Hailey Winetrobe

Sexually explicit cell phone messaging associated with sexual risk among adolescents

OBJECTIVES: Sexting (sending/receiving sexually explicit texts and images via cell phone) may be associated with sexual health consequences among adolescents. However, to date, no published data from a probability-based sample has examined associations between sexting and sexual activity. METHODS: A probability sample of 1839 students was collected alongside the 2011 Youth Risk Behavior Survey in Los Angeles high schools. Logistic regressions were used to assess the correlates of sexting behavior and associations between sexting and sexual risk-taking. RESULTS: Fifteen percent of adolescents with cell phone access reported sexting, and 54% reported knowing someone who had sent a sext. Adolescents whose peers sexted were more likely to sext themselves (odds ratio [OR] = 16.87, 95% confidence interval [CI]: 9.62–29.59). Adolescents who themselves sexted were more likely to report being sexually active (OR = 7.17, 95% CI: 5.01–10.25). Nonheterosexual students were more likely to report sexting (OR = 2.74, 95% CI: 1.86–4.04), sexual activity (OR = 1.52, 95% CI: 1.07–2.15), and unprotected sex at last sexual encounter (OR = 1.84, 95% CI: 1.17–2.89). CONCLUSIONS: Sexting, rather than functioning as an alternative to “real world” sexual risk behavior, appears to be part of a cluster of risky sexual behaviors among adolescents. We recommend that clinicians discuss sexting as an adolescent-friendly way of engaging patients in conversations about sexual activity, prevention of sexually transmitted infections, and unwanted pregnancy. We further recommend that discussion about sexting and its associated risk behavior be included in school-based sexual health curricula.

Sex risk among young men who have sex with men who use Grindr, a smartphone geosocial networking application.

Objectives: Smartphone geosocial networking applications, like Grindr, have become a new context through which young men who have sex with men (YMSM) can meet potential sex partners. Geosocial networking applications move beyond online social networking websites like Facebook by utilizing smartphones’ geo-location functions to facilitate connections with other users based on their current physical location. This study presents data on HIV risk-taking behaviors of YMSM who use Grindr, comparing the sex behaviors with partners met via the application to behaviors with partners met via other means (e.g., a bar, through friends, online). Methods: Utilizing the geo-locating feature of Grindr, 195 YMSM, aged 18 to 24, were randomly recruited based on their location within West Hollywood and Long Beach, CA between August and October, 2011. Participants completed an online survey. Results: YMSM reported using Grindr for entertainment, socializing, partner seeking, and gay community connection. Seventy-five percent of users reported sexual encounters with partners met on Grindr. YMSM reported significantly higher rates of condom use with partners met on Grindr (59.8%) relative to those partners met elsewhere (41.9%). Only 14.7% reported unprotected anal intercourse (UAI) with their last Grindr partner. YMSM who reported UAI with their last partners from Grindr reported significantly more recent male anal sex partners than YMSM who reported no UAI with their last Grindr-met partners. Conclusions: Grindr was used by YMSM for a variety of reasons, and not exclusively for the purpose of sex partner seeking. Overall YMSM who use Grindr practice safer sex with partners met via the application than with partners met elsewhere. YMSM engaging in UAI with partners on Grindr are an especially high-risk group and should be targeted by prevention efforts. Sexual risk behavior with geosocial networking-located partners could be addressed with mobile HIV prevention applications, or within Grindr and other similar applications.

Associations of unprotected anal intercourse with Grindr-met partners among Grindr-using young men who have sex with men in Los Angeles.

Grindr, a geosocial smartphone application, is a networking medium for men who have sex with men. Although three quarters of young men who have sex with men (YMSM) Grindr users report having sex with a Grindr-met partner, the correlates of risky sexual behavior with Grindr-met partners are unknown. A randomly selected sample of 18- to 24-year-old, Grindr-using YMSM completed an anonymous online questionnaire assessing patterns of Grindr use and sexual behavior with their last Grindr-met partners. Of the 146 YMSM who reported having sex with Grindr-met partners, 20% had unprotected anal intercourse (UAI) at last sex with their Grindr-met partner. In the multivariable model, YMSM who used Grindr for at least one year showed naked chest/abs in their profile photo, and reported more past month Grindr-met partners were more likely to report UAI. These findings suggest that familiarity with the app was associated with YMSMs UAI with Grindr-met partners. Moreover, sexualized profile photos (i.e., naked chest/abs) may be associated with sexual risk-taking behaviors. HIV prevention interventions delivered or linked through such apps should target individuals who are longer/frequent users and who present sexualized profiles.

Sexting and Sexual Behavior Among Middle School Students

OBJECTIVE: It is unknown if “sexting” (ie, sending/receiving sexually explicit cell phone text or picture messages) is associated with sexual activity and sexual risk behavior among early adolescents, as has been found for high school students. To date, no published data have examined these relationships exclusively among a probability sample of middle school students. METHODS: A probability sample of 1285 students was collected alongside the 2012 Youth Risk Behavior Survey in Los Angeles middle schools. Logistic regressions assessed the correlates of sexting behavior and associations between sexting and sexual activity and risk behavior (ie, unprotected sex). RESULTS: Twenty percent of students with text-capable cell phone access reported receiving a sext and 5% reported sending a sext. Students who text at least 100 times per day were more likely to report both receiving (odds ratio [OR]: 2.4) and sending (OR: 4.5) sexts and to be sexually active (OR: 4.1). Students who sent sexts (OR: 3.2) and students who received sexts (OR: 7.0) were more likely to report sexual activity. Compared with not being sexually active, excessive texting and receiving sexts were associated with both unprotected sex (ORs: 4.7 and 12.1, respectively) and with condom use (ORs: 3.7 and 5.5, respectively). CONCLUSIONS: Because early sexual debut is correlated with higher rates of sexually transmitted infections and teen pregnancies, pediatricians should discuss sexting with young adolescents because this may facilitate conversations about sexually transmitted infection and pregnancy prevention. Sexting and associated risks should be considered for inclusion in middle school sex education curricula.

Cyberbullying Perpetration and Victimization Among Middle-School Students

OBJECTIVES We examined correlations between gender, race, sexual identity, and technology use, and patterns of cyberbullying experiences and behaviors among middle-school students. METHODS We collected a probability sample of 1285 students alongside the 2012 Youth Risk Behavior Survey in Los Angeles Unified School District middle schools. We used logistic regressions to assess the correlates of being a cyberbully perpetrator, victim, and perpetrator-victim (i.e., bidirectional cyberbullying behavior). RESULTS In this sample, 6.6% reported being a cyberbully victim, 5.0% reported being a perpetrator, and 4.3% reported being a perpetrator-victim. Cyberbullying behavior frequently occurred on Facebook or via text messaging. Cyberbully perpetrators, victims, and perpetrators-victims all were more likely to report using the Internet for at least 3 hours per day. Sexual-minority students and students who texted at least 50 times per day were more likely to report cyberbullying victimization. Girls were more likely to report being perpetrators-victims. CONCLUSIONS Cyberbullying interventions should account for gender and sexual identity, as well as the possible benefits of educational interventions for intensive Internet users and frequent texters.

Homelessness Experiences, Sexual Orientation, and Sexual Risk Taking Among High School Students in Los Angeles

PURPOSE Prior studies reported homeless adolescents engage in more sexual risk than their housed peers. However, these comparisons are typically made post hoc by comparing homeless adolescent community-based samples with high school probability samples. This study uses a random sample of high school students to examine homelessness experiences and sexual risk behaviors. METHODS A supplemental survey to the Youth Risk Behavior Survey containing questions regarding homelessness and sexual health was administered to Los Angeles high school students (N = 1,839). Multivariate logistic regressions assessed the associations between demographics, past year homelessness experiences (i.e., place of nighttime residence), and being sexually active and condom use at last intercourse. RESULTS Homelessness experiences consisted of staying in a shelter (10.4%), a public place (10.1%), and with a stranger (5.6%). Lesbian, gay, bisexual, transgender, questioning (LGBTQ), younger, and male adolescents were more likely to experience homelessness. LGBTQ adolescents were also more likely to report staying with a stranger and less likely to report staying in a shelter. Compared to adolescents who stayed in shelters, adolescents who stayed with strangers and in public places were more likely to engage in unprotected sex at last intercourse. CONCLUSIONS Adolescents who report sexual activity and sexual risk taking are more likely to report homelessness experiences. With regard to sexual health, staying with strangers could be a particularly risky form of homelessness; LGBTQ and black adolescents are more likely to experience this form of homelessness. Efforts to reduce homelessness and sexual risk-taking need to recognize the specific vulnerabilities faced by these populations.

Transitioning from Homelessness: A “Fresh-Start” Event

Permanent supportive housing (PSH) has been recognized as central to the goal of ending chronic homelessness. This qualitative study considers the positive and negative expectations of 31 men and women in the Skid Row area of Los Angeles who are beginning the transition from homelessness to PSH through a Housing First approach. This study uses in-depth, qualitative interviews and an inductive approach informed by sensitizing concepts derived from the literature and thematic analysis of case summaries, interview transcripts, and interviewer feedback and observation. Three themes emerged from the data: (a) nowhere to go but up, (b) some things stay the same, and (c) neighborhood matters. These findings indicate that PSH is regarded as a fresh start and universally positive experience, and that the role of neighborhood highlights a tension in the pursuit of recovery from homeless between removing people from their neighborhoods versus keeping them close to their previous and familiar environments. Implications for social work practice include that maximizing a successful transition will require understanding and managing people’s expectations and reality.

Sexuality and Homelessness in Los Angeles Public Schools

Recently, Corliss et al.1 published important findings demonstrating the disproportionate numbers of sexual minority youths who experience homelessness in Massachusetts. Because of great variations in homelessness by region, we would like to add to this body of evidence with similar data from Los Angeles, California. We collected data on sexuality and homelessness experiences in conjunction with the 2011 administration of the Youth Risk Behavior Survey (YRBS) in the Los Angeles Unified School District (LAUSD). Among LAUSD students, 37% of lesbian, gay, bisexual, transgender, or unsure-identifying youths and 22% of heterosexual youths reported having spent at least one night homeless in the previous 12 months. We created a supplemental questionnaire administered in conjunction with the 2011 YRBS to LAUSD students. One item assessed sexual orientation: What do you consider your sexual orientation? 1) Homosexual (gay or lesbian), 2) bisexual, 3) heterosexual (straight), 4) transgender, 5) questioning/unsure. A second item addressed homelessness, using the questions from the landmark study by Ringwalt et al.2 that assessed the national prevalence of youth homelessness: During the past 12 months, have you spent the night in any of the following places? (check all that apply) 1) Youth or adult shelter, 2) public place, 3) abandoned building, 4) outside in a park, under a bridge, or rooftop, 5) subway or other public place underground, 6) with someone you did not know. Table 1 presents the breakdown of homelessness experience by sexuality and clearly shows that non-heterosexually identifying youths reported significantly more homelessness. TABLE 1— Proportion of Youths Aged 12–18 Years Reporting Homelessness Episodes of at Least 1 Nights Duration Within Previous 12 Months by Sexual Orientation: Supplement to the Youth Risk Behavior Survey, Los Angeles, CA, 2011 LAUSD is the second largest public school system in the United States. There are 162 225 high school students enrolled.3 According to our data, we estimated that 38 317 high school students in the LAUSD system experienced at least one night of homelessness in the past 12 months. This technique for assessing homelessness is an undercount—missing those youths whose housing instability leads to absentee days during data collection. The majority of students who experienced homelessness were unidentified by the school district.4 It has been well-established that youths of any sexual orientation who return to stable housing quickly are at greatly reduced risk for the negative health outcomes associated with homelessness.5 While LAUSDs Homeless Education Program works to advance academic achievement through social and educational programs, this program needs more funding and a mechanism to quickly identify newly homeless youths.

Prescription drug misuse among homeless youth

BACKGROUND Prescription drug misuse (PDM) is highly prevalent among youth in the U.S., and can have serious health consequences. Homeless youth are a particularly vulnerable population with high rates of substance use. However, PDM has not been studied in a sample comprised exclusively of homeless youth. METHODS A sample of 451 homeless youth recruited from drop-in centers in Los Angeles, CA, provided information on substance use, mental health, service utilization, trauma, and sexual risk behavior. Multivariable logistic regression assessed correlates of past month PDM. RESULTS Nearly 50% reported lifetime PDM and 21.6% reported PDM in the past month. The most frequently used prescriptions in the past month were: opioids only (24.5%), sedatives only (23.4%), and stimulants only (10.6%); 14.9% used some combination of these three types of prescription medications. Homeless youth reported that prescriptions were most commonly obtained for free from friends or relatives (24.5%). Foster care involvement was associated with decreased PDM, while hard drug use, suicidal ideation, and unprotected sex were associated with increased PDM. CONCLUSIONS Homeless youth report high rates of PDM, and access these medications most frequently from friends and family. PDM among homeless youth clusters with other risk factors, including hard drug use, unprotected sex, and suicidal ideation. Surprisingly, foster care history was associated with decreased PDM. Programs aimed at preventing PDM among homeless youth should recognize the clustering of risk behaviors, assess prescription use/access when providing mental health services, and educate the general public about proper disposal of prescriptions.

The Social Networks of Homeless Youth Experiencing Intimate Partner Violence

While there is a growing body of research on intimate partner violence (IPV) experienced by the housed youth population, a limited amount is known about IPV experienced by homeless youth. To our knowledge, no previous studies have examined how homeless youths’ experience of IPV is related to their social network, even though the social networks of homeless youth have been shown to be significant indicators of health and mental health. The purpose of this study is to understand the relationship between IPV, gender, and social networks among a sample of 386 homeless youth in Los Angeles, California. Results revealed that one fifth of the sample experienced IPV in the past year. Stratified regression models revealed that IPV was not significantly related to any measure of male social networks; however, females who experienced IPV had more male friends (β = 2.03, SE = 0.89, p < .05) than females who did not experience IPV. Female homeless youth who witnessed family violence during childhood had more male friends (β = 2.75, SE = 1.08, p < .05), but those who experienced sexual abuse during childhood had fewer male friends (β = −2.04, SE = 0.93, p < .05). Although there was no significant difference in the rate of IPV victimization across genders, the context of this abuse appears to be drastically different. The results suggest that females with more male friendships are at greater risk for exposure to IPV. To date, there are few effective youth-targeted IPV prevention programs and none have been shown to be effective with homeless youth. These results provide insight into future program development.