Dissertations and Theses
Date of Degree
6-3-2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy (Ph.D.)
Department
Health Policy and Management
Advisor(s)
Christian Grov
Committee Members
Kathleen Cravero
Sasha Fleary
Subject Categories
Public Health
Keywords
adolescent sexual health, early sexual debut, bullying, housing instability, HIV/STI testing, condom use, hormonal contraception, New York City adolescents
Abstract
Adolescent sexual and reproductive health remains a critical public health priority in the United States, particularly given the persistent burden of HIV and sexually transmitted infections (STIs) among young people. Adolescents and young adults account for a disproportionate share of STI cases, reflecting ongoing gaps in prevention, early detection, treatment, and equitable access to sexual health care and services. These patterns are shaped not only by individual behaviors but also by broader social, structural, and developmental contexts that influence adolescents’ opportunities to engage in preventive sexual health care.
This dissertation examined associations between early sexual debut, experiences of bullying, and three key sexual health behaviors—condom use at last sexual intercourse, engagement in HIV and STI testing, and hormonal contraception use—among sexually active public high school students in New York City. Analyses used data from the 2019 New York City Youth Risk Behavior Survey (YRBS) and applied survey-weighted logistic regression models adjusting for demographic and structural factors, including sex, race/ethnicity, sexual orientation, and housing stability.
Across the three studies, early sexual debut was associated with a lower likelihood of HIV and STI testing but was not associated with condom use or hormonal contraception use. Experiences of bullying were not associated with any of the sexual health behaviors examined. In contrast, demographic and structural factors—including gender, sexual orientation, race, and housing instability—emerged as more consistent predictors of adolescents’ engagement in sexual health behaviors.
These findings suggest that adolescent sexual health behaviors are shaped less by individual psychosocial exposures alone and more by broader social and structural conditions—including stigma—that shape access to care and engagement with preventive services. Improving adolescent sexual health outcomes requires public health approaches that address structural barriers, reduce stigma, expand access to youth-friendly and confidential services, and prioritize equity across diverse adolescent populations.
Recommended Citation
Ramirez, Valentina I., "BULLYING, EARLY SEXUAL DEBUT, AND SEXUAL HEALTH BEHAVIORS AMONG ADOLESCENTS IN NEW YORK CITY" (2026). CUNY Academic Works.
https://academicworks.cuny.edu/sph_etds/132
