Date of Award

Spring 5-15-2015

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Douglas Roblin

Second Advisor

Sheryl Strasser


BACKGROUND: According to the World Health Organization’s (WHO) 2008 global estimate, approximately 498 million individuals worldwide become infected each year with a sexually transmitted disease (STD) or infection. Although adolescents only make up about a quarter of the sexually active population, approximately half of the newly reported STDs in the U.S each year are among individuals aged 15-24 years (The Henry J. Kaiser Family Foundation, 2014). The CDC reports that approximately 46.8% of U.S. high school students reported already having experienced their sexual debut. When adolescents engage in sexual behaviors earlier, it puts them at greater risk for other risky behaviors and ultimately STD incidence. Family circumstances are also considered to have an impact on an adolescent’s likelihood to engage in earlier sexual behaviors.

METHODS: Data were obtained from the National Longitudinal Survey of Adolescent to Adult Health, Waves I and IV. Logistic regression was used to measure the strength of the relationship between early sexual debut and STD, and was also conducted to determine which family circumstances have the strongest associations with both early sexual debut and STD incidence. Statistical interaction was included to test for effect modification in the model. Gender was shown to be a significant predictor of STD incidence; therefore the model was tested for differential effects by gender.

RESULTS: Adolescents experiencing an early sexual debut (age) were 2.22 times more likely to experience an STD than those with a late debut (≥ 15 years of age) (95% CI 1.88, 2.62). With respect to family circumstances and their relation to STD, the strongest association lay within adolescents’ perception of fathers caring “none to very little” and STD incidence (OR=2.75, 95% CI: 1.60-4.70). The strongest associations of family circumstances with early sexual debut were adolescents whose mothers served jail time (OR=3.38, 95%CI: 2.37-4.82) and adolescents who felt like their mothers approved of their sex lives (OR=3.11, 95%CI: 2.09-4.64). Age of sexual debut was tested for statistical interaction in the model and was only significant among the variable for mother figure. Stratifying for gender, relationship to mother figure for males proved to have a statistically significant interaction with debut for both levels of mother figure (No mother p


Public health intervention programs that address adverse health consequences of early sexual debut among adolescents would be beneficial. Programs should consider familial structure among adolescents, particularly male adolescents, as a factor in modifying an adolescent’s likelihood to engage in sexual risk behaviors and risk of subsequent STD.