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The Association of Sexual Behaviors with Socioeconomic Status, Family Structure, and Race/Ethnicity among U.S. Adolescents

Original article authored by:
John S. Santelli, MD, MPH, Richard Lowry, MD, Nancy D. Brener, Ph.D., and Leah Robin, Ph.D.

This summary includes the following sections:

Introduction

The authors of this article note that previous research has shown that poverty and ethnic minority status have been associated with increased adolescent pregnancy and sexually transmitted infection (STI) rates. Lower socioeconomic status (SES) may negatively influence adolescents' health by limiting their social and educational opportunities and access to health care.

While lower SES may be a risk factor for adolescent pregnancy and STI infection rates, the impact of SES and race/ethnicity on sexual behaviors is unclear. In this study, the authors attempt to shed some light on this issue by addressing two questions:

  1. What is the relationship between adolescent sexual behaviors and SES, family structure, and race ethnicity?

  2. Does the relationship between race/ethnicity and sexual behavior change when the effects of SES and family structure are taken into account?

Methods

The authors of this article used data from two different surveys to find a link between household demographics and adolescent sexual behaviors. The authors selected 13,789 adolescents from the list of households that completed the 1992 National Health Interview Survey (NHIS). This survey measures family income, adult educational attainment, adolescent marital status, race/ethnicity, and family structure.

The authors then administered the 1992 Youth Risk Behavior Survey (YRBS) — which measures adolescent sexual behaviors — to this group of adolescents. The final analytic sample was composed of 3,904 adolescents between the ages of 14 and 17.

The influence of SES was examined for the following behaviors:

  1. ever having had sexual intercourse,
  2. recent sexual activity,
  3. recent multiple partners, and
  4. condom or oral contraceptive use at last intercourse.

Four demographic measures of SES were collapsed into four categories each:

  • Family income: less than $20,000 per year, $20,000-$34,999, $35,000-$49 999, or more than $50,000

  • Parent educational level: less than high school, high school graduate, some college, or college graduate

  • Family structure: living with both parents, with mother only, with father only, or with neither parent, and

  • Race/ethnicity: White, Black, Hispanic, or Other.

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Results

Demographics:

  • Approximately 74% of adolescents were living with both parents, 21% with their mother only, and the remaining 5% with either their father only or neither parent.

  • The sample was approximately 66% White, 15.5% Black, 12.5% Hispanic and 6% "Other.

  • Parental educational attainment, family income, and adolescent age varied widely and were approximately evenly split between the four categories.

General & Specific Patterns:

  • The relationship between race/ethnicity and sexual behavior was only slightly affected by adjustment for socioeconomic factors such as parental education, family income, and family structure. In other words, within racial/ethnic groups, SES was not a significant factor either as a risk or a protection against pregnancy or STIs.

  • Family income did not show a significant relation to any sexual behavior.

  • Regardless of race/ethnicity, there was a relationship between the educational level of parents and teens' sexual behavior. Female adolescents whose parents were college graduates were less likely to report recent sexual activity than females whose parents did not complete high school. Also, adolescents (male and female) whose parents were college graduates were less likely to have had sexual intercourse than their counterparts whose parents did not complete high school.

  • Family structure was a factor in teen sexual behavior. Adolescents who lived with both parents were less likely to have had sexual intercourse than were adolescents who lived with only one or neither parent.

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Discussion

The overall findings suggest that differences in sexual behavior by race/ethnicity cannot be attributed to the effect of a family's socioeconomic status. Sexual behavior differences by SES and race/ethnicity were not large enough to account for differences by race/ethnicity in national STI and birth rates. This finding suggests that larger societal influences not measured here — such as media portrayal of sexuality, HIV education programs, and access to health care — may have a significant impact on adolescent sexual behaviors.

The authors acknowledge several limitations of this study. First, cross-sectional surveys can determine whether a correlation between two variables exists, but not whether a difference in one causes a difference in another. Second, the data used in this study were self-reported and may have been either intentionally or unintentionally misreported.

Third, the study did not gather information about other factors affecting adolescent decision-making skills, such as parenting practices, peer influences, and self-efficacy. Finally, factors such as family income, parental education, and family structure provide only a partial explanation of the complex relationships between adolescents, their parents, and their communities.

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Implications

  • Adolescents from all economic strata are susceptible to STIs and pregnancy; thus prevention efforts for these health concerns should be universal.

  • Access to health care is an important factor in the prevention and control of STIs. Screening and treatment services need to be expanded with special attention given to communities that are traditionally medically underserved and where a high prevalence of STIs exists.

  • Adolescent connectedness to school and parental expectations of the adolescent’s success in school may be important factors in delaying the onset of intercourse and protecting against other risky sexual behaviors.

  • Adolescents with high aspirations and life opportunities are more likely to delay sexual activity. Therefore, efforts to reduce adolescent STI infection and pregnancy rates should move beyond the health care system and include parents, schools, and communities.

Santelli, J.S., Lowry, R., Brener, N.D., and Robin, L. The Association of Sexual Behaviors with Socioeconomic Status, Family Structure, and Race/Ethnicity among US Adolescents. American Journal of Public Health. Vol. 90, No. 10, 1582-1587, 2000.

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