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PubMed2006

Stress, bacterial vaginosis, and the role of immune processes.

Bacterial vaginosis (BV), the most common lower genital tract infection in women of reproductive age, is associated with adverse gynecologic and reproductive health outcomes. Women at highest risk for BV are young, unmarried, low income, undereducated, and African American. Behaviors such as vaginal douching, numerous sexual partners, frequent sexual intercourse, receptive oral sex, and substance use may contribute to risk, but they account for only a modest proportion of the observed race/ethnicity variance in BV. These subpopulations are also exposed to more social disadvantages or "stressors" such as poverty, poor housing, crime-infested neighborhoods, and discrimination than other groups. Growing physiologic evidence links psychosocial stress to the development of disease. Evidence supports a statistically significant, independent effect of stress on the risk and observed racial/ethnic disparity in the rate of BV. This paper reviews such evidence.

Journal Article↗

PubMed1995

Psychosocial factors influencing teenage sexual activity, use of contraception and unplanned pregnancy.

OBJECTIVE: to compare teenagers who become unintentionally pregnant and teenagers who have never been pregnant but are using contraception on matters related to family/partner stability, and communication with a parent or stable sexual partner about sexual matters. DESIGN: survey utilising self-completed questionnaire. SETTING: a hospital antenatal clinic and community-based family planning clinic. PARTICIPANTS: 30 teenagers with an unplanned pregnancy and 31 'never-pregnant' teenagers using contraception. FINDINGS: the two groups were similar on demographic factors, mean age at which sexual intercourse was first experienced, total number of sexual partnerships, the number of teenagers having a current, regular boyfriend and mean length of the interval between when the teenagers first started going out with their boyfriend and when first sexual intercourse took place. Teenagers in the family planning clinic group were more likely to be living with both natural parents and to be still at school or in higher education. The mean length of time pregnant teenagers had been going out with their boyfriend was longer, they were more likely to be cohabiting with him and to be unemployed. Participants from the antenatal clinic group communicated more with their mothers about sexual matters than those in the family planning clinic group, who were more likely to seek this information from books. The family planning clinic participants were more likely to discuss personal rules and values with friends than those in the antenatal clinic group. IMPLICATIONS FOR PRACTICE: to develop understanding of factors predisposing to unplanned pregnancy during adolescence and to implement measures to counter them, further studies to examine the influence of teenagers' perceptions of family relationships and future life prospects on contraception use and unplanned pregnancy were identified.

Adolescent↗

PubMed1995

Sexual histories of adolescent girls: comparison between interview and chart.

PURPOSE: The purpose of this study is to determine the reliability of sexual histories obtained from adolescents and the adequacy of chart documentation by providers of adolescent health care. METHODS: Responses to an interview by a female research assistant about sexual activity were compared to chart-documented sexual histories taken by physicians and nurse practitioners. The setting was an urban, hospital-based adolescent clinic. The subjects were 106 females, 15-18 years old; 82% were African-American and 18% Caucasian. RESULTS: Significant correlations between interview and chart were seen for information about menarche, age at first intercourse, number of sexually transmitted diseases (STDs), and number of sexual partners. Accuracy of reporting sexually transmitted infections varied according to the organism; HPV infection was underreported more than other infections. Chart documentation of sexual histories was inadequate. CONCLUSIONS: Adolescents generally provide reliable sexual histories, but health care providers may not be documenting these histories adequately.

Adolescent↗

PubMed2006

Mammalian animal models of psychosexual differentiation: when is 'translation' to the human situation possible?

Clinical investigators have been forced primarily to use experiments of nature (e.g., cloacal exstrophy; androgen insensitivity, congenital adrenal hyperplasia) to assess the contribution of fetal sex hormone exposure to the development of male- and female-typical profiles of gender identity and role behavior as well as sexual orientation. In this review, I summarize the results of numerous correlative as well as mechanistic animal experiments that shed significant light on general neuroendocrine mechanisms controlling the differentiation of neural circuits controlling sexual partner preference (sexual orientation) in mammalian species including man. I also argue, however, that results of animal studies can, at best, provide only indirect insights into the neuroendocrine determinants of human gender identity and role behaviors.

Animals↗

PubMedDate not supplied

The reliability of high-risk adolescent girls' report of their sexual history.

The purposes of this study were to determine the consistency in sexually active adolescent girls' self-report of sexual history and to examine their perceptions of providing sexual history information in an interview. Twenty-two adolescent girls (86% black and 14% white) were recruited from an outpatient dysplasia clinic to be interviewed 2 weeks apart. The interview consisted of questions regarding sexual history and whether they viewed their age at first intercourse as too young, too old, or appropriate. After the second interview they were asked whether there were any questions for which they thought other teenagers would be tempted not to tell the truth and any questions that were too embarrassing. Significant correlations between visits were seen for each sexual history variable. Girls described number of sexual partners and sexually transmitted disease history as questions to which adolescents might not be truthful. As part of sexual history taking, health care providers should explore with adolescent girls their perceptions of their history and address any concerns the girls have that might lead to inaccuracies or prevent the girls from obtaining appropriate anticipatory guidance.

Adolescent↗

PubMed2003

Seroprevalence of HTLV-I and HTLV-II infection among immigrants in northern Italy.

To assess the prevalence of human T cell leukemia virus type I (HTLV-I) and 2 (HTLV-II) infection and the associated risk factors among immigrants living in Northern Italy, we surveyed 3017 open-population subjects from three geographical areas and 371 prisoners. In the open population, the overall prevalence was 0.3% for HTLV-I and 0.1% for HTLV-II, while among prisoners, HTLV-I and HTLV-II infection were detected in 1.4 and 0.8% of subjects, respectively. HTLV-I prevalence was higher in subjects with multiple sexual partners or sexually transmitted diseases. This association was significant in the open-population group and close to significance in prisoners. Multivariate analysis showed that human immunodeficiency virus (HIV) seropositivity remained significantly associated with HTLV-I infection in both targeted populations (OR: 11.2 in the open population; OR: 9.9 among prisoners), whereas sexual exposure was associated with HTLV-I seropositivity only for prisoners (OR: 14.3). No independent variable was related to HTLV-II infection.

Adult↗

PubMed1996

Present versus future time perspective and HIV risk among heterosexual college students.

Because safer sex behaviors require planning and forethought and their primary motivations lie in the future, the hypothesis that behaviors that might reduce exposure to HIV would positively correlate with future time orientation, whereas risky behaviors would correlate with present time orientation, was tested in a survey of 188 heterosexual college students. As expected, those high in future time orientation were less likely to be sexually experienced and had fewer sexual partners. In contrast, present time orientation positively related to those measures. Those high in future orientation were more likely to use alternate methods of reducing exposure to HIV (e.g., inquiring about partner's sexual history, delaying or abstaining from sex). Time perspective also interacted with both gender and fear of AIDS. The responses of women and individuals low in fear were more related to time orientation.

Adolescent↗

PubMedDate not supplied

Developmental flexibility and the effect of social environment on fertility and fecundity in parthenogenetic reproduction.

One specialized environment that can influence development arises in the context of social interactions, including the environment contributed by a sexual partner during sexual reproduction. It is often difficult, however, to separate out the effect of mating (fertilization) from the effect of social environment. In the study reported here we examine the effect of social environment mediated by a pheromonal signal on the fertility and fecundity of the facultatively parthenogenetic cockroach Nauphoeta cinerea. By examining parthenogenetically reproducing females, we isolate the effects of social environment in the absence of mating or fertilization. Females exposed to male odors are more likely to produce parthenogenetic offspring. Further, increased exposure to the male pheromone increases the number of offspring produced. Variation in timing of reproduction is also dependent on the male. Thus, social environments are a mechanism by which males contribute to the development of their offspring, resulting in variation in development. This study illustrates the potential evolutionary importance of social environments in development, because a requirement for male-contributed environments may be a constraint to evolving asexual reproduction from a sexually reproducing species.

Analysis of Variance↗

PubMed2003

Gender-related concerns of rural women with severe and persistent mental illnesses.

This study used focus groups to investigate the perceptions of rural women with severe and persistent mental illness (SPMI) about their gender-related health concerns. In a series of five focus groups conducted with 16 women at rural psychosocial clubhouses, women with SPMI discussed many gender-related issues, including unresolved grief over loss of children, isolation from family members, lack of sexual partners, diminished sexuality, and bodily changes secondary to medication side-effects. Women with mental illness felt like their roles as women was superseded by their role as mentally ill individuals. Rural women with SPMI have unmet needs for women's health. Psychiatric nurses have the optimal background for addressing gender-related concerns of rural women with SPMI.

Adaptation, Psychological↗

PubMed2001

Condom use among US students: the importance of confidence in normative and attitudinal perceptions.

The author performed a study among U.S. undergraduates to test an earlier conclusion (D. Trafimow, 1994) that confidence in the correctness of one's perceptions of normative pressure to use a condom influences the correspondence between those perceptions and the intentions actually to perform the behavior. Consistent with previous findings (Trafimow), the participants' perceptions of normative pressure strongly predicted their intentions to use condoms only under conditions of extreme normative confidence. Otherwise, their attitudes were better predictors of their intentions to use condoms. In addition, 2 other variables (attitudinal confidence and perceived behavioral control) were found to be unimportant predictors of intentions. Results of a 2nd study suggest that behaviors performed by sexual partners and knowing the sexual partners affected the participants' normative confidence.

Adult↗

PubMedDate not supplied

Interaction effects of emotional status and sexual abuse on adult sexuality.

This study examined the additive, interaction effects of emotional status with sexual abuse on adult sexual functioning and sexual responsibility. The Golombok Rust Inventory of Sexual Satisfaction (GRISS; Rust & Golombok, 1986), the Personality Assessment Inventory (PAI; Morey, 1991), and a questionnaire regarding sexual experiences, number of unwanted pregnancies, number of unsafe sexual partners, and sexual abuse history, were administered to 200 psychology students. One hundred and forty-three participants were retained in the study. Two-way multivariate analyses of variance (MANOVA) were conducted for the sexual functioning variables (as measured by the GRISS), while two-way analyses of variance (ANOVA) were conducted for the sexual irresponsibility variables (as measured by the sexual experiences questionnaire). It was found that women who have high anxiety scores on the PAI and have a history of sexual abuse reported higher numbers of unwanted pregnancies, while sexual abuse history was not associated with numbers of unwanted pregnancies for women with lower levels of anxiety. Results were not significant, however, for the sexual functioning variables. In addition, depression and alcoholism did not have interacting effect on the association between sexual abuse history and any of the sexuality variables. These results may suggest that the effects of sexual abuse on adult sexuality may not be as pervasive as was once thought.

Adolescent↗

PubMed2006

Risk factors for hepatitis B infection during pregnancy in a Nigerian obstetric population.

We aimed to assess the risk factors for hepatitis B infection among pregnant women in Enugu, southeast Nigeria. This was a prospective case-control study of risk factors for hepatitis B surface antigen positivity among pregnant women seen in two tertiary health institutions in Enugu, southeast Nigeria. It was carried out over an 8-month period, January - August 2005. Of the 1,499 pregnant women attending the antenatal clinic, 4.6% (n = 69) were seropositive for hepatitis B surface antigen. A total of 35 (50.7%) HBsAg positive women and 71 negative controls were interviewed. The risk factors for HBsAg were present in 71% (n = 25) of the positive cases, while only 27% (n = 19) of the negative cases had risk factors. The significant risk factors for HBsAg positivity were higher mean parity, higher number of sexual partners since sexual debut, polygamy and previous positive history of sexually transmitted diseases (STD) (p < 0.05). The two groups did not differ with respect to presence of tattoo or scarification marks, positive history of jaundice or contact with a jaundiced patient, previous blood transfusion or contact with blood products, intravenous drug abuse or sharing personal instruments (p > 0.05). Screening pregnant women for hepatitis B infection on the basis of presence of risk factors may not effective. Universal antenatal screening for HBsAg, health education aimed at reducing risk factors and immunisation of all newborn and those at risk of hepatitis B is advocated.

Adult↗

PubMed1996

College students' perceptions of the prevalence of risky sexual behaviour.

In contrast to previous research which has largely focused on students' perceptions of other students' risk for contracting HIV/STDs, this study assessed single heterosexual college students' (96 men, 121 women) perceptions of the prevalence of different sexual behaviours which increase a person's risk for HIV/STD infection (e.g. multiple sexual partners, unprotected sexual intercourse, one-time sexual encounters). Consistent with previous research which has demonstrated an overestimation bias in judging others' risk for HIV/STD infection, students' estimates about the prevalence of sexual behaviours increasing a person's risk for HIV/STD infection were similarly overestimated relative to reported base rates. Gender differences were also observed. Although women generally tended to give higher prevalence estimates than men, overall, participants gave higher estimates when judging the behaviour of men compared to women. Both motivational and cognitive explanations of our data are discussed. Our findings highlight the importance of developing sexual risk reduction programmes which (a) enable students to make more accurate personal risk judgements, (b) increase students' awareness of the riskiness of their own sexual behaviours, and (c) promote positive health changes (e.g. increased condom use) in normative sexual behaviour among college students.

Adult↗

PubMed2002

Cervical cancer risk as a predictor of Pap smear use in rural North Carolina.

Risk for invasive cervical cancer is reported to be higher in rural areas than urban ones, and cervical cancer-related mortality is higher in rural women due to poorer utilization of preventive services and subsequent presentation at late stages of the disease. This cross-sectional study examined the relationship between prevalence of risk factors for cervical cancer and the degree of compliance with risk-appropriate screening guidelines for cervical cancer. Secondary data were analyzed for 614 women from Robeson County, NC, aged 40 and older, and of mainly rural and low socioeconomic status. High-risk status was determined by the presence of any of the following five risk factors: a history of more than two sexual partners, age at first sexual intercourse under 18 years, history of sexually transmitted disease, history of sexually transmitted disease in sexual partner(s), and smoking. Low-risk status was the absence of all factors. A high-risk participant was considered compliant if she had had at least three Pap smears in the 3 years prior to the interview, while a low-risk participant was considered compliant if she had had at least one Pap smear within the previous 3 years. Overall, 82% of the participants were at high risk for cervical cancer. However, only 41% of all participants were compliant with the risk-appropriate screening guidelines. Low-risk status was significantly associated with compliance with cervical cancer screening guidelines (adjusted OR = 6.7; 95% CI = 3.7 to 11.1, p = .0001). Findings in this study population suggest rural women at high risk for cervical cancer are less likely to be compliant with appropriate Pap smear screening guidelines, indicating the need to target educational programs.

Adult↗

PubMed1991

Stress and cancer surveys: attitudes of participants in a case-control study.

STUDY OBJECTIVE: The aim was to ascertain whether personal interviews carried out for cancer case-control studies cause stress to participants. DESIGN: Retrospective postal questionnaires were sent to women at least three months after interview for a case-control study of the aetiology of cervical cancer. The questionnaire covered attitudes to taking part in the study, stress engendered by participation, whether any particular questions were distressing, factors relevant to the decision to participate, and the role of their doctor with respect to participation. SETTING: South East and South West Thames health regions, United Kingdom. PATIENTS: Patients were women aged 20-45 years at diagnosis with invasive cervical cancer, and population based controls. MEASUREMENTS AND MAIN RESULTS: The response rate was 90%. Nearly all respondents were glad they had participated, while only 2/226 regretted taking part. Half the respondents (115/226) perceived some actual benefit from taking part. The interview carried out in the case-control study was both long and detailed and included topics such as numbers of sexual partners and history of sexually transmitted diseases. As expected, the questions causing most concern to interviewees were those on number of sexual partners, but only 13% of participants were bothered by these questions and only 4% felt inclined to terminate the interview early. CONCLUSIONS: The lack of evidence of stress caused by this potentially difficult interview suggests that, in the hands of experienced interviewers, stress is unlikely to be caused by participation. Many participants felt that they had benefited from taking part. Doctors and ethics committees should find these results reassuring.

Adult↗

PubMed2004

Running on empty: sexual co-factors are insufficient to fuel Africa's turbocharged HIV epidemic.

The hypothesis that heterosexual transmission drives sub-Saharan Africa's HIV epidemics requires much faster transmission dynamics in Africa than in the US and Europe, where heterosexual transmission is arguably insufficient to maintain existing levels of HIV prevalence. Initially, experts surmised that Africans had more sexual partners; however, studies of sexual behaviour circa 1990 undermined this assumption. Next, it was supposed that the high burden of bacterial sexually transmitted disease (STD) in Africa explained greater HIV transmission efficiency; however, during the 1990s, community studies in Africa showed that STD had much less than expected impact on HIV transmission. Current attempts to explain HIV as a primarily sexual epidemic in Africa propose multiple factors, including herpes simplex virus type 2, lack of male circumcision, concurrency, and others. These factors also fail for various reasons to account for Africa's HIV epidemics: they are present also in the US and/or Europe; they do not correlate with differences in HIV prevalence across Africa; etc. While behavioural and biological variables influence personal risk for HIV acquisition, the available evidence suggests that they do not differentiate African from US and European epidemics, nor do they determine the differential HIV epidemic trajectories noted across Africa.

Africa↗

PubMedDate not supplied

The 2004 International AIDS Conference and how to globally counter HIV/AIDS.

This article reports noteworthy HIV/AIDS clinical trials presented at the XVth International AIDS Conference, Bangkok, July 2004, and also outlines goals of comprehensive prevention, care, treatment, and monitoring plans. The Bangkok conference theme was "Access for All." Outlined are goals of comprehensive prevention, care, and treatment programs: increased education and prevention efforts, greater involvement of national health authorities, reduction of new HIV infections, increased use of voluntary counseling and testing, increased acceptance and use of condoms, acceptance of an individual's right to be protected against HIV infection during sexual activity, increased support of NGOs, reduction of sexual partners, increased sexual fidelity, availability of antiretroviral medication, prevention of mother-to-child transmission, reduction of AIDS deaths, improved surveillance of sexually transmitted infections, improved blood supply security, increased coordination with tuberculosis and malaria treatment, equity for urban and rural persons, increased orphan services, reduction of orphan rate, greater involvement of local leaders, increased media involvement, reducing HIV/AIDS discussion taboo, reduced injecting drug user needle sharing, and continuing education for health care professionals. Monitoring parameters include incidence and prevalence of HIV infections, use of voluntary counseling and testing, condom use and attitudes to right of protection, AIDS deaths, orphan rate, public advertisements, leadership participation, antiretroviral use and availability, public awareness of services, blood supply security, and professional education.

Anti-HIV Agents↗

PubMed2002

Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy.

OBJECTIVES: We investigated history of abuse and other HIV-related risk factors in a community sample of 490 HIV-positive and HIV-negative African American, European American, and Latina women. METHODS: Baseline interviews were analyzed, and logistic regressions were used to identify predictors of risk for positive HIV serostatus overall and by racial/ethnic group. RESULTS: Race/ethnicity was not an independent predictor of HIV-related risk, and few racial/ethnic differences in risk factors for HIV were seen. Regardless of race/ethnicity, HIV-positive women had more sexual partners, more sexually transmitted diseases, and more severe histories of abuse than did HIV-negative women. Trauma history was a general risk factor for women, irrespective of race/ethnicity. CONCLUSIONS: Limited material resources, exposure to violence, and high-risk sexual behaviors were the best predictors of HIV risk.

Adolescent↗