Semen says: assessing the accuracy of adolescents' self-reported sexual abstinence using a semen Y-chromosome biomarker

Inconsistencies in Adolescent Self-Reported Sexual Behavior: Experience from Four Randomized Controlled Trials

To examine the degree, correlates, and implications of inconsistent self-report data on sexual risk behaviors of adolescents. We analyzed data from four longitudinal group-randomized controlled trials of evidence-based HIV/STI/pregnancy prevention programs in Texas and California from 2000 to 2010. Across- and within-time logical inconsistencies in sexual behavior survey responses were analyzed using multilevel logistic regression. Rates of any inconsistencies ranged from 12 to 18% across the four trials. In all trials, rates were higher in males than in females. Age, normative beliefs, and race/ethnicity were most strongly associated with inconsistencies. We found substantial rates of inconsistencies in adolescents' self-reports of their sexual behavior, which did not occur at random. Studies should routinely report observed rates of inconsistencies and methods used to adjust for them so that any biases in the population to which the study generalizes are understood by public health practitioners and policy-makers looking to adopt programs for their particular population.

Is Client Reporting on Contraceptive Use Always Accurate? Measuring Consistency and Change with a Multicountry Study

The consistency of self-reported contraceptive use over short periods of time is important for understanding measurement reliability. We assess the consistency of and change in contraceptive use using longitudinal data from 9,390 urban female clients interviewed in DR Congo, India, Kenya, Niger, Nigeria, and Burkina Faso. Clients were interviewed in-person at a health facility and four to six months later by phone. We compared reports of contraceptive use at baseline with recall of baseline contraceptive use at follow-up. Agreement between these measures ranged from 59.1 percent in DR Congo to 84.4 percent in India. Change in both contraceptive method type (sterilization, long-acting, short-acting, nonuse) and use status (user, nonuser, discontinuer, adopter, switcher) was assessed comparing baseline to follow-up reports and retrospective versus current reports within the follow-up survey. More change in use was observed with panel reporting than within the cross section. The percent agreement between the two scenarios of change ranged from 64.8 percent in DR Congo to 84.5 percent in India, with cross-site variation. Consistently reported change in use status was highest for nonusers, followed by users, discontinuers, adopters, and switchers. Inconsistency in self-reported contraceptive use, even over four to six months, was nontrivial, indicating that studying measurement reliability of contraceptive use remains important.

Reproductive coercion sometimes works: evaluating whether young African-American women who experience reproductive coercion or birth control sabotage are more likely to become pregnant

Men engaging in reproductive coercion may coerce, force, or deceive female partners into pregnancy. This study evaluates whether the 3-month incidence of pregnancy is higher among women reporting reproductive coercion than similar women reporting no reproductive coercion. We tested this hypothesis in longitudinal data from a sample of African-American women ages 18–24 recruited from community settings in Atlanta, Georgia, US, in 2012–2014 (n = 560). Participants were surveyed at baseline, 3 months, 6 months, 9 months, and 12 months. To reduce selection bias, we used full matching on 22 baseline variables related to demographics, economic power, risky alcohol use, and gender-based power inequality. We used logistic regression in the matched sample with outcome pregnancy 3 months later, controlling for baseline fertility intentions (n = 482, n = 458, n = 452 at respectively 3, 6, 9 months). At 3 months, 15% of women reported reproductive coercion. At 6 months, 11.3% of women reporting coercion were pregnant vs. 4.6% of matched women reporting no coercion (p = 0.06). Women reporting coercion had 3 times the odds of pregnancy as matched women reporting no coercion (AOR 2.95, 95% CI (1.16, 6.98), p = 0.02). Among women pregnant after coercion, only 15% wanted to be pregnant then or sooner. Women reporting reproductive coercion are at greater risk of unwanted or mistimed pregnancies, and the semen exposure that caused these pregnancies could also transmit STI/HIV. Clinicians should screen patients for reproductive coercion; consider using semen exposure biomarkers such as PSA or Yc-PCR to identify condom sabotage or stealthing; and refer women experiencing reproductive coercion to supportive services.

Brief report: Assessing the risk of reporting bias in a RCT for adolescent mothers

INTRODUCTION

Most adolescent sexual and reproductive health studies rely solely upon self-report surveys to assess key variables such as pregnancy and sexually transmitted infections (STIs). The current study investigated the risk of reporting bias that may result from using such surveys to measure outcomes in randomized controlled trials (RCTs).

METHODS

As part of an RCT of a multicomponent intervention to delay repeat pregnancy among adolescent mothers, we compared survey data on repeat pregnancy with birth records from a state's vital statistics system. The survey assessed contraceptive use, pregnancy status, and future pregnancy intentions. The sample consisted of American adolescents ages 18 and 19 years who were at least 28 weeks pregnant or less than nine weeks postpartum.

RESULTS

For 14 of 331 study participants (4 percent), we found a birth record in the vital statistics system for a mother who reported not having gotten pregnant on the survey. We found no evidence of underreporting for the other survey respondents. The rate of underreporting was similar for the intervention and control groups.

CONCLUSIONS

A low rate of underreporting for repeat pregnancy in adolescent mothers was found in the present sample.

Inconsistent Use of Condom in Italian HIV-Serodiscordant Heterosexual Couples as Revealed by the Detection of Y Chromosomal (Yc) DNA in Vaginal Swabs

Introduction:

The prevention of transmission of HIV infection is based on the regular and correct use of condom and studies on transmission rates are generally based on the self-report of condom use.

However, consistent data on different population suggest that this often leads to overreporting possibly due to social desirability. In addition, self-report of condom use does not consider improper use or breakage.

Methods:

Vaginal biomarkers were proposed to detect exposure to semen and among these detection of chromosome Y DNA (Yc) appeared promising in different research settings.

Here, we searched for Yc in vaginal swabs of 33 Italian women, engaged in a regular heterosexual relationship with a HIV serodiscordant partner and reporting a regular use of condom during sexual intercourses.

Results & Discussion:

In 10 (30.3%) women Yc was detected, especially if the infected partner was male and if the couple did not have sons. This is confirmed in Italian heterosexual women and is already demonstrated in other populations: behavioural counselling is not always a valid tool and the self-reported use of condom is not fully reliable.

Conclusion:

Further studies could help in the future to individuate more effective preventive strategies for both HIV and sexually transmitted infections.