Penny S. Loosier

Group Differences in Risk Across Three Domains Using an Expanded Measure of Sexual Orientation

The purpose of this study was to highlight associations between sexual orientation and risk outcomes in late adolescence and early adulthood using an expanded measure of sexual orientation. Recent data indicate higher levels of risk behavior in a newly identified population, mostly heterosexuals, as compared to heterosexuals. Comparisons among groups using an expanded measure of sexual orientation such as this, however, often do not include all possible groups or may restrict comparisons between groups. Data were derived from the National Longitudinal Study of Adolescent Health (Add Health); participants identified as heterosexual, mostly heterosexual, bisexual, mostly gay, or gay. Main risk outcomes were parental mistreatment, home displacement, thoughts of suicide, depressive symptoms, frequency of drinking, and delinquency. A priori planned comparisons examined differences between: (a) heterosexual vs. mostly heterosexual, (b) gay vs. mostly gay, (c) mostly heterosexual vs. bisexual, (d) mostly gay vs. bisexual, (e) mostly heterosexual vs. mostly gay, (f) heterosexual vs. gay, (g) heterosexual vs. bisexual, and (h) gay vs. bisexual. Mostly heterosexual youth were at significantly greater risk than heterosexual youth on all outcomes but did not differ from bisexual or mostly gay youth. Heterosexuals were at lower risk as compared to mostly heterosexuals and bisexuals. This study provides further evidence of differential risk associations for sexual minorities.

The Legal Aspects of Expedited Partner Therapy Practice: Do State Laws and Policies Really Matter?

Background Expedited partner therapy (EPT) is a potential partner treatment strategy. Significant efforts have been devoted to policies intended to facilitate its practice. However, few studies have attempted to evaluate these policies. Methods We used data on interviewed gonorrhea cases from 12 sites in the STD Surveillance Network in 2010 (n = 3404). Patients reported whether they had received EPT. We coded state laws relevant to EPT for gonorrhea using Westlaw legal research database and the general legal status of EPT in STD Surveillance Network sites from Centers for Disease Control and Prevention’s Web site in 2010. We also coded policy statements by medical and other boards. We used &khgr;2 tests to compare receipt of EPT by legal/policy variables, patient characteristics, and provider type. Variables significant at P < 0.10 in bivariate analyses were included in a logistic regression model. Results Overall, 9.5% of 2564 interviewed patients with gonorrhea reported receiving EPT for their partners. Receipt of EPT was significantly higher where laws and policies authorizing EPT existed. Where EPT laws for gonorrhea existed and EPT was permissible, 13.3% of patients reported receiving EPT as compared with 5.4% where there were no EPT laws and EPT was permissible, and 1.0% where there were no EPT laws and EPT was potentially allowable (P < 0.01). Expedited partner therapy was higher where professional boards had policy statements supporting EPT (P < 0.01). Receipt of EPT did not differ by most patient characteristics or provider type. Policy-related findings were similar in adjusted analyses. Conclusions Expedited partner therapy laws and policies were associated with higher reports of receipt of EPT among interviewed gonorrhea cases.

Trends in receipt of sexually transmitted disease services among women 15 to 44 years old in the United States, 2002 to 2006-2010.

Background To describe recent trends in the receipt of sexually transmitted disease (STD) services among women (age, 15–44 years) from 2002 to 2006–2010 using the National Survey of Family Growth. Methods We analyzed trends in demographics, health insurance, and visit-related variables of women reporting receipt of STD services (counseling, testing, or treatment) in the past 12 months. We also analyzed trends in the source of STD services and the payment method used. Results Receipt of STD services reported by women in the past 12 months increased from 2002 (12.6%) to 2006–2010 (16.0%; P < 0.001). Receipt of services did not increase among adolescents (P = 0.592). Among women receiving STD services from a private doctor/HMO, the percentage with private insurance decreased over time (74.6%–66.8%), whereas the percentage with Medicaid increased (12.8%–19.7%; P = 0.020). For women receiving STD services at a public clinic or nonprimary care facility, there were no statistically significant differences by demographics, except that fewer adolescents but more young adults reported using a public clinic over time (P = 0.038). Among women who reported using Medicaid as payment, receipt of STD services at a public clinic significantly decreased (36.8%–25.4%; P = 0.019). For women who paid for STD services with private insurance, the only significant difference was an increase in having a copay over time (61.3%–70.1%; P = 0.012). Conclusions Despite a significant increase in receipt of STD services over time, many women at risk for STDs did not receive services including adolescents. In addition, we identified important shifts in payment methods during this time frame.

Sexual and Reproductive Health Care Receipt Among Young Males Aged 15–24

PURPOSE This study aimed to describe young mens sexual and reproductive health care (SRHC) receipt by sexual behavior and factors associated with greater SRHC receipt. METHODS There were 427 male patients aged 15-24 who were recruited from 3 primary care and 2 sexually transmitted disease (STD) clinics in 1 urban city. Immediately after the visit, the survey assessed receipt of 18 recommended SRHC services across four domains: screening history (sexual health, STD/HIV test, family planning); laboratories (STDs/HIV); condom products (condoms/lubrication); and counseling (STD/HIV risk reduction, family planning, condoms); in addition, demographic, sexual behavior, and visit characteristics were examined. Multivariable Poisson regressions examined factors associated with each SRHC subdomain adjusting for participant clustering within clinics. RESULTS Of the participants, 90% were non-Hispanic black, 61% were aged 20-24, 90% were sexually active, 71% had female partners (FPs), and 20% had male or male and female partners (M/MFPs). Among sexually active males, 1 in 10 received all services. Half or more were asked about sexual health and STD/HIV tests, tested for STDs/HIV, and were counseled on STD/HIV risk reduction and correct condom use. Fewer were asked about family planning (23%), were provided condom products (32%), and were counseled about family planning (35%). Overall and for each subdomain, never sexually active males reported fewer services than sexually active males. Factors consistently associated with greater SRHC receipt across subdomains included having M/MFPs versus FPs, routine versus non-STD-acute visit, time alone with provider without parent, and seen at STD versus primary care clinic. Males having FPs versus M/MFPs reported greater family planning counseling. CONCLUSIONS Findings have implications for improving young mens SRHC delivery beyond the narrow scope of STD/HIV care.

Prevalence of HIV Testing Provision at Community Organizations Serving Young People in a Mid-Atlantic City, 2013-2014

Objectives: Little is known about the prevalence of human immunodeficiency virus (HIV) testing at community organizations or the organizational characteristics associated with testing. The objective of this study was to describe (1) the prevalence of HIV testing at community organizations serving young people in a mid-Atlantic urban city and (2) the characteristics associated with organizations that provide such testing. Methods: We conducted telephone or in-person surveys between February 2013 and March 2014 with 51 directors and administrators of community organizations serving young people. We asked whether the organization provided HIV screening or testing, and we collected data on organizational characteristics (eg, setting, client, and staff member characteristics; services offered). We generated frequencies on measures and used Poisson regression analysis to examine the association between testing and organizational characteristics. Results: Of the 51 organizations surveyed, 21 provided HIV testing. Of the 30 organizations that did not provide HIV testing, only 7 had a relationship with programs that did provide it. Characteristics associated with the provision of HIV testing included offering general health services (relative risk [RR] = 4.57; 95% confidence interval [CI], 1.68-12.48; P = .003) and referral services for sexually transmitted infection screening (RR = 5.77; 95% CI, 1.70-19.59; P = .005) and HIV care (RR = 4.78; 95% CI, 1.61-14.21; P = .005), as well as among administrators who perceived their staff members were comfortable talking with young people about sexual health (RR = 3.29; 95% CI, 1.28-8.49; P = .01). Conclusions: The prevalence of HIV testing provision at organizations serving young people in this mid-Atlantic city was low, and few organizations offered linkages to HIV testing. Strategies are needed to increase the provision of HIV testing at community organizations serving young people, whether through direct or linked approaches.

Effectiveness of an Adaptation of the Project Connect Health Systems Intervention: Youth and Clinic-Level Findings.

BACKGROUND The Project Connect Health Systems Intervention (Project Connect) uses a systematic process of collecting community and healthcare infrastructure information to craft a referral guide highlighting local healthcare providers who provide high quality sexual and reproductive healthcare. Previous self-report data on healthcare usage indicated Project Connect was successful with sexually experienced female youth, where it increased rates of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) testing and receipt of contraception. This adaption of Project Connect examined its effectiveness in a new context and via collection of clinic encounter-level data. METHODS Project Connect was implemented in 3 high schools. (only 2 schools remained open throughout the entire project period). Participant recruitment and data collection occurred in 5 of 8 participating health clinics. Students completed Youth Surveys (N = 608) and a Clinic Survey (paired with medical data abstraction in 2 clinics [N = 305]). RESULTS Students were more likely than nonstudents to report having reached a clinic via Project Connect. Nearly 40% of students attended a Project Connect school, with 32.7% using Project Connect to reach the clinic. Students were most likely to have been referred by a school nurse or coach. CONCLUSIONS Project Connect is a low-cost, sustainable structural intervention with multiple applications within schools, either as a standalone intervention or in combination with ongoing efforts.

Missed Opportunities to Address Pregnancy Prevention With Young Men in Primary Care

Young men (aged 15-24 years) have pregnancy prevention needs, yet little is known about whether they perceive they learn about pregnancy prevention in primary care. A sample of 190 young men seen in primary care in one city from April 2014 to September 2016 were assessed on perceived learning about pregnancy prevention, background and visit characteristics, pregnancy prevention care receipt, and contraception needs at last sex. The majority of participants were non-Hispanic black (92%), aged 15 to 19 years (54%), seen for a physical examination (52%), and established patients (87%). Few participants perceived they learned about pregnancy prevention (32%), regardless of sexual activity (33% among sexually active participants, 26% among never sexually active). Poisson regression models determined that perceived learning about pregnancy prevention was independently associated with young men’s pregnancy prevention care receipt and contraception needs at last sex. Findings highlight the need to improve providers’ delivery of pregnancy prevention services to young men.

Do Nonclinical Community-Based Youth-Serving Professionals Talk With Young Men About Sexual and Reproductive Health and Intend to Refer Them for Care?

Young men (ages 15–24) may benefit from community-based connections to care since many have sexual and reproductive health (SRH) needs and low care use. This study describes nonclinical community-based youth-serving professionals’ (YSPs) SRH knowledge, confidence, past behaviors, and future intentions to talk with young men about SRH and refer them to care, and examines factors associated with care referral intentions. YSPs (n = 158) from 22 settings in one mid-Atlantic city answered questions about the study’s goal, their demographics and work environment from August 2014 to December 2015. Poisson regression assessed factors associated with YSPs’ care referral intentions. On average, YSPs answered 58% of knowledge questions correctly, knew 5 of 8 SRH care dimensions of where to refer young men, and perceived being somewhat/very confident talking with young men about SRH (63%) and referring them to care (77%). During the past month, the majority (63%) talked with young men about SRH but only one-third made care referrals; the majority (66%) were somewhat/very likely to refer them to care in the next 3 months. Adjusted models indicated YSPs were more likely to refer young men if they had a very supportive work environment to talk about SRH (adjusted RR = 1.51, 95% CI [1.15, 1.98]), greater confidence in SRH care referral (1.28 [1.00, 1.62]), and greater SRH care referrals in the past month (1.16 [1.02, 1.33]). Nonclinical community-based YSPs have poor-to-moderate knowledge about young men’s SRH care, and less than one-third reported referrals in the past month. Findings have implications for educating YSPs about young men’s SRH care.

O2-S2.01 The project connect health systems intervention: STD screening and HIV testing outcomes for female adolescents

Background Access to STD screening and HIV testing are important components of sexual and reproductive health care for adolescents. However, few youth have ever had an STD or HIV test, suggesting a need for new approaches to linking adolescents to care. Project Connect is an 8 year, quasi-experimental study of a multi-level intervention to prevent STD, HIV, and teen pregnancy. The Health Systems Intervention component was designed to provide an effective conduit to link youth to available health care services. Community health care providers who offered adolescents high quality care were identified and recruited for a referral system implemented through school nurses. Methods Six intervention and six control high schools in a public school district in the Los Angeles, California area participated in the study. Analyses included survey data from 6623 sexually experienced (ever engaged in sexual intercourse) and 4703 sexually active (engaged in intercourse in the past 3 months) female high school students across 5 years (T1–T5). Both samples were 78% Latino and 13% African American; the mean age was 16.6. A mixed model logistic regression analysis was used to test for intervention effects. Random effects on the student level were included to control for repeated measures. Results Statistically significant intervention effects were observed overall among both samples (see Abstract O2-S2.01 table 1 for adjusted OR and 95% CIs for sexually experienced sample) for receiving STD testing or treatment in the past year and ever being tested for HIV. At T1, for example, 18% of sexually experienced intervention females reported being tested/treated for an STD in the past year; at T5, 29.2% reported having done so. In the control condition, 17% reported STD testing/treatment in the past year at T1, which remained relatively stable by T5, at 19.9%. Among sexually experienced females statistically significant increases were also found for ever being tested for an STD. Abstract O2-S2.01 Table 1 Adjusted OR for the change between time points in sexually experienced females Time point paired difference AOR (95% CI) STD test/Tx past year Ever STD test Ever HIV test T2-T1 1.12 (0.66 to 1.98) 1.06 (0.57 to 1.97) 1.16 (0.59 to 2.26) T3-T1 1.73 (1.02 to 2.95)* 1.44 (0.77 to 2.70) 1.42 (0.73 to 2.28) T4-T1 1.67 (0.965 to 2.87) 1.97(1.03 to 3.77)* 2.20 (1.10 to 4.39)* T5-T1 1.93 (1.14 to 3.26)* 1.28 (0.68 to 2.41) 1.94 (0.99 to 3.81) T3-T2 1.55 (0.93 to 2.56) 1.36 (0.75 to 2.45) 1.23 (0.65 to 2.32) T4-T2 1.49 (0.88 to 2.51) 1.86 (0.99 to 3.48) 1.90 (0.97 to 3.71) T5-T2 1.72 (1.04 to 2.85)* 1.21 (0.66 to 2.22) 1.67 (0.86 to 3.24) T4-T3 0.96 (0.57 to 1.62) 1.36 (0.74 to 2.50) 1.55 (0.81 to 2.96) T5-T3 1.11 (0.67 to 1.84) 0.89 (0.49 to 1.61) 1.37 (0.72 to 2.59) T5-T4 1.16 (0.70 to 1.91) 0.65 (0.36 to 1.18) 0.88 (0.47 to 1.65) * p<0.05. Conclusions Project Connect was successful in linking female adolescents to sexual and reproductive health care through high school nurses. Rather than attempting to change provider behaviour, this structural intervention capitalises on existing, adolescent-focused expertise among local medical providers. It is a low-cost, sustainable strategy for linking (or ensuring access for) adolescents to care and could be widely implemented.