Young adult women's patterns of sexual risk behavior vary by race and ethnicity, but in all groups considered in an analysis of data from the National Longitudinal Study of Adolescent Health (Add Health), the most common pattern represented a moderate level of sexual risk.[1] The majority of women with a moderate risk level had had only one partner in the previous year, but substantial proportions engaged in risky behaviors, such as inconsistent use of condoms. Those categorized as having a moderate or high level of risk had elevated odds of either having had an STD in the past year or testing positive for one at the time of the survey.
Researchers used latent class analysis to identify patterns of sexual risk behavior among heterosexual women who participated in Wave 3 of Add Health, which was conducted in 2001–2002, when respondents were 18–27 years old. They conducted separate analyses for the 1,716 blacks, 1,181 Hispanics and 4,118 whites in the analytic sample. Associations between patterns of behavior and STD risk were assessed in multivariate analysis.
For black and Hispanic women, the analysis revealed three behavioral patterns; women were classified as recent abstainers (who were distinguished primarily by reports of no vaginal sex in the past year), moderate risk or high risk. For whites, an additional category was identified: low risk (reflecting a high likelihood that women had had only one vaginal sex partner in the past six years).
Among black women, 17% were recent abstainers, 55% were in the moderate risk group and 28% were classified as engaging in highly risky behaviors. The proportions for Hispanic women were 25%, 49% and 27%, respectively. Among white women, 19% were recent abstainers, 22% reflected low risk, 38% moderate risk and 22% high risk. The prevalence of risk-related behaviors differed among racial and ethnic groups, but variations by risk classification were similar across groups. For example, the proportion of women who had had multiple vaginal sex partners in the past year was significantly lower in the moderate risk group than in the high risk category: 21% vs. 64% among blacks, 11% vs. 44% among Hispanics and 26% vs. 54% among whites. Reports of inconsistent condom use in the last year also differed between the moderate and high risk categories: 42% vs. 70% among blacks, 36% vs. 60% among Hispanics and 45% vs. 62% among whites. In each racial or ethnic group, 5–6% of recent abstainers had first had sex by age 15, but the proportion increased to 26% among Hispanics and whites in the highest risk category, and to 35% among such blacks.
Partner-related characteristics that could affect STD acquisition also varied by behavioral pattern. For example, whereas one in five Hispanic women in each of the two lowest risk categories reported having had a nonmonogamous partner in the past six years, more than three in five of those at high risk did so. Among white women, the proportions reporting a nonmonogamous partner ranged from 9% of those at low risk to 66% of those at high risk. Similarly, black women and white women in the highest risk category were significantly more likely than their counterparts with a moderate risk to report that a recent partner had an STD history (36% vs. 8% and 16% vs. 5%, respectively).
Some 29% of black women, 10% of Hispanics and 6% of whites either reported that they had received an STD diagnosis in the past year or were found to be infected when tested as part of their participation in the survey. Within each racial and ethnic group, the likelihood of STD infection was higher for those in the moderate and high risk categories than for recent abstainers—odds ratios, 2.6 and 5.3 for blacks, 3.9 and 5.5 for Hispanics, and 2.5 and 6.1 for whites. Among whites, no significant difference was found between those classified as having low risk and recent abstainers.
The researchers observe that their study was limited by its retrospective design and use of secondary data, the absence of information on substance use (a documented predictor of sexual risk behaviors), the lack of information from respondents’ partners and the exclusion of males. They encourage future work to address these limitations and to further explore "how patterns of sexual behaviors group together to influence risk."—D. Hollander
Reference
1. Pflieger JC et al., Racial/ethnic differences in patterns of sexual risk behavior and rates of sexually transmitted infections among female young adults, American Journal of Public Health, 2013, 103(5):903–909.