Multi-level Correlates of Adolescent Sexual Behavior and Risk for STD Kathleen A. Ethier, Ph.D.

1. Multi-level Correlates of Adolescent Sexual Behavior and Risk for STD Kathleen A. Ethier, Ph.D. Christine J. De Rosa, Ph.D., Deborah H. Kim, MPH, Abdelmonem Afifi, Ph.D., Peter R. Kerndt, MD

2. Social/Ecological Model

3. Multiple behaviors pose risk for HIV/STD and teen pregnancy • Early age at first intercourse • Multiple/new sex partners • Unprotected intercourse • Lack of STD screening Niccolai, et al. 2004; Fortenberry et al.,2005; Celentano, 2004; Weller & Davis, 2005; Paz-Bailey et al, 2005; Coker, et al., 1994; Van Ranson, et al., 2000; Kaestle, et al., 2005

4. Multiple social context level factors impact adolescent sexual behavior • Parental monitoring • Parental communication • Family relationship quality • School involvement • After school supervision • Health care services • School-based health services and referrals, STD screening, condom and contraceptive availability) • Forehand et al., 1997; Miller, Kotchick & Forehand, 1999; Romer et al., 1999; Baker et al., 1999;Dittus, Jaccard & Gordon, 1999; Holtzman & Rubison, 1995; Miller, Levin, Whitaker & Xu, 1998; Romer et al., 1999; Whitaker, Miller, May & Levin, 1999; Karofsky et al., 2000; Hutchinson et al 2003; McNeely et al, 2002; Billy, Brewster, & Grady, 1994; Lammers et al., 2000; Manlove, 1998; McNeely et al., 2002; Bonny et al., 2000; Lonczak, 2002; Cohen et al., 2002; Miller et al., 1998; Sabo et al., 1998; Kirby, 2002

5. The Questions for STD Prevention • Do multiple social context factors relate to sexual behavior that puts adolescents at risk for STD? • Do relationships vary by specific behavior? • Are there particular social context factors or combinations of factors that, if intervened on, will give us the most impact on STD risk?

6. Methodology • Classroom-based survey of high school students (n=5930). • Classrooms were randomly selected from a list identified as classes all students would have to take (e.g., social studies) and would contain a single grade level. • Parental consent was obtained for all students under 18 years. • Survey took approximately 30 minutes. • Questions covered four social context areas (family, school, health care and community factors) and a wide range of sexual behaviors.

7. Analyses Step 1 • A set of bivariate logistic regression analyses for each of five STD risk factors • ever had sex (yes/no) • consistent condom use • 4 or more lifetime partners (yes/no) • new partner in the last 3 months (yes/no) • ever tested/treated for an STD (yes/no) • 21 social context factors • 7 family factors • 5 school factors • 4 health care factors • 6 community factors

8. Analyses Step 2 • A series of logistic regression analyses for each of the five STD risk factors • Included any social context factor that was significant at p<.10 in bivariate analyses • Controlled for age, race/ethnicity, and gender

9. Sample Characteristics • Race/ethnicity • Latino = 76.6% • African American = 11.4% • White = 2.1 % • Other = 9.8% • Grade • 9th = 24.1% • 10th = 19.7% • 11th = 24.3% • 12th = 31.9% • Gender • Male = 44.7% • Female = 55.3% • 67.4% received free or reduced lunch.

10. STD Risk Behavior • 47.7% have ever had sex • 40.0% used condoms every time/last 3 months* • 18.3% have had 4+ lifetime sex partners* • 12.3% had a new partner/last 3 months* • 22.7% ever screened or treated for an STD* * Among those who had ever had sex

11. Ever Had Sex

12. Consistent Condom Use

13. Multiple (4+) Lifetime Partners

14. New Partner Last 3 Months

15. Ever Screened or Treated for STD

16. Multi-level Factors Related to Risk Behavior Ever had sex Parental Monitoring Family Rules Consistent Condom Use Communication/Delay Communication/Consequences Communication/Protection Multiple Partners Relationship Satisfaction Unsupervised 3-5pm New Partner Know about CAP Used CAP Ever screened for STD Time in Neighborhood Neighborhood Satisfaction Connecting lines represent relationships significant at p<.05. Dashed Lines represent relationships in negative directions.

17. Level- specific Messages • Family factors have high impact. • Monitoring is not only related to initiation of sexual activity, but more monitoring is related to fewer sex partners. • Content specific communication is important. • Supervision is more important than where kids are supervised (school, community or home).

18. Multi-level Messages • No single level or factor is sufficient to prevent most risk behaviors. • Multiple levels of intervention could provide synergistic effects.

19. Acknowledgements Project Connect Study Staff Peter Kerndt – Principal Investigator Christine DeRosa – Co-Investigator and Project Director Deborah Kim, Emily Chung, and Laura Stroud -- Study Coordinators Steve Martinez, Kathy Wong and Jamila Small – School Liaisons The Project Connect Field Staff Project Connect Study Collaborators CDC - Patricia Dittus, Nicole Liddon, HRA - John Copeland, Sharon Hudson, Pamela Mahoney UCLA - Abdelmonem Afifi, Bill Cumberland, Jenny Kotlerman, Mark Schuster Rand - Deborah Cohen LA County Department of Health - Harlan Rotblatt The Los Angeles Unified School District Ric Loya, Linda Ward-Russell, Julie McAvoy The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.