Faculty Bibliography

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.

BACKGROUND:African American adolescent females have been understudied with regard to their continued sexually transmitted disease (STD) risk behavior during pregnancy. Preintervention studies of this population are especially important because the sequelae of STDs during pregnancy can be particularly problematic. OBJECTIVE:This exploratory study identified correlates of engaging in relatively frequent penile-vaginal sex, unprotected by a condom, among inner-city African American adolescents during their first or second trimester of pregnancy. STUDY DESIGN/METHODS:Baseline data collected as part of an HIV prevention study were used. Adolescents at their first prenatal visit completed a self-administered survey and face-to-face interview. Only adolescents reporting a current boyfriend were included in this exploratory analysis (n = 144). Significant bivariate correlates were assessed for multivariate significance. RESULTS:Significant bivariate correlates of relatively frequent unprotected vaginal sex were older age (P < 0.02), primiparity (P < 0.03), not being enrolled in school (P < 0.02), not residing with at least one parent (P < 0.001), reported infrequent sexual communication (communicating about sex) with the boyfriend (P < 0.01), spending at least 30 hours each week with the boyfriend (P < 0.001), reporting that the age of the current relationship was at least 2 years (P < 0.04), and using marijuana in the past 30 days (P < 0.03). Three correlates retained significance in the multivariate model: not residing with at least one parent (adjusted odds ratio [AOR] = 2.24; P < 0.04), spending at least 30 hours with the boyfriend each week (AOR = 3.70; P < 0.002), and infrequent sexual communication with the boyfriend (AOR = 2.88; P < 0.008). CONCLUSION/CONCLUSIONS:Given the potential of STDs to complicate pregnancy outcomes, clinic-based and community-based programs addressing relational dynamics and relational obstacles to safer sex may be warranted, particularly for adolescents not residing with parents.

OBJECTIVE:To prospectively determine (using an 18-month follow-up period) the association between African American female adolescents' perceptions of parental monitoring and their acquisition of biologically confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. DESIGN/METHODS:A prospective cohort study of 217 African American female adolescents enrolled in the control arm of a randomized trial of a human immunodeficiency virus prevention intervention program. SETTING AND PARTICIPANTS/METHODS:A volunteer sample of adolescents (aged 14-18 years) recruited from low-income neighborhoods characterized by high rates of unemployment, substance abuse, violence, and sexually transmitted diseases. MAIN OUTCOME MEASURES/METHODS:Adolescents provided 2 self-collected vaginal swab specimens. One was tested for C. trachomatis and N. gonorrhoeae DNA with ligase chain reaction. The other was used to inoculate culture medium for T. vaginalis. Identical assay procedures were repeated at the 6-month, 12-month, and 18-month follow-up intervals. RESULTS:Adjusted odds ratios indicated that adolescents who perceived infrequent parental monitoring at baseline were 1.8 (95% confidence interval, 1.01-3.21) and 2.4 (95% confidence interval, 1.22-4.87) times more likely to acquire chlamydia or trichomoniasis, respectively, compared with their counterparts who perceived greater levels of monitoring. Similarly, adolescents who perceived infrequent parental monitoring were 2.1 (95% confidence interval, 1.16-3.74) times more likely to test positive for a sexually transmitted infection during the course of the 18-month follow-up period. CONCLUSIONS:Adolescents' perceptions of their parental-monitoring levels predicted subsequent acquisition of biologically confirmed chlamydia and trichomoniasis infections. These findings suggest that expanded efforts leading toward effective clinic- and community-based sexually transmitted infection intervention programs involving parents may be warranted.

Condom promotion strategies for adolescents typically include provision of STD/HIV-associated knowledge, fostering favorable attitudes toward condom use, promoting positive peer norms regarding condom use, improving condom-related communication skills and self-efficacy, and overcoming barriers to condom use. The purpose of this study was to identify which of these constructs were prospectively associated with condom use among a high-risk sample of African American adolescent females reporting sexual activity with a steady male partner. Adolescents, 14-18 years old, were recruited from schools and health clinics. Adolescents completed an in-depth survey and interview at baseline and again 6 months later. Analyses were limited to adolescents with steady partners who reported sexual activity between the baseline and 6-month follow-up assessment periods (N = 179). At baseline, five-scale measures and a single-item measure were used to assess predictive constructs. At follow-up, adolescents were asked about their frequency of condom use over various periods of recall. Multivariate models were created to control for the confounding influence of pregnancy status. The findings were remarkably distinct. The evidence strongly supported the predictive role of perceived barriers toward condom use and peer norms. The measure of sexual communication achieved significance for two of the six assessed outcomes. Alternatively, measures of attitudes toward condom use, condom negotiation self-efficacy, and knowledge about STD/HIV-prevention were consistently nonsignificant. The findings suggest that to improve effectiveness of individual-level STD/HIV prevention programs, designed for this population, program emphasis should be on reducing barriers to condom use, teaching partner communication skills, and fostering positive peer norms relevant to condom use.

This exploratory study assessed the state-level association between social capital, poverty, and income inequality and adolescents' sexual risk and protective behaviors. A cross-sectional design using state-level correlations was employed. Seven outcome measures from the national 1999 Youth Risk Behavior Surveillance Survey were used. For females and males, social capital was significantly associated with five of the seven outcome measures (all associations p < 01). For females, the amount of variance explained by these correlations ranged from 23% to 45%; the range for males was 20% to 52%. Poverty was not a significant predictor of any outcome variable. Income inequality was a significant predictor of birth control usage among females, but in multivariate regression analyses, only social capital retained significance. Findings provide preliminary evidence that social capital may have a profound influence of adolescents' sexual risk and protective behaviors. Social capital was inversely correlated with sexual risk behaviors and positively correlated with protective sexual behaviors. Further and more comprehensive research involving social capital and adolescents is warranted.

BACKGROUND:Several recent studies have addressed the question of whether adolescent females who have sex with older partners have a greater risk of sexually transmitted disease (STD) acquisition. GOAL/OBJECTIVE:The goal was to identify differences in STD prevalence and selected measures of behavioral risk between unmarried pregnant African American adolescent females reporting sex with older partners and those reporting sex with similar-age partners. STUDY DESIGN/METHODS:Adolescents (n = 169) were recruited during their first prenatal visit. Adolescents completed a self-administered survey and a face-to-face interview and provided urine specimens for nucleic acid amplification assays. RESULTS:Approximately 65% of adolescents reported that their male sex partners were >/=2 years older, while 35% reported having similar-age male sex partners. In age-adjusted analyses, adolescents with older partners were four times more likely to test positive for chlamydia (P < 0.04) and were more than twice as likely to report that their partner was also having sex with other women (P < 0.04). With use of a 30-day recall period, the mean number of unprotected vaginal sexual encounters among adolescents with older partners was 4.1, as compared to a mean of 6.9 among those reporting similar-age partners; this difference approached significance (P = 0.051). Prevalence of trichomoniasis as well as scale measures of adolescents' self-efficacy for condom negotiation and frequency of sexual communication with partners did not differ between those adolescents with older or similar-age male sex partners. CONCLUSION/CONCLUSIONS:In resource-constrained clinical settings, one implication of these findings is that pregnant adolescents reporting older partners may be a priority for targeted delivery of partner services. More frequent screening for chlamydia may also be cost-effective for pregnant adolescents with older partners.

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.

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.

BACKGROUND:Numerous studies have examined the association between adolescents' marijuana use and their high-risk sexual behaviors and sexually transmitted diseases (STDs). However, the validity of the findings is questionable because most of the studies relied on self-reporting for measurement of marijuana use and key outcome (i.e., STDs). GOAL/OBJECTIVE:The goal was to investigate associations between biologically confirmed marijuana use and laboratory-confirmed STDs and condom use. STUDY DESIGN/METHODS:African American females adolescents (n = 522) completed a self-administered survey and face-to-face interview. The adolescents provided urine and vaginal swab specimens that were analyzed for marijuana metabolites and STDs, respectively. RESULTS:Among the study subjects, 5.4% tested positive for marijuana. These adolescents were more likely to test positive for Neisseria gonorrhoeae (adjusted odds ratio [AOR] = 3.4) and Chlamydia trachomatis (AOR = 3.9). They were more likely to have never used condoms in the previous 30 days (AOR = 2.9) and to have not used condoms consistently in the previous 6 months (AOR = 3.6). CONCLUSION/CONCLUSIONS:The findings represent unique biologic evidence that STDs and sexual risk behavior may co-occur with marijuana use. Interventions designed to reduce adolescents' risk of STDs and HIV infection should address marijuana use.