Differences by gender and sexual experience in adolescent sexual behavior: implications for education and HIV prevention.

Researchers examined individual characteristics and peer influences related to adolescents' sexual behavior, taking gender and sexual experience into account. As part of a larger, longitudinal study investigating youth health awareness, 8th, 9th, and 10th graders reported their intentions to engage in sexual activity and use condoms in the next year, the amount of pressure they felt to engage in sexual activity, and their perceptions about the number of their peers engaging in sexual activity. Findings suggest intentions to engage in sexual behavior and use condoms, feelings of pressure to have sex, and perceptions about the number of friends engaging in sexual intercourse differ by gender and sexual experience status. Implications of these findings for health and sexuality education, as well as HIV prevention programs targeted at adolescents, are discussed.

Psychological distress and substance use by adolescent mothers: associations with parenting attitudes and the quality of mother-child interaction.

This study examines associations between psychological distress and alcohol and drug use across the first five years of raising a child and parenting quality at child age six for 185 adolescent mothers. Overall, alcohol and other drug use in this sample was relatively low, but drug use was associated with more mother-reported unrealistic expectations of child behavior and more attributions of child intent to annoy parent by misbehaving. Maternal psychological distress was associated with maternal reports of negative control (yelling, pushing, spanking, etc.), and alcohol use moderated the association between psychological distress and negative control. At low levels of alcohol use, more maternal distress was associated with greater negative control; at higher levels of alcohol use, maternal distress was not related to negative control, but the absolute level of negative control was similar to that reported by more distressed mothers. Neither psychological distress nor alcohol and other drug use were related to maternal behavior during an interaction task. Overall, much stronger associations with parenting outcomes were found for an index of maternal vocabulary, compared with maternal psychological distress or maternal alcohol and other drug use.

The relative costs and benefits of telephone interviews versus self-administered diaries for daily data collection.

This article compares two methods of collecting daily data: self-administered diaries and telephone interviews. Study participants included 44 men and 56 women between the ages of 16 and 35 who participated in a larger study of drinking, drug use, and sexual activity. Participants were randomly assigned to either the written diary or the telephone interview conditions; question wording and format were identical in both conditions. Daily data were collected for a period of 8 weeks. Results indicate that although telephone interviews resulted in slightly more missed days of data collection, they generally yielded less item-level missing data, produced cleaner data and therefore were less costly to process, and were as palatable to participants as self-administered diaries. Except for reports of drinking and vegetable consumption, telephone and diary conditions did not differ in the amount of behavior reported; more drinking and vegetable consumption were reported with telephone interviews, however. Telephone interviews also imposed considerably higher overall personnel costs.

Children's beliefs about drinking.

This paper reports the results of a study in which age (grade level), racial/ethnic, and gender differences in beliefs and perceived norms about drinking were examined in a multi-ethnic urban sample of 4th through 7th grade children. Results showed that older children held beliefs and perceived norms that were more favorable toward drinking than younger children. The major difference between older and younger children lay in their differential estimates of the likelihood of certain consequences occurring and not in their evaluation of these consequences of drinking. Further, older children not only displayed less motivation to comply with their parents and greater motivation to comply with their peers, but they also perceived their parents, as well as their peers, as less disapproving of drinking than did younger children. There were few gender or race/ethnicity differences at these ages in children's beliefs and perceived norms about drinking.

Comparison of diary and retrospective measures for recording alcohol consumption and sexual activity.

This study examines issues in the measurement of HIV risk factors, using daily diaries to collect data on both alcohol use and sexual behavior. Seventy-nine adolescents and young adults recruited from an STD clinic and from a university campus were studied. Participants gave daily reports of their drinking, drug use, and sexual activities for 4 weeks. Respondents then completed a retrospective questionnaire asking about the frequencies of these behaviors during the preceding period. Diary reports of behavior were strongly correlated with retrospective reports. More frequent drinking was reported on the diary measure than the retrospective measure, and this discrepancy was larger for more frequent drinkers. Frequency of sexual activity was overreported on the retrospective measure only among adolescents. Errors in the measurement of alcohol use, sexual behavior, or their co-occurrence could affect estimations of the relationship of alcohol use to sexual behavior. The types of error inherent in these measures may differ, resulting in different tendencies toward over- or underreporting of alcohol use and sexual behavior, depending on frequency of the behavior and the characteristics of the subject population.

Beliefs about substance use among pregnant and parenting adolescents.

PIP: Although substance use among pregnant and parenting adolescents has serious health implications for both mother and infant, few studies have investigated the predictors of such behavior. The present study, based on the Theory of Reasoned Action, tracked substance use behavior, intentions, attitudes, perceived social norms, and beliefs from pregnancy to 12 months postpartum in a cohort of 255 US adolescents (mean age, 16 years). Documented was a pattern in which adolescent mothers engaged in low levels of cigarette, marijuana, and alcohol use during pregnancy, but resumed substance use in the first 6 postpartum months, with rates levelling off by 12 months postpartum. Attitudes and perceived social norms about cigarette, alcohol, and marijuana use became increasingly more favorable from pregnancy to 6 months postpartum, paralleling trends in use rates. Doctors were perceived as most opposed to substance use during and after pregnancy, while friends, boyfriends, and siblings were considered to be least opposed. In general, negative outcomes of substance use were viewed less negatively and as less likely after the baby was born. Consistent with the Theory of Reasoned Action, increases in substance use after delivery were accompanied by similar increases in intentions to use these substances, more favorable attitudes toward use, and less perceived disapproval of use. Adolescents' willingness to curtail substance use during pregnancy indicates a concern for the well-being of their infant. This study's findings suggest a need for educational programs that emphasize the need to avoid substance use after as well as during pregnancy.^ieng

Effects of a skill-based intervention to encourage condom use among high risk heterosexually active adolescents.

OBJECTIVES: In this article we describe the development and testing of three behavioral interventions to reduce the risk of contracting HIV/AIDS and other sexually transmitted diseases among heterosexually active adolescents. METHODS: The interventions include a comic book, a videotape, and a group skill training curriculum that emphasize skill development--for communicating and negotiating condom use with partners, in addition to providing basic information. Participants included 228 youths sampled in juvenile detention and 168 youths sampled from public health STD and other similar clinics. The samples included both young men and women, and were comprised of African American and European American adolescents, ages 14-19. RESULTS: Examination of the relative efficacy of the interventions at three and six months following intervention show very few differences among conditions, despite the fact that the interventions contained most of the elements that previously have been defined as essential for effective interventions. CONCLUSIONS: In the discussion, we consider possible reasons for this outcome and make recommendations for future research.

Drug use among adolescent mothers: prepregnancy to 18 months postpartum.

PURPOSE: Little is known about the substance use patterns of adolescent mothers, particularly in the postpartum period. This study provides descriptive, longitudinal data on the substance use behavior of a cohort of adolescent mothers. METHODS: A total of 241 pregnant adolescents, under 18 years old and planning to carry the pregnancy to term, completed the initial interview. Respondents were interviewed again at 1, 6, 12, and 18 months postpartum. The data reported here are based on the 229 respondents who completed all five interviews. RESULTS: Use of all substances decreased substantially during pregnancy, but increased steadily in the first 6 months postpartum. A similar pattern was observed for regular use of multiple substances. Regular use before and after the pregnancy, but not during it, was the most common pattern of substance use. CONCLUSIONS: The prevalence of substance use among adolescent mothers is significant. To capitalize on the large decreases in use during pregnancy, drug prevention programs for adolescent mothers should target the first 6 months postpartum.

PIP: To characterize patterns of legal and illicit drug use among pregnant and parenting adolescents, 241 unmarried US teens 17 years of age and younger were recruited from an urban, publicly funded prenatal clinic for a prospective study. Respondents were interviewed during pregnancy and at 1, 6, 12, and 18 months postpartum. 229 (95%) of these adolescents completed all five interviews. A substantial reduction in regular use of tobacco, alcohol, marijuana, and crack/cocaine occurred during pregnancy (e.g., 55% of respondents reported regular alcohol consumption before pregnancy, but only 4% admitted regular use during pregnancy); however, a steady increase in drug use occurred after delivery, especially in the first 6 months postpartum. 38.6% of respondents discontinued drug use during pregnancy, but resumed it in the postpartum period. Another 20.6% reported no use before, during, or after pregnancy. 16.7% initiated drug use in the postpartum period, while 14.5% were continuous users. These findings suggest a need for drug prevention interventions in the first few postpartum months aimed at capitalizing on young mothers' voluntary reductions in drug use during pregnancy. Such interventions could emphasize the findings that secondary cigarette smoke inhaled by children can increase their respiratory problems and alcohol passes to infants through breast milk. ¿

Misconceptions about AIDS among children who can identify the major routes of HIV transmission.

Described knowledge about HIV transmission among 1,048 third, fourth, fifth, and sixth graders from a multiethnic urban school district. Participants answered questions about behaviors leading to HIV transmission and about mechanisms of transmission. Children at all grade levels demonstrated a high level of recognition of the three primary routes of HIV transmission (through sex, through drug needle sharing, and in utero). However, children who knew about these routes also had many misconceptions about the mechanisms involved in acquiring HIV through these routes and about the ways HIV is not transmitted. Misconceptions decreased with grade and socioeconomic status (SES). Although there were no race/ethnicity differences in knowledge of actual routes and mechanisms of HIV transmission, there were more misconceptions about routes and mechanisms of HIV transmission among African American and Asian American children than among white children.

Beliefs about condoms and their association with intentions to use condoms among youths in detention.

PURPOSE: Youths in detention have been identified as a high-risk group for AIDS. To help inform AIDS-prevention efforts targeted for these youths, we surveyed youths in detention regarding their sexual behaviors, beliefs about condoms, intentions to use condoms, and actual condom use. We examined race and gender differences in these beliefs and behaviors, and we studied the relationship of these beliefs to condom-use intentions. METHODS: Questionnaires were administered to a sample of 201 youths in detention who were, on average, 16 years old. The sample was stratified on gender and race (African-American and white), with approximately equal numbers in each group. RESULTS: The results indicate that these youths had engaged in behaviors that put them at high risk of acquired immunodeficiency syndrome (AIDS) and other sexually transmitted diseases. Although they used condoms somewhat more consistently with casual partners than with their steady partners, the majority did not use condoms consistently with either partner type. Very few race or gender differences were found with regard to condom use, intentions to use condoms, or beliefs about the consequences of using condoms. Beliefs associated with intentions to use condoms with steady partners included protection against sexually transmitted diseases (STDs), and the beliefs that condoms reduce pleasure, are artificial, unromantic, and interrupt sex. In contrast, only the belief that condoms prevent pregnancy was related to intentions to use condoms with casual partners. CONCLUSION: The results suggest that interventions targeted at African-American and white males and females in detention need not differ greatly in content as long as they include the most salient concerns of each group; that interventions include content on the two protective benefits of condom use (pregnancy and STD prevention), as well as on how to minimize the perceived negative aspects of condom use; that they stress the need for condom use with steady as well as casual partners; and that they stress that anal intercourse is especially risky with regard to AIDS transmission.

PIP: The authors surveyed 201 teenagers of mean age 15.9 years in a large urban juvenile detention center in the Northwest US on their sex behaviors, beliefs about condoms, intentions to use condoms, and actual condom use. The group was comprised of 51 African American males, 50 African American females, 50 white males, and 50 white females. Aged 14-19, all had engaged in heterosexual intercourse during the previous three months. 66% had not finished high school and 78% were unemployed prior to incarceration. The average age of first intercourse was 13 years. 77% reported having had sex with five or more partners, 15% reported having had paid sex, at least 10% had sex with a needle user, and less than 4% reported having sex with a same-sex partner. 85% had a steady partner with whom they had had sex during the past three months. 16% used condoms every time with the partner, while more than 33% reported never using a condom with the partner. 18% reported having anal sex with a steady partner in the past three months, 10% of whom reported using a condom for each such act. 52% reported having had sex with a casual partner in the past three months, not including paid or paying partners. 55% of these youths reported using a condom during the most recent act of sexual intercourse with a casual partner. 13% of the 23% reporting having anal sex in the previous three months with a casual partner used a condom. Very little difference was seen according to race or gender with regard to condom use, intentions to use condoms, or belief about the consequences of using condoms. Beliefs associated with intentions to use condoms with steady partners included protection against sexually transmitted diseases (STD) and beliefs that condoms reduce pleasure, are artificial, unromantic, and interrupt sex. Only the belief that condoms prevent pregnancy was related to intentions to use condoms with casual partners. Pregnancy and STD prevention programs targeted to this population should take these findings into consideration.

Sexual risk behavior, knowledge, and condom use among adolescents in juvenile detention.

PIP: A study conducted among 119 adolescents incarcerated at a juvenile detention facility in Seattle, Washington, indicated that this population engages in behaviors that place it at high risk of sexually transmitted diseases, including human immunodeficiency virus. The subjects were 14-19 years of age; included in the sample were 30 White males, 30 Black males, 30 White females, and 29 Black females. The median age at first intercourse ranged from 11.8 years for Black males to 12.9 years among White males. Females averaged 5-10 sexual partners to date, while males averaged 11-25 partners. 30% of White females and 14% of Black subjects had been paid for sex, while 27% of White females, 13% of White males, and 10% of Black males and females had been sexually involved with an intravenous drug user. Less than a third reported condom use at last intercourse with a steady partner; condoms were used less frequently in anal than vaginal intercourse. On a scale in which 7 represented the most positive response, mean attitude toward condom use was 5.39 with a steady partner and 5,88 with a casual partner. The average condom knowledge score was 75.2%, but Whites were considerably more knowledgeable than their Black counterparts. Unexpectedly, knowledge was significantly negatively correlated with the perception that condoms are pleasant to use. Greater knowledge showed no association with frequency of condom use in the past three months or the intent to use condoms in the future, These findings suggest a need for interventions that challenge negative perceptions of condom use in this high-risk population.^ieng

Children's knowledge and beliefs about AIDS: qualitative data from focus group interviews.

Focus groups were used as a qualitative technique to elicit knowledge and attitudes of children in Grades 3 to 6 about acquired immune deficiency syndrome (AIDS). Twenty-seven small groups of children responded to open-ended questions about general AIDS knowledge; transmission, causation, consequences, and prevention of AIDS; emotional response to AIDS; and susceptibility. Results indicate that children have a high level of awareness about AIDS and correct knowledge about the modes of human immunodeficiency virus (HIV) transmission. They understand that AIDS is a serious illness that cannot be cured and know the main ways of preventing HIV infection. Participants had more difficulty explaining causation and greatly overestimated the number of people their age and in high school that might be infected. They also had difficulty applying accurate knowledge to the hypothetical situation of encountering a child with AIDS in school. Misconceptions about AIDS exist at all grade levels, but appear more prevalent in lower grades, whereas increased complexity seems to characterize responses of older children. Recommendations for health educators are made.

Substance use and other factors associated with risky sexual behavior among pregnant adolescents.

A study of the relationship between substance use and risky sexual behavior was conducted among 241 unmarried pregnant adolescents aged 17 and younger who lived in a metropolitan area in the Northwest. The respondents had comparable or higher lifetime use rates for all substances than did women in a national sample of high school seniors, even though the pregnant adolescents were younger. Ninety-four percent had used alcohol, 78% marijuana, 30% cocaine and 30% stimulants, compared with 92%, 48%, 14% and 23%, respectively, among women in the national sample. Among the pregnant adolescents, 84% had had more than one sexual partner, 39% had had a sexually transmitted disease and 60% had used contraceptives during less than half of their sexual encounters. At the bivariate level, use of cigarettes and alcohol in general and use of alcohol and drugs during sex were positively associated with risky sexual behavior. However, when other characteristics associated with risky sexual behavior--family bonding, parental monitoring, commitment to conventional values, peer associations, self-esteem and delinquent activities--were included in the multivariate analysis, the effect of substance use disappeared.

PIP: Among adolescents, rates of premarital intercourse have increased, age at first intercourse has decreased, and couples are delaying marriage to a greater extent since the 1970s. These factors effectively combine to increase the risk of female adolescents becoming pregnant and/or infected with sexually transmitted diseases (STD). As might be expected, birth and STD rates have also increased dramatically over the past two decades, confirming that youths continue to engage in unprotected sexual activity. Pregnant adolescents deserve particular attention from prevention interventions, for they show tangible evidence of a history of unprotected sexual activity. This study specifically considers risky sex behavior within a target group of 241 urban, unmarried pregnant adolescents aged 17 and younger and the behavioral relationship with substance use. Compared to women from a national sample of high school seniors, these pregnant women had higher or comparable lifetime use rates for all substances. 94% had used alcohol, 78% marijuana, 30% cocaine, and 30% stimulants compared to 92%, 48% 14%, and 23%, respectively, among women in the national sample. 84% of pregnant adolescents had had more than one sexual partner, 39% had had an STD, and 60% had used contraception in less than half their sexual encounters. Further, 70% ran away from home before pregnancy, 62% were suspended or expelled from school, and 24% served time in jail/detention. Cigarettes and alcohol in general, and alcohol and drug use during sex, were positively associated with risky sexual behavior. The effect of substance use, however, disappeared when controlling through multivariate analysis for family bonding, parental monitoring, commitment to conventional values, peer associations, self-esteem, and delinquent activities. These results suggest that both substance use and increased risk of pregnancy in the study sample may be associated with a syndrome of problem behaviors and life circumstances. While more research is needed, it appears that the messages "just say no" and "always use condoms" will be inadequate to bring about positive change.

Factors related to substance use by pregnant, school-age adolescents.

This study provides information on substance use among pregnant adolescents, and examines social influence, intrapersonal, and environmental factors associated with substance use during pregnancy in adolescence. The sample consists of premaritally pregnant adolescents (N = 241), who were interviewed as part of a longitudinal study of patterns of drug use among pregnant and parenting school-age adolescents. The findings indicate that, although the sample demonstrated a high rate of prepregnancy substance use, a significant drop in use occurred during pregnancy. Logistic regression analysis indicated that perceived harm of using substances while pregnant, best friend's substance use, boyfriend's substance use, and school status were related to substance use during pregnancy, even after controlling for the effects of prepregnancy substance use. The findings have implications for substance use prevention and intervention programs for pregnant and parenting adolescents.

Ethnic differences in family factors related to early drug initiation.

The literature on family predictors of substance use for the general population is reviewed and compared to findings for three specific ethnic groups: black, white and Asian Americans. Rates of substance use initiation are examined in a sample of 919 urban 5th-grade students. Ethnic differences on measures of family predictors are examined and significant ethnic differences are found on several of these factors. Finally, separate regressions for black, white and Asian American youths of family factors on the variety of substances initiated examine ethnic similarities and differences in predictors. The results demonstrate significant differences by ethnicity in family management practices, involvement in family activity, sibling deviance, parental disapproval of children's drinking and family structure. The regression equations identified unique as well as common predictors of the variety of substances initiated by the end of 5th grade. Implications of the results are discussed.

Race differences in antisocial behaviors and attitudes and early initiation of substance use.

This article examines racial differences in self-reported delinquency, school trouble, antisocial attitudes, and toughness and in teacher-rated aggressive and inattentive behaviors among fifth grade black, white, and Asian American subjects. Also examined are the relationships of these variables to substance initiation within each racial group. Controlling for socio-economic status, racial groups differed from one another in self-reported delinquency, school trouble and toughness, and in teacher-rated aggressiveness and inattention. Antisocial behavior and attitudes were stronger predictors of substance initiation for Asian American than for black and white children. For white children both self-reported and teacher-rated behavior were significantly related to substance initiation. For black children, only self-reported antisocial behavior, and for Asian American children only self-reported delinquent behavior and attitudes predicted substance initiation. Implications for prevention and research are discussed.

Factors related to cigarette smoking during adolescent pregnancy.

Previous research suggests that maternal smoking during pregnancy remains prevalent, particularly among adolescents. However, little is known about the factors related to smoking during adolescent pregnancy. The goal of the present study is to identify intrapersonal, familial, and peer factors that are related to smoking during adolescent pregnancy, and to determine the relative degree to which they affect this behavior. Interviews were conducted with 241 unmarried pregnant adolescents who planned to carry their pregnancies to term. Consistent with previous studies, 27% of the respondents reported daily smoking during pregnancy, and whites reported higher rates of use than members of other racial groups. Smoking during adolescent pregnancy was related to intrapersonal, familial, and peer factors. The results of a regression analysis suggest that perceived parental disapproval of smoking during pregnancy, friends' cigarette use, and race play a particularly important role in this behavior. The implications of these findings for preventive programs are discussed.

Structure of problem behaviors in preadolescence.

Earlier research suggests that diverse adolescent problem behaviors, such as substance use, school problems, early sexual intercourse, and delinquency, reflect a single underlying dimension of behavior. Data from an ongoing longitudinal study were used to examine this issue in a previously unexamined sample (N = 426) of preadolescent sixth-grade youth. Ss included boys and girls from diverse socioeconomic and racial/ethnic backgrounds, whose average ages were 11 and 12. By using confirmatory factor analyses to test competing models, multiple factor structures were detected, suggesting that earlier findings supporting a single factor conceptualization may not be generalizable to this age group. Implications of the finding that problem behaviors may be more differentiated in late childhood than in adolescence are discussed.