Cynthia Rosengard

Reproductive Health Care and Family Planning Needs Among Incarcerated Women

OBJECTIVES Women in correctional institutions have substantial reproductive health problems, yet they are underserved in receipt of reproductive health care. We assessed the level of risk for sexually transmitted diseases (STDs) and the reproductive health needs of 484 incarcerated women in Rhode Island to plan an intervention for women returning to the community. METHODS We used a 45-minute survey to assess medical histories, pregnancy and birth control use histories, current pregnancy intentions, substance use during the past 3 months, histories of childhood sexual abuse, and health attitudes and behaviors. RESULTS Participants had extremely high risks for STDs and pregnancy, which was characterized by inconsistent birth control (66.5%) and condom use (80.4%), multiple partners (38%), and a high prevalence of unplanned pregnancies (83.6%) and STDs (49%). Only 15.4% said it was not likely that they would have sexual relations with a man within 6 months after release. CONCLUSION Reproductive health services must be offered to incarcerated women. Such interventions will benefit the women, the criminal justice systems, and the communities to which the women will return.

Concepts of the advantages and disadvantages of teenage childbearing among pregnant adolescents: a qualitative analysis.

OBJECTIVE. We sought to enhance our understanding of pregnant adolescents’ concepts of the advantages and disadvantages of teen pregnancy and childbearing. METHODOLOGY. This is a qualitative study of 247 pregnant adolescents recruited during their first prenatal health care visit to a womens primary care clinic in Providence, Rhode Island. Participants responded in writing to open-ended questions assessing their ideas about what was advantageous and disadvantageous about having an infant during their teen years rather than waiting until they were older. Themes and patterns in responding were coded, and subgroup differences based on age, ethnicity, intendedness of current pregnancy, and pregnancy/parenting history were assessed. RESULTS. Themes related to advantages of teen pregnancy included enhancing connections, positive changes/benefits, and practical considerations. Themes related to disadvantages included lack of preparedness, changes/interference, and others’ perceptions. Differences among groups based on age, ethnicity, intendedness of the current pregnancy, and pregnancy/parenting history were examined and noted. CONCLUSIONS. Pregnant adolescents do not represent a homogeneous group. Considering differences in how pregnancy and childbearing are conceptualized along developmental, cultural, attitudinal, and experiential lines will strengthen our ability to tailor pregnancy-prevention messages.

Prevalence and Patterns of Sexual Assault Across the Life Span Among Incarcerated Women

This study investigated the prevalence of and associations among sexual assault by life stage (childhood, adolescence, or adulthood) and perpetrator (family, stranger, friend, or partner) via a survey of a statewide sample of incarcerated women (N = 484). Participants were 18 to 56 years old, and the majority were White (56%). Results demonstrate higher rates of sexual assault in childhood (35%) and adulthood (22%) as compared with adolescence (14%). Logistic regression analyses revealed significant associations between childhood sexual assault by family and adulthood sexual assault by friend, stranger, and partner; adolescent sexual assault was not significantly associated with sexual assault in childhood or adulthood. These findings suggest that the lifetime sexual victimization pattern of incarcerated women differs from that seen in the general population.

Suicidal ideation, bereavement, HIV serostatus and psychosocial variables in partners of men with AIDS

This prospective 2-year study examines suicidal ideation in 86 HIV-positive and 167 HIV-negative caregiving partners of men with AIDS. One hundred and fifty-six of the caregivers became bereaved during the course of the study. The study focuses on the relationship between suicidal ideation and bereavement status (bereaved vs non-bereaved), HIV serostatus (HIV-positive vs HIV-negative), and psycho-social factors (caregiving burdens, social support, coping, and optimism). Bereavement was related to suicidal ideation, but HIV serostatus was not. High suicidal ideators were characterized by feeling burdened by caregiving, perceiving low levels of social support and subjective social integration, and the use of behavioural escape-avoidance coping. Those who reported never having suicidal ideation were characterized by higher levels of optimism. Clinical implications are discussed.

Improving Birth Control Service Utilization By Offering Services Prerelease Vs Postincarceration

OBJECTIVES We examined whether incarcerated women would substantially increase birth control initiation if contraceptive services were available within the prison compared with after their release back into the community. METHODS During phase 1 of the study, a nurse educator met with women at the Rhode Island Adult Correctional Institute and offered them referrals for contraceptive services at a community health clinic after their release. During phase 2, contraceptive services were offered to women during their incarceration. RESULTS The majority of the participants (77.5%) reported a desire to initiate use of birth control methods. Within 4 weeks of their release, 4.4% of phase 1 participants initiated use of a contraceptive method, compared with 39.1% of phase 2 participants (odds ratio [OR]=14.6; 95% confidence interval [CI]=5.5, 38.8). CONCLUSIONS Provision of contraceptive services to women during their incarceration is feasible and greatly increases birth control initiation compared to providing services only in the community.

Randomized Clinical Trial of Motivational Enhancement of Substance Use Treatment Among Incarcerated Adolescents: Post-Release Condom Non-Use

ABSTRACT Evaluated impact of motivational enhancement (ME) of substance abuse treatment compared to relaxation training (RT) on sex without condoms (overall and involving substance use) 3 months following release among incarcerated adolescents. This randomized clinical trial involved 114 incarcerated adolescents from the Northeast. Regression analyses determined if treatment condition, baseline levels of depressive symptoms, and their interaction predicted condom non-use 3 months post-release, controlling for baseline condom non-use. Among those who reported fewer baseline depressive symptoms, those in ME condition reported significantly less condom non-use, in general and involving marijuana use compared with those in RT condition. Periods of incarceration represent opportunities to help juvenile detainees reduce behaviors that impact their health and the health of those with whom they interact in the Community.

Co-Occurring Sexual Risk and Substance Use Behaviors Among Incarcerated Adolescents

Incarcerated adolescents report greater sexual risk than do nonincarcerated peers. High-risk sexual behavior is associated with substance use. To determine how much sexual risk is combined with substance use, 167 incarcerated adolescents reported on their sexual risk behavior in the year before incarceration that involved alcohol or marijuana. For each risk behavior, marijuana use was more likely than was alcohol use. Marijuana use was more common for higher risk behaviors than for lower risk behaviors. Periods of incarceration provide opportunities for intervening on HIV-relevant risk behaviors among adolescents. The context of substance use within high-risk sexual situations ought to be a focus of interventions for incarcerated adolescents.

Perceived STD risk, relationship, and health values in adolescents' delaying sexual intercourse with new partners.

Objectives: To examine the amount of time adolescents waited to have intercourse with past partners (main and casual), and intentions to delay with future partners. To determine psychosocial factors which predict delay intentions among adolescent males and females with future partners (main and casual). Methods: Adolescent STD clinic attendees were approached before clinical appointments to participate in an interview. Data from 205 participants who had previous experience with both main and casual partners were used in the current study. Results: Adolescents waited less time to have intercourse with most recent casual than with most recent main partners (χ2 = 31.97, p<0.0001). The amount of time waited with past partners was shorter than intended time to wait in future relationships (medians of 1 month v 2 months (main) (t = 3.47, p<0.0010; medians of 2 weeks v 1 month (casual) (t = 6.14, p<0.0001)). Factors influencing intentions to delay intercourse with future main partners differed by sex; males were negatively influenced by importance of sex in relationships, while females were positively influenced by importance of intimacy in relationships, perceived risk of STDs, and health values. Conclusions: Implications for designing interventions for adolescent males and females are discussed.

Cognitive theories of human fear: An empirically derived integration

Abstract The predictions of four cognitive theories of fear and avoidance behavior were evaluated (Bandura, 1977, 1988; Beck, 1976; Beck & Clark, 1988; Beck & Emery, 1985; Kirsch, 1985, 1990; Reiss & McNally, 1985; Reiss, Peterson & Gursky, 1987). Ninety-four snake fearful subjects completed measures of danger expectancy, danger sensitivity, anxiety expectancy, anxiety sensitivity, fear tolerance, and self-efficacy. Half of the subjects received a motivational incentive to increase their performance. They were then asked to attempt tasks on a snake approach hierarchy and to rate the amount of fear they experienced during each step. The incentive significantly increased self-efficacy and approach behavior but did not alter anxiety expectancy or self-reported fear. A path analysis indicated that behavior was influenced by self-efficacy and fear tolerance, and fear was predicted by anxiety expectancy. Self-efficacy was predicted by anxiety expectancy and fear tolerance, and anxiety expectancy was predicted b...

Social, structural and behavioral drivers of concurrent partnerships among African American men in Philadelphia

Abstract African Americans face disproportionately higher risks of HIV infection. Concurrent sexual relationships, or sexual partnerships that overlap in time, are more common among African Americans than individuals of other races and may contribute to racial disparities in HIV infection. However, little is known about attitudes, norms and practices among individuals engaged in concurrent partnerships. Little is also known about the processes through which structural, behavioral, and social factors influence concurrent sexual relationships. We recruited 24 heterosexual African American men involved in concurrent sexual relationships from a public health clinic in Philadelphia. We conducted in-depth interviews exploring these mens sexual practices; social norms and individual attitudes about concurrency; perceived sexual health risks with main and non-main partners; and the social, structural, and behavioral factors contributing to concurrent sexual relationships. Twenty-two men reported having one main and one or more non-main partners; two reported having no main partners. Respondents generally perceived sexual relationships with non-main partners as riskier than relationships with main partners and used condoms far less frequently with main than non-main partners. Most participants commented that it is acceptable and often expected for men and women to engage in concurrent sexual relationships. Social factors influencing participants’ concurrent partnerships included being unmarried and trusting neither main nor non-main partners. Structural factors influencing concurrent partnerships included economic dependence on one or more women, incarceration, unstable housing, and unemployment. Several men commented that individual behavioral factors such as alcohol and cocaine use contributed to their concurrent sexual partnerships. Future research and interventions related to sexual concurrency should address social and structural factors in addition to conventional HIV risk-taking behaviors.