The Role of Psychosocial Conditions on Sexually Transmitted Infection Risk Among U.S. Young Adults

Background:  Numerous risk factors are associated with sexually transmitted infection (STI) risk; yet little is known about how co-occurring risk factors impact STI risk among young adults. The present study investigates: (1) if psychosocial conditions (illicit drug use, depression, childhood physical abuse and childhood sexual abuse) co-occur among sexually experienced young adults; (2) to assess if psychosocial conditions are associated with STIs (chlamydia and trichomoniasis) and sexual risk behaviors (early sexual debut, paying for sex, receiving money for sex, sex with a IV drug user and number of sex partners); and (3) to determine if there is evidence of a “syndemic” relationship between co-occurring psychosocial conditions and young adults’ engaging in sexual risk behaviors and acquiring STIs.

Methods:  Data were obtained from the National Longitudinal Study of Adolescent Health, Wave III (2001-2002) and the final analytical sample included 10,855 sexually experienced young adults, aged 18-28, with available STI biomarker results. Adjusted logistic regressions and incidence rate ratios were used to evaluate the associations and additive effects of psychosocial conditions on sexual risk behaviors and on STI outcomes. All analyses included survey weights.

Results:   Five percent of sexually experienced young adults had chlamydia and 2.4% had trichomoniasis. Young adults that reported past histories of childhood sexual abuse were significantly more likely to report other co-occurring conditions such as childhood physical abuse, illicit drug in young adulthood or depression in young adulthood. Young adults with multiple psychosocial conditions also had a higher likelihood of engaging in early sexual debut (AOR=1.38; CI=1.26-1.53, p<.001) and paying for sex (AOR=1.70; CI= 1.35-2.14, p<.001). Study findings did not support the hypothesized relationship between multiple psychosocial conditions and either STI. 

Conclusions:  Interventions targeting this population should address how psychosocial conditions such as violence, depression and drug use may impact young adults’ level of STI/HIV risk.