1. Partner Age Difference, Power, Intimate Partner Violence, and Sexual Risk In Adolescent Girls Ellen M. Volpe, PhD, FNP, Thomas Hardie, EdD, PMHCNS-BC, Catherine Cerulli, PhD, JD, Marilynn S. Sommers, PhD, RN, FAAN, and Dianne Morrison-Beedy, PhD, RN, FAAN

2. Funding Acknowledgments  National Institutes of Mental Health  F31MH082646-01A2 (PI E.Volpe, Sponsor: D. Morrison-Beedy)  National Institutes of Nursing Research  T32NR007100, (PI M. Sommers)  Sigma Theta Tau, Epsilon Chapter  Susan B. Anthony Institute

3. Background  Adolescent girls with older male partners at increased risk for HIV/STIs (e.g. Seth et al., 2010, Ryan et al., 2008, Senn et al., 2011)  Relationship power assumed to be the theoretical link between older partners and sexual risk behaviors (e.g. DiClemente et al., 2002; Teitelman et al., 2011)  Intimate Partner Violence (IPV) has been linked to sexual risk behavior ( e.g. Halpern et al., 2009, Howard et al., 2007, Seth et al. 2010)

4. Partner Age Difference as a Predictor of Relationship Power, IPV, and Consistent Condom use in Adolescent Girls Individuals’ social and economic characteristics Demographic characteristics Family/household characteristics Community characteristics Gender- based power in sexual relationships Access to and use of sexual & reproductive services Reproductive health domains: Consistent Condom Use Violence: Physical IPV/ Psychological IPV Relationship characteristics: Partner Age Difference

5. Specific Aims 1. Examine the proposed model: Partner Age Difference as a Predictor of Relationship Power, IPV, and Consistent Condom use in Adolescent Girls 2. Estimate the direct effects of partner age difference on consistent condom 3. Analyze the indirect effects of that relationship through proposed mediators, relationship power and IPV

6. Methods  Design  Cross-sectional, descriptive survey  Setting  School-based health center, mid-size city  Sample  155 sexually-active, low-income adolescent girls (ages 14-18) in reported “boyfriend” relationship  Procedures  Anonymous, computer assisted self-interview (CASI): Promote Health

7. Methods: Measures  Partner age difference  Sexual Relationship Power Scale (Pulerwitz et al., 2002)  Relationship Power  Decision-making Dominance  Conflict Tactics Scale (Straus & Douglas, 2004)  Severity of physical and psychological IPV  Consistent condom use

8. Methods: Analyses  Descriptives  Bivariate correlations  Multiple mediation models to estimate direct and indirect effects (Preacher & Hayes, 2008)

9. Results Table 1: Sample Characteristics (n=155) n (%)M (SD) Range (min; max) Participant Age 16.1 years (1.3) 14;18 years Partner’s Age 17.8 years (2.6) 14;33 years Partner Age Difference 1.6 years (2.2) -1;15 years Race Category African American/ Black 108 (69%) Caucasian 10 (7%) Race >1 28 (18%) Hispanic 30 (19%) Low SES 125 (81%)

10. Results: Condom Use  Average of 24.5 episodes of vaginal sex, and 7.9 episodes of unprotected sex in 3 months  Only 24% of adolescent girls reported consistent condom use

11. Results: Relationship Power  An average of 2.9 on relationship power scale (1- 4)  Almost 2/3rds fell into high relationship power level  Relationship control inversely correlated with IPV severity  Decision-making Dominance positively correlated with consistent condom use

12. Results: IPV  Adolescent girls reported high frequency of victimization  Physical: 18% minor only, 18% severe  Psychological: 47% minor only; 35% severe

13. Results: Direct and Indirect Effects Partner age difference Gender-based power in sexual relationships Consistent Condom Use Severity of Psychological IPV Severity of Physical IPV.012.651 -.429*.000.007 -.095 -.357 -.442* *= p<.05

14. Discussion  Partner age difference was negatively correlated with consistent condom use  Not explained by any of the proposed mediators: relationship power, severity of physical and psychological IPV  Alternative explanations:  Emotional manipulation not identified in relationship power  Clustering of adolescent risk behavior  Complexity of condom use decision-making in relationships

15. Discussion  Prevalence of physical and psychological IPV severity  Discreet constructions of relationship power  Relationship control: inversely related to IPV  Decision-making dominance: consistent condom use

16. Limitations  Cross-sectional design  Lack of variability in partner age difference  Lack of context for violence or measure of sexual risk

17. Implications  Elucidate the degree of partner age difference that predicts low relationship power  Investigate alternative explanations to explain partner age difference’s relationship to condom use  Examine implications of high relationship power among adolescent girls  Incorporate partner age, relationship control, and decision-making dominance in interventions

18. References DiClemente, R. J., Wingood, G. M., Crosby, R. A., Sionean, C., Cobb, B. K., Harrington, K.,... Oh, M. K. (2002). Sexual risk behaviors associated with having older sex partners: A study of black adolescent females. Sexually Transmitted Diseases, 29(1), 20-24. Halpern, C. T., Spriggs, A. L., Martin, S. L., & Kupper, L. L. (2009). Patterns of intimate partner violence victimization from adolescence to young adulthood in a nationally representative sample. Journal of Adolescent Health, 45(5), 508-516. Howard, D. E., Wang, M. Q., & Yan, F. (2007). Psychosocial factors associated with reports of physical dating violence among U.S. adolescent females. Adolescence, 42(166), 311-324. Pulerwitz, J., Gortmaker, S. L., & DeJong, W. (2000). Measuring sexual relationship power in HIV/STD research. Sex Roles, 42(7), 637-660. Preacher, K. J. & Hayes, A. F., (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40 (3), 879-891.

19. References (continued) Ryan, S., Franzetta, K., Manlove, J. S., & Schelar, E. (2008). Older sexual partners during adolescence: Links to reproductive health outcomes in young adulthood. Perspectives on Sexual & Reproductive Health, 40(1), 17-26. Senn, T. E., & Carey, M. P. (2011). Age of partner at first adolescent intercourse and adult sexual risk behavior among women. Journal of Women's Health, 20(1), 61-66. Seth, P., Raiford, J. L., Robinson, L. S., Wingood, G. M., & Diclemente, R. J. (2010). Intimate partner violence and other partner-related factors: Correlates of sexually transmissible infections and risky sexual behaviours among young adult African American women. Sexual Health, 7(1), 25-30. Straus, M. A., & Douglas, E. M. (2004). A short form of the revised Conflict Tactics Scales, and typologies for severity and mutuality. Violence and Victims, 19(5), 507-520. Teitelman, A. M., Tennille, J., Bohinski, J. M., Jemmott, L. S., & Jemmott, J. B. I. (2011). Unwanted unprotected sex: Condom coercion by male partners and self-silencing of condom negotiation among adolescent girls. Advances in Nursing Science, 34(3).