Adolescent Sexual Risk Behavior Research Articles

Effectiveness of digital interventions to reduce school-age adolescent sexual risks: A systematic review.

The increase in risky sexual behaviors among adolescent students has sparked alarm and has become an area of research interest. As adolescents prioritize confidentiality and accessibility, digital interventions are becoming increasingly relevant in sex education. We therefore posed the following research question: Are digital application interventions effective to prevent risky sexual behaviors in school adolescents? A systematic peer review was conducted between January and December 2023 in five databases (PubMed, Web of Science, Scopus, EMBASE, and PsycINFO) without restricting for language or year of publication. We included randomized control trials or quasi-experimental studies that measured the effectiveness of interventions targeting young people aged 10-19 years or their parents and developed in a school setting. Interventions aimed at young people with intellectual disabilities, learning difficulties, or any disease requiring a specific intervention were excluded. The search ultimately yielded 27 studies covering a total of 18 digital interventions that demonstrated positive effects, not maintained over time, on knowledge, attitudes, and behaviors, although the latter to a lesser extent. We have found very interesting digital interventions with effects, among others, on knowledge, attitudes, and contraceptive use in adolescents. In general, digital interventions have positive effects on knowledge and attitudes, but it is more difficult to modify behaviors with strictly digital interventions or combined with complementary face-to-face sessions or group class activities. We thus believe that digital interventions are adequate to reduce adolescent sexual risk behaviors, and our systematic review facilitates the implementation of these interventions by sharing existing digital interventions that have had positive effects, as well as the main characteristics a digital intervention should possess to reduce sexually risky behaviors in adolescents. Digital interventions with adolescents improve sexual behaviors and can be a valuable resource in education on this topic due to their accessibility and confidentiality, two key points for young people.

Associations of Parents-Adolescent Relationship with Adolescent Sexual Risk Behaviors: A Global Analysis Based on 156,649 School-Going Adolescents from 50 Countries

Our study, examining the Global School-Based Student Health Survey data from 50 countries across four WHO regions, found boys have higher sexual exposure (33.5 vs 17.7%) and risk behaviors – early sexual initiation (55.0 vs. 40.1%), multiple partners (45.2 vs. 26.2%), and condom nonuse (29.2 vs. 26.8%) – than girls. We found that adolescents with parents who understood their problems, monitored academic and leisure-time activities, and respected privacy were less likely to be engaged in sexual activities and risk behaviors. This study highlights the importance of parental involvement and advocates for gender-specific, family-focused interventions to mitigate adolescent sexual risks.

Recreational Cannabis Legalization and Adolescent Sexual Risk Behaviors

Little is known about the implications of cannabis legalization on adolescent health behaviors. This study sought to examine the relationship between recreational cannabis legalization and adolescent sexual risk behaviors. Data on 371,487 respondents who have ever had sexual intercourse from 41 states in the 2005 to 2019 Youth Risk Behavior Survey was linked with data on state-level cannabis policies. Difference-in-differences logistic regression models were conducted. Recreational cannabis legalization was associated with a reduced likelihood of respondents having 2+ sexual partners (adjusted OR [aOR] 0.63, 95% CI [0.47, 0.84]), but had no association with condom use (aOR 0.94, 95% CI [0.80, 1.11]). Changing social norms around cannabis is a potential pathway linking cannabis legalization to a reduction in sexual risk behaviors.

Screening for Adolescent Risk Behaviors: Preliminary Evidence for a Family Functioning Tool.

Family functioning is associated with adolescent drug use, alcohol use, cigarette use, and sexual risk behaviors. Assessing adolescents for family functioning, commonly associated with multiple risk behaviors, may help identify adolescents at risk for adverse health outcomes. This study examined whether a latent family functioning construct, encompassing multiple dimensions of family functioning, was associated with adolescents' substance use and sexual risk behaviors. This study used data harmonization with three intervention trials, including data from 1451 adolescents (M = 13.6, SD = 1.0), to perform a full-information item bifactor analysis on 46 family functioning items from five pre-existing family functioning measures. Regression analysis was used to examine the association between the identified subset of items and the following outcomes: cigarette use, alcohol use, drug use, and condom use. Bifactor analysis identified a 26-item latent family functioning construct. Regression analysis indicated that a 26-item latent family functioning construct was associated negatively with lifetime and past 90-day cigarette use, alcohol use, and drug use. In sum, the multi-dimensional latent family functioning construct may target specific barriers to risk screening in adolescent populations, including time constraint, hesitancy in discussing sensitive health topics, and use culturally appropriate and age-appropriate assessments.

A Comparative Case Study of the Implementation of a Digital App-Based Platform Aimed at Reducing Sexual Risk in Adolescents and Young Adults

Risky sexual behaviors in adolescents and young adults often result in negative outcomes, such as sexually transmitted infections (STIs) and unwanted pregnancies. This case study compares the experience of implementing a digital app-based platform aimed at reducing adolescent sexual risk behavior in a rural medical clinic and a university-based mental health clinic in an effort to better understand how the cliexa-OPTIONS mobile app can inform care and enhance the overall quality of treatment in very different clinical health settings. Clinicians in charge of the implementation of the digital app report that it opens up more transparent discussions with patients/clients, allowing them to provide better care in both medical and mental health settings. The differences in context provide different demographic-related challenges at the two sites. Challenges in online recruitment and workflow were evident only at the university-based mental health clinic as a result of the COVID-19 pandemic. Implementers at both sites indicated a highly positive overall experience with cliexa-OPTIONS and a desire to use the digital app in the future. Patient/client satisfaction surveys indicate that patients/clients enjoy using the digital app and find it easy to use.

Peer Educating: Health Education for Adolescent Girls to Prevent Adolescent Sexual Risk Behaviors

Adolescent girls aged 15-24 are at risk of contracting sexually transmitted diseases such as HIV/AIDS. The existence of adolescent promiscuity, inadequate knowledge of adolescents about HIV/AIDS, and lack of communication with parents on adolescent reproductive health are some related factors to the increased number of adolescents infected with sexually transmitted diseases and HIV/AIDS. Based on these situations, providing health education to adolescents is an alternative solution. The activities were carried out by implementing health education for teenage girls, conducted in four sessions. All sessions were held online, with interactive discussion methods, role play and demonstrations. A total of 18 adolescent girls participated in this activity. The final results showed that there is an increasing mean score of post-test on HIV knowledge (0.5), adolescent reproductive health (0.44), and self-esteem (0.39). There are no significant different between pre and post-test for the level of knowledge on HIV, adolescent reproductive health, adolescent risk behavior and self-esteem. Only risky behavior does not demonstrate an increase in the mean score. Providing health education to teenage girls has improved their knowledge and understanding of HIV/AIDS and adolescent reproductive health and increased adolescent self-esteem. However, these activities did not affect the score of teens’ behavior change. It was due to the duration of health education was not sufficient to change their behavior.

Adolescent sexual risk behaviors and participation in structured leisure activities (SLA): Role of socio-demographic characteristics and school-related behaviors

Adolescence is the transitional period between childhood and adulthood during which many physical, cognitive, social and emotional changes take place, characterized by an increasing interest in romantic and sexual relationships. During adolescence, young people enter into their first sexual partnerships. This may involve behaviors referred to as sexual risk behaviors. The aim of this study was to gain insight into the prevalence of sexual risk behaviors and to determine whether socio-demographic characteristics and school-related behaviors contribute to sexual risk behaviors among adolescents, independent of participation in SLA. The study was conducted from April to June 2021 in Croatia. The sample consisted only of students who reported having had sexual intercourse (N=702; 28.6%). Participants were between 14 and 21 years (46.3% female). Logistic analyses were conducted. The results of this study showed that socio-demographic characteristics make only a limited contribution to the sexual risk behaviors studied. However, it is evident that school-related behaviors are associated with sexual risk behaviors among adolescents, with slight differences depending on their participation in SLA. That is, better grades are a protective factor for sexual risk behavior for both those who do not participate in SLA and those who do, while intentionally skipping school is a risk factor for sexual risk behavior only for those who do participate in SLA. Even though the results show that some school-related behaviors are predictors of sexual risk behavior, it is not enough to implement preventive interventions only in school or leisure settings. It is important to intervene in all areas that influence adolescent development, because a comprehensive preventive approach that addresses all areas can have a greater impact on adolescent development. Therefore, it is necessary to plan comprehensive, evidence-based interventions targeting individuals and their environments, including SLA, to prevent sexual risk behaviors among adolescents.

Attitudes and risky sexual behavior among youth in Kampala, Uganda: Empirical analyses of risk factors by gender.

This study sought to examine gender differences and the influence of peer and parental perceptions on sexual risk behaviors among an at-risk sample of youth living in Kampala, Uganda. Using the cross-sectional Kampala Youth Survey (2014) based in Kampala, Uganda (n = 1134), bivariate and multivariable logistic regressions were conducted to determine the odds of sexual risk behaviors based on peer and parental influence variables and gender. The perceptions of peer, adult, and parental opinions on sexual activity were significantly associated with varying levels across all risky sexual behaviors explored. When indexed and adjusted for other variables, females compared to males were at increased odds of participating in 3-4 risky sexual behaviors (OR: 0.63, 95% CI: 0.44, 0.90) and 5-6 risky sexual behaviors (OR: 0.38, 95% CI: 0.21, 0.68) compared to zero risky sexual behaviors. Adolescent sexual risk behaviors are subject to peer and parental influence and vary between genders. This study emphasizes the importance of peer influences in adolescent sexual risk behaviors. Many of these youth are orphans, which may explain the lack of association between parental influences and sexual risk behavior. School-based and community-based interventions may be effective at preventing risky sexual behaviors for this vulnerable population.

Perceived causes of change in Nigerian adolescent sexual risk behaviour - Results from semi-structured mobile instant messaging interviews.

The study explores the perceived causes of change in sexual risk behaviour among Nigerian adolescents over the past years. By embedding the results into a theoretical context, the study aims to further develop interventions targeting adolescent sexual health. To do so, 23 semi-structured interviews are conducted through the mobile-instant-messaging tool WhatsApp. The interview sample consists of both female and male adolescents and adults from different regions in Nigeria. The interviews are conducted as simultaneous chats and analysed based on the qualitative content analysis approach. Respondents perceive a multitude of different factors as causes of change in sexual risk behaviour among Nigerian adolescents. They can be categorised into (1) individual factors, (2) structural factors, and (3) socio-cultural factors. Interrelations between the different factors can partly be observed. The other factors are mostly modifiable and can therefore contribute to reducing adolescent SRB.

Adolescent Sibling Associations among Alcohol, Cannabis, and Sexual Risk Behavior: A Test of Interdependence

Background Although siblings are conceptualized as a salient social influence during adolescence, few studies have examined how adolescent siblings influence each other’s substance use and risky sexual behavior. Objectives: In this study, we investigated the influence of alcohol use days, cannabis use days, and cannabis and alcohol co-use days on the sexual risk behavior of siblings while accounting for dyadic influence. Methods At the baseline visit for a randomized controlled trial for adolescents referred due to parents’ concerns about their substance use (“referred adolescents”; n = 99; Mage=15.95; 38.38% female), we assessed alcohol and cannabis use days as well as sexual risk behavior of the referred adolescents and their sibling (Mage=15.03; 51.52% female). We computed the number of days in the 30 days prior to the baseline that alcohol and cannabis use occurred on the same day. Using a cross-sectional actor partner interdependence model, we tested two models of how adolescents’ substance use is associated with their own (“actor effect”) and their siblings’ (“partner effect”) sexual risk behavior—one model for alcohol and cannabis use, and one model for daily co-use. Results For referred adolescents and their siblings, within an individual, greater alcohol, cannabis, and daily co-use was significantly associated with sexual risk behavior (actor effects). Furthermore, more sibling co-use days was positively associated with referred adolescent sexual risk behavior (partner effect), representing interdependence. Conclusion These findings confirm the influence siblings have on one another’s risky behavior in adolescence and have implications for prevention and intervention efforts for adolescent substance use.

Duration-Weighted Exposure to Neighborhood Disadvantage and Racial-Ethnic Differences in Adolescent Sexual Behavior.

Racial-ethnic disparities in adolescent sexual risk behavior are associated with health disparities during adulthood and are therefore important to understand. Some scholars argue that neighborhood disadvantage induces disparities, yet prior research is mixed. We extend neighborhood-effects research by addressing long-term exposure to neighborhood disadvantage and estimation bias resulting from inclusion of time-varying covariates. Drawing from the Fragile Families and Child Well-Being Study, we compare a point-in-time proximal measure of neighborhood disadvantage with a duration-weighted measure using marginal structural models with inverse probability of treatment weights. Findings indicate that multiracial, non-Hispanic black, and Hispanic youth exhibit significantly higher sexual risk and duration-weighted exposure to neighborhood disadvantage than non-Hispanic white adolescents. Duration-weighted exposure is a better predictor of sexual initiation and number of partners by age 15 than a point-in-time proximal measure of neighborhood disadvantage and accounts for a substantial portion of the race-ethnic differences in sexual risk.

South African Fathers Involvement and Their Adolescents' Sexual Risk Behavior and Alcohol Consumption.

Although considerable research has examined the influence of parent-adolescent relationships on the sexual health of adolescents, there is a great need for research to understand the influence of fathers on their children's HIV sexual risk behavior, particularly in sub-Saharan Africa. We examined how the residence and the involvement of fathers are related to their children's HIV sexual risk and alcohol consumption behaviors. A cross-sectional survey was completed by 175 sixth-grade adolescents in the Eastern Cape Province, South Africa. Analyses showed that adolescents living with their fathers had fewer sexual partners (B = -0.606, SE = 0.299, p = .043) and consumed alcohol less frequently (B = -0.642, SE = 0.294, p = .029). Adolescents who spent more quality days with their fathers in the past 30days had fewer sexual partners (B = -0.103, SE = 0.039, p = .008) and had condomless sex less frequently (B = -0.097, SE = 0.047, p = 0.041). It was also found that there were significant father-residence × child-gender interactions on sexual debut (B = 1.132, SE = 0.564, p = .045) and on frequency of condomless sex (B = -2.140, SE = 0.924, p = .021). These interactions indicate that boys living with their fathers were less likely to have had vaginal intercourse than girls and that girls living with their fathers were less likely to have unprotected sex than boys. This study highlights the importance of South African fathers' roles in their adolescent children's HIV sexual risk and alcohol drinking behaviors and the need to promote father-child relationships for adolescent health. The results suggest that health programs aiming to reduce South African adolescents' HIV sexual risk behaviors and alcohol consumption consider strategies that target their fathers.

A Family-Based Healthy Lifestyle Intervention: Crossover Effects on Substance Use and Sexual Risk Behaviors.

This study examined the efficacy of a healthy lifestyle family-based intervention in reducing substance use and sexual risk behaviors compared with prevention as usual over 24months in Hispanic adolescents. Participants were overweight/obese Hispanic adolescents (N = 280; M age 13.01; SD = .82) in the 7th/8th grade and their primary caregivers. Participants were randomized to either the healthy lifestyle family-based intervention or to the control condition (i.e., referral to community services offered for overweight and/or obese adolescents and their families). Outcomes included adolescent substance use and sexual risk behaviors among adolescents. Intervention effects were found for adolescent alcohol (b = -0.37, 95% CI = [-0.49, -0.26]), marijuana (b = -1.00, CI = [-1.22, -0.78]), and non-prescription drug use (b = -3.77, CI = [-6.49, -1.05]) over 24months. No significant intervention effects were found for adolescent sexual risk behaviors. Findings suggest that Familias Unidas for Health and Wellness reduces adolescent alcohol, marijuana, and non-prescription drug use across time. ClinicalTrials.gov Identifier: NCT03943628.

Peer Education and Sexual Risk Behavior Among Adolescents: Does Urban Status Matter?

BACKGROUND: As a result of elevated sexual risk behaviors among teenagers, millions of adolescents face sexual and reproductive health challenges, including high rates of an unfulfilled need for contraceptives, unintended pregnancy, and unsafe abortion. To develop their skills and prevent adolescent sexual activity from being unsafe, especially in urban areas, teachers and peers were advised that teaching adolescents about reproductive health should be carried out at any school.
 AIM: This study aims to evaluate the effect of peer education on the prevention of adolescent activity at sexual risk in urban areas.
 METHODS: This research was a pre-experimental quantitative approach with a one-group pre-post-test model. The survey used in this study had 63 respondents. Samples were collected using a purposeful sampling process. The research was conducted in April at SMP Negeri X Yogyakarta until June 2017. In this analysis, the independent variable was peer education, while the dependent variable was the prevention of sexual risk activity among adolescents.
 RESULTS: The Wilcoxon sign-rank test data analysis showed that there were no significant differences in the prevention of sexual risk behavior among adolescents in urban areas at pre- and post-sexual education through p-value peer education = 0.086.
 CONCLUSION: There is no significant impact on reducing adolescent sexual risk behaviors in urban areas through peer education. The media may significantly influence the prevention of the conduct of urban adolescents at sexual risk. To prevent sexual risk behavior among adolescents in an urban environment, further research is recommended to find the best intervention using more profound internal and external relevant variables and media impact association study.

The Relationship Between Violence Syndemics and Sexual Risk Behaviors Among African American Adolescents: Implications for Future Research

PurposeWe present a conceptual framework based on a review of the literature to highlight the interconnecting and reinforcing elements of a violence syndemic and how this syndemic influences sexual risk behaviors among African American heterosexual adolescents. MethodsWe review existing peer-reviewed published research from 2000 to 2020 that links a violence syndemic (i.e., racism and race-related stress, neighborhood and police violence, peer violence, and family violence and disruptions) to adolescent sexual risk behaviors. Empirical findings and theoretical underpinnings are used to document this relationship and illuminate the factors that mediate this relationship. ResultsEmpirical studies support the links between specific types of violence and sexual risk behaviors among African American adolescents. Further, existing studies point to the important relationships among the specific types of violence, supporting a violence syndemic approach. ConclusionsWhile more researchers are examining socio-ecological contextual factors as important predictors for sexual risk behaviors, there remains inadequate understanding about how violence types reinforce one another to heighten sexual risk behaviors among African American heterosexual adolescents. This article presents new directions for adolescent research, especially how a violence syndemic approach can be used to explain sexual risk, but also to refocus intervention design on the complex burdens experienced by this population.

Adverse Childhood Experiences and Teen Sexual Behaviors: The Role of Self-Regulation and School-Related Factors.

There is limited evidence addressing the impact of adverse childhood experiences (ACEs) on adolescent sexual risk behaviors and pregnancy. In this study, we examined whether individual and cumulative ACEs increased the risk of unhealthy sexual behaviors and adolescent pregnancy. To inform intervention efforts, potential mediating mechanisms focusing on youth developmental assets were examined to explain the association. Analyses included 88,815 (9th and 11th grade) students who completed the Minnesota Student Survey in the spring of 2016. Adolescents who reported each category of ACEs were more likely to initiate sex, have multiple sex partners, engage in unprotected sex, and be involved in pregnancy. Different youth assets, included self-regulation skills, connectedness to school, not skipping school, and academic performance, were associated with lower likelihood of sexual initiation and sexual risk-taking. They served as important mediators to reduce, though not completely diminish, the adverse effects of ACEs on sexual initiation and adolescent pregnancy. The results suggest that the relationship between ACEs and adolescent sexual risk behaviors and pregnancy is strong and graded. Effective school initiatives and intervention efforts should encourage the development of self-regulation and connectedness to school among teens who had been exposed to ACEs.

Developmental Trajectories of Adolescent Girls' Borderline Personality Symptoms and Sexual Risk Behaviors.

Adolescence is a developmental period during which youth tend to initiate sexual behavior, which may include sexual risk behavior. Symptoms of borderline personality disorder (BPD) are associated with increased rates of risky behaviors. However, little is known about longitudinal associations between BPD symptoms and sexual risk behaviors during adolescence. This study examines developmental trajectories of adolescent girls' BPD symptoms and sexual risk behaviors in a community sample of Black and White girls from the Pittsburgh Girls Study (n = 1620). Dual trajectory modeling provided insights into the temporal precedence and co-development of BPD symptoms and sexual risk behaviors from ages 14 to 18. In order to examine the unique association between BPD symptoms and sexual risk behaviors, analyses controlled for symptoms of depression and conduct disorder, as well as race, sexual orientation, and pubertal development. Girls with more BPD symptoms at age 14 showed steeper growth over time in sexual risk behaviors from ages 14 to 18. Additionally, adolescents who showed steeper increases in BPD symptoms over time also showed steeper increases in sexual risk behaviors across adolescence. Notably, however, sexual risk behavior at age 14 was not significantly associated with longitudinal trajectories of BPD symptoms. Results suggest that adolescent girls with early symptoms of BPD are at heightened risk for the development of sexual risk behaviors during adolescence, while the reverse association does not hold. Implications for adolescent development and sexual risk behavior are discussed.

The Sexual Risk Behaviors of Middle School Students According to School Nurse Placement Levels in Korea

PurposeThis study aimed to provide basic data for the future development of school-based sexuality education and school nurse placement policies by examining the sexuality education experience in middle schools according to levels of school nurse placement and identifying factors influencing on adolescent sexual risk behaviors. MethodsThis study examined data from the 2018 14th Korean Youth Risk Behavior Survey. The raw data from 30,229 middle school students enrolled in 400 schools were analyzed using descriptive statistics, Chi-square test, independent t test, and complex sample logistic regression analysis. ResultsIt is found that, in Korea, school nurse placement rates varied by region from 37.9% to 114.8%, resulting in different levels of sexuality and alcohol prevention education (p < .001). Sexuality and alcohol prevention education lowered the likelihood of sexual risk behaviors by 0.54 and 0.87 times, respectively. The experience of drinking alcohol increased a student's likelihood of committing sexual risk behaviors by 4.40 and 3.57 times, respectively, whereas the experience of using a drug increased the risk by 9.42 and 5.00 times, respectively. Personal factors (e.g., gender and academic achievement) and socioenvironmental factors (e.g., school type and perceived economic status) were also found to influence on the sexual risk behaviors of adolescents, although, not to the same degree as sexuality education or health risk behaviors. ConclusionTo protect students' sex-related health equity, more elaborate support policies are needed to ensure adequate placement of school nurses able to provide professional sexuality and related health education.

Eliciting Social Cultural Predictors of Risky Sexual Behaviour Among Adolescents and Young Adults in Nigeria.

The thrust of this paper was to elicit socio-cultural predictors of risky sexual behavior among adolescents and young adults in Nigeria .Socio-cultural parameters were seen to be those factors in the social environment that influences behaviour. The socio-cultural theory believes that people learn through interactions within the socio-cultural environment and such interaction includes; home (parental influence, social economical status of family), peers and culture (religious practices, age norms, and gender issues). This paper further examines these factors and how they predict risky sexual behaviour such as early marriage ,non utilization of contraception, early sex initiation, induced abortions, having multiple sex partners, sex under the influence of alcohol, and indulging in sex for financial and material gains, among adolescents and young adults in Nigeria. It was therefore concluded that socio-cultural environment is a strong predictor of adolescent and young adult sexual risk behavior in Nigeria. Thus it was recommended that social cultural environment should be shaped for optimum reproductive health behaviour among adolescents and young adults in Nigeria.

Predicting the impact of sexual behavior change on adolescent STI in the US and New York State: a case study of the teen-SPARC tool

PurposeAdolescents aged 13–18 years bear a large burden of sexually transmitted infections (STIs) and changing adolescent sexual risk behavior is a key component of reducing this burden. We demonstrate a novel publicly available modeling tool (teen-SPARC) to help state and local health departments predict the impact of behavioral change on gonorrhea, chlamydia, and HIV burden among adolescents. MethodsTeen-SPARC is built in Excel for familiarity and ease and parameterized using data from CDC's Youth Risk Behavior Surveillance System. We present teen-SPARC's methods, including derivation of national parameters and instructions to obtain local parameters. We model multiple scenarios of increasing condom use and estimate the impact on gonorrhea, chlamydia, and HIV incidence, comparing national and New York State (NYS) results. ResultsA 1% annual increase in condom use (consistent with Healthy People 2020 goals) could prevent nearly 10,000 cases of STIs nationwide. Increases in condom use of 17.1%, 2.2%, and 25.5% in NYS would be necessary to avert 1000 cases of gonorrhea, 1000 cases of chlamydia, and 10 cases of HIV infection, respectively. Additional results disaggregate outcomes by age, sex, partner sex, jurisdiction, and pathogen. ConclusionTeen-SPARC may be able to assist health departments aiming to tailor behavioral interventions for STI prevention among adolescents.