Suicide attempts among latinas who experienced early sex were largely mediated by substance abuse.

The purpose of this study was to describe the role of substance abuse as a mediating factor between early sexual experiences and suicide attempts among adult Latinas. In our study participants (n=158), nearly 15% had attempted suicide and 39% experienced their first sexual encounter at an age of 15 or younger (referred to hereafter as “early sex”). Latinas who experienced early sex were more likely to attempt suicide [OR=2.4, p<0.05], and this relationship was largely mediated by substance abuse. An early sexual debut may indicate an environmental adversity on the child that calls for long term intervention for prevention of substance abuse as well as promotion of psychological well-being later in life. Florida Public Health Review, 2009; 6, 75-84. Introduction . More girls have become sexually active at an earlier age over the past generations (Wells & Twenge, 2005). In 2002, almost 34% of girls in the United States (US) experienced vaginal or oral sex by the age of 15 (Mosher & Chandra, 2005). Due to its various adverse effects, the increasing number of younger girls engaging in sexual activity is a serious concern. Immature reproductive and immune systems make younger girls particularly vulnerable to Human Immunodeficiency Virus (HIV) and other sexually transmitted infections and risky pregnancy. In addition to biological risks, early initiation of sexual activity has also been connected to various behavioral and psychological problems. Adolescents who had an early sexual initiation relative to their peers were reportedly at a higher risk of experiencing delinquency (Armour & Haynie, 2007). Early onset of sexual activity has been linked to greater numbers of sexual partners over time and substance abuse (Ahmed, Davis, Gottman, & Payne, 2006; O'Donnell, O'Donnell, & Stueve, 2001; Brook, Brook, Pahl, & Montoya, 2002; Rosenbaum & Kandel, 1990). In terms of psychological well-being, early sexual activity for a young female increases the chance of suffering from depression (Rector, Johnson, & Noyes, 2003; Meier, 2007). Moreover, a study by the Heritage Foundation (Rector et al., 2003) found that sexually active teenagers were more likely to attempt suicide. Suicide is a widespread public health problem. In 2005, suicide was the 11 leading cause of death among people aged 16 or older, accounting for 32,170 deaths (Centers for Disease Control and Prevention, 2008). In addition to psychiatric disorders, both early sexual initiation (Rector et al., 2003) and substance abuse (Bronisch & Wittchen, 1994; Tiet, Ilgen, Byrnes, & Moos, 2006) were strongly associated with suicidal behavior. More Latinas have become sexually active at an earlier age over the past generations (Wells & Twenge, 2005) and the number of Latinas who abuse substances continue to increase in the US (Compton, Grant, Colliver, Glantz, & Stinson, 2004; Grant et al., 2004). However, there is little in the published literature about the relationship between early sexual activity and suicide attempts among Latinas. The lack of information limits the ability of health care providers to develop effective suicide prevention programs that target high-risk groups of Latinas. Suicidal ideation and behavior are both complex and multifaceted. The main objective of our study was to understand one aspect of it; how early sexual activity results in the increased likelihood of suicide attempts among Latinas. In accordance with literature, we hypothesized that the substance abuse may mediate the relationship between an early sex and suicide attempts. The mediation analysis is a form of causal analysis; therefore, we considered the time sequence of events as well as the plausibility of causal paths based on published literature. The presumed mediation model in Figure 1 depicts that early sexual activity (we defined as age of 15 or younger) is a significant predictor for suicide attempts with its influence being mostly mediated by substance abuse as an adult. Substance abuse functions as a mediator to the extent that it accounts for the relation between early sexual activity and suicide attempts. Explicitly, the path “A” shows the direct effect from the early sexual experience to the suicide attempt (Landheim, Bakken, & Vaglum, Florida Public Health Review, 2009; 6:75-84. http://health.usf.edu/publichealth/fphr/index.htm 75 2006; Rector et al., 2003). Path “B” shows the causal path from the early sexual experience to substance abuse (Ahmed et al., 2006; O'Donnell et al., 2001; Brook et al., 2002a; Rosenbaum & Kandel, 1990). Path “C” shows the causal path between substance abuse to the suicide attempt (Bronisch & Wittchen, 1994; O'Boyle & Brandon, 1998; Dhossche, Meloukheia, & Chakravorty, 2000; Kelly, Cornelius, & Lynch, 2002; Tiet et al., 2006; Rowan, 2001). This study is significant in investigating the role of substance abuse between early sexual activity and suicide attempts later in life particularly among Latinas. This added knowledge on the role of substance abuse as an interceding factor between early sexual experiences and suicide attempts would benefit health care professionals in developing effective suicide prevention programs that target high-risk groups among Latinas. Figure 1. Presumed mediation model between early sex (age 15 or younger) and suicide attempt a Substance abuse as