STD Risk Behaviors of Incarcerated Youth Angela Robertson and Connie Baird-Thomas Mississippi State University This work was funded by the National Institute on Drug Abuse grant DA

Purpose of the Study To screen incarcerated juveniles for two common sexually transmitted diseases as biomarkers of HIV risk To identify predictors of STD infection using a multi-system perspective To examine gender differences in STD/HIV risk

Background Incarcerated adolescents are at high risk for HIV because they engage in risk behaviors at higher rates and at earlier ages than adolescents in the general population. Significant rates of STD infections have been documented.

Methods 1,816 juvenile detainees were screened for chlamydia (CT) and gonorrhea (GC) between April 2002 and May who met inclusion criteria were approached and 763 (94%) completed a self-administered survey using audio- CASI technology. 690 (90%) gave permission for the project to link their STD test results with survey responses. Results presented here are based on 681 youth (249 females and 432 males) with complete data.

Survey Sample FemaleMale Ever Sexually Active Recently Sexually Active Age of Sexual Debut13.7 (1.7)12.5 (2.3) Number of Lifetime Partners 4.9 (7.3)12.9 (13.8) Number of Current Partners 1.6 (2.7)4.2 (5.2)

A Multi-System Perspective for Adolescent Sexual Behavior Self System: biological, psychological, and behavioral factors Family System: family structure and family process variables Extra-familial System: peer, school, and neighborhood influences Kotchick, Shaffer, Forehand, and Miller (2001)

Potential Predictors of STD Positivity Biological Gender (female) Age, range 13 to 18 years Psychological Sexual Abuse History of previous STD infection Alcohol and drug expectancy scales Enhances sex and socializing Loss of control Behavioral Number of lifetime partners Joint occurrence of sex and alcohol use Risk reduction strategy Inconsistent condom use 100% condom use Sexual abstinence Family Two parent home Extrafamilial High Risk Friends

Results: Infection Rates STD test results available on 1,789 detainees 231 or 12.9% for chlamydia; 8.1% of males and 24.7% of females 57 or 3.2% for gonorrhea; 1.5% of males and 7.3% of females 17.5% of survey participants tested positive for either CT or GC; 27.7% of females and 11.6% of males

Predictors of STD Infection for Total Sample VariableOdds Ratio Gender (female)3.69*** Age1.17+ AES-loss of control0.89+ Sex and Alcohol Use1.96* Risk Reduction Strategy (Abstained) Inconsistent condom use Always used condoms * Two parent family0.43* + p<.10, * p<.05, ** p<.01, *** p<.001

Predictors for Females Detainees VariableOdds Ratio Sex and Alcohol Use3.20** Number of lifetime partners1.05* Two parent family p<.10, * p<.05, ** p<.01, *** p<.001

Predictors for Males Detainees VariableOdds Ratio Age1.32* AES-loss of control0.80* AES-enhances sex STD history22.72*** Risk Reduction Strategy (Abstained) Inconsistent condom use Always used condoms ** + p<.10, * p<.05, ** p<.01, *** p<.001

Limitations Generalization: Results can not be generalized to all incarcerated youth as 90% of youth detained in the facility and participating in study were African American Veracity of self report: 49 out of 246 (19.9%) of youth reporting 100% condom-protected vaginal intercourse tested positive for CT or GC 31 out of 282 (11.0%) of youth reporting that they abstained from vaginal intercourse during the three months prior to incarceration tested positive

Conclusions Rates of undiagnosed CT and GC are high in incarcerated youth. A multi-system approach is useful for identifying potential risk/protective factors. Biological factors (gender and age) account for almost half (47%) of the total explained variance; youth behavior accounts for 33.5%. Yet family factors are also relevant for adolescent STD risk. Predictors vary by gender. Alcohol use and AOD expectations are associated with STD positivity.