Internet-Delivered Sexually Transmitted Infection and Teen Pregnancy Prevention Program: A Randomized Trial

BACKGROUND

Black older-teenaged women have disproportionately high rates of sexually transmitted infections (STI) and unintended pregnancy (UTP). Internet-based interventions can be delivered to large groups of people in a relatively inexpensive manner. In this randomized trial, we examine the efficacy of an evidence-based STI/UTP prevention intervention adapted for older teens and for Internet delivery.

METHODS

Black women aged 18-19 years who were not pregnant/seeking to become pregnant were enrolled (n = 637) and randomized to an 8-session intervention or attention control and were followed up at 6/12 months postintervention. The primary outcome was defined as uptake of reliable contraceptives. Other secondary outcomes were examined, including intention to use condoms, intention to use reliable contraception, and STI or pregnancy rates.

RESULTS

Overall, at baseline, reliable contraception was 54.8% and dual protection was 29.4%, and the prevalence of STI was 11.1%. Participants were similar by arm for most factors considered. Participation and follow-up rates were excellent (60.9% and 80.3%). There was no statistically significant difference in uptake of reliable contraception for intervention versus controls at 6 months (1.45 [0.99-2.12]) or 12 months (1.33 [0.92-1.91]). At 6 months, several secondary outcomes were improved/trended toward improvement in intervention compared with control, but this effect waned by 12 months, except for intention to use condoms which remained improved.

CONCLUSION AND RELEVANCE

The intervention was efficacious for increasing some self-reported UTP and STI prevention behaviors, which waned over time, and the intervention had minimal impact on STI or pregnancy rates suggesting that this type of online intervention may need additional components.

Patterns and correlates of substance use among young adult African American women

Patterns and correlates of substance use among urban African American young women (ages 18-19, n = 459) were examined. Four patterns were identified: no/infrequent alcohol and marijuana use (64.9%); recent alcohol only use (18.2%); recent marijuana only use (7.9%); and recent alcohol and marijuana use (9.0%). Having a recent male sexual partner and a history of sexual coercion were associated with increased odds of marijuana-only and dual use. Greater family support and childhood sexual abuse were associated with increased odds of alcohol-only use. Results suggest that sexual relationships and history of abuse/coercion are important factors in young African American women's substance use.

Parental Influences on Heavy Episodic Drinking Development in the Transition to Early Adulthood

PURPOSE

The purpose of this study was to examine how parental relationship quality (communication frequency, time spent together, and closeness) during early adulthood is related to heavy episodic drinking (HED) during this developmental period and whether effects vary according to age, youth sex, or parent sex.

METHODS

National data from the Panel Study of Income Dynamics-Transition to Adulthood Study were analyzed. Youth participated in up to four interviews (2005, 2007, 2009, and 2011; n = 1,320-1,489) between ages 18-25 years. At each wave, respondents reported past-year HED and their communication frequency, time spent, and closeness with each parent (items combined into an index). We tested differences in parental effects by age, parent sex, and youth sex using multigroup latent curve models.

RESULTS

Paternal relationship quality was negatively associated with HED for both males and females at each age; associations did not vary by respondent age or sex (odds ratio [OR] = .73, 95% confidence interval [CI]: .63-.85). Maternal relationship quality was significantly negatively associated with HED at ages 18-19 years among both sexes equally (OR = .50, 95% CI: .41-.61). Although protective associations continued until the age of 25 years for males, they weakened and became nonsignificant at ages 20-25 years for females (OR = .87, 95% CI: .72-1.04). Findings were robust to inclusion of multiple covariates associated with both parenting and alcohol use.

CONCLUSIONS

Having close, communicative parental relationships seems protective against HED in early adulthood, although for females maternal effects appear limited to late adolescence. Programs to improve relationship quality between young adults and their parents may help curb problematic drinking during this vulnerable period.

Factors Influencing Consumption of Fruits and Vegetables in Older Adults in New Orleans, Louisiana

BACKGROUND

OBJECTIVES

The objective of this study was to identify demographic, social and structural factors associated with intake of fruit and vegetables in older adults in New Orleans, Louisiana.

DESIGN

A cross-sectional randomly sampled, address-based telephone survey of households in Orleans Parish, Louisiana was conducted with the household's main grocery shopper.

SETTING

All participants were in the New Orleans metro area and were surveyed in 2011.

PARTICIPANTS

Participants were 2,834 residents identified as the households' main grocery shopper in Orleans Parish, Louisiana. Participants were primarily female (75%), African-American (53%), approximately 10 percent of the sample reported receipt of government assistance. Approximately 37% of the sample was age 65 and older.

MEASUREMENTS

Measures included a telephone administered survey assessing demographic characteristics, food intake, access to supermarkets and other food sources, transportation, self-reported health, and frequency of grocery shopping.

RESULTS

Older adults consumed fewer fresh fruits and vegetables (FV) than younger adults (p<0.01). Bivariate associations with decreased FV included older age, receipt of government assistance, African American race, use of mobility aid, and poorer health. Multivariate factors associated with lower consumption include age, African American race, and poorer self-reported health. Women reported more fruit and vegetable consumption than men.

CONCLUSIONS

FV consumption is associated with improved health and reduced mortality. Older adults are less likely to consume fruits and vegetables, therefore addressing reduced FV consumption in older adults is a potential target for improving health outcomes in older adults. Specifically targeting African Americans and those with poorer health, as well as males may be an important focus for interventions.

Treatment-related reductions in PTSD and changes in physical health symptoms in women

This study examined the relationship between change in posttraumatic stress disorder (PTSD) symptoms over the course of PTSD treatment and the association with changes in general physical health symptoms. Both positive health habits (e.g., exercise) and negative (e.g., smoking), were examined to determine if they accounted for the association between changes in PTSD severity over time and changes in physical health. Participants were 150 women seeking treatment for PTSD. Latent growth curve modeling indicated a substantial relationship (R (2) = 34%) between changes in PTSD and changes in physical health that occurred during and shortly following treatment for PTSD. However, there was no evidence to suggest that changes in health behaviors accounted for this relationship. Thus, PTSD treatment can have beneficial effects on self-reported physical health symptoms, even without direct treatment focus on health per se, and is not accounted for by shifts in health behavior.

The impact of stigma on medication adherence among HIV-positive adolescent and young adult females and the moderating effects of coping and satisfaction with health care

To explore whether HIV stigma negatively impacts adherence to antiviral medications in HIV-infected adolescent women, moderational analysis was conducted and factors identified that could alter said relationship. Study participants were 178 adolescent females age 15-24, enrolled between 2003-2005, from 5 different cities and 60 provided adherence information. Findings reported by this cohort of 60 adolescent women included: medication adherence, 64.3% reporting adherence at baseline and 45.0% at 12 months; HIV stigma score of 57.60 (standard deviation [SD], 11.83; range, 25-86). HIV stigma was not found to be a significant predictor when binary logit regression was run with medication adherence at 1 year. Using moderational analysis, factors that could moderate stigma's effect on medication adherence was still pursued and identified the following to be significant at 12 months: health care satisfaction (B = -0.020, standard error [SE] = 0.010, p < .05); and Coping (proactive coping strategies [B = 0.012, SE = 0.005, p < .05]; turning to family [B = 0.012, SE = 0.016, p < 0.05]; spiritual coping [B = 0.021, SE = 0.010, p < 0.05]; professional help [B = 0.021, SE = 0.010, p < 0.05]; physical diversions [B = 0.016, SE = 0.007, p < 0.05]). Factors that had no significant moderating effects included: social support measures (mean = 74.9; median = 74.0) and depression score greater than 16 = 43%. We conclude that HIV-infected adolescent women experience HIV stigma and poor adherence over time. Factors like health care satisfaction and coping may minimize stigma's effect on medication adherence. Our findings are tempered by a small sample size and lack of a direct relationship between stigma and adherence on binary logit regression analysis.

Health related quality of life and psychosocial correlates among HIV-infected adolescent and young adult women in the US

In this study HIV health-related quality of life (HIV-HRQOL) is examined among 179 behaviorally infected adolescent and young adult women. Modifiable psychosocial variables including depression, stigma, social support, and illness acceptance, and the biological end-points of CD4 cell count and viral load were explored in relation to HIV-HRQOL. The three factors of the HIV-HRQOL measure include current life satisfaction, illness related anxiety and illness burden. Bivariate linear regression analysis demonstrated statistically significant associations for all psychosocial variables and HIV HRQOL factors (p < .01), but not for biological end-points. In multivariate linear regression analysis significant associations remained between: depression (p = .006), illness acceptance (p < .001), social support (p = .001), and current life satisfaction, and depression (p = .012), illness acceptance (p = .015), and illness burden. A trend in association was noted for HIV stigma, with current life satisfaction and illness related anxiety but did not reach statistical significance (p = .097 and p = .109 respectively). Interventions that effectively decrease stigma and depression and increase social support and illness acceptance will likely improve the well-being and quality of life of HIV-infected adolescent women.

Mediators of HIV-related stigma and risk behavior in HIV infected young women

Stigma in HIV positive persons has been associated with numerous negative sequelae, including decreased social support, depressive symptoms, and engagement in risk behaviors. Few studies examined the interrelationships of these factors to facilitate understanding of the mechanisms by which HIV stigma influences risk behavior, thus the current study focuses on identifying pathways between HIV-related stigma and risk behavior in 147 young HIV positive women. Depression and social support were hypothesized to mediate between HIV-related stigma and risk behavior. Structural equation modeling was used to test these hypothesized pathways, results suggested that depression was a significant mediator between HIV-related stigma and risk behavior. Implications for interventions with young HIV positive women who report high levels of HIV-related stigma include a focus on depression as a method of reducing engagement in risk behavior and improving mental health and health behaviors in persons living with HIV.

Sexual victimization and reproductive health outcomes in urban youth

OBJECTIVE

Adolescents and adults with a history of sexual victimization (SV) are at increased risk of engaging in sexual risk behaviors. This study seeks to examine race- and gender-based differences in SV as well as the association between SV and reproductive health outcomes (pregnancy and sexually transmitted infections [STIs]) among young adults from an urban community with high rates of both outcomes.

METHODS

This study used cross-sectional data from the Young Adult Survey of the Baltimore Prevention Program's intervention trials. Participants initially enrolled as first graders were interviewed for the Young Adult Survey as they entered adulthood. A total of 1698 participants were asked about SV, pregnancy, and STIs. Data were analyzed by logistic regression analysis.

RESULTS

History of SV did not vary by racial background, but female participants were more likely to report SV than their male peers. Results for models predicting STIs revealed a significant interaction between gender and SV. Adolescent girls who reported a SV were significantly more likely to have an STI than adolescent girls who did not report victimization. Both adolescent boys and girls who reported SV were more likely to report involvement in a pregnancy.

CONCLUSIONS

Youth in urban communities with a history of SV are far more likely than those without victimization histories to have a pregnancy or STI before young adulthood. Further research is needed to explore the mediators of these outcomes and the value of sexual safety and child protection programs for pregnancy and STI prevention in urban environments.

HIV and housing assistance in four U.S. cities: variations in local experience

This paper provides an account of how young, HIV-positive women manage their lives on limited budgets in four United States cities: New York City, New Orleans, Miami, and Chicago. The study findings elucidate city-to-city variability in housing assistance, and how this manifests in locality specific differences in the experience of HIV. Our research suggests that the receipt of housing assistance has ramifications for women's engagement in care, and for their health. Women not receiving aid often move frequently in and out of homelessness, or "double up" with others in complex household arrangements to share costs. Women with long-term housing assistance, while still struggling financially, possess a stable base from which to approach daily life and HIV care. This account suggests a need for empirical research assessing the impact of local variations in housing assistance on specific health outcomes for those with HIV. It also highlights the importance of understanding local contexts when designing housing interventions at both the individual and structural levels.

Schools' mental health responses after Hurricanes Katrina and Rita

OBJECTIVE

After the displacement of students following Hurricanes Katrina and Rita, schools in several states enrolled many students with potential mental health needs. This study sought to understand how schools perceived the mental health needs of these students and what mental health programs they implemented.

METHODS

Mental health personnel at 19 public schools or school systems and 11 private or parochial schools in Louisiana, Alabama, Texas, and Mississippi were interviewed at two time points (spring and fall-winter of 2006).

RESULTS

Schools undertook diverse approaches to interventions, depending on the preexisting mental health infrastructure and personnel, the perceived needs of students, and the barriers or facilitators in each system. Interviewees described a rapid and comprehensive approach to the crisis in the immediate aftermath. Shortly afterward, some schools perceived little need for mental health services and refocused on their academic missions. Other school systems perceived student need but were unable to implement trauma-focused programs because staff were not prepared to deliver such services and funding was lacking. However, some systems and schools were able to implement new programs or extend programs to displaced students. Implementation challenges included difficulty communicating with parents, burnout among staff and program implementers, and efforts to balance the needs of the displaced students with those of the preexisting student population.

CONCLUSIONS

Despite significant efforts to support students affected by the hurricanes, schools were limited in their ability to implement disaster-focused programs. Extension of crisis plans to include precrisis training in mental health programming for students and staff who have ongoing difficulties after a disaster or crisis may be beneficial.

New sexually transmitted infections among adolescent girls infected with HIV

OBJECTIVES

Although the prevalence of sexually transmitted infections (STIs) among girls infected with HIV has been reported, the incidence of STI diagnoses has not been well documented. The objectives of this study were to examine (1) incident STI diagnoses and (2) the association between viral load (VL) and incident STI diagnosis among HIV-infected adolescent girls in care.

METHODS

This was a prospective longitudinal 18-month study of girls enrolled in the Adolescent HIV trials network. Cox proportional hazard modelling was performed to evaluate the incidence of STI by baseline viral load.

RESULTS

The mean (SD) age of participants was 20.6 (2.0) years, viral load of participants was 66,917 (165,942) copies/ml and median viral load was 7,096 copies/ml. The incidence of STIs for the entire cohort was 1.4 per 100 person-months. During the 18-month follow-up period, there were no significant differences in the STI incidence between the high and low viral load groups (hazard ratio (HR) = 0.86, 95% CI 0.37 to 1.95) There was also no significant association between STI incidence and log-transformed viral load (HR = 1.10, 95% CI 0.92 to 1.3).

CONCLUSIONS

Adolescent girls with HIV infection continue to acquire sexually transmitted infections after diagnosis. This analysis does not suggest that VL is a critical factor in STI acquisition over time. Additional work exploring the role of other contextual factors on STI acquisition among HIV-infected adolescent girls is warranted.

Predictors of post-rape medical care in a national sample of women

BACKGROUND

Rape has a negative impact on physical and mental health, health-related behaviors, and health service utilization. Timely medical care is important for preventive services.

METHODS

Cross-sectional data were obtained from a larger 2-year longitudinal study, the National Women's Study (NWS). A total of 3006 adult women participated in the final data collection wave of the NWS. During a structured telephone interview, women who reported a most-recent or only rape incident during adulthood were asked about rape characteristics, reporting to authorities, medical care, and rape-related concerns. The main outcome measures were receipt and timing of medical care received after an adult rape, and factors influencing whether or not medical care was received.

RESULTS

Of the sample, 214 (7.1%) had experienced a most-recent or only rape as an adult (aged >/=18), and 56 (26.2%) received rape-related medical care following that incident. The final model multivariable logistic regression indicated that reporting the crime to police or other authorities (odds ratio [OR], 9.45; 95% confidence interval [CI]=3. 34-26.70) and fear of sexually transmitted diseases (OR, 8.61; 95% CI=3.12-23.72) were significant predictors of receipt of post-rape medical care.

CONCLUSIONS

One in five victims reported an adult rape to police or other authorities; these women were nine times more likely to receive medical care than those who did not. Public health efforts are needed to increase the proportion of rape victims who receive immediate post-rape medical care.