Individual, Interpersonal, and Structural Power: Associations With Condom Use in a Sample of Young Adult Latinos

Parental Psychological Control and Self-Efficacy as Predictors of Romantic Relationship Power Dynamics

In the current study, we utilized a person-centered approach to examine the relations of parental psychological control (PPC) and relationship self-efficacy (RSE) to power dynamics in emerging adults' romantic relationships. College student emerging adults (N = 312) completed measures assessing retrospective PPC, RSE, and perceived self and partner power in current relationships. Latent profile analysis uncovered four relationship types based on reported self- and partner-power: balanced-unified, balanced-interchanging, unbalanced-high self, and unbalanced-high partner. Increases in PPC were related to increased odds of being in an unbalanced relationship. Higher levels of RSE were associated with decreased odds of being in an unbalanced relationship. Further, even individuals in the balanced profile who reported average levels of both self and partner power (balanced-interchanging) reported higher levels of PPC and lower levels of RSE compared to those in the balanced group where levels of both self and partner power were low (balanced-unified). These findings suggest using a person-centered approach to relationship power may advance our conceptualization of power distribution in romantic relationships. Further, experienced family dynamics and one's sense of self may be especially important for young adults' tendency to form healthy relationships. The current findings encourage future investigation into the mechanisms by which parental factors predict both dominance and submissiveness in romantic relationships. Understanding predictors of power dynamics may contribute to intimate partner violence prevention and intervention.

Barriers in Healthcare for Latinx Patients with Limited English Proficiency-a Narrative Review

Latinx (includes Hispanics and is the non-gendered term for Latino/Latina which is a person of Latin American origin or descent) constitutes the largest racial and ethnic minority group in the United States (US). Many members of this group report limited English proficiency, experience discrimination, feel distrust in the healthcare setting, and face poorer health outcomes than non-Latinx Whites. As healthcare systems assess internal structures of care, understanding the experiences of Latinx patients may inform strategies to improve care. This narrative review describes studies that assessed the experiences of Latinx patients with limited English proficiency (LEP) in the inpatient and outpatient settings in the US. We searched PubMed for studies published between January 1, 1990, and March 2021. We reviewed all citations and available abstracts (n = 429). We classified study titles (n = 156) as warranting detailed consideration of the original article. Limited English proficiency is a well-documented challenge reported by Latinx patients seeking care in the outpatient setting, resulting in mistrust of healthcare organizations and clinicians. The effects of LEP overlap substantially with challenges related to patients' immigration status, cultural traditions, and socioeconomic needs. Use of professional interpretation rather than ad hoc interpretation improves trust and satisfaction. There is no consensus about the most effective mode of delivering professional interpretation (in person, telephonic, video conferencing), although rapid simultaneous telephone translation is a promising modality. Increasing awareness of the barriers to effective communication, improving skills in communicating through translators, and increasing the amount of time spent with patients may improve communication and trust more than structural changes like mode of translation or bedside rounding. Cultural fluency training, standardized language training for providers, and incentive pay for fluency are also deserving of further consideration.

Analysing intersecting social resources in young people's ability to suggest safer sex - results from a national population-based survey in Sweden

Background

Safer sex is one of the most crucial areas in sexual and reproductive health and rights (SRHR). Drawing on the theory of health promotion where social life generates resources for health our hypothesis is that having control over one’s life situation, affects the ability for safer sex and thereby sexual health. The aim is to explore the association between having control over one’s life and the ability to suggest safer sex among young people aged 16–29, and how this plays out in relation to membership of six constructed social groups based on: gender, transgender experience, sexual identity, economy, being foreign-born, and social welfare recipiency followed by an in-depth analysis of the intersection of gender and sexual identity.

Methods

The data set comprises cross-sectional survey responses from a stratified random sample of 7755 in the total Swedish population of young people. The SRHR-focused questionnaire was developed within the HIV-monitoring program at the Public Health Agency of Sweden. Data collection was conducted by Statistics Sweden between April 15 and June 8 in 2015. The survey had a response rate of 26%, which was in line with the study design. Statistical analysis was used to explore the self-reported outcome variable ability for safer sex and the exposure variable control over one’s life. The methods used comprise multivariate logistic regression and an intersecting multivariate regression exploring 12 intersecting social positions by gender and sexual identity.

Results

The results show that young people’s control over their lives is associated with their ability for safer sex. Due to this, control over one’s life can be seen as a resource for safer sex. The associations in the 12 intersecting social positions showed complex patterns.

Conclusions

The intersections of resources show the complexity and that gender cannot account for all differences in the resources for young people’s ability to suggest safer sex. Implications for policy and practitioners involve both addressing and strengthening the sexual rights of young people from sexual minorities and tailoring interventions in a way that takes the intersections between gender and sexual identity into consideration.

Association of CAI Vulnerability and Sexual Minority Victimization Distress Among Adolescent Men Who Have Sex With Men

Adolescent men who have sex with men (AMSM) are at high HIV risk. Condomless anal intercourse (CAI) increases HIV risk and has been associated with interpersonal power imbalances, such as asymmetries in decision-making authority, social status, and emotional dependence, between male sexual partners. AMSM experience high levels of psychological and physical victimization due to their sexual minority status. Sexual minority victimization (SMV) is similarly associated with low interpersonal power and may relate to the extent to which AMSM are vulnerable to partner influences to engage in CAI. This online survey study of AMSM 14-17 years (N = 143) tested the hypothesis that experiences and attitudes reflecting vulnerability to partner CAI influence (CAI Vulnerability) and distress in response to experienced sexual minority victimization (SMV Distress) would be positively associated with participant and partner condom non-use during anal sex (CAI frequency). Approximately 35% reported they or their partner(s) had never or rarely used a condom. Positive correlations were found among partners' CAI frequency during sex with the participant, CAI Vulnerability, and SMV Distress. Multiple regression indicated CAI Vulnerability significantly accounted for the relation between SMV Distress and partner's CAI frequency. Findings suggest that distress in response to SMV may be associated with a diminished sense of interpersonal control resulting in CAI Vulnerability and subsequent more frequent instances of partner CAI. HIV prevention strategies designed to increase condom use among AMSM have the potential to benefit from procedures aimed at increasing interpersonal sexual assertiveness and decreasing distress associated with sexual minority victimization.

Factors Associated with HIV and Vulnerability Contexts for Women in Brazil

The purpose of this study was to identify factors associated with HIV and vulnerability contexts for women in Porto Alegre, Brazil. The participants were 1326 women recruited by complex sampling design, divided into two groups: 640 women with HIV (WLH) and 686 women who did not have HIV (WNLH). Gross and weighted statistical analyses were performed. Logistic regression models were used to estimate the odds ratio (OR) for 12 variables. The main results demonstrated that WLH had lower income (p < .001) and poorer education (p = .038), and few used condoms during their first sexual intercourse (p < .001). The occurrence of HIV was higher among the black population (p < .001). Sex in exchange for money (p < .001) and sexually transmitted infections (p < .001) were more frequent among WLH than among WNLH. The age of sexual debut and age difference from the partner at first sexual intercourse (FSI) were not associated with the outcome. The high percentage of non-use of condoms during the FSI shows how vulnerable individuals are right at the beginning of their sexual lives. More effective prevention strategies can be developed by nurses in view of the contexts of vulnerability surrounding women.

Development and Feasibility Testing of a Video Game to Reduce High-Risk Heterosexual Behavior in Spanish-Speaking Latinx Adolescents: Mixed Methods Study

Background

Similar to broader health disparities, Latinx adolescents have higher rates of high-risk sexual behavior resulting in pregnancy rates that are 2 times higher and sexually transmitted infection rates that are 5 to 8 times higher than non-Hispanic, white adolescents. Novel approaches are needed to reduce high-risk sexual behavior among Spanish-speaking Latinx adolescents who represent the fastest-growing group of US immigrants.

Objective

This study aimed to partner with Spanish-speaking Latinx adolescents in a participatory design process to develop and test a Spanish-language video game intervention to decrease high-risk heterosexual behavior.

Methods

This is an iterative, two-phase, mixed methods study. In phase 1, we conducted focus groups with Spanish-speaking Latinx adolescents to elicit feedback on the content and format of an existing English-language video game. Feedback was then incorporated into an expanded and culturally adapted Spanish-language video game. In phase 2, we pilot tested the feasibility, acceptability, and preliminary efficacy of the new Spanish-language video game intervention by measuring known antecedents to sexual behavior (intentions, self-efficacy, risk perception, and knowledge) assessed at enrollment and 12-week follow-up. We applied a thematic analysis to examine focus group feedback and a bivariate analysis to analyze pre- and postquantitative data.

Results

In phase 1, 15 Spanish-speaking Latinx adolescents provided feedback for further video game development. A Spanish-language video game was then produced and tested in phase 2. We recruited and enrolled 24 Spanish-speaking Latinx adolescents aged 15 to 17 years. Participants played the video game for an average of 4.2 hours during monitored sessions. Pilot testing demonstrated feasibility and acceptability; 65% (3/20) of participants stated that they would play it again, and 65% (3/20) said they would recommend it to friends. Condom-specific knowledge did significantly increase between baseline and follow-up (P=.007). Other variables of sexual behavior antecedents did not differ significantly between baseline and 12-week follow-up.

Conclusions

An iterative participatory design process in partnership with Spanish-speaking adolescents produced an innovative and acceptable Spanish-language video game intervention aimed at decreasing high-risk sexual behavior in adolescents. Pilot testing demonstrated preliminary feasibility and yielded essential information for further video game development.

Intimate Partner Violence and Coerced Unprotected Sex Among Young Women Attending Community College

The present study examined the mediating role of sexual assertiveness in the relationship between psychological, physical, and sexual intimate partner violence (IPV) victimization and unprotected sex as a result of condom use resistance among sexually active young women attending community college. Women reported engagement in unprotected sex as a result of a partner's use of one of 32 forms of condom use resistance (e.g., physical force, deception, or other forms of coercion to avoid using a condom during intercourse). Women ages 18-24 years (N = 212) attending community college were recruited through paper advertisements to complete assessments of social and dating behavior in the campus computer laboratory. Only the women with a history of sexual intercourse (N = 178; 84% of the sample) were included in analyses. More frequent engagement in unprotected sex as a result of a partner's condom use resistance was associated with physical, psychological, and sexual IPV victimization. Sexual assertiveness mediated the relationship between physical IPV victimization and the frequency of unprotected sex as a result of condom use resistance. Efforts to prevent dating violence and enhance the sexual health of community college women may benefit from focusing on targeting sexual assertiveness as a protective factor.

Gendered powerlessness in at-risk adolescent and young women: an empirical model

In the United States, youth aged 13-24 comprised approximately 21% of new HIV infections in 2017; 13% of these infections occurred among women, the majority of whom (86%) acquired HIV through heterosexual contact (Centers for Disease Control and Prevention. 2019a. HIV and youth. Retrieved from https://www.cdc.gov/hiv/group/age/youth/index.html, Centers for Disease Control and Prevention. 2019b. HIV among women. Retrieved from https://www.cdc.gov/hiv/group/gender/women/index.html). We fit and validated a developmentally appropriate empirical model of Connell's Theory of Gender and Power (Connell, R. W. 1987. Gender and power: Society, the person and sexual politics. Stanford, CA: Stanford University Press, Connell, R. W. 2013. Gender and power: Society, the person and sexual politics. Hoboken, NJ: John Wiley & Sons) in a sample of young women and assessed whether gendered powerlessness reflected a multidimensional higher-order latent factor, as the theory implies. Anonymous computer-assisted interviews were administered to at-risk, sexually active young women (N = 1,101). Factor analyses and structural equation modeling were used to determine the dimensionality of gendered powerlessness. Associations with condom use were examined to validate the model. We fit a three-component model of gendered powerlessness, but not a higher-order latent factor. We observed that high scores on two dimensions of gendered powerlessness - cathexis and sexual division of power - were associated with lower likelihood of condom use. Our three-component model helps elucidate the role that components of gendered powerlessness play in young women's health behaviors and underscores the need for measures tailored to young women at high risk of contracting HIV.

The Association of Cultural and Structural Factors with Perceived Medical Mistrust Among Young Adult Latinos in Rural Oregon

Although previous studies have examined the impact of medical mistrust on the health and health care seeking behaviors of diverse populations, including Latinos, limited research has explored cultural and structural factors that contribute to medical mistrust. The aim of the present study was to examine the associations between cultural and structural factors and perceived medical mistrust among a sample of young adult Latinos living in rural Oregon. We conducted in-person interviews with 499 young adult Latinos (ages 18-25). Medical mistrust was assessed using a modified version of the Group-Based Medical Mistrust Scale, which has been used with Latino populations. We included three cultural (acculturation, machismo, and familismo) and one structural (perceived everyday discrimination) variables, all measured using previously validated scales. Socio-demographic variables (eg, age, gender, income, educational level, employment) were also included in multivariable linear regression models. We found that everyday discrimination and traditional machismo values were associated with medical mistrust, the latter primarily among Latino women. It is possible that Latinos living in relatively new minority/immigrant settlement areas (such as rural Oregon) may be more vulnerable to experiencing discrimination, which in turn, may erode trust in health care providers. On the other hand, a strong ethnic identity, including the endorsement of machismo values, may serve as a protective mechanism for Latinos confronted by racial/ethnic discrimination. Culturally responsive, socio-cultural, and societal interventions are warranted to tackle the pervasive and ripple effects that racial/ethnic discrimination has on the health of Latinos and other minority populations.

Development and Validation of the Power Imbalance in Couples Scale

Few researchers have quantitatively explored the relationship power-HIV risk nexus in same-sex male couples. We developed and validated the Power Imbalance in Couples Scale (PICS) to measure relationship power among men in same-sex, committed relationships and its association with sexual risk behaviors. We recruited three independent and diverse samples of male couples in the greater San Francisco and New York City metropolitan areas and conducted qualitative interviews (N1 = 96) to inform item development, followed by two quantitative surveys (N2 = 341; N3 = 434) to assess the construct, predictive, convergent, and discriminant validity of the PICS. Exploratory factor analysis of the first survey's data yielded four factors-overtly controlling partner, supportive partner, conflict avoidant actor, and overtly controlling actor-that accounted for more than 50% of the shared variance among the PICS items. Confirmatory factor analysis (CFA) of the second survey's data supported these four factors: χ²(1823) = 2493.40, p < .001; CFI = .96, RMSEA = .03 and WRMR = 1.33. Strong interfactor correlations suggested the presence of a higher-order general perception of power imbalance factor; a higher-order factor CFA model was comparable in fit to the correlated lower-order factors' CFA: χ²(2) = 2.00, p = .37. Internal reliability of the PICS scale was strong: α = .94. Men perceiving greater power imbalances in their relationships had higher odds of engaging in condomless anal intercourse with outside partners of discordant or unknown HIV status (OR 1.27; 95% CI 1.01-1.60; p = .04). The PICS is an important contribution to measuring relationship power imbalance and its sequelae among male couples; it is applicable to research on relationships, sexuality, couples, and HIV prevention.

Ubiquitous Yet Unclear: A Systematic Review of Medical Mistrust

Peer-reviewed articles (n = 124) examining associations between medical mistrust (MM) and health outcomes from four databases, between January 1998 and May 2018, were reviewed; 36 qualitative and 88 quantitative studies met the inclusion criteria. The Williams and Mohammed framework guided our narrative synthesis of the studies; it argues that basic causes (e.g., biased institutions) affect the social status of marginalized groups which in turn effects multiple proximal pathways leading to responses and poor health. Most studies were cross-sectional with US-based samples. The MM in qualitative studies were categorized as interpersonal (n = 30), systemic (n = 22), and/or vicarious (n = 18); 25% did not explicitly note the basic causes of MM and race/ethnicity was often confounded with socioeconomic status (SES). All but three studies discussed an association between MM and a behavior response; no study focused on an actual health outcome. Most quantitative studies used multivariate regression analyses; only 15 of the 88 utilized advanced modeling techniques (e.g., mediation). Most (75%) studies did not describe basic causes for MM and 43% utilized low income samples. MM was conceptualized as a predictor/proximal pathway (in 73 studies) associated with a variety of responses, most commonly behavioral (e.g., diminished adherence); 14 studies found an association between MM and a specific health measure. This review underscores the need for future qualitative studies to place MM central to their research questions as in-depth descriptions of MM were limited. Future quantitative studies should replicate findings using more advanced analytical strategies that examine the relationship between MM and health outcomes.

Male Partner Contraceptive Interference: Associations With Destructive Conflict and Women’s Relational Power

We explored the relational context of male partner contraceptive interference (CI), acts that impede women’s contraceptive use. Undergraduate women ( N = 213) who had previously been involved in a sexual relationship with a male partner provided self-report data on relational power and conflict within the relationship, including whether the past partner enacted CI. Relationships involving CI were characterized by greater conflict about whether to engage in sex, perceived infidelity, partner conflict engagement, and women’s withdrawal. These quantitative data suggest that, in heterosexual dyads, women who experience partner CI also experience disempowerment and multiple forms of destructive sexual and verbal conflict.

Evaluating a Culturally Tailored HIV Risk Reduction Intervention Among Hispanic Women Delivered in a Real-World Setting by Community Agency Personnel

PURPOSE

To evaluate the effectiveness of Salud, Educación, Prevención, y Autocuidad/Health, Education, Prevention and Self-care (SEPA) to increase human immunodeficiency virus (HIV)/sexually transmitted infections (STI) prevention behaviors for Hispanic women delivered in a real-world setting.

DESIGN

Randomized controlled trial.

SETTING

Participants were recruited from the Miami Refugee Center, the Florida Department of Health, and public locations in Miami.

PARTICIPANTS

Three hundred twenty Hispanic women.

INTERVENTION

The SEPA is a culturally tailored intervention developed to address HIV/STI risk behaviors among Hispanic women. The SEPA intervention consisted of three 2.5 hour sessions per week conducted with small groups. The SEPA sessions consisted of group discussions, role playing, negotiation skills, partner communication, and skills building as part of the methodology.

MEASURES

Acculturation, HIV/STI risk behaviors, HIV knowledge, partner communication, intimate partner violence, drug/alcohol use, condom use.

ANALYSIS

Differences at baseline by group were assessed using Wilcoxon rank sum test, χ², and a negative-binomial model. Changes in dependent variables, compared to baseline, were analyzed in separate models. Log-binomial models and negative binomial models were used for dichotomous and count/rate-type dependent variables.

RESULTS

Significant outcome improvements were observed in the SEPA group at 6 and 12 months follow-up. The adjusted prevalence of any condom use was 30% and 37% higher at each follow-up. The adjusted prevalence of answering 10/12 HIV knowledge questions correctly rose by 57% and 63% at each follow-up. Intimate partner violence was significantly lower at each subsequent time point (62% and 41% of baseline). Moderate depressive symptoms were reduced to 50% and 42%, getting drunk was reduced to 20% and 30%, and condom use self-efficacy was significantly higher (84% and 96%).

CONCLUSION

The SEPA intervention reduced HIV/STI risk-related behaviors when delivered in a real-world setting. The results suggest that SEPA can be implemented in various settings to reach Hispanic women, and that SEPA could reach large numbers of women in an efficient, cost-effective way.

Determinants of condom use among parous women in North Central and South Western Nigeria: a cross-sectional survey

Objectives

There appears to be an increasing trend of condom use for pregnancy prevention among nulliparous and multiparous women in developing countries. Drawing from a cross-sectional survey involving 1227 women selected using a 3-stage cluster random sampling technique, the study examines the rates of condom use and its determinants among parous women in three states in North Central and South Western Nigeria.

Results

The rate of condom use among parous women was 13.8% and 23.2% among women using any form of contraceptives. After adjusting for confounding factors (religion and marital status, socioeconomic status and access to a health facility in the resident community), women aged 26–35 (AOR 2.7; CI 1.6–4.5), urban residence (AOR: 3.6; CI 2.2–5.8), no income (AOR: 2.7; CI 1.4–4.9), living in Ekiti State (AOR: 1.8; CI 1.2–2.8) and having a tertiary level of education (AOR: 4.5; CI 1.3–15.6) were the independent predictors of condom use. There is an increasing trend of condom use among parous women.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3573-5) contains supplementary material, which is available to authorized users.

Racial and Ethnic Discrimination, Medical Mistrust, and Satisfaction with Birth Control Services among Young Adult Latinas

BACKGROUND

Racial/ethnic discrimination and medical mistrust contribute to disparities in use of and satisfaction with health care services. Previous work examining the influence of discrimination and medical mistrust on health care experiences has focused primarily on African Americans. Despite the finding that Latinas report lower rates of contraceptive use than White women, little is known about the influence of these factors on health care satisfaction, specifically satisfaction with contraceptive services, among Latina women.

METHODS

We conducted computer-assisted interviews with 254 Latina women aged 18 to 25 living in rural communities in Oregon. Only the 211 women who reported ever receiving birth control services answered the question regarding satisfaction with birth control services and were included in the analytic sample. Using multivariable logistic regression models, we explored the relationship between medical mistrust and everyday discrimination on satisfaction with birth control services, accounting for relevant factors.

RESULTS

More than 80% of the total sample reported ever seeing a health care provider for birth control services and of these women, 75% reported being very or extremely satisfied with their birth control services. Latinas who reported higher levels of medical mistrust and racial/ethnic discrimination reported being less satisfied with birth control services. After adjusting for perceived barriers to accessing contraceptive services and other relevant factors, only perceived barriers and racial/ethnic discrimination remained significantly associated with satisfaction.

CONCLUSIONS

This study contributes to the growing understanding of the pervasive effects that racial/ethnic discrimination and medical mistrust have on satisfaction with health services among Latinas in the United States.

Contextual factors associated with consistent condom use and condom self-efficacy amongst African asylum seekers and refugees in Hong Kong

BACKGROUND

Hong Kong has no systematic domestic policies committed to the rights of asylum-seekers and refugees (ASRs). This study explores the sexual health behaviours and social inequities amongst African ASRs in Hong Kong.

METHODS

A cross-sectional survey of African ASRs was conducted through three local non-governmental organizations in 2013. A logistic model was used to test the interactions and relationship between the respondents' consistent condom use and contextual antecedents, socio-demographic factors, psychosocial factors and condom self-efficacy (CSE) score.

RESULTS

371 adult African ASRs were recruited. In the previous month, 35% and 38% of participants consistently had used condoms with regular and casual sexual partners respectively. However, less than 50% perceived no risk of HIV/STIs and less than 60% reported not knowing how to access sexual health screening. Consistent condom use was less likely among African ASRs who were married (adjusted odds ratio (aOR) = 0.10), used recreational drugs (aOR = 0.11) or were unsure of their sexual orientation (aOR = 0.05) and was positively associated with higher CSE scores (aOR = 1.09) Pre-migration determinants and lifestyle determinants accounted for most of the variance in the model.

CONCLUSION

The inconsistent condom use makes African ASRs vulnerable to HIV/STIs. Tailored interventions are needed to address the associated determinants and inequities amongst African ASRs living in Hong Kong.

Translation and Validation of a Condom Self-Efficacy Scale (CSES) Chinese Version

The English version of the Condom Self-Efficacy Scale (CSES) was translated, back-translated, and tested among a representative sample of the Hong Kong general population. It then underwent reconsolidation, confirmation, and validation following standard procedures. Construct validity was performed by exploratory factor analysis and item-scale correlation. Independent t-test and effect size were used to identify the score differences between consistent and non-consistent condom users. The factor loading scores of 14 items ranged between 0.749 and 0.884. Cronbach's alpha for the traditional Chinese version of CSES (CSES-TC) was 0.96 for the overall scale. The CSES-TC was highly correlated with self-reported condom use among the 265 participants who indicated they had been sexually active in the past 12 months. The CSES-TC demonstrated satisfactory psychometric properties in terms of validity, reliability, and sensitivity. This scale can be used as an instrument to measure condom use efficacy for condom promotion and intervention purposes.