Tracing the Roots of Early Sexual Debut Among Adolescents in Psychiatric Care

Abstract

Objective: To identify the most important social and personal characteristics related to early sexual debut among troubled teenagers. Method:One hundred ninety-eight youths aged 12-19 years were recruited from outpatient mental health clinics and completed self-reports and interviews about their age of sexual debut; family, peer, and partner relationships (e.g., parental hostile control, negative peer influence, need for intimacy); and personal characteristics (e.g., achievement motivation, externalizing problems). Broad-band (externalizing, internalizing) and narrow-band (depression/anxiety, delinquency) psychopathology was assessed with the Youth Self-Report and Child Behavior Checklist.Results: Optimal Data Analysis was used to generate a classification tree model to identify variables associated with whether or not youths initiated oral, vaginal, and/or anal sexual activity before or after age 14. Three social context variables (parental hostile control, negative and positive peer influence) and one personal characteristic (externalizing problems) correctly classified 87.4% of teenagers as initiating sexual activity at ≤14 or >14 years of age. Conclusions:Parental behavior and peer influence were the most important variables associated with the timing of sexual debut. Results support a social-personal framework for understanding sexual risk-taking among adolescents in psychiatric care, and the data offer relatively strong evidence that specific factors could be used to identify troubled teens at risk for early sexual debut. Keywords adolescents; sexual debut; social-personal context; psychiatric careIt has been 20 years since the first case of acquired immunodeficiency syndrome (AIDS) was diagnosed, and despite efforts to curb the spread of human immunodeficiency virus (HIV), rates of infection are rising among adolescents. Young people account for 25% of new sexually transmitted diseases (STDs) reported annually, and the number of HIV-infected youths doubles every 14 months (Centers for Disease Control and Prevention [CDC], 1998[CDC], , 2000a. Sexual activity is the primary mechanism of HIV transmission among teens (DiClemente, 1996;Pequagnat and Szapocznik, 2000), with 57% of males and 49% of females infected through sexual contact, but only 8% of males and 11% of females infected through intravenous drug use (CDC, 2000a). Teenagers are initiating sex at earlier ages (CDC, 2000a) NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript debut is associated with higher HIV exposure because it is linked to more frequent sexual intercourse, more lifetime STDs, less consistent contraceptive use, and more sexual partners (Brooks-Gunn and Paikoff, 1993; CDC, 1992;Durbin et al., 1993;Miller et al., 1999). Some youths are at greater risk than others. Teens in psychiatric care, for example, engage in higher rates of sexual risk-taking than their same-age peers (Brown et al., 1997;Donenberg et al., 2001); they initiate sex at earlier ages and report high rates of sex without a condom, sex w...

Applying a Cognitive-Behavioral Model of HIV Risk to Youths in Psychiatric Care

“…Consistent with earlier reports (Brown, Danovsky, et al, 1997;Donenberg, Bryant, Emerson, Wilson, & Pasch, 2003), teens reported high rates of sexual behavior; 40% reported ever having vaginal, anal, and/or oral sex. Youths reported a range from 0 to 5 sexual partners in the past 3 months (M = .48; SD = .90).…”

“…Psychological characteristics (e.g., low self-esteem, poor affect regulation, fear of rejection, need for intimacy, poor impulse control) may play a larger role in determining risk behavior for these youths than factors like information and motivation. Hence, in addition to cognitive-behavioral mechanisms, sexual risk taking among youths in psychiatric care may be explained more fully by social and personal factors such as parental monitoring, parental permissiveness and control, parental directiveness, peer influence, and concerns about relationship intimacy (Donenberg et al, 2002;Donenberg et al, 2003). Donenberg et al (2001) found evidence for these important factors.…”

Do Thai parents discuss sex and AIDS with young adolescents? A qualitative study

“…Effective parent-child communication about sex is positively associated with delayed sexual initiation, as well as condom use Adu-Mireku, 2003;Lieberman, 2006;Atienzo et al, 2009). This influence on adolescent sexual development and sexual socialization indicates that parents thus play an important role in the prevention of risky sexual behavior among their children (Perrino et al, 2000) and the promotion of adolescent sexual health (Donenberg et al, 2003).…”

Does substance use moderate the effects of parents and peers on risky sexual behaviour?

“…Parental involvement and low-risk contexts are perhaps especially important for troubled youths to avoid health-compromising situations. Effective parental monitoring and positive peer influences (Donenberg et al, 2003) can play critical roles in reducing exposure to risky situations that require skills yet to develop in troubled teens. Findings from this study underscore the importance of substance use above and beyond the impact of peers and parents in HIV/AIDS risk, highlighting the importance of substance use as an additional target of HIV prevention programs for this population.…”