Development of Sexual Risk in Minority Youth: Risk and Protective Factors in Early Adolescence

During the 1990s, teen sexual activity and pregnancies in the United States decreased, and condom use by adolescents increased (Kann et al., 2014; Martin, Hamilton, Osterman, Curtin, & Mathews, 2013). This trend was likely due to increased awareness of risk associated with the HIV/AIDS epidemic along with improved prevention efforts (Advocates for Youth, 2008; Kirby & DiClemente, 1994). However, these efforts have not resulted in adequate or sustained changes in youth sexual behavior. Rates of teen pregnancy, childbirth, sexually transmitted infections (STIs), and abortion remain higher in the United States than in nearly any other western industrialized nation (Kearney & Levine, 2012; Panchaud, Singh, Feivelson, & Darroch, 2000; Sedgh, Finer, Bankole, Eilers, & Singh, 2015). Since 2001, the number of sexually active U.S. high school students has remained relatively stable, and condom use by adolescents has decreased. Moreover, U.S. teens are less likely than adolescents in other developed countries to use contraception consistently and effectively (Santelli, Sandfort, & Orr, 2008). According to the most recent Centers for Disease Control and Prevention (CDC) data (Kann et al., 2016), approximately 40% of sexually active teens reported lack of condom use during last sexual intercourse, and 14% said that they were not using any form of contraception. Only 9% reported that they used both a condom and another form of birth control, the most reliable way to prevent both STIs and pregnancy, at last intercourse.

Adolescents from minority backgrounds continue to suffer from disproportionate rates of sexual health consequences. African American women aged 15 to 24 years experience the highest rates of STIs in the United States, relative to any other demographic group (CDC, 2014). Between 2003 and 2007, Black and Hispanic teens accounted for 87% of all new HIV infections among 13- to 19-year-olds and 79% of HIV infections among 20- to 24-year-olds in the United States, although these minority groups represent only 32% of youth these ages living in the United States (CDC, 2009). And teen birth rates are over twice as high among Hispanic and Black girls, relative to White girls (Martin et al., 2013). These race and ethnic disparities appear due in part to poor socioeconomic conditions, which can reduce access to health care and make sexual health a low priority relative to other basic needs. However, they do not disappear entirely in studies that adjust for socioeconomic status (Kirby & Lepore, 2007).

It is likely that the effects of racism, discrimination, and other forms of oppression and disadvantage contribute to disparities in sexual health outcomes. For example, mistrust of medical systems due to historical medical abuses has led to conspiracy theories that may impede sexual health practices, such as condom use, in some African American and Latino/a communities (Ross, Essien, & Torres, 2006). As another example, intersections of minority status and male-dominated power imbalance can undermine adolescent African American women’s ability to negotiate condom use (Crosby et al., 2008). Clearly, effective strategies are crucially needed to mitigate these historical disadvantages and reduce sexual risk among minority youth in the United States.

Intervention during early adolescence may offer an effective means of preventing risky sexual behaviors and, ultimately, sexual health outcomes of pregnancy and STIs later in adolescence. National surveillance suggests that approximately a quarter of teens are sexually active by the first year of high school, and over half become sexually active by senior year (Kann et al., 2016). Earlier onset of sexual activity is associated with riskier sexual behavior (Kuortti & Kosunen, 2009) and increased risk of teen pregnancy and STIs (Coker et al., 1994). Therefore, reaching teens during the window of early adolescence may offer a point of entry before sexual risk begins or becomes an entrenched pattern. Research in recent decades has identified over 500 potentially modifiable risk and protective factors related to adolescent sexual behavior and outcomes (Kirby & Lepore, 2007). These variables include characteristics measured at individual, family, peer, partner, and community levels. My research with African American girls growing up in low-income communities in Chicago highlights childhood violence exposure as a predictor of sexual risk during adolescence (Wilson et al., 2015; Wilson, Woods, Emerson, & Donenberg, 2012). This pattern began in early adolescence and related to earlier onset of sexual activity, greater number of sexual partners, and less consistent condom use (Wilson et al., 2015). Other findings from this longitudinal study revealed that more extensive dating experience in early adolescence helped to explain the link from early violence exposure to sexual risk (Wilson, 2012). Thus, interventions during early adolescence may be a powerful means of delaying the onset of sexual risk behavior among youth exposed to disadvantage such as violence exposure.

The current special issue highlights a number of culturally relevant variables that relate to sexual risk in early adolescents from minority race or ethnic backgrounds. Each of the four studies in this issue presents a unique perspective on factors that relate to increased risk or resilience in minority early adolescents. Therefore, findings reported in this special issue shed light on potential intervention strategies to deter the development of sexual risk in minority youth.

In the first article, “‘You Still Got to See Where She’s Coming From’: Using Photovoice to Understand African American Female Adolescents’ Perspectives on Sexual Risk,” Sidibe, Turner, Sparks, Woods-Jaeger, and Lightfoot present findings from a qualitative study that highlight unique challenges associated with race, gender, and developmental stage. The young women in this study revealed the transition from middle to high school as a particularly vulnerable period characterized by intensified peer pressure and lack of safety for young minority women. Participants also described how sexual risk-taking can represent a way for young women of color to feel independent and challenge authority. Finally, the article highlights the contribution of internalized racism and sexism to sexual risk for these women. The authors conclude with recommendations for developing intervention programs that address the intersection of racial and gender discrimination, foster positive expectations for Black women, and reduce bullying during early adolescence as strategies for reducing sexual risk.

The second study, “Predicting Age of Sexual Initiation: Family-Level Antecedents in Three Ethnic Groups,” by Moilanen, Leary, Watson, and Ottley used a longitudinal design to examine family characteristics measured at ages 12 to 13 years as predictors of the age of sexual initiation in a large nationally representative sample of White, Black, and Hispanic teens. Findings revealed slightly different pathways to early sexual activity across the three ethnic groups. Earlier sexual initiation was associated with father absence in the home during early adolescence for both Black and Hispanic youth. Greater perceptions of autonomy were associated with earlier onset for both Black and White teens. Male sex was associated with earlier sexual debut only for Black teens (Black males reported the earliest age of sexual initiation on average), and maternal age at first childbirth was only relevant for White teens. These findings may reflect cultural and family norms related to typical maternal age at onset of child-rearing and the presence of fathers during early adolescence. These findings also suggest the possibility of culturally specific effects of social modeling and social control and therefore support the development of culturally tailored programs to delay onset of sexual behavior in teens.

Also, using longitudinal methodology, the third article, “Developmental Assets and Risky Sexual Behaviors among American Indian Youth,” authored by Greene, Eitle, and McNulty Eitle examined a broad set of personal, family, school, and community assets in early adolescence as predictors of sexual risk in adulthood in an American Indian sample. Findings from this study apply to a group of youth who remain highly underrepresented in research on this topic, despite high rates of teen STIs and pregnancy. Drawing from a strengths-based approach, this study identified a select set of personal, family, school, and peer factors that predicted reduced sexual risk behaviors (early sexual debut, number of sexual partners, frequency of condom use). In particular, the authors highlight the importance of cumulative assets, or the additive effect of various developmental assets, within these youth. The authors conclude that a strengths-based approach focused on fostering early developmental assets may be particularly important for reducing risk in populations such as American Indians who have been marginalized, oppressed, and problemized by the scientific community.

Consistent with this recommendation of building on strengths or assets, the final article “Positive Youth Development Interventions Impacting the Sexual Health of Young Minority Adolescents: A Systematic Review,” by Harris and Cheney presents a review of interventions that have utilized positive youth development (PYD) concepts to promote sexual health in young minority adolescents. This review revealed that relatively few PYD-based interventions have been developed, or evaluated, specifically with early adolescents. Nonetheless, existent findings support PYD as a promising approach to reducing sexual risk in young minority youth. In particular, interventions that yielded significant findings included components to address social bonding, cognitive and behavioral development, and opportunities for prosocial involvement.

The four original articles presented in this issue suggest a need for increased attention to early adolescence as a window of opportunity for preventing sexual risk in minority teens. Effective interventions during the transition from middle to high school, when dating and sexual interests emerge for most youth, have the potential to cultivate healthy relationships and prevent the development of health compromising sexual behaviors. The evidence presented here suggests that effective interventions must focus on empowering minority youth, embrace cultural values, and move beyond standard sex education classes.