1. Relationships and Sexual Behavior:
A Closer Look Among Urban Middle
School Youth
2011 National HIV Prevention Conference
Karin K. Coyle, Pamela M. Anderson, James D.
Walker, Heather M. Franks, Lisa J. O'Connor

2. 2
Acknowledgments
• Funder
▫ National Institute of Nursing Research
(#NR011966)
• Participating Schools

3. 3
Purpose of Presentation
• Provide data on adolescent romantic
relationships and sexual behavior
• Highlight the potential of focusing on
relationships as a leverage point for prevention
education
• Identify other possible instructional foci for
school-based HIV/STI prevention programs

4. 4
Source of Data
• Baseline survey from a randomized trial (You-
Me-Us)
▫ 5 of 10 schools represented
• Self report survey
▫ Voluntary and confidential
▫ Consent and assent required
▫ Collected using PDAs
• Sample
▫ 487 7th grade youth

5. 5
Caveats
• Urban sample
• Preliminary data
• Represents half the sample
• Sexual behaviors included vaginal and oral sex
only

6. 6
Results: Sample Demographics (N=487)
Gender Race/Ethnicity
60 60
50 50
40 40
30 30
20 20
10 10
0 0
Male Female Black/Af Am Hispanic White

7. 7
DATING AND RELATIONSHIPS

8. 8
Results: Dating (N=487)
Ever been on date alone Ever been on date in group
80 80
70 70
60 60
50 50
40 Yes 40 Yes
30 No 30 No
20 20
10 10
0 0
Total Males Females Total Males Females

9. 9
Results: Relationships
Ever Had Boy/Girlfriend (N=487)
90
80
70
60
50
Yes
40
N0
30
20
10
0
Total Males Females

10. 10
Results: Relationships (n=360)
• Average number of boy/girlfriends, ever
▫ 7.95 (SD=6.08)
• Average number of boy/girlfriends, last 18
months
▫ 3.47 (SD=3.05)

11. 11
Results: 70
Relationships 60
Age of boy/
girlfriends among 50
those who have
ever had a
40
boy/girlfriend
(n=360)
30
20
10
0
Younger Same age 1-2 years 3-4 years 5+ years
older older older

12. 12
SEXUAL BEHAVIORS

13. 13
Results: Kissing
Ever Kissed By Relationship Status
(N=487) (n=360, 127, 185)
% Yes % Yes
100 100
90 90
80 80
70 70
60 60
50 50
40 40
30 30
20 20
10 10
0 0
Total Males Females Never Had Ever Had Current
Bf/Gf Bf/Gf Bf/Gf

14. 14
Results: Touched Private Parts
Ever Touched By Relationship Status
(N=487) (n=360, 127, 185)
% Yes % Yes
50 50
45 45
40 40
35 35
30 30
25 25
20 20
15 15
10 10
5 5
0 0
Total Males Females Never Had Ever Had Current
Bf/Gf Bf/Gf Bf/Gf

15. 15
Results: Let Someone Touch Your
Private Parts
Ever Let Someone Touch By Relationship Status
(N=487) (n=360, 127, 185)
% Yes % Yes
40 40
35 35
30 30
25 25
20 20
15 15
10 10
5 5
0 0
Total Males Females Never Had Ever Had Current
Bf/Gf Bf/Gf Bf/Gf

16. 16
Results: Had Vaginal Sex
Ever Had Vaginal Sex By Relationship Status
(N=487) (n=360, 127, 185)
% Yes % Yes
30 30
25 25
20 20
15 15
10 10
5 5
0 0
Total Males Females Never Had Ever Had Current
Bf/Gf Bf/Gf Bf/Gf

17. 17
Results: Had Oral Sex
Ever Had Oral Sex By Relationship Status
(N=487) (n=360, 127, 185)
% Yes % Yes
30 30
25 25
20 20
15 15
10 10
5 5
0 0
Total Males Females Never Had Ever Had Current
Bf/Gf Bf/Gf Bf/Gf

18. 18
CURRENT RELATIONSHIPS

19. 19
Results: Relationships
Have Current Boy/Girlfriend (n=360)
80
70
60
50
40 Yes
30 N0
20
10
0
Total Males Females

20. 20
Results: 45
Relationships 40
Length of time with
CURRENT 35
boy/girlfriend 30
(n=185)
25
20
15
10
5
0
Up to 1 1-3 Months 3-12 More than 1
Month Months Year

21. 21
Results: 45
Relationships 40
Time alone together
per week with 35
CURRENT 30
boy/girlfriend
(n=185) 25
20
15
10
5
0
0 Hours 1-2 Hours 3-5 Hours More than
5 Hours

22. 22
Results:
Relationships Went Out Alone
Selected activities
with CURRENT Met Parents
boy/girlfriend
(n=185)
Thought of Selves Total
as Couple* Males
Females
Bf/Gf Said Loved
Me*
Talked About
(*=gender difference Sexual Boundaries
significant)
0 10 20 30 40 50 60

23. 23
ASSOCIATIONS

24. 24
Results: Associations
• Number of boy/girlfriends is associated with
sexual risk behaviors (n=360)
▫ Kissed (.53**)
▫ Touched (.49**)
▫ Let someone touch (.41**)
▫ Had vaginal sex (.41**)
▫ Had oral sex (.34**)
(** Correlation significant at the 0.01 level, 2-tailed)

25. 25
Results: Associations
• For those currently in relationships (n=185)…
• Length of relationship is associated with time
alone and touching, but not other sexual
behaviors
▫ Time alone (.31**)
▫ Let someone touch (.15*)
(*Correlation significant at the 0.05 level, 2-tailed; ** Correlation significant at the 0.01 level, 2-
tailed)

26. 26
Results: Associations
• For those currently in relationships (n=185)…
• Time alone is associated with length of
relationship and oral sex, but not other sexual
behaviors
▫ Length of relationship (.31**)
▫ Had oral sex (.16*)
(*Correlation significant at the 0.05 level, 2-tailed; ** Correlation significant at the 0.01 level, 2-
tailed)

27. 27
Results: Associations
• For those currently in relationships (n=185)…
• Touching private parts is associated with other
sexual behaviors
▫ Let someone touch your private parts (.64**)
▫ Had vaginal sex (.49**)
▫ Had oral sex (.44*)
(*Correlation significant at the 0.05 level, 2-tailed; ** Correlation significant at the 0.01 level, 2-
tailed)

28. 28
IMPLICATIONS FOR PREVENTION

29. 29
Program Leverage Points
• Most MS youth have boy/girlfriends, suggesting
a focus on relationships is relevant
▫ We can benefit from using a relationship lense
when creating or adapting programs
▫ This approach may increase the accessibility of the
content for youth
• Most youth with current boy/girlfriends have
had partner of the same age or 1-2 years older
▫ This is an important norm to emphasize

30. 30
Program Leverage Points
• Greater numbers of boy/girlfriends is associated
with greater levels of sexual risk taking
▫ This is a behavioral target
• Touching private parts is a significant step in a
relationship and is associated with other risk
behaviors
▫ This is a behavioral target
• Relatively few youth talk about what they will
and won’t do sexually
▫ This is a skill target

31. 31
You-Me-Us Program
• 12 Session relationship-focused HIV/STI prevention
curriculum
• School-wide peer norm component
• Key messages
▫ Take Inventory…
 Know your personal boundaries and ask about your
partner’s boundaries.
▫ Take Your Time…
 Don’t rush into having sex.
▫ Take Action...
 Protect yourself from heartbreak, infections, and
pregnancy

32. 32
Conclusions
• The development of romantic feelings and
interests is a hallmark of the adolescent
developmental period (Hartup, 1993).
• Early romantic experiences are believed to
influence normative developmental tasks, such
as:
▫ Intimacy and identity development (Sullivan, 1953;
Erikson, 1968)
▫ Autonomy from the family (Furman & Shaffer,
2003).

33. 33
Conclusions
• Putting HIV prevention into a relationship
context can make the content more relevant and
accessible for youth
• This approach also changes the orientation of
what we typically teach in school-based HIV
prevention programs
▫ From an individual
▫ To an individual navigating a relationship