A latent class approach to adolescent sexual behavior

1. A latent class approach to adolescent sexual behavior Sara A. Vasilenko, Kari C. Kugler, Nicole Butera & Stephanie T. Lanza The Pennsylvania State University Background Method Discussion • Contractual data from the National Longitudinal Study of Adolescent Health (Add Health). • Subsample of adolescents from ages 16-18 in grades 10-12 at W2 (N=3,395, 54.1% female, 18.3% African American,10.8, % Hispanic, 4.1% other, 0.9% gay, 5.0% bisexual M age=16.9 years). • Latent class indicators from W2: • Timing of sexual intercourse (No sex, Nomative, Early). • Condom use at first sex (No sex, Used a Condom, Did not Use a Condom). • Lifetime Non-relationship Sex (No Sex, Only Relationship Sex, Ever Non-Relationship Sex) • Number of Past Year Partners (0, 1, 2+). • Timing of Oral Sex (No sex, Nomative, Early). • W1 predictors of Class Membership: Gender, Race/ethnicity, Sexual Orientation, Alcohol Use, Marijuana Use and Depression. • Self-reported any past year STI in young adulthood (W4; ages 28-30). • Latent class analysis using PROC LCA in SAS. • LCA Distal outcome macro to predict young adult STIs by class membership • Software freely available from www.methodology.com. • The majority of adolescents belonged to classes marked by abstinence or relatively safe patterns of behavior. • Consistent with prior, variable-oriented studies, being male, African-American and having same-sex attraction predicted riskier patterns of behavior. • Consistent with problem behavior theory (Jessor & Jessor, 1977), engaging in other problem behaviors predicted membership in classes marked by multiple partners. • Adolescent class membership was more strongly associated with increasing STI risk for young adult men compared to women, suggesting partner risk behavior may explain some of women’s STI risk. • Prevention programs could tailor programs to better represent the experiences of adolescents with different patterns of behavior and risk factors. • Sexuality is complex and multi-faceted, and behaviors can carry different meanings depending on the context in which they occur. (Hensel & Fortenberry, 2012; Welsh, Rostosky, & Kawaguchi, 2003). • However, most research uses variable-oriented approaches that ignore this complexity (Haydon, Herring, Prinstein, & Halpern, 2012). • Latent class analysis (LCA; Collins & Lanza, 2010) can help us understand this complexity by uncovering subgroups with particular patterns of behavior. • New, model-based approaches can examine how class membership predicts distal outcomes. • In this study we: • 1. Estimate latent classes of adolescent sexual behavior. • 2. Examine what factors predict latent class membership. • 3. Test how class membership is associated with young adult sexually transmitted infections (STIs). Results Table 3: Odds Ratios and Confidence Intervals Showing the Effect of Earlier Substance Use and Depression on Sexual Behavior Latent class Membership Table 1: Latent Class Prevelances and Item-Response Probabilities for Five Class Model of Adolescent Sexual Behavior Table 2: Latent Class Prevelances as a Function of Gender, Race/ethnicity, and Sexual Orientation Figure 1: Estimated Probability of Reporting an STI in the past year at Wave 4 (age 28 to 30), Conditional on Class Membership at Wave 2 (age 16-18) • Five-class model selected based on fit indices and interpretability (see Table 1). • Probabilities of class membership differed by gender, race/ethnicity and sexual orientation (see Table 2). • Alcohol use, marijuana and depressive symptoms were associated with greater odds of membership in classes with multiple past year partners and lesser odds of being abstinent (see Table 3). • Young women had higher rates of STIs across all adolescent classes except oral only (see Figure 1). • Membership in increasingly risky classes better predicted increased odds of young adult STI for men compared to women. • For men, odds of having an STI were higher for the Multi-Partner Early class compared to the Low-Risk and Multi-Partner Normative classes. • For women, STI rates were similarly high for those in all three of these adolescent sexual behavior classes. References • Collins, L. M., & Lanza, S. T. (2010). Latent class and latent transition analysis: With applications in the social, behavioral, and health sciences. New York: Wiley. • Haydon, A. A., Herring, A. H., Prinstein, M. J., & Halpern, C. T. (2012). Beyond age at first sex: Patterns of emerging sexual behavior in adolescence and young adulthood. Journal of Adolescent Health, 50, 456-463. • Hensel, D. J., & Fortenberry, J. D. (2013). A multidimensional model of sexual health and sexual and prevention behavior among adolescent women. The Journal of Adolescent Health, 52, 219-27. • Jessor, S. L., & Jessor, R. (1977). Problem behavior and psychosocial development: A longitudinal study of youth. New York: Academic Press. • Welsh, D. P., Rotosky, S.S. & Kawaguchi, C.M. (2000). A normative perspective of adolescent girls’ developing sexuality. In C. B. Travis & J. W. White (Eds.), Sexuality, society and feminism (pp. 111-140). Washington: American Psychological Association. Acknowledgments This research and the investigators were funded by NIDA grants P50-DA010075 and 2T32DA017629-06A1. Address correspondence to Sara Vasilenko at svasilenko@psu.edu.