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Biomedical subjects

Jonathan M Ellen

Publications and source records attributed to Jonathan M Ellen.

At least 19 recordsLinked to original sources
PubMed2007

Acceptability of urine-based screening for Chlamydia trachomatis to asymptomatic young men and their providers.

OBJECTIVE: The objective of this study was to describe acceptability of urine chlamydia testing among asymptomatic men and providers' attitudes toward testing. STUDY DESIGN: Asymptomatic men (no urethral discharge/dysuria) were offered free testing and characteristics of men who accepted were compared with those who declined. Acceptability logs tallied the proportion who accepted, and a standardized survey was administered to providers at study's end. RESULTS: Median acceptance was 64% (range, 8-100%). Men accepting were younger and more likely to be in adolescent primary care or detention, to report higher numbers of recent partners, no prior sexually transmitted disease, time to last healthcare visit >1 year, and to have received an incentive. Provider-reported barriers to testing included difficulty in conveying importance of testing to asymptomatic men (65%) and time constraints (24%). CONCLUSIONS: Asymptomatic men are likely to accept testing depending on venue and approach. However, barriers exist for men and providers, even when testing is free.

Adolescent↗
PubMed2006

Age-bridging among young, urban, heterosexual males with asymptomatic Chlamydia trachomatis.

OBJECTIVES: 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 > or =2 years. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Adolescent↗
PubMed2006

Laying the foundation for Connect to Protect: a multi-site community mobilization intervention to reduce HIV/AIDS incidence and prevalence among urban youth.

Despite the considerable resources that have been dedicated to HIV prevention interventions and services over the past decade, HIV incidence among young people in the United States remains alarmingly high. One reason is that the majority of prevention efforts continue to focus solely on modifying individual behavior, even though public health research strongly suggests that changes to a community's structural elements, such as their programs, practices, and laws or policies, may result in more effective and sustainable outcomes. Connect to Protect is a multi-city community mobilization intervention that focuses on altering or creating community structural elements in ways that will ultimately reduce youth HIV incidence and prevalence. The project, which spans 6 years, is sponsored by the Adolescent Medicine Trials Network for HIV/AIDS Interventions at multiple urban clinical research sites. This paper provides an overview of the study's three phases and describes key factors in setting a firm foundation for the initiation and execution of this type of undertaking. Connect to Protect's community mobilization approach to achieving structural change represents a relatively new and broad direction in HIV prevention research. To optimize opportunities for its success, time and resources must be initially placed into laying the groundwork. This includes activities such as building a strong overarching study infrastructure to ensure protocol tasks can be met across sites; tapping into local site and community expertise and knowledge; forming collaborative relationships between sites and community organizations and members; and fostering community input on and support for changes at a structural level. Failing to take steps such as these may lead to insurmountable implementation problems for an intervention of this kind.

Adolescent↗
PubMed2006

What you don't know can hurt you: perceptions of sex-partner concurrency and partner-reported behavior.

BACKGROUND: The objectives of this study were as follows: (1) to determine the extent of agreement between adolescents' perceptions of sex-partner concurrency (having a partner who has other overlapping sexual partnerships) and their partners' self-reported concurrency, and (2) to identify the relationship-level factors associated with agreement. METHODS: Adolescents ages 14 to 19 years, along with their main sex partners, were recruited from a primary care clinic and a public sexually transmitted disease clinic and interviewed separately about their own concurrency status and their perception of their partner's concurrency status. Information from both participants and their partners were included in this analysis (N = 90 couples). RESULTS: This sample consisted of African-American, sexually experienced heterosexual couples. For males and females who perceived their partner not to have other partners, 16% and 37% of their sex partners reported having other partners, respectively. Of males and females who perceived their partner to have other partners, 80% and 39% of their sex partners reported not having other partners, respectively. Multivariate logistic regression revealed that adolescents who had been with their partners for more than 6 months and considered themselves more emotionally close were nearly twice as likely to agree on concurrency. CONCLUSIONS: Among adolescent couples, agreement between perceptions of sex-partner concurrency and partner-reported behavior was low. To the extent that partner self-reports are accurate, individuals who presume that they are in a mutually monogamous relationship often underestimate their own sexually transmitted disease risk. To appropriately tailor risk reduction messages, prevention efforts need to consider adolescents' perceptions of concurrent sex partners.

Adolescent↗
PubMed2006

Gender-based differences in fertility beliefs and knowledge among adolescents from high sexually transmitted disease-prevalence communities.

PURPOSE: Limited information is available about adolescents' beliefs about fertility in women and its link to sexually transmitted disease (STD) and whether men and women differ in their beliefs. This information may be useful for developing messages intended to motivate youth to seek STD screening while they are asymptomatic. The purpose of this study was to examine gender-based differences in fertility beliefs and knowledge. METHODS: Data were derived from the Adolescent Health Study, a population-based telephone survey study in which urban household adolescents from a high STD-prevalence community were queried about their sexual experience, fertility-related knowledge, beliefs related to timing of childbearing, and risk assessment of future fertility problems. Chi2 and regression analyses were used to evaluate group differences. RESULTS: The majority of adolescents reported that having children was somewhat or very important, but that the 15- to 19-year-old age group was not the optimal time for a woman to have a child. Regression analyses indicated that female adolescents were more likely than male adolescents to identify chlamydia and pelvic inflammatory disease as causes of fertility problems. Seventy-two percent of adolescent girls thought there was some chance they would have future fertility problems and 58% thought they had little or no control over developing fertility problems in the future. CONCLUSION: Additional health education is needed if we are to motivate adolescents to participate in asymptomatic STD screening programs. Involving male adolescents may be a more significant challenge given that fewer male adolescents understand the link between female fertility and common STD-related conditions. Given our findings, fertility preservation may be a valuable teaching tool and social marketing agent for STD prevention in adolescents.

Adolescent↗
PubMed2006

Use of an institutional intervention to improve quality of care for adolescents treated in pediatric ambulatory settings for pelvic inflammatory disease.

PURPOSE: To evaluate the impact of a quality improvement intervention for outpatient management of pelvic inflammatory disease (PID) on provider compliance with published guidelines and to explore issues affecting patient adherence to outpatient care regimens. METHODS: This study utilized an interrupted time series design. The intervention included an algorithm and clinical practice guideline based on the 2002 Centers for Disease Control STD Guidelines, a complete course of medications to be given at discharge after initial doses given in the site, standardized discharge instructions, close follow-up at 24-48 hours and after two weeks of treatment by a member of the PID team, and a referral for follow-up. RESULTS: At baseline, 38% of patients did not receive an appropriate medication regimen and only 10% of clinic outpatients returned for follow-up evaluations within 72 hours. In the postintervention group, 91% of patients received an appropriate outpatient regimen and 43% of emergency department and clinic patients returned for care. Based on the results of logistic regression models, adolescents in the postintervention group were 8.4 times more likely (adjusted odds ratio [AOR]: 8.4, confidence interval [CI]: 2.6-26.8, p <. 001) to receive an appropriate outpatient medication regimen than girls in the baseline group. Follow-up interview revealed that 61% of postintervention patients completed all doses of the medication, 67% practiced temporary abstinence, 86% notified their partner for treatment, and 96% were satisfied with their care. CONCLUSIONS: Interventions utilizing a multi-level approach to the management of outpatient PID improve provider compliance with published guidelines and quality of care delivered to adolescents in academic settings. Many adolescents, however, continue to have difficulty with adherence. Additional research is warranted to address adherence to outpatient regimens for the treatment of PID in adolescent girls.

Adolescent↗
PubMed2006

Street-based STD testing and treatment of homeless youth are feasible, acceptable and effective.

PURPOSE: Current Centers for Disease Control (CDC) guidelines recommend that sexually transmitted disease (STD) screening measures for high-risk populations such as homeless youth prioritize testing in out-of-clinic settings and incorporate new approaches to STD eradication, such as field-delivered testing and treatment and patient-delivered partner therapy (PDPT). Our non-medically trained research staff offered field-based STI testing, field-delivered therapy, and PDPT to homeless youth in the context of a longitudinal study. METHODS: A total of 218 ethnically diverse (34% female) 15-24-year-old homeless youth recruited from street sites in San Francisco completed an audio computer-administered self-interview survey and provided a first-void urine sample for testing for chlamydia (CT) and gonorrhea (GC). Youth testing positive were offered field-delivered therapy and PDPT. A random subset of 157 youth was followed prospectively, of whom 110 (70%) were interviewed and 87 (55%) retested at six months. RESULTS: At baseline, 99% of youth in the study consented to STI testing, of whom 6.9% and .9% tested positive for CT and GC, respectively. Ninety-four percent of positive youth were treated, 50% within one week. The incidence rate for CT was 6.3 per 100 person-years (95% confidence interval [CI]: 1.3-18.4) and for GC was 4.2 per 100 person-years (95% CI: .5-15.2). None of the youth treated by study staff and tested six months later (n = 6) had CT or GC on follow-up testing (95% CI: 0-131.3). CONCLUSIONS: Field-delivered testing and field-delivered therapy are feasible, acceptable and effective interventions for the diagnosis and treatment of STDs in homeless youth. These measures along with PDPT may decrease rates of subsequent reinfection.

Adolescent↗
PubMed2006

Sex partner selection, social networks, and repeat sexually transmitted infections in young men: a preliminary report.

GOAL: The goal of this study was to examine the risk for repeat sexually transmitted infections (STIs) associated with reducing the number of sex partners who come from within the social networks of males 13 to 25 years old in Baltimore, Maryland, and Denver, Colorado. STUDY: Asymptomatic males diagnosed with chlamydia and/or gonorrhea as part of an asymptomatic chlamydia and gonorrhea male screening project were recruited and interviewed about their sexual behaviors and their perceptions of social characteristics and sexual behaviors of their sex partners. We characterized the sex partners of each participant as belonging to or not belonging to his social network. We examined whether a decrease in percentage of sex partners who were in the participant's social network was associated with repeat infection. RESULTS: There were 47 participants in Baltimore and 92 in Denver. In both cities, there was a trend toward a finding that decreasing the percentage of sex partners belonging to a participant's social network was protective for repeat STI. CONCLUSION: These data suggest that interventions may need to be designed to reduce the prevalence of infection in the social networks of infected men.

Adolescent↗
PubMed2006

Sexual bridging socially and over time: a simulation model exploring the relative effects of mixing and concurrency on viral sexually transmitted infection transmission.

BACKGROUND: Sexual partnerships between people at higher and lower risk for sexually transmitted infections (STIs) (i.e., bridging) occur through dissortative mixing and concurrent partnerships, yet the relative effects of these network patterns on population STI spread are poorly understood. GOAL: Using a stochastic model, the authors investigated the impact of mixing and concurrency on the spread of a persistent viral STI. STUDY DESIGN: A total of 1,050 populations were simulated of 1,000 subjects over 400 weeks with varied concurrency levels and mixing patterns. STI prevalence and the average number of secondary transmissions per subject were analyzed with regression. RESULTS: Mixing had a greater impact on prevalence for all groups, whereas concurrency was significant for only the lowest activity group. Mixing patterns moderated the magnitude of concurrency's impact on secondary transmissions. CONCLUSIONS: Through connecting subgroups of differential risk, sexual mixing facilitates dissemination of STIs throughout a population. Concurrency expedites transmission by shortening the time between sexual contacts among infected and susceptible persons, particularly during the highly infectious period.

Computer Simulation↗
PubMed2006

Understanding sex partner selection from the perspective of inner-city black adolescents.

CONTEXT: Black adolescents in inner-city settings are at increased risk for HIV and other STDs. Sex partner characteristics, as well as individual behavior, influence individuals' STD risk, yet little is known about the process of sex partner selection for adolescents in this setting. METHODS: Semistructured in-depth interviews were conducted during the summer and fall of 2002 with 50 inner-city black adolescents (26 females and 24 males) who had been purposively recruited from an STD clinic. Content analysis was used to study interview texts. RESULTS: Young women desire a monogamous romantic partner, rather than a casual sex partner; however, to fulfill their desire for emotional intimacy, they often accept a relationship with a nonmonogamous partner. Young men seek both physical and emotional benefits from being in a relationship; having a partner helps them to feel wanted, and they gain social status among their peers when they have multiple partners. For men, these benefits may help compensate for an inability to obtain jobs that would improve their financial and, as a result, social status. Both women and men assess partners' STD risk on the basis of appearance. CONCLUSIONS: HIV and other STD prevention initiatives must go beyond the scope of traditional messages aimed at behavior change and address the need for social support and socioeconomic opportunities among at-risk, inner-city adolescents.

Adolescent↗
PubMed2005

Geographic identification of high gonorrhea transmission areas in Baltimore, Maryland.

Geographic approaches to sexually transmitted infection (STI) research frequently seek to identify areas where outreach STI testing may most effectively interrupt continued transmission of STIs. Many of the studies are limited, however, in that they fail to control for racial/ethnic composition of the high prevalence areas. These studies thus may be merely identifying the broader sexual networks of the high morbidity population and not the high transmission networks within them. Cluster detection analysis may be an appropriate approach to identify critical STI disease transmission locations. This study determined whether statistically significant geographic clusters of high prevalence gonorrhea cases can be located after controlling for race/ethnicity. Using a spatial scan statistic, the authors analyzed reported cases of gonorrhea (n = 32,454) in Baltimore City, Maryland, from 1994 to 1999 geocoded to the primary address and aggregated to census block groups (n = 709). They adjusted for the underlying distribution of the population aged 15-39 years and percent African American per census block group. The results identified eight significant clusters of high STI prevalence areas, reinforcing the inference that risks for gonorrhea are associated with definable sociogeographic spaces. The areas identified may be critical to control STIs and may provide important direction for further study and targeted interventions.

Adolescent↗
PubMed2005

Understanding the role of perceived severity in STD-related care-seeking delays.

PURPOSE: To gain a more in-depth understanding of the relationship between perceived severity of symptoms and STD-related care-seeking behavior among adolescent African-American females in Baltimore City. METHODS: Twenty-one female adolescents were interviewed in depth to elicit their experiences with an STD in the previous 3 months. Comparisons were made between those who sought care on account of their symptoms and those who did not. RESULTS: High perceived seriousness about symptoms has both cognitive and emotional components that may function independently to either promote or delay STD-related care seeking. CONCLUSIONS: Both cognitive and emotional responses to STD symptoms must be considered when examining the effect of perceived severity on adolescents' STD-related care-seeking behaviors.

Adolescent↗
PubMed2005

Friends in the 'hood: Should peer-based health promotion programs target nonschool friendship networks?

PURPOSE: To examine the characteristics of inner city African-American adolescents nonschool-based and school-based friendship networks and to explore the influence of these networks on health risk behavior. METHODS: We assessed close friendships networks in a probability sample of inner city African-American youth living in a single neighborhood and describe the networks and health risk behavior of network members. The initial probability sample was obtained via telephone (Random Digit Dialing [RDD] sampling) and followed up with in-person interviews with telephone respondents (seeds). Subsequently, seeds' friends were recruited and completed an in-person interview. RESULTS: A majority of friendship networks included some nonschool friends (57%) and 24% of networks were composed exclusively of nonschool friends. As expected, youth were more likely to spend time with school-based friends on weekdays. On weekends, youth were equally likely to spend time with both school and nonschool networks. Youth in the same friendship group tended to engage in similar behaviors. Health risk behaviors were high regardless of whether networks were nonschool based, mixed, or school based. CONCLUSIONS: The high proportion of nonschool friendships suggests that out-of-school networks may be an important influence in this population. Youth spend time with their friends, regardless of network type, on weekends, and weekends are a high-risk period for health-damaging behaviors. Levels of experience with health risk behaviors suggest that both school and nonschool environments require intervention. Future social influence prevention efforts that are broad-based are likely to have maximal impact.

Adolescent↗
PubMed2005

Impact of sexual networks on risk for gonorrhea and chlamydia among low-income urban African American adolescents.

OBJECTIVE: To determine whether African American adolescents, whose recent sex partners reported having another sex partner, are at increased risk for exposure to genital chlamydial infection or gonorrhea. STUDY DESIGN: A household sample of low-income urban African American adolescents 14 to 19 years of age, up to two of their close friends, and their sex partners were interviewed and tested for gonorrhea and chlamydial infection. RESULTS: Thirty-four of 145 adolescents had at least one recent sex partner infected with Neisseria gonorrhoeae and/or Chlamydia trachomatis. The adjusted model showed that adolescents, whose recent sex partners reported having another sex partner, were more likely to have a recent sex partner with gonorrhea and/or chlamydial infection. CONCLUSION: In addition to individual factors, network factors may explain why African American adolescents are at increased risk for exposure to sexually transmitted infections (STIs). Multi-level community-based interventions may need to address network factors along with personal behaviors in order to prevent STIs among low-income urban African American adolescents.

Adolescent↗
PubMed2005

Rapid HIV testing of clients of a mobile STD/HIV clinic.

HIV rapid testing may enhance the effectiveness of a mobile HIV/sexually transmitted disease (STD) screening clinic in at-risk populations who normally do not seek care. Our goal was to determine the usability and post-test counseling rates of rapid HIV testing services for clients tested on a mobile clinic. HIV Oraquick rapid HIV-1 testing (OraSure Technologies, Inc., Bethlehem, PA) (blood) was offered to clients seeking HIV/STI counseling and testing services from the street at predetermined locations in areas of high STD morbidity, drug use, and commercial sex work. Rapid test results were available on the same day at the van within 10 minutes. Disease intervention specialists (DIS) attempted to locate and counsel positive clients who did not stay for results. By comparison, when offered at the same time, 64.5% of clients preferred Oraquick to traditional serologic testing. The post-test counseling rate for clients tested for Oraquick was 89% for infected and 93% for uninfected. By comparison, 11% of infected clients and 40% of uninfected clients tested for traditional test were post-test counseled. Clients who tested for the traditional enzyme immunoassay (EIA) test were told to return to the van in 14 days for results and post-test counseling. In the adjusted model, we also found statistically significant differences comparing clients who choose Oraquick to traditional serologic tests. These data suggest that rapid HIV testing services may enhance the effectiveness of mobile STD/HIV clinics.

AIDS Serodiagnosis↗
PubMed2005

Pelvic inflammatory disease in adolescents: care delivery in pediatric ambulatory settings.

OBJECTIVES: To evaluate care delivery patterns in patients treated for pelvic inflammatory disease in pediatric outpatient settings and to determine the effect of practice type on care delivery. DESIGN/SETTING: Retrospective review of medical records for patients treated as outpatients in an urban academic pediatric facility. Care patterns were evaluated according to the Centers for Disease Control sexually transmitted disease guidelines. PARTICIPANTS: Fifty-six adolescent patients who were diagnosed with pelvic inflammatory disease in pediatric ambulatory settings between January 1, 2002, and December 31, 2002. MAIN OUTCOME MEASURES: Demographic information, documented patient history and examination, laboratory data, and discharge instructions. RESULTS: Forty percent of patients were prescribed inadequate courses of medications. Patients who were seen in the pediatric emergency department were less likely to receive a standard medication regimen than those seen in the ambulatory setting. Most patients did not receive adequate instruction for self-care on review of written discharge instructions, and there were no differences based on location of care. CONCLUSIONS: Many adolescents treated as outpatients for pelvic inflammatory disease may not receive adequate medications and instructions for self-care at discharge in pediatric ambulatory settings. This study suggests a need for aggressive quality improvement measures to enhance the care of adolescents with pelvic inflammatory disease in pediatric outpatient settings.

Academic Medical Centers↗