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Division of Biostatistics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
c
The Regenstrief Institute, Indianapolis, Indiana
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doiManuscript received October 15, 2004; manuscript accepted February 2, 2005.
Background: Our objective was to describe familial, intrapersonal, and partner-related factors
associated with time of day of sexual activity among adolescent women.
Methods: Annual questionnaires and daily diaries were collected from 106 adolescents. Partici-
pants contributed up to 3 questionnaires and 5 12-week diary periods over 27 months. Predictor
variables included type of day (weekend, school day, vacation day); partner variables (argument
with partner, partner emotional support, time spent with partner); parent/family variables such as
supervision, monitoring, and attitudes about adolescent sexual behavior; and mood and behavior
variables such as negative mood, positive mood, and sexual interest. The outcome variable for each
diary day was no coitus, coitus between noon and 6 PM, or coitus after 6 PM.
Results: Coitus occurred on 12.0% of the diary days. Coital events were more than twice as likely
to occur after 6 PM (8.5% of days) than in the afternoon (3.5% of days). Afternoon sex was least
likely to occur on school days whereas evening sex occurred most often on weekends. An argument
with a partner, partner emotional support, time spent with partner, sexual interest, and coital
frequency were associated with increased likelihood of afternoon sex, whereas parental supervision
and negative mood were associated with decreased likelihood of afternoon sex. For school days,
skipping school was associated with increased likelihood of afternoon sex. Evening/night sexual
activity was not associated with any parent/family variables.
Conclusion: Afternoon sex on school days is relatively uncommon. Direct parental supervision
may decrease afternoon sexual activity but relationship and intrapersonal factors also are important
factors in the timing of sexual activity on any given day. © 2006 Society for Adolescent Medicine.
All rights reserved.
words: Sexuality; Parents; Sexual behavior
The after-school period is thought to represent an impor-
t opportunity for health risk behaviors among unsuper-
ed adolescents [1]. Because of the association of risk for
sexual activity and lack of parental monitoring/supervision,
some have advocated increased adult supervision during
after-school periods as a way to decrease adolescent sexual
activity [2,3]. A recent study noted that increased levels of
parental supervision were associated with decreased risks
for gonorrhea or chlamydia infection among adolescent
women [4].
However, the extent to which adolescent sexual activity
actually occurs during after-school periods (when adoles-
cents with working parents may be unsupervised for several
Supported by the National Institute of Allergy & Infectious Disease to
Mid-America Adolescent STD Cooperative Research Center (D.P.O.).
Presented in part at the Society for Adolescent Medicine meeting, San
go, CA, March 16, 2001, and at the International Society for STD
earch meeting, Ottawa, Canada, July 29, 2003.
*Address correspondence to: J. Dennis Fortenberry, M.D., M.S., RileyOrigina
Factors associated with tim
among adole
J. Dennis Fortenberry, M.D., M.S.,
a,
* Barry
Beth E. Juliar, M.A., M.S.,
b
Wanzhu T
a
Section of Adolescent Medicine, Department of Pediatrics, Mid-Ameri
Journal of Adolescent Hho
tio
spital Parking Garage, Room 070, 575 N. West Street, Indianapolis, IN
02.
E-mail address: jfortenb@iupui.edu
4-139X/06/$ – see front matter © 2006 Society for Adolescent Medicine. All ri
:10.1016/j.jadohealth.2005.02.006cle
f day of sexual activity
t women
atz, Ph.D.,
b
Margaret J. Blythe, M.D.,
a
h.D.,
b,c
and Donald P. Orr, M.D.
a
lescent STD Cooperative Research Center, Indianapolis, Indiana
8 (2006) 275–281urs) is not well documented. Retrospective cross-sec-
nal studies indicate that 15% to 17% of the first or most
ghts reserved.

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276 J.D. Fortenberry et al / Journal of Adolescent Health 38 (2006) 275–281ent coital events, respectively, appear to occur between 3
and 6 PM [2,5].
Other limitations of existing data include lack of atten-
n to factors that could explain apparent associations be-
een time of day and sexual activity. Distinction of school
ys from weekend days and vacation days is important [6].
me studies have not appropriately distinguished parental
nitoring from parental supervision [7]. Self-reported su-
rvision, a commonly used measure, could be a surrogate
other parental characteristics such as closeness or com-
nication [8,9]. Because homes of partners are among the
st common locations of adolescent sexual activity [5],
orted supervision also could be simply a function of
mbership in more populous households with fewer pri-
te opportunities for sex. The qualities of the adolescents’
erpersonal relationship with partners may be important
cause supervision of such relationships is likely to change
partners become known and trusted by family members
]. During the course of a school day, teenagers report
od changes, most often positive during after-school
urs [11]. Purposeful behaviors to avoid supervision, such
skipping school, likely are associated with a larger con-
llation of behaviors that include sexual activity [12].
The purpose of this study was to examine the occur-
ce of adolescents’ sexual activities during various
riods of the day, and to identify factors associated with
ital activity during those time periods. To address
itations of previous research, daily diaries were used
measure phenomena that are subject to day-to-day
riation in association with the likelihood of sexual
ivity, and to capture variations associated with school
ekdays, weekends, school holidays, and summer va-
ion. In addition, measures related to sexuality, mood,
rtners, and family were included to assess a potentially
mplex array of predictors associated with timing of
ual activity within a given day.
ethods
dy design and procedures
Data were collected as part of a larger longitudinal
dy of risk and protective factors associated with sex-
lly transmitted infections among girls in middle ado-
cence. Briefly, the larger study consisted of up to 3
nual questionnaires, interviews at 3-month intervals,
d up to five 84-day diary collection periods over a
-month period. Each 84-day diary collection period
s followed by a rest period of similar length in which
diary information was collected. Each annual ques-
nnaire was conducted in conjunction with a clinic visit
collection of additional interview and physical exam-
tion data related to the larger project. Other clinicits occurred at 3-month intervals for the duration of
project. These visits were at the beginning and end of
each diary collection period, allowing research personnel
reinforce diary collection procedures and maintain
rrent contact information. Informed consent was ob-
ned from each participant and written permission was
tained from a parent or legal guardian. This research
s approved by the institutional review board of Indiana
iversity/Purdue University at Indianapolis–Clarian.
The annual questionnaire consisted of multiple items
essing personal attitudes and behaviors as well as per-
ved parental attitudes and behaviors. The diary instru-
nt consisted of a single bar-coded, scannable sheet con-
ning probes and response options. Each diary sheet
mprised 2 sections: partner-specific behaviors occurring
the specified day and non–partner-specific items related
substance use, sexual interest, and mood. Partner-specific
ms were identified by partner initials or first names, and
items assessed partner interactions as well as coital
ivity. Items assessing marijuana use and mood are de-
ibed in detail later.
At the time of enrollment, participants received detailed
tructions regarding diary completion as well as a packet
blank diary sheets. Participants were asked to complete a
gle diary sheet at the end of each day, before going to
d. If an entry was forgotten, participants were asked to
mplete the form as soon as it was remembered. An ap-
intment time for diary pick-up was arranged for the sub-
uent week. At weekly intervals, trained field personnel
ited each participant (typically at their homes) to collect
mpleted diaries and leave blank diary forms. Field per-
nel reviewed diaries for ambiguous or missing data but
not retrospectively complete missing entries. Partici-
nts received $2.00 for each completed diary as well as a
nus for completion of 80% of scheduled diaries.
rticipants
Participants were English-speaking adolescent women
eiving health care in 1 of 3 primary health clinics in
ianapolis. These clinics serve primarily lower-class and
ddle-income residents of areas with high rates of teenage
gnancy and sexually transmitted diseases. Most partici-
nts (87%) reported their race as African-American, and
reported Hispanic ethnicity.
Clinic patients were eligible if they were between 14
d 17 years of age at enrollment, spoke English, and
re not pregnant at the time of enrollment. However,
rticipants who became pregnant were continued in the
dy. Prior sexual experience was not a requirement for
rticipation.
asures
Measures were obtained from both the annual question-
ire and the daily diaries. Age was calculated as the age onh given diary day.
Questionnaire measures included items and multi-item