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Zhang Y, Geng M, Xing Y, Ren X, Chen L, Liu J, Song X, Qin Y, Wang R, Jiang J, Guo T, Yuan W, Ma Y, Ma J, Wang L, Song Y, Dong Y. Improvement and exacerbation of multiple disparities in sexually transmitted infections among children and adolescents aged 6-22 years: An analysis of national surveillance data from 2013 to 2021. J Med Virol 2024; 96:e29808. [PMID: 39023086 DOI: 10.1002/jmv.29808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/04/2024] [Accepted: 07/06/2024] [Indexed: 07/20/2024]
Abstract
To investigate the progress of disparities in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), gonorrhea, and syphilis among children and adolescents aged 6-22 years in China during 2013-2021. A total of 614 325 cases data were extracted from the Chinese Information System for Infectious Diseases Control and Prevention during 2013-2021. Puberty health education data were drew from the Student Health Surveillance in 2021. Disparity patterns and average annual percentage changes (AAPCs) in sexually transmitted infections (STIs) incidence or new cases in China were examined using descriptive statistics and joinpoint regression. The incidence across 345 cities was stratified by gross domestic product (GDP). Between 2013 and 2021, there were 614 325 reported cases of HIV/AIDS, gonorrhea, and syphilis among children and adolescents aged 6-22, with an annual average incidence of 24.0967 per 100 000. The expansion of HIV/AIDS has halted, yet the surge in gonorrhea and syphilis remains notably pronounced. The ratio of male to female AIDS incidence increased from 2.75 (2.60, 2.90) to 7.13 (6.68, 7.62), but that of syphilis changed from 0.33 (0.32, 0.34) to 0.56 (0.55, 0.57). Students and out-of-school individuals aged 13-15 experienced a notably high increase in STI cases, surpassing other age groups, with an average annual percentage increase of 29.2% and 26.3%, respectively. Nonstudents consistently had a higher incidence rate than students, with an IRR reaching 31.80 (31.24, 32.37) in 2021. A noticeable clustering pattern of new cases emerged in the southeastern region of the Heihe-Tengchong line, extending inland from the coastal areas. Districts and counties with lower rates of puberty sexual health education tended to have higher average STI incidence rates. At the prefecture and city levels, there was a noticeable upward trend on average STI incidence rates in cities with per capita GDPs. Strategies to address those disparities include promoting equitable health education, and widespread sexual health education, particularly in areas with limited access to education and experiencing rapid economic development. The effectiveness of sexual health education intervention needs to be further evaluated in well-designed studies.
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Affiliation(s)
- Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- UNESCO Chair on Global Health and Education of Peking University, Beijing, China
| | - Mengjie Geng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yi Xing
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Xiang Ren
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Xinli Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yang Qin
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - RuoLin Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jianuo Jiang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Tongjun Guo
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Wen Yuan
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- UNESCO Chair on Global Health and Education of Peking University, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- UNESCO Chair on Global Health and Education of Peking University, Beijing, China
| | - Liping Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- UNESCO Chair on Global Health and Education of Peking University, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- UNESCO Chair on Global Health and Education of Peking University, Beijing, China
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Anley DT, Zemene MA, Gebeyehu AA, Gebeyehu NA, Adella GA, Kassie GA, Mengstie MA, Seid MA, Abebe EC, Gesese MM, Solomon Y, Moges N, Bantie B, Feleke SF, Dejenie TA, Chanie ES, Bayih WA, Tesfa NA, Taklual W, Tesfa D, Anteneh RM, Dessie AM. Hotspot areas of risky sexual behaviour and associated factors in Ethiopia: Further spatial and mixed effect analysis of Ethiopian demographic health survey. PLoS One 2024; 19:e0303574. [PMID: 38820433 PMCID: PMC11142568 DOI: 10.1371/journal.pone.0303574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 04/26/2024] [Indexed: 06/02/2024] Open
Abstract
INTRODUCTION Sexual behaviour needs to take a central position in the heart of public health policy makers and researchers. This is important in view of its association with Sexually Transmitted Infections (STIs), including HIV. Though the prevalence of HIV/AIDS is declining in Ethiopia, the country is still one of the hardest hit in the continent of Africa. Hence, this study was aimed at identifying hot spot areas and associated factors of risky sexual behavior (RSB). This would be vital for more targeted interventions which can produce a sexually healthy community in Ethiopia. METHODS In this study, a cross-sectional survey study design was employed. A further analysis of the 2016 Ethiopia Demographic and Health Survey data was done on a total weighted sample of 10,518 women and men age 15-49 years. ArcGIS version 10.7 and Kuldorff's SaTScan version 9.6 software were used for spatial analysis. Global Moran's I statistic was employed to test the spatial autocorrelation, and Getis-Ord Gi* as well as Bernoulli-based purely spatial scan statistics were used to detect significant spatial clusters of RSB. Mixed effect multivariable logistic regression model was fitted to identify predictors and variables with a p-value ≤0.05 were considered as statistically significant. RESULT The study subjects who had RSB were found to account about 10.2% (95% CI: 9.64%, 10.81%) of the population, and spatial clustering of RSB was observed (Moran's I = 0.82, p-value = 0.001). Significant hot spot areas of RSB were observed in Gambela, Addis Ababa and Dire Dawa. The primary and secondary SaTScan clusters were detected in Addis Ababa (RR = 3.26, LLR = 111.59, P<0.01), and almost the entire Gambela (RR = 2.95, LLR = 56.45, P<0.01) respectively. Age, literacy level, smoking status, ever heard of HIV/AIDS, residence and region were found to be significant predictors of RSB. CONCLUSION In this study, spatial clustering of risky sexual behaviour was observed in Ethiopia, and hot spot clusters were detected in Addis Ababa, Dire Dawa and Gambela regions. Therefore, interventions which can mitigate RSB should be designed and implemented in the identified hot spot areas of Ethiopia. Interventions targeting the identified factors could be helpful in controlling the problem.
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Affiliation(s)
- Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Aderajew Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asaye Alamneh Gebeyehu
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Woliata Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Woliata Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Department of Biomedical Science, Unit of Physiology, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Yenealem Solomon
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Moges
- Department of Pediatrics and Child Health Nursing, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Faculty of Medicine, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Natnael Amare Tesfa
- School of Medicine, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Wubet Taklual
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Dessalegn Tesfa
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Rahel Mulatie Anteneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Danielson CK, Moreland A, Hahn A, Banks D, Ruggiero KJ. Development and Usability Testing of an mHealth Tool for Trauma-Informed Prevention of Substance Use, HIV Acquisition, and Risky Sexual Behaviors Among Adolescents: Mixed Methods Study. JMIR Form Res 2024; 8:e52835. [PMID: 38236634 PMCID: PMC10835591 DOI: 10.2196/52835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Youth who experience traumatic events are at a substantially higher risk of engaging in substance use and sexual risk behaviors and problems (eg, HIV acquisition) than their non-trauma-exposed counterparts. Evidence-based substance use and risky sexual behavior prevention may reduce the risk of these outcomes. Trauma-focused mental health treatment provides a window of opportunity for the implementation of such preventive work with these youth. However, overburdened clinicians face challenges in adding prevention content while implementing evidence-based treatments. Mobile health (mHealth) tools can help reduce this burden in delivering prevention curricula. Trauma-Informed Prevention for Substance Use and Risky Sexual Behavior (TIPS) is an mHealth app that was developed to aid trauma-focused cognitive behavioral therapy (TF-CBT) clinicians in the implementation of an evidence-based risk behavior prevention curriculum. OBJECTIVE The goal of this paper is to describe the rationale for and development of the TIPS app and present the results of a mixed methods approach for the initial evaluation of its usability. METHODS Participants included clinicians (n=11), adolescents (n=11), and caregivers (n=10) who completed qualitative interviews and an adapted version of the Website Analysis and Measurement Inventory. RESULTS In total, 4 overarching themes emerged from the participants' answers to the qualitative interview questions, demonstrating a generally positive response to the app. The themes were (1) strength of app content, (2) suggestions about app content, (3) esthetics and usability, and (4) benefits to the patient and session implementation. Clinicians, adolescents, and caregivers all agreed that the content was very relevant to adolescents and used examples and language that adolescents could relate to. All 3 groups also discussed that the content was comprehensive and addressed issues often faced by adolescents. All 3 groups of users made suggestions about the esthetics, which mostly comprised suggestions to change the font, color, or pictures within the app. Of all the groups, adolescents were most positive about the esthetics and usability of the app. Results from the Website Analysis and Measurement Inventory further illustrated the users' favorable reaction to the TIPS app, with 100% (11/11) of clinicians, 100% (10/10) of caregivers, and most adolescents (7/11, 64%) selecting strongly agree or somewhat agree to the following statement: "This app has much that is of interest to me." Adolescents generally found the app easier to use than did caregivers and clinicians. CONCLUSIONS The TIPS app shows promise as an mHealth tool for TF-CBT clinicians to integrate evidence-based substance use, risky sexual behavior, and HIV prevention during treatment. Future research, including a randomized controlled trial comparing TF-CBT implementation with and without the inclusion of the app, is necessary to evaluate the feasibility and efficacy of the app in reducing the risk of substance use and risky sexual behavior among trauma-exposed adolescents. TRIAL REGISTRATION ClinicalTrials.gov NCT03710720; https://clinicaltrials.gov/study/NCT03710720.
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Affiliation(s)
- Carla Kmett Danielson
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Angela Moreland
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Austin Hahn
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Devin Banks
- Department of Psychology, University of Missouri-Saint Louis, Saint Louis, MO, United States
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
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Orr C, Kelty E, O'Donnell M, Fisher CM, Glauert R, Preen DB. Reproductive and sexual health of Australian adolescents exposed to family and domestic violence. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:245-253. [PMID: 36889813 DOI: 10.1136/bmjsrh-2022-201684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is a dearth of research investigating sexually transmitted infections (STIs) in children exposed to family and domestic violence (FDV). Further, there is no research on terminations of pregnancy in children exposed to FDV. METHODS This retrospective cohort study used linked administrative data from Western Australia to investigate whether exposure to FDV is associated with a risk of hospitalisations for STIs and terminations of pregnancy in adolescents. This study involved children born from 1987 to 2010 whose mother was a victim of FDV. Identification of family and domestic violence was from two sources: police and hospital records. This approach provided an exposed cohort of 16 356 and a non-exposed cohort of 41 996. Dependant variables were hospitalisations for pregnancy terminations and STIs in children aged from 13 up to 18 years of age. The primary explanatory variable was exposure to FDV. Multivariable Cox regression was used to investigate the association of FDV exposure and the outcomes. RESULTS Following adjustment for sociodemographic and clinical factors, children exposed to FDV had an increased risk of hospitalisations for STIs (HR 1.49, 95% CI 1.15 to 1.92) and terminations of pregnancy (HR 1.34, 95% CI 1.09 to 1.63) as an adolescent than non-exposed peers. CONCLUSION Children exposed to FDV are at an increased risk of hospitalisation for STI and termination of pregnancy as an adolescent. Effective interventions are needed to support children exposed to FDV.
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Affiliation(s)
- Carol Orr
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Erin Kelty
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- The Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
| | - Colleen M Fisher
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Rebecca Glauert
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Tenkorang EY. Physical, sexual, and psychosocial health impacts of child abuse: Evidence from Ghana. ADVANCES IN LIFE COURSE RESEARCH 2023; 57:100559. [PMID: 38054860 DOI: 10.1016/j.alcr.2023.100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/24/2023] [Accepted: 06/04/2023] [Indexed: 12/07/2023]
Abstract
Child abuse is a significant global health problem. While data on child abuse in Ghana are scant, anecdotal evidence suggests the vast majority of Ghanaian children have experienced some form of physical or sexual abuse. This paper explores links between early childhood abuse and health outcomes using a life course perspective. Nationally representative cross-sectional data were collected from a sample of 2289 ever-married Ghanaian women in 2017. Women provided retrospective accounts of different types of violence in early childhood. Random-effects logit models were used to examine the impact of two dimensions of early childhood abuse (physical and sexual) on the physical, sexual, and psychosocial health outcomes of women in later years. Women who experienced childhood physical abuse, but not often, were significantly more likely to report physical disabilities in later years than women who did not experience it. Women reporting childhood sexual abuse were more likely to be depressed in later years than those who never experienced such abuse. They were also significantly more likely to report sexually transmitted diseases. Our findings provide support for the life course theory by showing abuse experienced in childhood could have a long-term impact. We therefore suggest the need for early interventions to address child abuse.
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Affiliation(s)
- Eric Y Tenkorang
- Department of Sociology, Memorial University, St. John's, NL A1C 5S7, Canada.
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Jasthi DL, Lappen JR, Garber S, Kennedy S, McCarther N, Nagle-Yang S, Moore T, Frank S, Huth-Bocks A. Associations between adverse childhood experiences and obstetrical outcomes in a predominantly Black-identifying and low-income pregnant population. Am J Obstet Gynecol MFM 2023; 5:101008. [PMID: 37156467 DOI: 10.1016/j.ajogmf.2023.101008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Recent literature indicates that adverse childhood experiences have been associated with poor obstetrical outcomes, including pregnancy loss, preterm birth, and low birthweight. Several studies have been conducted in primarily self-identified White individuals who report middle to high income levels. Less is known about the impact of adverse childhood experiences on obstetrical outcomes in minority-identifying and low-income populations, who are known to experience a greater number of adverse childhood experiences and are at higher risk of maternal morbidity. OBJECTIVE This study aimed to examine associations between adverse childhood experiences and a broad range of obstetrical outcomes among predominantly Black-identifying pregnant persons who have low income and live in an urban area. STUDY DESIGN This is a single-center retrospective cohort study of pregnant persons referred to a mental healthcare manager because of elevated psychosocial risks identified by screening tools or provider concerns during the study period from April 2018 to May 2021. Pregnant persons aged <18 years and those who did not speak English were excluded. Patients completed validated mental and behavioral health screening tools including the Adverse Childhood Experiences Questionnaire. Medical charts were reviewed for obstetrical outcomes, including preterm birth, low birthweight, hypertensive disorders of pregnancy, gestational diabetes mellitus, chorioamnionitis, sexually transmitted infection, maternal group B streptococcus carrier status, type of delivery, and attendance of a postpartum visit. Associations between high (≥4) and very high (≥6) of 10 adverse childhood experience score and obstetrical outcomes were analyzed using bivariate analysis and multivariate logistic regression, adjusting for confounding factors (significant at P<.05 in bivariate analysis). RESULTS Our cohort included 192 pregnant persons, of whom 176 (91.7%) self-identified as Black or African American and 181 (94.8%) had public insurance (used as a proxy for low income). Adverse childhood experience score ≥4 was reported by 91 (47.4%) individuals and score ≥6 by 50 (26%). On univariate analysis, adverse childhood experience score ≥4 was associated with preterm birth (odds ratio, 2.17; 95% confidence interval, 1.02-4.61). Adverse childhood experience score ≥6 was associated with hypertensive disorders of pregnancy (odds ratio, 2.09; 95% confidence interval, 1.05-4.15) and preterm birth (odds ratio, 2.29; 95% confidence interval, 1.05-4.96). After accounting for chronic hypertension, associations between adverse childhood experience score and obstetrical outcomes were no longer significant. CONCLUSION Approximately half of the pregnant persons referred to a mental healthcare manager had a high adverse childhood experience score, underscoring the high burden of childhood trauma on populations facing long-standing systemic racism and barriers to healthcare access. High and very high adverse childhood experience score may be associated with chronic health conditions that predate pregnancy and can alter obstetrical outcomes. Obstetrical care providers have a unique opportunity to mitigate risk of associated poor health outcomes during preconception and prenatal care by screening for adverse childhood experiences.
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Affiliation(s)
- Divya L Jasthi
- Case Western Reserve University School of Medicine, Cleveland, OH (Ms Jasthi and Drs Frank and Huth-Bocks)
| | - Justin R Lappen
- Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH (Dr Lappen)
| | - Sarah Garber
- Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH (Drs Garber, Kennedy, McCarther, and Ms Moore)
| | - Sarah Kennedy
- Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH (Drs Garber, Kennedy, McCarther, and Ms Moore)
| | - Noria McCarther
- Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH (Drs Garber, Kennedy, McCarther, and Ms Moore)
| | - Sarah Nagle-Yang
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Denver, CO (Dr Nagle-Yang)
| | - Tamika Moore
- Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH (Drs Garber, Kennedy, McCarther, and Ms Moore)
| | - Scott Frank
- Case Western Reserve University School of Medicine, Cleveland, OH (Ms Jasthi and Drs Frank and Huth-Bocks)
| | - Alissa Huth-Bocks
- Case Western Reserve University School of Medicine, Cleveland, OH (Ms Jasthi and Drs Frank and Huth-Bocks); Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI (Dr Huth-Bocks).
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Thomas JL, Colich NL, McLaughlin KA, Sumner JA. Dimensions of Early Adversity and Sexual Behavior in a US Population-Based Adolescent Sample. J Adolesc Health 2023; 72:560-567. [PMID: 36529620 PMCID: PMC11107430 DOI: 10.1016/j.jadohealth.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/06/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Early life adversity (ELA) is associated with sexual risk, but ELA dimensions-and potential mechanisms-have been less examined. We evaluated associations between threat and deprivation-two key ELA dimensions-and sexual behaviors in adolescents. Secondary analyses investigated age at menarche as a mechanism linking ELA with sexual outcomes in girls. We predicted associations between threat and sexual behaviors, with younger age at menarche as a pathway. METHODS Data were from the National Comorbidity Survey, Adolescent Supplement. Adolescents and caregivers reported on youths' ELA experiences, which were categorized as threat- or deprivation-related. Adolescents reported if they engaged in sex (N = 9,937) and on specific sexual risk indicators, including age at first sex, number of past-year sexual partners, and condom use consistency ("always" vs. "not always" used). Girls reported age at menarche. RESULTS Threat (odds ratio [OR] = 1.76 [95% confidence interval [CI], 1.62-1.92]) and deprivation (OR = 1.51 [95% CI, 1.24-1.83]) were each linked with engagement in sex, ps<.05. Threat-related experiences were associated with multiple sexual risk markers, even when accounting for deprivation: earlier age at first sex (b = -0.20 [95% CI, -0.27 to 0.13]), greater number of partners (b = 0.17 [95% CI, 0.10-0.25]), and inconsistent condom use (OR = 0.72 [95% CI, 0.64-0.80]), ps <.001. Deprivation was not associated with sexual risk when adjusting for threat. We observed no significant indirect effects through age at menarche. DISCUSSION Although threat and deprivation were related to engagement in sexual activity, threat-related experiences were uniquely associated with sexual risk. Screening for threat-related ELA may identify adolescents at-risk for poor sexual health.
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Affiliation(s)
- Jordan L Thomas
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, California.
| | - Natalie L Colich
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | | | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, California
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Logistic Regression With Machine Learning Sheds Light on the Problematic Sexual Behavior Phenotype. J Addict Med 2023; 17:174-181. [PMID: 36193910 PMCID: PMC10022667 DOI: 10.1097/adm.0000000000001078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There has been a longstanding debate about whether the mechanisms involved in problematic sexual behavior (PSB) are similar to those observed in addictive disorders, or related to impulse control or to compulsivity. The aim of this report was to contribute to this debate by investigating the association between PSB, addictive disorders (internet addiction, compulsive buying), measures associated with the construct known as reward deficiency (RDS), and obsessive-compulsive disorder (OCD). METHODS A Canadian university Office of the Registrar invited 68,846 eligible students and postdoctoral fellows. Of 4710 expressing interest in participating, 3359 completed online questionnaires, and 1801 completed the Mini-International Neuropsychiatric Interview. PSB was measured by combining those screening positive (score at least 6) on the Sexual Addiction Screening Test-Revised Core with those self-reporting PSB. Current mental health condition(s) and childhood trauma were measured by self-report. OCD was assessed by a combination of self-report and Mini-International Neuropsychiatric Interview data. RESULTS Of 3341 participants, 407 (12.18%) screened positive on the Sexual Addiction Screening Test-Revised Core. On logistic regression, OCD, attention deficit, internet addiction, a family history of PSB, childhood trauma, compulsive buying, and male gender were associated with PSB. On multiple correspondence analysis, OCD appeared to cluster separately from the other measures, and the pattern of data differed by gender. CONCLUSIONS In our sample, factors that have previously been associated with RDS and OCD are both associated with increased odds of PSB. The factors associated with RDS appear to contribute to a separate data cluster from OCD and to lie closer to PSB.
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Reilly JJ, Naumann DN, Morris L, Blackburn L, Brooks A. Injury by knife crime amongst children is associated with socioeconomic deprivation: an observational study. Pediatr Surg Int 2022; 39:8. [PMID: 36441280 PMCID: PMC9705482 DOI: 10.1007/s00383-022-05298-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Children who live in areas of socioeconomic deprivation may be at higher risk of being victims of violent crime such as knife wounds. The current study investigated whether socioeconomic disparity was associated with higher risk of knife crime. METHODS An observational study included patients aged ≤ 17 years at a UK Major Trauma Centre injured by knife trauma from 2016 to 2022. Indices of deprivation were recorded according to the zip code of residence and compared with those of all of England. These included Index of Multiple Deprivation (IMD); income; employment; education and skills; health and disability; crime; barriers to housing and services; living environment; and Income Deprivation Affecting Children Index (IDACI). RESULTS There were 139 patients (96% male) with median age of 16 years. When compared with the whole of England, patients had worse indices of IMD (p = 0.021); income (p < 0.001); employment (p < 0.001); education and skills (p < 0.001); health and disability; and IDACI (p < 0.001). There were no significant differences in indices of crime, barriers to housing and services or living environment. CONCLUSIONS Paediatric knife injury was associated with poor socioeconomic status in multiple domains. Focussed efforts to address socioeconomic disparities should be a priority as a public health measure for vulnerable children.
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Affiliation(s)
- John-Joe Reilly
- Department of Major Trauma, East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
| | - David N Naumann
- Department of Major Trauma, East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK.
- University of Birmingham, Birmingham, UK.
| | - Louise Morris
- Department of Major Trauma, East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
| | - Lauren Blackburn
- Department of Major Trauma, East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
| | - Adam Brooks
- Department of Major Trauma, East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
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10
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Sexual violence experiences among adolescent and young adult males: a review to empower healthcare providers. Curr Opin Pediatr 2022; 34:297-305. [PMID: 35836391 DOI: 10.1097/mop.0000000000001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Despite 3-17% of adolescent and young adult males (AYAMs) experiencing sexual violence, there is a paucity of information regarding their sexual violence experiences leaving them vulnerable to dangerous and detrimental sequelae. RECENT FINDINGS There is underreporting and under-discussion of AYAMs' experiences of sexual violence, with disclosure influenced by societal perceptions of male sexuality, shame, and fear of discrimination. AYAMs experience sexual violence from individuals known to them, with many experiencing physical violence, threats, coercion, and electronic harassment. Intersectionality, previous traumas, inappropriate childhood exposures to sexually explicit situations, select online media consumption, and adverse childhood experiences (ACEs) increase the risk of sexual violence. AYAMs who experience sexual violence are at increased risk of re-victimization, perpetrating sexual violence, experiencing bodily harm, contracting sexually transmitted infections (STIs), and experiencing internalizing and externalizing symptoms, which can lead to significant morbidity and mortality. Research on male-specific protective and resilience factors is scarce and represents an ongoing need. SUMMARY After reviewing AYAMs' experiences of sexual violence, including risk and protective factors, media influences, detrimental sequelae, and resilience factors, we provide a screening framework to empower the healthcare provider (HCP) to champion tailored prevention, screening, intervention, and advocacy efforts to support AYAMs.
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Wang WL, Hung HY, Chung CH, Hsu JW, Huang KL, Chan YY, Chien WC, Chen MH. Risk of Personality disorders among childhood maltreatment victims: A nation-wide population-based study in Taiwan. J Affect Disord 2022; 305:28-36. [PMID: 34965397 DOI: 10.1016/j.jad.2021.12.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND To date, numerous cohort studies and meta-analyses have shown that childhood maltreatment is associated with a wide range of adverse physiological and psychological symptoms. Although childhood maltreatment has been linked to an increased risk of personality disorders, the direction and magnitude of the association remain uncertain. Therefore, this cohort study aimed to evaluate whether children who have suffered childhood maltreatment have a higher incidence of subsequent personality disorders, using a nationwide database in Taiwan. METHODS We conducted a large retrospective cohort study using data drawn from Taiwan's National Health Insurance Research Database between 2000 and 2015. A total of 10,345 children who experienced childhood maltreatment were identified using International Classification of Disease codes. They were then compared with 41,380 children who never experienced childhood maltreatment in terms of the prevalence rates of personality disorders. RESULTS Childhood maltreatment was associated with an increased risk of personality disorders (considering the control as reference: adjusted hazard ratio, 2.12; 95% confidence interval, 1.90-2.36; p < 0.001). The Kaplan-Meier analysis revealed a significantly higher 15-year cumulative incidence of personality disorders among childhood maltreatment victims than among controls (log-rank test, p < 0.001). CONCLUSIONS The present population-based study showed a positive association between prior childhood maltreatment and subsequent personality disorders in the general Taiwanese population. In order to reduce the risk of personality disorders, interventions should be implemented, identifying and supporting economically disadvantaged families and vulnerable children as early as possible.
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Affiliation(s)
- Wei-Li Wang
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hao-Yuan Hung
- Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan; Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 325, Chung-Gung Rd, Sec 2, Nei-Hu District 114, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuan-Yu Chan
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Department of Psychology, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 325, Chung-Gung Rd, Sec 2, Nei-Hu District 114, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; National Defense Medical Center, Graduate Institute of Life Sciences, Taipei, Taiwan.
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Font SA, Caniglia M, Kennedy R, Noll JG. Child Protection Intervention and the Sexual and Reproductive Health of Female Adolescents Ages 13 to 17 Years. JAMA Pediatr 2022; 176:461-469. [PMID: 35188543 PMCID: PMC8861893 DOI: 10.1001/jamapediatrics.2021.6605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/01/2021] [Indexed: 11/14/2022]
Abstract
Importance Child maltreatment adversely affects health and development, but evidence is needed regarding whether and how Child Protective Services (CPS) interventions may mitigate risks. Objective To assess whether different forms of CPS intervention are associated with sexual and reproductive health outcomes among female adolescents investigated by CPS for suspected exposure to maltreatment during childhood. Design, Setting, and Participants This cohort study used linked, longitudinal, statewide administrative data from Wisconsin, including medical assistance and CPS records, to examine the rates and correlates of sexual and reproductive health outcomes (sexual transmitted infections, pregnancies, births, and high-risk sexual behavior) among 9392 female adolescents tracked from age 13 through 17 years who were investigated by CPS for suspected exposure to maltreatment prior to their 13th birthday. The study assesses how these outcomes were associated with types and frequency of CPS involvement and intervention and with adolescent and family demographic characteristics. Participants were female adolescents born from 2000 through 2002 who were investigated by Wisconsin CPS for suspected exposure to maltreatment before 13 years of age and who were covered by medical assistance at least 85% of the time from 13 to 17 years of age. Exposures Varying levels and intensities of CPS interventions, ranging from a single investigation to adoption from foster care. Main Outcomes and Measures Dependent variables were pregnancy, birth, sexually transmitted infection, and an aggregate measure of sexual health concerns from 13 to 17 years of age. Primary explanatory variables were the intensity of CPS intervention (investigation only, in-home services, and foster care) and frequency of maltreatment concerns (number of investigations, continued involvement during adolescence). Logistic regression was used to assess the association of CPS measures with differences in sexual health outcomes. Data were analyzed from March 1 to October 12, 2021. Results This cohort study included 9392 female adolescents, among whom 3156 (33.6%) were born in 2000, 3064 (32.6%) in 2001, and 3173 (33.8%) in 2002; 2501 adolescents [26.6%] were Black, 1568 [16.7%] were Hispanic, 1024 [10.9%] were multiracial, 4024 [42.8%] were White, and 275 [2.9%] were listed as other [which included American Indian, Asian or Pacific Islander, or unknown race or ethnicity]). By 18 years of age, sizable proportions of maltreated female adolescents had at least 1 concerning sexual health outcome (23.5%), including diagnoses of gonorrhea, chlamydia, or trichomoniasis (8.4%), pregnancy (11.2%), and parenthood (6.1%). Compared with CPS investigation without formal intervention, foster care was associated with lower odds of pregnancy (adjusted odds ratio, 0.82; 95% C, 0.69-0.98) and live birth (adjusted odds ratio, 0.78; 95% CI, 0.61-0.99). Recurrent and ongoing CPS involvement was associated with adverse sexual health outcomes. Conclusions and Relevance This cohort study found that maltreated girls face increased risks of adverse sexual health outcomes in adolescence, but CPS interventions were associated with limited influence. More effective interventions are needed to help maltreated girls avoid teen pregnancy, sexually transmitted infections, and risky sexual behaviors in adolescence.
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Affiliation(s)
- Sarah A. Font
- Department of Sociology and Criminology, The Pennsylvania State University, University Park
- Child Maltreatment Solutions Network, The Pennsylvania State University, University Park
| | - Michael Caniglia
- Department of Sociology and Criminology, The Pennsylvania State University, University Park
| | - Reeve Kennedy
- Department of Sociology and Criminology, The Pennsylvania State University, University Park
- Child Maltreatment Solutions Network, The Pennsylvania State University, University Park
| | - Jennie G. Noll
- Child Maltreatment Solutions Network, The Pennsylvania State University, University Park
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park
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Thananowan N, Vongsirimas N, Kedcham A. Mediating Roles of Intimate Partner Violence, Stress, and Social Support on Depressive Symptoms Among Thai Women. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP6697-NP6719. [PMID: 33086916 DOI: 10.1177/0886260520967140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Prior research has shown that intimate partner violence (IPV), stress, and social support are associated with depressive symptoms. However, a possible mediating role of these variables linking depressive symptoms has not been fully investigated in Thailand. This study was conducted to assess the mediating roles of IPV, stress, and social support in the relationships between childhood abuse (CA), number of sexual partners (NSP), and depressive symptoms among 400 Thai women attending gynecology clinics. Results indicated that IPV was significantly positively correlated with stress and depressive symptoms but negatively correlated with social support. CA and NSP were significantly positively correlated with IPV, stress, and depressive symptoms, but negatively correlated with social support. Structural equation models (SEMs) showed that not only did IPV severity exhibit significantly indirect effect on depressive symptoms (β = .178; p < .05), but it also had a significant, positive total effect on depressive symptoms (β = .252; p < .05). In particular, IPV severity had the fully mediating effect on depressive symptoms through social support (β = -.204; p < .05) and stress (β = .158; p < .05). CA severity and NSP exhibited the significant indirect effect on depressive symptoms through IPV severity, stress, and social support. All the models analyzed showed that stress had an important mediator role (β = .583; p < .05) on depressive symptoms. The model fitted very well to the empirical data and explained 53% of variance. Findings affirmed the important role of these mediators as well as the need to design interventions for reducing stress or increasing support for women experiencing IPV. Utilizing an empowerment approach among female outpatients to decrease stress and depressive symptoms is recommended.
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Affiliation(s)
| | | | - Akadet Kedcham
- Bansomdejchaopraya Rajabhat University, Bangkok, Thailand
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14
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Associations Between Adverse Childhood Experiences and Prenatal Mental Health and Substance Use Among Urban, Low-Income Women. Community Ment Health J 2022; 58:595-605. [PMID: 34184153 DOI: 10.1007/s10597-021-00862-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
This study examined associations between Adverse Childhood Experiences (ACEs) and perinatal mental health and substance use among 98 low-income women (mean age 25.4 years; 93% Black/African American) referred to a mental health care manager in an urban women's clinic. Self-report and retrospective chart review data were utilized. Chi-squared and Fisher's Exact tests were performed to assess bivariate relationships between ACEs and mental health and substance use outcomes. Multivariate logistic regressions were used to examine the impact of ACEs on mental health and substance use, adjusting for marital status, education, and age. Findings indicate high levels of childhood adversity, specifically childhood abuse, are associated with negative perinatal mental health and substance use outcomes, including suicidal thoughts, anxiety, mood dysregulation, and tobacco and marijuana use. Inquiring about ACEs during prenatal care and/or in community health clinics may help identify patients' overall risk and provide opportunities for intervention for mothers and their infants.
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15
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Robin L, Timpe Z, Suarez NA, Li J, Barrios L, Ethier KA. Local Education Agency Impact on School Environments to Reduce Health Risk Behaviors and Experiences Among High School Students. J Adolesc Health 2022; 70:313-321. [PMID: 34531096 PMCID: PMC8792165 DOI: 10.1016/j.jadohealth.2021.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the study is to assess associations between exposure to a multilevel, socio-ecological health program administered by local education agencies and changes in health behaviors among high school students. METHODS This analysis used a multilevel difference-in-differences approach to compare student health experiences and outcomes between schools selected by local education agencies nationwide to implement the program (exposed schools) and schools that were not (unexposed schools). We measured repeated cross-sectional outcomes using the 2015 and 2017 Youth Risk Behaviors Surveys. The final analytic sample comprised 638 schools in total (N = 64,838 students), with 237 exposed schools (n = 30,336 students) and 401 unexposed schools (n = 34,502 students). RESULTS Students in exposed schools demonstrated significant reduction in odds compared with those in unexposed schools in ever having sex (adjusted odds ratio [aOR] = .88, 95% confidence interval [CI]: .81-.96), having four or more lifetime sexual partners (aOR = .84, 95% CI: .72-.97), being currently sexually active (aOR = .78, 95% CI: .78-.96), and using effective hormonal birth control (aOR = .7, 95% CI: .56-.88). Exposure to the program was associated with significant reduction in odds of not going to school because of safety concerns (aOR = .87, 95% CI: .78-.97), having experienced forced sex (aOR = .76, 95% CI: .68-.86), ever used marijuana (aOR = .89, 95% CI: .81-.98), and currently using marijuana (aOR = .77, 95% CI: .64-.93). CONCLUSIONS Exposure to the program was associated with significant decreases in sexual risk behaviors, experience of violence, and substance use.
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Affiliation(s)
- Leah Robin
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia.
| | - Zachary Timpe
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Nicolas A Suarez
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Jingjing Li
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Lisa Barrios
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Kathleen A Ethier
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
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16
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Kim Y, Lee H, Park A. Patterns of adverse childhood experiences and depressive symptoms: self-esteem as a mediating mechanism. Soc Psychiatry Psychiatr Epidemiol 2022; 57:331-341. [PMID: 34191037 PMCID: PMC8243305 DOI: 10.1007/s00127-021-02129-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022]
Abstract
PURPOSE There is a growing interest in the co-occurring natures of adverse childhood experiences (ACEs) and unmeasured types of adversity. The current body of knowledge may also lack plausible mechanisms linking ACEs to mental health in young adulthood. This study aims to identify early adversity patterns using expanded ACEs items and investigate the pathway of ACEs and self-esteem to depressive symptoms in young adulthood. METHODS Data were obtained from the National Longitudinal Study of Adolescent and Adult Health, including a nationally representative sample in the U.S. (N = 10,702). We identified the ACEs patterns and estimated the direct and indirect associations between ACEs and depressive symptoms through self-esteem, using a latent class analysis with a distal outcome. RESULTS This study identified four distinct groups of ACEs that include Child Maltreatment, Household Dysfunction, Violence, and Low Adversity. The Child Maltreatment class showed a significantly higher risk of depressive symptoms compared to other ACEs groups. Self-esteem mediated the negative association of child maltreatment with depressive symptoms. The Violence class presented a significantly higher risk of depressive symptoms than Low Adversity, but no mediation of self-esteem was found. CONCLUSION The study highlights the profound consequence of child abuse/neglect and identifies self-esteem as a plausible mediating mechanism. Researchers and practitioners should increase collaboration efforts to prevent early adversity exposures and detrimental effects on mental health.
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Affiliation(s)
- Youngmi Kim
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Avenue, PO Box 842027, Richmond, VA 23220 USA
| | - Haenim Lee
- Department of Social Welfare and Counselling, Dongguk University, 30 Pildong-ro 1gil, Jung-gu, Seoul, South Korea 04629
| | - Aely Park
- Department of Social Welfare, Sunchon National University, 255 Jungang-ro, Suncheon, Jeonnam, South Korea 57922
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Hirschmann R, Martins RC, Gonçalves H. [Child abuse and sexual risk behavior in adulthood: a systematic review]. CIENCIA & SAUDE COLETIVA 2021; 26:5057-5068. [PMID: 34787198 DOI: 10.1590/1413-812320212611.3.31562019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 02/07/2020] [Indexed: 11/22/2022] Open
Abstract
Child abuse is a public health problem and can lead to serious consequences, such as involvement in sexual risk behavior (SRB). The scope of this article is to identify the studies that evaluated the association between different types of child maltreatment and SRB in adulthood through a systematic review. The search was conducted in the PubMed, Web of Science, PsycNET and Lilacs databases. The inclusion criteria were: cross-sectional, cohort or case-control design; assessment of individuals who have been exposed to maltreatment before the age of 18; evaluation of SRB in adulthood. The search identified 18,951 articles, 34 of which were included in this study. The selection process was performed by two researchers independently. Studies have generally shown that sexual abuse is a risk factor for the tendency of SRB in adulthood, however there is less evidence of this association for other forms of child abuse, such as domestic violence, emotional abuse and neglect. Child maltreatment negatively influences SRB in early adulthood. Further studies are needed to evaluate this relationship longitudinally, including the different types of abuse and the possible mechanisms of this relationship.
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Affiliation(s)
- Roberta Hirschmann
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. R. Marechal Deodoro 1160, 3° andar, Centro. 96020-220 Pelotas RS Brasil.
| | - Rafaela Costa Martins
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. R. Marechal Deodoro 1160, 3° andar, Centro. 96020-220 Pelotas RS Brasil.
| | - Helen Gonçalves
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. R. Marechal Deodoro 1160, 3° andar, Centro. 96020-220 Pelotas RS Brasil.
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Stochero L, Moraes CL, Marques ES, Santos EBD, Pacheco DL, Reichenheim ME, Taquette SR. Prevalence and co-occurrence of Adverse Childhood Experiences: a school-based survey in Rio de Janeiro. CIENCIA & SAUDE COLETIVA 2021; 26:4115-4127. [PMID: 34586264 DOI: 10.1590/1413-81232021269.07412020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 06/22/2020] [Indexed: 11/21/2022] Open
Abstract
This study aimed to estimate the prevalence of categories of adverse childhood experiences (ACE) among high school students in Rio de Janeiro, investigate the ACE co-occurrence profile, and examine the distribution of exposure to ACE according to individual, family, socioeconomic, and school characteristics. A cross-sectional study was conducted with 681 individuals selected using a complex random sampling design. Exposure to ACE categories was identified using a cross-culturally adapted version of the Childhood Trauma Questionnaire (CTQ) and direct questions. We calculated prevalence and correlation between ACE pairs and determined the co-occurrence profile of childhood adversities. The findings reveal that the most common adversities were emotional abuse and neglect and biparental family dissolution. Seventy percent of the sample reported having been exposed to at least one ACE and 9% had been exposed to four or more. Around 20% of respondents reported exposure to abuse and neglect and 9% to the co-occurrence of abuse, neglect, and absence of at least one parent during childhood. The most vulnerable subgroups were girls and respondents who were born to teenage mothers, not living with both parents, studying at public schools, and from low-income families. The high prevalence and co-occurrence profile of ACE reveals the need for wide-ranging intersectoral policies designed to prevent adverse childhood experiences and provide victim support.
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Affiliation(s)
- Luciane Stochero
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rua São Francisco Xavier 524 7º andar Bloco D, Maracanã. 20550-013 Rio de Janeiro RJ Brasil.
| | - Claudia Leite Moraes
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rua São Francisco Xavier 524 7º andar Bloco D, Maracanã. 20550-013 Rio de Janeiro RJ Brasil.
| | - Emanuele Souza Marques
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rua São Francisco Xavier 524 7º andar Bloco D, Maracanã. 20550-013 Rio de Janeiro RJ Brasil.
| | | | - Deylaine Lourenço Pacheco
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rua São Francisco Xavier 524 7º andar Bloco D, Maracanã. 20550-013 Rio de Janeiro RJ Brasil.
| | - Michael Eduardo Reichenheim
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rua São Francisco Xavier 524 7º andar Bloco D, Maracanã. 20550-013 Rio de Janeiro RJ Brasil.
| | - Stella Regina Taquette
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro. Rio de Janeiro RJ Brasil
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Mendel WE, Sperlich M, Fava NM. "Is there anything else you would like me to know?": Applying a trauma-informed approach to the administration of the adverse childhood experiences questionnaire. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:1079-1099. [PMID: 33792050 PMCID: PMC8222088 DOI: 10.1002/jcop.22562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 05/28/2023]
Abstract
Nearly ubiquitous agreement exists regarding the potentially negative impact of adverse childhood experiences (ACEs) on health and well-being across the lifespan. This has propelled a movement across the nation for consistent screening of ACEs. Despite agreement regarding the consequences of ACEs, little research related specifically to the administration of the ACE questionnaire exists. Using data from a mixed-methods study of first-time mothers as means of illustration, this paper examines shortcomings of the ACE questionnaire. Participant responses revealed ambiguity with item structure, limited breadth of included events, and failure to capture the gravity of the experience. These shortcomings underscore inadequacies of the measure in accurately understanding individuals' lived experiences and call for the application of trauma-informed (TI) values, both in its content and administration. We apply the main tenets of a TI framework to the ACE questionnaire and make recommendations for its administration, translating theoretical underpinnings of a TI approach into action.
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Affiliation(s)
- Whitney E Mendel
- Master of Public Health Program, Daemen College, Amherst, New York, USA
| | - Mickey Sperlich
- School of Social Work, University at Buffalo, Buffalo, New York, USA
| | - Nicole M Fava
- Center for Children and Families, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, USA
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Perceived Stress, Sexually Transmitted Infection, and Pelvic Inflammatory Disease: Examination of Differences in Associations Among Black and White Women. Sex Transm Dis 2021; 47:617-624. [PMID: 32649581 DOI: 10.1097/olq.0000000000001232] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Perceived stress is linked to poor sexual and reproductive health, but its relationship with sexually transmitted infections (STIs) is less clear. The elevated burden of stress and STI among Black women suggests a need to examine racial differences in the associations on additive and multiplicative scales. METHODS Using data from Black and White female participants from wave IV of the National Longitudinal Study of Adolescent to Adult Health (n = 4744), we examined the association of high stress (scores ≥6 on the Perceived Stress Scale-4) with self-reported past-year chlamydia diagnosis, combined curable STI, and lifetime pelvic inflammatory disease using modified Poisson regression with robust variance to estimate prevalence ratios and prevalence differences. Models included a race-stress product-interaction term and adjusted for sociodemographic variables, prior trauma and stressors, and mental health factors. RESULTS In unadjusted analyses, stress was associated with STI among Black and White women. Adjusted associations were attenuated among White women; among Black women, stress remained associated with chlamydia (adjusted prevalence ratio, 2.22; 95% confidence interval, 1.30-3.79) and curable STI (adjusted prevalence ratio, 1.59; 95% confidence interval, 1.05-2.40), corresponding to approximately 5 excess cases of each. Among White women, poverty and personality traits were the strongest confounders; among Black women, poverty, trauma, and neurotic personality traits were the strongest confounders for chlamydia, although no factors seemed to confound the association with curable STI. CONCLUSIONS Stress is independently linked to STI, particularly among Black women. Additional research with longitudinal data is needed to understand the role of stress on STI and address a significant health disparity.
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Thomas JL, Lewis JB, Ickovics JR, Cunningham SD. Associations between Adverse Childhood Experiences and Sexual Risk among Postpartum Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3848. [PMID: 33917634 PMCID: PMC8038841 DOI: 10.3390/ijerph18073848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/16/2022]
Abstract
Epidemiological evidence suggests that exposure to adverse childhood experiences (ACEs) is associated with sexual risk, especially during adolescence, and with maternal and child health outcomes for women of reproductive age. However, no work has examined how ACE exposure relates to sexual risk for women during the postpartum period. In a convenience sample of 460 postpartum women, we used linear and logistic regression to investigate associations between ACE exposure (measured using the Adverse Childhood Experiences Scale) and five sexual risk outcomes of importance to maternal health: contraceptive use, efficacy of contraceptive method elected, condom use, rapid repeat pregnancy, and incidence of sexually transmitted infections (STIs). On average, women in the sample were 25.55 years of age (standard deviation = 5.56); most identified as Black (60.4%), White (18%), or Latina (14.8%). Approximately 40% were exposed to adversity prior to age 18, with the modal number of experiences among those exposed as 1. Women exposed to ACEs were significantly less likely to use contraception; more likely to elect less-efficacious contraceptive methods; and used condoms less frequently (p = 0.041 to 0.008). ACE exposure was not associated with rapid repeat pregnancy or STI acquisition, p > 0.10. Screening for ACEs during pregnancy may be informative to target interventions to reduce risky sexual behavior during the postpartum period.
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Affiliation(s)
- Jordan L. Thomas
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Jessica B. Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Jeannette R. Ickovics
- Yale-NUS College, Singapore 138527, Singapore;
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06032, USA
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Ménard AD, MacIntosh HB. Childhood Sexual Abuse and Adult Sexual Risk Behavior: A Review and Critique. JOURNAL OF CHILD SEXUAL ABUSE 2021; 30:298-331. [PMID: 33403939 DOI: 10.1080/10538712.2020.1869878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 09/14/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
Childhood sexual abuse (CSA) is a global problem with serious repercussions for survivors in various domains of adult interpersonal functioning, including sexual risk behavior. This review aimed to summarize findings from the recent literature on the connections between CSA and later adult sexual risk behaviors (e.g., unprotected intercourse, sexually transmitted infection [STSI] diagnosis). The sexual risk behaviors consistently associated with CSA were having sex under the influence of alcohol/substances and reports of concurrent sexual partners/infidelity. Notably, studies investigating the links between CSA and history of STI diagnosis and CSA and reports of unprotected sex (with the exception of samples comprised men who have sex with men) produced inconsistent findings. The methodological limitations of existing studies are considered and suggestions for future research are offered.
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Roettger M, Houle B. Assessing the relationship between parental imprisonment in childhood and risk of sexually transmitted infections: a cohort study of US adults in early adulthood. BMJ Open 2021; 11:e038445. [PMID: 33795290 PMCID: PMC8021740 DOI: 10.1136/bmjopen-2020-038445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES One in six young adults in the USA experiences parental imprisonment in childhood. Prior studies have associated parental imprisonment with risk of sexually transmitted infection (STI); however, potential data and methodological issues may have limited the reliability and accuracy of prior findings. Examining cumulative and longitudinal risk, we address several methodological limitations of prior studies and also examine comparative risk by respondent sex and ethnicity. We assess these associations using a range of control variables. DESIGN A national cohort study from the National Longitudinal Study of Adolescent to Adult Health using (1) a cross-sectional sample of adults at ages 24-32 years and (2) a longitudinal sample between ages 18 and 32 years. Both analyses estimate ORs for STI associated with parental imprisonment and examine variation by parent/child gender and respondent ethnicity. SETTING In-home interviews in the USA at wave 1 (1994-1995), wave 3 (2001-2003) and wave 4 (2007-2009). PARTICIPANTS 15 684 respondents completing interviews at wave 1 (ages 12-18 years) and wave 4 (ages 26-32 years), including 8556 women, 3437 black and 2397 respondents reporting parental imprisonment. RESULTS Father-only imprisonment is associated with 1.22 higher odds (95% CI: 1.09 to 1.37) of lifetime STI and 1.19 higher odds (95% CI: 1.01 to 1.41) of STI in the past 12 months between ages 18 and 32 years, adjusting for familial, neighbourhood, individual and sexual risk factors. Maternal imprisonment is not associated with higher risk of lifetime STI after adjusting for confounders (95% CI: 0.90 to 1.61). Examining predicted probabilities of STI, our findings show additive risks for women, black people and parental imprisonment. CONCLUSION Adjusting for confounders, only paternal imprisonment is associated with slightly elevated risk of annual and lifetime risk of STI. Additive effects show that parental imprisonment modestly increases ethnic and female risk for STI.
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Affiliation(s)
- Michael Roettger
- School of Demography, Australian National University College of Arts and Social Sciences, Acton, Australian Capital Territory, Australia
| | - Brian Houle
- School of Demography, Australian National University College of Arts and Social Sciences, Acton, Australian Capital Territory, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
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Niu L, Brown J, Till Hoyt L, Salandy A, Nucci-Sack A, Shankar V, Burk RD, Schlecht NF, Diaz A. Profiles of Childhood Maltreatment: Associations with Sexual Risk Behavior during Adolescence in a Sample of Racial/Ethnic Minority Girls. Child Dev 2021; 92:1421-1438. [PMID: 33442867 DOI: 10.1111/cdev.13498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study examines associations between childhood maltreatment and developmental trajectories of sexual risk behaviors (SRBs) in a sample of 882 sexually active adolescent girls, predominantly Hispanic or Black, assessed every 6 months between 13 and 23 years. Latent profile analyses revealed four distinct maltreatment profiles: Low Maltreatment (76%), Moderate Emotional Neglect Only (15%), Severe Physical/Emotional Abuse (3%), and Severe Sexual Abuse (6%). Multilevel growth analyses showed the Moderate Emotional Neglect Only and Severe Sexual Abuse profiles exhibited more SRBs starting in late adolescence, and the Severe Sexual Abuse profile also exhibited a faster increase than the Low Maltreatment profile. Understanding heterogeneity within maltreated populations may have important implications for healthy sexual development.
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Affiliation(s)
- Li Niu
- Fordham University.,Mount Sinai Adolescent Health Center.,Icahn School of Medicine at Mount Sinai
| | | | | | | | | | | | | | - Nicolas F Schlecht
- Albert Einstein College of Medicine.,Roswell Park Comprehensive Cancer Center
| | - Angela Diaz
- Mount Sinai Adolescent Health Center.,Icahn School of Medicine at Mount Sinai
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Small E, Kim YK, Yu M. Sexually Transmitted Diseases Among College Students in Sierra Leone: A Life Course Ecological Analysis. SEXUALITY & CULTURE 2021; 25:884-903. [PMID: 33437142 PMCID: PMC7790596 DOI: 10.1007/s12119-020-09799-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 06/12/2023]
Abstract
Applying life course theory, this study examined the direct and indirect effects of adverse childhood experiences (ACEs) on the risk of contracting sexually transmitted diseases (STDs), mediated by early sexual activity (first sexual experience before age 15), number of lifetime sex partners, and mental health problems. The link between ACEs and mental health on college students' sexual risk is still understudied. Using cross-sectional data from a sample of 327 college students in Sierra Leone, this study tested the hypothesized mediation model using structural equation modeling analysis. The results showed that ACEs significantly increased sexual risks. Specifically, ACEs increased the risk of early initiation of sexual activity and the number of lifetime sex partners, which in turn increased the risk of STDs. Furthermore, ACEs significantly predicted negative mental health and were significantly associated with an increased risk of STDs. Effective future intervention strategies should include health education programs to address the lifelong effects of ACEs and mental health treatment.
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Affiliation(s)
- Eusebius Small
- School of Social Work, University of Texas, Arlington, 211 S. Cooper St., Bldg. A, Arlington, TX 76019 USA
| | - Youn Kyoung Kim
- School of Social Work, Louisiana State University, 207 Huey P. Long Field House, Baton Rouge, LA 70803 USA
| | - Mansoo Yu
- School of Social Work, Department of Public Health, University of Missouri, 720 Clark Hall, Columbia, MO 65211 USA
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26
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Fortenberry JD. Reorienting Routine Adolescent Sexually Transmitted Infection Screening in a COVID-19 Pandemic. J Adolesc Health 2021; 68:3-4. [PMID: 33349358 DOI: 10.1016/j.jadohealth.2020.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022]
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Brewer A, Colbert AM, Sekula K, Bekemeier B. A need for trauma informed care in sexually transmitted disease clinics. Public Health Nurs 2020; 37:696-704. [PMID: 32776628 DOI: 10.1111/phn.12784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/16/2020] [Accepted: 07/19/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This review examines trauma from violence as a risk factor for sexually transmitted diseases (STDs) among women attending STD clinics. The review also aims to suggest trauma informed care (TIC) integrated into STD clinics might more effectively address traumatic effects of violence linked to sexual risk behaviors among this population. DESIGN AND SAMPLE A systematic literature review was conducted to identify empirical studies examining the relationship between multiple forms of violence and sexual risk behaviors among women attending STD clinics. RESULTS All studies found high rates of violence including childhood sexual abuse, intimate partner violence, and/or community violence associated with high rates of sexual risk behaviors among women attending these settings. Researchers recommend screening for multiple forms of violence, interdisciplinary STD clinic services, and more trauma informed sexual risk reduction interventions to address multiple forms of violence found prevalent among this population. CONCLUSION Women attending STD clinics very often experience multiple forms of violence during their lifetime. TIC to address traumatic effects of violence might reduce sexual risk behaviors and sexually transmitted disease rates for improved health outcomes among this population.
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Scheidell JD, Dyer TP, Severe M, Tembunde YE, Young KE, Khan MR. Childhood Traumatic Experiences and Receptive Anal Intercourse Among Women. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:23-30. [PMID: 32096340 PMCID: PMC8034482 DOI: 10.1363/psrh.12129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 10/01/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Receptive anal intercourse (RAI), which has become increasingly common among U.S. heterosexual women, is associated with STDs, including HIV, when it is unprotected and coercive. Childhood traumatic experiences may increase sexual risk behavior, but the relationship between childhood trauma and RAI among women has not been examined. METHODS Data from 4,876 female participants in Waves 1 (1994-1995), 3 (2001-2002) and 4 (2007-2008) of the National Longitudinal Study of Adolescent to Adult Health were used to examine associations between nine self-reported childhood traumas (neglect; emotional, physical and sexual abuse; parental binge drinking and incarceration; and witnessing, being threatened with and experiencing violence) and RAI during adulthood using modified Poisson regression analysis. Whether depression, low self-esteem, drug use, relationship characteristics or sex trade involvement mediated the relationship between trauma and RAI was also explored. RESULTS Forty percent of the sample reported having engaged in receptive anal intercourse. After adjustment for sociodemographic characteristics, eight of the nine childhood traumas were associated with increased risk of RAI (adjusted prevalence ratios, 1.2-1.5); the strongest association was with experience of violence. Each unit increase in the number of traumas yielded a 16% increase in RAI prevalence. In mediation analyses, only drug use and relationship factors slightly attenuated the association between childhood trauma and RAI (1.2 for each). CONCLUSIONS Women with a history of childhood trauma may be at increased risk of engaging in RAI, highlighting the importance of screening and trauma-informed education in sexual health settings. Pathways linking childhood trauma and RAI among women are complex and warrant further research.
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Affiliation(s)
- Joy D Scheidell
- Department of Population Health, New York University School of Medicine, New York
| | - Typhanye P Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park
| | - MacRegga Severe
- Department of Population Health, New York University School of Medicine, New York
| | - Yazmeen E Tembunde
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park
| | - Kailyn E Young
- Department of Population Health, New York University School of Medicine, New York
| | - Maria R Khan
- Department of Population Health, New York University School of Medicine, New York
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29
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Hogben M, Leichliter J, Aral SO. An Overview of Social and Behavioral Determinants of STI. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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30
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Jiang S, Postovit L, Cattaneo A, Binder EB, Aitchison KJ. Epigenetic Modifications in Stress Response Genes Associated With Childhood Trauma. Front Psychiatry 2019; 10:808. [PMID: 31780969 PMCID: PMC6857662 DOI: 10.3389/fpsyt.2019.00808] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/11/2019] [Indexed: 12/12/2022] Open
Abstract
Adverse childhood experiences (ACEs) may be referred to by other terms (e.g., early life adversity or stress and childhood trauma) and have a lifelong impact on mental and physical health. For example, childhood trauma has been associated with posttraumatic stress disorder (PTSD), anxiety, depression, bipolar disorder, diabetes, and cardiovascular disease. The heritability of ACE-related phenotypes such as PTSD, depression, and resilience is low to moderate, and, moreover, is very variable for a given phenotype, which implies that gene by environment interactions (such as through epigenetic modifications) may be involved in the onset of these phenotypes. Currently, there is increasing interest in the investigation of epigenetic contributions to ACE-induced differential health outcomes. Although there are a number of studies in this field, there are still research gaps. In this review, the basic concepts of epigenetic modifications (such as methylation) and the function of the hypothalamic-pituitary-adrenal (HPA) axis in the stress response are outlined. Examples of specific genes undergoing methylation in association with ACE-induced differential health outcomes are provided. Limitations in this field, e.g., uncertain clinical diagnosis, conceptual inconsistencies, and technical drawbacks, are reviewed, with suggestions for advances using new technologies and novel research directions. We thereby provide a platform on which the field of ACE-induced phenotypes in mental health may build.
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Affiliation(s)
- Shui Jiang
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Lynne Postovit
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Annamaria Cattaneo
- Biological Psychiatric Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elisabeth B. Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Katherine J. Aitchison
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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The Relationship between Childhood Maltreatment and Risky Sexual Behaviors: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193666. [PMID: 31569567 PMCID: PMC6801672 DOI: 10.3390/ijerph16193666] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 01/18/2023]
Abstract
Childhood maltreatment is associated with risky sexual behaviors (RSBs). Previous systematic reviews and meta-analysis focused only on the relationship between childhood sexual abuse and RSBs, thus the association between childhood maltreatment and RSBs has yet to be systematically and quantitatively reviewed. We aimed to provide a systematic meta-analysis exploring the effect of childhood maltreatment and its subtypes on subsequent RSBs in adolescence and adulthood. PubMed, Google Scholar, EMBASE, Medline were searched for qualified articles up to April 2019. We calculated the pooled risk estimates using either the random-effect model or fixed-effect model. The potential heterogeneity moderators were identified by subgroup and sensitivity analysis. Overall, childhood maltreatment was significantly associated with an early sexual debut (odds ratio (OR) = 2.22; 95% confidence interval (CI): 1.64–3.00), multiple sexual partners (OR = 2.22; 95% CI: 1.78–2.76), transactional sex (OR = 3.05; 95% CI: 1.92–4.86) and unprotected sex (OR = 1.59; 95% CI: 1.22-2.09). Additionally, different types of childhood maltreatment were also significantly associated with higher risk of RSBs. Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. Childhood maltreatment is significantly associated with risky sexual behaviors. The current meta-analysis indicates it is vital to protect children from any types of maltreatment and provide health education and support for maltreated individuals.
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Kidman R, Smith D, Piccolo LR, Kohler HP. Psychometric evaluation of the Adverse Childhood Experience International Questionnaire (ACE-IQ) in Malawian adolescents. CHILD ABUSE & NEGLECT 2019; 92:139-145. [PMID: 30974257 PMCID: PMC6513701 DOI: 10.1016/j.chiabu.2019.03.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) can have lifelong adverse impacts on health and behavior. While this relationship has been extensively documented in high-income countries, evidence from lower-income contexts is largely missing. In order to stimulate greater research on the prevalence and consequences of ACEs in low-income countries, the World Health Organization (WHO) developed the ACE-International Questionnaire (ACE-IQ). OBJECTIVE In this paper, we explore the factor structure, validity and reliability of the original ACE-IQ, and evaluate whether potential adaptations improve its predictive validity. PARTICIPANTS AND SETTING Four hundred and ten adolescents (age 10-16 years old) from Malawi. METHODS The adolescents answered an adapted version of ACE-IQ and Beck Depression Inventory (BDI). RESULTS Taken together, our results suggest that (a) the ACE-IQ is structured in three dimensions: household disruption, abuse, and neglect; (b) there is support for the validity of the scale evidenced by the correlation between subdimensions (average across 13 correlations, phi = .20, p < 0,01; across subdomains (phi = .10, p < 0,01); partial agreement among children with the same caregiver (ICC = .43, p < .001) and correlation between ACE and depression (predictive validity; r = .35, p < .001); (c) information on the timing of the adversities ("last year" in addition to "ever") modestly improved the predictive value of the ACE-IQ in models of depression (from R2 = .12 to .15, p < .001); and (d) additional HIV-related questions showed low endorsement and a modest correlation with BDI (r = .25, p < 0,01). CONCLUSION Our findings suggest that the ACE-IQ is appropriate for use among adolescents from a low-income context.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine, HSC Level 3, Stony Brook University (State University of New York), Stony Brook, NY 11794, United States.
| | - Dylan Smith
- Program in Public Health and Department of Family, Population and Preventive Medicine, HSC Level 3, Stony Brook University (State University of New York), Stony Brook, NY 11794, United States
| | - Luciane R Piccolo
- Program in Public Health, HSC Level 3, Stony Brook University (State University of New York), Stony Brook, NY 11794, United States
| | - Hans-Peter Kohler
- Department of Sociology and Population Studies Center, University of Pennsylvania, 3718 Locust Walk (272 McNeil Building), Philadelphia, PA 19104-6298, United States
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Fortenberry JD. Trust, Sexual Trust, and Sexual Health: An Interrogative Review. JOURNAL OF SEX RESEARCH 2019; 56:425-439. [PMID: 30289286 DOI: 10.1080/00224499.2018.1523999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Trust is experienced almost constantly in all forms of social and interpersonal relationships, including sexual relationships, and may contribute both directly and indirectly to sexual health. The purpose of this review is to link three aspects of trust to sexual health: (1) the role of trust in sexual relationships; (2) the role of trust in sexually transmitted infection (STI) prevention, particularly condom use; and (3) the relevance of trust in sexual relationships outside of the traditional model of monogamy. The review ends with consideration of perspectives that could guide new research toward understanding the enigmas of trust in partnered sexual relations in the context of sexual and public health.
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Dorn LD, Hostinar CE, Susman EJ, Pervanidou P. Conceptualizing Puberty as a Window of Opportunity for Impacting Health and Well-Being Across the Life Span. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2019; 29:155-176. [PMID: 30869846 DOI: 10.1111/jora.12431] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We promote the perspective that puberty, a separate biological process embedded in adolescence, is a "window of opportunity" for understanding and impacting health and development. First, we include a brief overview of pubertal change. Second, we propose a critical role for puberty in shaping life span health due to its connections with early life precursors, health issues and risks emerging during puberty, and health in young adulthood and beyond. Next, we discuss the importance of puberty measures in developmental research and suggest ways to make the science of puberty an important standalone research entity, as well as an essential component of studies conducted during adolescence. Finally, we discuss measurement issues, novel theoretical models of puberty, and the necessity of adopting an interdisciplinary perspective in research on puberty and in adolescence more broadly.
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Farrow VA, Bosch J, Crawford JN, Snead C, Schulkin J. Screening for History of Childhood Abuse: Beliefs, Practice Patterns, and Barriers Among Obstetrician-Gynecologists. Womens Health Issues 2018; 28:559-568. [PMID: 30340965 DOI: 10.1016/j.whi.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/30/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND A history of childhood abuse is strongly linked to adult health problems. Obstetrician-gynecologists will undoubtedly treat abuse survivors during their careers, and a number of patient presenting problems may be related to a history of childhood abuse (e.g., chronic pelvic pain, sexual dysfunction, mental health disorders, obesity, and chronic diseases). Knowledge of abuse history may assist with treatment planning and the delivery of trauma-informed care. The current study sought to explore obstetrician-gynecologists' training, knowledge, beliefs, practice patterns, and barriers around screening for history of childhood abuse in their adult patients. METHODS Eight hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were sent an electronic survey; 332 viewed recruitment emails. Data were analyzed with SPSS 24.0, including descriptive statistics, χ2, and t tests. RESULTS One-hundred forty-five physicians completed the survey. The majority of responding providers believe that assessment of abuse history is important and relevant to patient care, yet few reported screening regularly. Most did not have formal training in screening for childhood abuse or its effects, although those who completed their training more recently were more likely to report training in these areas, as well as more likely to screen regularly. The majority of respondents noted they were not confident to screen. Barriers to screening were identified. CONCLUSIONS Greater education and training about screening for childhood abuse history and the effects of childhood abuse are needed. The integration of mental health providers into practice is one method that may increase screening rates.
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Affiliation(s)
- Victoria A Farrow
- VA San Diego Healthcare System, San Diego, California; University of California, San Diego (UCSD) School of Medicine, Department of Psychiatry, La Jolla, California.
| | - Jeane Bosch
- VA San Diego Healthcare System, San Diego, California
| | | | - Carrie Snead
- The American College of Obstetricians and Gynecologists, Washington, DC
| | - Jay Schulkin
- The American College of Obstetricians and Gynecologists, Washington, DC
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Abstract
PURPOSE OF REVIEW Sexually transmitted infection (STI) incidence is on the rise in the United States. The increase is especially pronounced in adolescents (15-24 years of age). Despite making up only a quarter of the population, adolescents account for approximately half of new STIs in the United States every year. This review summarizes recent developments in the field of STIs, excluding HIV, in adolescents. RECENT FINDINGS In this review, we examine the epidemiology, screening, management, and prevention of STIs in adolescents. STI rates in adolescents have been rising since 2014, with young women and MSM at particularly high risk. Barriers to STI screening for adolescents include confidentiality concerns and lack of access to health services. Prevention through STI vaccines represents a promising way to combat the epidemic. SUMMARY STIs are a growing concern for adolescents. Routine screening and management are of critical importance. Furthermore, prevention efforts such as human papillomavirus vaccination should be prioritized. Much of the current literature on STIs does not address the unique nature of STIs in adolescents, and additional research into effective prevention and treatment strategies of STIs in adolescents is urgently needed.
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Affiliation(s)
- Chelsea L Shannon
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, California, USA
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