M. Kim Oh

Self-Concept and Adolescents′ Refusal of Unprotected Sex: A Test of Mediating Mechanisms Among African American Girls

During adolescence, girls form self-concepts that facilitate the transition to adulthood. This process may entail engaging in risky sexual behaviors resulting in STD infection and pregnancy. This study assessed the relation between self-concept and unwanted, unprotected sex refusal among 335 African American adolescent girls. The second aim was to determine whether attributes of partner communication about sex would act as a mediating mechanism on this hypothesized relationship. These assessments were made within the context of several theoretical models (social cognitive theory and theory of gender and power). Self-concept was composed of self-esteem, ethnic identity, and body image, whereas attributes of partner communication about sex was conceptualized as frequency of communication, fear of condom use negotiation, and self-efficacy of condom use negotiation. Structural equation modeling was used to analyze data. The results showed that self-concept was associated with partner communication attributes about sex, which in turn, was associated with frequency of unprotected sex refusal. The hypothesized mediating role of partner communication was also supported. STD-HIV preventive interventions for this population may be more effective if they target self-concept as opposed to only self-esteem, incorporate an Afrocentric approach, and focus on enhancing several attributes of partner communication about sex.

Medical status of adolescents at time of admission to a juvenile detention center

PURPOSEnTo examine the medical status and history of health care utilization of adolescents at the time of their admission to a juvenile detention facility.nnnMETHODSnData were collected over an 18-month period on all detainees admitted for the first time to a juvenile detention facility in a major southeastern city in the United States. Information was gathered through a private, confidential interview completed by a medical social worker and a physical examination by a physician. Information was obtained regarding past medical history, complaints at the time of admission, health care utilization, and physical examination.nnnRESULTSnApproximately 10% of teenagers admitted to a detention facility have a significant medical problem (excluding drug/alcohol abuse, or uncomplicated sexually transmitted diseases) that requires medical follow-up. The majority of these conditions were known to the adolescent at the time of admission. Only a third of adolescents admitted to the detention facility reported a regular source of medical care, and only about 20% reported having a private physician. A majority of all the detainees had already fallen behind in or dropped out of school. More than half of the families of the adolescents with a medical problem appeared to be unable or unwilling to assist in ensuring proper medical follow-up.nnnCONCLUSIONSnA significant percentage of adolescents entering a detention facility have a medical problem requiring health care services. Detention facilities offer an opportunity to deliver and coordinate medical care to high-risk adolescents. Programs linking public and private health care providers with the correctional care system may provide juveniles with an acceptable option for obtaining needed health care services.

Condom Use and Correlates of African American Adolescent Females’ Infrequent Communication with Sex Partners about Preventing Sexually Transmitted Diseases and Pregnancy

This study of 522 African American female adolescents, ages 14 to 18, investigated associations between condom use and infrequently communicating with sex partners about sexually transmitted diseases (STDs) and pregnancy prevention. Correlates of infrequent communication were identified. Sexually active adolescents were recruited from schools and adolescent medicine clinics in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a self-administered survey and face-to-face interview. Communication frequency was assessed using a five-item scale. Infrequent communication was significantly associated with lower odds of condom use. Multivariate correlates of infrequent communication were less frequent communication with parents about STD/pregnancy prevention, recent sex with a nonsteady partner, low perceived ability to negotiate condom use and fear of this negotiation, and low motivation to use condoms. Given the importance of partner communication in promoting safer sex behaviors, STD and pregnancy prevention programs may benefit adolescents by addressing the identified psychosocial correlates of infrequent communication with their partners.

Psychosocial and Behavioral Correlates of Refusing Unwanted Sex Among African-American Adolescent Females

PURPOSEnTo identify psychosocial and behavioral correlates of refusing unwanted sex among African-American female adolescents. We hypothesized that greater power in relationships, less concern about negative emotional consequences, supportive family and peers, positive self-perceptions, greater perceived risk, and fewer sexual risk behaviors would be associated with increased odds of refusing unwanted sex.nnnMETHODSnData regarding demographics, sexual behaviors, communication with parents, and psychosocial factors relevant to romantic and sexual partnerships were collected both via self-administered questionnaire and structured interview from a clinic- and school-based sample of 522 African-American adolescent females ages 14-18 years in Birmingham, Alabama. Adjusted odds ratios were calculated using logistic regression.nnnRESULTSnOf those who had experienced pressure for unwanted sex (n = 366), 69% consistently refused to engage in unwanted sex. Adolescents with high safer sex self-efficacy and low perceived partner-related barriers (i.e., concerns about partners negative emotional reactions) to condom negotiation were over 2.5 times more likely to consistently refuse unwanted sex than were those reporting low safer sex self-efficacy and high partner-related barriers. Adolescents who spoke more frequently with their parents about sexual issues were nearly twice as likely to consistently refuse unwanted sex than were those who spoke less frequently with their parents.nnnCONCLUSIONSnSexual-risk reduction efforts directed toward adolescent females should seek to build self-efficacy to negotiate safer sex and provide training in social competency skills that may help to reduce or eliminate partner barriers to condom use. Further, sexual risk-reduction programs may be more effective if they include parents as advocates of safer sexual behaviors.

Validity of self-reported sexually transmitted diseases among African American female adolescents participating in an HIV/STD prevention intervention trial.

Background Studies assessing the validity attributed to self-reported measures of sexually transmitted diseases (STDs) clearly are needed, particularly those used for high-risk populations such as female adolescents, in whom STD prevention is a priority. Goal To determine the accuracy of self-reported STD test results in female adolescents over a relatively brief period (≈28 days). Study Design A prospective, randomized, controlled clinical trial of STD/HIV prevention for African American females, ages 14 to 18, was conducted. Study participants were recruited from medical clinics and school health classes in low-income neighborhoods of Birmingham, Alabama, that had high rates of unemployment, substance abuse, violence, STDs, and teenage pregnancy. Results Of the 522 adolescents enrolled in the trial, 92% (n = 479) completed baseline STD testing and follow-up surveys. At baseline, 28% had positive test results for at least one disease: 4.8% for Neisseria gonorrhoeae, 17.1% for Chlamydia trachomatis, and 12.3% for Trichomonas vaginalis. Of the adolescents with negative STD test results, 98.8% were accurate in their self-report of STD status, as compared with 68.7% of the adolescents with positive results. Underreporting varied by type of STD. Adolescents who accurately reported their positive STD status were significantly more likely to report their receipt of treatment accurately (P < 0.001). Conclusions The substantial underreporting of STD incidence in this study suggests that reliance on self-reports of STD history may introduce misclassification bias, potentially leading to false conclusions regarding the efficacy of prevention interventions. This observation highlights the importance of using biologic indicators as outcome measures.

Efficacy of an HIV prevention program among female adolescents experiencing gender-based violence.

OBJECTIVESnWe examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence.nnnMETHODSnIn this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills.nnnRESULTSnRelative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills.nnnCONCLUSIONSnGiven the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.

Correlates of using dual methods for sexually transmitted diseases and pregnancy prevention among high-risk african-american female teens

PURPOSEnTo identify correlates of consistent dual-method use among African-American female adolescents at risk of sexually transmitted diseases (STDs) and pregnancy.nnnMETHODSnA convenience sample of 522 sexually active female teens attending adolescent medicine clinics, health department clinics, and school health classes volunteered. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a questionnaire and a face-to-face interview and provided vaginal swab specimens for laboratory diagnosis of STDs. Those reporting use of condoms and at least one other method of contraception, for each of the last five occasions they had sex were classified as consistent dual-method users. The questionnaire assessed frequency of adolescents communication with their parents and partners about sex. The questionnaire also assessed two measures of parental supervision and adolescents desire to avoid pregnancy. Multiple logistic regression assessed the independent contribution of each correlate of consistent dual-method use.nnnRESULTSnSeventy-one adolescents (13.6%) were classified as consistent dual-method users. A strong desire to avoid pregnancy was the most influential correlate of consistent dual-method use [odds ratio (OR) =2.3]. Adolescents reporting that their parents generally knew whom they were with (OR = 2.0) and those reporting more frequent communication with parents (OR = 1.9) were also more likely to be consistent dual users.nnnCONCLUSIONnThe findings suggest the need for research to examine the efficacy of interventions building on adolescent females desire to avoid pregnancy. Study findings also suggest that interventions promoting improved parent-adolescent communication and improved parental supervision may contribute to adolescents use of dual methods for STD and pregnancy prevention.

Risk for gonococcal and chlamydial cervicitis in adolescent females: Incidence and recurrence in a prospective cohort study

PURPOSEnThis study attempted to determine the incidence and risk for gonococcal and chlamydial cervicitis among sexually active urban adolescent females.nnnMETHODSnThe study design is a prospective cohort study. A cohort of 216 sexually active females were followed with repeat sexually transmitted diseases screening for 12-24 months. Subjects positive on any retest (FU) were compared with those who remained negative on all FU. Subjects were interviewed for history and screened for endocervical gonococcal and chlamydial infection.nnnRESULTSnThe number of visits per patient ranged from 2 to 9 (median, 3). The initial Chlamydia trachomatis and Neisseria gonorrhoeae rates were 23.2 and 11.6%, respectively. The cumulative FU positive rates were 20.8% for C. trachomatis and 17.1% for N. gonorrhoeae. Although the initial gonococcal infection was a significant risk for a subsequent infection by C. trachomatis (p = .05) and N. gonorrhoeae (p = .001), the initial C. trachomatis status was not predictive of subsequent infections. The number of partners was not predictive of subsequent infections with either. In the entire study period, 86 patients had at least one episode of C. trachomatis and N. gonorrhoeae infection was confirmed in 52; 20 patients had recurrent cervicitis. During the study, 101 episodes of C. trachomatis and 68 episodes of N. gonorrhoeae infections were identified. Those with recurrent cervicitis (9.3%) were responsible for 33% of all cervicitis episodes identified during the study.nnnCONCLUSIONSnAdolescents in our study were at high risk for cervicitis, particularly as a result of C. trachomatis. Risk for subsequent C. trachomatis cervicitis was the same among initially positive and negative groups. Our data underscore the importance of repeat screening for sexually transmitted infections and treatment of contacts of adolescent females.

Association of adolescents history of sexually transmitted disease (STD) and their current high-risk behavior and STD status. A case for intensifying clinic-based prevention efforts.

Background Adolescents are at high risk of sexually transmitted disease (STD)/HIV infection, and one vulnerable subgroup is African American females. The association between adolescents’ previous experience of STD and recent sexual risk behaviors has been ill-defined. Goal The goal was to examine the associations between adolescents’ self-reported history of STD diagnosis and current sexual risk behaviors, prevention knowledge and attitudes, and STD infection status. Study Design This was a cross-sectional survey. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama, characterized by high rates of unemployment, substance abuse, violence, and STDs. Participants were sexually active adolescent females (N = 522) 14 to 18 years of age. Information on STD history and current sexual behaviors (within the 30 days before assessment) was collected in face-to-face interviews. Less sensitive topics, such as STD prevention knowledge, attitudes about condom use, and perceived barriers to condom use, were addressed via self-administered survey. DNA amplification of vaginal swab specimens provided by the adolescents was performed to determine current STD status. Outcomes associated with past STD diagnosis were determined by means of logistic regression to calculate adjusted odds ratios (AORs) in the presence of observed covariates. Results Twenty-six percent of adolescents reported ever having an STD diagnosed. Although past STD diagnosis was associated with increased STD prevention knowledge, it was not associated with increased motivation to use condoms. Compared with adolescents who had never had an STD, adolescents with a history of diagnosed STD were more likely to report not using a condom at most recent intercourse (AOR = 2.54; 95% CI = 1.64–3.93;P = 0.0001), recent unprotected vaginal intercourse (AOR = 1.79; 95% CI = 1.15–2.79;P = 0.010), inconsistent condom use (AOR = 2.27; 95% CI = 1.46–3.51;P < .0001), sexual intercourse while drinking alcohol (AOR = 2.09; 95% CI = 1.33–3.28;P = 0.001), and unprotected intercourse with multiple partners (AOR = 3.29; 95% CI = 1.09–9.89;P = 0.034). Past STD diagnosis was associated with increased risk for current biologically confirmed gonorrhea and trichomoniasis (AOR = 2.48; 95% CI = 1.09–5.23;P = 0.030; and AOR = 2.05; 95% CI = 1.18–3.59;P = 0.011, respectively). Past STD diagnosis was not significantly associated with increased risk of current biologically confirmed chlamydia (AOR = 0.78; 95% CI = 0.45–1.37;P = 0.38). Conclusion Among this sample of female adolescents, past STD diagnosis was an indicator of current high-risk sexual activity and increased risk for two common STDs: gonorrhea and trichomoniasis. Although adolescents may gain factual knowledge from the experience of having an STD diagnosed, they are not applying that knowledge to their current sexual behaviors. Thus, these adolescents remain at risk for subsequent STD infection. Therefore, the findings suggest that there is a need to intensify clinic-based prevention efforts directed toward adolescents with a history of STDs, as a strategy for reducing STD-associated risk behaviors and, consequently, the likelihood of new STD infections.

Sexual Behavior and Sexually Transmitted Diseases Among Male Adolescents in Detention

Background: Youth in detention represent a medically underserved population at risk for a variety of medical and emotional disorders. Goal of the study: To determine prevalence of STDs and high-risk sexual behaviors for HIV/STD among adolescent males admitted to a juvenile detention facility. Study Design: Cross-sectional study of behavioral risk factors and STD prevalence among detained males, 11 to 18 years of age. Study subjects were interviewed for behavioral history and screened for STD. Results: The median number of lifetime partners of the population was 8 (range 1–100), the number of partners in the preceding 4 months was 2 in median (range 0–30), 59% used a condom with their last sex, and consistent condom use in the past 4 months was reported by 37%. A history of sexual intercourse within the last one week was reported by 43%. Chlamydia trachomatis infection rate was 6.9% (66/957), Neisseria gonorrhoeae 4.5% (42/940) and syphilis 0.9% (8/930) including one who seroconverted while in detention. Overall, 12% (109/908) of subjects tested for all three infections were positive for at least one STD. Stepwise logistic regression analysis showed that greater than one partner in the previous 4 months (OR 1.53, 95% confidence interval [95%CI] 1.18–1.98), inconsistent or no condom use in the preceding 4 months (OR 1.77, 95%CI 1.37–2.28), a history of recent STD (OR 1.80, 95%CI 1.33–2.42) and greater than five lifetime partners (OR 2.03, 95%CI 1.41–2.92) were independent predictors of these STDs in this population. Conclusion: Detained juvenile males in our study were at a high-risk for STD/HIV infections and probably form a core group of STD transmitters. Vigorous attempt to reduce STD reservoir and change behavior of juveniles in detention, such as our study subjects, is urgently needed for the control of the STD/HIV infections.