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Unadjusted odds ratios for sexual risk behavior generally rose with increasing exposure to adverse childhood experiences. Thus, for early onset of intercourse, odds ratios rose from 2.0 among those with one type of adverse experience to 10.9 among women with 6-7 such experiences (p for trend, <.000001). Likewise, for perceiving oneself as being at risk of AIDS, odds ratios climbed from 1.3 to 7.7 (p for trend, <.000001), and for having 30 or more partners, odds ratios rose from 1.9 to 14.4 (p for trend, <.000001). Moreover, when the number of partners was evaluated as a continuous variable, results showed that the mean number increased as the number of categories of adverse childhood experiences rose, from 3.6 among those with no adverse experiences to 5.0 among those with one, 6.1 among those with two, 7.5 among those with three, 10.2 among those with 4-5 and 28.7 among those with 6-7 (not shown).
When we adjusted for the effects of age and race, the odds ratios for having 30 or more partners and for perceiving oneself as being at risk of AIDS steadily increased with increasing exposure to types of adverse childhood experiences (Table 4). The odds of having 30 or more partners climbed from 1.6 among those with one type of adverse experience to 8.2 among those with 6-7 such experiences, and the odds of feeling at risk of AIDS rose from 1.2 to 4.9, respectively. Adjusted analyses showed a similar pattern for the association between early onset of intercourse and adverse childhood experiences, with odds ratios ranging from 1.8 among those with one type of adverse experience to 7.0 among those with 6-7. Compared with women who had experienced no types of adverse childhood experiences, those who experienced one or more of them were significantly and increasingly more likely to initiate intercourse at ages 15 years and younger (Table 4).
In further analyses, we focused on measures of exposure to household violence for which frequency of exposure could be evaluated. These included physical abuse, verbal abuse or having a battered mother. As exposure to physical abuse increased from rarely or never to often or very often, the prevalence of early initiation of intercourse increased from 7% to 20% (Table 5), the prevalence of self-perceived risk for AIDS climbed from 3% to 7% and the prevalence of having 30 or more sexual partners rose from 2% to 9%. Similarly, increases in the frequency of verbal abuse were consistently associated with increases in believing oneself to be at risk of AIDS, in having 30 or more partners and in initiating intercourse at an early age. Increased exposure to a mother’s being battered (from rarely or never to sometimes to often or very often) was also associated with a steady increase in the prevalence of having 30 or more partners (from 2% to 6%) and in the prevalence of initiating intercourse early (from 7% to 20%). Our findings regarding the dose-response association between sexual risk behaviors and adverse childhood experiences were robust: After adjusting for age and race, we found that the odds ratios for sexual risk behaviors increased along with the frequency of childhood exposure to physical and verbal abuse.
Each of seven categories of childhood adversity that we evaluated in this article was associated with increases in the risk of early onset of intercourse, multiple sexual partners and self-perceived risk of AIDS. As the frequency of exposure to violence during childhood increased (including physical abuse, verbal abuse and having a battered mother), the likelihood of experiencing an early onset of intercourse and having 30 or more lifetime sex partners also increased. Finally, as the number of categories of adverse childhood experiences increased, the prevalence of early onset of intercourse, of having 30 or more partners and of feeling at risk of AIDS consistently increased.
Previous reports have identified a number of risk factors for initiating intercourse at an early age and for having multiple partners. These include living in poverty, having parents with low levels of education, living in single-parent families, being young at menarche, performing poorly in school, having low church attendance, lacking parental support, using alcohol, smoking, using drugs, having school problems, dating at an early age, having sexually active friends, 21 being unable to discuss sex, feeling depressed, lacking college or career plans and being exposed to sexual images through television and the Internet. 22 To our knowledge, ours is one of the few large-scale studies to demonstrate an association between childhood abuse and household dysfunction and sexual risk behaviors that may appear later in adolescent or adult life.
Our findings suggest that increases in sexual risk behaviors appear to mediate the relationship that previous reports have demonstrated between adverse childhood experiences and unintended pregnancy and STDs. 23 Unfortunately, we do not have data to evaluate the diverse physiological, psychological, cognitive, social and cultural mechanisms by which exposure to family dysfunction during childhood may influence subsequent sexual risk behaviors. However, it is possible that the sexual risk behaviors of individuals with histories of adverse childhood experiences represent desperate attempts to achieve intimate interpersonal connections. Growing up in families unable to provide needed protection, these individuals may be unprepared to protect themselves and may grossly underestimate the risks they are taking in their hopeful, yet potentially misguided, attempts to achieve the intimacy that may have been lacking in their childhood. 24 If hope and optimism for the future are meager, risky behaviors may appear to have less potential for negative impact.
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