Risk Factors for Early Sexual Debut in Pregnant Adolescents

Persistent risk factors continue to contribute to teen pregnancy, despite reduced national rates of teen births. Some of these risks may be associated with the age of sexual debut. Tailoring interventions to address specific risk factors, including those related to early initiation of sexual activity, may enhance continuing efforts for teen pregnancy prevention. Purpose: To identify risk factors for earlier sexual debut <15 years versus later sexual debut 15+; and trends across four debut age groups (<14 to 16+) in multi-risk teens who go on to become teen mothers. Methods: As part of the NIH-DC Initiative to Reduce Infant Mortality in Minority Populations, analysis of 2005-07 baseline data of an RCT to reduce subsequent teen pregnancy is reported. African American and Latina teens (n= 187), ages 15-19, carrying a first infant to term, were interviewed during their last trimester. Measures of age at sexual debut, risk behaviors, parent monitoring, communication, family violence, and school and neighborhood factors were administered. Trend analyses were performed with the teens divided into balanced groups for at age of sexual debut <14(21%), 14(22%), 15(32%), and 16+(25%). Results: Median age at first intercourse was 15 years. Teens with early sexual debut (ESD) were more likely to have experienced physical abuse (OR=2.9, 95% CI:1.4-6.2), sexual abuse (OR=2.2, 95% CI:1.1-4.3) and to feel limited connection to their neighborhood (OR=2.8, 95% CI:1.2-6.6). Teens with ESD were also more likely to have had 3 or more partners before they became pregnant 72% vs 45% (p <.001) than those with later initiation of sexual activity. There was a high percentage of school failure (47%) across groups and having siblings who were teen parents (29%) was also common, but these did not differ by age at sexual debut. Trend analyses suggest that the prevalence of risk factors increases with decreasing age at sexual debut. Nine percent of girls with sexual debut at age 16 or after had poor parental monitoring, but 31% of those with early debut before age 14 had this risk (p=.01) Only 2% of girls with sexual debut at 16 or later had disruption in living with their biological mothers, but this was true for 11% of girls with ESD (p=.02). ESD was also associated with exposure to sexual abuse (41% vs 13%)(p=.003) and physical abuse (33% vs 4%) (p=.0005) as compared to girls with late sexual debut. Controlling for age and ethnicity, teens with ESD who go on to become pregnant, are more likely to have had disruption in living with their biological mothers (AOR=9.0, 95% CI:1.8-45.0), physical abuse (AOR=3.5, CI:1.4-8.9)and a limited sense of neighborhood connectedness (AOR=2.9, 95% CI:1.1-7.8). Conclusions: Family disruption, abuse and neighborhood isolation are risk factors that may be used to identify those teens at risk for early sexual debut. Health providers should be alert to teens with physical or sexual abuse and poor parent monitoring as being at particular risk. Interventions with parents emphasizing the importance of monitoring teen behavior and encouraging teens to engage in community and youth resources may help reduce risks for ESD. Funded by NICHD.