Defense Date

2013

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Epidemiology

First Advisor

Derek Chapman

Abstract

Introduction: Sexually Transmitted Diseases, including HIV/AIDS, continue to be a major burden in the United States. Sexual partnering behaviors contribute to the spread of STDs. Sexual concurrency has been shown to exponentially increase STD prevalence in populations. Serial monogamy with short periods between sexual partners also introduces risk. Methods: We identified sexually active men and women from the 2006-2010 National Survey of Family Growth (NSFG) and used sub sets for each particular study. Sexual partnering was defined as being concurrent, serially monogamous or monogamous in the previous year. Polytomous logistic regression models were developed to evaluate the associations between age of sexual debut among adult men, age of menarche and discordant heterosexual identity and behavior among all women and sexual partnering patterns. Descriptive, mediation, subpopulation and stratified analyses were also conducted. Results: Sexual debut < 15 and 15-17 years was associated with concurrency (adjusted odds ratio (aOR)<15: 2.19; 95% Confidence Interval (CI): 1.36-3.55; aOR 15-17: 1.69; 95% CI: 1.04-2.75). This association was mediated by lifetime number of partners (further adjusted for lifetime partners: OR<15: 1.26; 95% CI: 0.74-2.22; OR15-17: 1.13; 95% CI: 0.67-1.92). Age of menarche was not associated with subsequent concurrent sexual partnering (adjusted odds ratio (aOR)early: 1.09; 95% Confidence Interval (CI): 0.57-2.09; aORaverage: 1.13; 95% CI: 0.64-1.99) or serial monogamy (aORearly: 0.75; 95% CI: 0.41-1.38; aORaverage: 0.71; 95% CI: 0.39-1.29). A subanalysis among currently unmarried women did not alter this relationship. Heterosexually discordant women who had both male and female partners in the previous year were 5.5 times as likely to report having a concurrent relationship (95% CI: 2.77-11.09) and 2.43 times as likely to report engaging in serially monogamous relationships (95% CI: 1.19-4.97) with their male partners than concordant women. Conclusions: Sexual partnering behaviors are potentially modifiable and reducing risky partnerships will contribute to a decrease in STD acquisition and transmission. Our findings have important implications. Clinically, they support the provision of comprehensive services, regardless of sexual identity. For policy, they confirm the need for early, inclusive and thorough sexual and reproductive health programming for our youth, in particular focusing on the benefits of lifetime partner reduction.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

April 2013

Included in

Epidemiology Commons

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