTS

Compared with adult partnerships, adolescent partnerships were of shorter duration and had less social overlap but were more likely to be classified by the participants as main partnerships. Among adolescents, longer partnership duration was not associated with higher intimacy, yet higher intimacy was significantly correlated with inconsistent condom use.

CONCLUSIONS

These differences suggest that adolescent females perceive and characterize their sexual relationships differently from adults. This, in turn, may have implications for risk of sexually transmitted infections (STIs). Prevention efforts for adolescents, including interventions and counseling, should consider the nature of their sexual partnerships.

Relational commitment and threats to relationship maintenance goals: influences on condom use

OBJECTIVE

The authors examined the effects of relational commitment (high commitment versus low commitment) and relationship maintenance goals (high threat versus low threat) on decisions to request the use of a condom.

METHODS

The authors conducted a 2-part study using a survey of responses to hypothetical scenarios and decisions in actual relationships.

RESULTS

Results indicated that people with high relational commitment were less likely to request a condom than were people with low relational commitment. People who perceived threats to relationship maintenance goals if a condom was requested were less likely to request a condom than were people who did not perceive threats to relationship maintenance goals.

CONCLUSIONS

Findings from this study highlight the influence that relational threats and commitment levels have on condom use decision making.

Explaining associations between adolescent substance use and condom use

PURPOSE

This study examined different explanations for associations between adolescent substance use and lower condom use, in terms of the event-specific effects of alcohol or drugs, psychosocial factors, and sexual behaviors (intercourse frequency, greater number of partners and pill use).

METHODS

Pupils from 25 schools in Scotland, UK provided data on use of alcohol, tobacco, cannabis and psychosocial factors at ages 14 and 16 years; and sexual behaviors at age 16 years. Logistic regression was used to examine associations between substance use and condom use in those reporting intercourse more than once (n = 1322), adjusting for explanatory variables.

RESULTS

Regular use of any of the three substances at age 14 or 16 was associated with lower condom use at age 16, adjusting for gender and social background. The greatest attenuation of the substance use odds ratios was achieved by adjusting for all behaviors and psychosocial factors. This finding applied to different substance use groups, although cigarette-only and alcohol-only groups at age 16 differed in the relative importance of being "drunk or stoned" to other factors explaining condom use.

CONCLUSIONS

Among adolescent substance users, being "drunk or stoned" at intercourse was only one factor related to not using condoms. Psychosocial factors (including attitudes to sexual risks and peer sexual norms) and having more sexual partners also explained substance users' condom use, with lesser effects due to greater intercourse frequency and pill use. Multiple explanations for substance use/condom use associations may guide counseling and education services.

Contraceptive use patterns within females' first sexual relationships: the role of relationships, partners, and methods

This study used the 1995 National Survey of Family Growth (NSFG) to assess whether characteristics of females' sexual partners, relationships, and choice of contraceptive methods were associated with contraceptive use patterns within their first sexual relationship. White, black, and Hispanic females under age 25 (N=915) provided retrospective information on sexual activity and contraceptive use for first sexual relationships that occurred between 1991 and 1995. Females with older sexual partners and with same race/ethnicity partners (among Hispanics) had reduced odds of ever using contraception and/or uninterrupted use. Longer sexual relationships were associated with higher odds of ever using contraception but lower odds of uninterrupted use. Females who were older at first sex, who used hormonal methods (among whites), or who switched to more effective methods during their first sexual relationships had higher odds of ever using contraception and/or uninterrupted use. In contrast, switching to less effective methods during a first sexual relationship was associated with reduced odds of uninterrupted use.

Adolescent relationships and condom use: trust, love and commitment

Research indicates that people use condoms less often with a regular sexual partner than with a casual partner because they believe condoms are not needed. This article reports qualitative findings from four group meetings and 11 in-depth interviews in which sexually experienced inner-city adolescents aged 14-17 talked about their sexual relationships. Three types of relationships were described: messing, for sex only; boy-girlfriend, a more intense relationship, and "hubby-wifey," which mimics marriage. The four types of relationships differ along four analytic dimensions, which give them meaning: future commitment; public vs. secret; expectation of monogamy; and degree of affection and love. Decisions about condom use are influenced by these dimensions which may be underestimated in theoretical models that focus on individuals, not couples.

Oral versus vaginal sex among adolescents: perceptions, attitudes, and behavior

OBJECTIVE

Despite studies indicating that a significant proportion of adolescents are having oral sex, the focus of most empirical studies and intervention efforts concerning adolescent sexuality have focused on vaginal intercourse. This narrow focus has created a void in our understanding of adolescents' perceptions of oral sex. This study is the first to investigate adolescents' perceptions of the health, social, and emotional consequences associated with having oral sex as compared with vaginal sex, as well as whether adolescents view oral sex as more acceptable and more prevalent than vaginal sex.

METHODS

Participants were 580 ethnically diverse ninth-grade adolescents (mean age: 14.54; 58% female) who participated in a longitudinal study on the relationship between risk and benefit perceptions and sexual activity. Participants completed a self-administered questionnaire that inquired about their sexual experiences and percent chance of experiencing outcomes from, attitudes toward, and perceived prevalence of oral versus vaginal sex among adolescents.

RESULTS

More study participants reported having had oral sex (19.6%) than vaginal sex (13.5%), and more participants intended to have oral sex in the next 6 months (31.5%) than vaginal sex (26.3%). Adolescents evaluated oral sex as significantly less risky than vaginal sex on health, social, and emotional consequences. Adolescents also believed that oral sex is more acceptable than vaginal sex for adolescents their own age in both dating and nondating situations, oral sex is less of a threat to their values and beliefs, and more of their peers will have oral sex than vaginal sex in the near future.

CONCLUSIONS

Given that adolescents perceive oral sex as less risky, more prevalent, and more acceptable than vaginal sex, it stands to reason that adolescents are more likely to engage in oral sex. It is important that health care providers and others who work with youths recognize adolescents' views about oral sex and broaden their clinical preventive services to include screening, counseling, and education about oral sex.

Context of Acceptability of Topical Microbicides: Sexual Relationships

Domains central to the effects of sexual relationships on the acceptability of a vaginal protection method were explored in 14 focus groups and 38 in-depth interviews with women and men recruited from a health department's sexually transmitted infections (STI) and family planning clinics. Findings indicate that acceptability depended on a couple's relationship type, classified as serious, casual, or "new." Potential barriers to communication about product use may be overcome through direct or indirect covert use, depending on relationship type. More men than women thought women should always tell their partners if they use microbicides, regardless of relationship type. Results indicate the importance of the relationship context in understanding the likely acceptability of using microbicides, and perhaps any method of STI/HIV protection.

Interactive video behavioral intervention to reduce adolescent females’ STD risk: a randomized controlled trial

A longitudinal randomized design was used to evaluate the impact of a theoretically based, stand-alone interactive video intervention on 300 urban adolescent girls' (a) knowledge about sexually transmitted diseases (STDs), (b) self-reported sexual risk behavior, and (c) STD acquisition. It was compared to two controls, representing high-quality informational interventions. One used the same content in book form; the other used commercially available brochures. Following randomization, the interventions were administered at baseline, with booster sessions at 1, 3, and 6 months. Self-reports revealed that those assigned to the interactive video were significantly more likely to be abstinent in the first 3 months following initial exposure to the intervention, and experienced fewer condom failures in the following 3 months, compared to controls. Six months after enrollment, participants in the video condition were significantly less likely to report having been diagnosed with an STD. A non-significant trend in data from a clinical PCR assay of Chlamydia trachomatis was consistent with that finding.

A comparison of sexual behaviour and attitudes of healthy adolescents in a Danish high school in 1982, 1996, and 2001

AIM: To assess changes in sexual behaviour among students at a high school in Denmark from 1982 to 2001. METHODS: An anonymous self-administered questionnaire was used to compare data from three identical cross-sectional surveys performed in 1982, 1996, and 2001. RESULTS: Girls: More girls reported their first sexual intercourse before their 16th birthday in 2001 (42%) than in 1996 (29%) In 1982 it was also 42% (Chi-square for trend: p = 0.003). Fewer girls with no regular partner used condoms for their personal protection in 2001 (2%) than in 1996 (9%) and 1982 (0%) (Chi-square for trend p = 0.016). The proportion of girls with no regular partner who considered protection from sexually transmitted disease important for their choice of contraception was 39% in 2001 compared with 71% in 1996 and only 10% in 1982 (Chi-square for trend: p < 0.0001).Boys: More boys reported sexual debut before their 16th birthday in 2001 (40%) than in 1996 (37%) and 1982 (24%) (Chi-square for trend: p = 0.023). For boys with no regular partner, condom was preferred for personal protection by 85% in 2001, 91% in 1996 and 61% in 1982 (Chi-square for trend p = 0.007). Protection against sexually transmitted infection declined, especially among boys with no regular partner, from 51% in 2001 to 72% in 1996 and 21% in 1982 Chi-square for trend: p < 0.0001).The tendency towards earlier sexual debut and less use of safe sex practices to protect against sexually transmitted infections (STI) was accompanied by a rise in the number of detected STIs during this period. CONCLUSIONS: The period from 1982 to 1996 during which sexual attitudes were directed toward safer sex seems to have given way to a reverse trend in the period from 1996 to 2001. These findings may have significant implications for health care authorities organising preventive strategies for healthy adolescents.

Situational factors involved in college students' safer and risky sexual encounters

OBJECTIVE

To ascertain the differences between the situational factors of risky and safer sexual encounters in college students.

DESIGN

Descriptive.

SETTING

Community-dwelling college students from a large Midwestern university.

PARTICIPANTS

Participants were 84 college students ages 18 to 20 years. Fifty-five were female (67.5%), the majority (95.2%) were White, and all reported being heterosexual.

MAIN OUTCOME MEASURE

Use of safer or risky practices in last or most memorable sexual encounter.

RESULTS

Important situational characteristics of safer encounters were negative ambiance of the place, type of partner, unattractive qualities of the partner, communication with the partner, and having the encounter because of feeling desire. Important situational characteristics of risky encounters were a cozy ambiance, partner's attractiveness inducing desire, asking directly for the encounter, and encounters occurring after celebration or partying.

CONCLUSIONS

Many characteristics were similar for both risk groups. However, practitioners can tailor interventions to make clients aware of factors that were more prevalent in risky sexual encounters, such as having the encounter with a boyfriend or girlfriend and having an encounter after drinking alcohol and partying.

Need for intimacy in relationships and motives for sex as determinants of adolescent condom use

PURPOSE

To investigate the extent to which need for intimacy in relationships and motives for sex are capable of distinguishing between adolescents who always have protected sex and adolescents who do not, with reference to both steady and casual relationships.

METHODS

Seven-hundred-and-one adolescents (424 males and 277 females) aged 15 to 23 years filled out a questionnaire assessing determinants of sexual behavior and various outcome behaviors, such as having casual sex and condom use.

RESULTS

Two-thirds of the participants (470) were sexually experienced. Discriminant functions using constructs of the Theory of Planned Behavior (attitude, subjective norm, self-efficacy), as well as the need for intimacy in relationships and motives for sex, were found to distinguish significantly between adolescents who always had protected sexual intercourse and adolescents who did not. This was valid both for sex within steady and within casual relationships. Besides a positive attitude and high perceived subjective norms, protected sex with a steady partner was characterized by low scores on the scale for the motive for sex to express love, and on the scale for the need for intimacy in relationships. Consistent condom use with casual partners was related to high self-efficacy, attitude, and perceived subjective norms, as well as a greater need for intimacy in relationships. Gender differences emerged with respects to determinants of (un)safe sex with casual partner(s), in that for males the variables of the Theory of Planned Behavior were most important in distinguishing those who had unsafe casual sex from those who had safe casual sex. For females, on the other hand, the variables concerning the meaning attached to having sex or to the relationship within which sex occurs seemed to be of more significance in explaining (un)safe sex with casual partner(s). However, owing to small subsamples, caution is warranted when interpreting these differences.

CONCLUSIONS

In adolescence, the factors which influence the decision to have (un)protected sex depend on the kind of relationship that exists between the partners. In addition, the goals which adolescents pursue with regard to their relationships and with regard to having sex fulfill an important role in the decision-making process whether to use condoms.

Modeling condom-use stage of change in low-income, single, urban women

This study was undertaken to identify and test a model of the cognitive antecedents to condom use stage of change in low-income, single, urban women. A convenience sample of 537 women (M=30 years old) attending two urban primary health care settings in western New York State anonymously completed questionnaires based primarily on two leading social-cognitive models, the transtheoretical model and the information-motivation-behavioral skills model. We used structural equation modeling to examine the direct and indirect effects of HIV-related knowledge, social norms of discussing HIV risk and prevention, familiarity with HIV-infected persons, general readiness to change sexual behaviors, perceived vulnerability to HIV, and pros and cons of condom use on condom-use stage of change. The results indicated two models that differ by partner type. Condom-use stage of change in women with steady main partners was influenced most by social norms and the pros of condom use. Condom-use stage of change in women with "other" types (multiple, casual, or new) of sexual partners was influenced by HIV-related knowledge, general readiness to change sexual behaviors, and the pros of condom use. These findings suggest implications for developing gender-relevant HIV-prevention interventions.

Associations of depression, self-esteem, and substance use with sexual risk among adolescents

BACKGROUND

Adolescents are the population at highest risk for acquiring sexually transmitted diseases (STDs). Previous research has suggested that mental health problems, including depression and low self-esteem, may play an important role in the development and maintenance of sexual risk behaviors.

METHODS

National Longitudinal Study of Adolescent Health data from baseline interviews of 7th-12th graders reporting sexual intercourse in the preceding year were analyzed. Using logistic regression, associations of depressive symptoms, self-esteem, and substance use with condom nonuse at last sexual intercourse and with ever having had an STD were explored separately for each gender.

RESULTS

Among boys (N = 3,192), depressive symptoms were associated with an increased risk of condom nonuse at last sexual intercourse. The association between depressive symptoms and STD appeared to be mediated by alcohol and marijuana use. For girls (N = 3,391), depressive symptoms were associated with a history of STD, but not with condom nonuse. Self-esteem was not significant in any model that included depressive symptoms.

CONCLUSIONS

Adolescents with depressive symptoms are at risk for not using a condom and for having an STD. Further research is needed to elucidate the relationship among depression, substance use, and sexual risk to optimize STD prevention strategies for adolescents.

'Don't know' and 'didn't think of it': condom use at first intercourse by Latino adolescents

We examined the specific reasons Latino adolescents did or did not use condoms at first intercourse and their specific reasons for their perceived risk for contracting HIV. Latino adolescents (n = 618), ages 11-19, completed a face-to-face interview that included information on demographics (sex, age, family-status (lives with both natural parents versus other family structure) and country of birth) and sexual behaviour. The respondents cited 'don't know' (25.9%), 'not available' (25.9%) and 'didn't think of it' (23.5%) as the most frequent reasons for not using condoms at first intercourse. Anyone can get it (41.8%), unknown knowledge of partner's serostatus (24.7%) and unprotected sex (23.8%) were the top three reasons for perceiving oneself as being at risk for contracting HIV. Sexually active adolescents were more likely to perceive themselves at risk for contracting HIV than adolescents that had not had sex. Males were significantly more likely to report using condoms for protection at first intercourse than females. The remaining demographic factors were not significantly related to use of condoms at first intercourse nor to perceived risk for contracting HIV.

Concurrent sex partners and risk for sexually transmitted diseases among adolescents

BACKGROUND/OBJECTIVES

A large percentage of sexually active adolescents have multiple sex partners and are at high risk of acquiring sexually transmitted diseases (STDs). Little is known about adolescents' patterns of sexual partnerships (e.g., concurrent versus serial) and how these patterns influence STD risk.

GOAL OF THE STUDY

To determine the frequency with which adolescents have concurrent partners during a main relationship and the association between having concurrent partners and STD risk.

STUDY DESIGN

Adolescents seeking care at a public STD clinic were recruited from March, 1996, to May, 1998. Demographic and behavioral data were obtained during an interviewer-administered questionnaire. Sexually transmitted disease testing and physical exams were performed by clinicians.

RESULTS

Of those adolescents who reported having at least one main partner during the previous 6 months (n = 245), 110 (44.9%) had multiple partners, and 76 (31%) had at least one concurrent partner during a main relationship. Greater number of concurrent partners was associated with STD diagnosis/exposure after controlling for number of sex partners (OR = 1.6; 95% CI, 1.1-2.4).

CONCLUSIONS

A significant percentage of adolescents have concurrent partners during a main relationship, and having concurrent partners increases STD risk.