Value of consistent condom use: a study of sexually transmitted disease prevention among African American adolescent females.
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Adolescent↗
Biomedical subjects
Ralph J DiClemente
Publications and source records attributed to Ralph J DiClemente.
Pregnant African-American teens are less likely than their nonpregnant peers to use condoms.
OBJECTIVE: The aim of this study was to prospectively compare pregnant and nonpregnant adolescents' recent condom use and sexually transmitted disease (STD) acquisition. METHODS: Sexually active African-American females (N = 522), ages 14-18, were recruited from clinics and schools. Adolescents completed baseline interviews and provided vaginal swabs for STD testing, and urine for pregnancy testing. Assessments were repeated 6 and 12 months post baseline assessment. Analyses compared adolescents who became pregnant between baseline and the 6-month assessment with their peers who had negative pregnancy tests. Condom use between the 6- and 12-month assessments and incidence of STDs at the 12-month assessment served as outcomes. Adolescents who did not report sexual activity between the 6- and 12-month assessments were excluded. RESULTS: Ten percent of the adolescents became pregnant and continued sexual activity. Pregnant adolescents reported less overall condom use (P < 0.0001), more infrequent condom use (adjusted odds ratio [AOR] = 4.5, P < 0.001), and more unprotected vaginal sex (AOR = 4.7, P < 0.003). Pregnant adolescents were equally likely to test positive for STDs (31% vs 26%) and to self-report having STDs at the 12-month follow-up period (30% vs 23%). CONCLUSIONS: Findings suggest that pregnant adolescents may be less likely to use condoms than their nonpregnant peers and that STD incidence among pregnant adolescents may be high. Condom use promotion may be important during adolescents' prenatal care.
Adolescent↗
Prevalence and correlates of Chlamydia trachomatis among sexually active African-American adolescent females.
BACKGROUND: Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen in the United States and disproportionately affects African-American adolescents. The objectives of this study are to determine the prevalence of C. trachomatis and to identify correlates of infection among African-American adolescent females. METHODS: Sexually active African-American adolescent females (n = 522) completed a self-administered survey and structured interview and provided vaginal swab specimens for laboratory assessment of STDs. The relationship among selected psychosocial, behavioral, and biologically confirmed STDs and C. trachomatis was assessed. RESULTS: The prevalence of C. trachomatis was 17.4%. Results of multiple logistic regression revealed that adolescents testing positive for C. trachomatis infection were significantly more likely to test positive for gonorrhea (OR = 5.0; 95% confidence interval (CI) 1.69-14.83); to report nonuse of condoms with a steady partner (OR = 2.4; 95% CI 1.23-4.76); to be in shorter relationships (OR = 2.2, 95% CI 1.13-4.30); and to perceive less parental monitoring (OR = 2.1; 95% CI 1.08-4.15). CONCLUSIONS: Study findings emphasize the need for assessing psychosocial factors, behavioral factors, and the presence of other STDs when determining risk for C. trachomatis. Several of the constructs identified are particularly amenable to behavioral interventions designed to prevent infection.
Adolescent↗
Psychosocial and behavioral correlates of refusing unwanted sex among African-American adolescent females.
PURPOSE: To identify psychosocial and behavioral correlates of refusing unwanted sex among African-American female adolescents. We hypothesized that greater power in relationships, less concern about negative emotional consequences, supportive family and peers, positive self-perceptions, greater perceived risk, and fewer sexual risk behaviors would be associated with increased odds of refusing unwanted sex. METHODS: Data regarding demographics, sexual behaviors, communication with parents, and psychosocial factors relevant to romantic and sexual partnerships were collected both via self-administered questionnaire and structured interview from a clinic- and school-based sample of 522 African-American adolescent females ages 14-18 years in Birmingham, Alabama. Adjusted odds ratios were calculated using logistic regression. RESULTS: Of those who had experienced pressure for unwanted sex (n = 366), 69% consistently refused to engage in unwanted sex. Adolescents with high safer sex self-efficacy and low perceived partner-related barriers (i.e., concerns about partners' negative emotional reactions) to condom negotiation were over 2.5 times more likely to consistently refuse unwanted sex than were those reporting low safer sex self-efficacy and high partner-related barriers. Adolescents who spoke more frequently with their parents about sexual issues were nearly twice as likely to consistently refuse unwanted sex than were those who spoke less frequently with their parents. CONCLUSIONS: Sexual-risk reduction efforts directed toward adolescent females should seek to build self-efficacy to negotiate safer sex and provide training in social competency skills that may help to reduce or eliminate partner barriers to condom use. Further, sexual risk-reduction programs may be more effective if they include parents as advocates of safer sexual behaviors.
Adolescent↗
Low parental monitoring predicts subsequent pregnancy among African-American adolescent females.
STUDY OBJECTIVE: Accumulating evidence suggests that parental monitoring is associated with adolescents' sexual risk behaviors. However, evidence associating low parental monitoring with greater odds of becoming pregnant has not been reported. The objective of this study was to prospectively assess the relationship of low perceived parental monitoring with incidence of biologically confirmed pregnancy among a sample of low-income African-American adolescent females. DESIGN: A prospective study. SETTING AND PARTICIPANTS: African-American females 14-18 years of age were recruited from schools and health clinics in low-income neighborhoods. Adolescents completed an in-depth survey and interview at baseline and 6 months later. The study achieved an 85.7% baseline participation rate (n = 522) and 92% (n = 482) returned at follow-up. Only adolescents who initially tested negative for pregnancy were included in the analysis (n = 410). MAIN OUTCOME MEASURES Incidence of biologically assessed pregnancy. RESULTS: In controlled analyses, among adolescents testing negative for pregnancy at baseline, those who reported less parental monitoring were 2.5 times more likely to become pregnant in the 6-month follow-up period (AOR = 2.50, 95% CI = 1.1-5.9, P <.04). CONCLUSION: Low parental monitoring was prospectively associated with incidence of biologically confirmed pregnancy among minority adolescent females. This finding adds to a growing body of empirical literature that supports the value of parental monitoring as a protective factor in adolescents' lives. Interventions designed to increase parental monitoring or adolescent females' perceptions of their parents' monitoring may be effective components of pregnancy prevention programs designed for minority youth.
Adolescent↗
Psychosocial predictors of pregnancy among low-income African-American adolescent females: a prospective analysis.
OBJECTIVE: To prospectively identify psychosocial predictors of pregnancy among African-American adolescent females. METHODS: African-American females, 14-18 yrs old, were recruited from schools and health clinics in low-income neighborhoods. Adolescents completed an in-depth survey and provided urine specimens for pregnancy testing at baseline and 6-month intervals for 1.5 years. Selected problem behaviors, demographic, and psychosocial variables were tested for bivariate and multivariate significance relative to biologically confirmed pregnancy during the follow-up period. Only adolescents who initially tested negative for pregnancy were included (n = 241). RESULTS: About 26% (n = 63) of the adolescents became pregnant over the follow-up period. Although a broad spectrum of variables achieved bivariate significance, few retained significance in the multivariate model. Multivariate predictors of pregnancy were biologically confirmed marijuana use (adjusted odds ratios [AOR] = 12.4, P = 0.0003) and perceiving that the sex partner desired pregnancy (AOR = 1.27, P = 0.01). A protective effect was observed for adolescents who reported that a family member received welfare benefits; these adolescents were about 60% less likely to become pregnant (AOR = 0.38, P = 0.04). CONCLUSIONS: Pediatricians and other health professionals who participate in community efforts to prevent first and subsequent adolescent pregnancies may benefit from recognizing that marijuana use and pregnancy may be co-occurring problems. Adolescents' perceptions of their boyfriends' level of desire for conception may also be an important predictor of pregnancy risk. The findings also suggest a possible protective effect of receiving TANF (Temporary Assistance to Needy Families) benefits; adolescent recipients of these programs may be more vigilant in their pregnancy prevention practices than those who are not recipients.
Adolescent↗
Body image and African American females' sexual health.
OBJECTIVES: This study examines the association between African American adolescent females' body image and their sexual health. METHODS: African American adolescent females (n = 522) completed a survey that assessed body image using a 7-item scale (alpha = 0.71) and a face-to-face interview that assessed sexual behaviors. RESULTS: In logistic regression analyses, controlling for depression, self-esteem and body mass index (BMI), adolescents who were more dissatisfied with their body image were more likely to fear abandonment as a result of negotiating condom use (adjusted odds ratio [AOR] = 3.3, p = 0.02), more likely to perceive that they had fewer options for sexual partners (AOR = 2.4, p = 0.001), more likely to perceive themselves as having limited control in their sexual relationships (AOR = 2.0, p = 0.002), and more likely to worry about acquiring HIV(AOR = 1.5, p = 0.04). There was an association between having a greater dissatisfaction with one's body image and never using condoms during sexual intercourse in the past 30 days (AOR = 1.6, p = 0.04) and more likely to engage in unprotected vaginal sex in the prior 6 months (AOR = 1.6, p = 0.04). CONCLUSIONS: Prior research has demonstrated an association between African American women's body image and greater obesity risk, lower self-esteem, and greater depression. The present study has shown an association between body image dissatisfaction and a range of sexual attitudes, beliefs, and behaviors. Women who are more dissatisfied with their body image may be at greater risk for unintended pregnancy, sexually transmitted infections (STIs), and HIV infection.
Adolescent↗
Family-related correlates of sexually transmitted disease and barriers to care: a pilot study of pregnant African American adolescents.
This study explored associations between family-related measures and sexually transmitted disease (STD) history among 170 pregnant African American adolescent females, 14 to 20 years of age, attending prenatal care clinics in a large urban area of the South. Measures of low family support and infrequent mother-daughter communication were significant bivariate correlates of having at least one STD. Mother-daughter communication about preventing acquired immune deficiency syndrome remained significant in a multivariate model. The study also explored barriers to STD care-seeking behavior and found that few adolescents perceived access or financial issues as reasons to delay entry into the medical system. Low perceived family support was marginally associated with greater perceived barriers to STD care.
Adolescent↗
Sexual risk behaviors associated with having older sex partners: a study of black adolescent females.
BACKGROUND: Volunteer black adolescent females from neighborhoods characterized by high rates of unemployment, substance abuse, violence, and sexually transmitted disease were studied to determine the frequency of condom use and unprotected vaginal sex with steady, older partners during various time periods over the previous 6 months. GOAL: To examine associations between having male sex partners who were typically older (by at least 2 years) and adolescent females' sexually transmitted disease (STD)/HIV-associated sexual risk behaviors. STUDY DESIGN: In this cross-sectional study, 522 sexually active black adolescent females completed a questionnaire and a structured interview, of which a portion assessed the age difference between the adolescents and their typical sex partners. The adolescents' ages, length of relationship and their use of hormonal contraception were identified as covariates. Adjusted odds ratios (AOR), their 95% confidence intervals, and respective P values were calculated to detect significant associations. RESULTS: Sixty-two percent of the adolescents reported their typical sex partners were at least 2 years older. These adolescents were more likely to report never using condoms during the most recent sexual encounter (AOR = 2.0), during the last five sexual encounters (AOR = 2.0), and during the past month (AOR = 2.2). Similarly, having older partners was associated with greater odds of reporting any unprotected vaginal sex in the past 30 days (AOR = 1.7) or the past 6 months (AOR = 1.5). CONCLUSION: Our findings suggest that many adolescent females have sex partners who are at least 2 years older and that their relationship dynamics do not favor the adoption and maintenance of behavior protective against STD or HIV infection. Prevention programs could include training designed to help adolescent females overcome barriers to safer sex with older male partners.
Adolescent↗
Condom use and correlates of African American adolescent females' infrequent communication with sex partners about preventing sexually transmitted diseases and pregnancy.
This study of 522 African American female adolescents, ages 14 to 18, investigated associations between condom use and infrequently communicating with sex partners about sexually transmitted diseases (STDs) and pregnancy prevention. Correlates of infrequent communication were identified. Sexually active adolescents were recruited from schools and adolescent medicine clinics in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a self-administered survey and face-to-face interview. Communication frequency was assessed using a five-item scale. Infrequent communication was significantly associated with lower odds of condom use. Multivariate correlates of infrequent communication were less frequent communication with parents about STD/pregnancy prevention, recent sex with a nonsteady partner, low perceived ability to negotiate condom use and fear of this negotiation, and low motivation to use condoms. Given the importance of partner communication in promoting safer sex behaviors, STD and pregnancy prevention programs may benefit adolescents by addressing the identified psychosocial correlates of infrequent communication with their partners.
Adolescent↗
Risk among men who have sex with men in the United States: a comparison of an Internet sample and a conventional outreach sample.
This study compared the demographics and risk behaviors of two samples of men who have sex with men (MSM), using cross-sectional data that were collected via the Internet and through conventional bar-based outreach. The Internet sample was significantly older, more likely to identify as "bisexual," and less educated than the bar sample. After controlling for age and education, few differences were observed between the samples. However, three variables that markedly differentiated the samples were history of sexually transmitted disease infection, HIV serostatus, and sources utilized to obtain health information. No difference in Internet use was found. Based on the possible decreased social desirability promoted by the use of electronic data collection methodologies, these findings provide preliminary evidence that Internet and bar respondents are similar and that the Internet may serve as an expedient as well as reliable methodology to increase understanding of risk among MSM.
Adult↗
Gang involvement and the health of African American female adolescents.
OBJECTIVE: To examine the association between gang involvement and female adolescents' health. METHODS: African American adolescent females (N = 522) completed a survey that assessed their history of gang involvement and health behaviors and provided specimens that were analyzed for marijuana use and sexually transmitted diseases. RESULTS: In logistic regression analyses, adolescents with a history of gang involvement were more likely to have been expelled from school (odds ratio [OR]: 3.6), be a binge drinker (OR: 3.3), have a positive toxicologic test for marijuana (OR: 2.6), have been in 3 or more fights in the past 6 months (OR: 3.8), have a nonmonogamous partner (OR: 2.4), and test positive for Trichomonas vaginalis (OR: 2.2) and Neisseria gonorrhoeae (OR: 3.6). CONCLUSION: This study extends the current research on risk behaviors associated with gang involvement to include biological markers for substance use and sexual health outcomes, namely, marijuana use and sexually transmitted diseases.
Adolescent↗
HIV-associated histories, perceptions, and practices among low-income African American women: does rural residence matter?
OBJECTIVES: This study compared HIV-associated sexual health history, risk perceptions, and sexual risk behaviors of low-income rural and nonrural African American women. METHODS: A cross-sectional statewide survey of African American women (n = 571) attending federally funded Special Supplemental Nutrition Program for Women, Infants, and Children clinics was conducted. RESULTS: Adjusted analyses indicated that rural women were more likely to report not being counseled about HIV during pregnancy (P =.001), that a sex partner had not been tested for HIV (P =.005), no preferred method of prevention because they did not worry about sexually transmitted diseases (P =.02), not using condoms (P =.009), and a belief that their partner was HIV negative, despite lack of testing (P =.04). CONCLUSIONS: This study provided initial evidence that low-income rural African American women are an important population for HIV prevention programs.
AIDS Serodiagnosis↗
Protease inhibitor combination therapy and decreased condom use among gay men.
BACKGROUND: The objective of the study was to determine whether treatment with protease inhibitors is associated with unprotected sexual behavior. METHODS: A total of 592 HIV-infected persons recruited from statewide public clinics in nonurban Alabama communities completed an assessment that, among other variables, elicited information on demographics, current sexual practices, health status, and medication use. Associations of treatment with protease inhibitors and high-risk sexual behavior were estimated, adjusting for potential confounders. RESULTS: Treatment with protease inhibitors was not associated with whether a person was sexually active or with high-risk practices among sexually active heterosexual men and women. Among men who had sex with men, however, treatment with protease inhibitors was associated with never using condoms and with inconsistent use of condoms. CONCLUSIONS: Clinicians treating patients with protease inhibitors should consider providing risk-reduction counseling.
Adult↗
Participation by African-American adolescent females in social organizations: associations with HIV-protective behaviors.
BACKGROUND: African-American adolescent females are disproportionately affected by the HIV epidemic in the United States. One important potential, yet understudied, protective influence that may reduce African-American adolescents' HIV risk behavior is their involvement in social organizations. OBJECTIVE: To examine the association between high-risk African-American adolescent females' activity in social organizations and their recent HIV-associated sexual risk behavior. METHODS: Sexually active, African-American females (N=522) were recruited from schools and adolescent medicine clinics in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a self-administered survey and face-to-face interview. Adolescents' participation in Black social organizations was assessed. Measures of HIV protective behavior were also assessed. Bivariate analysis was followed by logistic regression to calculate adjusted odds ratios (AOR) for the outcomes. RESULTS: Adolescents not belonging to social organizations were about 1.6 times more likely to report recent acquiescence to unwanted sex without a condom, 1.9 times more likely to report that their current steady sex partner had other partners, and 1.9 times more likely to score low on the measure of sex-related communication with parents. DISCUSSION: Findings from controlled analyses suggest that community-based Black social organizations may be an important venue for protecting African-American adolescent females from having sex with a partner who has concurrent partners, and from having unwanted sex without a condom. Participation in Black social organizations was also associated with more frequent interaction between adolescents and their parents about sex-related issues such as HIV prevention. Models of HIV prevention that promote community involvement may be an under-utilized intervention modality with high potential impact.
Adolescent↗
HIV/STD prevention benefits of living in supportive families: a prospective analysis of high risk African-American female teens.
The relationship between family and sexual activity-related factors were measured among 522 African American adolescent girls recruited from schools and clinics in Birmingham, Alabama. Girls living with a mother in a supportive family were more likely to use condoms when having sex, less likely to have recent emotional abuse from their sex partners, less fear and higher self-efficacy in negotiating use of a condom, and fewer partner-related barriers to safer sex.
Adolescent↗
Pregnancy desire among disadvantaged African American adolescent females.
OBJECTIVE: To examine the prevalence and correlates of wanting to become pregnant among a sample of 462 sexually active nonpregnant African American adolescent females. METHODS: Multivariate logistic regression was used to calculate adjusted odds ratios, their 95% confidence intervals, and respective P values. RESULTS: Significant correlates with pregnancy desire included having a male partner who desired pregnancy, having a boyfriend at least 5 years older, having low self-esteem, perceiving greater perceived barriers to condom use, and perceiving low family support. CONCLUSIONS: Pregnancy prevention programs designed for economically disadvantaged African American adolescent females should address these correlates of their pregnancy desire.
Adolescent↗
Rural and nonrural African American high school students and STD/HIV sexual-risk behaviors.
OBJECTIVE: To determine differences between African American adolescents on STD/HIV sexual-risk behaviors and precursors to these risk behaviors. METHODS: Six hundred sixty-three rural and 3313 nonrural adolescents who completed the 1999 YRBS Survey were selected. RESULTS: Rural females and males were more likely to report ever having coitus and not using a condom during last coitus. Rural females were also more likely to report early coistus, having 3 or more lifetime coital partners, and having more than 1 coital partner in the last 3 months. CONCLUSIONS: African American rural adolescents, particularly females, may have greater risk for STD/HIV infection than do their nonrural counterparts.
Adolescent↗