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Borowsky, Ireland, and Resnick (2009)
"sought to determine the proportion of U.S. youth who anticipate
a high likelihood of early mortality and relationships with health status
and risk behaviors over time" (p. e81). The investigators
analyzed data from times
1 (1995), 2 (1996), and 3 (2001-2002) of the National Longitudinal Study
of Adolescent Health, a nationally representative sample of youth in
grades 7 through 12. . . . At time 1, 14.7% of the 20,594 respondents
reported at least a 50/50 chance that they would not live to age 35.
In adjusted models, illicit drug use, suicide attempt, fight-related
injury, police arrest, unsafe sexual activity, and a diagnosis of HIV/AIDS
predicted early death perception at time 2, time 3, or both. . . . Conversely,
perceived early mortality at time 1 predicted each of these behaviors
and outcomes, except illicit drug use, at time 2 or time 3, most strongly
a diagnosis of HIV/AIDS . . . in young adulthood. (p. e81)
Borowsky and colleagues observe that
perceived risk for untimely
death in adolescents is a powerful marker for involvement in health-jeopardizing
behaviors. The relationship between perceived risk for early death and
involvement in risky behavior is a reciprocal one, with judgments of
risk influencing behavior and health outcomes as well as behavioral
experience affecting perceived risk. Given the significant association
of adolescents' belief in premature death with serious health behaviors and outcomes, . . . [clinicians] who work
with youth . . . must tackle this unusually common negative view in
addressing adolescent morbidity and mortality. . . . [S]creening adolescents
for the perception of having a foreshortened life may serve as a useful
approach for identifying both a pessimistic explanatory style and involvement
in risk behaviors now and in the future. A question about perceived
risk for death can be incorporated into a discussion of future school,
work, and career plans and goals. This type of screening could provide
an indicator of multiple issues that deserve attention and offer an
opportunity to intervene to prevent risky behaviors and improve health
outcomes. (p. e86)
On the topic of potentially risky behaviors,
Lescano et al. (2009) "examined demographic, behavioral, relationship
context, attitudinal, substance use, and mental health correlates of
recent heterosexual anal intercourse among [1,348 at-risk] adolescents and young adults who reported engaging
in recent unprotected sex" (p. 1131). The investigators found that
"recent heterosexual anal intercourse was reported by 16% of respondents.
Females who engaged in anal intercourse were more likely to be living
with a sexual partner, to have had 2 or more partners, and to have experienced
coerced intercourse. For males, only a sexual orientation other than
heterosexual was a significant predictor of engaging in heterosexual
anal intercourse" (p. 1131). Lescano and colleagues stress that
open dialogue between providers
and their young clients about anal intercourse is important. When asking
young people about vaginal intercourse and protection behaviors, clinicians
should also be aware of the prevalence of anal intercourse and screen
for this behavior. In particular, clinicians should not presume that
types of sexual behaviors and partner gender are consistent with defined
sexual orientation. Thus, a detailed history of sexual behavior and
all partner types is required. In addition, power in relationships and
trauma from unwanted sexual intercourse are major factors and should
be addressed in HIV-prevention interventions. Teaching adolescent girls
and young women how to be assertive in sexual relationships – refusing
unwanted sexual acts and negotiating for safer sex, whether anal or
vaginal – is of the utmost importance. (pp. 1135-1136)
Seth, Raiji, DiClemente, Wingood, and
Rose (2009) conducted audio computer-assisted self-interviewing (ACASI)
with 715 African American female adolescents between the ages of 15
and 21 years and residing in a large southeastern city in the United
States. These young women were also assessed for current sexually transmitted
infections (STIs). The investigators found that, in this sample, "the
overall prevalence of high levels of psychological distress was 44.5%" (p. 291). Further analyses
revealed that adolescents
with high psychological distress, relative to those with low psychological
distress, were more likely to test positive for a biologically confirmed
STI, use condoms inconsistently, not use condoms during their last casual
sexual encounter, have sex while high on alcohol or drugs, have male
sexual partners with concurrent female sexual partners, have low condom
use self-efficacy, [low] partner sexual communication self-efficacy,
[low] refusal self-efficacy and be more fearful of communicating with
their partners. (p. 295)
Although these findings are preliminary,
they suggest, according to Seth and colleagues, that
screening for psychological
distress should be a part of regular health care maintenance and highlights
the importance of assessing psychological distress among African-American
female adolescents engaging in high-risk sexual behaviour. By coordinating
medical care with mental health services, early detection of potential
mental and physical health problems will be facilitated. Because psychological
resources serve as a protective agent against the effects of these risk
factors, there is a need to identify and intervene early rather th[a]n
dismiss these symptoms as transitory experiences. HIV intervention programs
should increasingly be geared towards increasing psychological resources
and coping mechanisms to buffer against potential negative consequences
of psychological distress. (p. 298)
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Fall 2009 Newsletter / Volume 11, Issue 1
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