Pamela A. Matson

Medicinal and recreational marijuana use among HIV-infected women in the Women's Interagency HIV Study (WIHS) cohort, 1994-2010.

Background:Despite the major benefits of effective antiretroviral therapy on HIV-related survival, there is an ongoing need to help alleviate medication side effects related to antiretroviral therapy use. Initial studies suggest that marijuana use may reduce HIV-related symptoms, but medical marijuana use among HIV-infected individuals has not been well described. Methods:The authors evaluated trends in marijuana use and reported motivations for use among 2776 HIV-infected women in the Womens Interagency HIV Study between October 1994 and March 2010. Predictors of any and daily marijuana use were explored in multivariate logistic regression models clustered by person using generalized estimating equation. In 2009, participants were asked if their marijuana use was medical, “meaning prescribed by a doctor,” or recreational, or both. Results:Over the 16 years of this study, the prevalence of current marijuana use decreased significantly from 21% to 14%. In contrast, daily marijuana use almost doubled from 3.3% to 6.1% of all women and from 18% to 51% of current marijuana users. Relaxation, appetite improvement, reduction of HIV-related symptoms, and social use were reported as common reasons for marijuana use. In 2009, most marijuana users reported either purely medicinal use (26%) or both medicinal and recreational usage (29%). Daily marijuana use was associated with higher CD4 cell count, quality of life, and older age. Demographic characteristics and risk behaviors were associated with current marijuana use overall but were not predictors of daily use. Conclusions:This study suggests that both recreational and medicinal marijuana use are relatively common among HIV-infected women in the United States.

Developmental Changes in Condom Use Among Urban Adolescent Females: Influence of Partner Context

PURPOSE National surveys have found that the percentage of female adolescents who report condom use at last sex differs by age group. Using longitudinal data, the authors examined whether there are longitudinal changes in condom use and whether these changes are due in part to developmental changes in the types of sexual relationships in which young women are involved. METHOD A clinic sample of 298 African American female adolescents aged 14-19 years at enrollment were interviewed every 6 months for a period of 36 months. At each interview, participants were asked to name all their recent sex partners, to classify each partner as main or casual, and to report whether a condom was used at last sex with each of these partners. Hierarchical generalized linear modeling was used to analyze repeated measures within individuals. RESULTS On average, there was no statistically significant change in condom use over time. The odds of having a single main partner increased by 4% for each 6 months spent in the study (odds ratio: 1.04%, 95% confidence interval: 1.02-1.05). Stratifying females by longitudinal relationship patterns resulted in three distinct condom use trajectories. CONCLUSION Data suggest that longitudinal changes in condom use are a function of developmental changes in relationships, whereby young women trend toward monogamous relationships. As condoms are abandoned within these monogamous relationships, lowering infection rates in sex partners through broader sexually transmitted infections screening or through community-level interventions aimed at sex networks might prove to be a more effective approach to reduce sexually transmitted infections risk in young women.

Television Viewing in Low-Income Latino Children: Variation by Ethnic Subgroup and English Proficiency

BACKGROUND Television viewing is associated with an increased risk for obesity in children. Latino children are at high risk for obesity and yet little is known about differences in television viewing habits within this population. The purpose of this study is to determine if hours of television viewed by young children with low-income Latina mothers differs by maternal ethnic subgroup and English language proficiency. METHODS This was a cross-sectional analysis of data from the Welfare, Children, & Families: A Three City Study. Participants were 422 low-income Latina mothers of Mexican and Puerto Rican descent with children ages 0-4 years old. The dependent variable was hours of daily television viewed by the child. The independent variable was maternal ethnic subgroup and English language proficiency. Analyses involved the use of multiple negative binomial regression models, which were adjusted for demographic variables. RESULTS Multivariable regression analyses showed that compared to children with mothers of Mexican descent, children of mothers of Puerto Rican descent watch more daily television (<2 years old, incidence rate ratio (IRR)=4.18, 95% confidence interval (CI) 1.68, 10.42; 2-4 years, IRR=1.54, 95% CI 1.06, 2.26). For children with mothers of Mexican descent, higher maternal English language proficiency was associated with higher amounts of child television viewing (IRR=1.29, 95% CI 1.04, 1.61). No relationship was found for children of Puerto Rican descent. CONCLUSIONS Child television viewing varies in low-income Latino children by maternal ethnic subgroup and English language proficiency. Interventionists must consider the varying sociocultural contexts of Latino children and their influence on television viewing.

Understanding variability in adolescent women's sexually transmitted infection-related perceptions and behaviors associated with main sex partners.

Background It is not well understood whether characteristics of adolescent main partnerships differ categorically from one relationship to the next or whether observed differences in sexually transmitted infection (STI)–related perceptions and sexual behaviors between main partnerships results from a failure to capture variability within adolescent main partnerships. The objective of this study was to examine the extent to which female adolescents’ STI-related feelings, perceptions, and sexual behavior associated with main sex partners varied over the course of their relationship. Methods A cohort of adolescent women aged 16 to 19 years at baseline, recruited from health clinics or community venues, completed daily diaries on a Smartphone continuously for 18 months. Participants reported daily on their partner-specific feelings of closeness, trust, commitment, perceived risk for acquiring a sexually transmitted disease (PRSTD), perception of partner concurrency (PPC), and condom use for their main sexual partners. Results Relationships from 49 participants were used to examine variability over time in STI-related feelings, perceptions, and behavior. Overall, relationships were characterized by high levels of trust, closeness, and commitment and low levels of PPC, PRSTD, and condom use. However, for all but PRSTD, there was more variation (>50%) within than between relationships for each of these measures, although variability of PRSTD was high (47.1%). Residual variability for all perceptions and behaviors remained significant after controlling for trends over time. Conclusions Diary data illustrate wide day-to-day fluctuations in feelings of intimacy, PPCs, PRSTDs, and condom use indicating that these are dynamic attributes of adolescent romantic relationships.

Young low-income ethnic minority children watch less television when their mothers regulate what they are viewing

Parenting practices can reduce how much television (TV) children watch. This study evaluated the longitudinal association between maternal regulation of TV content and the amount of TV watched by low‐income ethnic minority children.

Perceived Neighborhood Partner Availability, Partner Selection, and Risk for Sexually Transmitted Infections Within a Cohort of Adolescent Females

PURPOSE This research examined the association between a novel measure of perceived partner availability and discordance between ideal and actual partner characteristics as well as trajectories of ideal partner preferences and perceptions of partner availability over time. METHODS A clinic-recruited cohort of adolescent females (N = 92), aged 1619 years, were interviewed quarterly for 12 months using audio computer-assisted self-interview. Participants ranked the importance of characteristics for their ideal main sex partner and then reported on these characteristics for their current main partner. Participants reported on perceptions of availability of ideal sex partners in their neighborhood. Paired t-tests examined discordance between ideal and actual partner characteristics. Random-intercept regression models examined repeated measures. RESULTS Actual partner ratings were lower than ideal partner preferences for fidelity, equaled ideal preferences for emotional support and exceeded ideal preferences for social/economic status and physical attractiveness. Discordance on emotional support and social/economic status was associated with sex partner concurrency. Participants perceived low availability of ideal sex partners. Those who perceived more availability were less likely to be ideal/actual discordant on fidelity [OR = .88, 95% CI: .78, 1.0]. Neither ideal partner preferences nor perceptions of partner availability changed over 12 months. CONCLUSIONS Current main sex partners met or exceeded ideal partner preferences in all domains except fidelity. If emotional needs are met, adolescents may tolerate partner concurrency in areas of limited partner pools. Urban adolescent females who perceive low availability may be at increased risk for sexually transmitted infection (STI) because they may be more likely to have nonmonogamous partners.

Factors Associated With Emotional Satisfaction During First Anal Intercourse in a Sample of YMSM

ABSTRACT We sought to determine, in a sample of 2,813 HIV seronegative young men who had sex with other men age 18–24, whether physical satisfaction would explain emotional satisfaction during first anal intercourse and whether emotional satisfaction would impact having sex with a partner a second time. Emotional satisfaction was explained mostly by physical satisfaction during the event, but partner type also had direct impact on emotional satisfaction. Our findings suggest that first anal intercourse experiences in young men are both emotionally and physically satisfying and may impact subsequent sexual behavior and partner decision-making.

The status of adolescent medicine: Building a global adolescent workforce

Abstract Remarkable public health achievements to reduce infant and child mortality as well as improve the health and well-being of children worldwide have successfully resulted in increased survival and a growing population of young people aged 10–24 years. Population trends indicate that the current generation of 1.8 billion young people is the largest in history. However, there is a scarcity of dedicated resources available to effectively meet the health needs of adolescents and young adults worldwide. Growing recognition of the pivotal roles young people play in the cultures, societies, and countries in which they live has spurred an expanding global movement to address the needs of this special population. Building an effective global workforce of highly-skilled adolescent health professionals who understand the unique biological, psychological, behavioral, social, and environmental factors that affect the health of adolescents is a critical step in addressing the health needs of the growing cohort of young people. In this review, we aim to: 1) define a global assessment of the health needs for adolescents around the world; 2) describe examples of current training programs and requirements in adolescent medicine; 3) identify existing gaps and barriers to develop an effective adolescent health workforce; and 4) develop a call for targeted actions to build capacity of the adolescent health workforce, broaden culturally relevant research and evidence-based intervention strategies, and reinforce existing interdisciplinary global networks of youth advocates and adolescent health professionals to maximize the opportunities for training, research, and care delivery.

P2-S8.12 Feasibility of using cell phones for daily data collection within adolescent cohort studies

Background It is widely recognised that adolescents are a population who encounter frequent changes in their daily lives. In order to capture these important oscillations, daily data are needed to accurately record and track changes in STD associated perceptions and behaviours that adolescents experience. Methods Adolescent females 16-19 were enrolled in the study from a reproductive healthcare clinic. They are assigned a Palm Centro smartphone, and instructed to make daily diary entries on the phones using Pendragon software continuously for up to 18 months. Field staff meet with the participants every 2 weeks to hot sync the diary data from the phones, which is then compiled into a master database. Results We examined the number of data points collected over all participants as compared with the costs of the phones, service plans, and person-power needed to complete data collection as well as the subjective opinions of the participants. In an ongoing study, 107 participants have received a phone, and the overall retention rate is 70%. The cost of the cell phone, voice plan and study staff support is approximately

A System-Level Approach to Improve HIV Screening in an Urban Pediatric Primary Care Setting

105 per month for each participant. Participants have completed an average of 14 diary entries per month, with a total of 9916 collected. All participants who have completed 18 months in the study reported that the diary entry software was somewhat or very easy to use and 63% indicated that the cell phone was a reason that they remained in the study. Of the 185 phones that were distributed, 84 were reported broken or lost. Conclusions Utilising this method of data collection has yielded rich data, unlike any currently available in the literature. While the cost of the data collection process may be substantial, there are distinct advantages to the use of cell phones. These benefits include, participant satisfaction, date and time stamped data, an alarm prompt, reduced participant burden, as well as affording interactive and privacy advantages similar to ACASI technology. There are several ways to tailor the collection process so that it may be accessible to a wider variety of studies. Greater use of this technology should be an area of interest in further adolescent STD research.