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Biomedical subjects

J Dennis Fortenberry

Publications and source records attributed to J Dennis Fortenberry.

At least 19 recordsLinked to original sources
PubMed2006

Patterns of oral contraceptive pill-taking and condom use among adolescent contraceptive pill users.

PURPOSE: Imperfect oral contraceptive pill (OCP) regimen adherence may impair contraceptive effectiveness. The purpose of this study was to describe daily adherence patterns of OCP use, to analyze OCP protection on an event level basis, and to examine pill-taking and condom use during method transitions. METHODS: Women (n = 123, ages 14-17 years) completed quarterly interviews to classify OCP method choice into four categories: stable, initiated, stopped, and discordant use. Within each OCP category, daily diaries were used to assess occurrence of coitus, condom use, and patterns of day-to-day OCP use (i.e., consecutive days of OCP use reported with no more than two consecutive days of nonuse). A coital event was OCP protected if pills were used on both the day of the coitus and the day preceding. RESULTS: There were 123 participants who reported at least some OCP use in 210 diary periods (average diary length = 75.5 days). Fifty-three participants categorized as stable users reported 87 diary periods: the average interval of consecutive OCP use in this group was 32.5 days. Among stable users, only 45% of coital events were associated with both OCP and condom use. Over one-fifth of coital events in all groups were protected by no method of contraception. CONCLUSION: Dual use of OCP and barrier contraception remains an elusive goal. The time during OCP adoption or discontinuation is often unprotected by condoms. However, concurrent missed pills and condom nonuse increase pregnancy and infection risk even among stable OCP users. Understanding motivation for method usage may improve education and prevention techniques.

Adolescent↗
PubMed2006

The developmental association of relationship quality, hormonal contraceptive choice and condom non-use among adolescent women.

PURPOSE: Consistent condom use is critical to efforts to prevent sexually transmitted infections among adolescents, but condom use may decline as relationships and contraceptive needs change. The purpose of this research is to assess changes in condom non-use longitudinally in the context of changes in relationship quality, coital frequency and hormonal contraceptive choice. METHODS: Participants were women (aged 14-17 years at enrollment) recruited from three urban adolescent medicine clinics. Data were collected at three-month intervals using a face-to-face structured interview. Participants were able to contribute up to 10 interviews, but on average contributed 4.2 interviews over the 27-month period. Independent variables assessed partner-specific relationship quality (five items; scale range 5-25; alpha = .92, e.g., this partner is a very important person to me); and, number of coital events with a specific partner. Additional items assessed experience with oral contraceptive pills (OCP) use and injected depo medroxy-progesterone acetate (DMPA). The outcome variable was number of coital events without condom use during the past three months. Analyses were conducted as a three-level hierarchical linear growth curve model using HLM 6. The Level 1 predictor was time, to test the hypothesis that condom non-use increases over time. Level 2 predictors assessed relationship quality and coital frequency across all partners to assess hypotheses that participants' condom non-use increases over time as a function of relationship quality and coital frequency. Level 3 predictors assessed the participant-level influence of OCP or DMPA experience on time-related changes in condom non-use. RESULTS: A total of 176 women reported 279 sex partners and contributed 478 visits. Both average coital frequency and average condom non-use linearly increased during the 27-month follow-up. At any given follow-up, about 35% reported recent OCP use, and 65% reported DMPA use. HLM analyses showed that condom non-use increased as a function of time (beta = .12; p = .03, Level 1 analysis). Increased condom non-use over time was primarily a function of increased coital frequency (beta = .01; p = .00), although higher levels of relationship quality were associated with increased condom non-use at enrollment (beta = .44; p = .00, Level 2 analysis). The temporal rise in condom non-use significantly increased among DMPA users (beta = .06; p = .00) but not OCP users (Level 3 analysis) (beta = -.04; p = .06). CONCLUSIONS: Developmentally, relationship characteristics and coital frequency appear to have increasing weight in decisions about condom use. Hormonal contraceptive methods are not equivalently associated with the overall temporal decline in condom use. Future research associated with dual contraceptive/condom use should address differential factors associated condom use in combination with different hormonal methods.

Adolescent↗
PubMed2006

Partner age not associated with recurrent Chlamydia trachomatis infection, condom use, or partner treatment and referral among adolescent women.

PURPOSE: Among adolescent women, having older sexual partners has been associated with initial Chlamydia trachomatis (Ct) infection and high-risk behaviors. This study evaluates the role of older partners in the risk of three outcomes: recurrent Ct, lack of condom use, and nonadherence with partner management (PM) strategies. METHODS: Female participants aged 14 to 18 years enrolled in a randomized clinical trial of patient-delivered partner treatment (PDPT) with at least one follow-up visit were included in this secondary analysis. Patient- and partner-level data were collected at baseline, one, and four months follow-up. Generalized estimating equations (GEE) and logistic regression were used to examine unadjusted and adjusted associations. RESULTS: The majority of the 496 women were African-American (63.3%), aged 16 to 18 years (62.3%), and asymptomatic for Ct (66.7%). At baseline, all of the women had laboratory-demonstrated Ct and were treated; they had 622 partners during the last 60 days, 21.4% reported having more than one partner with a mean (SD) of 1.5 (.78) partners per woman, and 46.3% of the partners were at least three years older than the woman. Over follow-up, 16.1% of the women experienced Ct recurrence, in 41.9% of the partnerships a condom was not used at last sex, and 80.6% of women reported giving PM. After adjusting for confounders, having a partner at least three years older was not associated with increased risk of Ct recurrence, lack of condom use, or nonadherence to PM strategies. CONCLUSIONS: Risk of Ct recurrence, lack of condom use, and nonadherence to PM strategies was not higher among adolescent women with older partners.

Adolescent↗
PubMed2006

Brief report: initial testing of scales measuring parent and adolescent Perceptions of Adolescents' Assumption of Diabetes Management.

OBJECTIVE: This study tested parallel adolescent and parent versions of the Perceptions of Adolescents' Assumption of Diabetes Management scales. METHODS: First, 78 items developed from interview data were reviewed by a panel of adolescent and diabetes experts. Next, the scales were piloted with 43 adolescents with type 1 diabetes and their parents and, finally, tested with 100 dyads. Item and principal component analyses were performed. RESULTS: Following content validity and item analyses, five and four items remained in the advantages and disadvantages scales, respectively. One factor accounted for between 54 and 63% of variance, and internal consistency reliability ranged between .78 and .84 for the various versions of the scales. CONCLUSIONS: The Perceptions of Adolescents' Assumption of Diabetes Management scales show promise as parsimonious and reliable tools for use in research and practice related to parent-adolescent relationships in regard to adolescents' assumption of diabetes management.

Adolescent↗
PubMed2006

Association of condom use, sexual behaviors, and sexually transmitted infections with the duration of genital human papillomavirus infection among adolescent women.

OBJECTIVE: To examine the association of potentially modifiable factors such as condom use, sexual behaviors, and concurrent sexually transmitted infections with duration of genital human papillomavirus (HPV) infections among adolescent women. DESIGN: Longitudinal observational study. SETTING: Study conducted at 3 inner-city clinics in Indianapolis, Ind. PARTICIPANTS: Forty-nine HPV-positive adolescents were tested frequently for HPV infection and provided sexual behavior diaries. Main Exposures Condom use, sexual behaviors, number of partners, and concurrent infections with Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. MAIN OUTCOME MEASURES: Time from onset to clearance of type-specific HPV infections was analyzed with proportional hazard models. Adjusted hazard ratios (AHRs) were used to assess the effects of risk factors on the duration of HPV infection. Because viral clearance is a preferred outcome, a variable with an AHR less than 1 was considered a risk factor (ie, associated with reduced chance of viral clearance and prolonged infection). RESULTS: Prolonged HPV infection was associated with oncogenic HPV types (AHR, 0.58 [95% confidence interval (CI), 0.39-0.84]) less than median level of condom use during an HPV infection (AHR, 0.53 [95% CI, 0.33-0.84]) and coinfection with C trachomatis (AHR, 0.58 [95% CI, 0.31-0.89]) or T vaginalis (AHR, 0.32 [95% CI, 0.16-0.64]). Not having multiple sexual partners during an HPV infection was associated with early HPV clearance (AHR, 5.52 [95% CI, 3.28-9.30]). CONCLUSIONS: These findings support public health messages of reducing the number of sexual partners, promoting routine condom use, and frequent sexually transmitted infection screening that may be beneficial with HPV infections.

Adolescent↗
PubMed2006

Incidence and correlates of unwanted sex in relationships of middle and late adolescent women.

OBJECTIVES: To determine the 3-month incidence of unwanted sex and to examine relationship factors and health-risk behaviors associated with incident unwanted sex. DESIGN: Data collected from face-to-face interviews every 3 months in a longitudinal study with a minimum of 2 interviews and maximum of 10 across 27 months. SETTING: Primary health care clinics for teens in an urban setting. PARTICIPANTS: Adolescent women aged 14 through 17 years. MAIN OUTCOME MEASURES: At each 3-month visit, cervical and vaginal specimens were obtained for the evaluation of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infection; for each partner, relationship characteristics and sexual behaviors were assessed, as well as the occurrence of unwanted sex. A logistic model was used to account for within-subject variability to model the probability of unwanted sex as a function of predictor variables. RESULTS: A total of 279 participants with a mean age of 15.9 years were enrolled, and most were African American (88.5% [247/279]). Unwanted sex was reported by 40.9% (n=114) of participants and in 15.5% (292/1880) of partner-visits. The most prevalent type of unwanted sex was due to fear that the partner would get angry if denied sex (37.6%, or 105 participants). Factors associated with unwanted sex included having a baby with the partner, lower relationship quality, lack of sexual control, less condom use, and partner marijuana use. CONCLUSIONS: Unwanted sex occurs often within the sexual relationships of teens. These unwanted sexual experiences result in risk for sexually transmitted infections and pregnancies. Sexual health counseling to reduce risk should focus on both the patient's and the partner's behaviors.

Adolescent↗
PubMed2006

Family and friend closeness to adolescent sexual partners in relationship to condom use.

PURPOSE: The role of closeness of sexual partners to family and friends (i.e., how well the participant's family and friends knew their primary sexual partner) to a variety of relationship and sexual behavior measures was explored. METHODS: A sample of 151 adolescent females (aged 14-17 years) was assessed. Areas assessed include family and friend closeness, relationship intimacy, length of sexual relationship, and condom use. RESULTS: Bivariate correlations indicated that the integration of the sexual partner into the family and friend networks was related to greater relationship intimacy. Lowered condom use was related to a number of measures, including increased relationship intimacy and increased family closeness. A path analysis was conducted to assess for direct and indirect effects of family closeness, friend closeness, relationship length, and relationship intimacy on condom use. Social network closeness in family and friend networks was implicated in lowered condom use through higher relationship intimacy within adolescent dyads. CONCLUSIONS: Social network theory is useful in understanding adolescent health-related behavior. In particular, the integration of adolescent sexual partners into both family and friend networks is related to the expression of adolescent sexual behavior.

Adolescent↗
PubMed2006

Factors associated with time of day of sexual activity among adolescent women.

BACKGROUND: Our objective was to describe familial, intrapersonal, and partner-related factors associated with time of day of sexual activity among adolescent women. METHODS: Annual questionnaires and daily diaries were collected from 106 adolescents. Participants contributed up to 3 questionnaires and 5 12-week diary periods over 27 months. Predictor variables included type of day (weekend, school day, vacation day); partner variables (argument with partner, partner emotional support, time spent with partner); parent/family variables such as supervision, monitoring, and attitudes about adolescent sexual behavior; and mood and behavior variables such as negative mood, positive mood, and sexual interest. The outcome variable for each diary day was no coitus, coitus between noon and 6 pm, or coitus after 6 pm. RESULTS: Coitus occurred on 12.0% of the diary days. Coital events were more than twice as likely to occur after 6 pm (8.5% of days) than in the afternoon (3.5% of days). Afternoon sex was least likely to occur on school days whereas evening sex occurred most often on weekends. An argument with a partner, partner emotional support, time spent with partner, sexual interest, and coital frequency were associated with increased likelihood of afternoon sex, whereas parental supervision and negative mood were associated with decreased likelihood of afternoon sex. For school days, skipping school was associated with increased likelihood of afternoon sex. Evening/night sexual activity was not associated with any parent/family variables. CONCLUSION: Afternoon sex on school days is relatively uncommon. Direct parental supervision may decrease afternoon sexual activity but relationship and intrapersonal factors also are important factors in the timing of sexual activity on any given day.

Adolescent↗
PubMed2006

Perceptions of sexual abstinence among high-risk early and middle adolescents.

PURPOSE: Sexual abstinence has become the primary response to adolescent pregnancy and sexually transmitted infection (STI) prevention. However, most abstinence programs are based on adult ideas of abstinence, and little is known about how adolescents themselves conceptualize sexual abstinence. METHODS: In this qualitative study, we conducted semi-structured exploratory interviews with 42 adolescents aged 11-17 years recruited from primary care clinics. RESULTS: We observed marked confusion over the term "abstinence." However, the concept of abstinence, or choosing not to have sex, was clear and relevant. Participants viewed sexual abstinence as part of a normal developmental continuum. All adolescents were abstinent for a period of time, and then transitioned to sexual activity when they were ready. Readiness was determined by (1) individual factors, such as age, life events, physical maturity and social maturity, (2) relationship factors such as being with the "right" person, or having a committed relationship, (3) moral and religious beliefs, and (4) the balance of health, social, and family risks and benefits. Sex was considered something powerful, and the transition to first sex a rite of passage in which adolescents took on what they perceived to be adult roles. We observed differences by age, gender, and sexual experience in how adolescents determined readiness. CONCLUSIONS: Adolescents conceptualize sexual abstinence differently than adults, with differences by age, gender and sexual experience. Rather than a simple behavioral decision, our participants viewed abstinence as a broader part of normal development and viewed the transition to sex as an important rite of passage to adulthood.

Adolescent↗
PubMed2006

Incidence and prevalence of herpes simplex virus infections in adolescent women.

OBJECTIVES: We conducted this study to examine the incidence, prevalence, and risk factors for herpes simplex virus (HSV) 1 and HSV 2 infection in a cohort of young women who were closely followed for acquisition of sexually transmitted infections. STUDY DESIGN: Women between the ages of 14 and 18 years had blood and genital specimens obtained quarterly to test for incident sexually transmitted infections. Subjects also had 2 12-week periods each year when they kept a detailed behavioral diary and performed weekly vaginal swabs. Serum specimens were tested for HSV 1 and HSV 2 antibody, and genital specimens were tested for HSV DNA by PCR. RESULTS: A total of 100 subjects enrolled and had at least 2 sera that could be analyzed for seroconversion. The mean age of the subjects was 15.8 years at entry. The HSV 1 and HSV 2 seroprevalence at entry was 59.6% and 13.5%, respectively. During the study, 4 subjects acquired HSV 1 antibody and 7 acquired HSV 2 antibody, but there were no cases of symptomatic HSV infection identified. The annualized incidence among susceptible individuals was 8.9% for HSV 1 and 7.4% for HSV 2. Three of the 7 HSV 2 sero-converters had HSV 2 DNA detected in vaginal swabs. Age, duration of sexual activity, and the presence of other sexually transmitted infections were predictors of HSV 2 antibody positivity. CONCLUSIONS: Acquisition of HSV 1 and HSV 2 is relatively common in adolescent women, although symptomatic infection is uncommon. HSV 2 is shed in the genital tract despite the lack of symptoms.

Adolescent↗
PubMed2005

Prevalence, incidence, natural history, and response to treatment of Trichomonas vaginalis infection among adolescent women.

BACKGROUND: Trichomonas vaginalis infection is a sexually transmitted infection (STI) linked with reproductive health complications. However, few data exist concerning the epidemiologic profile of this pathogen in adolescent women, a group at high risk for other STIs. METHODS: Our objective was to describe the prevalence, incidence, natural history, and response to treatment of T. vaginalis infection in adolescent women. Women 14-17 years old were followed for up to 27 months. Vaginal swab samples were obtained during quarterly clinic visits and were self-obtained weekly during 12-week diary collection periods. The weekly samples were tested quarterly. Infections were identified by polymerase chain reaction and were treated with 2.0 g of oral metronidazole. Analysis was performed on the subset of participants who returned for at least 1 quarterly clinic visit. RESULTS: T. vaginalis infection was identified in 6.0% (16/268) of the participants at enrollment. Overall, 23.2% (57/245) of the participants with at least 3 months of follow-up had at least 1 infection episode; 31.6% (18/57) experienced multiple episodes. Seventy-two incident infection episodes were diagnosed. When treatment was not documented, weekly samples from participants were positive for up to 12 consecutive weeks. After treatment, T. vaginalis DNA was undetectable within 2 weeks in all but 3 participants. CONCLUSIONS: The incidence of T. vaginalis infection is high among adolescent women; untreated infections may last undetected for 3 months or longer. Reinfection is common. Treatment with oral metronidazole is effective, and T. vaginalis DNA disappears rapidly after treatment.

Adolescent↗
PubMed2005

Parent and adolescent versions of the diabetes-specific parental support for adolescents' autonomy scale: development and initial testing.

OBJECTIVE: To develop and initially test the psychometric properties of parent and adolescent versions of the Diabetes-Specific Parental Support for Adolescents' Autonomy Scale. METHODS: Data-based scale items were developed, analyzed for content validity, and then piloted with 43 adolescents with type 1 diabetes and their parents. Psychometric properties of the scales were then determined with 100 adolescents with type 1 diabetes and their parents. RESULTS: Content validity indices of .80 or greater were obtained for 26 items. Item analysis in the pilot and large-sample groups resulted in 22 items being deleted. Principal Components Analysis of the remaining four items indicated one factor in both parent and adolescent versions, accounting for 50-62% of variance and with Cronbach alpha coefficients of .67-.80. CONCLUSIONS: This newly developed parsimonious scale, initially tested to be reliable, and valid, will facilitate research on parental support for adolescents' development of diabetes management autonomy.

Adolescent↗
PubMed2005

Relationship quality, coital frequency, and condom use as predictors of incident genital Chlamydia trachomatis infection among adolescent women.

PURPOSE: To explore associations of relationship quality, coital frequency, unprotected coitus, and chlamydia infection over time. METHODS: Data came from 142 adolescent females with sexually transmitted infections attending three primary care adolescent clinics and one county STD clinic. Interview data were collected at 3 time points: enrollment, 1 month, and 3 months after enrollment. Predictor variables included relationship quality, coital frequency, unprotected coitus, and partner change. The outcome variable was infection with C. trachomatis at 3 months. Analyses were conducted using structural equation modeling. RESULTS: Chlamydia infection at 3 months was directly influenced by unprotected coitus during the previous 2 months (Beta = .25; p < or = .05) and partner change during the enrollment/1-month interval. Unprotected coitus was directly associated with coital frequency, both cross-sectionally and longitudinally. Increased relationship quality was associated with increased coital frequency but did not have direct effects on unprotected coitus. CONCLUSIONS: The data showed a protective effect of condom use for chlamydia infections. Prevention efforts should attend to the interpersonal factors behind decisions to use or not use condoms.

Adolescent↗
PubMed2005

Daily mood, partner support, sexual interest, and sexual activity among adolescent women.

The main objective of this study was to examine day-to-day associations of coitus, sexual interest, partner emotional support, negative mood, and positive mood among adolescent women. Diaries assessed partner interactions, sexual activity, substance use, and mood. Participants were 146 adolescent women who provided 28,376 diary days. Correlates of coitus on a given day included age, increased coital frequency in previous week, coitus on the previous day, partner support, increased same-day sexual interest, and decreased same-day negative mood. The data demonstrate complex associations of sexual interest, mood, partner interactions, and sexual activity. The findings extend understanding of the sexuality of adolescent women and have implications for a variety of interventions to reduce sexually transmitted infections and unplanned pregnancies.

Adolescent↗
PubMed2005

HPV infection in adolescents: natural history, complications, and indicators for viral typing.

Human papillomavirus (HPV) is the most common sexually transmitted disease in both men and women. Prevalence rates are the highest for adolescents. Despite the high prevalence rates, sequelae of genital warts, dysplasia, and cancer are rare developments. Knowledge about the natural history, virology, and cancerous transformation has lead to improved viral detection, including the use of HPV DNA detection tests, screening efforts for HPV-related precancerous and cancerous lesions, and clinical interventions and treatments, including both therapeutic and prophylactic vaccinations.

Adolescent↗
PubMed2005

The prevalence of chlamydia, gonorrhea, and trichomonas in sexual partnerships: implications for partner notification and treatment.

BACKGROUND: Treatment of sex partners by patient-delivered partner therapy (PDPT) may prove to be an effective strategy in reducing reinfection and preventing the sequelae of sexually transmitted infections (STIs). However, limited data exists regarding STIs within sexual partnerships (dyads). OBJECTIVE: The objective of this study was to determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and Trichomonas vaginalis (TV) in sexual dyads to estimate the potential yield and limitations of PDPT. METHODS: Male and female STI clinic attendees were invited to participate. Index subjects and partners were interviewed and tested for CT, GC, and TV. All partners were sought regardless of infection status of the index subject. RESULTS: Of 210 dyads, the prevalence in index subjects was CT, 46%; GC, 18%; and TV, 14%. Considering the partners of 72 CT-only-infected index subjects, 57% had CT, 6% had GC, and 11% had TV. Considering the partners of 35 index subjects with GC or GC-CT coinfection, 57% had GC and/or CT; however, in 20% of partners, unsuspected TV was present. Among 74 dyads with uninfected index subjects, 26% of partners had an STI. Among the partners of 19 index subjects with TV only, 11% had CT, 5% had GC, and 37% had TV. CONCLUSION: In our clinic population, a substantial number of partners had infections different from or in addition to those infections in the index. Many of these infected partners would not be diagnosed and treated using PDPT. Partners of index attendees without detected infection were at high risk (26%) for STI, mostly CT.

Adolescent↗