Associação entre iniciação sexual precoce e coocorrência de comportamentos de risco à saúde: Pesquisa Nacional de Saúde do Escolar – PeNSE 2015

Abstract

Introduction: Early sexual initiation, before age 14, is associated with risky sexual behaviors, substance use (alcohol, tobacco and illicit drugs), mental problems, body dissatisfaction and behaviors indicative of eating disorders. However, there is not enough evidence in Brazil about the association between early sexual initiation and co-occurrence of health risk behaviors. Objective: To examine the co-occurrence of health risk behaviors according to the timing of sexual initiation (not early and early) by sex among Brazilian adolescents. Methods: We used secondary data from the 2015 National School Health Survey (PeNSE 2015) a cross-sectional study with 3,096 adolescents from the high school adolescent sample (sample 2). The exposure was the sexual initiation before the age 14, hereinafter referred to as early sexual initiation. The outcomes were four domains of health risk-behaviors: risky sexual behavior (no condom use in first and last sexual intercourse and multiple partners), substance use (alcohol, tobacco and illicit drugs), internalizing symptoms (social isolation and anxiety-induced sleep disturbance) and unhealthy weight control behavior (body dissatisfaction, unhealthy weight loss and gain practices). We used Venn diagram to describe the co-occurrence of health risk-behaviors and logistic regression models to assess the association between and the outcomes, stratified by sex and adjusted for covariates. Results: Boys and girls with early sexual initiation presented more prevalence of co-occurrence of all risk behaviors. The cooccurrence of health risk-behaviors among adolescents with early sexual initiation was greater compared with their counterparts; and its magnitude was greater among girls (13.4% vs 9.8%) than among boys (6.4% vs 5.6%). Early sexual initiation was associated with no condom use in first intercourse (ORboys: 2.95 95%CI=2.22-3.91; ORgirls: 1.66 95%CI=1.07-2.56) and in last intercourse (ORboys: 1.46 95CI%=1.08-1.97; ORgirls: 2.50 95%CI=1.63-3.83), multiple partners (ORgirls:4.71 95%CI=2.78-7.98; ORboys:4.59 95%CI=3.09-6.81) and unhealthy weight control practices to lose weight (ORboys: 1.90 95%CI=1.23-2.93; ORgirls: 2.03 95%CI=1.11-3.69) among boys and girls. Early sexual initiation was associated with all substances use among girls (ORalcohol: 1.55 95%CI=1.02-2.35; ORtobacco: 1.92 95%CI=1.09-3.36; ORdrugs: 2.04 95%CI=1.07-3.87), and alcohol (ORalcohol: 1.57 95%CI=1.19-2.09) and illicit drugs (ORdrugs: 1.52 95%CI=1.02-2.27) use among boys. Early sexual initiation was not associated with internalizing symptoms and body dissatisfaction for both sexes. Conclusion: Early sexual initiation was associated with cooccurrence of several health risk-behaviors in the fields of risky sexual behaviors and substance use, and the magnitude of this co-occurrence was greater among girls. The understanding of this co-occurrence can contribute to the education and health sectors in elaborating health promotion strategies for adolescents.