Patterns of risky behavior among youth who pass through the juvenile justice system may persist for years, keeping these young men and women at high risk of acquiring, and transmitting, STDs.1 In a study of youth who spent time in a Chicago detention center in the late 1990s, 54% of males and 69% of females who had had unprotected vaginal sex shortly before being detained said in a follow-up interview about three years later that they had recently had unprotected vaginal sex; 75% of males and 58% of females who reported at baseline that they had had unprotected sex while drunk or high gave a similar report at follow-up. In addition, substantial proportions of young people adopted risky behaviors in the years after their detention.
To examine the prevalence, development and persistence of behaviors that increase STD risk among delinquent youth, researchers collected information from a stratified random sample of 10–18-year-olds who entered the short-term detention center between early 1997 and mid-1998. Baseline data were gathered in face-to-face interviews, generally conducted within two days after participants entered the facility. Follow-up interviews were conducted in person or by telephone, depending on where participants lived, an average of three years later. At each interview, participants were asked about a wide range of behaviors related to sexual activity and the use of injection drugs and other substances.
The analyses are based on the 316 females and 408 males who provided information on risk behaviors at follow-up. Slightly more than half of the participants were black, and the rest were almost evenly divided between Hispanic and white youth. At follow-up, 66% of participants were living in the community, and 5% lived in communities more than two hours away; the rest were in correctional facilities (26%) or residential placement facilities (3%).
At baseline, nine in 10 male participants were sexually active, and six in 10 had had more than one partner in the previous three months. Ninety percent had had vaginal sex, 43% oral sex and 10% anal sex. Two-thirds said they had had sex while drunk or high, and more than one-third had had unprotected sex in these circumstances. Marijuana use was common, and 60% of males had smoked marijuana more than three times in the past month. Analyses using an adjusted Wald F statistic indicate that the proportions of men reporting several risky behaviors were significantly higher at follow-up than at baseline: oral sex (59% vs. 43%), anal sex (22% vs. 10%), sex while drunk or high (80% vs. 66%) and unprotected sex while drunk or high (55% vs. 36%). By contrast, the proportions reporting that they had had multiple partners during the previous three months and had smoked marijuana in the past month declined between interviews. Men who were incarcerated at follow-up had a significantly lower prevalence of several risk behaviors than did those living in the community; however, they were more likely to report anal sex with a high-risk partner (15% vs. 2%).
Eighty-seven percent of women were sexually active when they entered detention, and 27% had recently had multiple partners. Vaginal sex was far more common than oral or anal sex (reported by 84%, 32% and 8%, respectively). Substantial proportions of females reported recent episodes of unprotected sex, and nine in 10 reported alcohol or marijuana use. Significantly higher proportions at follow-up than at baseline reported recent unprotected vaginal sex (62% vs. 51%) or oral sex (36% vs. 24%), unprotected sex while drunk or high (46% vs. 35%), and trading sex for drugs (8% vs. 3%). Reports of multiple partners, alcohol use and marijuana use were less common at follow-up than at the time of detention. A number of behaviors were more prevalent among women in the community than among incarcerated women at follow-up. Notably, virtually all of the former and three-quarters of the latter were sexually active; 65% and 23%, respectively, had recently had unprotected vaginal sex.
Among both males and females, a certain proportion of participants who did not report a given behavior at baseline reported it in the follow-up interview. For some behaviors, this proportion was small—for example, fewer than 1% of males who had not had receptive anal sex before detention had done so by follow-up, and fewer than 1% of females who had not had anal sex with a high-risk partner at baseline had done so by their second interview. For others, it was substantial. In particular, among participants who had not reported these behaviors at baseline, 39% of males and 55% of females reported recent unprotected vaginal sex at follow-up, and 23% and 30% reported recent unprotected oral sex; 66% and 44% said at follow-up that they had had sex while drunk or high, and 44% and 39% reported having done so without using protection.
By and large, risky behavior that was present at baseline persisted throughout the study period. Four in 10 males and two in 10 females who had had more than one partner shortly before detention had also had multiple partners shortly before follow-up, and levels of persistence were even higher for several other behaviors. Among both men and women, more than half of those who initially reported recent unprotected vaginal sex (54% and 69%, respectively) or unprotected oral sex (59% and 55%) reported the same behaviors at follow-up. Eighty-eight percent of males and 72% of women who said at baseline that they had had sex while drunk or high said the same thing at follow-up; 75% of males and 58% who had had unprotected sex while drunk or high before entering detention had also done so before their second interview.
Results of logistic regression analyses revealed few racial and ethnic differences in patterns of risky behavior, but several significant differences by gender. At follow-up, males were considerably less likely than females to report use of injection drugs (odds ratio, 0.1), but were more likely to report a range of other behaviors, including having had more than one recent partner (6.7), more than three recent partners (11.1) and a high-risk partner for anal sex (10.7). Similarly, at follow-up, men were less likely than women to report having begun injecting drugs (0.1) or using substances other than alcohol or marijuana (0.4); they were more likely to report having begun to engage in a number of sexual behaviors, including multiple partners, vaginal sex with a high-risk partner and anal sex (2.1–8.0). And the likelihood that two risky behaviors—having had more than one partner in the past three months and having had sex while drunk or high—persisted throughout the period was greater among males than among females (5.0 and 4.7, respectively).
Although the researchers acknowledge that the study has several limitations stemming from the nature of the sample and the measures used, they conclude that it yields important lessons. "Because most detained youth return to their communities," they write, "[STD] risk behaviors in delinquent youth are a community public health problem, not just a problem for the juvenile justice system." Coordinating interventions designed for delinquent youth presents "the opportunity to redress significant health disparities and threats to public health." —D. Hollander
1. Romero EG et al., A longitudinal study of the prevalence, development, and persistence of HIV/sexually transmitted infection risk behaviors in delinquent youth: implications for health care in the community, Pediatrics, 2007, 119(5):e1126–e1141, <www.pediatrics.org/cgi/doi/10.1542/peds.2006-0128>, accessed May 1, 2007.