Associations Between Age of Sexual Initiation, High-Risk Sexual Behaviors, and Area-Based Social Determinants of Health

Background: Early sexual initiation is correlated with engagement in other high risk behaviors which place individuals at increased risk of acquiring STDs.  Age of first sex may also be associated with the social and economic characteristics of the neighborhoods in which individuals reside.

Objectives: Assess determinants of early age of sexual initiation and correlations with engagement in other high-risk sexual behaviors among STD clinic patients.

Methods: Data on patient demographics and risk behaviors were captured for individuals presenting to STD clinics in the Richmond, Virginia area from 2008-2010 by the Virginia Department of Health (VDH) as part of the STD Surveillance Network (SSuN) project.  STD clinic patients were interviewed using self-administered paper-based forms.  Differences in self-reported age of first vaginal or anal intercourse were assessed by various patient demographics and risk behaviors, as well as by the socio-economic characteristics of their census tract of residence.  Multi-level regression analysis was used to create a parsimonious model to predict early sexual initiation by individual-level and neighborhood-level socio-demographic characteristics.

Results: There were 10,713 interviews from unique patients available for analysis.  Approximately half of all patients reported first engagement in sexual intercourse between 10 and 15 years of age (19% between 10-13 years; 30% between 14-15 years).  Nineteen percent of heterosexual, 12% of homosexual, and 27% of bisexual patients reported early age of first sex (10-13 years).  Early age of sexual initiation was significantly associated with all individual and area-based measures examined, as well as with all other high-risk sexual behaviors.

Conclusions: Early age of sexual initiation is an important predictor of high-risk sexual behaviors, and is strongly associated with both individual and area-based characteristics.

Implications for Programs, Policy, and Research: Identifying characteristics (both demographic and geographic) of populations at increased risk of engaging in high risk behaviors may inform better targeting of limited prevention resources.