Substance use and other factors associated with risky sexual behavior among pregnant adolescents

Abstract

A study of the relationship between substance use and risky sexual behavior was conducted among 241 unmarried pregnant adolescents aged 17 and younger who lived in a metropolitan area in the Northwest. The respondents had comparable or higher lifetime use rates for all substances than did women in a national sample of high school seniors, even though the pregnant adolescents were younger. Ninety-four percent had used alcohol, 78% marijuana, 30% cocaine and 30% stimulants, compared with 92%, 48%, 14% and 23%, respectively, among women in the national sample. Among the pregnant adolescents, 84% had had more than one sexual partner, 39% had had a sexually transmitted disease and 60% had used contraceptives during less than half of their sexual encounters. At the bivariate level, use of cigarettes and alcohol in general and use of alcohol and drugs during sex were positively associated with risky sexual behavior. However, when other characteristics associated with risky sexual behavior--family bonding, parental monitoring, commitment to conventional values, peer associations, self-esteem and delinquent activities--were included in the multivariate analysis, the effect of substance use disappeared.

PIP: Among adolescents, rates of premarital intercourse have increased, age at first intercourse has decreased, and couples are delaying marriage to a greater extent since the 1970s. These factors effectively combine to increase the risk of female adolescents becoming pregnant and/or infected with sexually transmitted diseases (STD). As might be expected, birth and STD rates have also increased dramatically over the past two decades, confirming that youths continue to engage in unprotected sexual activity. Pregnant adolescents deserve particular attention from prevention interventions, for they show tangible evidence of a history of unprotected sexual activity. This study specifically considers risky sex behavior within a target group of 241 urban, unmarried pregnant adolescents aged 17 and younger and the behavioral relationship with substance use. Compared to women from a national sample of high school seniors, these pregnant women had higher or comparable lifetime use rates for all substances. 94% had used alcohol, 78% marijuana, 30% cocaine, and 30% stimulants compared to 92%, 48% 14%, and 23%, respectively, among women in the national sample. 84% of pregnant adolescents had had more than one sexual partner, 39% had had an STD, and 60% had used contraception in less than half their sexual encounters. Further, 70% ran away from home before pregnancy, 62% were suspended or expelled from school, and 24% served time in jail/detention. Cigarettes and alcohol in general, and alcohol and drug use during sex, were positively associated with risky sexual behavior. The effect of substance use, however, disappeared when controlling through multivariate analysis for family bonding, parental monitoring, commitment to conventional values, peer associations, self-esteem, and delinquent activities. These results suggest that both substance use and increased risk of pregnancy in the study sample may be associated with a syndrome of problem behaviors and life circumstances. While more research is needed, it appears that the messages "just say no" and "always use condoms" will be inadequate to bring about positive change.