Lilly M. Langer

The link between the use of crack cocaine and the sexually transmitted diseases of a clinic population : A comparison of adolescents with adults

Background and Objectives: To determine whether personal and/or a partners use of crack cocaine is associated with the diagnosis of early syphilis or gonorrhea independent of high‐risk sex behaviors, and to determine whether the relationships between crack cocaine and associated sexually transmitted diseases (STDs) are similar for adolescents and adults. Study Design: A cross‐sectional behavioral survey of heterosexual males and females attending public STD clinics in three cities. Logistic regression was used to identify risk behavior patterns associated with each STD compared with no STD. Results: Multivariate analysis revealed that men who were high on drugs, including crack cocaine, before or during sex were more likely to be diagnosed with syphilis (Odds Ratio [OR] = 1.49; Confidence Intervals [CI] = 1.06, 2.13). Males more likely to be diagnosed with gonorrhea were younger (OR = 0.94; CI = 0.92, 0.96), had sex with a crack cocaine user (OR = 1.99; CI = 1.36, 2.91), did not use condoms last time they had sex with a nonmain partner (OR = 1.59; CI = 1.09, 2.13), and did not have sex with an intravenous drug user (OR = 0.45; CI = 0.22, 0.95). For women, there were no independent risk factor for syphilis but younger age was a risk factor for gonorrhea (OR = 0.95; CI = 0.91, 0.99). The associations between crack cocaine and syphilis and gonorrhea in men and between crack cocaine and syphilis in women were not significant among adolescents in this study. Conclusion: The results of this study highlight the differences in the crack cocaine‐related behaviors of adults and adolescents at risk for gonorrhea and syphilis. The nature of these differences support the use of distinct intervention strategies for each STD and for adolescents and adults.

Improving Estimates of Prevalence Rates of Sensitive Behaviors: The Randomized Lists Technique and Consideration of Self-Reported Honesty

Although self‐report data are generally accepted by behavioral scientists, there continues to be concern about the validity and reliability of self‐reports of sensitive behaviors, such as sexual behaviors, drug use, and criminal behavior. Our aim for the current study was to present an example of the use of the Randomized Lists Technique (RLT, a variation of the Randomized Response Technique) in conjunction with self‐reported honesty in assessing and improving the validity of prevalence estimates of sexual behaviors with a sample of high school students. Both techniques allow respondents to provide information to the researcher about a sensitive behavior without having to report the behavior directly. Study participants included 1,886 tenth grade students in the Dade County (Greater Miami) Public Schools. The RLT‐estimated prevalence rate was 80% higher for sex with a same‐gender partner than the result for the direct question. Inconsistencies in reporting sex with a same‐gender partner or having had inte...

Which is more important to high school students: preventing pregnancy or preventing AIDS?

A sample of about 2,900 high school students in greater Miami, Florida, was surveyed to determine their attitudes toward pregnancy prevention vs. AIDS prevention and how these attitudes affect condom use. Female, Hispanic and black respondents were the most likely to consider pregnancy and AIDS prevention to be equally important. White non-Hispanics and males were relatively more likely to believe that preventing pregnancy is less important than preventing AIDS, whereas males and females involved in a steady relationship placed more emphasis on pregnancy prevention than AIDS prevention. The more knowledge about HIV and AIDS a respondent had, the less importance he or she placed on pregnancy prevention, and as the importance of preventing pregnancy declined, so did the frequency of condom use. Males who were in a steady dating relationship and perceived pregnancy prevention as more important than AIDS prevention were the most likely to report using condoms often.

“About last night”: The social ecology of sexual behavior relative to alcohol use among adolescents and young adults in substance abuse treatment

Data were collected in face-to-face interviews from 120 substance-abusing adolescents and young adults (87 men, 33 women; M age = 17.2 years old) recruited from residential and nonresidential treatment facilities in South Florida. Participants described two recent sexual events, one with and one without concurrent alcohol use. Participants described social aspects of these sexual events, actual and intended behaviors, and their feelings about sex in the two alcohol-use contexts. High levels of discrete, risky behaviors occurred in both contexts. Event analysis produced only limited evidence suggesting a higher level of risk in the alcohol-use context. Participants reported less positive feelings about sex when alcohol was used.

Patterns of Depressive Symptoms, Drinking Motives, and Sexual Behavior among Substance Abusing Adolescents: Implications for Health Risk.

ABSTRACT Adolescents with substance use problems were classified into four distinct and meaningful subgroups based on patterns of depressive symptoms and motives for drinking before sex (i.e., avoidance, enhancement and social motives) using cluster analysis. Data were collected in face-to-face interviews from 120 adolescents and young adults (87 men, 33 women; mean age = 17.2 years) undergoing substance abuse treatment. Groups with higher and lower functioning were validated via significant group differences in conceptually relevant variables assessing psychological distress, alcohol use behaviors, and HIV-relevant risk behaviors. These analyses identified a subgroup of adolescents with high levels of depressive symptoms and drinking motives who are at elevated risk for HIV/STD exposure due to higher levels of risky sexual behavior and altered sexual behavior related to co-occurring alcohol use. Implications for morbidity, mortality and treatment effectiveness in this at-risk sample are discussed.

Coerced Sexual Experiences Among Adolescent Substance Abusers: A Potential Pathway to Increased Vulnerability to HIV Exposure

This study describes the forced sexual experiences, serious internalizing problems, risky sexual behavior, and alcohol-related correlates of risky sexual behavior of 120 substance abusing adolescents and young adults (87 men, 33 women; mean age = 17.2 years) undergoing treatment. Prior coerced sexual experiences were associated with suicidal thoughts and attempts, higher levels of risky sexual behaviors, avoidance motives for drinking, and sexual decision-making conducive to risky sexual behavior. Sexual coercion was associated with patterns of sexual behavior and alcohol use that potentially increase vulnerability to HIV exposure. Social workers can play a number of significant roles in addressing ongoing psychological distress associated with sexual coercion among these predominantly female adolescents. Therefore, effective social work practice should enhance treatment effectiveness and reduce risk for a range of maladaptive outcomes including exposure to sexually transmitted diseases (STDs) and revictimization.

Virgins' Expectations and Nonvirgins' Reports How Adolescents Feel about Themselves

This study examined anticipated attitudes of virgins and actual attitudes of nonvirgins regarding how they would feel or felt about themselves, respectively, after losing their virginity. Data were collected over5 monthsfrom high school students in Miami, Florida (N = 1,305). The degree to which virgins predicted they would feel better afterfirst experiencing sex was significantly less than that which nonvirgins reported actually feeling. For virgins, anticipated positive feelings were associated with being male, placing less value on postponing intercourse, being a peer-influenced decision maker, and being African American. Reports offeeling better by nonvirgins were associated with being male and havingagreaternumberof sexpartners. Thefinding thatnonvirgins reported having felt better afterfirst sex suggests an HIV risk-reduction intervention should emphasize thatfeeling good is not to be a state of being one would be willing to die for

Risky Sexual Behaviors among Substance-Abusing Adolescents: Assessing the Effect Of Decision-Making and Avoidance Motives

ABSTRACT Findings are presented in an endeavor to extend the scope of understanding of HIV-related risky sexual behaviors among a multi-ethnic sample of youth in treatment for substance abuse. Cross-sectional data were collected in face-to-face interviews from 120 substance abusing adolescents undergoing treatment. Three separate multiple regression models were tested, one using a general measure of risky sexual behavior and the others using measures of substance use and condom use during sex. Consistent with our theoretical model, three variables—rational decision-making, avoidance motives for drinking with sex, and substance use—were identified as significant predictors of risky sexual behaviors. Since HIV/AIDS knowledge was not found to be a predictor of more or less risky sexual behavior, these factors may work in tandem to reduce the effect of information about risk on actual behavior. Study data indicate that it would be worthwhile to focus future research efforts that target high-risk adolescents o...