1. Chantal Lewis, Masters of Public Health Candidate 2017
ASSOCIATION BETWEEN SEXUAL DEBUT AGE AND STD DIAGNOSIS AMONG ADULT FEMALES
School of Public Health, Brown University, Providence, RI
BACKGROUND
OBJECTIVE
METHODS
RESULTS
CONCLUSIONS
ACKNOWLEDGEMENTS
REFERENCES
• To examine the association between age of sexual
debut and later STD diagnosis among women who
have had sex.
• A special thank you Annie Gjelsvik, PhD and Don
Operario, PhD, for their support and contributions.
• 2011-2012 aggregated National Health and
Nutrition Examination Survey (NHANES) data. A
total of 9,756 participants took part in the survey of
whom 4900 were women.
• Only women who have had sex and reported a valid
response for having a STD diagnosis as well as a
sexual debut age were included in this study,
yielding an analytic sample size of n=1,540
• Sex debut age was defined as: 1) younger than
14yrs old 2) 14-18yrs old and 3) older than 18yrs
old.
• Women who reported a diagnosis of at least one of
the following were considered to have the study’s
outcome: gonorrhea, chlamydia, genital herpes, and
genital warts.
• Chi-square tests and logistic regression analyses
were performed to examine the association
between sexual debut age and STD diagnosis
likelihood. Tests were carried out using STATA v14.0.
• Healthcare providers should encourage their younger
female patients to undertake behavior education (such
as STD education), before initiating sexual acts.
• These programs should target various groups of
women (such as immigrant women) using different
programs. A future cohort
• STDs remain a significant public health challenge in
the United States with an estimated annual
19million new
• There is a notably heavy burden of STDs for women,
who face serious long-term health consequences
such as infertility.
• Healthypeople.gov. Sexually Transmitted Diseases | Healthy People 2020 [Internet]. 2015 [cited 2015 Dec 19];Available from:
http://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseases
• Centers for Disease Control and Prevention. Reported STDs in the United States, 2014 [Internet]. 2015 [cited 2015 Dec
13];Available from: http://www.cdc.gov/std/stats14/std-trends-508.pdf
TABLE 1—Comparison of Age of Initial Sex Act Among Adult Females and at least one STD
Diagnosis and other Socioeconomic Variables: National Health and Nutrition Examination
Survey, United States, 2011-2012
TABLE 2—Adjusted Odds Ratio of having received at least one STD Diagnosis according to Age
of Initial Sex Act and Selected Demographic, and Socioeconomic among Women by Age of
Sexual Debut
* Unweighted number of respondents. ** Weighted percentage.
Age of Initial Sex Act
<14yrs
n* (%)**
96 (5.0%)
14-18yrs
n* (%)**
804 (54.0%)
>18yrs
n* (%)**
646 (41.0%)
P-value
Have You Been Diagnosed with STD?
Yes
No
11 (11.0%)
85 (89.0%)
84 (12.0%)
720 (88.0%)
42 (8.7%)
604 (91.0%)
0.2015
Health Insurance
Yes
No
65 (71.0%)
31 (29.0%)
607 (79.0%)
196 (21.0%)
482 (80.0%)
164 (20.0%)
0.3786
Race/Ethnicity
Non-Hispanic African American
Non-Hispanic White
Hispanic
Mixed or other
11 (12.0%)
39 (60.0%)
42 (25.0%)
4 (3.0%)
158 (13.0%)
309 (67.0%)
263 (15.0%)
74 (5.0%)
149 (17.0%)
188 (61.0%)
152 (11.0%)
157 (11.0%)
0.0005
Family Income $
<20,000
≥ 20,000
35 (28.0%)
95 (72.0%)
197 (18.0%)
579 (82.0%)
116 (14.0%)
499 (86.0%)
0.0519
Regular Provider
Yes
No
84 (89.0%)
12 (11.0%)
700 (87.0%)
104 (13.0%)
554 (58.0%)
92 (12.0%)
0.9269
Place of birth
Born in the US
Born outside the US
91 (97.0%)
5 (3.0%)
670 (89.0%)
134 (11.0%)
370 (74.0%)
276 (26.0%)
0.0000
Current Age
Younger than 20 yrs
20-39 yrs
40-59 yrs
60-70
3 (1.4%)
41 (44.0%)
44 (41.0%)
7 (13.0%)
26 (2.0%)
326 (41.0%)
395 (50.0%)
52 (6.0%)
13 (1.0%)
227 (36.0%)
351 (55.0%)
52 (7.0%)
0.1559
Characteristics Unadjusted OR (UOR) Adjusted OR (AOR)
Age of Sexual Debut
Younger than 14yrs
14-18yrs
Over 18yrs
1.21(0.60, 2.44)
1.00 (Ref)
0.53(.35, 0.79)
1.31(0.61, 2.80)
1.00 (Ref)
0.54(0.37, 0.80)
• Of the women have had sex , 5% reported sexual
debut age of younger than 14, while 54% and 41%
reported ages of between 14-18 yrs and older than 18
yrs respectively. (Table1)
• Of the women have had sex, 21% reported one or
more STD diagnosis. (Table 1)
• Sexually debuted women who were younger than 14
yrs and older than 18 yrs old were 1.21(95% CI:0.60,
2.44) and 0.53 (95% CI: 0.35,0.79) respectively, times
likely to have been told by a doctor that they had at
least one STD, compared to women who were
between the ages of 14-18yrs old.
• The odds of the older than 18yrs old group remained
significant after adjustments.
Adjusted for : Health Insurance, race/ethnicity, family annual income, having a regular provider, place of birth and current age.