Anne M. Teitelman

Unwanted Unprotected Sex Condom Coercion by Male Partners and Self-silencing of Condom Negotiation Among Adolescent Girls

This exploratory study used the theory of reasoned action and the theory of gender and power to guide elicitation of partner-related impediments to condom use among 64 adolescent girls living in poor urban areas with high rates of HIV and partner abuse. About 53% indicated that they had experienced unwanted, unprotected vaginal sex and 25% indicated that they were unable to discuss condom use with a partner. Novel qualitative findings related to condom coercion, condom sabotage, and self-silencing of condom negotiation are discussed in the context of connecting partner abuse to interpersonal control over condom use. Implications for intervention design are discussed.

Adolescent Girls’ Perspectives of Family Interactions Related to Menarche and Sexual Health

In this study, the author explores what girls learn at menarche from family about acknowledging and accepting positive feelings in relation to their bodies and about making active decisions regarding their bodies and potential sexual practices. The author conducted in-depth individual interviews with 22 African American, European American, and multiethnic girls, aged 14 to 18 years, from both high- and low-income families. She employed an interpretive methodological approach using narrative analysis. The results of this study revealed that girls who were prepared for the physical changes at menarche were better able to acknowledge and accept this bodily change. Also, when girls’wider potentials, such as intellectual or creative capacities, were recognized, they were more likely to describe pleasurable aspects associated with this transition. In contrast, when sex and reproduction were referenced, girls were more likely to associate fear, shame, dysfunction, and victimization with their bodies.

Recent and Past Intimate Partner Abuse and HIV Risk Among Young Women

OBJECTIVE To examine the associations between past intimate partner abuse experienced during adolescence (verbal and physical), recent intimate partner abuse (verbal, physical, and sexual), and HIV risk (as indicated by lack of condom use) for sexually active young adult women in relationships with male partners. DESIGN Secondary data analysis of waves II and III of the National Longitudinal Study of Adolescent Health (Add Health). SETTING The Add Health Study is a longitudinal, in-home survey of a nationally representative sample of adolescents. SAMPLE Analyses involved 2,058 sexually active young adult women. MAIN OUTCOME MEASURES HIV risk was measured by consistent condom use over the past 12 months. RESULTS Physical and verbal abuse experienced in adolescence were associated with physical/verbal abuse experienced in young adulthood. Young, sexually active women experiencing no abuse in their relationships were more likely to consistently use condoms in the past 12 months than were their abused counterparts. CONCLUSION A causal pathway may exist between prior abuse, current abuse, and HIV risk.

Human Papillomavirus, Current Vaccines, and Cervical Cancer Prevention

Human papillomavirus infection, the most common sexually transmitted infection in the United States, is associated with the development of cervical cancer. The new human papillomavirus vaccine advances cervical cancer prevention; however, provider-recommended screening with Papanicolaou tests and lifestyle modifications are still needed. Widespread implementation of the vaccine and delivering cervical cancer screening to underserved populations remain a challenge. Nurses are ideally suited to address these needs by providing education to patients and families.

Theory-Based Behavioral Intervention Increases Self-Reported Physical Activity in South African Men: A Cluster-Randomized Controlled Trial

OBJECTIVE To determine whether a health-promotion intervention increases South African mens adherence to physical-activity guidelines. METHOD We utilized a cluster-randomized controlled trial design. Eligible clusters, residential neighborhoods near East London, South Africa, were matched in pairs. Within randomly selected pairs, neighborhoods were randomized to theory-based, culturally congruent health-promotion intervention encouraging physical activity or attention-matched HIV/STI risk-reduction control intervention. Men residing in the neighborhoods and reporting coitus in the previous 3 months were eligible. Primary outcome was self-reported individual-level adherence to physical-activity guidelines averaged over 6-month and 12-month post-intervention assessments. Data were collected in 2007-2010. Data collectors, but not facilitators or participants, were blind to group assignment. RESULTS Primary outcome intention-to-treat analysis included 22 of 22 clusters and 537 of 572 men in the health-promotion intervention and 22 of 22 clusters and 569 of 609 men in the attention-control intervention. Model-estimated probability of meeting physical-activity guidelines was 51.0% in the health-promotion intervention and 44.7% in attention-matched control (OR=1.34; 95% CI, 1.09-1.63), adjusting for baseline prevalence and clustering from 44 neighborhoods. CONCLUSION A theory-based culturally congruent intervention increased South African mens self-reported physical activity, a key contributor to deaths from non-communicable diseases in South Africa. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01490359.

The Health of Women and Girls Determines the Health and Well-Being of Our Modern World: A White Paper From the International Council on Women's Health Issues

The International Council on Womens Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research. We are a multidisciplinary network of womens health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girls health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally.

A Unique Set of Interactions: The MSU Sustained Partnership Model of Nurse Practitioner Primary Care

Purpose To present a unified conceptual model that identifies the integral processes of nurse practitioner (NP) care delivery and that integrates major structural influences and potential outcomes. The model is further characterized to delineate the unique and “value‐added” nature of NP primary care and to describe how this nature may be correlated with specific clinical outcomes. Data Sources Extensive review of the literature, relevant conceptual models, clinical experiences of the authors, and two sets of qualitative data exploring differences between NP practice and other practices. Conclusions The basis of NP primary care is the unique provider‐client relationship that develops within the primary care setting. This relationship is oriented toward (a) helping clients become empowered to more appropriately manage their own care in a way that will best meet their needs, (b) encouraging mutual decision making, (c) ensuring clients’ continuity of care, and (d) providing a holistic approach to primary care. The major structural influences are NP role components, interdisciplinary practice relationships, budget resources and payer mix, and environmental characteristics. The potential outcomes are increased healthpromoting behaviors, improved utilization of care, higher client satisfaction levels, and improved health status. Implications for Practice NPs can use this model to articulate the unique contribution of NP practice and its interrelationships within the broader primary care setting. Practicing NPs can use this framework to better understand the complexities of their current and future primary care practices. Faculty can utilize the concepts to help guide students’ understanding of their prospective roles as advanced practice nurses. Finally, this conceptual framework can inform research about specific NP processes and related outcomes. A clearly delineated model that accurately depicts structures, processes, and outcomes relevant to NP primary care can strengthen NP education, distinguish NP practice, and advance evidenced‐based research linking NP practice and outcomes.

Mediation effects of problem drinking and marijuana use on HIV sexual risk behaviors among childhood sexually abused South African heterosexual men

HIV/AIDS prevalence in South Africa is one of the highest in the world with heterosexual, transmission predominantly promoting the epidemic. The goal of this study is to examine whether, marijuana use and problem drinking mediate the relationship between histories of childhood sexual, abuse (CSA) and HIV risk behaviors among heterosexual men. Participants were 1181 Black men aged, 18-45 from randomly selected neighborhoods in Eastern Cape Province, South Africa. Audio computer assisted, self-interviewing was used to assess self-reported childhood sexual abuse, problem drinking, and marijuana (dagga) use, and HIV sexual transmission behavior with steady and casual partners. Data were analyzed using multiple meditational modeling. There was more support for problem, drinking than marijuana use as a mediator. Findings suggest that problem drinking and marijuana use, mediate HIV sexual risk behaviors in men with histories of CSA. Focusing on men with histories of CSA, and their use of marijuana and alcohol may be particularly useful for designing strategies to reduce, HIV sexual transmission in South Africa.

Associations between psychosocial factors and incidence of sexually transmitted disease among South African adolescents

Background Adolescents living in South Africa are at high risk for HIV and other sexually transmitted diseases (STDs). The present study sought to identify correlates of curable STD incidence among a cohort of adolescents in Eastern Cape Province, South Africa. Methods Data were collected in conjunction with an HIV/STD prevention intervention randomized controlled trial.1 At 54 months postintervention, curable STD incidence (gonorrhea, chlamydial infection, and trichomoniasis) was assayed and self-report measures of potential correlates of STD incidence were collected. Results Participants were adolescents reporting at least 1 sexual partner in the past 3 months (n = 659). As expected, univariate analyses revealed that girls were more likely than boys to have an STD. In addition, intimate partner violence, unprotected sex, and having older partners were associated with incident STD. In Poisson multiple regression analyses, sex (risk ratio [RR], 4.00; 95% confidence interval [CI], 2.51–6.39), intimate partner violence (RR, 1.23; 95% CI, 1.12–1.35), unprotected sex (RR, 1.42; 95% CI, 1.09–2.01), and multiple partners (RR, 1.70; 95% CI, 1.11–2.61), but not partner’s age (RR, 1.00; 95% CI, 0.94–1.07) were associated with incident STD, adjusting for 42-month STD prevalence. Binge drinking, forced sex, and age were unrelated to STD incidence in both analyses. Interactions between sex and the hypothesized correlates were nonsignificant, suggesting that sex did not modify these relationships. Conclusions Interventions to reduce HIV/STD incidence among adolescents in South Africa should address the risk associated with sex, unprotected sex, intimate partner violence, and multiple partnerships.

Emotional, physical and sexual abuse are associated with a heightened limbic response to cocaine cues

Drug‐reward cues trigger motivational circuitry, a response linked to drug‐seeking in animals and in humans. Adverse life events have been reported to increase sensitivity to drug rewards and to bolster drug reward signaling. Therefore, we hypothesized that cocaine‐dependent individuals with prior emotional, physical and sexual abuse might have a heightened mesolimbic brain response to cues for drug reward in a new brief‐cue probe. Cocaine‐dependent human individuals (N = 68) were stabilized in an inpatient setting and then completed an event‐related blood‐oxygen‐level dependent functional magnetic resonance imaging task featuring 500‐ms evocative (cocaine, sexual, aversive) and comparator (neutral) cues. Responses to three questions about emotional, physical and sexual abuse from the Addiction Severity Index were used to divide the patients into subgroups (history of Abuse [n = 40] versus No Abuse [n = 28]). When subjects were grouped by the historical presence or absence of emotional, physical or sexual abuse, the Abuse group showed a heightened midbrain, thalamic, caudate, and caudal orbitofrontal cortex response to cocaine cues; a similar result was found in other evocative cues, as well. These findings are the first reported for a 500‐ms cocaine‐cue probe, and they highlight the ability of very brief evocative cues to activate the brains motivational circuitry. Although all participants had severe cocaine use disorders, individuals reporting prior abuse had a heightened mesolimbic response to evocative cues. To our knowledge, this is the first study in humans linking a history of abuse to a brain vulnerability (heightened mesolimbic response to drug cues) previously shown to contribute to drug‐seeking.