A Multidimensional Model of Sexual Health, Condom Use and STI Among Adolescent Women

Background: Sexual health has emerged as a guiding paradigm for public health approaches to STI prevention among adolescents, yet it remains poorly operationalized, with little empirical evidence linking it to specific health indicators.

Objectives: 1) Empirically validate a multi-dimensional model of sexual health in adolescent women; 2) examine the effect of sexual health on condom use, number of partners and STI.

Methods: Data were quarterly interviews from a cohort of young women in Indianapolis (N=387, 14-17 yrs.); the current project used a subsample (N=242) reporting no pregnancy and only one partner. Using an existing definition (WHO, 2002), sexual health dimensions were: relationship quality (6-items, α=0.95), sexual-relationship satisfaction (5-items, α=0.94), sexual autonomy (3 items, α=0.83), absence of sexual pain (3-items, α=0.80), pregnancy prevention attitudes (3-items, α=0.76), condom use self-efficacy (4-items, α=0.85). Outcomes were: number of lifetime sexual partners, condom use (proportion of condom-protected penile-vaginal intercourse events) and STI (any chlamydia, gonorrhea, or trichomonas). Second-order latent variable modeling (AMOS/17.0): (1) evaluated dimensions as first-order latent indicators of second-order latent sexual health variable; (2) predicted condom use, number of partners and STI using sexual health.

Results: First order latent dimensions were significant sexual health indicators (B=0.21 – 0.73; p<.05). Higher sexual health predicted a lower number of lifetime sexual partners (B=-0.15, p<.10) as well as greater condom use (B=0.19, p<.05) and was negatively associated with incident STI (B=-0.19).

Conclusions: Sexual health is a measureable, empirically identifiable construct, with direct links to key STI-related public health indicators.

Implications for Programs, Policy, and Research: These data provide empirical evidence for a public health approach to sexual health which both endorses healthy sexual development and maintains attention on primary prevention of adverse outcomes such as STI. This means that a key public health function – sentinel surveillance – could be implemented using measures that are reasonably easy to collect from diverse populations.