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A Prospective Study of Psychological Distress and Sexual Risk Behavior
Among Black Adolescent Females.
Pediatrics 2001;108(5):e85.
DiClemente RJ, Wingood GM, Crosby RA, Sionean C, Brown L, Rothbaum B,
Zimand E, Cobb BK, Harrington K, Davies S.
Abstract
Objective. The purpose of the study was to examine the association between
adolescents' psychological distress and their sexually transmitted disease/human
immunodeficiency virus (STD/HIV)-associated sexual behaviors and attitudes.
Method. Sexually active black adolescent females (N = 522) completed, at baseline
and again 6 months later, a self-administered questionnaire that assessed sexual
health attitudes and emotional distress symptoms (using standardized measures,
[alpha] = .84), a structured interview that assessed STD/HIV-associated sexual
risk behaviors, and a urine screen for pregnancy.
Results. In multivariate analyses, controlling for observed covariates, adolescents
with significant distress at baseline were more likely than their peers, after
6 months, to be pregnant (adjusted odds ratio [AOR]: = 2.0), have had unprotected
vaginal sex (AOR = 2.1), have nonmonogamous sex partners (AOR = 1.7), and not
use any form of contraception (AOR = 1.5). Additionally, they were also more
likely to: perceive barriers to condom use (AOR = 2.2), be fearful of the adverse
consequences of negotiating condom use (AOR = 2.0), perceive less control in
their relationship (AOR = 2.0), have experienced dating violence (AOR = 2.4),
feel less efficacious in negotiating condom use with a new sex partner (AOR
= 1.6), and have norms nonsupportive of a healthy sexual relationship (AOR
= 1.7).
Discussion. The findings suggest that psychological distress is predictive
over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors
and high-risk attitudes. Brief screening to detect distress or depressive symptoms
among adolescent females can alert the clinician to the need to conduct a sexual
health history, initiate STD/HIV-preventive counseling, and refer for comprehensive
psychological assessment and appropriate treatment. Among adolescents receiving
STD treatment, those with even moderate emotional distress may be at heightened
risk for further unhealthy outcomes. STD/HIV interventions should also consider
psychological distress as one potential risk factor that may impact program
efficacy.