Sung-Heui Bae1
Youngran Yang- 1College of Nursing, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, South Korea
- 2Graduate School of Clinical and Public Health Convergence, Ewha Womans University, Seoul, South Korea
- 3College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, South Korea
Objectives: This review aims to examine the association between community-level factors, namely, community structure and condition, and risky sexual behavior (RSB) including early sexual debut, having multiple sex partners, and unprotected sex, in adolescents and young adults.
Methods: In total, 17 observational studies were identified for review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Among the 11,216 identified articles, excluded articles comprised 8,361 duplicates, 2,855 articles by title screening, 893 by abstract screening, and 667 by full-text screening. Finally, eight additional articles were added by manual search.
Results: The community structural factors included social disadvantage, economic, employment, education status, racial or ethnic composition, residential stability, and physical environment. The current review found that social disadvantage (six studies) and economic status (10 studies) were most frequently examined. Particularly, higher levels of social disadvantage were associated with higher rates of early sexual initiation, inconsistent condom use, and multiple sexual partners.
Conclusion: This study highlights that community structure and conditions in terms of social disadvantages should be addressed to prevent RSB in the young population.
Introduction
Recent global population data reveal a significant increase in the proportion of young people below the age of 25 years, accounting for 42% (>3 billion) of the global population (World Health Organization [1]. Notably, populations of individuals aged 10–24 years were more prevalent in the least developed countries (31.7%) in contrast to developed countries (16.6%) (United Nations Population Fund [2]. Approximately 70% of both males and females reported adolescents are not psychologically and emotionally mature enough to deal with the negative health consequences of sexual behavior. Therefore, RSB by adolescents and young adults may lead to human immunodeficiency virus (HIV) infections, sexually transmitted infections (STI), unintended pregnancies requiring abortion, and legal conflicts [3]. In 2019, 460,000 young people (aged 10–24 years) were newly infected with HIV worldwide [4]. In the United States, young people (aged between 13 and 24 years) accounted for 21% of all new HIV diagnoses in 2018 and 50% of the 20 million new STIs reported annually. Furthermore, approximately 180,000 babies were born to teenage girls in 2018 (Centers for Disease Control and Prevention [5]. Thus, adolescent sexual and reproductive health is an important public health issue that requires a consistent and innovative approach.
Karvonen and Rimpelä [6] described community structure and conditions as strong determinants of adolescent health behavior. The social disorganization theory states that structurally disadvantaged neighborhoods, characterized by lower socio-economic status, racial and ethnic heterogeneity, and residential stability, are most likely associated with a higher incidence of problematic behaviors than advantaged ones [7, 8]. Furthermore, lower community education and employment status can negatively influence adolescent health outcomes [9]. Neighborhood disadvantage describes the percentage of single households with children below 18 years and households receiving public assistance. Moreover, neighborhood disadvantage influences the high level of inconsistent condom use among high school students [10]. Particularly, higher poverty rates in the community are associated with early sexual debut (<16 years of age [11–13]) and having multiple sexual partners among adolescents and young adults [14].
Understanding how the community influences disparities in sexual health among adolescents is essential to developing effective HIV, STI, and pregnancy prevention programs that function beyond the micro-level, considering individual-, family-, peer-, and school-level characteristics. The ecological system theory states that different types of environments can affect human development [15]. Major aspects of people’s lives occur within society. Thus, the organizational structure and processes within a society can foster personal changes and significantly impact people’s health and behaviors [16, 17]. Health research underscoring the roles of the community and its structure in relation to adolescent sexual behavior is severely limited. Furthermore, systematic reviews or meta-analyses on factors contributing to adolescent RSBs have focused largely on individual or family-related factors such as alcohol consumption [18], media exposure [19], parental monitoring [20], and parent–adolescent sexual communication [21]. However, Decker’s review focused on the relationship between neighborhood characteristics and the reproductive health outcomes of adolescents including adolescent pregnancy, contraceptive use, and teen birth rate [22]. In contrast, this review focused on RSB with the primary purpose of preventing HIV and STI. Therefore, this review aimed to examine the association between community-level factors, particularly community structure and condition, as well as RSB in adolescents and young adults.
Methods
Design
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [23] were followed throughout the review process. This review applied a five-step approach [24] comprising problem formulation, literature search, data evaluation, data analysis, and presentation. The search strategy, search selection, quality appraisal, data extraction, and synthesis are presented in this section. Since the study did not involve any human participants, ethical approval was waived.
Search Strategy
In August 2020, a literature search was conducted across eight electronic bibliographic databases, namely, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Elton B. Stephens Company (EBSCO), PubMed, PsycINFO, Web of Science, DataBase Periodical Information Academic (DBpia, Korea), and Research Information Sharing Service (RISS, Korea). Particularly, a combination of keywords was used to search through the title and abstract fields to identify relevant articles published between January 2000 and July 2020. The keywords used were (factor(s) AND sexual behavior) OR (risky sexual behavior) AND (adolescent(s) OR young adult(s)). Thereafter, full-text versions of the retrieved articles were screened based on the pre-specified inclusion and exclusion criteria.
Inclusion and Exclusion Criteria
The criteria for inclusion comprised studies that were: 1) reporting original research and published in peer-reviewed journals; 2) original research articles with a quantitative approach and non-experimental; 3) either published in English or Korean; 4) reporting on adolescents aged 10–19 years (adolescents were classified as either early: 10–14 years, middle: 15–17 years, and late: 18–19-year [25]) and unmarried young adults aged 20–25 years; and 5) examining the association between community-related factors and RSB among adolescents and young adults. For this study, RSB was defined as early sexual debut, multiple partners, and unprotected sex (i.e., inconsistent condom use). Depending on the study, individual categories or a combination were used as the outcome variable (i.e., RSB). For example, to measure RSB, studies could include varying time frames of recall (e.g., last intercourse, last 3 months, and past year). Studies have provided inconsistent descriptions of early sexual debut, which varies from 11–17 to 11–14 years [26]; 14–16 years [27]; ≤13 years [28, 29]; <14 years [30]; <15 years [31, 32]; and <16 years [33]. This review used Hofmann’s classification of adolescents [25, 34] to include studies that examine sexual debut among individuals below the age of 16 years or the experience of sexual intercourse in primary or middle school. Moreover, multiple sexual partners indicated studies presented with estimated values of the average of sexual partners or, one or more sexual partners in contrast to no sexual experience. Finally, studies that had incomplete information on the study participants and presented only the average age were excluded.
The exclusion criteria involved studies that: 1) focused on sexual minority youth; 2) comprised study participants belonging to a specific population, such as juvenile (arrested) youth, homeless, refugees, individuals living in slums, or military youth; 3) consisted of study participants who were pregnant or had given birth; 4) comprised study participants that had medical problems, such as HIV/AIDS, STIs, or other mental health problems, such as depression, bipolar disorder, schizophrenia, conduct problems, or substance use problems except for alcohol; 5) underscored sexual experience that does not emerge from a consensual relationship, such as sexual violence, abuse, or transactional sex; and 6) the community variable only consisted of residential areas, such as urban, suburban, or rural.
The outcome (i.e., unprotected sex) only focused on inconsistent condom use. Thus, studies examining contraceptive methods, such as pills, contraceptive implants, injections, or intrauterine devices (IUD) were excluded.
Generally, community variables can be divided into two domains: 1) structural factors and conditions of the community, and 2) social processes and mechanisms within the community [22]. Structural factors and conditions define social disadvantage, employment status, education status, household composition, racial or ethnic composition, residential stability, and the physical environment of the community. The social processes and mechanisms within the community describe informal social control, community bonding, mutual trust, community resources, community disorder, community safety, and community norms. The current systematic review of the literature focuses on structural factors and conditions in the community.
Study Screening
Figure 1 presents the study selection process using the PRISMA guidelines [23]. Among the 11,216 identified articles, 8,361 duplicates were removed and 1,962 articles were excluded after title screening. The remaining 893 articles were screened based on their abstracts and 288 were excluded.
FIGURE 1. Flowchart of systematic review (Worldwide, 2001-2020).
Following the abstract screening, 79 full-text articles were screened and studies not related to the RSB outcome were excluded. Furthermore, 178 articles were excluded if discrepancies were found with the study samples regarding the inclusion criteria including age, homosexual or bisexual samples, marital status, and members of specific community subgroups (i.e., military youth, adolescent youth, or individuals living in slums). The remaining 348 articles were categorized based on their individual, family or parent, peer, school, and community factors before being reviewed. Thereafter, 277 articles were excluded because the independent variables were not related to the community factors. In the second full-text screening, 71 articles exploring community variables were reviewed thoroughly. Consequently, 39 articles that examined the association between residential area and RSB were excluded. Moreover, 23 articles were excluded because they either did not examine the structural and conditional factors of the community (n = 20) or lacked detailed assessments of the community factors (n = 3).
Additionally, eight eligible articles were searched and added to the reference list [22]. In total, 17 articles were analyzed. During the screening of the final selected studies, all researchers independently reviewed the title, abstract, and full texts. Any discrepancies or disagreements concerning a study were resolved through discussion and reaching consensus regarding its possible inclusion.
Quality Appraisal
To ensure the quality and validity of the included articles, all 17 articles were subjected to a quality appraisal via a nine-point assessment scale [35]. The original scale was developed for a meta-analysis [36] and was thus revised for the current study. The revised scale used nine items addressing different questions, namely, defined sample, representative sample, inclusion of controls in the analysis, predictors measured, completion rate, demographic information, definition of RSB, details of RSB, and publication status (in a peer-reviewed journal or book). For each criterion, articles received a score of 0 (no) or 1 (yes) which were summed to provide the highest score of 9. According to the adapted tool [36], the categorizations used for the studies were low (score <2), moderate (3–5), or high quality (>6). Consequently, all 17 articles were rated as high-quality articles (Table 1).
TABLE 1. Study Quality Scoring for Each Study Included in the analysis (Worldwide, 2001–2020).
Data Extraction and Synthesis
For this review, information was extracted from the selected articles and tabulated to compile the extracted data (Table 2), namely, author(s), year of publication, country of study, study design, study setting, source of primary data, sample size or demographic information, theoretical framework, outcome variables, community-related variables, data analysis, and results. Furthermore, the relationship between community factors and RSB in adolescents and young adults was further categorized into a significant or non-significant relationship.
TABLE 2. Characteristics of included articles (Worldwide, 2001-2020).
Results
Study Characteristics
Among the 17 studies reviewed, 12 were conducted in the US, 1 in Canada, and 4 in South Africa. Fourteen studies applied a longitudinal study design, while the remaining three used cross-sectional designs. The sample sizes ranged from 691 to 14,058 participants and most studies included both women and men, except one that focused exclusively on men. To investigate the relationship between community structure or conditions and different RSB outcomes in this population, many studies used large administrative datasets such as the National Longitudinal Study of Adolescent to Adult Health (Add Health) data and the National Longitudinal Survey of Youth (NLSY) in the United States, as well as the Cape Area Panel Study (CAPS) in South Africa among other surveys. Add Health contained a national-level representative sample of over 20,000 adolescents from grades 7 to 12 during the 1994–1995 school year and has been followed for five waves to date with most recent update in 2016–2018. Furthermore, the study was designed to assess adolescent health, focusing on multiple social contexts, including homes, schools, neighborhoods, and peer networks [26]. The NLSY cohort also comprised a nationally representative sample of 8,209 adolescents aged from 12 to 16 years in 1997. The survey examined school progress, labor force behavior, and the transition from school to work in the United States [27]. Furthermore, CAPS was a representative longitudinal study conducted in South Africa involving 4,752 adolescents aged 14–22 years in 2002, and followed up in 2005. CAPS concluded that sexual behavior changes over time. Moreover, CAPS suggests that current behaviors are related to a range of household-level variables that were measured earlier in the life of young adults [13, 37].
To synthesize and interpret the findings, theoretical frameworks were applied. One study utilized the social disorganization theory [38] (for an expanded overview, see [39]), one used the ecological model [15], another study employed the ecological [15] and developmental models [40], and another study utilized the life course perspective (life course theory) [41].
All studies used self-reported surveys to examine the RSBs. Some studies included additional variables for RSB, such as substance or alcohol use during sex or sex with someone who uses these substances. The number of studies for each data analysis technique was eight for logistic regression, two for multilevel model, two for probit regression, two for multilevel discrete-time logit model, one for Poisson regression (multimethod), one for multinominal regression, and one for multilevel structural equation models (SEM).
Concept and Measurement of Structural Factors and Conditions in the Community
As mentioned above, the current study designated structural and condition-related factors of the community under eight categories. To simplify the concept of community factors, a single term was used for consistency even if the variable despite the different name from the different studies (Table 2). Table 3 summarizes the results of the analysis based on the outcomes.
TABLE 3. Community variables by risky sexual behavior, of quantitative studies reviewed (Worldwide, 2001-2020).
Social Disadvantage
Six studies used a neighborhood disadvantage scale or index, combining more than one indicator. All scales included at least one measure of income (most commonly measuring the poverty rate), percentage of families using public assistance, or percentage of families with or without high incomes. Each scale also included a variety of additional indicators, such as employment, education, household composition, residential stability, and physical environment [33]. Examined the association between community disadvantage and adolescent RSB and found that community disadvantage was associated with early sexual debut and inconsistent condom use but not with multiple sexual partners. In contrast, a study found that neighborhood disadvantage was associated with multiple sexual partners but not with condom use [42]. Two studies reported an association between neighborhood disadvantage and multiple sexual partners [43, 44], while one study described an association between neighborhood disadvantage and inconsistent condom use [10]. Meanwhile, Warner [45] did not find a significant relationship between neighborhood disadvantage and sexual debut or number of sexual partners.
Economic Status
Nine studies examined the association between economic status, usually measured according to neighborhood poverty, and RSB in adolescents. Browning [11, 12] found a significant association between concentrated poverty and early sexual debut [11, 12], while Dinkelman [13, 46] reported that living below the poverty line was linked to RSB only in men. One of Dinkelman’s studies also found an association between community poverty rate and condom use but not with multiple partners Dinkelman [46], whereas the other study revealed an association of community poverty rate with early sexual debut but not with multiple sexual partners and condom use [13]. A researcher measured the mean annual house income and household poverty line and reported that living below the poverty line was only associated with multiple sexual partners [14]. Another study found that household income and receiving public assistance were associated with inconsistent condom use [10]. Finally, the three remaining studies did not find significant results between neighborhood poverty and adolescent RSB ([26]; Orihuela 2020 [47]).
Employment Status
Three studies examined the association between employment status and RSB in adolescents. Clark [48] found that a higher proportion of wage labor can be linked to greater odds of condom use, but only for females. The study also concluded that a greater proportion of idle youth was associated with decreased odds of condom use by males. The other two studies found no significant associations for unemployment status [10, 14].
Education Status
Two studies assessed and correlated community education levels with adolescent RSB outcomes, one of which reported that higher education levels were associated with a decreased likelihood of condom use in men (Clark 2004). The other study revealed a significant association between lower education levels and inconsistent condom use [10].
Household Composition
Two studies assessed household composition categorized as married households or female-headed households. A study about married households reported that a significant proportion of married households demonstrated inconsistent condom use [10]. In contrast, another study found that female-headed households had a significant association with multiple sexual partners for females [14].
Racial or Ethnic Composition
Three studies assessed the impact of racial or ethnic composition at the community level on RSB in adolescents. All racial and ethnicity categories were defined as per a review of the census data by the researchers or through respondent information in a survey. A study found an association between a higher proportion of individuals from the black African community and multiple sexual partners among South African adolescents and young adults [14]. Furthermore, Browning defined immigrant concentration as a combined percentage of Latino and foreign-born American adolescents and reported no significant association between immigrant concentration and RSB among American adolescents [11, 12].
Residential Stability
Residential stability refers to the measure of continuity of residence, such as the percentage of residents living in the same house and housing occupied by owners. This factor could affect the sexual behaviors of adolescents through environmental and emotional safety. Four studies examined residential stability at the community level. One study found that informal dwelling was significantly associated with having multiple sexual partners in males [14], while another study found an association between residential mobility and RSB [49]. The remaining two studies found no significant association between residential stability and early sexual debut [11, 12].
Physical Environment
Two studies examined how the physical environment at the community level, which includes geographic accessibility from home to family planning clinics (FPCs), commercial decay (e.g., the number of abandoned commercial buildings), or residential decay (i.e., the number of abandoned residential units), may influence RSB in adolescents. Orihuela [50] reported an association between greater residential decay and early sexual debut but not with multiple sexual partners. However, commercial decay was not significantly related to RSB [50]. While the remaining study found no significant results for geographic accessibility with FPCs [51].
Discussion
This review examined the relationship between the community’s structural factors and their impacts on the sexual behaviors of adolescents. Consequently, eight concepts were found for community structure, namely, social disadvantage, economic status, employment status, education status, household composition, racial or ethnic composition, residential stability, and physical environment. Furthermore, social disadvantage (n = 6) and economic status (n = 10) were examined most often while evaluating their impacts on RSB in adolescents and young adults. After controlling the effect of individual- and family-level variables, this study found that the macro-level factors (i.e., community structural factors), were associated with RSB in adolescents, implying that the community influences the behaviors of its adolescent and young adult members.
Social disadvantage was moderately associated with RSB in young people, with most studies emphasizing the importance of social disadvantage in preventing adolescent RSB. Furthermore, this study found that increased social disadvantage exacerbated the risks of early sexual initiation, inconsistent condom use, and multiple sexual partners. Moreover, non-significant relationships were reported by several authors. However, more than half of the relationships (6 out of 10 relationships) between social disadvantage and adolescent RSB were significant with an expected direction.
The existing reviews on this subject also reported similar results, underscoring the impact of higher neighborhood disadvantage on earlier sexual onset [22, 52]. Another review found that social disadvantage affected sexual behaviors and sexual health risk among indigenous Australian adolescents [53]. However, Decker et al. [22] found mixed results for the association between neighborhood disadvantage and contraceptive use. Table 2 presents the size of the effect and the analysis methods with a p-value of 0.05. Three studies [33, 42, 45] found insignificant relationships and did not report exact p-values. Consequently, it was not possible to determine whether the p-values of the insignificant results were close to 0.05 and the coefficients indicate a large impact in the expected direction. Furthermore, the measurements of social disadvantage vary for each study. Thus, the effect size could not be synthesized with a meta-analysis. Future studies ought to determine how substantial a change in social disadvantage should be to ascertain a relevant impact on sexual behavior.
The results regarding the existence of a relationship between economic status and adolescent RSB were inconclusive. Furthermore, this review found that the evidence supporting both significant and non-significant relationships between increased poverty rate and RSB among adolescents was comparable. However, the findings contradict a previous review [22] that described fairly consistent associations between neighborhood poverty and a decreased likelihood of contraceptive use. Previous studies also reported that income inequality at the community level is associated with certain health outcomes, including injuries, general physical symptoms, limiting conditions, mental health, health behaviors, and physical health of adolescents [9]. Furthermore, provincial income inequality was related to certain physical (e.g., injuries and general physical symptoms) and mental health issues in young adults [9]. These studies found moderately supportive evidence for a relationship between community income and health outcomes in adolescents. Thus, this study cannot state conclusively whether higher poverty rates lead to increased RSB in adolescents and young adults. While these variables measure similar items, economic status is usually a simple measure of neighborhood poverty rate while social disadvantage is a more complex measure. Typically, social advantage includes a diverse set of indicators such as percentage of single-parent households, percentage of households without a car, and percentage of non-employed adults under 65 [55].
Few studies have evaluated the roles of employment status (n = 4), education status (n = 2), and household composition (n = 3) in the young population’s adoption of RSB. Notably, these community structures are significantly correlated with inconsistent condom use and multiple sexual partners. Research also found consistent associations between neighborhood education and employment and adolescent reproductive health outcomes [22]. However, a definitive conclusion could not be made because of the small number of studies exploring this association.
Previous researchers have analyzed the relationship between a higher proportion of Black Africans and Hispanics in the community and RSB and found no indication of their effect on early sexual initiation or inconsistent condom use. Only one study [14, 56] reported a significant relationship between a higher proportion of black Africans and multiple sexual partners in South Africa, consistent with Decker et al. [22]. Nevertheless, it remains unclear whether racial or ethnic concentrations within a community affect the behavior of its young population. Consequently, it was difficult to define the extent to which a certain racial and ethnic group dominates a community. Some authors also pointed out the intricacies of analyzing racial segregation in a community [22,57]. According to an analysis of the data from the National Longitudinal Survey of Youth from 1997 to 2007, African American adolescents exhibited higher sexual risk than Caucasian adolescents by age 19. However, the risk in whites increased thereafter [57]. Thus, the effect of racial segregation on sexual behavior may change over time. Additionally, even if segregation may not be associated directly with sexually risky behaviors, it can influence sexual risk through another mechanism, such as sexual network patterns. Thus, these ideas should be considered in future research.
Lastly, there is insufficient evidence to determine the extent of the influence of residential stability and the physical environment of a community on the sexual behaviors of its adolescent and young adult population. Consequently, most studies found non-significant relationships between these community factors and RSB in adolescents.
Neighborhood disadvantage could further limit the availability of social capital [58] and increase vulnerability to HIV/STIs through RSBs in adolescents and young adults [10]. The current findings also emphasize the principal value of community investment to enhance safer sexual behaviors among the young population. Furthermore, the current findings provide information about high-risk groups regarding RSBs in adolescents and young adults. The findings also underscore the need to monitor and develop programs to ensure safer sexual behaviors among the young population. Particularly, improving the robustness of the police for the young population and their families as well as increasing connections in the community of socially disadvantaged populations may reduce this risk [44]. Moreover, community-level interventions, such as community mobilization and female empowerment, have a positive effect on adolescent issues like sexual and reproductive health [59]. Consequently, increasing emphasis has been placed on community engagement and the implementation of community-developed and community-driven programs [53].
To develop and implement relevant programs and policies, it is important to ascertain the magnitude of changes in the community factors that can produce a relevant social outcome at a reasonable cost. Depending on the financial constraints in the health sector, cost-effectiveness has been used widely to evaluate the costs and health impacts of interventions to optimize resource allocation and maximize the target population’s health [60]. Based on the findings of the present study, the costs of community-level interventions or individual or family-level interventions with socially disadvantaged populations can be examined. Furthermore, their social impacts, including sexual behavior outcomes or health outcomes (e.g., STI, HIV infections, or related deaths) could be used for cost-effective analyses. Cost-effective health interventions for HIV testing [60] and gonorrhea vaccination [61] were also examined. The current findings indicate that intervention programs that target adolescents and young adults living in relatively disadvantaged communities need to be developed. Simultaneously, it is necessary to evaluate their cost-effectiveness before large-scale implementation.
Increased emphasis should be placed on improving a single factor, such as the economic or employment status of the community, as well as to target general social disadvantages within the community such as lower income, poverty rate, percentage of families using public assistance, employment, education, household composition, residential stability, and physical environment. This type of approach can potentially reduce the prevalence of RSBs and their adverse health consequences within the community. Notably, improving health outcomes arising from disparities in community conditions and resource gaps will require a substantial amount of time. Thus, the government’s annual health agenda should include adolescent sexual health among its priorities. A multisector approach (e.g., ministries of education, health, welfare, labor, housing, and environment) and interventions involving community collaborations should be employed. Moreover, empowerment activities should be carried out vigorously.
This systematic review comprised several limitations. First, a causal relationship between community structure and adolescent RSB could not be inferred from this study design. Furthermore, some of the included studies were cross-sectional and thus it was not possible to determine a causal relationship. The current study included a variety of community structure factors, heterogeneous variables and measures, and different analytic models. Consequently, it was not possible to conduct a meta-analysis. Moreover, this study intended to include all studies examining the community structure and RSB in adolescents and young adults. However, the search methods might have limited the scope for the inclusion of all published studies.
In conclusion, this review found notable evidence that community structure, especially social disadvantage, was significantly associated with RSB in adolescents and young adults. Social disadvantage is a multifaceted component, including income, poverty rate, and other community structure factors. Therefore, the current study findings can be used to develop and implement prevention and education programs that target the young population, with a particular emphasis on the socially disadvantaged section of the community. The findings also provide a foundation for facilitating the formulation of a tailored health policy that can prevent RSB in this population and promote reproductive health. Future studies need to address the extent of changes in these community factors, which have socially relevant impacts and related costs, to determine cost-effective programs and policies.
Author Contributions
All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.
Funding
This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2020S1A5A2A03047080).
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References
1. WHO, . Coming of Age: Adolescent Health. Genève, Switzerland: World Health Organization (2021). Available at: https://www.who.int/news-room/spotlight/coming-of-age-adolescent-health (Accessed August 31, 2021).
2.UNFPA. World Population Dashboard. San Francisco, California: United Nations (2021). Available at: https://www.unfpa.org/data/world-population-dashboard (Accessed July 6, 2021).
3. Chawla, N, and Sarkar, S. Defining “High-Risk Sexual Behavior” in the Context of Substance Use. J Psychosexual Health (2019) 1(1):26–31. doi:10.1177/2631831818822015
4.UNICEF. Adolescent HIV Prevention. New York: United Nations (2020). Available at: https://data.unicef.org/topic/hivaids/adolescents-young-people/#:∼:text=In%202019%2C%20about%201.7%20million,of%20new%20adult%20HIV%20infections (Accessed July 6, 2021).
5.CDC. Adolescent and School Health. Atlanta, GA: National Youth Risk Behaviour Survey (2019). Available at: https://www.cdc.gov/healthyyouth/sexualbehaviors/index.htm (Accessed July 6, 2021).
6. Karvonen, S, Rimpelä, A, and Rimpela, A. Socio-regional Context as a Determinant of Adolescents' Health Behaviour in Finland. Soc Sci Med (1996) 43(10):1467–74. doi:10.1016/0277-9536(96)00044-5
7. Bellair, P. Social Disorganization Theory. In: Oxford Research Encyclopaedia of Criminology and Criminal justice. London: UK Publishing (2017).
8. Kingston, B, Huizinga, D, and Elliott, DS. A Test of Social Disorganization Theory in High-Risk Urban Neighborhoods. Youth Soc (2009) 41(1):53–79. doi:10.1177/0044118X09338343
9. Quon, EC, and McGrath, JJ. Community, Family, and Subjective Socioeconomic Status: Relative Status and Adolescent Health. Health Psychol (2015) 34(6):591–601. doi:10.1037/hea0000135
10. Bauermeister, JA, Zimmerman, MA, and Caldwell, CH. Neighborhood Disadvantage and Changes in Condom Use Among African American Adolescents. J Urban Health (2011) 88(1):66–83. doi:10.1007/s11524-010-9506-9
11. Browning, CR, Leventhal, T, and Brooks-Gunn, J. Neighborhood Context and Racial Differences in Early Adolescent Sexual Activity. Demography (2004) 41(4):697–720. doi:10.1353/dem.2004.0029
12. Browning, CR, Leventhal, T, and Brooks-Gunn, J. Sexual Initiation in Early Adolescence: the Nexus of Parental and Community Control. Am Sociol Rev (2005) 70(5):758–78. doi:10.1177/000312240507000502
13. Dinkelman, TL, Lam, D, and Leibbrandt, M. Linking Poverty and Income Shocks to Risky Sexual Behaviour: Evidence from a Panel Study of Young Adults in Cape Town. S Afr J Econ (2008) 76(1):s52–74. doi:10.1111/j.1813-6982.2008.00170.x
14. Muchiri, EO, Odimegwu, C, Banda, P, Ntoimo, L, and Adedini, S. Ecological Correlates of Multiple Sexual Partnerships Among Adolescents and Young Adults in Urban Cape Town: a Cumulative Risk Factor Approach. Afr J AIDS Res (2017) 16(2):119–28. doi:10.2989/16085906.2017.1318762
15. Bronfenbrenner, U. The Ecology of Human Development: Experiments by Nature and Design. Harvard University Press (1979).
16. Corcoran, J. Ecological Factors Associated with Adolescent Sexual Activity. Soc Work Health Care (2000) 30(4):93–111. doi:10.1300/J010v30n04_06
17. Salazar, LF, Bradley, EL, Younge, SN, Daluga, NA, Crosby, RA, Lang, DL, et al. Applying Ecological Perspectives to Adolescent Sexual Health in the United States: Rhetoric or Reality? Health Educ Res (2010) 25(4):552–62. doi:10.1093/her/cyp065
18. Wagenaar, C, Florence, M, Adams, S, and Savahl, S. Factors Influencing the Relationship between Alcohol Consumption and Risky Sexual Behaviour Among Young People: a Systematic Review. Cogent Psychol (2018) 5(1):1483049. doi:10.1080/23311908.2018.1483049
19. Coyne, SM, Ward, LM, Kroff, SL, Davis, EJ, Holmgren, HG, Jensen, AC, et al. Contributions of Mainstream Sexual Media Exposure to Sexual Attitudes, Perceived Peer Norms, and Sexual Behavior: A Meta-Analysis. J Adolesc Health (2019) 64(4):430–6. doi:10.1016/j.jadohealth.2018.11.016
20. Dittus, PJ, Michael, SL, Becasen, JS, Gloppen, KM, McCarthy, K, and Guilamo-Ramos, V. Parental Monitoring and its Associations with Adolescent Sexual Risk Behavior: A Meta-Analysis. Pediatrics (2015) 136(6):e1587–99. doi:10.1542/peds.2015-0305
21. Widman, L, Choukas-Bradley, S, Noar, SM, Nesi, J, and Garrett, K. Parent-Adolescent Sexual Communication and Adolescent Safer Sex Behavior: A Meta-Analysis. JAMA Pediatr (2016) 170(1):52–61. doi:10.1001/jamapediatrics.2015.2731
22. Decker, MJ, Isquick, S, Tilley, L, Zhi, Q, Gutman, A, Luong, W, et al. Neighborhoods Matter. A Systematic Review of Neighborhood Characteristics and Adolescent Reproductive Health Outcomes. Health Place (2018) 54:178–90. doi:10.1016/j.healthplace.2018.09.001
23. Moher, D, Liberati, A, Tetzlaff, J, and Altman, DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. BMJ (2009) 339:b2535. doi:10.1136/bmj.b2535
25. WHO, . Orientation Programme on Adolescent Health for Health-Care Providers. Genève, Switzerland: World Health Organization (2006). Available at: https://apps.who.int/iris/handle/10665/42868 (Accessed July 6, 2021).
26. Cubbin, C, Brindis, CD, Jain, S, Santelli, J, and Braveman, P. Neighborhood Poverty, Aspirations and Expectations, and Initiation of Sex. J Adolesc Health (2010) 47(4):399–406. doi:10.1016/j.jadohealth.2010.02.010
27. Kaye, K, Moore, KA, Hair, EC, Hadley, AM, Day, RD, and Orthner, DK. Parent Marital Quality and the Parent–Adolescent Relationship: Effects on Sexual Activity Among Adolescents and Youth. Marriage Fam Rev (2009) 45(2-3):270–88. doi:10.1080/01494920902733641
28. Kalolo, AM, Mazalale, J, Krumeich, A, and Chenault, M. Social Cohesion, Social Trust, Social Participation and Sexual Behaviors of Adolescents in Rural Tanzania. BMC Public Health (2019) 19:193. doi:10.1186/s12889-019-6428-7
29. Yi, SY, Poudel, KC, Yasuoka, J, Palmer, PH, Yi, SK, and Jimba, M. Role of Risk and Protective Factors in Risky Sexual Behavior Among High School Students in Cambodia. BMC Public Health (2010) 10:477. doi:10.1186/1471-2458-10-477
30. Kogan, S, Simons, LG, Allen, KA, Beach, S, Simons, RL, Gibbons, FX, et al. Pubertal Timing and Sexual Risk Behaviors Among Rural African American Male Youth: Testing a Model Based on Life History Theory. Arch Sex Behav (2015) 44(3):609–18. doi:10.1007/s10508-014-0410-3
31. Greene, KM, Eitle, D, and Eitle, TM. Developmental Assets and Risky Sexual Behaviors Among American Indian Youth. J Early Adolesc (2018) 38(1):50–73. doi:10.1177/0272431615596427
32. Lohman, BJ, and Billings, A. Protective and Risk Factors Associated with Adolescent Boys’ Early Sexual Debut and Risky Sexual Behaviors. J Youth Adolesc (2008) 37(6):723–35. doi:10.1007/s10964-008-9283-x
33. Wickrama, TM, Merten, MJ, and Wickrama, KAS. Early Socioeconomic Disadvantage and Young Adult Sexual Health. Am J Health Behav (2012) 36(6):834–48. doi:10.5993/ajhb.36.6.10
35. Mori, C, Temple, JR, Browne, D, and Madigan, S. Association of Sexting with Sexual Behaviors and Mental Health Among Adolescents: A Systematic Review and Meta-Analysis. JAMA Pediatr (2019) 173(8):770–9. doi:10.1001/jamapediatrics.2019.1658
36. Madigan, S, Ly, A, Rash, CL, Van Ouytsel, J, and Temple, JR. Prevalence of Multiple Forms of Sexting Behavior Among Youth: A Systematic Review and Meta-Analysis. JAMA Pediatr (2018) 172(4):327–35. doi:10.1001/jamapediatrics.2017.5314
37. Dinkelman, TL, Lam, D, and Leibbrandt, M. Household and Community Income, Economic Shocks and Risky Sexual Behavior of Young Adults: Evidence from the Cape Area Panel Study 2002 and 2005. Aids (2002) 21(7):S49–56. doi:10.1097/01.aids.0000300535.05226.a9
38. Robe, C. Juvenile Delinquency and Urban Areas. A Study of Rates of Delinquents in Relation to Differential Characteristics of Local Communities in American Cities. University of Chicago Press (1942).
39. Porter, J, Capellan, J, and Chintakrindi, S. Social Disorganization Theory. In: Porter JR, Capellan J, and Chintakrindi S, editors. "Social Disorganization theory." the Encyclopedia of Crime and Punishment (2015). p. 1–7. doi:10.1002/9781118519639.wbecpx169
40. Whitbeck, LB, Yoder, KA, Hoyt, DR, and Conger, RD. Early Adolescent Sexual Activity: a Developmental Study. J Marriage Fam (1999) 61(4):934–46. doi:10.2307/354014
41. Elder, GH. The Life Course as Developmental Theory. Child Dev (1998) 69(1):1–12. doi:10.1111/j.1467-8624.1998.tb06128.x
42. Lindberg, LD, and Orr, M. Neighborhood-level Influences on Young Men's Sexual and Reproductive Health Behaviors. Am J Public Health (2011) 101(2):271–4. doi:10.2105/AJPH.2009.185769
43. Baumer, EP, and South, SJ. Community Effects on Youth Sexual Activity. J Marriage Fam (2001) 63(2):540–54. doi:10.1111/j.1741-3737.2001.00540.x
44. Carlson, DL, McNulty, TL, Bellair, PE, and Watts, S. Neighborhoods and Racial/ethnic Disparities in Adolescent Sexual Risk Behavior. J Youth Adolesc (2014) 43(9):1536–49. doi:10.1007/s10964-013-0052-0
45. Warner, TD, Giordano, PC, Manning, WD, and Longmore, MA. Everybody's Doin' it (Right?): Neighbourhood Norms and Sexual Activity in Adolescence. Soc Sci Res (2011) 40(6):1676–90. doi:10.1016/j.ssresearch.2011.06.009
46. Dinkelman, TL, and Leibbrandt, M. Household and Community Income, Economic Shocks and Risky Sexual Behavior of Young Adults: Evidence from the Cape Area Panel Study 2002 and 2005. Aids (2007) 21(7):S49–56. doi:10.1097/01.aids.0000300535.05226.a9
47. Dupéré, V, Lacourse, E, Willms, JD, Leventhal, T, and Tremblay, RE. Neighborhood Poverty and Early Transition to Sexual Activity in Young Adolescents: a Developmental Ecological Approach. Child Dev (2008) 79(5):1463–76. doi:10.1111/j.1467-8624.2008.01199.x
48. Clark, SK, Carol, E, Manzini, N, and May, J. Communities, Opportunities, and Adolescents' Sexual Behavior in KwaZulu-Natal, South Africa. Stud Fam Plann (2004) 35(4):261–74. doi:10.1111/j.0039-3665.2004.00030.x
49. Fleming, CM, Eisenberg, N, Catalano, RF, Kosterman, R, Cambron, C, David Hawkins, J, et al. Optimizing Assessment of Risk and protection for Diverse Adolescent Outcomes: Do Risk and Protective Factors for Delinquency and Substance Use Also Predict Risky Sexual Behaviour? Prev Sci (2019) 20(5):788–99. doi:10.1007/s11121-019-0987-9
50. Orihuela, CA, Mrug, S, Davies, S, Elliott, MN, Emery, ST, Peskin, MF, et al. Neighborhood Disorder, Family Functioning, and Risky Sexual Behaviors in Adolescence. J Youth Adolesc (2020) 49(5):991–1004. doi:10.1007/s10964-020-01211-3
51. Bersamin, M, Todd, M, and Remer, L. Does Distance Matter? Access to Family Planning Clinics and Adolescent Sexual Behaviours. Matern Child Health J (2011) 15(5):652–9. doi:10.1007/s10995-010-0618-3
52. Lee, RLT, Yuen Loke, A, Hung, TTM, and Sobel, H. A Systematic Review on Identifying Risk Factors Associated with Early Sexual Debut and Coerced Sex Among Adolescents and Young People in Communities. J Clin Nurs (2018) 27(3-4):478–501. doi:10.1111/jocn.13933
53. MacPhail, C, and McKay, K. Social Determinants in the Sexual Health of Adolescent Aboriginal Australians: a Systematic Review. Health Soc Care Community (2018) 26(2):131–46. doi:10.1111/hsc.12355
54. Quon, EC, and McGrath, JJ. Province-level Income Inequality and Health Outcomes in Canadian Adolescents. J Pediatr Psychol (2015) 40(2):251–61. doi:10.1093/jpepsy/jsu089
55.Robert Graham Center. Social Deprivation Index (SDI). Washington, DC: Robert Graham Center (2022). Available at: https://www.graham-center.org/maps-data-tools/social-deprivation-index.html (Accessed September 2, 2022).
56. Hajizade-Valokolaee, M, Yazdani-Khermandichali, F, Shahhosseini, Z, and Hamzehgardeshi, Z. Adolescents’ Sexual and Reproductive Health: an Ecological Perspective. Int J Adolesc Med Health (2017) 29(4). doi:10.1515/ijamh-2015-0097
57. Biello, KB, Niccolai, L, Kershaw, TS, Lin, H, and Ickovics, J. Residential Racial Segregation and Racial Differences in Sexual Behaviours: an 11-year Longitudinal Study of Sexual Risk of Adolescents Transitioning to Adulthood. J Epidemiol Community Health (2013) 67(1):28–34. doi:10.1136/jech-2011-200520
58. Nation, M. Concentrated Disadvantage in Urban Neighborhoods: Psychopolitical Validity as a Framework for Developing Psychology-Related Solutions. J Community Psychol (2008) 36(2):187–98. doi:10.1002/jcop.20230
59. Salam, RA, Faqqah, A, Sajjad, N, Lassi, ZS, Das, JK, Kaufman, M, et al. Improving Adolescent Sexual and Reproductive Health: a Systematic Review of Potential Interventions. J Adolesc Health (2016) 59(4):S11-S28–28. doi:10.1016/j.jadohealth.2016.05.022
60. Coomes, D, Green, D, Barnabas, R, Sharma, M, Barr-DiChiara, M, Jamil, MS, et al. Cost-effectiveness of Implementing HIV and HIV/syphilis Dual Testing Among Key Populations in Viet Nam: a Modelling Analysis. BMJ Open (2022) 12(8):e056887. doi:10.1136/bmjopen-2021-056887
Keywords: systematic review, risky sexual behavior, adolescent, community structure, community condition
Citation: Bae S-H, Jeong J and Yang Y (2022) Socially Disadvantaged Community Structures and Conditions Negatively Influence Risky Sexual Behavior in Adolescents and Young Adults: A Systematic Review. Int J Public Health 67:1604488. doi: 10.3389/ijph.2022.1604488
Received: 26 September 2021; Accepted: 19 October 2022;
Published: 07 November 2022.
Edited by:
Katherine Frohlich, Université de Montréal, CanadaReviewed by:
Nichola Driver, University of Arkansas, United StatesDick Durevall, University of Gothenburg, Sweden
Copyright © 2022 Bae, Jeong and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Youngran Yang, youngran13@jbnu.ac.kr