Dawn M. Upchurch

Condom use to prevent incident STDs: the validity of self-reported condom use.

Background Studies of sexual behavior and of interventions designed to reduce human immunodeficiency virus risk usually depend on self-report. Validation of self-reported condom use measures has not been previously reported in an urban population at high risk for sexually transmitted diseases and human immunodeficiency virus. Methods A prospective cohort study was performed in subjects recruited from sexually transmitted disease clinics in Baltimore. At enrollment, a questionnaire was administered that assessed human immunodeficiency virus risk factors and sexually transmitted disease history, and used a retrospective calendar to assess sexual events and condom use over the previous 30 days. Clinical evaluation was performed for sexually transmitted diseases. At follow-up 3 months later, the same procedures were repeated. Incident sexually transmitted diseases at follow-up were defined as new culture or serologically documented diagnoses of gonorrhea, chlamydia, syphilis, or trichomoniasis. Results In the 323 male and 275 female (total = 598) subjects who completed a follow-up visit, 21% reported using condoms for every act of sexual intercourse over the previous 30 days, 21% reported occasionally using condoms, and 59% reported not using condoms. At follow-up, 21% of subjects had new incident gonorrhea, chlamydia, syphilis, or trichomoniasis. Fifteen percent of the men who were “always” condom users had incident sexually transmitted diseases compared with 15.3% of “never users;” 23.5% of women who were “always” users had incident sexually transmitted diseases compared with 26.8% of “never” users. Conclusions In this high-risk population, self-reported condom use is not associated with lower sexually transmitted disease incidence. This finding suggests that self-reported condom use measures, even in a research setting, may be subject to substantial reporting bias.

Violence and injury in marital arguments: risk patterns and gender differences.

OBJECTIVES Community-based research on violence against women typically focuses on marital arguments rather than on resulting injuries. This study investigated patterns of victimization, violence perpetration, and injury in marital arguments. METHODS Data from the National Survey on Families and Households and binomial and multinomial logit models were used to analyze characteristics of those who experienced physical violence, as well as to determine who was the perpetrator and who was the victim. RESULTS Men and women reported similar behaviors during verbal arguments. Young persons, urban dwellers, the less educated, those with low incomes, and Blacks were more likely to report that there had been physical violence in their marriages in the past year. Ethnicity, income, education, and number and age of children at home were not associated consistently with injury of the wife, the husband, or both. CONCLUSIONS Persons who report physical violence in their marriage are very similar to those who are at increased risk of interpersonal violence in general. The co-occurrence of street and other nonfamily violence with spousal violence may be a fruitful area for future research.

Neighborhood and family contexts of adolescent sexual activity

Although numerous studies have examined the sociodemographic and psychosocial factors associated with first sex there is little research on the contribution of social context. The impact of neighborhood and family structure on adolescents risk of first sex was investigated in a community-based sample of 879 ethnically diverse youth 12-17 years of age (mean age 14.5 years) from Los Angeles California. 48.7% of respondents were Hispanic; 57.9% lived with both biological parents. Commonly reported neighborhood hazards included gangs (59.8%) and drug use or dealing (43.4%). Males who lived in underclass Black or working class Hispanic neighborhoods had significantly higher rates of first sex than those from middle or upper-middle class White neighborhoods. Those reporting more ambient hazards in their neighborhoods had the highest levels of first sex suggesting that neighborhood structural effects are mediated by adolescents perceptions of the level of threat and social disintegration. Males and females living in single-parent or step-parent families had significantly higher rates of first sex than their counterparts living with both biological parents. Parental socio-emotional support and control captured distinct dimensions of the family contexts and were particularly important dimensions for males risk of first sex. These findings suggest that adolescents experience of their neighborhoods and their family situations are key determinants of their propensity to become sexually active. Both families and neighborhoods provide a milieu of opportunities and norms that shape social behavior.

Gender and ethnic differences in the timing of first sexual intercourse.

CONTEXT Whether the effect of gender on the risk of first intercourse in influenced by adolescents ethnicity has received limited attention in research on age at first sex. Such information could provide a more complete understanding of adolescent sexual behavior. METHODS Life-table analysis using data from a population-based, ethnically diverse sample of 87/Los Angeles County youths was employed to estimate the median age at first sex for each gender-and-ethnicity group. Multivariate analysis using proportional hazards techniques was conducted to determine the relative risk of sexual activity among teenagers in each group. RESULTS Overall, the teenagers in the sample had a median age at first sex of 16.9 years. Black males had the lowest observed median (15.0), and Asian American males the highest (18.1); white and Hispanic males, and white and black females, reported similar ages (about 16.5 years). Hispanic and Asian American females had rates of first sex about half that of white females, although these protective effects were explained by differences in family structure. Even after controlling for background characteristics, black males had rates of first sex that were about 3-5 times the rates of the other gender-and-ethnicity groups. In addition, Asian American males were less likely than Hispanic males to be sexually experienced, and Hispanic males had almost twice the rates of sexual activity of Hispanic females. CONCLUSIONS Socioeconomic conditions account for ethnic differences among females in the age at first sex, and cultural influences may contribute to the difference between Hispanic males and females; explanations for black males, however, remain elusive.

Neighborhood context and the risk of childbearing among metropolitan-area black adolescents

The authors examine whether neighborhood racial composition or poverty is the more important predictor of premarital adolescent childbearing among metropolitan-area black people, and how family socioeconomic status moderates these neighborhood influences. They analyze data from a special release of the Panel Study of Income Dynamics that appends census tract information to the individual records of 940 metropolitan black women. Using cluster analysis, they create neighborhood types that reflect the racial and economic composition of neighborhoods where metropolitan the black people live. Compared with living in a racially mixed neighborhood, living in a highly segregated neighborhood is associated with a 50-percent increase in the rate of a premarital first birth, regardless of neighborhood socioeconomic status. Living in a white middle-class neighborhood is associated with lower rates of a premarital first birth for affluent black teens, but has no effect on their less affluent black peers. These findings support the hypothesis that neighborhood racial composition directly influences adolescent childbearing by sealing off participation in mainstream social and economic arenas

Nonmarital Childbearing: Influences of Education, Marriage, and Fertility

We examined the determinants of nonmarital fertility, focusing on the effects of other life-course events: education, marriage, marital dissolution, and marital fertility. Since these determinants are potentially endogenous, we modeled the processes that generate them jointly with nonmarital fertility and accounted for the sequencing of events and the unobserved correlations across processes. The results showed that the risk of nonmarital conception increases immediately after leaving school and that the educational effects are less pronounced for black women than for other women. The risk is lower for previously married women than for never-married women, even controlling for age, but this reduction is significant only for black women. The more children a woman already has, the lower her risk of nonmarital childbearing, particularly if the earlier children were born during a previous marriage. Ignoring endogeneity issues seriously biases the estimates of several substantively important effects.

Inconsistencies in reporting the occurrence and timing of first intercourse among adolescents

Two types of reporting inconsistency for sexual initiation were analyzed—event occurrence and its timing—using data from two waves of the National Longitudinal Study of Adolescent Health (Add Health). Overall, 11.1% of those who reported they were sexually active at the time of first interview denied this at the subsequent one. Males of each race/ethnic group had higher percentages of inconsistency than their female counterparts. Being older, not living with parents, or having a highly educated mother was negatively associated with rescinding. Among those reporting sexual experience at both interviews, only 22.2% reported the same date of first sex. On average, teens revised their age at first sex to older ages, and boys, especially African American boys, had large variability in reporting dates, as did teens with lower verbal ability. Seven strategies for resolving inconsistent reports are presented and implications for substantive findings are discussed.

Use of complementary and alternative medicine during the menopause transition: longitudinal results from the Study of Women's Health Across the Nation.

Objective: This study examined whether use of complementary and alternative (CAM) therapies during the menopause transition varied by ethnicity. Design: The Study of Womens Health Across the Nation is a prospective cohort study following a group of 3,302 women from five racial/ethnic groups at seven clinical sites nationwide. Using longitudinal data encompassing 6 years of follow-up, we examined trends in use of five categories of CAM (nutritional, physical, psychological, herbal, and folk) by menopause status and ethnicity. To account for potential secular trends in CAM use or availability, we also evaluated the trends in CAM use over calendar time. Results: Approximately 80% of all participants had used some form of CAM at some time during the 6-year study period. White and Japanese women had the highest rates of use (60%), followed by Chinese (46%), African American (40%), and Hispanic (20%) women. Overall use of CAM therapy remained relatively stable over the study period. In general, CAM use did not seem to be strongly associated with change in menopause transition status. Use of CAM among white women did not change with transition status. Among Chinese and African American participants, we observed an increase in CAM use as women transitioned to perimenopause and a decrease in use of CAM with transition to postmenopause. Among Hispanic and Japanese women, we observed a decrease in use of CAM in early perimenopause, followed by an increase as women entered late perimenopause and a decrease as they progressed to postmenopause. Patterns of use for the five individual types of CAM varied. White women had relatively stable use of all CAM therapies through the transition. Japanese women decreased use of nutritional and psychological remedies and increased use of physical remedies as they transitioned into late perimenopause. Among African American women, use of psychological remedies increased as they progressed through menopause. Conclusions: Although CAM use did vary in some ethnic groups in relation to advancing menopause status, there was no evidence of influence of calendar time on CAM use. Patterns of CAM use during menopause are likely to be driven by personal experience, menopausal health, and access to therapies. Womens personal preferences should be taken into consideration by healthcare providers for medical decision making during menopause and throughout the aging process.

Cross-sectional analysis of specific complementary and alternative medicine (CAM) use by racial/ethnic group and menopausal status: the Study of Women's Health Across the Nation (SWAN).

Objective:To examine the relationships of race/ethnicity, menopausal status, health characteristics, and symptoms with use of 21 types of complementary and alternative medicine (CAM) in midlife women. Design:Cross-sectional, multiple logistic regression analyses of 2,118 women completing the sixth annual visit in the Study of Womens Health Across the Nation, a multisite, multiethnic, longitudinal study. Results:More than half of women used some type of CAM. Use of most types of CAM differed significantly by race/ethnicity, except the use of ginkgo biloba and glucosamine. Significantly more African Americans at most sites and Chinese women used ginseng. Use of most types of CAM did not differ significantly by menopausal status or vasomotor symptoms, except the use of soy supplements, which was significantly greater among women who reported vasomotor symptoms. Women reporting somatic symptoms were significantly more likely to use glucosamine. Women reporting psychological symptoms were significantly more likely to use ginkgo biloba and soy supplements. The number of comorbidities, moderate or high socioeconomic status, number of healthy behaviors, symptom sensitivity, age, and dietary genistein intake were significantly positively associated with use of several types of CAM. Conclusions:The use of most types of CAM is not related to menopausal status or symptom reporting but to sociodemographic factors, comorbidities, and health behaviors. Given the large proportion of midlife women who use CAM and the potential for interactions with prescribed medications, healthcare practitioners should inquire about CAM use and be aware of which factors influence the use of different types of CAM.

Racial and Ethnic Patterns of Allostatic Load Among Adult Women in the United States: Findings from the National Health and Nutrition Examination Survey 1999–2004

OBJECTIVE This study provides a descriptive sociodemographic profile of allostatic load (AL) among adult women of all age groups, focusing on how age patterns of AL vary across racial/ethnic groups. Allostatic load, an index of cumulative physiological dysregulation, captures how the cumulative impact of physiological stress responses from person-environment interactions causes wear and tear on the bodys regulatory systems, which in turn can lead to disease outcomes and health disparities. METHODS Using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004, this study examines AL in a nationally representative sample of women ≥18 years of age (n=5765). Measures of AL using 10 biomarkers representing cardiovascular, inflammatory, and metabolic system functioning were created. Multivariate negative binomial regression models were used, and predicted AL scores were computed. RESULTS Black women had the highest predicted AL scores relative to other racial/ethnic groups, and a marked black/white gap in AL persisted across all age groups. Age by race/ethnicity interaction terms revealed significant racial/ethnic differences in AL patterns across age groups. Black women 40-49 years old had AL scores 1.14 times higher than white women 50-59 years old, suggesting earlier health deterioration. Mexican women not born in the United States had lower predicted AL scores than those born in the United States. CONCLUSIONS This study provides one of the first descriptive profiles of AL among a nationally representative sample of adult women in the United States and presents racial/ethnic trends in AL across age groups that are useful for identifying demographically and clinically important subgroups at risk of having high cumulative physiological dysregulation.