Impact of Demographics, Sexual History, and Psychological Functioning on the Acquisition of STDs in Adolescents
Rosenthal, Susan L., Biro, Frank M., Succop, Paul A., Bernstein, David I., Stanberry, Lawrence R., Adolescence
Sexually transmitted diseases (STDs) among adolescents are associated with significant morbidity. Multiple episodes increase the risk of involuntary infertility (Sellors, Mahony, Chernesky, & Rath, 1988; Minassian et al., 1990), and sexually transmitted organisms are associated with epididymitis and Reiter's syndrome, and are also a risk factor for HIV infection (Stiffman & Earls, 1990). Factors that may be associated with acquiring STDs include demographic characteristics, psychological functioning, and sexual behavior. In terms of demographics, men are more likely to transmit STDs to susceptible partners (McCutchan, 1984), and for nearly all STDs, adolescents are the highest risk group (Biro, 1992; Aral, Schaffer, Mosher, & Cates, 1988; Aral & Cates, 1989). African-American adolescents generally have higher rates of
STD (Biro, 1992). Aspects of psychological functioning that have been linked to behavior related to STD risk among adolescents include knowledge and perceptions, sociocultural context, and management skills (Biro & Rosenthal, 1995). An earlier age at first intercourse (Rosenthal, Biro, Succop, Cohen, & Stanberry, 1994), lack of condom use (Centers for Disease Control, 1988; Stone, Grimes, & Magder, 1986; Upchurch, Brady, Reichart, & Hook, 1990), and partner selection patterns (Hook et al., 1992; Aral, Soskoline, Joesoef, & O'Reilly, 1991) have all been linked to STD acquisition.
The focus of this study was to extend previous research through an examination of variables related to multiple episodes of STD among adolescent females and males. Much attention has been paid to attitudes and the prevalence of risky behaviors among adolescents, but less attention has been focused on the relationship of attitudes and behavior to actual acquisition of STD. Previous studies that have examined these issues have focused on one gender (Resenthal, Biro, Succop, Cohen, & Stanberry, 1994; Joffe et al., 1992; Greenberg, Magder, & Aral, 1992) or older participants, primarily from STD clinics (Upchurch et al., 1990; Aral, Soskoline, et al., 1991).
Adolescent males (n = 48) and females (n = 276) were recruited from an urban primary-care adolescent clinic to participate in a herpes seroprevalence study. Those with a history of STD were over recruited in order to obtain a sample of high-risk sexually active teenagers. The adolescents were given $10 to participate and were interviewed by a research assistant of the same gender. Informed consent was obtained from parents or guardians and all adolescents. The study was approved by the Institutional Review Board.
In order to compare the variables associated with multiple episodes of STD, a subsample of the entire subject pool was chosen from those who were sexually active. The females and males were matched on age and race. Since there were more females, each male was matched with two females.to yield a final sample size of 88 females and 44 males. Subjects aged 12 to 13 years were grouped together for the purpose of determining a match. The sample was 86% African-American and 14% Caucasian. The mean age was 16.8 years (SD = 2), and the mean age at onset of sexual activity was 14.1 years. They had a self-reported history of 0 to 10 STD episodes. A comparison of medical charts and self-report for a sample of the female subjects indicated acceptable reliability for number of STD episodes (Hornberger, Rosenthal, Biro, & Stanberry, 1995). For purposes of analysis, subjects were grouped into those with no history of an STD episode (n = 43), those with a history of one episode (n = 41), those with a history of two episodes (n = 21), and those with a history of three or more episodes (n = 27).
Sexual history. Adolescents were asked several questions regarding their sexual history. Responses to their number of lifetime partners were coded as the actual number for 4 partners or under, as 7 for those with 5 to 9 partners, as 13 for those with 10 to 19 partners, and as 20 for those with 20 or more partners. …