Adolescent males involved in pregnancy: associations of forced sexual contact and risk behaviors

Die Entwicklung von Sexualität bei Kindern und Jugendlichen mit sexuellen Gewalterfahrungen

Zusammenfassung. Theoretischer Hintergrund: Zu den Folgen sexueller Gewalt gehören neben somatischen und psychischen Folgen auch Veränderungen in der Entwicklung der Sexualität. Fragestellung: Ziel dieses Reviews ist es, einen systematischen Überblick über den aktuellen Forschungsstand bezüglich der Entwicklung von Sexualität bei Kindern und Jugendlichen nach sexuellen Gewalterfahrungen zu geben. Methode: Eine systematische Literaturrecherche wurde in den Datenbanken PubMed, ERIC, Cochrane und PubPsych durchgeführt. Die Folgen von sexueller Gewalt bezüglich der Sexualität wurden systematisch analysiert. Ergebnisse: Es konnten insgesamt 127 Studien zur Sexualität nach sexueller Gewalt identifiziert werden, die acht Unterkategorien zugeordnet werden konnten: Sexuelles Risikoverhalten, Teenagerschwangerschaft, jugendliche Sexualstraftäter_innen, sexuelle Verhaltensauffälligkeiten, sexuelle Überzeugungen, Prostitution, Geschlechtskrankheiten und körperliche Symptome. Diskussion und Schlussfolgerung: Insgesamt zeigt die Literaturrecherche, dass die Sexualität von Kindern und Jugendlichen mit sexuellen Gewalterfahrungen teilweise nur lückenhaft untersucht wurde.

The Prevalence of Sexual Abuse Among Adolescents in School

Sexual abuse is a profound stressor that complicates the development and health of adolescents, yet its prevalence has been difficult to estimate among adolescents in school populations. This study explored the prevalence of both incest and nonfamily abuse in 2 cohorts of adolescents in Minnesota in the 1990s (1992: N = 77,374; 1998: N = 81,247). Findings indicate that sexual abuse was reported by both boys and girls and among students of all ethnic groups. Approximately 10% of adolescents reported sexual abuse in each cohort, with girls 5 times more likely to report abuse than boys. Ethnic variation was minor, with African American, Native American, and Hispanic teens slightly more likely to report abuse than White or Asian American youth. School nurses should routinely assess for a history of sexual abuse in adolescents and should be prepared to provide support and referral for abused students and their families.). Findings indicate that sexual abuse was reported by both boys and girls and among students of all ethnic groups. Approximately 10% of adolescents reported sexual abuse in each cohort, with girls 5 times more likely to report abuse than boys. Ethnic variation was minor, with African American, Native American, and Hispanic teens slightly more likely to report abuse than White or Asian American youth. School nurses should routinely assess for a history of sexual abuse in adolescents and should be prepared to provide support and referral for abused students and their families.

Sexual Orientation and Risk of Pregnancy Among New York City High-School Students

OBJECTIVES

We examined associations between sexual orientation and pregnancy risk among sexually experienced New York City high-school students.

METHODS

We analyzed data from 2005, 2007, and 2009 New York City Youth Risk Behavior Surveys. We excluded students who had never engaged in sexual intercourse, only had same-gender sexual partners, or had missing data on variables of interest, resulting in a final sample of 4892 female and 4811 male students. We employed multivariable logistic regression to examine pregnancy risk by sexual orientation, measured as self-reported sexual identity and gender of sexual partners, with adjustment for demographics and sexual behaviors. We stratified analyses by gender.

RESULTS

Overall, 14.3% of female and 10.8% of male students had experienced a pregnancy. Students who identified as gay, lesbian, or bisexual or reported both male and female sexual partners had higher odds of pregnancy than heterosexual students or students who only had opposite-gender sexual partners. Sexual behaviors accounted for higher odds of pregnancy among female, but only partially accounted for higher odds of pregnancy involvement among male, sexual-minority students.

CONCLUSIONS

Sexual orientation should be considered in future adolescent pregnancy-prevention efforts, including the design of pregnancy-prevention interventions.

Factors Associated With Being Pleased With a Female Partner Pregnancy Among Sexually Active U.S. Adolescent Males

Adolescent pregnancy remains a major U.S. public health problem. Little is known about pregnancy attitudes in U.S. adolescent males. The study objective was to identify factors from different domains that are associated with sexually active U.S. adolescent males who would be pleased with a female partner pregnancy (hereafter known as pleased with a pregnancy). The National Survey of Family Growth is a nationally representative survey of those 15 to 44 years old. Bivariate and multivariable analyses were performed of the 2002 and 2006-2010 cycles to examine factors associated with being pleased with a pregnancy among sexually active U.S. males. Among the 1,445 sexually active U.S. adolescent males surveyed, 25% would be pleased with a pregnancy. In bivariate analyses, ever being suspended from school, having sporadic health insurance, age, and ever HIV tested were significantly associated with being pleased with a pregnancy. In final multivariable analyses, sporadic insurance was associated with almost triple the odds, and being older and ever HIV tested with double the odds of being pleased with a pregnancy. Higher educational attainment for both adolescent males and adolescent males' fathers was associated with reduced odds of a being pleased with a pregnancy. One quarter of sexually active U.S. adolescent males would be pleased with a pregnancy. Adolescent males who have been sporadically insured, are older, and ever HIV tested have higher odds of being pleased with a pregnancy. Targeting these adolescent males for more focused pregnancy-prevention counseling may prove useful in reducing adolescent pregnancy rates.

Victimization and Perpetration of Unwanted Sexual Activities Among High School Students

The objective of this study was to report the frequency of perpetration and victimization of unwanted sexual activities (threatened to end relationship or other pressures to engage in sexual activities, threatened or actual physical force, and facilitated by drugs or alcohol) in a large, statewide sample of high school males and females. Among 18,030 students, 18.5% reported victimization and 8.0% perpetration in the past year. Although females were more likely to report unwanted sexual activities due to feeling pressured, there were no significant sex differences among those reporting physical force or unwanted sexual activities due to alcohol or drug use.

Does adolescent gambling co-occur with young fatherhood?

BACKGROUND

Young fatherhood is associated with various adverse outcomes. This study aims to describe the relationship of adolescent gambling with young fatherhood (by age 20) while adjusting for several young fatherhood antecedents.

METHODS

Data were from 294 males who have been followed for 16 years since entering first grade in nine inner city public schools (86% African Americans, 81% of the original male cohort). Self-reports of impregnation (including age) and gambling were collected during late adolescence. Nelson-Aalen curves and Cox regression models assessed the hazard of young fatherhood among adolescent nongamblers, social gamblers, and problem gamblers.

RESULTS

More young fathers than nonfathers reported adolescent social (49.2% vs. 42.5%) and problem gambling (28.3% vs. 13.2%, p < .001). Problem gamblers were the most likely to impregnate someone by age 20, followed by social gamblers, then nongamblers. Problem gambling (aHR = 3.16, 95% CI = 1.75, 5.72, p < .001) had the highest increased hazards of young fatherhood, followed by social gambling (aHR = 1.95, 95% CI = 1.30, 2.94, p = .001), high school dropout (aHR = 1.75, 95% CI = 1.14, 2.70, p = .01), and subsidized lunch status (aHR = 1.69, 95% CI = 1.01, 2.38, p = .04).

CONCLUSION

Adolescent male gamblers, particularly problem gamblers, were more likely than their nongambling peers to become fathers by the age of 20. Such a result shows that there is a subpopulation of males who are at high risk for adverse outcomes such as young parenthood and problem behaviors. Only through further studies could the needs of this subpopulation be better assessed so that appropriate assistance could be delivered to better the lives of such individuals.

The relationship between sexual abuse and risky sexual behavior among adolescent boys: a meta-analysis

PURPOSE

Childhood and adolescent sexual abuse has been shown to lead to increased odds of sexual behaviors that lead to sexually transmitted infections and early pregnancy involvement. Research, meta-analyses, and interventions, however, have focused primarily on girls and young women who have experienced abuse, yet some adolescent boys are also sexually abused. We performed a meta-analysis of the existing studies to assess the magnitudes of the link between a history of sexual abuse and each of the three risky sexual behaviors among adolescent boys in North America.

METHODS

The three outcomes were (a) unprotected sexual intercourse, (b) multiple sexual partners, and (c) pregnancy involvement. Weighted mean effect sizes were computed from ten independent samples, from nine studies published between 1990 and 2011.

RESULTS

Sexually abused boys were significantly more likely than nonabused boys to report all three risky sexual behaviors. Weighted mean odds ratios were 1.91 for unprotected intercourse, 2.91 for multiple sexual partners, and 4.81 for pregnancy involvement.

CONCLUSIONS

Our results indicate that childhood and adolescent sexual abuse can substantially influence sexual behavior in adolescence among male survivors. To improve sexual health for all adolescents, even young men, we should strengthen sexual abuse prevention initiatives, raise awareness about male sexual abuse survivors' existence and sexual health issues, improve sexual health promotion for abused young men, and screen all people, regardless of gender, for a history of sexual abuse.

Social Factors Associated with History of Sexual Assault Among Ethnically Diverse Adolescents

We examine the association of adolescents' self-reported sexual assault victimization with their living arrangements, parent's education, and plans for college. Participants included 1,634 ethnically-diverse and economically-disadvantaged high school students in southeast Texas. Lifetime history of forced sexual assault was reported by 8.3% of girls and 9% of boys. No association with gender, age, or parent's education was detected. However, adolescents in non-traditional households (living with one parent, grandparents, or other) were more likely to report rape than youth living with both parents. Adolescents who were one race/ethnicity were less likely to report being raped than those in the multiple race category. Sexual assault intervention programs should account for a teenager's living situation; and prevention efforts may benefit from targeting individuals in non-traditional households. The lack of an association with either gender or socio-educational status indicates that all children are at risk and that school-based programs should be broadly targeted.

Childhood sexual abuse and adolescent pregnancy: a meta-analytic update

OBJECTIVE

Recent increases in adolescent pregnancies have sparked a renewed impetus to identify risk factors, such as childhood sexual abuse (CSA), associated with adolescent pregnancy. Given mixed evidence regarding the strength of the relationship between CSA and adolescent pregnancy (Blinn-Pike, Berger, Dixon, Kuschel, & Kaplan, 2002), our objective was to provide an estimate of the effect size of this relationship using updated literature and meta-analytic techniques.

METHODS

Meta-analyses of 21 studies were conducted using a random effects model of binary outcomes to determine aggregate effect-size estimates controlling for study heterogeneity.

RESULTS

CSA significantly increased the odds of experiencing an adolescent pregnancy by 2.21-fold (95% CI: 1.94-2.51). A supplemental analysis suggested that 4.5 out of 10 pregnant adolescents may have a prior history of CSA.

CONCLUSIONS

CSA places females at increased risk for subsequent adolescent pregnancy. Addressing conditions associated with CSA might impact the overall adolescent pregnancy rate.

Pregnancy and sexual health among homeless young injection drug users

Research on pregnancy and sexual health among homeless youth is limited. In this study, qualitative interviews were conducted with 41 homeless young injection drug users (IDUs) in Los Angeles with a history of pregnancy. The relationship between recent pregnancy outcomes, contraception practices, housing status, substance use, utilization of prenatal care, and histories of sexual victimization are described. A total of 81 lifetime pregnancies and 26 children were reported. Infrequent and ineffective use of contraception was common. While pregnancy motivated some homeless youth to establish housing, miscarriages and terminations were more frequent among youth who reported being housed. Widespread access to prenatal and medical services was reported during pregnancy, but utilization varied. Many women continued to use substances throughout pregnancy. Several youth reported childhood sexual abuse and sexual victimization while homeless. Pregnancy presents a unique opportunity to encourage positive health behaviors in a high-risk population seldom seen in a clinical setting.

Sexual victimization and reproductive health outcomes in urban youth

OBJECTIVE

Adolescents and adults with a history of sexual victimization (SV) are at increased risk of engaging in sexual risk behaviors. This study seeks to examine race- and gender-based differences in SV as well as the association between SV and reproductive health outcomes (pregnancy and sexually transmitted infections [STIs]) among young adults from an urban community with high rates of both outcomes.

METHODS

This study used cross-sectional data from the Young Adult Survey of the Baltimore Prevention Program's intervention trials. Participants initially enrolled as first graders were interviewed for the Young Adult Survey as they entered adulthood. A total of 1698 participants were asked about SV, pregnancy, and STIs. Data were analyzed by logistic regression analysis.

RESULTS

History of SV did not vary by racial background, but female participants were more likely to report SV than their male peers. Results for models predicting STIs revealed a significant interaction between gender and SV. Adolescent girls who reported a SV were significantly more likely to have an STI than adolescent girls who did not report victimization. Both adolescent boys and girls who reported SV were more likely to report involvement in a pregnancy.

CONCLUSIONS

Youth in urban communities with a history of SV are far more likely than those without victimization histories to have a pregnancy or STI before young adulthood. Further research is needed to explore the mediators of these outcomes and the value of sexual safety and child protection programs for pregnancy and STI prevention in urban environments.

What they tell you to forget: from child sexual abuse to adolescent motherhood

This study explores the relationship between child sexual abuse and adolescent motherhood, using a life story interview method. The sample consists of 27 mothers participating in a home-visitation parenting program for mothers at risk of child maltreatment. The failure to articulate the violation of child sexual abuse and to appropriately construct blame resulted in a range of self-destructive behaviors, some of which placed mothers at greater risk of teen pregnancy. Repressed feelings associated with the trauma often resurfaced with motherhood as victims re-experienced their innocence and vulnerability as children.

The association between self-reported lifetime history of forced sexual intercourse and recent health-risk behaviors: findings from the 2003 National Youth Risk Behavior Survey

PURPOSE

To expand the understanding of the association between recent health-risk behaviors and a history of forced sexual intercourse, using a nationally representative sample of female and male high school students.

METHODS

Data were from the 2003 National Youth Risk Behavior Survey, a nationally representative biennial survey of U.S. high school students. Lifetime history of forced sex, recent physical dating violence, and health-risk behaviors (substance use, diet-related behaviors, violence-related behaviors, and health promoting behaviors) were assessed. Analyses were stratified by gender and controlled for grade and race/ethnicity.

RESULTS

Of students surveyed, 8.9% reported ever being forced to have sex. One in eight females and one in 16 males experienced forced sex in their lifetime. For females and males, a history of forced sex was associated with experiencing physical dating violence and suicidal ideation in the 12 months preceding the survey and with substance use in the previous 30 days. Female victims were not as likely as female nonvictims to have participated in team sports during the previous 12 months. Male victims were more likely than male nonvictims to have fasted for more than 24 hours to lose weight during the previous 30 days.

CONCLUSIONS

A lifetime history of forced sex is associated with recent dating violence and participation in unhealthy behaviors. Services and intervention programs for victimized youth should address health concerns that have been linked to sexual assault. Such programs would provide opportunities for early intervention with lasting implications for improved health.

Sexual exploitation of very young Hmong girls

PURPOSE

Recent increases in Hmong girls referred to a Midwest hospital-based child advocacy center prompted this comparison of abuse experiences for Hmong extra-familial sexual abuse cases versus peers.

METHODS

Retrospective chart review of all girls, aged 10 to 14 years, with extra-familial sexual abuse 1998-2003 (n = 226). Fourteen percent of cases were Hmong (n = 32). Demographics, risk behaviors, abuse experiences, physical findings and legal outcomes were compared for Hmong (H) and Other (O) girls using chi-square. Multivariate logistic regressions explored differences in gynecologic findings and sexually transmitted disease (STD) results.

RESULTS

Hmong girls were more likely to be runaways (90% H vs. 8% O), truant (97% H vs. 13% O), self-mutilating (38% H vs. 10% O), and suicidal (41% H vs. 21% O). Seventy-seven percent of Hmong reported gang rape, prostitution, or multiple assaults versus 16% Others; most had 5+ perpetrators (69% H vs. 2% O) and 5+ assaults (75% H vs. 24% O, both p < .001). Gynecologic findings were more prevalent among Hmong girls (63% H vs. 21% O). Controlling for penetration, number of partners/assaults, and acuity at examination, Hmong ethnicity predicted gynecologic findings (adjusted odds ration [AOR] = 6.57). Hmong girls were more likely to have a positive chlamydia screen (36% H vs. 4% O, p < .001), but only number of perpetrators was an independent predictor (AOR = 15.09). Most cases were prosecuted, but Hmong had higher prosecution rates (83% H vs. 57% O, p < .001).

CONCLUSIONS

Hmong girl assault experiences were markedly more severe than peers. Health care providers need appropriate knowledge of Hmong culture to conduct forensic examinations. Abused Hmong girls need culturally sensitive, developmentally appropriate after-care that helps connect them back with families and school.

Psychosocial correlates of U.S. adolescents who report a history of forced sexual intercourse

BACKGROUND

A comprehensive assessment of the psychosocial risk profiles of adolescents who report forced sexual intercourse remains an important gap in the literature, precluding meaningful discussion of the implications of such experiences.

METHODS

Ninth through twelfth grade high school adolescents (n = 13,601) who completed the 2001 national Youth Risk Behavior Survey were participants. Multivariate logistic regression was used to examine all significant independent relationships.

RESULTS

The lifetime prevalence of forced sex for females and males was 10.2% and 5.1%, respectively. For the overall sample, feeling sad/hopeless(odds ratio [OR] 1.9), having considered (OR 2.1) or attempted (OR 1.4) suicide, being a victim of physical dating violence (OR 2.8) heavy cigarette use (OR 1.4), binge drinking (OR 0.7), having multiple recent sexual partners (OR 8.3) and unprotected sex (OR 1.7) were correlated with a history of forced sex. Among females, associations were found among sad/hopeless feelings (OR 1.6), having considered suicide(OR 2.2), fighting (OR 1.3), physical dating violence (OR 2.1) heavy cigarette use (OR 1.8), multiple sexual partners (OR 9.3) , alcohol/or drug use before sex (OR 1.6) and unprotected sex (OR 1.5). Among males, associations were found among sad/hopeless feelings (OR 1.8), attempted suicide (OR 1.9), gun carrying (OR 1.8), physical dating violence (OR 4.3), multiple sexual partners (OR 7.8), unprotected sex (OR 1.9), and other ethnicity (OR 3.3).

CONCLUSIONS

Although a history of forced sexual intercourse affects a small number of adolescents, it is an important public health issue. The psychological and behavioral correlates of forced sexuality suggest that these youth have been harmed and may further place themselves in harm's way. Furthermore, the profiles of adolescent females and males who report such experiences are distinct in ways that warrant their independent examination and attention.

Unintentional and violent injuries among pre-school children of teenage mothers in Sweden: a national cohort study

STUDY OBJECTIVE

This study investigates the risk and mediating mechanisms of unintentional and violent injuries in pre-school children of teenage mothers.

DESIGN

Cohort study based on Swedish national registers. Cox analyses of proportional hazard were used to estimate the relative risk of hospital admission and death attributable to injuries in analyses of data from national registers.

PARTICIPANTS

The study population was a national cohort of 800,192 children born in Sweden during 1987-93 who were followed up prospectively from birth to their 7th birthday.

MAIN RESULTS

Children of teenage mothers had higher relative risks (RRs) of hospital admissions for violent as well as unintentional injuries; age adjusted RRs of 2.7 (95% CI 1.2 to 6.1) and 1.6 (1.4 to 1.8), respectively, for children of mothers under 18 years of age and 2.5 (1.6 to 3.8) and 1.5 (1.4 to 1.6) of mothers aged 18-19 are compared with those with mothers aged at least 32 at the birth of the child. When the models were adjusted to socioeconomic variables and indicators of parental substance misuse and psychiatric illness the risk decreased slightly but remained well above that of children with older mothers. In addition, children of teenage mothers had an increased risk of death attributable to violent injuries (RR 6.7 (2.6 to 16.0), as well as to unintentional injuries (RR 3.5 (2.0 to 6.1).

CONCLUSIONS

Maternal age is an important determinant of injuries in pre-school children in Sweden and the children of teenage mothers are at particular risk. Young parents should be given priority in injury prevention programmes.

Potential factors associated with contraceptive intention among adolescent males in Taiwan

This study explored the predictors of contraceptive intention in adolescent males in Taiwan. It used a cross-sectional design and a sample of 1,000 vocational high school male students to determine the potential factors associated with contraceptive intention. Data were collected on an anonymous, self-administered questionnaire, including personal background variables, prior sexual experience, contraceptive knowledge, contraceptive attitude, contraceptive self-efficacy, perception of peers' contraceptive behavior, perception of support from significant others, and parental-adolescent communication about contraception. A total of 230 participants (23%) had prior sexual experience, 13% (30) of whom reported being involved in their girlfriends' pregnancies. Of the participants, 45% recognized the use of condoms as the most favorable contraceptive method for future sexual intercourse. Second to condom use, the combination of the calendar method and condom use was also popular (13.1%). Multiple stepwise regression indicated that better contraceptive attitudes, higher contraceptive self-efficacy, no prior sexual experience, more perception of peers' contraceptive behavior, and higher perception of support from significant others were predictors of higher contraceptive intention. The above predicting factors explained 31.9% of the total variance for contraceptive intention among adolescents. These results provide health professionals with important information to understand the reality adolescents encounter and to design effective contraceptive programs for male adolescents.

The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death

OBJECTIVES

Few reports address the impact of cumulative exposure to childhood abuse and family dysfunction on teen pregnancy and consequences commonly attributed to teen pregnancy. Therefore, we examined whether adolescent pregnancy increased as types of adverse childhood experiences (ACE score) increased and whether ACEs or adolescent pregnancy was the principal source of elevated risk for long-term psychosocial consequences and fetal death.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective cohort study of 9159 women aged > or = 18 years (mean 56 years) who attended a primary care clinic in San Diego, California in 1995-1997.

MAIN OUTCOME MEASURE

Adolescent pregnancy, psychosocial consequences, and fetal death, compared by ACE score (emotional, physical, or sexual abuse; exposure to domestic violence, substance abusing, mentally ill, or criminal household member; or separated/divorced parent).

RESULTS

Sixty-six percent (n = 6015) of women reported > or = 1 ACE. Teen pregnancy occurred in 16%, 21%, 26%, 29%, 32%, 40%, 43%, and 53% of those with 0, 1, 2, 3, 4, 5, 6, and 7 to 8 ACEs. As the ACE score rose from zero to 1 to 2, 3 to 4, and > or = 5, odds ratios for each adult consequence increased (family problems: 1.0, 1.5, 2.2, 3.3; financial problems: 1.0, 1.6, 2.3, 2.4; job problems: 1.0, 1.4, 2.3, 2.9; high stress: 1.0, 1.4, 1.9, 2.2; and uncontrollable anger: 1.0, 1.6, 2.8, 4.5, respectively). Adolescent pregnancy was not associated with any of these adult outcomes in the absence of childhood adversity (ACEs: 0). The ACE score was associated with increased fetal death after first pregnancy (odds ratios for 0, 1-2, 3-4, and 5-8 ACEs: 1.0, 1.2, 1.4, and 1.8, respectively); teen pregnancy was not related to fetal death.

CONCLUSIONS

The relationship between ACEs and adolescent pregnancy is strong and graded. Moreover, the negative psychosocial sequelae and fetal deaths commonly attributed to adolescent pregnancy seem to result from underlying ACEs rather than adolescent pregnancy per se.

Reproductive history and involvement in pregnancy and childbirth of fathers of babies born to teenage mothers in Stockholm, Sweden

OBJECTIVE

to describe and compare sexual and reproductive history as well as reactions to the pregnancy and attendance in antenatal care, family classes and childbirth of fathers of babies born to teenage mothers and fathers of babies born to average aged mothers.

DESIGN

a descriptive comparative study using a structured questionnaire for data collection.

SETTING

eleven postnatal wards at the five obstetric and gynaecological departments in the Stockholm area.

PARTICIPANTS

132 fathers of babies born to primiparous teenage mothers (Group A) and the same number of fathers of babies born to primiparous women aged between 25-29 years (Group B) who were present in the postnatal wards.

FINDINGS

43 of Group A compared to 17% of the Group B fathers had their first intercourse before 15 years of age. This early sexual debut was related to other health hazard, such as use of illicit drugs and cigarette smoking. The majority of the pregnancies in Group A were unplanned but most fathers reacted positively to the pregnancy and participated in the antenatal care. In contrast, only half of these fathers attended family classes.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

fathers of babies born to teenage mothers differed from fathers of babies to older mothers regarding reproductive background as well as involvement during pregnancy. The findings of this study challenge midwives to organise clinical practice in order to meet the specific needs of this group.

Abused boys, battered mothers, and male involvement in teen pregnancy

BACKGROUND

The relationship between boyhood exposure to physical abuse, sexual abuse, or to a battered mother and subsequent risk of impregnating a teenage girl has not previously been examined.

METHODS

In a retrospective cohort study set in a primary care clinic for adult members of a large health maintenance organization, questionnaire responses from 4127 men were analyzed. Respondents provided the age of the youngest female whom they had impregnated, their own ages at the time, and information regarding childhood exposure to physical or sexual abuse and battered mothers. We calculated the prevalence and adjusted odds ratio (OR) for having impregnated a teenage girl according to these 3 adverse childhood experiences, regardless of the male's age at the time of impregnation. Using logistic regression, ORs were adjusted for the male's age at time of survey, race, and education.

RESULTS

Nineteen percent of the men reported that they had ever impregnated a teenage girl. During childhood, 32% of respondents had been physically abused, 15% sexually abused, and 11% had battered mothers. Compared with respondents reporting no abuse, frequent physical abuse or battering of mothers increased the risk of involvement in teen pregnancy by 70% (OR: 1.7; 95% confidence interval [CI]: 1.2-2.5) and 140% (OR: 2.4; 95% CI: 1.1-5.0), respectively. Sexual abuse as a boy at age 10 years or younger increased the risk of impregnating a teenage girl by 80% (OR: 1.8; 95% CI: 1.3-2.4); sexual abuse with violence increased the risk by 110% (OR: 2.1; 95% CI: 1.2-3.4). We found a dose-response relationship between the number of types of exposures and the risk of impregnating a teenage girl; men who reported all 3 types of exposures were more than twice as likely to have been involved than those with no exposures (OR: 2.2; 95% CI: 1.4-3.5).

CONCLUSIONS

Boyhood exposure to physical or sexual abuse or to a battered mother is associated with an increased risk of involvement in a teen pregnancy-during both adolescence and adulthood. Because these exposures are common and interrelated, boys and adult men who have had these experiences should be identified via routine screening by pediatricians and other health care providers and counseled about sexual practices and contraception. Such efforts may prevent teen pregnancy and the intergenerational transmission of child abuse and domestic violence.

The relationship between sexual abuse and sexual risk among high school students: findings from the 1997 Massachusetts Youth Risk Behavior Survey

OBJECTIVE

To assess whether adolescents with a history of sexual abuse were more likely than those with no such history to engage in sexual risk behaviors.

METHODS

Data for this study were obtained through the 1997 Massachusetts Youth Risk Behavior Survey, a self-report questionnaire administered to a representative sample of 9th through 12th graders (N = 4,014) to assess a variety of adolescent risk behaviors. Only sexually experienced adolescents (n = 1,610; female = 779, male = 831) were included in the present study. Logistic regression models were constructed to examine the relationship of sexual abuse history to sexual risk behaviors. Adolescents were considered as having a history of sexual abuse if they reported ever having had sexual contact against their will.

RESULTS

Almost one-third of sexually experienced adolescent girls (30.2%) and one-tenth (9.3%) of adolescent boys reported a history of sexual abuse. After controlling for related demographics and risk behaviors, sexually abused female students were significantly more likely than those without such a history to have had earlier first coitus (OR = 2.2, 95%CI = 1.46-3.47), to have had three or more sex partners ever (OR = 2.5, 95%CI = 1.71-3.68), and to have been pregnant (OR = 1.9, 95%CI = 1.21-2.92). Sexually abused male students were significantly more likely than those without such a history to have ever had multiple partners (OR = 3.2, 95%CI = 1.56-6.57), to have had multiple sex partners in the past 3 months (OR = 2.9, 95%CI = 1.71-3.68), and to have engaged in sex resulting in pregnancy (OR = 3.4, 95%CI = 1.53-7.34).

CONCLUSION

Both adolescent girls and boys with a history of sexual abuse report greater sexual risk-taking than those without such a history. However, although sexual abuse is more prevalent among girls than boys, the impact of sexual abuse on sexual risk appears to be even greater for boys. Programs addressing both sexual abuse and sexual risk must be made available to all adolescents.