American adolescents commonly have a sexual partner from a different age-group or ethnic group, an analysis of national data on adolescent health reveals.1 Nearly one-half of teenage relationships are between partners who are two or more years apart in age, and nearly one-quarter are between partners from different ethnic groups. More than half of sexually active teenagers have two or more partners within 18 months; of these, more than half have two or more relationships that overlap in time. Some partner choices seem to influence condom use: Female adolescents with more than one partner and adolescents with different-age partners have a reduced likelihood of using condoms. Furthermore, the more sexual partners a teenager has, the less likely that a condom is used. Having overlapping relationships, however, increases the likelihood of condom use.
Researchers analyzed data from the National Longitudinal Study of Adolescent Health (Add Health) to examine the patterns of heterosexual relationships reported by teenage high school students, in terms of the ethnicity and age of partners and the occurrence of overlapping relationships. They also assessed the level of condom use among adolescents who reported a total of two or more partners. The Add Health data came from a survey of adolescents from schools that covered a range of locations, types, sizes and ethnic mixes. A questionnaire was administered to students in their homes in 1994-1995 and again two years later. Of the 90,118 respondents to the first questionnaire, 18,924 were identified as being representative of American adolescents. Of these students, 13,570 completed the second questionnaire.
By pooling replies from both questionnaires, the researchers found that 8,024 students had had a total of 17,266 heterosexual partners in the 18 months before each round of study. When asked to identify their ethnicity, 62% of students indicated white, compared with 19% black, 12% Hispanic and 7% "other." The male-to-female ratio was about one to one. More than half of respondents (54%) were aged 17 or older, whereas about 36% were 15-16; the remainder were 14 or younger.
Most relationships were between adolescents of the same ethnicity (78%) and of a similar age (55%). The proportions of multiethnic partnerships were significantly lower among black and white students (15% and 13%, respectively) than among Hispanics (42%) and other groups (77%). Partners were older by two or more years in 32% of relationships and younger by two or more years in 13%. Females were more likely than males to have older partners (49% vs. 14%), whereas males were more likely than females to have younger partners (22% vs. 4%).
More than half of respondents reported a total of two or more partners during the 18 months before each survey round (56% of both males and females). Significantly higher proportions of black adolescents and those of other ethnicities (61% and 59%, respectively) had had two or more partners when compared with Hispanic (56%) and white (54%) adolescents. Males were significantly more likely to have had more than one partner than were females among black (63% vs. 58%) and Hispanic (59% vs. 51%) respondents, whereas the trend was reversed for white respondents (56% of females and 52% of males had had two or more partners).
When the investigators focused on respondents reporting two or more partners, they found that 69% also reported partners outside their own age-group; females were more likely than males to do so (77% vs. 61%). More than one-third (35%) of respondents--38% of males and 33% of females--reported partners from two different ethnic groups. Hispanics and other adolescents were more likely to have partners in two ethnic groups (60% and 91%, respectively) than were whites (26%) and blacks (28%). Furthermore, 54% of respondents who reported two or more partners also reported relationships that overlapped in time. A significantly higher proportion of females than of males reported overlapping relationships (58% vs. 50%).
An assessment of condom use among respondents who reported two or more partners revealed that 33% had used a condom with at least one partner. This proportion was slightly lower if partners were of a different age (29%) or ethnicity (30%), or if respondents reported overlapping relationships (29%). According to logistic regression analyses, being in simultaneous relationships significantly increased the likelihood that a condom was used (odds ratio, 1.2). In contrast, having partners from a different age-group and being female significantly decreased the odds that a condom was used (0.8 for each). And for each additional partner that an adolescent had, the odds of condom use were reduced by 55%. Ethnicity of either respondents or partners was not associated with condom use.
The researchers summarize by stating that adolescents commonly have partners with different characteristics: Female adolescents commonly have partners of a different age, and Hispanics and adolescents of other ethnicities commonly have multiethnic relationships. The study also reveals that teenagers commonly report a total of two or more partners and overlapping relationships. The investigators state that the findings are important to sexually transmitted disease and family planning clinics, as well as other health care providers who work with sexually active adolescents. According to the authors, adolescents with more than one partner and those with partners of a different age-group or ethnicity have an increased risk of contracting sexually transmitted infections, especially given the lower likelihood of condom use among the first two groups. They conclude, "The counseling of sexually active adolescents should include discussion of differences in power or communication that may occur where a partner's personal characteristics may differ."--T. Lane
1. Ford K et al., American adolescents: sexual mixing patterns, bridge partners, and concurrency, Sexually Transmitted Diseases, 2002, 29(1):13-19.