Abigail A. Haydon

Growing Up With a Chronic Illness: Social Success, Educational/Vocational Distress

OBJECTIVES We compared adult educational, vocational, and social outcomes among young adults with and without childhood-onset chronic illness in a nationally representative U.S. sample. METHODS We used data from Wave IV (2008) of the National Longitudinal Study of Adolescent Health. We compared respondents who reported childhood-onset cancer, heart disease, diabetes, or epilepsy with young adults without these chronic illnesses in terms of marriage, having children, living with parents, romantic relationship quality, educational attainment, income, and employment. Multivariate models controlled for sociodemographic factors and adult-onset chronic illness. RESULTS As compared with those without childhood chronic illness, respondents with childhood chronic illness had similar odds of marriage (odds ratios [OR] = .89, 95% CI: .65-1.24), having children (OR = .99, 95% CI: .70-1.42), and living with parents (OR = 1.49, 95% CI .94-2.33), and similar reports of romantic relationship quality. However, the chronic illness group had lower odds of graduating college (OR = .49, 95% CI: .31-.78) and being employed (OR = .56, 95% CI: .39-.80), and higher odds of receiving public assistance (OR = 2.13, 95% CI: 1.39-3.25), and lower mean income. CONCLUSIONS Young adults growing up with chronic illness succeed socially, but are at increased risk of poorer educational and vocational outcomes.

Young Adult Outcomes of Children Growing up with Chronic Illness: An analysis of the National Longitudinal Study of Adolescent Health

OBJECTIVE To examine young adult outcomes in a nationally representative US cohort of young adults growing up with a chronic illness. DESIGN Secondary analysis of nationally representative data from wave III (in 2001) of the National Longitudinal Study of Adolescent Health. SETTING United States. PARTICIPANTS The analytic sample comprised 13 236 young adults aged 18 to 28 years at wave III. MAIN EXPOSURE Self-report of a chronic physical illness (asthma, cancer, diabetes mellitus, or epilepsy) in adolescence. Respondents with asthma or nonasthmatic chronic illness (cancer, diabetes mellitus, or epilepsy) were compared with individuals without these conditions. MAIN OUTCOME MEASURES Self-report of high school graduation, ever having employment, currently having employment, living with a parent/guardian, and ever receiving public assistance. RESULTS Three percent of young adults had nonasthmatic chronic illness (cancer, diabetes, or epilepsy), and 16.0% had asthma. Most young adults with chronic illness graduated high school (81.3%) and currently had employment (60.4%). However, compared with healthy young adults, those with nonasthmatic chronic illness were significantly less likely to graduate high school, ever have had employment, or currently have employment and were more likely to receive public assistance. Compared with young adults with asthma, those with nonasthmatic chronic illness again had significantly worse young adult outcomes on all measures. CONCLUSIONS Most young adults growing up with a chronic illness graduate high school and have employment. However, these young adults are significantly less likely than their healthy peers to achieve these important educational and vocational milestones.

Beyond Age at First Sex: Patterns of Emerging Sexual Behavior in Adolescence and Young Adulthood

PURPOSE Although the emergence of sexual expression during adolescence and early adulthood is nearly universal, little is known about patterns of initiation. METHODS We used latent class analysis to group 12,194 respondents from waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health) into one of five classes based on variety, timing, spacing, and sequencing of oral-genital, anal, and vaginal sex. Multinomial logistic regression models, stratified by biological sex, examined associations between sociodemographic characteristics and class membership. RESULTS Approximately half of respondents followed a pattern characterized predominately by initiation of vaginal sex first, average age of initiation of approximately 16 years, and spacing of >1 year between initiation of the first and second behaviors; almost one-third initiated sexual activity slightly later but reported first experiences of oral-genital and vaginal sex within the same year. Classes characterized by postponement of sexual activity, initiation of only one type of behavior, or adolescent initiation of anal sex were substantially less common. Compared with white respondents, black respondents were more likely to appear in classes characterized by initiation of vaginal sex first. Respondents from lower socioeconomic backgrounds were more likely to be in classes distinguished by early/atypical patterns of initiation. CONCLUSIONS A small number of typical and atypical patterns capture the emergence of sexual behavior during adolescence, but these patterns reveal complex associations among different elements of emerging sexuality that should be considered in future research.

Childhood Abuse and Neglect and the Risk of STDs in Early Adulthood

CONTEXT Given the threat posed by STDs in young adulthood, identifying early predictors of STD risk is a priority. Exposure to childhood maltreatment has been linked to sexual risk behaviors, but its association with STDs is unclear. METHODS Associations between maltreatment by parents or other adult caregivers during childhood and adolescence and STD outcomes in young adulthood were examined using data on 8,922 respondents to Waves 1, 3 and 4 of the National Longitudinal Study of Adolescent Health. Four types of maltreatment (sexual abuse, physical abuse, supervision neglect and physical neglect) and two STD outcomes (self-reported recent and test-identified current STD) were assessed. Multivariate logistic regression analyses, stratified by sex, tested for moderators and mediators. RESULTS Among females, even after adjustment for socioeconomic and demographic characteristics, self-report of a recent STD was positively associated with sexual abuse (odds ratio, 1.8), physical abuse (1.7), physical neglect (2.1) and supervision neglect (1.6). Additionally, a positive association between physical neglect and having a test-identified STD remained significant after further adjustments for exposure to other types of maltreatment and sexual risk behaviors (1.8). Among males, the only association (observed only in an unadjusted model) was between physical neglect and test-identified STD (1.6). CONCLUSIONS Young women who experienced physical neglect as children are at increased risk of test-identified STDs in young adulthood, and exposure to any type of maltreatment is associated with an elevated likelihood of self-reported STDs. Further research is needed to understand the behavioral mechanisms and sexual network characteristics that underlie these associations.

Associations between patterns of emerging sexual behavior and young adult reproductive health.

CONTEXT Identifying young adult outcomes associated with adolescent sexual behavior, including patterns of first oral, vaginal and anal sex, is critical to promoting healthy sexual development. METHODS Associations between patterns of emerging sexual behavior, defined using latent class analysis, and young adult sexual and reproductive health were examined among 9,441 respondents to Waves 1 (1994-1995), 3 (2001-2002) and 4 (2008) of the National Longitudinal Study of Adolescent Health. Logistic regression analyses examined associations between class membership and young adult outcomes, and tested for interactions by race and ethnicity. RESULTS Compared with respondents who initiated vaginal sex first and reported other sexual behaviors within two years, those who initiated oral and vaginal sex during the same year had similar odds of having had an STD diagnosis ever or in the last year, of having had concurrent sexual partnerships in the last year and of having exchanged sex for money. However, respondents who postponed sexual activity had reduced odds of each outcome (odds ratios, 0.2-0.4); those who initiated vaginal sex and reported only one type of sexual behavior had reduced odds of reporting STD diagnoses and concurrent partnerships (0.4-0.6). Respondents who reported early initiation of sexual activity combined with anal sex experience during adolescence had elevated odds of having had concurrent partnerships (1.6). The data suggest racial and ethnic disparities even when patterns of emerging sexual behavior were the same. CONCLUSIONS Patterns of early sexual behavior considered high-risk may not predict poor sexual and reproductive health in young adulthood.

Sexual timetables for oral-genital, vaginal, and anal intercourse: sociodemographic comparisons in a nationally representative sample of adolescents.

OBJECTIVES We documented the prevalence and relative timing of oral-genital, vaginal, and anal intercourse during adolescence and examined whether these timetables varied by sociodemographic factors. METHODS We used data from almost 14 ,000 Wave IV respondents to the National Longitudinal Study of Adolescent Health to generate prevalence estimates for adolescents who reached age 18 years by 2001 and logistic and ordinary least squares regression to examine sociodemographic correlates of sexual patterns. RESULTS One in 5 adolescents did not engage in any of these sexual behaviors by age 18 years. More than two thirds reported vaginal or oral-genital sexual activity, but only about half experienced both. One in 10 reported anal intercourse experience. A third initiated 2 or more behaviors within a 1-year period. In longer timetables, vaginal intercourse was more often initiated first. Most sociodemographic characteristics examined were uniquely associated with prevalence and sexual timing. CONCLUSIONS Diversity in patterns of sexual initiation occurring in the 1990s underscores the ongoing need for comprehensive and nuanced examinations of adolescent sexual trajectories and their implications for sexual health in more recent cohorts.

Protective Connections and Educational Attainment Among Young Adults With Childhood‐Onset Chronic Illness

BACKGROUND Youth with childhood-onset chronic illness (COCI) are at risk of poor educational attainment. Specific protective factors that promote college graduation in this population have not been studied previously. In this study, we examine the role protective factors during adolescence play in promoting college graduation among young adults with COCI. METHODS Data were collected from 10,925 participants in the National Longitudinal Study of Adolescent Health (Add Health). Protective factors present before 18 years of age included mentoring, parent relationship quality, school connectedness, and religious attendance. College graduation was the outcome of interest assessed when participants had a mean age of 28 years. Analysis was stratified by presence of COCI. RESULTS About 2% of participants (N = 230) had 1 of 4 COCIs (cancer, diabetes, epilepsy, or heart disease). All 4 protective factors were associated with college graduation for youth without COCI. In the final multivariate model, only school connectedness was associated with college graduation for youth with COCI. CONCLUSION School connectedness is of particular importance in promoting educational attainment for youth with COCI.

Unwanted Sex Among Young Adults in the United States The Role of Physical Disability and Cognitive Performance

This study examined associations between unwanted sexual experiences and both physical disability and cognitive performance in a nationally representative sample of young adults. We used data from 11,878 participants (ages 26-32) in Waves I, III, and IV of the National Longitudinal Study of Adolescent Health (Add Health). Logistic regressions determined associations between physical disability and level of cognitive performance (using a modified Peabody Picture Vocabulary Test) and the odds of experiencing physically forced and nonphysically coerced sex. Approximately 24% of females and 4% of males reported unwanted sexual experiences. Compared to respondents without disabilities, females with a physical disability had greater odds of experiencing forced sex (OR = 1.49; 95% CI [1.06, 2.08]), whereas males with a physical disability had greater odds of coerced sex (OR = 1.90; 95% CI [1.02, 3.52]). Compared to those with average cognitive performance scores, females with scores above 110 had slightly higher odds of coerced sex (OR = 1.20; 95% CI [1.03-1.41]). Further research on pathways underlying these associations is needed to inform prevention efforts.

Longitudinal Consistency in Self-Reported Age of First Vaginal Intercourse among Young Adults

We examined consistency in self-reports of age at first vaginal sex among 9,399 male and female respondents who participated in Waves III and IV (separated by approximately seven years) of the National Longitudinal Study of Adolescent Health (Add Health). Respondents were coded as consistent if they reported an age at first vaginal intercourse at Wave IV that was within one year of the age they reported at Wave III. Sociodemographic, behavioral, and cognitive predictors of consistency were examined using bivariate and multivariate logistic regression. Overall, 85.43% of respondents were able to provide consistent reports. Among both males and females, consistency was associated with age, years since first vaginal intercourse, race/ethnicity, and lifetime number of other-sex partners in final multivariate models. Respondents who were older and had more recently had their first sexual experience were more likely to be consistent. For females only, those who reported a history of nonparental, physically forced sex were less likely to be consistent. Most young adults consistently report age at first vaginal intercourse, supporting the credibility of retrospective self-reports about salient sexual events such as timing of first vaginal intercourse.

Reproductive health of young adults with physical disabilities in the U.S.

OBJECTIVE Previous research shows reduced cervical and breast cancer screening among women with physical disabilities. However, other indicators of reproductive health have been largely ignored. We aimed to compare the reproductive health of young adults in the U.S. with and without physical disabilities in a nationally-representative sample. METHODS Data are from 13,819 respondents aged 18-26 who participated in Waves I (1994-1995) and III (2001-2002) of the National Longitudinal Study of Adolescent Health (Add Health). Using logistic regression, we examined associations between physical disability and multiple reproductive health indicators including sexually transmitted infection (STI) testing, STI diagnosis, receipt of a gynecologic exam, and cervical cancer screening. Analyses were stratified by sex and adjusted for the complex study design. RESULTS We identified 5.8% of respondents as having a physical disability. In multivariate analyses, females with physical disabilities had lower odds of having a Pap smear in the past 12 months than females without disabilities (OR=0.77; 95% CI: 0.61, 0.97). Physical disability was not associated with other reproductive health indicators among females or males. CONCLUSION We found few differences in examined reproductive health indicators of young adults with and without physical disabilities, but findings suggest differences in some screening services that merit additional study.