Background

Although sexuality is a normal "developmental task" of adolescence, early sexual debut (before age 16) is well known as a "risk behaviour" with negative public health consequences in terms of greater STIs and teenage pregnancy compared to later debut. There is some evidence that early sexual behaviour shares common antecedents with other teenage risk behaviours such as substance use and antisocial behaviour. The proposed study would explore two areas highlighted for further research in a recent major review of US longitudinal research on sexual development [1]:

* Behavioural, emotional and school problems as predictors of early sexual debut: which factors are important, and when do they become predictive? (at early primary stage, or not until the age of transition from primary to secondary school?)

* Different developmental pathways to early sexual debut - what is the role of behavioural, emotional and school problems in these?

Behavioural, emotional and school problems as predictors of early sexual debut

The Zimmer-Gembeck and Helfand review ("ZGH review") found that behavioural, emotional and school problems appear uniquely associated with early, rather than later, sexual debut. The reviewers called for more research: fewUSstudies were able to examine these predictors, and existing research focused on children around the age of puberty, rather than earlier in childhood.

There is now a handful of population studies conducted since or outside the terms of the ZGH review indicating that behavioural problems (conduct and hyperactivity) in early childhood are predictive of early sexual debut [2-6]. None was conducted in the UK. We have found no studies looking at early depressive symptoms, which the ZGH review also suggests may predict early debut, especially in girls (relevant studies in review are all of early teens). Existing studies of school problems (low grades, negative attitudes to school and low educational aspirations) in relation to early sexual debut have measured problems around ages 10 to 13. This "transition" period is likely to be a particularly vulnerable time in terms of pubertal development, move to secondary school, and greater autonomy from parents. There is limited UK longitudinal research on school problems in relation to sexual debut and risk-taking for this age group [7].

The proposed study would examine behavioural, emotional and school problems as predictors of early sex reported in clinics up to and including the 15+ teen clinic. It would look at problems at different ages from the start of primary school, with a particular interest in whether any effects on early sexual debut may be traced back to early primary school, or do not emerge until the "transition" years.

For behavioural and emotional problems, the study would use SDQ and DAWBA scores and child's early antisocial behaviour including substance use (mother and teacher reports). For school problems, the study would use attitudes to school (mother and child reports) and SATs results (linked data). The analysis would adjust for well-established predictors of early sexual debut, including stage of pubertal development, socio-demographics, family adversity, romantic involvement, and parental monitoring. As school problems are one of the main areas of interest, it will also be important to adjust for IQ.

Different developmental pathways to sexual debut, and the role of behavioural, emotional and school problems

The ZGH review put forward the idea of different developmental pathways to sexual behaviour. Its interest was in different predictors of early (pre-16), mid (16-18) and late (post 18) sexual debut. Behavioural, emotional and school problems were suggested as "unique" predictors of early sexual debut. Mid adolescent sexual debut did not seem to have these antecedents characteristic of the development of a "problem behaviour" syndrome, but fitted a "biosocial" model of sexual development (emphasis on biological and social factors, and much less involvement in other risk behaviours). However, many biosocial predictors of mid debut were shared with early debut: these included physical maturity, not living with both biological parents, low parental monitoring, greater involvement in dating behaviour, and having friends who use substances. This raises the question of whether teenagers reporting early sexual debut are a heterogeneous rather than homogeneous group, making it possible to distinguish between those following biosocial and problem behaviour pathways. Other US work has found different developmental pathways to two groups of adolescents with high or low sexual risk-taking 'profiles', in keeping with a problem behaviour/biosocial pathway division [8].

The proposed study would attempt to categorise teenagers according to level of involvement in other risk behaviours around/just before sexual debut, and could also take account of later risky early sexual behaviour (eg condom use, partners). We would explore the hypothesis that early behavioural, emotional and school problems predict early sexual debut for teenagers with a high concurrent level of involvement in other risk behaviours, but are not important for teenagers without this risk involvement.

For this part of the study, information would be required on teenager's sexual risk (condom use, partners, etc), engagement in other risk behaviours including substance use and delinquent behaviour, from clinics up to and including the teen 15+ clinic and postal questionnaires at the same age.

References

1. Zimmer-Gembeck, M.J. and M. Helfand, Ten years of longitudinal research on U.S. adolescent sexual behavior: Developmental correlates of sexual intercourse, and the importance of age, gender and ethnic background. Developmental Review, 2008. 28(2): p. 153-224.

2. Fergusson, D.M., L.J. Horwood, and E.M. Ridder, Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. Journal of Child Psychology and Psychiatry, 2005. 46(8): p. 837-849.

3. Ramrakha, S.M.A., et al., Childhood Behavior Problems Linked to Sexual Risk Taking in Young Adulthood: A Birth Cohort Study. Journal of the American Academy of Child and Adolescent Psychiatry, 2007. 46(10): p. 1272-1279.

4. Schofield, H.L.T., et al., Predicting Early Sexual Activity with Behavior Problems Exhibited at School Entry and in Early Adolescence. Journal of Abnormal Child Psychology, 2008. 36(8): p. 1175-1188.

5. McLeod, J., D. and S. Knight, The Association of Socioemotional Problems With Early Sexual Initiation. Perspectives on Sexual and Reproductive Health, 2010. 42(2): p. 93-101.

6. Galera, C., et al., Disruptive behaviors and early sexual intercourse: The GAZEL Youth Study. Psychiatry research, 2010. 177(3): p. 361-363.

7. Bonell, C., et al., The effect of dislike of school on risk of teenage pregnancy: testing of hypotheses using longitudinal data from a randomised trial of sex education. Journal of Epidemiology and Community Health, 2005. 59(3): p. 223-230.

8. Siebenbruner, J., M.J. Zimmer-Gembeck, and B. Egeland, Sexual Partners and Contraceptive Use: A 16-Year Prospective Study Predicting Abstinence and Risk Behavior. Journal of Research on Adolescence (Blackwell Publishing Limited), 2007. 17(1): p. 179-206.