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Edelman N, Whetham J, Cassell J, de Visser R, Mercer C, Jones C, Gersten A, Bremner S. Performance of a tool to identify different types of self-reported sexual risk among women attending a contraception and sexual health clinic: results of a cross-sectional survey. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:117-128. [PMID: 32499381 PMCID: PMC8053341 DOI: 10.1136/bmjsrh-2019-200482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION A clinical prediction rule (CPR) using psychosocial questions was previously derived to target sexual healthcare in general practice by identifying women at risk of unintended pregnancy (UIP) and sexually transmitted infections (STIs). This psychosocial CPR may help target resources within contraception and sexual health (CASH) services. This study investigated how well it predicted recent self-reported risk of UIP and STI acquisition among women attending a CASH clinic. METHODS Female patients aged 16-44 years attending a CASH clinic in South-East England were offered a questionnaire on arrival. This comprised psychosocial questions, and others addressing three sexual risks: (1) two or more male sexual partners in the last year (2+P), (2) risk of STI acquisition through most recent partner and (3) risk of UIP in the last 6 months. A CPR score was calculated for each participant and cross-tabulated against self-report of each sexual risk to estimate CPR sensitivity and specificity. RESULTS The psychosocial questions predicting 2+P had sensitivity 83.2% (95% CI 79.3% to 86.5%) and specificity 56.1% (95% CI 51.3%-60.6%). Those predicting combined 2+P and/or risk of STI acquisition through most recent partner had a sensitivity of 89.1% (95% CI 85.7%-91.8%) and specificity of 43.7% (95% CI 39.0%-48.5%). Questions predicting risk of UIP in the last 6 months had a sensitivity of 82.5% (95% CI 78.6%-86.0%) and specificity of 48.3% (95% CI 43.4%-53.1%). CONCLUSIONS The CPR demonstrated good sensitivity but low specificity, so may be suited to triaging or stratifying which interventions to offer CASH patients and by which mode (eg, online vs face-to-face). Further investigation of causal links between psychosocial factors and sexual risk is warranted to support development of psychosocial interventions for this patient group.
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Affiliation(s)
- Natalie Edelman
- School of Health Sciences, University of Brighton, Brighton & Hove, UK
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | - Jennifer Whetham
- Claude Nicol Centre, Brighton & Sussex University Hospitals Trust, Brighton and Hove, UK
| | - Jackie Cassell
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | | | - Catherine Mercer
- Centre for Population Research in Sexual Health and HIV, University College London, London, UK
| | - Christopher Jones
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | | | - Stephen Bremner
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
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Edelman NL, Cassell JA, Mercer CH, Bremner SA, Jones CI, Gersten A, deVisser RO. Deriving a clinical prediction rule to target sexual healthcare to women attending British General Practices. Prev Med 2018; 112:185-192. [PMID: 29719219 DOI: 10.1016/j.ypmed.2018.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/24/2018] [Accepted: 04/28/2018] [Indexed: 10/17/2022]
Abstract
Some women attending General Practices (GPs) are at higher risk of unintended pregnancy (RUIP) and sexually transmitted infections (STI) than others. A clinical prediction rule (CPR) may help target resources using psychosocial questions as an acceptable, effective means of assessment. The aim was to derive a CPR that discriminates women who would benefit from sexual health discussion and intervention. Participants were recruited to a cross-sectional survey from six GPs in a city in South-East England in 2016. On arrival, female patients aged 16-44 years were invited to complete a questionnaire that addressed psychosocial factors, and the following self-reported outcomes: 2+ sexual partners in the last year (2PP) and RUIP. For each sexual risk, psychosocial questions were retained from logistic regression modelling which best discriminated women at risk using the C-statistic. Sensitivity and specificity were established in consultation with GP staff. The final sample comprised N = 1238 women. 2PP was predicted by 11 questions including age, binge-drinking weekly, ever having a partner who insulted you often, current smoking, and not cohabiting (C-statistic = 0.83, sensitivity = 73% and specificity = 77%). RUIP was predicted by 5 questions including sexual debut <16 years, and emergency contraception use in the last 6 months (C-statistic = 0.70, sensitivity = 69% and specificity = 57%). 2PP was better discriminated than RUIP but neither to a clinically-useful degree. The finding that different psychosocial factors predicted each outcome has implications for prevention strategies. Further research should investigate causal links between psychosocial factors and sexual risk.
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Affiliation(s)
- N L Edelman
- Brighton & Sussex Medical School, United Kingdom; University of Brighton, United Kingdom.
| | - J A Cassell
- Brighton & Sussex Medical School, United Kingdom
| | - C H Mercer
- University College London, United Kingdom
| | - S A Bremner
- Brighton & Sussex Medical School, United Kingdom
| | - C I Jones
- Brighton & Sussex Medical School, United Kingdom
| | - A Gersten
- Pavilion General Practice, United Kingdom
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Ghobadzadeh M, Sieving RE, Gloppen K. Positive Youth Development and Contraceptive Use Consistency. J Pediatr Health Care 2016; 30:308-16. [PMID: 26481270 DOI: 10.1016/j.pedhc.2015.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/17/2015] [Accepted: 08/31/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Understanding protective factors associated with adolescent contraceptive use can guide strategies to prevent unprotected sex and its consequences. The current study investigated associations between a set of protective factors, specifically indicators of positive youth development, and consistency of contraceptive use. METHOD This cross-sectional study examined relationships between positive youth development indicators and consistency of contraceptive use among sexually active adolescent girls at elevated risk for pregnancy. Multivariate models assessed whether measures of individual attributes, social attachments, and social norms were associated with consistent condom and hormonal contraceptive use. RESULTS Adolescents with higher self-esteem and greater family connectedness reported more consistent hormonal contraceptive use. Two factors, stress management skills and perceived peer prosocial norms, were protective for consistent condom use. In contrast, steady partnership status was associated with less consistent condom use. DISCUSSION Findings suggest that interventions targeting protective factors may influence adolescents' contraceptive use, in addition to promoting their healthy development.
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Victor EC, Chung R, Thompson RJ. Identifying Adolescent Patients at Risk for Sexually Transmitted Infections: Development of a Brief Sexual Health Screening Survey. Clin Pediatr (Phila) 2015; 54:878-87. [PMID: 25527529 DOI: 10.1177/0009922814563273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the association between survey responses to health behaviors, personality/psychosocial factors, and self-reported sexually transmitted infections (STIs) to create a brief survey to identify youth at risk for contracting STIs. Participants included 200 racially diverse 14- to 18-year-old patients from a pediatric primary care clinic. Two sexual behavior variables and one peer norm variable were used to differentiate subgroups of individuals at risk of contracting a STI based on reported history of STIs using probability (decision tree) analyses. These items, as well as sexual orientation and having ever had oral sex, were used to create a brief sexual health screening (BSHS) survey. Each point increase in total BSHS score was associated with exponential growth in the percentage of sexually active adolescents reporting STIs. Findings suggest that the BSHS could serve as a useful tool for clinicians to quickly and accurately detect sexual risk among adolescent patients.
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Shlafer RJ, McMorris BJ, Sieving RE, Gower AL. The impact of family and peer protective factors on girls' violence perpetration and victimization. J Adolesc Health 2013; 52:365-71. [PMID: 23299002 PMCID: PMC3579999 DOI: 10.1016/j.jadohealth.2012.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 07/12/2012] [Accepted: 07/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE This study investigates whether family and peer connections and prosocial norms buffer adolescent girls' violence involvement and whether a youth development intervention augments the power of these protective factors in reducing girls' risk for violence. METHODS Data were obtained from 253 13-17-year-olds enrolled in a randomized controlled trial of Prime Time, a youth development intervention offered through urban clinic settings to girls at high risk for pregnancy. Participants completed an audio computer-assisted self-interview survey at baseline and 6, 12, and 18 months after enrollment. Protective factors included scales assessing family and peer connections and prosocial norms. Outcome variables were violence victimization and perpetration scales measured at 18 months. RESULTS Family connections and prosocial norms independently protected girls against violence involvement. Peer prosocial norms also served as a protective buffer against violence perpetration and victimization; however, girls with strong peer connections had higher levels of violence perpetration. Participation in Prime Time augmented the protective effects of family and peer connections on girls' violence victimization but not perpetration. Prime Time participants who had high levels of family connections reported the lowest levels of violence victimization at 18 months. Prime Time participants with strong peer connections trended toward lower levels of violence victimization than other girls. CONCLUSIONS Results suggest that effects of the Prime Time intervention on violence victimization were optimized among high-risk adolescent girls with strong connections to family and peers. The intervention was most potent in preventing violence victimization among girls with strong prosocial connections to family and peers.
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Affiliation(s)
- Rebecca J Shlafer
- Healthy Youth Development-Prevention Research Center, Division of Adolescent Health and Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN 55414, USA.
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Sieving RE, McMorris BJ, Beckman KJ, Pettingell SL, Secor-Turner M, Kugler K, Garwick AW, Resnick MD, Bearinger LH. Prime Time: 12-month sexual health outcomes of a clinic-based intervention to prevent pregnancy risk behaviors. J Adolesc Health 2011; 49:172-9. [PMID: 21783050 PMCID: PMC3143373 DOI: 10.1016/j.jadohealth.2010.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 11/28/2010] [Accepted: 12/02/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic service who are at high risk for pregnancy. This article examines sexual risk behaviors and hypothesized psychosocial mediators after 12 months of the Prime Time intervention. METHODS This study was a randomized controlled trial with 253 girls aged 13-17 years meeting specified risk criteria. Intervention participants were involved in Prime Time programming plus usual clinic services for 18 months, control participants received usual clinic services. The intervention used a combination of case management and peer leadership programs. Participants in this interim outcomes study completed self-report surveys at baseline and 12 months after enrollment. Surveys assessed sexual risk behaviors and psychosocial factors targeted for change by Prime Time. RESULTS At the 12-month interim, the intervention group reported more consistent use of condoms, hormonal contraception, and dual contraceptive methods with their most recent partner as compared with the control group. The intervention group also reported greater stress management skills with trends toward higher levels of prosocial connectedness at school and with family. No between-group differences were noted in psychosocial measures specific to sex and contraceptive use. CONCLUSION Preventing early pregnancy among high-risk adolescents requires multifaceted, sustained approaches. An important research focus involves testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have emphasized a dual approach of building protective factors while addressing risk. Findings suggest that youth development interventions through clinic settings hold promise in reducing pregnancy risk among high-risk youth.
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Affiliation(s)
- Renee E Sieving
- Center for Adolescent Nursing, School of Nursing, University of Minnesota, Minneapolis, MN 55455-0342, USA.
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Sieving RE, Bernat DH, Resnick MD, Oliphant J, Pettingell S, Plowman S, Skay C. A Clinic-Based Youth Development Program to Reduce Sexual Risk Behaviors Among Adolescent Girls. Health Promot Pract 2011; 13:462-71. [DOI: 10.1177/1524839910386011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Multifaceted, sustained efforts are needed to reduce early pregnancy and sexually transmitted diseases among high-risk adolescents. An important area for research is testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have rigorously evaluated a dual approach of building protective factors while addressing risk. This article presents findings from a pilot study of Prime Time, a clinic-based youth development intervention to reduce sexual risk behaviors among girls at risk for early pregnancy. Girls aged 13 to 17 years meeting specified risk criteria were assigned to Prime Time treatment groups. The Prime Time intervention included a combination of case management services and peer leadership groups. Participants completed self-report surveys at baseline, 12 and 18 months following enrollment. At 12 months, the intervention group reported significantly fewer sexual partners than the control group. At 18 months, the intervention group reported significantly more consistent condom use with trends toward more consistent hormonal and dual method use. Dose-response analyses suggested that relatively high levels of exposure to a youth development intervention were needed to change contraceptive use behaviors among adolescents at risk for early pregnancy. Given promising findings, further testing of the Prime Time intervention is warranted.
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Affiliation(s)
| | - Debra H. Bernat
- Florida State University College of Medicine, Tallahassee, FL, USA
| | | | | | | | | | - Carol Skay
- University of Minnesota, Minneapolis, MN, USA
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Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Schootman M, Peipert JF, Cottler LB, Bierut LJ. Type of contraception method used at last intercourse and associations with health risk behaviors among US adolescents. Contraception 2010; 82:549-55. [PMID: 21074019 DOI: 10.1016/j.contraception.2010.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 04/08/2010] [Accepted: 05/10/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study was conducted to examine associations with contraception methods used at last sexual intercourse among US adolescents. STUDY DESIGN Data consisted of sexually active adolescents (9th-12th grade, weighted n=24,638) from the 1999-2007 Youth Risk Behavior Surveillance System (YRBSS). We performed multinomial multivariable logistic regression analyses with condom users at last sexual intercourse as the reference group. RESULTS Males who used alcohol, cigarettes, marijuana and cocaine were more likely to use no method/unsure of method (OR=2.4, CI=1.7-3.4) or rely on withdrawal (OR=2.6, CI=1.5-4.3). Females with six or more sexual partners were more likely to rely on withdrawal (OR=2.9, CI=2.1-3.9) or contraception methods that offer no STI protection [i.e., birth control pills: OR=1.9, CI=1.4-2.5; and depot medroxyprogesterone acetate (DMPA, marketed as Depo-Provera): OR=2.6, CI=1.6-4.2]. Earlier age of sexual debut was also associated with nonuse. CONCLUSION Prevention efforts should focus on at-risk adolescents including substance-using males, females with six or more sexual partners, and those who initiate sexual intercourse at an early age.
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Affiliation(s)
- Patricia A Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, St. Louis, MO 63110, USA.
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