Experiencing sexual harassment by males and associated substance use & poor mental health outcomes among adolescent girls in the US

Purpose

Among a sample of adolescent girls, we assessed: 1) prevalence of sexual harassment by type, place of occurrence, and perpetrators; 2) association with substance use and poor mental health outcomes; and 3) the proportion of girls experiencing sexual harassment in more than one place and relation to study outcomes.

Methods

We collected survey data from 159 sexually active girls (aged 15–19 years) recruited from an urban health clinic in Southern California. We used multivariable regression models to assess associations between sexual harassment in the past 6 months and the following outcomes: 1) substance use in past 30 days (alcohol use, binge drinking, and marijuana use, respectively); 2) other drug use ever; and 3) feelings of depression and anxiety, respectively, in past 30 days.

Results

Almost two-thirds of girls (65.4%) reported experiencing sexual harassment in the past 6 months. Among those reporting recent harassment (n = 104), the abuse most frequently occurred in public spaces (on public transport [50.5%], at school [42.7%], and in their neighborhoods [39.8%]) and most often in the form of sexual comments, jokes, or gestures (57.2%), although 12.6% were “touched, grabbed, or pinched in a sexual way.” The vast majority (82.7%) did not know the perpetrators (82.7%). Experiences of sexual harassment in the past 6 months were significantly associated with alcohol use (odds ratio [OR], 4.5; 95% confidence interval [CI], 2.0–10.2), binge drinking (OR, 4.2; 95% CI, 1.8–9.8), and marijuana use (OR, 2.6; 95% CI, 1.2–5.7) in the past 30 days; other drug use ever (OR, 5.4; 95% CI, 1.8–16.4); and feelings of depression (OR: 2.7; 95%CI: 1.3–5.5) and anxiety (OR: 2.6; 95%CI: 1.2–5.5) in the past 30 days. Just over half (55.3%) reported sexual harassment in more than one place, which was also associated with poor substance use and mental health outcomes.

Conclusions

Findings suggest that sexual harassment experiences are pervasive, occur in girls' immediate and everyday environments, and are associated with girls’ substance use and adverse mental health outcomes.

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We found a high prevalence of recent experiences of sexual harassment (65%) among this clinic-based sample of girls.

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Victimization is largely occurring in girls’ immediate environments and predominantly perpetrated by strangers.

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Sexual harassment was associated with substance use, as well as depression and anxiety among adolescent girls.

Cyber Sexual Harassment: Prevalence and association with substance use, poor mental health, and STI history among sexually active adolescent girls

INTRODUCTION

The current study aims to assess the prevalence, perpetrators, and consequences of cyber sexual harassment (CSH) among adolescent females.

METHODS

Sexually active adolescent females (N = 159) ages 15-19 were recruited from a health clinic in a low-income, urban area of southeast San Diego County, California to complete a tablet-administered survey that included items on sexual violence and harassment, including CSH. Using logistic regression models, we assessed CSH in relation to substance use, poor mental health outcomes and STI history.

RESULTS

Participants were, on average, 17 years of age and half were currently in a relationship. The majority of girls (68%) reported at least one form of CSH, which included receiving unwanted sexual messages/photos (53%), receiving unwanted messages asking them to do something sexual (49%), being pressured to send sexual photos (36%), and having sexual photos shared without permission (6%). Perpetrators included known and unknown males; almost a third (27%) reported perpetration by a relationship partner. In logistic regression models adjusting for race, CSH was associated with: past 30-day alcohol use, drug use (ever), feeling depressed (past 30 days), and feeling anxious (past 30 days) (Odds Ratios ranged: 2.9-7.5). CSH was also associated with past-year suicidal thoughts and STI diagnosis (ever) (p < 0.05, ORs not presented due to small numbers).

CONCLUSIONS

Our findings suggest that in some subgroups, CSH appears to be affecting the majority of girls, which is especially concerning given its association with multiple poor health outcomes.

Cross-sectional time series analysis of associations between education and girl child marriage in Bangladesh, India, Nepal and Pakistan, 1991-2011

Background

Girl education is believed to be the best means of reducing girl child marriage (marriage <18 years) globally. However, in South Asia, where the majority of girl child marriages occur, substantial improvements in girl education have not corresponded to equivalent reductions in child marriage. This study examines the levels of education associated with female age at marriage over the previous 20 years across four South Asian nations with high rates (>20%) of girl child marriage- Bangladesh, India, Nepal and Pakistan.

Methods

Cross-sectional time series analyses were conducted on Demographic and Health Surveys (DHS) from 1991 to 2011 in the four focal nations. Analyses were restricted to ever-married women aged 20–24 years. Multinomial logistic regression models were used to assess the effect of highest level of education received (none, primary, secondary or higher) on age at marriage (<14, 14–15, 16–17, 18 and older).

Results

In Bangladesh and Pakistan, primary education was not protective against girl child marriage; in Nepal, it was protective against marriage at <14 years (AOR = 0.42) but not for older adolescents. Secondary education was protective across minor age at marriage categories in Bangladesh (<14 years AOR = 0.10; 14–15 years AOR = .25; 16–17 years AOR = 0.64) and Nepal (<14 years AOR = 0.21; 14–15 years AOR = 0.25; 16–17 years AOR = 0.57), but protective against marriage of only younger adolescents in Pakistan (<14 years AOR = 0.19; 14–15 years AOR = 0.23). In India, primary and secondary education were respectively protective across all age at marriage categories (<14 years AOR = 0.34, AOR = 0.05; 14–15 years AOR = 0.52, AOR = 0.20; 16–17 years AOR = 0.71, AOR = 0.48).

Conclusion

Primary education is likely insufficient to reduce girl child marriage in South Asia, outside of India. Secondary education may be a better protective strategy against this practice for the region, but may be less effective for prevention of marriage among older relative to younger adolescents.

The Association between active and passive smoking and latent tuberculosis infection in adults and children in the united states: results from NHANES

BACKGROUND

Few studies assessing the relationship between active and passive smoking and tuberculosis have used biomarkers to measure smoke exposure. We sought to determine the association between active and passive smoking and LTBI in a representative sample of US adults and children.

METHODS

We used the 1999-2000 US National Health and Nutrition Examination Survey (NHANES) dataset with tuberculin skin test (TST) data to assess the association between cotinine-confirmed smoke exposure and latent tuberculosis infection (LTBI) among adults ages ≥20 years (n = 3598) and children 3-19 years (n = 2943) and estimate the prevalence of smoke exposure among those with LTBI. Weighted multivariate logistic regression was used to measure the associations between active and passive smoking and LTBI.

RESULTS

LTBI prevalence in 1999-2000 among cotinine-confirmed active, passive, and non-smoking adults and children was 6.0%, 5.2%, 3.3% and 0.3%, 1.0%, 1.5%, respectively. This corresponds to approximately 3,556,000 active and 3,379,000 passive smoking adults with LTBI in the US civilian non-institutionalized population in 1999-2000. Controlling for age, gender, socioeconomic status, race, birthplace (US vs. foreign-born), household size, and having ever lived with someone with TB, adult active smokers were significantly more likely to have LTBI than non-smoking adults (AOR = 2.31 95% CI 1.17-4.55). Adult passive smokers also had a greater odds of LTBI compared with non-smokers, but this association did not achieve statistical significance (AOR = 2.00 95% CI 0.87-4.60). Neither active or passive smoking was associated with LTBI among children. Among only the foreign-born adults, both active (AOR = 2.56 (95% CI 1.20-5.45) and passive smoking (AOR = 2.27 95% CI 1.09-4.72) were significantly associated with LTBI.

CONCLUSIONS

Active adult smokers and both foreign-born active and passive smokers in the United States are at elevated risk for LTBI. Targeted smoking prevention and cessation programs should be included in comprehensive national and international TB control efforts.

The longitudinal association of venue stability with consistent condom use among female sex workers in two Mexico-USA border cities

We examined the relationship between venue stability and consistent condom use (CCU) among female sex workers who inject drugs (FSW-IDUs; n = 584) and were enrolled in a behavioural intervention in two Mexico-USA border cities. Using a generalized estimating equation approach stratified by client type and city, we found venue stability affected CCU. In Tijuana, operating primarily indoors was significantly associated with a four-fold increase in the odds of CCU among regular clients (odds ratio [OR]: 3.77, 95% confidence interval [CI]: 1.44, 9.89), and a seven-fold increase among casual clients (OR: 7.18, 95% CI: 2.32, 22.21), relative to FSW-IDUs spending equal time between indoor and outdoor sex work venues. In Ciudad Juarez, the trajectory of CCU increased over time and was highest among those operating primarily indoors. Results from this analysis highlight the importance of considering local mobility, including venue type and venue stability, as these characteristics jointly influence HIV risk behaviours.

Venue-level correlates of female sex worker registration status: a multilevel analysis of bars in Tijuana, Mexico

In Tijuana, Mexico, sex work is regulated by the municipal government, through registration cards issued to female sex workers (FSWs) for an annual fee. Registration has been associated with decreased drug use and increase condom use and HIV testing. Previously, it was demonstrated that FSWs operating in bars were more likely than street-based FSWs to be registered. This implies that certain venues may be more accessible to local authorities for the enforcement of this type of programme. Taking a novel multilevel approach, we examined whether venue characteristics of bars reflecting greater organised management and visibility affect registration status of FSWs. In an analysis of venue-level characteristics, predictors of being registered were availability of free condoms at work and distance to the main sex strip; however, these were not independently associated after inclusion of FSWs' income, illicit drug use and history of HIV testing. Our findings suggest that sex work regulations may inadvertently exclude venues in which the more vulnerable and less visible FSWs, such as injection drug users and those with limited financial resources, are situated. Efforts to revise or reconsider sex work regulations to ensure that they best promote FSWs' health, human and labour rights are recommended.

Pasa la voz (spread the word): using women's social networks for HIV education and testing

Pasa la Voz (spread the word) is a human immunodeficiency virus (HIV) prevention methodology inspired by respondent-driven sampling (RDS) that uses social networks to access hard-to-reach populations. As field testing showed the approach to be efficacious among at-risk women in West Texas and Southern New Mexico, we set out to evaluate the methodology in a Mexican context. A local community organization, Programa Compañeros, first implemented a traditional one-on-one outreach strategy using promotoras (outreach workers) in Ciudad Juarez, Mexico, from September 2005 to January 2006. This was followed by implementation of Pasa la Voz from February 2006 to January 2007. The percentage of women agreeing to be tested increased from 11.9% to 49.9%, and staff time declined from 22.70 hours to 3.68 hours per HIV test, comparing the one-on-one with the Pasa la Voz methodology, respectively. Pasa la Voz was successful at imparting a cost-savings prevention education program with significant increases in the number of at-risk women being tested for HIV.

Associations between migrant status and sexually transmitted infections among female sex workers in Tijuana, Mexico

OBJECTIVE

To examine associations between migration and sexually transmitted infection (STI) prevalence among Mexican female sex workers (FSW).

METHODS

FSW aged 18 years and older in Tijuana, Baja California (BC) underwent interviews and testing for HIV, syphilis, gonorrhoea and chlamydia. Multivariate logistic regressions identified correlates of STI.

RESULTS

Of 471 FSW, 79% were migrants to BC. Among migrant FSW, prevalence of HIV, syphilis, gonorrhoea, chlamydia and any STI was 6.6%, 13.2%, 7.8%, 16.3% and 31.1% compared with 10.9%, 18.2%, 13.0%, 19.0% and 42.4% among FSW born in BC. A greater proportion of migrant FSW were registered with local health services and were ever tested for HIV. Migrant status was protective for any STI in unadjusted models (unadjusted odds ratio 0.61, 95% CI 0.39 to 0.97). In multivariate models controlling for confounders, migrant status was not associated with an elevated odds of STI acquisition and trended towards a protective association.

CONCLUSIONS

Unexpectedly, migrant status (vs native-born status) appeared protective for any STI acquisition. It is unclear which social or economic conditions may protect against STI and whether these erode over time in migrants. Additional research is needed to inform our understanding of whether or how geography, variations in health capital, or social network composition and information-sharing attributes can contribute to health protective behaviours in migrant FSW. By capitalising on such mechanisms, efforts to preserve protective health behaviours in migrant FSW will help control STI in the population and may lead to the identification of strategies that are generalisable to other FSW.

Preliminary development of a scale to measure stigma relating to sexually transmitted infections among women in a high risk neighbourhood

Background

As stigma is a socially constructed concept, it would follow that stigma related to sexual behaviours and sexually transmitted infections would carry with it many of the gender-based morals that are entrenched in social constructs of sexuality. In many societies, women tend to be judged more harshly with respect to sexual morals, and would therefore have a different experience of stigma related to sexual behaviours as compared to men. While a variety of stigma scales exist for sexually transmitted infections (STIs) in general; none incorporate these female-specific aspects. The objective of this study was to develop a scale to measure the unique experience of STI-related stigma among women.

Methods

A pool of items was identified from qualitative and quantitative literature on sexual behaviour and STIs among women. Women attending a social evening program at a local community health clinic in a low-income neighbourhood with high prevalence of substance use were passively recruited to take part in a cross-sectional structured interview, including questions on sexual behaviour, sexual health and STI-related stigma. Exploratory factor analysis was used to identify stigma scales, and descriptive statistics were used to assess the associations of demographics, sexual and drug-related risk behaviours with the emerging scales.

Results

Three scales emerged from exploratory factor analysis – female-specific moral stigma, social stigma (judgement by others) and internal stigma (self-judgement) – with alpha co-efficients of 0.737, 0.705 and 0.729, respectively. In this population of women, internal stigma and social stigma carried higher scores than female-specific moral stigma. Aboriginal ethnicity was associated with higher internal and female-specific moral stigma scores, while older age (>30 years) was associated with higher female-specific moral stigma scores.

Conclusion

Descriptive statistics indicated an important influence of culture and age on specific types of stigma. Quantitative researchers examining STI-stigma should consider incorporating these female-specific factors in order to tailor scales for women.

Nonadherence increases the risk of hospitalization among HIV-infected antiretroviral naive patients started on HAART

BACKGROUND

Since the advent of highly active antiretroviral therapy (HAART), AIDS-related hospitalizations have decreased. The objective of this study was to assess the impact of adherence on hospitalization among antiretroviral-naïve HIV-infected persons initiating HAART.

METHODS

Analysis was based on a cohort of individuals initiating HAART between 1996 and 2001. The primary outcome was hospitalization for one or more days. Survival methods were used to assess the impact of adherence on hospitalization.

RESULTS

Of 1605 eligible participants, 672 (42%) were hospitalized for one or more days after initiating HAART. Median adherence levels were 92 (IQR: 58, 100) and 100 (IQR: 83, 100) among those ever and never hospitalized, respectively. After controlling for confounders, those with <95% adherence had 1.88 times (95% CI: 1.60, 2.21) higher risk for hospitalization.

CONCLUSIONS

Suboptimal adherence among HIV-infected patients taking HAART predicts hospitalization. Identifying and addressing factors contributing to poor adherence early in treatment could improve patient care and lower hospitalization costs.