Skip to main content

Patterns of Adolescent Sexual Behavior Predicting Young Adult Sexually Transmitted Infections: A Latent Class Analysis Approach

Abstract

Adolescent sexual behavior is multidimensional, yet most studies of the topic use variable-oriented methods that reduce behaviors to a single dimension. In this study, we used a person-oriented approach to model adolescent sexual behavior comprehensively, using data from the National Longitudinal Study of Adolescent Health. We identified five latent classes of adolescent sexual behavior: Abstinent (39 %), Oral Sex (10 %), Low-Risk (25 %), Multi-Partner Normative (12 %), and Multi-Partner Early (13 %). Membership in riskier classes of sexual behavior was predicted by substance use and depressive symptoms. Class membership was also associated with young adult STI outcomes although these associations differed by gender. Male adolescents’ STI rates increased with membership in classes with more risky behaviors whereas females’ rates were consistent among all sexually active classes. These findings demonstrate the advantages of examining adolescent sexuality in a way that emphasizes its complexity.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  • Alfonsi, G. A., & Shlay, J. (2005). The effectiveness of condoms for the prevention of sexually transmitted diseases. Current Women’s Health Reviews, 1, 151–159.

    Article  Google Scholar 

  • Beadnell, B., Morrison, D. M., Wilsdon, A., Wells, E. A., Murowchick, E., Hoppe, M. J., et al. (2005). Condom use, frequency of sex, and number of partners: Multidimensional characterization of adolescent sexual risk-taking. Journal of Sex Research, 42, 192–202. doi:10.1080/00224490509552274.

    Article  PubMed  Google Scholar 

  • Beckman, L. J., & Harvey, M. (1996). Attitudes about condoms and condom use among college students. Journal of American College Health, 44, 243–255. doi:10.1080/07448481.1996.9936851.

    Article  PubMed  Google Scholar 

  • Brooks-Gunn, J., & Paikoff, R. L. (1993). “Sex is a gamble, kissing is a game”: Adolescent sexuality and health promotion. In S. G. Millstein, A. C. Peterson, & E. O. Nightingale (Eds.), Promoting the health of adolescents: New directions for the twenty-first century (pp. 180–208). New York: Oxford University Press.

    Google Scholar 

  • Brown, N. R., & Sinclair, R. C. (1999). Estimating number of lifetime sexual partners: Men and women do it differently. Journal of Sex Research, 36, 292–297.

    Article  Google Scholar 

  • Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Schootman, M., Bucholz, K. K., Peipert, J. F., et al. (2009). Age of sexual debut among US adolescents. Contraception, 80, 158–162. doi:10.1016/j.contraception.2009.02.014.

    PubMed Central  Article  PubMed  Google Scholar 

  • Centers for Disease Control. (2008). HIV/AIDS surveillance report, 2006. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention.

  • Centers for Disease Control. (2011). Sexually transmitted disease surveillance, 2010. Atlanta, GA: US Department of Health and Human Services.

    Google Scholar 

  • 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.

    Google Scholar 

  • Costa, F. M., Jessor, R., Donovan, J. E., & Fortenberry, J. D. (1995). Early initiation of sexual intercourse: The influence of psychosocial unconventionality. Journal of Research on Adolescence, 5, 93–121. doi:10.1207/s15327795jra0501_5.

    Article  Google Scholar 

  • Diamond, L. M., & Savin-Williams, R. C. (2009). Adolescent sexuality. In R. M. Lerner & L. Steinberg (Eds.), Handbook of adolescent psychology (pp. 479–523). Hoboken, NJ: Wiley.

  • Douglas, K. A., Collins, J. L., Warren, C., Kann, L., Gold, R., Clayton, S., et al. (1997). Results from the 1995 National College Health Risk Behavior Survey. Journal of American College Health, 46, 55–66. doi:10.1080/07448489709595589.

    Article  PubMed  Google Scholar 

  • Eisenberg, M. (2001). Differences in sexual risk behaviors between college students with same-sex and opposite-sex experience: Results from a national survey. Archives of Sexual Behavior, 30, 575–589.

    Article  PubMed  Google Scholar 

  • Espinosa-Hernández, G., & Lefkowitz, E. S. (2009). Sexual behaviors and attitudes and ethnic identity during college. Journal of Sex Research, 46, 471–482. doi:10.1080/00224490902829616.

    Article  PubMed  Google Scholar 

  • Finer, L. B. (2010). Unintended pregnancy among U.S. adolescents: Accounting for sexual activity. Journal of Adolescent Health, 47, 312–314. doi:10.1016/j.jadohealth.2010.02.002.

    Article  PubMed  Google Scholar 

  • Gallo, M. F., Steiner, M. J., Warner, L., Hylton-Kong, T., Figueroa, J. P., Hobbs, M. M., et al. (2007). Self-reported condom use is associated with reduced risk of chlamydia, gonorrhea, and trichomoniasis. Sexually Transmitted Diseases, 34, 829–833.

    PubMed  Google Scholar 

  • Garofalo, R., Wolf, R. C., Kessel, S., Palfrey, J., & DuRant, R. H. (1998). The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics, 101, 895–902.

    Article  PubMed  Google Scholar 

  • Gillison, M. L., D’Souza, G., Westra, W., Sugar, E., Xiao, W., Begum, S., et al. (2008). Distinct risk factor profiles for human papillomavirus type 16–positive and human papillomavirus type 16–negative head and neck cancers. Journal of the National Cancer Institute, 100, 407–420. doi:10.1093/jnci/djn025.

    Article  PubMed  Google Scholar 

  • Goodenow, C., Netherland, J., & Szalacha, L. (2002). AIDS-related risk among adolescent males who have sex with males, females, or both: Evidence from a statewide survey. American Journal of Public Health, 92, 203–210.

    PubMed Central  Article  PubMed  Google Scholar 

  • Goodman, L. A. (1974). Exploratory latent structure analysis using both identifiable and unidentifiable models. Biometrika, 61, 215–231.

    Article  Google Scholar 

  • Goodman, E. (1999). The role of socioeconomic status gradients in explaining differences in US adolescents’ health. American Journal of Public Health, 89, 1522–1528.

    PubMed Central  Article  PubMed  Google Scholar 

  • Gray-Swain, M. R., & Peipert, J. F. (2006). Pelvic inflammatory disease in adolescents. Current Opinion in Obstetrics and Gynecology, 18, 503–510. doi:10.1097/01.gco.0000242952.87125.69.

    Article  PubMed  Google Scholar 

  • Halpern-Felsher, B. L., Cornell, J. L., Kropp, R. Y., & Tschann, J. M. (2005). Oral versus vaginal sex among adolescents: Perceptions, attitudes, and behavior. Pediatrics, 115, 845–851. doi:10.1542/peds.2004-2108.

    Article  PubMed  Google Scholar 

  • Harris, K. M. (2011). Design features of Add Health. Chapel Hill, NC: University of North Carolina at Chapel Hill.

    Google Scholar 

  • 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. doi:10.1016/j.jadohealth.2011.09.006.

    PubMed Central  Article  PubMed  Google Scholar 

  • Hipwell, A. E., Stepp, S. D., Keenan, K., Chung, T., & Loeber, R. (2011). Parsing the heterogeneity of adolescent girls’ sexual behavior: Relationships to individual and interpersonal factors. Journal of Adolescence, 34, 589–592. doi:10.1016/j.adolescence.2010.03.002.

    PubMed Central  Article  PubMed  Google Scholar 

  • Jessor, S. J., & Jessor, R. (1977). Transition from virginity to non-virginity among youth: A social-psychological study over time. Developmental Psychology, 11, 473–484.

    Article  Google Scholar 

  • Kaestle, C. E., Halpern, C. T., Miller, W. C., & Ford, C. A. (2005). Young age at first sexual intercourse and sexually transmitted infections in adolescents and young adults. American Journal of Epidemiology, 161, 774–780. doi:10.1093/aje/kwi095.

    Article  PubMed  Google Scholar 

  • Kelley, S., Borawski, E., Flocke, S., & Keen, K. (2003). The role of sequential and concurrent sexual relationships in the risk of sexually transmitted diseases among adolescents. Journal of Adolescent Health, 32, 296–305. doi:10.1016/S1054-139X(02)00710-3.

    Article  PubMed  Google Scholar 

  • Kenyon, D. B., Sieving, R. E., Jerstad, S. J., Pettingell, S. L., & Skay, C. L. (2010). Individual, interpersonal, and relationship factors predicting hormonal and condom use consistency among adolescent girls. Journal of Pediatric Health Care, 24, 241–249. doi:10.1016/j.pedhc.2009.06.014.

    Article  PubMed  Google Scholar 

  • Lanza, S. T., & Collins, L. M. (2008). A new SAS procedure for latent transition analysis: Transitions in dating and sexual risk behavior. Developmental Psychology, 44, 446–456. doi:10.1037/0012-1649.44.2.446.

    PubMed Central  Article  PubMed  Google Scholar 

  • Lanza, S. T., Collins, L. M., Lemmon, D. R., & Schafer, J. L. (2007). PROC LCA: A SAS procedure for latent class analysis. Structural Equation Modeling, 14, 671–694.

    PubMed Central  Article  PubMed  Google Scholar 

  • Lanza, S. T., Kugler, K. C., & Mathur, C. (2011a). Differential effects for sexual risk behavior: An application of finite mixture regression. The Open Family Studies Journal, 4, 81–88.

    PubMed Central  Article  PubMed  Google Scholar 

  • Lanza, S. T., Tan, X., & Bray, B. C. (2011). A technical introduction: A model‐based approach to latent class analysis with distal outcomes (Report No. 11-116). University Park, PA: The Methodology Center, Pennsylvania State University State. Retrieved from http://methodology.psu.edu.

  • Lehrer, J. A., Shrier, L. A., Gortmaker, S., & Buka, S. (2006). Depressive symptoms as a longitudinal predictor of sexual risk behaviors among US middle and high school students. Pediatrics, 118, 189–200. doi:10.1542/peds.2005-1320.

    Article  PubMed  Google Scholar 

  • Lindberg, L. D., Jones, R., & Santelli, J. S. (2008). Noncoital sexual activities among adolescents. Journal of Adolescent Health, 43, 231–238. doi:10.1016/j.jadohealth.2007.12.010.

    Article  PubMed  Google Scholar 

  • Manning, W. D., Giordano, P. C., & Longmore, M. A. (2006). Hooking up: The relationship contexts of “nonrelationship” sex. Journal of Adolescent Research, 21, 459–483. doi:10.1177/0743558406291692.

    Article  Google Scholar 

  • Meier, A. M. (2007). Adolescent first sex and subsequent mental health. American Journal of Sociology, 112, 1811–1847. doi:10.1086/512708.

    Article  Google Scholar 

  • Radloff, L. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  • Reece, M., Herbenick, D., Schick, V., Sanders, S. A., Dodge, B., & Fortenberry, J. D. (2010). Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States. Journal of Sexual Medicine, 7, 266–276. doi:10.1111/j.1743-6109.2010.02017.x.

    Article  PubMed  Google Scholar 

  • Roberts, R. E., Lewinsohn, P. M., & Seeley, J. R. (1991). Screening for adolescent depression: A comparison of depression scales. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 58–66.

    Article  PubMed  Google Scholar 

  • Saewyc, E. M., Poon, C. S., Homma, Y., & Skay, C. L. (2008). Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in British Columbia. Canadian Journal of Human Sexuality, 17, 123–139.

    PubMed Central  PubMed  Google Scholar 

  • Santelli, J. S., Lindberg, L. D., Abma, J., McNeely, C. S., & Resnick, M. (2000). Adolescent sexual behavior: Estimates and trends from four nationally representative surveys. Family Planning Perspectives, 32(156–165), 194.

    Google Scholar 

  • Scott, H. M., Bernstein, K. T., Raymond, H. F., Kohn, R., & Klausner, J. D. (2010). Racial/ethnic and sexual behavior disparities in rates of sexually transmitted infections, San Francisco, 1999-2008. BMC Public Health, 10, 315. doi:10.1186/1471-2458-10-315.

    PubMed Central  Article  PubMed  Google Scholar 

  • Scully, C. (2005). Oral cancer: The evidence for sexual transmission. British Dental Journal, 199, 203–207.

    Article  PubMed  Google Scholar 

  • Shafii, T., Stovel, K., Davis, R., & Holmes, K. (2004). Is condom use habit forming?: Condom use at sexual debut and subsequent condom use. Sexually Transmitted Diseases, 31, 366–372.

    Article  PubMed  Google Scholar 

  • Shrier, L. A., Harris, S. K., Sternberg, M., & Beardslee, W. R. (2001). Associations of depression, self-esteem, and substance use with sexual risk among adolescents. Preventive Medicine, 33, 179–189. doi:10.1006/pmed.2001.0869.

    Article  PubMed  Google Scholar 

  • Tolman, D. L., & McClelland, S. I. (2011). Normative sexuality development in adolescence: A decade in review, 2000-2009. Journal of Research on Adolescence, 21, 242–255. doi:10.1111/j.1532-7795.2010.00726.x.

    Article  Google Scholar 

  • Tubman, J. G., Windle, M., & Windle, R. C. (1996). Cumulative sexual intercourse patterns among middle adolescents: Problem behavior precursors and concurrent health risk behaviors. Journal of Adolescent Health, 18, 182–191. doi:10.1016/1054-139X(95)00128-F.

    Article  PubMed  Google Scholar 

  • Upchurch, D. M., Mason, W. M., Kusunoki, Y., & Johnson, M. (2004). Social and behavioral determinants of self-reported STDs among adolescents. Perspectives on Sexual and Reproductive Health, 36, 276–287. doi:10.1363/3627604.

    Article  PubMed  Google Scholar 

  • Von Eye, A., & Bergman, L. R. (2003). Research strategies in developmental psychopathology: Dimensional identity and the person-oriented approach. Development and Psychopathology, 15, 553–580.

    Google Scholar 

  • Wald, A., Langenberg, A. G. M., Krantz, E., Douglas, J. M., Handsfield, H. H., DiCarlo, R. P., et al. (2005). The relationship between condom use and herpes simplex virus acquisition. Annals of Intern Medicine, 143, 707–713.

    Article  Google Scholar 

  • Weinstock, H., Berman, S., & Cates, W. (2004). Sexually transmitted diseases among American youth: Incidence and prevalence estimates. Perspectives on Sexual and Reproductive Health, 36, 6–10.

    Article  PubMed  Google Scholar 

  • 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, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Whitbeck, L. B., Yoder, K. A., Hoyt, D. R., & Conger, R. D. (1999). Early adolescent sexual activity: A developmental study. Family Relations, 61, 934–946. doi:10.2307/354014.

    Google Scholar 

  • Winer, R., Hughes, J. P., Feng, Q., O’Reilly, S., Kiviat, N. B., Holmes, K. K., et al. (2006). Consistent condom use from time of first vaginal intercourse and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine, 354, 2645–2654.

    Article  PubMed  Google Scholar 

  • Yang, J., Tan, X., Lanza, S. T., & Wagner, A. T. (2012). LCA distal SAS macro users’ guide (Version 2.0). University Park, PA: The Methodology Center, Pennsylvania State University. Retrieved from http://methodology.psu.edu.

Download references

Acknowledgments

This research used data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth). No direct support was received from grant P01-HD31921 for this analysis. This research and the investigators were funded by National Institute on Drug Abuse grants P50-DA010075-15 and 2T32DA 017629-06A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or NIDA.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sara A. Vasilenko.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Vasilenko, S.A., Kugler, K.C., Butera, N.M. et al. Patterns of Adolescent Sexual Behavior Predicting Young Adult Sexually Transmitted Infections: A Latent Class Analysis Approach. Arch Sex Behav 44, 705–715 (2015). https://doi.org/10.1007/s10508-014-0258-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-014-0258-6

Keywords

  • Sexual behavior
  • Adolescence
  • Latent class analysis
  • Sexually transmitted infections