Pregnant African-American teens are less likely than their nonpregnant peers to use condoms

"PrEP protects us": Behavioural, normative, and control beliefs influencing pre-exposure prophylaxis uptake among pregnant and breastfeeding women in Zambia

Background

Although pre-exposure prophylaxis (PrEP) is recommended for pregnant and breastfeeding women at elevated HIV risk, uptake has been low in Zambia.

Methods

In in-depth interviews, we explored beliefs about PrEP among 24 HIV-negative pregnant and breastfeeding Zambian women. Thematic analysis was used to identify behavioural, normative and control beliefs likely to influence PrEP uptake.

Results

Most women viewed PrEP as a good method of protecting themselves and their babies from HIV infection. Partners were cited as key referents in decision making about PrEP use. Many women felt that PrEP use was not entirely in their control. Most reported that they would not use PrEP if their partners did not approve. Health care providers with negative attitudes, long distance to clinics, and extended waiting times were cited as barriers to PrEP uptake.

Conclusion

HIV-negative pregnant and breastfeeding women had a positive attitude towards PrEP but barriers to uptake are multifaceted.

Adolescent Pregnancy Guidelines

OBJECTIVE

To describe the needs and evidence-based practice specific to care of the pregnant adolescent in Canada, including special populations.

OUTCOMES

Healthy pregnancies for adolescent women in Canada, with culturally sensitive and age-appropriate care to ensure the best possible outcomes for these young women and their infants and young families, and to reduce repeat pregnancy rates.

EVIDENCE

Published literature was retrieved through searches of PubMed and The Cochrane Library on May 23, 2012 using appropriate controlled vocabulary (e.g., Pregnancy in Adolescence) and key words (e.g., pregnancy, teen, youth). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to English or French language materials published in or after 1990. Searches were updated on a regular basis and incorporated in the guideline to July 6, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, national and international medical specialty societies, and clinical practice guideline collections.

VALUES

The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS/HARMS/COSTS: These guidelines are designed to help practitioners caring for adolescent women during pregnancy in Canada and allow them to take the best care of these young women in a manner appropriate for their age, cultural backgrounds, and risk profiles.

RECOMMENDATIONS

1. Health care providers should adapt their prenatal care for adolescents and offer multidisciplinary care that is easily accessible to the adolescent early in the pregnancy, recognizing that adolescents often present to care later than their adult counterparts. A model that provides an opportunity to address all of these needs at one site may be the preferred model of care for pregnant adolescents. (II-1A) 2. Health care providers should be sensitive to the unique developmental needs of adolescents through all stages of pregnancy and during intrapartum and postpartum care. (III-B) 3. Adolescents have high-risk pregnancies and should be managed accordingly within programs that have the capacity to manage their care. The unique physical risks of adolescent pregnancy should be recognized and the care provided must address these. (II-1A) 4. Fathers and partners should be included as much as possible in pregnancy care and prenatal/infant care education. (III-B) 5. A first-trimester ultrasound is recommended not only for the usual reasons for properly dating the pregnancy, but also for assessing the increased risks of preterm birth. (I-A) 6. Counselling about all available pregnancy outcome options (abortion, adoption, and parenting) should be provided to any adolescent with a confirmed intrauterine gestation. (III-A) 7. Testing for sexually transmitted infections (STI) (II-2A) and bacterial vaginosis (III-B) should be performed routinely upon presentation for pregnancy care and again in the third trimester; STI testing should also be performed postpartum and when needed symptomatically. a. Because pregnant adolescents are inherently at increased risk for preterm labour, preterm birth, and preterm pre-labour rupture of membranes, screening and management of bacterial vaginosis is recommended. (III-B) b. After treatment for a positive test, a test of cure is needed 3 to 4 weeks after completion of treatment. Refer partner for screening and treatment. Take the opportunity to discuss condom use. (III-A) 8. Routine and repeated screening for alcohol use, substance abuse, and violence in pregnancy is recommended because of their increased rates in this population. (II-2A) 9. Routine and repeated screening for and treatment of mood disorders in pregnancy is recommended because of their increased rates in this population. The Edinburgh Postnatal Depression Scale administered in each trimester and postpartum, and more frequently if deemed necessary, is one option for such screening. (II-2A) 10. Pregnant adolescents should have a nutritional assessment, vitamins and food supplementation if needed, and access to a strategy to reduce anemia and low birth weight and to optimize weight gain in pregnancy. (II-2A) 11. Conflicting evidence supports and refutes differences in gestational hypertension in the adolescent population; therefore, the care usual for adult populations is supported for pregnant adolescents at this time. (II-2A) 12. Practitioners should consult gestational diabetes mellitus (GDM) guidelines. In theory, testing all patients is appropriate, although rates of GDM are generally lower in adolescent populations. Practitioners should be aware, however, that certain ethnic groups including Aboriginal populations are at high risk of GDM. (II-2A) 13. An ultrasound anatomical assessment at 16 to 20 weeks is recommended because of increased rates of congenital anomalies in this population. (II-2A) 14. As in other populations at risk of intrauterine growth restriction (IUGR) and low birth weight, an ultrasound to assess fetal well-being and estimated fetal weight at 32 to 34 weeks gestational age is suggested to screen for IUGR. (III-A) 15. Visits in the second or third trimester should be more frequent to address the increased risk of preterm labour and preterm birth and to assess fetal well-being. All caregivers should be aware of the signs and symptoms of preterm labour and should educate their patients to recognize them. (III-A) 16. It should be recognized that adolescents have improved vaginal delivery rates and a concomitantly lower Caesarean section rate than their adult counterparts. (II-2A) As with antenatal care, peripartum care in hospital should be multidisciplinary, involving social care, support for breastfeeding and lactation, and the involvement of children's aid services when warranted. (III-B) 17. Postpartum care should include a focus on contraceptive methods, especially long-acting reversible contraception methods, as a means to decrease the high rates of repeat pregnancy in this population; discussion of contraception should begin before delivery. (III-A) 18. Breastfeeding should be recommended and sufficient support given to this population at high risk for discontinuation. (II-2A) 19. Postpartum care programs should be available to support adolescent parents and their children, to improve the mothers' knowledge of parenting, to increase breastfeeding rates, to screen for and manage postpartum depression, to increase birth intervals, and to decrease repeated unintended pregnancy rates. (III-B) 20. Adolescent women in rural, remote, northern, and Aboriginal communities should be supported to give birth as close to home as possible. (II-2A) 21. Adolescent pregnant women who need to be evacuated from a remote community should be able to have a family member or other person accompany them to provide support and encouragement. (II-2A) 22. Culturally safe prenatal care including emotional, educational, and clinical support to assist adolescent parents in leading healthier lives should be available, especially in northern and Aboriginal communities. (II-3A) 23. Cultural beliefs around miscarriage and pregnancy issues, and special considerations in the handling of fetal remains, placental tissue, and the umbilical cord, must be respected. (III).

Associations of a sexually transmitted disease diagnosis during a relationship with condom use and psychosocial outcomes: (short) windows of opportunity

Few studies have examined whether and how receiving an sexually transmitted disease (STD) diagnosis while in a romantic relationship relates to condom use and psychosocial sexual outcomes. Using dyadic data, we examined associations of a personal or a partner's STD diagnosis during a relationship with condom use, monogamy intentions, condom intentions and attitudes, and STD susceptibility and communication. Because beliefs about how the STD was acquired may shape associations with behavior and cognitions, gender and suspecting that one's partner had other sexual partners (i.e., partner concurrency) were examined as moderators. Participants were 592 individuals in 296 couples expecting a baby; 108 individuals had been diagnosed with an STD during the relationship. Personal STD diagnosis was unrelated to outcomes or was associated with increased risk. A partner's diagnosis related to more positive condom intentions and attitudes. Among men who suspected concurrency, both a personal and a partner's STD diagnosis were associated with less condom use. Receiving the STD diagnosis during pregnancy was associated with greater susceptibility and marginally greater condom use. Results suggest potential benefits of enhancing communication and encouraging joint risk reduction counseling among couples, engaging men more fully in preventive efforts, and capitalizing on the short window during which risk reduction occurs.

Condom-use intentions and the influence of partner-related barriers among women at risk for HIV

AIMS AND OBJECTIVES

To examine intentions to engage in condom use and potential partner-related barriers to condom use, including intimate partner violence (IPV), low levels of sexual relationship power and perceptions of monogamy, among women at risk for HIV.

BACKGROUND

In the United States, women account for approximately one in four new HIV infections. Despite the effectiveness of consistent condom use, women often confront biological, cultural and psychosocial barriers that limit their ability to engage in condom-use.

DESIGN

Cross-sectional, quantitative study.

METHODS

Participants (N = 90) were recruited from a domestic violence shelter, a domestic violence support organisation and an obstetrics/gynaecology clinic in Philadelphia, PA. Data were collected by questionnaires to assess women's condom-use intentions, actual condom-use behaviour, sexual partner risk factors, experience of IPV, level of sexual relationship power and perceptions of monogamy.

RESULTS

Fifty-eight per cent of participants (n = 52) indicated a difference between their preference and intentions to use condoms vs. their actual use, with 62% (n = 32) using condoms less frequently than they would like. Significant differences in condom use emerged for women with low vs. high sexual relationship power and women who reported being in a monogamous relationship vs. those who did not. Of particular concern, a majority of these relationships were with high-risk partners, further increasing women's already elevated risk of acquiring HIV.

CONCLUSIONS

Condom use is a multifaceted issue, particularly in sexual relationships involving power differentials and perceived monogamy. Condom use was complicated by women's own preferences, sexual relationship power differentials and by the perceived exclusivity of the relationship with their sexual partners.

RELEVANCE TO CLINICAL PRACTICE

These findings have important implications for nurses as they are uniquely positioned to facilitate HIV risk reduction among their patients through the discussion of sexual health issues and barriers to negotiating condom use that women may confront.

Black adolescent mothers' perspectives on sex and parenting in nonmarital relationships with the biological fathers of their children

OBJECTIVE

To understand single Black adolescent mothers' perspectives on the sexual and parenting-related aspects of their relationships with the biological fathers of their children.

METHODS

The study was a qualitative description of perspectives from a convenience sample of Black single (nonmarried) adolescent mothers. Data were generated through focus groups and interviews. Participants were recruited using self-referral and health provider referrals.

SETTING

The study was conducted in a county public health department sexually transmitted diseases clinic in Rochester, New York.

PARTICIPANTS

Single mothers (N = 31) ages 15 to 19 participated in the study. The mean age of participants was 17.5 years (SD = 1.4).

FINDINGS

Four themes were identified that reflected the major characteristics of the relationships between the mothers and the biological fathers of their children: (a) You will always care about your "baby daddy" because of your child, (b) Negative behavior is tolerated to keep the family together, (c) The "baby daddy" can get sex as long as we are not on bad terms, and (d) He will always be part of our lives.

CONCLUSION

Black adolescent mothers have complex relationships with the biological fathers of their children that may include ongoing sexual activity. The intersection of coparenting and sexual health needs among adolescent mothers highlights the importance of integrating sexually transmitted infections prevention with perinatal health programs. It is important to consider this unique coparenting relationship when providing risk-reduction counseling to young mothers.

Exploring why young African American women do not change condom-use behavior following participation in an STI/HIV prevention intervention

Human immunodeficiency virus (HIV) interventions can significantly reduce risky sexual behaviors among vulnerable populations. However, not everyone exposed to an intervention will reduce their sexual risk behavior. This qualitative study sought to identify factors associated with young African American females' lack of increase in condom use post-participation in an HIV prevention intervention. Semi-structured interviews were conducted with 50 young African American women (18-23 years; approximately half were mothers) after participating in a demonstrated effective HIV prevention intervention; 24 did not increase condom use post-intervention. Interviews were thematically coded for barriers to condom-use post-intervention. Although nearly all young women reported partner-associated challenges to using condoms, there were relational differences observed among those who changed their condom use versus those who did not. Many 'non-changers' were engaged in non-stable 'on and off' relationships, with high rates of infidelity, often with the father of their child, in which they were fearful of requesting condom use. 'Non-changers' also reported more substance use, feeling incapable of change and not thinking about condom use. Thus, future HIV prevention efforts may benefit from incorporating strategies on how young mothers can maintain a non-sexual relationship with their child's father, as well as elaborating on the intersection of substance use and risky sexual decision-making.

Always, never, or sometimes: examining variation in condom-use decision making among Black adolescent mothers

Our purpose in this study was to describe Black adolescent mothers' decisions regarding condom use and non-use with their male sex partners, including their children's fathers. Research on partner type and condom use has been insufficiently focused on understanding the specific influence that the biological father of the baby has on condom use among adolescent mothers. We conducted five focus groups and three interviews with 31 predominantly African-American mothers. We found that their decisions to use condoms always, never, or sometimes were based on partner type and on emotional and relationship factors. The "baby daddy" was the only partner with whom they never used condoms. HIV/STI prevention interventions for adolescent mothers must address risk taking with their children's biological fathers.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae and repeat infection among pregnant urban adolescents

BACKGROUND

Negative maternal and fetal consequences associated with Chlamydia trachomatis and Neisseria gonorrhoeae during pregnancy make diagnosis essential. The Centers for Disease Control and Prevention recommend routine screening for sexually transmitted infections at the first prenatal visit, and third trimester repeat screening, specifically for C. trachomatis, is recommended for women under age 25 or at increased infection risk. The effect of repeat screening on diagnosis during pregnancy is not well documented among adolescents.

METHODS

A prospective cohort of 125 pregnant adolescents with at least one prenatal screening for C. trachomatis and N. gonorrhoeae was analyzed. All participants received prenatal care and delivered at one urban teaching hospital in Washington, DC. Screening results were documented for both sexually transmitted infections. Descriptive and univariate analyses were performed to describe disease prevalence.

RESULTS

Of pregnant adolescents, 31% were diagnosed with either C. trachomatis or N. gonorrhoeae infection during pregnancy. Of the 75% (95/125) of patients who had more than one screening test, 11% (10/95) had a reinfection, and 7% (7/95) had a new infection on repeat testing. Nine percent (9/95) had recurrent C. trachomatis, whereas 4% (4/95) had a new diagnosis. Three percent (3/95) had recurrent N. gonorrhoeae, whereas 4% (4/95) had a new diagnosis. Some experienced coinfection at either initial or repeat testing.

CONCLUSIONS

Screening for C. trachomatis and N. gonorrhoeae is recommended during pregnancy. In this sample of pregnant adolescents, the overall high incidence and recurrence of C. trachomatis and N. gonorrhoeae support Centers for Disease Control and Prevention screening and rescreening recommendations, regardless of initial test results.

Evaluation of an HIV/STD sexual risk-reduction intervention for pregnant African American adolescents attending a prenatal clinic in an urban public hospital: preliminary evidence of efficacy

STUDY OBJECTIVE

To evaluate an intervention to reduce HIV/STD-associated behaviors and enhance psychosocial mediators for pregnant African-American adolescents.

DESIGN

A randomized controlled trial. Participants completed baseline and follow-up assessments.

SETTING

An urban public hospital in the Southeastern U.S.

PARTICIPANTS

Pregnant African-American adolescents (N=170), 14-20 years of age, attending a prenatal clinic.

INTERVENTION

Intervention participants received two 4-hr group sessions enhancing self-concept and self-worth, HIV/STD prevention skills, and safer sex practices. Participants in the comparison condition received a 2-hr session on healthy nutrition.

MAIN OUTCOME MEASURES

Consistent condom use.

RESULTS

Intervention participants reported greater condom use at last intercourse (adjusted odds ratio=3.9, P=0.05) and consistent condom use (AOR=7.9, P=0.05), higher sexual communication frequency, enhanced ethnic pride, higher self-efficacy to refuse risky sex, and were less likely to fear abandonment as a result of negotiating safer sex.

CONCLUSIONS

Interventions for pregnant African-American adolescents can enhance condom use and psychosocial mediators.

Multilevel predictors of inconsistent condom use among adolescent mothers

OBJECTIVES

We used Bronfenbrenner's ecological systems theory to identify factors that predicted never or sometimes using condoms in a multiethnic cohort of adolescent mothers.

METHODS

We interviewed adolescent mothers within 48 hours of delivery and surveyed them 6 and 12 months after delivery (n = 636). We used multinomial logistic regression to identify individual-, dyad-, family-, and peer and community-level factors associated with never or sometimes using versus always using condoms during intercourse at 12 months postpartum.

RESULTS

Pregnancy status, partner refusal to use condoms, intimate partner violence, and race/ethnicity predicted both never and sometimes using condoms. Condom use 6 months earlier and church attendance also predicted never using condoms, whereas maternal monitoring was an additional predictor for sometimes using condoms.

CONCLUSIONS

Overlapping yet distinct risk profiles predicted never or sometimes using versus always using condoms. Factors from multiple levels of influence affected the condom use behaviors of adolescent mothers indicating that multilevel interventions are needed to promote safer sexual practices among these young women.

Psychosocial predictors of HIV-associated sexual behaviors and the efficacy of prevention interventions in adolescents at-risk for HIV infection: what works and what doesn't work?

The HIV epidemic among adolescents in the United States is inherently tied to individual, psychosocial, and cultural phenomena. Expanding intervention development and implementation to incorporate a broader spectrum of determinants of adolescents' sexual risk for sexually transmitted infections (STIs)/HIV acquisition may provide an opportunity to prevent disease transmission more effectively. To address the STI/HIV prevention needs of adolescents, we highlight research assessing adolescents' sexual risk behavior and place the findings in the context of the diverse array of psychosocial factors influencing adolescents. This synthesis provides an opportunity to examine why adolescents engage in risky sexual behavior and to review the effectiveness of theory-based prevention programs. Subsequently, we offer recommendations for improving future programs aimed at reducing the incidence of STI/HIV infection among adolescents.

Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective--a commentary

The sexually transmitted infection (STI) epidemic among adolescents in the USA is inextricably tied to individual, psychosocial and cultural phenomena. Reconceptualizing the epidemic within an expanded socio-ecological framework may provide an opportunity to better confront its challenges. In this article, we use a socio-ecological framework to identify determinants of adolescents' sexual risk and protective behaviours as well as antecedents of their STI acquisition. The goal is to provide a synthesis of several discrete categories of research. Subsequently, we propose an integrated strategy that addresses the STI epidemic among adolescents by promoting a socio-ecological perspective in both basic research and intervention design. This approach may expand the knowledge base and facilitate the development of a broader array of intervention strategies, such as community-level interventions, policy initiatives, institutionally based programmes, and macro-level societal changes. Although there are inherent challenges associated with such an approach, the end result may have reciprocal and reinforcing effects designed to enhance the adoption and maintenance of STI-preventive practices among adolescents, and further reduce the rate of STIs.

Health-risk behaviors in a sample of first-time pregnant adolescents

OBJECTIVE

The purpose of this study was to assess the frequency of prenatal health-risk behaviors (substance use, sexual risk taking, and prenatal class attendance) among a nonrandom sample of first-time pregnant adolescents.

DESIGN

The design is descriptive.

SAMPLE

145 ethnically diverse first-time pregnant adolescents aged 15-18 years.

MEASUREMENT

Health behavior questions modified from the Center for Disease Control's Youth Risk Behavior Surveillance System.

RESULTS

The health-risk behavior most modified during pregnancy was alcohol use (64/145 drank but quit and 1/145 did not quit). Of the 52/145 who used street drugs, nine continued despite pregnancy. Of the 75/145 who smoked early in pregnancy, 39 continued. The majority did not use a condom at last sexual intercourse. Approximately half attended a prenatal class and half attended a teen parenting class.

CONCLUSION

Health-risk behaviors captured by birth certificate data are thought to be underreported for all age groups, and the prevalence of health-risk behaviors in this sample of pregnant teens was often greater than the most recent national trend data available. The magnitude of the effects of health-risk behaviors on pregnancy outcomes necessitates improved data gathering to enhance planning and evaluation of research and interventions at community, system, and individual/family levels.

Condom use, frequency of sex, and number of partners: multidimensional characterization of adolescent sexual risk-taking

Sexual health research often relies on single risk indicators. However multi-variable composites may better capture the underlying construct of risk-taking. Latent Profile Analysis identified subgroups based on condom use consistency, partner numbers, and sex frequency among 605 adolescents. Three profiles were identified for each of grades 8 to 10 (Condom Users, Few Partners, and Risk-Takers) and 4 in grades 11 and 12 (Condom Users, One Partner Two Partners, and Risk-Takers). Inconsistent condom use groups reported more non-condom (and often less effective) birth control use and STD and pregnancy histories. Females had greater representation in the Few Partners, One Partners, and Two Partners groups, which also contained increasing proportions of participants in each subsequent year. Males had greater representation in the Risk-Takers group. A profile approach to measurement has methodological advantages, can add to substantive knowledge, and can inform content, timing, and targets of sexual health interventions.

Respecting and protecting our relationships: a community research HIV prevention program for teen fathers and mothers

This article describes a two-phase community and academic collaboration funded by the California Collaborative Research Initiative to develop and test the feasibility of an innovative HIV prevention program relevant to the needs of the population of inner-city Latino teen parenting couples and realistic for implementation in community settings. The article describes (a) the identification of special issues that needed to be addressed before formation of a productive academic-community-based organization research partnership, including integrating a dominant theoretical model used in health education with principles of practice derived from clinical experience; (b) the first phase of the project that helped to inform the development of the HIV prevention program for couples; (c) examples from the intervention pilot study (Phase 2) that illustrate both the intervention strategies and the young participants' responses to the curriculum; and (d) the feasibility of program implementation and evaluation in a community setting.

Systematic review of sexual risk among pregnant and mothering teens in the USA: pregnancy as an opportunity for integrated prevention of STD and repeat pregnancy

Behaviors that lead to teen pregnancy also place young women at risk for STDs and repeat pregnancy. Compared to the broad literature on adolescent sexual risk behavior, our understanding of sexual risk in pregnant/mothering teens lags far behind. Primary objectives of this systematic review (1981-2003) of pregnant/mothering teens were to: (1) document rates of STD, repeat pregnancy, condom use, and contraception; (2) identify correlates of these biological and behavioral outcomes; (3) review sexual risk reduction interventions; and (4) discuss directions for future research and implications for clinical care. Fifty-one studies met inclusion criteria. Rates of STD and repeat pregnancy were high, with the majority of teens engaging in unprotected sex during and after pregnancy. An Ecological Model of Sexual Risk, based on Bronfenbrenner's (1989) Ecological Systems Theory, was proposed to organize findings on correlates of sexual risk. Improvements in research, including integration of outcomes and risk factors, stronger methodologies, and standardized assessments, are essential. Results suggest that teen pregnancy is a marker for future sexual risk behavior and adverse outcomes, and that pregnant/mothering teens need hybrid interventions promoting dual use of condoms and hormonal contraception. Pregnancy may provide a critical "window of opportunity" for sexual risk reduction.

Older partners and STD prevalence among pregnant African American teens

BACKGROUND

Several recent studies have addressed the question of whether adolescent females who have sex with older partners have a greater risk of sexually transmitted disease (STD) acquisition.

GOAL

The goal was to identify differences in STD prevalence and selected measures of behavioral risk between unmarried pregnant African American adolescent females reporting sex with older partners and those reporting sex with similar-age partners.

STUDY DESIGN

Adolescents (n = 169) were recruited during their first prenatal visit. Adolescents completed a self-administered survey and a face-to-face interview and provided urine specimens for nucleic acid amplification assays.

RESULTS

Approximately 65% of adolescents reported that their male sex partners were >/=2 years older, while 35% reported having similar-age male sex partners. In age-adjusted analyses, adolescents with older partners were four times more likely to test positive for chlamydia (P < 0.04) and were more than twice as likely to report that their partner was also having sex with other women (P < 0.04). With use of a 30-day recall period, the mean number of unprotected vaginal sexual encounters among adolescents with older partners was 4.1, as compared to a mean of 6.9 among those reporting similar-age partners; this difference approached significance (P = 0.051). Prevalence of trichomoniasis as well as scale measures of adolescents' self-efficacy for condom negotiation and frequency of sexual communication with partners did not differ between those adolescents with older or similar-age male sex partners.

CONCLUSION

In resource-constrained clinical settings, one implication of these findings is that pregnant adolescents reporting older partners may be a priority for targeted delivery of partner services. More frequent screening for chlamydia may also be cost-effective for pregnant adolescents with older partners.

Teen pregnancy, motherhood, and unprotected sexual activity

The sexual behaviors and attitudes toward condom use of adolescent mothers (N = 572) from ethnic minority groups were examined. Constructs from social cognitive theory (SCT), the theory of reasoned action (TRA), and the theory of planned behavior (TPB; e.g., intentions to use condoms, self-efficacy, outcome expectancies) were measured with questionnaires. Measures of AIDS and condom-use knowledge and selected psychosocial, behavioral, and demographic variables were included. Many adolescents reported early onset of sexual activity, multiple lifetime sexual partners, substance use, and childhood sexual or physical abuse. Only 18% stated a condom was used at last intercourse. Using hierarchical regression analysis, 13% of the variance for factors associated with unprotected sex was accounted for by TRA constructs. Other variables contributed an additional 17% of the variance. Unprotected sex was associated with behavioral intentions to use condoms, pregnancy, having a steady partner, more frequent church service attendance, and ever having anal sex. Findings support the urgent need for broad-based HIV prevention efforts for adolescent mothers that build on theoretical concepts and address the realities of their lives.

Correlates of continued risky sex among pregnant African American teens: implications for STD prevention

BACKGROUND

African American adolescent females have been understudied with regard to their continued sexually transmitted disease (STD) risk behavior during pregnancy. Preintervention studies of this population are especially important because the sequelae of STDs during pregnancy can be particularly problematic.

OBJECTIVE

This exploratory study identified correlates of engaging in relatively frequent penile-vaginal sex, unprotected by a condom, among inner-city African American adolescents during their first or second trimester of pregnancy.

STUDY DESIGN

Baseline data collected as part of an HIV prevention study were used. Adolescents at their first prenatal visit completed a self-administered survey and face-to-face interview. Only adolescents reporting a current boyfriend were included in this exploratory analysis (n = 144). Significant bivariate correlates were assessed for multivariate significance.

RESULTS

Significant bivariate correlates of relatively frequent unprotected vaginal sex were older age (P < 0.02), primiparity (P < 0.03), not being enrolled in school (P < 0.02), not residing with at least one parent (P < 0.001), reported infrequent sexual communication (communicating about sex) with the boyfriend (P < 0.01), spending at least 30 hours each week with the boyfriend (P < 0.001), reporting that the age of the current relationship was at least 2 years (P < 0.04), and using marijuana in the past 30 days (P < 0.03). Three correlates retained significance in the multivariate model: not residing with at least one parent (adjusted odds ratio [AOR] = 2.24; P < 0.04), spending at least 30 hours with the boyfriend each week (AOR = 3.70; P < 0.002), and infrequent sexual communication with the boyfriend (AOR = 2.88; P < 0.008).

CONCLUSION

Given the potential of STDs to complicate pregnancy outcomes, clinic-based and community-based programs addressing relational dynamics and relational obstacles to safer sex may be warranted, particularly for adolescents not residing with parents.