Gender differences in sexual risk behaviours and sexually transmissible infections among adolescents in mental health treatment
Puja Seth A B G * , Delia L. Lang A B , Ralph J. DiClemente A B , Nikia D. Braxton A , Richard A. Crosby C , Larry K. Brown D E , Wendy Hadley D E and Geri R. Donenberg F
+ Author Affiliations
- Author Affiliations
A Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
B Emory Center for AIDS Research, Social and Behavioral Sciences Core, Atlanta, GA 30322, USA.
C Department of Health Behavior, College of Public Health, University of Kentucky, Lexington, KY 40379, USA.
D Bradley/Hasbro Children’s Research Center, Rhode Island Hospital, Providence, RI 02903, USA.
E Alpert Medical School, Brown University, Providence, RI 02903, USA.
F Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60606, USA.
G Corresponding author. Email: pseth@cdc.gov
Sexual Health 9(3) 240-246 https://doi.org/10.1071/SH10098
Submitted: 19 August 2010 Accepted: 19 July 2011 Published: 19 December 2011
Abstract
Background: Adolescents with a history of psychiatric disorder(s) are particularly vulnerable to contracting sexually transmissible infections (STIs) as a result of psychological and emotional states associated with higher rates of risky sexual behaviour. The present study examined gender differences in sexual risk behaviours and STI among adolescents in mental health treatment. Methods: Three hundred and seventy nine sexually active adolescents, aged 13–18 years, from a larger multisite study, who received mental health treatment during the past year, completed an audio computer-assisted self interview assessing sociodemographics, psychiatric symptomatology and HIV/STI risk behaviours, and provided urine specimens tested for STI. Results: After controlling for covariates, multivariate logistic regression models indicated that female adolescents were more likely to have had an HIV test (adjusted odds ratio (AOR) = 3.2, P = 0.0001), obtain their HIV test results (AOR = 2.9, P = 0.03), refuse sex out of fear for STI acquisition (AOR = 1.7, P = 0.04), or avoid a situation that might lead to sex (AOR = 2.4, P = 0.001), and were less likely to have a casual sex partner (AOR = 0.40, P = 0.002). Additionally, females were more likely to report inconsistent condom use (AOR = 2.60, P = 0.001) and have a STI (AOR = 9.1, P = 0.0001) than their male counterparts. Conclusions: Female adolescents receiving mental health treatment were more than nine times as likely to have an STI and more likely to use condoms inconsistently. The standard of care for mental health practice for adolescents should include referrals for STI screening and treatment as well as assessment and discussion of risky sexual behaviours as part of the treatment plan when indicated. Effective programs should address gender-specific communication and behavioural skills.
Additional keywords: risky sexual behaviour.
References
[1] Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36 6–10.| Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000.Crossref | GoogleScholarGoogle Scholar |
[2] Torian L, Chen M, Rhodes P, Hall I. HIV surveillance – United States, 1981–2008. MMWR Morb Mortal Wkly Rep 2011; 60 689–93.
[3] Brown LK, Danovsky MB, Lourie K, DiClemente RJ, Ponton LE. Adolescents with psychiatric disorders and the risk of HIV. J Am Acad Child Adolesc Psychiatry 1997; 36 1609–17.
| 1:STN:280:DyaK1c%2Fls12mtQ%3D%3D&md5=70d5c12271058407c330804be082f0a3CAS |
[4] Brown LK, Hadley W, Stewart A, Lescano C, Whiteley L, Donenberg G, et al Psychiatric disorders and sexual risk among adolescents in mental health treatment. J Consult Clin Psychol 2010; 78 590–7.
| Psychiatric disorders and sexual risk among adolescents in mental health treatment.Crossref | GoogleScholarGoogle Scholar |
[5] Halifors D, Iritani B, Miller W, Bauer D. Sexual and drug behavior patterns and HIV/STD racial disparities: the need for new directions. Am J Public Health 2007; 97 1–8.
[6] Abrantes AM, Strong DR, Ramsey SE, Kazura AN, Brown RA. HIV-risk behaviors among psychiatrically hospitalized adolescents with and without comorbid SUD. J Dual Diagn 2006; 2 85–100.
| HIV-risk behaviors among psychiatrically hospitalized adolescents with and without comorbid SUD.Crossref | GoogleScholarGoogle Scholar |
[7] Donenberg GR, Emerson E, Bryant FB, Wilson H, Weber-Shifrin E. Understanding AIDS-risk behavior among adolescents in psychiatric care: links to psychopathology and peer relationships. J Am Acad Child Adolesc Psychiatry 2001; 40 642–53.
| Understanding AIDS-risk behavior among adolescents in psychiatric care: links to psychopathology and peer relationships.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mzhslymuw%3D%3D&md5=4d9f187ff8f3a8cd5ff20d3338aa981cCAS |
[8] Beck AT. Cognitive therapy: basics and beyond. New York: Guilford Press; 1995.
[9] Beck AT. Cognitive therapy and emotional disorders. New York: International Universities Press; 1976.
[10] Sales JM, Spitalnick JS, Crittenden CP, DiClemente RJ. Depression and sexual risk-taking in adolescents. In: Columbus F, editor. Sexual risk behaviors. Hauppauge, NY: Nova Science Publishers, Inc; 2009.
[11] DiClemente RJ, Ponton LE. HIV-related risk behaviors among psychiatrically hospitalized adolescents and school-based adolescents. Am J Psychiatry 1993; 150 324–5.
| 1:STN:280:DyaK3s7jsFaktQ%3D%3D&md5=41f0c8caa329da1314cbea43cbf8d9feCAS |
[12] Valois RF, Bryant ES, Rivard JC, Hinkle KT. Sexual risk-taking behaviors among adolescents with severe emotional disturbance. J Child Fam Stud 1997; 6 409–19.
| Sexual risk-taking behaviors among adolescents with severe emotional disturbance.Crossref | GoogleScholarGoogle Scholar |
[13] Ramrakha S, Caspi A, Dickson N, Moffitt T, Paul C. Psychiatric disorders and risky sexual behavior in young adulthood: cross sectional study in birth cohort. BMJ 2000; 321 263–6.
| Psychiatric disorders and risky sexual behavior in young adulthood: cross sectional study in birth cohort.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvhvVSgtA%3D%3D&md5=9f991ed713bcd77768a45923d0a81449CAS |
[14] Seth P, Raiji PT, DiClemente RJ, Wingood GM, Rose E. Psychological distress as a correlate of a biologically-confirmed STI, risky sexual practices, self-efficacy, and communication with male sex partners in African-American female adolescents. Psychol Health Med 2009; 14 291–300.
| Psychological distress as a correlate of a biologically-confirmed STI, risky sexual practices, self-efficacy, and communication with male sex partners in African-American female adolescents.Crossref | GoogleScholarGoogle Scholar |
[15] Seth P, Patel SN, Sales JM, DiClemente RJ, Wingood GM, Rose E. The impact of depressive symptomatology on risky sexual behavior and sexual communication among African American female adolescents. Psychol Health Med 2011; 16 346–56.
| The impact of depressive symptomatology on risky sexual behavior and sexual communication among African American female adolescents.Crossref | GoogleScholarGoogle Scholar |
[16] Connell RW. Gender and power. Standford: Standford University Press; 1987.
[17] Wingood GM, DiClemente RJ. Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Educ Behav 2000; 27 539–65.
| Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvlt1Ontw%3D%3D&md5=093c2f7d3c75edf2d73751e401aa04beCAS |
[18] Hader SL, Smith DK, Moore JS, Holmberg SD. HIV infection in women in the United States: status at the millennium. JAMA 2001; 285 1186–92.
| HIV infection in women in the United States: status at the millennium.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7msVKmsg%3D%3D&md5=76d3f4afcdac013ef3a8826b2cbed8f7CAS |
[19] Suarez-Al-Adam M, Raffaelli M, O’Leary A. Influence of abuse and partner hypermasculinity on the sexual behavior of Latinas. AIDS Educ Prev 2000; 12 263–74.
| 1:STN:280:DC%2BD3M%2Fjt1Wltg%3D%3D&md5=d9f83d04e262fe9fe2974c1c47fde187CAS |
[20] European Study Group on Heterosexual Transmission of HIV Comparison of female to male and male to female transmission of HIV in 563 stable couples. BMJ 1992; 304 809–13.
| Comparison of female to male and male to female transmission of HIV in 563 stable couples.Crossref | GoogleScholarGoogle Scholar |
[21] Padian NS, Shiboski SC, Jewell NP. Female-to-male transmission of human immunodeficiency virus. JAMA 1991; 266 1664–7.
| Female-to-male transmission of human immunodeficiency virus.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3MzlvFeqtA%3D%3D&md5=f05aacebee85cd99f7f9bd33f2ae8c5fCAS |
[22] Spiegel HML, Futterman DC. Adolescents and HIV: prevention and clinical care. Curr HIV/AIDS Rep 2009; 6 100–7.
| Adolescents and HIV: prevention and clinical care.Crossref | GoogleScholarGoogle Scholar |
[23] Raiford JL, DiClemente RJ, Wingood GM. Effects of fear of abuse and possible STI acquisition on the sexual behavior of young African American women. Am J Public Health 2009; 99 1067–71.
| Effects of fear of abuse and possible STI acquisition on the sexual behavior of young African American women.Crossref | GoogleScholarGoogle Scholar |
[24] Murphy DA, Rotheram-Borus MJ, Reid HM. Adolescent gender differences in HIV-related sexual risk acts, social-cognitive factors and behavioral skills. J Adolesc 1998; 21 197–208.
| Adolescent gender differences in HIV-related sexual risk acts, social-cognitive factors and behavioral skills.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3mtVOrtQ%3D%3D&md5=79b2cbabb3bcdabf793120bafcb7cfc4CAS |
[25] Centers for Disease Control and Prevention. Sexually transmitted disease surveillance, 2007. Atlanta: US Department of Health and Human Services; 2008.
[26] DiClemente RJ, Crittenden CP, Rose E, Sales JM, Wingood GM, Crosby RA, et al Psychosocial predictors of HIV-associated sexual behaviors and the efficacy of prevention interventions in adolescents at-risk for HIV infection: what works and what doesn’t work? Psychosom Med 2008; 70 598–605.
| Psychosocial predictors of HIV-associated sexual behaviors and the efficacy of prevention interventions in adolescents at-risk for HIV infection: what works and what doesn’t work?Crossref | GoogleScholarGoogle Scholar |
[27] Lindberg LD, Boggess S, Williams S. Multiple threats: The co-occurrence of teen health risk behaviors. Trends in the well-being of America’s children and youth, 1999. Washington, DC: Department of Health and Human Services; 2000.
[28] DiClemente RJ, Wingood GM, Crosby RA, Cobb BK, Harrington K, Davies SL. Parent-adolescent communication about sexuality-related topics and adolescents’ risky sexual behaviors, communication with sex partners, and self-efficacy to discuss sexuality-related issues with sex partners. J Pediatr 2001; 139 407–12.
| Parent-adolescent communication about sexuality-related topics and adolescents’ risky sexual behaviors, communication with sex partners, and self-efficacy to discuss sexuality-related issues with sex partners.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrktFyhsQ%3D%3D&md5=40d58639c7959707fb7ec6fbbf47211bCAS |
[29] Sionéan C, DiClemente RJ, Wingood GM, Crosby RA, Cobb BK, Harrington K, et al Psychosocial and behavioral correlates of refusing unwanted intercourse among African American female adolescents. J Adolesc Health 2002; 30 55–63.
| Psychosocial and behavioral correlates of refusing unwanted intercourse among African American female adolescents.Crossref | GoogleScholarGoogle Scholar |
[30] Crosby RA, DiClemente RJ, Wingood GM, Sionean C, Cobb B, Harrington K. Correlates of unprotected vaginal sex among African American female teens: the importance of relationship dynamics. Arch Pediatr Adolesc Med 2000; 154 893–9.
| 1:STN:280:DC%2BD3cvntVSqsg%3D%3D&md5=b22039495c2243ee74c88330e0bcffa9CAS |
[31] Fortenberry JD, Tu W, Harezlak J, Katz BP, Orr DP. Condom use as a function of time in new and established adolescent sexual relationships. Am J Public Health 2002; 92 211–3.
| Condom use as a function of time in new and established adolescent sexual relationships.Crossref | GoogleScholarGoogle Scholar |
[32] Begley E, Crosby RA, DiClemente RJ, Wingood GM, Rose E. Older partners and STD prevalence among pregnant African American teens. Sex Transm Dis 2003; 30 211–3.
| Older partners and STD prevalence among pregnant African American teens.Crossref | GoogleScholarGoogle Scholar |
[33] DiClemente RJ, Wingood GM, Crosby RA, Sionean C, Cobb BK, Harrington K, et al Sexual risk behaviors associated with having older sex partners: a study of African American female adolescents. Sex Transm Dis 2002; 29 20–4.
| Sexual risk behaviors associated with having older sex partners: a study of African American female adolescents.Crossref | GoogleScholarGoogle Scholar |
[34] Wingood GM, Seth P, DiClemente RJ, Robinson LS. Association of sexual abuse with incident high-risk human papillomavirus infection among young African American women. Sex Transm Dis 2009; 36 784–6.
| Association of sexual abuse with incident high-risk human papillomavirus infection among young African American women.Crossref | GoogleScholarGoogle Scholar |
[35] Seth P, Raiford JL, Robinson LS, Wingood GM, Diclemente RJ. Intimate partner violence and other partner-related factors: correlates of sexually transmissible infections and risky sexual behaviours among young adult African American women. Sex Health 2010; 7 25–30.
| Intimate partner violence and other partner-related factors: correlates of sexually transmissible infections and risky sexual behaviours among young adult African American women.Crossref | GoogleScholarGoogle Scholar |
[36] Wilson MD, Kastrinakis M, D’Angelo LJ, Getson P. Attitudes, knowledge, and behavior regarding condom use in urban black adolescent males. Adolescence 1994; 29 13–26.
| 1:STN:280:DyaK2czhtFSmtA%3D%3D&md5=989508f7b65cfceefcec64cf8b6ff2d3CAS |
[37] Ku L, Sonenstein FL, Pleck J. The dynamics of youg men’s condom use during and across relationships. Fam Plann Perspect 1994; 26 246–51.
| The dynamics of youg men’s condom use during and across relationships.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M7nt1ajtw%3D%3D&md5=eeec059b3824549ea9a31586c02315ddCAS |
[38] Lindberg LD, Ku L, Sonenstein FL. Adolescent males’ combined use of condoms with partners’ use of female contraceptive methods. Matern Child Health J 1998; 2 201–9.
| Adolescent males’ combined use of condoms with partners’ use of female contraceptive methods.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7pt1Ghsw%3D%3D&md5=cb7d4896ebc927511d9b84efd3279314CAS |
[39] Pendergrast RA, Durant RH, Gaillard GL. Attitudinal and behavioral correlates of condom use in urban adolescent males. J Adolesc Health 1992; 13 133–9.
| Attitudinal and behavioral correlates of condom use in urban adolescent males.Crossref | GoogleScholarGoogle Scholar |
[40] Valleroy LA, MacKellar DA, Karon JM, Janssen RS, Hayman DR. HIV infection in disadvantaged out-of-school youth: prevalence for U.S. Job Corp entrants, 1990 through 1996. J Acquir Immune Defic Syndr 1998; 19 67–73.
| HIV infection in disadvantaged out-of-school youth: prevalence for U.S. Job Corp entrants, 1990 through 1996.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1cvgtVyhsw%3D%3D&md5=7417f523708432c3623af05fea6f6338CAS |
[41] DiClemente RJ, Lodico M, Grinstead O, Harper G, Rickman R, Evans P, et al African-American adolescents residing in high-risk urban environments do use condoms: correlates and predictors of condom use among adolescents in public housing developments. Pediatrics 1996; 98 269–78.
| 1:STN:280:DyaK28zgvFOhtg%3D%3D&md5=95aa25eca815c291170b642ffaf84fdbCAS |
[42] Newman P, Zimmerman M. Gender differences in HIV-related risk behavior among urban African-American youth: a multivariate approach. AIDS Educ Prev 2000; 12 308–25.
| 1:STN:280:DC%2BD3M%2Fmt1Omug%3D%3D&md5=e2c7b5040045e8471fcba4e71bdd8651CAS |
[43] Donenberg GR, Wilson HW, Emerson E, Bryant FB. Holding the line with a watchful eye: the impact of perceived parental permissiveness and parental monitoring on risky sexual behavior among adolescents in psychiatric care. AIDS Educ Prev 2002; 14 138–57.
| Holding the line with a watchful eye: the impact of perceived parental permissiveness and parental monitoring on risky sexual behavior among adolescents in psychiatric care.Crossref | GoogleScholarGoogle Scholar |
[44] Auslander WF, McMillen JC, Elze D, Thompson R, Jonson-Reid M, Stiffman A. Mental health problems and sexual abuse among adolescents in foster care: relationship to HIV risk behaviors and intentions. AIDS Behav 2002; 6 351–9.
| Mental health problems and sexual abuse among adolescents in foster care: relationship to HIV risk behaviors and intentions.Crossref | GoogleScholarGoogle Scholar |
[45] Baker SA, Thalberg SP, Morrison DM. Parents’ behavioral norms as predictors of adolescent sexual activity and contraceptive use. Adolescence 1988; 23 265–82.
| 1:STN:280:DyaL1czgs12rsg%3D%3D&md5=5e91d3d414788d551c98ac485642e555CAS |
[46] Barnes HL, Olson DH. Parent-adolescent communication and the circumplex model. Child Dev 1985; 56 438–48.
| Parent-adolescent communication and the circumplex model.Crossref | GoogleScholarGoogle Scholar |
[47] Hosmer DW, Lemeshow SL. Applied logistic regression. New York: Wiley and Sons; 2000.
[48] Fortenberry JD, Schick V, Herbenick D, Sanders SA, Dodge B, Reece M. Sexual behaviors and condom use at last vaginal intercourse: a national sample of adolescents ages 14 to 17 years. J Sex Med 2010; 7 305–14.
| Sexual behaviors and condom use at last vaginal intercourse: a national sample of adolescents ages 14 to 17 years.Crossref | GoogleScholarGoogle Scholar |
[49] Reece M, Herbenick D, Schick V, Sanders SA, Dodge B, Fortenberry JD. Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States. J Sex Med 2010; 7 266–76.
| Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States.Crossref | GoogleScholarGoogle Scholar |
[50] Nkansah-Amankra S, Diedhiou A, Agbanu HLK, Harrod C, Dhawan A. Correlates of sexual risk behaviors among high school students in Colorado: analysis and implications for school-based HIV/AIDS programs. Matern Child Health J 2011; 15 730–41.
| Correlates of sexual risk behaviors among high school students in Colorado: analysis and implications for school-based HIV/AIDS programs.Crossref | GoogleScholarGoogle Scholar |
[51] Romero EG, Teplin LA, McClelland GM, Abram KM, Welty LG, Washburn JJ. A longitudinal study of the prevalence, development, and persistence of HIV/STI risk behaviors in delinquent youth: implications for health care in the community. Pediatrics 2007; 119 e1126–41.
| A longitudinal study of the prevalence, development, and persistence of HIV/STI risk behaviors in delinquent youth: implications for health care in the community.Crossref | GoogleScholarGoogle Scholar |
[52] Danielson CK, de Arellano MA, Ehrenreich JT, Suarez LM, Bennett SM, Cheron DM, et al Identification of high-risk behaviors among victimized adolescents and implications for empirically supported psychosocial treatment. J Psychiatr Pract 2006; 12 364–83.
| Identification of high-risk behaviors among victimized adolescents and implications for empirically supported psychosocial treatment.Crossref | GoogleScholarGoogle Scholar |
[53] Essau CA, Lewinsohn PM, Seeley JR, Sasagawa S. Gender differences in the developmental course of depression. J Affect Disord 2010; 127 185–90.
| Gender differences in the developmental course of depression.Crossref | GoogleScholarGoogle Scholar |
[54] Swenson RR, Rizzo CJ, Brown LK, Payne N, DiClemente RJ, Salazar LF, et al Prevalence and correlates of HIV testing among sexually active African American adolescents in 4 US cities. Sex Transm Dis 2009; 36 584–91.
| Prevalence and correlates of HIV testing among sexually active African American adolescents in 4 US cities.Crossref | GoogleScholarGoogle Scholar |
