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1.  Sexually transmitted infection risk behaviors in rural Thai adolescents and young adults: Support for gender- and age-specific interventions 
Sexually transmitted diseases  2013;40(3):216-220.
STI prevalence and risks in a sample of rural Thai adolescents and young adults (14–29 years old) were examined. Unprotected sex with a casual partner conferred the greatest risk for prevalent STIs, particularly for younger adolescents and alcohol use increased the STI risk for women but not for men.
PMCID: PMC3572507  PMID: 23403603
Thailand; adolescents; sexually transmitted infections; gender; social norms
2.  Strategies and Outcomes of HIV Status Disclosure in HIV-Positive Young Women with Abuse Histories 
AIDS Patient Care and STDs  2013;27(3):191-200.
Young women with HIV and histories of physical and/or sexual abuse in childhood may be vulnerable to difficulties with disclosure to sexual partners. Abuse in childhood is highly prevalent in HIV-positive women, and has been associated with poorer communication, low assertiveness, low self worth, and increased risk for sexual and other risk behaviors that increase the risk of secondary transmission of HIV. HIV disclosure may be an important link between abuse and sexual risk behaviors. Qualitative interviews with 40 HIV-positive young women with childhood physical and/or sexual abuse were conducted; some women had also experienced adult victimization. Results suggest that HIV-positive women with abuse histories use a host of strategies to deal with disclosure of HIV status, including delaying disclosure, assessing hypothetical responses of partners, and determining appropriate stages in a relationship to disclose. Stigma was an important theme related to disclosure. We discuss how these disclosure processes impact sexual behavior and relationships and discuss intervention opportunities based on our findings.
PMCID: PMC3595953  PMID: 23596649
3.  Television Viewing in Low-Income Latino Children: Variation by Ethnic Subgroup and English Proficiency 
Childhood Obesity  2013;9(1):22-28.
Television viewing is associated with an increased risk for obesity in children. Latino children are at high risk for obesity and yet little is known about differences in television viewing habits within this population. The purpose of this study is to determine if hours of television viewed by young children with low-income Latina mothers differs by maternal ethnic subgroup and English language proficiency.
This was a cross-sectional analysis of data from the Welfare, Children, & Families: A Three City Study. Participants were 422 low-income Latina mothers of Mexican and Puerto Rican descent with children ages 0–4 years old. The dependent variable was hours of daily television viewed by the child. The independent variable was maternal ethnic subgroup and English language proficiency. Analyses involved the use of multiple negative binomial regression models, which were adjusted for demographic variables.
Multivariable regression analyses showed that compared to children with mothers of Mexican descent, children of mothers of Puerto Rican descent watch more daily television (<2 years old, incidence rate ratio (IRR)=4.18, 95% confidence interval (CI) 1.68, 10.42; 2–4 years, IRR=1.54, 95% CI 1.06, 2.26). For children with mothers of Mexican descent, higher maternal English language proficiency was associated with higher amounts of child television viewing (IRR=1.29, 95% CI 1.04, 1.61). No relationship was found for children of Puerto Rican descent.
Child television viewing varies in low-income Latino children by maternal ethnic subgroup and English language proficiency. Interventionists must consider the varying sociocultural contexts of Latino children and their influence on television viewing.
PMCID: PMC3601541  PMID: 23301653
4.  Norms governing urban African American adolescents’ sexual and substance-using behavior 
Journal of adolescence  2012;36(1):31-43.
Using a probability-based neighborhood sample of urban African American youth and a sample of their close friends (N = 202), we conducted a one-year longitudinal study to examine key questions regarding sexual and drug using norms. The results provide validation of social norms governing sexual behavior, condom use, and substance use among friendship groups. These norms had strong to moderate homogeneity; and both normative strength and homogeneity were relatively stable over a one-year period independent of changes in group membership. The data further suggest that sex and substance using norms may operate as a normative set. Similar to studies of adults, we identified three distinct “norm-based” social strata in our sample. Together, our findings suggest that the norms investigated are valid targets for health promotion efforts, and such efforts may benefit from tailoring programs to the normative sets that make up the different social strata in a given adolescent community.
PMCID: PMC3604793  PMID: 23072891
Adolescents; Friendships; African American; HIV risk behavior; Norm validity; Norm stability
5.  Core Sexual/Reproductive Health Care to Deliver to Male Adolescents: Perceptions of Clinicians Focused on Male Health 
Male adolescents experience adverse sexual/reproductive health (SRH) outcomes, yet few providers deliver male SRH care. Given the lack of evidence base for male SRH care, the purpose of this study was to examine perceived importance in delivering SRH care to male adolescents among clinicians focused on male health.
Seventeen primary care clinicians focused on male health, representing pediatricians, family physicians, internists, and nurse practitioners, were individually queried about male adolescents’ SRH needs and perceived importance to screen/assess for 13 male SRH services using a case-scenario approach varying by visit type and allotted time.
Participants were highly consistent in identifying a scope of 10 SRH services to deliver to male adolescents during a longer annual visit and a core set of 6 SRH services during a shorter annual visit including 1) counseling on sexually transmitted infection/human immunodeficiency (STI/HIV) risk reduction including testing/treatment; and assessing for 2) pubertal growth/development; 3) substance abuse/mental health; 4) non-STI/HIV genital abnormalities; 5) physical/sexual abuse; and 6) male pregnancy prevention methods. Participants did not agree whether SRH care should be delivered during non-annual acute visits.
Despite lack of data for male SRH care, clinicians focused on male health strongly agreed upon male SRH care to deliver during annual visits that varied by visit type and allotted time. Study findings provide a foundation for much needed clinical guidelines for male adolescents’ SRH care and have implications for education and training health professionals at all levels and the organization and delivery of male SRH services.
PMCID: PMC3383603  PMID: 22727075
Adolescent males; Clinical practice; Health care delivery/access; Reproductive health
6.  Differential Challenges in Coalition Building among HIV Prevention Coalitions Targeting Specific Youth Populations 
Journal of prevention & intervention in the community  2012;40(2):10.1080/10852352.2012.660124.
Coalitions provide the potential for merging the power, influence, and resources of fragmented individuals and institutions into one collective group that can more effectively focus its efforts on a specific community health issue. Connect to Protect® coalitions devote resources to address the HIV epidemic at a structural level. This research examines differential challenges in coalition processes that may facilitate/hinder coalition building to achieve HIV prevention through structural change. Qualitative interviews conducted with community partners participating across 10 coalitions were analyzed to compare responses of those individuals working on HIV prevention coalitions targeting adolescent and young adult gay and bisexual men versus those targeting adolescent and young adult heterosexual women. Community partner responses revealed differences across several key areas including: a) acceptability and goals in discussing sexual issues with adolescents, b) goals of sexual health promotion activities, and c) competition among collaborating agencies. Themes highlighted in this research can complement existing community intervention literature by helping community mobilizers, interventionists, and researchers understand how cultural norms affect youth-specific coalition work.
PMCID: PMC3818727  PMID: 24188354
coalitions; African American and Latino adolescent and young adults; structural change; HIV prevention
7.  Neighborhood Drug Markets: A risk environment for bacterial sexually transmitted infections among urban youth 
Social science & medicine (1982)  2012;74(8):1240-1250.
We hypothesized that neighborhoods with drug markets, as compared to those without, have a greater concentration of infected sex partners, i.e. core transmitters, and that in these areas, there is an increased risk environment for STIs. This study determined if neighborhood drug markets were associated with a high-risk sex partnership and, separately, with a current bacterial STI (chlamydia and/or gonorrhea) after controlling for individual demographic and sexual risk factors among a household sample of young people in Baltimore City, MD. Analyses also tested whether links were independent of neighborhood socioeconomic status. Data for this study were collected from a household study, systematic social observations and police arrest, public health STI surveillance and U.S. census data. Nonlinear multilevel models showed that living in neighborhoods with household survey-reported drug markets increased the likelihood of having a high-risk sex partnership after controlling for individual level demographic factors and illicit drug use and neighborhood socioeconomic status. Further, living in neighborhoods with survey-reported drug markets increased the likelihood of having a current bacterial STI after controlling for individual level demographic and sexual risk factors and neighborhood socioeconomic status. The results suggest that local conditions in neighborhoods with drug markets may play an important role in setting-up risk environments for high-risk sex partnerships and bacterial STIs. Patterns observed appeared dependent on the type of drug market indicator used. Future studies should explore how conditions in areas with local drug markets may alter sexual networks structures and whether specific types of drug markets are particularly important in determining STI risk.
PMCID: PMC3383619  PMID: 22386616
USA; sexually transmitted infections; drug markets; social epidemiology; medical geography; core transmitters
8.  Desire for Pregnancy and Risk Behavior in Young HIV-Positive Women 
AIDS Patient Care and STDs  2012;26(3):173-180.
This cross-sectional study utilized data from 130 young women with behaviorally acquired HIV to examine the association between desire for pregnancy (DFP) and both sociodemographic variables and sexual risk behaviors. A single item was utilized to assess DFP. Bivariate and multivariate regression analyses were conducted. At the bivariate level, DFP was associated with increased rates of intercourse, decreased condom use, increased partner concurrency, increased rates of unprotected sex with a nonconcordant partner, and a higher number of previous sexually transmitted infections (STIs). Multivariate analyses suggested that DFP was associated with increased likelihood of recent intercourse, condom-unprotected sex, and oral sex. DFP was related to few sociodemographic variables but was associated with having fewer children currently, a history of victimization, and decreased rates of disclosure of HIV status. The few sociodemographic variables that were associated with DFP suggest that social relationships may play a role in DFP. DFP was associated with sexual behaviors that may place young women at risk for STI acquisition and secondary HIV transmission to partners. Health care providers should assess DFP in routine HIV care, providing education about fertility options, interventions for vertical transmission, family planning, and risk reduction counseling.
PMCID: PMC3286807  PMID: 22482121
9.  Conflict transformation, stigma, and HIV-preventive structural change 
Over the prior decade, structural change efforts have become an important component of community-based HIV prevention initiatives. However, these efforts may not succeed when structural change initiatives encounter political resistance or invoke conflicting values, which may be likely when changes are intended to benefit a stigmatized population. The current study sought to examine the impact of target population stigma on the ability of 13 community coalitions to achieve structural change objectives. Results indicated that coalitions working on behalf of highly stigmatized populations had to abandon objectives more often than did coalitions working for less stigmatized populations because of external opposition to coalition objectives and resultant internal conflict over goals. Those coalitions that were most successful in meeting external challenges used opposition and conflict as transformative occasions by targeting conflicts directly and attempting to neutralize oppositional groups or turn them into strategic allies; less successful coalitions working on behalf of stigmatized groups struggled to determine an appropriate response to opposition. The role of conflict transformation as a success strategy for working on behalf of stigmatized groups is discussed.
PMCID: PMC3348352  PMID: 21805217
prevention; coalitions; structural change; HIV/AIDS; stigma
The aim of this study is to examine how physicians use clinical practice guidelines that call for routine HIV screening in a general adolescent medicine clinic and to determine how adolescent patients respond to routine screening. Physicians offered screening to 116 of 217 patients (53%) aged 13-21 who completed a survey. Physicians’ offers conformed to the latest Centers for Disease Control and Prevention (CDC) guidelines with 73% of patients because some patients not offered a test had been screened within the last year. Physicians were three times more likely (OR = 3.0; 95% CI = 1.3-6.8) to offer HIV screening to sexually active adolescents than to adolescents who reported no sexual history. Adolescent medicine physicians and their patients endorse the idea of routine screening as embodied in the latest CDC recommendations, but adolescents with no sexual history are less likely than other adolescents to accept screening when it is offered and to support a clinic policy of routine screening. Both physicians and their adolescent patients continue to test based on risk assessments.
PMCID: PMC3105471  PMID: 21204629
11.  Victimization and Sexual Risk Behavior in Young, HIV Positive Women: Exploration of Mediators 
AIDS and Behavior  2012;16(4):999-1010.
In this study we explore associations between child and adult victimization and sexual risk behavior in 118 young, HIV positive women. Prior research has demonstrated associations between victimization and engagement in sexual risk behavior. Victimization sequelae can include disrupted assertiveness and communication, as well as increased association with risky partners, both of which are also linked with engagement in sexual risk behavior. Thus, we propose a model wherein victimization is linked to sexual risk behavior through two mediating pathways, sexual communication and affiliation with risky partners. We also examine the moderating effects of the presence of an anxiety or depressive disorder on the path from child to adult victimization. Results suggested that adult victimization was associated with unprotected sex with a main partner; however, this association was mediated by less sexual communication and having a risky partner. Trends toward significance were found for depression and anxiety as a moderator of the relationship between child and adult victimization. Child victimization did not have direct effects on unprotected sex. Implications for secondary prevention of HIV and healthy intimate relationships are discussed.
PMCID: PMC3338894  PMID: 21452050
Victimization; HIV; Women; Sexual risk
12.  Annual physical examination reports vary by gender once teenagers become sexually active 
Few sexually active male adolescents receive sexual/reproductive health (SRH) services. We examine whether the association between adolescents’ sexual behavior status and physical examination over time can help us understand why.
We conducted longitudinal cohort analysis of the National Longitudinal Study of Adolescent Health with 9239 adolescents who completed the baseline school (1994/95) and Wave 2 (1996) follow-up surveys approximately 1.5 years later (retention rate=71%). We fit logistic regression models with random effects to estimate individual odds of reporting a physical examination in the past 12 months at follow-up, as compared to baseline, stratified by sexual behavior status and gender, and adjusting for sociodemographic and healthcare access factors.
34.5% males and 38.2% females reported experiencing vaginal intercourse by follow-up, and 22.4% males and 24.7% females reported first experiencing intercourse during the study. Among sexually active adolescents, about half reported annual exams and one-fifth no exams. Among females, baseline to follow-up exam reports significantly increased in: sex initiators (adjusted Odds Ratio [95% confidence interval]=2.09 [1.66–2.64]); those reporting sex at both times (2.16 [1.51–3.09]); and those reporting no sex either time (2.47 [2.00–3.04]). Among males, baseline to follow-up exam reports significantly increased in those reporting no sex either time (1.57 [1.26–1.96]) and showed increasing trends in sex initiators (1.27 [0.92–1.76]).
A majority of sexually active adolescents report annual physical exams over time. Providers should not miss opportunities to deliver evidence-based SRH to sexually active adolescents. Future efforts are needed to increase all adolescents’ access to SRH services.
PMCID: PMC3124664  PMID: 21700156
Health Services Accessibility; Male; Female
13.  New sexually transmitted infections among adolescent girls infected with HIV 
Sexually Transmitted Infections  2007;83(6):468-469.
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.
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.
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 7096 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).
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.
PMCID: PMC2598696  PMID: 17699560
adolescence; HIV; sexually transmitted infection (STI)
14.  Age‐bridging among young, urban, heterosexual males with asymptomatic Chlamydia trachomatis 
Sexually Transmitted Infections  2006;83(2):136-141.
To determine the prevalence of age‐bridgers among urban males aged 14–24 years, asymptomatically infected with chlamydia and to determine factors that distinguish age‐bridgers from non age‐bridgers. An index was defined as an age‐bridger if within 2 months, he had had at least two sexual partners who differed from him in age by ⩾2 years.
Infected males provided data about themselves and up to four sexual partners in the past 2 months. Bivariate and multivariable logistic regression was used in the analysis.
The prevalence of age bridging was 21% in Baltimore and 26% in Denver. In both cities, in bivariate analysis, age‐bridgers and their partners engaged in significantly more risky sexual behaviours. In adjusted multivariable analysis after controlling for number of sexual partners, age bridging was associated with having a sexual partner in the past 2 months, who, at time of last sexual intercourse, was drinking.
Age‐bridgers represented major proportions of the study populations and, along with their sexual partners, were more likely to engage in risky sexual behaviours. Male age‐bridgers may be key players in the transmission of sexually transmitted infections among youth linking age‐disparate sexual networks.
PMCID: PMC2598631  PMID: 17151025
15.  The Available Pool of Sex Partners and Risk for a Current Sexually Transmitted Infection 
Annals of epidemiology  2010;20(7):532-538.
STI transmission models propose that incident STIs are related to exposure to infected sex partners. The objective of this study was to determine whether the prevalence of STIs among the available pool of sex partners in a neighborhood, measured indirectly, is an independent determinant of a current incident STI.
The target population comprised 58,299 English-speaking, sexually active 15–24 year olds in 486 census block groups (CBGs) in Baltimore, MD. A sample of 65 CBGs was selected using a stratified, systematic, probability-proportional-to-size strategy and 13,873 households were randomly selected. From 2004–2007, research assistants administered an audio-CASI survey and collected biologic samples for gonorrhea and chlamydia testing.
The final sample size included 575 participants from 63 CBGs. Additional data provided gonorrhea prevalence from 2004–2005 per 15–49 year olds per 100,000 per CBG. After adjusting for individual-level STI risk factors in a multilevel probability model, adolescents and young adults living in high (vs. low) prevalence STI areas were 4.73 times (95% confidence interval (CI): 3.65–6.15) more likely to have a current incident STI.
To inform prevention programs, future research should focus on identifying mechanisms through which context causes changes in local sexual networks and their STI prevalence.
PMCID: PMC2884146  PMID: 20538196
Sexually transmitted diseases; gonorrhea; residence Characteristics; adolescent; urban population; urban health
16.  Social Disadvantage as a Risk for First Pregnancy Among Adolescent Females in the United States 
Differences in underlying determinants of pregnancy at different stages of adolescent development have implications for prevention strategies. We sought to determine whether social disparities in rates of adolescent pregnancy vary between early, middle and late adolescence. We hypothesized that as age increases, racial and socioeconomic disparities in rates of teen conception decrease.
Data were obtained from the National Survey of Family Growth Cycle 6. Outcome variables indicated whether respondents' had a first pregnancy at ages <15 years, 15–17 years, or 18–19 years. Independent variables were race and maternal education level. Logistic regression was used to calculate the relative odds of first conception in a given age range by race and maternal education level.
The disparity in odds of pregnancy between black and white teens is maximal in early adolescence (OR <15years 3.89) and decreased by up to 40% in late adolescence (OR 18–19 years 2.01, p<0.01). After stratifying by maternal education level, the same trends are seen.
In accordance with our hypothesis, we found that social disparities in pregnancy rates decrease between early and late adolescence. While pregnancy prevention efforts often target those at social risk including poor minority youth, fewer acknowledge and target the risks associated with development of sexuality in all teens. Efforts to better define the nature of healthy adolescent sexual development may lead to pregnancy prevention interventions focused on developmental risk that can apply to a wider set of adolescents.
PMCID: PMC3200531  PMID: 22018570
17.  Correlates of HIV Testing History among Urban Youth Recruited through Venue-Based Testing in 15 US Cities 
Sexually transmitted diseases  2011;38(8):691-696.
Adolescents and young adults comprise disproportionately high percentages of individuals living with HIV and those with undiagnosed HIV. Our objective was to determine factors associated with history of HIV testing and receipt of results among a sample of urban, high-risk, sexually active adolescents in 15 U.S. cities.
20–30 sexually active youth, aged 12–24 years, were recruited to participate in an anonymous survey and HIV antibody testing at 2–3 venues per city identified by young men who have sex with men, young women of color, or intravenous drug users.
Of the 1457 participants, 72% reported having been previously tested for HIV (89% of whom were aware of their test results). Our sample was diverse in terms of gender, race/ethnicity, and sexual orientation. Factors found to be predictive of testing typically reflect high risk for HIV, except for some high risk partner characteristics, including having had a partner that made the youth have sex without a condom or had a partner with unknown HIV status. Factors associated with knowledge of serostatus are reported. HIV testing appears to be tied more to STI testing services than to primary care.
More strategies are needed that increase testing, including targeting partners of high-risk individuals, insuring receipt of test results, and increasing testing in primary care settings.
PMCID: PMC3155007  PMID: 21758020
18.  Infidelity, Trust, and Condom Use among Latino Youth in Dating Relationships 
Sexually transmitted diseases  2009;36(4):227-231.
Latino youth in the United States are at greater risk for contracting sexually transmitted infections (STIs) in comparison to non-Hispanic white youth.
Sexually active Latino youth aged 16-22 years (N=647) were recruited for interviews through a large health maintenance organization or community clinics.
Adjusting for gender, age, ethnic heritage, and recruitment method, woman's consistent use of hormonal contraceptives, ambivalence with respect to avoiding pregnancy, longer length of sexual relationship, and greater overall trust in main partner were independently associated with inconsistent condom use and engagement in a greater number of sexual intercourse acts that were unprotected by condom use. Perception that one's main partner had potentially been unfaithful, but not one's own sexual concurrency, was associated with consistent condom use and fewer acts of unprotected sexual intercourse. Sexually concurrent youth who engaged in inconsistent condom use with other partners were more likely to engage in inconsistent condom use and a greater number of unprotected sexual intercourse acts with main partners.
Increasing attachment between youth may be a risk factor for the transmission of STIs via normative declines in condom use. Perception that one's partner has potentially been unfaithful may result in greater condom use. However, many Latino adolescents and young adults who engage in sexual concurrency may not take adequate steps to protect their partners from contracting STIs. Some youth may be more focused on the emotional and social repercussions of potentially revealing infidelity by advocating condom use than the physical repercussions of unsafe sex.
PMCID: PMC2925537  PMID: 19265741
adolescent; condom; infidelity; sexual concurrency; Latino
19.  Youth Living with HIV and Partner-specific Risk for the Secondary Transmission of HIV 
Sexually transmitted diseases  2009;36(7):439-444.
A comparison of risks for the secondary transmission of HIV between young HIV-infected women-who-have-sex-with-men (WSM) and men-who-have-sex-with-men (MSM) found that recent partner-specific sexual risk behaviors are high among both populations. However, differences in the specific behaviors between WSM and MSM support population-specific interventions to reduce the secondary transmission of HIV.
Secondary transmission remains a significant concern among HIV-infected youth. Little is known, however, about how partner-specific sexual risk behaviors for the secondary transmission of HIV may differ between the two largest subgroups of HIV positive youth, women-who-have-sex-with-men (WSM) and men-who-have-sex-with-men (MSM),
During 2003-2004, a convenience sample of HIV-infected youth, 13-24 years of age, were recruited from 15 Adolescent Medicine Trials Network clinical sites. Approximately 10-15 youth were recruited at each site. Participants completed an ACASI survey including questions about sex partners in the past year. Cross-sectional data analyses, including bivariate and multivariable regressions using generalized estimating equations, were conducted during 2008 to compare recent partner-specific sexual risk behaviors between WSM and MSM.
Of 409 participants, 91% (371) were included in this analysis, including 176 WSM and 195 MSM. Ninety-two percent (163 WSM, 177 MSM) provided information on characteristics of their sexual partners. There were significant differences between the two groups in recent partner-specific sexual risk behaviors including: lower rates of condom use at last sex among WSM (61% WSM vs. 78% MSM; p=0.0011); a larger proportion of the sex partners of MSM reported as concurrent (56% MSM vs. 36% WSM; p=0.0001); and greater use of hard drugs at last sex by MSM and/or their partner (18% MSM vs. 4% WSM; p=0.0008). When measuring risk as a composite measure of sexual risk behaviors known to be associated with HIV transmission, both groups had high rates of risky behaviors, 74.7% among young MSM compared to 68.1% of WSM.
These data suggest that recent partner-specific sexual risk behaviors for HIV transmission are high among young infected MSM and WSM. These findings suggest the need to offer interventions to reduce the secondary transmission of HIV to all HIV-positive youth in care. However, differences in risk behaviors between young MSM and WSM supports population-specific interventions.
PMCID: PMC2725398  PMID: 19525889
20.  Discordance between Adolescent Real and Ideal Sex Partners and Association with STI Risk Behaviors 
Epidemic levels of sexually transmitted infections (STIs) among urban youth have drawn attention to the potential role of sex partner selection in creating risk for STIs. The objectives of this study were to describe the ideal preferences and real selection of sex partners, to evaluate sex partner ideal vs. real discordance using quantitative methods and to determine the association between discordance and STI risk behaviors.
Data are from an urban, household sample of 429 15–24 year olds. Trait clusters were developed for participants’ ratings of their real and ideal sex partners and tested for reliability. Discordance between the ratings of real and ideal partners was measured. Logistic regression was used to assess associations between sex partner discordance and STI risk behaviors.
Real sex partners ratings were often lower than participants’ ideal sex partner ratings. Thirty-three percent of males and 66% of females were discordant on at least one trait cluster. Males discordant on the emotional support they expected of their partner were more likely to report >2 sex partners in the past 90 days (OR=2.13, 95% CI: 1.06, 4.26) and perceived partner concurrency (OR=3.85, 95% CI: 1.53, 9.72). For females, discordance on fidelity or emotional support significantly increased the odds of all risk behaviors.
Male and female adolescents with discordant real and ideal sex partner ratings were more likely to report STI-related risk behaviors. Next steps should involve identification of factors associated with ideal vs. real sex partner discordance such as features of the social context.
PMCID: PMC3150491  PMID: 21575821
sex partner selection; STI risk; adolescents; social epidemiology
21.  Developmental Changes in Condom Use among Urban Adolescent Females: Influence of Partner Context 
National surveys have found the percentage of female adolescents who report condom use at last sex differs by age group. Using longitudinal data, the authors examined whether there are longitudinal changes in condom use and whether these longitudinal changes are due in part to developmental changes in the types of sexual relationships in which young women are involved.
A clinic sample of 298 African American females aged 14 to 19 years at enrollment were interviewed every 6 months for 36 months. At each interview, participants were asked to name all their recent sex partners, to classify each partner as main or casual and to report whether or not a condom was used at last sex with each of these partners. Hierarchical generalized linear modeling was used to analyze repeated measures within individuals.
On average, there was no statistically significant change in condom use over time. The odds of having a single main partner increased by 4% for each six months spent in the study (OR: 1.04, 95%CI: 1.02, 1.05). Stratifying females by longitudinal relationship patterns resulted in three distinct condom use trajectories.
Data suggest that longitudinal changes in condom use are a function of developmental changes in relationships, whereby young women trend toward monogamous relationships. As condoms are abandoned within these monogamous relationships, lowering infection rates in sex partners through broader STI screening or through community-level interventions aimed at sex networks may prove to be a more effective approach to reduce STI risk in young women.
PMCID: PMC3058143  PMID: 21402268
22.  Transition of Adolescents With HIV to Adult Care: Characteristics and Current Practices of the Adolescent Trials Network for HIV/AIDS Interventions 
The transition process from pediatric to adult health care for adolescents with chronic diseases is always challenging and can be even more so for adolescents with HIV disease. The purpose of this study was to describe characteristics and current practices surrounding the transition of adolescents from the clinics of the Adolescent Trials Network for HIV/AIDS Interventions to adult medical care. This report focuses on the processes of transition, perceived barriers and facilitators, and anecdotal reports of successes and failures. Practice models used to assist adolescents during transition to adult medical care are described. Interviews were conducted with 19 key informants from 14 Adolescent Trials Network clinics. Findings revealed no consistent definition of “successful” transition, little consensus among the sites regarding specific elements of a transition program, and a lack of mechanisms to assess outcomes. Sites that viewed transition as a process rather than an event consistently described more structured program elements.
PMCID: PMC3315706  PMID: 20541443
adolescent; AIDS; developmental; HIV; transition
23.  Mindfulness-Based Stress Reduction for Urban Youth 
The objectives of this study were to assess the general acceptability and to assess domains of potential effect of a mindfulness-based stress reduction (MBSR) program for human immunodeficiency virus (HIV)–infected and at-risk urban youth.
Thirteen-to twenty-one-year-old youth were recruited from the pediatric primary care clinic of an urban tertiary care hospital to participate in 4 MBSR groups. Each MBSR group consisted of nine weekly sessions of MBSR instruction. This mixed-methods evaluation consisted of quantitative data—attendance, psychologic symptoms (Symptom Checklist 90-Revised), and quality of life (Child Health and Illness Profile–Adolescent Edition)—and qualitative data—in-depth individual interviews conducted in a convenience sample of participants until interview themes were saturated. Analysis involved comparison of pre- and postintervention surveys and content analysis of interviews.
Thirty-three (33) youth attended at least one MBSR session. Of the 33 who attended any sessions, 26 youth (79%) attended the majority of the MBSR sessions and were considered “program completers.” Among program completers, 11 were HIV-infected, 77% were female, all were African American, and the average age was 16.8 years. Quantitative data show that following the MBSR program, participants had a significant reduction in hostility (p = 0.02), general discomfort (p = 0.01), and emotional discomfort (p = 0.02). Qualitative data (n = 10) show perceived improvements in interpersonal relationships (including less conflict), school achievement, physical health, and reduced stress.
The data suggest that MBSR instruction for urban youth may have a positive effect in domains related to hostility, interpersonal relationships, school achievement, and physical health. However, because of the small sample size and lack of control group, it cannot be distinguished whether the changes observed are due to MBSR or to nonspecific group effects. Further controlled trials should include assessment of the MBSR program's efficacy in these domains.
PMCID: PMC3157305  PMID: 21348798
AIDS Education and Prevention  2011;23(4):367-381.
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.
PMCID: PMC3287350  PMID: 21966746
25.  Methamphetamine Use and Risk for HIV Among Young Men Who Have Sex With Men in 8 US Cities 
To examine methamphetamine use and its association with sexual behavior among young men who have sex with men.
Cross-sectional observational analysis.
Eight US cities.
As part of the Adolescent Trials Network for HIV/AIDS Interventions, adolescent boys and young men who have sex with men, aged 12 to 24 years, were recruited from social venues (eg, clubs, parks, and street corners) between January 3, 2005, and August 21, 2006, to complete a study survey.
Main Outcome Measures
Reported methamphetamine use in the past 90 days and reported sexual risk behavior compared with individuals reporting no hard drug use and individuals reporting hard drug use in the past 90 days.
Among 595 adolescent boys and young men, 64 reported recent methamphetamine use, and 444 reported no recent hard drug use (87 reported use of hard drugs other than methamphetamine). Recent methamphetamine use was associated with a history of sexually transmitted diseases (51.6%), 2 or more sex partners in the past 90 days (85.7%), sex with an injection drug user (51.6%), and sex with someone who has human immunodeficiency virus (32.8%) compared with individuals reporting no recent hard drug use (21.1%, 63.1%, 10.7%, and 11.1%, respectively; P<.05 for all [n=441]). Recent users of methamphetamine were more likely to have a history of homelessness (71.9%) and were less likely to be currently attending school (35.9%) compared with individuals reporting no recent hard drug use (28.4% and 60.4%, respectively; P<.001 for both).
Adolescent boys and young men who have sex with men and use methamphetamine seem to be at high risk for human immunodeficiency virus. Prevention programs among this age group should address issues like housing, polydrug use, and educational needs.
PMCID: PMC3278965  PMID: 21810635

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