Dimensions of Early Adversity and Sexual Behavior in a US Population-Based Adolescent Sample

Purpose: Early life adversity (ELA) is associated with sexual risk, but ELA dimensions-and po-tential mechanisms-have been less examined. We evaluated associations between threat and deprivation-two key ELA dimensions-and sexual behaviors in adolescents. Secondary analyses investigated age at menarche as a mechanism linking ELA with sexual outcomes in girls. We predicted associations between threat and sexual behaviors, with younger age at menarche as a pathway. Methods: Data were from the National Comorbidity Survey, Adolescent Supplement. Adolescents and caregivers reported on youths' ELA experiences, which were categorized as threat-or deprivation-related. Adolescents reported if they engaged in sex (N = 9,937) and on specific sexual risk indicators, including age at first sex, number of past-year sexual partners, and condom use consistency ("always" vs. "not always" used). Girls reported age at menarche. Results: Threat (odds ratio [OR] = 1.76 [95% confidence interval [CI], 1.62e1.92]) and deprivation (OR = 1.51 [95% CI, 1.24e1.83]) were each linked with engagement in sex, ps<.05. Threat-related experiences were associated with multiple sexual risk markers, even when accounting for depri-vation: earlier age at first sex (b =-0.20 [95% CI,-0.27 to 0.13]), greater number of partners (b = 0.17 [95% CI, 0.10e0.25]), and inconsistent condom use (OR = 0.72 [95% CI, 0.64e0.80]), ps <.001. Deprivation was not associated with sexual risk when adjusting for threat. We observed no signif-icant indirect effects through age at menarche. Discussion: Although threat and deprivation were related to engagement in sexual activity, threat -related experiences were uniquely associated with sexual risk. Screening for threat-related ELA may identify adolescents at-risk for poor sexual health. (c) 2022 Society for Adolescent Health and Medicine. All rights reserved.