THE ROLE OF PERCEIVED POWERLESSNESS IN SEXUAL RISK TAKING AMONG URBAN YOUTH

Background: Sexually transmitted infections (STIs) disproportionately affect youth and especially those who are socially disadvantaged. Generalized perceived powerlessness (PP) is an underexplored psychosocial construct that may influence sexual risk behaviors among youth. However, there are a dearth of studies that employ demographically diverse, longitudinal samples through the use of appropriate statistical methods. Objectives: We first aimed to validate a novel PP scale through psychometric testing. We then sought to determine whether PP predicts a range of sexual risk behaviors among youth and assessed for mediating and moderating effects in this relationship. Methods: This thesis was based on secondary analysis of a longitudinal random household sample of youth (ages 16 to 25) residing in Baltimore, MD. We conducted exploratory and confirmatory factor analyses to assess the scale’s psychometric properties and to determine the scale’s invariance across gender, race, and SES. We used multiple logistic regression to determine whether PP predicted four sexual risk behaviors (i.e., multiple partners, inconsistent condom use, condomless sex at last sex, and concurrency). Finally, we used structural equation modeling (SEM) and multi-group SEM to determine mediating and moderating factors in the longitudinal relationship between PP and sexual risk behaviors. Results: The PP scale was found to be valid and reliable. Results of factor analyses indicated that the scale was multidimensional on the first order and unidimensional on the second order. Results of multiple logistic regression showed that PP at baseline predicted sexual risk behaviors at six-month follow-up: multiple partners (aOR: 2.13, p=0.019), condomless sex at last sex (aOR: 1.70, p¬=0.049), and inconsistent condom use (aOR: 1.76, p=0.042). Results of SEM demonstrated that the need for sexual validation mediated the relationship between PP and condomless sex among black youth (indirect effect: β=0.246; p=0.052) and concurrency among white youth (indirect effect: β=0.189; p=0.044). The mediated relationship from PP to the need for sexual validation to concurrency among white youth was moderated by SES. Conclusions: Generalized PP is an important distal, psychosocial driver that influences sexual risk among urban youth. Future research should continue to assess for mediating and moderating effects for development of tailored STI interventions for youth