Adolescent overweight, social relationships and the transition to first sex: gender and racial variations

'Teenagers are into perfect-looking things': Dating, sexual attitudes and experiences of adolescents with severe obesity

BACKGROUND

This qualitative study explored the dating and sexual health attitudes and behaviours among adolescents with severe obesity (body mass index [BMI] > 99th%) attending a multidisciplinary weight-management programme.

METHODS

Semi-structured interviews were conducted with 19 participants (12 females, 7 males; M_age  = 16.8) and analysed through reflective thematic analysis.

RESULTS

Participants described polarized dating behaviours in which dating and sexual relationships were either avoided due to this not being a priority, lack of time, feared rejection, and/or body size as perceived barrier or in contrast, when approached, involved greater sexual risk.

CONCLUSIONS

These findings have numerous implications including the need for increased education on the romantic developmental challenges faced by adolescents with severe obesity, the importance of ongoing screening of high-risk sexual behaviours and body dissatisfaction from frontline care providers, and the ability to support referrals to psychosocial services when appropriate.

Racial/Ethnic Disparities in Female Sexual Health from Adolescence to Young Adulthood: How Adolescent Characteristics Matter?

STUDY OBJECTIVE

To describe sexual initiation patterns in female adolescents and examine their association with adolescent characteristics and racial disparities in adverse sexual health across adolescence into early adulthood.

DESIGN

A prospective, longitudinal, observational study from adolescence to adulthood.

SETTING

Nationally representative, the National Longitudinal Study of Adolescent to Adult Health data, in the range of 24-32 years old at final assessment.

PARTICIPANTS

Data from 43,577 US women from 1994 to 2008.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Adolescent sex-related characteristics at the individual-, family-, and school peer-level were assessed, and multiple sex partners, sexually transmitted infections (STIs)/HIV, and intimate partner violence (IPV) were longitudinally tracked. The sexual initiation pattern and its longitudinal association with sexual health were analyzed using latent class analysis and mixed effects Poisson regression models.

RESULTS

Of the 43,577 subjects, the sexual initiation patterns were determined as normative (n = 28,712, 65.9%), late (n = 10,799, 24.8%), and early but unempowered (n = 4,066, 9.3%). The highest rate of the early-unempowered group was shown in Hispanic individuals (1,054/7,307 = 14.4%); they were more likely to be depressed, unsatisfied with their bodies, receiving welfare, and have less educated/permissive parents to their sexual initiation than others. The late group had a higher body mass index and greater satisfaction with their bodies. The highest number of STIs/HIV and IPV victimization was shown in non-Hispanic Black (NHB) and Hispanic individuals, respectively. However, NHB females' higher number of STIs/HIV was shown in the late/normative groups, not in the early-unempowered group. Among Hispanic females, adolescent sexual initiation patterns were not directly associated with their frequent IPV victimization.

CONCLUSION

NHB females' higher STI/HIV in late/normative groups and Hispanic females' frequent IPV victimization regardless of their sexual initiation patterns might indicate that racial/ethnic disparities in female sexual health was not directly determined by adolescent risk behaviors.

Sexual Health Determinants of Normal Weight, Overweight, and Obese Sexual Minority Men

BACKGROUND

With the growing recognition of overweight and obesity as significant, international public health concerns, the body of research investigating the relationship between body mass index (BMI), sexual health, and sexual functioning in sexual minority men is still scarce.

OBJECTIVE

The purpose of this study is to assess sexual health determinants (sexual behavior and sexual functioning) in relation to normal weight, overweight, and obesity among gay and bisexual men.

METHODS AND MATERIALS

The survey included four categories of questions/measurements, encompassing sociodemographic information, protected/unprotected sexual behaviors, sexual functioning, and BMI. The survey was conducted online, and recruitment consisted of online notifications (emails and electronic messages) and advertisements sent to LGBT community organizations, mailing lists, and social networks.

RESULTS

The study sample was composed of 741 gay and bisexual men, ranging in age from 21 to 75 years (M age = 43.30, SDage = 11.37); 62.5% of men self-identified as gay and 37.5% as bisexual. Prevalence of normal weight was 50.3%, of overweight, 33.3%, and of obesity, 16.4%. Participants with overweight and obesity showed a lower frequency of anal receptive sex without condoms when scompared to participants with normal weight. Hierarchical multiple regression analysis to assess the effects of BMI on sexual health showed that being younger in age, self-identifying as gay, being in a relationship, having longer penises, adopting insertive position in sex, and being normal weight were significant predictors of anal receptive sex without condoms, explaining 24.2% of the total variance. Yet, BMI was not predictive of sexual functioning.

CONCLUSION

These findings highlight the importance of including BMI in sexual behavior models of sexual minority men to better understand BMI's role in influencing sexual risk.

Adolescent characteristics and incidence of pre-malignant disease and invasive tumors of the cervix

INTRODUCTION

Pre-malignant cervical disease and invasive cervical cancer present a significant global health burden with respect to morbidity and mortality, mostly in low- and middle-income countries. Human papillomavirus (HPV) infection typically manifests for the first time in adolescence. We aimed to identify adolescent sociodemographic and anthropometric characteristics associated with subsequent risk for pre-malignant cervical disease and cervical cancer, in a country that offers free screening and HPV vaccines.

METHODS

This historical cohort study included 969 123 Israeli women examined and anthropometrically measured at age 17 years between January 1967 and December 2011. Data on pre-malignant disease and invasive cervical tumors were obtained from the national cancer registry by linkage. We excluded non-Jewish minorities (a total of 25 472 women) and orthodox/ultraorthodox Jewish women since these populations are not required by law to serve in the military, as well as women with a pre-examination diagnosis of cancer. Cox proportional hazards regression models were applied per each lesion type, adjusted for origin, measured body mass index, height, education, dwelling type, birth year, and age at examination.

RESULTS

In total, 5094 and 859 incident pre-malignant cervical disease and cervical cancer cases, respectively, were diagnosed during a median follow-up of 17.6 years. Risk for both lesions was origin-dependent, with higher incidence in women of North-African origin (HR (pre-malignant cervical disease) 1.22, 95% CI 1.04 to 1.42; HR (cervical cancer) 1.87, 95% CI 1.30 to 2.69) compared with European origin. Height, lower education, and later birth year were associated with higher pre-malignant cervical disease and cervical cancer risk also. Adolescent overweight (HR 0.81, 95% CI 0.74 to 0.90) and obesity (HR 0.56, 95% CI 0.43 to 0.71) status were associated with reduced pre-malignant cervical disease but not cervical cancer incidence, as did urban (vs rural) residence.

DISCUSSION

Ethnic background, tall stature, and education were associated with pre-malignant cervical disease and cervical cancer incidence, while adolescent overweight and obesity were inversely associated with only pre-malignant cervical disease. Despite free screening and HPV vaccines, these findings suggest that there is still a need for appropriate safe sex and screening education in adolescence.

Sexual Risk Behaviors during Adolescence: Associations with Childhood and Adolescent BMI

Research examining associations between unhealthy weight and sexual risk behaviors derives primarily from cross-sectional studies conducted at varying ages during adolescence. The present study examined longitudinal associations between adolescent sexual risk behaviors and Body Mass Index (BMI), the latter measured prospectively from childhood through adolescence. Data were drawn from an 8095 individuals between the ages of 14 and 19 at last assessment, including 1768 Hispanic (52% female), 2659 non-Hispanic Black (Black; 50% female), and 3668 non-Hispanic, non-Black (predominantly White; 49% female). Childhood BMI predicted increased sexual risk-taking during adolescence for Black and White youth, and increases in BMI predicted increased sexual risk-taking for White females and Black males. The findings highlight differential patterns of association between BMI and sexual risk behaviors for Hispanic, Black, and White females and males with implications for prevention discussed.

Associations between Childhood Weight Status and Timing of First Sex in an Ethnically Diverse Sample

BACKGROUND

Most research linking weight status and timing of first sexual intercourse is cross-sectional in design, with few longitudinal analyses published to date. We examined associations between childhood weight status and subsequent onset of first sexual intercourse within a survival analytic framework, testing for differences among Hispanic, black, and white females and males.

METHODS

Data were drawn from 6379 child respondents of the 1979 National Longitudinal Survey of Youth aged 13 and older at last assessment. Cox proportional hazards regression models were estimated predicting age at first sexual intercourse from weight status during childhood without and with adjustment for correlated risk factors. Analyses were conducted separately by sex and race/ethnicity, with interactions among weight status, respondent sex, and race/ethnicity modeled in subsidiary analyses.

RESULTS

Overweight status predicted earlier sexual intercourse among Hispanic females, whereas obese status predicted delayed sexual intercourse among white males, both relative to peers of the same race/ethnicity with healthy weight. Underweight status predicted delayed sexual intercourse among Hispanic males relative to peers with healthy weight. Significant differences by sex and race/ethnicity were observed in tests of interactions.

CONCLUSIONS

Findings document associations between childhood weight status and subsequent onset of first sexual intercourse, especially among Hispanic females and males and white males. Together, results highlight respondent sex and race/ethnicity as potential moderators and also unique risk for Hispanic females who were overweight as children, and who may benefit from early screening and education to delay sexual initiation to reduce risk of early unplanned pregnancy and sexually transmitted infections.

Objective and Perceived Weight: Associations with Risky Adolescent Sexual Behavior

CONTEXT

Studies have shown that obesity is associated with increased sexual risk-taking, particularly among adolescent females, but the relationships between obesity, perceived weight and sexual risk behaviors are poorly understood.

METHODS

Integrative data analysis was performed that combined baseline data from the 1994-1995 National Longitudinal Study of Adolescent Health (from 17,606 respondents in grades 7-12) and the 1997 National Longitudinal Survey of Youth (from 7,752 respondents aged 12-16). Using six sexual behaviors measured in both data sets (age at first intercourse, various measures of contraceptive use and number of partners), cluster analysis was conducted that identified five distinct behavior clusters. Multivariate ordinal logistic regression analysis examined associations between adolescents' weight status (categorized as underweight, normal-weight, overweight or obese) and weight perception and their cluster membership.

RESULTS

Among males, being underweight, rather than normal-weight, was negatively associated with membership in increasingly risky clusters (odds ratio, 0.5), as was the perception of being overweight, as opposed to about the right weight (0.8). However, being overweight was positively associated with males' membership in increasingly risky clusters (1.3). Among females, being obese, rather than normal-weight, was negatively correlated with membership in increasingly risky clusters (0.8), while the perception of being overweight was positively correlated with such membership (1.1).

CONCLUSIONS

Both objective and subjective assessments of weight are associated with the clustering of risky sexual behaviors among adolescents, and these behavioral patterns differ by gender.

Extreme Weight-Control Behaviors and Suicide Risk Among High School Students

BACKGROUND

Suicide is the third leading cause of death for people ages 15-19. Research has established an association across numerous risk factors and suicide, including depression, substance abuse, bullying victimization, and feelings of alienation. However, the connection between disordered eating as manifested in extreme weight-control behaviors (EWCB), and suicidal thoughts, ideation, and attempts among adolescents is less understood. Given the prevalence of adolescent suicide, this investigation examined associations between EWCB and suicide risk among high school students.

METHODS

Data were collected from a convenience sample of 4178 students in grades 9-12 attending 5 public high schools using the Youth Risk Behavior Survey (YRBS) questionnaire. Logistic regressions were used to estimate associations between EWCB and suicide controlling for grade level and race, reported separately by sex.

RESULTS

Students who reported seriously considering suicide had higher odds of exhibiting all 3 EWCBs [adjusted odds ratio (AOR)(male) = 3.0 (confidence interval (CI): 1.4, 6.5); AOR(female) = 4.5 (CI: 2.5, 8.3)]. Moreover, students who reported they made plans about suicide were also more likely to exhibit all EWCBs [AOR(male) = 3.7 (CI: 1.7, 7.9); AOR(female) = 4.2 (CI: 2.3, 7.7)].

CONCLUSIONS

EWCBs were significantly associated with suicide risk, furthering the evidence suggesting a link between disordered eating and suicide. Findings demonstrated the need for school health services that address disordered eating in the effort to reduce adolescent suicide.

Weight perceptions, misperceptions, and dating violence victimization among U.S. adolescents

Dating violence is a major public health issue among youth. Overweight/obese adolescents experience peer victimization and discrimination and may be at increased risk of dating violence victimization. Furthermore, given the stigma associated with overweight/obesity, perceptions and misperceptions of overweight may be more important than actual weight status for dating violence victimization. This study examines the association of three weight indices (weight status, perceived weight, and weight perception accuracy) with psychological and physical dating violence victimization. The 2010 baseline survey of the 7-year NEXT Generation Health Study used a three-stage stratified clustered sampling design to select a nationally representative sample of U.S. 10th-grade students (n = 1,983). Participants who have had a boyfriend/girlfriend reported dating violence victimization and perceived weight. Weight status was computed from measured height/weight. Weight perception accuracy (accurate/underestimate/overestimate) was calculated by comparing weight status and perceived weight. Gender-stratified regressions examined the association of weight indices and dating violence victimization. Racial/ethnic differences were also examined. The association of weight indices with dating violence victimization significantly differed by gender. Overall, among boys, no associations were observed. Among girls, weight status was not associated with dating violence victimization, nor with number of dating violence victimization acts; however, perceived weight and weight perception accuracy were significantly associated with dating violence victimization, type of victimization, and number of victimization acts. Post hoc analyses revealed significant racial/ethnic differences. White girls who perceive themselves (accurately or not) to be overweight, and Hispanic girls who are overweight, may be at increased risk of dating violence victimization. These findings suggest a targeted approach to dating violence victimization prevention.

Correlates of adolescent and young adult sexual initiation patterns

CONTEXT

Identifying adolescent characteristics associated with different patterns of sexual initiation is critical to promoting healthy sexual development.

METHODS

Patterns of sexual initiation were examined among 12,378 respondents to Waves 1 (1994-1995) and 4 (2008) of the National Longitudinal Study of Adolescent Health. Multinomial logistic regression explored associations between adolescent characteristics and membership in five latent classes capturing the timing, sequence, pace and variety of sexual initiation patterns.

RESULTS

Age and indicators of greater psychosocial conventionality were associated with membership in the atypical "postponers" class (characterized by postponement of oral, vaginal and anal sexual activity until early adulthood), although patterns of associations varied by gender. For example, compared with males who attended religious services at least once a week, males who never attended religious services were more likely to appear in the vaginal initiators/multiple behaviors class (characterized by initiation of vaginal sex first and then initiation of another behavior after at least one year), rather than in the postponers class (relative risk ratio, 2.5). Compared with women who prayed at least once a day, those who never prayed were more likely to be in the vaginal initiators/single behavior class (whose members typically engaged in only one type of behavior), rather than in the postponers class (2.0).

CONCLUSIONS

Individuals who are more adherent, and presumably more committed, to the attitudes, values and expectations of conventional society are more likely than others to delay multiple types of sexual activity until well beyond the norm for their peers.