Precursors to Sexual Risk Taking in Early Adolescence Among American Indian and Alaska Native Teens: A Review of the Literature

Introduction: Sexual risk prevention efforts are increasingly focusing on young adolescents—ages 10-14, before sexual risk taking begins—to mitigate increased rates of adverse sexual health outcomes among teens. This shift in focus is especially important for American Indian and Alaska Native (AIAN) youth. Chlamydia and gonorrhea rates among AIAN teens are nearly three times higher compared to non-Hispanic whites; with a twenty-fold increase in STI rates from early to late adolescence. Efforts to evaluate interventions among younger adolescents commonly use outcomes such as sexual initiation that are less valid during early adolescence. Researchers have begun to explore developmentally relevant measures that are predictive of subsequent sexual behaviors in later years. However, to date, no review has synthesized what is known about these diverse measures, their relationship to later sexual risk, nor how they might vary in salience across cultural settings. To address this gap in research we conducted a review of the literature to assess the types and scope of measures used and the conceptual frameworks supporting them. Findings inform our conceptualization of precursors to sexual risks among AIAN youth.

Methods: A search of health, psychology, social science, and education databases between 2000-2017 identified 50 original English language articles that measured sexual risk precursors. After applying exclusion criteria, we retained 20 articles on precursors to sexual risk taking. A heuristic framework classifying study findings into two major domains of adolescent development, cognitive and psychological as well as social and behavioral development, was used as a guide. Key information such as psychometric properties, study design, and major findings was extracted.

Results: While many studies stated a focus on early and middle adolescence, this developmental stage was inconsistently defined. Most studies were cross-sectional and thus could not explore the predictive ability of precursors on sexual behaviors. They tended to focus on psychosocial constructs such as sex expectancies, knowledge, and self-efficacy, but were not standardized across studies; few incorporated social and behavioral precursors. Many studies lacked a specific theoretical or conceptual framework. The heavy focus on urban communities precluded addressing common conditions in rural/tribal settings which might shape sexual risk patterns.

Conclusions: Despite growing awareness of the importance of early prevention, little is known about how to assess precursors to sexual risk taking among young adolescents, especially among minority youth such as AIANs. If early prevention efforts are to be adequately evaluated, we must be able to measure what we are trying to change.