Here's yet another reason to focus on kids' early years. Children who grow up in well-managed households, enjoy school, and have friends who stay out of trouble report fewer sexually transmitted diseases in young adulthood, according to a new analysis.
The findings, from University of Washington longitudinal surveys of nearly 2,000 participants, suggest that efforts to curb the spread of sexually transmitted diseases should begin years before most people start having sex.
"Pay less attention to the sex aspect of this and think of the larger context," is lead author Marina Epstein's advice to parents and educators.
"Kids don't engage in risky behaviors in a vacuum, there are environmental opportunities that have to be created," she said. "Monitor your kid more generally, make sure they're engaged in school and have friends who don't get into trouble."
Epstein is a researcher at the UW's Social Development Research Group. The new study, funded by the National Institute on Drug Abuse, was recently published online and will appear in an upcoming issue of the Journal of Adolescent Health.
Much is known about how to prevent STDs -- wear condoms, limit your sexual partners, don't have sex while under the influence of drugs or alcohol -- yet they are the most common type of infection in the U.S. Young adults ages 15 to 24 account for half of new cases, according to a previous study.
"A lot of prevention happens after the fact," said co-author Lisa Manhart, an associate professor of epidemiology at the UW Center for AIDS and STD. "Either youth are already having risky sex by the time they hear prevention messages, or they're in an STD clinic because they think they have an STD and someone is saying 'here are some things you can do to not get another one.'"
Prevention programs promoting abstinence or delay of sexual activity have had mixed results in reducing STDs. "When they are effective, it is very short term. Like dieting," Manhart said. "What we don't do often in the STD prevention world is think about why people engage in sex early, why they don't use condoms, and what drives these risky behaviors."
The UW team looked at what else might be at play.
Becoming sexually active early in life is commonly linked to contracting an STD. So the researchers looked for factors shared by youth who became sexually active early -- younger than age 15, as measured in Epstein's study.
The data came from two longitudinal youth development studies -- Seattle Social Development Project and Raising Healthy Children -- that began in the mid-1980s and early 1990s in urban and suburban schools in the Seattle area.
At age 24, participants from both studies had averaged eight sexual partners in their lifetimes and around a fifth said that they had been diagnosed with an STD, including herpes, syphilis, gonorrhea, chlamydia or HIV/AIDS.
Of youth in the study who became sexually active before age 15, more -- about a third -- had an STD compared with about 16 percent of those who were older when they started having sex.
Having more sexual partners was directly related to both early initiation of sexual activity and STD diagnosis. Having sex after drinking alcohol or using drugs was also related to STDs among youth in the Raising Healthy Children study.
In addition to the standard risky behaviors, researchers examined survey data from the participants' childhoods, when they were ages 10 to 14. Included were parent responses to questions about how closely they monitor their kids and whether they establish rules, discipline and rewards. In families that were well-managed, youngsters were less likely to have early sexual debuts.
School engagement -- how much kids between ages 10 and 14 liked school, their teachers and schoolwork -- also buffered against sexual activity at young ages. But having childhood friends who got into trouble with teachers or police or who were in gangs increased the risk for early sexual activity.
"We spent millions of dollars, with little success, on teaching adolescents that abstinence until marriage is best," Epstein said. "Most teenagers do end up having sex, and we would be better off spending that money preparing them to make healthy and responsible choices."
She recommends prevention efforts that take into account family dynamics and youth development.
"We already have good programs that have been shown to be effective at improving parent-child relationships and intervening with at-risk youth," Epstein said. "We should use our prevention dollars on programs that we know work and that show effects on a range of behaviors, including risky sex practices."
- Marina Epstein, Jennifer A. Bailey, Lisa E. Manhart, Karl G. Hill, J. David Hawkins, Kevin P. Haggerty, Richard F. Catalano. Understanding the Link Between Early Sexual Initiation and Later Sexually Transmitted Infection: Test and Replication in Two Longitudinal Studies. Journal of Adolescent Health, 2013; DOI: 10.1016/j.jadohealth.2013.09.016
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