Sexually transmitted infections in U.S. adolescents : an ecosocial perspective

Includes bibliographical references (p. 44-48)Nearly half of all the new sexually transmitted infections in the U.S. occur among adolescents. Traditionally, epidemiology has focused on changing individual behaviors to prevent STI's but years of research have proven that this is not the only solution. This study examined the association between ecosocial factors and sexually transmitted infections among U.S. adolescent men and women (aged 18 to 26) that have had vaginal intercourse by using data from Wave III of the National Adolescent Health Survey. This study also investigated the association between exposure to childhood/societal violence and individual sexual risk behaviors among these adolescent men and women. All analyses were stratified by gender and 2 models were created (one examining STI's as the outcome and the other examining behaviors as the outcome of interest). In the first model, the univariate associations show that neglect and physical abuse were found to be significantly associated with STI's for females but not for males. Sexual abuse was significant for both genders but males had a higher unadjusted OR in comparison to females. Results from the final multivariate logistic regression model demonstrate that among males, all interpersonal and social variables were overwhelmed by individual behaviors when examining STI's as the outcome. Transactional sex, number of lifetime partners, condom use, and race/ethnicity were found to be significant. Among females, number of lifetime partners, condom use, race/ethnicity, and physical abuse were all found to be significantly associated with STI's (p-value <.05). In the second model, the univariate analysis examined four different behaviors (sexual debut, lifetime partners, transactional sex, condom use) and childhood/societal violence variables (neglect, physical abuse, sexual abuse, direct/indirect violence). Transactional sex was selected to be analyzed in logistic regression. The final multivariate model shows that: females had higher odds of engaging in transactional sex if they were exposed to indirect societal violence, exposure to sexual abuse was a significant predictor of transactional sex practices only among males, and exposure to childhood neglect was significant for both genders. This study showed the importance of a broader social perspective in the analysis of STI's among adolescents. Results from this study confirm that ecosocial variables affect individual behaviors and it is possible to decrease the STI burden by positively changing interpersonal factors. This study calls for further research to understand the complex ecosocial mechanisms that lead to STI's among adolescents