Beyond Age at First Sex: Adolescent Sexual Patterns and Adult Sexual and Reproductive Health

Although the emergence of sexual expression during adolescence and early adulthood is nearly universal, little is known about broad patterns of initiation. This dissertation identifies patterns of first oral-genital, anal, and vaginal sex and describes their implications for reproductive health and sexual risk taking in adulthood using data from the National Longitudinal Study of Adolescent Health (Add Health). In the first paper, I use latent class analysis to classify 12,194 respondents from Wave I and Wave IV of Add Health on the basis of variety, timing, spacing, and sequencing of oral-genital, anal, and vaginal sex. Approximately one half of respondents followed a pattern characterized predominately by initiation of vaginal sex first, average age of initiation of approximately 16 years, and spacing of one year or more between initiation of the first and second behaviors. Almost one third initiated sexual activity slightly later but reported first experiences of oral-genital and vaginal sex within the same year. Classes characterized by postponement of sexual activity, initiation of only one type of behavior, or adolescent initiation of anal sex were substantially less common. Compared to White respondents, Black respondents were more likely to appear in classes characterized by initiation of vaginal sex first. Respondents from lower socioeconomic backgrounds were more likely to be in classes distinguished by early/atypical patterns of initiation. The second paper describes associations between class membership and sexually transmitted infections, partner counts, concurrent sexual partnerships, and giving/receiving money for sex, with extensive controls for sociodemographics, behavioral, and psychosocial characteristics. I find that, with the exception of postponement of sexual activity until young adulthood, associations between adolescent sexual patterns and reproductive health/sexual risk taking are complex. While greater sexual variety is generally associated with poorer reproductive and sexual health outcomes, these relationships are not entirely consistent across outcomes and across classes. Greater attention to the relational and interpersonal contexts of early sexual patterns may help elucidate their implications for subsequent wellbeing. More broadly, this dissertation highlights the importance of considering the multiple interactive factors that contribute to processes of normative sexuality development

Older Romantic Partners and Depressive Symptoms During Adolescence

Although developmental theory predicts that adolescent romantic relationships have important benefits, empirical evidence suggests that they may also carry substantial psychosocial risk. This study uses data from 4,948 respondents (50% female) in Wave I and Wave II of the National Longitudinal Study of Adolescent Health to examine the association between involvement with an older romantic partner and depressive symptoms during adolescence. Ordinary least squares regression models compared Wave II depressive symptoms among respondents with older partners (defined as an age difference of 2 or more years) to respondents with same-age or younger partners, controlling for baseline depressive symptoms and sociodemographic characteristics. Ten percent of females and two percent of males reported having an older romantic partner at Wave II. Among females only, involvement with an older romantic partner was associated with a modest but significant increase in depressive symptoms between waves. This association was largely mediated by increases in substance use. Findings suggest that involvement with an older male partner during adolescence may increase the risk of poor emotional outcomes among females

Sexual Timetables for Oral-Genital, Vaginal, and Anal Intercourse: Sociodemographic Comparisons in a Nationally Representative Sample of Adolescents

Objectives. We documented the prevalence and relative timing of oral-genital, vaginal, and anal intercourse during adolescence and examined whether these timetables varied by sociodemographic factors

Unwanted Sex Among Young Adults in the United States: The Role of Physical Disability and Cognitive Performance

This study examined associations between unwanted sexual experiences and both physical disability and cognitive performance in a nationally representative sample of young adults. We used data from 11,878 participants (ages 26–32) in Waves I, III, and IV of the National Longitudinal Study of Adolescent Health (Add Health). Logistic regressions determined associations between physical disability and level of cognitive performance (using a modified Peabody Picture Vocabulary Test) and the odds of experiencing physically forced and non-physically coerced sex. Approximately 24% of females and 4% of males reported unwanted sexual experiences. Compared to respondents without disabilities, females with a physical disability had greater odds of experiencing forced sex (OR=1.49; 95% CI: 1.06, 2.08), while males with a physical disability had greater odds of coerced sex (OR: 1.90; 95% CI: 1.02, 3.52). Compared to those with average cognitive performance scores, females with scores above 110 had slightly higher odds of coerced sex (OR=1.20; 95% CI: 1.03–1.41). Further research on pathways underlying these associations is needed to inform prevention efforts

Childhood Abuse and Neglect and the Risk of STDs In Early Adulthood

Given the threat posed by STDs in young adulthood, identifying early predictors of STD risk is a priority. Exposure to childhood maltreatment has been linked to sexual risk behaviors, but its association with STDs is unclear

Reproductive health of young adults with physical disabilities in the U.S.

Previous research shows reduced cervical and breast cancer screening among women with physical disabilities. However, other indicators of reproductive health have been largely ignored. We aimed to compare the reproductive health of young adults in the U.S. with and without physical disabilities in a nationally-representative sample

Associations Between Patterns of Emerging Sexual Behavior and Young Adult Reproductive Health

Identifying young adult outcomes associated with adolescent sexual behavior, including patterns of first oral, vaginal and anal sex, is critical to promoting healthy sexual development

The Association Between Sequences of Sexual Initiation and the Likelihood of Teenage Pregnancy

Few studies have examined the health and developmental consequences, including unintended pregnancy, of different sexual behavior initiation sequences. Some work suggests that engaging in oral-genital sex first may slow the transition to coital activity and lead to more consistent contraception among adolescents

Longitudinal Consistency in Self-Reported Age of First Vaginal Intercourse among Young Adults

We examined consistency in self-reports of age at first vaginal sex among 9,399 male and female respondents who participated in Waves III and IV (separated by approximately 7 years) of the National Longitudinal Study of Adolescent Health (Add Health). Respondents were coded as consistent if they reported an age at first vaginal intercourse at Wave IV that was within 1 year of the age they reported at Wave III. Sociodemographic, behavioral, and cognitive predictors of consistency were examined using bivariate and multivariate logistic regression. Overall, 85.43% of respondents were able to provide consistent reports. Among both males and females, consistency was associated with age, years since first vaginal intercourse, race/ethnicity, and lifetime number of other-sex partners in final multivariate models. Respondents who were older and had more recently had their first sexual experience were more likely to be consistent. For females only, those who reported a history of non-parental, physically forced sex were less likely to be consistent. Most young adults consistently report age at first vaginal intercourse, supporting the credibility of retrospective self-reports about salient sexual events such as timing of first vaginal intercourse

Growing Up With a Chronic Illness: Social Success, Educational/Vocational Distress

We compared adult educational, vocational, and social outcomes among young adults with and without childhood-onset chronic illness in a nationally representative US sample