Abstract
The goal of this study was to examine, in a nationally representative sample, relationships between various sexual initiation patterns, subsequent sexual partnerships, and related health outcomes from adolescence through early adulthood. Data were from a subset of 6587 respondents from the National Longitudinal Study of Adolescent to Adult Health. Bivariate analyses and adjusted logistic and ordinary least squares regression models were used to determine associations between membership in three sexual initiation classes, lifetime sexual partner counts, and multiple health outcomes, including lifetime sexually transmitted infection or disease (STI/STD) diagnosis, lifetime unintended pregnancy, and romantic relationship quality. Broadly, having fewer lifetime sexual partners was associated with lower odds of STI/STD diagnosis and unintended pregnancy, and better relationship quality; however, findings also indicated both within and between sexual initiation class differences in the relationship between lifetime sexual partners and all three health outcomes. In particular, results showed little variation in health outcomes by sexual partnering among those who postponed sexual activity, but members of the class characterized by early and atypical sexual initiation patterns who had fewer lifetime partners exhibited better health outcomes than most other initiation groups. These results show that while both sexual initiation and partnering patterns add important information for understanding sexual health from adolescence to early adulthood, partnering may be more relevant to these sexual health outcomes. Findings indicate a need for more comprehensive sexuality education focused on sexual risk reduction and promotion of relationship skills among adolescents and adults.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Post hoc analyses stratified by partner group showed few differences across sexual initiation classes for each outcome (results available upon request). Among those with 4–7 partners, Early/Atypical Initiators had 1.71 times greater odds of unintended pregnancy compared to the odds of Vaginal Initiators/Multiple Behaviors members. Although only marginally significant, members of the Early/Atypical class with ≥ 8 partners had 0.77 times lower odds of an unintended pregnancy than Vaginal Initiators/Multiple Behaviors members with the same number of partners (p = .059). No such differences emerged for STI/STD diagnosis and romantic relationship quality.
References
Ashenhurst, J. R., Wilhite, E. R., Harden, K. P., & Fromme, K. (2017). Number of sexual partners and relationship status are associated with unprotected sex across emerging adulthood. Archives of Sexual Behavior, 46, 419–432. https://doi.org/10.1007/s10508-016-0692-8.
Basilevsky, A., Sabourin, D., Hum, D., & Anderson, A. (1985). Missing data estimators in the general linear model: An evaluation of simulated data as an experimental design. Communications in Statistics-Simulation and Computation, 14, 371–394. https://doi.org/10.1080/03610918508812445.
Centers for Disease Control and Prevention (CDC). (2016). Adolescents and young adults: Sexually transmitted diseases. Retrieved September 28, 2016, from http://www.cdc.gov/std/life-stages-populations/adolescents-youngadults.htm.
Cicchetti, D., & Rogosch, F. A. (1996). Equifinality and multifinality in developmental psychopathology [Editorial]. Development and Psychopathology, 8, 597–600. https://doi.org/10.1017/S0954579400007318.
Donovan, J. E., Jessor, R., & Costa, F. M. (1991). Adolescent health behavior and conventionality-unconventionality: An extension of Problem-Behavior Theory. Health Psychology, 70, 52–61. https://doi.org/10.1037/0278-6133.10.1.52.
Eisenberg, M. L., Shindel, A. W., Smith, J. F., Breyer, B. N., & Lipshultz, L. I. (2010). Socioeconomic, anthropomorphic, and demographic predictors of adult sexual activity in the United States: Data from the National Survey of Family Growth. Journal of Sexual Medicine, 7, 50–58. https://doi.org/10.1111/j.1743-6109.2009.01522.x.
Elder, G. H., & Shanahan, M. J. (2006). The life course and human development. In W. Damon & R. M. Lerner (Eds.), Handbook of child psychology (6th ed., pp. 665–715). Hoboken, NJ: Wiley.
Fergusson, D. M., Horwood, L. J., & Lynskey, M. T. (1997). Childhood sexual abuse, adolescent sexual behaviors and sexual revictimization. Child Abuse and Neglect, 21, 789–803.
Finer, L. B., & Philbin, J. M. (2013). Sexual initiation, contraceptive use, and pregnancy among young adolescents. Pediatrics, 131, 886–891. https://doi.org/10.1542/peds.2012-3495.
Finer, L. B., & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception, 84, 478–485. https://doi.org/10.1016/j.contraception.2011.07.013.
Garbers, S., Scheinmann, R., Gold, M. A., Catallozzi, M., House, L., Koumans, E. H., & Bell, D. L. (2017). Males’ ability to report their partner’s contraceptive use at last sex in a nationally representative sample: Implications for unintended pregnancy prevention evaluations. American Journal of Men’s Health, 11, 711–718. https://doi.org/10.1177/1557988316681667.
Goldberg, S. K., & Halpern, C. T. (2017). Sexual initiation patterns of sexual minority youth: A latent class analysis. Perspectives on Sexual and Reproductive Health, 49, 55–67. https://doi.org/10.1363/psrh.12020.
Halpern, C. T. (2010). Reframing research on adolescent sexuality: Healthy sexual development as part of the life course. Perspectives on Sexual and Reproductive Health, 42, 6–7. https://doi.org/10.1363/4200610.
Halpern, C. T., & Haydon, A. A. (2012). Sexual timetables for oral-genital, vaginal, and anal intercourse: Sociodemographic comparisons in a nationally representative sample of adolescents. American Journal of Public Health, 102, 1221–1228. https://doi.org/10.2105/AJPH.2011.300394.
Halpern, C. T., Waller, M. W., Spriggs, A., & Hallfors, D. D. (2006). Adolescent predictors of emerging adult sexual patterns. Journal of Adolescent Health, 39, 926:e1–10. https://doi.org/10.1016/j.jadohealth.2006.08.005.
Harden, K. P. (2012). True love waits? A sibling-comparison study of age at first sexual intercourse and romantic relationships in young adulthood. Psychological Science, 23, 1324–1336. https://doi.org/10.1177/0956797612442550.
Harris, K. M., Halpern, C. T., Whitsel, E., Hussey, J., Tabor, J., Entzel, P., & Udry, J. R. (2009). Add Health Research Design. Retrieved from http://www.cpc.unc.edu/projects/addhealth/design.
Harris, K. M., Udry, J. R., & Bearman, P. S. (2013). The Add Health Study: Design and accomplishments. Chapel Hill, NC. Retrieved from http://www.cpc.unc.edu/projects/addhealth/documentation/guides/DesignPaperWIIV.pdf.
Haydon, A. A., Herring, A. H., & Halpern, C. T. (2012a). Associations between patterns of emerging sexual behavior and young adult reproductive health. Perspectives on Sexual and Reproductive Health, 44, 218–227. https://doi.org/10.1363/4421812.
Haydon, A. A., Herring, A. H., Prinstein, M. J., & Halpern, C. T. (2012b). Beyond age at first sex: Patterns of emerging sexual behavior in adolescence and young adulthood. Journal of Adolescent Health, 50, 456–463. https://doi.org/10.1016/j.jadohealth.2011.09.006.
Heywood, W., Patrick, K., Smith, A. M. A., & Pitts, M. K. (2015). Associations between early first sexual intercourse and later sexual and reproductive outcomes: A systematic review of population-based data. Archives of Sexual Behavior, 44, 531–569. https://doi.org/10.1007/s10508-014-0374-3.
Hipwell, A. E., Stepp, S. D., Keenan, K., Chung, T., & Loeber, R. (2011). Parsing the heterogeneity of adolescent girls’ sexual behavior: Relationships to individual and interpersonal factors. Journal of Adolescence, 34, 589–592. https://doi.org/10.1016/j.adolescence.2010.03.002.
Hsueh, J., & Knox, V. (2014). Supporting healthy marriage evaluation: Eight sites within the United States, 2003–2013. Ann Arbor, MI: Inter-university Consortium for Political and Social Research. https://doi.org/10.3886/ICPSR34420.v2.
Jessor, R., & Jessor, S. L. (1977). Problem behavior and psychosocial development. New York, NY: Academic Press.
Jurich, J. A., & Myers-Bowman, K. S. (1998). Systems theory and its application to research on human sexuality. Journal of Sex Research, 35, 72–87. https://doi.org/10.1080/00224499809551918.
Kaestle, C. E., Halpern, C. T., Miller, W. C., & Ford, C. A. (2005). Young age at first sexual intercourse and sexually transmitted infections in adolescents and young adults. American Journal of Epidemiology, 161, 774–780. https://doi.org/10.1093/aje/kwi095.
Kim, J.-O., & Curry, J. (1977). The treatment of missing data in multivariate analysis. Sociological Methods & Research, 6, 215–240.
Lanza, S. T., Kugler, K. C., & Mathur, C. (2011). Differential effects for sexual risk behavior: An application of finite mixture regression. The Open Family Studies Journal, 4(Suppl. 1-MP), 81–88.
Lerner, J. E., & Hawkins, R. L. (2016). Welfare, liberty, and security for all? U.S. sex education policy and the 1996 Title V Section 510 of the Social Security Act. Archives of Sexual Behavior, 45, 1027–1038. https://doi.org/10.1007/s10508-016-0731-5.
McGuire, J. K., & Barber, B. L. (2010). A person-centered approach to the multifaceted nature of young adult sexual behavior. Journal of Sex Research, 47, 301–313. https://doi.org/10.1080/00224490903062266.
Mitchell, C. M., Kaufman, C. E., Beals, J., Bauduy, S., Bell, C. A. E., Crow, C. B., … Kaufman, B. (2004). Equifinality and multifinality as guides for preventive interventions: HIV risk/protection among American Indian young adults. Journal of Primary Prevention, 25, 491–510. http://doi.org/10.1023/B:JOPP.0000048114.49642.b2.
Moilanen, K. L., Crockett, L. J., Raffaelli, M., & Jones, B. L. (2010). Trajectories of sexual risk from middle adolescence to early adulthood. Journal of Research on Adolescence, 20, 114–139. https://doi.org/10.1111/j.1532-7795.2009.00628.x.
Mosher, W. D., Jones, J., & Abma, J. C. (2012). Intended and unintended births in the United States: 1982–2010. National Health Statistics Reports (Vol. 55). Hyattsville, MD. Retrieved from https://www.cdc.gov/nchs/data/nhsr/nhsr055.pdf.
Noll, J. G., Trickett, P. K., & Putnam, F. W. (2003). A prospective investigation of the impact of childhood sexual abuse on the development of sexuality. Journal of Consulting and Clinical Psychology, 71, 575–586. https://doi.org/10.1037/0022-006X.71.3.575.
O’Donnell, B. L., O’Donnell, C. R., Stueve, A., O’Donnell, L., O’Donnell, C. R., & Stueve, A. (2001). Early sexual initiation and subsequent sex-related risks among urban minority youth: The Reach for Health Study. Family Planning Perspectives, 33, 268–275. https://doi.org/10.2307/3030194.
Reese, B. M., Choukas-Bradley, S., Herring, A. H., & Halpern, C. T. (2014). Correlates of adolescent and young adult sexual initiation patterns. Perspectives on Sexual and Reproductive Health, 46, 211–221. https://doi.org/10.1363/46e2214.
Reese, B. M., Haydon, A. A., Herring, A. H., & Halpern, C. T. (2013). The association between sequences of sexual initiation and the likelihood of teenage pregnancy. Journal of Adolescent Health, 52, 228–233. https://doi.org/10.1016/j.jadohealth.2012.06.005.
Rendall, M. S., Clarke, L., Peters, H. E., Ranjit, N., & Verropoulou, G. (1999). Incomplete reporting of men’s fertility in the United States and Britain: A research note. Demography, 36, 135–144. Retrieved from http://www.jstor.org/stable/2648139.
Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., … Udry, J. R. (1997). Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association, 278, 823–832. http://doi.org/10.1001/jama.1997.03550100049038.
Sandfort, T. G. M., Orr, M., Hirsch, J. S., & Santelli, J. (2008). Long-term health correlates of timing of sexual debut: Results from a national US study. American Journal of Public Health, 98, 155–161. https://doi.org/10.2105/AJPH.2006.097444.
Santelli, J. S., Kantor, L. M., Grilo, S. A., Speizer, I. S., Lindberg, L. D., Heitel, J., … Ott, M. A. (2017). Abstinence-only-until-marriage: An updated review of U.S. policies and programs and their impact. Journal of Adolescent Health, 61, 273–280. http://doi.org/10.1016/j.jadohealth.2017.05.031.
Sassler, S., Addo, F. R., & Lichter, D. T. (2012). The tempo of sexual activity and later relationship quality. Journal of Marriage and Family, 74, 708–725. https://doi.org/10.1111/j.1741-3737.2012.00996.x.
Schalet, A. T., Santelli, J. S., Russell, S. T., Halpern, C. T., Miller, S. A., Pickering, S. S., … Hoenig, J. M. (2014). Broadening the evidence for adolescent sexual and reproductive health and education in the United States [Invited commentary]. Journal of Youth and Adolescence, 43, 1595–1610. http://doi.org/10.1007/s10964-014-0178-8.
Smith, L. H., & Ford, J. (2010). History of forced sex and recent sexual risk indicators among young adult males. Perspectives on Sexual and Reproductive Health, 42, 87–92. https://doi.org/10.1363/420871.
StataCorp. (2015). Stata statistical software: Release 14. College Station, TX: StataCorp LP.
Stockman, J. K., Campbell, J. C., & Celentano, D. D. (2010). Sexual violence and HIV risk behaviors among a nationally representative sample of heterosexual American women: The importance of sexual coercion. Journal of Acquired Immune Deficiency Syndrome, 53, 136–143. https://doi.org/10.1097/QAI.0b013e3181b3a8cc.
The Society for Adolescent Health and Medicine. (2017). Abstinence-only-until-marriage policies and programs: An updated position paper of the Society for Adolescent Health and Medicine. Journal of Adolescent Health, 61, 400–403. https://doi.org/10.1016/j.jadohealth.2017.06.001.
Tolman, D. L., & McClelland, S. I. (2011). Normative sexuality development in adolescence: A decade in review, 2000–2009. Journal of Research on Adolescence, 21, 242–255. https://doi.org/10.1111/j.1532-7795.2010.00726.x.
Upchurch, D. M., Mason, W. M., Kusunoki, Y., & Kriechbaum, M. J. (2004). Social and behavioral determinants of self-reported STD among adolescents. Perspectives on Sexual and Reproductive Health, 36, 276–287. https://doi.org/10.1363/psrh.36.276.04.
Vasilenko, S. A., Kugler, K. C., Butera, N. M., & Lanza, S. T. (2015). Patterns of adolescent sexual behavior predicting young adult sexually transmitted infections: A latent class analysis approach. Archives of Sexual Behavior, 44, 705–715. https://doi.org/10.1007/s10508-014-0258-6.
Vasilenko, S. A., Kugler, K. C., & Rice, C. E. (2016). Timing of first sexual intercourse and young adult health outcomes. Journal of Adolescent Health, 59, 291–297. https://doi.org/10.1016/j.jadohealth.2016.04.019.
von Bertalanffy, L. (1968). General systems theory: Foundations, development, applications. New York: Braziller.
Wesche, R., Lefkowitz, E. S., & Vasilenko, S. A. (2017). Latent classes of sexual behaviors: Prevalence, predictors, and consequences. Sexuality Research and Social Policy, 14, 100–111. https://doi.org/10.1007/s13178-016-0228-y.
Wilson, H. W., & Widom, C. S. (2009). Sexually transmitted diseases among adults who had been abused and neglected as children: A 30-year prospective study. American Journal of Public Health, 99(S1), S197–S203. https://doi.org/10.2105/AJPH.2007.131599.
Acknowledgments
This research used data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, the University of North Carolina at Chapel Hill, Carolina Population Center, 206 W. Franklin Street, Chapel Hill, NC 27516-2524 (addhealth_contracts@unc.edu). We are grateful to the Carolina Population Center for general support (P2C HD050924).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kahn, N.F., Halpern, C.T. Associations Between Patterns of Sexual Initiation, Sexual Partnering, and Sexual Health Outcomes from Adolescence to Early Adulthood. Arch Sex Behav 47, 1791–1810 (2018). https://doi.org/10.1007/s10508-018-1176-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-018-1176-9