title: Family structure effects on early sexual debut among adolescent girls in Rakai, Uganda.
abstract: This study assessed the association between household family structure and early sexual debut among adolescent girls, ages 15-19, in rural Rakai District, Uganda. Early sexual debut is associated with detrimental physical, emotional and social outcomes, including increased risk of HIV. However, research on the family's role on adolescents' sexual risk behaviors in sub-Sahara Africa has been minimal and rarely takes into account the varying family structures within which African adolescents develop. Using six rounds of survey data (2001-2008) from the Rakai Community Cohort Study, unmarried adolescent girls (n=1940) aged 15-17 at their baseline survey, were followed until age 19. Parametric survival models showed that compared to adolescent girls living with both biological parents, girls who headed their own household and girls living with step-fathers, grandparents, siblings, or other relatives had significantly higher hazards of early sexual debut before age 16. Adolescent girls were significantly more likely to debut sexually if neither parent resided in the household, either due to death or other reasons. In addition, absence of the living biological father from the home was associated with higher risk of sexual debut, regardless of the biological mother's presence in the home. Our study's findings suggest that family structure is important to adolescent girls' sexual behavior. There is need for research to understand the underlying processes, interactions and dynamics of both low and high risk family structures in order to devise and strategically target interventions targeted for specific types of family structures.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Nanlesta A
authors.initials: NA
authors.lastname: Pilgrim
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sekasanvu
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe.
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe.
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe ; Makerere University School of Public Health, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer