Crack cocaine use and high-risk behaviors among sexually active black adolescents

Abstract

The recent spread of crack cocaine use among inner-city teenagers has been accompanied by dramatic increases in juvenile delinquency and sexually transmitted diseases (STDs) among teenagers. This study examined the prevalence of five factors which promote STDs, including human immunodeficiency virus (HIV), among a sample of sexually active black adolescent crack users and non-users from the San Francisco Bay Area. Significant differences were observed between these groups with respect to history of engaging in sexual intercourse under the influence of drugs or alcohol, exchanging sexual favors for drugs or money, condom use in the most recent sexual encounter, and having five or more sexual partners in the last year. Approximately 63% of all respondents reported engaging in at least one of these risk behaviors. In multiple logistic regression analysis, reporting one or more of these STD/HIV risk behaviors was significantly associated with crack use and having one or more relatives who used drugs. Intervention efforts need to address both individual and environmental risk factors in order to reduce teens' risk for STDs, including HIV.

PIP: Researchers combined data from two surveys conducted in the summer of 1988 to examine the association between sexually transmitted diseases (STD) risk behaviors and crack cocaine use among sexually active, black teenagers. All of the subjects lived in an inner city neighborhood in the San Francisco Bay Area in California. The Centers for Disease Control had earlier found a large increase in gonorrhea among black teenagers in San Francisco. Crack users were more likely the nonusers to have sexual intercourse under the influence of drugs or alcohol (43% vs. 11% for boys and 46% vs. 14% for girls; p .001), to take part in sexual acts placing them at risk for STD in exchange for money or drugs (29% vs. 4% for boys and 25% vs. 0 for girls; p .001), and to have more sexual partners in the last year (11.1 vs. 5.3 partners for boys; p .01 and 4.5 vs. 2.5 partners for girls; insignificant). Female nonusers were more likely to have used a condom during last sexual intercourse than were female crack users (39% vs. 18%; p .01). For both groups of boys, condom use during the last sexual act was at the same low rate (about 25%). Approximately 63% of all adolescents admitted to having at least one sexual risk behavior. Crack cocaine use and having at least one relative who used drugs were the greatest predictors of STD risk behavior (odds ratios, 2.2 and 1.97; p .001 and .01, respectively). An urban anthropology study in the same neighborhoods showed that the teenagers lived in an area conducive to high-risk behaviors including drug use common among friends and relatives, more than one sexual partner/year, high prevalence of STDs, and low condom use. The findings from these studies indicated that public health workers planning to implement interventions to prevent or reduce the risk of teenage drug use and/or HIV infection must consider both individual and environmental influences.