Partner Age Difference, Power, Intimate Partner Violence, and Sexual Risk In Adolescent Girls Ellen M. Volpe, PhD, FNP, Thomas Hardie, EdD, PMHCNS-BC , Catherine Cerulli, PhD, JD, Marilynn S. Sommers, PhD, RN, FAAN, and Dianne Morrison-Beedy, PhD, RN, FAAN

Funding Acknowledgments

National Institutes of Mental Health

F31MH082646-01A2 (PI E.Volpe, Sponsor: D. Morrison-Beedy)

National Institutes of Nursing Research

T32NR007100, (PI M. Sommers)

Sigma Theta Tau, Epsilon Chapter

Susan B. Anthony Institute

Background

Adolescent girls with older male partners at increased risk for HIV/STIs (e.g. Seth et al., 2010, Ryan et al., 2008, Senn et al., 2011)

Relationship power assumed to be the theoretical link between older partners and sexual risk behaviors (e.g. DiClemente et al., 2002; Teitelman et al., 2011)

Intimate Partner Violence (IPV) has been linked to sexual risk behavior ( e.g. Halpern et al., 2009, Howard et al., 2007, Seth et al. 2010)

Partner Age Difference as a Predictor of Relationship Power, IPV, and Consistent Condom use  in Adolescent Girls

Individuals’ social and economic characteristics

Demographic characteristics

Family/household characteristics

Community characteristics

Gender-based power

in sexual relationships

Access to and use of sexual

& reproductive

services

Reproductive health domains:

Consistent Condom Use

Violence: Physical IPV/

Psychological IPV

Relationship characteristics:• Partner Age Difference

Specific Aims

1. Examine the proposed model: Partner Age Difference as a Predictor of Relationship Power, IPV, and Consistent Condom use in Adolescent Girls

2. Estimate the direct effects of partner age difference on consistent condom

3. Analyze the indirect effects of that relationship through proposed mediators, relationship power and IPV

Methods

Design Cross-sectional, descriptive survey

Setting School-based health center, mid-size city

Sample 155 sexually-active, low-income adolescent

girls (ages 14-18) in reported “boyfriend” relationship

Procedures Anonymous, computer assisted self-

interview (CASI): Promote Health

Methods: Measures

Partner age difference

Sexual Relationship Power Scale (Pulerwitz et al., 2002)

Relationship Power

Decision-making Dominance

Conflict Tactics Scale (Straus & Douglas, 2004)

Severity of physical and psychological IPV

Consistent condom use

Methods: Analyses

Descriptives

Bivariate correlations

Multiple mediation models to estimate direct and indirect effects (Preacher & Hayes, 2008)

Results

Table 1: Sample Characteristics (n=155)

n (%) M (SD)Range (min;

max)

Participant Age   16.1 years (1.3) 14;18 yearsPartner’s Age   17.8 years (2.6) 14;33 years

Partner Age Difference   1.6 years (2.2) -1;15 years

Race Category      • African American/ Black 108 (69%)    • Caucasian 10 (7%)    • Race >1 28 (18%)    Hispanic 30 (19%)    Low SES 125 (81%)    

Results: Condom Use

Average of 24.5 episodes of vaginal sex, and 7.9 episodes of unprotected sex in 3 months

Only 24% of adolescent girls reported consistent condom use

Results: Relationship Power

An average of 2.9 on relationship power scale (1-4)

Almost 2/3rds fell into high relationship power level

Relationship control inversely correlated with IPV severity

Decision-making Dominance positively correlated with consistent condom use

Results: IPV

Adolescent girls reported high frequency of victimization Physical: 18% minor only, 18% severe Psychological: 47% minor only; 35% severe

Results: Direct and Indirect Effects

Partner age difference

Gender-based power in

sexual relationships

Consistent Condom Use

Severity of Psychological IPV

Severity of Physical IPV

.012

.651

-.429*

.000

.007 -.095

-.357

-.442*

*= p< .05

Discussion

Partner age difference was negatively correlated with consistent condom use

Not explained by any of the proposed mediators: relationship power, severity of physical and psychological IPV

Alternative explanations: Emotional manipulation not identified in relationship

power Clustering of adolescent risk behavior Complexity of condom use decision-making in

relationships

Discussion

Prevalence of physical and psychological IPV severity

Discreet constructions of relationship power Relationship control: inversely

related to IPV Decision-making dominance:

consistent condom use

Limitations

Cross-sectional design

Lack of variability in partner age difference

Lack of context for violence or measure of sexual risk

Implications

Elucidate the degree of partner age difference that predicts low relationship power

Investigate alternative explanations to explain partner age difference’s relationship to condom use

Examine implications of high relationship power among adolescent girls

Incorporate partner age, relationship control, and decision-making dominance in interventions

ReferencesDiClemente, R. J., Wingood, G. M., Crosby, R. A., Sionean, C., Cobb, B. K., Harrington, K., . . . Oh, M. K. (2002). Sexual risk behaviors associated with having older sex partners: A study of black adolescent females. Sexually Transmitted Diseases, 29(1), 20-24.

Halpern, C. T., Spriggs, A. L., Martin, S. L., & Kupper, L. L. (2009). Patterns of intimate partner violence victimization from adolescence to young adulthood in a nationally representative sample. Journal of Adolescent Health, 45(5), 508-516.

Howard, D. E., Wang, M. Q., & Yan, F. (2007). Psychosocial factors associated with reports of physical dating violence among U.S. adolescent females. Adolescence, 42(166), 311-324.

Pulerwitz, J., Gortmaker, S. L., & DeJong, W. (2000). Measuring sexual relationship power in HIV/STD research. Sex Roles, 42(7), 637-660.

Preacher, K. J. & Hayes, A. F., (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40 (3), 879-891.

References (continued)

Ryan, S., Franzetta, K., Manlove, J. S., & Schelar, E. (2008). Older sexual partners during adolescence: Links to reproductive health outcomes in young adulthood. Perspectives on Sexual & Reproductive Health, 40(1), 17-26.

Senn, T. E., & Carey, M. P. (2011). Age of partner at first adolescent intercourse and adult sexual risk behavior among women. Journal of Women's Health, 20(1), 61-66.

Seth, P., Raiford, J. L., Robinson, L. S., Wingood, G. M., & Diclemente, R. J. (2010). Intimate partner violence and other partner-related factors: Correlates of sexually transmissible infections and risky sexual behaviours among young adult African American women. Sexual Health, 7(1), 25-30.

Straus, M. A., & Douglas, E. M. (2004). A short form of the revised Conflict Tactics Scales, and typologies for severity and mutuality. Violence and Victims, 19(5), 507-520.

Teitelman, A. M., Tennille, J., Bohinski, J. M., Jemmott, L. S., & Jemmott, J. B. I. (2011). Unwanted unprotected sex: Condom coercion by male partners and self-silencing of condom negotiation among adolescent girls. Advances in Nursing Science, 34(3).