Neighborhood social environment associations with initiation of sexual activity in early and middle adolescence

Abstract

Purpose: Initiation of sexual activity is a typical event of adolescence in the United States. Neighborhood social environments have the potential to support adolescents in adopting protective sexual health behaviors (e.g., later initiation, utilization of effective contraception), though can likewise heighten risks with consequences for well-being. Early sexual initiation is linked to a longer exposure period for pregnancy and sexually transmitted infections during adolescence. It is important, therefore, to understand the social contexts that promote or limit adolescents in making informed decisions about the timing of sexual initiation, contraceptive use, and access to reproductive health services to minimize disparities in sexual health outcomes. Among a population of adolescents residing in the urban center of a California agricultural county, the objectives of this study are: 1) to determine if aspects of the social environment are associated with early sexual initiation; and 2) to assess contraceptive use, contraceptive attitudes and motivations, and access to sexual health services to inform opportunities to promote positive health outcomes. Methods: A Crecer: The Salinas Teen Health Study enrolled 599 8th grade youth (aged 12-15) recruited from four middle schools into a prospective cohort study with two years of follow-up. Social environment measures included perceived social cohesion (5-items, alpha=0.75), experiences of discrimination (7-item inventory), neighborhood disorder (11-item inventory), and school connectedness (8-items, alpha=0.80). Sexual behavior, including timing of initiation and contraceptive use, were assessed prospectively. Contraceptive attitudes and motivations, and access to sexual health services were assessed at the 2-year visit. We used Poisson regression models with robust standard errors to estimate associations between baseline neighborhood environment and early initiation of sexual behavior (before age 15). We compared differences in contraceptive use, attitudes, motivations and perceived access to and use of sexual health services by timing of sexual initiation. Results: Nearly all youth were Latino (94%) and age 13 (70%) or 14 (26%) at enrollment. Half (51%) were female and 46% had a parent employed in agriculture. Retention over two years was 93%. Approximately one-quarter (23%) reported having vaginal sex by year-2; 15% reported early initiation. Neighborhood disorder (IRR: 1.12, p=0.001), experiences of discrimination (IRR: 1.15, p