Dating violence and the sexual health of black adolescent females

Moderation Effects of Gender on the Association between Intimate Partner Violence and Suicidal Ideation or Attempt among Adolescents: A Secondary Analysis of the 2017 YRBS

OBJECTIVE

Physical and sexual intimate partner violence (IPV) among adolescents leads to adverse health behaviors, particularly suicidal ideation and attempts. Studies demonstrated the link between IPV and suicidal ideation and attempts among adolescents, yet there is conflicting evidence regarding differences between adolescent males and females; research evaluating the interaction of gender and the association between IPV and suicidal ideation and attempts is limited. The present study used a nationally representative sample from the Youth Behavioral Risk Surveillance questionnaire to determine whether there is an interaction of gender on the relationship between physical IPV, sexual IPV, and suicidal ideation and suicidal attempts.

METHOD

Weighted logistic regressions were fit using Stata 15.1 and multiple imputations were used to account for missing data.

RESULTS

There is a significant gender by sexual IPV interaction (AOR = 0.66, CI = 0.51-0.84, p = 0.002) such that at low levels of sexual IPV there were no differences between genders in reported suicide attempts (t[33] = 1.19, p = 0.242). However, at moderate and high instances of sexual IPV, adolescent females were significantly less likely than males to report attempting suicide in the past year (t[33] = -2.71, p = 0.011; t[33] = -3.17, p = 0.003, respectively).

CONCLUSIONS

The present study demonstrates the vital need for IPV and suicidal ideation and attempt screening, tailored multi-level interventions, and advocacy for adolescents. Policies are essential to increase screening among medical providers, and increase school- and community-based interventions and IPV and suicide awareness to decrease rates among adolescents.HIGHLIGHTSFemale students were more likely than males to report suicidal ideation.Significant interaction between sex and sexual IPV on suicide attempts.Gender differences at medium and high levels of sexual IPV on suicide attempts.

Dating Violence Prevention for Juvenile-Justice Involved Females: A Hybrid Trial

OBJECTIVE

The primary objective of this hybrid I clinical trial of Date SMART (Date Skills to Manage Aggression in Relationships for Teens) was to reduce adolescent dating violence (ADV) among juvenile-justice involved females over 1 year. Secondary objectives were to determine if the intervention reduced sexual risk behavior and delinquency. Last, we evaluate system buy-in vis à vis mandated referrals to the program.

METHODS

Participants were females, ages 14 to 18 (N = 240), involved in a family court in the Northeast United States. The Date SMART group intervention consisted of cognitive-behavioral skill building, and the knowledge-only comparison group consisted of psychoeducation regarding sexual health, ADV, mental health and substance use.

RESULTS

Court mandates to intervention were common (41%). Among those with ADV exposure, Date SMART participants reported fewer acts of physical and/or sexual ADV (rate ratio, 0.57; 95% confidence interval [CI], 0.33-0.99) and cyber ADV (rate ratio, 0.75; 95% CI, 0.58-0.96) at follow-up, relative to control. There were significant reductions in the number of vaginal and/or anal sex acts reported by Date SMART participants relative to control (rate ratio, 0.81; 95% CI 0.74-0.89). In the overall sample, within group reductions in some ADV behaviors and delinquency were observed in both conditions.

CONCLUSIONS

Date SMART was seamlessly integrated into the family court setting and received stakeholder buy-in. Although not superior to control as a primary prevention tool, Date SMART was effective in reducing physical and/or sexual ADV, and cyber ADV, as well as vaginal and/or anal sex acts, among females with ADV exposure over 1 year.

Client-Perpetrated Violence Experience Among Female Sex Worker in Guangdong, South China: Results from a Cross-Sectional Study

Client-perpetrated violence (CPV) can lead to worse health consequences. However, little attention is paid to the CPV experience among Chinese female sex workers. Our study aimed to assess the association between CPV experience and health risk behaviors among FSWs in China. Data used in this study was from the baseline interviewer-administered questionnaire of a cluster randomized controlled trial conducted in June-October 2020. The collected information included sociodemographic characteristics, HIV/STI symptoms, number of clients, quality of the workplace, and past CPV experience. The association between violence experience and potential HIV/STI risk factors was explored using multivariable regression. Among 480 FSWs who participated in this study, 13.5% experienced CPV in the past. Compared to those who had never experienced CPV, FSWs who experienced CPV were more likely to report previous STI-related symptoms (aOR 4.29, 95% CI 1.73-10.64), more than 15 clients in the past month (aOR 2.56, 95% CI 1.18-5.52), a history of HIV testing (aOR 2.99, 95% CI 1.64-5.46), and work at low-tier workplaces (aOR 2.09, 95% CI 1.18-3.70). Overall, CPV prevalence is not low among Chinese FSWs, and there are some associations with HIV/STI risk factors; a future intervention targeting CPV in HIV/STI prevention programs is needed.

Superwoman, Racial Identity, and Teen Dating Violence Victimization among Young Black Women

Young Black women consistently report the highest rates of teen dating violence (TDV) in the United States. They are also navigating a world in which they are facing historical marginalization and intersectional oppression. The Superwoman stereotypic role, in which Black women showcase strength and resist vulnerability, is often adapted in reaction to this normalized existence. Yet little research has examined how these constructs are related. In addition, research suggests that a positive racial identity may function as a psychological buffer against society's negative view of Black Americans and reduce involvement in violence. The current study examined the relationship between endorsement of a Superwoman role and TDV victimization among young Black women. A total of 481 Black women, aged 18-19, completed online survey measures assessing their racial identity beliefs, endorsement of racial stereotypes, and TDV experiences. The results of the path models showed that endorsement of a Superwoman role was associated with increased TDV victimization. Results also showed that racial centrality was inversely associated with TDV; the more the young women felt that being Black was a central part of their identity, the less they reported victimization. Findings suggest a need for attention to stereotype development and racial identity in the development of healthy romantic relationships for Black youth.

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.

Money, Power, and Relationships: Economic Vulnerability in Girls' Lives and Risk for Partner Violence Among Girls in Ibadan, Nigeria

This study explored the experience of economic vulnerability and its effect on girls' future aspirations, relationships, and financial reliance on male partners, as well as risk for intimate partner violence (IPV) and related health consequences. Thirteen Focus Group Discussions (FGDs) were conducted among 122 female adolescents aged 15-19 years. Participants reported that lack of economic resources limits girls' ability to be economically independent by reducing opportunities to receive education or enter into a trade. Economic vulnerability decreases girls' ability to become economically independent, increasing financial reliance on male partners, and in turn, increasing risk for IPV, sexually transmitted infections, and unintended pregnancy.

Community-level influences on women's experience of intimate partner violence and modern contraceptive use in Nigeria: a multilevel analysis of nationally representative survey

Background : Modern contraceptives (MC) are important strategies for reducing unwanted pregnancies, unsafe abortion and maternal mortality, but MC remains low at 18% in Nigeria. Similarly, while there is increasing prevalence of intimate partner violence (IPV) in Nigeria, its effects on contraceptive use remain unclear. This study examined the influence of IPV on MC use, while adjusting for individual- and community-level confounders. Methods : The study utilized 2018 Nigeria Demographic and Health Survey data. We performed multilevel binary logistic regression analysis on 24,973 married women aged 15-49 49 (nested within 1,400 communities), who were sexually active and were not pregnant at the time of the survey. Results : Findings show that use of MC was higher among married women who reported experience of IPV than those without IPV exposure. After adjusting for individual-level and contextual factors, the odds of using MC was significantly higher among women who experienced any form of IPV (OR: 1.61, 95% CI: 1.17-2.21, p<0.005) compared to those who reported no IPV experience. Around one-quarter of the total variance in contraceptive use with respect to the different types of IPV could be explained at the community level. Conclusion : The study provides empirical evidence that there is significant community effect on IPV exposure and women's contraceptive uptake. Attention must therefore be given to the context-specific social and gender norms that affect women's sexual and reproductive health in Nigeria.

Community-level influences on women’s experience of intimate partner violence and modern contraceptive use in Nigeria: a multilevel analysis of nationally representative survey

Background: Modern contraceptives (MC) are important strategies for reducing unwanted pregnancies, unsafe abortion and maternal mortality, but MC remains low at 18% in Nigeria. Similarly, while there is increasing prevalence of intimate partner violence (IPV) in Nigeria, its effects on contraceptive use remain unclear. This study examined the influence of IPV on MC use, while adjusting for individual- and community-level confounders. Methods: The study utilized 2018 Nigeria Demographic and Health Survey data. We performed multilevel binary logistic regression analysis on 24,973 married women aged 15-49, who were sexually active and were not pregnant at the time of the survey. Results: Findings show that use of MC was higher among married women who reported experience of IPV than those without IPV exposure. After adjusting for individual-level and contextual factors, the odds of using MC was significantly higher among women who experienced any form of IPV (OR: 1.61, 95% CI: 1.17-2.21, p<0.005) compared to those who reported no IPV experience. Around one-quarter of the total variance in contraceptive use with respect to the different types of IPV could be explained at the community level. Conclusion: The study provides empirical evidence that there is significant community effect on IPV exposure and women’s contraceptive uptake. Attention must therefore be given to the context-specific social and gender norms that affect women’s sexual and reproductive health in Nigeria.

Individual and Institutional Predictors of IPV/SV Screening in College Health Centers

Intimate partner violence (IPV) and sexual violence (SV) are significant public health issues for women, particularly for college women. IPV and SV have been associated with numerous adverse health consequences and involvement in unhealthy behaviors. Given the health risks and high rates of IPV/SV among college women, it is important to understand and promote screening in this population. The purpose of this study was to examine college women's experiences with IPV/SV screening at college health centers and identify individual and institutional characteristics associated with screening. Random samples of female undergraduate college students from five colleges in the northeast United States were recruited to participate in an anonymous online survey in January 2015. Inclusion criteria included at least one visit to the college health center during the preceding fall semester. Participants were questioned regarding demographics and whether they were screened or asked about IPV/SV at the college health center. A total of 873 women met the inclusion criteria and completed surveys. Only 10.2% of the college women in the study reported that they were screened for IPV/SV at their most recent visit to the college health center. Participants from public colleges/universities were 3 times more likely than others to report screening, whereas participants from urban college/university campuses were more than twice as likely as others to report screening. College women who went to the college health center for a gynecological or sexual health reason were nearly 4 times as likely as other women to report being screened for IPV/SV. Low rates of IPV/SV screening at college health centers represent missed opportunities. Further research across more numerous and diverse college sites is needed to understand the factors that promote or inhibit IPV/SV screening in college health centers to develop interventions to facilitate routine screening practices.

Dating Violence in Adolescence: Implications for Girls' Sexual Health

Adolescents in the United States are too often involved in relationships characterized by coercion and violence. An emerging body of research suggests that dating violence is linked with other health risks in adolescent relationships, particularly sexual risk behavior. The confluence of risks conferred by dating violence and sexual risk behavior are particularly acute for adolescent girls. Adolescent gynecology providers need to understand the nature of dating violence in adolescence and the ways in which dating violence and sexual risk behavior are mutually influential. This article reviews the literature on the links between dating violence and sexual risk in adolescent girls' relationships. The prevalence, risk factors, and consequences of dating violence in adolescence are discussed, followed by a review of the research linking dating violence and sexual risk, with a focus on common mechanisms underlying these relationship risk behaviors. The review concludes with implications for screening, prevention, intervention, and future directions for research.

Intimate Partner Violence and Coerced Unprotected Sex Among Young Women Attending Community College

The present study examined the mediating role of sexual assertiveness in the relationship between psychological, physical, and sexual intimate partner violence (IPV) victimization and unprotected sex as a result of condom use resistance among sexually active young women attending community college. Women reported engagement in unprotected sex as a result of a partner's use of one of 32 forms of condom use resistance (e.g., physical force, deception, or other forms of coercion to avoid using a condom during intercourse). Women ages 18-24 years (N = 212) attending community college were recruited through paper advertisements to complete assessments of social and dating behavior in the campus computer laboratory. Only the women with a history of sexual intercourse (N = 178; 84% of the sample) were included in analyses. More frequent engagement in unprotected sex as a result of a partner's condom use resistance was associated with physical, psychological, and sexual IPV victimization. Sexual assertiveness mediated the relationship between physical IPV victimization and the frequency of unprotected sex as a result of condom use resistance. Efforts to prevent dating violence and enhance the sexual health of community college women may benefit from focusing on targeting sexual assertiveness as a protective factor.

Individual and Relationship Characteristics of Adolescent Girls With Histories of Physical Dating Violence

The objective of this article is to examine the individual and relational characteristics of adolescent girls with a history of physical DV, as well as to utilize partner-specific, temporal data to explore links between these factors and recent or ongoing DV experiences. Participants were 109 high school girls (ages 14-17) identified as having a history of DV through a school-based screening procedure. Details regarding the timing of DV and links with specific dating partners were gathered using Timeline Followback (TLFB) interview methodology. At study entry, 30% endorsed clinical levels of depression symptoms and 89% reported delinquent behaviors. Forty-four percent reported vaginal intercourse in their lifetime and of those, 35% reported not using a condom at last sex. During the 90 days prior to study entry, 69% of youth reported having a romantic relationship and 58% of those youth reported physical/sexual violence. Data revealed that more physical/sexual violence was associated with longer relationship length, Wald χ²(2) = 1,142.63, p < .001. Furthermore, depressive symptoms, not delinquency, contributed significantly to recent DV experiences, even when relationship length was controlled. Our findings suggest that prevention programs for this population should teach participants how to quickly recognize unhealthy relationship characteristics, as violence severity increases with relationship length. Programs for adolescent girls should also address depressive symptoms, which are linked to DV severity when other risks are taken into account. Finally, the TLFB calendar method appears useful for gathering the temporal and partner-specific data needed to understand the complexity of dating relationships and violence experiences in this population.

Study protocol for a randomized controlled trial to evaluate a web-based comprehensive sexual health and media literacy education program for high school students

BACKGROUND

School-based comprehensive sexual health education can improve adolescent health outcomes, and web-based programs are a promising approach to overcoming challenges associated with teacher-led formats by ensuring that students receive content that is consistent, unbiased, and medically accurate. However, many adolescents do not receive high-quality sexual health education and turn to the media for information about sex and relationships. Consumption of sexual media messages is related to early and risky sexual behaviors. Media literacy education (MLE) is a proven approach to adolescent sexual health promotion, yet there are no rigorously evaluated web-based MLE programs to promote sexual and relationship health among high school students.

METHODS

This study will test the efficacy, in a randomized controlled trial, of Media Aware, a web-based comprehensive sexual health promotion program for high school students that uses an MLE approach. Participants will be students in 9th and 10th grade health classes in participating schools. Randomization will take place at the school level, and data collection will take place at three time points (i.e., pretest, posttest, and 3 months follow-up). Students in the intervention classrooms will receive Media Aware between pretest and posttest, and students in the delayed-intervention classrooms will receive Media Aware after study completion (i.e., after 3 months follow-up data collection). Students in the delayed-intervention classes will receive their standard health education programming, and teachers in the delayed-intervention classes will be asked to refrain from teaching sexual health or MLE during the study timeframe. The primary outcome variables are intentions, willingness, and behaviors related to sexual health and sexual activity.

DISCUSSION

There are currently no evidence-based comprehensive sexual health programs for high school students that are web-based and use an MLE approach. Media Aware has the potential to be an engaging, less expensive, and effective sexual and relationship health program for high school students. Media Aware is unique in two important ways: (1) the web-based format reduces many of the challenges to fidelity of implementation associated with teacher-led sexual health education; and (2) the MLE approach addresses a commonly ignored influence on adolescent sexual and relationship health, namely, media.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04035694. Registered on 29 July 2019. Contact for Scientific Queries: Tracy Scull, PhD (Principal Investigator); innovation Research & Training at 5316 Highgate Drive, Suite 121, Durham, North Carolina, USA 27713; tscull@irtinc.us.

Relationship power and HIV risk among young Black men who have sex with men in the Southern United States

Background The purpose of this study was to examine the impact of relationship power on HIV risk behaviour among young Black men who have sex with men (MSM) in the Southern US.

METHODS

Data from 425 Black/African American males aged 18-29 years who reported recent anal intercourse with a male partner were analysed. Five selected measures of relationship power were tested for correlation and association with protected receptive anal intercourse using contingency tables and logistic regression analysis.

RESULTS

Acts of 100% protected receptive anal intercourse were common (n=277, 65.2%). Men who reported low barriers to condom negotiation were significantly more likely to report protected acts (P<0.001). Men who reported 100% protected acts were less likely to report financial dependence on male sexual partners and serosorting behaviour (12.0% vs 20.7%, P=0.02; 31.5% vs 49.8%, P<0.001 respectively).

CONCLUSION

Future efforts should further examine the role of relationship power in HIV risk among young Black MSM, including the intersection of individual, dyadic and social-structure risks.

Project Date SMART: a Dating Violence (DV) and Sexual Risk Prevention Program for Adolescent Girls with Prior DV Exposure

This study assessed the initial feasibility, acceptability, and efficacy of an intervention aimed at reducing dating violence and sexual risk behavior in a sample of adolescent girls (ages 14-17) with prior exposure to physical dating violence (DV). One hundred and nine girls were randomly assigned to Date SMART (Skills to Manage Aggression in Relationships for Teens) or a Knowledge-only (KO) comparison group. Both intervention arms consisted of six, weekly 2-h sessions and one "booster" session 6 weeks later. Based on principles of cognitive behavioral therapy, the Date SMART intervention was designed to target common underlying skills deficits linked to both DV and sexual risk behavior in adolescent females: depression, self-regulation deficits, and interpersonal skills deficits. Assessments were administered at four time points (baseline, 3, 6, and 9 months). The Date SMART group was effective as reducing sexual DV involvement across the 9-month follow-up period. Both groups evidenced clinically meaningful reductions in physical, emotional, and digital DV involvement, total time in dating relationships, as well as reductions in depression. Findings indicate that delivering a DV and sexual risk prevention intervention to DV-affected adolescent girls is feasible and well-received. Furthermore, a skills-based approach that addresses the co-occurrence of DV and sexual risk behavior may be particularly useful for promoting reductions of sexual DV among high-risk adolescent girls. A future, large-scale trial with an inactive comparison condition is needed to evaluate the efficacy of Date SMART further.

TRIAL REGISTRATION

Clinical Trials, NCT01326195, and http://www.clinicaltrials.gov.

Relationship Violence Typologies and Condom Use in Young Adult Dating Relationships

CONTEXT

Intimate partner violence is one dimension of relationships that may influence condom use, yet few studies have examined male- and female-initiated violence in efforts to understand variation in condom use.

METHODS

Power dynamics and relationship conflict approaches were employed to examine the association between relationship violence and condom use. In a latent class analysis of 8,599 dating relationships from Wave 3 (2001-2002) of the National Longitudinal Study of Adolescent to Adult Health, when the respondents were aged 18-25, relationship violence was characterized by the severity and frequency of violence and the perpetrator's gender. Random-effects logistic regression analyses assessed the association between violence classes and condom use.

RESULTS

One in five young adult dating relationships involved violence in the past year. Four violence classes were identified: one male-dominant class (3% of relationships), in which many relationships had reciprocal violence; two female-dominant classes, differentiated by the frequency and severity of violence (2% low-intensity, 4% medium-intensity); and one class with limited or no violence (91%). Male-perpetrated violence was reported less frequently but was more severe than female-perpetrated violence. Respondents in relationships in the male-dominant/high-intensity and the female-dominant/medium-intensity classes were less likely to report condom use than those in relationships in the no/low-violence class (odds ratios, 0.4-0.5).

CONCLUSIONS

This work expands on research focusing only on male-perpetrated violence and highlights the importance of capturing relationship violence in national data sets. Future surveys that collect information about violence from both partners can inform efforts to prevent violence and to support victims.

The Dynamics of Intimate Partner Violence and the Risk of Pregnancy during the Transition to Adulthood

Using a reproductive coercion framework, we investigate the role of intimate partner violence (IPV) in pregnancy during the transition to adulthood. We use two types of data from a population-based sample of 867 young women in a Michigan county: a 60-minute survey interview with 2.5 years of weekly follow-up surveys, and semi-structured interviews with a subsample of 40 pregnant women. The semi-structured interviews illustrate the violence women experienced. Discrete-time logit hazard models demonstrate that threats and physical assault are associated with higher pregnancy rates during ages 18 to 22. However, this holds only when the violence is recent; violence occurring more than a month earlier is not associated with higher pregnancy rates. These associations are independent of violent experiences with prior partners, which are also associated with higher pregnancy rates. Fixed-effects models show that during violent weeks, women perceive more pregnancy desire from their partners, have more sex, and use less contraception than during nonviolent weeks. Finally, mediation analyses and the semi-structured interviews are consistent with reproductive coercion: violent young men are more likely to want their girlfriends pregnant, and they use threats and physical assault to implement their preferences via sex and contraceptive non-use, which in turn increase pregnancy rates.

Sexual Teen Dating Violence Victimization: Associations With Sexual Risk Behaviors Among U.S. High School Students

Adolescent dating violence may lead to adverse health behaviors. We examined associations between sexual teen dating violence victimization (TDVV) and sexual risk behaviors among U.S. high school students using 2013 and 2015 National Youth Risk Behavior Survey data (combined n = 29,346). Sex-stratified logistic regression models were used to estimate these associations among students who had dated or gone out with someone during the past 12 months (n = 20,093). Among these students, 10.5% experienced sexual TDVV. Sexual TDVV was positively associated with sexual intercourse before age 13, four or more lifetime sexual partners, current sexual activity, alcohol or drug use before last sexual intercourse, and no pregnancy prevention during last sexual intercourse. Given significant findings among both sexes, it is valuable for dating violence prevention efforts to target both female and male students.

The Mediating Role of Trauma Symptoms in the Association between Past and Future Teen Dating Violence Victimization

We examined whether the frequency of recent physical and sexual teen dating violence (TDV) victimization is positively associated with trauma symptom clusters (re-experiencing, avoidance, and hyperarousal), and whether these symptom clusters, in turn, are positively associated with the frequency of later TDV victimization. Participants were recruited primarily from truancy courts, and the sample consisted of 108 (47% female) 14-to-17-year-olds. Participants completed three assessments, spaced three months apart. Results indicated that the frequency of recent TDV victimization related positively to all three trauma symptom clusters. Re-experiencing symptoms mediated the relation between recent TDV victimization and TDV victimization six months later, even after controlling for exposure to community and interparental violence and demographic variables. The findings suggest that the trauma symptom clusters may differentially contribute to risk of future TDV victimization. Further research examining the cognitive and emotional processes involved in re-experiencing trauma symptoms will likely enhance our understanding of risk factors for TDV re-victimization.

Intimate violence as it relates to risky sexual behavior among at-risk females

OBJECTIVE

Rates of sexually transmitted infections (STIs) among adolescents are on the rise. The majority of adolescents who contract STIs do so through risky sexual behavior. Previous literature has identified multiple correlates of risky sexual behaviors among adolescents, including physical and sexual victimization, mental health concerns, and substance use. Few studies, however, have examined these relationships together in a comprehensive model. The primary purpose of this study was to examine whether relationship violence was related to risky sexual behavior, and whether mental health symptoms and substance use mediated this relationship.

METHOD

A cross-sectional design was used, and adolescent females (N = 179), recruited from social service agencies, were 18.9 years old on average and were 37.2% White, 19.3% Black, 37.9% multiracial, and 5.6% other.

RESULTS

Regression results revealed that females who were physically assaulted and sexually victimized by their intimate partners did engage in more sex without condoms. Mediational analyses indicated that PTSD symptoms significantly influenced the relationship between (1) physical assault and risky sexual behavior and (2) sexual victimization and risky sexual behavior.

CONCLUSION

Contrary to expectations, PTSD may act to reduce risk perhaps by reducing interest in sex. It is important to address victimization, PTSD, and sexual risk in young women. More work is needed to understand these complex relationships using longitudinal designs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Strength in the midst of pain: Abuse as a predictor of sexual relationship power among substance-abusing Black women

The aim of this research was to explore the association of abuse experiences (child sexual abuse and adult physical/sexual violence) to sexual relationship power among Black substance-abusing women. The study was a secondary analysis of baseline data collected from 124 Black women in 12 drug treatment programs across the United States who initially participated in an HIV risk reduction trial conducted within the National Drug Abuse Treatment Clinical Trials Network of the National Institute on Drug Abuse (NIDA). The findings revealed that adult sexual abuse, but not childhood sexual or adult physical abuse, was associated with lower relationship control and decision-making dominance as measured by the Sexual Relationship Power Scale. The findings suggest that designing and implementing sexual risk reduction interventions that address adult sexual violence may enhance the relationship power of Black substance-abusing women and in turn may promote safer sex practices.

Gender Norms and Age-Disparate Sexual Relationships as Predictors of Intimate Partner Violence, Sexual Violence, and Risky Sex among Adolescent Gang Members

Unequal gender norms and age-disparate sexual relationships can lead to power imbalances and are also associated with intimate partner violence (IPV), sexual coercion and violence, and sexual risk behaviors. The present study examined these variables from both victim and perpetrator perspectives among adolescent gang members. Age-disparate sexual relationships were defined as sex partners 5 or more years older among female participants and 5 or more years younger among male participants. Participants were recruited from a mid-sized Midwestern city and completed a 60-90-min audio computer-assisted self-interview in a community-based setting. Participants in this study included 107 female gang members (68 % African-American, 19 % Latina; mean age, 17.6) and 169 male gang members (62 % African-American, 28 % Latino; mean age, 17.7). As hypothesized, endorsing unequal gender norms toward women was significantly related to IPV victimization among female participants and perpetration among male participants, and engagement in group sex in the past month among both female and male participants (ps < 0.05). Additionally, unequal gender norms were significantly related to male participants' perpetrating rape (p < 0.05). As hypothesized, female gang members who had been in age-disparate sexual relationships were significantly more likely to have experienced more IPV and report being raped and males gang members who had age-disparate sexual relationships were significantly more likely to perpetrate IPV in the past year and perpetrate rape (ps < 0.05). Age-disparate sexual relationships were also significantly related to being gang raped among female gang members and participating in a gang rape among male gang members, and engaging in group sex among both female and male gang members (ps < 0.05). Female participants who had been in age-disparate sexual relationships were more likely to have been pregnant (ps < 0.05). It is essential for researchers and public health practitioners to create programs for female adolescents to reduce or avoid risky situations, such as inability to negotiate condom use with older sex partners. Additionally, programs must be developed for both female and male gang members to help them understand and identify unequal gender norms, and interpersonal and sexual coercion/violence. Early intervention will also be necessary as these adolescent gang members are already engaged in extremely high-risk, coercive, and violent behaviors.

Childhood Maltreatment and Unprotected Sex among Female Juvenile Offenders: Evidence of Mediation by Substance Abuse and Psychological Distress

PURPOSE

Research has shown that childhood maltreatment is associated with sexual risk taking among female juvenile offenders; however, the mechanisms by which maltreatment influences sexual risk remain poorly understood. We assessed whether substance abuse, psychological distress, and dating violence mediate the relationship between childhood maltreatment and unprotected sex.

METHODS

Sexually active female juvenile offenders (13-17 years of age) completed audio computer-assisted self-interviews (n = 232). Logistic regression with a risk decrement approach, the Sobel test, and the Goodman I test were used to evaluate mediation.

RESULTS

Maltreatment before sixth grade was common in our sample, including physical abuse (48.7%), sexual abuse (14.7%), supervision neglect (57.3%), and physical neglect (18.5%). Cumulative childhood maltreatment was also high with 42.2% reporting two or more types. In the fully adjusted model, cumulative childhood maltreatment remained associated with unprotected sex (odds ratio, 2.43; 95% confidence interval, 1.27, 4.65). The percent of the total effect in the relationship between childhood maltreatment and unprotected sex that was mediated by substance abuse was 16.4% (Sobel = 2.54 [p = .01]; Goodman I = 2.49 [p = .01]) and psychological distress accounted for 23.7% (Sobel = 2.55 [p = .01]; Goodman I = 2.51 [p = .01]). Dating violence was not a significant mediator in our analyses.

CONCLUSION

We found a strong relationship between childhood maltreatment and unprotected sex among female juvenile offenders that was partially mediated through substance abuse and psychological distress. These findings can be used to develop public health strategies to increase condom use among female juvenile offenders. Trauma-informed approaches to sexual health promotion that address substance abuse and psychological distress are warranted.

NETWORK MAP OF ADVERSE HEALTH EFFECTS AMONG VICTIMS OF INTIMATE PARTNER VIOLENCE

Intimate partner violence (IPV) is a serious problem with devastating health consequences. Screening procedures may overlook relationships between IPV and negative health effects. To identify IPV-associated women's health issues, we mined national, aggregated de-identified electronic health record data and compared female health issues of domestic abuse (DA) versus non-DA records, identifying terms significantly more frequent for the DA group. After coding these terms into 28 broad categories, we developed a network map to determine strength of relationships between categories in the context of DA, finding that acute conditions are strongly connected to cardiovascular, gastrointestinal, gynecological, and neurological conditions among victims.

Mining Electronic Health Records Data: Domestic Violence and Adverse Health Effects

Intimate partner violence (IPV) often culminates in acute physical injury, sexual assault, and mental health issues. It is crucial to understand the healthcare habits of victims to develop interventions that can drastically improve a victim's quality of life and prevent future abuse. The objective of this study is to mine de-identified and aggregated Electronic Health Record data to identify women's health issues that are potentially associated with IPV. In this study we compared health issues of female domestic abuse victims to female non-domestic abuse victims. The Domestic abuse population contained 5870 patients, while the Non-Domestic Abuse population contained 14,315,140 patients. Explorys provides National Big Data from the entire USA. Statistical analysis identified 2429 terms as significantly more prevalent among victims of domestic abuse, compared to the general population. These terms were classified into broad categories, including acute injury, chronic conditions, substance abuse, mental health, disorders, gynecological and pregnancy related problems.

From Sexual Assault to Sexual Risk: A Relational Pathway?

Among women and gay and bisexual men, sexual assault is associated with increased rates of sexual risk behavior and negative sexual health outcomes. Although the mechanisms of these effects are potentially myriad, the current analyses examine the role of perceived partner pressure for condomless sex in mediating the association between adult sexual assault (ASA) and recent anal or vaginal sex without a condom. In a sample of 205 young adult women and gay and bisexual men, ASA was indirectly associated with condomless anal and/or vaginal sex via perceptions of partner pressure for condomless sex, χ²(1) = 5.66, p = .02, after controlling for race, age, gender and sexual identity, and relationship status. The elucidation of this relational mechanism points to several potential intervention and prevention strategies that may reduce actual and perceived pressure for sex without a condom, including strategies designed to facilitate the prioritization of health and safety over relational goals and the improvement of partner selection and perceptions of partner pressure.

Theory-based interventions for contraception

BACKGROUND

The explicit use of theory in research helps expand the knowledge base. Theories and models have been used extensively in HIV-prevention research and in interventions for preventing sexually transmitted infections (STIs). The health behavior field uses many theories or models of change. However, many educational interventions addressing contraception have no explicit theoretical base.

OBJECTIVES

To review randomized controlled trials (RCTs) that tested a theoretical approach to inform contraceptive choice and encourage or improve contraceptive use.

SEARCH METHODS

To 1 November 2016, we searched for trials that tested a theory-based intervention for improving contraceptive use in PubMed, CENTRAL, POPLINE, Web of Science, ClinicalTrials.gov, and ICTRP. For the initial review, we wrote to investigators to find other trials.

SELECTION CRITERIA

Included trials tested a theory-based intervention for improving contraceptive use. Interventions addressed the use of one or more methods for contraception. The reports provided evidence that the intervention was based on a specific theory or model. The primary outcomes were pregnancy and contraceptive choice or use.

DATA COLLECTION AND ANALYSIS

We assessed titles and abstracts identified during the searches. One author extracted and entered the data into Review Manager; a second author verified accuracy. We examined studies for methodological quality.For unadjusted dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI). Cluster randomized trials used various methods of accounting for the clustering, such as multilevel modeling. Most reports did not provide information to calculate the effective sample size. Therefore, we presented the results as reported by the investigators. We did not conduct meta-analysis due to varied interventions and outcome measures.

MAIN RESULTS

We included 10 new trials for a total of 25. Five were conducted outside the USA. Fifteen randomly assigned individuals and 10 randomized clusters. This section focuses on nine trials with high or moderate quality evidence and an intervention effect. Five based on social cognitive theory addressed preventing adolescent pregnancy and were one to two years long. The comparison was usual care or education. Adolescent mothers with a home-based curriculum had fewer second births in two years (OR 0.41, 95% CI 0.17 to 1.00). Twelve months after a school-based curriculum, the intervention group was more likely to report using an effective contraceptive method (adjusted OR 1.76 ± standard error (SE) 0.29) and using condoms during last intercourse (adjusted OR 1.68 ± SE 0.25). In alternative schools, after five months the intervention group reported more condom use during last intercourse (reported adjusted OR 2.12, 95% CI 1.24 to 3.56). After a school-based risk-reduction program, at three months the intervention group was less likely to report no condom use at last intercourse (adjusted OR 0.67, 95% CI 0.47 to 0.96). The risk avoidance group (abstinence-focused) was less likely to do so at 15 months (OR 0.61, 95% CI 0.45 to 0.85). At 24 months after a case management and peer-leadership program, the intervention group reported more consistent use of hormonal contraceptives (adjusted relative risk (RR) 1.30, 95% CI 1.06 to 1.58), condoms (RR 1.57, 95% CI 1.28 to 1.94), and dual methods (RR 1.36, 95% CI 1.01 to 1.85).Four of the nine trials used motivational interviewing (MI). In three studies, the comparison group received handouts. The MI group more often reported effective contraception use at nine months (OR 2.04, 95% CI 1.47 to 2.83). In two studies, the MI group was less likely to report using ineffective contraception at three months (OR 0.31, 95% CI 0.12 to 0.77) and four months (OR 0.56, 95% CI 0.31 to 0.98), respectively. In the fourth trial, the MI group was more likely than a group with non-standard counseling to initiate long-acting reversible contraception (LARC) by one month (OR 3.99, 95% CI 1.36 to 11.68) and to report using LARC at three months (OR 3.38, 95% CI 1.06 to 10.71).

AUTHORS' CONCLUSIONS

The overall quality of evidence was moderate. Trials based on social cognitive theory focused on adolescents and provided multiple sessions. Those using motivational interviewing had a wider age range but specific populations. Sites with low resources need effective interventions adapted for their settings and their typical clients. Reports could be clearer about how the theory was used to design and implement the intervention.

Physical and Sexual Violence Predictors: 20 Years of the Women's Interagency HIV Study Cohort

INTRODUCTION

Gender-based violence (GBV) threatens women's health and safety. Few prospective studies examine physical and sexual violence predictors. Baseline/index GBV history and polyvictimization (intimate partner violence, non-partner sexual assault, and childhood sexual abuse) were characterized. Predictors of physical and sexual violence were evaluated over follow-up.

METHODS

HIV-infected and uninfected participants (n=2,838) in the Women's Interagency HIV Study provided GBV history; 2,669 participants contributed 26,363 person years of follow-up from 1994 to 2014. In 2015-2016, multivariate log-binomial/Poisson regression models examined violence predictors, including GBV history, substance use, HIV status, and transactional sex.

RESULTS

Overall, 61% reported index GBV history; over follow-up, 10% reported sexual and 21% reported physical violence. Having experienced all three forms of past GBV posed the greatest risk (adjusted incidence rate ratio [AIRR]physical=2.23, 95% CI=1.57, 3.19; AIRRsexual=3.17, 95% CI=1.89, 5.31). Time-varying risk factors included recent transactional sex (AIRRphysical=1.29, 95% CI=1.03, 1.61; AIRRsexual=2.98, 95% CI=2.12, 4.19), low income (AIRRphysical=1.22, 95% CI=1.01, 1.45; AIRRsexual=1.38, 95% CI=1.03, 1.85), and marijuana use (AIRRphysical=1.43, 95% CI=1.22, 1.68; AIRRsexual=1.57, 95% CI=1.19, 2.08). For physical violence, time-varying risk factors additionally included housing instability (AIRR=1.37, 95% CI=1.15, 1.62); unemployment (AIRR=1.38, 95% CI=1.14, 1.67); exceeding seven drinks/week (AIRR=1.44, 95% CI=1.21, 1.71); and use of crack, cocaine, or heroin (AIRR=1.76, 95% CI=1.46, 2.11).

CONCLUSIONS

Urban women living with HIV and their uninfected counterparts face sustained GBV risk. Past experiences of violence create sustained risk. Trauma-informed care, and addressing polyvictimization, structural inequality, transactional sex, and substance use treatment, can improve women's safety.

Young women's sexual involvement in emerging adulthood

Using data from the Relationship Dynamics and Social Life Study, this study examined the association of peer, family, attitudinal, aspirational, and attainment factors relevant to 820 young women's (aged 18-19) number of sexual partners. Overall, this study found that perceived peer norms and early onset of sexual initiation had a positive and statistically significant association with the respondents' number of lifetime sexual partners. While high school performance and college aspirations were inversely associated with the number of lifetime partners, their current level of educational attainment was not. Finally, racial disparities in the accrual of partners were contingent upon the respondents' attitude to premarital abstinence and educationally related factors. Understanding risk and protective factors may help public health policy planners and health care professionals formulate a more effective ecologically based approach to mitigate sexual health risks and social repercussion related to dating for young women.

Intimate Partner Violence: Associated Factors and Acceptability of Contraception Among the Women

Objective:

To determine the prevalence of various types of domestic violence and to find out the impact of intimate partner violence (IPV) on adoption of contraceptive measures among the women who are victim to this.

Materials and Methods:

This questionnaire-based, cross-sectional study was conducted in the department of obstetrics and gynecology of a tertiary care hospital in Delhi. Four hundred and one postpartum females were randomly selected over a period of 5 months and were questioned about their age, parity, educational status, occupation, husband's education, monthly family income, and, if present, IPV in detail. These study participants were enquired about their contraceptive knowledge and use.

Results:

Sexual violence was seen in 38.4% of the cases, physical violence in 22.4% of the cases, and verbal abuse was seen in nearly 32.7% of the cases. In response to any of the three violence faced, only 23 women (11.79%) reacted by discussing with parents and friends. In 4.61% of the cases, the violence was so severe that she had to inform police. This study showed that higher percentage of women without IPV accepted immediate postpartum contraception methods as compared to those with IPV (35.9% vs. 25%, P = 0.023), but the overall frequency of using contraceptive methods was higher in those with IPV as compared to those without IPV (49% vs. 47%, P = 0.690).

Conclusion:

IPV is associated with increased contraceptive adoption.

Abusive Experiences and Young Women's Sexual Health Outcomes: Is Condom Negotiation Self-Efficacy a Mediator?

CONTEXT

Intimate partner violence and reproductive coercion are associated with unintended pregnancies and STDs. Greater condom negotiation self-efficacy among young women may mediate these associations.

METHODS

A sample of 841 female adolescents (aged 16-19) and 1,387 young adult women (aged 20-24) recruited from 24 family planning clinics in western Pennsylvania in 2011-2012 reported on intimate partner violence, reproductive coercion, condom negotiation self-efficacy and sexual health outcomes at baseline and four- and 12-month follow-ups. Mixed models were used to test associations of intimate partner violence and reproductive coercion with unintended pregnancy and STD diagnosis. The Sobel test of mediation was used to measure indirect effects of condom negotiation self-efficacy.

RESULTS

At baseline, 15% of adolescents and 11% of young adults reported recent intimate partner violence victimization; 7% and 6%, respectively, reported recent reproductive coercion. For both age-groups, intimate partner violence and reproductive coercion were associated with a reduced level of condom negotiation self-efficacy (coefficients, -0.27 to -0.13) and increased odds of STD diagnosis (odds ratios, 1.03-1.1). However, only reproductive coercion was associated with unintended pregnancy (odds ratios, 1.1 for each group). The only association that condom negotiation self-efficacy mediated was between reproductive coercion and unintended pregnancy among young adults (17% of total effect).

CONCLUSIONS

Targeting condom negotiation self-efficacy alone in abusive relationships would likely not translate into improved sexual health outcomes in this population. Other strategies are needed to prevent unintended pregnancy and STDs.

Dating Violence and Substance Use as Longitudinal Predictors of Adolescents' Risky Sexual Behavior

The objectives of this study is to examine dating violence perpetration and victimization (physical, psychological, and sexual) and lifetime substance use (alcohol, marijuana, and hard drugs) as longitudinal predictors of adolescents' risky sexual behavior across 1 year and to determine whether predictors varied across adolescents' gender and ethnicity. A sample of Caucasian, African American, and Hispanic male and female adolescents from seven public high schools in Texas (N = 882) participated. Adolescents completed self-report measures of dating violence, lifetime substance use, and risky sexual behavior at baseline and, 1-year later, completed a second assessment of their risky sexual behavior. Path analysis demonstrated that greater physical dating violence victimization, lifetime alcohol use, lifetime marijuana use, and age (being older) were all significant predictors of risky sexual behavior at the 1-year follow-up. These results did not vary across gender or the three ethnic groups (Caucasian, African American, and Hispanic). Overall, substance use was a longitudinal predictor of risky sexual behavior across the three ethnic groups, with physical dating violence victimization being the only type of dating violence longitudinally predicting risky sexual behavior. Prevention efforts should consider the roles of physical dating violence and substance use in preventing risky sexual behavior.

Father Involvement, Dating Violence, and Sexual Risk Behaviors Among a National Sample of Adolescent Females

This study explored the relationship between the involvement of biological fathers and the sexual risk behaviors and dating violence/victimization and/or perpetration of adolescent girls. The data used in this cross-sectional analysis were drawn from the second wave of the public release of the National Longitudinal Study of Adolescent Health. Only adolescents who reported their biological sex as female, reported a history of being sexually active, and reported having a romantic partner in the previous 18 months were selected (N = 879). This study focused on overall positive sexual behaviors and use of contraception. Structural equation modeling (SEM) was used to best utilize capacity for dealing with latent variables and to test for possible mediation effects. The analysis demonstrated main effects of dating violence and father involvement on sexual behaviors. The more dating violence an adolescent girl experiences, the less likely she is to engage in healthy sexual behaviors. Likewise, the more involvement the biological father has in a woman's life, the more likely she is to engage in positive sexual behaviors. Perceived father involvement was associated with risky sexual behaviors among sexually experienced adolescent girls. Dating violence was directly associated with risky sexual behaviors among sexually experienced adolescent girls, particularly non-White girls. Future studies should use longitudinal models and test theoretically and empirically guided potential mediators. Future studies should also consider father figures such as step-fathers and grandfathers in addition to biological fathers, as having a father figure may be a stronger predictor of adolescent sexual behaviors than having a biological connection.

Positive and Negative Aspects of Relationship Quality and Unprotected Sex among Young Women

The aim of this study was to examine both positive and negative aspects of relationship quality in relation to condom use. Sexually active young women aged 14-18 years (n=111; 34% non-white) were recruited from community clinics and schools in the Midwest USA and provided data via an online survey. The number of unprotected sex acts in the past month with the most recent male partner was regressed on relationship quality with that partner, adjusting for demographics and other characteristics. Negative relationship quality was associated with a greater number of unprotected sex acts among women reporting a low level of positive relationship quality and among women taking hormonal/IUD contraception. Positive relationship quality was associated with unprotected sex among women who reported multiple partners in the past month. Both positive and negative aspects of relationship quality may confer risk for unprotected sex. This risk appears modified by patterns of contraceptive use and other sexual behaviours. Health professionals may be more effective in promoting condom use if they ask questions about both positive and negative aspects of young people's relationship quality and tailor their conversations based on the responses received.

The effect of Teach One Reach One (TORO) on youth acceptance of couple violence

This study evaluated the impact of the Teach One Reach One intervention, a community-based participatory research project designed to address the co-occurrence of adolescent risk behaviors on acceptance of teen dating violence. Data were derived from 331 rural African American youth between 10-14 years of age who participated in caregiver-youth dyads as either: 1) peer lay health advisor dyads, or Ambassadors, 2) caregiver-youth dyads recruited by Ambassadors, or Allies, or 3) comparison dyads. The following study focuses on participating youth only and our results indicated that: 1) Ambassadors and Allies reported less acceptance of couple violence than youth within the comparison group, and 2) less family cohesion, greater family conflict, and greater knowledge of healthy dating behaviors predicted greater acceptance of couple violence. Our findings highlight the efficaciousness of the TORO intervention, which directly engaged participants in prevention efforts through community-based participatory research methods and the use of lay heath advisors.

Adolescents and parental caregivers as lay health advisers in a community-based risk reduction intervention for youth: baseline data from Teach One, Reach One

The purpose of the current study is to describe the demographic, behavioral, and psychosocial characteristics of adolescent and caregiver lay health advisers (LHAs) participating in an intervention designed to reduce risk behaviors among rural African-American adolescents. Teach One, Reach One integrates constructs from the Theory of Planned Behavior and Social Cognitive Theory. It acknowledges that changing the sexual behaviors of African-American adolescents requires changing one's knowledge, attitudes, normative beliefs about the behavior of peers, and self-efficacy regarding adolescent sexual behavior, parent-teen communication about sex, and healthy dating relations among adolescents. Study participants completed baseline questionnaires assessing demographics and psychosocial determinants (knowledge, attitudes, perceived social norms, and self-efficacy) of sexual behaviors. Sixty-two adolescent and caregiver dyads participated. Caregivers included biological parents, legal guardians, or other parental figures. Strengths and areas in need of improvement were determined using median splits. Few adolescents had initiated sex. Their strengths included high levels of open parent-teen communication; positive attitudes and normative beliefs regarding both sex communication and healthy dating relationships; and high knowledge and self-efficacy for healthy dating behaviors. Areas needing improvement included low knowledge, unfavorable attitudes, poor normative beliefs, and low self-efficacy regarding condom use. Caregiver strengths included positive attitudes, normative beliefs, and self-efficacy for sex communication; positive attitudes and self-efficacy for condom use; and low acceptance of couple violence. Areas needing improvement included low levels of actual communication about sex and low knowledge about effective communication strategies and condom use. The current study highlights the value of assessing baseline characteristics of LHAs prior to intervention implementation, as it enables a better understanding of the key characteristics necessary for planning and implementing interventions, as well as engaging in targeted training activities.

A First Look at Gender Inequality as a Societal Risk Factor for Dating Violence

INTRODUCTION

One of ten U.S. high school students is a victim of adolescent dating violence (ADV). Understanding ADV risk factors guides prevention efforts; however, research examining community- and societal-level risk factors is scant. Societal gender inequality is a known risk factor for violence against women, but has yet to be explored in relation to ADV. This study aims to determine whether the Gender Inequality Index (GII) correlates with levels of physical and sexual ADV victimization across U.S. states.

METHODS

State-representative prevalence rates of self-reported physical and sexual ADV victimization were obtained from the 2013 Youth Risk Behavior Survey. The state GII includes five indicators: (1) maternal mortality; (2) adolescent birth rate; (3) government representation; (4) educational attainment; and (5) labor force participation. Pearson correlation coefficients determined the association between physical and sexual ADV victimization, the GII, and GII indicators. Analyses were conducted in August 2014.

RESULTS

Among U.S. states, the prevalence of physical ADV victimization in 2013 ranged from 7.0% to 14.8%, and the prevalence of sexual ADV victimization ranged from 7.8% to 13.8%. The GII was significantly associated with the state prevalence of female physical ADV victimization (r=0.48, p<0.01) but not female sexual ADV victimization. Neither physical nor sexual male ADV victimization was associated with the GII.

CONCLUSIONS

This exploratory study suggests that gender inequality may be a societal-level risk factor for female physical ADV victimization. As ADV prevention strategies are implemented at the state level, further research examining the effect of gender inequality on ADV is needed.

Screening for Intimate Partner and Sexual Violence in College Women: Missed Opportunities

BACKGROUND

Intimate partner violence (IPV) and sexual violence (SV) are significant health issues for college women. Leading organizations and experts recommend screening for IPV/SV in health care settings, including college health centers. Given the prevalence and health risks associated with IPV/SV among college women, it is important to examine screening in this population.

METHODS

A cross-sectional, web-based survey was administered to college women at two universities in the northeastern United States. The survey consisted of demographic questions, assessment of experiences with IPV/SV (lifetime and past 6 months), use of health care services with either a college health center or an off-campus provider, and assessment of health care setting screening practices.

RESULTS

The sample included 615 college women (M = 21.5 years). Lifetime experiences of IPV/SV were reported by 222 women (36.1%). Approximately 8.1% of participants (n = 51) experienced IPV/SV in the past 6 months. Almost 63% (n = 238) reported not being asked about IPV/SV at their most recent off-campus health care visit. Nearly 90% (n = 237) reported not being asked about IPV/SV at their most recent visit to the college health center.

CONCLUSIONS

Participants reported high rates of IPV/SV and low rates of violence screening at college health centers and off-campus settings. Routine provider screening for IPV/SV in health care settings can identify women at risk and can lead to interventions that reduce subsequent violence and improve health outcomes and referrals. Theory-based, culture-specific, multilevel interventions are needed to promote IPV/SV screening among college health providers.

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.

Differences by sexual minority status in relationship abuse and sexual and reproductive health among adolescent females

PURPOSE

Little is known about adolescent relationship abuse (ARA) and related sexual and reproductive health among females who either identify as lesbian or bisexual or engage in sexual behavior with female partners (i.e., sexual minority girls [SMGs]).

METHODS

Baseline data were collected from 564 sexually active girls ages 14-19 years seeking care at eight California school-based health centers participating in a randomized controlled trial. Associations between ARA, sexual minority status and study outcomes (vaginal, oral, and anal sex, number and age of sex partners, contraceptive nonuse, reproductive coercion, sexually transmitted infection [STI] and pregnancy testing) were assessed via logistic regression models for clustered survey data.

RESULTS

SMGs comprised 23% (n = 130) of the sample. Controlling for exposure to ARA, SMGs were less likely to report recent vaginal sex (adjusted odds ratio [AOR], .51; 95% confidence interval [CI], .35-.75) and more likely to report recent oral sex (AOR, 2.01; 95% CI, 1.38-2.92) and anal sex (AOR, 1.76; 95% CI, 1.26-2.46) compared with heterosexual girls. Heterosexual girls with ARA exposure (AOR, 2.85; 95% CI, 1.07-7.59) and SMGs without ARA exposure (AOR, 3.01; 95% CI, 2.01-4.50) were more likely than nonabused heterosexual girls be seeking care for STI testing or treatment than heterosexual girls without recent victimization.

CONCLUSIONS

Findings suggest the need for attention to STI risk among all girls, but SMGs in particular. Clinicians should be trained to assess youth for sexual contacts and sexual identity and counsel all youth on healthy relationships, consensual sex, and safer sex practices relevant to their sexual experiences.

Fiction or not? Fifty Shades is associated with health risks in adolescent and young adult females

BACKGROUND

No prior study has empirically characterized the association between health risks and reading popular fiction depicting violence against women. Fifty Shades--a blockbuster fiction series--depicts pervasive violence against women, perpetuating a broader social narrative that normalizes these types of risks and behaviors in women's lives. The present study characterized the association between health risks in women who read and did not read Fifty Shades; while our cross-sectional study design precluded causal determinations, an empirical representation of the health risks in women consuming the problematic messages in Fifty Shades is made.

METHODS

Females ages 18 to 24 (n=715), who were enrolled in a large Midwestern university, completed a cross-sectional online survey about their health behaviors and Fifty Shades' readership. The analysis included 655 females (219 who read at least the first Fifty Shades novel and 436 who did not read any part of Fifty Shades). Age- and race-adjusted multivariable models characterized Fifty Shades' readers and nonreaders on intimate partner violence victimization (experiencing physical, sexual and psychological abuse, including cyber-abuse, at some point during their lifetime); binge drinking (consuming five or more alcoholic beverages on six or more days in the last month); sexual practices (having five or more intercourse partners and/or one or more anal sex partner during their lifetime); and using diet aids or fasting for 24 or more hours at some point during their lifetime.

RESULTS

One-third of subjects read Fifty Shades (18.6%, or 122/655, read all three novels, and 14.8%, or 97/655, read at least the first novel but not all three). In age- and race-adjusted models, compared with nonreaders, females who read at least the first novel (but not all three) were more likely than nonreaders to have had, during their lifetime, a partner who shouted, yelled, or swore at them (relative risk [RR]=1.25) and who delivered unwanted calls/text messages (RR=1.34); they were also more likely to report fasting (RR=1.80) and using diet aids (RR=1.77) at some point during their lifetime. Compared with nonreaders, females who read all three novels were more likely to report binge drinking in the last month (RR=1.65) and to report using diet aids (RR=1.65) and having five or more intercourse partners during their lifetime (RR=1.63).

CONCLUSIONS

Problematic depictions of violence against women in popular culture-such as in film, novels, music, or pornography-create a broader social narrative that normalizes these risks and behaviors in women's lives. Our study showed strong correlations between health risks in women's lives-including violence victimization-and consumption of Fifty Shades, a fiction series that portrays violence against women. While our cross-sectional study cannot determine temporality, the order of the relationship may be inconsequential; for example, if women experienced adverse health behaviors first (e.g., disordered eating), reading Fifty Shades might reaffirm those experiences and potentially aggravate related trauma. Likewise, if women read Fifty Shades before experiencing the health behaviors assessed in our study, it is possible that the book influenced the onset of these behaviors by creating an underlying context for the behaviors.

Interaction between 5-HTTLPR polymorphism and abuse history on adolescent African-American females' condom use behavior following participation in an HIV prevention intervention

Not everyone exposed to an efficacious human immunodeficiency virus (HIV) intervention will reduce sexual risk behaviors, yet little is known about factors associated with "failure to change" high-risk sexual behaviors post-intervention. History of abuse and polymorphisms in the serotonin transporter gene (5-HTT) may be associated with non-change. The current study sought to identify genetic, life history, and psychosocial factors associated with adolescents' failure to change condom use behaviors post-participation in an HIV prevention intervention. A sub-set of participants from a clinic-based sample of adolescent African-American females (N = 254) enrolled in a randomized trial of an HIV-prevention was utilized for the current study. Forty-four percent did not increase their condom use from baseline levels 6 months after participating in the sexually transmitted infection (STI)/HIV prevention intervention. In multivariable logistic regression analysis, an interaction between abuse and 5-HTTLPR group was significantly associated with non-change status, along with partner communication frequency scores at follow-up. Follow-up tests found that having a history of abuse was significantly associated with greater odds of non-change in condom use post-intervention for only those with the s allele. For those with ll allele, participants with higher partner communication frequency scores were at decreased odds of non-change in condom use post-intervention. Thus, STI/HIV interventions for adolescent females may consider providing a more in-depth discussion and instruction on how to manage and overcome fear or anxiety related to being assertive in sexual decisions or sexual situations. Doing so may improve the efficacy of STI/HIV prevention programs for adolescent women who have experienced abuse in their lifetime.

Condom negotiation: findings and future directions

The aim of this review was to summarize factors associated with condom negotiation among heterosexual men. Literature searches were conducted using multiple databases spanning several disciplines. Studies examining psychological, demographic, relational, communication, and environmental factors related to condom negotiation are described, and a three-dimensional framework of condom negotiation is proposed. This framework of condom negotiation may aid researchers in operationalizing this construct, organizing this literature, and facilitating measurement development. We used this three-dimensional framework to articulate the influence of gender, ethnicity, relationship type, partner characteristics, trauma history, post-traumatic stress, and alcohol use on condom negotiation. Areas for future research are outlined. More research is needed to understand how these factors interact to influence condom negotiation, as well as the interaction between gender and the identified factors.

Recent partner violence and sexual and drug-related STI/HIV risk among adolescent and young adult women attending family planning clinics

BACKGROUND/OBJECTIVES

Adolescent and young adult women are at high risk for sexually transmitted infections (STIs)/HIV and intimate partner violence (IPV). We evaluate the prevalence of IPV in the past 3 months and its associations with STI/HIV risk, STI and related care-seeking over the same time period.

METHODS

Female family planning clinic patients ages 16-29 years (n=3504) participated in a cross-sectional survey in 2011-2012 as a baseline assessment for an intervention study. We examined associations of recent IPV with sexual and drug-related STI/HIV risk behaviour, self-reported STI and STI-related clinical care seeking via logistic regression.

RESULTS

Recent physical or sexual IPV (prevalence 11%) was associated with recent sexual and drug-related STI/HIV risk, specifically unprotected vaginal sex (adjusted OR (AOR) 1.93, 95% CI 1.52 to 2.44), unprotected anal sex (AOR 2.22, 95% CI 1.51 to 3.27) and injection drug use, their own (AOR 3.39, 95% CI 1.47 to 7.79) and their partner's (AOR 3.85, 1.91 to 7.75). IPV was also linked with coercive sexual risk: involuntary condom non-use (AOR 1.87 to 95% CI 1.51 to 2.33), and fears of requesting condoms (AOR 4.15, 95% CI 2.73 to 6.30) and refusing sex (AOR 11.84, 95% CI 7.59 to 18.45). STI-related care-seeking was also more common among those abused (AOR 2.49, 95% CI 1.87 to 3.31).

CONCLUSIONS

Recent IPV is concurrent with sexual and drug-related STI/HIV risk, including coercive sexual risk, thus compromising women's agency in STI/HIV risk reduction. Clinical risk assessments should broaden to include unprotected heterosexual anal sex, coercive sexual risk and IPV, and should promote safety and harm reduction.

Fear of violent consequences and condom use among women attending an STD clinic

Intimate partner violence (IPV) has been associated with risk for HIV infection. This cross-sectional study tested the hypothesis that fear of violent consequences when negotiating condom use mediated the relation between IPV and condom use. Participants (n = 478) were recruited between March 1, 2004 and June 30, 2006 from a public clinic that treats sexually transmitted diseases in upstate New York as part of a randomized controlled trial. They completed an audio, computer-assisted, self-administered questionnaire with items on risky sexual behavior, intimate relationships, and related covariates and confounding variables. Seventeen percent of the sample reported IPV in the past three months. Recent IPV was associated with fear of violent consequences to requests for condom use, and such fear was associated with inconsistent condom use. Women who reported IPV also reported greater difficulties in negotiating safer sex behaviors with their abusers. So fear of violent consequences appeared to hinder their ability to protect themselves against HIV infection. The results were consistent with fear of violent consequences mediating the relationship between IPV and condom use. Health care providers involved in HIV prevention and sexual risk reduction interventions need to address IPV and, more specifically, fear of IPV when negotiating safer sex as part of their services for providing more comprehensive care to the women they serve.

Sexual health and dissociative experiences among abused women

Sexually transmitted infections are a significant public health issue impacting women. Intimate partner violence (IPV) is one risk factor for STIs/HIV. Women who are the victims of IPV often experience psychological difficulties, including dissociation. Dissociative symptoms may play a role in women's ability to practice safe sex and negotiate condom use, although this has been underexplored. This mixed methods study examined the dissociative symptoms of 22 women experiencing IPV and examined the ways in which these women described their own sexual health and behaviors as well as how they protected themselves from sexually transmitted infections and HIV.