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J Adolesc Health. 2014 Apr;54(4):435-441.e2. doi: 10.1016/j.jadohealth.2013.09.016. Epub 2013 Nov 23.

Understanding the link between early sexual initiation and later sexually transmitted infection: test and replication in two longitudinal studies.

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Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington. Electronic address:
Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington.
Center for AIDS and STD, School of Public Health, University of Washington, Seattle, Washington.



Age at sexual initiation is strongly associated with sexually transmitted infections (STI); yet, prevention programs aiming to delay sexual initiation have shown mixed results in reducing STI. This study tested three explanatory mechanisms for the relationship between early sexual debut and STI: number of sexual partners, individual characteristics, and environmental antecedents.


A test-and-replicate strategy was employed using two longitudinal studies: the Seattle Social Development Project (SSDP) and Raising Healthy Children (RHC). Childhood measures included pubertal age, behavioral disinhibition, and family, school, and peer influences. Alcohol use and age of sexual debut were measured during adolescence. Lifetime number of sexual partners and having sex under the influence were measured during young adulthood. Sexually transmitted infection diagnosis was self-reported at age 24. Early sex was defined as debut at <15 years. Path models were developed in SSDP evaluating relationships between measures, and were then tested in RHC.


The relationship between early sex and STI was fully mediated by lifetime sex partners in SSDP, but only partially in RHC, after accounting for co-occurring factors. Behavioral disinhibition predicted early sex, early alcohol use, number of sexual partners, and sex under the influence, but had no direct effect on STI. Family management protected against early sex and early alcohol use, whereas antisocial peers exacerbated the risk.


Early sexual initiation, a key mediator of STI, is driven by antecedents that influence multiple risk behaviors. Targeting co-occurring individual and environmental factors may be more effective than discouraging early sexual debut and may concomitantly improve other risk behaviors.


Adolescence; Alcohol use; Antisocial peers; Behavioral disinhibition; Early sexual initiation; Family management; Lifetime number of sexual partners; Sex under the influence; Sexually transmitted infection

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