Which forms of child/adolescent externalizing behaviors account for late adolescent risky sexual behavior and substance use?

Background: Health risk behaviors like substance use (alcohol, tobacco, soft/hard drugs) and risky sexual behavior become more prevalent in adolescence. Children with behavior problems are thought to be prone to engage in health risk behaviors later in life. It is, however, unclear which problems within the externalizing spectrum account for these outcomes. Methods: Three hundred and nine children were followed from age 4/5 years to 18 years (14-year follow-up). Level and course of parent-rated opposition, physical aggression, status violations and property violations were used to predict adolescent-reported substance use and risky sexual behavior at age 18 years. Results: Both level and change in physical aggression were unique predictors of all forms of adolescent health risk behavior. Levels of status violations predicted smoking and soft drug use only, while change in property violations predicted each of the health risk behaviors. The links between opposition and health risk behaviors were accounted for by co-occurring problem behaviors. Conclusions: Of externalizing problems, physical aggression is the best predictor of adolescent substance use and risky sexual behavior from childhood onwards. Possible explanations and implications of these findings, and future research directions are discussed. © 2007 The Authors

Efficacy of SISTA South Africa on sexual behavior and relationship control among isiXhosa women in South Africa: results of a randomized-controlled trial

Background: The HIV epidemic has a devastating impact among South African women. The current study evaluated the efficacy of SISTA South Africa, a culturally congruent HIV intervention for isiXhosa women in South Africa, which was adapted from SISTA, an HIV intervention for African American women. Methods: A randomized-controlled trial recruited 342 isiXhosa women aged 18-35 years. Participants were randomized to the general health comparison or the SISTA South Africa intervention. Xhosa-speaking peer health educators tailored the SISTA South Africa curriculum, while maintaining the core elements of the original SISTA intervention. Participants completed assessments at baseline and 6 months follow-up. Results: Relative to participants in the comparison, participants in the HIV intervention reduced the frequency of unprotected vaginal intercourse acts (adjusted mean difference = 1.06; P = 0.02), were more likely to report not desiring dry sex (adjusted odds ratio = 0.229; 95% confidence interval = 0.10 to 0.47; P = 0.0001), and were more likely to perceive that their main sexual partner did not desire dry sex (adjusted odds ratio = 0.24; 95% confidence interval = 0.11 to 0.52; P = 0.0001). In addition, women randomized to the intervention also reported an increase in HIV knowledge, greater relationship control, and had more opposing attitudes toward HIV stigma. The HIV intervention did not reduce sexually transmitted infection incidence. Conclusions: This trial demonstrates that an HIV intervention, which is adapted to enhance its gender and cultural relevance for rural isiXhosa women, can reduce self-reported sexual risk behaviors and enhance mediators of HIV among this vulnerable population.

Individual and Neighborhood Correlates of HIV Testing Among African American Youth Transitioning from Adolescence into Young Adulthood

Disparities in HIV testing rates exist among socially disadvantaged communities. Using a longitudinal sample of urban African American youth followed from adolescence into young adulthood (n = 396; 51% female), we examined whether HIV testing was associated with individual (e.g., gender, socioeconomic status [SES], education, and history of sexually transmitted infections [STIs]) and area (i.e., neighborhood disadvantage and HIV prevalence) characteristics. In our multilevel regressions, we found females were more likely to have tested for HIV, with the magnitude of this association increasing if they lived in areas of greater disadvantage yet decreasing in higher HIV prevalence areas. Those without a high school degree, with a lower SES, or with a history of STIs in adolescence were less likely to test if they lived in greater disadvantage and HIV prevalence areas. We discuss the implications of these findings from an ecological perspective and propose recommendations for increasing testing among African American youth.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85178/1/Johnsetal10.pd