Trajectories of Sexual Risk Behavior in Adolescence and the Transition to Adulthood

Marc A. Zimmerman

School of Public Health

University of Michigan

Stevenson Fergus

Queens University

Stevenson Fergus

Jose Bauermeister

Sex Risk in Adolescence

CDC report 50% African-American adolescent females with STI

Limited negotiation skills

Limited risk assessment

Sex Risk in Young Adulthood

Risk behavior follows from adolescence

Sexual activity high

Rarely studied longitudinally

Many university studies

Developmental Transitions

Few studies of the transition from adolescence to young adulthood

Vital Developmental TransitionNew responsibilitiesIntimacy changes More independence

Correlates of Sex Risk

AODMixed findingsMostly cross-sectional Decreases during adult transition

Parental supportPositive resource in youths’ livesMother vs. fathers

Research Limitations to Date

Mostly cross sectional or few waves of data

Non-diverse samples

Few include adult transitional period

Few study risk and promotive behaviors in a longitudinal design

Flint Adolescent Study

8 years of data

Started in 1994

NIDA funded

Guided by Resiliency Theory

Sample

Four public schools in Flint

850 9th graders (680 African-American)

50% females

GPA of 3.0 or lower in 8th grade Not diagnosed as emotionally or

developmentally disabled

Procedure

50-60 minute face-to-face interviews

Pencil-and-paper questionnaire for

sensitive information such as substance use

Privacy in school or community setting

Initial Findings

Sex risk accelerates during adolescence

Sex risk slows down and levels off during adult transition (but still high)

African-American youth start out riskier

White youth accelerate and pass A-A youth

(Fergus, Zimmerman, Caldwell (2007). AJPH)

Initial Findings

A-A Males

White Females

Analytic Strategy

HLM growth curve analysis

Condom use trajectories

Substance use (level 2)

Mother & Father Support (level 2)

Control Variables

Dependent Variable

Frequency of condom use past year5-point scale (1 = almost never; 5=always)

55% indicated always

Recoded to dichotomous variable• 0 = no sex/always used condom• 1 = used condoms less than always

Level 2 Predictors

Substance Use Frequency last month Alcohol use Binge drinking (5+ drinks in a row) Marijuana use

Mother & Father Support 5 items 5-point Scale (1 = not true; 5 = very true) Separate measures

Control Variables

Father residence (wave 2)

Serious relationship (waves 5-8)

Age of sexual debut

Socioeconomic status (prestige score)

8th grade GPA (school records)

Ethnicity and sex

Waven

Sex Without a Condom

Mean Age (SD)

1 795 25.3% 14.9 (.6)

2 772 27.1% 15.9 (.6)

3 731 34.6% 16.8 (.6)

4 732 46.9% 17.8 (.6)

5 557 63.3% 20.1 (.7)

6 620 57.3% 21.0 (.6)

7 549 63.1% 22.1 (.7)

8 536 56.0% 23.1 (.7)

Total 5292 44.6% 18.5 (2.9)

Results

Results

0.0

0.1

0.2

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0.5

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1.0

15 16 17 18 19 20 21 22 23

Age

Pro

bab

ility

of

Sex

Wit

ho

ut

a C

on

do

mProbability of Sex Without a Condom by Age

Results:Control Variables (level 2) Steeper risk trajectory

Lower GPAEarlier debut

Higher Odds of low condom useSerious relationship in young adulthood

No effects (level or slope)SESFather absence from household

Results:Control Variables (level 2)

Sex DifferencesFemales less condom use at 18 yrs old

Ethnicity DifferencesSteeper slope for risk among whitesWhites less condom use at 18 years old

Results:Independent Variables More substance use

Less condom use

More mother support More condom use at age 18 No effects on linear trend

More father support More condom use at age 18 Mean levels fastest linear growth

ResultsSubstance Use

0.0

0.1

0.2

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0.5

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15 16 17 18 19 20 21 22 23

Age

Pro

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f S

ex W

ith

ou

t a

Co

nd

om

Low

Medium

High

High Substance Use

ResultsMother Support

0.0

0.1

0.2

0.3

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0.5

0.6

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1.0

15 16 17 18 19 20 21 22 23

Age

Pro

bab

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f S

ex W

ith

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t a

Co

nd

om

Low

Medium

High

No contact

Low Mother Support

No Contact

Father Support

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

15 16 17 18 19 20 21 22 23

Age

Pro

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y o

f S

ex W

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on

do

m

Low

Medium

High

No contact

Results

Moderate Father Support

High Father Support

Discussion

Duh, AOD associated with steeper risk

Duh, parents matter

Hmmm, Medium support from father & no contact with mother greatest risk

Phew, results not explained by control variables

Limitations

Generalizability

Romantic relationships in H.S. not assessed

Single item dependent variable

Implications

Role of parental support for prevention

Integrate sex risk prevention in AOD programs

Focus on H.S. to limit acceleration

Prevention during adult transition

Future Directions

Assess STI

Assess (serial) monogamy in H.S.

Study ethnicity and gender interactions

Include multi-item sex risk index

Examine protective effects of parent support

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