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The purpose of the present study was to examine the feasibility of conducting a parent-based intervention in a pediatric health clinic to prevent HIV, sexually transmitted infections (STIs), and unintended pregnancies among urban African American and Latino youth. Eight focus groups were conducted with health care providers, adolescent patients and the mothers of adolescent patients (n = 41) from December 2007 to February 2008. All participants were recruited from a community-based pediatric health clinic in the Bronx, New York. Content analysis of focus group transcripts identified results in three primary areas: (1) the role of parents and providers in preventing HIV, STDs and unintended pregnancies among adolescents, (2) feasibility of the intervention in the clinic setting; and (3) optimal recruitment, retention and intervention delivery strategies. Study results suggest that a parent-based intervention delivered in a community-based pediatric health clinic setting is feasible. Focused recommendations for intervention recruitment, delivery, and retention are provided.
Abstract : Unintended pregnancies (UIPs) and STDs with their sequelae of ectopic pregnancy continue to be epidemic among active duty enlisted women. Such reproductive health problems result in major morbidity among affected women as well as posing a potential threat to combat readiness. UIPs and STDs result from complex interactions between biological and behavioral factors. The ultimate control in preventing such morbidities must rely on both behavioral and biologic strategies. The primary aim of the project is to develop, implement and evaluate an intervention which emphasizes correct information, motivation and behavioral skills building (IMB Model) coupled with non-invasive screening using urine-based amplified DNA techniques to detect C. trachomatis and N. gonorrhoeae and urine-based pregnancy testing. A randomized controlled trial design was employed to evaluate the impact of the intervention on the experimental group using both self-report questionnaires (psychosocial and behavioral risk factors) and results from the STD and pregnancy screening tests as measures. The control intervention consisted of a prevention program focusing on nutrition, breast cancer, fitness and injury prevention. Questionnaires and biologic testing were completed as baseline, 2-4 weeks, 9-12 months post intervention. Participants (N=2157) were women enrolled in recruit training for the U.S. Marine Corps. Results show that the intervention has had a significant impact on decreasing STDs over the study period.
ABSTRACT We set out to determine the prevalences of Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction as well as to determine the prevalence of Trichomonas vaginalis by culture in a large and diverse national sample of non-health-care-seeking young women entering the military; we also sought to compare the abilities of three different techniques of collecting specimens (first-void urine, self-collected vaginal swab, and clinician-collected endocervical swab) to identify a positive specimen. A cross-sectional sample of young women was voluntarily recruited; as a part of their routine entry pelvic examination visit, they completed a self-administered reproductive health questionnaire and provided first-void urine (used to detect C. trachomatis and N. gonorrhoeae ) and self-collected vaginal swabs (used to detect C. trachomatis , N. gonorrhoeae , and T. vaginalis ). The number of positive tests divided by the number of sexually active women screened by each sampling method determined the rates of prevalence. The rate of infection with any of the three sexually transmitted diseases (STDs) tested was 14.1%. The total positive rates for each STD (identified by ≥1 specimen) were the following: for C. trachomatis , 11.6%; N. gonorrhoeae , 2.4%; and T. vaginalis , 1.7%. The proportions of positives identified by specimen type were, for C. trachomatis and N. gonorrhoeae , respectively, endocervix, 65 and 40%; urine, 72 and 24%; and vagina, 81 and 72%. The proportions of positives when specimen results were combined were, for C. trachomatis and N. gonorrhoeae , respectively, cervix plus urine, 86 and 49%; cervix plus vagina, 91 and 93%; and vagina plus urine, 94 and 79%. We concluded that STDs were epidemic in this population. Self-collected vaginal swabs identified the highest number of positive test results among single specimens, with the combined cervix-vagina results identifying the highest number of positive results. Self-collected vaginal swab collections are a feasible alternative to cervical specimen collections in this population, and the use of multiple types of specimens increases the positive yield markedly.
Abstract Much attention has been focused on efforts to reduce unintended pregnancy by improving contraceptive use among high-risk women; however, there is limited information to guide interventions to engage young men in contraceptive decision-making. We conducted focus groups of young men, aged 19–26, from diverse racial backgrounds from low-income communities in the San Francisco Bay Area to examine social norms about sexual relationships and how they impact on contraceptive use. The data were analysed using content analysis. A range of relationships were described, however casual relationships predominated. While young men expressed strong desires to avoid pregnancy in casual relationships, the unpredictable nature of relationships, together with low communication and regard for the women involved, made stressing consistent contraceptive use among partners unlikely. The themes expressed by these young men about sex and behaviour in different relationships illustrate a spectrum of decision-making dilemmas and illustrate the inherent difficulty in fully engaging young men in contraceptive decision-making. A strategy is needed to address relationship values, dynamics and condom use beyond STI-prevention frameworks and young women's ability to make appropriate contraceptive choices in light of the inherent difficulties and uncertainty associated with casual relationships. Beaucoup d'attention a été prêtée aux efforts visant à réduire le nombre de grossesses non désirées en augmentant l'usage des contraceptifs chez les femmes à risque élevé; cependant, l'information permettant de guider ces interventions est trop limitée pour que les jeunes hommes s'engagent dans la prise de décision en matière de contraception. Nous avons conduit des groupes de discussion thématiques avec des jeunes hommes, âgés de 19 à 26 ans, d'origines ethniques différentes et issus de communautés à faibles ressources de la Région de la Baie de San Francisco, pour examiner les normes sociales sous-tendant les relations sexuelles et comment elles impactent l'usage des contraceptifs. Les données ont été analysées par la méthode de l'analyse de contenu. Une gamme de relations a été décrite, avec toutefois une prédominance des relations non suivies. Alors que les jeunes hommes ont fortement exprimé le souhait d'éviter les grossesses dans le cadre de relations non suivies, la nature imprévisible de ces relations, parallèlement à un faible niveau de communication et de considération pour les femmes impliquées, font qu'il paraît improbable qu'ils puissent insister auprès de leurs partenaires pour un usage régulier des méthodes contraceptives. Les thèmes exprimés concernant les rapports sexuels et les comportements dans le cadre de relations différentes illustrent une gamme de dilemmes dans les prises de décisions et la difficulté inhérente pour que les jeunes hommes s'engagent pleinement dans la prise de décision relative au recours à des méthodes contraceptives. Il est nécessaire d'élaborer une stratégie pour aborder la valeur et la dynamique des relations, et l'usage du préservatif au-delà de la prévention des IST, ainsi que la capacité des jeunes femmes à faire des choix appropriés en méthodes contraceptives, à la lumière des difficultés inhérentes et des incertitudes associées aux relations occasionnelles. Se ha prestado mucha atención a los esfuerzos por reducir los embarazos no deseados mejorando el uso de anticonceptivos entre mujeres de alto riesgo. Sin embargo, hay poca información para guiar las intervenciones a fin de que los hombres jóvenes participen en las decisiones contraceptivas. A fin de examinar las normas sociales sobre relaciones sexuales y cómo influyen en el uso de anticonceptivos, llevamos a cabo entrevistas en grupo con hombres jóvenes con edades comprendidas entre 19 y 26 años, de diferentes orígenes raciales de comunidades con bajos ingresos en la Bahía de San Francisco. Se analizaron los datos mediante un análisis de contenido. Se describieron toda una serie de relaciones, no obstante, predominaban las relaciones casuales. Aunque los hombres mostraron un fuerte deseo de evitar los embarazos en las relaciones casuales, era improbable que prestaran mucha atención al uso constante de métodos de contracepción entre los compañeros sexuales debido a la naturaleza impredecible de este tipo de relaciones, junto con una falta de comunicación y consideración con las mujeres con las que tenían relaciones. Los temas que estos hombres jóvenes expresaron sobre sexo y conducta en diferentes relaciones ilustran toda una serie de dilemas con respecto a tomar decisiones y destacan la dificultad inherente que tienen a la hora de participar totalmente en las decisiones contraceptivas. Es necesaria una estrategia para abordar los valores en las relaciones así como las dinámicas y el uso de preservativos más allá de las estructuras de prevención de infecciones de transmisión sexual y la capacidad de las chicas de tomar decisiones apropiadas en cuanto a anticonceptivos teniendo en cuenta las dificultades inherentes e incertidumbres vinculadas a las relaciones casuales. Keywords: relationshipsyoung mencontraceptiondecision-makingUSA Acknowledgements This study was supported by National Institute of Child Health and Human Development Grant R01 HD045480.
Despite the large body of extant literature on sexually transmitted infections (STIs) in adolescents and young adults (AYAs), more research on social and environmental contextual factors is needed. Also, further examination of STI indicators by gender remains a critical area of research focus.Anonymous survey data were collected using audio computer-assisted self-interviews in community venues in urban, low-income, STI prevalent, US neighborhoods to reach AYAs, aged 12 to 24 years. Conventional descriptive statistics, bivariate analysis, and multiple logistical regression models were used to assess indicators of a self-reported lifetime prevalence of STIs.Participants (N = 1540) were on average 20.6 years; 57.2% were women, the majority were racial and ethnic minorities (92%), and almost half (49.2%) identified as sexual minorities. Nearly one third (32.%) had 1 or more STIs. As expected, gender differences were identified. For AYA men, being African American/Black, moving residences more than 4 times since kindergarten, and having a history of human immunodeficiency virus testing were each positively associated with STIs. Also, those who strongly disagreed that many young people in their community exchanged sex for money had a significantly lower likelihood of having an STI. For AYA women, exchanging sex for drugs or money, lacking money, which prevented activities, and using marijuana were each associated with STIs.This research extends our understanding of social and environmental contextual influences on AYAs' risk for STIs. It highlights differences in risk exposures that are distinctly different for AYA women and men, suggesting the need for tailored interventions to address their unique economic needs and social challenges.
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