Social and behavioral determinants of self-reported STD among adolescents.

CONTEXT Adolescents have among the highest sexually transmitted disease (STD) rates. Rich data are now available to characterize the social and behavioral factors that affect adolescent STD risk. METHODS Data from Wave 1 (1995) of the National Longitudinal Study of Adolescent Health (Add Health) are used to estimate school, neighborhood, family and individual level effects on acquiring an STD. Data from Waves 1 and 2 (1996) of Add Health are also used to estimate the effects of prior STD acquisition and other factors on STD occurrence between waves. Random intercept logistic regression and random intercept piecewise exponential hazard regression are used to account for possible clustering in the Add Health data. RESULTS Seven percent of sexually experienced teenagers reported ever having had an STD as of Wave 1, and almost 7% reported having had an STD between Waves 1 and 2. Respondents' age, gender, race or ethnicity, and their family background, neighborhood and school characteristics affect STD acquisition at Wave 1. Among teenagers who were sexually experienced at Wave 1, younger age at first intercourse elevates STD risk. Other factors contribute, but to a lesser degree. For acquisition of an STD between Waves 1 and 2, females, blacks, teenagers with lower levels of mother's education and those who have had a prior STD are at higher risk. CONCLUSIONS Multiple social and behavioral factors influence lifetime history of STD. Age at first intercourse and STD history affect subsequent STD acquisition. Self-reports of STD acquisition in probability samples of the general population are useful.