More than 3% of Teens Have Swapped Sex for Money or Drugs

CHAPEL HILL, N.C., Aug. 10 -- Of U.S. adolescents in the general population, 3.5% have exchanged sex for money or drugs, and two-thirds of these youths were boys, researchers here reported.

The prevalence of having ever exchanged sex for drugs was 3.5% (n=471; 95% CI 3.0-4.0) in a survey of 13,294 adolescents taking part in the National Longitudinal Study of Adolescent Health (wave I, 1995, and wave II 1996), said Jessica Edwards, Ph.D., of the Pacific Institute for Research and Evaluation, and colleagues.

Adolescents with a history of exchanging sex are also at risk for poor health outcomes, including depression, HIV, and other sexually transmitted disease (STD), they reported online in Sexually Transmitted Infections, a BMJ journal

Of the sex-exchange teenagers, 67.9% were boys (P<0.05), the researchers found. The odds of participating in an exchange were also higher for African American youths, those who lived in a household with a family structure defined as "other," and youths whose parents had a high school education or less (P<0.05).

Compared with youths who had never exchanged sex, larger proportions of exchange youths had used drugs in the past 30 days. For example, 10.6% reported using cocaine, compared with 1.0% of the no-exchange teens (P<0.05).

The most drastic difference among the exchange groups, the researchers said, was for those who had injected drugs within the previous 30 days. The odds of exchanging sex for these teens was 34 times that of those who had not injected drugs recently (OR 33.84, CI 12.60-90.91).

Additional findings were:

• Other factors increasing the odds of the exchange were depression, which more than doubled the risk (OR = 2.31; 95% CI 1.67-3.17) and having run away in the previous year, which tripled the risk (OR 2.99, CI 2.10-4.25).
• Fifteen percent of the boys and almost 20% of the girls reported that they had ever been told by a doctor or nurse that they had HIV or another STD. This contrasted with 2.3% of the boys and 4.1% of girls who had never exchanged sex.
• Larger numbers of adolescents who had exchanged sex reported that they had ever had a same-sex experience and had been diagnosed with a sexually transmitted disease.
• Of the boys, 10% said they had ever physically forced someone to have sex, while 16.8% of the girls said they had been physically forced to have sex.

The median number of sex exchanges was only one time, and few youths reported exchanging sex in both the 1995 and 1996 waves of the study. This suggests, the authors said, that many youths may have done so for reasons other than survival or substance addiction. Still, there are some who may have done so for survival, or some one-timers may also have had an acute period of need, they said.

"These results show that a disproportionate burden of HIV and other STDs that youth experience relative to other age groups is exacerbated by adolescents who exchange sex," the researchers wrote.

This analysis did not control for potential confounding factors, such as a failure to disclose and loss of follow-up between the two waves of the study. Therefore, they said, the prevalence of exchanging sex reported here may be a conservative estimate. In addition, the surveys did not include questions about exchanges involving oral sex.

One of the main strengths of this study is that the results derived from a large nationally representative sample of adolescents, Dr. Edwards said. Nevertheless, she added, research is needed to understand, for example, the role of lower parental education and the disproportionate representation of African American adolescents.

Also, the investigators said, future studies need to examine the context in which sex exchanges occur. Are the exchange partners peers or adults? What precipitates the exchanges (for example, peer pressure or lack of parental supervision)? The respondents' definition of "sex exchange" also needs further study.

Investigators may also need to examine other factors not considered here, including parental substance use and other indicators of family well-being. A better understanding of all these factors can help formulate appropriate prevention and intervention strategies, Dr Edwards said.