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Doherty IA, Browne FA, Wechsberg WM. Think Inside the Box: the Heterogeneity of "in Risk" Among "at Risk" Female African American Adolescents in North Carolina. J Racial Ethn Health Disparities 2020; 7:1150-1159. [PMID: 32297304 PMCID: PMC10961606 DOI: 10.1007/s40615-020-00739-1] [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: 11/04/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION An abundance of research investigates the health of often referred to as "at risk" or "high risk" youth from underserved communities and usually racial/ethnic minorities. These ubiquitous terms relate to poverty, violence, and unsafe behaviors (e.g., sex without condoms, alcohol, and drug use). METHODS This analysis distinguished the heterogeneity of risks among African American female adolescents recruited for an intervention study from underserved communities in North Carolina. Eligibility included: ages 16-19, considered or dropped out of school, never completed high school, and during the past 3 months had sex with a male partner and used drugs or alcohol. A variable was created to represent the continuum of risk comprised of history of homelessness, or trading sex, or current heavy alcohol and marijuana use. Participants fell into 0, 1, or 2-3 categories. Ordinal logistic regression estimated the odds of adverse poor outcomes by category. Linear regression estimated reduction in material and emotional support by category. RESULTS Of the 237 participants, 59.5%, 27.8%, and 12.7% were in 0, 1, or 2-3 categories, respectively. Relative to adolescents in 0 categories, participants in other categories were more likely to report food insecurity (OR = 3.27, 95%CI [1.8, 5.94]); past arrest (OR = 3.56 [2.08, 6.09]); run away (OR = 3.30 [1.79, 6.10]); multiple sex partners (2.97 [1.61, 5.48]); and vaginal/anal sexual abuse (OR = 3.21[1.73, 5.96]). Material and emotional support was significantly lower for participants in 2-3 risk categories. CONCLUSIONS Vague use of "at risk" fails to recognize the heterogeneity of experiences and needs of underserved African American youth.
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Affiliation(s)
- Irene A Doherty
- RTI International, Research Triangle Park, Durham, NC, USA.
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC, USA.
| | - F A Browne
- RTI International, Research Triangle Park, Durham, NC, USA
| | - W M Wechsberg
- RTI International, Research Triangle Park, Durham, NC, USA
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Banks DE, Hensel DJ, Zapolski TCB. Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1939-1964. [PMID: 32157486 PMCID: PMC7321914 DOI: 10.1007/s10508-019-01609-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 05/21/2023]
Abstract
Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.
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Affiliation(s)
- Devin E Banks
- Department of Psychology, Indiana University Purdue University-Indianapolis, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA.
| | - Devon J Hensel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tamika C B Zapolski
- Department of Psychology, Indiana University Purdue University-Indianapolis, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA
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Socioeconomic Vulnerability and Sexually Transmitted Infection Among Pregnant Haitian Women. Sex Transm Dis 2019; 45:626-631. [PMID: 29697553 DOI: 10.1097/olq.0000000000000861] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite evidence that education and poverty act through distinct pathways to influence sexually transmitted infection (STI), few studies have examined the unique, independent associations of these socioeconomic vulnerabilities with sexual risk behaviors and STI among women. METHODS From August to October 2013, women at an antenatal clinic in Gressier, Haiti, were interviewed and tested for chlamydial infection, gonorrhea, and trichomoniasis (N = 200). We measured low educational attainment as less than 9 years of schooling and currently living in poverty based on crowding, defined as more than 2 people sleeping in one room. We used logistic regression to estimate independent associations between each socioeconomic indicator and outcomes of sexual behaviors and STI. RESULTS Approximately 29% of the sample had a current STI (chlamydia, 8.0%; gonorrhea, 3.0%; trichomoniasis, 20.5%), with 2.5% testing positive for more than 1 STI. Forty percent of the sample reported low educational attainment and 40% reported current poverty. Low educational attainment was associated with early risk behaviors, including twice the odds of earlier sexual debut (adjusted odds ratio [AOR], 2.09; 95% confidence interval [CI],: 1.14-3.84). Poverty was associated with reporting the current main sexual partner to be nonmonogamous (AOR, 2.01; 95% CI, 1.00-4.01) and current STI (AOR, 2.50; 95% CI, 1.26-4.98). CONCLUSIONS Education and poverty seem to independently influence STI behaviors and infection, with low education associated with early sexual risk and poverty associated with current risk and infection. Improving women's educational attainment may be important in improving risk awareness, thereby reducing risky sexual behaviors and preventing a trajectory of STI risk.
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Prather C, Fuller TR, Jeffries WL, Marshall KJ, Howell AV, Belyue-Umole A, King W. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health Equity 2018; 2:249-259. [PMID: 30283874 PMCID: PMC6167003 DOI: 10.1089/heq.2017.0045] [Citation(s) in RCA: 212] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: The sexual and reproductive health of African American women has been compromised due to multiple experiences of racism, including discriminatory healthcare practices from slavery through the post-Civil Rights era. However, studies rarely consider how the historical underpinnings of racism negatively influence the present-day health outcomes of African American women. Although some improvements to ensure equitable healthcare have been made, these historical influences provide an unexplored context for illuminating present-day epidemiology of sexual and reproductive health disparities among African American women. Methods: To account for the unique healthcare experiences influenced by racism, including healthcare provision, we searched online databases for peer-reviewed sources and books published in English only. We explored the link between historical and current experiences of racism and sexual and reproductive health outcomes. Results: The legacy of medical experimentation and inadequate healthcare coupled with social determinants has exacerbated African American women's complex relationship with healthcare systems. The social determinants of health associated with institutionalized and interpersonal racism, including poverty, unemployment, and residential segregation, may make African American women more vulnerable to disparate sexual and reproductive health outcomes. Conclusions: The development of innovative models and strategies to improve the health of African American women may be informed by an understanding of the historical and enduring legacy of racism in the United States. Addressing sexual and reproductive health through a historical lens and ensuring the implementation of culturally appropriate programs, research, and treatment efforts will likely move public health toward achieving health equity. Furthermore, it is necessary to develop interventions that address the intersection of the social determinants of health that contribute to sexual and reproductive health inequities.
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Affiliation(s)
- Cynthia Prather
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Taleria R. Fuller
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William L. Jeffries
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Khiya J. Marshall
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - A. Vyann Howell
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela Belyue-Umole
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Winifred King
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Voisin DR, Hotton A, Neilands T. Exposure to Community Violence and Sexual Behaviors Among African American Youth: Testing Multiple Pathways. Behav Med 2018; 44:19-27. [PMID: 27223490 DOI: 10.1080/08964289.2016.1189394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
African American youth bear a disproportionate burden of sexually transmitted infections. A growing number of studies document that youth exposure to community violence and sexual behaviors are highly correlated. Despite such growing evidence, only a few studies have empirically tested conceptually driven pathways that may account for such relationships. This study seeks to address that gap by exploring multiple pathways linking exposure to community violence and youth sexual behaviors. Using an existing sample of 563 African American youth attending high school, we examined whether possible links between exposure to community violence and sexual activity, sexual risk behaviors were mediated by aggression, low student-teacher connectedness, and negative peer norms. Major findings indicated indirect relationships between exposures to community violence and both sexual activity and risky sex, mediated by aggression and negative peer norms with no significant differences based on gender or socioeconomic status. Overall findings also indicated a significant indirect effect of aggression to risky sex via negative peer norms and from community violence to risky peer norms via aggression. By illuminating ways that community violence, aggression, peer norms, and sexual behaviors are dynamically interrelated, these findings have significant implications for future research and intervention initiatives aimed at addressing the different pathways.
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Respress BN, Amutah-Onukagha NN, Opara I. The Effects of School-Based Discrimination on Adolescents of Color Sexual Health Outcomes: A Social Determinants Approach. SOCIAL WORK IN PUBLIC HEALTH 2017; 33:1-16. [PMID: 29199912 DOI: 10.1080/19371918.2017.1378953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Social inequalities are at the heart of disparities in sexual health outcomes among African American and Latino/a adolescents living in the United States. Schools are typically the largest and primary context in youth development. School characteristics such as peer and teacher discrimination and school performance were examined to determine whether such characteristics predict sexual behavior in adolescents of color. This study utilized a representative sample of high school age students to assess sexual risk behavior. Findings indicate that there was a clear disparity in sexually transmitted infection diagnoses. School characteristics such as teacher discrimination and Grade Point Average were significant predictors to sexual risky behaviors among adolescents of color. The study adds to the literature in examining contextual factors that are associated with adolescent sexual risk behavior, and findings provide implications for future prevention work.
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Affiliation(s)
- Brandon N Respress
- a College of Nursing and Health Innovation , University of Texas at Arlington , Arlington , Texas , USA
| | - Ndidiamaka N Amutah-Onukagha
- b Department of Public Health and Community Medicine, School of Medicine , Tufts University , Boston , Massachusetts , USA
| | - Ijeoma Opara
- c Department of Family Science and Human Development , Montclair State University , Montclair , New Jersey , USA
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Voisin DR, Sales JM, Hong JS, Jackson JM, Rose ES, DiClemente RJ. Social Context and Problem Factors among Youth with Juvenile Justice Involvement Histories. Behav Med 2017; 43:71-78. [PMID: 26244631 DOI: 10.1080/08964289.2015.1065789] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Youth with juvenile justice histories often reside in poorly resourced communities and report high rates of depression, gang involved networks, and STI-sexual related risk behaviors, compared to their counterparts. The primary aim of this study was to examine the relationship between social context (ie, a combined index score comprised of living in public housing, being a recipient of free school lunch, and witnessing community violence) and risk factors that are disproportionately worse for juvenile justice youth such as depression, gang involved networks and STI sexual risk behaviors. Data were collected from a sample of detained youth ages 14 to 16 (N = 489). Questions assessed demographics, social context, depression, gang-involved networks, and STI risk behaviors. Multiple logistic regression models, controlling for age, gender, race, school enrollment, and family social support, indicated that participants who reported poorer social context had double the odds of reporting being depressed; three times higher odds of being in a gang; three times higher odds of personally knowing a gang member; and double the odds of having engaged in STI-risk behaviors. These results provide significant information that can help service providers target certain profiles of youth with juvenile justice histories for early intervention initiatives.
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Affiliation(s)
- Dexter R Voisin
- a The University of Chicago School of Social Service Administration and the STI/HIV Intervention Network
| | | | - Jun Sung Hong
- c School of Social Work, Wayne State University and Department of Social Welfare , Sungkyunkwan University
| | | | - Eve S Rose
- b Rollins School of Public Health, Emory University
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Shaw SY, Metge C, Taylor C, Chartier M, Charette C, Lix L, Santos R, Sarkar J, Nickel NC, Burland E, Chateau D, Katz A, Brownell M, Martens PJ. Teen clinics: missing the mark? Comparing pregnancy and sexually transmitted infections rates among enrolled and non-enrolled adolescents. Int J Equity Health 2016; 15:95. [PMID: 27328711 PMCID: PMC4915138 DOI: 10.1186/s12939-016-0386-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/16/2016] [Indexed: 11/17/2022] Open
Abstract
Background In Manitoba, Canada, school-based clinics providing sexual and reproductive health services for adolescents have been implemented to address high rates of sexually transmitted infections (STIs) and pregnancies. Methods The objectives of this population-based study were to compare pregnancy and STI rates between adolescents enrolled in schools with school-based clinics, those in schools without clinics, and those not enrolled in school. Data were from the PATHS Data Resource held in the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy. Adolescents aged 14 to 19 between 2003 and 2009 were included in the study. Annualized rates of pregnancies and positive STI tests were estimated and Poisson regression models were used to test for differences in rates amongst the three groups. Results As a proportion, pregnancies among non-enrolled female adolescents accounted for 55 % of all pregnancies in this age group during the study period. Pregnancy rates were 2–3 times as high among non-enrolled female adolescents. Compared to adolescents enrolled in schools without school-based clinics, age-adjusted STI rates were 3.5 times (p < .001) higher in non-enrolled males and 2.3 times (p < .001) higher in non-enrolled females. Conclusions The highest rates for pregnancies and STIs were observed among non-enrolled adolescents. Although provision of reproductive and health services to in-school adolescents should remain a priority, program planning and design should consider optimal strategies to engage out of school youth. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0386-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Souradet Y Shaw
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada. .,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Colleen Metge
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Carole Taylor
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Catherine Charette
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Lisa Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Rob Santos
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada.,Healthy Child Manitoba, Winnipeg, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Nathan C Nickel
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Elaine Burland
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
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Tran LTH, Bui TC, Markham CM, Swartz MD, Tran QM, Nyitray AG, Huynh TTT, Hwang LY. Women's communication self-efficacy and expectations of primary male partners' cooperation in sexually transmitted infection treatment in Ho Chi Minh City, Vietnam: a cross-sectional study. BMC Public Health 2016; 16:28. [PMID: 26758034 PMCID: PMC4710979 DOI: 10.1186/s12889-016-2690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 01/05/2016] [Indexed: 12/01/2022] Open
Abstract
Background Effective control of sexually transmitted infections (STIs) depends on affected patients notifying their sexual partners, and partners following through with screening and treatment. Our study assessed high-risk-STI women’s confidence in STI-diagnosis-related communications with their primary male partners in Ho Chi Minh City, Vietnam, and determined associated characteristics of the women and their partners. Methods We employed convenience and snowball sampling in a clinic-based setting to recruit 126 women from August to October 2013. All data were obtained from women’s self-report. Results The proportions of participants who were “slightly confident” or “very confident” that they could disclose their STI positivity to partners, ask partners to have an STI examination or treatment, and give partners bacterial-STI medications were 70.3 %, 62.1 %, and 69.0 %, respectively. The proportions who perceived that their partners would be “very likely” to have an STI examination and to take STI medications were 16.2 % and 38.8 %, respectively. Significantly lower self-efficacy was observed in women who had a lower education level, who had ever traded sex, or whose primary partners were not husbands or fiancés. Conclusions Our results suggest potential for piloting STI-partner-targeted interventions. To be effective, these programs should improve women’s self-efficacy and primary partners’ cooperation with screening and treatment.
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Affiliation(s)
- Ly Thi-Hai Tran
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Thanh Cong Bui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christine M Markham
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michael D Swartz
- Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Quan Minh Tran
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Alan G Nyitray
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Lu-Yu Hwang
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Identifying psychosocial and social correlates of sexually transmitted diseases among black female teenagers. Sex Transm Dis 2015; 42:192-7. [PMID: 25763671 DOI: 10.1097/olq.0000000000000254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Black teenagers have relatively high rates of sexually transmitted diseases (STDs), and recent research suggests the role of contextual factors, as well as risk behaviors. We explore the role of 4 categories of risk and protective factors on having a biologically confirmed STD among black, female teenagers. METHODS Black teenage girls (14-19 years old) accessing services at a publicly funded family planning clinic provided a urine specimen for STD testing and completed an audio computer-assisted self-interview that assessed the following: risk behaviors, relationship characteristics, social factors, and psychosocial factors. We examined bivariate associations between each risk and protective factor and having gonorrhea and/or chlamydia, as well as multivariate logistic regression among 339 black female teenagers. RESULTS More than one-fourth (26.5%) of participants had either gonorrhea and/or chlamydia. In multivariate analyses, having initiated sex before age 15 (adjusted odds ratio [aOR], 1.87) and having concurrent sex partners in the past 6 months (aOR, 1.55) were positively associated with having an STD. Living with her father (aOR, 0.44), believing that an STD is the worst thing that could happen (aOR, 0.50), and believing she would feel dirty and embarrassed about an STD (aOR, 0.44) were negatively associated with having an STD. CONCLUSIONS Social factors and attitudes toward STDs and select risk behaviors were associated with the risk for STDs, suggesting the need for interventions that address more distal factors. Future studies should investigate how such factors influence safer sexual behaviors and the risk for STDs among black female teenagers.
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Crosby RA, Ricks JM, Salazar LF, Geter A, Jones J. Predictors of Conceiving a Pregnancy: A Longitudinal Study of Young Black Males. JOURNAL OF MEN'S HEALTH 2014. [DOI: 10.1089/jomh.2014.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Voisin DR, Elsaesser C. Brief report: The protective effects of school engagement for African American adolescent males. J Health Psychol 2014; 21:573-6. [DOI: 10.1177/1359105314531607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examined whether school engagement was protective with regard to externalizing behaviors, gang involvement, sexual debut, and unsafe sexual behaviors among African American adolescent males. Self-administered surveys were administered to 219 male students from an urban Chicago high school. Controlling for age and socioeconomic status, higher school engagement levels were associated with lower rates of aggressive behaviors, lower levels of gang involvement, delay of sexual debut, and lower levels of unsafe sexual behaviors. Findings support the development of school-based interventions designed to promote student–teacher bonds, academic performance, and after-school activities for African American youth.
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Type of Primary Education Is Associated With Condom Use at Sexual Debut Among Chilean Adolescents. Sex Transm Dis 2014; 41:306-11. [DOI: 10.1097/olq.0000000000000122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Voisin DR, Hotton AL, Neilands TB. Testing pathways linking exposure to community violence and sexual behaviors among African American youth. J Youth Adolesc 2013; 43:1513-26. [PMID: 24327295 DOI: 10.1007/s10964-013-0068-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
Abstract
Exposure to community violence and HIV sexual risks are two major public health concerns among youth. This study tests various pathways linking exposure to community violence and sexual behaviors among African American adolescents. Using a sample of 563 (61% females) African American youth attending high school we examined whether problematic psychological symptoms, low school engagement, and/or negative perceptions of peer norms about safer sex functioned as pathways linking exposure to community violence and sexual behaviors. Major findings indicated that, for boys, the relationship between exposure to community violence and sexual début and sexual risk behaviors were linked by aggression. In addition, the relationship between exposure to community violence and sexual risk behaviors were linked by negative perceptions of peer attitudes about safer sex. For girls, the relationship between exposure to community violence and sexual début was linked by aggression and negative perceptions of peer attitudes about safer sex. These findings provide support for pathways linking exposure to community violence to sexual behaviors.
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Affiliation(s)
- Dexter R Voisin
- School of Social Service Administration, University of Chicago, 969 East 60th Street, Chicago, IL, 60637, USA,
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Painter JE, Wingood GM, DiClemente RJ, Depadilla LM, Simpson-Robinson L. College graduation reduces vulnerability to STIs/HIV among African-American young adult women. Womens Health Issues 2012; 22:e303-10. [PMID: 22555218 DOI: 10.1016/j.whi.2012.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 03/05/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
African-American women are disproportionately affected by sexually transmitted infections (STIs), including HIV. The Theory of Gender and Power (TGP) posits that socioeconomic exposures, including educational attainment, place women at increased risk for STIs/HIV. This study examined the association between educational attainment and vulnerability to STIs/HIV, as well as potential TGP-driven mediators of this association, among African-American women. Baseline data were assessed from an STI/HIV prevention intervention for African-American women (n = 848) aged 18 to 29 recruited from three Kaiser Permanente Centers in Atlanta, Georgia. Data collection included a survey of demographic, psychosocial, and behavioral measures and self-collected, laboratory-confirmed vaginal swabs for STIs (trichomoniasis, chlamydia, gonorrhea, and human papillomavirus). Multiple regression analyses and multivariate mediation analyses were used to examine the association between educational attainment with a laboratory-confirmed STI and potential TGP mediators. Controlling for age and receipt of public assistance, the odds of an STI diagnosis were 73% lower among participants with a college degree or greater compared with participants who had not completed high school. There were also significant associations between educational attainment and multiple TGP mediators from the sexual division of power and the structure of cathexis. TGP constructs did not mediate the association between educational attainment and laboratory-confirmed STI. The current study suggests that graduating from college may lead to a beneficial reduction in vulnerability to STIs/HIV among African-American women. Findings from this study support expanding structural-level interventions, emphasizing both high school and college graduation, as a means of reducing vulnerability to STIs/HIV among African-American women.
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Affiliation(s)
- Julia E Painter
- Vaccinology Training Program, Emory University School of Medicine, Rollins School of Public Health, Atlanta, Georgia, USA.
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Social support associated with a reduced risk of sexually transmitted infection in Canadians. J Public Health (Oxf) 2010. [DOI: 10.1007/s10389-010-0351-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Barry PM, Scott KC, McCright J, Snell A, Lee M, Bascom T, Kent CK, Klausner JD. Stay in school? Results of a sexually transmitted diseases screening program in San Francisco high schools-2007. Sex Transm Dis 2008; 35:550-2. [PMID: 18356770 DOI: 10.1097/olq.0b013e31816a43d3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To provide chlamydia and gonorrhea screening and treatment to adolescents presumed to be at high risk, school screening was conducted among the 11th and 12th graders in San Francisco. STUDY DESIGN Two schools in neighborhoods with high chlamydia and gonorrhea rates and student populations > or = 15% black were chosen. Students viewed a 10-minute presentation and received test kits. Students decided in a private bathroom stall whether to test. All students were encouraged to return a test kit (whether they returned a urine specimen). RESULTS Of 967 eligible students, 853 (88%) were in attendance. Of these, 21 (2%) declined to participate and 537 (63%) returned a specimen for testing. Students who tested were predominately heterosexual (93%) and nonwhite (99%). No students tested positive for gonorrhea; 7 (1.3%) tested positive for chlamydia. Positivity was 2.2% (5 of 227) for female students and 0.6% (2 of 310) for male students. Positivity by race/ethnicity was 5.4% (4 of 74) for blacks, 2.0% (2 of 98) for Hispanics, 0.3% (1 of 342) for Asian/Pacific Islanders, and 0% (0 of 4) for whites. The highest positivity was among black female students: 9.3% (4 of 43). Not including planning and follow-up, each case identified used 63 staff hours. CONCLUSIONS Despite high participation among students attending school in high morbidity neighborhoods, few infections were identified. This is likely because students have low rates of sexual activity and do not necessarily attend neighborhood schools. Screening used substantial resources. Sexually transmitted disease control programs considering school screening should consider local epidemiology and whether schools have substantial proportions of students likely at high risk for sexually transmitted diseases.
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Affiliation(s)
- Pennan M Barry
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Krishnan S, Dunbar MS, Minnis AM, Medlin CA, Gerdts CE, Padian NS. Poverty, gender inequities, and women's risk of human immunodeficiency virus/AIDS. Ann N Y Acad Sci 2007; 1136:101-10. [PMID: 17954681 DOI: 10.1196/annals.1425.013] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Entrenched economic and gender inequities together are driving a globally expanding, increasingly female, human immunodeficiency virus (HIV)/AIDS epidemic. To date, significant population-level declines in HIV transmission have not been observed, at least in part because most approaches to prevention have presumed a degree of individual control in decision making that does not speak to the reality of women's and girls' circumstances in many parts of the world. Such efforts have paid insufficient attention to critical characteristics of the risk environment, most notably poverty and gender power inequities. Even fewer interventions have addressed specific mechanisms through which these inequities engender risky sexual practices that result in women's disproportionately increased vulnerabilities to HIV infection. This article focuses on identifying those mechanisms, or structural pathways, that stem from the interactions between poverty and entrenched gender inequities and recommending strategies to address and potentially modify those pathways. We highlight four such structural pathways to HIV risk, all of which could be transformed: (1) lack of access to critical information and health services for HIV/sexually transmitted infection (STI) prevention, (2) limited access to formal education and skill development, (3) intimate partner violence, and (4) the negative consequences of migration prompted by insufficient economic resources. We argue for interventions that enhance women's access to education, training, employment, and HIV/STI prevention information and tools; minimize migration; and by working with men and communities, at the same time reduce women's poverty and promote gender-equitable norms. In conclusion, we identify challenges in developing and evaluating strategies to address these structural pathways.
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Affiliation(s)
- Suneeta Krishnan
- Women's Global Health Imperative, Research Triangle Institute International, 114 Sansome St., Suite 500, San Francisco, CA 94104, USA.
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