Nancy L. Brown

Secondhand Tobacco Smoke in Children With Asthma: Sources of and Parental Perceptions About Exposure in Children and Parental Readiness To Change

BACKGROUND Secondhand smoke triggers childhood asthma. Understanding sources of exposure, parental beliefs about exposure, and readiness to change that exposure are important for designing smoke exposure reduction interventions. METHODS As part of screening for a clinical trial of a smoke exposure reduction intervention, 519 smoke-exposed children 3 to 12 years old with asthma provided urine specimens for cotinine testing, and their primary caregivers completed questionnaires. RESULTS The urine cotinine to creatinine ratio (CCR) was lowest if neither the primary caregiver nor day-care provider smoked (mean CCR, 14.0; SD, 14.4), greater if either smoked (mean CCR, 22.2; SD, 21.3; and mean, CCR, 26.3; SD, 22.2, respectively), and greatest if both smoked (mean CCR, 39.6; SD, 27.5; p < 0.01). Parental perception of their childs exposure was weakly associated with the childs CCR (r(2) = 0.11, p < 0.001). Most parents (58.3%) reported that tobacco smoke exposure had small/no negative effect on their childs asthma. Substantial proportions of those for whom a specific exposure reduction action was relevant were classified as contemplating, preparing, or had recently taken action to reduce their childs exposure, including smoking cessation (61.3%), keeping the child out of smoke-exposed places (72.7%), and making the childs home (49.2%) and areas out of the home smoke free (66.9%). CONCLUSIONS Smoking by the primary caregiver and day-care provider are important sources of exposure for children with asthma. Parental assessment of their childs exposure is associated with biologically confirmed exposure but cannot be relied on to assess that exposure. Although the harm of smoke exposure was frequently underestimated, many parents appeared receptive to considering action to reduce their childs exposure. TRIAL REGISTRATION (Clinicaltrials.gov). Identifier: NCT00217958.

Effects of Interviewer Characteristics on Reported Sexual Behavior of California Latino Couples

Effects of interviewer gender and age on disclosure of sexual behavior by 573 California Latino men and their female partners were analyzed,adjusting for interviewee clustering within interviewer. Larger standard errors in adjusted than in naive/unadjusted regression models demonstrated the existence of interviewer effects on responding,but these were only attributable to interviewer gender or age for a small number of specific topics. Men interviewed by women reported fewer sexual partners and were less likely to report sex with strangers than men interviewed by men; they were more likely to report sex with prostitutes or other men to older than to younger interviewers. Women were less likely to report oral sex to older interviewers. Sexual behavior surveys should evaluate and, where detected, adjust for fixed interviewer effects and should routinely report interviewer numbers, panel sizes, and other characteristics.

Correlates of sexual risk for HIV infection in female members of heterosexual California Latino couples: an application of a Bernoulli process model.

Individual HIV risk estimates were generated from reported sexual behavior for 1,146 California Latino Couples Study participants (573 couples). These Bernoulli process model-based estimates proved strongly associated with individual sexually transmitted disease history. Mean estimated background risk from sexual contacts other than with their primary partner was substantially lower for the females than the males (1.4 vs. 7.4 per 10,000). After including their chance of infection from each other, mean net estimated risk was higher for the females than the males (9.2 vs. 8.6 per 10,000). Individual background risk was predicted by individual demographic and psychosocial characteristics (females: coefficient of concordance C = 0.84 predicting any (nonzero) risk; adjusted R2 = 36% predicting level of risk, given any risk; males: C = 0.78; R2 = 24%). Characteristics of women with higher risk primary partners were also identifiable (C = 0.65; R2 = 13%). There was no significant negative association between the male partners background sexual risk and the aggregate infectivity of the woman from him (taking into account the total number of their condom-protected and unprotected acts of different types).

Correlates of Sexual Abuse and Subsequent Risk Taking

Correlates of sexual abuse among female participants in the California Latino Couples Study were examined in two sets of comparisons: (a) nonabused women versus women reporting any sexual abuse and (b) among sexually abused women, those reporting forced intercourse versus those with no forced intercourse. Women who reported any sexual abuse (n = 208) differed from women who reported no abuse (n = 363) in their age at first voluntary sexual intercourse, risk-taking scores, and sexually transmitted infection (STI) history. Among the abused women, those who experienced forced intercourse (n = 101) were more likely to report sexual intercourse with an injection drug user, a history of STIs, unhappy intimate relationships, depression, and elevated stress scores compared wth women who had been touched inappropriately but not forced to have sexual intercourse.

Condom use by women recently diagnosed with a sexually transmitted infection: Effects of study methodology on the apparent influence of hormonal/surgical contraception

Objective/Goal: The objective of this study was to investigate potential predictors of consistent condom use (CCU), including the influence of hormonal contraception/surgical sterilization (HC/SS). Study: Regression methods were used to predict CCU and other measures of CU among 214 sexually active, 18- to 45-year-old women previously diagnosed with a sexually transmitted infection. Results: CCU was significantly associated with younger age, African American ethnicity, having casual partners, recent HIV testing, condom use self-efficacy, and concern about partner relationship. HC/SS was not significantly associated with the likelihood of CCU, before (HC/SS, 21.3%, non-HC/SS, 25.3%; odds ratio [OR], 0.798; P = 0.4914) or after (OR, 1.209; P = 0.5995) controlling for confounders (age, ethnicity, casual partners). Controlling for age and ethnicity eliminated initial significant or near-significant inverse associations between HC/SS and 3 alternative measures of interval condom use (“any use,” “number of unprotected acts,” “proportion condom-protected contacts”) and substantially diminished the association between HC/SS and “condom use at last sex.” Conclusions: Choice of condom use measure and control of confounding variables can substantially affect results when studying potential predictors of condom use such as HC/SS.

Healthcare utilization by women in a comprehensive managed care population subsequent to diagnosis of a sexually transmitted disease.

Background Healthcare utilization (HCU) following a sexually transmitted disease (STD) diagnosis is poorly characterized. Goal The goal was to quantify HCU for new/recurrent STDs and other relevant Ob-Gyn and mental health problems in the 18 months subsequent to an STD diagnosis. Study Design We compared HCU between a group of females aged 18 to 45 years who were Kaiser Permanente Medical Program members with a diagnosed STD (n = 1205) and a medical center– and age group–matched sample of women seen for a non-STD diagnosis in the same time period (n = 4820), with controlling where appropriate for age, medical center, and chronic disease status. Results An STD diagnosis was associated with significantly greater likelihood of subsequent visits for STDs (relative risk [RR] = 3.8), pelvic inflammatory disease/endometritis (RR = 2.9), candidiasis (RR = 2.0), vaginitis (RR = 2.4), cervical dysplasia (RR = 1.7), menstrual disorders/abnormal bleeding (RR = 1.3), high risk/complicated/ectopic pregnancy (RR = 1.5), and behavioral/mental health problems (RR = 1.3) than for women seen for a non-STD diagnosis. Conclusion Detrimental sequelae of STDs are reflected in substantially elevated near-term HCU following an STD diagnosis.