To examine national estimates of sexual behaviors and health care access by acculturation among adolescents.
Using the 2006–2010 National Survey of Family Growth, four acculturation groups of Hispanic and non-Hispanic whites aged 15–24 years were analyzed by sexual behaviors and health care access.
In analyses adjusted for demographics, English-speaking immigrants, Hispanic natives, and non-Hispanic white youth were less likely to have a partner age difference of ≥6 years (adjusted odds ratio [AOR], .28; 95% confidence interval [CI], .13–.60; AOR, .13; 95% CI, .07–.26; AOR, .16; 95% CI, .08–.32, respectively) and more likely to use a condom at the first vaginal sex (AOR, 1.99; 95% CI, 1.10–3.61; AOR, 2.10; 95% CI, 1.33–3.31; AOR, 2.39; 95% CI, 1.53–3.74, respectively) than Spanish-speaking immigrants. Non-Hispanic white youth and Hispanic natives were more likely to have a regular place for medical care (AOR, 2.07; 95% CI, 1.36–3.16; AOR, 3.66; 95% CI, 2.36–5.68, respectively) and a chlamydia test in the past 12 months (AOR, 3.62; 95% CI, 1.52–8.60; AOR, 2.94; 95% CI, 1.32–6.54) than Spanish-speaking immigrants.
Interventions to reduce risk and increase health care access are needed for immigrant Hispanic youth, particularly Spanish-speaking immigrants.
Hispanic youth face many sexual and reproductive health challenges including unplanned pregnancy and a disproportionate burden of sexually transmitted infections (STIs) compared with non-Hispanic white youth [
Data are from the 2006–2010 National Survey of Family Growth, a national household probability sample of men and women in the United States. Interviews were conducted in English and Spanish; Hispanics and youth (ages 15–24 years) were oversampled. Demographics and health care access were collected through computer-assisted personal interviews. Sexual behavior and self-reported chlamydia testing were collected through audio computer-assisted self-interviews. The response rate was 75% for males and 78% for females. Analyses were restricted to 6,091 Hispanic and non-Hispanic white youth, ages 15–24 years.
We created a proxy for acculturation, similar to previous acculturation studies, using three variables: race/ethnicity (Hispanic and non-Hispanic white), language of the audio computer-assisted self-interviews survey (English speaking or Spanish speaking), and nativity (U.S. native or non-U.S. native) [
We analyzed acculturation groups by demographics, sexual behaviors, and health care access using bivariate analyses. We examined acculturation groups adjusted for demographics in association with selected behavioral and health care access outcomes identified from previous research [
English-speaking immigrants reported living in the United States for an average of 12.6 years compared with 4.8 years for Spanish-speaking immigrants (
The majority (62.9%) of Hispanic and non-Hispanic white adolescents and young adults reported ever having vaginal sex (data not shown in tables). However, in bivariate analyses, reports of ever having vaginal sex were significantly higher among Spanish-speaking immigrants (76.2%) compared with other acculturation groups (61.7%–65.8%). Age difference with a partner at the first vaginal sex varied significantly by acculturation group with 27.2% of Spanish-speaking immigrants reporting an age difference of ≥6 years compared with <10% among other groups (4.2%–8.2%). Among youth who ever reported vaginal sex, significantly fewer Spanish-speaking immigrants used a condom at first sex (52.6%) compared with the other groups (70.6%–73.6%). However, condom use at the most recent vaginal sex did not significantly differ in acculturation group. Among other sexual behaviors, more non-Hispanic white youth (57.3%) reported ever having oral sex compared with Hispanic youth (47.5%–47.9%) but there was no significant difference in reporting ever having anal sex.
For health care access, most Spanish-speaking immigrants (64.8%) reported no health insurance coverage as opposed to most non-Hispanic white youth reporting private health insurance (70.2%). Similar to trends of health insurance coverage, 70.2% of Spanish-speaking immigrants reported a gap in insurance during the past 12 months compared with only 22.8% of non-Hispanic white youth. For health care utilization, among females, reporting receipt of a chlamydia test (past 12 months) was significantly higher for U.S.-native youth (Hispanic and non-Hispanic white) compared with Hispanic immigrants. Among males, reporting receipt of an STD test (past 12 months) did not differ in acculturation groups.
After controlling for demographics in adjusted analyses, English-speaking immigrants, Hispanic natives, and non-Hispanic white youth did not differ significantly in ever having vaginal sex compared with Spanish-speaking immigrants, but they were less likely to have an age difference of ≥6 years with their partner at the first vaginal sex (
Sexual behavior and health care access varied by acculturation groups within this nationally representative sample of Hispanic and non-Hispanic white youth. Similar to previous literature, condom use at the first sex was higher among Hispanic subgroups considered more acculturated, and Hispanic youth were less likely to report access to health care [
Few sexual health interventions have been developed and systematically evaluated to reach Hispanic youth [
A portion of these data were presented at the 2013 Society for Adolescent Health and Medicine Meeting, Atlanta, Georgia, March 14, 2013.
This research was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention (CDC) administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and CDC.
Demographic characteristics, sexual behaviors, and health care access and utilization of Hispanic and non-Hispanic white adolescents and young adults, age 15–24 years, by language of interview and nativity, National Survey of Family Growth 2006–2010 (n = 6,091)
| Unweighted sample size (weighted %) | Racial/ethnic groups by language and nativity | ||||
|---|---|---|---|---|---|
|
| |||||
| Hispanic, Spanish, | Hispanic, | Hispanic, | Non-Hispanic white, | ||
| Population total estimate | 1,296,000 | 1,052,000 | 5,023,000 | 24,874,000 | |
| Time in U.S. (years), mean (SE) | 4.8 (.4) | 12.6 (.5) | — | — | <.0001 |
| Demographic characteristics | |||||
| Age (years) | <.0001 | ||||
| 15–19 | 28.2 (3.8) | 52.9 (3.8) | 58.6 (1.9) | 49.9 (1.7) | |
| 20–24 | 71.8 (3.8) | 47.1 (3.8) | 41.4 (1.9) | 50.1 (1.7) | |
| Gender | .9347 | ||||
| Female | 46.1 (4.7) | 49.1 (4.3) | 49.2 (1.8) | 49.0 (1.1) | |
| Male | 54.0 (4.7) | 50.9 (4.3) | 50.8 (1.8) | 51.0 (1.1) | |
| Income–poverty ratio | <.0001 | ||||
| 0%–133% federal poverty level | 70.6 (3.5) | 49.4 (4.1) | 46.3 (2.5) | 30.2 (1.3) | |
| ≥134% federal poverty level | 29.4 (3.5) | 50.6 (4.1) | 53.7 (2.5) | 69.8 (1.3) | |
| Residence | .0002 | ||||
| MSA, central city | 41.2 (4.6) | 38.9 (4.9) | 41.5 (3.8) | 29.5 (3.8) | |
| MSA, other | 46.2 (5.2) | 50.3 (5.5) | 50.9 (4.4) | 45.1 (3.0) | |
| Non-MSA | 12.6 (5.1) | 10.8 (4.3) | 7.6 (2.2) | 25.4 (2.7) | |
| Sexual behaviors | |||||
| Ever had vaginal sex | .0024 | ||||
| Yes | 76.2 (3.3) | 65.8 (3.8) | 64.7 (1.7) | 61.7 (1.7) | |
| No | 23.8 (3.3) | 34.2 (3.8) | 35.3 (1.7) | 38.3 (1.7) | |
| Only had vaginal sex once | .1654 | ||||
| Yes | 1.8 (1.0) | 4.6 (1.7) | 5.0 (.9) | 3.8 (.5) | |
| No | 98.3 (1.0) | 95.4 (1.7) | 95.0 (.9) | 96.3 (.5) | |
| Age difference at the first vaginal sex | .0004 | ||||
| ≤5 years | 72.9 (4.1) | 91.8 (2.8) | 95.8 (.8) | 94.9 (.8) | |
| ≥6 years | 27.2 (4.1) | 8.2 (2.8) | 4.2 (.8) | 5.1 (.8) | |
| Condom use at the first vaginal sex | .0022 | ||||
| Yes | 52.6 (4.3) | 70.6 (4.3) | 71.0 (2.5) | 73.6 (2.1) | |
| No | 47.4 (4.3) | 29.4 (4.3) | 29.0 (2.5) | 26.4 (2.1) | |
| Condom use at the last vaginal sex | .1305 | ||||
| Yes | 41.0 (4.7) | 53.1 (5.4) | 51.7 (2.6) | 53.3 (1.9) | |
| No | 59.0 (4.7) | 46.9 (5.4) | 48.3 (2.6) | 46.7 (1.9) | |
| Ever had oral sex | .0066 | ||||
| Yes | 47.8 (4.2) | 47.9 (3.7) | 47.5 (1.8) | 57.3 (2.0) | |
| No | 54.2 (4.2) | 52.1 (3.7) | 52.6 (1.8) | 42.7 (2.0) | |
| Ever had anal sex | .3913 | ||||
| Yes | 28.2 (4.2) | 26.3 (3.6) | 22.7 (1.3) | 22.0 (1.4) | |
| No | 71.8 (4.2) | 73.7 (3.6) | 77.3 (1.3) | 78.0 (1.4) | |
| Health care access and utilization | |||||
| Health insurance coverage | <.0001 | ||||
| Private insurance | 15.1 (3.6) | 35.9 (3.4) | 42.8 (2.0) | 70.2 (1.8) | |
| Public insurance | 20.1 (3.2) | 23.3 (3.1) | 32.1 (2.1) | 15.0 (1.1) | |
| No insurance | 64.8 (4.2) | 40.8 (3.6) | 25.1 (2.0) | 14.8 (1.0) | |
| Gap in health insurance, past 12 months | <.0001 | ||||
| Yes | 70.2 (3.8) | 53.4 (3.8) | 33.3 (2.3) | 22.8 (1.3) | |
| No | 29.8 (3.8) | 46.6 (3.8) | 66.7 (2.3) | 77.2 (1.3) | |
| Regular place for medical care | .0001 | ||||
| Yes | 48.5 (5.3) | 60.2 (4.7) | 70.5 (1.9) | 80.8 (1.2) | |
| No | 51.5 (5.3) | 39.8 (4.7) | 29.6 (1.9) | 19.2 (1.2) | |
| Chlamydia test, past 12 months (females) | .0191 | ||||
| Yes | 15.1 (4.6) | 19.3 (3.8) | 28.1 (3.2) | 25.5 (1.8) | |
| No | 84.9 (4.6) | 80.7 (3.8) | 71.9 (3.2) | 74.5 (1.8) | |
| STD test, past 12 months (males) | .2059 | ||||
| Yes | 14.5 (4.8) | 15.5 (4.9) | 17.3 (1.9) | 12.3 (1.4) | |
| No | 85.5 (4.8) | 84.5 (4.9) | 82.7 (1.9) | 87.7 (1.4) | |
| STD treatment, past 12 months | .6193 | ||||
| Yes | 2.9 (1.1) | 2.4 (.9) | 3.8 (.6) | 3.7 (.4) | |
| No | 91.1 (1.1) | 97.6 (.9) | 96.3 (.6) | 96.3 (.4) | |
CMH = Cochran-Mantel-Haenszel; MSA = metropolitan statistical area; SE = standard error; STD = sexually transmitted disease.
The following variables were only asked of respondents that reported ever having vaginal sex: only had vaginal sex once, age difference at the first vaginal sex, condom use at the first vaginal sex, and condom use at the last vaginal sex.
Health insurance coverage was current as of the interview date. Several response options were recoded into public, private, and no insurance.
Private health insurance includes private or Medi-Gap.
Public health insurance includes Medicaid, Children’s Health Insurance Program, state-sponsored health plan, Medicare, military health care, or other government health care.
No health insurance includes single-service plan, only by the Indian Health Service, or not covered by health insurance.
The regular place for medical care was asked from 2008 to 2010 (n = 4,599).
For males, the STD test is for gonorrhea, chlamydia, herpes, or syphilis, in the past 12 months. For females, the STD test is a chlamydia test in the past 12 months. There is a statistically significant difference in the CMH chi-square test of association for gender and STD test (
Adjusted analyses (adjusted odds ratios and 95% confidence intervals) for sexual behaviors and health services by demographic characteristics of Hispanic and non-Hispanic white adolescents and young adults, aged 15–24 years, National Survey of Family Growth, 2006–2010
| Correlate | Sexual behaviors and health services | ||||
|---|---|---|---|---|---|
|
| |||||
| Ever had vaginal sex; unweighted n = 6,091 | Age difference of ≥6 years at the first vaginal sex; unweighted n = 3,877 | Used condom at the first vaginal sex; unweighted n = 3,877 | Regular place for medical care; unweighted n = 4,599 | Chlamydia test, past 12 months (females only); unweighted n = 3,089 | |
| Racial/ethnic group | |||||
| Hispanic, Spanish, non-U.S. native | Referent | Referent | Referent | Referent | Referent |
| Hispanic, English, non-U.S. native | .96 (.54–1.68) | .28 (.13–.60) | 1.99 (1.10–3.61) | 1.30 (.70–2.42) | 1.73 (.66–4.55) |
| Hispanic, English, U.S. native | 1.04 (.72–1.48) | .13 (.07–.26) | 2.10 (1.33–3.31) | 2.07 (1.36–3.16) | 3.62 (1.52–8.60) |
| Non-Hispanic white, English, U.S. native | .65 (.41–1.04) | .16 (.08–.32) | 2.39 (1.53–3.74) | 3.66 (2.36–5.68) | 2.94 (1.32–6.54) |
| Age (years) | |||||
| 15–19 | .12 (.09–.15) | .73 (.50–1.07) | 1.20 (.93–1.54) | 1.60 (1.29–1.99) | .29 (.23–.36) |
| 20–24 | Referent | Referent | Referent | Referent | Referent |
| Gender | |||||
| Female | 1.14 (.97–1.34) | 2.53 (1.50–4.27) | .60 (.48–.75) | 1.78 (1.39–2.27) | — |
| Male | Referent | Referent | Referent | Referent | — |
| Income–poverty ratio | |||||
| 0%–133% federal poverty level | .90 (.70–1.16) | 1.47 (.93–2.34) | .89 (.71–1.10) | .84 (.68–1.05) | 1.30 (1.01–1.68) |
| ≥134% federal poverty level | Referent | Referent | Referent | Referent | Referent |
| Residence | |||||
| MSA, central city | .63 (.39–1.01) | .96 (.54–1.69) | .89 (.53–1.52) | .78 (.50–1.24) | 1.16 (.67–2.01) |
| MSA other | .75 (.58–.97) | .87 (.47–1.63) | 1.06 (.72–1.56) | .85 (.56–1.30) | 1.25 (.87–1.79) |
| Non-MSA | Referent | Referent | Referent | Referent | Referent |
MSA = metropolitan statistical area.
Analyses were adjusted for age, gender, income–poverty ratio, and residence.
The following variables were only asked of respondents who reported ever having vaginal sex: age difference at the first vaginal sex and condom use at the first vaginal sex.
The regular place for medical care was asked from 2008 to 2010 (n = 4,599).
Language of the audio computer-assisted self-interviews survey.
This study describes national estimates of sexual behaviors and health care access among three acculturation groups of Hispanic adolescents and young adults and non-Hispanic white youth. Findings from this study are generalizable and may benefit interventions to reduce risk and improve access to health care among Hispanic youth.