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HIV, substance use and related behaviour of gay and bisexual men: an examination of the talking sex project cohort.

This paper reports on the substance use of 612 gay and bisexual men who participated in an HIV risk reduction project. Use/non-use, level of substance use, and reported frequency of use prior to sexual activity were examined in relation to number of sexual partners, sexual activities, HIV antibody test seeking behaviour and known HIV status. The use of substances among the study cohort appear to be higher than in a comparable heterosexual male group. An association was found between substance use, and both number of sexual partners and sexual activities. However, no significant difference was found in substance use between men participating in protected versus unprotected anal sex. Similarly, no significant difference was found in the reported frequency of substance use prior to sex by those participating in protected and unprotected anal intercourse. Greater drug use was reported among those who were known to be HIV antibody positive. These findings raise issues for further research. The high use of alcohol and drugs by gay and bisexual men may pose significant health risks for this group of men.

AIDS Serodiagnosis↗

The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900.

BACKGROUND: We examined the relationship of the number of adverse childhood experiences (ACE score) to six health problems among four successive birth cohorts dating back to 1900 to assess the strength and consistency of these relationships in face of secular influences the 20th century brought in changing health behaviors and conditions. We hypothesized that the ACE score/health problem relationship would be relatively "immune" to secular influences, in support of recent studies documenting the negative neurobiologic effects of childhood stressors on the developing brain. METHODS: A retrospective cohort study of 17,337 adult health maintenance organization (HMO) members who completed a survey about childhood abuse and household dysfunction, as well as their health. We used logistic regression to examine the relationships between ACE score and six health problems (depressed affect, suicide attempts, multiple sexual partners, sexually transmitted diseases, smoking, and alcoholism) across four successive birth cohorts: 1900-1931, 1932-1946, 1947-1961, and 1962-1978. RESULTS: The ACE score increased the risk for each health problem in a consistent, strong, and graded manner across four birth cohorts (P < 0.05). For each unit increase in the ACE score (range: 0-8), the adjusted odds ratios (ORs) for depressed affect, STDs, and multiple sexual partners were increased within a narrow range (ORs: 1.2-1.3 per unit increase) for each of the birth cohorts; the increase in risk for suicide attempts was stronger but also in a narrow range (ORs: 1.5-1.7). CONCLUSIONS: Growing up with ACEs increased the risk of numerous health behaviors and outcomes for 20th century birth cohorts, suggesting that the effects of ACEs on the risk of various health problems are unaffected by social or secular changes. Research showing detrimental and lasting neurobiologic effects of child abuse on the developing brain provides a plausible explanation for the consistency and dose-response relationships found for each health problem across birth cohorts, despite changing secular influences.

Adult↗

Can one ever be too wealthy or too chaste? Searching for nonlinearities in mate judgment.

In 3 studies, the authors searched for nonlinearities as possible clues to context-sensitive mechanisms involved in mating decisions. Participants judged targets' sexual desirability, marital desirability, or social status on the basis of information about income or number of past sexual partners. Because one cannot know in advance where nonlinearities occur or measure all values of independent variables, a "zoom and focus" method was used. The authors began by sampling a wide range of values, followed by successively more focused examination of potentially interesting regions. Across studies, income and desirability were linked exponentially, particularly for male targets and marriage partners. Sexual partners and desirability were sometimes linked nonmonotonically, with more partners first increasing, then decreasing, desirability. The authors discuss how nonmonotonic functions may suggest competing underlying processes.

Adolescent↗

Stimulus qualities of a preferred female partner and sexual behavior of old rhesus males.

A vaginal lavage from a preferred female sexual partner (donor) with whom old (21-27 yr) rhesus males readily copulated or a distilled water lavage was applied to the perineum of non-preferred females (N = 8) with whom old males rarely copulated. The donor and recipients were ovariectomized and were treated with estradiol benzoate (EB) before being tested. Sexual performance of the males did not differ under the two conditions of testing, but the rate of sexual solicitation by the females was significantly higher when treated with the vaginal lavage. One month later the non-preferred females were again treated with EB and paired with the old males. In these tests the preferred female was present in a cage adjacent to and in view of the test pairs. Sexual behavior was not altered significantly, but whereas these males had never threatened or aggressed their partners in previous tests, there was a significant increase in the rate at which they threatened their partners and aggression occurred for the first time. When paired with the preferred female, males ejaculated in 100% of the tests and the average ejaculation latency was less than 2.5 minutes.

Aging↗

Chlamydial infection and unplanned pregnancy in women with ready access to health care.

OBJECTIVE: To apply urine-based ligase chain reaction for Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae) detection and standard urine-based pregnancy testing for Navy-enlisted women, and to compare the prevalence and epidemiologic correlates of these adverse reproductive outcomes. METHODS: Participants were surveyed and urine was collected for pregnancy testing using standard laboratory methods and detection of C. trachomatis and N. gonorrhoeae infection by ligase chain reaction. Self-administered surveys facilitated collection of demographics, sexual behavior, including contraceptive use, sexual partners, sexually transmitted disease, and pregnancy history. RESULTS: Among 299 of 314 participants, the prevalence of chlamydial infection was 4.7% and of pregnancy was 9.7%, with 48.3% of the pregnancies unplanned. Chlamydia trachomatis infection was univariately associated with having a new sex partner within the last 6 months, more sexual partners, single marital status, condom use, drinking until passing out or vomiting in the past 30 days (alcohol misuse), and current pregnancy. Unplanned pregnancy was univariately associated with young age, single marital status, inconsistent condom use, having a new sex partner within the last 6 months, and more recent sexual partners. Among the pregnant women, four (13.8%) were infected with C. trachomatis. CONCLUSION: The high rates of chlamydial infection and unplanned pregnancy found in this population of employed young women with ready access to health care and health education underscore the challenge of enhancing reproductive health via compliance with effective contraceptive and sexually transmitted disease prevention methods. This is a challenge that remains unmet.

Adolescent↗

Teenagers' awareness of the acquired immunodeficiency syndrome and the impact on their sexual behavior.

One hundred female teenagers attending a teenage pregnancy program were studied to determine the extent of their awareness about acquired immunodeficiency syndrome (AIDS) and the impact of such knowledge on their sexual behavior. Ninety-eight knew that AIDS is a disease, 45 stated that it is fatal, and all knew that it can be transmitted by sexual intercourse. After becoming aware of AIDS, 59 changed their sexual habits, 41 decreased their number of sexual partners, and 13 who had not used condoms started using them. However, only seven obtained more information about their partners' sexual and social histories, and half of those who decreased their number of partners still continued relationships with more than one. The survey showed that the publicity about AIDS has resulted in a favorable change in the sexual practices of these teenagers. However, it also indicated a need for further improvement in specific areas of education, such as the value of obtaining more information about sexual partners, more awareness of the importance of multiple-partner relationships in the spread of AIDS, and more emphasis on the important role of condoms in preventing AIDS virus transmission.

Acquired Immunodeficiency Syndrome↗

Hepatitis C virus infection in a large cohort of homosexually active men: independent associations with HIV-1 infection and injecting drug use but not sexual behaviour.

OBJECTIVE: To determine the prevalence and risk factors for hepatitis C virus (HCV) infection in a cohort of homosexually active men, with particular reference to assessing sexual transmission. DESIGN: Prevalence based on cross-sectional testing for HCV (c100 protein) antibody in a cohort using sera stored between 1984 and 1989, and assessment of risk factors using a case-control analysis based on questionnaire data from HCV positive and negative subjects. SUBJECTS/SETTING: 1038 homosexually active men who were participating in a prospective study established to identify risk factors for AIDS. They had been recruited through private and public primary care and sexually transmissible disease (STD) services in central Sydney. MAIN OUTCOME MEASURES: Prevalence of HCV antibody and its association with human immunodeficiency virus type 1 (HIV-1) infection and other STDs, number of sexual partners, sexual practices and recreational drug use. RESULTS: Overall, 7.6% of subjects tested were seropositive for HCV antibody. In univariate analysis, HCV infection was significantly associated with injecting drug use (IDU) (OR = 8.18, p < 0.0001) and HIV infection (OR = 3.14, p < 0.0001) and with self reported history of syphilis (OR = 1.88, p = 0.016), anogenital herpes (OR = 1.93, p = 0.017), gonorrhoea (OR = 2.43, p = 0.009) and hepatitis B (OR = 1.92, p = 0.010). In case control analysis, similar sexual behaviours (partner numbers and practices) were reported by HCV positive and HCV negative subjects except that HCV negative subjects more frequently reported engaging than HCV positive subject in unprotected receptive anal intercourse without ejaculation (OR = 0.61, p = 0.034), unprotected insertive (OR = 0.59, p = 0.039) and receptive (OR = 0.56, p = 0.016) oro-anal intercourse (rimming) and insertive fisting (OR = 0.48, p = 0.034). In multiple logistic regression analyses, only HIV-1 infection (OR = 3.18, p < 0.0001) and IDU in the previous six months (OR = 7.24, p < 0.0001) remained significantly associated with the presence of HCV antibody. CONCLUSIONS: IDU was the major behavioural risk factor for HCV infection. If sexual or another from of transmission did occur, it may have been facilitated by concurrent HIV-1 infection.

Adolescent↗

[Sexual behavior in adolescents and young subjects].

The purpose of this paper was to obtain information about sexual behavior of university students. To achieve this goal we implemented a survey which was answered anonymously by 438 students, 123 women and 315 men. They were divided into three age groups. Between women, sexual activity grew with age, but between men, on the contrary, the highest percentage was verified in the youngest age group. The age at which sexual activity was started decreased in one year each four years of age and is two years ahead in boys. Reasons stated for this decision by women were based on values and love, while pleasure and opportunity were appointed by men. Both men and women of all ages showed a high number of sexual partners. Sexual transmitted diseases were acknowledged by a high number of students. This results clearly show the necessity of an educational programme including sexual advisory and sexual transmitted diseases prevention in all health care actions designed for university students.

Adolescent↗

AIDS related knowledge and sexual behaviour among commercial farm residents in Zimbabwe.

OBJECTIVE: To describe sexual behaviour among residents of commercial farms in Zimbabwe, their gender-specific differences; to examine implications of these for HIV/AIDS transmission. DESIGN: A cross sectional descriptive study. SETTING: Three commercial farming communities near Harare, Zimbabwe. SUBJECTS: Convenience sample of 218 adult (age 18+, or ever married) farm residents. MAIN OUTCOME MEASURES: Number of sexual partners, secondary sexual relationships outside marriage, condom ever-use, first sexual partner, sexually transmitted disease (STD) experience, unprompted knowledge of HIV. RESULTS: Knowledge of HIV transmission was high, with eight to 88% of respondents reporting various correct means of transmission. Males reported engaging in riskier behaviour than females, with 60% of currently married males (n = 81) reporting extra marital affairs compared to 4% of currently married females (n = 91) (OR: 4.02; 95% CI: 1.8 to 9.04). Males were more likely than females to report a second or further marriage (OR: 37.9; 95% CI: 16.01 to 92.1). Females were more likely than men to report first sexual partner as spouse. Fourteen percent of respondents had children of various ages outside their current union. Reported STD experiences under various circumstances were negligible with no differences by sex. CONCLUSION: While HIV/AIDS prevention measures largely rely on individual behavioural change, preventive efforts should also encompass differences in sexual behaviour between categories like male and female. Importantly, this will determine composition of preventive policy, but also allow a clearer determination of trends based on the gender-specific behaviours. There is also need for more research work that attends to determinants of reporting behaviour beyond aspects of reported behaviour per se.

Adolescent↗

Herpes simplex virus type 2 transmission: risk factors and virus shedding.

The prevalence of herpes simplex virus type 2 (HSV-2) infection is not uniform, with some populations bearing a greater burden of disease than others. Potential risk factors that influence HSV-2 transmission rates have been identified, largely from observational prospective and retrospective studies. Risk factors can be categorized as biological or behavioural. These risk factors can be markers of population subgroups that are likely to have acquired, or are at high risk of acquiring, HSV-2. Major factors associated with HSV-2 seropositivity include female gender, race (black), history of sexually transmitted infections, increasing numbers of sexual partners, sexual contact with commercial sex workers and low socio-economic status or level of education. Age-related risk factors are important, likely reflecting the cumulative number of sex partners, age of initiation of sexual activity, and duration of sexual activity as well as chronic nature of HSV-2 infection. Understanding and identifying these factors may help to direct interventions to reduce HSV-2 transmission and acquisition. An important contributing factor to the spread of genital herpes is unrecognized virus shedding, often allowing transmission from individuals who are not aware that they are infected or who are not having a recurrence. Antiviral therapy reduces both the frequency and amount of HSV reactivation, whereas behavioural risk factors can be addressed in part with educational initiatives. Clinical history is a poor predictor of HSV-2 infection and type-specific serological testing is recommended to detect HSV-2 seropositivity.

CD4 Lymphocyte Count↗

Parent-daughter transmission of the androgen receptor gene as an explanation of the effect of father absence on age of menarche.

Based on an evolutionary theory of socialization, Belsky and colleagues proposed that girls exposed to a stressful environment, especially when due to father absence in the first 7 years of life, showed an early onset of puberty, precocious sexuality, and unstable relationships as adults. The authors of this article examined an alternative explanation that a variant X-linked androgen receptor (AR) gene, predisposing the father to behaviors that include family abandonment, may be passed to their daughters causing early puberty, precocious sexuality, and behavior problems. The results of a study of 121 White males and 164 White females showed a significant association of the short alleles of the GGC repeat polymorphism of the AR gene with a range of measures of aggression and impulsivity, increased number of sexual partners, sexual compulsivity, and lifetime number of sex partners in males; and paternal divorce, father absence, and early age of menarche in females. These findings support a genetic explanation of the Belsky psychosocial evolutionary hypothesis regarding the association of fathers' absence and parental stress with early age of onset of menarche and early sexual activity in their daughters. A genetic explanation of the father absence effect is proposed in which fathers carrying the AR alleles are more likely to abandon a marriage (father absence) and pass those alleles to their daughters in whom they produce an earlier age of menarche and behavioral problems.

Adult↗

Adolescent girls with illegally induced abortion in Dar es Salaam: the discrepancy between sexual behaviour and lack of access to contraception.

This article reports on a study of induced abortion among adolescent girls in Dar es Salaam, Tanzania, who were admitted to a district hospital in Dar es Salaam because of an illegally induced abortion in 1997. In the quantitative part of the study, 197 teenage girls (aged 14-19) were asked for socio-economic details, contraceptive knowledge/use, age at first intercourse and number of sexual partners. In the qualitative part, 51 teenage girls were interviewed in-depth about their relationships with their partners, sexual behaviour, contraceptive use and reasons for non-use, and why they became pregnant. The girls were sexually active at an early age and having sex mainly with men older than themselves. Although most of the girls were in love with and enjoyed sex with their partners, they also entered these relationships to obtain money or gifts in exchange for sex. Most were not using contraception or condoms though they were also at risk of STDs and HIV. These girls were getting pregnant expecting their boyfriends to marry them, or because they did not think they could become pregnant or failed to use contraception correctly. Most adolescent girls are not aware of the 1994 Tanzanian policy that gave them the right to seek family planning services and in practice these services are not being provided. There is a need for youth-friendly family planning services and to make abortion safe and legal, in order to reduce unwanted pregnancies and abortion-related complications and deaths among adolescent girls.

Abortion, Illegal↗

Sexual experience of partners after hysterectomy, comparing subtotal with total abdominal hysterectomy.

BACKGROUND: There is a lack of knowledge about partners' sexual experience after hysterectomy. The aim of this study was to explore potential differences in the experience of sexual intercourse by the partner, related to the operation method (subtotal versus total abdominal hysterectomy). METHOD: Of all patients having undergone abdominal hysterectomy for benign indications at St Olav Hospital, Trondheim between February 2001 and March 2003, Norway, 120 patients (60 total, 60 subtotal abdominal hysterectomy) were identified. Each patient and partner received a postal questionnaire addressing sexuality in connection with the operation. RESULTS: Of the 240 questionnaires, 111 were returned, a response rate of 46%. Among partners of women having undergone total hysterectomy, proportionally more noticed during sexual intercourse that the uterus had been removed (12%) compared to partners of women having undergone subtotal hysterectomy (4%); this was not significant and all of these partners experienced this as positive. Sexual satisfaction was improved or unchanged in most women and their partners, regardless of operation type. Partners who reported poor satisfaction before the operation were significantly more likely to report poor satisfaction after the operation. A high proportion of partners in both hysterectomy groups had not discussed sexuality in relation to the surgery either before or after the operation (subtotal: 44%; total: 24%; not significant). CONCLUSION: The majority of women and their partners reported no negative impact on sexual satisfaction after abdominal hysterectomy, regardless if subtotal or total. The only predictor of negative sexual experience of partners after hysterectomy was negative sexual experience before hysterectomy.

Adult↗

Clinical predictors of Chlamydia trachomatis endocervicitis in adolescent women. Looking for the right combination.

Chlamydial disease in adolescent women is a serious public health problem, but secondary preventive efforts through early detection and treatment are encumbered by the cost and complexity of mass screening. This study was undertaken to identify clinical predictors of infection that might narrow the scope of screening adolescent populations. Demographic/clinical data and endocervical smears for the direct-specimen fluorescein-conjugated monoclonal antibody test for Chlamydia trachomatis were collected from 244 consecutive women, 21 years of age or less, attending an adolescent health clinic. Positive direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results were associated with a past history of chlamydial infection, multiple sexual partners, sexual contact with men with urethritis, nonuse of condoms, metrorrhagia, exocervicitis, mucopurulent endocervical discharge, abnormal cervical cytologic features, and isolation of Neisseria gonorrhoeae from the endocervix. These variables were entered into a discriminant analysis to predict direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results. The discriminant function was statistically significant but explained only 17% of between-group variance. Two variables alone, exocervicitis and partners with urethritis, correctly predicted direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results in 79% of all cases (negative predictive value 90%; positive predictive value 35%). When routine screening with reliable laboratory tests is not feasible, selective testing or empirical treatment of adolescent women with either risk factor may be cost-effective alternatives.

Adolescent↗

Enhancing partner support to improve smoking cessation.

BACKGROUND: While many cessation programs are available to assist smokers in quitting, research suggests that partner involvement may encourage long-term abstinence. OBJECTIVES: The purpose of this review was to determine if an intervention to enhance partner support helps smoking cessation when added as an adjunct to a smoking cessation program. SEARCH STRATEGY: The search was performed in: Cochrane Tobacco Addiction Group specialized register (Aug 2001), Cochrane controlled trials register (Apr 2000), CDC and Prevention-Tobacco Information and Prevention Database (Jul 2000), MEDLINE (1966-Jul 2000), Cancer Lit (1966-Jul 2000), EMBASE (1974-Apr 2000), CINAHL (1966-Jul 2000), PsycInfo (1861-Oct 2000), ERIC, PsycLit, & Dissertation Abstracts (1861-Dec 1999), SSCI (1972-Jul 2000) and HealthStar (1975-Jul 2000). The search terms used were smoking (prevention, control, therapy), smoking cessation, and support (family, marriage, spouse, partner, sexual partner, buddy, friend, co-habitees, and co-worker). The search was also limited to English language. SELECTION CRITERIA: Randomized controlled trials of smoking cessation interventions that compared an intervention that included a partner support component with an otherwise identical intervention and reported follow-up of 6 months or greater. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data using a structured form. A third reviewer was consulted to aid in the resolution of discrepancies. Abstinence and biochemical assessment were the primary outcome measures and were analyzed at two post-treatment intervals: 6-9 months and >12 months. The scores of PIQ (partner interaction questionnaire) were also analyzed to assess partner support. A fixed-effects model was used to assess the summary effect of the studies. MAIN RESULTS: A total of 31 articles were identified for this review. Only eight articles (nine studies) met the inclusion criteria. The definition of partner varied among the studies. All studies included data on self reported smoking cessation rates, but there was limited biochemical validation of abstinence rates. The odds ratio for self-reported abstinence at 6-9 months was 1.08 (CI 95%, 0.81 -1.44); and at 12 months post-treatment was 1.0 (CI 95%, 0.75 - 1.34). Of the six studies that measured partner support at follow-up, only two studies reported significant increase in partner support in the intervention groups. REVIEWER'S CONCLUSIONS: We conclude that interventions designed to enhance partner support for smokers in cessation programs did not increase quit rates. Limited data from several of the RCTs suggest that these interventions did not increase partner support either. No conclusions can be made about the impact of partner support on smoking cessation. More systematic intervention to affect partnership significantly should be delivered if partner support were part of an existing cessation program.

Humans↗

Enhancing partner support to improve smoking cessation.

BACKGROUND: While many cessation programs are available to assist smokers in quitting, research suggests that partner involvement may encourage long-term abstinence. OBJECTIVES: The purpose of this review was to determine if an intervention to enhance partner support helps smoking cessation when added as an adjunct to a smoking cessation program. SEARCH STRATEGY: The search was performed in: Cochrane Tobacco Addiction Group specialized register (Apr 2004), Cochrane controlled trials register (Apr 2004), CDC and Prevention-Tobacco Information and Prevention Database (Jul 2000), MEDLINE (1966-Apr 2004), Cancer Lit (1966-Apr 2004), EMBASE (1974-Apr 2004), CINAHL (1966-Jul 2000), PsycInfo (1861-Apr 2004), ERIC, PsycLit, & Dissertation Abstracts (1861-Dec 1999), SSCI (1972-Apr 2004) and HealthStar (1975-Jul 2000). The search terms used were smoking (prevention, control, therapy), smoking cessation, and support (family, marriage, spouse, partner, sexual partner, buddy, friend, co-habitees, and co-worker). The search was also limited to English language. SELECTION CRITERIA: Randomized controlled trials of smoking cessation interventions that compared an intervention that included a partner support component with an otherwise identical intervention and reported follow-up of 6 months or greater. DATA COLLECTION AND ANALYSIS: Two reviewers independently identified the included studies and extracted data using a structured form. A third reviewer was consulted to aid in the resolution of discrepancies. Abstinence and biochemical assessment were the primary outcome measures and were analyzed at two post-treatment intervals: 6-9 months and >12 months. The scores of PIQ (partner interaction questionnaire) were also analyzed to assess partner support. A fixed-effects model was used to assess the summary effect of the studies. MAIN RESULTS: A total of 40 articles were identified for this review. Only eight articles (nine studies) met the inclusion criteria. The definition of partner varied among the studies. All studies included data on self reported smoking cessation rates, but there was limited biochemical validation of abstinence rates. The odds ratio for self-reported abstinence at 6-9 months was 1.08 (CI 95%, 0.81 -1.44); and at 12 months post-treatment was 1.0 (CI 95%, 0.75 - 1.34). Of the six studies that measured partner support at follow-up, only two studies reported significant increase in partner support in the intervention groups. REVIEWERS' CONCLUSIONS: In this review of the randomized controlled trials of interventions designed to enhance partner support for smokers in cessation programs, we failed to detect an increase in quit rates. Limited data from several of the trials suggest that these interventions did not increase partner support either. No conclusions can be made about the impact of partner support on smoking cessation. More systematic intervention to affect partnership significantly should be delivered if partner support were part of an existing cessation program.

Humans↗

Perceptions of cervical cancer and Pap smear screening behavior by women's sexual orientation.

This study examined 330 adult females' perceptions and practices regarding cervical cancer by sexual orientation. Ninety-four percent of respondents were unable to correctly identify all 5 risk factors associated with increased risk for cervical cancer (smoking, sexual intercourse with men, multiple male sexual partners, sexual intercourse before age 16, and having genital warts) regardless of sexual orientation. Furthermore, 20% were not able to identify any of the 5 risk factors for cervical cancer. Lesbians perceived themselves to be less susceptible to cervical cancer than heterosexuals or bisexuals even though 79% of lesbians had sexual intercourse with a male. Eight percent of the respondents believed that most women who develop cervical cancer die from the disease. The main barriers identified by non-regular Pap screeners (N = 127) were: no health insurance (33%), forgetting to get a pap test (32%), and not liking to get a Pap test (31%). Three-fourths (75%) have had a Pap test within the last 2 years and planned to continue having them on a regular basis. The results of this survey indicate that there is considerable room for improvement in knowledge, perceptions, and practices of all women, regardless of sexual orientation, regarding cervical cancer.

Adolescent↗

Adolescent sexual risk assessment.

This article describes the use of a self-administered event history calendar and interviews about sexual partners, sexual activity, and contraception within the broader context of the adolescent's life. Constant comparative analysis was used to analyze the event history calendar interview data. Detailed 5- to 9-year sexual histories were obtained on the event history calendars, including patterns of sexual activity progression and triggers for unintended sexual intercourse. Discussions of protective and risky sexual decision making were stimulated by adolescents' self-report of sexual risk behavior in their own words and reflective responses on the event history calendar. Both the adolescents and the interviewers thought the calendars encouraged recall and discussion of sexual risk behavior.

Adolescent↗