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PubMed1996

Cumulative sexual intercourse patterns among middle adolescents: problem behavior precursors and concurrent health risk behaviors.

PURPOSE: The purpose of this study is to document associations among problem behaviors in childhood and early adolescence and several health risk behaviors in middle adolescence, including a cumulative index of sexual intercourse risk. METHOD: A nontreatment sample of 1167 10th and 11th grade students was recruited from three homogeneous suburban high schools in western New York. Intercourse activity and number of sexual partners were assessed four times at 6-month intervals over a 2-year period via self-report questionnaires administered in classroom settings. RESULTS: Sexual intercourse activity, once initiated, was found to be relatively persistent, rather than sporadic, for most adolescents. Repeated intercourse experience with multiple partners over the assessed time periods was associated with higher levels of externalizing childhood behavior problems, earlier onset of antisocial behaviors and substance use, and higher concurrent substance use. An avoidant, withdrawn behavioral style in childhood was associated with lower rates of sexual involvement in adolescence. CONCLUSIONS: Temporal linkages among childhood precursors and adolescent sexual behaviors were identified as critical to understanding adolescent risk behaviors. These cross-time relationships may identify potential targets for future intervention/prevention efforts among high risk subsamples of children and adolescents.

Adolescent↗

PubMed1999

Psychological abuse: implications for adjustment and commitment to leave violent partners.

The contribution of psychological abuse, beyond that of physical abuse, to battered women's psychological adjustment and their intentions to terminate their abusive relationships was examined. Sixty-eight battered women residing in shelters for battered women provided information on their: (1) physical and psychological abuse; (2) psychological symptomatology; (3) strategies for coping with and perceptions of control over partner violence; and (4) intentions to return to their abusive partners. Multiple regression analyses indicated that frequency and severity of physical abuse was not a significant predictor of posttraumatic stress disorder (PTSD) symptomatology nor of women's intentions to terminate their abusive relationships. However, psychological abuse was a significant predictor of both PTSD symptomatology and intentions to permanently leave abusive partners even after controlling for the effects of physical abuse. PTSD symptomatology moderated the relationship between psychological abuse and intentions to terminate the abusive relationships: resolve to leave the abusive partner as a function of level of psychological abuse was significant only among women characterized by low levels of PTSD symptomatology. Greater use of emotion-focused coping strategies, absolutely and relative to problem-focused coping, had direct effects on PTSD symptomatology. However, neither coping nor perceptions of control moderated the effects of psychological abuse on psychological adjustment. The results of the investigation suggested that psychological abuse and ensuing PTSD symptomatology are important variables to assess among physically battered women.

Adaptation, Psychological↗

PubMed1983

Acquired immunodeficiency syndrome, opportunistic infections, and malignancies in male homosexuals. A hypothesis of etiologic factors in pathogenesis.

The acquired immunodeficiency syndrome (AIDS) occurs in a subgroup of male homosexuals having sexual contact with a large number of partners. Uncommonly, AIDS has also been diagnosed in Haitians, hemophiliacs, and intravenous drug users and their infants. Manifestations include autoimmune disturbances, opportunistic infections, Kaposi's sarcoma, chronic lymphadenomegaly, non-Hodgkin's lymphoma, or squamous cell carcinoma. The hypothesis receiving most consideration is that a yet-to-be-identified virus causes AIDS. An alternative view is that repeated sexual involvement with multiple partners, in a subgroup of male homosexuals, exposes the men to the immunosuppressive impact of cytomegalovirus (CMV) and allogeneic semen. Antibody to asialo-Gm1 and other antigens on sperm react with and impair lymphoid cells. We propose a biphasic process. First, a reversible acquisition phase of impaired T-cell immunoregulation permits reactivation of Epstein-Barr virus (EBV), and autoantibodies are produced by the activated B cells. If sexual activity continues at a high level, accumulating immune defects, including destruction of thymic epithelium, lead to a second, self-sustaining phase wherein cytotoxic lymphocytes fail to eliminate herpesvirus-infected cells. Evidence is mounting that Kaposi's sarcoma is caused by CMV and that EBV is responsible for the B-cell lymphomas in these patients. Multiple factors, rather than a novel virus, probably induce AIDS in male homosexuals. If this hypothesis is correct, then rational bases for prevention and intervention can be designed.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Patterns of sexual behavior and risk taking among young New York City gay men.

One-hundred and seventy-four young New York City gay men (aged 18-24) were studied over a two-year period. We describe patterns of HIV risk taking behavior and factors that predict risk taking. Among men who engaged in receptive anal intercourse we discerned different patterns of behaviors. We defined risk takers as men who engaged in receptive anal intercourse. About two-thirds of the men fall into this category in each year, and about half of those (one third of the total) engaged in unprotected anal intercourse. Most of these men seem to make implicit decisions in managing their risk for HIV. Men who engaged in receptive anal intercourse were more likely to be in a coupled relationship and to know their partners' HIV status. Alcohol and/or drug use during sex, earlier sexual experiences, and greater integration into the gay community were also related to receptive anal intercourse. By contrast, a significant minority of the men, about 6% of the sample, engaged in very high risk behavior in each year of the study-defined as unprotected receptive anal intercourse with multiple partners. It appears that very high risk takers are qualitatively different from other risk takers: They reported more mental health problems, including more drug use, and higher levels of internalized homophobia and AIDS-related traumatic stress response. Implications for AIDS education and prevention are discussed.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Sex, alcohol and sexually transmitted diseases: a national survey.

The analysis of a representative national survey of households provides strong evidence that alcohol overshadows illicit drug use as a risk factor for sexually transmitted diseases (STDs). Men and women who report a history of STDs are significantly more likely to have a history of problem drinking, independent of high-risk sexual activities and demographic characteristics. However, a high rate of change in sexual partners over the past five years also increases the chance of STD infection. Sexual orientation is a major STD risk factor among men but not among women. Although both black men and black women are at greater risk of STDs than are those in other racial or ethnic groups, results indicate that black women's greater likelihood of having sex with men who have multiple partners, rather than their own rates of partner change, makes the crucial difference between their risk and that of white women.

Adult↗

PubMed1990

Hepatitis B: transmission by sexual contact and needle sharing.

In the Western world most cases of hepatitis B virus (HBV) infection are acquired through sexual intercourse and through needle sharing by intravenous drug users (IVDU). The major risk factors for HBV infection in homosexual men include the number of sex partners and receptive anal intercourse. In heterosexuals, this risk also rises with an increasing number of sex partners. IVDU consistently show the highest HBV infection rates in Europe and North America, presently accounting for 25 to 50% of all hepatitis B cases. Infection with the human immunodeficiency virus affects the course of HBV infection as well as the immunological response to hepatitis B vaccines. Thus, in the industrialized world, interventions against HBV infection should primarily be targeted to homosexual men, heterosexuals with multiple partners, and IVDU.

HIV Infections↗

PubMed1998

Multiple-risk behaviour in adolescents and young adults.

OBJECTIVES: This article examines the prevalence of four risk behaviours among teenagers and young adults: smoking, binge drinking, sex with multiple partners, and sex without a condom. DATA SOURCE: The data are from a Health Canada-sponsored supplement to the 1994/95 National Population Health Survey. The analysis is based on 905 respondents aged 15 to 19 and 1,055 respondents aged 20 to 24. ANALYTICAL TECHNIQUES: Prevalence estimates of the four risk behaviours were calculated for males and females in each age group. An index of multiple-risk behaviour was derived by summing the four risk behaviours. Hierarchical multiple regression was used to examine how sets of variables are related to multiple-risk behaviour. MAIN RESULTS: Multiple-risk behaviour was higher among young people who had never married, who were not students, and who did not live with a parent. Feeling distressed was positively linked with multiple-risk behaviour, while regular attendance at religious services was negatively linked with such conduct.

Adolescent↗

PubMed1995

Factors predicting continued high-risk behavior among gay men in small cities: psychological, behavioral, and demographic characteristics related to unsafe sex.

Nearly 6,000 men entering gay bars in 16 small American cities were anonymously surveyed to assess their sexual behavior and to determine predictors of risky sexual practices. Excluding individuals in long-term exclusive relationships, 27% of the men reported engaging in unprotected anal intercourse in the past 2 months. Factors strongly predictive of risk included having a large number of different male partners, estimating oneself to be at greater risk, having weak intentions to use condoms at next intercourse, believing that safer sex is not an expected norm within one's peer reference group, being of younger age, and having less education. These findings indicate that HIV prevention efforts are urgently needed for gay men in smaller cities, with efforts particularly focused on young and less educated men sexually active with multiple partners. Prevention should focus on strengthening intentions to change behavior and on changing social norms to foster safer sex.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Current etiopathogenetic views in vulvar cancer.

We considered 59 patients, from 19 to 79 years, treated for vulvar neoplastic pathology (32 of 59 had multiple squamous neoplasias of the anogenital region). It appeared that vulvar cancer is a disease of aged women and in particular between sixty and seventy years, while it isn't common under the age of thirty years. It is a hormone-independent pathology. 85% of vulvar malignant tumors is constituted by squamous cell carcinomas. The principal risk factors are: 1) chronic vulvitis (in particular Lichen sclerosus); 2) leucoplachia, 3) immunosuppression, 4) coitus in a young woman with different partners, multiple abortions, 5) HPV infection (mostly HPV type 6 and 16), 6) other genital carcinomas, 7) capacity to activate or not protoncogenes and to produce interferon, 8) tobacco smoking, 9) VIN.

Adult↗

PubMed1997

Influence of sexual abuse on HIV-related attitudes and behaviors in adolescent psychiatric inpatients.

OBJECTIVE: To investigate the associations between sexual abuse and human immunodeficiency virus (HIV)-related attitudes and behaviors of adolescents with a psychiatric disorder. METHOD: HIV-related knowledge, attitudes, and behaviors were examined by self-report assessment of adolescents admitted to a psychiatric hospital (N = 100). A subsample (n = 30) completed a role-playing exercise regarding HIV-preventive behavior that was scored for the degree of effective communication by raters blind to the subjects' abuse history. RESULTS: HIV-related risk behaviors were prevalent, including unprotected sexual intercourse (67%) and multiple partners (27%) among the sexually active (71% of the total). Also frequent were alcohol and drug use (25%) and sharing cutting instruments (22%) among those engaged in self-cutting behavior (62%). The 38% of the sample identified as having a history of sexual abuse indicated significantly poorer self-efficacy concerning condom use than their peers. Abused females scored significantly lower on the self-efficacy of condom use scale and reported significantly more frequent alcohol use than nonabused females (p = .003). A hierarchical multiple regression that controlled for consistency of condom use and tolerance of people with acquired immunodeficiency syndrome found that abuse history uniquely accounted for 16% of the variance in condom use self-efficacy. Analysis of the videotaped role-play found that abused adolescents were significantly less competent and had more difficulty in effective communication than their peers (p = .003). CONCLUSION: A history of sexual abuse is associated with impaired safe sexual decision-making and HIV-preventive communication skills, even in this already at-risk group. This study also underscores the importance of actively addressing these issues in the context of clinical care.

Adolescent↗

PubMed1996

Sexual behavior and vaginal colonization by group B streptococcus among minority women.

OBJECTIVE: To test the hypothesis that sexual behaviors predict colonization of the vagina by group B streptococcus among minority women. METHODS: We conducted a prospective, descriptive study of 192 consecutive African-American (37%) and Hispanic women (63%). Each woman underwent a detailed interview concerning sexual behavior. Separate specimens were taken from the endocervix, upper vagina, lower vagina, and anorectum and placed in selective broth media for isolation of group B streptococcus. Significant behavioral predictors of vaginal group B streptococcus colonization and heavy (3-4+) colonization were identified using stepwise logistic regression. RESULTS: The incidence of vaginal colonization was 39% and heavy colonization was 35%. Nineteen percent reported anal intercourse, 46% reported sex at least two times per week, and 21% reported more than one partner in the previous 30 days. The significant predictors of vaginal group B streptococcal infection were: African-American ethnicity, adjusted odds ratio (OR) 6.1 (95% confidence interval [CI] 2.5-15.1); presence of rectal group B streptococcus, adjusted OR 100.6 (95% CI 26.7-379.3); nulliparous, adjusted OR 3.6 (95% CI 1.4-9.5); and nonpregnant status, adjusted OR 3.9 (95% CI 1.3-12.2). The significant predictors of heavy colonization were: more than one partner in the last 30 days, adjusted OR 2.6 (95% CI 1.2-5.6); and African-American ethnicity, adjusted OR 2.3 (95% CI 1.2-4.5). Anal intercourse was associated with a reduced likelihood of vaginal group B streptococcal infection, adjusted OR 0.34 (95% CI 0.12-0.91). CONCLUSION: Sexual behavior, especially anal intercourse, does not predict vaginal colonization by group B streptococcus. African-American women are more likely to have vaginal and heavy group B streptococcus colonization. Heavy vaginal colonization is associated with multiple partners in African-American women.

Adult↗

PubMed1999

Sexual behaviour and sexually transmitted infection among African and Caribbean men in London.

We studied 180 black heterosexual men of whom 133 (74%) were Caribbean and 47 (26%) African. Seventy-three per cent of Caribbeans and 27% of Africans were UK born. We found no difference in age, but more Africans were married (30% cf 10%; P=0.002) and students (26% cf 10%; P=0.00008). More Caribbeans smoked 1-10 cigarettes a day (42% cf 22%; P=0.02) and more drank alcohol (89% cf 74%; P=0.002). Sixty-nine per cent of Caribbeans reported intercourse before the age of 17 compared with 48% of Africans (P=0.004), but there was no difference in the numbers of sexual partners, either in the previous year or in total. Twenty-four (18%) of the 133 Caribbeans had gonorrhoea compared with one (2%) of the 47 Africans (P=0.001). Multivariate analysis showed that coitarche under 16 years of age (odds ratio (OR) 50) and gonococcal and/or chlamydial infection (OR 12.5) were independently associated with Caribbeans. Within this group, gonorrhoea was found more often in teenagers (OR 9.5) who had commenced intercourse before the age of 16 (OR 3.3) and chlamydial infection in those with multiple partners (OR 24). New problem-orientated approaches are needed to eradicate these curable infections which facilitate infection with HIV.

Adult↗

PubMed1999

Sexually transmitted diseases in a health maintenance organization teen clinic: associations of race, partner's age, and marijuana use.

OBJECTIVE: To determine the role of sociodemographic risk markers and behavioral risk factors associated with sexually transmitted diseases (STDs) in sexually experienced youth seeking care at an urban, general health maintenance organization teen clinic. DESIGN: Cross-sectional. PARTICIPANTS: A consecutive, racially and ethnically diverse sample of 285 sexually experienced youth who were preponderantly female (58.6%) and who were aged 16.7 years on average. METHODS: All participants completed a self-report questionnaire and were screened for Chlamydia trachomatis using the ligase chain reaction technique and for Neisseria gonorrhoeae and other STDs using conventional methods. RESULTS: Many of these youth were at high risk for STDs, having a self-reported history of sex with multiple partners (49.1%), sex with a new partner (42.5%), inconsistent use of condoms (71.9%), and frequent substance use (24.5% used marijuana 1-2 times per week or more). Sexually transmitted disease screening revealed that 11.6% of the participants had 1 or more STDs. A logistic regression analysis to determine the best model for predicting STDs indicated that youth who are African American (odds ratio, 3.34; 95% confidence interval, 1.52-7.35), had sexual partners who were 2 or more years older (odds ratio, 2.63, 95% confidence interval, 1.22-5.67), and used marijuana 1 to 2 times or more per week (odds ratio, 2.27; 95% confidence interval, 1.01-5.13) were more likely to have STDs at screening. CONCLUSIONS: A brief sociodemographic and behavioral risk assessment that includes these factors may be useful for clinicians in deciding when to screen for STDs in sexually active youth seeking care for reasons not related to reproductive health.

Adolescent↗

PubMed1989

Risk factors for cervical cancer in Greenland and Denmark: a population-based cross-sectional study.

The incidence of cervical cancer in Greenlandic women aged 20-39 years is nearly 6 times higher than in Danish women of the same age. Possible determinants of cervical cancer incidence were investigated in a population-based cross-sectional study. From Nuuk (Greenland) and Nykøbing Falster (Denmark) a sample of 800 women aged 20-39 years was drawn at random. A total of 586 and 661 women were studied in Greenland and Denmark, respectively. All underwent a personal interview. In Greenland, 13% of the women reported first intercourse before the age of 14 in contrast to 3.5% in Denmark, and nearly 85% of the Greenlanders had their sexual debut before the end of the 16th year of age whereas this applied to only 45% of the Danish women. The prevalence of women with 0-1 lifetime sexual partner was 20.4% in Denmark, and only 1.7% in Greenland. In contrast, 53.2% of the Greenlandic women reported more than 20 partners and 22.4% more than 40 partners. The corresponding figures for Denmark were 3.6% and 0.3%, respectively. In Greenland the most common contraceptive method was the use of intra-uterine devices (73.6%), whereas, in Denmark, oral contraceptive use was most frequent (87.9%). Few Greenlanders had ever used "barrier" contraceptives (diaphragm: 1.4%; condom: 18.1%) compared to Denmark (diaphragm: 10.1%; condom: 53.9%). As many as 87.4% were current smokers in Greenland (Denmark: 53.6%) and 5.6% claimed to have never smoked, whereas this applied to 35.3% in Denmark. The indications of a higher sexual activity (multiple partners, early age at first intercourse) in Greenland compared to Denmark are in line with the observed higher rates of sexually transmitted diseases and with the hypothesis that differences in cervical cancer incidence between Greenland and Denmark are determined by aspects of sexual background.

Adult↗

PubMed2000

A decade of HIV/AIDS prevention in Sweden: changes in attitudes associated with HIV and sexual risk behaviour from 1987 to 1997.

OBJECTIVE: The objective of the present study was to monitor the changes in determinants of HIV-related attitudes and behaviour over a 10 year period. DESIGN/METHODS: In the past decade, over 11,000 individuals in Sweden participated in this repeated cross-sectional study to assess the changes in attitudes and behaviour associated with HIV. Changes in the fear of persons who are HIV seropositive, optimism that scientists will find a cure or vaccine for HIV/AIDS, engagement in discussions concerning HIV/AIDS as well as condom use, the number of sexual partners, and frequency of unprotected casual sex were assessed during four study years, 1987, 1989, 1994, and 1997. RESULTS: The findings of this study suggest that changes in attitudes regarding HIV were more robust whereas only modest changes in sexual behaviour were observed. The fear of HIV-seropositive persons, optimism that a cure or vaccine would be developed, and engagement in discussions concerning HIV all decreased over the 10 year period. A trend in increased condom use was observed, particularly in younger participants, but little change in sex with multiple partners and unprotected casual sex was observed between 1987 and 1997. CONCLUSION: Changes in attitudes regarding HIV are usually more often observed than changes in sexual behaviour. However, increased condom use in younger participants may be reflective of secular changes in sexual behaviour that may facilitate the prevention of HIV in Sweden.

Adolescent↗

PubMed1993

Adolescents, sexual behaviour and implications for an epidemic of HIV/AIDS among the young.

OBJECTIVE: To determine the patterns of sexual behaviour, condom use and sexually transmitted diseases among young New Zealanders, and the characteristics of those with many sexual partners. SUBJECTS: A cohort of young people enrolled in a longitudinal cohort study, and followed up since age three. METHODS: Subjects were interviewed at age 18 years as part of a multidisciplinary health and development study. Questions about sexual behaviour were presented by computer. RESULTS: Overall 862/1027 (83.9%) surviving in the cohort was interviewed. Only 1.4% declined to answer the section on sexual behaviour. Sexual intercourse in the previous 12 months was reported by 57.6% of the young men and 67.9% of the young women. Amongst those who were sexually active more of the young men reported multiple partners than the young women (59.8% v 46.5% p < 0.001). There was a trend for increasing number of partners with indices of lower school achievement but no significant association with socio-economic status. Condom use decreased with increasing number of partners for the young women, and for the young men there was no association. Sexually transmitted diseases were reported more commonly with increasing number of sexual partners for both men and women. The rates of sexual activity were substantially higher than reported in a comparable survey 20 years ago. CONCLUSIONS: The pattern of sexual behaviour and condom use, and the occurrence of sexually transmitted diseases in this sample give cause for concern about the spread of sexually transmitted diseases including the possibility of an epidemic of HIV among heterosexual young people in New Zealand. The findings should help in targeting health promotional activities within this age group.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Urban minority youth: alcohol and marijuana use and exposure to unprotected intercourse.

This article focuses on the use of alcohol and marijuana in the context of sexual relationships and the impact of these substances on the consistency of condom use by urban, minority youth. Regression models are presented to test for the effects of alcohol and marijuana use with sexual partners while controlling for the effects of respondents' sexual history. The results indicated that when alcohol or marijuana was used with a partner, the consistency of condom use decreased even when other variables related to sexual history were controlled for. Alcohol use had a greater negative effect on condom use for Hispanic men and marijuana for African-American women than it did for Hispanic women and African-American men. These findings argue for the need for targeted safer-sex intervention programs for urban, low-income, minority youth, and suggest that such programs may need to emphasize the increased risk of human immunodeficiency virus exposure that may result from substance use, casual sex, and sex with multiple partners.

Adolescent↗

PubMed1999

Risk factors for gonococcal and chlamydial cervical infection in pregnant and non-pregnant women in Zimbabwe.

OBJECTIVE: To identify demographic, behavioural and clinical characteristics of symptomatic and asymptomatic women with gonococcal and/or chlamydial cervicitis a study was conducted among women attending antenatal clinics and primary care clinics in Harare, Zimbabwe. DESIGN: Cross sectional study. SETTING: Primary care clinics and antenatal clinics in Harare. SUBJECTS: 467 women with vaginal discharge and 1,189 asymptomatic pregnant women. MAIN OUTCOME MEASURES: Behavioural and clinical correlates of gonococcal and chlamydial cervical infection. RESULTS: The mean age of symptomatic women was 26.11 +/- 6.84 years (range: 15 to 52 years) and that of asymptomatic pregnant women was 24.67 +/- 5.43 years (range: 15 to 45 years). Gonococcal and/or chlamydial cervical infection was found in 69 of 1,189 (5.8%) pregnant women and in 77 of 467 (16.5%) non-pregnant women. Logistic regression analysis identified the following predictors of gonococcal or chlamydial infection in women with vaginal discharge: being separated from the partner for a month or more (p = 0.002), having had sex with a new partner in the last three months (p = 0.002), current use of condoms (p = 0.011), and the finding on examination of a purulent vaginal discharge (p = 0.004). Amongst these women an increasing educational level was inversely associated with cervical infection (p = 0.007). Amongst asymptomatic pregnant women the following were identified as predictors of cervical infection: the patient admitting to having a vaginal discharge on direct questioning (p = 0.004), and the finding of a purulent vaginal discharge on examination (p = 0.001). CONCLUSIONS: Amongst symptomatic and asymptomatic women certain behavioural factors and some clinical findings are associated with cervical gonococcal or chlamydial infection. Women with multiple partners and with partners who are currently using condoms with them and those women with a purulent vaginal discharge are likely to be infected. The age and marital status of subjects was not associated with cervical infection. These findings are useful in providing appropriate care for women with overt or minimal symptoms.

Adolescent↗