African-American adolescents residing in high-risk urban environments do use condoms: correlates and predictors of condom use among adolescents in public housing developments.

OBJECTIVE: African-American adolescents living in high-risk inner-city environments have been disproportionately affected by the epidemics of human immunodeficiency virus (HIV) and other sexually transmitted diseases. Understanding the factors that influence the use of condoms by adolescents is critical for developing effective behavioral interventions. The present study examined the demographic, psychosocial, and behavioral correlates of condom use among African-American adolescents residing in public housing developments in an HIV epicenter (San Francisco) and prospectively evaluated the stability of these significant cross-sectional variables to predict consistent condom use. DESIGN: A prospective study. SETTING: Two public housing developments in San Francisco. PARTICIPANTS: African-American adolescents and young adults between 12 and 21 years of age were recruited though street outreach and completed a theoretically derived research interview assessing HIV-related knowledge, attitudes, and behaviors. After a 6-month period, adolescents completed a follow-up interview similar to the baseline measure. Among adolescents reporting sexual activity in the 6 months before completing the baseline interview (n = 116), logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on consistent condom use. RESULTS: Adolescents who had high assertive self-efficacy to demand condom use (adjusted odds ratio [OR], 11), perceived peer norms as supporting condom use (OR, 4.2), had greater impulse control (OR, 3.7), were male (OR, 4.7), and were younger (OR, 2.9) were more likely to report consistent condom use. Frequency of sexual intercourse was inversely related to condom use; adolescents with higher numbers of sexual episodes were less likely to use condoms consistently. Prospective analyses identified the baseline level of condom use as the best predictor of condom use at the 6-month follow-up. Adolescents who were consistent condom users at baseline were 7.4 times as likely to be consistent condom users during the follow-up period. Of those adolescents changing their frequency of condom use during the follow-up interval, significantly more engaged in risky behavior; 33.3% changed from consistent to inconsistent condom use, whereas 20.6% changed from inconsistent to consistent use (OR, 1.6). CONCLUSIONS: The findings suggest that HIV prevention programs need to be implemented early, before high-risk behaviors are established and may be more difficult to modify.

Early drinking onset and its association with alcohol use and problem behavior in late adolescence.

OBJECTIVE: To examine the relationship between age of drinking onset and patterns of use, abuse of other substances, and the prevalence of other alcohol-related problems in a population of midwestern high school seniors. DESIGN: We analyzed self-report survey data on public school students' history of alcohol and other drug use and related problems from the Minnesota Student Survey conducted in 1989. The sample consisted of 2,650 male and female seniors, representing a 10% random sample of all white seniors in the study. RESULTS: The findings suggest that early onset of alcohol use (by age 12) is associated with subsequent abuse of alcohol and related problem behaviors in later adolescence, including alcohol-related violence, injuries, drinking and driving, and absenteeism from school or work, as well as increased risks for using other drugs. CONCLUSION: This paper identifies the preadolescent years from age 10 to 12 as a particularly vulnerable period for the development of early alcohol dependence and abuse. Delaying alcohol use onset to age 13 may significantly reduce the risk of severe alcohol abuse in later adolescence.

Childhood sexual abuse and coercive sex among school-based adolescents in a midwestern state.

PURPOSE: Childhood sexual abuse has been identified in several studies as a predictor of adult sexual aggression or sexual victimization. Aggression and victimization are defined in this study as coercive sex. To date, no study of a sample of high school adolescents has investigated the association between a self-reported history of childhood sexual abuse and adolescent coercive sex. METHOD: Findings from the present study are based on a 10% random sample of the white and all the African American and Native American 9th and 12th grade students of a Midwestern state who completed a state-wide anonymous survey of risk-taking behavior in 1989. RESULTS: The present study identified a 10% prevalence of sexual abuse. Females were four times more likely to report sexual abuse than males, while Native Americans and African Americans were approximately twice as likely as whites to report sexual abuse. Sexually abused adolescents were five times more likely to report any type of coercive sex with a friend or date than their nonabused peers. Specifically, compared to nonabused peers, sexually abused adolescents were twice as likely to report sexual aggression, and six times more likely to report sexual victimization and the co-occurrence of sexual aggression and victimization. CONCLUSIONS: Both by victimizing and being revictimized, sexually abused adolescents perpetuate their abusive experience. Adolescent health care providers should assess patients for sexually coercive behavior if they report childhood sexual abuse and assess adolescents who report current sexually coercive behavior for childhood sexual abuse.

Sexual communication is associated with condom use by sexually active incarcerated adolescents.

PURPOSE: Incarcerated adolescents are at increased risk for infection by sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). Moreover, condom use by this population is extremely low. Although interpersonal variables such as sexual communication have been found to be associated with condom use in other populations, few researchers have investigated this relationship among adolescents requiring detention in juvenile facilities. The present study investigated the relationship between communication about sexual history and incarcerated adolescents' condom use. METHODS: We used multivariate logistic regression techniques to analyze interview data from a predominantly Latino sample of 2,132 sexually active adolescents detained in Los Angeles County Juvenile Hall. RESULTS: Despite high numbers of lifetime sexual partners, a substantial majority of respondents (67%) reported that they never used condoms during sexual intercourse. Respondents who communicated with their sex partner(s) about each others' sexual history were significantly more likely to use condoms during sexual intercourse. Adolescents who reported that they knew someone with AIDS were also more likely to use condoms. CONCLUSIONS: Interventions designed to increase condom use among sexually active incarcerated adolescents should include a component addressing sexual communication practices. More research is needed on the ways in which adolescents learn to communicate about sex.

PIP: Approximately 25,000 adolescents are incarcerated per year in Los Angeles, California. Since only a very small proportion of this population uses or has used condoms during sexual intercourse, incarcerated adolescents are generally at increased risk for infection with sexually transmitted diseases (STDs), including HIV. The authors use multivariate logistic regression techniques on interview data collected over the period January 1991 -May 1992 from a sample of 2132 sexually active adolescents in Los Angeles County Juvenile Hall to investigate the relationship between communication about sexual history and incarcerated adolescents' condom use. The sample was comprised of 1815 males and 317 females; 50% Hispanic, 31% African-American, and 9% Caucasian; and 59% aged 12-16 years and 41% aged 17 and older. 53% had 7 or more vaginal sex partners in their lifetime, while 47% had 6 or fewer. 15% had 2 or more vaginal sex partners in the preceding two months. While 33% reported using a condom at least once, 67% reported never using condoms during sexual intercourse. Latinos were 2.5 times less likely than whites and African-Americans to report using condoms. Further, respondents who communicated with their sex partner(s) about each other's sex history were almost three times more likely to use condoms during sexual intercourse. Adolescents who reported that they knew someone with AIDS were almost twice as likely to report having used a condom during sexual intercourse. The authors conclude that interventions designed to increase condom use among sexually active incarcerated adolescents should include a component addressing sexual communication practices. More research on how adolescents learn to communicate about sex is also warranted.

The effects of child abuse and race on risk-taking in male adolescents.

This study explores the effects of abuse on the risk-taking behaviors of 2973 black and white adolescent males, 412 of whom were sexually or physically abused. Surveys on mental and physical health, risk-taking behaviors and attitudes, and family living were administered to 9th and 12th graders in an urban midwestern state. The surveys included questions on past history of sexual and physical abuse. More black than white males reported experiencing incest, extrafamilial sexual abuse, and physical abuse. As for outcome risk-taking behaviors, blacks were more likely to use illegal substances, run away, skip school, attempt suicide, force partners into sex, and commit violent acts; however, the racial effects decreased when abuse histories were taken into consideration. Whites were more likely to drink and drive, and to drink before having sex; abuse history did not decrease this racial effect. Abuse but not race was predictive of drinking and of having serious drinking problems. The results point to the importance of pediatricians, psychologists, and other healthcare workers, as well as those in the legal and criminal justice system screening for a history of abuse among adolescents who demonstrate these or other risk-taking behaviors.

Comparison of AIDS knowledge and HIV-related sexual risk behaviors among adolescents in low and high AIDS prevalence communities.

Data were collected from students attending high school in a rural, low acquired immunodeficiency syndrome (AIDS) prevalence community in Northern California, and compared with students in an inner-city AIDS epicenter (San Francisco). The findings demonstrate that rural adolescents have higher levels of human immunodeficiency virus (HIV) knowledge, especially about risk-reduction strategies. However, rural adolescents also report higher rates of HIV-related sexual risk behaviors. Rural adolescents may not perceive the personal salience of practicing HIV risk-reduction behaviors thus increasing their risk for exposure to sexually-transmitted diseases, including HIV infection. School-based HIV prevention programs developed for rural communities will need to enhance the personal salience of HIV for adolescents' and discourage their discounting of personal risk attributable to a lower prevalence of AIDS in the community. Physicians must become more actively involved in HIV prevention efforts by routinely assessing adolescent patient's sexual behavior and utilizing their clinical interaction to provide HIV education and promote the adoption of HIV risk-reduction behaviors.

Comparison of AIDS knowledge, attitudes, and behaviors among incarcerated adolescents and a public school sample in San Francisco.

Data collected from incarcerated youth (n = 113) and a public school sample (n = 802) demonstrate that both adolescent groups have a high level of AIDS knowledge. Incarcerated youth are less aware of HIV risk-reduction behaviors and report markedly higher rates of HIV risk behaviors. Incarcerated youth are at substantially increased risk of HIV infection relative to their school-based counterparts and should be a primary target of HIV prevention programs.