Introduction: The Positive Youth Development (PYD) framework addresses health through a multi-faceted approach focusing on youth in the context of their environment. Connectedness, or bonding, has been included in many PYD models as a crucial piece to promote positive health outcomes. Neighborhood connectedness, specifically, as it relates to sexual practices needs further study.
Hypothesis: To determine if the presence of higher levels of neighborhood connectedness is associated with healthier sexual practices in sexually active adolescents from a nationally representative dataset.
Methods: The study was based on a cross-sectional analysis using the Add Health dataset. Sexually active adolescents, grades 7-12, were included. Neighborhood protective factors were selected based on literature review to reflect aspects of connectedness and were analyzed individually, as well as in a composite manner. Logistic regression analysis was done to test the association between connectedness and sexual practice outcomes, including contraceptive use at first sex and at most recent sex. A secondary outcome was pregnancy in females. Covariates included gender, grade level, race, maternal education and urbanicity.
Results: The study population consisted of 2,565 adolescents. Significant associations (p≤.05) were seen between higher connectedness and healthy sexual practices for: any contraceptive use at first sex adjusted odds ratio (OR)=1.100 (95th % CI 1.034,1.171); condom use at first sex OR=1.100 (CI 1.036, 1.169); any contraceptive use at most recent sex OR=1.154 (CI 1.084,1.228); condom use at most recent sex OR=1.168 (CI 1.101, 1.239); and history of pregnancy OR=.885 (CI .791, .989). Individual factors, such as using a neighborhood recreation center, happiness living in ones' neighborhood and unhappiness moving from ones' neighborhood had consistently significant associations with healthier sexual practices.
Conclusions: Neighborhood connectedness was associated with healthier sexual practices. Adolescents with higher levels of connectedness had increased odds of using contraceptives at first sex, at most recent sex, and had decreased odds of pregnancy. Individual neighborhood protective factors were also associated with healthier sexual practices. These findings underscore the importance of a neighborhood component in PYD programs to promote healthy sexual practices in adolescents.