Personal, relational, and peer-level risk factors for laboratory confirmed STD prevalence among low-income African American adolescent females

Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model

Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.

Gender Attitudes, Sexual Risk, Intimate Partner Violence, and Coercive Sex Among Adolescent Gang Members

PURPOSE

Adolescent gang members are at greater risk of poor sexual health outcomes than nongang members. Gang members' beliefs about gender may explain variation in their sexual health outcomes. The purpose of this study was to examine how gangs' and gang members' beliefs about gender are associated with sexual health outcomes, including sexual risk-taking, intimate partner violence, and coercive sex.

METHODS

Gang members (N = 281; 46% female; 73% black/African American, 25% Hispanic/Latino, 4% white, age = 14-19 years) from 32 gangs completed surveys. Multilevel models assessed how gang norms and individuals' beliefs about women/girls as romantic partners, gang members, and sexual partners were associated with sexual risk-taking, intimate partner violence, and coercive sex (forced sex and gang rape).

RESULTS

Gangs and individual gang members who held more equitable beliefs about girls' role as gang members were at increased risk of experiencing several negative outcomes, including intimate partner violence victimization and perpetration, forced sex victimization, and gang rape victimization. These associations were stronger for gangs with a higher ratio of male members to female members. In contrast, equitable beliefs about women/girls as romantic and sexual partners were protective against intimate partner violence and coercive sex victimization and perpetration.

CONCLUSION

Interventions that address gender beliefs among gang members may improve intimate partner violence and coercive sex. These programs may be most effective if they aim to improve equity in sexual and romantic relationships, rather than focusing on respect for female gang members.

Identifying psychosocial and social correlates of sexually transmitted diseases among black female teenagers

BACKGROUND

Black teenagers have relatively high rates of sexually transmitted diseases (STDs), and recent research suggests the role of contextual factors, as well as risk behaviors. We explore the role of 4 categories of risk and protective factors on having a biologically confirmed STD among black, female teenagers.

METHODS

Black teenage girls (14-19 years old) accessing services at a publicly funded family planning clinic provided a urine specimen for STD testing and completed an audio computer-assisted self-interview that assessed the following: risk behaviors, relationship characteristics, social factors, and psychosocial factors. We examined bivariate associations between each risk and protective factor and having gonorrhea and/or chlamydia, as well as multivariate logistic regression among 339 black female teenagers.

RESULTS

More than one-fourth (26.5%) of participants had either gonorrhea and/or chlamydia. In multivariate analyses, having initiated sex before age 15 (adjusted odds ratio [aOR], 1.87) and having concurrent sex partners in the past 6 months (aOR, 1.55) were positively associated with having an STD. Living with her father (aOR, 0.44), believing that an STD is the worst thing that could happen (aOR, 0.50), and believing she would feel dirty and embarrassed about an STD (aOR, 0.44) were negatively associated with having an STD.

CONCLUSIONS

Social factors and attitudes toward STDs and select risk behaviors were associated with the risk for STDs, suggesting the need for interventions that address more distal factors. Future studies should investigate how such factors influence safer sexual behaviors and the risk for STDs among black female teenagers.

Adolescent gang involvement: The role of individual, family, peer, and school factors in a multilevel perspective

Youth gang involvement is a serious public health challenge as adolescents involved in gangs are more likely than others to engage in violence and aggression. To better understand gang involvement, we examined the role of protective (empathy and parental support) and risk (peer deviance and lack of safety at school) factors, as well as their interactions, in predicting adolescent gang affiliation. The study involved a sample of 26,232 students (53.4% females; mean age = 14.62, SD = 1.69) participating in the California Healthy Kids Survey (CHKS), a survey investigating a wide range of youth health and risk behaviors administered in all California schools every 2 years. Using hierarchical linear modeling (HLM), findings indicated that high levels of empathy and parental support were associated with a lower likelihood of affiliating with a gang. Associating with deviant peers and perceiving the school as unsafe were positively correlated with gang membership. At the school level, lack of safety and type of school (special education, vocational, or alternative school vs. comprehensive schools) were associated with greater probability of gang membership. Empathy mitigated the association between deviant peers and gang membership.

A partner-related risk behavior index to identify people at elevated risk for sexually transmitted infections

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.

Having "The Talk": Individual, Family, and Partner Factors on Unprotected Sex among Female Adolescent Offenders

This study assessed the influence of individual age and substance use, family support and communication, and partner support and communication on the frequency of unprotected sex among incarcerated adolescent females. Subjects (n = 273) completed a survey on psychosocial correlates and risk behaviors for sexually transmitted infections (STI). Communication with male partners and sex while under the influence have a significant impact on condom use. Findings highlight the necessity of providing assertive communication skills training and increasing self-efficacy as STI/HIV prevention components for adolescent females thus empowering their decision-making processes.

Respect, Protection, Faith, and Love

Purpose:

The purpose of this study was to discover universal and diverse care meanings and expressions of the selected urban African American adolescent gang culture within a qualitative paradigm.

Design:

The study was conducted using ethnonursing research methodology and was guided by Leininger’s theory of culture care. Thirteen key participants and 28 general participants were selected from a school setting in a Midwestern city. Data were collected and analyzed over a 12-month period, in which the researcher participated daily in school and extracurricular activities of the gang members. Leininger’s Data Analysis Guide included collection of raw data and maintenance of a field journal, coding and examining of the data for behavioral patterns and structural meanings, and finally formulation of major themes.

Findings:

Culture care constructs that emerged from the major themes were respect, being listened to/accepted, worthiness, concern for others, protection, surveillance, trust, and faith.

Conclusions:

Nurses may promote health and well-being through collaborative partnerships with gang members and working with other caregivers to encourage more healthy lifestyles. Nurses should assume a leadership role in restructuring health policy that would give equal voice to underprivileged members of American society.

Current issues and considerations regarding trichomoniasis and human immunodeficiency virus in African-Americans

Trichomonas vaginalis has long been recognized as one of the most prevalent sexually transmitted infections. However, it is only in recent years that it has been appreciated that Trichomonas may play a critical role in amplifying human immunodeficiency virus (HIV) transmission. Given the evidence that T. vaginalis likely promotes HIV infection, the apparent high level of Trichomonas infection in the African-American community is cause for concern. Even if T. vaginalis increases the risk of HIV transmission by a small or modest amount, it translates into a sizable population effect since Trichomonas is so common in this community. Therefore, control of trichomoniasis may represent an important avenue of control for the prevention of HIV transmission, particularly among African-Americans.

Preventing recurrent sexually transmitted diseases in minority adolescents: a randomized controlled trial

OBJECTIVE

To compare the efficacy of a randomized controlled trial of the Sexual Awareness For Everyone (SAFE) behavioral intervention on teenagers (aged 14 to 18 years) compared with adult rates of reinfection with Neiserria gonorrhea or Chlamydia trachomatis cervicitis, and to identify behaviors associated with recurrent infection.

METHODS

Mexican-American and African-American females with a nonviral sexually transmitted disease (STD) were enrolled in SAFE or assigned to the control group. All participants were interviewed and examined at baseline, 6, and 12 months. The primary outcome variable was reinfection with N. gonorrhea or C. trachomatis. Secondary outcomes were changes in risky sexual behavior.

RESULTS

Teens randomized to participation in SAFE had a statistically lower incidence of recurrent N. gonorrhea and C. trachomatis at 0 to 6 months (52%, P=.04) and cumulatively (39%, P=.04) compared with teens in the control group. Cumulatively, teens as a group had higher rates of reinfection (33.1%) than adults (14.4%) (P<.001). Adolescent reinfection was explained by unprotected sex with untreated partners (adjusted odds ratio [OR] 5.58), nonmonogamy (adjusted OR 5.14), and rapid partner turnover (adjusted OR 2.02). In adults, reinfection was predicted by unprotected sex with untreated partners (adjusted OR 4.90), unsafe sex (adjusted OR 2.18), rapid partner turnover (adjusted OR 3.13), and douching after sex (adjusted OR 2.14).

CONCLUSION

Sexual Awareness for Everyone significantly reduced recurrent STDs in teenagers. Adults and teens randomized to the SAFE intervention had significant decreases in high-risk sexual behaviors as compared with those in the control group. Although not specifically designed for teens, the SAFE intervention worked very well in this high-risk population.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov, ClinicalTrials.gov, HSC2004415H.

LEVEL OF EVIDENCE

I.