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ABSTRACT: Investigations of reproductive health within Lationos living in the United States suggest that sexual behaviors and contraception
use practices vary by ethnicity and between foreign- and US-born adolescents. This article compares high-risk sexual behaviors
and reproductive health among foreign-born Latinas, US-born Latinas, and US-born non-Latinas aged 15–24 years. We recruited
361 females from reproductive health clinics in the San Francisco Bay Area of California between 1995 and 1998; these women
completed an interview that assessed sexual risk behaviors and history of pregnancy, abortion, and sexually transmitted infections.
Current chlamydial and gonococcal infections were detected through biological testing. Among participants aged 15–18 years,
US-born Latinas were more likely to have been pregnant (odds ratio [OR] comparing US-born Latinas and US-born non-Latinas=3.9,
95% confidence interval [CI] 1.3, 11.4), whereas among respondents aged 19–24 years, foreign-born Latinas were more likely
to have been pregnant than US-born Latinas (OR=11.3, 95% CI 1.0, 130.8) and US-born non-Latinas (OR=64.2, 95%CI 9.9, 416.3).
US-born Latinas were most likely to have had an abortion (OR comparing US-born Latinas and US-born non-Latinas=2.0, 95% CI
0.9, 4.7). They were also most likely to have chlamydial infection at study enrollment (8.2% prevalence compared to 2.2% and
1.0% for foreign-born Latinas and US-born non-Latinas, respectively; P=0.009). Reproductive health differences between foreign and US-born females and within the US-born population warrant further
examination and highlight the need for targeted prevention.
KeywordsAbortion-Adolescence-Hispanic Americans-Immigrants-Pregnancy-Sex behavior-Sexually transmitted diseases
Journal of Urban Health 04/2012; 78(4):627-637. · 2.13 Impact Factor
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ABSTRACT: Audio computer-assisted self-interviews (ACASI) are increasingly used in health research to improve the accuracy of data on sensitive behaviors. However, evidence is limited on its use among low-income populations in countries like India and for measurement of sensitive issues such as domestic violence.
We compared reports of domestic violence and three less sensitive behaviors related to household decision making and spousal communication in ACASI and face-to-face interviews (FTFI) among 464 young married women enrolled in a longitudinal study of gender-based power and adverse health outcomes in low-income communities in Bangalore, India. We used a test-retest design. At the 12-month study visit, we elicited responses from each participant through FTFI first, followed by ACASI. At the 24-month visit, we reversed the order, implementing ACASI first, followed by FTFI. Univariable log-linear regression models and kappa statistics were used to examine ACASI's effects on self-reports.
Regression results showed significantly lower reporting in ACASI relative to FTFI at both visits, including for domestic violence (12-month risk ratio [RR] = 0.61, 95% CI = 0.52, 0.73; 24-month RR = 0.74, 95% CI = 0.62, 0.89). Response agreement between interview modes, calculated by kappa scores, was universally low, though highest for domestic violence (12-month κ = 0.45; 24-month κ = 0.48). Older age and greater educational attainment appeared associated with higher response agreement.
Greater reporting in FTFI may be due to social desirability bias for the less sensitive questions and perceptions of therapeutic benefit for domestic violence. These results cast doubt on the appropriateness of using ACASI for measurement of sensitive behaviors in India.
Journal of Interpersonal Violence 01/2011; 26(12):2437-56. · 1.64 Impact Factor
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ABSTRACT: We examined alcohol and marijuana use trajectories among Latino adolescents in the San Francisco Bay Area.
A total of 410 Latino adolescents aged 14-19 years were recruited from community venues from years 2001 to 2004 and followed up for 2 years. In separate models, we identified groups with similar temporal patterns of alcohol and marijuana use using semi-parametric latent group trajectory modeling. Multivariable multinomial logistic regression was used to identify factors associated with the probability of trajectory group membership.
The use of alcohol (76%) and marijuana (55%) in the previous 6 months was common. Three alcohol-use trajectories were identified: low users (18%), moderate users (37%), and frequent users (45%). Low alcohol users (vs. moderate users) were found to be younger in age, preferred Spanish language, and had more parental monitoring. Frequent users were more likely to be male, sexually active, gang exposed, and have less parental monitoring than moderate users. Similarly, three marijuana-use trajectories were identified: low users (36%), moderate users (35%), and frequent users (28%), with similar correlates of group membership.
Urban Latino adolescents' substance use is shaped by complex cultural and environmental influences. Patterns of substance use emerge by early adolescence highlighting the need for timely intervention.
Journal of Adolescent Health 12/2010; 47(6):564-74. · 3.33 Impact Factor
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ABSTRACT: We examined the use of male condoms and the diaphragm following completion of a clinical trial of the diaphragm's HIV prevention effectiveness. In the trial, called Methods for Improving Reproductive Health in Africa (MIRA), women were randomized to a diaphragm group (diaphragm, gel and condoms) or a condom-only control group. At trial exit, all women were offered the diaphragm and condoms.
Our sample consisted of 801 Zimbabwean MIRA participants who completed one post-trial visit (median lapse: nine months; range two to 20 months). We assessed condom, diaphragm and any barrier method use at last sex act at enrolment, final MIRA and post-trial visits. We used multivariable random effects logistic regression to examine changes in method use between these three time points.
In the condom group, condom use decreased from 86% at the final trial visit to 67% post trial (AOR = 0.20; 95% CI: 0.12 to 0.33). In the diaphragm group, condom use was 61% at the final trial visit, and did not decrease significantly post trial (AOR = 0.77; 95% CI: 0.55 to 1.09), while diaphragm use decreased from 79% to 50% post trial (AOR = 0.18; 95% CI: 0.12 to 0.28). Condom use significantly decreased between the enrolment and post-trial visits in both groups. Use of any barrier method was similar in both groups: it significantly decreased between the final trial and the post-trial visits, but did not change between enrolment and the post-trial visits.
High condom use levels achieved during the trial were not sustained post trial in the condom group. Post-trial diaphragm use remained relatively high in the diaphragm group (given its unknown effectiveness), but was very low in the condom group. Introducing "new" methods for HIV prevention may require time and user skills before they get adopted. Our findings underscore the potential benefit of providing a mix of methods to women as it may encourage more protected acts.
Journal of the International AIDS Society 10/2010; 13:39. · 3.26 Impact Factor
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ABSTRACT: The extent to which pregnancy intentions mediate the relationship between individual, familial and cultural characteristics and adolescent pregnancy is not well understood. The role of intentions may be particularly important among Latina teenagers, whose attitudes toward pregnancy are more favorable than those of other groups and whose pregnancy rates are high.
Prospective, time-varying data from 2001-2004 were used to investigate whether two measures of pregnancy intentions, wantedness and happiness, mediated associations between risk factors and pregnancy among 213 Latina adolescents in San Francisco. Participants were tested for pregnancy and interviewed about pregnancy intentions, partnerships, family characteristics and activities every six months for two years. Associations and mediation were examined using logistic regression.
Neither pregnancy intention variable mediated relationships between participant characteristics and pregnancy. After adjustment for other measures, wantedness was strongly associated with pregnancy (odds ratio, 2.6), while happiness was not. Having a strong family orientation was associated with happiness (3.7) but unrelated to pregnancy. Low power in a sexual relationship with a main partner was associated with an elevated risk of pregnancy (3.3). If the pregnancy intentions of all participants were changed to definitely not wanting pregnancy, the estimated decline in pregnancy risk would be 16%.
Pregnancy intentions were important not as mediators but rather as independent risk factors for pregnancy. Differences in pregnancy rates between groups of Latinas may be less a function of intentional choice than of situational factors. Interventions and research should focus on identifying and targeting factors that hinder effective contraceptive use among teenagers who want to avoid pregnancy.
Perspectives on Sexual and Reproductive Health 09/2010; 42(3):186-96. · 1.41 Impact Factor
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ABSTRACT: Using data from a prospective cohort of 555 adolescent girls and boys from a predominantly Latino neighborhood of San Francisco, we examined how well four survey questionnaire items measuring pregnancy intentions predicted the incidence of pregnancy. We also compared consistency of responses among items and assessed how intentions fluctuated over time. Girls experienced 72 pregnancies over two years (six-month cumulative incidence = 8 percent), and boys reported being responsible for 50 pregnancies (six-month cumulative incidence = 10 percent). Although the probability of becoming pregnant generally increased with higher intention to do so, the risk of becoming pregnant was elevated only at the highest response categories for each item. Most pregnancies occurred among teenagers reporting the lowest levels of intention: for instance, 73 percent of pregnancies occurred among girls who reported that they definitely did not want to become pregnant. Considerable change in respondents' intentions were found over short periods of time: 18 percent and 41 percent of responses to the wantedness and happiness items, respectively, changed between six-month survey visits. The development of appropriate strategies to reduce pregnancy among adolescents would benefit from a more nuanced understanding of how teenagers view the prospect of pregnancy and what determines whether they actively protect themselves from unintended pregnancy.
Studies in Family Planning 09/2010; 41(3):179-92. · 1.28 Impact Factor
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ABSTRACT: To determine which condom-use measures best predict biological outcomes in STI/HIV-prevention research.
In a prospective cohort study of 2296 HIV-negative Zimbabwean women aged 18-35 followed for up to 2 years, the authors compared four measures of condom use (use since last visit, use at last sex, frequency of use and count of unprotected acts). The authors evaluated the performance of each in predicting incidence of pregnancy, cervical STIs (chlamydia/gonorrhoea) and HIV.
Over follow-up, 19.3% of women became pregnant, 10.3% acquired a cervical STI, and 6.9% acquired HIV infection. In multivariable analysis, all four condom-use measures were significantly associated with a reduced pregnancy incidence; statistical tests of fit suggest that the frequency of use measure was most predictive. The time to pregnancy was longer for women who, in a typical month during the previous 3 months, reported always using condoms as compared with those who never used a condom (HR 0.19; 95% CI 0.14 to 0.26). Among those women diagnosed as having prevalent chlamydia/gonorrhoea at study enrolment, three of the four reported condom-use measures were associated with a non-significant but decreased risk of incident cervical STI. Reported condom use was associated with an increased risk for cervical STI among women without chlamydia/gonorrhoea at enrolment. None of the condom-use measures were associated with HIV infection.
The frequency of reported condom use measure best predicted pregnancy incidence; however, the authors found no evidence for a clear 'best' condom-use measure for use in STI/HIV prevention research in this population of Zimbabwean women.
Sexually transmitted infections 11/2009; 86(3):231-5. · 2.18 Impact Factor
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ABSTRACT: Challenges in the accurate measurement of sexual behavior in human immunodeficiency virus (HIV) prevention research are well documented and have prompted discussion about whether valid assessments are possible. Audio computer-assisted self-interviewing (ACASI) may increase the validity of self-reported behavioral data. In 2006-2007, Zimbabwean women participated in a randomized, cross-sectional study that compared self-reports of recent vaginal sex and condom use collected through ACASI or face-to-face interviewing (FTFI) with a validated objective biomarker of recent semen exposure (prostate-specific antigen (PSA) levels). Of 910 study participants, 196 (21.5%) tested positive for PSA, an indication of semen exposure during the previous 2 days. Of these 196 participants, 23 (11.7%) reported no sex in the previous 2 days, with no difference in reported sexual activity between interview modes (12.5% ACASI vs. 10.9% FTFI; Fisher's exact test: P = 0.72). In addition, 71 PSA-positive participants (36.2%) reported condom-protected vaginal sex only; their reports also indicated no difference between interview modes (33.7% ACASI vs. 39.1% FTFI; P = 0.26). Only 52% of PSA-positive participants reported unprotected sex during the previous 2 days. Self-report was a poor predictor of recent sexual activity and condom use in this study, regardless of interview mode, providing evidence that such data should be interpreted cautiously.
American journal of epidemiology 10/2009; 170(7):918-24. · 5.59 Impact Factor
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ABSTRACT: Entrenched economic and gender inequities together are driving a globally expanding, increasingly female, human immunodeficiency virus (HIV)/AIDS epidemic. To date, significant population-level declines in HIV transmission have not been observed, at least in part because most approaches to prevention have presumed a degree of individual control in decision making that does not speak to the reality of women's and girls' circumstances in many parts of the world. Such efforts have paid insufficient attention to critical characteristics of the risk environment, most notably poverty and gender power inequities. Even fewer interventions have addressed specific mechanisms through which these inequities engender risky sexual practices that result in women's disproportionately increased vulnerabilities to HIV infection. This article focuses on identifying those mechanisms, or structural pathways, that stem from the interactions between poverty and entrenched gender inequities and recommending strategies to address and potentially modify those pathways. We highlight four such structural pathways to HIV risk, all of which could be transformed: (1) lack of access to critical information and health services for HIV/sexually transmitted infection (STI) prevention, (2) limited access to formal education and skill development, (3) intimate partner violence, and (4) the negative consequences of migration prompted by insufficient economic resources. We argue for interventions that enhance women's access to education, training, employment, and HIV/STI prevention information and tools; minimize migration; and by working with men and communities, at the same time reduce women's poverty and promote gender-equitable norms. In conclusion, we identify challenges in developing and evaluating strategies to address these structural pathways.
Annals of the New York Academy of Sciences 02/2008; 1136:101-10. · 3.15 Impact Factor
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ABSTRACT: Research on the measurement of HIV risk demonstrates that interview mode can affect reporting; however, few studies have applied these findings to assessments of hormonal contraceptive use. This paper examines how audio computer-assisted self-interviewing (ACASI) influenced reports of hormonal contraceptive use and pregnancy among Zimbabwean women.
Using a prospective, randomized, cross-over design, we compared self-reports obtained with ACASI and face-to-face (FTF) interview among 655 women enrolled in a prospective study on hormonal contraceptive use and HIV acquisition. In addition, self-report data were compared to those collected during clinical exams.
Compared to FTF interviews, reports of hormonal contraceptive use were lower in ACASI [odds ratio (OR)=0.6; 95% confidence interval (95% CI)=0.5-0.6], and reports of pregnancy were higher (OR=1.5; 95% CI=1.1-1.9). Both modes of self-report differed from records on contraceptive method disbursement.
Although ACASI yielded higher reports of several reproductive health behaviors, discrepancies between self-reports and clinical data on method disbursement highlight persistent measurement challenges.
Contraception 02/2007; 75(1):59-65. · 2.72 Impact Factor
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ABSTRACT: This study investigates the role of male sexual partners and relationships in determining whether women seek emergency contraception (EC) when needed.
Data on EC use from a clinic-based sample of sexually active women, aged 15 to 30 years, in the San Francisco Bay area (n=497) were analyzed with multivariate logistic regression analysis.
Results show that factors measuring power dynamics, such as male dominant decision making (odds ratio [OR]=4.1, P=.035) and pressure for sex (OR=2.7, P=.006), as well as a strong desire to avoid pregnancy on the part of the male partner (OR=4.2, P <or=.001), have a significant association with the use of EC. However, relationship factors known to be associated with use of other contraceptive methods, such as communication, satisfaction, and commitment, show no association with EC use.
Factors predicting EC use, including male partner and relationship factors, may not always be evident to a clinician, so it is important to include EC as part of routine counseling.
American Journal of Obstetrics and Gynecology 11/2003; 189(4):1093-9. · 3.47 Impact Factor
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ABSTRACT: The need for safe and effective female-controlled methods that protect against sexually transmitted pathogens is widely recognized. Product effectiveness is inextricably bound to use, and, therefore, the needs and preferences of potential consumers must be considered. The degree to which measures of acceptability correlate with actual barrier method use remains unexamined.
The goal was to evaluate associations between measures of acceptability and use of existing over-the-counter barrier methods.
In the San Francisco Bay Area, 510 females aged 15 to 30 years were recruited from reproductive health clinics for this longitudinal study.
Neither hypothetical acceptability nor product choice predicted use. Fewer than 50% of participants who chose a female-controlled method used it. Similarly, method satisfaction was not associated with use (14.3-51.4% of satisfied users used the method again). However, dissatisfaction was predictive of low levels of subsequent use (0-15.3% used the method again). Male condoms were used despite dissatisfaction.
The lack of association among assessments of acceptability, choice, satisfaction, and use suggests a need to reframe how product acceptability is evaluated in prevention research so it is more predictive of method use.
Sex Transm Dis 08/2003; 30(7):556-61. · 2.87 Impact Factor
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ABSTRACT: The objective of this study was to examine the relationship between contraceptive method choice, sexual risk and various demographic and social factors. Data were collected on 378, 15- to 24-year-old women, recruited from health clinics and through community outreach in Northern California. Logistic regression analysis was used to estimate the association of predictors with contraceptive method used at last sex. Asian and Latina women were less likely to use any method. Women who were raised with a religion, or thought they were infertile, were also less likely to use any method. Women with multiple partners were generally less likely to use any method, but were more likely to use barrier methods when they did use one. Few women (7%) were dual method users. Women appear to act in a rational fashion within their own social context and may use no methods at all or use methods that are less effective for pregnancy prevention but offer more protection from sexually transmitted infections.
Contraception 08/2003; 68(1):19-25. · 2.72 Impact Factor
