Examination of the relationship between African American adolescents' condom use at sexual onset and later sexual behavior: implications for condom distribution programs

School-based condom distribution programs have generated considerable controversy across the country. In the present study 249 sexually active African American adolescents who did (n = 119) and did not (n = 130) use a condom during their initial sexual experience were compared to assess whether condom use at the onset of sexual activity was associated with later differences in sexual behavior. The results indicated that youths who used a condom from the onset of sexual activity were more likely to have used a condom in the most recent intercourse occasion, less likely to be diagnosed with a sexually transmitted disease (STD) or to combine substance use with sexual activity, endorsed more positive attitudes toward condoms, and were older when they initiated sexual activity. The findings have implications for condom availability programs and indicate that initial condom use was not associated with earlier onset of sexual activity and was associated with higher rates of precautionary behavior among sexually active minority adolescents.     

Continued high-risk sex among HIV seropositive gay and bisexual men seeking HIV prevention services.

The authors examined HIV risk-related sexual behaviors in an ethnically diverse sample of HIV seropositive gay and bisexual men (N?=?86). Measures of sexual behavior, substance use, condom attitudes, behavior change intentions, and engagement in risk-reducing practices were completed. Thirty-nine percent of the men reported engaging in unprotected anal intercourse in the past 3 months. Unprotected anal intercourse was associated with using nitrite inhalants, sex partners who used substances before sex, and low intentions to change risk behavior. These results highlight the difficulties that people living with HIV infection face in maintaining a lifetime of safer sex and the necessity of integrating clinical and prevention interventions for these persons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual behaviour in young people

A review of the literature from the United Kingdom reveals a progressive reduction in recent decades in the age at first intercourse, an increase in the prevalence of premarital sex to the point of near universality, and a convergence of the sexual behavior of males and females. Over the past 30 years, the median age at first intercourse in the UK has dropped from 16 to 14 years for females and from 15 to 13 years for males. Fewer than 1% of women 16-24 years of age had their first sexual experience within marriage compared with 40% of women 45-59 years old. These trends reflect biologic factors, including earlier age at menarche, and social factors such as liberalization of norms governing sex behavior and peer pressure. Age at first intercourse increases with educational level and social class status. Curiosity is the factor most commonly cited by males as motivating first intercourse, while females identify romantic reasons. Nearly half of young women and over half of young men who have intercourse before the age of 16 years have unprotected sex. Contraceptive use is more likely with casual than steady sex partners. The condom is the most widely used contraceptive method in the early stages of sexual experience, and its use is increasing as a result of awareness of acquired immunodeficiency syndrome. More than two-thirds of young people consider themselves inadequately prepared at first intercourse in terms of information on sexual matters. Although the majority gain their information about sexuality from friends, schools are cited as a preferred source. The importance of sex education is confirmed by the positive association of predominantly school-based information and contraceptive use at first intercourse. There is no evidence that sex education hastens the onset of sexual activity.     

Bacterial translocation in the course of acute pancreatitis: beneficial role of nonabsorbable antibiotics and lactitol enemas

BACKGROUND: In epidemiologic research, information about sexual frequency and condom use is by necessity based on self-reports. This study investigated the reliability of self-reported sexual behavior in 162 heterosexual partnerships. METHODS: Subjects were part of a larger study of condom use and sexually transmitted diseases (STD) conducted in two Baltimore STD clinics from 1990 to 1992. Partners were enrolled on the same day and were interviewed separately. Information about sexual activity and condom use was collected using a retrospective calendar for the 30 days before enrollment. RESULTS: Participants were predominantly young, unmarried African-Americans. Based on Spearman's correlation coefficients and kappa statistics, the authors found only fair agreement (K = 0.43; r = 0.51) between partner reports of overall condom use for the 30-day period before the interview. Correlation coefficients ranged from 0.43 for frequency of any sexual activity to 0.56 for number of days on which vaginal intercourse occurred. CONCLUSIONS: Partner agreement for condom use and frequency of sexual activity decreased as the recall period increased. Higher partner agreement was observed for questions with definite answers compared to the more open-ended sexual behavior questions. These findings indicate potential reporting bias in self-reports of sexual behavior in a population at high risk for STDs.     

Sexual behavior in young adulthood: A population-based twin study.

Objective: With behavior genetic analyses of data from young adult twins, we evaluated theoretical perspectives that differentially emphasize biological dispositions, social/cultural factors, or universal pathways to explain individual differences in sexual behaviors. Design: We fit biometric sex limitation models to three aspects of sexual behavior reported by 4,925 Finnish twins ages 23-27. Main Outcome Measure: From a postal questionnaire, we obtained self-report information on initiation/abstinence of sexual intercourse, onset age, and number of sexual partners. Results: Genetic and non-shared environmental influences were significant for all three measures. There were trends for common environmental influences on initiation and, in females, age at first intercourse. Some differential effects in males and females were found. Results comparing onset age and number of partners among experienced twins from pairs concordant and discordant for initiation found genetic and environmental influences on initiation/abstinence overlapped those found for the other aspects of sexual behavior. Conclusions: These results document genetic variation in individual differences in sexual behavior of young adults. Incorporating genetic dispositions into integrated models of sexual behavior will facilitate more effective health promotion and risk taking intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epidemiology of herpes simplex virus type 2 infections in a high-risk adolescent population

The seroprevalence of infection with type 2 herpes simplex virus (HSV-2) was determined in 135 adolescents detained in a juvenile detention facility. A total of 16% of enrollees were seropositive for HSV-2. Age of onset of sexual intercourse, number of lifetime partners, frequency of condom use, and history of sexually transmitted diseases did not predict HSV-2 seropositivity.     

Balloon angioplasty combined with primary stenting versus balloon angioplasty alone in femoropopliteal obstructions: A comparative randomized study

PURPOSE: The objective of this research is to describe aspects of the organization of adolescent sexual behavior in order to understand factors associated with risk for sexually transmitted diseases (STD). METHODS: Subjects were 82 females (ages 16-19 years; 77% African-American) participating in a larger STD study. Subjects completed diaries for each coital event, recording date of event, partner initial, condom use, and use of drugs or alcohol before intercourse. Partner change was defined as any event for which the sex partner initials differed from those listed for the most recent previous coital event. RESULTS: The 82 subjects recorded 1265 coital events; the average span of the records was 10 weeks. Intercourse was least likely on Sundays (154 of 1265; 12.2%) and most common on Friday and Saturday (221 of 1265 for each day; 17.5%). The proportion of coital events associated with drugs or alcohol increased from Sunday to Saturday, although the proportion of coital events in which a condom was used did not vary significantly. Intercourse was most common in spring and summer, and least frequent in winter. CONCLUSIONS: These data indicate substantial temporal organization of adolescent sexual behaviors that may be related to risk of sexually transmitted diseases. Some STD-preventive interventions may be most effective when targeted to higher risk times.     

How can parents make a difference? Longitudinal associations with adolescent sexual behavior.

Parents have the potential to protect against adolescent sexual risk, including early sexual behavior, inconsistent condom use, and outcomes such as pregnancy and sexually transmitted infections (STIs). Identification of the specific parenting dimensions associated with sexual risk in adolescence and young adulthood is necessary to inform and focus prevention efforts. The current study examined the relation of proximal (e.g., discussions of sexual costs) and distal (e.g., parental involvement, relationship quality) parenting variables with concurrent and longitudinal adolescent sexual behavior. The National Longitudinal Study of Adolescent Health (Add Health) provided a nationally representative sample with information about the family using adolescent and parent informants. Longitudinal information about sexual risk included adolescent condom use and adolescent sexual initiation, as well as young adult unintended pregnancy, reports of STIs, and biological assay results for three STIs. Higher parent–adolescent relationship quality was associated with lower levels of adolescent unprotected intercourse and intercourse initiation. Better relationship quality was also associated with lower levels of young adult STIs, even when accounting for prior sexual activity. Unexpectedly, more parent reports of communication regarding the risks associated with sexual activity were negatively associated with condom use and greater likelihood of sexual initiation. These results demonstrate that parents play an important role, both positive and negative, in sexual behavior, which extends to young adulthood, and underscores the value of family interventions in sexual risk prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inhibition conflict and alcohol expectancy as moderators of alcohol's relationship to condom use.

Inhibition conflict theory predicts that alcohol will decrease condom use only among individuals who are highly conflicted about using a condom, whereas expectancy theory predicts such an effect only among individuals who hold strong beliefs about alcohol's effects on sexual risk taking. In Study 1, the first of these two theories was tested using a newly developed measure of conflict. Data from 308 college students who reported on the first time they had sexual intercourse with their most recent partner (FMRP) supported the utility of this measure and showed that quantity of alcohol consumed was negatively associated with condom use only among high-conflict individuals. In Study 2, 17–25-year-old respondents reported on their first sexual intercourse, FMRP, and last intercourse (ns = 465, 1136, and 984, respectively). In a simultaneous test of both inhibition conflict theory and expectancy theory, amount of alcohol consumed was found to be negatively associated with condom use at first intercourse among individuals high in both conflict and expectancy, at FMRP among high-expectancy individuals, and at last intercourse among high-conflict individuals. These results lend partial support to both theories of alcohol's effects and suggest that an integration of these two perspectives will ultimately be required if researchers are to model adequately alcohol's effects on human social behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual behavior among U.S. high school students, 1990-1995

CONTEXT: High rates of unintended pregnancy and sexually transmitted diseases (STDs), including HIV infection, among adolescents are major public health concerns that have created interest in trends in teenage sexual activity. METHODS: Nationally representative data from Youth Risk Behavior Surveys conducted in 1990, 1991, 1993 and 1995 are used to examine levels of sexual experience, age at first intercourse, current sexual activity and condom use at last intercourse among students in grades 9-12. RESULTS: The proportion of students who reported being sexually experienced remained at 53-54% from 1990 through 1995, while the percentage of sexually active students who used condoms at last intercourse rose from 46% to 54% between 1991 and 1995. Black students were more likely than white students to report being sexually experienced, being currently sexually active and having had four or more lifetime sexual partners; black students also reported a significantly younger age at first intercourse. Gender differences in sexual behavior were found more frequently among black students than among white or Hispanic students. CONCLUSIONS: Although levels of sexual experience for high school students in the United States have not risen during the 1990s, a very high percentage of students continue to be at risk for unintended pregnancy and STDs, including HIV infection.     

Telethermographic studies on the effect of immunoglobulins (Beriglobin) on heat radiation behavior in radiodermatitis

OBJECTIVES: To determine the criterion-related validity of alternative approaches to the measurement of sexual intercourse using sexually transmitted diseases (STD) as a biomarker (the criterion). STUDY DESIGN: Analyses are based on an urban sample of 255 adolescent women, 15 to 19 years of age, treated for genitourinary infections with Neisseria gonorrhoeae, Chlamydia trachomatis or Trichomonas vaginalis who returned 3 months later for reexamination. Subjects completed self-administered questionnaires at enrollment and at 3 months. Genitourinary cultures were obtained at enrollment, 2 to 4 weeks later at a test-of-treatment visit (TOT), and at 3 months. RESULTS: Two hundred fourteen of the 255 adolescents also returned for a TOT culture; 186 of these 214 (73%) were free of infection 2 to 4 weeks after enrollment and 30% (56/186) acquired a subsequent STD by 3 months. The validity of questions about sexual behavior differed. No adolescent who denied interim intercourse by reporting "0" sexual partners or "0" coitions acquired an interval STD. Adolescents who denied regular intercourse (vaginal sex) or failed to indicate the number of interim coitions were at high risk for new STD-23% and 21%, respectively. A new measure of sexual intercourse using both the number of sexual partners and the number of coitions contained no missing data; adolescents classified as not having had interim sexual intercourse were free of infection at 3 months, whereas 32% of those who reported intercourse acquired an interim infection. CONCLUSIONS: These data suggest that high-risk urban adolescent women can accurately report whether they have engaged in vaginal intercourse. The validity of the report appears sensitive to the wording and content of the questions.     

Correlates and predictors of HIV risk among inner-city African American female teenagers.

Objective Design: For human immunodeficiency virus (HIV)-related prevention initiatives to be most effective, they should be broad-based and incorporate multiple domains of influence. This study tested how several ecodevelopmental domains influenced HIV-risk related attitudes and behaviors in a community sample of African American female teens (N = 242). Main Outcome Measures: Outcome measures were number of partners, frequency of intercourse, number of pregnancies, abstinence/condom use, HIV/AIDS-related attitudes and behaviors, and HIV testing. Results: Structural Equation Modeling revealed many direct paths from ecodvelopmental domains to risky sexual behaviors. The findings include having more partners was associated with parental alcohol-related problems, more drug use, and a younger age at first intercourse. More frequent intercourse was associated with less cultural pride and more drug use. More pregnancies were related to a younger age at first intercourse and parental alcohol problems. HIV testing was associated with having experienced sexual abuse, an older age at first intercourse, and stronger self-efficacy. Conclusions: Prevention programs that focus on risk reduction could expand their focus beyond sexual behavior to include a broad-range of psychosocial domains that are associated with HIV-risk. The effectiveness of prevention programs should be monitored carefully for appropriateness in different ethnic groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reinforcement value of unsafe sex as a predictor of condom use and continued HIV/AIDS risk behavior among gay and bisexual men.

The pleasure or reinforcement value of high-risk sex may be an important influence on success in risk reduction efforts. Seronegative gay and bisexual men (N?=?297) completed measures assessing their unprotected and safer sex practices, as well as measures of cognitive and skill factors and a measure assessing the subjective reinforcement value of unprotected anal intercourse. Regression analyses showed that the reinforcement value of unprotected anal intercourse accounted for variance in predicting levels of condom use above that that could be accounted for by factors such as knowledge, behavior change intentions, perceived vulnerability, condom attitudes, and sexual communication skills. Only reinforcement value of unprotected sex and substance use significantly predicted how frequently participants engaged in high-risk sex. Increased attention to the valence of sexual reinforcers will improve HIV risk reduction models and enhance AIDS prevention efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of genital human papillomavirus infection among cytologically normal women attending the University of New Mexico student health center

OBJECTIVES: To confirm the risk factors for genital human papillomavirus (HPV) infection. GOAL OF THIS STUDY: To investigate risk factors for HPV detection apart from the correlated risk factors for cervical neoplasia. STUDY DESIGN: Cervical human papillomavirus (HPV) DNA was assessed in 357 cytologically normal women attending the University of New Mexico student health center. Cervical swab samples were obtained for HPV DNA detection and typing using a PCR-based DNA amplification system. Possible determinants of cervical HPV were examined including age, ethnicity, history of sexually transmitted disease, oral contraceptive use, smoking, age at first intercourse, lifetime number of sex partners, marital status, and history of pregnancy. RESULTS: A 44.3% overall prevalence of cervical HPV was observed. On univariate analysis, factors associated with increasing HPV prevalence included higher lifetime number of sex partners and single marital status. After adjustment for potential confounding variables, we found that HPV prevalence increased with higher lifetime number of sexual partners. CONCLUSION: These findings, along with those from the companion reports in this issue of the journal, support the sexual route of transmission of the virus.     

HIV risk correlates among non-injection cocaine dependent men in treatment

Guided by the AIDS Risk Reduction Model (ARRM), psychosocial correlates of HIV risk behavior were examined among noninjection cocaine dependent, heterosexual men (NI-CD-HM) in treatment. Subjects (N = 111) completed a structured interview to measure ARRM mediating variables and HIV risk behaviors. The results indicated that greater perceived susceptibility to contracting HIV, lower sexual self-efficacy, higher lifetime incidence of sexually transmitted diseases, and being under the influence of alcohol or other drugs during sex predicted having more sexual partners in the month prior to admission. Despite adequate knowledge of safer sex guidelines, subjects remained misinformed regarding certain aspects of HIV transmission. Men who perceived that their partners viewed condoms more positively and who exchanged drugs for sex were more likely to use condoms, yet condom use skills were typically inadequate to ensure effective prevention. These results suggest that HIV prevention interventions among NI-CD-HM should focus on improving knowledge, enhancing beliefs in the capacity to enact safer sex behaviors for preventing HIV and other STDs, building relevant skills (e.g., condom use, open sexual communication between partners), and emphasizing psychoactive substance abstinence. Couple interventions, in which partners actually rehearse safer sex negotiations, may be particularly effective in this regard.     

Prioritizing education about condom use among sexually active adolescent females

Many factors have been shown to influence condom use among adolescents, including negative experiences with prior use, risk-taking behaviors, perception of condom efficacy, and self-efficacy in obtaining and using condoms. In order to help prioritize topics for clinic-based education, this study attempted to determine which factors are most significantly associated with planned condom use. A 53-item questionnaire was administered to sexually active females presenting consecutively to an adolescent clinic. Two hundred ethnically and religiously diverse patients, with a median age of 17 years, participated. Median age at first sexual encounter was 15. Median number of lifetime partners was 2, with a median of 1 partner in the last year. Past condom use was reported by 88%, with 22% always, 38% usually, and 26% occasionally using condoms. Only 47% had used condoms during their most recent sexual encounter. Negative experiences with condom use were reported by 85%. Only 54% stated they would definitely use condoms during their next sexual encounter. Intent to use condoms in the future was significantly associated with both past use and fear of HIV infection. Intent was not significantly associated with most prior negative experiences, perception of condom efficacy in preventing STDs and pregnancy, or other perceived benefits of condom use. Thus, this novel approach to prioritizing topics revealed that health education among a clinic-based population should emphasize condom use from the onset of sexual activity, as well as its efficacy in preventing HIV infection.     

Patterns of condom use among adolescents: the impact of mother-adolescent communication

OBJECTIVES: The association between the timing of discussions about condoms between mother and adolescent and adolescents' condom use during their first and subsequent sexual encounters was examined. METHODS: Sexually active adolescents reported whether and when they discussed condoms with their mother and answered questions about their own condom use. RESULTS: Mother-adolescent discussions about condoms that occurred prior to sexual debut were strongly associated with greater condom use during first intercourse and most recent intercourse, along with greater lifetime regular condom use. CONCLUSIONS: Discussions about condoms prior to sexual debut are important in promoting condom use among adolescents.     

Using the theory of reasoned action (TRA) to understand the decision to use condoms in an STD clinic population

The theory of reasoned action (TRA) provides useful information when designing health education interventions. In this study, 703 heterosexual STD clinic clients responded to a TRA-based survey. With steady partners, social norms and attitudes toward condom use were significant predictors of intention for both men and women. The interaction of attitude and norm increased prediction for men (R = .64, p < 0.001) and women (R = .70, p < 0.001). With casual partners, attitude was a predictor for men and social norm was a predictor for women. Prior use of condoms increased prediction for men (R = .38, p < 0.001) and women (R = .47, p < 0.001). Findings suggest that, in addition to traditional TRA model variables, the relationship between sexual partners and the individual's prior experience with condom use should be incorporated into attempts to understand this complex, dyadic behavior. Examining specific outcome and normative beliefs also provides important information for intervention design.     

Trends in attitudes and behaviour relevant to AIDS in Ugandan community

Behaviour-related preventive measures are still the main weapon against the spread of AIDS. Intensive AIDS prevention and control activities conducted over the last ten years need to be evaluated on the basis of their impact on attitudes and behaviour relevant to AIDS. The main objective of this study was to document and evaluate trends in attitudes and behaviour relevant to AIDS in a Ugandan community over a seven year follow up period. The study was a longitudinal community-based closed cohort. Periodic surveys were conducted on the study group and data on condom use, attitudes about condoms, rates of sexual partner change and reported frequency of sexually transmitted diseases were collected in all surveys. Data reported are from surveys conducted during 1987, 1992 and 1994 in which similar questions were asked and emerging trends identified. Reported condom use ever, increased from 3.9% in 1987 to 10.1% in 1992 and to 27.2% in 1994. This is a 7.3 fold increase over seven years. In females, reported use of condoms increased from 1.2% in 1987 to 18.2% in 1994 while in males it increased from 6.9% to 35.3% over the same period. In this study group there are still more people opposed to the ongoing intensive condom campaign than there are those supporting it. The percentage supporting the campaign was 28% in 1987, 26% in 1992 and 40.8% in 1994. This is a rising trend. The rate of sexual partner change has declined. During the baseline survey, 26.5% of the respondents reported that they had intercourse with two or more sexual partners in the six months period before the interview. This proportion decreased to 6.8% in 1992 but then increased to 17.1% in 1994. During the baseline survey, 2.6% of the study group reported that they had sexual intercourse with six or more partners during the six months period before the interview but during the 1992 and 1994 surveys, no one reported sexual intercourse with more than five partners during a similar period. The reported frequency of sexually transmitted diseases during a twelve month recall period, reflecting STD incidence, decreased from 3.5% in 1992 to 1.9% in 1994. In conclusion during the seven year followup period of this community-based closed cohort, we have identified a sharp increase in condom use, a reduced rate of sexual partner change and a decline in the reported frequency of sexually transmitted disease. The percentage of people supporting the condom campaign is rising. These are some of the outstanding outcomes of the AIDS prevention activities conducted in the country over the last 10 years.     

African-American adolescents' knowledge, health-related attitudes, sexual behavior, and contraceptive decisions: Implications for the prevention of adolescent HIV infection.

195 African-American adolescents completed measures of knowledge related to AIDS, attitudes toward condoms, health locus of control, vulnerability to HIV infection, peer sexual norms, personal sexual behavior for the past 6 mo, and contraceptive preferences. Hotelling's T–2 tests revealed that girls were more knowledgeable about AIDS, reported fewer sexual partners, held more positive attitudes toward precautionary sexual behavior, and perceived themselves to have greater control than boys. Five variables accounted for 44% of the variance in condom use: condom use from the 1st intercourse occasion, earlier grade in school, lower belief in an external locus of control, and higher scores on the Effect on Sexual Experience and Self-Control subscales of the Condom Attitude Scale. Implications for the content, format, and timing of HIV prevention with African-American adolescents are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)