Abstract
This study investigated the influence of illness on sexual risk behavior in adolescence and the transition to adulthood, both directly and through moderation of the impact of social disadvantage. We hypothesized positive effects for social disadvantages and illness on sexual risk behavior, consistent with the development of faster life history strategies among young people facing greater life adversity. Using the first two waves of the National Longitudinal Study of Adolescent to Adult Health, we developed a mixed-effects multinomial logistic regression model predicting sexual risk behavior in three comparisons: risky nonmonogamous sex versus safer nonmonogamous sex, versus monogamous sex, and versus being sexually inactive, by social characteristics, illness, interactions thereof, and control covariates. Multiple imputation was used to address a modest amount of missing data. Subjects reporting higher levels of illness had lower odds of having safer nonmonogamous sex (OR = 0.84, p < .001), monogamous sex (OR = 0.82, p < .001), and being sexually inactive (OR = 0.74, p < .001) versus risky nonmonogamous sex, relative to subjects in better health. Illness significantly moderated the sex (OR = 0.88, p < .01), race/ethnicity (e.g., OR = 1.21, p < .001), and childhood SES (OR = 0.94; p < .01) effects for the sexually inactive versus risky nonmonogamous sex comparison. Substantive findings were generally robust across waves and in sensitivity analyses. These findings offer general support for the predictions of life history theory. Illness and various social disadvantages are associated with increased sexual risk behavior in adolescence and the transition to adulthood. Further, analyses indicate that the buffering effects of several protective social statuses against sexual risk-taking are substantially eroded by illness.
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Acknowledgements
We thank the Consortium of Families and Health Research (C-FAHR) at the University of Utah for providing the forum in which this paper was developed. We are grateful to Cynthia A. Berg, Claudia Geist, and Bruce Ellis for guidance and editorial input. This research uses 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.
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All authors contributed to the study conception and design. Material preparation, data acquisition, and analysis were performed by DEA, JA, RU, ZA, and RYO. The first draft of the manuscript was written by DEA and JA, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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All authors (Jenna Alley, Rebecca Y. Owen, Sarah E. Wawrzynski, Lauren Lasrich, Zobayer Ahmmad, Rebecca Utz, and Daniel E. Adkins) declare they have no conflicts of interest. This study has been approved by the University of Utah Institutional Review Board (IRB_00107767). Add Health participants provided written informed consent for participation in all aspects of Add Health per University of North Carolina School of Public Health Institutional Review Board guidelines, which are based on the Code of Federal Regulations on the Protection of Human Subjects 45CFR46: http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.html. Add Health participants provided written, informed consent for participation in all aspects of Add Health per the University of North Carolina School of Public Health Institutional Review Board guidelines (https://www.cpc.unc.edu/projects/addhealth/faqs/index.html#Was-informed-consent-required). This analysis has been approved by the University of Utah Institutional Review Board (IRB_00107767).
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University of Utah, Institutional Review Board; IRB_00107767) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Alley, J., Owen, R.Y., Wawrzynski, S.E. et al. Illness, Social Disadvantage, and Sexual Risk Behavior in Adolescence and the Transition to Adulthood. Arch Sex Behav 50, 205–217 (2021). https://doi.org/10.1007/s10508-020-01747-2
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DOI: https://doi.org/10.1007/s10508-020-01747-2