South Carolina high school students who have engaged in or who have been the victim of a range of risky behaviors are at risk of having had multiple sexual partners. For example, adolescent women who have experienced date violence or smoked marijuana are especially likely to have had two or more sexual partners, as opposed to no partners. Among adolescent men, those who have carried a weapon or have consumed alcohol are especially likely to have had multiple partners. Levels of involvement with risky behavior and its effect on sexual activity vary widely by race and gender. These findings, according to the researchers, point to the need for multifaceted prevention programs.1
The cross-sectional data come from responses to questionnaires distributed over the 1993-1994 academic year in 56 public high schools (grades 9-12) across South Carolina. A total of 3,805 anonymous questionnaires were used in the analysis--1,156 from white female adolescents, 1,143 from white males, 829 from black females and 677 from black males. Respondents were asked whether they had ever had sexual intercourse and with how many partners, and whether they had any involvement in 10 health risk behaviors--carrying a weapon, physical fighting, violently assaulting a date, being a victim of date violence, committing rape, being a rape victim, drinking alcohol, bingeing on alcohol, smoking marijuana and smoking cigarettes.
The researchers conducted polychotomous logistic regression analyses, controlling for grade level, for each racial-and-gender subgroup. These analyses explored how the 10 health risk behaviors were associated with three outcomes--having had one sexual partner, having had 2-3 partners and having had four or more. The resulting odds ratios compare the likelihood of each outcome with that of never having had sex.
Fifty-two percent of the white female adolescents had ever had sexual intercourse (19% with just one partner, 18% with two or three partners and 15% with four or more); the corresponding proportion among white male high school students was 61% (18% had had one partner, 18% had had two or three and 25% four or more). Among the young black women, 70% were sexually experienced (20% had had one partner, 24% had had 2-3 and 26% four or more); 88% of the black male adolescents had ever had sex (10% with one partner, 22% with 2-3 and 56% with four or more).
In all four racial-and-gender subgroups, the proportion of students reporting individual risk behaviors varied from less than 10% to about 50%. Young men in both racial subgroups were far more likely to have carried a weapon (35-50%) than were young women (9-14%). Important gender differentials also emerged in the proportions reporting having physically fought (43-46% among males vs. 28-30% among females), having been raped (5-9% among males vs. 17-18% among females) and having been victimized by date violence (4-6% vs. 10%).
White high school students were more likely than black students to have ever smoked cigarettes (34-35% vs. 4-8%) or marijuana (25-35% vs. 9-23%), but differences by race in the proportions who had ever drunk alcohol were smaller (46-52% among whites vs. 32-42% among blacks). While there was virtually no difference among young women by race in the proportions who reported having been raped (17-18%), black men were more than twice as likely as white men to report having committed a rape (9% vs. 4%).
•White females. Once grade level and all risk behaviors were controlled for, four individual behaviors independently increased white female students' likelihood of ever having had sexual intercourse and of having had multiple partners: having been raped (odds ratios, 4.3-15.5), having been the victim of date violence (3.2-4.0), having drunk alcohol (1.5-2.5) and having smoked cigarettes (1.7-2.9). Smoking marijuana significantly increased the likelihood of having had 2-3 partners (3.5) and of having had four or more (8.1), but had no significant impact on the likelihood of ever having had intercourse.
•Black females. The same five risk behaviors were significantly associated with sexual activity among black females, although the pattern of the results was somewhat different than that observed for young white women. Having been a victim of date violence and having drunk alcohol again had independent effects on all three outcomes (odds ratios, 5.9-9.3 and 1.9-4.1, respectively). However, having been raped raised black females' likelihood only of having had four or more partners (4.5), and having smoked cigarettes was associated only with an increased likelihood of having had 2-3 partners (7.8) or four or more partners (5.4). Having smoked marijuana elevated the odds of four or more partners ninefold (odd ratio, 9.3). Physical fighting emerged as a sixth significant predictor of sexual activity in this subgroup: Black females who had been in a fight were roughly 2-3 times as likely as those who had not done so to have ever had sex, to have had 2-3 partners and to have had four or more partners (odds ratios, 1.9-2.6).
•White males. As expected, a somewhat different set of risk behaviors independently affected the number of sexual partners among adolescent men. For white young men, once grade level was controlled for, ever having consumed alcohol raised the likelihood of ever having had sex (odds ratio, 2.0) and of having had multiple partners (3.0-3.5). Other factors did not affect the odds of being sexually experienced, but elevated the likelihood of having had 2-3 or four or more partners: having carried a weapon (1.9-2.5), having been in a fight (1.7-5.2) and having smoked marijuana (2.8-4.1). A history of cigarette smoking increased the likelihood that young white men had had sex with four or more partners (2.6).
•Black males. While having carried a weapon independently elevated the likelihood of having had four or more partners among young black males (odds ratio, 4.7), having gotten into a fight doubled the likelihood of 2-3 and four or more partners (2.2-2.3). Having consumed alcohol had the strongest independent effect in this subgroup, increasing the likelihood of 2-3 partners by a factor of 13.3 and that of four or more partners by a factor of 15.2. However, having smoked cigarettes or marijuana failed to have any independent association with sexual activity among black males. In addition, none of the risk factors that were significant in this subgroup emerged as independent predictors across all three sexual-partner outcomes.
The researchers caution that their study is limited by its cross-sectional nature, so causality cannot be inferred, and by possible bias inherent in self-reported information. In addition, the in-school administration of the questionnaire might have introduced another potential source of bias, since students who were absent the day the survey was conducted are not represented. Nonetheless, the investigators assert that their robust findings of "associations between an increased number of sexual partners, violence, and aggression, and alcohol, tobacco and other drug use suggest the need for multicomponent prevention programs addressing all these risk behaviors." They recommend that clinicians elicit a thorough history of risk behaviors from their adolescent clients, along with a complete sexual history.--L. Remez
1. Valois RF et al., Relationship between number of sexual intercourse partners and selected health risk behaviors among public high school adolescents, Journal of Adolescent Health, 1999, 25(5):328-335.