Using Boredom to Compare Competing Sexual Risks in Adolescence

Introduction: Early and risky sex in adolescence are related to transmission of HIV/AIDS and other STDs and unintended pregnancy. Sexual debut often co-occurs with other risky sexual behaviors including substance use, transactional sex (e.g., having sex in exchange for money or food), and condom use, contributing to an increased risk of negative health outcomes. High levels of leisure boredom predict increased risk taking behavior at sexual debut. These patterns of leisure boredom and timing of sexual debut differ between males and females. Prevention programs with leisure boredom components could be tailored to target risky behaviors at sexual debut that are associated with leisure boredom.

Methods: The study sample is comprised of three cohorts of control students (N=3,654) from an effectiveness trial of HealthWise South Africa. Data were collected at up to eight waves for each individual and include timing of first sex and co-occurring risk behaviors (i.e., alcohol use, transactional sex, and condom use). Leisure boredom scores are computed by averaging individual leisure boredom scores across all waves and then dichotomizing into high and low categories. 

Because individuals may initiate sexual activity with a variety of co-occurring risky behaviors, a competing risks model is utilized to compare four distinct survival curves representing each risk type (i.e., sexual debut with no co-occurring risk, sexual debut with alcohol, transactional sex at debut, and sexual debut with no condom). In these survival curves, the event failure is operationalized as time of sexual debut. Leisure boredom is used as a time-invariant predictor in a Cox proportional hazards model to examine whether boredom in adolescence predicts each of the competing risks. Gender is included in the model as a covariate.

Results: Survival curves for a preliminary subsample (N₁=325) indicate significant differences in hazard rates (p<.001) for individuals initiating sex with no risks and those with any co-occurring risk. The hazard rate for co-occurring risk at sexual debut increased more quickly than the hazard rate for sexual debut with no risk. Analyses further indicate differences in hazard rates by gender (p<.001) and boredom (p=.022), with no significant interaction. Individual Cox proportional hazards models for each of the three co-occurring risk behaviors will be used to examine leisure boredom and gender as predictors.

Conclusions: This study compares the timing of sexual debut and the hazard rate of a co-occurring risky behavior. Results demonstrate gender and boredom as significant predictors of co-occurring risks at sexual debut. Using boredom as a predictor of hazard scores informs the utility of targeting boredom in preventing specific risky behaviors at sexual debut.