Rules, Behaviors, and Networks that Influence STD Prevention among Adolescents

1. Rules, Behaviors, and Networks that Influence STD Prevention among Adolescents • The structure of adolescent sexual networks. • The troubling relationship between virginity pledges in adolescence and STD acquisition in young adulthood.

2. AMERICAN JOURNAL OF SOCIOLOGY, JULY 2004 Chains of Affection: The Structure of Adolescent Romantic and Sexual Networks  Peter S. Bearman* Institute for Social and Economic Research and Policy Columbia University  James Moody Department of Sociology Ohio State University  Katherine Stovel Department of Sociology University of Washington Data for this paper are drawn from the National Longitudinal Study of Adolescent Health (Add Health), a program project designed by J. Richard Udry and Peter Bearman, and funded by a grant HD31921 from the National Institute of Child Health and Human Development to the Carolina Population Center, University of North Carolina at Chapel Hill, with cooperative funding participation by the following agencies: The National Cancer Institute; The National Institute of Alcohol Abuse and Alcoholism; the National Institute on Deafness and other Communication Disorders; the National Institute on Drug Abuse; the National Institute of General Medical Sciences; the National Institute of Mental health; the Office of AIDS Research, NIH; the Office of Director, NIH; The National Center for Health Statistics, Centers for Disease Control and Prevention, HHS; Office of Minority Health, Centers for Disease Control and prevention, HHS, Office of the Assistant Secretary for Planning and Evaluation, HHS; and the National Science Foundation. The authors thank Douglas White, Martina Morris, Mark Hancock, and J. Richard Udry for helpful comments on previous drafts of this paper. *Corresponding author. Institute for Social and Economic Research and Policy. 814 SIPA Building, Columbia University, New York NY 10027. Email: psb17@columbia.edu

3. Contact structure? Local vision

4. Contact structure Global vision

6. A sexual and romantic network for a single high school 2 12 9 Male Female 63

7. A sexual and romantic network for a single high school 2 12 9 Male Female 63

8. Bob Alice ? Time 1 Time 1 Carol Ted Time 2 Hypothetical Romantic Cycle

9. Indirect Pathways

10. Indirect Cores: Removing cut-point ties in indirect relationship graph Shaded nodes are members of indirect cores

11. What Are the Implications of This Work, for Intervention? • Cores may be absent in adolescent sexual networks. Therefore concentrating on intervention amongst adolescents identified as likely to be in a CORE – from number of sexual partners, for example, is unlikely to be effective. • Very small changes in behavior anywhere in the system can have very significant impacts on the structure of disease diffusion. • But, we cannot tell ex ante where such cuts will have the biggest impact. One predictor that would seem important is not at all important – number of sex partners.

12. What Are the Implications of This Work, for Intervention? • Very subtle micro-level rules that govern adolescent decisions have extremely large macro-level consequences. Understanding the adolescent culture is critical for effective intervention. 5. Or, with less subtlety, Adolescents are different than adults. Importing adult models of sexual networks into the adolescent context is misleading.

13. The Relationship Between Virginity Pledges in Adolescence and STD Acquisition in Young Adulthood. After the promise: The long-term consequences of adolescent virginity pledges Peter Bearman Columbia University Hannah Brückner Yale University

14. Previous Work on the Pledge Showed… • On average, the pledge delayed the transition to first sex by 18 months, for adolescents age 12-18. But we also showed that: • The pledge worked for some kids in some contexts, but not all kids in all contexts, specifically. • If no other adolescents in the community pledged, there was no pledge effect. • If too many adolescents in the community pledged, there was no pledge effect. Equally problematic: • Pledgers were much less likely to contracept at first intercourse than non-pledgers. Consequently, their risk to STD acquisition and pregnancy was as high, despite the delay.

15. Most Frequent Answer Patterns Across Waves

19. Context Effect on Sexual Debut: Consistent Pledgers

20. STD Rates, by Race/Ethnicity and Gender

26. Summary So Far • Pledge STD rates are as high as non-pledge STD rates. They should not be because: • Pledgers debut to first-sex later than non-pledgers • Pledgers marry earlier than non-pledgers • Pledgers have fewer partners than non-pledgers • Pledgers have less cumulative exposure than non-pledgers • Pledgers’ partners are less likely to cheat than non-pledgers’ partners (from self-report)

27. On the Other Hand: • Pledge condom use is significantly lower than non-pledge condom use And • Pledge partners are as risky on average as non-pledge partners

28. Knowledge Do pledgers differ from non-pledgers in terms of: • Getting tested? • Getting diagnosed? • Seeing a doctor?

32. Pledge:

33. The end (whew) • Three points: • All adolescents count • Understanding is key • Knowledge is crucial All data are drawn from the National Longitudinal Study of Adolescent Health (Add Health), a program project funded by the NICHD and fifteen federal agencies, including the CDC. Add Health was designed by J. Richard Udry, Peter Bearman, and Kathleen Harris.