A prospective study of psychological distress and sexual risk behavior among black adolescent females.

OBJECTIVE: The purpose of the study was to examine the association between adolescents' psychological distress and their sexually transmitted disease/human immunodeficiency virus (STD/HIV)-associated sexual behaviors and attitudes. METHOD: Sexually active black adolescent females (N = 522) completed, at baseline and again 6 months later, a self-administered questionnaire that assessed sexual health attitudes and emotional distress symptoms (using standardized measures, alpha =.84), a structured interview that assessed STD/HIV-associated sexual risk behaviors, and a urine screen for pregnancy. RESULTS: In multivariate analyses, controlling for observed covariates, adolescents with significant distress at baseline were more likely than their peers, after 6 months, to be pregnant (adjusted odds ratio [AOR]: = 2.0), have had unprotected vaginal sex (AOR = 2.1), have nonmonogamous sex partners (AOR = 1.7), and not use any form of contraception (AOR = 1.5). Additionally, they were also more likely to: perceive barriers to condom use (AOR = 2.2), be fearful of the adverse consequences of negotiating condom use (AOR = 2.0), perceive less control in their relationship (AOR = 2.0), have experienced dating violence (AOR = 2.4), feel less efficacious in negotiating condom use with a new sex partner (AOR = 1.6), and have norms nonsupportive of a healthy sexual relationship (AOR = 1.7). DISCUSSION: The findings suggest that psychological distress is predictive over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors and high-risk attitudes. Brief screening to detect distress or depressive symptoms among adolescent females can alert the clinician to the need to conduct a sexual health history, initiate STD/HIV-preventive counseling, and refer for comprehensive psychological assessment and appropriate treatment. Among adolescents receiving STD treatment, those with even moderate emotional distress may be at heightened risk for further unhealthy outcomes. STD/HIV interventions should also consider psychological distress as one potential risk factor that may impact program efficacy.

Correlates of adolescent females' worry about undesired pregnancy. the importance of partner desire for pregnancy.

STUDY OBJECTIVE: The purpose of this study was to determine correlates of worry about pregnancy among a high-risk sample of low-income African-American adolescent females. Specifically, we tested the hypothesis that perceived male partner desire for pregnancy and level of sexual communication would be independently associated with adolescent females' worry about becoming pregnant. DESIGN: A survey of sexually active African-American adolescent females, 14-18 years of age. SETTING: Recruitment was conducted in low-income neighborhoods of Birmingham, Alabama, characterized by high rates of unemployment, substance abuse, violence, and teen pregnancy. PARTICIPANTS: Adolescents (N = 522) completed a survey and a face-to-face interview, and provided a urine specimen for pregnancy testing. MAIN OUTCOME MEASURE: Nonpregnant adolescents reporting steady relationships with a male sex partner (over the past 6 months) and indicating no immediate desire to become pregnant were included in the analysis (n = 196). Two questionnaire items assessed level of worry about becoming pregnant. RESULTS: Compared to adolescent females reporting their partner did not desire pregnancy, those perceiving their partner desired pregnancy were nearly three times more likely to experience high worry about becoming pregnant (AOR = 2.85; P =.009). Engaging in sex unprotected by a condom was an equally important correlate of high worry (AOR = 2.84; P =.013). Level of communication between partners about pregnancy prevention was not significant. CONCLUSIONS: Adolescent females may experience high worry about becoming pregnant due to desires of their male partner as well as their recent sexual risk behavior.

Parent-adolescent communication and sexual risk behaviors among African American adolescent females.

OBJECTIVE: To examine associations between parent-adolescent communication about sex-related topics and the sex-related communication and practices of African American adolescent females with partners, as well as their perceived ability to negotiate safer sex. DESIGN: A theory-guided survey and structured interview were administered to 522 sexually active African American females 14 to 18 years old. Recruitment sites were neighborhoods with high rates of unemployment, substance abuse, violence, and sexually transmitted diseases. Multivariate analyses, controlling for observed covariates, were used to identify the association of less frequent parent-adolescent communication with multiple assessed outcomes. RESULTS: Less frequent parent-adolescent communication (scores below the median) was associated with adolescents' non-use of contraceptives in the past 6 months (adjusted odds ratio [AOR] = 1.7) and non-use of contraceptives during the last 5 sexual encounters (AOR = 1.6). Less communication increased the odds of never using condoms in the past month (AOR = 1.6), during the last 5 sexual encounters (AOR = 1.7), and at last intercourse (AOR = 1.7). Less communication was also associated with less communication between adolescents and their sex partners (AOR = 3.3) and lower self-efficacy to negotiate safer sex (AOR = 1.8). CONCLUSIONS: The findings demonstrate the importance of involving parents in human immunodeficiency virus/sexually transmitted disease and pregnancy prevention efforts directed at female adolescents. Pediatricians and other clinicians can play an important role in facilitating parent-adolescent communication about sexual activity.

Correct condom application among African-American adolescent females: the relationship to perceived self-efficacy and the association to confirmed STDs.

PURPOSE: To assess condom application ability and the relationship between perceived ability and demonstrated ability. Also, to examine the association between high-demonstrated condom application ability and recent sexual risk behaviors and laboratory-diagnosed sexually transmitted diseases (STDs) among African-American adolescent females. METHODS: A purposeful sample of sexually active African-American females (n = 522) completed a structured interview and provided vaginal swab specimens for STD testing. Subsequent to the interview, adolescents demonstrated their condom application skills using a penile model. A 9-item scale assessed adolescents' perceived self-efficacy to apply condoms. Sexual risk behaviors assessed by interview were noncondom use at last intercourse and the last five intercourse occasions for steady and casual sex partners as well as any unprotected vaginal sex in the past 30 days and the past 6 months. RESULTS: Approximately 28% of the sample tested positive for at least one STD and nearly 26% self-reported a history of STDs. Controlled analyses indicated that adolescents' self-efficacy for correct use was not related to demonstrated skill. Adolescents' demonstrated ability was not related to any of the sexual risk behaviors. Likewise, recent experience applying condoms to a partner's penis and demonstrated ability were not related to laboratory-diagnosed STDs or self-reported STD history. CONCLUSIONS: Adolescents may unknowingly be at risk for human immunodeficiency virus and STD infection owing to incorrect condom application. Further, high-demonstrated ability to apply condoms was not related to safer sex or STDs. Reducing sexual risk behaviors may require more than enhancing adolescent females' condom application skills and may require addressing other relational skills.

HIV/STD-protective benefits of living with mothers in perceived supportive families: a study of high-risk African American female teens.

BACKGROUND: The joint influence of living with the mother in a perceived supportive family may be an important HIV/STD-protective factor among sexually active female adolescents. METHODS: Sexually active African American female adolescents (N = 522) completed a self-administered survey and structured interview. Adolescents scoring high on family support and reporting that their mother lived with them were compared with the remaining adolescents in respect to unprotected vaginal sex (past 30 days), sex with a non-steady partner (past 6 months), communication with sex partners, attitudes toward condoms, and perceived ability to negotiate condom use. Logistic regression analyses controlled for the influence of parent-adolescent communication about sex and parental monitoring. RESULTS: Adolescents residing with their mothers in a perceived supportive family were more likely to communicate with their sex partners about sexual risk (OR = 1.53). They were less likely to report sex with a non-steady partner (OR = 0.51) or having unprotected sex with a steady partner (OR = 0.52) or any partner (OR = 0.55). CONCLUSIONS: Controlled analyses suggest that living with the mother in a perceived supportive family is an important HIV/STD-protective factor among female adolescents. HIV/STD prevention programs for female adolescents that include the mothers may promote positive and lasting effects.

Condom carrying is not associated with condom use and lower prevalence of sexually transmitted diseases among minority adolescent females.

BACKGROUND: Most of the studies associated with condom carrying and use have been conducted with adults. Because minority teenage females are particularly at risk for STD/HIV infection, further investigations specifically focusing on this population are warranted. GOAL: To determine whether observed condom carrying among adolescent females was associated with multiple measures of self-reported condom use, self-reported history of sexually transmitted diseases, and prevalence of biologically confirmed sexually transmitted diseases. METHODS: For this study, 522 sexually active African American adolescent females were recruited from low-income neighborhoods in Birmingham, Alabama. Measures of self-reported condom use, STD history, and condom carrying were collected. Adolescents were also tested for three prevalent sexually transmitted diseases. RESULTS: At the time of the assessment, 8% of the adolescents were observed to have a condom with them. Condom carrying was not found to be significantly associated with condom use and prevalence of sexually transmitted diseases. CONCLUSION: Condom carrying may not be an important outcome of sexually transmitted disease/HIV prevention programs designed to reduce HIV/sexually transmitted disease risk among adolescent females.

Parental monitoring: association with adolescents' risk behaviors.

CONTEXT: Contemporary threats to adolescents' health are primarily the consequence of risk behaviors and their related adverse outcomes. Identifying factors associated with adolescents' risk behaviors is critical for developing effective prevention strategies. A number of risk factors have been identified, including familial environment; however, few studies have examined the impact of parental monitoring. OBJECTIVE: To examine the influence of less perceived parental monitoring on a spectrum of adolescent health-compromising behaviors and outcomes. Design. Survey. SETTING: A family medicine clinic. Participants. To assess eligibility, recruiters screened a sample of 1130 teens residing in low-income neighborhoods. Adolescents were eligible if they were black females, between the ages of 14 and 18 years, sexually active in the previous 6 months, and provided written informed consent. Most teens (n = 609) were eligible, with 522 (85.7%) agreeing to participate. MAIN OUTCOME MEASURES: Variables in 6 domains were assessed, including: sexually transmitted diseases, sexual behaviors, marijuana use, alcohol use, antisocial behavior, and violence. RESULTS: In logistic regression analyses, controlling for observed covariates, adolescents perceiving less parental monitoring were more likely to test positive for a sexually transmitted disease (odds ratio [OR]: 1.7), report not using a condom at last sexual intercourse (OR: 1.7), have multiple sexual partners in the past 6 months (OR: 2.0), have risky sex partners (OR: 1.5), have a new sex partner in the past 30 days (OR: 3.0), and not use any contraception during the last sexual intercourse episode (OR: 1.9). Furthermore, adolescents perceiving less parental monitoring were more likely to have a history of marijuana use and use marijuana more often in the past 30 days (OR: 2.3 and OR: 2.5, respectively); a history of alcohol use and greater alcohol consumption in the past 30 days (OR: 1.4 and OR: 1.9, respectively); have a history of arrest (OR: 2.1); and there was a trend toward having engaged in fights in the past 6 months (OR: 1.4). CONCLUSIONS: The findings demonstrate a consistent pattern of health risk behaviors and adverse biological outcomes associated with less perceived parental monitoring. Additional research needs to focus on developing theoretical models that help explain the influence of familial environment on adolescent health and develop and evaluate interventions to promote the health of adolescents.

Correlates of using dual methods for sexually transmitted diseases and pregnancy prevention among high-risk African-American female teens.

PURPOSE: To identify correlates of consistent dual-method use among African-American female adolescents at risk of sexually transmitted diseases (STDs) and pregnancy. METHODS: A convenience sample of 522 sexually active female teens attending adolescent medicine clinics, health department clinics, and school health classes volunteered. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a questionnaire and a face-to-face interview and provided vaginal swab specimens for laboratory diagnosis of STDs. Those reporting use of condoms and at least one other method of contraception, for each of the last five occasions they had sex were classified as consistent dual-method users. The questionnaire assessed frequency of adolescents' communication with their parents and partners about sex. The questionnaire also assessed two measures of parental supervision and adolescents' desire to avoid pregnancy. Multiple logistic regression assessed the independent contribution of each correlate of consistent dual-method use. RESULTS: Seventy-one adolescents (13.6%) were classified as consistent dual-method users. A strong desire to avoid pregnancy was the most influential correlate of consistent dual-method use [odds ratio (OR) =2.3]. Adolescents reporting that their parents generally knew whom they were with (OR = 2.0) and those reporting more frequent communication with parents (OR = 1.9) were also more likely to be consistent dual users. CONCLUSION: The findings suggest the need for research to examine the efficacy of interventions building on adolescent females' desire to avoid pregnancy. Study findings also suggest that interventions promoting improved parent-adolescent communication and improved parental supervision may contribute to adolescents' use of dual methods for STD and pregnancy prevention.

Socioeconomic status and self-reported gonorrhea among African American female adolescents.

BACKGROUND: Socioeconomic status is often used to explain race differences in sexually transmitted diseases (STDs), yet the independent association of socioeconomic status and STDs among adolescents has been understudied. OBJECTIVE: To examine the associations between socioeconomic status and self-reported gonorrhea among black female adolescents, after controlling for sexual risk behaviors. METHODS: Interviews and surveys were completed by 522 sexually active black adolescent females residing in low-income urban neighborhoods. RESULTS: Adolescents whose parents were unemployed were more than twice as likely to report a history of gonorrhea, compared with those with employed parents. Adolescents living with two parents were less likely to report a history of gonorrhea. CONCLUSIONS: The results of this study indicate that gonorrhea is associated with low socioeconomic status among black adolescent females regardless of the level of sexual risk behaviors. Lower socioeconomic status may be an marker for risky sociosexual environments.

Correlates of unprotected vaginal sex among African American female adolescents: importance of relationship dynamics.

OBJECTIVE: To determine the associations between the frequency of unprotected vaginal sex (UVS) and female adolescents' perceptions, particularly their perceptions of relationship dynamics. DESIGN: Cross-sectional study of 522 African American female adolescents enrolled in a sexually transmitted disease (STD) and human immunodeficiency virus prevention intervention trial. SETTING AND PARTICIPANTS: A volunteer sample of adolescents recruited from neighborhoods characterized by high rates of unemployment, substance abuse, violence, and STDs; 28% tested positive for STDs as assessed by DNA amplification or culture. MAIN OUTCOME MEASURE: Frequency of UVS assessed by interview using a 6-month recall period. RESULTS: Among adolescents having steady relationships, those spending more time with their boyfriends and having longer relationships reported a significantly greater frequency of UVS. Other significant correlates included perception of more girlfriends using condoms, no history of STDs, stronger normative beliefs favoring male decision making in relationships, greater pregnancy worry, and greater perceived invulnerability to STDs. For adolescents reporting casual relationships, personal barriers to condom use, no history of STDs, and reporting that their boyfriends typically decide when to have sex were associated with more frequent UVS. CONCLUSIONS: Adolescents' perceptions, particularly their perceptions of relationship dynamics, played an integral role in explaining female adolescents' frequency of UVS with both steady and casual partners. Female adolescents in steady relationships differ from those in casual relationships relative to their prevention needs. These findings have implications for clinic- or community-based STD and human immunodeficiency virus prevention programs.

Communication types and sexual protective practices of college women.

Sexually transmitted disease, such as the fatal HIV disease, continues to threaten the health of young women. Adolescents have typically been inconsistent users of effective strategies that prevent the spread of disease during sexual activity. Communication practices related to disease-related sexual protection have received little attention as a variable separate from sexual protection. The purpose of this study was to explore the relationship among different types of interpersonal communication of young women and their new sexual partners and their implementation of disease-related sexual protection. A sample of 163 young women who had experienced sexual intercourse completed the Safe Sex Behavior Questionnaire. Interpersonal communication was explored using the general-information-seeking (getting to know a partner), sexual self-disclosure, and specific-disease risk-information-seeking scales. These scales were combined; factor analysis revealed three subscales closely related to the original scales. Findings suggest that young women who seek specific information about their new sexual partner's disease risk status are more likely to implement sexual protective practices. These findings provide guidance to nurses who work with adolescent women in advising on aspects of interpersonal relationships that need to be enhanced to protect one's health status.

A longitudinal study of the role of sociodemographic factors and childhood aggression on adolescent injury and "close calls".

PURPOSE: This study examined the: (1) relationships among gender, race, and socioeconomic status and the incidence of adolescent injury and "close calls" (near accidents); (2) ability of childhood aggression to predict injury and "close calls" during adolescence; and (3) characteristics of injury and "close-call" events, including contributing mechanisms and risk-taking behaviors. METHODS: Subjects were a subsample (N = 271) of the Carolina Longitudinal Study who reported an injury (48%) or "close-call" (52%) during a 9th, 10th, or 11th grade interview (mean age 16.3 years); 52% were female and 23% African American. They were recruited beginning at grade 4 and grade 7 and were interviewed annually. RESULTS: More males than females reported an injury (chi 2 = 4.97, p < .05); motor vehicles and sports were major contributors. Caucasian females reported more injuries (chi 2 = 3.90, p < .05) and "close calls" (X2 = 4.13, p < .05) than African American females. More males than females reported risk-taking behaviors associated with injuries (chi 2 = 4.35, p < .05) and "close calls" (X2 = 4.29, p < .05), especially Caucasians. Logistic regression demonstrated that childhood aggression was a robust predictor of adolescent injury and "close calls." CONCLUSIONS: Reports of "close calls" by a majority of the sample suggest that mortality and morbidity statistics in this age group may underestimate the vulnerability of youth to serious injury. These results further add risk for physical injury in adolescence to the sequalae of childhood aggression. These findings suggest the need for the incorporation of injury prevention into school curriculum and activities of all children, but especially for children assessed as aggressive.

Changes in nursing administration research priorities. A sign of the times.

Although research is the critical element in the advancement of knowledge, for research to contribute knowledge to the practice of nursing it must be focused on subjects germane to the practice arena. When the focus of research in a discipline is not congruent with the needs of the discipline, knowledge development is compromised. By comparing the aforementioned retrospective research reviews to the research priority lists, we see that published research in nursing administration has not been tied closely to identified priorities. Healthcare reform provides nursing administration with a renewed opportunity to focus its research on priority areas. With the implementation of healthcare reforms, the practice arena for nursing and nursing administration will shift from the acute care setting to community and home-based settings, necessitating a shift in research to address these new delivery settings and the required care systems. The priorities generated from the national consensus group represent that shift, and may provide meaningful foci for future nursing administration research.