Patterns of Risk Behavior Change from Adolescence to Emerging Adulthood: Implications for HIV/STD Racial Disparities

Hallfors, Denise Dion; Haydon, Abigail A.; Halpern, Carolyn Tucker; & Iritani, Bonita J. (2016). Patterns of Risk Behavior Change from Adolescence to Emerging Adulthood: Implications for HIV/STD Racial Disparities. In Thomas, Yonette F. & Price, LeShawndra N. (Eds.), Drug Use Trajectories among Minority Youth (pp. 367-98). Dordrecht, Netherlands: Springer Science+Business Media.

Hallfors, Denise Dion; Haydon, Abigail A.; Halpern, Carolyn Tucker; & Iritani, Bonita J. (2016). Patterns of Risk Behavior Change from Adolescence to Emerging Adulthood: Implications for HIV/STD Racial Disparities. In Thomas, Yonette F. & Price, LeShawndra N. (Eds.), Drug Use Trajectories among Minority Youth (pp. 367-98). Dordrecht, Netherlands: Springer Science+Business Media.

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Our previous studies documented large racial disparities in sexually transmitted infections (STI) between Black and White young adults. In this chapter, we apply a longitudinal person-centered analysis of sex and drug use behavior to examine whether infection among young adults varies by the trajectory of such behaviors over time. Findings suggest Whites were more likely to increase their risk behavior or persist in high risk behavior over time while Blacks (and especially Black women) were more likely to continue in stable low risk patterns or decrease their risk behavior over time. Nevertheless, Black men and women were much more likely than White men and women to have a positive STI/HIV test in young adulthood across all trajectories. These findings confirm conclusions that the current prevention paradigm, to reduce personal risk behavior and increase personal protective behavior (condom use), does not seem adequate for racial STD/HIV disparities. Structural and contextual factors may provide better clues to address the problem. Sexually transmitted infections are a significant health threat to adolescents and young adults. Fifteen to thirty percent of all HIV infections occur in individuals younger than age 25 (Morris et al. 2006). In 2000, youth between the ages of 15–24 accounted for almost half of new cases of sexually transmitted infections (STIs) (Weinstock et al. 2004). Racial and ethnic minorities are disproportionately affected by HIV and other STIs. The Centers for Disease Control and Prevention estimated that African Americans accounted for approximately 45 % of new HIV infections in 2006 and 48 % of persons living with HIV/AIDS in 2007 (CDC 2009). Results from a nationally representative sample of young adults indicate that the prevalences of Chlamydia infection and Trichomoniasis were both approximately six times greater among African American young adults compared with Whites in 2001–2002. Although the overall prevalence of gonorrhea was low compared to other STIs, prevalence was approximately 22 times greater among African American young adults compared with Whites (Miller et al. 2004, 2005). Some sexual behaviors increase the risk of HIV and STIs, including multiple sexual partners, inconsistent condom use, and early age at first sexual intercourse, although early sexual transition appears to elevate risk only during the adolescent years (Coker et al. 1994; Kaestle et al. 2005; Miller et al. 1999; Upchurch et al. 2004). Drug use can also place individuals at risk, either through unsafe patterns of intravenous drug use (CDC 2002) or through effecting changes in sexual behavior such as inconsistent condom use and/or having multiple, potentially high risk, partners (Kotchick et al. 2001). Beyond the clear risk posed by drug–related behaviors such as needle sharing, the implications of substance use for STI risk among adolescents and young adults are not clear. For example, substance use may disinhibit sexual behavior, which could elevate STI risk, but findings about this possible mediating mechanism are ambiguous (Rashad and Kaestner 2004). If substance use plays a central role in STI risk, whether as a distal or proximal factor, we would expect that individuals who exhibit high levels of drug use or especially risky types of use (e.g., sharing needles) would be at elevated risk of infection. However, most work to date has examined single risk behaviors and sociodemographic characteristics such as socioeconomic status, and those elements do not account for the striking racial disparities in HIV and STIs (Ellen et al. 1995, 1998; Santelli et al. 2000; Harawa et al. 2003). In previous research, we extended the investigation of the contributions of individual risk behaviors to disparities in STIs by examining the covariation of sexual risk taking and substance use. The goal of this work was to understand how patterns of multiple risk behaviors may contribute to STI risk (Halpern et al. 2004; Hallfors et al. 2007). Examination of patterns of risk behavior is important because if relevant behaviors share causal antecedents, those antecedents could be targeted more effectively in prevention and intervention efforts. Identification of patterns of behavior that map onto infection patterns would also indicate that targeting single risk behaviors is likely to be ineffective. Better documenting patterns of risk-taking related to sexual activity and drug use may be especially important for disparities in STI risk, as there is some evidence that the consistency and magnitude of covariation of these behaviors vary across adolescent sociodemographic groups (Fortenberry 1995). For example, some findings indicate that the association between these behaviors is weaker among African American adolescents than among Whites (Stanton et al. 1993). However, findings have been inconsistent, probably due to reliance on non-representative samples and inadequate controls for confounders. Differences in patterns of risk taking are also evident between male and female adolescents, with females being less likely to engage in multiple risk behaviors (Halpern et al. 2004) but more likely to experience sexually transmitted infections (Halpern et al. 2004; CDC 2008). Thus, it is important to characterize patterns of risk-taking in sexual behavior and drug use using representative samples to determine whether the sociodemographic groups that are most burdened with STIs exhibit distinctive patterns of risk-taking that are linked to infection outcomes over time.


Sexual Behavior, Contraceptive Use, and Reproductive Health
Population Movement, Diversity, Inequality


CHAP

Drug Use Trajectories among Minority Youth


Hallfors, Denise Dion
Haydon, Abigail A.
Halpern, Carolyn Tucker
Iritani, Bonita J.

Thomas, Yonette F.
Price, LeShawndra N.


2016





367-98




Springer Science+Business Media

Dordrecht, Netherlands





3989

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