Devon J. Hensel

Variations in Coital and Noncoital Sexual Repertoire among Adolescent Women

PURPOSE Little is known about factors associated with the day-to-day selection and orchestration of sexual repertoire among adolescent women. Analyzing differences in adolescent womens sexual activity may augment both the clinical and behavioral understanding of sexuality development and sexual decision making, and may yield important points to enhance existing programs for prevention of sexually transmitted infection or pregnancy. METHODS Adolescent women (N = 387, aged 14-17 years at enrollment) were recruited from primary care adolescent clinics serving primarily lower- and middle-income patients. Data were taken from daily sexual diaries. A four-category outcome variable, using generalized estimating equation multinomial logistic regression assessed the likelihood of specific sexual behaviors on a given day: none (abstinence), non-coital-only, coital-only, and dual noncoital/coitus. Separate models were analyzed for fellatio, cunnilingus, and anal sex. Predictor variables included age, menstrual bleeding, alcohol or marijuana use, positive or negative mood, recent coitus, recent noncoital sexual activity, partner support or negativity, sexual interest, feeling in love, time of the week, and same-day noncoital behaviors. Coital-only sexual behavior was used as the reference category. RESULTS Among adolescent women, abstinence is prevalent on the majority of days. When sexual activity does occur, coital-only activity is most common; however, noncoital behaviors alone and/or in tandem with coitus are not rare. CONCLUSIONS Differing associations of intrapersonal, partner and situational variables with specific types of day-to-day sexual activity underscores a complex sexual repertoire which may be insufficiently examined with a simple focus on coital risk.

THE NEED FOR ORGANIZATIONAL CHANGE IN PATIENT SAFETY INITIATIVES

OBJECTIVES This study describes a computer simulation model that has been developed to explore organizational changes required to improve patient safety based on a medication error reporting system. METHODS Model parameters for the simulation model were estimated from data submitted to the MEDMARX medication error reporting system from 570 healthcare facilities in the U.S. The models results were validated with data from the Pittsburgh Regional Healthcare Initiative consisting of 44 hospitals in Pennsylvania that have adopted the MEDMARX medication error reporting system. The model was used to examine the effects of organizational changes in response to the error reporting system. Four interventions were simulated involving the implementation of computerized physician order entry, decision support systems and a clinical pharmacist on hospital rounds. CONCLUSIONS Results of the analysis indicate that improved patient safety requires more than clinical initiatives and voluntary reporting of errors. Organizational change is essential for significant improvements in patient safety. In order to be successful, these initiatives must be designed and implemented through organizational support structures and institutionalized through enhanced education, training, and implementation of information technology that improves work flow capabilities.

The Developmental Association of Sexual Self-Concept with Sexual Behavior among Adolescent Women.

Developing a sexual self-concept is an important developmental task of adolescence; however, little empirical evidence describes this development, nor how these changes are related to development in sexual behavior. Using longitudinal cohort data from adolescent women, we invoked latent growth curve analysis to: (1) examine reciprocal development in sexual self-concept (sexual openness, sexual esteem and sexual anxiety) over a four year time frame; (2) describe the relationship of these trajectories with changes in sexual behavior. We found significant transactional effects between these dimensions and behavior: sexual self-concept evolved during adolescence in a manner consistent with less reserve, less anxiety and greater personal comfort with sexuality and sexual behavior. Moreover, we found that sexual self-concept results from sexual behavior, as well as regulates future behavior.

Pubic Hair Removal and Sexual Behavior: Findings from a Prospective Daily Diary Study of Sexually Active Women in the United States

INTRODUCTION Pubic hair removal is prevalent among women in the United States. However, most studies related to pubic hair removal are based on cross-sectional surveys and retrospective recall. AIM The purpose of this research was to, in a prospective event-level daily diary study, assess demographic, affective, relational, situational, and behavioral factors related to womens pubic hair removal. METHOD Data collection occurred as part of a 5-week prospective, Internet-based daily diary study. MAIN OUTCOME MEASURES Age; Affective predictors (positive mood, negative mood, feeling interested in sex, feeling in love); Relational predictors (partner support, partner negativity, partner type, partner gender); Situational predictors (any vaginal symptoms, use of any vaginal hygiene products; having applied any creams to the genitals); Behavioral variables (penile-vaginal sex, penile-anal sex, had finger inserted into vagina, had clitoris stimulated with fingers, inserted toy into vagina, used vibrator on clitoris, inserted finger into anus, inserted toy into anus, duration of penetration, intensity of penetration). RESULTS A total of 2,453 women ages 18 to 68 (mean age 32.69) completed the study, contributing 49,287 total diaries (mean per person 24.5; standard deviation 10.3, median 30); 15.2% of all days (N = 7,362) involved pubic hair waxing or shaving, with the vast majority of hair removal days involving shaving (N = 7,302; 99%). Pubic hair removal was significantly associated with younger age, a greater interest in sex, vaginal fingering, finger-clitoral stimulation, having a casual sex partner, using vaginal hygiene products, and applying cream to the genitals. Hair removal was marginally associated with longer duration of vaginal penetration. CONCLUSIONS These findings provide greater insight into the factors associated with womens pubic hair removal and their sexual experiences on a day-to-day level. Clinical and educational implications are discussed.

The feasibility of cell phone based electronic diaries for STI/HIV research

BackgroundSelf-reports of sensitive, socially stigmatized or illegal behavior are common in STI/HIV research, but can raise challenges in terms of data reliability and validity. The use of electronic data collection tools, including ecological momentary assessment (EMA), can increase the accuracy of this information by allowing a participant to self-administer a survey or diary entry, in their own environment, as close to the occurrence of the behavior as possible. In this paper, we evaluate the feasibility of using cell phone-based EMA as a tool for understanding sexual risk and STI among adult men and women.MethodsAs part of a larger prospective clinical study on sexual risk behavior and incident STI in clinically recruited adult men and women, using study-provided cell phones, participants (N = 243) completed thrice–daily EMA diaries monitoring individual and partner-specific emotional attributes, non-sexual activities, non-coital or coital sexual behaviors, and contraceptive behaviors. Using these data, we assess feasibility in terms of participant compliance, behavior reactivity, general method acceptability and method efficacy for capturing behaviors.ResultsParticipants were highly compliant with diary entry protocol and schedule: over the entire 12 study weeks, participants submitted 89.7% (54,914/61,236) of the expected diary entries, with an average of 18.86 of the 21 expected diaries (85.7%) each week. Submission did not differ substantially across gender, race/ethnicity and baseline sexually transmitted infection status. A sufficient volume and range of sexual behaviors were captured, with reporting trends in different legal and illegal behaviors showing small variation over time. Participants found the methodology to be acceptable, enjoyed and felt comfortable participating in the study.ConclusionAchieving the correct medium of data collection can drastically improve, or degrade, the timeliness and quality of an individual’s self-reported sexual risk behavior, which in turn, is a key factor in the success of intervention or education programs relying on this information. Our findings demonstrate that completion of electronic diaries via cellular phone is feasible way to describe STI/HIV risk among clinically recruited adult men and women.

Sexual event-level characteristics of condom use during anal intercourse among HIV-negative men who have sex with men.

Background: Condom use remains central to sexually transmitted infections/HIV prevention among gay men and other men who have sex with men (MSM). To support the development of accurate and appropriate interventions, a better understanding is needed as to how the characteristics of a given sexual event differentially influence condom use during anal intercourse. Methods: Daily diary data were collected from (n = 3877) HIV-negative MSM who were members of several online Web sites facilitating social or sexual interactions with other men. Sexual event-specific factors related to condom use during anal intercourse were evaluated using logistic regression, with generalized estimating equation adjustment for multiple within-participant sexual events (STATA, 10.0; all P < 0.05). Results: Participants contributed 25,149 behavioral diaries. Of these, men reported 730 (2.9%) acts of anal intercourse as insertive partner and 662 (2.6%) as receptive partner. Condoms were used during 25.5% (n = 184) of insertive events, and 18.8% (n = 125) of receptive events. For both insertive and receptive anal roles, condom use was more likely with casual partners (OR = 4.24–6.59). Positive ratings of sexual pleasure were associated with condom use among men who were the insertive partner during anal intercourse, whereas condom nonuse was significantly related to higher ratings of pleasure among men who were the receptive partner. Conclusions: Event-level relational and sexual-situational factors predict condom use differently, depending on whether men are the insertive or receptive partner in anal intercourse. Understanding these differences will help clinicians and health educators engage MSM in dialogue to increase condom use in situations where it is warranted.

A multidimensional model of sexual health and sexual and prevention behavior among adolescent women

PURPOSE Sexual health refers a state of lifespan well-being related to sexuality. Among young people, sexual health has multiple dimensions, including the positive developmental contributions of sexuality, as well as the acquisition of skills pertinent to avoiding adverse sexual outcomes such as unintended pregnancy and sexually transmitted infections (STIs). Existing efforts to understand sexual health, however, have yet to empirically operationalize a multi-dimensional model of sexual health and to evaluate its association to different sexual/prevention behaviors. METHODS Sexual health dimensions and sexual/prevention behaviors were drawn from a larger longitudinal cohort study of sexual relationships among adolescent women (N = 387, 14-17 years). Second order latent variable modeling (AMOS/19.0) evaluated the relationship between sexual health and dimensions and analyzed the effect of sexual health to sexual/prevention outcomes. RESULTS All first order latent variables were significant indicators of sexual health (β: 0.192 - 0.874, all p < .001). Greater sexual health was significantly associated with sexual abstinence, as well as with more frequent non-coital and vaginal sex, condom use at last sex, a higher proportion of condom-protected events, use of hormonal or other methods of pregnancy control and absence of STI. All models showed good fit. CONCLUSIONS Sexual health is an empirically coherent structure, in which the totality of its dimensions is significantly linked to a wide range of outcomes, including sexual abstinence, condom use and absence of STI. This means that, regardless of a young persons experiences, sexual health is an important construct for promoting positive sexual development and for primary prevention.

When Condom Use is Not Condom Use: An Event‐Level Analysis of Condom Use Behaviors during Vaginal Intercourse

INTRODUCTION Little is known about event-level condom use errors during vaginal sex. AIMS The aim of this article is to examine factors associated with complete condom use compared to forms of incomplete condom use, including delayed condom application and early condom removal, over a 30-day period. METHODS Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Incomplete condom use was assessed during vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation multinomial logistic regression. MAIN OUTCOME MEASURES Condom use during vaginal sex: complete use, delayed application, early removal, and both delayed application/early removal. RESULTS Of 29,714 diary reports, 30% (8,876) included vaginal intercourse. Analyses were conducted (in 2009) on 83.2% of these intercourse events (6,325), during which condoms were used and for which participants provided complete data. Incomplete condom use included penetration before applying condoms during 12% of events (749), removing condoms before intercourse ended during 3.1% (198), and both types of incomplete use during 2% (129) of events. Erection quality (less than typical erect penile length and circumference, less rigidity, and difficulty maintaining erection) was associated with greater odds of incomplete use, as was a participants history of other recent incomplete use. Perceptions of condom comfort and recent previous complete use were protective factors against incomplete use. CONCLUSIONS Mens incomplete condom use is associated with recent condom use patterns, as well as with their physiological characteristics and perceptions of condoms during sexual intercourse. Event-level analyses such as these help describe how incomplete condom use occurs among individuals incorporating condoms into their sexual activities.

Event-level marijuana use, alcohol use, and condom use among adolescent women.

Background: It is widely believed that marijuana use and alcohol use directly intercede on successful condom use. However, measurement differences and inconsistent findings in past research remain unclear whether marijuana and alcohol work directly to influence condom behavior, or spuriously function through other factors that actually reflect an increased likelihood of vaginal sex. The current study prospectively disentangles the association of marijuana and alcohol use on condom behavior among adolescent women. Methods: Young women (N = 387; 14–17 years) provided daily sexual diaries as part of a longitudinal cohort study (1999–2009) of sexual behavior and sexual relationships. To separate the effects of marijuana and alcohol use on vaginal sex from condom use (when vaginal sex occurs), we estimated a 3-category outcome variable (no vaginal sex, vaginal sex with a condom, vaginal sex without a condom), alternating no sex (Model 1) and sex without a condom (Model 2) as the referent categories. Generalized estimating equation multinomial logistic regression adjusted odds ratios for multiple sexual events from the same young woman over time. Results: Subjects contributed 14,538 coital events; 30% of these events were condom-protected. Neither marijuana nor alcohol use was directly associated with lower condom use; the strongest effect of condom use (adjusted odds ratio) and nonuse was performance of these behaviors in the past week. Conclusions: This study finds no evidence of a relationship between marijuana or alcohol use and condom nonuse. Both condom use and nonuse were identified as consistent behavioral patterns, regardless of the effect of marijuana and alcohol use.

The association of sexual interest and sexual behaviors among adolescent women: A daily diary perspective

Theoretical and empirical linkages of adult womens sexual interest and sexual behaviors are relatively well-established, but few data address similar issues in adolescent women. This paper reviews data from published reports of associations of adolescent womens sexual interest and various sexual behaviors. All of the papers reported data collected from a single longitudinal cohort of young women. The primary source of data collection was daily diaries, allowing close temporal pairing of sexual interest with sexual behaviors. Young womens sexual interest on a given day was consistently and independently associated with sexual activity on that day, whether the behavior was first lifetime coitus, coitus, fellatio, cunnilingus, anal intercourse, or coitus during menses. We also found no evidence of influence of hormonal contraceptives on young womens sexual interest. Taken together, these data demonstrate the relevance of sexual interest as a key factor in young womens sexuality and sexual behavior.