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Because many teenagers and young adults fail to use condoms correctly and consistently, the of sexual partners they have is an important risk factor for sexually transmitted diseases, including HIV. Identifying factors that are associated with having multiple partners can help in the de of disease interventions. Data on 8, males and females aged who participated in the Youth Risk Behavior Survey were used to examine the prevalence of and factors associated with young people's having multiple partners.

In logistic regression analyses, alcohol use, illicit drug use and young age at first coitus were associated with increased odds that females had had two or more partners in the three months, and being married lowered the odds; black or Hispanic race or ethnicity, alcohol use and young age at first coitus increased the odds for males, and being married reduced the odds.

The strong association between alcohol use and having multiple sexual partners underscores the need to educate young people about the effects of alcohol on partner choice and the risk of infection with sexually transmitted diseases. S exually transmitted diseases STDs are enormously costly to society in terms both of human pain and suffering and of health care expenditures.

Of an estimated 12 million new STD infections that occur each year in the United States, three million occur among people younger than 20, and another four million occur among those aged Having multiple sexual partners represents an important behavioral risk factor for STDs among adolescents Wives seeking sex tonight Lowrys young adults, especially if they fail to use condoms correctly and consistently.

Most teenagers do not have multiple concurrent sexual partners; however, because many adolescent relationships are of short duration, teenagers often have multiple sequential partners. research has demonstrated that adolescents are more likely than adults to report having had multiple sexual partners in the recent past. Studies of primarily adult populations have identified several demographic markers for multiple sexual partners; younger age has consistently emerged as a risk marker.

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Unmarried teenagers were about as likely as unmarried women in their 20s to have had multiple partners. Similarly, in the National AIDS Behavioral Surveys, risk factors for multiple partners in the past year among year-old men and women included male gender, younger age, unmarried status, urban residence and higher educational status for whites. For a variety of social, physiological and individual reasons, alcohol and drug use among adolescents may influence sexual behavior, including an individual's of partners.

Use of alcohol and other substances has been associated with sexual risk behavior in some studies, 10 but most of these have focused on condom use. Prior use of alcohol and drugs greatly increases the risk of early initiation of sexual intercourse, 11 and beginning intercourse at a young age, having multiple partners and failing to use condoms are interrelated.

Given the relationship between multiple sexual partners and STDs, the purpose of our study was to examine potential risk factors associated with having multiple sexual partners among youth in the United States. Our analysis was guided by three questions: What is the prevalence of having multiple partners among U. After controlling for demographic factors, are young people's risk behaviors, particularly alcohol or drug use and early onset of sexual intercourse, associated with having multiple partners?

Finally, what is the relationship between a young person's of sexual partners and his or her condom use? The last question is important because individuals with multiple partners have the greatest need to use condoms. The NHIS is an annual household interview survey of the civilian, noninstitutionalized population of the United States; the survey uses a multistage probability cluster de to obtain data representative of the U.

The NHIS enumerated all year-olds from sampled households, including those who were married and those who were living away from their family of origin. YRBS respondents were randomly selected from this list. Out-of-school youth were oversampled; one in-school Wives seeking sex tonight Lowrys up to two out-of-school youth were selected from each family. A weighting factor was applied to each YRBS record to adjust for oversampling and nonresponse. The final sample was weighted to be representative of the population of youth aged residing in U.

Youth were surveyed approximately two months after the initial household survey. Data collection used audio interview technology; participants privately listened through headphones to a tape recording of the questionnaire, and they recorded their responses on a standardized answer sheet.

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This technique was used to address young people's potential concerns about confidentiality with in-home interviewing. Most data included in our analysis were reported by the respondent, but the youth's race, ethnicity, residence and marital status were reported by the adult who completed the core NHIS interview. Our analysis excluded the 2, respondents agedbecause the survey for this age-group did not ask about their sexual activity; the resulting sample consisted of 8, youth, including who were 21 years of age at the time of the core NHIS but had turned 22 by the time of the YRBS.

We limited our analysis of lifetime sexual partners to the 5, respondents who were sexually experienced i. Analyses related to the of recent sexual partners and condom use were restricted to the 4, young people who were currently sexually active i. Specific analyses are based only on respondents who answered the relevant questions. We used factor analysis to create scales for various risk behaviors. We initially examined items related to drug and alcohol use, weapon carrying and fighting, and age at first sexual intercourse.

Males and females showed similar factor structures. Initial factor analysis suggested that risk behaviors clustered into two factors: one for substance use and one including weapon carrying, fighting and age at first intercourse. The second factor showed poor internal consistency and could not be used to create a homogeneous scale. After orthogonal rotation, substance use could be divided into two factors with eigen values of one or greater.

The first factor described alcohol use and included five items: ever-use of alcohol, binge drinking i. The second factor described illicit drug use and included three items: ever-use of marijuana, cocaine and other illicit drugs. Scores were determined by the of behaviors in which the adolescent had participated. A score of zero, for example, meant that none of the behaviors applied. Because the of sexual partners is highly skewed, we dichotomized each dependent variable and used logistic regression to estimate the independent influence of the predictors.

The of recent sexual partners was dichotomized as one versus two or more. Lifetime partners was dichotomized as versus six or more. In building logistic models, we first examined cross-tabulations to identify potential independent predictors of multiple sexual partners. We conducted separate analyses for males and females. Variables evaluated as potential predictors included demographic characteristics age; race or ethnicity; marital status; and urban, rural or suburban residencethe scales for alcohol and illicit drug use, and a sexual Wives seeking sex tonight Lowrys variable age at first coitus.

Generally, we entered demographic factors first into each logistic analysis. We also assessed interactions between ificant demographic variables and each independent variable or scale. We used direct standardization with sample weights in SUDAAN to demonstrate the independent effect of the alcohol scale on having multiple sexual partners in the three months.

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Probabilities were standardized for age, race or ethnicity, marital status and age at first intercourse. All estimates were based on weighted data. At every age, most sexually experienced young people reported two or more lifetime partners Table 2. A progression to multiple lifetime partners was apparent even among and year-olds. Correspondingly, the proportion reporting one lifetime partner declined steadily with age. Next, we examined cross-tabulations between an individual's of recent sexual partners and potential risk factors not shown.

For females and males, age at first intercourse, alcohol use and illicit drug use were related to the of sexual partners in the past three months. Married males and females had had fewer recent partners than their single counterparts. Among females, age, race or ethnicity and urban residence showed little relationship to the of recent partners. Black males and males living in urban areas were somewhat more likely to report two or more partners than were those in other racial or ethnic groups and residents of nonurban areas.

of the first set of logistic regression analyses Table 3 revealed that among those who were currently sexually active, married females were ificantly less likely than their never-married counterparts to have had multiple partners in the past three months odds ratio, 0. Alcohol use substantially raised the probability that a female had recently had multiple partners; the odds ratio 1. Illicit drug use also had a ificant, although smaller, effect 1.

Finally, young women who first had sex before age 14 were about twice as likely to have had multiple partners as were those whose first intercourse occurred at age 16 or later 2. For currently sexually active males, many of the were similar to those for females. Being married lowered the probability of having had multiple partners 0. Early initiation of sexual intercourse raised the probability of multiple partners, and the effect was greater than for females.

However, several notable differences also emerged. Black and Hispanic males were ificantly more likely than whites to report multiple partners in the past three months odds ratios, 2. Urban residence was not ificant in the final calculations for males. However, because of multicollinearity between race or ethnicity and urban status, we reran the analyses with race or ethnicity removed not shown.

In these calculations, urban residents were ificantly more likely than suburban males to have had multiple partners odds ratio, 1. The analyses estimating the effects of various factors on the odds of having had six or more lifetime sexual partners yielded generally similar for each gender Table 4. Alcohol use and illicit drug use showed substantial impact for both odds ratios, 1. Older current age and earlier age at sexual initiation ificantly increased the odds of having had six or more lifetime partners; this finding is not surprising, since both of these factors increase the period of time that a person has been sexually active.

Black and Hispanic respondents were ificantly more likely than their white peers to report six or more lifetime partners odds ratios, 1. Next, using direct standardization, we adjusted for the influence of age, race or ethnicity, marital status and age at first intercourse to examine the independent influence of alcohol on having multiple sexual partners. As the alcohol-use scale increased, the probability of reporting multiple partners rose dramatically Table 5. Finally, we examined the association between having multiple partners and condom use.

Condom use at last intercourse showed no relationship with the of partners in the past three months. Respondents who had not had sex in the three months were more likely than those who were currently sexually active to have used a condom the last time they had Wives seeking sex tonight Lowrys not shown. Our analyses yield findings that will be of use to health care practitioners and health educators seeking to reduce adolescents' risk of infection with HIV and other STDs.

We found that most sexually experienced youth at every age have had two or more lifetime sexual partners, and many have had six or more. Many young people have recently had multiple sexual partners, which should not be unexpected, given the instability of many relationships among adolescents and young adults. Consistent with earlier studies, involving primarily adult samples, 14 we find that demographic factors and early age at first intercourse are associated Wives seeking sex tonight Lowrys young people's odds of having had multiple partners.

Additionally, however, our analyses reveal that alcohol and drug use are ificant determinants of their lifetime of partners, and alcohol-related behavior is one of the most important risk factors for multiple sexual partners in the recent past. The association between alcohol or other drug use and risky sexual behavior may be explained through social, physiological or individual mechanisms.

Alternatively, a youth's personal characteristics e. The relationship between alcohol use and multiple sexual partners meets three criteria for suggesting causation on the basis of epidemiologic data: a strong association, evidence of a dose-response relationship and biological plausibility. Further research is needed into the mechanisms by which alcohol influences the initiation of new sexual partnerships. Our finding of an association between a past event early initiation of intercourse and current behavior having multiple partners in a three-month period is consistent with findings from other studies that age at first intercourse is a risk marker for sexual risk behavior, such as failing to use condoms 17 and having multiple sexual partners, 18 long after sexual initiation.

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