Elizabeth Eggleston

Sexual attitudes and behavior among young adolescents in Jamaica.

This study describes sexual attitudes and behaviors among adolescents from low-income families attending poor quality schools in Jamaica. Data were obtained from the Jamaican Adolescent Study among 945 male and female adolescents 11-14 years old in 1995 who attended 5 Grade 7 Project schools. Data were also obtained from focus groups among 64 male and female students. Under 10% were informed about reproduction. Boys knew more than girls. Knowledge of methods was incomplete. Students generally disapproved of early sex. Boys had mixed approval of early sex. Both sexes thought contraception should be used. 64% of boys and 6% of girls reported sexual experience. The mean reported age of first sex was 11.3 years for girls and 9.4 for boys. Focus groups revealed a disparity between actual sex behavior and disapproval of early first sex. Sex experience was motivated by curiosity love and other notions of dos and donts related to having a boyfriend. Boys related having early sex with physical pleasure elevated status among peers and attainment of manhood. Girls were not likely to report sex behavior to parents. Fewer than 50% used contraceptives at first sex. Students associated family planning with promiscuity. Most did not desire early parenthood. Girls pointed out societal disapproval of early sex and pregnancy. Few mentioned marriage preceding childbearing. Findings support early introduction of family life education.

Consistency of self-reports of sexual activity among young adolescents in Jamaica.

Data from a three-round longitudinal study of 698 young adolescents in Jamaica were used to examine consistency in the reporting of first sexual intercourse. Adolescents were asked to respond to multiple questions about their first intercourse within each round of the survey and the items were repeated in subsequent rounds. A multivariate logistic regression analysis was conducted to examine the factors independently influencing the likelihood that adolescents would report their sexual experience inconsistently. The vast majority of respondents (95-100%) reported their sexual experience status consistently within a given survey round. However when agreement of responses between rounds was examined 37% of respondents (12% of girls and 65% of boys) responded inconsistently. Multivariate logistic regression analysis indicated that boys were nearly 14 times as likely as girls to report their sexual experience inconsistently. Pervasive inconsistency in the reporting of sexual activity especially among boys highlights the limitations of relying on self-reported data to identify sexually active adolescents and to quantify that activity. Using such data to evaluate the impact of interventions designed to delay first intercourse may also be problematic. (authors)

Unintended pregnancy and women's psychological well-being in Indonesia.

Few studies have examined the impact of unintended pregnancy on women in developing countries. This paper examines the impact of unintended pregnancy on Indonesian womens psychological well-being. It is hypothesized that experiencing unintended pregnancy is associated with lower psychological well-being and that use of family planning and small family size are associated with higher levels of psychological well-being. Data are drawn from a 1996 survey of 796 women aged 15-49 from two Indonesian provinces, Lampung and South Sumatra. This article focuses on the 71% of women (n=562) who answered all 41 survey items related to psychological well-being. In cluster analysis, women grouped into three clusters, differentiated by their scores on four scales of well-being established through factor analysis (general negative feelings, satisfaction with relationships, satisfaction with economic/family/personal conditions, and negative feelings regarding domestic issues). Women in cluster 3 were characterized mainly by their high level of psychological well-being. Women in cluster 1 had the lowest level of well-being, and women in cluster 2 were in the middle. Multinomial logistic regression was used to assess jointly the effect of unintended pregnancy, contraceptive use, number of children and other factors on a womans level of psychological well-being. Unintended pregnancy was associated with lower levels of psychological well-being and contraceptive use was associated with higher levels of psychological well-being, while number of children was not associated with level of well-being. Women who had experienced an unintended pregnancy were less likely to be in the high psychosocial well-being cluster versus both the medium and low clusters. In addition, women using contraception were more likely to be classified in the high than in the low or medium well-being clusters.

T-ACASI reduces bias in STD measurements: The National STD and Behavior Measurement Experiment:

Background: Although telephone surveys provide an economical method for assessing patterns of diagnosed sexually transmitted diseases (STDs) and STD-related behaviors in populations, the requirement that respondents report such information to human telephone interviewers introduces an opportunity for substantial reporting bias. Telephone computer-assisted self-interviewing (T-ACASI) surveys substitute a computer for human interviewers when asking sensitive questions. Methods: A randomized experiment was embedded in a telephone survey that drew probability samples of the populations of the United States (N = 1543) and Baltimore city (N = 744). Respondents were randomly assigned to have sensitive questions asked either by a T-ACASI computer or by a human telephone interviewer. Results: Respondents interviewed by a T-ACASI computer were more likely to report STD symptoms [dysuria, genital sores, genital discharge, and genital warts; adjusted odds ratios (ORs) = 1.5–2.8] and a diagnosis of gonococcal or chlamydial infection during the past year (adjusted ORs = 3.6 and 6.1). T-ACASI respondents with a main sex partner in the past year were more likely to report that their partner has had an STD (adjusted OR = 2.4). For some measurements, the impact of T-ACASI was strongest among younger and less-educated respondents. When sampling weights were applied to project National STD and Behavior Measurement Experiment results to the populations of the United States and Baltimore, we found that reliance on data obtained by human interviewers would underestimate the annual incidence of chlamydial and gonococcal infections in these populations by factors of 2.4 to 9.7. Conclusions: Compared with human telephone interviewers, T-ACASI surveys obtain increased reporting of STD symptoms, infections, and STD-related behaviors.

Chlamydia trachomatis infection among 15- to 35-year-olds in Baltimore, MD.

Background: Chlamydia trachomatis (Ct) is the most frequently reported infectious disease in the United States. This article reports population and subpopulation prevalence estimates of Ct and correlates of infection among 15- to 35-year-olds in Baltimore, MD. Methods: The Monitoring STIs Survey Program (MSSP) monitored sexually transmitted infection (STI) prevalence among probability samples of residents of Baltimore, a city with high STI rates. MSSP respondents completed telephone audio computer-assisted self-interviews and provided biospecimens for STI testing. Results: Among 2120 Baltimore residents aged 15 to 35 years, the estimated prevalence of chlamydia was 3.9% (95% confidence interval [CI]: 2.8, 5.0). Prevalence was 5.8% (95% CI: 4.1, 7.6) among black MSSP respondents versus 0.7% (95% CI: 0.0, 1.4) among nonblack respondents; all but 4 infections detected were among black respondents. Sexual behaviors and other factors associated with infection were far more prevalent among black than nonblack Baltimore residents. Racial disparities persisted after adjustment for sociodemographic, behavioral, and health factors. Conclusion: The MSSP highlights a higher Ct prevalence among young people in Baltimore than in the United States overall, with notable racial disparities in infection and associated risk behaviors. Public health efforts are needed to improve the diagnosis and treatment of asymptomatic infections in this population.

Epidemiology of Undiagnosed Trichomoniasis in a Probability Sample of Urban Young Adults

T. vaginalis infection (trichomoniasis) is the most common curable sexually transmitted infection (STI) in the U.S. It is associated with increased HIV risk and adverse pregnancy outcomes. Trichomoniasis surveillance data do not exist for either national or local populations. The Monitoring STIs Survey Program (MSSP) collected survey data and specimens which were tested using nucleic acid amplification tests to monitor trichomoniasis and other STIs in 2006–09 among a probability sample of young adults (N = 2,936) in Baltimore, Maryland — an urban area with high rates of reported STIs. The estimated prevalence of trichomoniasis was 7.5% (95% CI 6.3, 9.1) in the overall population and 16.1% (95% CI 13.0, 19.8) among Black women. The overwhelming majority of infected men (98.5%) and women (73.3%) were asymptomatic. Infections were more common in both women (OR = 3.6, 95% CI 1.6, 8.2) and men (OR = 9.0, 95% CI 1.8, 44.3) with concurrent chlamydial infection. Trichomoniasis did not vary significantly by age for either men or women. Women with two or more partners in the past year and women with a history of personal or partner incarceration were more likely to have an infection. Overall, these results suggest that routine T vaginalis screening in populations at elevated risk of infection should be considered.

Gender-Based Screening for Chlamydial Infection and Divergent Infection Trends in Men and Women

Objectives To assess the potential impact of chlamydial screening policy that recommends routine screening of women but not men. Methods Population surveys of probability samples of Baltimore adults aged 18 to 35 years in 1997–1998 and 2006–2009 collected biospecimens to estimate trends in undiagnosed chlamydial infection. Survey estimates are compared to surveillance data on diagnosed chlamydial infections reported to the Health Department. Results Prevalence of undiagnosed chlamydial infection among men increased from 1.6% to 4.0%, but it declined from 4.3% to 3.1% among women (p = 0.028 for test of interaction). The annual (average) number of diagnosed infections was substantially higher among women than men in both time periods and increased among both men and women. Undiagnosed infection prevalence was substantially higher among black than non-black adults (4.0% vs 1.2%, p = 0.042 in 1997–98 and 5.5% vs 0.7%, p<0.001 in 2006–09). Conclusion Divergent trends in undiagnosed chlamydial infection by gender parallel divergent screening recommendations that encourage chlamydial testing for women but not for men.