What's age got to do with it? Partner age difference, power, intimate partner violence, and sexual risk in urban adolescents

The Role of Identity and Gender Beliefs in Self-Identification of Abuse for Male Victims of IPV

Men experience numerous barriers in seeking help or resources after intimate partner violence (IPV) victimization, with one barrier being a reluctance or lack of ability to identify that they have been victims of IPV. This study examines factors relating to male victims of IPV self-identification of abuse. Using a gender socialization approach, demographics and facets of masculine honor ideology were tested to see whether they were significantly related to self-identifying as experiencing abuse in their relationship. Using a sample of 289 men, the frequency of individuals who self-identified as someone who had been in an abusive relationship was compared to the number of individuals who indicated IPV victimization on the Revised Conflict Tactics Scale (CTS2), and percentages of correct identification were calculated. In addition, a binary logistic regression was run to examine factors that were related to someone identifying as a victim of IPV compared to those that were not. When directly asked if they had ever experienced abuse in a romantic relationship, a total of 41 (14.2%) men self-identified as having been a victim of IPV. However, when examining scores on the CTS2, 69 (23.9%) reported some sexual IPV, 201 (69.6%) indicated psychological abuse, and 59 (20.4%) indicated physical abuse. Subscales of the Masculine Honor Belief Scale were not found to have a significant relationship with self-identification, but differences were found among types of IPV and demographics. Specifically, men who identify as LGBTQ+ were significantly more likely to identify when they experienced IPV victimization. Barriers to male self-identification and treatment are discussed.

Adolescents and sexual assault: A critical integrative review

Adolescents are sexually assaulted at remarkably high rates. Adolescents are also unique given the specific dynamics of adolescent sexual assault, their current stage in human development, their limited legal standing and rights, and their experiences navigating postassault services and resources. While literature exists within each of these domains, it is somewhat disconnected and overlooks how adolescents are often relegated to the margins in research and practice. The purpose of this integrative review is to (1) provide a more complete understanding of adolescent sexual assault and survivors' nuanced needs; (2) frame adolescent survivors as a too-often-overlooked oppressed group that researchers and responders must consider and center in their work, lest contribute to their further marginalization; and (3) inspire and orient social justice-minded scholar activists to various action steps to take to center and prioritize adolescents in research and practice. Through our intersectional feminist approach, we offer specific action steps for social justice-minded scholar activists to recenter adolescents in their research and practice.

Femicides and Victim's age-Associated Factors in Peru

Background. Femicides are an increasing social problem worldwide. In this study, we aim to describe the trend of femicides in the prepandemic decade and characterize the femicide victims and their perpetrators. Methods. We assessed the trend of femicides in Peru during 2010-2019 and performed a cross-sectional study to analyze the femicides reported in 2019 using open data. Results. We analyzed 166 femicides reported in 24/25 regions of Peru in 2019 and calculated a yearly incidence of 1.01 femicides per 100,000 women. This incidence level represents an increase of 38% compared to the mean annual incidence from 2010 to 2018 (0.74 femicides per 100,000 women). Most femicides occurred in urban areas (64%), through strangling/asphyxiation (25.9%), stabbing (23%), and shooting (16%). Most victims were mothers (61%) 30 years old or over (51%). Most perpetrators have had a partner history with their victims (69%), 30 years old or over (62%), employed (57%), and consumed enablers (51%). Our regression analysis observed that the victim's age was associated with the perpetrator's age and partner history. Conclusions. Femicides are endemic in Peru, and the main characteristics of the victims and their perpetrators offer opportunities for tackling this social problem in Peru and similar low- to middle-income countries.

Alday A, Jay J. Aurellano A, Raven R. Escala S, Ermelo V. Hernandez P, Esrom P. Matienzo J, Marian R. Panaguiton K, Charmaine C. Tan A, Zsila Á. Minority Stressors and Attitudes Toward Intimate Partner Violence Among Lesbian and Gay Individuals

Sexual minority individuals experience more intimate partner violence (IPV) than those in heterosexual relationships. Issues of mistrust, stigma, and anticipation of abuse contribute to these rates. Lesbian and gay IPV victims have distinct experiences from their abuses with exposure to homophobia, heterosexism, discrimination, and threats of sexual disclosure, among others. These unique and additive minority stressors can lead to adverse health concerns, increase vulnerability to victimization, and elevate abuse perpetration. This study aimed to investigate whether experiences of minority stressors are associated with attitudes toward intimate partner violence among a sample of 240 lesbian and gay Filipinos (155 lesbian and 85 gay participants) aged 20 to 40. Through convenience sampling, lesbian and gay Filipinos completed the Sexual Minority Stress Scale (SMSS) and Intimate Partner Violence Attitude Scale-Revised (IPVAS-Revised). Comparing the minority stressors levels among the participants, lesbians expressed higher expectations of rejection, while gay men experienced more sexual minority adverse events. Lesbians also reported higher satisfaction with outness. Regarding IPV, gay men expressed slightly more favorable attitudes toward abuse, which could make them at risk of becoming victims or perpetrators. Internalized homophobia was associated with more favorable attitudes toward abuse and control, indicating its contribution to more favorable IPV attitudes, although the explanatory power was modest.

It Ain't Over Till It's Over?: Correlates of Post-Separation Abuse Among Unmarried Women in the Republic of Korea

This study investigates the correlates of post-separation abuse among unmarried women in the Republic of Korea (n = 744). The study employs a logistic regression model to consider if prior intimate partner violence victimization, relationship characteristics, and separation characteristics are associated with post-separation abuse. The results showed that experiencing coercive control by the former partner during the relationship, initiating the separation, and having a lower income than her former partner's income increased the odds of post-separation abuse. The findings imply that programs designed to prevent victimization or enhance victims' safety need to consider broader relationship and separation contexts.

Directionality of Dating Violence Among High School Youth: Rates and Correlates by Gender and Sexual Orientation

Sexual minority adolescents are at greater risk for experiencing teen dating violence (TDV) in their dating relationships. Although adolescents in dating relationships often report experiencing and perpetrating various forms of TDV, the directionality of TDV based on youth's reported gender and sexual orientation is not known. A sample of 10th-grade students (N = 1,622) recruited from high schools in the Northeastern United States completed assessments of TDV victimization and perpetration and reported their past-month heavy alcohol use and marijuana use. Sexual minority girls (58%) and boys (36%) were more likely to experience TDV than heterosexual girls (38%) and boys (25%), respectively. Sexual minority boys were less likely, although the confidence intervals included one, to engage in dual-role physical TDV (odds ratio [OR] = 0.14, 95% confidence interval [CI] [0.00, 1.26]) and threatening TDV (OR = 0.14, 95% CI [0.00, 1.02]), and instead were more likely to be victimized. In contrast, the profiles of TDV were similar for girls, with sexual minority girls only being more likely than heterosexual girls to report dual-role physical TDV (OR = 2.23, 95% CI [1.07, 4.66]). Compared with unidirectional TDV, bidirectional TDV was significantly associated with sexual minority girls' substance use, but not with heterosexual girls' substance use. Sexual minority youth report higher rates of TDV, with sexual minority boys being distinctly at-risk for being victimized within their dating relationships. Engagement in both TDV victimization and perpetration was distinctly associated with substance use for sexual minority girls, highlighting the need for integrated prevention efforts and support.

Association of HIV Intervention Uptake With HIV Prevalence in Adolescent Girls and Young Women in South Africa

IMPORTANCE

In South Africa, adolescent girls and young women aged 15 to 24 years are among the most high-risk groups for acquiring HIV. Progress in reducing HIV incidence in this population has been slow.

OBJECTIVE

To describe HIV prevalence and HIV risk behaviors among a sample of adolescent girls and young women and to model the association between exposure to multiple or layered interventions and key HIV biological and behavioral outcomes.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional survey was conducted between March 13, 2017, and June 22, 2018, in 2 districts in Gauteng province and in 2 districts in KwaZulu-Natal province in South Africa. A stratified cluster random sampling method was used. Participants included adolescent girls and young women aged 12 to 24 years who lived in each sampled household. Overall, 10 384 participants were enrolled in Gauteng province and 7912 in KwaZulu-Natal province. One parent or caregiver was interviewed in each household. Data analysis was performed from March 12, 2021, to March 1, 2022.

EXPOSURES

DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe)-like interventions.

MAIN OUTCOMES AND MEASURES

The primary outcome was HIV prevalence. HIV status was obtained from laboratory-based testing of peripheral blood samples. Secondary outcomes included HIV testing and antiretroviral therapy uptake as well as numerous HIV risk variables that the DREAMS program sought to improve, such as pregnancy, sexually transmitted infection, intimate partner violence, and age-disparate sex.

RESULTS

The final sample included 18 296 adolescent girls and young women (median [IQR] age, 19 [15-21] years) in 10 642 households. Approximately half of participants (49.9%; n = 8414) reported engaging in sexual activity, and 48.1% (n = 3946) reported condom use at the most recent sexual encounter. KwaZulu-Natal province had a higher HIV prevalence than Gauteng province (15.1% vs 7.8%; P < .001). Approximately one-fifth of participants (17.6%; n = 3291) were not exposed to any interventions, whereas 43.7% (n = 8144) were exposed to 3 or more interventions. There was no association between exposure to DREAMS-like interventions and HIV status. Adolescent girls and young women who accessed 3 or more interventions were more likely to have undergone HIV testing (adjusted odds ratio, 2.39; 95% CI, 2.11-2.71; P < .001) and to have used condoms consistently in the previous 12 months (adjusted odds ratio, 1.68; 95% CI, 1.33-2.12; P < .001) than those who were not exposed to any interventions.

CONCLUSIONS AND RELEVANCE

Results of this study suggest that self-reported exposures to multiple or layered DREAMS-like interventions were associated with favorable behavioral outcomes. The beneficial aspects of layering HIV interventions warrant further research to support the sexual and reproductive health of adolescent girls and young women.

Addressing Adolescent Relationship Abuse in the Context of Reproductive Health Care

Adolescent relationship abuse (ARA) is a significant public health issue that includes physical, sexual, psychological and cyber abuse, reproductive coercion, and/or sexual exploitation within an intimate relationship in which one or both partners is a minor. ARA is associated with numerous negative outcomes that include all domains of health. Many negative outcomes of ARA are related to reproductive and sexual health (RSH); thus, reproductive health care providers must be equipped to recognize and address ARA. This article will review the epidemiology and outcomes of ARA, followed by a discussion of means to robustly address ARA in health care settings. We recommend a strengths-based approach that promotes healthy adolescent relationships, connects adolescents experiencing ARA to harm reduction resources, and equips adolescents to serve as a resource for their peers.

Understanding the Psychological Impacts of Teenage Pregnancy through a Socio-ecological Framework and Life Course Approach

The relationship between mental health and teenage pregnancy is complex. Mental health can be both an antecedent and contributing factor to teenage pregnancy and a concurrent factor wherein pregnancy itself can contribute to depression. Expectant and parenting teens (EPT) are faced with the simultaneous challenges of pregnancy and parenting while navigating the developmental tasks of adolescence which increases their risk for mental health problems. In addition, adolescents growing up in stressful community or home situations where their parents experienced depression, further places them and their children at greater risk of repeated patterns over time. However, adverse mental health outcomes are not inevitable. The socio-ecological model combined with a life course perspective provides a framework for understanding the complexity of risk and protective factors at multiple levels that influence knowledge, attitudes, behaviors, and other health outcomes later in life and across generations. This approach has important implications for reducing adolescents' risk of an unintended/mistimed pregnancy and improving mental health and other outcomes for EPT. This paper describes the prevalence of mental health problems in EPT and using a socio-ecological framework and life course perspective explains variations in mental health outcome among EPT. Implications for interventions and innovative approaches are also discussed.

Correlates of intimate partner violence among adolescents in East Africa: a multi-country analysis

Introduction

intimate partner violence (IPV) is a global concern not only among adults but also adolescents. It has been reported that 35% of adolescent women have ever experienced IPV - occuring more so in non-industrialized countries. This study sought to understand the correlates associated with experiencing IPV among adolescent women between the ages 15 and 24 in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda.

Methods

this was a secondary analysis of Demographic and Health Survey (DHS) data on adolescent women aged 15-24 years in five East African countries. IPV was measured as a composite variable of emotional, physical, and sexual violence. Other sociodemographic, income, maternal, sexual, knowledge, behavioral, and partner-related variables were included in the analysis.

Results

the prevalence of ever experiencing IPV was 45.1% (n=2380). A higher proportion of women who reported experiencing IPV had their first sexual encounter when they were less than 18 years of age (p<0.001). The adjusted odds ratio (aOR) of experiencing IPV increased almost two times for women who were aged 18-24 years (aOR: 1.7; CI: 1.3-2.3), almost four times (aOR 3.8; CI: 1.7-8.3) for those who had two or more children, and two-fold for women who had ever terminated a pregnancy compared to those who had not (aOR 2.2; CI: 1.0-4.9). Additionally, there was a higher odds (aOR: 1.5 (1.0-2.3)) of experiencing IPV if the respondent believed their husband/spouse´s abuse was justified.

Conclusion

raising early awareness and educating both the young males and females appropriately to mitigate contributing factors to IPV could ensure stable, healthy relationships free of domestic violence in the future.

Trends and correlates of HIV prevalence among adolescents in South Africa: evidence from the 2008, 2012 and 2017 South African National HIV Prevalence, Incidence and Behaviour surveys

BACKGROUND

Adolescents are at increased risk of HIV infection compared to other age groups. There is an urgent need for strategic information that will inform programmes to reduce risk and vulnerability to HIV and reverse the pattern of increasing HIV infection as they transition to adulthood. This paper analysed trends and factors associated with HIV prevalence among adolescents in South Africa using the national HIV population-based household surveys conducted in 2008, 2012 and 2017.

METHODS

All three surveys used a multistage cross-sectional design. A trend analysis was conducted to assess the differences in HIV prevalence and covariates overtime using P-trend Chi-squared statistic. Univariate and multivariate logistic regression models were used to determine factors associated with HIV prevalence.

RESULTS

Overall there was a significant increase in HIV prevalence among adolescents aged 12-19 years from 3.0% (n = 2892) in 2008 to 3.2% (n = 4829) in 2012 and 4.1% (n = 3937) in 2017 (p = 0.031). The odds of being HIV positive among adolescents aged 12-19 years was significantly higher among females [AOR = 2.24; 95% CI (1.73-2.91); p < 0.001] than males, those residing in KwaZulu-Natal province [AOR = 2.01; 95% CI (1.-3.99); p = 0.027] than Northern Cape, and those who did not attend an educational institution and were unemployed [AOR = 2.66; 95% CI (1.91-3.67); p < 0.001] compared to those attending an educational institution. The odds were significantly lower among Whites [AOR = 0.29; 95% CI (0.09-0.93); p = 0.037], Coloureds [AOR = 0.21; 95% CI (0.11-0.37); p ≤ 0.001] and Indian/Asian [AOR = 0.08; 95% CI (0.02-0.34); p = 0.001] population groups than Black Africans.

CONCLUSION

The observed increasing trend and gender disparities in HIV prevalence suggests an urgent need for age appropriate and gender specific HIV interventions tailored and targeted at identified drivers of HIV infection among adolescents.

The gender symmetry problem in physical teen dating violence: A commentary and suggestions for a research agenda

Dating violence is a serious manifestation of harmful behaviour during adolescence. During the past decades, considerable research has shed light on patterns, causes, and consequences of dating violence. One of the most notable findings emerging from widely used survey instruments is that female adolescents report perpetrating physical dating violence more or equally frequently as male adolescents. Similarly, male youth appear to equally frequently report that they have been victims of physical dating violence as female adolescents. This commentary reviews issues emerging from the debate on gender symmetry in dating violence and proposes directions for future research. It suggests that future research needs to consider three interrelated issues to advance the field, namely: to improve the understanding of differences in harm, advance the knowledge of gender differences in the short-term dynamics involved in conflict and aggression, and strengthen the evidence base on shared and gender-specific developmental aetiologies of dating violence.

Bayesian semi-parametric spatial modelling of intimate partner violence in Namibia using 2013 Demographic Health Survey Data

BACKGROUND

Intimate partner violence (IPV) is an important public health problem with health and socioeconomic consequences and is endemic in Namibia. Studies assessing risk factors for IPV often use logistic and Poisson regression without geographical location information and spatial effects. We used a Bayesian spatial semi-parametric regression model to determine the risk factors for IPV in Namibia; assess the non-linear effects of age difference between partners and determine spatial effects in the different regions on IPV prevalence.

METHODS

We used the couples' dataset of the 2013-2014 Namibia Demographic and Health Survey (DHS) obtained on request from Measure DHS. The DHS domestic violence module included 2226 women. We generated a binary variable measuring IPV from the questions "ever experienced physical, sexual or emotional violence?" Covariates included respondent's educational level, age, couples' age difference, place of residence and partner's educational level. All estimation was done with the full Bayesian approach using R version 3.5.2 implementing the R2BayesX package.

RESULTS

IPV country prevalence was 33.3% (95% CI = 30.1-36.5%); Kavango had the highest [50.6% (95% CI = 41.2-60.1%)] and Oshana the lowest [11.5% (95% CI = 3.2-19.9%)] regional prevalence. IPV prevalence was highest among teenagers [60.8% (95% CI = 36.9-84.7%)]). The spatial semi-parametric model used for adjusted results controlled for regional spatial effects, respondent's age, age difference, respondent's years of education, residence, wealth, and education levels. Women with higher education were 50% less likely to experience IPV [aOR: 0.46, 95% CI = 0.23-0.87]. For non-linear effects, the risk of IPV was high for women ≥ 5 years older or ≥ 25 years younger than their partners. Younger and older women had higher risks of IPV than those between 25 and 45 years. For spatial variation of IPV prevalence, northern regions had low spatial effects while western regions had very high spatial effects.

CONCLUSION

The prevalence of IPV among Namibia women was high especially among teenagers, with higher educational levels being protective. The risk of IPV was lower in rural than urban areas and higher with wide partner age differences. Interventions and policies for IPV prevention in Namibia are needed for couples with wide age differences as well as for younger women, women with lower educational attainment and in urban and western regions.

Predictors of Sexual Violence Across Young Women's Relationship Histories

The goal of the current study was to identify risk factors that predict sexual intimate partner violence (IPV) victimization across young women's relationship histories, within a socioeconomically diverse sample recruited from a university, a 2-year college, and community organizations serving low-income young women. We interviewed 148 young women aged 18 to 24 years about partner victimization (physical IPV, coercive control, and sexual IPV) within each of their relationships (up to four relationships, beginning with their first; 388 in total). We used the life history calendar to structure the interviews and obtain detailed information about each relationship, including age difference between participants and their partners, and relationship length. We used multilevel modeling to examine primary caregiver highest grade completed (an indicator of socioeconomic status [SES]), participant age, age difference, relationship length, setting, and physical IPV/coercive control as predictors of sexual IPV during their first relationship and across Relationships 1 to 4. Sexual IPV during participants' first relationship was inversely associated with SES and age, and positively associated with physical IPV/coercive control; 2-year college and community participants reported lower rates of sexual IPV during the first relationship, compared with university participants. The trajectory of sexual IPV across Relationships 1 to 4 declined among university participants and increased among 2-year college participants; age difference and physical IPV/coercive control positively covaried with sexual IPV across Relationships 1 to 4. Low SES, young age, large age difference, and the presence of physical IPV and coercive control may be risk factors for sexual IPV victimization within adolescent relationships. Sexual violence prevention and intervention approaches should incorporate these risk factors, and be designed to reach an increasingly socioeconomically diverse population across a variety of settings, to be effective.

Attitudes Toward Intimate Partner Violence in Dyadic Perspective: Evidence From Sub-Saharan Africa

Although intimate partner violence (IPV) is inherently a relational event shaped by couple-level factors, most empirical examinations of IPV-related attitudes have used individuals as the unit of analysis. We apply a dyadic perspective to the study of attitudes about the acceptability of IPV, harnessing couple-level data from 33 countries in sub-Saharan Africa, a region characterized by particularly high levels of both the incidence and acceptance of IPV. We document considerable geographic heterogeneity in the distribution of attitudinal concordance or discordance regarding the acceptability of IPV within couples, a descriptive finding that is overlooked by studies focused on individuals as the unit of analysis. In addition, applying a dyadic perspective to the correlates of attitudinal concordance, we demonstrate that joint exposure to schooling, work, and media is more predictive of joint rejection of IPV than are singular exposures of wives or husbands. Finally, we show that distinct combinations of attitudes within couples are associated with differential likelihoods of wives reporting having recently experienced emotional, physical, or sexual IPV. In particular, when both partners reject IPV, wives are significantly less likely to report experiencing each type of IPV in the past year compared with any other combination of attitudes. Our results reveal that a dyadic perspective provides a comprehensive understanding of intracouple contexts that enhances our perspective on these important demographic outcomes.

The Influence of Demographic, Relational, and Risk Asymmetries on the Frequency of Intimate Partner Violence in Young Adulthood

Social characteristics are prominent factors in mate selection, but they can be risk factors for intimate partner violence. Yet this prior work is limited, as it largely focuses on demographic differences (or asymmetries) between intimate partners. In addition to demographic asymmetries, we explored how differences in relational and risk behaviors were associated with intimate partner violence. Examining data from the Toledo Adolescent Relationships Study (TARS) (n=828), we found that either partner's unemployment is associated with greater frequency of relationship violence; and, compared to same-race relationships, interracial relationships reported higher frequency of partner violence. Additionally, relationships in which men compared to their partners were more invested, were characterized by lower frequency of violence. Relationships characterized by any asymmetry in power, compared to those in which both partners held equal power, were also characterized by higher frequency of partner violence. Relationships in which the female partner was more successful at school or work compared to the male partner were associated with more frequent partner violence. Lastly, compared to relationships in which neither partner engaged in antisocial/criminal activity, those in which the male, but not female partner was antisocial/criminal and those in which both partners engaged in antisocial/criminal activity reported greater frequency of partner violence. These findings highlighted the importance of considering different types of asymmetries for understanding intimate partner violence in young adult relationships.

The “dating game”: age differences at first sex of college students in Italy

Researchers have devoted much attention both to the analysis of the first sexual experience and to how the couple was established, but little is still known about age differences of partners at their first sexual relationship. The availability of two highly comparable waves of a survey on the sexual behavior of college students in Italy (SELFY—Sexual and Emotional LiFe of Youth) carried out in 2000 and 2017 allowed us to study the predictors of age differences between partners at first sex, filling the existing gap on recent research. Results of multivariate analyses show important gender differences on mate selection: women tend to choose an older partner for having their first sexual experience and are less likely as men to be involved in age discordant first sex relationships with a younger partner. Age gaps between partners also influence age at sexual debut, which tends to occur earlier in a relationship with an older partner and later if having first sex with a younger partner. Another important predictor of the age gap is the type of relationship that linked the respondent to its partner at first sex. Our estimations indicate a lower likelihood of having had an older first sex partner for students who had their first sexual experience with the own boy/girl-friend or with a friend compared to those who have had it with a stranger. Finally, we have found a higher likelihood of first sex relationships among same-age partners relative to older partners through SELFY waves and small changes on variables influencing such relationships.

Spatial analysis of individual- and village-level sociodemographic characteristics associated with age at marriage among married adolescents in rural Niger

Background

Niger has the highest prevalence of child marriage in the world. While child marriage in Niger is clearly normative in the sense that it is commonly practiced, the social and contextual factors that contribute to it are still unclear.

Methods

Here, we tested the importance of village-level factors as predictors of young age at marriage for a group of married adolescent girls (N = 1031) in the Dosso district of rural Niger, using multi-level and geographic analyses. We aggregated significant individual level factors to determine whether, independent of a girl’s own sociodemographic characteristics, the impact of each factor is associated at the village level. Finally, we tested for spatial dependence and heterogeneity in examining whether the village-level associations we find with age at marriage differ geographically.

Results

The mean age of marriage for girls in our study was 14.20 years (SD 1.8). Our statistical results are consistent with other literature suggesting that education is associated with delayed marriage, even among adolescent girls. Younger ages at marriage are also associated with a greater age difference between spouses and with a greater likelihood of women being engaged in agricultural work. Consistent with results at the individual level, at the village level we found that the proportion of girls who do agricultural work and the mean age difference between spouses were both predictive of a lower age at marriage for individual girls. Finally, mapping age at marriage at the village level revealed that there is geographical variation in age at marriage, with a cluster of hot spots in the Hausa-dominated eastern area where age at marriage is particularly low and a cluster of cold spots in the Zarma-dominated western areas where age at marriage is relatively high.

Conclusions

Our findings suggest that large-scale approaches to eliminating child marriage in these communities may be less successful if they do not take into consideration geographically and socially determined contextual factors at the village level.

Survival analysis and prognostic factors of time to first domestic violence after marriage among Nigeria, Kenya, and Mozambique women

OBJECTIVES

How soon an ever-married woman falls a victim of domestic violence after marriage is not documented in Africa. This study sought to assess the timing of first domestic violence (FDV) against women after marriage and determined the factors associated with the timings in Nigeria, Kenya, and Mozambique.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Data of 29,793 ever-married women of reproductive age consisting of 21,564, 4237 and 3992 from Demographic and Health Survey conducted in Nigeria (2013), Kenya (2014) and Mozambique (2011), respectively, were used. The timing of FDV was the time interval between marriage date and date of the FDV for those with reported violence but censored as the time interval between marriage date and the survey date for those without domestic violence. Survival analysis techniques were used to assess the timing and the factors influencing the timing at (P = 0.05).

RESULTS

The lifetime prevalence of domestic violence among the ever-married women in Nigeria, Kenya and Mozambique was 15.4%, 39.0% and 31.0%, respectively. The overall median time to FDV was 3 years. The risk of FDV was twice higher in Kenya (adjusted hazard ratio (aHR) = 1.934; 95% confidence interval (CI): 1.729-2.132) and 15% higher in Mozambique (aHR = 1.156; 95% CI: 1.156-1.223) than in Nigeria. The hazard of domestic violence was significantly higher among separated/divorced women across the three countries (aHR = 1.326; 95% CI: 1.237-1.801). Other factors associated with the timing of FDV against women were respondents' education, age at first marriage, region and location of residence, religion, ethnicity, employment status, wealth quintile, spouse consuming alcohol and husbands' educational attainment.

CONCLUSIONS

Domestic violence against married women by their intimate partners is prevalent across Mozambique, Nigeria and Kenya, with earlier occurrences in Kenya and Mozambique. Age at first marriage, education factors, religion, ethnicity and region of residence in each country affected the timing of the first incidence of domestic violence.

Sexual mixing in opposite-sex partnerships in Britain and its implications for STI risk: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Background

The extent to which individuals are similar to their sexual partners influences STI-transmission probabilities, yet there is a dearth of empirical data, especially those representative of the population.

Methods

Analyses of data reported by 10 759 sexually active people aged 16–74 y interviewed for a British national probability survey undertaken in 2010–12. Computer-assisted self-interviews asked about partner numbers and characteristics of participants’ three most recent partnerships (MRPs). Opposite-sex MRPs were weighted to represent all such partnerships in the past year (N = 16 451). Estimates of disassortative age mixing (≥±5-y difference), ethnic mixing (partner of a different ethnic group) and geographical mixing (partner from a different region/country when they first met) were calculated, stratified by gender, age group and partnership status (casual/steady). Multivariable regression examined how these disassortative mixing measures were associated with STI-risk measures: condom use at first sex together at the partnership-level and, at the participant-level, STI-risk perception and reporting STI diagnoses.

Results

Disassortative age mixing occurred in around one-third of opposite-sex partnerships, with men ≥5 y older in most cases, although this proportion varied by participant’s gender and age group. Ethnic mixing occurred less frequently (11.3% of men’s and 8.6% of women’s partnerships) as did geographical mixing (14.1 and 16.3%, respectively). Disassortative mixing was more common among casual vs steady partnerships. Condom use at first sex was less likely in women’s partnerships that were age-disassortative [adjusted odds ratio (AOR): 0.79, 95% confidence interval (CI): 0.69–0.95], whereas men reporting disassortative ethnic mixing were more likely to perceive themselves at STI risk (AOR: 1.76, 95% CI: 1.23–2.52) and report STI diagnoses (AOR: 2.37, 95% CI: 1.22–4.59).

Conclusions

Disassortative mixing, although uncommon among opposite-sex partnerships in Britain, is independently associated with STI risk, warranting consideration in STI-prevention efforts.

Risk Markers for Physical Teen Dating Violence Victimization in the United States: A Meta-Analysis

Teen dating violence is a serious health concern in the United States. The goal of this study was to synthesize the current knowledge of risk markers for physical teen dating violence victimization through the use of a meta-analysis. A total of 50 studies, yielding 221 unique effect sizes, met the inclusion criteria for the analysis. Using Dutton's nested ecological model as a framework, a total of 29 risk markers for physical teen dating violence victimization were examined. There were enough effect sizes found to be able to examine 18 risk markers in the ontogenetic system, nine risk markers in the microsystem, and two risk markers in the exosystem. The results indicated that the strongest risk markers located in the ontogenetic system were substance use, risky sexual behaviors, having carried a weapon, suicide attempts, and disordered eating. The strongest risk markers found in the adolescents' microsystem were related to other forms of teen dating violence perpetration and victimization (i.e., physical dating violence perpetration, sexual dating violence victimization, emotional dating violence victimization). The two risk markers found in the exosystem (neighborhood disorganization and low socioeconomic status) were significant but small in magnitude. This study also compared the strength of 10 risk markers for teen dating violence victimization between male and female adolescents and did not find any significant differences related to gender. Examining which risk markers for physical teen dating violence are the strongest in magnitude can highlight various markers that might help identify adolescents who are being victimized in their romantic relationships and need additional resources.

Evaluating DREAMS HIV prevention interventions targeting adolescent girls and young women in high HIV prevalence districts in South Africa: protocol for a cross-sectional study

BACKGROUND

Young women in sub-Saharan Africa remain at the epicentre of the HIV epidemic, with surveillance data indicating persistent high levels of HIV incidence. In South Africa, adolescent girls and young women (AGYW) account for a quarter of all new HIV infections. Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) is a strategy introduced by the United States President's Emergency Plan for AIDS Relief (PEPFAR) aimed at reducing HIV incidence among AGYW in 10 countries in sub-Saharan Africa by 25% in the programme's first year, and by 40% in the second year. This study will assess the change in HIV incidence and reduction in risk associated behaviours that can be attributed to the DREAMS initiative in South Africa, using a population-based cross-sectional survey.

METHODS

Data will be collected from a household-based representative sample of AGYW (between the ages 12-24 years) in four high prevalence districts (more than 10% of the population have HIV in these districts) in South Africa in which DREAMS has been implemented. A stratified cluster-based sampling approach will be used to select eligible participants for a cross-sectional survey with 18,500, to be conducted over 2017/2018. A questionnaire will be administered containing questions on sexual risk behaviour, selected academic and developmental milestones, prevalence of gender based violence, whilst examining exposure to DREAMS programmes. Biological samples, including two micro-containers of blood and self-collected vulvovaginal swab samples, are collected in each survey to test for HIV infection, HIV incidence, sexually transmitted infections (STIs) and pregnancy. This study will measure trends in population level HIV incidence using the Limiting antigen (LAg) Avidity Enzyme Immuno-Assay (EIA) and monitor changes in HIV incidence.

DISCUSSION

Ending the HIV/AIDS pandemic by 2030 requires the continual monitoring and evaluation of prevention programmes, with the aim of optimising efforts and ensuring the achievement of epidemic control. This study will determine the impact DREAMS interventions have had on HIV incidence among AGYW in a 'real world, non-trial setting'.

Recently formed age-disparate partnerships are associated with elevated HIV-incidence among young women in South Africa

OBJECTIVE

Cross-sectional and cohort studies draw different conclusions on whether age-disparate partnerships increase HIV-acquisition risk for young women. We investigated whether age-disparities were associated with HIV-infection risk early in relationships. This could result in the exclusion of women who seroconverted during high-risk age-disparate partnerships from cohort studies of HIV incidence - which exclude HIV-positive women - and explain null findings in these studies.

DESIGN

Prospective cohort study.

METHODS

We used data on 15-24-year-old, HIV-negative women in heterosexual partnerships (N = 830) in KwaZulu-Natal, South Africa. The association between age-disparate partnering (i.e., male partner ≥5 years older) and subsequent HIV seroconversion was assessed using Cox hazard models. We examined heterogeneity in HIV-acquisition risk by duration of partnership (defined by quartiles) at cohort enrolment.

RESULTS

During 1139 person-years (mean: 1.4 years) of follow-up, 54 (6.5%) women seroconverted, a weighted HIV-incidence estimate of 4.41/100 person-years [95% confidence interval (CI): 3.30-6.06]. HIV-acquisition risk did not differ significantly between women in age-disparate vs. age-similar partnerships (adjusted hazard ratios: 1.10, 95% CI: 0.55-2.21). However, for women in the shortest partnership quartile (<1.09 years) at baseline, risk of HIV seroconversion was higher for women in age-disparate partnerships (adjusted hazard ratios: 3.13, 95% CI: 1.02-9.65, P = 0.047). HIV acquisition was not statistically different by partnership type among women in longer partnerships.

CONCLUSION

The association between age-disparate partnerships and HIV-acquisition risk is evident early in young women's relationships. Results provide a potential explanation for null findings in cohort studies, whose research designs may exclude women in such partnerships, and affirms the elevated risk of HIV acquisition for young women in age-disparate relationships.

The impact of exposure to parental intimate partner violence on adolescent precocious transitions to adulthood

INTRODUCTION

Precocious transitions can create stress by placing excessive demands on adolescents and are associated with adverse outcomes that extend into adulthood. The current study assessed whether exposure to parental intimate partner violence (IPV) is associated with adolescent precocious transitions to adulthood.

METHODS

Data come from 33,360 individuals aged 18+ years in the United States who participated in the National Epidemiologic Surveys of Alcohol and Related Conditions. Six precocious transitions (leaving home early, early sex, early marriage, early parenthood, early full-time employment, and dropping out of high school) were examined. Robust Poisson regression was used to calculate relative risks for the association between IPV exposure and each precocious transition, adjusting for confounders. We assessed effect modification by gender and by exposure to childhood abuse or neglect.

RESULTS

Participants exposed to IPV in childhood were at higher risk of engaging in early sex; dropping out of high school; entering into early full-time employment; entering into early marriage; and entering into early parenthood relative to participants not exposed to IPV. Significant interactions between gender and exposure to IPV were detected for early sex and early full-time work outcomes, such that the associations were stronger for females compared to males. Participants exposed to more frequent or more severe IPV in childhood were at even higher risk for experiencing precocious transitions.

CONCLUSIONS

Individuals exposed to IPV in childhood are more likely to experience precocious transitions to adulthood. Findings highlight the need for interventions to mitigate adverse outcomes in adolescence for children exposed to IPV.

Making a Case for Integrating Evidence-Based Sexual Risk Reduction and Mental Health Interventions for Adolescent Girls

Recently identified as the top concern of teens, mental health issues now compete with sexual health risks as major threats to the well-being of adolescent females. Depression and anxiety can lead to or compound the negative repercussions of sexual behavior choices that result in disproportionately high rates of sexually-transmitted infections (STIs), hetero-sexually acquired HIV, and unplanned pregnancy rates in girls ages 15-19. There are a limited number of CDC- and DHHS-recognized HIV/STI and teen pregnancy evidence-based interventions (EBIs) targeted to adolescent girls of diverse races/ethnicities and none that simultaneously address common mental health disorders. The Health Improvement Project for Teens (HIPTeens), a manualized gender-specific sexual risk reduction intervention, and the Creating Opportunities for Personal Empowerment (COPE) Program, a manualized cognitive-behavioral skills intervention that reduces depression and anxiety, are recognized by national agencies as strong EBIs that have successfully improved their targeted outcomes. Baseline data from the HIPTeens clinical trial revealed that a substantial portion of the more than 700 girls enrolled had moderate to high levels of depressive symptoms as well as other mental health challenges (e.g., binge drinking and eating, cannabis use). Thus, there is an urgent need to combine EBIs, such as HIPTeens and COPE, to curtail these leading public health problems confronting today's adolescents.

Adolescents' Contraceptive Use with School-Discordant Partners: Exploring Individual- and Relationship-Level Characteristics

CONTEXT

Heterosexual adolescents are less likely to use contraceptives when their partners are of different backgrounds or social circles. It is unclear why risky behaviors are more common within these relationships, and characteristics associated with school-discordant partners-that is, partners who do not attend the adolescent's school-are particularly understudied.

METHODS

Characteristics of romantic relationships and contraceptive use were examined among 1,043 female and 961 male respondents in Waves 1 (1994-1995) and 2 (1996) of the National Longitudinal Study of Adolescent to Adult Health. Generalized linear regression and structural equation models identified individual- and relationship-level characteristics that were associated with school-discordant relationships and contraceptive use.

RESULTS

For females, the likelihood of ever having used a condom with a partner was reduced when that partner had not attended her school at the start of the relationship (odds ratio, 0.5) or when he was two or more years older (0.6). Notably, however, having a school- or age-discordant partner was not associated with ever having used hormonal or dual methods for females, or with any contraceptive measures for males. For females, lower emotional intimacy with school-discordant partners was positively associated with ever having used condoms with such partners (1.2).

CONCLUSIONS

Characteristics of school-discordant relationships are correlated with condom use in varying and sometimes countervailing ways. Future research examining the mechanisms linking school discordance to decreased condom use, particularly for females, would deepen understanding of the emotional and psychosocial processes involved in adolescents' sexual and contraceptive behavior.

Coital frequency and condom use in age-disparate partnerships involving women aged 15 to 24: evidence from a cross-sectional study in KwaZulu-Natal, South Africa

OBJECTIVE

This study examines the role of age-disparate partnerships on young women's HIV risk by investigating coital frequency and condom use within age-disparate partnerships involving women aged 15 to 24.

DESIGN

A community-based, cross-sectional study was conducted.

SETTING

Participants were randomly selected using a two-stage random sampling method in uMgungundlovu district, KwaZulu-Natal, South Africa, between June 2014 and June 2015.

PARTICIPANTS

A total of 1306 15-24-year-old women in an ongoing heterosexual partnership were included in the analysis. Participants had to be a resident in the area for 12 months, and able to provide informed consent and speak one of the local languages (Zulu or English).

PRIMARY AND SECONDARY OUTCOME MEASURES

Sexual frequency was assessed by asking participants how many times they had sex with each partner in the past 12 months. The degree of condomless sex within partnerships was assessed in the survey by asking participants how often they used a condom with their partners.

RESULTS

Age-disparate partnerships were associated with a higher order category (once, 2-5, 6-10, 11-20, >20) of coital frequency (adjusted OR (aOR) 1.32, p<0.05, 95% CI 1.02 to 1.71) and with sex on more than 10 occasions (aOR 1.48, p<0.01, 95% CI 1.12 to 1.96) compared with age-similar partnerships. Age-disparate partnerships were also more likely to involve sex on more than 10 occasions with inconsistent condom use (aOR 1.43, p<0.05, 95% CI 1.04 to 1.96) in the previous 12 months.

CONCLUSION

The finding that increased sexual activity is positively associated with age-disparate partnerships adds to the evidence that age-disparate partnerships pose greater HIV risk for young women. Our study results indicate that interventions to reduce risky sexual behaviour within age-disparate partnerships remain relevant to reducing the high HIV incidence rates among adolescent girls and young women.

Age-disparate partnerships and HSV-2 among adolescent girls and young women in South Africa: implications for HIV infection risk

OBJECTIVE

There is an urgent need to understand high HIV-infection rates among young women in sub-Saharan Africa. While age-disparate partnerships have been characterised with high-risk sexual behaviours, the mechanisms through which these partnerships may increase HIV-risk are not fully understood. This study assessed the association between age-disparate partnerships and herpes simplex virus type-2 (HSV-2) infection, a factor known to increase HIV-infection risk.

METHODS

Cross-sectional face-to-face questionnaire data, and laboratory HSV-2 and HIV antibody data were collected among a representative sample in the 2014/2015 household survey of the HIV Incidence Provincial Surveillance System in KwaZulu-Natal, South Africa. Among 15-24-year-old women who reported having ever had sex (n=1550), the association between age-disparate partnerships (ie, male partner ≥5 years older) and HSV-2 antibody status was assessed using multivariable Poisson regression models with robust variance. Analyses were repeated among HIV-negative women.

RESULTS

HSV-2 prevalence was 55% among 15-24-year-old women. Women who reported an age-disparate partnership with their most recent partner were more likely to test HSV-2 positive compared with women with age-similar partners (64% vs 51%; adjusted prevalence ratio (aPR):1.19 (95% CI 1.07 to 1.32, p<0.01)). HSV-2 prevalence was also significantly higher among HIV-negative women who reported age-disparate partnerships (51% vs 40 %; aPR:1.25 (95% CI 1.05 to 1.50, p=0.014)).

CONCLUSIONS

Results indicate that age-disparate partnerships are associated with a greater risk of HSV-2 among young women. These findings point towards an additional mechanism through which age-disparate partnerships could increase HIV-infection risk. Importantly, by increasing the HSV-2 risk, age-disparate partnerships have the potential to increase the HIV-infection risk within subsequent partnerships, regardless of the partner age-difference in those relationships.

HIV Risk Among Adolescent Girls and Young Women in Age-Disparate Partnerships: Evidence From KwaZulu-Natal, South Africa

BACKGROUND

Evidence on the role of age-disparate partnerships in high HIV-infection rates among young women in sub-Saharan Africa remains inconclusive. This study examined the HIV-infection risk associated with age-disparate partnerships among 15- to 24-year-old women in a hyperendemic setting in South Africa.

METHODS

Face-to-face questionnaire, and laboratory HIV and viral load data were collected during 2014-2015 among a representative sample (15-49 years old) in KwaZulu-Natal. The association between age-disparate partnerships (age difference ≥5 years) and HIV status among 15- to 24-year-old women (N = 1459) was assessed using multiple logistic regression analyses. Data from the male sample on all on-going partnerships (N = 1229) involving 15- to 24-year-old women were used to assess whether young women's age-disparate male partners were more likely to have a viral load ≥1000 copies per milliliter, a marker of HIV-infection risk.

RESULTS

Women reporting an age disparity in any of their 3 most recent partnerships were more likely to test HIV positive compared to women with only age-similar partners [adjusted odds ratio (aOR): 1.58, 95% confidence interval (CI): 1.20 to 2.09, P < 0.01]. Among partnerships men reported with 15- to 24-year-old women, the age-disparate male partners were more likely to be HIV positive and have a viral load ≥1000 copies per milliliter (aOR: 2.05, 95% CI: 1.30 to 3.24, P < 0.01) compared with age-similar partners. Results were similar for each category of age disparity: partners 5-9 years older (aOR: 2.01, 95% CI: 1.18 to 3.43, P = 0.010) and those ≥10 years older (aOR: 2.17, 95% CI: 1.01-4.66, P = 0.048).

CONCLUSIONS

Results indicate that age-disparate partnerships increase young women's HIV risk, although conclusive evidence was not ascertained. Interventions addressing risk from age-disparate sexual partnering, including expanding antiretroviral treatment among older partners, may help to reduce HIV incidence among young women.

Violence Exposure and Mental Health of College Students in the United States

Background: Despite the well-established link between exposure to violence and mental health problems, less is known about this association among college students. The current study aimed to investigate the association between history of exposure to violence and mental health of American college students. Methods: Healthy Mind Study (HMS, 2016⁻2017) is a national online survey of 41,898 adult college students. The independent variable was lifetime history of exposure to violence (psychological, physical, and sexual). The dependent variables were anxiety, depression, and suicidality. Race, age, gender, sexual orientation, parental education, financial stress, transfer status, enrollment status, and graduate status were covariates. Linear and logistic regression models were used for data analysis. Results: History of exposure to violence was associated with all three aspects of poor mental health, namely general anxiety, depression, and suicidality. These associations were independent of covariates and type of abuse. Conclusions: There is a need to address various mental health needs of college students who have experienced various forms of violence. College students who screen positive for history of violence exposure should be evaluated for anxiety, depression, and suicidal behaviors.

Exploratory analysis of the ecological variables associated with sexual health profiles in high-risk, sexually-active female learners in rural KwaZulu-Natal

PURPOSE

Young women are at high risk for negative sexual health outcomes. Despite their high risk, many sexually-active women never experience negative sexual health outcomes. This study explored the ecological risk factors associated with the risk profiles of sexually-active female high school-learners in rural KwaZulu-Natal, South Africa.

METHODS

Using baseline data from N = 596 sexually-active school-going women, we explored the ecological factors associated with being sexually-active and managing risk successfully [SARS] or unsuccessfully [SARU]. Generalised estimated equations (GEE) were applied to data collected at multiple levels while adjusting for school and other included variables. GEE were used to calculate probability of being SARU.

RESULTS

Amongst SARU learners, 21.9% had HIV, 38.6% had HSV-2, 12.5% were pregnant, 28.7% self-reported STI symptoms and 51.9% reported a previous pregnancy. Individual-level factors had the greatest impact on being SARU. Univariate and multivariate analysis highlighted several important partner factors associated with SARU. Age was significantly associated with the risk profiles (p<0.0001), a greater proportion of SARU learners were 18 or older compared to the SARS learners. The odds of being SARU decreased when ≥18 years (aOR = 0.2577, 95% CI 0.1462-0.4542) or if not falling pregnant was important (aOR = 0.6343, 95% CI 0.4218-0.9538). Having >1 HIV test (aOR = 2.2161, 95% CI 1.3964-3.5169) increased the odds a SARU profile.

CONCLUSION

Individual and partner level factors are important for the sexual health profile of an adolescent female. While the exploratory findings require further research; managing multiple sexual health outcomes, tailoring responses around a risk profile and including partners is essential for successful interventions.

Spousal age difference and associated predictors of intimate partner violence in Nigeria

Background

The growth in Intimate Partner Violence (IPV) cases among couples in Nigeria has been significant in recent years. Victims, which are often females, face numerous health challenges, including early death. I examined the linkages between spousal age differences and IPV in Nigeria.

Method

The couples recode data section of the 2013 Nigeria Demographic Health and Survey was used (n = 6765). Intimate partner violence was measured using 13-item questions. Data were analyzed using the logistic regression model (α = .05).

Results

The mean spousal age difference was 8.20 ± 5.0 years. About 23.5, 18.0, 13.5 and 4.7% of couples surveyed had experienced some form of IPV, emotional, physical and sexual violence respectively. Also, IPV prevalence was 27.0, 23.7, 22.0 and 18.7% among couples with age differences of 0–4, 5–9, 10–14 and ≥15 years respectively; this pattern was exhibited across all domains of IPV. Among women who experienced physical violence, 20.5% had only bruises, 8.0% had at least one case of eye injuries, sprains and/or dislocations, and 3.7% had either one or more cases of wounds, broken bones or broken teeth. The identified predictors of IPV were: family size, ethnicity, household wealth, education, number of marital unions and husband drinks alcohol. The unadjusted likelihood of IPV was 1.60 (C.I = 1.30–1.98, p < 0.001) and 1.35 (C.I = 1.10–1.64, p < 0.01) higher in households where the spousal age difference was 0–4 and 5–9 years respectively, than the likelihoods among those with a spousal age difference ≥ 15 years, but the strength of the association weakens when other variables were included in the model.

Conclusion

The level of IPV was generally high in Nigeria, but it reduced with increasing spousal age difference. This study underscores the need for men to reach a certain level of maturity before marriage, as this is likely to reduce the level of IPV in Nigeria.

Understanding the "Why" for High-Risk Behavior: Adolescent Girls' Motivations for Sex

Identifying why girls participate in safe and risky sexual behaviors is key to developing successful intervention strategies. This study identified motivations for sex in 738 girls enrolled in the Health Improvement Project for Teens (HIPTeens) randomized controlled trial and analyzed differences in sex motives among at-risk subgroups. Sexually active girls, ages 15-19 years, were recruited from urban community-based settings. Baseline data were collected via audio computer-assisted self-interview surveys including a modified Sex Motives Scale based on six domains (intimacy, enhancement, self-affirmation, coping, peer pressure, and partner approval), assessing drivers of both protective and risk-promoting motivations. Statistically significant motive differences across domains were identified among subgroups with different risk profiles, including mental health issues (depression, drug and alcohol use) as well as demographic group characteristics (race, age, and parental status). Understanding why girls have sex provides an opportunity to address motivation-focused strategies that may augment intervention efficacy.

Contraceptive non-use and emergency contraceptive use at first sexual intercourse among nearly 12 000 Scandinavian women

INTRODUCTION

The aim of this study was to describe recent patterns of contraceptive use at first sexual intercourse and to examine whether selected factors are associated with non-use and emergency contraceptive pill use at first sexual intercourse, among 18- to 26-year-old women from Denmark, Norway and Sweden.

MATERIAL AND METHODS

This was a population-based, questionnaire study of randomly chosen 18- to 26-year-old Scandinavian women. The prevalence of contraception methods used at first sexual intercourse was calculated. Factors associated with contraceptive non-use and emergency contraceptive pill use at first sexual intercourse were determined using log binomial models.

RESULTS

The prevalence of contraceptive non-use and emergency contraceptive pill use was lowest in Denmark (9.6 and 2.1%, respectively) compared with Norway (14.1 and 4.4%) and Sweden (16.6 and 4.5%). The risk of contraceptive non-use increased in women who had first sexual intercourse at or before 14 years of age (13-14 years: prevalence ratio 1.40; 95% confidence interval 1.24-1.58). The risk of both non-use and emergency contraceptive pill use increased when the partner at first sexual intercourse was 20 years or older, and with increasing age difference between the partner and the woman at her first sexual intercourse. Smoking initiation prior to first sexual intercourse increased risk of contraceptive non-use (prevalence ratio 1.70; 95% confidence interval 1.50-1.92), and alcohol initiation prior to first sexual intercourse increased risk of emergency contraceptive pill use at first sexual intercourse (prevalence ratio 1.95; 95% confidence interval 1.49-2.54).

CONCLUSIONS

Contraceptive non-use at first sexual intercourse was strongly associated with early age at first sexual intercourse. Emergency contraceptive pill and contraceptive non-use at first sexual intercourse were both strongly associated with increasing partner age and an increasing difference in age between the woman and her partner. Hence, young women should be educated to negotiate contraceptive use with their partners.

Depression and intimate partner violence among college students in Iran

Intimate partner violence (IPV) is a significant public health threat and causes mental as well as physical health problems. Depression is a common mental health consequence of IPV. While Iran has a high prevalence of IPV and depression, the association between IPV and depression has not been well examined. The Iranian data from the International Dating Violence Study (IDVS) 2001-2006 (ICPSR 29583) were analyzed. Twenty-three male and 75 female college students were selected in the IDVS Iranian data. Nearly all of the participants, male and female, reported being victims and perpetrators of IPV. Female participants were more likely to report depression compared to male participants. Participants who had experienced sexual IPV reported significantly higher levels of depression compared to those who did not experience sexual IPV. However, when substance abuse and partner conflict were analyzed, the contribution of sexual IPV on depression was no longer significant. This study suggests that IPV prevention and intervention programs should take into consideration that college-aged men and women frequently experience and use violence in dating relationships. Depression interventions should be included for female students. Substance abuse and partner conflict are important risk factors for depression.

Relationship Characteristics Associated with Teen Dating Violence Perpetration

Teen dating violence (TDV) is unstable across dating relationships, suggesting that characteristics of the relationship could be related to TDV. Few empirical studies have examined these links. This study examined associations between relationship characteristics and TDV perpetration among teens and sex differences in those associations. Relationship characteristics examined include tactics used to manipulate partners; ways of responding to relationship problems; relationship duration; exclusivity of the relationship; age difference between partners; and history of sexual intercourse with partner. Data were drawn from 667 teens in a current relationship (62.5% female and 81.4% white) enrolled in the 11^th or 12^th grade in 14 public schools in a rural US state. Bivariate and multivariable regression analyses examined proposed associations. 30.1% and 8.2% of teens reported controlling and physical TDV perpetration, respectively. In multivariable models, frequent use manipulation tactics increased risk for controlling or physical TDV perpetration. Teens dating a partner two or more years younger were at significantly increased risk for both controlling and physical perpetration. A significant interaction emerged between sex and exit/neglect accommodation for physical TDV. Characteristics of a current dating relationship play an important role in determining risk for controlling and physical TDV perpetration.

Sexual Behaviour of Men and Women within Age-Disparate Partnerships in South Africa: Implications for Young Women's HIV Risk

Background

Age-disparate partnerships are hypothesized to increase HIV-risk for young women. However, the evidence base remains mixed. Most studies have focused only on unprotected sex among women in the partnership. Consequently, little is known about other risky behaviours, such as transactional sex, alcohol use, and concurrency, as well as the behaviours of the men who partner with young women. We therefore examined differences in various sexual behaviours of both young women and their male partners by partnership age difference.

Methods

We used nationally representative data from South Africa (2012) on partnerships reported by 16–24 year old black African women (n = 818) and by black African men in partnerships with 16–24 year old women (n = 985). We compared sexual behaviours in age-disparate partnerships and age-similar partnerships, using multiple logistic regression to control for potential confounders and to assess rural/urban differences.

Results

Young women in age-disparate partnerships were more likely to report unprotected sex than young women in similar-aged partnerships (aOR:1.51; p = 0.014; 95%CI:1.09–2.11). Men in partnerships with young women were more likely to report unprotected sex (aOR:1.92; p<0.01; 95%CI:1.31–2.81), transactional sex (aOR:2.73; p<0.01; 95%CI:1.64–4.56), drinking alcohol before sex (aOR:1.60; p = 0.062; 95%CI:0.98–2.61), and concurrency (aOR:1.39; p = 0.097; 95%CI:0.94–2.07) when their partners were five or more years younger. The association between age-disparate partnerships and transactional sex (aOR:4.14; p<0.01; 95%CI: 2.03–8.46) and alcohol use (aOR:2.24; p<0.013; 95%CI:1.20–4.19) was only found in urban areas.

Conclusions

Results provide evidence that young women’s age-disparate partnerships involve greater sexual risk, particularly through the risky behaviours of their male partners, with the risk amplified for young women in urban areas.

Teenage intimate partner violence: Factors associated with victimization among Norwegian youths

OBJECTIVE

The aim of the present study was threefold: (1) learn more about factors associated with teenage intimate partner violence (IPV) victimization; (2) explore aspects of digital media use in connection with teenage IPV; (3) and compare the impact IPV victimization has on boys and girls.

METHOD

Survey data from 549 Norwegian students, mean age 15.2 years, who had experience(s) with being in intimate relationship(s), were examined. Experiences with psychological, physical, digital, and sexual violence were analyzed.

RESULTS

In total, 42.9% of the participants had experienced some form of IPV: 29.1% had experienced digital violence; 25.9% had experienced psychological violence; 18.8% had experienced sexual violence; and 12.8% had experienced physical violence. Factors significantly associated with teenage IPV victimization were female gender, older partners, domestic violence, bullying victimization, low academic achievements, and sending sexual messages via digital media. Girls reported to be significantly more negatively impacted by the victimization than boys.

CONCLUSIONS

Some teenagers experience victimization in their intimate relationships, and for many digital media seems to play a central role in this violence. Teenagers who experience victimization outside their relationships or have risky lifestyles have a higher risk of experiencing IPV victimization. A focus on teenage IPV, and especially digital media's role in this violence, is needed if this public health issue is to be combated.

Recalled Explanations for Adolescent Girls' Engagement in Age-Discordant Sexual Relationships

Age-discordant sexual relationships are associated with negative sexual health outcomes for adolescent females. We were particularly interested in females' motivations for engaging in these relationships, and in contextual factors that increase receptivity to age-discordant relationships in the United States (U.S.). However, recent research addressing this topic in the U.S. has been sparse. To address this gap in the literature, we recruited 15 women (Mdn age = 26 years; 93 % African American) from an urban, publicly funded sexually transmitted disease clinic to qualitative interviews. Reasons given by women for their involvement in age-discordant sexual relationships as adolescents included: (a) desire for an actively engaged father figure, (b) to obtain material support, (c) to escape from a troubled home life, and (d) to express independence and maturity. Thus, familial, economic, and developmental factors motivate socioeconomically disadvantaged adolescent females to enter into age-discordant sexual relationships. Efforts to reduce females' participation in these relationships will need to address socioeconomic vulnerability and family relationships.

Risk Factors Associated With HIV Among Men Who Have Sex With Men (MSM) in Ecuador

The Joint United Nations Program on HIV/AIDS estimates that between 0.3% and 0.7% of adults aged 15 to 49 years were living with HIV in Ecuador in 2013. However, very little is known about the HIV prevalence rate among men who have sex with men (MSM) in that country. A cross-sectional survey was conducted to investigate the knowledge, attitudes, and practices regarding HIV/AIDS as well as to estimate the prevalence of HIV among MSM in one of the cities with high HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 307 adult MSM. An HIV prevalence of 10% was observed. Knowledge about HIV was high; 91% of participants could identify how HIV is transmitted. Although consistent condom use for anal sex was relatively high (89%) among participants who reported having pay-for-service clients, only 64% reported using a condom during oral sex with a client. Participants who had multiple male sexual partners (i.e., their stable male partners plus other partner[s]) had 3.7 times higher odds of testing positive for HIV compared with those who did not. They also had reduced odds of condom use. Participants who were forced to have anal receptive sex had 3 times higher odds of testing positive for HIV. Despite the finding that participants exhibited high knowledge about HIV/AIDS, a high prevalence rate of HIV was observed, which warrants targeted behavioral interventions. These data are consistent with MSM being one of the highest at-risk population groups for HIV in this region of Ecuador.

Cross-sectional data on alcohol and marijuana use and sexual behavior among male and female secondary school students in New Providence, The Bahamas

BACKGROUND

While The Bahamas have significantly reduced poor reproductive health outcomes among adolescents and emerging adults, data indicate that youth are engaged in sexual risk behaviors. Substance use has been linked to increased risk for HIV and sexually transmitted infections in other contexts. There are limited data on Bahamian youth in relation to consumption of alcohol and marijuana use and engagement in sexual behaviors.

OBJECTIVE

This study aimed to assess potential relationships between alcohol and marijuana use and engagement in sexual behavior among government secondary school students in New Providence, The Bahamas.

MATERIALS AND METHODS

Total sample size was 2572, and about 56% of respondents were female. Mean age was 14.2 (SD 2.7 years). Cross-sectional data came from a baseline survey conducted as part of a longitudinal randomized controlled evaluation of a school-based HIV prevention and reproductive health program in New Providence.

RESULTS

Overall, 46.5% (519) males and 44.8% (652) females reported alcohol consumption; 7.3% (82) males and 1.7% (25) females reported use of marijuana in the last 6 months. About 43% (477) male respondents and 16% (231) female respondents reported ever having vaginal sex. Logistic regression analysis indicates that increased likelihood of engaging in sex during the past 6 months is associated with being older, male, and consuming alcohol and marijuana.

CONCLUSION

These data provide a 'global correlation' between substance use and engagement in sexual behaviors among Bahamian adolescents. Longitudinal research is needed to assess event specific risks and identify mediating and moderating factors. These findings indicate the importance of integrating reproductive health and substance use education.

Co-Parenting Relationship Experiences of Black Adolescent Mothers in Active Romantic Partnerships With the Fathers of Their Children

We conducted an interpretive description of co-parenting relationship experiences of romantically involved Black adolescent mothers and fathers with shared biological children. The study was conducted in Brooklyn, New York, using data from individual in-depth interviews with adolescent mothers and fathers (n = 10). Four themes were identified: (a) putting our heads together; (b) balancing childhood and parenthood; (c) less money, more problems; and (d) if we use condoms, it is for contraception. The co-parenting couples managed very complex relationships, but their mutual interest in the welfare of their children was a relational asset. Co-parents had sparse financial resources but used a moral economy strategy to provide mutual support. Future research is needed that focuses on identifying other co-parent relationship assets and integrating and evaluating their utility for enhancing interventions for adolescent families.

Sexual risk factors for partner age discordance in adolescent girls and their male partners

AIMS AND OBJECTIVES

To investigate differences in sexual risk factors between adolescent girls reporting similar-aged or older sex partners.

BACKGROUND

Adolescent girls are at significant risk of heterosexual-acquired HIV infection and other long-term reproductive health issues. Sexual partner age discordance in teen girls has been correlated with STIs, lack of protection, multiple partners and earlier age of sexual transition.

DESIGN

A descriptive study comparing girls currently involved with age-discordant partners to those with similar-aged partners. Two-sample t-test for continuous variables and chi-squared test or Fisher's exact test for categorical variables were used to compare groups.

METHODS

Baseline data from 738 sexually active, urban, adolescent girls aged 15-19 were analysed to determine which behaviours were more likely to occur in girls with older partners. Data were collected as part of a gender-specific HIV-prevention intervention in a randomised controlled trial (RCT) tailored to adolescent girls.

RESULTS

Multiple reported sexual risk behaviours were found to significantly differ between the two groups at baseline. Overall, girls with older partners had more episodes of sexual instances (vaginal, anal and oral). Specific sexual risk behaviours were found to be statistically significant between the two groups. Girls with older partners started having sex at earlier ages, had more lifetime sexual partners, higher incidents of STIs and were reluctant to discuss using condoms with their partners. Girls with similar-aged partners were less willing to engage in risky sexual behaviours.

CONCLUSIONS

Findings from this investigation support data from other studies. Relationships with older male partners place adolescent girls at increased risk of HIV/STIs and unintended pregnancy.

RELEVANCE TO CLINICAL PRACTICE

Adolescent girls in age-discordant relationships are at risk of immediate and long-term sexual health morbidities. Identifying girls who are at increased risk by asking tailored questions will enable nurses to recommend appropriate diagnostics for this population and provide age-specific counselling.

Urban adolescent girls' perspectives on romantic relationships: initiation, involvement, negotiation, and conflict

The purpose of this paper was to describe romantic relationships from the perspective of urban, adolescent girls, to address gaps in our understanding of their relationship dimensions. Minority adolescent girls (n  =  17) participated in private semi-structured interviews aimed to elicit the understanding of the adolescents' perspectives on their own relationship experiences and dynamics. The research team conducted conventional content analysis of the interview transcripts. Four major themes emerged about romantic relationships: (1) influence of male pursuit and social norms on relationship initiation factors; (2) a romantic partner is a confidant, friend, and companion; (3) negotiating intimacy respectfully; and (4) relationship conflict through control and abuse. Adolescents described sub-themes of social norms of male pursuit and relationship pressures that dictated relationship initiation. Relationships were depicted by emotional support, caring, and companionship. Adolescents described positive negotiation skills. However, relationship conflict, including controlling behaviors and violence, was illustrated in these same relationships. This study provides a rich description of romantic relationships from the perspectives of urban, adolescent girls. Most salient findings included social pressures and a combination of both positive and negative attributes. Implications include the need for intervention development at the community level to address social pressures, recognition of positive adolescent relationship attributes, and facilitation of skills to identify and address low-quality relationship characteristics.

Influence of sexual sensation-seeking on factors associated with risky sexual behaviour among African-American female adolescents

Background The identification of antecedents to sexual risk among youth is critical to the development and dissemination of multilevel interventions. Therefore, the aim of the present study was to examine the effect of sexual sensation-seeking on partner age, partner communication, and the sexual attitudes and behaviours of African-American female youth.

METHODS

This study examined survey data collected by audio computer-assisted self-interviews from 701 young African-American females between 14 and 20 years of age. The survey consisted of items designed to measure adolescents' sexual risk and preventive behaviours.

RESULTS

The results of this study suggest that sexual sensation-seeking is associated with condom use among adolescent African-American females. For adolescents who reported greater sexual sensation-seeking, lower levels of sexual happiness were associated with a decreased likelihood of condom use at last intercourse (β=1.01, P≤0.05). For those reporting lower levels of sexual sensation-seeking, greater sexual enjoyment was associated with a greater likelihood of condom use at last intercourse (β=0.93, P≤0.01). Adolescents with younger sexual partners and lower levels of sexual sensation-seeking reported a higher proportion of condom use in the past 6 months (β=0.70, P=0.01). Higher partner communication self-efficacy and decreasing levels of sexual sensation-seeking were associated with fewer lifetime sexual partners (β=-0.54, P≤0.05).

CONCLUSIONS

Future research should address the impact of these variables on adolescent relationship dynamics and sexual decision-making.

Is younger really safer? A qualitative study of perceived risks and benefits of age-disparate relationships among women in Cape Town, South Africa

Young women in age-asymmetric relationships may be at an elevated risk for acquisition of HIV, since relationships with older men are also correlated with other risk behaviors like less condom use. Qualitative studies have shown that women are motivated to participate in these relationships for money and emotional support. However, there is a paucity of research on women’s perceived risks of these relationships, particularly in South Africa. To this end, we conducted in-depth interviews with 23 women recruited from three urban communities in Cape Town. A thematic question guide was used to direct the interviews. Thematic content analysis was used to explore women’s perceived risks of age-disparate and non-age-disparate relationships, the benefits of dating older men, and risk perceptions that influence decisions around beginning or ending a relationship. A plurality of women thought that dating an older man does not bring any adverse consequences, although some thought that older men do not use condoms and may be involved in concurrent partnerships. Many women were less inclined to date same-age or younger men, because they were viewed as being disrespectful and abusive. This study points to the need for more awareness raising about the risks of age-disparate relationships. In addition to these initiatives, there is an urgent need to implement holistic approaches to relationship health, in order to curb intimate partner violence, improve gender equity and make non-age-disparate relationships more attractive.