Ann Stueve

Early sexual initiation and subsequent sex-related risks among urban minority youth: the reach for health study.

CONTEXT Since the 1980s, the age at which U.S. teenagers, especially minority youth, begin having sex has decreased. There is limited information on the relationship between early sexual initiation and subsequent risky sexual behaviors. METHODS A sample of 1,287 urban minority adolescents completed three surveys in seventh and eighth grade, and 970 completed a follow-up in 10th grade. Logistic regression was used to test the effects of timing of initiation on 10th-grade sexual behaviors and risks, adjusting for gender, ethnicity and age. RESULTS At baseline, 31% of males and 8% of females reported sexual initiation; by the 10th grade, these figures were 66% and 52%, respectively. Recent intercourse among males increased from 20% at baseline to 39% in eighth grade; 54% reported recent sex and 6% had made a partner pregnant by 10th grade. Among females, recent intercourse tripled from baseline to eighth grade (5% to 15%); 42% reported recent sex and 12% had been pregnant by grade 10. Early initiators had an increased likelihood of having had multiple sex partners, been involved in a pregnancy, forced a partner to have sex, had frequent intercourse and had sex while drunk or high. There were significant gender differences for all outcomes except frequency of intercourse and being drunk or high during sex. CONCLUSIONS Minority adolescents who initiate sexual activity early engage in behaviors that place them at high risk for negative health outcomes. It is important to involve parents and schools in prevention efforts that address sexual initiation in early adolescence and that target youth who continue to place themselves and their partners at risk.

Early Alcohol Initiation and Subsequent Sexual and Alcohol Risk Behaviors Among Urban Youths

OBJECTIVES We examined relations between early alcohol use and subsequent alcohol and sexual risk behaviors among urban adolescents. METHODS A total of 1034 African American and Hispanic youths completed surveys assessing alcohol and sexual behaviors at 7th and 10th grade. After we controlled for early sexual initiation, we examined relations between early drinking and subsequent alcohol and sexual behaviors. RESULTS Early drinking was associated with alcohol and sexual risks through mid-adolescence. Early drinkers were more likely to report subsequent alcohol problems, unprotected sexual intercourse, multiple partners, being drunk or high during sexual intercourse, and pregnancy. Among females, early drinking was also related to sexual initiation and recent sexual intercourse. CONCLUSIONS Prevention programs should address combined risks of early alcohol use and sexual intercourse, especially where levels of HIV and other sexually transmitted infections are elevated.

The Stigma of Homelessness: The Impact of the Label "Homeless" on Attitudes Toward Poor Persons

Poor people have long been stigmatized and blamed for their situation. According to theory about stigma and about inequality-legitimating ideologies, homeless people should be stigmatized even more severely than the generic poor. Recent research suggests that the opposite may be true, but the data used in comparing attitudes toward homeless and other poor people have not been strictly comparable. Thus the conclusions that can be drawn are limited Using a vignette experiment designed to directly compare attitudes toward a homeless and a domiciled poor man and to compare the effects of being labeled homeless with those of being labeled mentally ill, we find that (1) the homeless man is blamed no less than the domiciled man and generally is stigmatized more severely; (2) the strength of the stigma attached to the homelessness label equals that for mental hospitalization; and (3) the stigmas of homelessness and mental hospitalization are independent of one another. Thus, in addition to the hardships of the homeless condition itself homeless people suffer stigmatization by their fellow citizens. The results also suggest that the robust tendency to blame the disadvantaged for their predicament holds true for modern homelessness as well.

Real in Their Consequences: A Sociological Approach to Understanding the Association between Psychotic Symptoms and Violence:

Studies conducted over the past three decades have consistently reported an association between mental illness and violence. We propose a sociologically inspired explanation for this association by referring to the Thomas Theorem - if situations are defined as real, they are real in their consequences. We identify a small subset of psychotic symptoms, termed threat/control-override symptoms, that tend to induce violence because they influence the definitions of situations. Our data come from an epidemiological study conducted in Israel that includes a psychiatrist-administered diagnostic interview. We find an association between violent behaviors and psychiatric diagnosis that cannot be accounted for by sociodemographic variables. Threat/control-override symptoms also are strongly related to violent behaviors and explain a substantial part of the association between violence and psychiatric diagnoses. Other equally severe psychotic symptoms are not related to indicators of violence when threat/control-override symptoms are controlled. These findings support our explanation for the association between mental illness and violence, and challenge the stereotype that most people with mental illnesses are dangerous

VIOLENCE AND PSYCHIATRIC DISORDERS: RESULTS FROM AN EPIDEMIOLOGICAL STUDY OF YOUNG ADULTS IN ISRAEL

This paper investigates the association between various psychiatric disorders and violent behavior using data from a community-based epidemiological study of young adults in Israel (N = 2678). Self-reports of recent fighting and weapon use were elevated among respondents diagnosed with psychotic or bipolar disorders but not among those diagnosed with non-psychotic depression, generalized anxiety disorder or phobias compared to respondents without these disorders. Violence was measured using the Psychiatric Epidemiology Research Interview; psychiatric disorders were diagnosed using a modified version of the Schedule for Affective Disorders and Schizophrenia. The analyses controlled for lifetime substance abuse, antisocial personality disorder and demographic characteristics, thereby extending support for a causal connection between some types of psychiatric disorders and violence. The association between disorder and violence was stronger among respondents with less education, indicating the potentially important role of social and cultural contexts in moderating the association between mental illness and violence.

The effectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students.

OBJECTIVES This study evaluated the effectiveness of a community youth service (CYS) program in reducing sexual risk behaviors among African American and Latino urban young adolescents. METHODS A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up. Students at one school were randomly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only. Students at the other school served as controls. RESULTS At follow-up. CYS participants reported significantly less recent sexual activity (P < .05) and scored lower on a sexual activity index than those in the control condition (P < .03). The greatest effect was among eighth graders, who received the most intensive service program (P < .03). The benefit of the curriculum-only intervention appeared greatest among students in special education classes. CONCLUSIONS Well-organized CYS that couples community involvement with classroom health instruction can have a positive impact on the sexual behaviors of young adolescents at risk for HIV, sexually transmitted diseases, and unintended pregnancy. This study also suggests the importance of including students in special education classes in health education programs.

Sexual Behaviors and Risks Among Bisexually- and Gay-Identified Young Latino Men

This research compares patterns of sexual behavior and sexual risk of bisexually- and gay-identified Latino young men who have sex with men (YMSM). Four hundred forty-one Latino YMSM were surveyed at community venues in New York City. Twenty-two percent of the sample identified as bisexual, and 78% identified as gay. Bisexually-identified men were more likely to report having had multiple male sex partners in the last 3 months and less likely to report being exclusively involved with a main male partner. They were also approximately 31/2; times more likely to report unprotected insertive anal intercourse at last sexual contact with a nonmain male partner and more likely to report being high at last contact with both main and nonmain male partners. Findings suggest that prevention programs need to address the particular sexual risk patterns of bisexually-identified Latino YMSM that place them at risk of both HIV infection and transmission.

Public knowledge, attitudes, and beliefs about homeless people: evidence for compassion fatigue.

Media reports suggest that the public is becoming impatient with the homeless—that so-called “compassion fatigue” has gripped the nation. This characterization of public sentiment could have important policy consequences—restrictive measures can be justified by growing public impatience, and progressive housing policies seem infeasible within a hostile climate of opinion. But evidence to support the compassion fatigue notion is anecdotal. We examine the issue by tracking the results of public opinion polls and by reporting detailed evidence from a nationwide random-digit dial telephone survey (N=1,507) concerning knowledge attitudes and beliefs about homeless people. To be sure, the public sees homelessness as an undesirable social problem and wants something done about it. However, although the homeless are clearly stigmatized, there is little evidence to suggest that the public has lost compassion and is unwilling to support policies to help homeless people.

Understanding differences in HIV sexual transmission among Latino and black men who have sex with men: The Brothers y Hermanos Study.

HIV sexual transmission risk behaviors were examined among 1,065 Latino and 1,140 black men who have sex with men (MSM). Participants completed a computer-administered questionnaire and were tested for HIV infection. Of men who reported that their last HIV test was negative or that they had never been tested or did not get the result of their last test, 17% of black and 5% of Latino MSM tested HIV-positive in our study. In both ethnic groups, the three-month prevalence of unprotected anal intercourse (UAI) with HIV-negative or unknown serostatus partners was twice as high among men unaware of their HIV infection than men who knew they were HIV seropositive at the time of enrollment. UAI exclusively with HIV-positive partners was more prevalent among HIV-positive/aware than HIV-positive/unaware men. The findings advance understanding of the high incidence of HIV infection among black MSM in the U.S.

Prevalence and protective value of serosorting and strategic positioning among Black and Latino men who have sex with men.

Self-reported HIV-negative black and Latino MSM who engaged in serosorting or strategic positioning were less likely to have unrecognized HIV infection than men who engaged in unprotected anal intercourse without using these risk-reduction strategies.