Associations Between Patterns of Sexual Initiation, Sexual Partnering, and Sexual Health Outcomes from Adolescence to Early Adulthood
The goal of this study was to examine, in a nationally representative sample, relationships between various sexual initiation patterns, subsequent sexual partnerships, and related health outcomes from adolescence through early adulthood. Data were from a subset of 6587 respondents from the National Longitudinal Study of Adolescent to Adult Health. Bivariate analyses and adjusted logistic and ordinary least squares regression models were used to determine associations between membership in three sexual initiation classes, lifetime sexual partner counts, and multiple health outcomes, including lifetime sexually transmitted infection or disease (STI/STD) diagnosis, lifetime unintended pregnancy, and romantic relationship quality. Broadly, having fewer lifetime sexual partners was associated with lower odds of STI/STD diagnosis and unintended pregnancy, and better relationship quality; however, findings also indicated both within and between sexual initiation class differences in the relationship between lifetime sexual partners and all three health outcomes. In particular, results showed little variation in health outcomes by sexual partnering among those who postponed sexual activity, but members of the class characterized by early and atypical sexual initiation patterns who had fewer lifetime partners exhibited better health outcomes than most other initiation groups. These results show that while both sexual initiation and partnering patterns add important information for understanding sexual health from adolescence to early adulthood, partnering may be more relevant to these sexual health outcomes. Findings indicate a need for more comprehensive sexuality education focused on sexual risk reduction and promotion of relationship skills among adolescents and adults.
KeywordsSexual initiation Sexual partnering Sexual health Add Health Adolescence Early adulthood
This research used data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, the University of North Carolina at Chapel Hill, Carolina Population Center, 206 W. Franklin Street, Chapel Hill, NC 27516-2524 (email@example.com). We are grateful to the Carolina Population Center for general support (P2C HD050924).
- Basilevsky, A., Sabourin, D., Hum, D., & Anderson, A. (1985). Missing data estimators in the general linear model: An evaluation of simulated data as an experimental design. Communications in Statistics-Simulation and Computation, 14, 371–394. https://doi.org/10.1080/03610918508812445.CrossRefGoogle Scholar
- Centers for Disease Control and Prevention (CDC). (2016). Adolescents and young adults: Sexually transmitted diseases. Retrieved September 28, 2016, from http://www.cdc.gov/std/life-stages-populations/adolescents-youngadults.htm.
- Cicchetti, D., & Rogosch, F. A. (1996). Equifinality and multifinality in developmental psychopathology [Editorial]. Development and Psychopathology, 8, 597–600. https://doi.org/10.1017/S0954579400007318.
- Eisenberg, M. L., Shindel, A. W., Smith, J. F., Breyer, B. N., & Lipshultz, L. I. (2010). Socioeconomic, anthropomorphic, and demographic predictors of adult sexual activity in the United States: Data from the National Survey of Family Growth. Journal of Sexual Medicine, 7, 50–58. https://doi.org/10.1111/j.1743-6109.2009.01522.x.CrossRefPubMedGoogle Scholar
- Elder, G. H., & Shanahan, M. J. (2006). The life course and human development. In W. Damon & R. M. Lerner (Eds.), Handbook of child psychology (6th ed., pp. 665–715). Hoboken, NJ: Wiley.Google Scholar
- Finer, L. B., & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception, 84, 478–485. https://doi.org/10.1016/j.contraception.2011.07.013.CrossRefPubMedPubMedCentralGoogle Scholar
- Garbers, S., Scheinmann, R., Gold, M. A., Catallozzi, M., House, L., Koumans, E. H., & Bell, D. L. (2017). Males’ ability to report their partner’s contraceptive use at last sex in a nationally representative sample: Implications for unintended pregnancy prevention evaluations. American Journal of Men’s Health, 11, 711–718. https://doi.org/10.1177/1557988316681667.CrossRefPubMedGoogle Scholar
- Halpern, C. T., & Haydon, A. A. (2012). Sexual timetables for oral-genital, vaginal, and anal intercourse: Sociodemographic comparisons in a nationally representative sample of adolescents. American Journal of Public Health, 102, 1221–1228. https://doi.org/10.2105/AJPH.2011.300394.CrossRefPubMedPubMedCentralGoogle Scholar
- Harris, K. M., Halpern, C. T., Whitsel, E., Hussey, J., Tabor, J., Entzel, P., & Udry, J. R. (2009). Add Health Research Design. Retrieved from http://www.cpc.unc.edu/projects/addhealth/design.
- Harris, K. M., Udry, J. R., & Bearman, P. S. (2013). The Add Health Study: Design and accomplishments. Chapel Hill, NC. Retrieved from http://www.cpc.unc.edu/projects/addhealth/documentation/guides/DesignPaperWIIV.pdf.
- Heywood, W., Patrick, K., Smith, A. M. A., & Pitts, M. K. (2015). Associations between early first sexual intercourse and later sexual and reproductive outcomes: A systematic review of population-based data. Archives of Sexual Behavior, 44, 531–569. https://doi.org/10.1007/s10508-014-0374-3.CrossRefPubMedGoogle 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. https://doi.org/10.1016/j.adolescence.2010.03.002.CrossRefPubMedGoogle Scholar
- Jessor, R., & Jessor, S. L. (1977). Problem behavior and psychosocial development. New York, NY: Academic Press.Google Scholar
- Mitchell, C. M., Kaufman, C. E., Beals, J., Bauduy, S., Bell, C. A. E., Crow, C. B., … Kaufman, B. (2004). Equifinality and multifinality as guides for preventive interventions: HIV risk/protection among American Indian young adults. Journal of Primary Prevention, 25, 491–510. http://doi.org/10.1023/B:JOPP.0000048114.49642.b2.
- Mosher, W. D., Jones, J., & Abma, J. C. (2012). Intended and unintended births in the United States: 1982–2010. National Health Statistics Reports (Vol. 55). Hyattsville, MD. Retrieved from https://www.cdc.gov/nchs/data/nhsr/nhsr055.pdf.
- O’Donnell, B. L., O’Donnell, C. R., Stueve, A., O’Donnell, L., O’Donnell, C. R., & Stueve, A. (2001). Early sexual initiation and subsequent sex-related risks among urban minority youth: The Reach for Health Study. Family Planning Perspectives, 33, 268–275. https://doi.org/10.2307/3030194.CrossRefPubMedGoogle Scholar
- Rendall, M. S., Clarke, L., Peters, H. E., Ranjit, N., & Verropoulou, G. (1999). Incomplete reporting of men’s fertility in the United States and Britain: A research note. Demography, 36, 135–144. Retrieved from http://www.jstor.org/stable/2648139.
- Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., … Udry, J. R. (1997). Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association, 278, 823–832. http://doi.org/10.1001/jama.1997.03550100049038.
- Santelli, J. S., Kantor, L. M., Grilo, S. A., Speizer, I. S., Lindberg, L. D., Heitel, J., … Ott, M. A. (2017). Abstinence-only-until-marriage: An updated review of U.S. policies and programs and their impact. Journal of Adolescent Health, 61, 273–280. http://doi.org/10.1016/j.jadohealth.2017.05.031.
- Schalet, A. T., Santelli, J. S., Russell, S. T., Halpern, C. T., Miller, S. A., Pickering, S. S., … Hoenig, J. M. (2014). Broadening the evidence for adolescent sexual and reproductive health and education in the United States [Invited commentary]. Journal of Youth and Adolescence, 43, 1595–1610. http://doi.org/10.1007/s10964-014-0178-8.
- StataCorp. (2015). Stata statistical software: Release 14. College Station, TX: StataCorp LP.Google Scholar
- Stockman, J. K., Campbell, J. C., & Celentano, D. D. (2010). Sexual violence and HIV risk behaviors among a nationally representative sample of heterosexual American women: The importance of sexual coercion. Journal of Acquired Immune Deficiency Syndrome, 53, 136–143. https://doi.org/10.1097/QAI.0b013e3181b3a8cc.CrossRefGoogle Scholar
- The Society for Adolescent Health and Medicine. (2017). Abstinence-only-until-marriage policies and programs: An updated position paper of the Society for Adolescent Health and Medicine. Journal of Adolescent Health, 61, 400–403. https://doi.org/10.1016/j.jadohealth.2017.06.001.CrossRefGoogle Scholar
- Vasilenko, S. A., Kugler, K. C., Butera, N. M., & Lanza, S. T. (2015). Patterns of adolescent sexual behavior predicting young adult sexually transmitted infections: A latent class analysis approach. Archives of Sexual Behavior, 44, 705–715. https://doi.org/10.1007/s10508-014-0258-6.CrossRefPubMedGoogle Scholar
- von Bertalanffy, L. (1968). General systems theory: Foundations, development, applications. New York: Braziller.Google Scholar