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HIV/Sexually Transmitted Infection Prevention Messaging: Targeting Root Causes of Sexual Risk Behavior

Manhart, Lisa E. PhD*‡; Epstein, Marina PhD; Bailey, Jennifer A. PhD; Hill, Karl G. PhD; Haggerty, Kevin P. PhD; Catalano, Richard F. PhD

doi: 10.1097/OLQ.0000000000000402
Original Study

Introduction Sexual risk behaviors (SRBs) often lead to sexually transmitted infections (STI), yet little is known about what drives SRB and whether this differs by sex.

Method Participants (n = 920; 75% white) were drawn from the Raising Healthy Children study, enrolled in 1993 and 1994 in grades 1 to 2, and followed up through age 24/25 years. Lifetime STI diagnosis was defined by self-report or seropositivity for Chlamydia trachomatis or herpes simplex virus 2. Multivariable models assessed individual (social skills, behavioral disinhibition) and environmental factors (family involvement, school bonding, antisocial friends) predictive of STI diagnosis as mediated by 3 proximal SRB (sex under the influence of drugs or alcohol, condom use, lifetime number of sex partners).

Results Twenty-five percent of participants had ever had an STI. All SRBs differed by sex (P < 0.001), and female participants were more likely to have had an STI (P < 0.001). Behavioral disinhibition and antisocial friends in adolescence were associated with more SRB for both sexes, whereas social skills were associated with less SRB in female but more in male participants. Considering SRB and individual and environmental factors together, lifetime number of sex partners (adjusted relative risk [ARR], 1.04per partner; 95% confidence interval [CI], 1.03–1.05) and inconsistent condom use (ARR, 1.10per year; 95% CI, 1.04–1.16) were associated with increased risk of STI, whereas social skills were associated with decreased risk of STI (ARR, 0.84; 95% CI, 0.75–0.93). Behavioral disinhibition seemed to drive SRB, but family involvement mitigated this in several cases.

Conclusions Adolescent environmental influences and individual characteristics drive some SRB and may be more effective targets for STI/HIV prevention interventions than proximal risk behaviors.

Longitudinal data demonstrated that potentially modifiable adolescent environmental and individual characteristics may drive sexual risk behavior and risk for sexually transmitted infections.

From the *Department of Epidemiology; †Social Development Research Group, School of Social Work, Seattle, WA; and ‡Center for AIDS and STD, University of Washington, Seattle, WA.

Lisa E. Manhart, PhD, and Marina Epstein, PhD, contributed equally to this work.

This work was supported by the National Institute of Drug Abuse: NIH/NIDA DA024411-01-06 (Karl G. Hill, Principal Investigator) and DA08093-16 (Richard F. Catalano, Principal Investigator).

Richard F. Catalano is a board member of Channing Bete Company, distributor of Supporting School Success, and Guiding Good Choices. Although the intervention effects are not studied in this manuscript, these programs were tested in the studies that produced the data sets used in this manuscript.

Correspondence: Lisa E. Manhart, PhD, UW Center for AIDS and STD, Box 359931, 325 9th Ave, Seattle, WA. E-mail:

An earlier version of this paper was presented at the 2013 annual meeting of the Society for Prevention Research held from May 29 to 31 in San Francisco, CA.

Received for publication June 24, 2015, and accepted October 26, 2015.

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© Copyright 2016 American Sexually Transmitted Diseases Association