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• At-risk sexual behaviors. Information about risky sexual behaviors was obtained as part of the standard medical history in the adult health clinic and through the self-administered adverse childhood experiences questionnaire. The three questions (and the possible responses) used were: 1) “How old were you the first time you had sexual intercourse?” (age in years); 2) “With how many different partners have you ever had sexual intercourse?” (number of partners); and 3) “Are you concerned [that] you are at risk for AIDS?” (yes/no). Participants who reported having initiated intercourse by age 15 or who had more than 30 partners in their lifetime † were considered to have engaged in risky sexual behavior.
Persons with incomplete information about an adverse childhood experience were considered not to have had that experience. Analyses using this classification were almost identical to analyses that excluded participants with incomplete information. We estimated the association between each of the seven categories of adverse childhood experiences and having begun intercourse at or before age 15, having had 30 or more partners and perceiving oneself to be at risk of AIDS, using separate logistic regression models to obtain adjusted odds ratios and 95% confidence intervals. 18 Findings were statistically significant if the confidence intervals did not include the null value of 1.0.
We used the Mantel-Haenszel chi-square test for linear trend in proportions to evaluate whether the prevalence of risky sexual behavior increased as the number of categories of adverse childhood experiences (classified as 0, 1, 2, 3, 4-5 or 6-7) increased. 19 Covariates in all models included age and race (defined as other vs. white).
For the purposes of the analysis, we included survey data from a total of 5,060 women. Characteristics of this study population have been reported previously. 20 In brief, the majority were 35 and older at the time of interview (88%), were white (77%), had some college education (69%), were currently married (67%), and were either employed full-time (41%) or retired or unemployed (48%) (Table 1, page 207).
More than half of women (59%) reported one or more types of adverse experience during childhood. Three percent of the study population reported a self-perceived risk of AIDS, 2% reported having had 30 or more sex partners and 8% had initiated intercourse at age 15 or younger (not shown).
Among the women who had had any one of the types of adverse experiences, the proportion who had had sex by age 15 ranged from 12% to 17%, while among those who had not had an adverse childhood experience, these proportions ranged from 6% to 8% (Table 2). Thus, the relative risks of having intercourse before age 15 were significantly associated with each of the seven categories of adverse childhood experiences: physical abuse (relative risk, 2.0), verbal abuse (relative risk, 2.4), sexual abuse (relative risk, 2.6), having a battered mother (relative risk, 2.1), having an incarcerated family member (relative risk, 2.3), observing household substance abuse (relative risk, 2.5) and observing household mental illness (relative risk, 1.6).
Likewise, among women who experienced adverse events during childhood, the percentages who perceived themselves to be at risk of AIDS ranged from 5% to 8%; in contrast, among those who did not have a specified adverse experience, these percentages ranged from 2% to 3%. A significantly increased probability of perceiving oneself to be at risk of AIDS was thus associated with physical abuse (1.7), verbal abuse (1.8), sexual abuse (2.0), having a battered mother (2.6), having an incarcerated family member (2.4), observing household substance abuse (1.7) and observing household mental illness (1.5).
Finally, among women with at least one adverse childhood experience, the proportions with 30 or more sexual partners ranged from 3% to 6%, while among those with no adverse experience, this proportion was about 2%. Having 30 or more partners was significantly associated with six of the seven categories of adverse childhood experiences—physical abuse (2.2), verbal abuse (3.8), sexual abuse (2.8), an incarcerated family member (2.3), household substance abuse (2.4) and household mental illness (3.3). Having a battered mother was associated with a borderline increased risk (1.6). Of all associations between individual categories of adverse childhood experiences and sexual risk behaviors in women that were considered, the strongest association was between verbal abuse and having 30 or more sex partners (relative risk, 3.8).
The prevalence of early onset of sexual intercourse, of having 30 or more partners and of feeling at risk of AIDS increased as the number of categories of exposure to adverse experiences during childhood increased (Table 3). The prevalence of early onset of intercourse ranged from 4% for those reporting no adverse childhood experiences to 31% for those reporting 6-7 types of experiences. Similarly, 2% of women reporting no exposure to adverse childhood experiences reported feeling at risk of AIDS, compared with 15% of those exposed to 6-7 types of adverse childhood experiences. Likewise, only 1% of those with no exposure to adverse childhood experiences had 30 or more partners, compared with 12% of those reporting 6-7 types of adverse experiences. Although the prevalence of sexual risk behaviors among those experiencing 6-7 types of adverse childhood experiences was notably higher than that for women experiencing a lower number of categories of adverse childhood experiences, it is worth noting that even in the highest-risk groups, the majority of the study population did not report risky sexual behaviors.
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