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Gaudet BA, Liu N, Kayne AN, Jarvill TL, Zemanek C, Downen JM, Cuadrado HM, Smith AB, Greenberg MR, Jacoby JL, Quinones JN. Relationship Between Sexual Activity, Contraceptive Utilization and Biopsychosocial Characteristics Among Homeless Shelter Adolescents. Cureus 2021; 13:e18128. [PMID: 34692338 PMCID: PMC8525671 DOI: 10.7759/cureus.18128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: To determine whether biopsychosocial factors are associated with sexual activity and contraceptive utilization among homeless shelter adolescents. Methods: A retrospective study of 440 adolescents at a shelter in Pennsylvania between February 2015 and September 2019 was conducted. The cohort was evaluated to determine what relationship age, gender identity, substance use, and trauma history have with sexual activity and contraceptive utilization. Results: Sexual activity was significantly related to age (mean 15.8+1.4 years in sexually active vs. 14.7+1.6 years in abstinent youth, p<0.001); remote history of self-harm behavior (relative risk ratio (RR) 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001). There were 55.7% sexually active females vs. 42.50% males reporting contraception use (p=0.01). After adjustment, older age and substance use remained significantly associated with sexual activity (adjusted odds ratio (AOR) 1.58 [95% CI 1.36-1.83]; p<0.001 and AOR 5.18 [95% CI 3.28-8.18]; p<0.001, respectively). Conclusions: Females self-reported sexual activity using contraception more than males. After adjustment, older age and substance use were associated with sexual activity. By better understanding the impact these factors can have on contraceptive utilization, informed policy and practice interventions can be developed and implemented to help increase safe sex practices in spaces where homeless adolescents access healthcare.
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Affiliation(s)
- Brittney A Gaudet
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Nina Liu
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Allison N Kayne
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Taylor L Jarvill
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Cecilia Zemanek
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Jeffrey M Downen
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Hoonani M Cuadrado
- Department of Community Health and Health Studies, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA.,Street Medicine, Valley Health Partners, Allentown, USA
| | - Amy B Smith
- Department of Education, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Marna R Greenberg
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Jessica L Jacoby
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Joanne N Quinones
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
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Using a "Positive Deviance" Framework to Discover Adaptive Risk Reduction Behaviors Among High-Risk HIV Negative Black Men Who Have Sex with Men. AIDS Behav 2018; 22:1699-1712. [PMID: 28501965 DOI: 10.1007/s10461-017-1790-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Despite the high incidence of HIV among young Black MSM in the United States and engagement in high risk behaviors, many men in this group avoid infection. This suggests that some men may engage in systematic risk reduction behaviors when not always using condoms or abstaining from substances. Using a "positive deviance" framework, we conducted qualitative interviews with HIV-negative, Black MSM between 25 and 35 who reported unprotected anal sex and drug use in the past six months or current heavy drinking (N = 29) to discover behaviors that could facilitate remaining HIV-uninfected. Findings showed that MSM who remain HIV negative despite continuing to engage in high-risk behaviors may be engaging in adaptive risk reduction behaviors that, through successive decisions and advance planning along the timeline to a sexual event, could lead to increased condom use, avoidance or delay of a risky sexual event, or reduction of HIV positive partners.
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D'Amico EJ, Houck JM, Tucker JS, Ewing BA, Pedersen ER. Group motivational interviewing for homeless young adults: Associations of change talk with substance use and sexual risk behavior. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017. [PMID: 28627914 DOI: 10.1037/adb0000288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Homeless young adults exhibit high rates of alcohol and other drug (AOD) use and sexual risk behaviors. This study is a secondary analysis of data collected in a randomized clinical trial of AWARE, a new 4 session group motivational interviewing intervention. AWARE mainly focused on alcohol use and sexual risk behavior given focus group feedback. We used sequential coding to analyze how the group process affected both AOD use and sexual risk behavior at 3-month follow up among homeless young adults by examining facilitator behavior and participant change talk (CT) and sustain talk (ST). We analyzed 57 group session digital recordings of 100 youth (69% male, 74% heterosexual, 28% non-Hispanic white, 23% African American, 26% Hispanic, 23% multiracial/other; mean age 21.75). Outcomes included importance and readiness to change AOD use and risky sexual behavior, AOD use and consequences, number of partners and unprotected sex, and condom self-efficacy. Sequential analysis indicated that facilitator open-ended questions and reflections of CT increased Group CT. Group CT was associated with a lower likelihood of being a heavy drinker 3 months later; Group ST was associated with decreased readiness and confidence to change alcohol use. There were no associations with CT or ST for drug use or risky sexual behavior. Facilitator speech and peer responses were related to CT and ST during the group sessions with this high risk population, which were then associated with individual changes for alcohol use. Further research is needed to explore associations with drug use and sexual risk behavior. (PsycINFO Database Record
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Affiliation(s)
| | - Jon M Houck
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
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Cheng T, Johnston C, Kerr T, Nguyen P, Wood E, DeBeck K. Substance use patterns and unprotected sex among street-involved youth in a Canadian setting: a prospective cohort study. BMC Public Health 2016; 16:4. [PMID: 26728877 PMCID: PMC4700772 DOI: 10.1186/s12889-015-2627-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/16/2015] [Indexed: 11/21/2022] Open
Abstract
Background Rates of sexually transmitted infections (STI) and unplanned pregnancy are high among youth. While the intersection between drug and alcohol use and unprotected sex is well recognized, few studies have examined the relationship between substance use patterns and unprotected sex among high risk-populations such as street-involved youth. Methods Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth from Vancouver, Canada. Generalized estimating equations (GEE) were used to examine substance use patterns that were independently associated with unprotected sex, defined as (vaginal or anal) sexual intercourse without consistent condom use. Results Between September 2005 and May 2013, 1,026 youth were recruited into the ARYS cohort and 75 % (n = 766) reported engaging in recent unprotected sex at some point during the study period. In a multivariable analysis, female gender (adjusted odds ratio [AOR] = 1.46, 95 % confidence interval [CI]: 1.18-1.81), Caucasian ancestry (AOR = 1.38, 95 % CI: 1.13-1.68), being in a stable relationship (AOR = 4.64, 95 % CI: 3.82-5.65), having multiple sex partners (AOR = 2.60, 95 % CI: 2.18-3.10) and the following substance use patterns were all independently associated with recent unprotected sex: injection or non-injection crystal methamphetamine use (AOR = 1.21, 95 % CI: 1.03-1.43), injection or non-injection cocaine use (AOR = 1.20, 95 % CI: 1.02-1.41), marijuana use (AOR = 1.23, 95 % CI: 1.02-1.49), ecstasy use (AOR = 1.23, 95 % CI: 1.01-1.48) and alcohol use (AOR = 1.31, 95 % CI: 1.11-1.55) (all p < 0.05). Conclusions Unprotected sex was prevalent among street-involved youth in this setting, and independently associated with female gender and a wide range of substance use patterns. Evidence-based and gender-informed sexual health interventions are needed in addition to increased access to youth-centered addiction treatment services. STI testing and linkages to healthcare professionals remain important priorities for street-involved youth, and should be integrated across all health and social services.
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Affiliation(s)
- Tessa Cheng
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6. .,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, B.C., Canada, V5A 1S6.
| | - Caitlin Johnston
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6. .,BC Women Hospital and Health Centre, 4500 Oak St, Vancouver, B.C., Canada, V6H 3V5.
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6. .,Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, B.C., Canada, V6T 1Z3.
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6.
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6. .,Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, B.C., Canada, V6T 1Z3.
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6. .,School of Public Policy, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, B.C., Canada, V6B 5K3.
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Abstract
OBJECTIVE While representing only 25% of the sexually active population, 50% of all new sexually transmitted infections occur among young people mostly because of inconsistent condom use. Critically, the majority of adolescent sexual activity takes place in the context of romantic relationships; thus, it is important to understand how relationship factors may influence decision making about the use of protection. METHODS We used a mixed-method approach to investigate the extent to which relationship length, degree of trust or love in the relationship, and frequency of intercourse influence both perceptions of the probability of condom use and self-reported condom use in the context of relationships among a diverse sample of high-risk adolescents (age 12-19 yr). RESULTS Participants were least likely to use condoms if they were in relationships with high trust or love and high frequency of intercourse. Importantly, sexual experience status was a strong moderator of primary effects. CONCLUSION The perspective of motivated cognition provides a useful theoretical framework to better understand adolescent decision making about condom use, particularly for sexually experienced youth.
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