Sexual Health and Multiple Forms of Discrimination Among Heterosexual Youth
Eric Anthony Grollman
Social Problems, Volume 64, Issue 1, February 2017, Pages 156–175, https://doi-org.ezproxy.lib.uh.edu/10.1093/socpro/spw031
Research suggests that inequality in material conditions contributes greatly to disparities in sexual health among youth; however, scholars have overlooked the effect of one manifestation of social disadvantage—interpersonal discrimination—on sexual health. This article uses data from a nationally representative survey of 15 to 25 year olds (N = 955) to investigate the relationship between interpersonal discrimination and sexual health among heterosexual youth. I examine whether exposure to multiple forms of discrimination (e.g., race and gender) is associated with risky sexual behaviors, as well as STI history, teenage pregnancy, and abortion history. The findings suggest that experiences of multiple forms of discrimination are associated with sexual activity, including early sexual debut and multiple sexual partners. However, discrimination is not linked with condom and contraceptive use, or the negative outcomes of (risky) sexual activity. These findings emphasize the importance of examining, rather than presuming, risk associated with youths’ sexual activity.
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disadvantage, discrimination, intersectionality, risk, sexual health, youth
Issue Section:
Social scientists have attempted to determine the social factors that contribute to the persistent racial, ethnic, gender, and social class disparities in sexually transmitted infections (STIs), and teenage and unintended pregnancy among youth. One factor—social disadvantage—has been identified as a key determinant of differences in sexual behaviors that are associated with risk for these negative outcomes. Yet, researchers have primarily examined inequality in material conditions (e.g., neighborhood poverty), overlooking the interpersonal aspects of disadvantage, including interpersonal discrimination. Few studies have investigated the relationship between discrimination and sexual behaviors defined as risky (Pascoe and Richman 2009). Thus, little is known about the effect of interpersonal discrimination on sexual health. Beyond the presumption of risk, it is unclear whether discrimination is associated with actual negative outcomes of sexual behavior, namely STIs, teenage pregnancy, and abortion.
This article uses data from the Black Youth Culture Survey, a nationally representative sample of black, Latina/o, and white heterosexual youth, to examine the effect of multiple forms of interpersonal discrimination—race, gender, and social class—on risky sexual practices and negative sexual outcomes. Specifically, I investigate two research questions. First, are experiences of multiple forms of interpersonal discrimination associated with youths’ sexual activity, including risky sexual behaviors: early sexual debut, multiple sexual partners, and inconsistent condom and contraception use? Second, are experiences of multiple forms of interpersonal discrimination associated with the consequences of these risky behaviors, including STIs, teenage pregnancy, and abortion?
BACKGROUND
Social Determinants of Sexual Health
Sexual health is broadly defined as “the state of physical, emotional, mental, and social well-being in relation to sexuality” (WHO 2006:5). The present article focuses specifically on freedom from sexually transmitted infections and other negative and unintended consequences of sexual activity (WASH 2008). Persistent disparities exist in this domain of sexual health, wherein disadvantaged youth are disproportionately burdened by sexual health problems. In particular, girls and young women, black and Latina/o youth, and poor youth have higher rates of STIs, human immunodeficiency virus (HIV), and teen pregnancy than their respective privileged counterparts (CDC 2013; Penman-Aguilar et al. 2013). In addition, black and Latina girls and young women have higher rates of unintended pregnancy and abortion than their white peers (Curtin et al. 2013; Dehlendorf, Harris, and Weitz 2013).
One major source of these disparities is sociodemographic differences in sexual behaviors, particularly those that place heterosexual youth at risk for negative consequences of sexual activity (Slaymaker et al. 2004). Indeed, Latina/o and black youth report an earlier sexual debut and more sexual partners than white youth, and girls and young women report less consistent condom use than boys and young men (CDC 2012). Researchers have documented family and community characteristics that help to explain racial, ethnic, and gender differences in youths’ sexual behavior. Generally, youth who have little parental involvement in their lives, live in unstable or non-intact homes, and live in impoverished and socially disintegrated communities are most likely to engage in risky sexual practices (Browning, Leventhal, and Brooks-Gunn 2004). However, scholars have almost exclusively attended to the role of social disadvantage in the form of such material conditions. Little is known about the effect of interpersonal aspects of disadvantage, namely interpersonal discrimination, on youths’ sexual health and behaviors.
Sexual Health and Interpersonal Discrimination
To elaborate the link between interpersonal discrimination and health, scholars have drawn extensively from stress theory (Pearlin 1999). Interpersonal discrimination is any kind of differential or unfair treatment by another person or group of people on the basis of one’s social group membership (e.g., being denied a job because of one’s race). Discriminatory treatment reflects a social interaction that is distressing in nature, which, when experienced chronically, compromises victims’ ability to cope and makes them more vulnerable to poor health. As such, scholars have conceptualized discrimination as a social stressor (Thoits 2010). Researchers have consistently found that these experiences are associated with myriad negative mental and physical health outcomes (Paradies 2006; Pascoe and Richman 2009; Williams, Neighbors, and Jackson 2003).
Marginalized groups, including people of color and women, are disproportionately burdened by experiences of interpersonal discrimination (see Thoits 2010 for a review). Ilan Meyer (1995) proposed a minority stress model, wherein minority-specific stressors (e.g., discrimination) are further compounded by disparities in general stressors and coping resources (Lantz et al. 2005; Turner and Lloyd 1999) thus placing marginalized groups at an elevated risk for poor mental and physical health (Hatzenbuehler 2009; Meyer 1995; Turner and Avison 2003). Some evidence suggests that interpersonal discrimination contributes to explaining mental and physical health disparities (e.g., Grollman 2012, 2014). Scholars have theorized that systems of oppression (i.e., racism, sexism, and classism) likely impact behaviors as well, thus producing disparities in sexual health (e.g., Ziegler and Krieger 1997).
The impact of interpersonal discrimination on sexual health may stem primarily from behavioral responses to discriminatory treatment. Drawing upon a stress and coping framework, some scholars have suggested that victims may engage in sexual activity as a means of coping with discrimination (Folkman et al. 1992). Indeed, relieving stress, relaxing, and experiencing pleasure are commonly cited reasons for sexual activity (Hill and Preston 1996; Meston and Buss 2007). Thus, sex may serve as a healthy means of coping with stress—in this case, the distress following discriminatory treatment. However, like smoking, drinking, and drug use (Pascoe and Richman 2009; Richman and Lattanner 2014), individuals may seek out riskier sexual practices as a means to avoid or escape their stressful circumstances (Cooper, Shapiro, and Powers 1998; Martin, Pryce, and Leeper 2005). Experimental research suggests that victims of discrimination experience physiological, cognitive, and emotional changes following exposure to discrimination that, in turn, make them more likely to engage in risk-taking behavior (Jamieson et al. 2012). They may become more disinhibited following discriminatory treatment, focusing on short-term means of coping without regard to their long-term consequences (Richman and Lattanner 2014). Alternatively, victims of interpersonal discrimination may be more likely to engage in sexual situations in which it is difficult to assert the use of safe sex practices (e.g., under the influence of drugs or alcohol) likely due to increased depressive symptoms or suppressed self-control (Pascoe and Richman 2009; Stock et al. 2013).
Among adults, researchers have generally found that discrimination is associated with greater participation in risky sexual practices, including inconsistent condom use and multiple sexual partners (Bowleg et al. 2013; Choi, Bowleg, and Neilands, 2011; Reed et al. 2013). However, some scholars have found that discrimination is associated with greater efforts to reduce one’s risk for STIs (e.g., consistent condom use, STI/HIV testing); in addition, other scholars have found no association with sexual behaviors (Bowleg, Neilands, and Choi 2008; Ford et al. 2009; Jipguep, Sanders-Phillips, and Cotton 2004). It is unclear whether interpersonal discrimination is associated with contraception use (Bird and Bogart 2003; Kossler et al. 2011). Overwhelmingly, prior research has focused on heterosexual adult women and gay and bisexual adult men. Reflecting the broader trend in discrimination research, little work has examined the effect of interpersonal discrimination on youths’ sexual activity (Sanders-Phillips et al. 2009; Williams et al. 2003).
Preliminary research on discrimination and sexual behaviors among youth has yielded patterns that mirror those found among adults. Youths’ self-reports of discrimination are associated with multiple sexual partners and inconsistent condom use (Kogan et al. 2011; Stevens-Watkins, Brown-Wright, and Tyler 2011; Tobler et al. 2013). In addition, youth who face discriminatory treatment may be more likely to begin sexual activity at an earlier age (Tobler et al. 2013; Tsunokai, McGrath, and Hernandez-Hernandez 2012). However, longitudinal research has yielded mixed findings regarding the association between risky sexual behaviors and discrimination (Burrow, Tubman, and Gil 2007; Roberts et al. 2012; Rosenthal et al. 2014; Stock et al. 2013). Most of the prior research on youth has focused on the effect of racial discrimination among black and Latina/o youth. No study to date has utilized a nationally representative sample of youth.
There are two major limitations of prior research that may contribute to the inconsistent findings regarding the association between interpersonal discrimination and sexual health. The first major limitation is inattention to the association between discrimination and actual (negative) outcomes of sexual activity. Researchers have overwhelmingly focused on sexual behaviors—especially number of sex partners and condom use—that are presumed to put individuals at risk for STIs, and teenage and unintended pregnancy. The few studies that have directly examined the link between discrimination and negative sexual outcomes (i.e., STI or HIV infection) have yielded mixed findings, including no association (Bradford et al. 2013), a positive effect (Rosenthal et al. 2014), and an inverse relationship (Raymond et al. 2011). Beyond STIs, researchers have not yet investigated the effects of interpersonal discrimination on other outcomes of sexual activity, namely teenage and unintended pregnancy, and abortion. Further, scholars tend to conflate any sexual activity in adolescence or young adulthood with sexual risk (Pearson and Wilkinson 2013; Tolman and McClelland 2011). Some of the aforementioned studies included youth who have not experienced sexual activity in analyses of sexual behaviors (e.g., Roberts et al. 2012; Stock et al. 2013; Tobler et al. 2013). Statistically, this may distort the relationship between discrimination and youths’ (risky) sexual behaviors. Overall, little is known regarding the extent to which interpersonal discrimination impacts individuals’ actual sexual health, especially among youth.
Second, scholars have overwhelmingly focused on the sexual health consequences of one form of interpersonal discrimination (e.g., race discrimination) in isolation from other forms. Increasingly, health scholars have recognized that individuals’ health and well-being are not shaped by a single system of stratification (Schulz and Mullings 2006). Rather, drawing on the theoretical framework of intersectionality, these scholars recognize that individuals’ health is impacted by the interlocking and mutually reinforcing relationships among multiple systems of oppression (Collins 2000). One line of research, focusing on individuals’ exposure to more than one form of interpersonal discrimination (e.g., race and gender), has found that such experiences have harmful effects on mental and physical health that exceed those of a single form (Grollman 2012, 2014). Forms of discrimination reflect qualitatively distinct experiences that may have different consequences for victims’ sexual health and behaviors (Sue 2010). Further, youth who face multiple forms of discrimination experience discriminatory treatment more frequently, thus placing them at greater risk for poor health (Grollman 2012).
Few studies on sexual health have examined multiple forms of interpersonal discrimination, including only one that examined the simultaneous effects of more than one form of discrimination on sexual behaviors (Mizuno et al. 2012). Yuko Mizuno and colleagues (2012)found that, among Latino sexual minority adult men, exposure to race and sexual orientation discrimination, but not one form alone, was associated with condomless anal sex; a focus on race discrimination in isolation from sexual orientation discrimination, or vice versa, might have led the researchers to inaccurately conclude that discrimination is not associated with this risky sexual behavior. Such increased vulnerability may be missed in studies that examine only one form of interpersonal discrimination in isolation from others. No studies, to date, have examined the effects of multiple forms of discrimination on sexual health and behavior among youth, nor among heterosexuals.
The present study uses a nationally representative sample of heterosexual youth to investigate the effect of interpersonal discrimination on sexual health and behaviors. First, this study assesses whether multiple forms of interpersonal discrimination have an effect on sexual activity above and beyond the effect of only one form among youth. In particular, I examine the effect of multiple forms of discrimination on sexually experienced youths’ participation in risky sexual behaviors (early sexual initiation, multiple sexual partners, inconsistent condom and contraceptive use). Then, I examine whether facing multiple forms of interpersonal discrimination is directly associated with the outcomes of risky sexual behaviors (STI, teenage pregnancy, and abortion).
DATA AND METHODS
Data
The present study uses data from the Black Youth Culture Survey (BYCS), a nationally representative survey of 1,590 15 to 25 year olds in the United States conducted in 2005 (Cohen 2005, 2007). The BYCS employed a complex survey design, administered by the National Opinion Research Center (NORC), including two sampling strategies. First, the BYCS used random-digit dial (RDD) sampling of all U.S. households with a telephone to yield a nationally representative sample. Second, the survey used RDD sampling of households in areas where at least 15 percent of the population was Latina/o or black in order to oversample from these groups. Selected households were then screened to determine whether any household members were eligible to participate. The data were collected using computer-assisted phone interviews, which lasted 45 minutes, on average. The overall BYCS response rate was 62 percent. Don't use plagiarised sources.Get your custom essay just from $11/page
This study uses data specifically from the 1,062 black, Latina/o, and white heterosexual-identified adolescent (15 to 17 years old) and young adult (18 to 25 years old) BYCS respondents; respondents of other races and sexual identities are excluded in the present study. Data are missing systematically only in one way: young adults were significantly more likely than adolescents to fail to report the number of sexual partners they have had in their lifetime; these estimates should be interpreted with caution because of the potential age bias. Listwise deletion for missing information on independent and dependent variables is employed. This yielded a final sample of 955 respondents who provided valid information for all variables. Analyses are based on weighted data, which account for estimates from the March 2004 Current Population Survey to adjust for racial and ethnic differences between the BYCS sample and the U.S. population of 15 to 25 year olds.
Measures
Self-Reported Sexual Behaviors
This study examines sexual behaviors that are associated with risk for sexually transmitted infections (STIs), teenage pregnancy, and abortion,1 which are similar to measures in previous research on youth (Burrow et al. 2007; Roberts et al. 2012). A binary indicator is used to determine whether youth report having any sexual experience, including oral, vaginal, and/or anal sex (yes = 1). Subsequent measures of sexual behaviors and outcomes are restricted to sexually experienced youth (N = 602).
Sexually experienced respondents were asked a series of questions regarding their experiences with sexual intercourse, defined as “any type of vaginal or anal penetration.” Early sexual initiation is a dichotomous variable for respondents who report having had sexual intercourse for the first time before the age of 15 (yes = 1). The cut-off at age 15 has been used in prior research because of the social and psychological consequences of sexual activity prior to this age (Lohman and Billings 2008; Miller et al. 2002). Lifetime number of sexual partners is a count of the number of different partners with whom respondents report having had sexual intercourse, ranging from none (0) to 11 or more (11) (M = 3.81; SD = 3.61). Respondents were also asked to report how frequently they or their partners (1) “use protection such as condoms to prevent getting a sexually transmitted disease,” and (2) “use contraception to prevent pregnancy, meaning do things like take birth control pills, use condoms, get a shot of Depo Provera, or use a contraception patch” (“never” to “always” for both). From these reports, binary indicators are used for inconsistent condom use and inconsistent contraceptive use (always use = 0; all else = 1, for both). This article uses the consistent/inconsistent distinction because consistent condom and contraceptive use are critical for the prevention of STI transmission and unintended pregnancy. However, supplemental analyses using the full range—“never” (0) to “always” (4)—yield similar results (available upon request).
Self-Reported Negative Sexual Outcomes
This article also investigates three negative outcomes of self-reported sexual activity. STI history is a binary indicator of whether respondents report ever having a sexually transmitted infection in their lifetime (yes = 1). Teenage pregnancy is a dichotomous indicator of whether respondents report ever becoming pregnant (girls and young women) or impregnating a female partner (boys and young men), and/or becoming a parent prior to the age of 18 (yes = 1). Finally, abortion history is a binary measure of whether respondents report ever having had an abortion (females) or impregnating a female partner who later had an abortion (males) (yes = 1).
Self-Reported Discrimination
Respondents were asked a series of questions regarding their exposure to interpersonal discrimination using the prompt, “How often have you been discriminated against because of your” … “race”; “sex meaning male or female”; and, “class or how much money you or your parents make.” Respondents were asked to report the relative frequency of each of these forms of discrimination, using the response categories “never,” “rarely,” “every now and then,” “often,” or “very often.” The relative frequency of each form of interpersonal discrimination is measured as an ordinal variable, ranging from 0 (never) to 4 (very often). To investigate multiple forms of discrimination, I created two additional variables: a count of the number of forms of interpersonal discrimination reported, and a scale of the cumulative frequency of interpersonal discrimination reported. The number of forms of discrimination is a sum total of the distinct forms reported (none [0] to all three [3]). The cumulative frequency of discrimination is measured by a sum of the relative frequencies of the three forms, ranging from 0 (no discrimination) to 12 (all three forms experienced very often) (α = .68). This scale captures both the number of forms and relative frequency of interpersonal discrimination reported. These measures of discrimination are similar to those used with the BYCS survey by Grollman (2012).
Sociodemographic Characteristics
The present analyses include controls for sociodemographic characteristics that may be associated with discrimination and sexual health. Race and ethnicity is measured by dichotomous variables for non-Hispanic blacks (yes = 1) and Latina/os (yes = 1), with non-Hispanic whites used as the reference group for each. Gender is measured by a dichotomous variable (male = 0; female = 1). A binary indicator of past family welfare recipiency (welfare recipient = 1) is used as a measure of socioeconomic status. This indicator of socioeconomic status is generally more accurate than youths’ reports of their parents’ education (Ridolfo and Maitland 2011).
Controls are also included for age, nativity, and depressive symptoms. Age is measured in years, ranging from 15 to 25 (M = 18.68; SD = 2.96). Nativity is measured as a dichotomous variable where immigrant = 1 (i.e., born outside of the United States) and U.S. born = 0. Finally, a control is included for depressive symptoms in the past 30 days (M = 8.68; SD = 11.62)—an additive scale (α = .64) composed of two items: number of days feeling “down, depressed, or helpless” (0 to 30 days), and number of days experiencing “little interest or pleasure in doing things” (0 to 30 days). The depressive symptoms scale ranges from 0 (no days of depressive symptoms) to 60 (experienced both depressive symptoms everyday in the past month).
Analysis Plan
After providing descriptive statistics for interpersonal discrimination, sexual behaviors, and outcomes, the analyses proceed as follows: First, the effects of race-, gender-, and social class-based discrimination are predicted on sexual experience using binary logistic regression (N = 955). These analyses will determine whether interpersonal discrimination is associated with any sexual experience. Second, among sexually experienced youth (N = 602), the effects of each of these forms of interpersonal discrimination are estimated on the four risky sexual behaviors—early sexual debut (binary logistic regression), number of sex partners (negative binomial regression), inconsistent condom use (binary logistic regression), and contraceptive use (binary logistic regression). Third, binary logistic regression modeling is used to assess whether the relative frequencies of race, gender, and social class discrimination predict the three negative sexual outcomes among sexually experienced youth: STI history, teenage pregnancy, and abortion history. In the final step, I assess the effect of multiple forms of interpersonal discrimination and cumulative frequency of discrimination on those sexual behaviors and outcomes that were associated with one or more forms of interpersonal discrimination in the aforementioned analyses. This step moves beyond the previous analyses, which assess the effect of a single form of interpersonal discrimination in isolation from others; instead, I assess whether there is an effect of multiple forms of interpersonal discrimination on sexual health above and beyond the effect of a single form.
RESULTS
Descriptive Statistics
Table 1 presents means for youths’ self-reports of interpersonal discrimination—relative frequency of each form, number of forms, and the cumulative frequency of discrimination—for the entire BYCS sample, and by race, ethnicity, gender, and social class (N = 955). The mean relative frequencies of race-, gender-, and social class-based discrimination are just below 1 (“rarely” = 1), suggesting that these experiences are rare, on average; indeed, the modal response for each is “never” (analyses not shown). While 22 percent of youth report no discrimination and 20 percent report facing only one form, the majority of respondents reporting experiencing two (26 percent) or all three (31 percent) forms of discrimination (mean = 1.62; median = 2; SD = 1.66). Accounting for both the number of forms reported and the relative frequency of each form, the mean cumulative frequency for discrimination (0 to 12) is 2.68 (median = 2; SD = 2.93), roughly the equivalent of facing all three forms rarely. In general, marginalized youth (i.e., blacks and Latina/os, girls and young women, and welfare recipients) face more forms of discrimination and greater cumulative frequency of discrimination than their privileged counterparts (also see Grollman 2012).2
Table 1.
Sample and Race, Ethnicity, Gender, and Social Class Group-Specific Interpersonal of Discrimination
| Sample
| Race and Ethnicity
| Gender
| Social Class
| ||||||
| M | (SD) | White | Black | Latina/o | Male | Female | Non- Recipient | Welfare Recipient | |
| Relative frequency of discrimination | |||||||||
| Race discrimination (very often = 4) | .97 | (1.14) | .79 | 1.48*** | 1.15***a | 1.02 | .91* | .85 | 1.22*** |
| Gender discrimination (very often = 4) | .80 | (.83) | .79 | .96 | .75a | .58 | 1.05*** | .74 | .93** |
| Social class discrimination (very often = 4) | .91 | (.96) | .85 | .98 | 1.01 | .87 | .94 | .81 | 1.09** |
| Multiple forms of discrimination | |||||||||
| Number of forms of discrimination (0-3) | 1.62 | (1.66) | 1.60 | 1.75 | 1.63 | 1.47 | 1.80** | 1.55 | 1.78* |
| Cumulative frequency of discrimination (0-12) | 2.68 | (2.93) | 2.43 | 3.42*** | 2.90a | 2.48 | 2.90 | 2.40 | 3.25*** |
| n | 325 | 339 | 291 | 478 | 477 | 567 | 388 | ||
Note: Sample sizes and bivariate comparisons based on unweighted data.
Source: Black Youth Culture Survey (BYCS) (Cohen 2005, 2007).
a
Latina/os significantly differ from black respondents (p < .05).
*
p <.05 ** p <.01 *** p <.001 for Latina/os and blacks compared to non-Hispanic whites, girls, and young women compared to boys and young men, and welfare recipients compared to non-recipients.
Table 2 presents descriptive statistics for sexual behaviors and outcomes among sexually experienced respondents (N = 602). The majority of BYCS respondents (63 percent) have experienced sexual activity (analyses not shown). One-fifth of youth report experiencing sexual intercourse earlier than the age of 15. On average, respondents report 3.81 lifetime sexual partners (SD = 3.61). Similar to other national estimates, the majority of youth (55 percent) report consistently using condoms (CDC 2012); similarly, only one-third of youth report inconsistent use of contraceptives. Few respondents report ever having an STI (6 percent), pregnancy before age 18 (8 percent), or an abortion (6 percent).
Table 2.
Self-Reported Sexual Behaviors and Outcomes Among Sexually Experienceda Youth
| Sample
| Race and Ethnicity
| Gender
| Social Class
| ||||||
| M | (SD) | White | Black | Latina/o | Male | Female | Non- Recipient | Welfare Recipient | |
| Risky sexual behaviors | |||||||||
| Early sexual initiation (yes = 1) | .19 | — | .15 | .29** | .22 | .22 | .15** | .12 | .33*** |
| Number of sex partners (1-11+) | 3.81 | (3.61) | 3.57 | 4.37* | 4.10* | 4.31 | 3.21*** | 3.53 | 4.37 |
| Inconsistent condom use (yes = 1) | .45 | — | .43 | .34* | .55*b | .39 | .52** | .43 | .49 |
| Inconsistent contra ceptive use (yes = 1) | .31 | — | .24 | .36 | .44** | .29 | .33 | .27 | .40* |
| Negative sexual outcomes | |||||||||
| STI history (yes = 1) | .06 | — | .04 | .07 | .09* | .04 | .08** | .03 | .10** |
| Teen pregnancy (yes = 1)c | .08 | — | .06 | .08 | .13* | .06 | .10** | .05 | .14*** |
| Abortion history (yes = 1)d | .06 | — | .05 | .11** | .07 | .04 | .09* | .03 | .13* |
| n | 194 | 210 | 198 | 313 | 289 | 350 | 252 | ||
Notes: Sample sizes and bivariate comparisons based on unweighted data. N = 602.
Source: Black Youth Culture Survey (BYCS) (Cohen 2005, 2007).
a
Sexual experience includes any reports of oral, vaginal, and/or anal sexual activities.
b
Latina/os significantly differ from black respondents (p < .05).
c
This item assesses whether respondents have ever gotten pregnant (girls and young women) or impregnated a female sexual partner (boys and young men) before the age of 18.
d
This item assesses whether sexually experienced respondents have ever had an abortion (girls and young women) or impregnated a female sexual partner who later had an abortion (boys and young men).
*
p <.05 ** p <.01 *** p <.001 for Latina/os and blacks compared to non-Hispanic whites, girls, and young women compared to boys and young men, and welfare recipients compared to non-recipients.
Table 2 also presents racial, ethnic, gender, and social class group-specific reports of sexual behaviors and outcomes among sexually experienced respondents. Compared to white youth, black respondents are significantly more likely to report having sexual intercourse before age 15, report more sexual partners, and are more likely to have had an abortion. However, black youth are significantly more likely to report consistent condom use than white and Latina/o youth. Latina/os are significantly more likely than whites to report inconsistent condom and contraceptive use, multiple sex partners, and to have had an STI and teen pregnancy. Compared to their male counterparts, girls and young women report a later sexual debut and fewer sexual partners, yet are significantly more likely to have experienced all three negative sexual outcomes (i.e., STI, teen pregnancy, abortion). Finally, respondents whose families have received welfare are significantly more likely to report early sexual initiation, inconsistent contraceptive use, and experiencing all three negative sexual outcomes than their non-recipient peers.
Sexual Health and Interpersonal Discrimination
Table 3 presents the estimates for interpersonal discrimination on sexual experience among youth. The effects of race, gender, and social class discrimination are examined separately, first unadjusted and then adjusted for race, ethnicity, gender, welfare recipiency, age, nativity, and depressive symptoms. In both the unadjusted (OR: 1.53; CI: 1.2-1.9) and adjusted models (OR: 1.37; CI: 1.1-1.7), BYCS respondents who report more frequent race discrimination are significantly more likely to report any oral, vaginal, and/or anal sexual experience. The unadjusted and adjusted models for the relative frequency of gender- and social class-based discrimination yield similar patterns: respondents who face more frequent gender (adjusted OR: 1.35; CI: 1.1-1.7) and social class (adjusted OR: 1.24; CI: 1.1-1.5) discrimination are significantly more likely to be sexually experienced. Thus, regardless of the form, heterosexual adolescents and young adults who face more frequent interpersonal discrimination are more likely to have experienced sexual activity.
Table 3.
Binary Logistic Odds Ratios for Sexual Experience on the Relative Frequency of Each Form of Interpersonal Discrimination
| Any Sexual Experiencea
| ||
| Odds Ratios | (95% CI) | |
| Relative frequency of race discrimination | ||
| Without controls | 1.53*** | (1.23-1.89) |
| With controls | 1.37** | (1.09-1.74) |
| Relative frequency of gender discrimination | ||
| Without controls | 1.56*** | (1.27-1.90) |
| With controls | 1.35** | (1.09-1.68) |
| Relative frequency of social class discrimination | ||
| Without controls | 1.37*** | (1.17-1.59) |
| With controls | 1.24** | (1.06-1.46) |
Notes: Exponentiated coefficients are presented, with 95 percent confidence intervals (CI) in parentheses. Controls include race, ethnicity, gender, welfare recipiency, age, nativity, and depressive symptoms. N = 955.
Source: Black Youth Culture Survey (BYCS) (Cohen 2005, 2007).
a
Sexual experience includes any reports of oral, vaginal, and anal sexual activities.
*
p < .05 ** p < .01 *** p < .001 (two-tailed tests)
Table 4 presents the exponentiated coefficients for interpersonal discrimination on the four risky sexual behaviors among sexually experienced BYCS respondents: early sexual initiation (binary logistic regression); number of sexual partners (negative binomial regression); inconsistent condom use (binary logistic regression); and, inconsistent contraceptive use (binary logistic regression). The effects of each form of discrimination are examined separately, first unadjusted and then adjusted for race, ethnicity, gender, welfare recipiency, age, nativity, and depressive symptoms. The latter models estimate the effects of each form of discrimination on the sexual behaviors net of the effects of respondents’ sociodemographic characteristics and depressive symptoms.
Table 4.
Exponentiated Coefficients for Sexual Behaviors on Interpersonal Discrimination Among Sexually ExperiencedaYouth
| Relative Frequency of Interpersonal Discrimination | Early Sexual Initiation
| Number of Sex Partners
| Inconsistent Condom Use
| Inconsistent Contraceptive Use
| ||||
| ORb | (95% CI) | IRRc | (95% CI) | ORb | (95% CI) | ORb | (95% CI) | |
| Race discrimination | ||||||||
| Without controls | 1.43** | (1.1-1.8) | 1.26*** | (1.2-1.4) | 1.20 | (1.0-1.5) | 1.31** | (1.1-1.6) |
| With controls | 1.25 | (1.0-1.6) | 1.21*** | (1.1-1.3) | 1.20 | (1.0-1.5) | 1.20 | (1.0-1.5) |
| Gender discrimination | ||||||||
| Without controls | 1.12 | (.9-1.4) | 1.14** | (1.0-1.3) | 1.26* | (1.0-1.5) | 1.13 | (.9-1.4) |
| With controls | 1.13 | (.9-1.5) | 1.11* | (1.0-1.2) | 1.01 | (.8-1.3) | 1.02 | (.8-1.3) |
| Social class discrimination | ||||||||
| Without controls | 1.43*** | (1.2-1.8) | 1.18*** | (1.1-1.3) | 1.13 | (.9-1.4) | 1.07 | (.9-1.3) |
| With controls | 1.34** | (1.1-1.7) | 1.13** | (1.0-1.2) | 1.03 | (.9-1.3) | 1.01 | (.8-1.2) |
Notes: Exponentiated coefficients are presented, with 95 percent confidence intervals (CI) in parentheses. Controls include race, ethnicity, gender, welfare recipiency, age, nativity, and depressive symptoms. N = 602.
Source: Black Youth Culture Survey (BYCS) (Cohen 2005, 2007).
a
Sexual experience includes any reports of oral, vaginal, and anal sexual activities.
b
Binary logistic odds ratios (OR).
c
Negative binomial incidence risk ratios (IRR).
*
p < .05 ** p < .01 *** p < .001 (two-tailed tests)
The first column displays the odds ratios (OR) for early sexual initiation (i.e., before age 15) on interpersonal discrimination. In the unadjusted model, the relative frequency of race-based discrimination is significantly associated with early sexual debut (OR: 1.43; CI: 1.1-1.8); however, the association is nonsignificant in the adjusted model (OR: 1.25; CI: 1.0-1.6). In both the unadjusted (OR: 1.12; CI: .9-1.4) and adjusted (OR: 1.13; CI: .9-1.5) models, the relative frequency of gender discrimination is not significantly associated with early sexual debut. Yet, more frequent social class discrimination is significantly associated with early sexual intercourse in both models (OR: 1.34; CI: 1.1-1.7 in adjusted model). Youth who report more frequent social class discrimination are significantly more likely to report sexual intercourse before age 15 than those who face it less frequently.
The second column of Table 4 displays the incidence risk ratios (IRR) for number of sexual partners on interpersonal discrimination. For all three forms, more frequent interpersonal discrimination is associated with significantly more sexual partners in both unadjusted and adjusted models. Youth who face more frequent race (adjusted IRR: 1.21; CI: 1.1-1.3), gender (adjusted IRR: 1.11; CI: 1.0-1.2), and social class (adjusted IRR: 1.13; CI: 1.0-1.2) discrimination report significantly more sex partners than youth who face these forms less frequently. The third and fourth columns of Table 4 display the odds ratios for inconsistent condom use and contraceptive use on discrimination, respectively. In adjusted models, more frequent race-, gender-, and social class-based discrimination are not significantly associated with these two risky behaviors.
Table 5 displays the odds ratios for STI history, teen pregnancy, and abortion history on interpersonal discrimination among sexually experienced youth. Each form of discrimination is examined separately, first unadjusted and then adjusted for race, ethnicity, gender, welfare recipiency, age, nativity, and depressive symptoms. There is only one significant association. In the unadjusted models, BYCS respondents who report more frequent gender discrimination are significantly more likely to have terminated a pregnancy through abortion (OR: 1.46; CI: 1.1-2.0); however, this association is nonsignificant in the adjusted model (OR: 1.13; CI: .9-1.5). Thus, in general, interpersonal discrimination is not significantly associated with the three negative outcomes of sexual activity.
Table 5.
Binary Logistic Odds Ratios for Sexual Outcomes on the Relative Frequency of Each Form of Interpersonal Discrimination Among Sexually Experienceda Youth
| Relative Frequency of Interpersonal Discrimination | STI History
| Teen Pregnancyb
| Abortion Historyc
| |||
| OR | (95% CI) | OR | (95% CI) | OR | (95% CI) | |
| Race discrimination | ||||||
| Without controls | 1.15 | (.9-1.5) | 1.26 | (1.0-1.6) | 1.23 | (.9-1.7) |
| With controls | 1.07 | (.8-1.4) | 1.10 | (.8-1.5) | 1.09 | (.7-1.7) |
| Gender discrimination | ||||||
| Without controls | 1.16 | (.8-1.6) | 1.30 | (1.0-1.7) | 1.46* | (1.1-2.0) |
| With controls | .98 | (.7-1.5) | 1.13 | (.8-1.5) | 1.13 | (.9-1.5) |
| Social class discrimination | ||||||
| Without controls | 1.28 | (.9-1.7) | 1.12 | (.8-1.6) | 1.30 | (1.0-1.8) |
| With controls | 1.26 | (.9-1.8) | 1.03 | (.8-1.4) | 1.20 | (.9-1.7) |
Notes: Exponentiated coefficients are presented, with 95 percent confidence intervals (CI) in parentheses. Controls include race, ethnicity, gender, welfare recipiency, age, nativity, and depressive symptoms. N = 602.
Source: Black Youth Culture Survey (BYCS) (Cohen 2005, 2007).
a
Sexual experience includes any reports of oral, vaginal, and anal sexual activities.
b
This item assesses whether respondents have ever gotten pregnant (girls and young women) or impregnated a female sexual partner (boys and young men) before the age of 18.
c
This item assesses whether respondents have ever had an abortion (girls and young women) or impregnated a female sexual partner who later had an abortion (boys and young men).
*
p < .05 ** p < .01 *** p < .001 (two-tailed tests)
Taken together, these results suggest that heterosexual youth who face frequent interpersonal discrimination—regardless of the form—are more likely to report multiple sexual partners. This pattern also exists for sexual activity in early adolescence for more frequent social class discrimination (and race discrimination at the bivariate level). However, interpersonal discrimination is not associated with the consistency of condom and contraceptive use, or the three negative outcomes of sexual activity (i.e., history of STIs, teen pregnancy, or abortion).
Sexual Health and Multiple Forms of Interpersonal Discrimination
The next set of analyses investigates whether there is an effect of experiencing more than one form of interpersonal discrimination over and above that of only one form on any sexual experience (Table 6) and early sexual initiation and number of sexual partners (Table 7). The first set of models (Models 1) present the exponentiated coefficients for each outcome on race, ethnicity, gender, and welfare recipiency, controlling for age, nativity, and depressive symptoms. The second set of models (Models 2) adds the number of forms of interpersonal discrimination, and the third set of models (Models 3) adds the cumulative frequency of discrimination.
Table 6.
Binary Logistic Odds Ratios for Sexual Experience on Interpersonal Discrimination
| Any Sexual Experiencea
| |||
| Model 1 | Model 2 | Model 3 | |
| Black | 1.14 | 1.08 | 1.01 |
| (.74-1.76) | (.69-1.67) | (.65-1.56) | |
| Latina/o | .98 | .97 | .94 |
| (.62-1.54) | (.62-1.54) | (.59-1.48) | |
| Female | 1.01 | .90 | .96 |
| (.68-1.49) | (.61-1.33) | (.64-1.42) | |
| Welfare recipient | 1.00 | .96 | .92 |
| (.64-1.56) | (.61-1.51) | (.58-1.45) | |
| Age | 1.48*** | 1.47*** | 1.47*** |
| (1.34-1.65) | (1.32-1.63) | (1.32-1.63) | |
| Immigrant | 1.25 | 1.36 | 1.39 |
| (.52-3.02) | (.58-3.18) | (.59-3.30) | |
| Depressive symptoms | 1.03** | 1.02* | 1.03* |
| (1.01-1.05) | (1.00-1.04) | (1.01-1.05) | |
| Number of forms of discrimination | 1.40*** | ||
| (1.17-1.68) | |||
| Cumulative frequency of discrimination | 1.17*** | ||
| (1.07-1.28) | |||
Notes: Exponentiated coefficients are presented, with 95 percent confidence intervals in parentheses. Non-Hispanic white respondents are the reference racial-ethnic group. N = 955.
Source: Black Youth Culture Survey (BYCS) (Cohen 2005, 2007).
a
Sexual experience includes any reports of oral, vaginal, and anal sexual activities.
*
p < .05 ** p < .01 *** p < .001 (two-tailed tests)
Table 7.
Exponentiated Coefficients for Early Sexual Initiation and Number of Sexual Partners Among Sexually Experienceda Youth
| Early Sexual Initiationb
| Number of Sexual Partnersc
| |||||
| Model 1 | Model 2 | Model 3 | Model 1 | Model 2 | Model 3 | |
| Black | 1.58 | 1.55 | 1.44 | 1.30* | 1.31** | 1.26* |
| (.85-2.93) | (.84-2.89) | (.77-2.70) | (1.06-1.58) | (1.08-1.59) | (1.04-1.52) | |
| Latina/o | 1.42 | 1.47 | 1.38 | 1.12 | 1.14 | 1.11 |
| (.77-2.61) | (.81-2.69) | (.76-2.53) | (.90-1.38) | (.92-1.41) | (.90-1.37) | |
| Female | .56* | .52* | .54* | .75** | .74** | .76** |
| (.32-.98) | (.29-.92) | (.30-.95) | (.63-.90) | (.62-.89) | (.63-.91) | |
| Welfare recipient | 3.08*** | 3.08*** | 2.93*** | 1.29** | 1.26* | 1.22* |
| (1.67-5.71) | (1.67-5.70) | (1.58-5.42) | (1.06-1.57) | (1.05-1.50) | (1.03-1.46) | |
| Age | .92 | .90* | .91* | 1.13*** | 1.12*** | 1.13*** |
| (.83-1.01) | (.82-.99) | (.82-1.00) | (1.10-1.17) | (1.09-1.16) | (1.09-1.16) | |
| Immigrant | 1.04 | 1.13 | 1.19 | .70 | .72 | .75 |
| (.40-2.68) | (.45-2.86) | (.47-3.01) | (.49-1.00) | (.51-1.03) | (.53-1.07) | |
| Depressive symptoms | 1.02* | 1.02 | 1.02 | 1.00 | 1.00 | 1.00 |
| (1.00-1.04) | (1.00-1.04) | (1.00-1.04) | (.99-1.01) | (.99-1.00) | (.99-1.00) | |
| Number of forms of discrimination | 1.30* | 1.15** | ||||
| (1.00-1.69) | (1.05-1.26) | |||||
| Cumulative frequency of discrimination | 1.13* | 1.08*** | ||||
| (1.01-1.26) | (1.04-1.12) | |||||
Notes: Exponentiated coefficients are presented, with 95 percent confidence intervals in parentheses. Non-Hispanic white respondents are the reference racial-ethnic group. N = 602.
Source: Black Youth Culture Survey (BYCS) (Cohen 2005, 2007).
a
Sexual experience includes any reports of oral, vaginal, and anal sexual activities.
b
Binary logistic odds ratios.
c
Negative binomial incidence risk ratios.
*
p < .05 ** p < .01 *** p < .001 (two-tailed tests)
Table 6 displays the odds ratios for sexual experience among all respondents (N = 955). In Model 1, only age (OR: 1.48; CI: 1.3-1.7) and depressive symptoms (OR: 1.03; CI: 1.0-1.1) are significantly associated with sexual experience, wherein youth with more depressive symptoms are more likely to report any oral, vaginal, and/or anal sexual experience. In Model 2, number of forms of interpersonal discrimination reported is significantly associated with sexual experience (OR: 1.40; CI: 1.2-1.7). Respondents who report facing more forms of discrimination are significantly more likely to report sexual activity than those facing fewer or no forms. A similar pattern is found in Model 3 for cumulative frequency of discrimination, wherein respondents who face more frequent discrimination overall are significantly more likely to be sexually experienced (OR: 1.17; CI: 1.1-1.3). There are no significant racial, ethnic, gender, or social class differences in sexual experience.
Table 7 displays the exponentiated coefficients for multiple forms of interpersonal discrimination on early sexual activity (odds ratios) and number of sex partners (incidence risk ratios) among sexually experienced youth (N = 602). In Models 2, number of forms of discrimination reported is significantly associated with early sexual initiation (OR: 1.30; CI: 1.0-1.7) and number of sexual partners (OR: 1.15; CI: 1.1-1.3). Youth who report more forms of discrimination are significantly more likely to have had sexual experience before age 15 and report significantly more sex partners than youth who report fewer or no forms. Similarly, in Models 3, the cumulative frequency of discrimination is significantly associated with early sexual initiation (OR: 1.3; CI: 1.0-1.3) and number of sex partners (OR: 1.08; CI: 1.0-1.1). Taken together, these findings suggest that heterosexual youth who face more forms of discrimination and greater cumulative frequency of discrimination are more likely to initiate sexual activity earlier and have multiple sexual partners than their peers who face less discrimination.
Table 7 also highlights a number of significant racial, gender, and social class differences in risky sexual behaviors, net of age, nativity, and depressive symptoms. Though early sexual debut does not significantly vary by race and ethnicity, black youth report significantly more sexual partners than their white counterparts (OR: 1.26; CI: 1.0-1.5 in Model 3). Girls and young women are significantly less likely to report early sexual debut (OR: .54; CI: .3-1.0 in Model 3) and report significantly fewer sexual partners (OR: .76; CI: .6-.9 in Model 3) than their male counterparts. In addition, welfare recipients are significantly more likely to report sexual activity before age 15 (OR: 2.93; CI: 1.6-5.4 in Model 3) and report significantly more sexual partners (OR: 1.22; CI: 1.0-1.5 in Model 3) compared to non-recipients. Post-hoc Sobel tests (Sobel 1982) for mediation (including all controls) suggest that these racial, gender, and social class differences in sexual behaviors are not significantly mediated by number of forms of nor the cumulative frequency of interpersonal discrimination (available upon request). Thus, experiences of discrimination do not significantly contribute to explaining differences in sexual behavior.
DISCUSSION
This study is the first investigation of interpersonal discrimination and sexual health within a nationally representative sample of heterosexual adolescents and young adults. Whereas prior research that focuses on one form of discrimination in isolation from others may misspecify the discrimination-health relationship (Grollman 2012, 2014), the present article assesses whether multiple forms of interpersonal discrimination have an effect on sexual health over and above that of only one form. The majority of youth (57 percent) reported facing more than one form of discrimination, with the modal, or most commonly reported, number being all three forms. In addition to examining the association between discrimination and sexual practices among sexually experienced youth, this article directly assesses the effect of interpersonal discrimination on negative outcomes of these sexual behaviors (i.e., STI, teenage pregnancy, and abortion). The majority of youth (65 percent) reported having experienced sexual activity. A substantial number of sexually experienced youth reported participating in risky sexual practices: sexual intercourse before age 15 (19 percent), multiple sexual partners (64 percent), and inconsistent condom (45 percent) and contraceptive use (31 percent). Despite the high levels of these risky behaviors, fewer than 10 percent of respondents reported STIs, teen pregnancy, or having an abortion.
This study offers three key findings. First, the findings suggest a positive association between multiple forms of interpersonal discrimination and sexual experience among heterosexual youth. Adolescents and young adults who faced multiple forms of discrimination were more likely to report having experienced any sexual activity than those experiencing fewer or no forms. Similarly, those who reported greater cumulative frequency of discrimination were more likely to be sexually experienced than those who faced discrimination less frequently. Thus, before considering whether interpersonal discrimination is linked with risky sexual activity, it is important to note that these experiences are linked with sexual experience in general among 15 to 25 year olds (also see Tsunokai et al. 2012).
The second key finding is that experiences of multiple forms of interpersonal discrimination were also linked with two of the four risky sexual behaviors: lifetime number of sexual partners and age of sexual debut. Sexually experienced respondents who faced multiple forms of discrimination reported more sexual partners and were more likely to have sexual intercourse before age 15 than those who faced fewer or no forms. The same pattern was found for youth who faced greater cumulative frequency of discrimination compared to those who faced it less frequently. However, interpersonal discrimination was not associated with the consistency of condom use or contraceptive use. Indeed, some evidence suggests that one’s motivations to have sex, including coping or stress relief, do not appear to affect one’s use of condoms and other contraceptives (Patrick et al. 2011). With the exception of condom use, these findings are consistent with prior research on discrimination and sexual behaviors (Bird and Bogart 2003; Stevens-Watkins et al. 2011; Tobler et al. 2013).
Finally, interpersonal discrimination was not associated with the three outcomes for which the aforementioned sexual behaviors are presumed to put youth at risk: STIs, teenage pregnancy, and abortion history. Despite its association with early sexual debut and multiple sex partners, interpersonal discrimination may not be directly linked with an elevated risk for STIs and teenage and unintended pregnancy because the consistency of condom and contraceptive use were not affected. Further, discrimination did not contribute to explaining racial, ethnic, gender, and social class disparities in sexual behaviors or outcomes. Indeed, sociodemographic differences in sexual behaviors only partially explain sexual health disparities (Earnshaw et al. 2013). For example, black youth who engage in relatively low-risk sexual behaviors are still much more likely to contract STIs and HIV than their white peers (Hallfors et al. 2007). Other factors, including sexual networks and access to sexual and reproductive health care, may also contribute to sexual health disparities (Kraut-Becher et al. 2008). Researchers should continue to identify the social factors that contribute to disparities in sexual health, and investigate whether and how these factors are shaped by interpersonal, institutional, and structural discrimination.
In two ways, the present article contributes to a growing body of literature that challenges the conceptualization of youths’ sexual activity exclusively as risk (Pearson and Wilkinson 2013; Tolman and McClelland 2011). First, the findings emphasize the importance of explicitly examining whether social factors—in this case, discrimination—are directly associated with negative outcomes of risky sexual behaviors. The findings suggest that interpersonal discrimination was linked with participation in two of the four risky sexual behaviors, but not with the negative outcomes of these behaviors. Scholars may inaccurately conclude that discrimination places youth at risk for STIs and teenage and unwanted pregnancy when they focus exclusively on sexual behaviors presumed to put them at risk for these outcomes. It is crucial that researchers move beyond this presumption of risk and further examine youths’ efforts to minimize or avoid risk (e.g., regular STI testing; Ford et al. 2009) that may co-occur with their participation in risky sexual behaviors.
Second, the present article distinguishes sexual experience in adolescence and young adulthood from risky sexual behaviors. In particular, I excluded youth who have not experienced sexual activity from the analyses of sexual behaviors and outcomes. The only other study to date that has excluded virgins found no association between discrimination and risky sexual behavior (Burrow et al. 2007); interestingly, studies that include virgins found that discrimination is linked with these behaviors (e.g., Roberts et al. 2012; Stock et al. 2013; Tobler et al. 2013). In supplemental analyses including virgins, I found that that interpersonal discrimination was positively associated with all four risky sexual behaviors, as well as teen pregnancy and abortion (available upon request). Thus, researchers may misspecify the relationship between discrimination and sexual behaviors by including youth who have not had sex.
Increasingly, scholars view sexual activity in adolescence and young adulthood as a normal component of one’s development that simultaneously entails risk and the potential for pleasure, exploration, and intimacy (Tolman and McClelland 2011). The findings can be viewed within the “both/and” framework proposed by Deborah Tolman and Sara McClelland (2011). On one hand, young victims of discrimination may begin having sexual intercourse earlier, and with more partners; yet, their efforts to protect themselves against STIs and unintended pregnancy are not affected by experiences of discrimination. Sexual activity may serve as a relatively low-risk coping strategy, possibly as a means of obtaining pleasure, intimacy, support, or connection with others following the damaging experience of discriminatory treatment (Ziegler and Krieger 1997). On the other hand, there are additional social and psychological risks associated with youths’ sexual activity, especially in early adolescence (Frisco 2008; Meier 2007; Spriggs and Halpern 2008), which may contribute to the lifetime accumulation of disadvantage in health for marginalized youth (e.g., Umberson et al. 2014). Future work should continue to move beyond the exclusive focus on risk and negative outcomes, broadening attention to include sexual well-being and subjective understandings of the sexual self (Hunter, Guerro, and Cohen 2010).
This article also contributes to research on the health consequences of interpersonal discrimination. The findings suggest that the damaging effects of discrimination to victims’ health and well-being also extend somewhat to their sexual lives. In addition, this study emphasizes the importance of accounting for multiple forms of interpersonal discrimination in research on sexual health, as well as mental and physical health (Grollman 2012). Studies that examine one form of discrimination in isolation from others miss the heightened exposure to discrimination (e.g., greater relative frequency) and health consequences of experiencing multiple forms (Grollman 2014). Finally, this study offers further insight into the impact of discrimination in the lives of youth—a population that has been largely overlooked in discrimination research (Sanders-Phillips et al. 2009; Williams et al. 2003). Future research should continue to investigate the mental, physical, and sexual health consequences of youths’ experiences of multiple forms of discrimination.
The present study faces a few limitations that should be noted. First, the aforementioned results are based on cross-sectional data, which limits the possibility of discerning whether sexual behaviors and outcomes influence later reports of interpersonal discrimination or vice versa. A related concern is that the measures of discrimination, and sexual behaviors and outcomes, are not time-specific; this is of particular concern for the lifetime measures of sexual behaviors and outcomes (i.e., number of sex partners, STI history, abortion history). Thus, the time ordering of these variables could not be determined. As such, it is plausible that discriminatory treatment stems from sexual experience. For example, prior research suggests that girls and young women are often “slut-shamed,” viewed and treated negatively by their peers because of their actual or presumed sexual experience (Allison and Risman 2013; Kreager and Staff 2009). However, prior studies using longitudinal data confirm that experiences of discrimination predict health (including mental, physical, and sexual health), but health does not predict later reports of discrimination (Paradies 2006; Roberts et al. 2012). Future work should rely in longitudinal data and analyses to further investigate the causal relationships among stigma (including discrimination), sexual behaviors, and negative outcomes of sexual activity.
Second, this study relies on self-report measures of discrimination. Specifically, I rely on respondents’ perceptions of discrimination, which cannot capture undetected events of discrimination, nor discrimination at the institutional and structural levels (Major, Mendes, and Dovidio 2013; Meyer 2003). Although scholars have raised concerns that self-reports of discrimination may be over- or understated due to hypervigilance or minimization, respectively, there is evidence that self-reports reflect actual experiences of discrimination (NRC 2004). Future research should employ measures of discrimination that include questions about specific events of discriminatory treatment rather than more global measures of discrimination (see Krieger 2000 for a review). For example, in the study of sexual health consequences of interpersonal discrimination, researchers should further examine discrimination that occurs in sex education and sexual health care settings (Bird and Bogart 2003; Garcia 2009; Mann 2013).
A final limitation is the reliance on youths’ self-reported sexual behaviors and sexual health status. Scholars have raised concerns about the impact of recall bias, social desirability, and interview mode on such self-report measures (e.g., Jaccard et al. 2002). For example, a minority of youth report abstaining from or never experiencing sexual activity, but test positive for STIs in laboratory tests (DiClemente et al. 2011). Yet, some evidence suggests that inaccuracies in self-reports of sexual behaviors are negligible and randomly distributed (Brauner-Otto, Yarger, and Abma 2012; Upchurch et al. 2002), and self-reports of STI diagnoses are as reliable as medical and health department records (Niccolai et al. 2005). Although expensive and time-consuming, assessing official medical records and conducting health examinations may be ideal for future research on discrimination and sexual and reproductive health. In addition, future research should employ more extensive measures of sexual behaviors that put youth at risk for or fail to protect them from negative outcomes of sexual activity (e.g., accuracy of condom use; Dolezal et al. 2014, Sanders et al. 2011).
Despite the aforementioned limitations, this study contributes to a growing understanding of adolescents’ and young adults’ exposure to discriminatory treatment, and the harmful effects of these experiences on their health and well-being. It complements growing research on the mental and physical health consequences of interpersonal discrimination, in this case by focusing on sexual behaviors and the negative outcomes of these behaviors. Despite its association with some, but not all, of the risky sexual behaviors, interpersonal discrimination was not associated with the outcomes for which sexually experienced youth are at risk: STIs, teenage pregnancy, and abortion. As such, these findings emphasize that scholars who rely on a simplistic model of sexual risk among youth (i.e., that all sexual activity is risky) may misspecify the relationship between discrimination and sexual health. Scholars should empirically assess whether sexually experienced youth (particularly marginalized youth) are truly at risk, and the outcomes for which they are at risk, rather than automatically labeling these youth as “at-risk” (Bay-Cheng and Fava 2014).
The author would like to thank Brittany Charlton, Patricia Herrera, Natalie Ingraham, Pamela Braboy Jackson, Brian C. Kelly, Krystale E. Littlejohn, Eliza K. Pavalko, Brian Powell, Bedelia Richards-Dowden, Sonya A. Satinsky, Louise Seamster, Peggy A. Thoits, and Eric R. Wright, as well as the Social Problems editor and anonymous reviewers, for their helpful feedback on this article. This work was supported by a Ford Foundation predoctoral fellowship awarded to the author.
1 Supplemental multivariate analyses suggest that each of the four sexual behaviors significantly predicts one or more of the negative sexual outcomes (i.e., STIs, teen pregnancy, abortion), net of sociodemographic characteristics and depressive symptoms (available upon request).
2 In supplemental multivariate analyses, which control for age, nativity, and depressive symptoms, black and Latina/o youth report more frequent race discrimination than white youth, black youth report greater cumulative frequency of discrimination than white youth, girls and young women report more frequent gender discrimination and more forms of interpersonal discrimination than boys and young men, and respondents whose families have received welfare report greater cumulative frequency of discrimination than those whose families have not (p < .05).
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