The study, published online by the American Journal of Public Health, is among the first to report on the little-known factors associated with heterosexual anal intercourse among adolescents and young adults.
"The topic of anal intercourse is often considered taboo – especially when discussed in the context of youth relationships – even though we know that this behavior is a significant risk factor for HIV and other sexually transmitted infections. It's critical that we recognize that more and more young people are engaging in anal sex so we can open the lines of communications and help them protect their sexual health," says lead author Celia Lescano, PhD, of the Bradley Hasbro Children's Research Center (BHCRC).
Researchers assessed the sexual behavior of 1,348 adolescents and young adults between the ages of 15 and 21 who had unprotected sex in the previous three months. They found that 16 percent had engaged in heterosexual anal intercourse within the timeframe, with condoms being used just 29 percent of the time.
Females who had heterosexual anal sex were more likely to be living with their partners, to have two or more sexual partners and to have previously experienced coerced intercourse. Males who engaged in heterosexual anal intercourse were more likely to identify themselves as being homosexual, bisexual or undecided.
"These findings suggest that the factors associated with anal intercourse among females in the study relate to the context and power balance of sexual relationships," says Lescano, who's also an assistant professor of psychiatry (research) at the Warren Alpert Medical School of Brown University. "We must teach teen girls and young women how to be assertive in sexual relationships, such as refusing unwanted sexual acts and negotiating for safer sex, whether it's anal or vaginal."
However, there were several factors related to anal intercourse that were consistent in both genders. In general, those who felt that using condoms decreased the pleasure of sex and those who used drugs at the time of intercourse engaged in riskier behaviors, suggesting that interventions should emphasize that sex can be both pleasurable and safe.
"An open dialogue between health care providers and their young patients about anal intercourse is becoming increasingly important, and clinicians should ask about anal sex during discussions about vaginal intercourse and protection – regardless of the patient's gender or reported sexual orientation," says Lescano.
Study participants in Atlanta, Miami and Providence completed a self-interview designed to measure sexual risk behaviors, relationships, sexual risk attitudes, substance use and mental health. The majority of the group (92 percent) defined themselves as being heterosexual. Overall, 56 percent were female; approximately half of the participants were African American, 24 percent were Hispanic and 20 percent were white.