Self-Reported Sexual Behavior by Socio-Economic Status at the Individual Vs. Zip-Code Level Among Inner-City Adolescents in a Small Urban Setting

Background: Although studies show that STDs and teen pregnancies are higher in lower-income areas, few have examined whether socio-economic status (SES), both at area- and individual-levels, correlates with self-reported sexual behaviors, particularly in small-urban settings. 

Objectives: To examine relationships between SES at the individual- and area-levels and sexual behavior.

Methods: Interviews were conducted with 432 participants aged 14-18 of a summer employment program in Albany, NY.  Participants were asked about demographics, behaviors, and social environment.  Low area-level SES was defined as living in an Albany zip code with median household income below the national average.  Low individual-level SES was defined as receiving Welfare, SSI, Food Stamps, or living in public housing.  Bivariate and log-binomial regression analyses were performed to assess the effect of SES on sexual risk.

Results: More participants were categorized as having low SES at the area vs. individual level (59.3% vs. 47.2%, p<0.0001).  Almost half (43.4%) ever had sex; among these, 54.8% reported multiple partners (max of 40).  Participants with low area-level SES were more likely to report sexual activity and multiple partners (PR = 1.56, 95% CI = 1.21, 2.02; PR = 2.21, 95% CI = 1.43, 3.41, respectively).  Similar results were seen for low individual-level SES.  Even after controlling for individual-level SES, area-level SES was associated with sexual activity (PR = 1.91, 95% CI = 1.22, 3.00) and multiple partners (PR = 2.10, 95% CI = 1.31, 3.38).

Conclusions: Low-income SES at both individual- and area-levels was associated with increased sexual behavior among adolescents in a small urban setting.  Participants in low-income zip codes were at increased risk even after adjusting for individual-level SES.

Implications for Programs, Policy, and/or Research: Adolescents are shaped by their economic environment at multiple levels.  Interventions and programs are needed that deal with both risky sexual behaviors and socio-environmental context.