Violence victimization of young men in heterosexual relationships: does alcohol outlet density influence outcomes?

This study examined whether alcohol outlet density is associated with male physical and sexual victimization by a female partner. Data were from the National Longitudinal Study of Adolescent Health (Add Health). A total of 3,179 young adult men identified a current heterosexual relationship and had complete intimate partner violence (IPV) victimization data. Almost 16% of this sample reported being the victim of physical only IPV in their relationship over the previous 12 months; an additional 6.4% were victims of sexual only or sexual and physical IPV. Multivariate analyses indicated high alcohol outlet density was associated with greater odds of experiencing physical IPV only (odds ratio [OR] = 2.07). Heavy drinkers experienced increased odds of physical and sexual IPV victimization. Alcohol outlet density should be addressed in prevention efforts.

Parental supervision of teenage drivers in a graduated licensing system.

OBJECTIVES: Most states now have lengthy learner periods for young, beginning drivers as part of their graduated driver licensing (GDL) systems. Although parents play a vital role during the learner stage of GDL by supervising driving practice, virtually nothing is known about the nature and quality of parental supervision. The objectives of this study were to investigate parents' supervisory behavior and parent-teen relationships during the learner stage of graduated licensing and to evaluate two approaches for assisting parents in supervising their teenager's early driving experience. METHODS: Families of teenagers applying for a learner permit received either a booklet describing highly structured practice sessions for beginning drivers, a series of "tip sheets" offering more generalized guidance, or no special materials. Questionnaires were sent separately to parents and teenagers three to six months after teenagers obtained their permit. RESULTS: Of 1,190 participating families, 653 parents (55%) and 609 teenagers (51%) responded. Both parents and teenagers perceived parents as supportive and helpful during driving sessions. Parents often demonstrated positive behaviors, such as complimenting their teenager and pointing out possible hazards; they also exhibited less desirable behaviors, such as raising their voice, but these were less frequent. A majority of parents (71%) and teenagers (52%) reported that they enjoyed spending this time together. About four months after obtaining a permit, most parents believed their teenager did not yet have enough experience and was not ready to drive unsupervised. Although the reported behaviors are encouraging, within-family agreement was low on most items. Finally, efforts to assist parents proved unsuccessful. Although parents thought the booklet and tip sheets were helpful, most used these materials only in a general way. CONCLUSIONS: The extended learning experience required by GDL programs is a positive experience for many families. However, finding a method for helping parents achieve maximum benefits during this process will be challenging. The results also suggest that current requirements in the learner phase of most state GDL systems (six months; 30-50 hours) may be inadequate to ensure that teenagers obtain a sufficient amount of experience to begin driving safely on their own.

Which comes first in adolescence--sex and drugs or depression?

BACKGROUND: The notion that adolescents "self-medicate" depression with substance use and sexual behaviors is widespread, but the temporal ordering of depression and these risk behaviors is not clear. This study tests whether gender-specific patterns of substance use and sexual behavior precede and predict depression or vice versa. METHODS: Data are from the National Longitudinal Study of Adolescent Health, weighted to produce population estimates. The sample includes 13,491 youth, grades 7 to 11, interviewed in 1995 and again 1 year later. Multivariate logistic regression analyses, conducted in 2004, tested temporal ordering, controlling for covariates. The main outcome measures were depression, as measured by a modified Center for Epidemiological Studies-Depression Scale (CES-D), and three behavior patterns: (1) abstaining from sexual intercourse and drug use, (2) experimental behavior patterns, and (3) high-risk behavior patterns. RESULTS: Overall, sex and drug behavior predicted an increased likelihood of depression, but depression did not predict behavior. Among girls, both experimental and high-risk behavior patterns predicted depression. Among boys, only high-risk behavior patterns increased the odds of later depression. Depression did not predict behavior in boys, or experimental behavior in girls; but it decreased the odds of high-risk behavior among abstaining girls (RRR = 0.14) and increased the odds of high-risk behavior (RRR = 2.68) among girls already experimenting with substance use. CONCLUSIONS: Engaging in sex and drug behaviors places adolescents, and especially girls, at risk for future depression. Future research is needed to better understand the mechanisms of the relationship between adolescent behavior and depression, and to determine whether interventions to prevent or stop risky behaviors will also reduce the risk of later depression.

Adolescent depression and suicide risk: association with sex and drug behavior.

BACKGROUND: Depression is common among adolescents, and suicide is the third leading cause of death among 15- to 19-year-olds. Although both health problems have been associated with drug use and early sexual intercourse, the relationship has not been systematically studied in a nationally representative sample. METHODS: Sixteen patterns of combined sex and drug use behaviors were obtained using cluster analysis of responses to Wave I of the National Longitudinal Study of Adolescent Health conducted from September 1994 through December 1995. Bivariate and multivariate analyses tested correlations between behavior patterns and current depression, serious suicidal ideation, and previous suicide attempt, controlling for gender, race/ethnicity, Hispanic ethnicity, family structure, and parent education. RESULTS: Compared to youth who abstain from risk behaviors, involvement in any drinking, smoking, and/or sexual activity was associated with significantly increased odds of depression, suicidal ideation, and suicide attempts. Odds ratios were highest among youth who engaged in illegal drug use. There were few differences between boys and girls who abstain from sex and drug behaviors. Girls were less likely than boys to engage in high-risk behaviors, but those who did tended to be more vulnerable to depression, suicidal ideation, and suicide attempt. CONCLUSIONS: Teens engaging in risk behaviors are at increased odds for depression, suicidal ideation, and suicide attempts. Although causal direction has not been established, involvement in any sex or drug use is cause for concern, and should be a clinical indication for mental health screening for girls; both boys and girls should be screened if engaging in any marijuana or illegal drug use.

Implications of racial and gender differences in patterns of adolescent risk behavior for HIV and other sexually transmitted diseases.

CONTEXT: Sexual and substance use behaviors covary in adolescence. Prevalence of HIV and other sexually transmitted diseases (STDs) differs according to race and gender, yet few studies have systematically investigated risk behavior patterns by subgroup, particularly with nationally representative data. METHODS: A priori considerations and K-means cluster analysis were used to group 13,998 non-Hispanic black and white participants in the National Longitudinal Study of Adolescent Health, Wave 1, according to self-reported substance use and sexual behavior. Multinomial logit analyses examined racial and gender differences by cluster. RESULTS: Among 16 clusters, the two defined by the lowest risk behaviors (sexual abstinence and little or no substance use) comprised 47% of adolescents; fewer than 1% in these groups reported ever having received an STD diagnosis. The next largest cluster-characterized by sexual activity (on average, with one lifetime partner) and infrequent substance use-contained 15% of participants but nearly one-third of adolescent with STDs. Blacks were more likely than whites to be in this group. Black males also were more likely than white males to be in three small clusters characterized by high-risk sexual behaviors (i.e., having had sex with a male or with at least 14 partners, or for drugs or money). Black females generally were the least likely to be in high-risk behavior clusters but the most likely to report STDs. CONCLUSIONS: Adolescents' risk behavior patterns vary by race and gender, and do not necessarily correlate with their STD prevalence. Further investigation of adolescents' partners and sexual networks is needed.

Prevalence of partner violence in same-sex romantic and sexual relationships in a national sample of adolescents.

PURPOSE: To present the first national prevalence estimates of psychological and physical intimate partner violence between adolescents in same-sex relationships. METHODS: Analyses focus on 117 adolescents aged 12-21 years (50% female) from Wave II of the National Longitudinal Study of Adolescent Health who reported exclusively same-sex romantic or sexual relationships in the 18 months before interview. Items from the Conflict Tactics Scale were used to measure partner violence victimization. Data analysis included computation of prevalence estimates and a logistic regression analysis to assess associations between sociodemographic characteristics and violence victimization. RESULTS: Almost one-quarter of adolescents with same-sex romantic or sexual partners reported some type of partner violence victimization; about 1 in 10 reported physical victimization. Significant sex differences were found (OR = .29, CI = 0.08, 1.00), with males being less likely than females to report "any violence." Of six other sociodemographic characteristics examined, importance of religion (OR = .27, CI = 0.07-1.07) and school size (OR = .32, CI = 0.09-1.11) were associated with victimization at the p < .10 level. Adolescents who reported that religion was important to them and adolescents who attended larger schools were at lower risk of "any violence." CONCLUSIONS: As with opposite-sex relationships, psychological and minor physical violence victimization is common among adolescents involved in same-sex intimate relationships. Males reporting exclusively same-sex relationships were less likely than females to report experiencing the violence behaviors examined.

Sexually active students' willingness to use school-based health centers for reproductive health care services in North Carolina.

OBJECTIVE: School-based health centers (SBHCs) in North Carolina offer limited reproductive health care services. We investigate sexually active students' willingness to seek these services at SBHCs if available and predictors of willingness to seek services. METHODS: Cross-sectional survey of 949 sexually experienced students in 2 middle and 5 high schools in North Carolina in 1994. Bivariate and multivariate analyses tested the influence of sociodemographic characteristics, risk of pregnancy/sexually transmitted infections (STIs), and past health care utilization on willingness to use SBHCs for sexuality-related services. RESULTS: Participants were 52% female, 52% black, and median age at first coitus was 13.0 years. Many (49%) had sex at least once a month. Most (52%) reported inconsistent contraception use. One-fifth (18%) of females had been pregnant; 10% of males reported getting a partner pregnant. Seventy-five percent had used SBHCs. Most reported they would use SBHCs for information to protect against pregnancy and STIs (58%), pregnancy testing (51%), and birth control (48%) if available. Females were more likely than males to report they would use these services (adjusted odds ratio = 3.4, 95% confidence interval = 1.9-6.7), especially those receiving free lunch (adjusted odds ratio = 2.9, 95% confidence interval = 1.2-6.8]) and those with inconsistent use of contraception. We found no association between past health care and willingness to use SBHC services. CONCLUSIONS: Most sexually experienced students report they would use their SBHC for reproductive/STI services if they were available. Absence of these services in SBHCs represents a missed opportunity to provide health care to adolescents who are at substantial risk of pregnancy and STIs.

Perpetration of intimate partner violence by young adult males: the association with alcohol outlet density and drinking behavior.

OBJECTIVE: This study examined the association between alcohol outlet density and male to female intimate partner violence (IPV). METHOD: Data were analyzed from a national probability sample of males who reported a current heterosexual relationship (N=3194). Multinomial logistic regression was used to examine the likelihood of having perpetrated IPV. RESULTS: High alcohol outlet density was associated with having perpetrated physical only IPV (odds ratio [OR]=2.51; 95% confidence interval [CI]: 1.21-5.20). Outlet density was not associated with greater odds of sexual IPV perpetration. CONCLUSIONS: Alcohol outlet density was found to be associated with perpetration of physical IPV. Developing environmental strategies with respect to alcohol outlets could potentially reduce perpetration of male-to-female physical IPV.

Alcohol Outlet Density and Young Women's Perpetration of Violence Toward Male Intimate Partners.

This paper examines the relationships between alcohol outlet density, alcohol use, and perpetration of intimate partner violence (IPV) among young adult women in the US. Data were from Wave III of the National Longitudinal Study of Adolescent Health (Add Health; N = 4,430 in present analyses). Multinomial logistic regression was used to examine occurrence of past year IPV perpetration toward a male partner based on tract-level on-premise and off-premise alcohol outlet density, controlling for individuals' demographic, alcohol use, and childhood abuse characteristics and neighborhood socio-demographic factors. Higher off-premise alcohol outlet density was found to be associated with young women's perpetration of physical only IPV, controlling for individual-level and ecological factors. Alcohol use had an independent association with IPV perpetration but was not a mediator of the outlet density-IPV relationship. Findings suggest that considering alcohol-related environmental factors may help efforts aimed at preventing young women's use of physical violence toward partners.

Relationships among alcohol outlet density, alcohol use, and intimate partner violence victimization among young women in the United States.

Greater access to alcohol has been widely found to be associated with many negative outcomes including violence perpetration. This study examines the relationship between alcohol outlet density, alcohol use, and intimate partner violence (IPV) victimization among young women in the United States. A direct association between alcohol outlet density in one's neighborhood and the likelihood of IPV victimization was examined. Data were from Wave III of the National Longitudinal Study of Adolescent Health (Add Health), which followed a nationally representative sample of adolescents into adulthood. Participants were young adult females age 18 to 26 at Wave III. Of the 4,571 female respondents who reported a current heterosexual relationship and had IPV data, 13.2% reported having been the victim of physical violence only and 6.5% experienced sexual only or physical and sexual violence in the relationship during the past year. In the regression models tested, there was no significant direct association between neighborhood alcohol outlet density and IPV victimization nor was there an association between outlet density and drinking behaviors, thus eliminating the possibility of an indirect association. Results of fully adjusted models indicate females who drank heavily, whether infrequently or frequently, were at significant risk for experiencing sexual only IPV or sexual and physical IPV. Asians and Native Americans were at significantly greater odds of experiencing sexual only or sexual and physical IPV compared with non-Hispanic Whites, while non-Hispanic Blacks were at significantly greater odds for physical only IPV. We conclude that a continuous measure of alcohol outlet density was not associated with IPV in models controlling for individual and other neighborhood characteristics. Young women who drink heavily, whether infrequently or frequently, have greater odds of experiencing sexual only or sexual and physical compared to abstainers. Similar to previous study findings, young women living with or married to their partner were at far greater risk of experiencing physical only and/or sexual only or sexual and physical IPV. The study adds to the growing body of literature that examines how community characteristics such as outlet density influence the likelihood of IPV.

The Association Between Same-Sex Romantic Attractions and Relationships and Running Away Among a Nationally Representative Sample of Adolescents.

Sexual minorities are overrepresented among the runaway population, and sexual minority runaways are at greater risk for adverse health outcomes than their heterosexual peers. Our knowledge of this vulnerable population has been restricted by methodological limitations of existing studies. This study used a nationally representative sample of U.S. adolescents to explore the association between same-sex romantic attractions and relationships and run away behavior over a two year period. Results indicated that although the association between sexual orientation and running away appears to be partially attenuated by other risk factors for running away, there remains a significant positive association between same-sex romantic attractions and running away. Furthermore, youth with no romantic or sexual relationships were significantly less likely to report running away compared to youth with only opposite-sex relationships. These associations remained significant even after controlling for other risk factors.

Bacterial STDs and perceived risk among sexual minority young adults.

CONTEXT: Most sexual health interventions focus on heterosexual sexual risk behavior. Health practitioners face a lack of information about the sexual health of sexual minority young adults (aged 18-26). METHODS: Three indicators of sexual minority status (identity, behavior and romantic attractions) were assessed in 10,986 young adults who participated in Wave 3 of the National Longitudinal Study of Adolescent Health (2001-2002). Logistic regression analyses examined associations between these indicators and individuals' perceived risk for STDs and actual infection with STDs. Data from the 1,154 respondents who had current or recent bacterial STDs were investigated further to determine whether they had underestimated their risk. RESULTS: Outcomes varied by sexual minority status indicator and by sex. Bisexual females had significantly higher odds of STDs than heterosexual females (odds ratios, 1.4), and females attracted to both sexes had significantly higher odds of STDs than females attracted only to males (1.8). In contrast, none of the sexual minority status indicators predicted STDs for males. Among respondents who had an STD, females who reported only same-sex sexual relationships were more likely to believe they were at very low risk for STDs than were females reporting only opposite-sex sexual relationships (17.2); homosexual females had a higher likelihood of this outcome than heterosexual females (19.7). CONCLUSIONS: Health practitioners need to assist sexual minority young adults, particularly females, in under-standing their risk for STDs and in taking safer-sex precautions.

Racial and gender differences in adolescent sexual attitudes and longitudinal associations with coital debut.

PURPOSE: Delay of sexual debut is an important strategy in reducing the risk of negative adolescent health outcomes. Race and gender are known to be related to sexual behavior and outcomes, but little is known about how these characteristics affect sexual attitudes. This article examines differences in coital and pregnancy attitudes by gender and race, the influence of attitudes on transition to first coitus for each subgroup, and implications for prevention. METHODS: Data are from Waves I and II of the National Longitudinal Study of Adolescent Health, limited to Non-Hispanic White and African American adolescents (n = 6652). We factor analyzed attitude items, and examined effects of race, gender, and their interaction, controlling for sexual debut at Wave I. We regressed sexual debut longitudinally by attitudes for virgins (n = 3281) separately for each subgroup, controlling for covariates. RESULTS: Compared with boys, girls perceived less positive benefits from sex and more shame and guilt with sex, but had fewer negative perceptions about pregnancy. Compared with White boys, African American boys perceived less shame and guilt about sex; girls did not differ by race. Higher perceived benefits of sex increased the likelihood of sexual debut among African American girls. Perceived shame and guilt lowered the likelihood for White boys and girls. CONCLUSIONS: Reinforcing protective attitudes through gender and race-specific programs may delay sexual intercourse, but more research is needed. More research is also needed to determine whether there is an optimal coital age after which negative health outcomes are attenuated, and whether this differs by gender and race.

Sexual behavior and drug use among Asian and Latino adolescents: association with immigrant status.

This paper contributes new evidence on the association between immigrant status and health by describing and attempting to explain patterns of co-occurring sex and drug use behaviors among Asian and Latino adolescents in the United States. Nine patterns of sex and drug use behaviors were identified from a cluster analysis of data from 3,924 Asian and Latino youth (grades 7-12) who participated in the National Longitudinal Study of Adolescent Health (Add Health). The relationship between immigrant status and risk cluster membership was evaluated with multinomial logistic regression. Compared to foreign-born youth, U.S. born Asian and Latino adolescents were more likely to engage in sex and drug risk behaviors. Family and residential characteristics associated with immigrant status partly accounted for this finding. The results indicate that among Asian and Latino adolescents, assimilation to U.S. risk behavior norms occurs rapidly and is evident by the second generation.

Who runs? A demographic profile of runaway youth in the United States.

Prevention and treatment programs for runaways have been hindered by an inadequate population profile. Using Add Health data to determine 12-month prevalence and demographic predictors of running away, we found that over 6% of youths reported running away. Running was predicted by biological gender, age, region, urbanicity, and family structure.

Adolescent predictors of emerging adult sexual patterns.

PURPOSE: This study estimates the percentages of young adults who fall into three groups based on the context of sexual transition: (1) those who had vaginal intercourse before marriage (Premaritals), (2) those who postponed sex until after marriage (Postponers), and (3) those who have never had vaginal intercourse (Virgins). The second purpose is to determine adolescent biopsychosocial factors that predict membership in these adult groups. METHODS: Analyses are based on 11,407 respondents ages 18-27 years who participated in Waves I and III of the National Longitudinal Study of Adolescent Health. Adolescent indicators reflecting sociodemographic, biosocial, experiential, and contextual factors were used to predict young adult sexual status using multinomial logistic regression models. RESULTS: About 8% of the sample were virgins and 2% were virgins until marriage. Almost 90% had sex before marriage (Premaritals--referent group). Most predictors of status were similar for males and females. Compared with Premaritals, Virgins were younger, non-Black, not advanced in physical maturity relative to peers in adolescence, had higher body mass indexes, were more religious, and perceived parental disapproval of sex during adolescence. Postponers were also more religious than Premaritals but were older. Female Postponers were non-Black and perceived parental disapproval of sex during adolescence. Male Postponers were less likely to have same-gender attractions or no sexual attractions. CONCLUSIONS: Findings document premarital sexual activity as the almost universal sexual trajectory into young adulthood for these cohorts and underscore the roles of biosocial factors and conventional institutions in emerging sexual patterns.