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Physical illness, social disadvantage, and risky sexual behavior in adolescence and young adulthood

Purpose This study investigates the influence of physical illness on sexual risk-taking behaviors in adolescence and young adulthood, both directly and through moderation of the impact of social disadvantage. We hypothesize positive effects for social disadvantage and physical illness on sexual risk behavior, consistent with the development of fast life history behavioral strategies among young people facing greater life adversity. Methods Using the first two waves of the National Longitudinal Study of Adolescent Health, we develop a mixed effects multinomial logistic regression model predicting sexual risk behavior (nonmonogamous sex v. monogamous sex, and nonmonogamous sex v. no sex) by social characteristics, physical illness, interactions thereof, and control covariates. Analyses use multiple imputation to address a modest amount of missing data. Results Subjects reporting higher levels of physical illness had lower odds of abstinence v. engaging in nonmonogamous sex (OR=0.79, p<0.001), and lower odds of having monogamous sex v. engaging in nonmonogamous sex (OR=0.89, p<0.001), compared to individuals in better health. Physical illness significantly moderated the gender (OR=0.85, p<0.001), race/ethnicity (e.g., OR=1.23, p<0.001), and childhood SES (OR=0.95; p<0.05) effects for the abstinent v. nonmonogamous sex comparison. All substantive findings were robust across waves and in sensitivity analyses. Conclusions These findings offer general, but not universal, support for the predictions of life history theory. Physical illness and various social disadvantages are generally associated with increased sexual risk behavior in adolescence and young adulthood. Further, analyses show that the buffering effects of several protective social statuses against sexual risk-taking are substantially eroded by physical illness. Implications and Contribution Various social disadvantages and physical illness are positively associated with adolescent and young adult nonmonogamous sex. Additionally, the protective effects of female gender, white identity, and socioeconomic advantage against sexual risk-taking in adolescence and young adulthood are substantially reduced by physical illness. Findings elucidate the powerful influence of physical illness on adolescent and young adult sexual behavior.