Correlates of Unmet Need for Modern Contraception Among Reproductive-Aged Women Involved in New York City Criminal Legal Systems.

Introduction: The population of women involved in criminal legal systems (WICL), a majority of whom are reproductive-aged, has risen steadily in the United States. They contend with numerous barriers to sexual and reproductive health services resulting in high rates of unmet need for contraception and unintended pregnancy. Materials and Methods: This study included 132 non-pregnancy seeking reproductive-aged WICL enrolled in the baseline assessment of the HIV prevention intervention, "Women on the Road to Health" (WORTH). A multivariate generalized linear logistic regression model with robust estimation examined effects of past 6-month intimate partner violence (IPV; sexual and physical/injurious), past 3-month substance use (binge drinking, cannabis, other illegal drug use), and lifetime mental health diagnoses (anxiety, depression, bipolar disorder) on women's unmet need for modern contraception, adjusting for significant demographic and socioeconomic factors. Results: Women who were younger in age (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.63-0.88) and reporting lifetime diagnoses of anxiety disorders (OR: 13.64; 95% CI: 2.71-68.34) were significantly more likely to meet the criteria for unmet need for modern contraception. Women with a regular gynecologist (OR: 0.11; 95% CI: 0.01-0.86) reporting lifetime diagnoses of bipolar disorder and past 6-month sexual IPV histories (OR: 0.04; 95% CI: 0.002-0.86) were significantly less likely to meet the criteria for unmet need for modern contraception. Conclusions: Distinct mental health diagnoses and experiences of IPV may uniquely impact unmet need for modern contraception among WICL. These findings emphasize the need for a more nuanced comprehension of these relationships to deliver comprehensive and holistic health services that address the intersecting needs of this population.Trial registration: ClinicalTrials.gov NCT01784809. Registered 6 February 2013.

Women with substance use disorders are highly impacted by the overturning of Roe v. Wade: Advocacy steps are urgently needed.

The Supreme Court's ruling to overturn the 1973 Roe v. Wade verdict represents a major setback for women's reproductive freedoms in the United States. This ruling revokes constitutional protection for abortion rights and returns the decision to the states. Since this ruling in June 2022, numerous states have adopted total or near total abortion bans, with many of these bans offering no exception for rape, incest, or nonfatal maternal health risks. Legal experts also warn that this ruling can open the door to restrict contraceptive rights previously protected under the same implied constitutional right to privacy as abortion. Already, this decision has increased momentum for states to place restrictions on specific forms of contraception. Certain groups of women will be disproportionately harmed by these bans, such as women with substance use disorders (SUDs). Women with SUDs face unique barriers to sexual and reproductive health services that exist at the structural level (e.g., criminalization; costs and accessibility), interpersonal level (e.g., higher rates of intimate partner violence) and individual level (e.g., reduced reproductive autonomy). These synergistic barriers interact to produce lower contraceptive use, increased unintended pregnancy rates, and subsequently a greater need for abortion services among this population. This ruling will exacerbate the effects of these barriers on women with SUDs, resulting in even greater difficulties accessing contraceptive and abortion services, and ultimately increasing rates of criminalization among pregnant and parenting women with SUDs. This commentary describes these barriers and highlights potential advocacy steps that are urgently needed to assist reproductive-aged women with SUDs during these challenging times when essential health services are increasingly inaccessible.

Inclusive State Legislation and Reduced Risk of Past-Year Suicide Attempts Among Lesbian, Gay, Bisexual, and Questioning Adolescents in the United States.

OBJECTIVE: This study examines the relationship between state legislation relevant to equality for sexual minorities and past-year suicide attempts among lesbian, gay, bisexual, and questioning (LGBQ) adolescents in the United States. METHODS: Data were aggregated from 24 states that participated in the 2017 Youth Risk Behavior Surveillance System (N = 70,599). We utilized multilevel logistic regression to determine whether observed positive associations between sexual minority identity and past-year suicide attempts differ as a function of 2016 State Equality Index (SEI), an objective measure of state laws and policies affecting equality for sexual minorities. RESULTS: LGBQ adolescents were significantly more likely to report having made a suicide attempt in the past year than heterosexual youth (adjusted odds ratio [AOR]: 3.82; 95% confidence interval [CI]: 3.29-4.44). The 2016 SEI moderated the positive association between sexual minority identity and suicide attempts, with odds of past-year suicide attempts significantly reduced in states with more inclusive legislation (AOR: 0.91; CI: 0.85-0.97). Among sexual minority subgroups, significant effect modifications were found for bisexual (AOR: 0.88; CI: 0.77-0.99) and questioning (AOR: 0.87; CI: 0.78-0.96) - but not gay or lesbian (AOR: 1.10; CI: 0.97-1.24) - adolescents. The effect modification was strongest for bisexual males (AOR: 0.68; CI: 0.47-0.99). CONCLUSIONS: State legislation relevant to equality for sexual minorities differentially affected associations between sexual minority identity and suicide attempts, such that past-year suicide attempts were substantially lower in states with more inclusive legislation. Inclusive state legislation may exert a protective effect on risk for suicide attempts among sexual minority youth.

Availability of informal social support and the impact on health services utilization among women in community corrections who engage in substance use and risky sexual behavior: New York City, 2009-2012.

BACKGROUND: Women under community supervision in the U.S. experience high rates of substance use and HIV/STDs and face multiple barriers to healthcare services. Informal social support, provided by family, friends, and other peers, is important for reducing drug and sexual risk behaviors and improving utilization of healthcare services. The availability of informal social support and the impact on receipt of healthcare services among the growing and highly vulnerable population of sexually-active and drug- and justice-involved women has not been documented. Among this population, this study aims to: 1) describe characteristics of informal social support, including the prevalence of different types, size of networks, and frequency of receiving support; and 2) longitudinally examine the impact of informal social support on receipt of healthcare services, including drug or alcohol counseling/treatment, HIV or STD counseling/education, birth control counseling/education, reproductive healthcare, and individual counseling over a 12-month period. RESULTS: The sample included 306 women in community supervision programs in New York, New York, USA, with a recent history of substance use and risky sexual behavior. At baseline, 96.1% of women reported having at least one friend or family member with whom they could discuss personal or emotional problems, 92.5% had support for tangible aid or service, 83.0% had support for sexual risk reduction, and 80.0% had support for substance use risk reduction. Women with support for substance use risk reduction were more likely than women without this type of support to receive all health services analyzed in this study. Having support for sexual risk reduction was also positively associated will receipt of all services, except reproductive healthcare. Having support for personal or emotional problems was only associated with receiving drug or alcohol counseling or treatment, while having support for tangible aid or service did not impact receipt of any health services. CONCLUSIONS: Engagement of sexually-active and drug- and justice-involved women in health services should address the availability and strengthening of informal social support, particularly ensuring individuals' informal networks allow for discussions on the harms of risky sexual and drug use behaviors. TRIAL REGISTRATION: ClinicalTrials.gov NCT01784809 . Registered 6 February 2013 - Retrospectively registered.

Harnessing the Power of Social Media to Understand the Impact of COVID-19 on People Who Use Drugs During Lockdown and Social Distancing.

OBJECTIVES: This paper uses a social media platform, Reddit, to identify real-time experiences of people who use drugs during the COVID-19 lock-down. METHODS: Reddit is a popular and growing social media platform, providing a large, publicly available dataset necessary for high performance of machine learning and topic modeling techniques. We used opioid-related "subreddits," communities where Reddit users engage in conversations about drug use, to examine COVID-19-related content of posts and comments from March to May 2020. This paper investigates the latent topics of users' posts/comments using Latent Dirichlet Allocation, an unsupervised machine learning approach that uncovers the thematic structure of a document collection. We also examine how topics changed over time. RESULTS: The final dataset consists of 525 posts and 9284 comments, for a total of 9809 posts/comments (3756 posts/comments in r/opiates, 1641 in r/OpiatesRecovery, 1203 in r/suboxone, and 3209 in r/Methadone) among 2342 unique individuals. There were 5256 posts/comments in March; 3185 in April; and 1368 in May (until May 22). Topics that appeared most frequently in COVID-19-related discussions included medication for opioid use disorder experiences and access issues (22.6%), recovery (24.2%), and drug withdrawal (20.2%). CONCLUSIONS: During the first three months of the COVID-19 pandemic, people who use drugs were impacted in several ways, including forced or intentional withdrawal, confusion between withdrawal and COVID-19 symptoms, take-home medication for opioid use disorder issues, and barriers to recovery. As the pandemic progresses, providers and policymakers should consider these experiences among people who use drugs during the early stage of the pandemic.

Associations between Cannabis Use and Sexual Risk Behavior among Women under Community Supervision: A Brief Report.

OBJECTIVES: Cannabis use and sexual risk behavior have been found to co-occur, but more research on these associations is needed among criminal justice-involved women (i.e., courts, jails, or prisons). METHODS: Regression models examined past 90-day cannabis use on unprotected sex, multiple sexual partners, and STIs/HIV among 306 women under NYC community supervision, adjusting for alcohol, other illicit substances, and socio-demographics. RESULTS: Cannabis use, but not alcohol or other illicit substance use, was positively associated with having unprotected sex and multiple sexual partners, but not STIs or HIV. CONCLUSIONS: Criminal justice-involved women may benefit from sexual risk reduction interventions incorporating cannabis content.

Gender-based differential item functioning in the Cannabis-Associated Problems Questionnaire: A replication and extension.

BACKGROUND: Gender bias in measures of cannabis problems may differentially affect how men and women endorse items. This gender invariance might mask, exaggerate, or otherwise obscure true distinctions in experiences of cannabis consequences. METHODS: The Cannabis-Associated Problems Questionnaire (CAPQ), a measure of interpersonal deficits, occupational impairment, psychological issues, and physical side effects related to cannabis use, contained items with gender-based differential item functioning (DIF) in previous work-a finding we aim to replicate and extend (Lavender, Looby, & Earleywine, 2008). RESULTS: In a sample of 4053 cannabis users, gender differences were apparent in global scores on the CAPQ. A DIF analysis revealed two gender-biased items, including one identified previously. Removal of these items did not significantly alter the scale's relation to cannabis use. Gender differences on the CAPQ persisted after removal of the two problematic items, indicating true gender differences still exist in men and women's experiences of cannabis-related consequences. Gender appeared to significantly contribute to scores on the full CAPQ and the short-form of the CAPQ with biased item removed, even after controlling for indices of cannabis use. CONCLUSIONS: These findings suggest that the CAPQ evidences less gender bias than previously thought, perhaps due to diminishing gender-based stereotypes. Future work might opt to use the short form of the CAPQ to minimize gender-based DIF. In addition, potential biases in measures of substance use problems deserve more attention.

Gender-Related Differences in Associations Between Sexual Abuse and Hypersexuality.

BACKGROUND: Individuals with histories of sexual abuse may be more likely to experience sexual-related problems including hypersexuality, but gender-related differences remain unclear. AIM: This online study examined sexual abuse history and hypersexuality by gender among 16,823 Hungarian adults, adjusting for age, sexual orientation, relationship status, education, employment status, and residence. METHODS: An online questionnaire on one of the largest Hungarian news portals advertised this study examining sexual activities in January 2017. 3 categorizations of age-related sexual abuse were examined: child sexual abuse (CSA) occurring at age 13 and earlier (compared to no abuse), adolescent/adult sexual abuse (AASA; compared to no abuse), and CSA and AASA (CSA/AASA; compared to one age-related category of abuse or the other). OUTCOMES: The outcome variable, hypersexuality, was examined as a continuous variable due to the low prevalence of clinical hypersexuality in this sample. 3 multivariate linear regression analyses adjusting for covariates aimed to predict hypersexuality from each category of abuse, along with gender and its interaction with each category. RESULTS: In all models, younger age, non-heterosexual sexual orientation, male gender, single relationship status, less than full-time work, and living in a capital city were associated with hypersexuality, and education was not a significant predictor. CSA, AASA, and CSA/AASA predicted hypersexuality in both men and women. There was a significant interaction between CSA/AASA and gender, such that the relationship between CSA/AASA and hypersexuality was stronger in men than in women. CLINICAL TRANSLATION: Sexual abuse at each developmental time-point may influence hypersexuality among men and women, although the cumulative impact of CSA and AASA on hypersexuality may be particularly relevant among men. STRENGTHS & LIMITATIONS: This is one of the largest studies to examine gender-related differences in the relationship between sexual abuse and hypersexuality. Nevertheless, our study is cross-sectional, and longitudinal work is needed to determine how sexual abuse affects children, adolescents, and adults throughout their lives. CONCLUSION: Developmental impacts of sexual abuse may be considered in a gender-informed fashion in order to develop and optimize effective prevention and treatment strategies for hypersexuality. Slavin MN, Blycker GR, Potenza MN, et al. Gender-Related Differences in Associations Between Sexual Abuse and Hypersexuality. J Sex Med 2020;17:2029-2038.

Child Sexual Abuse and Compulsive Sexual Behavior: A Systematic Literature Review.

PURPOSE OF REVIEW: Information on potential risk factors and clinical correlates of compulsive sexual behavior (CSB) may help inform more effective prevention and treatment measures. Sexual victimization, specifically, child sexual abuse (CSA), has been associated with CSB. RECENT FINDINGS: This systematic review describes 21 studies on the relationship between CSA and CSB. Most studies identified a significant association between CSA and CSB. However, variability in measurements, potential differences in links among community versus clinical samples, relevance of research among college samples, lack of support for gender-related differences, and the need for more longitudinal designs were identified. SUMMARY: Research would benefit from more formalized assessments of CSB across different populations. Prevention efforts should be aimed toward individuals who experienced CSA and/or other abuse, particularly if they report engaging in risky sexual behavior. Individuals with CSB who have experienced sexual abuse may benefit from trauma-focused treatment.

Cannabis and Vulvodynia Symptoms: A Preliminary Report.

Medical marijuana has a long history of use as an analgesic for chronic pain disorders, including dyspareunia (pain during intercourse), a hallmark of the rare chronic pain disorder vulvodynia. Many women's health topics remain under investigated. Few studies address cannabis's potential to treat vulvodynia symptoms despite their dramatic impact on quality of life. Women who had used cannabis and who reported experiencing vulvodynia symptoms (N = 38) completed an online survey assessing symptoms, expectancies regarding cannabis-associated relief from vulvodynia symptoms, cannabis use, and cannabis-related problems. Generally, women expected cannabis to have moderate to large effects on vulvodynia symptoms (d = .63-1.19). Nevertheless, women expected greater relief for burning/stabbing pain than for itching and pain associated with tampon insertion, as well greater relief for dyspareunia than for pain associated with tampon insertion. Those whose symptoms were worse expected more relief from cannabis treatment. Expectations of cannabis-induced relief did not increase frequency of use or problems. These data support the idea that further work is warranted, including placebo-controlled randomized clinical trials to rule out any placebo effects and identify potential adverse side effects from a cannabis treatment for vulvodynia.

Effects of Messaging and Psychological Reactance on Marijuana Craving.

Background: Psychological Reactance Theory asserts that people experience reactance (a motivational state characterized by negative affect and cognition) when they perceive threats to their autonomy. Reactance may lead to "boomerang effects" by which individuals engage in the opposed behavior. Objectives: This experiment sought to determine whether a message encouraging marijuana (MJ) abstinence evoked greater reactance than a harm-reduction message and whether the message and reactance influenced individuals' attitudes, MJ craving, and intent to comply with the message request. Methods: College students and community members (n = 388) participated in an online study where they were randomly assigned to receive a message promoting MJ abstinence or harm reduction. Regression analyses adjusting for MJ use, alcohol use, and age determined the effects of the message and reactance on individuals' attitudes, MJ craving, and intent to comply. Follow-up analyses determined the significant reactance subscales. Results: The abstinence message evoked greater reactance than the harm reduction message and led to less favorable attitudes toward the advocated behavior. Across messages, reactance (specifically negative cognitive appraisal) was related to less favorable attitudes toward the advocated behavior and the study, as well as lower intent to comply. Additionally, reactance (specifically anger) was associated with greater self-reported craving. Conclusions/Importance: Anti-MJ messages designed to discourage use might heighten reactance and inadvertently lead to greater craving and intent to use. The link between reactance and craving may be more affectively mediated than the link between reactance and message rejection.

Aversiveness and Meaningfulness of Uncomfortable Experiences with Edible Cannabis.

Cannabis remains the most frequently used illicit drug in the United States. As its legal status has changed, more people have turned to oral administration ("edibles"). 172 individuals who reported an uncomfortable experience with edible cannabis completed an online survey. Despite the aversive nature of the experience, 62.9% of the sample reported that the edible experience was at least somewhat meaningful and the majority of participants (95.2%) did not report any medical problems. The most common non-medical problem reported was going to bed early or lying down (75.8%). Most participants (69.2%) reported that dose was the key contributor to their negative experience. Participants who rated the experience as more aversive were less likely to use edibles again, r (167) = - .180, p < . 05. In addition, the duration of the aversive experience correlated positively with aversiveness rating, r (167) = . 244, p < . 05. With increased legalization of cannabis, edible use may rise. Dose seems to be associated with uncomfortable experiences with edible cannabis. Notwithstanding these uncomfortable experiences, the vast majority of the sample used cannabis edibles again, reported that the experience was at least somewhat meaningful, and did not report significant problems associated with the experience.

Marijuana Use, Marijuana Expectancies, and Hypersexuality among College Students.

Research supports links between marijuana effect expectancies and risky sexual behaviors among marijuana users, but associations between marijuana expectancies and hypersexuality have yet to be investigated. The current study examined links between marijuana lifetime use and hypersexuality among university students. A hierarchical regression adjusting for gender and alcohol use was used to determine the degree to which marijuana use and expectancies accounted for variance in hypersexuality. Marijuana lifetime use and hypersexuality were significantly and positive related. After adjusting for covariates, perceptual and cognitive enhancement expectancies positively correlated with hypersexuality, while tension reduction and relaxation expectancies negatively correlated with hypersexuality.