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Cain D, Samrock S, Jones SS, Jimenez RH, Dilones R, Tanney M, Outlaw A, Friedman L, Naar S, Starks TJ. Marijuana and illicit drugs: Correlates of condomless anal sex among adolescent and emerging adult sexual minority men. Addict Behav 2021; 122:107018. [PMID: 34171584 DOI: 10.1016/j.addbeh.2021.107018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
The association between "illicit drugs" (e.g., cocaine/crack, methamphetamine, gamma-hydroxybutyrate-GHB, ketamine, and ecstasy) and condomless anal sex (CAS) with casual partners is well established for sexual minority men (SMM). Recent evidence from adult SMM has indicated that marijuana is associated with the occurrence of CAS with casual partners above and beyond illicit drug use. The purpose of the current study was to evaluate associations between CAS and the use of marijuana and illicit drugs in a sample of young SMM (aged 15-24). Participants (n = 578) completed an online survey assessing demographics, current PrEP prescription, age, marijuana use, as well as drug use and sexual behavior in the past 90 days. A hurdle model simultaneously predicted the occurrence of CAS as well as the frequency of CAS among those reporting it. Illicit drug use was associated with both the occurrence (OR = 2.26; p = .01) and frequency of CAS (RR = 1.63; p = .02). In contrast, marijuana use was associated with the occurrence (OR = 1.69; p = .01), but not the frequency of CAS (RR = 1.07; p = .74). Findings mirror recent observations in large samples of adult SMM. While the effect size of marijuana is more modest than illicit drug use, marijuana does have significant and unique associations with the occurrence of CAS. HIV prevention services for young SMM may therefore benefit from assessing and addressing marijuana use in the context of HIV sexual behavior.
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Affiliation(s)
- Demetria Cain
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Steven Samrock
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - S Scott Jones
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Ruben H Jimenez
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Rafael Dilones
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Mary Tanney
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Angulique Outlaw
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 60 West Hancock, Detroit, MI 48201 USA.
| | - Lawrence Friedman
- Department of Pediatrics, University of Miami, 1580 Northwest 10th Avenue, Miami, FL 33136, USA.
| | - Sylvie Naar
- Center for Translational Behavioral Science, 12236 Florida State University (FSU) College of Medicine, Tallahassee, FL, USA.
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA; Doctoral Program in Health Psychology and Clinical Science, Graduate Center of CUNY, 695 Park Avenue, New York, NY 10065, USA.
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Kan E, Knowles A, Peniche M, Frick PJ, Steinberg L, Cauffman E. Neighborhood Disorder and Risk-Taking Among Justice-Involved Youth-The Mediating Role of Life Expectancy. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2021; 31:282-298. [PMID: 33232554 DOI: 10.1111/jora.12596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Neighborhood disorder has been linked to perceptions of shorter life expectancies, and shorter life expectancies have been associated with greater risk-taking. Yet, no studies have combined these two pathways. Using data from the longitudinal Crossroads study, the present study assessed whether life expectancy mediates the association between neighborhood disorder and risk-taking-substance use, crime, and risky sex-among 1,093 justice-involved adolescents. Results indicate that neighborhood disorder was linked to lower estimated life expectancy which in turn related to higher rates of cigarette use, binge drinking, illicit drug use, offending, and casual sex. However, life expectancy did not explain the association between neighborhood disorder and marijuana use or inconsistent condom use.
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Affiliation(s)
- Emily Kan
- University of California, Irvine, USA
| | | | | | - Paul J Frick
- Louisiana State University & Australian Catholic University, USA
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Lobo R, Rayson J, Hallett J, Mak DB. Risk perceptions, misperceptions and sexual behaviours among young heterosexual people with gonorrhoea in Perth, Western Australia. ACTA ACUST UNITED AC 2020; 44. [PMID: 32418513 DOI: 10.33321/cdi.2020.44.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Notification rates of gonorrhoea in Australia for heterosexual young adults rose by 63% between 2012 and 2016. In Western Australian major cities, there was a 612% increase among non-Aboriginal females and a 358% increase in non-Aboriginal males in the ten-year period 2007-2016. A qualitative public health investigation was initiated to inform appropriate action. Methods Eighteen semi-structured telephone interviews were conducted with non-Aboriginal heterosexual young adults aged 18-34 years living in Perth, Western Australia, who had recently been notified to the Department of Health with gonorrhoea, to explore the context of their sexual interactions and lifestyles which could have predisposed them to contracting gonorrhoea. Data were thematically analysed. Results Common themes were having several casual sexual partners, limited communication between sexual partners about condom use or sexual history prior to engaging in sexual activity, inconsistent condom use, normalisation of some sexually transmissible infections amongst young people, and poor understandings and assessment of sexually transmissible infection risk. Conclusion The findings support public health interventions that focus on communication between sexual partners and shifting of risk perceptions in sexual health education programs, ensuring accessibility of quality sexual health information, increasing condom accessibility and acceptability, and on strategies for addressing misperceptions of young people in relation to sexually transmitted infections.
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Affiliation(s)
- Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), School of Public Health, Curtin University, GPO BOX U1987, Bentley, Western Australia, WA 6845
| | - Josephine Rayson
- Communicable Disease Control Directorate, Public and Aboriginal Health Division, Department of Health , CDCD, 189 Royal St, East Perth, Western Australia, WA 6004
| | - Jonathan Hallett
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), School of Public Health, Curtin University, GPO BOX U1987, Bentley, Western Australia, WA 6845
| | - Donna B Mak
- Communicable Disease Control Directorate, Public and Aboriginal Health Division, Department of Health , CDCD, 189 Royal St, East Perth, Western Australia, WA 6004; School of Medicine, Fremantle, University of Notre Dame Australia, PO BOX 1225, Fremantle, Western Australia WA 6959
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Associations Between Cannabis Use, Sexual Behavior, and Sexually Transmitted Infections/Human Immunodeficiency Virus in a Cohort of Young Men Who Have Sex With Men. Sex Transm Dis 2020; 46:105-111. [PMID: 30640212 DOI: 10.1097/olq.0000000000000919] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Among men who have sex with men (MSM) the relationship between sexually transmitted infections (STIs) and cannabis use is not well established. We assessed cannabis use, sexual behavior, and STIs including human immunodeficiency virus (HIV) in a diverse cohort of young MSM. METHODS In Los Angeles, the mSTUDY cohort conducted visits every 6 months with 512 MSM between 2014 and 2017 collecting demographics, sexual behaviors, and reports of frequency of substance use. Each visit conducted testing for gonorrhea, chlamydia, and syphilis via blood, urine, and pharyngeal and rectal swabs by PCR, Human immunodeficiency virus was assessed using rapid tests for HIV-negatives and viral load for HIV-positives. We analyzed the relationship between cannabis use, sexual behaviors and STIs/HIV across 1535 visits. RESULTS Significantly fewer participants tested positive for STIs at visits when reporting the previous 6 months use of only cannabis (11.7%) compared with no drugs (16.3%) or other drugs (20.0%, P = 0.01). Fewer MSM reporting only cannabis use than no or other drug use had been incarcerated, had incarcerated partners, experienced interpersonal violence, and were HIV-positive. In multivariable analyses visits with positive STIs were associated with other drug use (adjusted odds ratio, 1.69; 95% confidence interval, 1.03-2.78) but not use of cannabis only or no drug use after controlling for age, HIV status, new sex partners, and number of sex partners. CONCLUSIONS When MSM reported using cannabis exclusively fewer STIs were detected and lower risk sexual engagements reported than when MSM reported no drug or other drug use.
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Knowles A, Rinehart JK, Steinberg L, Frick PJ, Cauffman E. Risky Sexual Behavior among Arrested Adolescent Males: The Role of Future Expectations and Impulse Control. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2020; 30 Suppl 2:562-579. [PMID: 30983069 DOI: 10.1111/jora.12499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The current study evaluates two predictors of adolescent sexual risk-taking, specifically whether impulse control or future expectations predict condom use and casual sex. We examine whether risky sex occurs among youth who tend to act without thinking about the future, or instead, youth who report low future expectations. We consider these relations longitudinally among a sample of sexually active justice-involved adolescent males (N = 752, M age = 15.58) a group at heightened risk for sexual risk-taking. We found that optimistic expectations for the future predict a higher likelihood of engaging in consistent condom use, whereas high impulse control is related to a lower likelihood of casual sex. Implications for intervention and research on positive sexual health are discussed.
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Affiliation(s)
| | | | | | - Paul J Frick
- Louisiana State University System
- Australian Catholic University
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Abstract
Adolescents are at high risk for acquisition and transmission of sexually transmitted infections (STI) secondary to both cognitive and biological susceptibility. The prevention, diagnosis, and treatment of STIs are a critical part of adolescent health care. This article discusses the most common bacterial, parasitic, and viral STIs encountered in this age group with an emphasis on new guidelines for screening and management.
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Morgan E, Khanna AS, Skaathun B, Michaels S, Young L, Duvoisin R, Chang M, Voisin D, Cornwell B, Coombs RW, Friedman SR, Schneider JA. Marijuana Use Among Young Black Men Who Have Sex With Men and the HIV Care Continuum: Findings From the uConnect Cohort. Subst Use Misuse 2016; 51:1751-9. [PMID: 27556866 PMCID: PMC5031235 DOI: 10.1080/10826084.2016.1197265] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Young Black men who have sex with men (YBMSM) are at highest risk for HIV seroconversion in the United States. Successful movement through the HIV care continuum is an important intervention for limiting onwards HIV transmission. OBJECTIVE Little data exists on how substances most commonly used by YBMSM, such as marijuana, are related to the HIV continuum, which represents the primary aim of this study. METHODS A cohort of YBMSM (n = 618) was generated through respondent-driven sampling. Frequency of marijuana use and marijuana use as a sex-drug were assessed across the HIV care continuum using weighted logistic regression models. RESULTS Study participants reported more intermittent marijuana use (n = 254, 56.2%) compared to heavy use (n = 198, 43.8%). Our sample contained 212 (34.3%) HIV seropositive participants of which 52 (24.5%) were unaware of their HIV positive status. Study participants who were heavy marijuana users were more likely to be unaware of their HIV seropositive status (AOR: 4.18; 95% CI 1.26, 13.89). All other stages in the care continuum demonstrated no significant differences between those who use marijuana intermittently or heavily or as a sex-drug and nonusers. CONCLUSIONS YBMSM who used marijuana heavily were more likely to be HIV-positive unaware than those who never used marijuana. Findings were inconclusive regarding the relationships between marijuana use and other HIV care continuum metrics. However, knowledge of ones' HIV status is a critical requirement for engaging in care and may have implications for onwards HIV transmission.
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Affiliation(s)
- Ethan Morgan
- a Department of Public Health Sciences , University of Chicago , Chicago , Illinois , USA
| | - Aditya S Khanna
- b Department of Medicine , University of Chicago , Chicago , Illinois , USA
| | - Britt Skaathun
- a Department of Public Health Sciences , University of Chicago , Chicago , Illinois , USA
| | - Stuart Michaels
- c NORC at the University of Chicago, University of Chicago , Chicago , Illinois , USA
| | - Lindsay Young
- b Department of Medicine , University of Chicago , Chicago , Illinois , USA
| | - Rebeccah Duvoisin
- c NORC at the University of Chicago, University of Chicago , Chicago , Illinois , USA
| | - Ming Chang
- d Department of Laboratory Medicine , University of Washington , Seattle , Washington , USA
| | - Dexter Voisin
- e School of Social Service Administration , University of Chicago , Chicago , Illinois , USA
| | - Benjamin Cornwell
- f Department of Sociology , Cornell University , Ithaca , New York , USA
| | - Robert W Coombs
- d Department of Laboratory Medicine , University of Washington , Seattle , Washington , USA
| | - Samuel R Friedman
- g National Development and Research Institutes , New York , New York , USA
| | - John A Schneider
- a Department of Public Health Sciences , University of Chicago , Chicago , Illinois , USA
- b Department of Medicine , University of Chicago , Chicago , Illinois , USA
- c NORC at the University of Chicago, University of Chicago , Chicago , Illinois , USA
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Abstract
Black men who have sex with men (BMSM) are highest risk for HIV seroconversion in the United States. Little attention has been paid to marijuana use among BMSM and potential for HIV risk. A sample of 202 BMSM was generated through respondent driven sampling. The relationship between differential marijuana use and both HIV risk behavior and social network factors were examined using weighted logistic regression. Of the BMSM in this sample 60.4 % use marijuana in general and 20.8 % use marijuana as sex-drug. General marijuana use was significantly associated with participation in group sex (AOR 3.50; 95 % CI 1.10-11.10) while marijuana use as a sex drug was significantly associated with both participation in condomless sex (AOR 2.86; 95% CI 1.07-7.67) and group sex (AOR 3.39; 95% CI 1.03-11.22). Respondents with a moderate or high perception of network members who use marijuana were more likely to use marijuana both in general and as a sex-drug. Network member marijuana use, while not associated with risk behaviors, is associated with individual marijuana use and individual marijuana use in the context of sex is associated with risk practices. Targeting interventions towards individuals and their respective networks that use marijuana as a sex drug may reduce HIV risk.
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Crosby RA, Milhausen RR, Sanders SA, Graham CA, Yarber WL. Condoms are more effective when applied by males: a study of young black males in the United States. Ann Epidemiol 2014; 24:868-70. [PMID: 25193014 PMCID: PMC4578151 DOI: 10.1016/j.annepidem.2014.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 07/26/2014] [Accepted: 07/31/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine, among a sample of young black male (YBM), whether female application of male condoms for penile-vaginal intercourse would be associated with higher or lower rates of breakage or slippage. A secondary aim was to investigate if higher rates of breakage or slippage were associated with increased odds of acquiring chlamydia and/or gonorrhea. METHODS A cross-sectional study of 412 YBM, aged 15 to 23 years, was conducted in three US cities located in the Southern United States. RESULTS Among YBM reporting frequent female application of condoms, 43.5% reported one or more instance of breakage or slippage, compared with those reporting less frequent female application (27.2%, P = .003). Among YBM reporting one or more event of breakage or slippage, 25.4% tested positive for chlamydia and/or gonorrhea. In contrast, among those not reporting breakage or slippage, 17.2% tested positive (P = .047). CONCLUSIONS Findings suggest that educational and behavioral interventions should seek to improve young women's skills relative to condom application and use. Further studies could also investigate whether intervention efforts should encourage some YBM to be responsible for their own condom application.
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Affiliation(s)
- Richard A Crosby
- College of Public Health, University of Kentucky, Lexington; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Bloomington, IN; Rural Center for AIDS/STD Prevention, Indiana University, Bloomington.
| | - Robin R Milhausen
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Bloomington, IN; Rural Center for AIDS/STD Prevention, Indiana University, Bloomington; Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
| | - Stephanie A Sanders
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Bloomington, IN; Rural Center for AIDS/STD Prevention, Indiana University, Bloomington; Department of Gender Studies, Indiana University, Bloomington
| | - Cynthia A Graham
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Bloomington, IN; Department of Psychology, University of Southampton, Southampton, UK
| | - William L Yarber
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington; School of Public Health-Bloomington, Indiana University, Bloomington
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A partner-related risk behavior index to identify people at elevated risk for sexually transmitted infections. J Prim Prev 2014; 34:81-7. [PMID: 23355254 DOI: 10.1007/s10935-013-0290-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to develop and test a sexual-partner-related risk behavior index to identify high-risk individuals most likely to have a sexually transmitted infection (STI). Patients from five STI and adolescent medical clinics in three US cities were recruited (N = 928; M age = 29.2 years). Data were collected using audio-computer-assisted self-interviewing. Of seven sexual-partner-related variables, those that were significantly associated with the outcomes were combined into a partner-related risk behavior index. The dependent variables were laboratory-confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis. Nearly one-fifth of the sample (169/928; 18.4%) tested positive for an STI. Three of the seven items were significantly associated with having one or more STIs: sex with a newly released prisoner, sex with a person known or suspected of having an STI, and sexual concurrency. In combined form, this three-item index was significantly associated with STI prevalence (p < .001). In the presence of three covariates (gender, race, and age), those classified as being at-risk by the index were 1.8 times more likely than those not classified as such to test positive for an STI (p < .001). Among individuals at risk for STIs, a three-item index predicted testing positive for one or more of three STIs. This index could be used to prioritize and guide intensified clinic-based counseling for high-risk patients of STI and other clinics.
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It takes 2: partner attributes associated with sexually transmitted infections among adolescents. Sex Transm Dis 2013; 40:372-8. [PMID: 23588126 DOI: 10.1097/olq.0b013e318283d2c9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of this study were to identify partner attributes associated with sexually transmitted infections (STIs) among adolescents and to summarize implications for research and prevention. DESIGN The design of this study was systematic review. METHODS We identified peer-reviewed studies published in 1990 through 2010 that assessed 1 or more partner attributes in relation to a biologically confirmed STI among adolescents (15-24 years) by searching MEDLINE and included articles. Studies that included adolescents but more than 50% of the sample or with mean or median age of 25 years or greater were excluded. RESULTS Sixty-four studies met the eligibility criteria; 61% were conducted in high-income countries; 80% were cross sectional; and 91% enrolled females and 42% enrolled males. There was no standard "partner" definition. Partner attributes assessed most frequently included the following: age, race/ethnicity, multiple sex partners, and STI symptoms. Older partners were associated with prevalent STIs but largely unrelated to incidence. Black race was associated with STIs but not uniformly. Partners with multiple partners and STI symptoms seem to be associated with STIs predominantly among females. Although significant associations were reported, weaker evidence exists for the following: other partner sociodemographics, sexual and other behaviors (sexual concurrency, intimate partner violence, substance use, travel), and STI history. There were no apparent differences by STI. CONCLUSIONS Partner attributes are independently associated with STIs among male and female adolescents worldwide. These findings reinforce the importance of assessing partner attributes when determining STI risk. Prevention efforts should continue to promote and address barriers to condom use. Increased efforts are needed to screen and treat STIs and reduce risky behavior among men. A standard partner definition would facilitate the interpretation of findings in future studies.
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McLaughlin MM, Chow EPF, Wang C, Yang LG, Yang B, Huang JZ, Wang Y, Zhang L, Tucker JD. Sexually transmitted infections among heterosexual male clients of female sex workers in China: a systematic review and meta-analysis. PLoS One 2013; 8:e71394. [PMID: 23951153 PMCID: PMC3741140 DOI: 10.1371/journal.pone.0071394] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 06/29/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Female sex workers have been the target of numerous sexually transmitted infection (STI) prevention strategies in China, but their male clients have attracted considerably less public health attention and resources. We sought to systematically assess the prevalence of HIV, syphilis, gonorrhea, and chlamydia among heterosexual male clients of female sex workers in China. METHODS/PRINCIPAL FINDINGS Original research manuscripts were identified by searching Chinese and English language databases, and 37 studies analyzing 26,552 male clients were included in the review. Client STI prevalence across studies was heterogeneous. Pooled prevalence estimates and 95% confidence intervals were 0.68% (0.36-1.28%) for HIV, 2.91% (2.17-3.89%) for syphilis, 2.16% (1.46-3.17%) for gonorrhea, and 8.01% (4.94-12.72%) for chlamydia. CONCLUSIONS/SIGNIFICANCE The pooled prevalence estimates of HIV, syphilis, gonorrhea, and chlamydia among clients in this review exceed the prevalences previously reported among population-representative samples and low-risk groups in China. However, heterogeneity across studies and sampling limitations prevent definitive conclusions about how the prevalence of STIs in this population compares to the general population. These findings suggest a need for greater attention to clients' sexual risk and disease prevalence in China's STI research agenda in order to inform effective prevention policies.
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Affiliation(s)
| | - Eric P. F. Chow
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Cheng Wang
- Guangdong Provincial Center for STI & Skin Diseases Control, Guangzhou, China
| | - Li-Gang Yang
- Guangdong Provincial Center for STI & Skin Diseases Control, Guangzhou, China
| | - Bin Yang
- Guangdong Provincial Center for STI & Skin Diseases Control, Guangzhou, China
| | - Jennifer Z. Huang
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, United States of America
| | - Yanjie Wang
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Lei Zhang
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Joseph D. Tucker
- UNC Project – China, Guangzhou, China
- Guangdong Provincial Center for STI & Skin Diseases Control, Guangzhou, China
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Yarber WL, Graham CA, Sanders SA, Crosby RA, Butler SM, Hartzell RM. ‘Do You Know What You’re Doing?’ College Students’ Experiences with Male Condoms. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2007.10598990] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- William L. Yarber
- a Indiana University , Kinsey Institute for Research in Sex, Gender, and Reproduction
| | - Cynthia A. Graham
- b Oxford University Doctoral Course in Clinical Psychology , Kinsey Institute, Rural Center
| | | | | | - Scott M. Butler
- e Health Education Faculty , State University, Georgia College
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Stack JC, Bansal S, Kumar VSA, Grenfell B. Inferring population-level contact heterogeneity from common epidemic data. J R Soc Interface 2013; 10:20120578. [PMID: 23034353 PMCID: PMC3565785 DOI: 10.1098/rsif.2012.0578] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/10/2012] [Indexed: 11/27/2022] Open
Abstract
Models of infectious disease spread that incorporate contact heterogeneity through contact networks are an important tool for epidemiologists studying disease dynamics and assessing intervention strategies. One of the challenges of contact network epidemiology has been the difficulty of collecting individual and population-level data needed to develop an accurate representation of the underlying host population's contact structure. In this study, we evaluate the utility of common epidemiological measures (R0, epidemic peak size, duration and final size) for inferring the degree of heterogeneity in a population's unobserved contact structure through a Bayesian approach. We test the method using ground truth data and find that some of these epidemiological metrics are effective at classifying contact heterogeneity. The classification is also consistent across pathogen transmission probabilities, and so can be applied even when this characteristic is unknown. In particular, the reproductive number, R0, turns out to be a poor classifier of the degree heterogeneity, while, unexpectedly, final epidemic size is a powerful predictor of network structure across the range of heterogeneity. We also evaluate our framework on empirical epidemiological data from past and recent outbreaks to demonstrate its application in practice and to gather insights about the relevance of particular contact structures for both specific systems and general classes of infectious disease. We thus introduce a simple approach that can shed light on the unobserved connectivity of a host population given epidemic data. Our study has the potential to inform future data-collection efforts and study design by driving our understanding of germane epidemic measures, and highlights a general inferential approach to learning about host contact structure in contemporary or historic populations of humans and animals.
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Affiliation(s)
- J. Conrad Stack
- Department of Biology, Pennsylvania State University, University Park, PA 16802-5301, USA
| | - Shweta Bansal
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA 16802-5301, USA
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-220, USA
| | - V. S. Anil Kumar
- Department of Computer Science and Virginia Bioinformatics Institute, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
| | - Bryan Grenfell
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-220, USA
- Department of Ecology and Evolutionary Biology and Woodrow Wilson School, Princeton University, Princeton, NJ 08540, USA
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Zhou Y, Li X, Yang H, Hong Y, Fang X, Wang B, Stanton B. Effect of condom-use measures in predicting sexually transmitted diseases: variation by individual and contextual factors of sexual risk. Int J STD AIDS 2012; 23:e27-34. [DOI: 10.1258/ijsa.2009.009071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Inconsistent findings in the global literature regarding the effectiveness of condom use against sexually transmitted diseases (STDs) may result from variations in the measurement of condom use. In this study, we assess the sensitivity and specificity of six condom-use measures in predicting STD infection, and assess the difference in sensitivity and specificity by type of sexual partner (clients versus stable partners), type of STD, ethnicity (Han versus non-Han), years of formal schooling (≤6 versus >6 years) and level of risk of STD exposure (high versus low). Cross-sectional data were obtained from 454 female sex workers (FSWs) in Guangxi, China. Measurements of condom use were created along types of use (any use, consistent use, correct use, or the combination of consistent and correct use) and periods of recall (life time, last month or recent three sexual episodes). Measures of consistent use had higher sensitivity and lower specificity than measures of any use in predicting STDs among FSWs, regardless of the recall period and type of sexual partner. Incorporating correct use improved the measures of consistent use. Measures of consistent use and the combination of consistent and correct use demonstrated high sensitivity in predicting particular STDs. They showed higher sensitivity in predicting STDs among FSWs who reported higher risk for STD exposure than among FSWs who reported lower risk of exposure to STDs. In conclusion, the findings suggest the superiority of consistent use and correct use of condoms in predicting STD infection. The findings also underscore the importance of considering the context of sexual risk such as type of sexual partner and risk of exposure to STD infection when we measure condom use. Future studies of condom effectiveness should collect and quantify these contextual and individual factors among the target population.
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Affiliation(s)
- Y Zhou
- Guangxi Provincial CDC AIDS/STD Division, Nanning, Guangxi, China
| | - X Li
- Wayne State University, Carman and Ann Adams Department of Pediatrics Prevention Research Center, Detroit, MI
| | - H Yang
- Population Services International, Washington, DC
| | - Y Hong
- Texas A&M Health Science Center Department of Social and Behavioral Health, College Station, TX, USA
| | - X Fang
- Beijing Normal University Institute of Developmental Psychology, Beijing, China
| | - B Wang
- University of Southern Mississippi, Department of Community Health Sciences, Hattiesburg, MS, USA
| | - B Stanton
- Wayne State University, Carman and Ann Adams Department of Pediatrics Prevention Research Center, Detroit, MI
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Manlove J, Wildsmith E, Ikramullah E, Terry-Humen E, Schelar E. Family environments and the relationship context of first adolescent sex: Correlates of first sex in a casual versus steady relationship. SOCIAL SCIENCE RESEARCH 2012; 41:861-875. [PMID: 23017856 DOI: 10.1016/j.ssresearch.2012.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 02/02/2012] [Accepted: 02/07/2012] [Indexed: 06/01/2023]
Abstract
Limited research has examined how family environments are associated with the relationship context of first sex, an important indicator of reproductive health risk. We use data from the 1997 National Longitudinal Survey of Youth to assess the association between the family environment - parent-parent relationships, parent-adolescent relationships, and family structure - and relationship context of first heterosexual sexual intercourse, distinguishing between the transition to first sex in serious and casual relationships. Twenty-five percent of females and 43% of males who had sex by age 18 did so in a casual relationship. All dimensions of the family environment were linked to the relationship context of first sex. Notably, higher parental monitoring was associated with a reduced risk of transitioning to first sex in a casual relationship versus no sex, and greater family routines were associated with a reduced risk of transitioning to sex in a steady relationship versus having no sex, for males and females. A strong maternal-adolescent relationship was associated with a reduced risk of first sex in a casual relationship but only for males. Additionally, in two-parent families, a strong father-adolescent relationship was associated with reduced risk of transitioning to casual sex, but only for females. Pregnancy and STI prevention programs should work with parents to foster positive parent-adolescent relationships, to become aware of their adolescents' activities and to recognize that parents are important models for adolescent relationship behaviors.
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Affiliation(s)
- Jennifer Manlove
- Child Trends 4301 Connecticut Ave., NW Suite 350, Washington, DC 20008, United States
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Crosby R, Bounse S. Condom effectiveness: where are we now? Sex Health 2012; 9:10-7. [DOI: 10.1071/sh11036] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2011] [Indexed: 01/18/2023]
Abstract
After performing a review of prospective cohort evaluations, a focussed assessment of the current knowledge base and methodology pertaining to condom effectiveness against sexually transmissible infections, including HIV, was also conducted. Key observations included the point that studies of condom effectiveness are inherently complex and the potential forms of study bias all generally favour the null hypothesis. Perhaps the most challenging obstacle to rigor in these studies lies in determining which events of condom-protected sex occurred before infection as opposed to after infection when, in fact, infection occurs. This problem leads to misclassification bias; however, other sources of misclassification bias are common. Greater attention to the selection of a recall period, improved precision of self-reported measures, and accounting for condom use errors and problems are critical steps that must occur to promote rigor in these studies. Despite multiple shortcomings, prospective studies of condom effectiveness provide a reasonably favourable evaluation. Subsequent studies, however, should be designed to greatly reduce the error variance that predisposes condom effectiveness studies to type 2 errors that mask the potential value of condoms.
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Calsyn DA, Campbell AN, Tross S, Hatch-Maillette MA. Is monogamy or committed relationship status a marker for low sexual risk among men in substance abuse treatment? Clinical and methodological considerations. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:294-300. [PMID: 21854271 DOI: 10.3109/00952990.2011.596874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND HIV prevention interventions often promote monogamy to reduce sexual risk. However, there is little consensus about how to define monogamy. OBJECTIVE To determine the extent to which recent monogamy and/or being in a committed relationship serve as markers for low sexual risk among men in substance abuse treatment. METHODS Participants were 360 men enrolled in the National Institute on Drug Abuse Clinical Trials Network "Real Men Are Safe" protocol who completed all assessments (baseline, 3 months, and 6 months). Self-reported behaviors included number of sexual partners, type of relationships, frequency of vaginal/anal intercourse, and percentage of condom use. RESULTS The rate of self-reported monogamy in the prior 90 days was stable across assessments (54.2%, 53.1%, 58.3%). However, at each assessment 7.5-10% of monogamous men identified their partner as a casual partner, and only 123 (34.2%) reported being monogamous at every assessment. Of these, 20 (5.6%) reported being monogamous with different partners across assessments. Men with both committed relationship and casual partners reported more condom use with their committed relationship partners than men with only a committed relationship partner. CONCLUSION Clinicians and researchers should consider individual relationship context and behavior and avoid assuming that recent monogamy or being in a committed relationship denotes low risk. SCIENTIFIC SIGNIFICANCE This study provides evidence that, in male drug users, monogamy does not necessarily reflect low sexual risk. Rather, "monogamous" men actually encompass various combinations of partner types and levels of risk behavior that are unstable, even over brief time periods. Clinicians and researchers must take these variations into account.
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Affiliation(s)
- Donald A Calsyn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
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Hendershot CS, Magnan RE, Bryan AD. Associations of marijuana use and sex-related marijuana expectancies with HIV/STD risk behavior in high-risk adolescents. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2011; 24:404-14. [PMID: 20853925 DOI: 10.1037/a0019844] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple studies suggest an association of marijuana use with increased rates of sexual risk behavior and sexually transmitted diseases (STDs). Most studies have focused on global associations of marijuana use with sexual risk outcomes and few have examined relevant cognitive variables. Adolescents in the juvenile justice system are at elevated risk for HIV/STDs and preliminary evidence suggests that marijuana is a potentially important cofactor for sexual risk behavior in this population. This study evaluated global, situational and event-level associations of marijuana use and sex-related marijuana expectancies with sexual risk outcomes in a large, racially diverse sample of adjudicated youth (n = 656, 66% male, mean age = 16.7 years). Cross-sectional and prospective analyses identified associations of marijuana use and dependence symptoms with sexual risk outcomes, including lower frequency of condom use and higher STD incidence. Stronger sex-related marijuana expectancies predicted greater intentions for and frequency of marijuana use in sexual situations. In event-level analyses that controlled for alcohol, marijuana use predicted a significantly decreased likelihood of condom use; this association was moderated by sex-related marijuana expectancies. Mediation analyses suggested that behavioral intentions partly accounted for the prospective association of expectancies with marijuana use before sex. These results provide further evidence that marijuana use is a potentially important cofactor for HIV/STD transmission in high-risk adolescents and suggest that cognitive factors could be important for characterizing this association.
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Affiliation(s)
- Christian S Hendershot
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico, USA.
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20
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Hensel DJ, Stupiansky NW, Herbenick D, Dodge B, Reece M. When Condom Use is Not Condom Use: An Event‐Level Analysis of Condom Use Behaviors during Vaginal Intercourse. J Sex Med 2011; 8:28-34. [DOI: 10.1111/j.1743-6109.2010.02031.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Crosby RA, Graham CA, Yarber WL, Sanders SA. Problems with condoms may be reduced for men taking ample time to apply them. Sex Health 2010; 7:66-70. [DOI: 10.1071/sh09020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 09/21/2009] [Indexed: 01/17/2023]
Abstract
Background: One potentially important antecedent of experiencing problems with condom use during penile-vaginal sex is the amount of time that men (and perhaps women) allow for condom application. To examine whether men reporting that ample time was available to apply a male condom (the last time a condom was used for penile-vaginal sex) were also less likely to report problems with condom use such as breakage, slippage and erection difficulties during that sexual event. Methods: A convenience sample of men (n = 440) was recruited via advertisements in newspapers (two urban and one small town) and a blog on the website of a condom sales company. Men completed a questionnaire posted on the website of The Kinsey Institute for Research in Sex, Gender, and Reproduction. Inclusion criteria were that participants were: at least 18 years old; used condoms for penile-vaginal intercourse in the past 3 months; and able to read English. Results: In controlled, event-specific analyses, men reporting that they did not have sufficient time for condom application were ~three times more likely to report breakage and ~2.4 times more likely to report slippage. In addition, men who reported that they lacked time for condom application were ~2.4 times more likely to experience any of nine sexual problems, 3.4 times more likely to report difficulty with erection, 2.1 times more likely to report reduced sexual pleasure, 2.2 times more likely to report reduced sexual pleasure of their female partner and 2.6 times more likely to report that the condom irritated their partner’s vagina. Conclusions: This is the first study using an event-specific analysis to examine the effect of not having enough time for condom application on condom breakage, slippage and several outcomes related to sexual pleasure. Sexually transmissible infections and pregnancy prevention messages should include recommendations to men to take their time applying condoms.
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Williams JK, Ramamurthi HC, Manago C, Harawa NT. Learning from successful interventions: A culturally congruent HIV risk-reduction intervention for African American men who have sex with men and women. Am J Public Health 2009; 99:1008-12. [PMID: 19372517 DOI: 10.2105/ajph.2008.140558] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Few HIV prevention interventions have been developed for African American men who have sex with men or who have sex with both men and women. Many interventions neglect the historical, structural or institutional, and sociocultural factors that hinder or support risk reduction in this high-risk group. We examined ways to incorporate these factors into Men of African American Legacy Empowering Self, a culturally congruent HIV intervention targeting African American men who have sex with men and women. We also studied how to apply key elements from successful interventions to future efforts. These elements include having gender specificity, a target population, a theoretical foundation, cultural and historical congruence, skill-building components, and well-defined goals.
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Affiliation(s)
- John K Williams
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 90024-1759, USA.
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23
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Grimley DM, Hook EW. A 15-minute interactive, computerized condom use intervention with biological endpoints. Sex Transm Dis 2009; 36:73-8. [PMID: 19125141 DOI: 10.1097/olq.0b013e31818eea81] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Brief face-to-face-behavioral interventions have been shown to be efficacious, but are costly to sustain and to widely disseminate. This study evaluated the efficacy of a 15-minute theory-based behavioral intervention designed to increase condom use and reduce new cases of Neisseria gonorrhoeae and Chlamydia trachomatis. METHODS Participants were randomly assigned via the computer to the intervention or the comparison group stratified by gender and their baseline stage of change (motivational readiness) for using condoms consistently (100%) with their main partners. Behavioral data and biologic specimens for testing of Neisseria gonorrhoeae and Chlamydia trachomatis were obtained at baseline and at 6 months post intervention. The intervention was delivered via an audio, multimedia, computerized application that provided individualized interventions to patients based on their responses to assessment items; comparison patients interacted with a 15-minute, computerized, multiple health risk assessment with no intervention. RESULTS The majority of the sample (N = 430) was black (88%); 54.5% women; with a mean age = 24.5. Assuming all participants who did not return to the clinic at 6 months were not using condoms consistently, 32% of the treatment group versus 23% in the comparison group reported consistent condom use (P = 0.03). The combined Neisseria gonorrhoeae and Chlamydia trachomatis incidence declined to 6% in the intervention group versus 13% in the comparison group (P = 0.04). Results from a regression analysis revealed that the only statically significant predictor of sexually transmitted diseases infection at the follow-up was group assignment (OR = 1.91, 95% confidence index = 1.09-3.34; P = 0.043). CONCLUSIONS These findings suggest that brief, interactive, computer-delivered interventions provided at the evaluation visit increase condom use and reduce sexually transmitted diseases without putting additional burden on clinicians or staff.
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Affiliation(s)
- Diane M Grimley
- Department of Health Behavior, School of Public Health, University of Alabama, Birmingham, AL, USA.
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24
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Crosby RA, Salazar LF, Yarber WL, Sanders SA, Graham CA, Head S, Arno JN. A theory-based approach to understanding condom errors and problems reported by men attending an STI clinic. AIDS Behav 2008; 12:412-8. [PMID: 17588147 DOI: 10.1007/s10461-007-9264-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 05/30/2007] [Indexed: 11/27/2022]
Abstract
We employed the information-motivation-behavioral skills (IMB) model to guide an investigation of correlates for correct condom use among 278 adult (18-35 years old) male clients attending a sexually transmitted infection (STI) clinic. An anonymous questionnaire aided by a CD-recording of the questions was administered. Linear Structural Relations Program was used to conduct path analyses of the hypothesized IMB model. Parameter estimates showed that while information did not directly affect behavioral skills, it did have a direct (negative) effect on condom use errors. Motivation had a significant direct (positive) effect on behavioral skills and a significant indirect (positive) effect on condom use errors through behavioral skills. Behavioral skills had a direct (negative) effect on condom use errors. Among men attending a public STI clinic, these findings suggest brief, clinic-based, safer sex programs for men who have sex with women should incorporate activities to convey correct condom use information, instill motivation to use condoms correctly, and directly enhance men's behavioral skills for correct use of condoms.
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Affiliation(s)
- Richard A Crosby
- College of Public Health, University of Kentucky, 121 Washington Avenue, Suite 111C, Lexington, KY 40506-0003, USA.
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25
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Buffardi AL, Thomas KK, Holmes KK, Manhart LE. Moving upstream: ecosocial and psychosocial correlates of sexually transmitted infections among young adults in the United States. Am J Public Health 2008; 98:1128-36. [PMID: 18445794 DOI: 10.2105/ajph.2007.120451] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined the associations of ecosocial factors and psychosocial factors with having a prevalent sexually transmitted infection (STI), recent STI diagnoses, and sexual risk behaviors. METHODS Young adults aged 18 to 27 years in the National Longitudinal Study of Adolescent Health (n=14322) provided ecosocial, psychosocial, behavioral, and STI-history data. Urine was tested for Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction and for Trichomonas vaginalis, human papillomavirus, and Mycoplasma genitalium by polymerase chain reaction. RESULTS Prevalent STI was associated with housing insecurity (adjusted odds ratio [AOR] = 1.3; 95% confidence interval [CI] = 1.00, 1.72), exposure to crime (AOR=1.4; 95% CI=1.02, 1.80), and having been arrested (AOR=1.4; 95% CI=1.07, 1.84). STI prevalence increased linearly from 4.9% for 0 factors to 14.6% for 4 or more (P < .001, for trend). Nearly all contextual conditions predicted more lifetime partners and earlier sexual debut. Recent STI diagnosis was associated with childhood sexual abuse, gang participation, frequent alcohol use, and depression, adjusted for sexual risk behaviors. CONCLUSIONS Often present before sexual debut, contextual conditions enhance STI risk by increasing sexual risk behaviors and likelihood of exposure to infection. These findings suggest that upstream conditions such as housing and safety contribute to the burden of STIs and are appropriate targets for future intervention.
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Affiliation(s)
- Anne L Buffardi
- UW Center for AIDS and STD, University of Washington, 325 9th Ave, Box 359931, Seattle, WA 98104-2499, USA
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26
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Crosby R, Yarber WL, Sanders SA, Graham CA, Arno JN. Slips, breaks and ‘falls’: condom errors and problems reported by men attending an STD clinic. Int J STD AIDS 2008; 19:90-3. [DOI: 10.1258/ijsa.2007.007103] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Summary The objective was to comprehensively assess the prevalence of condom-use errors and problems among male clients attending a public sexually transmitted disease (STD) clinic. Men ( n = 278) attending an STD clinic completed an anonymous questionnaire. Seven errors and six problems were assessed. Summative scores were tested for associations with three key variables. Of 834 condom-protected events: 19% were associated with ‘fit and feel’ problems, 15% involved breakage, 14% involved lost erection, 9% were associated with lost erection while applying condoms, 8% involved slippage during withdrawal and 7% involved slippage during sex. A mean of 6.4 errors/problems were observed. None of these summative variables (total errors, total problems or total of errors and problems) were significantly associated with age, minority status or whether men indicated they had ever been taught how to use condoms. Multiple types of condom-use errors and problems may be highly prevalent among high-risk men attending public STD clinics.
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Affiliation(s)
- Richard Crosby
- College of Public Health, University of Kentucky, Lexington, KY, USA
- Rural Center for AIDS/STD Prevention
- The Kinsey Institute for Research in Sex, Gender and Reproduction
| | - William L Yarber
- Rural Center for AIDS/STD Prevention
- The Kinsey Institute for Research in Sex, Gender and Reproduction
- Department of Applied Health Science
| | - Stephanie A Sanders
- Rural Center for AIDS/STD Prevention
- The Kinsey Institute for Research in Sex, Gender and Reproduction
- Department of Gender Studies, Indiana University, Bloomington, IN, USA
| | - Cynthia A Graham
- Rural Center for AIDS/STD Prevention
- The Kinsey Institute for Research in Sex, Gender and Reproduction
- Oxford Doctoral Course in Clinical Psychology, University of Oxford, Oxford, UK
| | - Janet N Arno
- Rural Center for AIDS/STD Prevention
- Department of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
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Grimley DM, Bachmann LH, Jenckes MW, Erbelding EJ. Provider-delivered, theory-based, individualized prevention interventions for HIV positive adults receiving HIV comprehensive care. AIDS Behav 2007; 11:S39-47. [PMID: 17149671 DOI: 10.1007/s10461-006-9196-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 11/14/2006] [Indexed: 10/23/2022]
Abstract
HIV prevention efforts are often difficult to emphasize in settings delivering comprehensive HIV care due to factors such as time constraints and differing priorities about the use of clinical time. To assist clinicians within dedicated HIV clinics to offer prevention strategies, investigators at two universities in the United States (Johns Hopkins University and the University of Alabama at Birmingham) have developed and implemented similar, audio-computerized-assisted, self-interviewing systems that have been programmed to assess individual patient risk factors and identify based on the patient's self-assessment, the patient's behavioral stage or, readiness for changing, each identified target behavior. Following the assessment, the systems provide printouts of key elements of this information along with individualized, theory-based intervention strategies to the medical provider. This paper will describe our efforts in developing provider-delivered, individualized, stage-based interventions intended to reduce high-risk behaviors among HIV-infected persons.
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Affiliation(s)
- Diane M Grimley
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, RPHB 227, 1530 3rd Ave. South, Birmingham, AL, USA.
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Yarber WL, Crosby RA, Graham CA, Sanders SA, Arno J, Hartzell RM, McBride K, Milhausen R, Brown L, Legocki LJ, Payne M, Rothring A. Correlates of Putting Condoms On After Sex Has Begun and of Removing Them Before Sex Ends: A Study of Men Attending an Urban Public STD Clinic. Am J Mens Health 2007; 1:190-6. [DOI: 10.1177/1557988307301276] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
This study aimed to identify possible correlates of putting condoms on after sex has begun and taking them off before sex has ended among male patients of an urban, public sexually transmitted disease clinic. Participants responded to a questionnaire and were largely African American men, 18 to 35 years old, who had used a condom during penile-vaginal intercourse at least three times in the past 3 months. In controlled analyses, men who were not highly motivated to use condoms correctly were nearly twice as likely to put a condom on after sex had begun. Men who reported erection loss during sex were about twice as likely to remove condoms before sex ended. Men reporting difficulties with the fit and feel of condoms were 2.5 times more likely to remove condoms early. Identified correlates may be amenable to clinic-based education and counseling augmented by offering a variety of condom brands and sizes to patients.
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Affiliation(s)
| | | | - Cynthia A. Graham
- Indiana University, Bloomington, Indiana, Oxford Doctoral Course in Clinical Psychology, Warneford Hospital, Oxford, United Kingdom
| | | | - Janet Arno
- Bell Flower Clinic, Indianapolis, Indiana
| | | | | | | | | | | | - Martha Payne
- Substance Abuse and Mental Health Services Administration, Indianapolis, Indiana
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Cook RL, Comer DM, Wiesenfeld HC, Chang CCH, Tarter R, Lave JR, Clark DB. Alcohol and drug use and related disorders: An underrecognized health issue among adolescents and young adults attending sexually transmitted disease clinics. Sex Transm Dis 2006; 33:565-70. [PMID: 16572042 DOI: 10.1097/01.olq.0000206422.40319.54] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objectives of this study were to describe patterns of alcohol and drug use disorders among young persons attending a public sexually transmitted disease (STD) clinic and to determine their associations with sexual risk behaviors and STDs. STUDY DESIGN Four hundred forty-eight men and women aged 15 to 24 who were attending an urban STD clinic completed an interviewer-administered questionnaire that assessed a broad range of substance use in general and for alcohol and marijuana use disorders. RESULTS Overall, 42.9% had an alcohol or marijuana use disorder (51.6% of males and 34.2% of females), whereas 30.6% had a confirmed STD. Participants with a substance use disorder were significantly more likely to have multiple sexual partners (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.5-3.4), to be inconsistent condom users (OR = 3.1; 95% CI = 1.5-6.3), and to have an STD (OR = 1.7; 95% CI = 1.1-2.6). CONCLUSIONS Among young STD clinic attendees, substance use disorders were more common than confirmed STDs. STD clinics may be an appropriate setting to screen for and address substance use disorders in young persons.
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Affiliation(s)
- Robert L Cook
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Auerswald CL, Muth SQ, Brown B, Padian N, Ellen J. Does partner selection contribute to sex differences in sexually transmitted infection rates among African American adolescents in San Francisco? Sex Transm Dis 2006; 33:480-4. [PMID: 16645551 DOI: 10.1097/01.olq.0000204549.79603.d6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Little is known regarding whether partner characteristics explain sex differences in sexually transmitted infection (STI) rates in nonclinic-based, school-aged African American youth. MATERIALS AND METHODS A random digit dial household sample of 14- to 19-year-old youth in San Francisco reported the total number, age, race, and perceived history of incarceration, gang membership, and level of sexual activity of their partners. Youth were tested for gonorrhea and chlamydia. RESULTS Female participants were more likely than male participants to have a partner who was older or had been incarcerated and less likely to have a non-African American partner. Controlling for partner number, female's odds ratio (OR) for having an STI was 1.39 (95% confidence interval [CI] = 0.98-1.98; P = 0.07). Controlling for partner incarceration and number of partners, the borderline sex difference was eliminated (OR = 1.07; 95% CI = 0.70-1.63). CONCLUSION Sex differences in STI rates among African American adolescents may be determined more by the risk of the partner than the risk of the individual.
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Affiliation(s)
- Colette L Auerswald
- Division of Adolescent Medicine, Department of Pediatrics, University of California at San Francisco, San Francisco, California 94143-0503, USA.
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Warner L, Stone KM, Macaluso M, Buehler JW, Austin HD. Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006; 33:36-51. [PMID: 16385221 DOI: 10.1097/01.olq.0000187908.42622.fd] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies of condom use to reduce risk of most sexually transmitted infection provide inconsistent results. This inconsistency is often attributed to methodologic limitations yet has not been assessed systematically. OBJECTIVES The objectives of this study were to review studies of condom use and risk of gonorrhea and chlamydia, and to evaluate the importance of 4 key design and measurement factors on condom effectiveness estimates. DESIGN We reviewed studies published 1966-2004 to assess risk reduction for gonorrhea and/or chlamydia associated with male condom use. RESULTS Of 45 studies identified, most found reduced risk of infection associated with condom use. All studies reviewed had methodologic limitations: only 28 (62%) distinguished consistent from inconsistent use; 2 (4%) reported on correct use or use problems; 13 (29%) distinguished incident from prevalent infection; and one (2%) included a population with documented exposure to infection. Eight of 10 studies with 2 or more of these attributes reported statistically significant protective effects for condom use versus 15 of 35 studies with zero or one attribute (80% vs. 43%, P = 0.04). CONCLUSIONS Condom use was associated with reduced risk of gonorrhea and chlamydia in men and women in most studies, despite methodologic limitations that likely underestimate condom effectiveness. Epidemiologic studies that better address these factors are needed to provide more accurate assessment of condom effectiveness.
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Affiliation(s)
- Lee Warner
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA
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Grimley DM, Oh MK, Desmond RA, Hook EW, Vermund SH. An intervention to reduce vaginal douching among adolescent and young adult women: a randomized, controlled trial. Sex Transm Dis 2006; 32:752-8. [PMID: 16314772 DOI: 10.1097/01.olq.0000190018.58079.05] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate an intervention to reduce vaginal douching among adolescent and young women who report douching. STUDY This study consisted of a randomized, controlled trial of 275 primarily black adolescent and young adults aged 14 to 23 years. All women participated in 3 15-minute individualized counseling sessions. The experimental group received interventions based on their stage of readiness for ceasing vaginal douching. The comparison condition emphasized healthy eating and nutrition. The primary outcome measure was douching cessation (i.e., no douching in the preceding 3 months) at the 6-and 12-month assessment; a secondary outcome was progression through the stages of change toward douching cessation. RESULTS Based on an intention-to-treat model, participants assigned to the douching intervention group were significantly more likely to report having stopped douching at 6 months (relative risk [RR], 1.34; 95% confidence interval [CI], 1.03-1.73) and at 12 months (RR, 1.60; 95% CI, 1.28-2.00). At baseline, 89.9% of all women reported no intention to stop douching. Also based on an intention-to-treat model, there were no differences in stage across the 2 groups at 6 months (P = 0.29); however, at 12 months, the difference between the intervention and comparison group was statistically significant (P = 0.008). CONCLUSION Stage-matched interventions can reduce douching among adolescent and young adult women.
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Affiliation(s)
- Diane M Grimley
- School of Public Health, Department of Health Behavior, RPHB 227, 1530 3rd Ave. South, University of Alabama at Birmingham, 35294-0022, USA.
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Crosby R, Salazar LF, DiClemente RJ, Yarber WL, Caliendo AM, Staples-Horne M. Accounting for failures may improve precision: evidence supporting improved validity of self-reported condom use. Sex Transm Dis 2005; 32:513-5. [PMID: 16041255 DOI: 10.1097/01.olq.0000170442.10150.28] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether a measure of unprotected vaginal sex that is adjusted for condom failures would produce improved accuracy in predicting biologically confirmed STDs (chlamydia and gonorrhea) among female teens. METHODS Self-reported measures were collected using audio-computer-assisted self-interviewing. DNA amplification for the presence of Chlamydia trachomatis and Neisseria gonorrhoeae was conducted. RESULTS The unadjusted measure of unprotected vaginal sex was not significantly associated with biologically confirmed prevalence of STDs (prevalence ratio [PR] = 1.51; 95% CI = 0.71-3.21; P = 0.28). Alternatively, the adjusted measure achieved significance (PR = 3.59; 95% CI = 1.13-11.38; P = 0.014). More than one quarter (25.6%) of teens using condoms inconsistently and/or incorrectly tested positive for an STD compared to 7.1% among those reporting the consistent and correct use of condoms. CONCLUSION Findings demonstrate that studies of condom effectiveness should use an adjusted measure of condom use to achieve precision and rigor.
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Affiliation(s)
- Richard Crosby
- College of Public Health, University of Kentucky, Lexington, Kentucky 40506-0003, USA.
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Kaye KS, Engemann JJ, Fraimow HS, Abrutyn E. Pathogens resistant to antimicrobial agents: epidemiology, molecular mechanisms, and clinical management. Infect Dis Clin North Am 2004; 18:467-511, viii. [PMID: 15308273 DOI: 10.1016/j.idc.2004.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Resistance to antimicrobial drugs is increasing at an alarming rate among both gram-positive and gram-negative bacteria. Traditionally, bacteria resistant to multiple antimicrobial agents have been restricted to the nosocomial environment. A disturbing trend has been the recent emergence and spread of resistant pathogens and resistance traits in nursing homes, the community, as well as in hospitals. This article reviews the epidemiology, molecular mechanisms of resistance, and treatment options for pathogens resistant to antimicrobial drugs.
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Affiliation(s)
- Keith S Kaye
- Department of Medicine, Duke University Medical Center, Box 3152, Durham, NC 27710, USA.
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Crosby RA, Graham CA, Yarber WL, Sanders SA. If the condom fits, wear it: a qualitative study of young African-American men. Sex Transm Infect 2004; 80:306-9. [PMID: 15295131 PMCID: PMC1744878 DOI: 10.1136/sti.2003.008227] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To extend the current knowledge base pertaining to condom failure among young African-American men by assessing their experiences with male condom use. METHODS Qualitative assessments were conducted with 19 African-American men (aged 18-29 years) who had just been diagnosed with an STI and reported using condoms in the previous 3 months. RESULTS Five categories were identified from the data. These categories pertained to: (1) the "fit and feel" of condoms; (2) condom brand and size; (3) application problems; (4) availability of condoms and lubricants; and (5) commitment to condom use. Common themes included reasons why men believed condoms would break or slip off during sex. Comfort problems, including tightly fitting condoms and condoms drying out during intercourse, were mentioned frequently. Condom associated erection problems were often described. Many men also noted that condom use reduced the level of sexual satisfaction for their female partners. Men noted that finding the right kind of condom was not always easy and it became apparent during the interviews that men typically did not acquire lubrication to add to condoms. Despite their expressed problems with using condoms, men were, none the less, typically emphatic that condom use is an important part of their protective behaviour against STIs. CONCLUSION Men were highly motivated to use condoms; however, they experienced a broad range of problems with condom use. With the exception of losing the sensation of skin to skin contact, the vast majority of these problems may be amenable to behavioural interventions.
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Affiliation(s)
- R A Crosby
- Kentucky School of Public Health, Division of Human Behavior, 121 Washington Avenue, Room 111C, Lexington, KY 40506-0003, USA.
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Crosby R, Sanders S, Yarber WL, Graham CA. Condom-use errors and problems: a neglected aspect of studies assessing condom effectiveness. Am J Prev Med 2003; 24:367-70. [PMID: 12726876 DOI: 10.1016/s0749-3797(03)00015-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess and compare condom-use errors and problems among condom-using university males and females. METHODS A convenience sample of 260 undergraduates was utilized. Males (n=118) and females (n=142) reported using condoms in the past 3 months for at least one episode of sex (penis in the mouth, vagina, or rectum) with a partner of the other sex. A questionnaire assessed 15 errors and problems associated with condom use that could be observed or experienced by females as well as males. RESULTS About 44% reported lack of condom availability. Errors that could contribute to failure included using sharp instruments to open condom packages (11%), storing condoms in wallets (19%), and not using a new condom when switching from one form of sex to another (83%). Thirty-eight percent reported that condoms were applied after sex had begun, and nearly 14% indicated they removed condoms before sex was concluded. Problems included loss of erection during condom application (15%) or during sex (10%). About 28% reported that condoms had either slipped off or broken. Nearly 19% perceived, at least once, that their condom problems necessitated the use of a new condom. Few differences were observed in errors and problems between males and females. CONCLUSIONS Findings suggest that condom-use errors and problems may be quite common and that assessment of errors and problems do not necessarily need to be gender specific. Findings also suggest that correcting "user failure" may represent an important challenge in the practice of preventive medicine.
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Affiliation(s)
- Richard Crosby
- Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 542, Atlanta, GA 30322, USA.
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Abstract
BACKGROUND An essential yet understudied aspect of condom use is whether they are used correctly. GOAL The goal of the study was to comprehensively evaluate condom use errors and problems reported by heterosexual college men (N = 158). STUDY DESIGN A cross-sectional survey, involving a 3-month recall period, was conducted. RESULTS Of the 158 participants, 60% did not discuss condom use with their partner before sex; 42% reported they wanted to use condoms but did not have any available; 43% put condoms on after starting sex; 15% removed condoms before ending sex; 40% did not leave space at the tip; 30% placed the condom upside down on the penis and had to flip it over; and 32% reported losing erections in association with condom use. Nearly one-third reported breakage or slippage during sex. Few participants reported errors related to lubrication, storage, and reusing condoms. Higher error scores were associated with breakage/slippage rather than with consistency of condom use. CONCLUSION Condom use errors were common, and error scores were associated with breakage and slippage. Increasing the focus on correcting potential user failures may be an important public health strategy.
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Affiliation(s)
- Richard A Crosby
- Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Exploring the Context of Women's Relationship Perceptions, Sexual Behavior, and Contraceptive Strategies. ACTA ACUST UNITED AC 2002. [DOI: 10.1300/j056v13n02_01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
This study evaluated differences in sexual behavior and risk for sexually transmitted diseases (STDs) among men who have sex with men (MSM) who met their partners on-line and those who did not. A self-administered questionnaire on sexual behavior was offered to a convenience sample of patients seeking public STD services. Thirty-two percent of MSM patients reported meeting a sexual partner over the Internet in the past year. MSM with on-line partners were younger, more likely to report sex with an HIV-positive person in the last year, and more likely to report casual partners in the last year compared with MSM with only off-line partners. HIV-negative MSM with on-line partners were more likely than HIV-negative MSM with only off-line partners to have received money or drugs for sex in the past year and to report sex with an HIV-positive partner in the past year. Although meeting partners on the Internet was common and associated with increased risk for STDs in MSM, it also presents new untapped opportunities for on-line health promotion and disease prevention.
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Affiliation(s)
- A A Kim
- HIV Seoepidemiology Unit, San Francisco Department of Public Health, San Francisco, California 94102, USA.
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Rawlins S. Nonviral Sexually Transmitted Infections. J Obstet Gynecol Neonatal Nurs 2001. [DOI: 10.1111/j.1552-6909.2001.tb01551.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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