The Developmental Etiology of the Onset of Sexually Transmitted Infection: Are Individual, Family, Peer, School and Substance Use Influences On STI Onset Moderated by Time, Ethnicity, or Gender?

Introduction: In the United States, most sexually transmitted infection (STI) and pregnancy prevention efforts have focused on immediate sexual antecedents of risky sex, seeking to provide youth with the knowledge, attitudes and skills to avoid sexual intercourse or to use protection properly. Although influences on young people’s sexual behavior are not limited to explicit messages about sex, many non-sexual antecedents of youth risky sexual behavior have been generally ignored in STI/HIV and pregnancy prevention programs until recently. There is some evidence, however,  that interventions promoting positive youth development and addressing multiple developmental contexts may be more effective or long lasting than interventions focusing on the immediate antecedents of sexual risk behavior. This study examines the association between prosocial family environment, bonding to school, antisocial peers, and substance use and STI onset.

Methods: Data were drawn from the Seattle Social Development Project, a longitudinal study of the development of both prosocial and antisocial behavior. The sample includes 808 participants who were recruited from 18 Seattle elementary schools in 5^th grade (age 10; 1985) and followed through age 33 (2008). Survival analyses examined associations between time-varying measures of prosocial family environment, bonding to school, antisocial peers, and substance use and the hazard of STI onset.

Results: Results indicated that the hazard for STI diagnosis in this sample increased sharply beginning around age 15, peaked at age 21, declined slightly by age 24, and then dropped off across the 20s. Higher levels of positive family environment and bonding to school were associated with a lower hazard of STI onset. Higher levels of antisocial peers and cigarette use, but not alcohol or marijuana use, predicted a higher hazard of STI onset. Analyses also examine the degree to which the influence of predictors is constant across development and the degree to which findings generalize across gender and race/ethnicity.

Conclusions: The current results suggest that STI prevention programs need to consider non-sexual antecedents of sexual behavior including family functioning, school bonding, association with antisocial peers, and engagement in other risk behaviors such as substance use. These results are in line with the growing body of research supporting preventive interventions focusing on positive youth development.