Multi-person sex among a sample of adolescent female urban health clinic patients.

Adolescent sexual activity involving three or more people is an emerging public health concern. The goal of this exploratory, cross-sectional study was to describe the prevalence, correlates, and context of multiple-person sex among a sample of adolescent females seeking health care from an urban clinic. Because sex involving multiple people may either be consensual (i.e., "three-ways" or "group sex") or forced (i.e., "gang rape"), we use the term "multi-person sex" (MPS) to encompass these experiences. Subjects were 328 females, ages 14-20 years old, who utilized a Boston-area community- or school-based health clinic between April and December of 2006, and completed an anonymous survey using computer-assisted self-interview software. Overall, 7.3% reported ever having had a MPS experience. Of these, 52% reported ever being pressured to engage in MPS and 43% reported ever being threatened or forced. Condom nonuse by at least one male participant in the most recent MPS was reported by 45%. Controlling for potential demographic confounders, MPS was associated with cigarette smoking (adjusted prevalence ratio [APR], 3.83; 95% confidence interval [CI], 1.56-9.44), sexual initiation prior to age 15 (APR, 2.50; 95% CI, 1.04-5.98), ever being diagnosed with an STI (APR, 2.55; 95% CI, 1.08-6.03), dating violence victimization (APR, 4.43; 95% CI, 1.68-11.69), childhood sexual abuse victimization (APR, 4.30; 95% CI, 1.83-10.07) and past-month pornography exposure (APR, 4.79; 95% CI, 1.91-11.98). Additional study of the perpetration and prevention of adolescent MPS is urgently needed.