Risk and Protective Factors Associated With Lifetime Sexual Experience Among Rural, Reservation-Based American Indian Youth

Abstract

Early sexual initiation is a catalyst for sexually transmitted infection and unintended pregnancy. American Indian/Alaska Native (AI/AN) youth initiate sex prior to age 13 more often than other U.S. youth, contributing to current inequalities in sexual health. Identifying what factors were associated with lifetime sexual experience among AI/AN youth can inform the development of primary prevention programming to delay sexual initiation, alleviate the costs of early sexual activity, and improve sexual health outcomes in this population. We analyzed cross-sectional data from 267 AI youth ages 13-19, recruited from a rural, reservation-based community. We used multivariate logistic regression models to estimate associations between independent variables and lifetime sexual experience (vaginal and/or anal sex) across the following categories: sociodemographic, knowledge, attitudes/perceptions, beliefs, intentions, skills, behaviors, and theoretical constructs. The sample was 56.2% female, mean age 15.1 years (SD = 1.7), and 22.5% were sexually experienced. In our final model, condom use self-efficacy (attitude/perception factor) and intentions to remain abstinent until marriage (intention factor) were associated with lower odds of lifetime sexual experience. Age (sociodemographic factor), intention to have sex (intention factor), use of any contraception (behavior factor), and higher response efficacy (theoretical construct) were associated with lifetime sexual experience. Of these, intention to have sex was the strongest indicator. These results both corroborate and contrast with other research conducted among rural, reservation-based AI/AN youth. Our findings show programs targeting intentions may have the greatest impact among reservation-based AI youth, and justify program delivery stratified by age group in this setting.

Conversation, Condoms, and Contraception: How Does Communication With Sexual Partners Affect Safer Sexual Behaviors Among American Indian Youth?

“…Using an ecological model (McLeroy et al, 1988) to frame sexual health influences, there are significant opportunities to intervene and promote healthy sexual behavior. Previous research supports a myriad of influences on American Indian adolescents’ sexual risk behaviors across levels of the social–ecological model including parent–adolescent communication and relationships (Saftner, 2016), peer norms (Chambers et al, 2018; Saftner, Martyn, Momper, Loveland-Cherry, & Low, 2015), perceived impact of risky sexual behavior (Chambers et al, 2018), intention to have sex (Tingey et al, 2018), and condom use self-efficacy (Tingey et al, 2018).…”

Diné (Navajo) Female Perspectives on Mother–Daughter Cultural Assets Around the Transition to Womanhood: A Qualitative Study

“…In addition, our program can align with Hozhó teachings that reverberated throughout data by including holistic wellness goals. The development of life skills, healthy recreation, and goal setting are also established protective factors against substance use (Tingey et al, 2018).…”

“…With 574 federally recognized tribes throughout the United States, American Indian/Alaska Native (AIAN) people comprise 1.7% of the overall U.S. population (Department of Health and Human Services, 2021). AIAN youth and young adults ages 15–24 years have pervasive behavioral health inequities including early sexual initiation and early substance use—which share similar risk and protective factors and are inextricably linked (Tingey et al, 2018; Whitesell et al, 2014). These disparities were identified as areas of concern by the participating tribal communities because early substance use and early sexual initiation portend increased risk for sexually transmitted infections (STI), unintended teen pregnancy, and related health problems including substance abuse and disorder (Tingey et al, 2018; Whitesell et al, 2014).…”

Diné (Navajo) female perspectives on mother–daughter communication and cultural assets around the transition to womanhood: a cross-sectional survey

“…The dual challenge of early substance use and teenage pregnancy are two of the most critical areas of concern for American Indian and Alaska Native (AIAN) communities [ 1 – 3 ]. Adolescent substance use, in particular, has the potential to initiate adverse consequences throughout the life course in addition to unintended teen pregnancy, including: violence, injuries, sexually transmitted infections (STIs), physical or sexual assault, impaired adolescent brain development, suicide, and school dropout [ 1 , 4 – 9 ].…”