Healthy Sexuality and Adolescents

by Mary Hrovat

Dr. Donald Orr, a professor of pediatrics and director of the Adolescent Medicine section of the Department of Pediatrics of Indiana University's School of Medicine, believes that researchers know relatively little about adolescent sexuality, despite the relevance of sexual behavior to adolescent health. The need to understand adolescent sexuality drew professors in the Adolescent Medicine section and researchers at the Kinsey Institute for Research in Sex, Gender, and Reproduction into collaboration. "We knew about STDs [sexually transmitted diseases] and we knew about adolescents," Orr says, "but we knew far less about sexuality than we wanted to."

Dr. J. Dennis Fortenberry, an associate professor of pediatrics and medicine, and Dr. Gregory Zimet, an associate professor of pediatrics and clinical psychology in psychiatry, both at the IU School of Medicine, work with Orr in the study of adolescent sexual health. When the section needed an advisory committee for a study involving adolescent sexuality, Dr. John Bancroft, a clinical professor of psychiatry at Indiana University Bloomington and director of the Kinsey Institute, agreed to sit on the committee. It soon became evident that their common interests went beyond that project.

Young people, who are at relatively high risk for contracting STDs, can be a difficult population to study (parental consent may be required and adolescents tend to lead irregular lives). Fortenberry points out that "issues of sexuality are often predominant" in determining adolescent sexual behavior, and complex emotional and sexual issues are central to the effort to enhance STD-prevention campaigns.

Of adolescents who have been successfully treated for an STD, approximately forty percent will contract a second STD within a few months. Fortenberry and Orr are examining the social context of these reinfections by studying young people over a six-month period after they have been treated for an STD. They use a unique combination of data-gathering methods--a questionnaire, an interview, and a diary- to investigate sexual and contraceptive habits, as well as emotional and social factors. Subjects use the diaries to record sexual activity, contraceptive use, and any alcohol or drug use associated with sexual activity. Fortenberry is trying to determine the social and emotional factors that influence whether or not adolescents choose to protect themselves during sexual activity. Such factors could include the length and commitment level of a sexual relationship, or the perceived relative economic power of the partners. Understanding the influences that affect sexual behavior can help to make public health campaigns and individual counseling techniques better able to promote less risky behavior.

In the literature on STDs, particularly on HIV, researchers tend to view vaccines as prospective "magic bullets" that will remove the need for behavioral means of controlling the STD in question. But acceptance of a vaccine also depends on behaviors that scientists do not fully understand. Zimet recently administered questionnaires to three groups of young people to determine how their health beliefs, the characteristics of a potential vaccine, and their health behaviors would influence their acceptance or rejection of the vaccine. The results revealed that the major factors that would influence acceptance were perceived susceptibility to the STD and the perception of belonging to an at-risk group: the stronger either of these perceptions, the higher the likelihood of acceptance. The type of vaccine would also influence acceptance: these groups indicated that they would be less likely to accept a vaccine that used live attenuated HIV, for example. Zimet has also begun a study of the attitudes toward and actual acceptance or rejection of a hepatitis B vaccine among STD clinic patients. In addition, he would like to investigate the attitudes of health care providers toward STD vaccines for young people. Even those who support such vaccinations are not always able to deal comfortably with the actual interactions involved, and this could be a factor in the effectiveness of a vaccination campaign. Although a vaccine for HIV is not yet available, Zimet believes that, if it does become available, it will be the focus of intense public reaction, so his research provides "an opportunity to anticipate some of the issues now," he says.

The informal partnership between the Kinsey Institute and the Adolescent Medicine section continues to enhance the research opportunities for all participants. Researchers hold joint meetings every month to discuss their work. Also, Fortenberry made a presentation entitled "Adolescent Sex and the Rhetoric of Risk and Protection" in April 1997 at the Kinsey Institute's series of interdisciplinary seminars. Orr describes the collaboration with the institute as "a mechanism to share ideas and to increase our understanding of sexuality." He believes the next step is a joint research project on some aspect of adolescent sexuality to cement this useful working relationship and to "expand the research base" of both organizations. Kinsey