A Multicountry Study of the Violence-Related Risk Factors for Early Sexual Debut and Risky Sexual Behavior in Adolescents

Abstract

Globally, the prevalence of adolescent sexual intercourse and violence is high. However, to date, no study has investigated the association between violence and sexual behavior in a large representative sample of adolescents, while multicountry studies are also lacking. The objective was thus to examine the relationship between being physically attacked and physical fighting with sexual intercourse, multiple sexual partners, and non-condom use among adolescents aged 12 to 15 years from 43 low- and middle-income countries. Cross-sectional data from 127,513 adolescents participating in the Global School-based Student Health Survey 2003–2016 were analyzed. Data on being physically attacked and physical fighting were assessed through self-report. Data on sexual behavior were collected as follows: (a) ever having had intercourse; among those who reported having had intercourse, (b) multiple (≥2) lifetime sexual partners, and (c) condom use in last sexual intercourse. Data were analyzed using multivariable logistic regression analysis with violence as the exposure and sexual behavior as the outcome, with odds ratios being estimated. Physical attack was dose-dependently and significantly associated with all three sexual behavior outcomes with it being associated with 1.42 (95% confidence interval [CI] = [1.16, 1.74]), 2.13 (95% CI = [1.39, 3.27]), and 1.48 (95% CI = [1.10, 2.00]) times higher odds for sexual intercourse, condom non-use, and multiple sex partners, respectively, when the highest category was compared with the lowest (i.e., ≥4 times vs. 0 times). As for physical fights, compared with not being in a fight in the past 12 months, being in a fight ≥4 times was associated with 2.34 (95% CI = [2.03, 2.70]) and 1.98 (95% CI = [1.56, 2.52]) times higher odds for sexual intercourse and multiple sex partners, respectively. In conclusion, in a large global sample of adolescents, physical attack and physical fight were associated with greater risk of engaging in sexual behavior. Multidimensional government programs and policies addressing violence in young adolescents may lead to reduction in early sexual debut and other risky sexual behavior.

Keywords

violence sexual behavior multicountry adolescents epidemiology low- and middle-income countries

Get full access to this article

View all access options for this article.

References

Albus

K. E.

Weist

M. D.

Perez-Smith

A. M.

(2004). Associations between youth risk behavior and exposure to violence: Implications for the provision of mental health services in urban schools. Behavior Modification, 28(4), 548–564. https://doi.org/10.1177/0145445503259512

Australian Institute of Health and Welfare. (2019). Australia’s children. https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/injuries

Berenson

A. B.

Wiemann

C. M.

McCombs

(2001). Exposure to violence and associated health-risk behaviors among adolescent girls. Archives of Pediatrics & Adolescent Medicine, 155(11), 1238–1242. https://doi.org/10.1001/archpedi.155.11.1238

Brener

N. D.

Collins

J. L.

Kann

Warren

C. W.

Williams

B. I.

(1995). Reliability of the youth risk behavior survey questionnaire. American Journal of Epidemiology, 141(6), 575–580. https://doi.org/10.1093/oxfordjournals.aje.a117473

Butchart

Garcia-Moreno

Mikton

(2010). Preventing intimate partner and sexual violence against women: Taking action and generating evidence. World Health Organization.

Carvalho

A. F.

Stubbs

Vancampfort

Kloiber

Maes

Firth

Koyanagi

(2019). Cannabis use and suicide attempts among 86,254 adolescents aged 12–15 years from 21 low-and middle-income countries. European Psychiatry, 56, 8–13. https://doi.org/10.1016/j.eurpsy.2018.10.006

Centers for Disease Control and Prevention. (2018). STDs in adolescents and young adults. https://www.cdc.gov/std/stats17/adolescents.htm

Elgar

F. J.

McKinnon

Walsh

S. D.

Freeman

Donnelly

P. D.

de Matos

M. G.

Currie

(2015). Structural determinants of youth bullying and fighting in 79 countries. Journal of Adolescent Health, 57(6), 643–650. https://doi.org/10.1016/j.jadohealth.2015.08.007

Foshee

V. A.

Linder

MacDougall

J. E.

Bangdiwala

(2001). Gender differences in the longitudinal predictors of adolescent dating violence. Preventive Medicine, 32(2), 128–141. https://doi.org/10.1006/pmed.2000.0793

10.

Harris

K. M.

Udry

J. R.

(2014). National longitudinal study of adolescent to adult health (add health), 1994-2008 [Public Use]. Carolina Population Center, University of North Carolina-Chapel Hill [distributor], Inter-university Consortium for Political and Social Research [distributor]. https://doi.org/10.3886/ICPSR21600.v21

11.

Klein

J. D.

(2005). Adolescent pregnancy: Current trends and issues. Pediatrics, 116(1), 281–286. https://doi.org/10.1542/peds.2005-099910.1542/peds.2005-0999

12.

Longmore

M. A.

Manning

W. D.

Giordano

P. C.

Rudolph

J. L.

(2003). Contraceptive self-efficacy: Does it influence adolescents’ contraceptive use? Journal of Health and Social Behavior, 44(1), 45–60. https://doi.org/10.2307/1519815

13.

McKinnon

Gariépy

Sentenac

Elgar

F. J.

(2016). Adolescent suicidal behaviours in 32 low-and middle-income countries. Bulletin of the World Health Organization, 94(5), 340–350. https://doi.org/10.2471/BLT.15.163295

14.

Miniño

A. M.

(2010). Mortality among teenagers aged 12-19 years: United States, 1999-2006 (NCHS Data Brief, 37, 1–8). https://doi.org/10.2471/BLT.15.163295

15.

Monson

R. R.

(1990). Occupational epidemiology (2nd ed.). CRC Press.

16.

Mota

N. P.

Cox

B. J.

Katz

L. Y.

Sareen

(2010). Relationship between mental disorders/suicidality and three sexual behaviors: Results from the National Comorbidity Survey Replication. Archives of Sexual Behavior, 39(3), 724–734. https://doi.org/10.1007/s10508-008-9463-5

17.

Nygaard

Johansen

V. A.

Siqveland

Hussain

Heir

(2017). Longitudinal relationship between self-efficacy and posttraumatic stress symptoms 8 years after a violent assault: An autoregressive cross-lagged model. Frontiers in Psychology, 8, Article 913. https://doi.org/10.3389/fpsyg.2017.00913

18.

O’Keefe

(1998). Factors mediating the link between witnessing interparental violence and dating violence. Journal of Family Violence, 13(1), 39–57.

19.

Patton

G. C.

Coffey

Sawyer

S. M.

Viner

R. M.

Haller

D. M.

Bose

Mathers

C. D.

(2009). Global patterns of mortality in young people: A systematic analysis of population health data. The Lancet, 374(9693), 881–892. https://doi.org/101016/S0140673609607418

20.

Potard

Courtois

Rusch

(2008). The influence of peers on risky sexual behaviour during adolescence. The European Journal of Contraception & Reproductive Health Care, 13(3), 264–270. https://doi.org/10.1080/13625180802273530

21.

Smith

Jackson

S. E.

Jacob

Grabovac

Nisbet

L. A.

López-Sánchez

G. F.

, . Koyanagi

(2019). Association between cannabis use and sexual behavior among adolescents aged 12–15 years in 21 low-and middle-income countries. Addictive Behaviors, 99, 106073. https://doi.org/10.1016/j.addbeh.2019.106073

22.

Smith

Jackson

S. E.

Jacob

Grabovac

Yang

Johnstone

Koyanagi

(2019). Leisure-time sedentary behavior, alcohol consumption, and sexual intercourse among adolescents aged 12-15 years in 19 countries from Africa, the Americas, and Asia. The Journal of Sexual Medicine, 16(9), 1355–1363. https://doi.org/10.1016/j.jsxm.2019.06.013

23.

Smith

Jackson

S. E.

Vancampfort

Jacob

Firth

Grabovac

Veronese

(2019). Sexual behavior and suicide attempts among adolescents aged 12–15 years from 38 countries: A global perspective. Psychiatry Research, 287, 112564. https://doi.org/10.1016/j.psychres.2019.112564

24.

Stansfeld

S. A.

Rothon

Das-Munshi

Mathews

Adams

Clark

Lund

(2017). Exposure to violence and mental health of adolescents: South African Health and Well-being Study. BJPsych Open, 3(5), 257–264. https://doi.org/10.1192/bjpo.bp.117.004861

25.

Vancampfort

Stubbs

Firth

Van Damme

Koyanagi

(2018). Sedentary behavior and depressive symptoms among 67,077 adolescents aged 12–15 years from 30 low-and middle-income countries. International Journal of Behavioral Nutrition and Physical Activity, 15(1), Article 73. https://doi.org/10.1186/s12966-018-0708-y

26.

Voisin

D. R.

Chen

Fullilove

Jacobson

K. C.

(2015). Community violence exposure and sexual behaviors in a nationally representative sample of young adults: The effects of race/ethnicity and gender. Journal of Social Service Research, 41(3), 295–306. https://doi.org/10.1080/01488376.2014.987941

27.

Warner

T. D.

Warner

D. F.

(2019). Precocious and Problematic? The consequences of youth violent victimization for adolescent sexual behavior. Journal of Developmental and Life-Course Criminology, 5, 554–586. https://doi.org/10.1007/s40865-019-00122-7

28.

Wilson

H. W.

Woods

B. A.

Emerson

Donenberg

G. R.

(2012). Patterns of violence exposure and sexual risk in low-income, urban African American girls. Psychology of Violence, 2(2), 194–207. https://doi.org/10.1037/a0027265

29.

Wilson

Asbridge

Kisely

Langille

(2010). Associations of risk of depression with sexual risk taking among adolescents in Nova Scotia high schools. The Canadian Journal of Psychiatry, 55(9), 577–585. https://doi.org/10.1177/070674371005500906

30.

World Health Organization. (2014). Global status report on violence prevention 2014. https://www.who.int/violence_injury_prevention/violence/status_report/2014/en/

31.

World Health Organization. (2018). Adolescent pregnancy. https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy

32.

World Health Organization. (2019). Preventing youth violence: An overview of the evidence. https://www.who.int/violence_injury_prevention/violence/youth/youth_violence/en/

33.

Zuckerman

Kuhlman

D. M.

(2000). Personality and risk‐taking: Common bisocial factors. Journal of Personality, 68(6), 999–1029. https://doi.org/10.1111/1467-6494.00124