Community-level violence linked to teens' risky sexual behavior

The findings of the Baltimore-based study could eventually lead to new ways to improve sexual health among this population. They will be presented at the International Conference on Family Planning in Nusa Dua, Indonesia.

Violence is a common experience among youth living across the United States, particularly in poor, urban communities. While a growing body of research links violence to poor sexual and reproductive health outcomes, these studies have primarily focused on violence within relationships, such as intimate partner violence or gender-based violence. Less is known about how violence at the community level might affect teens' sexual choices and, consequently, their sexual health, says Hannah Lantos, PhD, a recent graduate of the Johns Hopkins Bloomberg School of Public Health in the Department of Population, Family, and Reproductive Health and a research scientist at Child Trends, a nonprofit, nonpartisan research center.

"We need to help young people understand what's happening to them in terms of violent experiences in order to help them feel empowered to make healthy choices about sex, sexual partners and condom use," says Lantos, who will present the findings from her study. "A first priority in these neighborhoods is to reduce the high levels of violence that adolescents fear and experience. However, if we cannot put a stop to violence in these neighborhoods, helping young people process these experiences and learn coping skills may have a broader impact on their behavior."

Lantos gathered data from the Well-Being of Adolescents in Vulnerable Environments (WAVE) study, a project run jointly by Hopkins' Center for Adolescent Health, its Urban Health Institute and the drug maker Astrazeneca. Started in 2011, WAVE collected information from young people in five study sites (Baltimore; Johannesburg, South Africa; Shanghai, China; Delhi, India; and Ibadan, Nigeria) to further the health of teens in low-income communities around the world.

Lantos used data from 426 participants between the ages of 15 and 19 (245 male and 181 female), who took a 30-minute computer survey at Johns Hopkins. These participants, all from East Baltimore neighborhoods, answered a series of questions asking about their experience with violence in their communities. These questions focused on the participants' fear of violence, observations of violence or whether they'd been victims of violence themselves. In addition, the teens also answered questions about whether they'd had sex in the past year and whether they'd used a condom the last time they'd had sex.

Results showed that the teens' experience with violence and sex differed between males and females. While 71 percent of the female participants reported fear of violence, only 41 percent of the male participants did. Females were also about 7 percentage points more likely to report observing violence, though males and females were equally likely to have been victims of violence.

Males were about 10 percentage points more likely to report having sexual intercourse in the past year, and condom use was about the same between the two genders. For the female participants, all three experiences of violence increased the odds of having sex in the past year. Fear increased the likelihood that females engaged in sex by 40 percent, females who observed violence were 3.5 times as likely to engage in sexual activity, and being a victim of violence more than tripled it.

For the male participants, victimization wasn't associated with sexual activity, but fear cut the odds of engaging in sex by more than 50 percent. Observation of violence more than doubled the likelihood of sexual activity for males.

Condom use also differed by gender. For females, experiencing fear was associated with a 70 percent reduction in condom use the last time they engaged in sexual activity, while for males observing violence cut the likelihood that they used a condom the last time they engaged in sexual activity by half.

Though the study was unable to ascertain why violence was linked with sexual behavior or why it might differ by gender, Lantos suggests that showing that this link exists could eventually help researchers develop interventions that could help protect teens against the negative effects of violence while also assisting them in making decisions to improve their sexual health.