1. Trajectories of Sexual Risk Behavior in Adolescence and the Transition to Adulthood Marc A. Zimmerman School of Public Health University of Michigan Stevenson Fergus Queens University

2. Stevenson Fergus Jose Bauermeister

3. Sex Risk in Adolescence CDC report 50% African-American adolescent females with STI Limited negotiation skills Limited risk assessment

4. Sex Risk in Young Adulthood Risk behavior follows from adolescence Sexual activity high Rarely studied longitudinally Many university studies

5. Developmental Transitions Few studies of the transition from adolescence to young adulthood Vital Developmental Transition New responsibilities Intimacy changes More independence

6. Correlates of Sex Risk AOD Mixed findings Mostly cross-sectional Decreases during adult transition Parental support Positive resource in youths’ lives Mother vs. fathers

7. Research Limitations to Date Mostly cross sectional or few waves of data Non-diverse samples Few include adult transitional period Few study risk and promotive behaviors in a longitudinal design

8. Flint Adolescent Study 8 years of data Started in 1994 NIDA funded Guided by Resiliency Theory

9. Sample Four public schools in Flint 850 9th graders (680 African-American) 50% females GPA of 3.0 or lower in 8th grade Not diagnosed as emotionally or developmentally disabled

10. Procedure 50-60 minute face-to-face interviews Pencil-and-paper questionnaire for sensitive information such as substance use Privacy in school or community setting

11. Initial Findings Sex risk accelerates during adolescence Sex risk slows down and levels off during adult transition (but still high) African-American youth start out riskier White youth accelerate and pass A-A youth (Fergus, Zimmerman, Caldwell (2007). AJPH)

12. Initial Findings A-A Males White Females

13. Analytic Strategy HLM growth curve analysis Condom use trajectories Substance use (level 2) Mother & Father Support (level 2) Control Variables

14. Dependent Variable Frequency of condom use past year 5-point scale (1 = almost never; 5=always) 55% indicated always Recoded to dichotomous variable 0 = no sex/always used condom 1 = used condoms less than always

15. Level 2 Predictors Substance Use Frequency last month Alcohol use Binge drinking (5+ drinks in a row) Marijuana use Mother & Father Support 5 items 5-point Scale (1 = not true; 5 = very true) Separate measures

16. Control Variables Father residence (wave 2) Serious relationship (waves 5-8) Age of sexual debut Socioeconomic status (prestige score) 8 th grade GPA (school records) Ethnicity and sex

17. Wave n Sex Without a Condom Mean Age (SD) 1 79525.3%14.9 (.6) 2 77227.1%15.9 (.6) 3 73134.6%16.8 (.6) 4 73246.9%17.8 (.6) 5 55763.3%20.1 (.7) 6 62057.3%21.0 (.6) 7 54963.1%22.1 (.7) 8 53656.0%23.1 (.7) Total 529244.6%18.5 (2.9) Results

18. Probability of Sex Without a Condom by Age

19. Results: Control Variables (level 2) Steeper risk trajectory Lower GPA Earlier debut Higher Odds of low condom use Serious relationship in young adulthood No effects (level or slope) SES Father absence from household

20. Results: Control Variables (level 2) Sex Differences Females less condom use at 18 yrs old Ethnicity Differences Steeper slope for risk among whites Whites less condom use at 18 years old

21. Results: Independent Variables More substance use Less condom use More mother support More condom use at age 18 No effects on linear trend More father support More condom use at age 18 Mean levels fastest linear growth

22. Results High Substance Use

23. Results Low Mother Support No Contact

24. Results Moderate Father Support High Father Support

25. Discussion Duh, AOD associated with steeper risk Duh, parents matter Hmmm, Medium support from father & no contact with mother greatest risk Phew, results not explained by control variables

26. Limitations Generalizability Romantic relationships in H.S. not assessed Single item dependent variable

27. Implications Role of parental support for prevention Integrate sex risk prevention in AOD programs Focus on H.S. to limit acceleration Prevention during adult transition

28. Future Directions Assess STI Assess (serial) monogamy in H.S. Study ethnicity and gender interactions Include multi-item sex risk index Examine protective effects of parent support

29. HIV Center