1. Parental Alcohol Problems and Early Sexual Debut in Young Adult Women Claudia Gambrah, Alexis E. Duncan, Andrew C. Heath

2. Introduction Increased vulnerability to sexually transmitted disease and greater number of sexual partners (Westrom & Eschenback 199). Young people (ages 15-19) display the greatest number of sexually transmitted disease cases and represent the group with the sharpest rises in rate of sexually transmitted disease per year (CDC, 2009 ). More sexual partners leads to higher HIV exposure and increased risk (CDC, 2009). Disease is not the only problem (Cavazos Rehg et al., 2007)

3. What Do We Know Studies have shown that parental history of alcohol dependence is directly associated with increased risk of becoming sexually active at 16 years of age. However, there are few studies that have been done to corroborate this finding (“Predictors” Cavazos-Rehg et al).

4. Objective We sought to characterize the association between maternal and paternal alcohol problems and early sex

5. Methods The Missouri Adolescent Female Twin Study (MOAFTS) Longitudinal study of female twin pairs born in Missouri between 1975 and 1985 Sample demographically representative of the Missouri population Data from Wave 4 assessment when twins were aged 18-28 years Telephone interview with an adaptation of the Semi-Structured Assessment for the Genetics of Alcoholism

6. Methods Parental alcohol problems Endorsement of one of the following two questions for mother and/or father: “Has drinking ever caused you biological mother/father to have problems with health, family, job or police, or other problems?” “Have you ever felt that your biological mother/father was an excessive drinker?”

7. Methods Early Sex Endorsement of the following question ▫Have you ever had sexual intercourse (other than when you were forced)? Endorsement of the following question with age of less than 16 years ▫How old were you when you first had sexual intercourse (other than when you were forced to)?

8. Methods Covariates ▫Disagreement between Parent and Child  How often did you have an unpleasant disagreement or conflict with your mother/father figure ▫Quality of Relationship between Parent and Child  Overall how close were you and your mother/father figure ▫Rules Established in the Household  Did your mother/father figure have any rules for the household ▫No Mother or Father Figure  If only one parent figure coded yes, questions were asked about that parent figure only

9. Methods Covariates ▫Parental Education  Less than high school education or unknown level of education ▫Early Maturation  Age of first period less than 12 years of age ▫Conduct Disorder  Diagnosis by endorsing questions related to conduct disorder ▫Childhood Sexual Abuse  If age of childhood rape, molestation or forced sex less than 16 years of age ▫Childhood Physical Abuse  Endorsement of either of the following: were you physically abused as a child; were you ever physically injured or hurt on purpose by an adult; were you ever slapped by a parental figure when you did something wrong when 6-13 years of age

10. Data Analysis Logistic regression in Stata Robust standard errors to account for relatedness of co-twins In addition to the full model, a more parsimonious model was constructed by backwards elimination of covariates, beginning with the least statistically significant. If removal of a covariate resulted in a change in parental alcohol problem ORs >10%, it was retained in the model.

11. Results

12. Descriptive Statistics of Association Between Early Sex and Parental Covariates Table 1. African Americans BothMom OnlyDad OnlyNeitherP-Value Drinking Problem50.0040.0021.1324.350.0015 Disagreements with Parent0.0033.3322.2226.110.1169 Not Being Close with Parent35.0035.7126.9821.350.1102 No Rules from Parent49.3336.3626.4815.91<0.0001 No Mother Figure9.590.0331 No Father Figure 63.01 0.0144 Table 1. non African Americans BothMom OnlyDad OnlyNeitherP-Value Drinking Problem38.9829.6930.7715.36<0.0001 Disagreements with Parent33.8730.6729.4518.55<0.0001 Not Being Close with Parent28.6534.1331.1514.18<0.0001 No Rules from Parent22.0931.6328.1715.47<0.0001 No Mother Figure4.000<0.0001 No Father Figure 29.08 <0.0001

13. Table 1. Logistic Regression Model for the Association between Early Sex & Parental, Environmental and Self Variables (African Americans) Parental Drinking ProblemsUnadjustedFully Adjusted*Most Parsimonious** Mom Drinking Problem2.766 (1.601 4.779)1.990 (1.025 3.864)1.942 (1.1015 3.716) Dad Drinking Problem0.93 (0.608 1.425)0.709 (0.421 1.190)0.715 (0.435 1.178) Disagreements With Parents0.871 (0.395 1.918) No Close Relationship With Mother1.407 (0.632 3.133) No Close Relationship With Father0.343 (0.138 0.852)0.379 (0.157 0.915) No Rules Established By Parents2.432 (1.175 5.009)2.572 (1.250 5.293) Maternal Education < high school1.800 (0.975 3.321) 1.722 (0.959 3.128) missing0.710 (0.194 2.608) 0.779 (0.346 1.788) Paternal Education < high school0.967 (0.540 1.731) missing1.126 (0.409 3.096) No Mother Figure1.086 (0.345 3.422) 1.120 (0.605 3.202) No Father Figure1.967 (0.844 4.582) 1.793 (0.761 3.924) Age greater than 161.084 (0.669 1.757) Early Maturation1.442 (0.905 2.296) Conduct Disorder2.843 (1.358 5.952) 2.584 (1.306 5.431) Child Sexual Abuse2.659 (1.503 4.704) 2.733 (1.591 4.813) Child Physical Abuse0.799 (0.463 1.381)

14. Table 2. Logistic Regression Model for the Association between Early Sex & Parental, Environmental and Self Variables (non African Americans) Parental Drinking ProblemsUnadjustedFully Adjusted*Most Parsimonious** Mom Drinking Problem1.828 (1.370 2.438)1.215 (0.842 1.754)1.273 (0.881 1.839) Dad Drinking Problem2.304 (1.903 2.789)1.541 (1.214 1.955)1.704 (1.352 2.147) Disagreements With Parents 1.255 (0.942 1.672) No Close Relationship With Mother 1.073 (0.742 1.550) No Close Relationship With Father 1.206 (0.904 1.610) No Rules Established By Parents 1.172 (0.937 1.479) Maternal Education < high school 1.487 (1.032 2.140) missing 0.505 (0.161 1.586) Paternal Education < high school 1.367 (1.003 1.863) missing 2.564 (0.854 7.701) No Mother Figure 1.822 (0.888 3.737)2.168 (1.122 4.188) No Father Figure 1.388 (0.984 1.959)1.877 (1.445 2.437) Age greather than 16 1.587 (1.277 1.973)1.568 (1.266 1.943) Early Maturation 1.602 (1.265 2.029) Conduct Disorder 4.511 (3.054 6.664)4.851 (3.302 7.110) Child Sexual Abuse 1.464 (1.085 1.974)1.674 (1.247 2.246) Child Physical Abuse 1.073 (0.787 1.464)1.287 (0.962 1.721)

15. Discussion In the African American model, women who had a mother with a drinking problem were significantly more likely to have early sex. ▫Even when adjusting for confounding factors, the association remained very strong. In non African American Model, women having a father with a drinking problem were more likely to have early sex. ▫Before adjusting for covariates, having both either parent with a drinking problems was associated with having early sex. However, after adjusting for confounding factors, the association between having a mother with a drinking problem and early sex was no longer significant.

16. Complementary Data African- American (n=553) Non-African- American (n=3233)P-value Parents not married75.0536.84<0.001 No mother figure5.972.04<0.001 No father figure54.2516.64<0.001

17. Limitations Parental drinking problems were reported by offspring rather than the parents themselves Drinking problem was defined for biological parent whereas other variables were defined for parental figure African American group is significantly smaller in number than that of non African American group

18. Future Directions Survival Analysis ▫To look at time to sexual debut, in addition to findings regarding early sexual debut presented here Further explore the association of Parental Drinking Problems and negative familial environment ▫How much does parental alcoholism relate to factors such as parent-child closeness, rules in the household, etc.?

19. Questions?