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Risk and Protective Factors Associated With Lifetime Sexual Experience Among Rural, Reservation-Based American Indian Youth

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Abstract

Early sexual initiation is a catalyst for sexually transmitted infection and unintended pregnancy. American Indian/Alaska Native (AI/AN) youth initiate sex prior to age 13 more often than other U.S. youth, contributing to current inequalities in sexual health. Identifying what factors were associated with lifetime sexual experience among AI/AN youth can inform the development of primary prevention programming to delay sexual initiation, alleviate the costs of early sexual activity, and improve sexual health outcomes in this population. We analyzed cross-sectional data from 267 AI youth ages 13–19, recruited from a rural, reservation-based community. We used multivariate logistic regression models to estimate associations between independent variables and lifetime sexual experience (vaginal and/or anal sex) across the following categories: sociodemographic, knowledge, attitudes/perceptions, beliefs, intentions, skills, behaviors, and theoretical constructs. The sample was 56.2% female, mean age 15.1 years (SD = 1.7), and 22.5% were sexually experienced. In our final model, condom use self-efficacy (attitude/perception factor) and intentions to remain abstinent until marriage (intention factor) were associated with lower odds of lifetime sexual experience. Age (sociodemographic factor), intention to have sex (intention factor), use of any contraception (behavior factor), and higher response efficacy (theoretical construct) were associated with lifetime sexual experience. Of these, intention to have sex was the strongest indicator. These results both corroborate and contrast with other research conducted among rural, reservation-based AI/AN youth. Our findings show programs targeting intentions may have the greatest impact among reservation-based AI youth, and justify program delivery stratified by age group in this setting.

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References

  • Baele, J., Dusseldorp, E., & Maes, S. (2001). Condom use self-efficacy: Effect on intended and actual condom use in adolescents. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 28(5), 421–431. https://doi.org/10.1016/S1054-139X(00)00215-9.

    Article  CAS  Google Scholar 

  • Buhi, E. R., & Goodson, P. (2007). Predictors of adolescent sexual behavior and intention: A theory-guided systematic review. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 40, 4–21. https://doi.org/10.1016/j.jadohealth.2006.09.027.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (2013). Vital signs: Repeat births among teens—United States, 2007–2010. Morbidity and Mortality Weekly Report, 62, 249–255.

    Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (2015a). Sexually Transmitted Disease Surveillance 2014. Atlanta, GA: Division of STD Prevention, U.S. Department of Health and Human Services. https://www.cdc.gov/std/stats15/std-surveillance-2015-print.pdf. Accessed December 23, 2015.

  • Centers for Disease Control and Prevention (CDC). (2015b). 1991–2013 High School Youth Risk Behavior Survey data. http://nccd.cdc.gov/youthonline/. Accessed December 23, 2015.

  • Centers for Disease Control and Prevention, & Indian Health Service. (2014). Indian Health Surveillance report—Sexually transmitted diseases 2011. Atlanta, GA: US Department of Health and Human Services.

    Google Scholar 

  • Chambers, R., Tingey, L., Mullany, B., Parker, S., Lee, A., & Barlow, A. (2016). Exploring sexual risk taking among American Indian adolescents through Protection Motivation Theory. AIDS Care, 28(9), 1089–1096.

    Article  PubMed  Google Scholar 

  • Chen, X., Stanton, B., Gomez, P., Lunn, S., Deveaux, L., Brathwaite, N., et al. (2010). Effects on condom use of an HIV prevention programme 36 months postintervention: A cluster randomized controlled trial among Bahamian youth. International Journal of STD and AIDS, 21(9), 622–630. https://doi.org/10.1258/ijsa.2010.010039.

    Article  PubMed  CAS  Google Scholar 

  • Chewning, B., Douglas, J., Kokotailo, P. K., LaCourt, J., Clair, D. S., & Wilson, D. (2001). Protective factors associated with American Indian adolescents’ safer sexual patterns. Maternal and Child Health Journal, 5, 273–280.

    Article  PubMed  CAS  Google Scholar 

  • Dickens, D. D., Dieterich, S. E., Henry, K. L., & Beauvais, F. (2012). School bonding as a moderator of the effect of peer influences on alcohol use among American Indian adolescents. Journal of Studies on Alcohol and Drugs, 73, 597–603. https://doi.org/10.15288/jsad.2012.73.597.

    Article  PubMed  PubMed Central  Google Scholar 

  • Flanigan, C. M. (2003). Sexual activity among girls under age 15: Findings from the national survey of family growth. In B. Albert, S. Brown, & C. M. Flanigan (Eds.), 14 and younger: The sexual behavior of young adolescents (pp. 57–64). Washington DC: National Campaign to Prevent Teen Pregnancy.

    Google Scholar 

  • Griese, E. R., Kenyon, D. B., & McMahon, T. R. (2016). Identifying sexual health protective factors among Northern Plains American Indian youth: An ecological approach utilizing multiple perspectives. American Indian and Alaska Native Mental Health Research (Online), 23, 16–43. https://doi.org/10.5820/aian.2304.2016.16.

    Article  Google Scholar 

  • Hamilton, B. E., Martin, J. A., Osterman, M. J., Curtin, S. C., & Matthews, T. J. (2015). Births: Final data for 2014. National vital statistics reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 64, 1–64.

    Google Scholar 

  • Hellerstedt, W. L., Peterson-Hickey, M., Rhodes, K. L., & Garwick, A. (2006). Environmental, social, and personal correlates of having ever had sexual intercourse among American Indian youths. American Journal of Public Health, 96, 2228–2234. https://doi.org/10.2105/AJPH.2004.053454.

    Article  PubMed  PubMed Central  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. https://doi.org/10.1093/aje/kwi095.

    Article  PubMed  Google Scholar 

  • Kalichman, S. C., Heckman, T., & Kelly, J. A. (1996). Sensation seeking as an explanation for the association between substance use and HIV-related risky sexual behavior. Archives of Sexual Behavior, 25, 141–154.

    Article  PubMed  CAS  Google Scholar 

  • Kaljee, L., Genberg, B., Riel, R., Cole, M., Tho, L. H., Thi Kim Thoa, L., et al. (2005). Effectiveness of a theory-based risk reduction HIV prevention program for rural Vietnamese adolescents. AIDS Education and Prevention, 17(3), 185–199. https://doi.org/10.1521/aeap.17.4.185.66534.

    Article  PubMed  Google Scholar 

  • Kaufman, C., Beals, J., Mitchell, C. M., Lemaster, P., Fickenscher, A., & The Pathways of Choice and Healthy Ways Project Teams. (2004). Stress, trauma, and risky sexual behaviour among American Indians in young adulthood. Culture, Health & Sexuality, 6(4), 301–318.

    Article  Google Scholar 

  • Kaufman, C., Desserick, J., Big Crow, C. K., Holy Rock, B., Keane, E., & Mitchell, C. M. (2007a). Culture, context, and sexual risk among Northern Plains American Indian youth. Social Science and Medicine, 64, 2152–2164.

    Article  PubMed  Google Scholar 

  • Kaufman, C. E., Shelby, L., Mosure, D. J., Marrazzo, J., Wong, D., de Ravello, L., et al. (2007b). Within the hidden epidemic: Sexually transmitted diseases and HIV/AIDS among American Indians and Alaska Natives. Sexually Transmitted Diseases, 34, 767–777. https://doi.org/10.1097/01.olq.0000260915.64098.cb.

    Article  PubMed  Google Scholar 

  • Markham, C. M., Craig Rushing, S., Jessen, C., Lane, T. L., Gorman, G., Gaston, A., et al. (2015). Factors associated with early sexual experience among American Indian and Alaska Native youth. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 57, 334–341. https://doi.org/10.1016/j.jadohealth.2015.06.003.

    Article  Google Scholar 

  • Markham, C. M., Fleschler Peskin, M., Addy, R. C., Baumler, E. R., & Tortolero, S. R. (2009). Patterns of vaginal, oral, and anal sexual intercourse in an urban seventh-grade population. The Journal of School Health, 79, 193–200. https://doi.org/10.1111/j.1746-1561.2008.00389.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Markham, C. M., Lormand, D., Gloppen, K. M., Peskin, M. F., Flores, B., Low, B., et al. (2010). Connectedness as a predictor of sexual and reproductive health outcomes for youth. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 46, S23–S41. https://doi.org/10.1016/j.jadohealth.2009.11.214.

    Article  Google Scholar 

  • Markham, C. M., Tortolero, S. R., Peskin, M. F., Shegog, R., Thiel, M., Baumler, E. R., et al. (2012). Sexual risk avoidance and sexual risk reduction interventions for middle school youth: A randomized controlled trial. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 50, 279–288. https://doi.org/10.1016/j.jadohealth.2011.07.010.

    Article  Google Scholar 

  • Martin, J. A., Hamilton, B. E., Osterman, M. J., Curtin, S. C., & Matthews, T. J. (2013). Births: Final data for 2012. National Vital Statistics reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 62, 1–68.

    Google Scholar 

  • McNutt, L. A., Wu, C., Xue, X., & Hafner, J. P. (2003). Estimating the relative risk in cohort studies and clinical trials of common outcomes. American Journal of Epidemiology, 157, 940–943.

    Article  PubMed  Google Scholar 

  • Mitchell, C. M., Kaufman, C. E., & The Pathways of Choice and Healthy Ways Project Team. (2002). Structure of HIV knowledge, attitudes, and behaviors among American Indian young adults. AIDS Education and Prevention, 14(5), 401–418.

    Article  PubMed  Google Scholar 

  • Mitchell, C. M., Whitesell, N. R., Spicer, P., Beals, J., Kaufman, C. E., & The Pathways of Choice and Healthy Ways Project Team. (2007). Cumulative risk for early sexual initiation among American Indian youth: A discrete-time survival analysis. Journal of Research on Adolescence, 17, 387–412. https://doi.org/10.1111/j.1532-7795.2007.00527.x.

    Article  Google Scholar 

  • Nwangwu-Ike, N., Hernandez, A. L., An, Q., Huang, T., & Hall, H. I. (2015). The epidemiology of human immunodeficiency virus infection and care among adult and adolescent females in the United States, 2008–2012. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 25, 711–719. https://doi.org/10.1016/j.whi.2015.07.004.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Poobalan, A. S., Pitchforth, E., Imamura, M., Tucker, J. S., Philip, K., Spratt, J., et al. (2009). Characteristics of effective interventions in improving young people’s sexual health: A review of reviews. Sex Education, 9, 319–336. https://doi.org/10.1080/14681810903059185.

    Article  Google Scholar 

  • Protogerou, C., & Johnson, B. T. (2014). Factors underlying the success of behavioral HIV-prevention interventions for adolescents: A meta-review. AIDS and Behavior, 18, 1847–1863. https://doi.org/10.1007/s10461-014-0807-y.

    Article  PubMed  Google Scholar 

  • Rogers, R. W. (1983). Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation. In T. Cacioppi & R. E. Petty (Eds.), Social Psychology (pp. 153–176). New York: Guilford.

    Google Scholar 

  • Shneyderman, Y., & Schwartz, S. J. (2013). Contextual and intrapersonal predictors of adolescent risky sexual behavior and outcomes. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 40, 400–414. https://doi.org/10.1177/1090198112447800.

    Article  Google Scholar 

  • Stanton, B. F., Aronson, R., Borgatti, S., Galbraith, J., & Feigelman, S. (1993). Urban adolescent high-risk sexual behavior: Corroboration of focus group discussions through pile-sorting. The AIDS Youth Research Team. AIDS Education and Prevention: Official Publication of the International Society for AIDS Education, 5, 162–174.

    CAS  Google Scholar 

  • Stanton, B., Black, M., Feigelman, S., Ricardo, I., Galbraith, J., Li, X., et al. (1995). Development of a culturally, theoretically and developmentally based survey instrument for assessing risk behaviors among African-American early adolescents living in urban low-income neighborhoods. AIDS Education and Prevention, 7, 160–177.

    PubMed  CAS  Google Scholar 

  • Stanton, B., Fang, X., Li, X., Feigelman, S., Galbraith, J., & Ricardo, I. (1997). Evolution of risk behaviors over 2 years among a cohort of urban African American adolescents. Archives of Pediatrics and Adolescent Medicine, 151, 398–406. https://doi.org/10.1001/archpedi.1997.02170410072010.

    Article  PubMed  CAS  Google Scholar 

  • Stanton, B. F., Li, X., Ricardo, I., Galbraith, J., Feigelman, S., & Kaljee, L. (1996). A randomized, controlled effectiveness trial of an AIDS prevention program for low-income African-American youths. Archives of Pediatrics and Adolescent Medicine, 150, 363–372.

    Article  PubMed  CAS  Google Scholar 

  • StataCorp. (2015). Stata statistical software: Release 14. College Station: StataCorp.

    Google Scholar 

  • Tingey, L., Mullany, B., Strom, R., Hastings, R., Barlow, A., & Rompalo, A. (2015a). The Respecting the Circle of Life trial for American Indian adolescents: Rationale, design, methods and baseline characteristics. AIDS Care, 27(7), 885–891.

    Article  PubMed  Google Scholar 

  • Tingey, L., Mullany, B., Strom, R., Hastings, R., Lee, A., Parker, A., et al. (2015b). Respecting the Circle of Life: One year outcomes from a randomized controlled comparison of an HIV risk reduction intervention for American Indian adolescents. AIDS Care, 27(9), 1087–1097.

    Article  PubMed  Google Scholar 

  • Walker, F. J., Kelly, J. M., Doshani, M., Saduvala, N., & Prejean, J. (2014). Epidemiology of HIV among American Indians and Alaska Natives—United States, 2008–2011. Journal of Health Disparities Research and Practice, 8, Article 7.

  • Walker, F. J., Llata, E., Doshani, M., Taylor, M. M., Bertolli, J., Weinstock, H. S., et al. (2015). HIV, Chlamydia, Gonorrhea, and primary and secondary Syphilis among American Indians and Alaska Natives within Indian health service areas in the United States, 2007–2010. Journal of Community Health, 40, 484–492. https://doi.org/10.1007/s10900-014-9961-4.

    Article  PubMed  Google Scholar 

  • Wingo, P. A., Lesesne, C. A., Smith, R. A., de Ravello, L., Espey, D. K., Arambula Solomon, T. G., et al. (2012). Geographic variation in trends and characteristics of teen childbearing among American Indians and Alaska Natives, 1990–2007. Maternal and Child Health Journal, 16, 1779–1790. https://doi.org/10.1007/s10995-011-0924-4.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors respectfully acknowledge the youth, families, community members, and tribal leaders from the participating tribal community for their innovation and leadership in pioneering research strategies. The authors give thanks to the Native American Research Centers for Health for funding this research.

Funding

This work was supported by the Native American Research Centers for Health (Grant Number U26IHS300286/03).

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Authors and Affiliations

  1. Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA

    Lauren Tingey, Rachel Chambers, Summer Rosenstock, Francene Larzelere, Novalene Goklish, Angelita Lee & Anne Rompalo

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  1. Lauren Tingey
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  2. Rachel Chambers
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  3. Summer Rosenstock
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Correspondence to Lauren Tingey.

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Tingey, L., Chambers, R., Rosenstock, S. et al. Risk and Protective Factors Associated With Lifetime Sexual Experience Among Rural, Reservation-Based American Indian Youth. J Primary Prevent 39, 401–420 (2018). https://doi.org/10.1007/s10935-018-0517-8

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