Pathways From Peer Victimization to Sexually Transmitted Infections Among African American Adolescents ********************
Peer victimization and high rates of sexually transmitted infections (STIs) are major public health concerns, especially for African American youths residing in low-income communities. However, less frequently studied is the link between the two. Bullying refers to frequent, unwanted aggressive behaviors enacted by an individual or group of individuals who are not siblings or cur-rent dating partners (Gladden, Vivolo-Kantor, Hamburger, & Lumpkin, 2014). There is a pervasive imbalanced power relationship between perpetrator and victim, and victims of bullying are likely to experience physical, psychologi-cal, social, and educational harm (Gladden et al., 2014). Although bullying is a serious concern for all youths, parents, teachers, and school officials, it has particularly affected African American youths. According to the Bureau of Justice Statistics, in 2014-2015, 25% of African American students nation-wide were bullied compared with 22% Whites and 17% Hispanic students (Musu-Gillette, Zhang, Wang, Zhang, & Oudekerk, 2017). Moreover, 17% of African American students reported being made fun of, called names, or insulted compared with 14% of White and 9% of Hispanic students (Musu-Gillette et al., 2017). Studies have documented that experiencing bullying can contribute to adverse physical and psychosocial outcomes, including internal-izing problems, suicidal thoughts and behaviors, and substance use (e.g., Holt et al., 2015; Ttofi, Farrington, Losel, Crago, & Theodorakis, 2016). Less fre-quently studied is the link between peer victimization and sexual risks.Among teenagers and young adults, aged 15 to 24 years, rates of STIs, including chlamydia, gonorrhea, and syphilis, have increased from 2015 to 2016 (Centers for Disease Control and Prevention [CDC], 2017). In 2016, 63.1% of all chlamydia cases were reported by individuals aged 15 to 24 years old, with the rate of gonorrhea increasing by 11.3% and syphilis cases increasing by 13.0% among 15- to 19-year-olds from 2015 to 2016 (CDC, 2017). Among African American adolescents (ages 15-19 years), the total reported cases of chlamydia in 2016 were 131,081. For gonorrhea, there was
a total of 40,280 reported cases, and during 2015-2016, the rate of gonorrhea cases increased 11.3% for individuals aged 15 to 19 years, and 10.9% for those aged 20 to 24 years (CDC, 2017). For syphilis, there was a total of 614 reported cases and the rate increased by 13.0% among individuals aged 15 to 19 years and by 8.1% among those aged 20 to 24 years from 2015 to 2016 (CDC, 2017). Among adolescents aged 15 to 19 years, the rates of chlamydia, gonorrhea, and syphilis were highest among African Americans relative to adolescents of other racial and ethnic groups.African American adolescents, particularly those living in urban communi-ties with limited resources, are frequently confronted with violence, which places them at a heightened risk of peer victimization. These youths are also vulnerable to STIs, as they are exposed to unsafe behaviors and risky activities in their community. A small number of emerging research findings suggests a significant positive association between experiencing peer victimization and STI acquisition. However, studies to date have not explored pathways linking peer victimization and STIs, which represents the aim of the current study.
Exploring the Link Between Peer Victimization and STI Acquisition
Numerous studies have documented that peer victimization during childhood is a precursor to risk behaviors, such as substance use. Despite extant cross-sectional and longitudinal studies that have revealed that bullied youth have an elevated risk of acquiring STIs and HIV during adolescence (Okumu, Mengo, Ombayo, & Small, 2017) and adulthood (Friedman, Marshall, Stall, Cheong, & Wright, 2008; Kamen et al., 2013; Russell, Ryan, Toomey, Diaz, & Sanchez, 2011), research examining the link between peer victimization and STIs is limited. Okumu et al.’s (2017) findings from a nationally representative sam-ple of 13,571 youths in Grades 9 to 12 suggest a significant positive associa-tion between bullying experiences and HIV risks. Similarly, Friedman et al.’s (2008) study, which focused on childhood victimization and health outcomes in adulthood among 1,383 gay/bisexual men, reported that gay-related peer victimization and physical abuse elevated the risk of HIV infection. The posi-tive association between peer victimization and STI acquisition appears to be consistent across the adolescent population in general (Okumu et al., 2017), as well as among sexual minorities (Friedman et al., 2008; Russell et al., 2011) and people living with HIV in particular (Kamen et al., 2013).Although a significant association between peer victimization and STIs has been reported in several studies, it is also conceivable that victimization may lead to STI acquisition through diverse pathways. Youths who are fre-quently bullied in school often have negative feelings about their sense of self
(Ellis & Eriksen, 2002) and might cope in unhealthy ways by engaging in behaviors that can increase their risk of STIs, such as affiliation with deviant peers. Bullied youths typically have weak social bonds and emotional con-nections with their peers (Kendrick, Jutengren, & Stattin, 2012), which may exclude them from conventional peer groups due to loss of social standing or being labeled as outcasts (Bukowski & Sippola, 2001). These youths may turn to a peer group that engages in deviant and risky behaviors because of the lack of viable alternatives (Rudolph et al., 2014; Sijtsema, Lindenberg, & Veenstra, 2010). Bullied youths who report feeling socially alienated are likely to be influenced by deviant peers (Rudolph et al., 2014), which is a salient factor in the development of antisocial and risk-taking behaviors in adolescents (Dodge, Dishion, & Lansford, 2006).Notably, an emerging body of the literature has documented a positive association between delinquent peer affiliation and risk behaviors, including early sexual intercourse (French & Dishion, 2003) and unprotected sexual activities (Dishion, Ha, & Veronneau, 2012; Houck et al., 2006; Lansford, Dodge, Fontaine, Bates, & Pettit, 2014). According to one longitudinal study (Lansford et al., 2014), peer rejection during childhood and deviant peer affil-iation during preadolescence predicted greater sexual risk-taking behavior in adulthood. Furthermore, deviant peer groups who endorse lenient sexual practices may increase adolescents’ risk of substance use, which can contrib-ute to unsafe sexual practices (Houck et al., 2006).Victims of bullying may also turn to alcohol, tobacco, and drugs as means of coping with emotional distress. Existing studies report that peer victimiza-tion is positively associated with alcohol, marijuana, and/or tobacco use (Earnshaw et al., 2017; Luk, Wang, & Simons-Morton, 2010; Sullivan, Farrell, & Kliewer, 2006; Tharp-Taylor, Haviland, & D’Amico, 2009), as well as frequent polysubstance use (Gilreath, Astor, Estrada, Benbenishty, & Unger, 2014). The disinhibiting effects and impaired cognitive functioning of alcohol and drugs can encourage risky sexual practices by reinforcing lower perceptions of the risks involved in unprotected and risky sexual activities (Fromme, Amico, & Katz, 1999; Poulos, Parker, & Le, 1998). Hence, drug and alcohol use can lead to sexual risk-taking behaviors, including unpro-tected sex, which can result in unintended pregnancy (Asante, Meyer-Weitz, & Peterson, 2014; Celentano et al., 2006; Cook & Clark, 2005; Salas-Wright, Vaughn, Ugalde, & Todic, 2015; Tapert, Aarons, Sedlar, & Brown, 2001).Youths who are victimized are more likely to experience significant distress and low self-esteem and are less likely to have romantic relationships (Arnocky & Vaillancourt, 2012). Consequently, these youths may engage in risky and unprotected sex (Hertz, Jones, Barrios, David-Ferdon, & Holt, 2015), which reflects a coping mechanism and an attempt to identify with peer groups
Kristsotakis, Papanikolaou, Androulakis, & Philalithis, 2017). Not surpris-ingly, a positive association between peer victimization and noncontraceptive sexual practices has been reported in several studies. Li, DiStefano, Mouttapa, and Gill’s (2014) retrospective study with a sample of young adult males (aged 18-29 years) found that peer victimization during high school was linked to unprotected receptive anal intercourse. Hong, Voisin, Cho, and Espelage’s (2016) study with urban African American youth also documented that experi-ences with peer victimization were negatively correlated with condom use dur-ing sex. Kristsotakis et al. (2017) also documented that adolescents who reported experiencing bullying victimization in middle and high school had a significant reduction in condom use during college, relative to their peers unin-volved in bullying. As engaging in unsafe sexual practices without condoms significantly increases the probability of acquiring STIs (CDC, 2013), address-ing precursors to risk behaviors is a national public health priority
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The acquisition of STIs represents one of several negative health outcomes that is linked to peer victimization, particularly among vulnerable adoles-cents residing in low-income communities where health care access may be limited. Although studies that examine the link between peer victimization and STIs are rare, a positive association has been reported in extant studies. However, urban African American adolescents’ frequent exposure to vio-lence and crime can also increase their likelihood of victimization and engagement in risky behaviors (e.g., substance use and unprotected sex), placing them at an elevated risk for STI acquisition. It is essential to explore the pathways between victimization and STIs to understand how bullied ado-lescents may acquire STIs
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