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Neilson EC, Schraufnagel TJ, George WH, Davis KC. The Effects of Childhood Sexual Abuse, Mental Health, and Motives for Sex on Sexual Risk-Taking Among United States Men Who Have Sex with Women. JOURNAL OF CHILD SEXUAL ABUSE 2023; 32:3-21. [PMID: 36515168 PMCID: PMC9911360 DOI: 10.1080/10538712.2022.2155284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
This study assessed the role of mental health symptoms and motives for sex in the association between childhood sexual abuse (CSA) and sexual risk-taking among men who have sex with women (MSW). The sample consisted of young adult (ages 21 to 30), non-monogamous MSW (N = 532) who reported having condomless sex at least once in the past year. Due to alcohol-related aims from two larger studies from which the data were analyzed, participation was excluded to men who regularly consumed alcohol (3 to 35 weekly drinks) and reported no symptoms of alcohol use disorder. Participants answered background questionnaires in lab and then completed a six-week, follow-up survey assessing the number of sex partners and condom use during the prior six weeks. CSA survivors reported greater mental health symptoms and sex motives related to coping, self-affirmation, and partner approval relative to non-survivors. CSA, sex for partner approval, and sex to enhance motives were positively associated with the number of sex partners. Participants endorsing self-affirmation sex motives reported higher condom use than those who did not. CSA contributes to long-term mental and sexual health outcomes among MSW. Identifying and treating depressive and anxiety symptoms and motives for sex may improve sexual health among CSA survivors.
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Affiliation(s)
- Elizabeth C Neilson
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States
| | | | - William H George
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Kelly Cue Davis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
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2
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Rizzo CJ, Joppa MC, Barker D, Zlotnick C, Warren J, Cadely HSE, Brown LK. Individual and Relationship Characteristics of Adolescent Girls With Histories of Physical Dating Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:1389-1414. [PMID: 29294672 PMCID: PMC6092250 DOI: 10.1177/0886260517696859] [Citation(s) in RCA: 4] [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
The objective of this article is to examine the individual and relational characteristics of adolescent girls with a history of physical DV, as well as to utilize partner-specific, temporal data to explore links between these factors and recent or ongoing DV experiences. Participants were 109 high school girls (ages 14-17) identified as having a history of DV through a school-based screening procedure. Details regarding the timing of DV and links with specific dating partners were gathered using Timeline Followback (TLFB) interview methodology. At study entry, 30% endorsed clinical levels of depression symptoms and 89% reported delinquent behaviors. Forty-four percent reported vaginal intercourse in their lifetime and of those, 35% reported not using a condom at last sex. During the 90 days prior to study entry, 69% of youth reported having a romantic relationship and 58% of those youth reported physical/sexual violence. Data revealed that more physical/sexual violence was associated with longer relationship length, Wald χ2(2) = 1,142.63, p < .001. Furthermore, depressive symptoms, not delinquency, contributed significantly to recent DV experiences, even when relationship length was controlled. Our findings suggest that prevention programs for this population should teach participants how to quickly recognize unhealthy relationship characteristics, as violence severity increases with relationship length. Programs for adolescent girls should also address depressive symptoms, which are linked to DV severity when other risks are taken into account. Finally, the TLFB calendar method appears useful for gathering the temporal and partner-specific data needed to understand the complexity of dating relationships and violence experiences in this population.
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Affiliation(s)
| | | | - David Barker
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Caron Zlotnick
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Justine Warren
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Larry K. Brown
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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3
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Rizzo CJ, Joppa M, Barker D, Collibee C, Zlotnick C, Brown LK. Project Date SMART: a Dating Violence (DV) and Sexual Risk Prevention Program for Adolescent Girls with Prior DV Exposure. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:416-426. [PMID: 29352400 DOI: 10.1007/s11121-018-0871-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study assessed the initial feasibility, acceptability, and efficacy of an intervention aimed at reducing dating violence and sexual risk behavior in a sample of adolescent girls (ages 14-17) with prior exposure to physical dating violence (DV). One hundred and nine girls were randomly assigned to Date SMART (Skills to Manage Aggression in Relationships for Teens) or a Knowledge-only (KO) comparison group. Both intervention arms consisted of six, weekly 2-h sessions and one "booster" session 6 weeks later. Based on principles of cognitive behavioral therapy, the Date SMART intervention was designed to target common underlying skills deficits linked to both DV and sexual risk behavior in adolescent females: depression, self-regulation deficits, and interpersonal skills deficits. Assessments were administered at four time points (baseline, 3, 6, and 9 months). The Date SMART group was effective as reducing sexual DV involvement across the 9-month follow-up period. Both groups evidenced clinically meaningful reductions in physical, emotional, and digital DV involvement, total time in dating relationships, as well as reductions in depression. Findings indicate that delivering a DV and sexual risk prevention intervention to DV-affected adolescent girls is feasible and well-received. Furthermore, a skills-based approach that addresses the co-occurrence of DV and sexual risk behavior may be particularly useful for promoting reductions of sexual DV among high-risk adolescent girls. A future, large-scale trial with an inactive comparison condition is needed to evaluate the efficacy of Date SMART further. TRIAL REGISTRATION Clinical Trials, NCT01326195, and http://www.clinicaltrials.gov.
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Affiliation(s)
- Christie J Rizzo
- Bouvé College of Health Sciences, Department of Applied Psychology, Northeastern University, 432 INV, 360 Huntington Ave., Boston, MA, 02115-5000, USA.
| | | | - David Barker
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital, Providence, RI, USA.,Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Charlene Collibee
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Caron Zlotnick
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital, Providence, RI, USA.,University of Cape Town, Cape Town, South Africa
| | - Larry K Brown
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital, Providence, RI, USA.,Warren Alpert Medical School of Brown University, Providence, RI, USA
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4
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Yoon S, Voith LA, Kobulsky JM. Gender differences in pathways from child physical and sexual abuse to adolescent risky sexual behavior among high-risk youth. J Adolesc 2018; 64:89-97. [PMID: 29438874 DOI: 10.1016/j.adolescence.2018.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 01/07/2023]
Abstract
This study investigated gender differences in the roles of internalizing and externalizing symptoms and substance use as pathways linking child physical and sexual abuse to risky sexual behavior among youth at risk of maltreatment. Path analysis was performed with 862 adolescents drawn from Longitudinal Studies of Child Abuse and Neglect. Four waves of data collected in the United States were used: childhood physical and sexual abuse experiences (from ages 0-12) were assessed by Child Protective Services reports, internalizing and externalizing symptoms were measured at age 14, substance use was measured at age 16, and risky sexual behavior was measured at age 18. Physical abuse was directly associated with risky sexual behavior in boys but not girls. For girls, physical abuse had a significant indirect effect on risky sexual behavior via externalizing symptoms. Gender-focused preventive intervention strategies may be effective in reducing risky sexual behavior among at-risk adolescents.
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Affiliation(s)
- Susan Yoon
- College of Social Work, The Ohio State University, Columbus, OH, USA.
| | - Laura A Voith
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA.
| | - Julia M Kobulsky
- School of Social Work, The University of Maryland, Baltimore, MD, USA.
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5
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Abajobir AA, Kisely S, Williams G, Strathearn L, Najman JM. Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study. JOURNAL OF SEX RESEARCH 2018; 55:106-119. [PMID: 28972390 DOI: 10.1080/00224499.2017.1368975] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Childhood maltreatment is associated with a range of adverse mental and physical health outcomes, including increased rates of sexually transmitted infections (STIs) later in life. However, the impact on risky sexual behaviors and pregnancy outcomes has not been adequately studied. This is particularly true for physical abuse, emotional abuse, and neglect. We examined associations between prospectively substantiated childhood maltreatment and reports of risky sexual behaviors by men and women, as well as selected pregnancy outcomes in women. We followed up 3,081 (45.7% female) participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian birth cohort study. Using logistic regression, we examined the association between substantiated childhood maltreatment from birth to 14 years, and self-reported risky sexual behaviors and youth pregnancy outcomes at the 21-year follow-up. In adjusted analyses, children who had experienced multiple childhood maltreatment exhibited more risky sexual behaviors than their nonmaltreated counterparts. In specific models, those exposed to each form of childhood maltreatment, independent of co-occurring forms of childhood maltreatment, had an increased likelihood of risky sexual behaviors, particularly an early sexual debut and, for women, youth pregnancy. Neglect was also associated with multiple sexual partners, and emotional abuse with higher rates of miscarriage. There was no difference between men and women in how different forms of childhood maltreatment predicted risky sexual behaviors in young adulthood. All forms of substantiated childhood maltreatment, including multiple substantiations, were associated with risky sexual behavior in both sexes as well as higher rates of youth pregnancy in women. Moreover, emotional abuse persistently predicted miscarriages in young adult women. Understanding the association between childhood maltreatment and risky sexual behaviors and youth pregnancy outcomes may help suggest preventive strategies.
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Affiliation(s)
- Amanuel A Abajobir
- a Faculty of Medicine, School of Public Health , The University of Queensland
| | - Steve Kisely
- b Faculty of Medicine, School of Medicine , University of Queensland, Princess Alexandra Hospital
- c Faculty of Medicine, Departments of Psychiatry, Community Health and Epidemiology , Dalhousie University
| | - Gail Williams
- d Faculty of Medicine, School of Medicine , University of Queensland
| | - Lane Strathearn
- e Stead Family Department of Pediatrics, Division of Developmental and Behavioral Pediatrics , University of Iowa
- f Center for Disabilities and Development , University of Iowa Stead Family Children's Hospital
| | - Jake M Najman
- a Faculty of Medicine, School of Public Health , The University of Queensland
- g Queensland Alcohol and Drug Research and Education Centre , The University of Queensland
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Cunningham K, Martinez DA, Scott-Sheldon LAJ, Carey KB, Carey MP. Alcohol Use and Sexual Risk Behaviors among Adolescents with Psychiatric Disorders: A Systematic Review and Meta-Analysis. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017; 26:353-366. [PMID: 29204066 DOI: 10.1080/1067828x.2017.1305934] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Adolescents with psychiatric disorders appear to be at increased risk for acquiring HIV and other sexually transmitted infections; however, little is known about the prevalence of behavioral risk factors in this population. This meta-analysis aimed to assess the prevalence of alcohol use and sexual risk behaviors among adolescents with psychiatric disorders. Electronic database searches identified studies sampling adolescents diagnosed with psychiatric disorders and assessing both alcohol and sexual risk behaviors. Fourteen studies sampling 3,029 adolescents with psychiatric disorders were included. The majority of adolescents with psychiatric disorders report alcohol use and sexual risk behaviors. Risk reduction interventions targeting these two behaviors are needed.
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Affiliation(s)
- Karlene Cunningham
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Bradley/Hasbro Children's Research Center, Rhode Island Hospital, Providence, RI, USA
| | - David A Martinez
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Bradley/Hasbro Children's Research Center, Rhode Island Hospital, Providence, RI, USA
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
| | - Kate B Carey
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA.,Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
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7
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Senn TE, Braksmajer A, Hutchins H, Carey MP. Development and Refinement of a Targeted Sexual Risk Reduction Intervention for Women With a History of Childhood Sexual Abuse. COGNITIVE AND BEHAVIORAL PRACTICE 2017; 24:496-507. [PMID: 29062220 DOI: 10.1016/j.cbpra.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood. Traditional sexual risk reduction interventions do not meet the unique needs of women who have been sexually abused. In the current paper, we describe the four-stage process we followed to develop and refine a targeted sexual risk reduction intervention for this population. First, initial quantitative work revealed that the intervention should address how maladaptive thoughts related to traumatic sexualization, trust, powerlessness, and guilt/shame (traumagenic dynamics constructs) influence current sexual behavior. Second, qualitative interviews with 10 women who reported a history of CSA (M age = 34 years; 90% African American) as well as current sexual risk behavior provided support for targeting maladaptive thoughts associated with these traumagenic dynamics constructs. Third, based on the qualitative and quantitative results, we developed a 5-session, group-delivered intervention to address the maladaptive thoughts that occurred as a result of CSA, as well as the cognitive-behavioral determinants of sexual risk behavior. This intervention drew heavily on cognitive behavioral techniques to address cognitions associated with CSA and the links between these cognitions and current sexual risk behavior. Techniques from trauma-based therapies, as well as motivational techniques, were also incorporated into the intervention. Finally, we refined the intervention with 24 women (M age = 33 years; 79% African American), and assessed feasibility and acceptability. These women reported high levels of satisfaction with the intervention. The resultant intervention is currently being evaluated in a small, randomized controlled trial.
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8
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Wells BE, Starks TJ, Robel E, Kelly BC, Parsons JT, Golub SA. From Sexual Assault to Sexual Risk: A Relational Pathway? JOURNAL OF INTERPERSONAL VIOLENCE 2016; 31:3377-3395. [PMID: 25944835 PMCID: PMC4635062 DOI: 10.1177/0886260515584353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Among women and gay and bisexual men, sexual assault is associated with increased rates of sexual risk behavior and negative sexual health outcomes. Although the mechanisms of these effects are potentially myriad, the current analyses examine the role of perceived partner pressure for condomless sex in mediating the association between adult sexual assault (ASA) and recent anal or vaginal sex without a condom. In a sample of 205 young adult women and gay and bisexual men, ASA was indirectly associated with condomless anal and/or vaginal sex via perceptions of partner pressure for condomless sex, χ2(1) = 5.66, p = .02, after controlling for race, age, gender and sexual identity, and relationship status. The elucidation of this relational mechanism points to several potential intervention and prevention strategies that may reduce actual and perceived pressure for sex without a condom, including strategies designed to facilitate the prioritization of health and safety over relational goals and the improvement of partner selection and perceptions of partner pressure.
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Affiliation(s)
- Brooke E Wells
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Tyrel J Starks
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Erika Robel
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Brian C Kelly
- Hunter College and Graduate Center of the City University of New York, NY, USA
- Purdue University, West Lafayette, IN, USA
| | - Jeffrey T Parsons
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Sarit A Golub
- Hunter College and Graduate Center of the City University of New York, NY, USA
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9
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Tabet M, Flick LH, Cook CA, Xian H, Chang JJ. Age at First Birth and Psychiatric Disorders in Low-Income Pregnant Women. J Womens Health (Larchmt) 2016; 25:810-7. [PMID: 27248210 PMCID: PMC6037188 DOI: 10.1089/jwh.2015.5236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young maternal age at first birth has been associated with poor mental health. However, few studies directly compared the prevalence of psychiatric disorders among adolescent versus adult mothers at first birth using a comprehensive diagnostic tool. This study examined the association between age at first birth and 22 current and lifetime psychiatric disorders in a cohort of low-income pregnant women. METHODS The sample consisted of 744 low-income currently pregnant women who were Medicaid-eligible and enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Saint Louis City and 5 rural counties in Southeastern Missouri. Current (previous 12 months) and lifetime psychiatric disorders were assessed using the Diagnostic Interview Schedule IV (DIS-IV). Logistic regression analyses tested the association between women's age at first birth and psychiatric disorders, controlling for potential confounders, including relative poverty. RESULTS When adjusting for confounders, mothers giving birth in their teens had 2.5 times the odds of having a lifetime behavior disorder (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.35-5.24) and current posttraumatic stress disorder (PTSD) (OR 2.54, 95% CI 1.38-4.70) and almost twice the odds of having at least one anxiety disorder compared to older women at first birth (OR 1.78, 95% CI 1.10-2.85). CONCLUSION Low-income women who have their first birth in adolescence have higher odds of psychiatric disorders and should be the target of psychiatric screening during their pregnancy. Mothers beginning childbearing before age 19 should be screened during pregnancy for anxiety disorders, including PTSD, and behavior disorders.
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Affiliation(s)
- Maya Tabet
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Louise H. Flick
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Cynthia A.L. Cook
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Hong Xian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Jen Jen Chang
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
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10
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HIV status disclosure, depressive symptoms, and sexual risk behavior among HIV-positive young men who have sex with men. J Behav Med 2015; 38:507-17. [PMID: 25773478 DOI: 10.1007/s10865-015-9624-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 02/14/2015] [Indexed: 11/27/2022]
Abstract
The rate of HIV infection among young men who have sex with men (YMSM) is increasing in the United States, and targeted research is needed to inform interventions aimed at reducing HIV transmission in this population. This study aims to understand the association between HIV status disclosure and sexual risk behavior among HIV-positive YMSM. A particular focus is given to depressive symptoms and their potential role in explaining the association between HIV disclosure and sexual risk behavior. In a sample of 991 YMSM receiving care at 20 clinics across the United States, Univariate and multivariate analyses were conducted to explore these associations. Approximately one-half (52.4 %) of participants reported disclosing to their current sexual/romantic partner. Disclosure to family members was negatively associated with sexual risk behavior. Also, depressive symptoms were positively associated with sexual risk behavior. We discuss the implications of our findings for future research and intervention.
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11
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Children Seeking Refuge: A Review of the Escalating Humanitarian Crisis of Child Sexual Abuse and HIV/AIDS in Latin America. J Assoc Nurses AIDS Care 2015; 26:432-42. [PMID: 25769757 DOI: 10.1016/j.jana.2015.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 01/17/2015] [Indexed: 10/24/2022]
Abstract
Early identification and intervention for victims of child sexual abuse (CSA) is essential to halting the spread of HIV in Latino populations because children who are sexually abused are at an increased risk of contracting HIV. The recent influx of unaccompanied children into the United States exposed histories of victimization, vulnerability to CSA, and suggested an epidemic of CSA in Latin America. CSA has been identified as a contributory event to HIV infection. The aim of our research was to identify factors associated with CSA and Latin Americans. A systematic review and a document search were conducted on factors associated with CSA in Latin America. Victimization was associated with lifelong risk factors for HIV. Males were consistently underrepresented in the published CSA literature and machismo attitudes may contribute to abuses of sexual power by males and contribute to males not reporting or under-reporting victimization.
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12
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Abstract
The effect of interpersonal trauma on sexuality can be profound. The field of sexual trauma is complex empirically and clinically, with contradictory theories and conflicting data. Research definitions and treatment protocols for child sexual abuse are very imprecise. There are no firm, empirically proven guidelines for treating men and women who have been sexually abused as children or adolescents. Overt sexual abuse (OSA) in children and adolescents is defined here as molestation, rape, or incest. Research has shown that OSA may, but does not necessarily, lead to sexual dysfunction in adulthood. The effects of OSA are worsened by concurrent types of family of origin abuse, such as emotional abuse or physical abuse. One factor that seems related to the varying impact of OSA on adult sexuality is the patients’ family of origin experience with nonsexual Milestones of Sexual Development. Without positive experiences with touch, trust and empathy, the ability to relax and be soothed, and power, the effects of OSA are potentiated and complicated. Sexuality is embodied, so experiences with touch are particularly important when working with OSA. A three-color Body Map technique which assesses stored associations to touch is provided. The concept of developmental sexual trauma (DST) is introduced as a way to label traumagenic family events which potentiate OSA or negatively effect sex but which are not explicitly sexual in origin. Strategies to assess and treat OSA are reviewed. Body Maps are recommended to assess and treat sexual trauma.
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13
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Brown JL, Young AM, Sales JM, DiClemente RJ, Rose ES, Wingood GM. Impact of Abuse History on Adolescent African-American Women's Current HIV/STD-associated Behaviors and Psychosocial Mediators of HIV/STD Risk. JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2014; 23:151-167. [PMID: 25505369 PMCID: PMC4258877 DOI: 10.1080/10926771.2014.873511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study examined if relationship power, sex refusal self-efficacy, and/or fear of condom negotiation mediated the relationship between abuse history and consistent condom use (CCU) among African-American female adolescents (n=593). Participants with an abuse history (58%) were less likely to report CCU (p=.003). Women with an abuse history reported less relationship power (p=.006) and self-efficacy for refusing sex (p<.001), and more fear of condom negotiation (p=.003), none of which independently or jointly mediated the association between abuse and CCU. Notably, history of abuse was associated with CCU across mediator models (p=.037 to p=.067), despite inclusion of psychosocial mediators. This study demonstrates the importance of understanding adolescents' condom use behaviors within the context of their life experiences, especially past abuse history.
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Affiliation(s)
- Jennifer L. Brown
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta GA 30322
- Emory University Center for AIDS Research
| | - April M. Young
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta GA 30322
| | - Jessica M. Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta GA 30322
- Emory University Center for AIDS Research
| | - Ralph J. DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta GA 30322
- Emory University Center for AIDS Research
- Department of Pediatrics, Division of Infectious Diseases, Epidemiology, and Immunology, Emory University, Atlanta, GA
| | - Eve S. Rose
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta GA 30322
- Emory University Center for AIDS Research
| | - Gina M. Wingood
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta GA 30322
- Emory University Center for AIDS Research
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14
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Conrad SM, Swenson RR, Hancock E, Brown LK. Sex differences and HIV risk behaviors: the interaction between the experience of multiple types of abuse and self-restraint on HIV risk behaviors. JOURNAL OF CHILD SEXUAL ABUSE 2014; 23:558-576. [PMID: 24818645 PMCID: PMC4116559 DOI: 10.1080/10538712.2014.919371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Adolescents with abuse histories have been shown to be at increased risk to acquire human immunodeficiency virus and sexually transmitted infections. In addition, teens with lower levels of self-restraint or higher levels of distress, such as those with psychiatric concerns, have also demonstrated increased sexual risk behaviors. This study explored sex differences in sexual risk behaviors among a sample of adolescents in a therapeutic/alternative high school setting. Moderated regression analysis showed that a lower level of self-restraint was associated with sexual risk behaviors in boys but not in girls. Rather, the interaction of self-restraint and multiple types of abuse was associated with greater sex risk within girls in this sample. Results suggest that girls and boys with abuse histories and low levels of self-restraint may have different intervention needs related to sexual risk behaviors.
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Affiliation(s)
- Selby M Conrad
- a Bradley Hasbro Children's Research Center, Rhode Island Hospital , The Warren Alpert Medical School of Brown University , Providence , Rhode Island , USA
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15
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Gratitude is associated with greater levels of protective factors and lower levels of risks in African American adolescents. J Adolesc 2013; 36:983-91. [PMID: 24011114 DOI: 10.1016/j.adolescence.2013.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 04/26/2013] [Accepted: 07/22/2013] [Indexed: 11/23/2022]
Abstract
The literature suggests gratitude is associated with positive youth development. The current study examined the relationship between gratitude and protective/risk factors among African American youth. Adolescents (N = 389; 50.4% males) ages 12-14 completed measures of gratitude (moral affect and life-orientation), protective factors (e.g., academic and activity engagement, family relationship), and high-risk behaviors (e.g., sexual attitudes and behaviors, drug/alcohol use). Results indicated greater moral affect gratitude was the only variable significantly associated with greater academic interest, better academic performance, and more extra-curricular activity engagement. Greater moral affect and life-orientation gratitude both significantly correlated with positive family relationship. Greater life-orientation gratitude was the only variable significantly associated with abstinence from sexual intimacy, sexual intercourse, likelihood of engaging in sex during primary school, and abstinence from drug/alcohol use. The findings suggest that moral affect gratitude may enhance protective factors while life-orientation gratitude may buffer against high-risk behaviors among African American youth.
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Wilson HW, Emerson E, Donenberg GR, Pettineo L. History of sexual abuse and development of sexual risk behavior in low-income, urban African American girls seeking mental health treatment. Women Health 2013; 53:384-404. [PMID: 23751092 DOI: 10.1080/03630242.2013.790337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study examined relationships between sexual abuse and patterns of sexual risk-taking among low-income, urban African American adolescent girls seeking mental health treatment. METHOD Participants (N = 158) were 12- to 16-year-old African American girls recruited from outpatient mental health clinics serving urban, mostly low-socioeconomic status communities in Chicago, Illinois and followed for two years between 2003 and 2010. This study included self-reports of sexual abuse and four waves (T2-T5) of self-reported data on sexual experience and sexual risk-taking (number of partners, inconsistent condom use, and sex with a risky partner). Latent curve modeling was used to examine patterns of sexual behavior over the four time points with sexual abuse and mental health symptoms as covariates. RESULTS Sexual abuse was significantly associated with T2 sexual experience, T2-T4 number of partners, T3 inconsistent condom use, and T2-T3 having a risky partner. These relationships decreased when mental health symptoms were controlled. CONCLUSIONS This longitudinal study revealed a complex relationship between sexual abuse and sexual risk that would be missed if sexual risk were assessed at a single time point. Findings supported early intervention to delay onset of sexual risk behavior among low-income African American girls with mental health concerns and histories of sexual abuse.
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Affiliation(s)
- Helen W Wilson
- Department of Psychiatry andBehavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA94305-5718, USA.
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17
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Clum GA, Czaplicki L, Andrinopoulos K, Muessig K, Hamvas L, Ellen, and the Adolescent Medicine JM. Strategies and outcomes of HIV status disclosure in HIV-positive young women with abuse histories. AIDS Patient Care STDS 2013; 27:191-200. [PMID: 23596649 DOI: 10.1089/apc.2012.0441] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Young women with HIV and histories of physical and/or sexual abuse in childhood may be vulnerable to difficulties with disclosure to sexual partners. Abuse in childhood is highly prevalent in HIV-positive women, and has been associated with poorer communication, low assertiveness, low self worth, and increased risk for sexual and other risk behaviors that increase the risk of secondary transmission of HIV. HIV disclosure may be an important link between abuse and sexual risk behaviors. Qualitative interviews with 40 HIV-positive young women with childhood physical and/or sexual abuse were conducted; some women had also experienced adult victimization. Results suggest that HIV-positive women with abuse histories use a host of strategies to deal with disclosure of HIV status, including delaying disclosure, assessing hypothetical responses of partners, and determining appropriate stages in a relationship to disclose. Stigma was an important theme related to disclosure. We discuss how these disclosure processes impact sexual behavior and relationships and discuss intervention opportunities based on our findings.
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Affiliation(s)
- Gretchen A. Clum
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | | | | | - L. Hamvas
- Washington University, St. Louis, Missouri
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Senn TE, Carey MP, Coury-Doniger P. Mediators of the relation between childhood sexual abuse and women's sexual risk behavior: a comparison of two theoretical frameworks. ARCHIVES OF SEXUAL BEHAVIOR 2012; 41:1363-77. [PMID: 22282323 PMCID: PMC3351532 DOI: 10.1007/s10508-011-9897-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 07/22/2011] [Accepted: 09/25/2011] [Indexed: 05/16/2023]
Abstract
Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood, but little research has investigated processes that might mediate this relation. The purpose of this study was to investigate whether constructs suggested by the traumagenic dynamics (TD) model (a theory of the effects of CSA) or constructs suggested by the information-motivation-behavioral skills (IMB) model (a theory of the antecedents of sexual risk behavior) better mediated the relation between CSA and sexual risk behavior in adulthood. Participants were 481 women attending a sexually transmitted infection clinic (66% African American) who completed a computerized survey as well as behavioral simulations assessing condom application and sexual assertiveness skills. Forty-five percent of the sample met criteria for CSA and CSA was associated with sexual risk behavior in adulthood. In multiple mediator models, the TD constructs mediated the relation between CSA and the number of sexual partners whereas the IMB constructs mediated the relation between CSA and unprotected sex. In addition, the TD constructs better mediated the relation between CSA and the number of sexual partners; the TD and IMB constructs did not differ in their ability to mediate the relation between CSA and unprotected sex. Sexual risk reduction interventions for women who were sexually abused should target not only the constructs from health behavior models (e.g., motivation and skills to reduce sexual risk), but also constructs that are specific to sexual abuse (e.g., traumatic sexualization and guilt).
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Affiliation(s)
- Theresa E Senn
- Center for Health and Behavior, Syracuse University, Syracuse, NY 13244, USA.
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19
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Steinberg JR, Tschann JM. Childhood adversities and subsequent risk of one or multiple abortions. Soc Sci Med 2012; 81:53-9. [PMID: 23312795 DOI: 10.1016/j.socscimed.2012.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/08/2012] [Accepted: 11/08/2012] [Indexed: 11/16/2022]
Abstract
Although many studies have found an association between childhood adversities and mental health disorders, few have examined whether childhood adversities are linked to having abortions. This research investigates the association between a range of childhood adversities and risk of abortion in part to identify which adversities should be considered when examining the association between abortion and subsequent mental health. Using the U.S. National Comorbidity Survey-Replication (NCS-R), we tested the association between 10 childhood adversities and risk of 0, 1, or multiple abortions among 1511 women ages 18-41. We employed multinomial logistic regression to examine the independent association between each childhood adversity and number of subsequent abortions, controlling for sociodemographic factors, total number of pregnancies, and each adversity. Women who had experienced two or more personal safety threats, one parental mental illness, or two or more parental mental illnesses while growing up were more likely subsequently to have multiple versus no abortions [Relative Risk Ratio (RRR) = 9.87, 95% CI: 2.45-39.72; OR = 2.81, 95% CI: 1.27-6.21; RRR = 5.28, 95% CI: 1.60-17.38, respectively], and multiple versus one abortion [RRR = 13.33, 95% CI: 2.48-71.68; RRR = 2.17, 95% CI: 1.03-4.56; RRR = 3.67, 95% CI: 1.15-11.76, respectively]. Women who had experienced childhood physical abuse were more likely to have one compared to no abortions [RRR = 2.00; 1.19-3.34]. These results suggest that some childhood adversities may partially explain the association between abortion and mental health. Accordingly, they should be considered in future research examining the link between abortion and mental health.
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Affiliation(s)
- Julia R Steinberg
- Department of Psychiatry, University of California, San Francisco, 3333 California St., Ste. 465, Box 0848, San Francisco, CA 94143-0848, USA.
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20
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Weine S, Bahromov M, Loue S, Owens L. Trauma exposure, PTSD, and HIV sexual risk behaviors among labor migrants from Tajikistan. AIDS Behav 2012; 16:1659-69. [PMID: 22261829 DOI: 10.1007/s10461-011-0122-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Little is known about the role of trauma and PTSD symptoms in the context of migration-associated HIV risk behaviors. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method (quantitative and qualitative) study. The mean PC-PTSD score was 1.2 with one-quarter of migrants scoring at or above the cutoff of 3 indicating likely PTSD diagnosis. PC-PTSD score was directly correlated with both direct and indirect trauma exposure, but PC-PTSD score did not predict either HIV sexual risk behaviors or HIV protective behaviors. HIV sexual risk behavior was associated with higher indirect trauma exposure. PC-PTSD score was associated with some indicators of increased caution (e.g., more talking with partners about HIV and condoms; more use of condom when drinking). Qualitative findings were used to illustrate the differences between direct and indirect traumas in terms of HIV sexual risk. The study findings call for future efforts to address labor migrant's mental health needs and to integrate trauma dimensions into HIV prevention.
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Affiliation(s)
- Stevan Weine
- Department of Psychiatry, University of Illinois at Chicago, USA.
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21
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Loeb TB, Gaines T, Wyatt GE, Zhang M, Liu H. Associations between child sexual abuse and negative sexual experiences and revictimization among women: does measuring severity matter? CHILD ABUSE & NEGLECT 2011; 35:946-55. [PMID: 22078081 PMCID: PMC3262588 DOI: 10.1016/j.chiabu.2011.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 06/06/2011] [Accepted: 06/09/2011] [Indexed: 05/08/2023]
Abstract
Women with histories of child sexual abuse (CSA) are more likely than those without such experiences to report a variety of negative sexual outcomes. This study examines the explanatory power of a CSA summed composite versus dichotomous (presence/absence) measurement in predicting a comprehensive negative sexual behavior outcome. Study participants were obtained from a community based sample examining women's sexual decision-making. The continuous CSA measurement reflects cumulative histories of CSA through a composite score capturing abuse specific characteristics. Using a cross-validation approach, the sample (n=835) was randomly split and the explanatory power of each measure was examined through a series of multiple linear regressions comparing model fit indexes and performing a formal likelihood ratio test of one model against another. All CSA measures explained a similar percentage of variance but overall the CSA summed composite explained the data significantly better in terms predicting negative sexual experiences and revictimization than a binary measure as demonstrated with the likelihood ratio test. The results were replicated by cross-validating the predictive power of the CSA composite score between the split samples. Consistency of CSA regression estimates for the summed composite between training and validation samples were also confirmed. Given the superiority of the CSA summed composites over the binary variable, we recommend using this measure when examining associations between CSA histories and negative sexual experiences and revictimization.
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Affiliation(s)
- Tamra B Loeb
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, CA 90024-1759, USA
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22
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Brown LK, Nugent NR, Houck CD, Lescano CM, Whiteley LB, Barker D, Viau L, Zlotnick C. Safe Thinking and Affect Regulation (STAR): human immunodeficiency virus prevention in alternative/therapeutic schools. J Am Acad Child Adolesc Psychiatry 2011; 50:1065-74. [PMID: 21961780 PMCID: PMC3185294 DOI: 10.1016/j.jaac.2011.06.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 06/28/2011] [Accepted: 06/30/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of Safe Thinking and Affect Regulation (STAR), a 14-session HIV-prevention program for adolescents at alternative/therapeutic schools. Because these youth frequently have difficulties with emotions and cognitions, it was designed to improve sexuality-specific affect management and cognitive monitoring, as well as HIV-related knowledge and attitudes. It was hypothesized that STAR would lead to a decrease in sexual risk and improved HIV knowledge and attitudes. METHOD Fourteen schools were randomly assigned by year either to the STAR intervention or a brief educational program. Schools received the alternate intervention the following year. A total of 185 adolescents in 29 cohorts (groups) participated in the interventions. Assessment of sexual behavior, knowledge and attitudes with audio computer-assisted self-interviews occurred at 3, 6, and 9 months post intervention. RESULTS Hierarchical linear model (HLM) analyses found that adolescents in the STAR intervention reported a significantly greater decrease (p < .05) in the Sexual Risk Index than youth in the control group over the 6 months post intervention and similar improvements in the HIV Knowledge Scale and the Condom Use Self Efficacy Scale. There were no group differences between 6 and 9 months post intervention. CONCLUSIONS This STAR intervention for youth in alternative schools was associated with decreased sexual risk for 6 months after the intervention. These data suggest that intervention strategies that target cognitions and affect within a sexual context might be usefully applied to improving sexual behavior but may need to be reinforced over time. Clinical trial registration information--HIV, Abuse, and Psychiatric Disorders Among Youth; http://clinicaltrials.gov; NCT00603369.
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Affiliation(s)
- Larry K Brown
- Bradley/Hasbro Children's Research Center of Rhode Island Hospital, and the Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
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23
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Miller CL, Fielden SJ, Tyndall MW, Zhang R, Gibson K, Shannon K. Individual and structural vulnerability among female youth who exchange sex for survival. J Adolesc Health 2011; 49:36-41. [PMID: 21700154 PMCID: PMC3392207 DOI: 10.1016/j.jadohealth.2010.10.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 10/08/2010] [Accepted: 10/10/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE Because of growing concerns regarding the heightened vulnerabilities and risk of human immunodeficiency virus infection among youth who exchange sex for survival, we investigated individual risk patterns and structural barriers among young (≤24 years) female sex workers (FSWs) in Vancouver, Canada. METHODS Between 2005 and 2008, a total of 255 street-based FSWs (≥14 years) were enrolled into a community-based prospective cohort, and were asked to participate in baseline and biannual questionnaires administered through interviews and human immunodeficiency virus screening. We used contingency table analysis to compare individual and structural barrier results obtained at baseline for younger (≤24 years) FSWs with those of the older (>25 years) FSWs. For longitudinal data, we used generalized estimating equations throughout the follow-up period to determine factors associated with being a young FSW in the past 6 months. RESULTS In comparison with older FSWs (n = 199), youth (n = 56) were more likely to spend fewer years engaging in sex exchange (median: 6.4 [interquartile range: 4.6-9.1] vs. 19.9 [interquartile range: 10.0-26.8]; p ≤ .001), belong to an aboriginal ancestry (59% vs. 44%; p = .052), and be homeless (68% vs. 36%; p ≤ .001). In the multivariate generalized estimating equations analysis, youth reported a significantly elevated proportional odds of being homeless (odds ratio [OR]: 1.26 [confidence interval {CI}: 1.08-1.48]), servicing clients in public places (OR: 1.28 [CI: 1.04-1.57]), injecting heroin on a daily basis (OR: 1.35 [CI: 1.06-1.74]), and a significantly reduced odds of accessing methadone maintenance therapy (OR: .76 [CI: .62-.93]). CONCLUSIONS This study demonstrates significant displacement of youth who engage in sex exchange to marginalized working and living spaces. The findings of this study bring to attention the critical need for targeted structural interventions including access to youth and gender-specific social housing, safe working spaces, reduction in the amount of harm caused to them, and addiction treatment services for youth engaged in survival sex work.
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Affiliation(s)
- CL Miller
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - SJ Fielden
- Faculty of Health Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - MW Tyndall
- Faculty of Health Sciences, University of British Columbia, Vancouver, British Columbia, Canada,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - R Zhang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - K Gibson
- Women’s Information Safe Haven (WISH) Drop-In Centre Society, Vancouver, British Columbia, Canada
| | - K Shannon
- Faculty of Health Sciences, University of British Columbia, Vancouver, British Columbia, Canada,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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Brown LK, Hadley W, Stewart A, Lescano C, Whiteley L, Donenberg G, DiClemente R. Psychiatric disorders and sexual risk among adolescents in mental health treatment. J Consult Clin Psychol 2010; 78:590-7. [PMID: 20658815 DOI: 10.1037/a0019632] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. METHOD Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). RESULTS Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. CONCLUSIONS The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment.
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Affiliation(s)
- Larry K Brown
- Bradley/Hasbro Children's Research Center, One Hoppin Street, Providence, RI 02903, USA.
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25
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Heaphy ELG, Loue S, Sajatovic M, Tisch DJ. Impact of psychiatric and social characteristics on HIV sexual risk behavior in Puerto Rican women with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 2010; 45:1043-54. [PMID: 19855911 PMCID: PMC3483882 DOI: 10.1007/s00127-009-0146-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 09/22/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Latinos in the United States have been identified as a high-risk group for depression, anxiety, and substance abuse. HIV/AIDS has disproportionately impacted Latinos. Review findings suggest that HIV-risk behaviors among persons with severe mental illness (SMI) are influenced by a multitude of factors including psychiatric illness, cognitive-behavioral factors, substance use, childhood abuse, and social relationships. OBJECTIVE To examine the impact of psychiatric and social correlates of HIV sexual risk behavior in Puerto Rican women with SMI. METHODS Data collected longitudinally (from 2002 to 2005) in semi-structured interviews and from non-continuous participant observation was analyzed using a cross-sectional design. Bivariate associations between predictor variables and sexual risk behaviors were examined using binary and ordinal logistic regression. Linear regression was used to examine the association between significant predictor variables and the total number of risk behaviors the women engaged in during the 6 months prior to baseline. RESULTS Just over one-third (35.9%) of the study population (N = 53) was diagnosed with bipolar disorder and GAF scores ranged from 30 to 80 with a median score of 60. Participants ranged in age from 18 to 50 years (M = 32.6 ± 8.7), three-fourths reported a history of either sexual or physical abuse or of both in childhood, and one-fourth had abused substances in their lifetimes. Bivariate analyses indicated that psychiatric and social factors were differentially associated with sexual risk behaviors. Multivariate linear regression models showed that suffering from increased severity of psychiatric symptoms and factors and living below the poverty line are predictive of engagement in a greater number of HIV sexual risk behaviors. PRACTICAL IMPLICATIONS Puerto Rican women with SMI are at high risk for HIV infection and are in need of targeted sexual risk reduction interventions that simultaneously address substance abuse prevention and treatment, childhood abuse, and the indirect effects associated with SMI such as living in poverty. Mental health programs should address risk behavior among adults with SMI in the context of specific symptomatology and comorbidities.
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Affiliation(s)
- Emily Lenore Goldman Heaphy
- School of Medicine, Room E202, Division of Infectious Diseases, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4984, USA.
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Prevalence of child and adult sexual abuse and risk taking practices among HIV serodiscordant African-American couples. AIDS Behav 2010; 14:1032-44. [PMID: 20499150 PMCID: PMC2944965 DOI: 10.1007/s10461-010-9700-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study reports the prevalence of child (CSA) and adult (ASA) sexual abuse among 535 African American HIV serodiscordant couples from four major United State cities, and its relationship to personal and couple related vulnerabilities and HIV risk factors. As part of a randomized, clinical trial, CSA and ASA histories were obtained through face-to-face interviews. Results indicate that HIV positive women were significantly more likely to report one kind of abuse (32.32%), either before or since age 18 or both (32.6%). HIV-positive men (34.9%) were significantly more likely to report CSA than HIV-negative men (22.0%). Overall, 72% of couples reported that one or both had CSA histories. These findings underscore the heightened emotional vulnerability, and STI and HIV transmission risk taking practices, associated with sexual abuse. Sexual abuse histories among couples should be assessed to better understand how these histories may contribute to couples dynamics and risk-taking practices.
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Schraufnagel TJ, Davis KC, George WH, Norris J. Childhood sexual abuse in males and subsequent risky sexual behavior: a potential alcohol-use pathway. CHILD ABUSE & NEGLECT 2010; 34:369-78. [PMID: 20359749 PMCID: PMC2866783 DOI: 10.1016/j.chiabu.2009.08.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 06/18/2009] [Accepted: 08/28/2009] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Childhood sexual abuse (CSA) among boys has been associated with a variety of subsequent maladaptive behaviors. This study explored a potential connection between CSA and an increased likelihood of risky sexual behavior in adulthood. Further, the study examined whether or not alcohol use may contribute to this relationship. METHOD As part of a study on alcohol and sexual decision-making, 280 heterosexual men completed multiple background questionnaires pertaining to past and current sexual experiences and patterns of alcohol use. CSA history was obtained and severity ratings were made based on type of contact reported. RESULTS CSA was reported by 56 men (20%). Structural equation modeling revealed that CSA positively predicted number of sexual partners directly as well as indirectly, through its effect on alcohol use. Specifically, greater CSA severity predicted significantly lower age of first intoxication, which in turn predicted greater current alcohol consumption, followed by greater use of alcohol before sexual intercourse, leading to an increased number of reported sexual partners. The reported frequency of condom use was not predicted by CSA severity or the alcohol-use pathway. CONCLUSIONS These findings suggest that CSA influences risky sexual behavior via multiple pathways and that more severe CSA may lead to elevated sexual risk indices. Moreover, these results suggest that men may elevate their risk of sexually transmitted infections via high numbers of sexual partners versus irregular condom use. PRACTICAL IMPLICATIONS These results highlight the need for adequate assessment and early interventions in order to mitigate the effects CSA may have on subsequent alcohol use and risky sexual behavior. Secondly, ensuring that male CSA victims understand the inherent risks of high numbers of sexual partners may be an effective strategy to interrupt the path toward risk-taking.
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Tolou-Shams M, Ewing SWF, Tarantino N, Brown LK. Crack and Cocaine Use among Adolescents in Psychiatric Treatment: Associations with HIV Risk. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2010; 19:122-134. [PMID: 22224066 DOI: 10.1080/10678281003634926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Crack and cocaine use among adults has been associated with co-occurring psychiatric disorders as well as other drug use and unprotected sex. However, this issue is relatively unstudied in adolescents. This study collected data from 282 adolescents (mean age=14.9 years) treated in intensive psychiatric treatment settings to understand the relationship between crack/cocaine use and HIV risk. Thirteen percent of youth reported ever using crack or cocaine. Use was not associated with age, gender, race/ethnicity or SES. After controlling for known factors that influence unprotected sex, the odds that those with a history of crack/cocaine use engaged in inconsistent condom use was six times greater than that for those youth who did not ever use. Thus, crack/cocaine use is prevalent even among younger adolescents with psychiatric disorders who are not in drug treatment. Its use is associated with high rates of sexual and other risk behaviors. A history of use should alert clinicians to a wide variety of possible behavioral risks. These results can also inform future adolescent HIV prevention intervention development.
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Affiliation(s)
- Marina Tolou-Shams
- Bradley Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University
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29
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Jones DJ, Runyan DK, Lewis T, Litrownik AJ, Black MM, Wiley T, English DE, Proctor LJ, Jones BL, Nagin DS. Trajectories of childhood sexual abuse and early adolescent HIV/AIDS risk behaviors: the role of other maltreatment, witnessed violence, and child gender. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2010; 39:667-80. [PMID: 20706919 PMCID: PMC3758233 DOI: 10.1080/15374416.2010.501286] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Childhood sexual abuse (CSA) has been associated with HIV/AIDS risk behavior; however, much of this work is retrospective and focuses on women. The current study used semi-parametric mixture modeling with youth (n = 844; 48.8% boys) from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) to examine the link between trajectories of CSA (2 to 12 years old) and HIV/AIDS risk behavior at age 14 (i.e., sexual intercourse & alcohol use). Trajectory analyses revealed a link between a history of CSA and the development of risky behavior. In addition, trajectories for physical and emotional abuse, but not neglect or witnessed violence, contributed to risky behavior over and above the role of CSA. Child gender did not moderate the findings. Findings highlight the significance of CSA histories, as well as the broader context of maltreatment, for better understanding the development of risk behaviors in both girls and boys.
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Affiliation(s)
- Deborah J Jones
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA.
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30
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Houck CD, Nugent NR, Lescano CM, Peters A, Brown LK. Sexual abuse and sexual risk behavior: beyond the impact of psychiatric problems. J Pediatr Psychol 2009; 35:473-83. [PMID: 19966316 DOI: 10.1093/jpepsy/jsp111] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study examined the association between sexual abuse (SA) and sex risk in girls and boys placed in alternative and therapeutic school settings while controlling for psychiatric problems. METHOD Adolescents were recruited from alternative and therapeutic schools. Youth completed audio computer-assisted self-interviews assessing childhood abuse, sexual behaviors, sexual attitudes, and psychiatric symptoms. RESULTS Of the 162 youth with available data, 23% reported a moderate or severe SA history. After controlling for gender and the presence of a psychiatric diagnosis, youth with a SA history were significantly more likely to have engaged in sex, had sex in the last 90 days, and engaged in unprotected sex. Adolescents with a history of SA also endorsed fewer advantages of using condoms. CONCLUSIONS SA is uniquely associated with sexual behavior and attitudes even when adjusting for the presence of a psychiatric diagnosis. These data have implications for interventions for those with SA histories.
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Affiliation(s)
- Christopher D Houck
- Bradley/Hasbro Children's Research Center, One Hoppin Street, Suite 204, Providence, RI 02903, USA.
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Gault-Sherman M, Silver E, Sigfúsdóttir ID. Gender and the associated impairments of childhood sexual abuse: A national study of Icelandic youth. Soc Sci Med 2009; 69:1515-22. [DOI: 10.1016/j.socscimed.2009.08.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Indexed: 10/20/2022]
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Feiring C, Simon VA, Cleland CM. Childhood sexual abuse, stigmatization, internalizing symptoms, and the development of sexual difficulties and dating aggression. J Consult Clin Psychol 2009; 77:127-37. [PMID: 19170459 DOI: 10.1037/a0013475] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Potential pathways from childhood sexual abuse (CSA) to subsequent romantic intimacy problems were examined in a prospective longitudinal study of 160 ethnically diverse youth with confirmed CSA histories. Participants were interviewed at the time of abuse discovery, when they were 8-15 years of age, and again 1-6 years later. Stigmatization (abuse-specific shame and self-blame) and internalizing symptoms (posttraumatic stress and depressive symptoms), more than abuse severity, explained which youth with CSA histories experienced more sexual difficulties and dating aggression. Stigmatization was found to operate as a predictive mechanism for subsequent sexual difficulties. Internalizing symptoms were not predictive of romantic intimacy problems, although they did show correlational relations with sexual difficulties and dating aggression. Early interventions such as trauma-focused cognitive-behavioral therapy that target stigmatization may be important for preventing the development of sexual difficulties in CSA youth.
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Affiliation(s)
- Candice Feiring
- Center for Youth Relationship Development, The College of New Jersey, P.O. Box 7718, Ewing, NJ 08628, USA.
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Heaphy ELG, Loue S. Comparing two approaches to acquiring HIV-risk data from Puerto Rican women with severe mental illness. J Immigr Minor Health 2009; 12:74-82. [PMID: 19373553 DOI: 10.1007/s10903-009-9251-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 04/06/2009] [Indexed: 11/28/2022]
Abstract
Renewed interest has been expressed by researchers in mixed-method assessment that employs both quantitative and qualitative techniques in an expansive style that utilizes a variety of tactics to address research questions. Participants consisted of Puerto Rican women with severe mental illness living in Cuyahoga County, Ohio. The women were shadowed over a 2-year period to observe and verify behaviors that were self-reported using standardized instruments in semi-structured interviews. Concurrent criterion-related validity was employed to determine the extent of the correlation between responses obtained from the two approaches. Forty-four percent of the women were diagnosed with major depression and the mean overall GAF score was 58.5 +/- 14.5. A comparison of the data collected using the different methodologies revealed that inconsistent and contradictory responses are not uncommon. The mixed-method design provided a more complete way of obtaining HIV-risk behavior data. Researchers and clinicians could benefit from mixed methods research that can provide greater opportunities to obtain data of a sensitive nature.
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Affiliation(s)
- Emily L G Heaphy
- Center for Minority Public Health, 3404 Lorain Avenue, Cleveland, OH 44113, USA.
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Wilson HW, Widom CS. Sexually transmitted diseases among adults who had been abused and neglected as children: a 30-year prospective study. Am J Public Health 2009; 99 Suppl 1:S197-203. [PMID: 19218173 PMCID: PMC2724945 DOI: 10.2105/ajph.2007.131599] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined associations between childhood abuse and neglect and the risk in adulthood for sexually transmitted diseases. METHODS In a prospective cohort design, we matched children aged 0 to 11 years with documented cases of abuse or neglect during 1967 to 1971 with a control group of children who had not been maltreated (754 participants in all) and followed them into adulthood. Information about lifetime history of sexually transmitted diseases was collected as part of a medical status examination when participants were approximately 41 years old. RESULTS Childhood sexual abuse increased risk for any sexually transmitted disease (odds ratio [OR] = 1.94; 95% confidence interval [CI] = 1.00, 3.77; P = .05) and more than 1 type of sexually transmitted disease (OR = 3.33; 95% CI = 1.33, 8.22; P = .01). Physical abuse increased risk for more than 1 type of sexually transmitted disease (OR = 3.61; 95% CI = 1.39, 9.38; P = .009). CONCLUSIONS Our results provided the first prospective evidence that child physical and sexual abuse increases risk for sexually transmitted diseases. Early screening and interventions are needed to identify and prevent sexually transmitted diseases among child abuse victims.
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Affiliation(s)
- Helen W Wilson
- Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York, NY, USA.
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Meade CS, Kershaw TS, Hansen NB, Sikkema KJ. Long-term correlates of childhood abuse among adults with severe mental illness: adult victimization, substance abuse, and HIV sexual risk behavior. AIDS Behav 2009; 13:207-16. [PMID: 17968646 DOI: 10.1007/s10461-007-9326-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 10/15/2007] [Indexed: 10/22/2022]
Abstract
The prevalence of childhood sexual and physical abuse among persons with severe mental illness (SMI) is disproportionately high. Adults with SMI also engage in high rates of HIV risk behaviors. This study examined the association between childhood abuse and adult victimization, substance abuse, and lifetime HIV sexual risk in a sample of 152 adults with SMI receiving community mental health services. Structured interviews assessed psychiatric, psychosocial, and behavioral risk factors. Seventy percent reported childhood physical and/or sexual abuse, and 32% reported both types of abuse. Participants with childhood abuse were more likely to report adult victimization and greater HIV risk. A structural equation model found that childhood abuse was directly and indirectly associated with HIV risk through drug abuse and adult vicitimization. Integrated treatment approaches that address interpersonal violence and substance abuse may be necessary for HIV risk reduction in this population.
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Ma M, Kibler JL, Dollar KM, Sly K, Samuels D, Benford MW, Coleman M, Lott L, Patterson K, Wiley F. The relationship of character strengths to sexual behaviors and related risks among African American adolescents. Int J Behav Med 2009; 15:319-27. [PMID: 19005932 DOI: 10.1080/10705500802365573] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Relatively few studies have examined positive character traits that are associated with lower HIV/STD risks. PURPOSE In the present study, the relationships of character strengths with sexual behaviors and attitudes were assessed among 383 African-American adolescents. METHOD Character strengths were measured using the Values in Action Inventory of Strengths. Because the strengths were highly inter-correlated, stepwise discriminant function analyses were utilized to assess their independent associations with sexual behaviors and attitudes. RESULTS Greater Love of Learning was related to self-reported abstinence from sexual intercourse for boys and self-reported abstinence from drug use for boys and girls. Greater Love of Learning and Curiosity were related to the belief in no premarital sex for boys, whereas only Curiosity was significant for girls. Prudence was related to reported abstinence from sexual intimacy (e.g., touching or kissing). Judgment was related to sexual initiation efficacy for girls and boys, whereas Leadership was only significant for girls. CONCLUSIONS The findings suggest that character strengths may be associated with lower levels of sexual behaviors and sex-related beliefs among a sample of African-American adolescents.
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Affiliation(s)
- Mindy Ma
- Nova Southeastern University, Farquhar Collegeof Arts and Sciences, Division of Social and Behavioral Sciences, Fort Lauderdale, Florida 33314, USA.
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Cavanaugh CE, Classen CC. Intergenerational pathways linking childhood sexual abuse to HIV risk among women. J Trauma Dissociation 2009; 10:151-69. [PMID: 19333846 PMCID: PMC2688954 DOI: 10.1080/15299730802624536] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Childhood sexual abuse is prevalent among women, and it has been linked to a number of problems affecting women's health and functioning, including women's parenting practices. Another body of literature has linked specific maternal parenting practices--including mother-daughter sex communication, monitoring/knowledge about daughters' activities, mother-daughter relationship quality, attitudes toward sex, and modeling of sexual values--to daughters' HIV risk. This article reviews and links these two bodies of literature to indicate how mothers' histories of childhood sexual abuse may compromise their parenting practices, which may in turn impact daughters' HIV risk. We also build upon R. Malow, J. Devieux, and B. A. Lucenko's (2006) model of the associations between childhood sexual abuse and HIV risk to present a model indicating potential intergenerational pathways between childhood sexual abuse and HIV risk among women. The literature supporting this model and gaps in the literature are described.
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Affiliation(s)
- Courtenay E Cavanaugh
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
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Senn TE, Carey MP, Vanable PA. Childhood and adolescent sexual abuse and subsequent sexual risk behavior: evidence from controlled studies, methodological critique, and suggestions for research. Clin Psychol Rev 2008; 28:711-35. [PMID: 18045760 PMCID: PMC2416446 DOI: 10.1016/j.cpr.2007.10.002] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Revised: 10/15/2007] [Accepted: 10/22/2007] [Indexed: 12/16/2022]
Abstract
Childhood and adolescent sexual abuse (CSA) is associated with a wide variety of adverse psychological and health outcomes, including negative sexual health outcomes. In this paper, we review the literature investigating the relation between CSA and subsequent sexual risk behaviors among men and women. Previous research has found a relatively consistent association between CSA and higher rates of sexual risk behaviors, particularly sex trading, more sexual partners, and an earlier age of first intercourse. However, there are a number of limitations to this research, including lack of a consistent definition of CSA, failure to investigate gender as a moderator, and possible confounding of the CSA experience with some of the sexual behavior outcome variables. Further, although there appears to be an association between CSA and later sexual risk behavior, researchers have not established whether this association is causal. Suggestions for future research and implications for clinical practice are discussed.
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Affiliation(s)
- Theresa E Senn
- Center for Health and Behavior, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244-2340, USA
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Abstract
OBJECTIVE A wide range exists in the frequency of adolescent self-cutting behavior; however, the implications of this variability are relatively unexplored. Although evidence suggesting a relationship between self-harm and sexual risk behaviors has been identified, little is known regarding the relationship between frequency of self-cutting and sexual risk. The present study aimed to test the hypothesis that adolescents who repeatedly self-cut would report more HIV risk behaviors and riskier attitudes than those who had engaged in infrequent self-injury. METHOD Adolescents (11-18 years; mean age, 15 years) from intensive psychiatric treatment programs with a history of self-cutting (N = 105, 53% female) completed measures of self-cutting, sexual risk behaviors, and risk attitudes. RESULTS Frequent self-cutting (more than three times, lifetime) was associated with being sexually active, using condoms inconsistently, and sharing cutting instruments. Frequent self-cutters were significantly more likely to be female and nonwhite, and report low self-restraint. They also showed a trend toward being more likely to have a history of sexual abuse. CONCLUSIONS This study found important differences in self-cutters based on frequency of cutting. Adolescent self-cutting may be a spectrum of behavior that ranges from habitual, repeated behavior contrasted with infrequent, experimental, socially motivated cutting. The associations between frequent cutting, sexual risk, and low self-restraint suggest that common underlying mechanisms may determine these patterns.
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40
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Simon VA, Feiring C. Sexual anxiety and eroticism predict the development of sexual problems in youth with a history of sexual abuse. CHILD MALTREATMENT 2008; 13:167-81. [PMID: 18408212 PMCID: PMC5593751 DOI: 10.1177/1077559508315602] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Youth with confirmed histories of sexual abuse (N = 118) were followed longitudinally to examine associations between their initial sexual reactions to abuse and subsequent sexual functioning. Participants were interviewed at abuse discovery (ages 8 through 15) and again 1 and 6 years later. Eroticism and sexual anxiety emerged as distinct indices of abuse-specific sexual reactions and predicted subsequent sexual functioning. Eroticism was associated with indicators of heightened sexuality, including more sexual risk behavior and views of sexual intimacy focused on partners' needs. Sexual anxiety was associated with indicators of diminished sexuality, including few sexual partners and avoidant views of sexual intimacy. Age at abuse discovery moderated some associations, suggesting that the timing of abuse-specific reactions affects trajectories of sexual development. Findings point to the need for a developmental approach to understanding how abuse-specific sexual reactions disrupt sexual development and the need for early interventions promoting healthy sexual development.
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Affiliation(s)
- Valerie A Simon
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI 48202, USA.
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Whitaker DJ, Le B, Karl Hanson R, Baker CK, McMahon PM, Ryan G, Klein A, Rice DD. Risk factors for the perpetration of child sexual abuse: a review and meta-analysis. CHILD ABUSE & NEGLECT 2008; 32:529-48. [PMID: 18513795 DOI: 10.1016/j.chiabu.2007.08.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 07/16/2007] [Accepted: 08/06/2007] [Indexed: 05/08/2023]
Abstract
OBJECTIVES Since the late 1980s, there has been a strong theoretical focus on psychological and social influences of perpetration of child sexual abuse. This paper presents the results of a review and meta-analysis of studies examining risk factors for perpetration of child sexual abuse published since 1990. METHOD Eighty-nine studies published between 1990 and April of 2003 were reviewed. Risk factors were classified into one of the following six broad categories: family factors, externalizing behaviors, internalizing behaviors, social deficits, sexual problems, and attitudes/beliefs. Sex offenders against children (SOC) were compared to three comparison groups identified within the 89 studies: sex offenders who perpetrated against adults (SOA), non-sex offenders, and non-offenders with no history of criminal or sexual behavior problems. RESULTS Results for the six major categories showed that SOC were not different from SOA (all d between -.02 and .14) other than showing lower externalizing behaviors (d=-.25). Sex offenders against children were somewhat different from non-sex offenders, especially with regard to sexual problems and attitudes (d=.83 and .51). Sex offenders against children showed substantial differences from non-offenders with medium sized effects in all six major categories (d's range from .39 to .58). CONCLUSION Child sex offenders are different from non-sex offenders and non-offenders but not from sex offenders against adults. PRACTICE IMPLICATIONS This study suggests that the presence of general risk factors may lead to a variety of negative behavioral outcomes, including the perpetration of child sexual offending. Family factors were strongly related to the perpetration of child sex offending (vs. non-sexual offending or non-offending) and may be valuable intervention points for interrupting the development of child sex offending, as well as other negative behaviors. Other potential points for intervention may focus on the development of appropriate social and emotional skills that contribute to sexual offending.
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Abrams GB, Etkind P, Burke MC, Cram V. Sexual Violence and Subsequent Risk of Sexually Transmitted Disease Among Incarcerated Women. JOURNAL OF CORRECTIONAL HEALTH CARE 2008. [DOI: 10.1177/1078345807313797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gina Baral Abrams
- School of Social Work, Boston University
- Princeton University, Princeton, New Jersey
| | - Paul Etkind
- Division of STD Prevention, Massachusetts Department of Public Health, Boston
- Division of Public Health and Community Services, City of Nashua, New Hampshire
| | - M. Christine Burke
- Division of STD Prevention, Massachusetts Department of Public Health, Boston
- Massachusetts Department of Public Health, Boston
| | - Virginia Cram
- Division of STD Prevention, Massachusetts Department of Public Health, Boston
- Commonwealth Medicine, University of Massachusetts Medical School, Worcester
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Abstract
HIV, the cause of AIDS, has infected more than 65 million people worldwide, including 1 million children. An estimated 39.5 million people are living with HIV. As of 2006, 4.3 million were newly infected, with 2.8 million occurring in sub-Saharan Africa. Rates of infection have risen more than 50% in Eastern Europe and Central Asia. Mother-to-child transmission occurs rarely with antiretroviral treatments in the United States, and congenitally infected children are living to adulthood. HIV is now a "youth-driven disease" worldwide. In the United States, 40% of new HIV infections occur in individuals less than 25 years old, and HIV is the sixth-leading cause of death among adolescents. Young people with HIV/AIDS live with this chronic condition and its associated medical and psychological morbidities while coping with identity and maturation issues. In this paper, we review what we know about HIV and psychiatric disorders among adolescents.
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Affiliation(s)
- Tami D Benton
- Department of Psychiatry, University of Pennsylvania, The Children's Hospital of Philadelphia, 3440 Market Street, Philadelphia, PA 19104, USA.
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Kirkengen AL. Inscriptions of violence: societal and medical neglect of child abuse--impact on life and health. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2008; 11:99-110. [PMID: 17549605 DOI: 10.1007/s11019-007-9076-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 03/10/2007] [Indexed: 05/15/2023]
Abstract
OBJECTIVE A sickness history from General Practice will be unfolded with regard to its implicit lived meanings. This experiential matrix will be analyzed with regard to its medico-theoretical aspects. METHOD The analysis is grounded in a phenomenology of the body. The patient Katherine Kaplan lends a particular portrait to the dynamics that are enacted in the interface between socially silenced domestic violence and the theoretical assumptions of human health as these inform the clinical practice of health care. RESULTS By applying an understanding of sickness that transcends the mind-body split, a concealed and complex logic emerges. This logic is embedded in a nexus of the impact of childhood abuse experience and the medical disinterest in subjective experiences and their impact on selfhood and health. Its core is twofold: the violation of embodiment resulting from intra-familial abuse and existential threat, and the embodiment of violation resulting from social rules and the theoretically blinded medical gaze. CONCLUSION A considerable medical investment, apparently conducted in a correct and consistent manner as to diagnostic and therapeutic measures, results in the complete incapacitation of a young physician.
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Clements-Nolle K, Guzman R, Harris SG. Sex trade in a male-to-female transgender population: psychosocial correlates of inconsistent condom use. Sex Health 2008; 5:49-54. [DOI: 10.1071/sh07045] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 10/30/2007] [Indexed: 11/23/2022]
Abstract
Background: Research suggests that because of economic necessity, many male-to-female (MTF) transgender individuals trade sex for money, drugs, housing, and other things they may need. To date, no studies have quantitatively assessed psychosocial correlates of condom use with this population. Methods: We conducted a cross sectional study with 190 MTF transgender individuals involved in sex trade in San Francisco, California. Multivariate logistic regression was used to determine factors independently associated with inconsistent condom use during receptive anal sex with exchange partners. Results: About one fifth of our participants reported inconsistent condom use during receptive anal sex in the past 6 months. In the multivariate model, low self-esteem [adjusted odds ratio (AOR) = 3.09; 95% confidence interval (CI) (1.28, 7.47)], a history of forced sex or rape [AOR = 2.91; 95% CI (1.06, 8.01)], and use of crack-cocaine [AOR = 2.59; 95% CI (1.09, 6.13)] were independently associated with inconsistent condom use. Conclusions: Our findings highlight an urgent need for multilevel risk reduction interventions for MTF transgender individuals involved in sex trade. Such interventions will be most effective if they address the psychosocial context of sexual risk taking by focusing on issues such as low self-esteem, sexual violence, and illicit drug use.
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Tolou-Shams M, Payne N, Houck C, Pugatch D, Beausoleil N, Brown LK. HIV testing among at-risk adolescents and young adults: a prospective analysis of a community sample. J Adolesc Health 2007; 41:586-93. [PMID: 18023788 DOI: 10.1016/j.jadohealth.2007.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 06/01/2007] [Accepted: 06/06/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE Little is known about predictors of human immunodeficiency virus (HIV) testing among sexually active adolescents, who account for a large proportion of new HIV infections. This study sought to determine predictors of HIV testing among a large community-based sample of adolescents in three cities who had recent unprotected sexual intercourse. METHODS Sexually active adolescents (N = 1222) completed baseline and 3-month assessments of sexual behavior, substance use and HIV testing behaviors as part of a larger, multi-site, brief HIV prevention program. RESULTS Approximately half of the adolescents reported having previously been tested for HIV, and of those one third were tested in the next 3 months without a specific intervention. Adolescents who received HIV testing were more likely at baseline to have ever been tested, to have a STI diagnosis, to have not used substances during sex and to have been assertive about condom use with a partner. CONCLUSIONS Health care models encouraging more widespread, universal testing may be an important public health initiative to curb the spread of HIV. Regular HIV screenings provide an opportunity to enhance awareness of behavioral risk and HIV status, as well as provide opportunities for early detection and care.
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Affiliation(s)
- Marina Tolou-Shams
- Bradley Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA
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Bailey SL, Ouellet LJ, Mackesy-Amiti ME, Golub ET, Hagan H, Hudson SM, Latka MH, Gao W, Garfein RS. Perceived risk, peer influences, and injection partner type predict receptive syringe sharing among young adult injection drug users in five U.S. cities. Drug Alcohol Depend 2007; 91 Suppl 1:S18-29. [PMID: 17434267 DOI: 10.1016/j.drugalcdep.2007.02.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 02/14/2007] [Accepted: 02/14/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study examined risk factors for receptive syringe sharing (RSS) during illicit drug injection by persons 15-30 years old in five U.S. cities. METHODS Participants were recruited through street outreach and respondent-driven referrals in Baltimore, Chicago, Los Angeles, New York, and Seattle between May 2002 and January 2004. Surveys of drug use, sexual behaviors, and correlates were administered through audio computer-assisted self-interviews at baseline and, for the subset of participants who enrolled in an HIV/HCV prevention intervention trial, at 3-months and 6-months post-baseline. The proportions of injections involving RSS at baseline and at follow-up were used as outcomes in multivariate models that adjusted for intervention effects. RESULTS At baseline, 54% of 3128 participants reported RSS in the past 3 months. RSS decreased to 21% at 6-months post-baseline for the combined trial arms. Participants were more likely to report RSS if they perceived that their peers were not against RSS and if they injected with sex partners. Lower levels of perceived risk of infection with HIV (baseline, p<.001) or HCV (follow-up, p<.001) through RSS were also significant predictors of greater RSS. CONCLUSIONS Perceived risks, peer influences, and type of injection partner were robust predictors of RSS. Perceived risks and peer influences are particularly amenable to intervention efforts that may prevent RSS in this age group.
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Affiliation(s)
- Susan L Bailey
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, IL, USA
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Lescano CM, Hadley WS, Beausoleil NI, Brown LK, D'eramo D, Zimskind A. A brief screening measure of adolescent risk behavior. Child Psychiatry Hum Dev 2007; 37:325-36. [PMID: 17109222 DOI: 10.1007/s10578-006-0037-2] [Citation(s) in RCA: 17] [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: 11/03/2005] [Accepted: 05/18/2006] [Indexed: 11/30/2022]
Abstract
This study examined the factor structure and reliability of a brief but comprehensive measure, the adolescent risk inventory (ARI), designed to assess adolescent risk behaviors and attitudes. Measures assessing demographics and risk behaviors were administered to 134 youth (ages 12-19) in psychiatric treatment. A confirmatory factor analysis of the four attitude scales (HIV Anxiety, HIV Prevention Self-Efficacy, General Distress, and General Risk) revealed excellent goodness of fit statistics. Exploratory factor analysis of the behavior items revealed three behavior factors (Sex Risk, Abuse/Self-Harm, and Acting Out). The preliminary analysis suggested that all subscales had reasonable internal consistency reliability and appeared to be independent measures, rather than part of a single unitary construct. Differences emerged based on gender, sexual activity status, and trauma history. Exploratory regression analyses revealed that, even when controlling for demographic factors and sex risk attitudes (e.g., HIV Prevention Self-Efficacy), Abuse/self-harm behaviors were highly significantly predictive of sex risk. These analyses suggest that the ARI can be useful in quickly identifying the broad range of risk behaviors found among adolescents with psychiatric disorders.
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Affiliation(s)
- Celia M Lescano
- Department of Psychiatry and Human Behavior, Brown Medical School, Bradley/Hasbro Children's Research Center, Rhode Island Hospital, One Hoppin Street, Suite 204, Providence, RI, 02903, USA,
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Brown LK, Tolou-Shams M, Lescano C, Houck C, Zeidman J, Pugatch D, Lourie KJ. Depressive symptoms as a predictor of sexual risk among African American adolescents and young adults. J Adolesc Health 2006; 39:444.e1-8. [PMID: 16919811 DOI: 10.1016/j.jadohealth.2006.01.015] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 01/17/2006] [Accepted: 01/24/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE To understand the prospective relationship between depressive symptoms and sexual risk behavior among a community sample of African American adolescents. METHODS African American adolescents (n = 415) who participated in a larger multi-site human immunodeficiency virus (HIV) prevention program provided baseline data on demographics, psychosocial context and depressive symptoms. At six-month follow-up, data were collected regarding sexual activity in the past 90 days. Multivariate logistic regression was conducted to determine the prospective relationship between depressive symptoms and proportion of condom use while controlling for relevant demographic and contextual factors. RESULTS The odds that African American adolescents who reported depressive symptoms at baseline would report inconsistent condom use at six-month follow-up was approximately four times greater than that of their peers who did not report depressive symptoms. Older adolescents and females were less likely to use condoms consistently and certain contextual factors, such as less pleasurable expectations about condom use, and living with a partner also heightened HIV/STI risk. CONCLUSIONS Clinicians should assess for depression symptoms in African American adolescent patients as an indicator of future sexual risk. Prevention interventions that address depressed mood could have a significant impact on later HIV/STI sexual risk behaviors. Further research is needed to understand the effect of depressive symptoms on sexual risk among adolescents of other race/ethnicities and to examine the potential cultural forces that affect this relationship.
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Affiliation(s)
- Larry K Brown
- Department of Child and Adolescent Psychiatry, Bradley/Hasbro Children's Research Center, Rhode Island Hospital and Brown Medical School, Providence, Rhode Island 02903, USA.
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