title: Economic dependence and unprotected sex: the role of sexual assertiveness among young urban mothers.
abstract: In the USA, sexual intercourse is the leading route of human immunodeficiency virus transmission among women, primarily through their main partner. Because male condom use is not directly under a woman's control, gender inequalities may help shape this sexual risk behavior. To examine this association, data came from follow-up interviews of young, primarily minority, pregnant women enrolled in a prospective, randomized controlled trial. Specifically, we aimed to determine the relationship between economic dependence on a male partner and condom use, and to establish whether this relationship was mediated by sexual assertiveness. Overall, 28% of women reported being economically dependent on a male partner. Young women dependent on a male partner were 1.6 times more likely to report not using a condom at last sex than women not dependent on their partner (95% confidence interval = 1.11-2.32; p = 0.01). Sexual assertiveness mediated the relationship between economic dependence and condom use (Sobel = 2.05, p = 0.04). Coupled with past research, this study supports the premise that sexual behaviors may be rooted in a complex web of social determinants. Addressing gender inequalities in contextual factors may promote healthier decisions within sexual relationships.
authors.affiliation: Yale School of Public Health and Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA. katie.biello@yale.edu
authors.forename: Katie Brooks
authors.initials: KB
authors.lastname: Biello
authors.forename: Heather L
authors.initials: HL
authors.lastname: Sipsma
authors.forename: Jeannette R
authors.initials: JR
authors.lastname: Ickovics
authors.forename: Trace
authors.initials: T
authors.lastname: Kershaw
mesh_terms: D000293:Adolescent; D000328:Adult; D001242:Assertiveness; D004467:Economics; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D009035:Mothers / Q000523:psychology; D009769:Object Attachment; D014481:United States; D047568:Unsafe Sex; D014505:Urban Population; D055815:Young Adult