Journal of BehavioralMedicine, VoL 13, No. 3, 1990
Social and Behavioral Factors Associated with High-Risk Sexual Behavior Among Adolescents A n t h o n y Biglan, I Carol W . Metzler, I Roger Wirt, I D e n n i s A r y , ~ J o h n N o e l l , ~ Linda Ochs, ~ Christine French, x and D o n H o o d I
Acceptedfor publication: October 8, 1988
Relationships among risky sexual behaviors, other problem behaviors, and the family and peer context were examined for two samples o f adolescents. Many adolescents reported behaviors (e.g., promiscuity or nonuse o f condoms) which risked H I V or other sexually transmitted disease infection. Such risky behaviois were significantly intercorrelated. Consistent condom use was rare among those whose behavior otherwise entailed the greatest risk o f infection. In both samples, an index o f high-risk sexual behavior was significantly related to antisocial behavior, cigarette smoking, and illicit drug or alcohol use. Social context variables, including family structure, parenting practices, and friends" engagement in problem behaviors, were associated with high-risk sexual behavior. Finally, for sexually active adolescents, problem behaviors and social context variables were predictive of nonuse of condoms. Results were consistent across the two studies and regression weights held up well under cross-validation. KEY WORDS: HIV infection; sexual behavior; adolescence; alcohol; drug use; smoking.
This research was supported in part by National Cancer Institute Grants CA44648 and CA38273. The authors would like to thank John Reid for his consultation and advice on the development of this study. ~Oregon Research Institute, 1899 Willamette Street, Eugene, Oregon 97401.
245 0160-7715/90/0600-0245506.00/0 9 1990 Plenum Publishing Corporation
246
Biglan et
al.
INTRODUCTION This paper examines social and behavioral factors associated with highrisk heterosexual behavior among adolescents. The identification of such factors could contribute to the development of programs to prevent or modify high-risk sexual behavior. This goal has taken on increased significance given the threat of an AIDS epidemic among adolescents (Haffner, 1987). Although the prevalence of HIV infection among adolescents is not currently high, the threat of an AIDS epidemic among adolescents is suggested by the current prevalence of AIDS among people in their twenties and by the prevalence of other sexually transmitted diseases (STDs) among adolescents. The November 28, 1988, Weekly Surveillance Report (Centers for Disease Control, 1988) indicated that 21~ of AIDS cases are among 20- to 29-year-olds. Given the latency of AIDS development (Curran et al., 1985), it is likely that some of these cases were contracted during adolescence. The incidence of other sexually transmitted diseases among adolescents has been estimated to be as high as 30% among sexually active adolescents (Chambers et al., 1987). This incidence suggests that, if HIV penetrated the adolescent population to a greater extent, it could spread rapidly.
High-Risk Sexual Behavior
Any sexual activity that brings a person in contact with semen, blood, or vaginal secretions of a person infected with HIV puts that person at risk for infection (Goedert, 1987). For this reason, condom use is a critical target behavior. Condoms are not, however, believed to be more than 93% effective in preventing infection when used in vaginal intercourse (Wellings, 1986). Therefore, the frequency of intercourse, ranging from total abstinence to very high frequency, is presumably associated with the risk of infection. Sex with members of high-risk groups (e.g., prostitutes, homosexual or bisexual men, intravenous drug users) also puts one at risk for HIV infection. Perhaps for this reason, having sex with a person of unknown status and having multiple partners have been identified as risk factors (Goedert, 1987; National Academy of Sciences, 1986). In this study, interrelationships among high-risk heterosexual behaviors were examined and the degree to which they converge was assessed in order to see if forming a single index of sexually risky behavior was appropriate. The Behavioral Context
There is growing evidence that different adolescent problem behaviors are interrelated (Donovan and Jessor, 1985; Mott and Haurin, 1988; Osgood
Sexual Behavior
247
et al., 1988). However, although some studies have shown that the general frequency of sexual experience is associated with other problem behaviors such as delinquent acts or substance use (Donovan and Jessor, 1985), no studies have examined whether the specific sexual behaviors that put one at risk for HIV infection or other STDs are more likely among deviance-prone adolescents. It could be that only the most deviance-prone are engaging in high-risk sexual behaviors. This fact would point to the appropriateness of targeting this subgroup in preventive efforts and would suggest that interventions proven effective with other problem behaviors could be valuable in constructing programs for preventing HIV infection. On the other hand, the relatively high prevalence of sexual intercourse among adolescents (Hofferth, 1987) could imply widespread risk of HIV and other STD infection among this group. In this case, preventive efforts would need to be directed toward most teenagers. The Social Context
Whatever the association of high-risk sexual behavior with problem or prosocial behavior, identifying the social context that influences the behavior is essential. It is inevitably the social context which must be manipulated if high-risk sexual behavior is going to be prevented or modified (Biglan, in press; Hayes and Brownstein, 1986). In the present study, we tested the applicability of Patterson's (Patterson et al., 1990) theory of coercive family processes to high-risk sexual behavior. In a series of studies, Patterson and his colleagues (1990; Bank et al., 1987) have shown that antisocial behavior is more likely among children whose parents (a) use coercive discipline practices, (b) fail to monitor their children's activities, (c) fail to support prosocial behavior, and (d) are not skilled at discussing problems with their children. Although there has been a good deal of research on parental influences on adolescent sexual behavior (Miller et al., 1986, 1987; Nathanson and Becker, 1986; Newcomer and Udry, 1985), the possible role of these important parenting skills has not been examined. High-risk sexual behavior of adolescents might be influenced less by parents' direct discussions about sexuality (Kahn et al., 1984) than by a family environment which simply fails to develop prosocial behavior and low levels of risk taking. Therefore, measures of these parenting constructs were obtained in the present study and their relationship to high-risk sexual behavior was examined. Peers appear to influence adolescents to engage in a variety of problem behaviors (Brown et al., 1986; Elliott et al., 1983; Jessor and Jessor, 1977). However, the role of peer influences on sexual behavior is more complex. There is evidence that white girls' engagement in sexual intercourse is influenced by their same-sex friends but that white boys and black girls and
248
Biglan et
al.
boys are less influenced by their friends (Billy and Udry, 1985a, b). White girls' contraceptive use has also been shown to be influenced by same-sex friends, while for black females, contraceptive use is associated more strongly with maternal involvement (Nathanson and Becker, 1986). However, the influence of peers on engagement in behaviors that risk HIV infection or other STD's has not been examined. One reason that peer influences on sexual behavior may not be evident is that adolescents may not have accurate information about their friends' sexual behavior. However, sexual behavior may be prompted by peers in other ways. For example, evidence of a "general deviance" factor (Donovan and Jessor, 1985; Osgood, et al., 1988) suggests that associating with peers who engage in a variety of forms of deviant or antisocial behavior could increase the likelihood of sexual behavior generally and high-risk sexual behavior specifically, simply as a matter of influence to engage in deviant behavior. Therefore, we examined the relationship between peers' engagement in various antisocial behaviors and subjects' high-risk sexual behavior.
METHOD Subjects Two successive samples of adolescents were recruited to participate. The first wave consisted of 64 males and 67 females in grades 8 through 12, with the largest proportion (43%) being in grade 10. Subjects lived in the Eugene-Springfield, Oregon, area. Ninety percent of these subjects were white, 3o70 were black, and 5~ were Native American. For Sample 1, we also asked a parent to complete a questionnaire about the adolescent, family life, and aspects of their own behavior. Of 131 adolescent subjects, parent questionnaires were obtained for 106. The data were supplied by the mother in 98 cases (92~ and by the father in the remainder of cases. Sample 2 consisted of 42 females and 57 males. These subjects also ranged from eighth to twelfth graders, with the largest proportion (41%) being in grade 12. Ninety-two percent were white, 2O/owere black, 4070 were Native American, 1~ were Hispanic, and the rest were unspecified. Data were not obtained from parents of Sample 2 subjects. Subjects were recruited through newspaper advertisements, public service announcements, and leaflets that were distributed at local high schools and places where adolescents congregate. Subjects were paid $20.00 for their participation. Parents of Sample 1 subjects who completed the questionnaire were paid $10.00.
Sexual Behavior
249 Measures and Data Reduction
Sexual Behavior. The questionnaire contained items about sexual behavior that would put a person at risk for AIDS or other STDs (Gilchrist, personal communication, February 1988). An index of high-risk sexual behavior was composed from the mean of the z scores for six of the items which involved heterosexual behavior: (a) number of partners in the past year; (b) number of times the subject had intercourse with partners he or she did not know well; (c) number of times the subject had sex with a partner who injected drugs; (d) number of times the subject had sex with someone he or she knew was having sex with someone else; (e) frequency of intercourse without the use of condoms; and (f) whether or not the subject had engaged in anal sex. Problem and Prosocial Behavior. Self-reports were obtained regarding the following aspects of adolescent behavior: (a) antisocial behavior (aggressive behavior and delinquent acts such as stealing and vandalism); (b) prosocial behavior such as membership in school organizations; (c) school difficulties such as truancy and school failure; (d) cigarette smoking; (e) alcohol consumption; and (f) use of marijuana and other illicit drugs. Measures of each of these behaviors were composed from multiple items. In virtually every case, the items were taken from measures validated in previous research. Measures of smoking, alcohol, marijuana, and other drug use came from our own research (Ary and Biglan, 1988; Biglan et al., 1987a, b). Measures of aggressive, delinquent, prosocial, and school behavior were taken from work by Patterson and his colleagues (1990; Bank et al., 1987), Elliott and his colleagues (1983), and Jessor's work (e.g., Donovan and Jessor, 1985). Family and Peer Context. A measure of family structure was composed to reflect the likelihood that parents would be physically and psychologically available to the subject. For this purpose, the following continuum of family organizations was assumed to range from most to least facilitative of the young person's development: (a) having two natural parents in the home; (b) having one natural parent and another adult in the home; (c) having a single parent; (d) living in foster care; and (e) having no parent or other adult present. The z scores for subjects' values on this scale were averaged with z scores for responses to two other items: (a) amount of time spent with both parents in the last year and (b) amount of contact with the parent the subject did not live with (if applicable). The four aspects of parenting practices assessed were (a) coercive exchange occurring in the family, (b) parental monitoring of adolescents' activities, (c) social support for the adolescent, and (d) family problem-solving skill. Items and the procedures for combining them into measures of parent-
250
Biglan et aL
ing practices were adapted on the basis of Patterson's research (Bank et al., 1987; Patterson et al., 1990) and Moos' work (1974) on the family environment. In Sample 1, items from parent questionnaire were used as well as items from the adolescent questionnaire. Examples of items involving coercive exchanges included (a) "At least once a day we get angry at each other" and (b) "In general, I don't think we get along very well." Items regarding monitoring included (a) "Most afternoons, my parents know exactly where I am when school is out" and (b) "On days when I go home after school, one of my parents, or another adult, is usually home." Sample items for social support included (a) "We do a lot of things together" and (b) "We have fun together." Finally, sample items involving family problem-solving included (a) "We both compromise (give a little) during arguments" and (b) "The talks we have are frustrating." Teenagers answered these questions about both parents where appropriate, and parents (in Sample I) answered them concerning their relationship to the child who was a subject in our study. The questionnaire also included items about peers' aggressive, delinquent, prosocial, and school behavior which were taken from the Patterson group (Patterson et al., 1990) and combined to form a composite measure of peer engagement in problem behavior. Data on peers' alcohol and drug use were also collected. These data were treated as distinct forms of substance use, because it was felt that they might independently influence adolescent engagement in high-risk sexual behavior. In Sample 1, parents as well as subjects answered questions regarding peers' behavior. Procedures
Subjects completed questionnaires in small, same-sex groups. Each group was led by two persons of the same sex as the subjects. An active consent procedure was used in which subjects were required to have signed statements of informed consent from a parent or guardian in order to participate, unless they were above the age of 18. Subjects in Sample 1 took questionnaires home to their parents subsequent to completing their own questionnaires. Reminder letters were sent when parents did not return the questionnaires. Half of the subjects in Sample 2 were also assigned at random to a bogus pipeline condition in which they were told that their reports of sexual behavior would be corroborated by analysis of urine samples. Subjects were debriefed following the study. Since this instruction did not affect reports of sexual behavior, this variable was not analyzed further.
Sexual Behavior
251
RESULTS Patterns of Sexual Behavior
Table I presents summary statistics concerning the sexual behavior of each sample, stratified by gender. As will be seen, 69~ of the boys in Sample 1 and 61~ of the girls reported sexual intercourse in the previous year. In Sample 2, 61% of the boys and 60% of the girls reported sexual intercourse. Responses to items regarding sexual behavior risking HIV infection or other STDs indicated that a substantial minority of subjects were placing themselves at risk (from 4 to 41%, depending on the measure).
Table I. P e r c e n t a g e of Subjects E n g a g i n g in V a r i o u s B e h a v i o r s in E a c h S a m p l e Percentage Sample 1 Males H a d i n t e r c o u r s e in the p a s t year Had more than two partners in the past year H a d sex m o r e t h a n once in p a s t year a n d never used a condom H a d sex w i t h s o m e o n e d i d n ' t k n o w very well H a d sex w i t h s o m e o n e w h o injected d r u g s H a d sex with a p a r t n e r w h o was h a v i n g sex w i t h o t h e r people H a d a n a l sex
Females
Sample 2 Males
Females
69 61 (n = 44) (n = 41)
61 60 (n = 35) (n = 25)
39 25 (n = 25) (n = 17)
30 29 (n = 17) (n = 12)
17 10 (n = 11) (n = 7)
5 (n = 3)
41 28 (n = 26) (n = 19)
35 29 (n = 20) (n = 12)
5 (n = 3)
10 (n = 7)
27 28 (n = 17) (n = 18) 8 (n = 5)
11 (n = 7)
4 (n = 2)
12 (n = 5)
17 (n = 7)
20 27 (n = 11) (n = 11) 7 (n = 4)
8 (n = 3)
252
Biglan et
al.
Convergence of High-Risk Sexual Behaviors Table II presents correlations among the questionnaire items involving high-risk sexual behavior for each sample. Sample 1 data are above the diagonal and Sample 2 are below. In general, the items were moderately intercorrelated. For Sample 1, the coefficient alpha (Cronbach, 1951) for this index was .77 while for Sample 2 it was .73. The z scores of this series of items were averaged to form a composite index of high-risk sexual behavior. Scores on this index did not differ significantly by gender. If adolescents always used condoms when they were engaging in risky sexual behaviors such as having multiple partners, the actual risk of disease would be reduced greatly. We therefore examined the correlation between condom nonuse and an index composed of the remaining items in our index of risky sexual behavior for those subjects who reported having had sexual intercourse. Those who engage in other forms of risky sexual behavior are significantly less likely to use condoms. In Sample 1 the correlation was .50 (p < .001), while in Sample 2 it was .48 (p < .001).
High-Risk Sexual Behavior and Other Problem Behavior Table III presents correlations between the sexual risk index and measures of other types of problem behavior.2 In Sample I, self-reported engagement in high-risk sexual behavior was significantly related to reports of antisocial behavior, low levels of reported prosocial behavior, and high levels of academic difficulties, smoking, alcohol use, and other drug use. In Sample 2, high-risk sexual behavior was related to these same variables, except for the measures o f academic difficulties and prosocial behavior. Hierarchical multiple regression was used to examine the degree to which these predictors accounted for independent variance in risky sexual behavior and the degree to which there were sex differences in the relationships. Table III presents these results for each sample. Because there is evidence that antisocial behavior precedes academic difficulty, which precedes smoking and other drug use developmentally (Jessor and Jessor, 1977; Patterson et aL, 1990), the measure of antisocial behavior was entered first, followed by measures of prosocial behavior and academic difficulty. Smoking, alcohol use, and the use of illicit drugs were then entered in that order. For Sample 1, the R 2 was .26. Antisocial behavior accounted for significant variance (R 2 = .04, F = 5.69, p = .019). Prosocial behavior did 2Expiredair samples, which were analyzedfor carbon monoxide, were obtained from subjects in Sample2 in order to corroborateself-reportsof smokingand increasetheir accuracy.Although this measurewas not obtained in Sample 1, inspectionof the correlationsbetweenself-reported smoking and other variablesin the two samples indicatedverylittle differencebetweensamples.
< < <
Social and Behavioral Factors Associated with High-Risk Sexual Behavior Among Adolescents A n t h o n y Biglan, I Carol W . Metzler, I Roger Wirt, I D e n n i s A r y , ~ J o h n N o e l l , ~ Linda Ochs, ~ Christine French, x and D o n H o o d I
Acceptedfor publication: October 8, 1988
Relationships among risky sexual behaviors, other problem behaviors, and the family and peer context were examined for two samples o f adolescents. Many adolescents reported behaviors (e.g., promiscuity or nonuse o f condoms) which risked H I V or other sexually transmitted disease infection. Such risky behaviois were significantly intercorrelated. Consistent condom use was rare among those whose behavior otherwise entailed the greatest risk o f infection. In both samples, an index o f high-risk sexual behavior was significantly related to antisocial behavior, cigarette smoking, and illicit drug or alcohol use. Social context variables, including family structure, parenting practices, and friends" engagement in problem behaviors, were associated with high-risk sexual behavior. Finally, for sexually active adolescents, problem behaviors and social context variables were predictive of nonuse of condoms. Results were consistent across the two studies and regression weights held up well under cross-validation. KEY WORDS: HIV infection; sexual behavior; adolescence; alcohol; drug use; smoking.
This research was supported in part by National Cancer Institute Grants CA44648 and CA38273. The authors would like to thank John Reid for his consultation and advice on the development of this study. ~Oregon Research Institute, 1899 Willamette Street, Eugene, Oregon 97401.
245 0160-7715/90/0600-0245506.00/0 9 1990 Plenum Publishing Corporation
246
Biglan et
al.
INTRODUCTION This paper examines social and behavioral factors associated with highrisk heterosexual behavior among adolescents. The identification of such factors could contribute to the development of programs to prevent or modify high-risk sexual behavior. This goal has taken on increased significance given the threat of an AIDS epidemic among adolescents (Haffner, 1987). Although the prevalence of HIV infection among adolescents is not currently high, the threat of an AIDS epidemic among adolescents is suggested by the current prevalence of AIDS among people in their twenties and by the prevalence of other sexually transmitted diseases (STDs) among adolescents. The November 28, 1988, Weekly Surveillance Report (Centers for Disease Control, 1988) indicated that 21~ of AIDS cases are among 20- to 29-year-olds. Given the latency of AIDS development (Curran et al., 1985), it is likely that some of these cases were contracted during adolescence. The incidence of other sexually transmitted diseases among adolescents has been estimated to be as high as 30% among sexually active adolescents (Chambers et al., 1987). This incidence suggests that, if HIV penetrated the adolescent population to a greater extent, it could spread rapidly.
High-Risk Sexual Behavior
Any sexual activity that brings a person in contact with semen, blood, or vaginal secretions of a person infected with HIV puts that person at risk for infection (Goedert, 1987). For this reason, condom use is a critical target behavior. Condoms are not, however, believed to be more than 93% effective in preventing infection when used in vaginal intercourse (Wellings, 1986). Therefore, the frequency of intercourse, ranging from total abstinence to very high frequency, is presumably associated with the risk of infection. Sex with members of high-risk groups (e.g., prostitutes, homosexual or bisexual men, intravenous drug users) also puts one at risk for HIV infection. Perhaps for this reason, having sex with a person of unknown status and having multiple partners have been identified as risk factors (Goedert, 1987; National Academy of Sciences, 1986). In this study, interrelationships among high-risk heterosexual behaviors were examined and the degree to which they converge was assessed in order to see if forming a single index of sexually risky behavior was appropriate. The Behavioral Context
There is growing evidence that different adolescent problem behaviors are interrelated (Donovan and Jessor, 1985; Mott and Haurin, 1988; Osgood
Sexual Behavior
247
et al., 1988). However, although some studies have shown that the general frequency of sexual experience is associated with other problem behaviors such as delinquent acts or substance use (Donovan and Jessor, 1985), no studies have examined whether the specific sexual behaviors that put one at risk for HIV infection or other STDs are more likely among deviance-prone adolescents. It could be that only the most deviance-prone are engaging in high-risk sexual behaviors. This fact would point to the appropriateness of targeting this subgroup in preventive efforts and would suggest that interventions proven effective with other problem behaviors could be valuable in constructing programs for preventing HIV infection. On the other hand, the relatively high prevalence of sexual intercourse among adolescents (Hofferth, 1987) could imply widespread risk of HIV and other STD infection among this group. In this case, preventive efforts would need to be directed toward most teenagers. The Social Context
Whatever the association of high-risk sexual behavior with problem or prosocial behavior, identifying the social context that influences the behavior is essential. It is inevitably the social context which must be manipulated if high-risk sexual behavior is going to be prevented or modified (Biglan, in press; Hayes and Brownstein, 1986). In the present study, we tested the applicability of Patterson's (Patterson et al., 1990) theory of coercive family processes to high-risk sexual behavior. In a series of studies, Patterson and his colleagues (1990; Bank et al., 1987) have shown that antisocial behavior is more likely among children whose parents (a) use coercive discipline practices, (b) fail to monitor their children's activities, (c) fail to support prosocial behavior, and (d) are not skilled at discussing problems with their children. Although there has been a good deal of research on parental influences on adolescent sexual behavior (Miller et al., 1986, 1987; Nathanson and Becker, 1986; Newcomer and Udry, 1985), the possible role of these important parenting skills has not been examined. High-risk sexual behavior of adolescents might be influenced less by parents' direct discussions about sexuality (Kahn et al., 1984) than by a family environment which simply fails to develop prosocial behavior and low levels of risk taking. Therefore, measures of these parenting constructs were obtained in the present study and their relationship to high-risk sexual behavior was examined. Peers appear to influence adolescents to engage in a variety of problem behaviors (Brown et al., 1986; Elliott et al., 1983; Jessor and Jessor, 1977). However, the role of peer influences on sexual behavior is more complex. There is evidence that white girls' engagement in sexual intercourse is influenced by their same-sex friends but that white boys and black girls and
248
Biglan et
al.
boys are less influenced by their friends (Billy and Udry, 1985a, b). White girls' contraceptive use has also been shown to be influenced by same-sex friends, while for black females, contraceptive use is associated more strongly with maternal involvement (Nathanson and Becker, 1986). However, the influence of peers on engagement in behaviors that risk HIV infection or other STD's has not been examined. One reason that peer influences on sexual behavior may not be evident is that adolescents may not have accurate information about their friends' sexual behavior. However, sexual behavior may be prompted by peers in other ways. For example, evidence of a "general deviance" factor (Donovan and Jessor, 1985; Osgood, et al., 1988) suggests that associating with peers who engage in a variety of forms of deviant or antisocial behavior could increase the likelihood of sexual behavior generally and high-risk sexual behavior specifically, simply as a matter of influence to engage in deviant behavior. Therefore, we examined the relationship between peers' engagement in various antisocial behaviors and subjects' high-risk sexual behavior.
METHOD Subjects Two successive samples of adolescents were recruited to participate. The first wave consisted of 64 males and 67 females in grades 8 through 12, with the largest proportion (43%) being in grade 10. Subjects lived in the Eugene-Springfield, Oregon, area. Ninety percent of these subjects were white, 3o70 were black, and 5~ were Native American. For Sample 1, we also asked a parent to complete a questionnaire about the adolescent, family life, and aspects of their own behavior. Of 131 adolescent subjects, parent questionnaires were obtained for 106. The data were supplied by the mother in 98 cases (92~ and by the father in the remainder of cases. Sample 2 consisted of 42 females and 57 males. These subjects also ranged from eighth to twelfth graders, with the largest proportion (41%) being in grade 12. Ninety-two percent were white, 2O/owere black, 4070 were Native American, 1~ were Hispanic, and the rest were unspecified. Data were not obtained from parents of Sample 2 subjects. Subjects were recruited through newspaper advertisements, public service announcements, and leaflets that were distributed at local high schools and places where adolescents congregate. Subjects were paid $20.00 for their participation. Parents of Sample 1 subjects who completed the questionnaire were paid $10.00.
Sexual Behavior
249 Measures and Data Reduction
Sexual Behavior. The questionnaire contained items about sexual behavior that would put a person at risk for AIDS or other STDs (Gilchrist, personal communication, February 1988). An index of high-risk sexual behavior was composed from the mean of the z scores for six of the items which involved heterosexual behavior: (a) number of partners in the past year; (b) number of times the subject had intercourse with partners he or she did not know well; (c) number of times the subject had sex with a partner who injected drugs; (d) number of times the subject had sex with someone he or she knew was having sex with someone else; (e) frequency of intercourse without the use of condoms; and (f) whether or not the subject had engaged in anal sex. Problem and Prosocial Behavior. Self-reports were obtained regarding the following aspects of adolescent behavior: (a) antisocial behavior (aggressive behavior and delinquent acts such as stealing and vandalism); (b) prosocial behavior such as membership in school organizations; (c) school difficulties such as truancy and school failure; (d) cigarette smoking; (e) alcohol consumption; and (f) use of marijuana and other illicit drugs. Measures of each of these behaviors were composed from multiple items. In virtually every case, the items were taken from measures validated in previous research. Measures of smoking, alcohol, marijuana, and other drug use came from our own research (Ary and Biglan, 1988; Biglan et al., 1987a, b). Measures of aggressive, delinquent, prosocial, and school behavior were taken from work by Patterson and his colleagues (1990; Bank et al., 1987), Elliott and his colleagues (1983), and Jessor's work (e.g., Donovan and Jessor, 1985). Family and Peer Context. A measure of family structure was composed to reflect the likelihood that parents would be physically and psychologically available to the subject. For this purpose, the following continuum of family organizations was assumed to range from most to least facilitative of the young person's development: (a) having two natural parents in the home; (b) having one natural parent and another adult in the home; (c) having a single parent; (d) living in foster care; and (e) having no parent or other adult present. The z scores for subjects' values on this scale were averaged with z scores for responses to two other items: (a) amount of time spent with both parents in the last year and (b) amount of contact with the parent the subject did not live with (if applicable). The four aspects of parenting practices assessed were (a) coercive exchange occurring in the family, (b) parental monitoring of adolescents' activities, (c) social support for the adolescent, and (d) family problem-solving skill. Items and the procedures for combining them into measures of parent-
250
Biglan et aL
ing practices were adapted on the basis of Patterson's research (Bank et al., 1987; Patterson et al., 1990) and Moos' work (1974) on the family environment. In Sample 1, items from parent questionnaire were used as well as items from the adolescent questionnaire. Examples of items involving coercive exchanges included (a) "At least once a day we get angry at each other" and (b) "In general, I don't think we get along very well." Items regarding monitoring included (a) "Most afternoons, my parents know exactly where I am when school is out" and (b) "On days when I go home after school, one of my parents, or another adult, is usually home." Sample items for social support included (a) "We do a lot of things together" and (b) "We have fun together." Finally, sample items involving family problem-solving included (a) "We both compromise (give a little) during arguments" and (b) "The talks we have are frustrating." Teenagers answered these questions about both parents where appropriate, and parents (in Sample I) answered them concerning their relationship to the child who was a subject in our study. The questionnaire also included items about peers' aggressive, delinquent, prosocial, and school behavior which were taken from the Patterson group (Patterson et al., 1990) and combined to form a composite measure of peer engagement in problem behavior. Data on peers' alcohol and drug use were also collected. These data were treated as distinct forms of substance use, because it was felt that they might independently influence adolescent engagement in high-risk sexual behavior. In Sample 1, parents as well as subjects answered questions regarding peers' behavior. Procedures
Subjects completed questionnaires in small, same-sex groups. Each group was led by two persons of the same sex as the subjects. An active consent procedure was used in which subjects were required to have signed statements of informed consent from a parent or guardian in order to participate, unless they were above the age of 18. Subjects in Sample 1 took questionnaires home to their parents subsequent to completing their own questionnaires. Reminder letters were sent when parents did not return the questionnaires. Half of the subjects in Sample 2 were also assigned at random to a bogus pipeline condition in which they were told that their reports of sexual behavior would be corroborated by analysis of urine samples. Subjects were debriefed following the study. Since this instruction did not affect reports of sexual behavior, this variable was not analyzed further.
Sexual Behavior
251
RESULTS Patterns of Sexual Behavior
Table I presents summary statistics concerning the sexual behavior of each sample, stratified by gender. As will be seen, 69~ of the boys in Sample 1 and 61~ of the girls reported sexual intercourse in the previous year. In Sample 2, 61% of the boys and 60% of the girls reported sexual intercourse. Responses to items regarding sexual behavior risking HIV infection or other STDs indicated that a substantial minority of subjects were placing themselves at risk (from 4 to 41%, depending on the measure).
Table I. P e r c e n t a g e of Subjects E n g a g i n g in V a r i o u s B e h a v i o r s in E a c h S a m p l e Percentage Sample 1 Males H a d i n t e r c o u r s e in the p a s t year Had more than two partners in the past year H a d sex m o r e t h a n once in p a s t year a n d never used a condom H a d sex w i t h s o m e o n e d i d n ' t k n o w very well H a d sex w i t h s o m e o n e w h o injected d r u g s H a d sex with a p a r t n e r w h o was h a v i n g sex w i t h o t h e r people H a d a n a l sex
Females
Sample 2 Males
Females
69 61 (n = 44) (n = 41)
61 60 (n = 35) (n = 25)
39 25 (n = 25) (n = 17)
30 29 (n = 17) (n = 12)
17 10 (n = 11) (n = 7)
5 (n = 3)
41 28 (n = 26) (n = 19)
35 29 (n = 20) (n = 12)
5 (n = 3)
10 (n = 7)
27 28 (n = 17) (n = 18) 8 (n = 5)
11 (n = 7)
4 (n = 2)
12 (n = 5)
17 (n = 7)
20 27 (n = 11) (n = 11) 7 (n = 4)
8 (n = 3)
252
Biglan et
al.
Convergence of High-Risk Sexual Behaviors Table II presents correlations among the questionnaire items involving high-risk sexual behavior for each sample. Sample 1 data are above the diagonal and Sample 2 are below. In general, the items were moderately intercorrelated. For Sample 1, the coefficient alpha (Cronbach, 1951) for this index was .77 while for Sample 2 it was .73. The z scores of this series of items were averaged to form a composite index of high-risk sexual behavior. Scores on this index did not differ significantly by gender. If adolescents always used condoms when they were engaging in risky sexual behaviors such as having multiple partners, the actual risk of disease would be reduced greatly. We therefore examined the correlation between condom nonuse and an index composed of the remaining items in our index of risky sexual behavior for those subjects who reported having had sexual intercourse. Those who engage in other forms of risky sexual behavior are significantly less likely to use condoms. In Sample 1 the correlation was .50 (p < .001), while in Sample 2 it was .48 (p < .001).
High-Risk Sexual Behavior and Other Problem Behavior Table III presents correlations between the sexual risk index and measures of other types of problem behavior.2 In Sample I, self-reported engagement in high-risk sexual behavior was significantly related to reports of antisocial behavior, low levels of reported prosocial behavior, and high levels of academic difficulties, smoking, alcohol use, and other drug use. In Sample 2, high-risk sexual behavior was related to these same variables, except for the measures o f academic difficulties and prosocial behavior. Hierarchical multiple regression was used to examine the degree to which these predictors accounted for independent variance in risky sexual behavior and the degree to which there were sex differences in the relationships. Table III presents these results for each sample. Because there is evidence that antisocial behavior precedes academic difficulty, which precedes smoking and other drug use developmentally (Jessor and Jessor, 1977; Patterson et aL, 1990), the measure of antisocial behavior was entered first, followed by measures of prosocial behavior and academic difficulty. Smoking, alcohol use, and the use of illicit drugs were then entered in that order. For Sample 1, the R 2 was .26. Antisocial behavior accounted for significant variance (R 2 = .04, F = 5.69, p = .019). Prosocial behavior did 2Expiredair samples, which were analyzedfor carbon monoxide, were obtained from subjects in Sample2 in order to corroborateself-reportsof smokingand increasetheir accuracy.Although this measurewas not obtained in Sample 1, inspectionof the correlationsbetweenself-reported smoking and other variablesin the two samples indicatedverylittle differencebetweensamples.
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