Relational underpinnings of condom use: Findings from the project on partner dynamics.

OBJECTIVE: To examine how relational qualities, including commitment to a sexual partner, are associated with condom use among young heterosexual adults at increased risk for sexually transmitted infections. Guided by the investment model of commitment processes, we hypothesized that sexual partner commitment is a function of satisfaction with, alternatives to, and investments in the relationship. Commitment to a sexual partner is, in turn, associated with reduced perceptions of vulnerability to sexually transmitted infection acquisition, which results in lowered condom use intentions and use. METHOD: We tested the hypothesized model using data from the Project on Partner Dynamics (POPD), a 4-wave, 1-year longitudinal study featuring a Time 1 sample of 538 African American, Hispanic, and White young adult from East Los Angeles, California, who provided data on all their sexual relationships over the year. RESULTS: Findings from hierarchical path models supported the hypotheses, with relational qualities significantly linked to condom use via commitment, perceived vulnerability to harm from partner and intentions to use. CONCLUSION: These findings have implications for improving the health of high-risk individuals, including suggesting the importance of raising awareness of relational qualities that may give rise to unsafe sexual practices. (PsycINFO Database Record

Competing Priorities: Partner-Specific Relationship Characteristics and Motives for Condom Use Among At-Risk Young Adults.

Condoms protect against human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) and unintended pregnancy and are essential to sexual health efforts targeting young adults, who are disproportionately affected by both outcomes. Understanding condom use motives is critical to increasing condom use. Research in this area is limited, particularly regarding the roles of partners and relationship factors. Using a longitudinal sample of 441 young adults and 684 reported partnerships we examined associations between relationship factors and condom use motives (pregnancy prevention, disease prevention, or dual protection). Simultaneous multilevel models identified variables associated with motives; level-specific models identified the levels (individual, partnership, time) variables impacted motives. Participants reported choosing condoms for pregnancy prevention, disease prevention, and dual protection in 51%, 17%, and 33% of partnerships, respectively. Partner-specific factors varied, to a differing degree, across the three levels. Seven variables (duration, condom self-efficacy, commitment, sexual decision-making, power, and vulnerability to harm [HIV/STIs] and pregnancy) distinguished condom use motives. The level of this association varied but was most pronounced at the partner and individual levels. Researchers and practitioners should consider the impact of both individual- and partner-level factors on condom use motives, in both research and sexual health programs.

Can Young Adults Accurately Report Sexual Partnership Dates? Factors Associated With Interpartner and Dyad Agreement.

BACKGROUND: Sexual partnership dates are critical to sexually transmitted infection/HIV research and control programs, although validity is limited by inaccurate recall and reporting. METHODS: We examined data from 302 heterosexual adults (151 index-partner dyads) to assess reliability of reporting. Dates of first sex and last sex were collected through individual interviews and joint dyad questionnaires, which were completed together with their partners. We compared index- and partner-reported dates to estimate interpartner agreement. We used log-linear regression to model associations between interpartner differences and partnership characteristics. To assess validity, we compared individually reported dates with those from joint dyad questionnaires. RESULTS: Most partnerships (66.2%) were 2 years or less in duration, and many (36.2%) were nonmonogamous. Interpartner agreement to within 1, 30, and 365 days was, respectively, 5.6%, 43.1%, and 81.3% for first sex, and 32.9%, 94.5%, and 100.0% for last sex. In adjusted models, longer relationship duration was associated with disagreement on first sex dates; partnership nonmonogamy was associated with disagreement on dates of first sex and last sex. Within dyads, several participant characteristics were associated with reporting dates closer to joint dyad responses (e.g., for first sex date, female sex [54.7%], having fewer sex partners [58.5%], and greater relationship commitment [57.3%]). However, percent agreement to within 30, 60, and 90 days was similar for all groups for both first and last sex dates. CONCLUSIONS: Agreement was high on date of last sex but only moderate on date of first sex. Methods to increase accuracy of reporting of dates of sex may improve STI research.

Association of perceived partner non-monogamy with prevalent and incident sexual concurrency.

OBJECTIVES: Concurrency is suggested as an important factor in sexually transmitted infection transmission and acquisition, though little is known regarding factors that may predict concurrency initiation. We examined the association between perception of a partner's non-monogamy (PPNM) and simultaneous or subsequent concurrency among at-risk heterosexual young adults in the Los Angeles area. METHODS: We used Poisson regression models to estimate the relationship between PPNM and incident concurrency among 536 participants participating in a cohort study, interviewed at 4-month periods during 1 year. Concurrency was defined as an overlap in reported sexual partnership dates; PPNM was defined as believing a partner was also having sex with someone else. RESULTS: Participants (51% female; 30% non-Hispanic white, 28% non-Hispanic black, 27% Hispanic/Latino) had a mean age of 23 years and lifetime median of nine sex partners. At each interview (baseline, 4-month, 8-month and 12-month), 4-month concurrency prevalence was, respectively, 38.8%, 27.4%, 23.1% and 24.5%. Four-month concurrency incidence at 4, 8 and 12 months was 8.5%, 10.6% and 17.8%, respectively. Participants with recent PPNM were more likely to initiate concurrency (crude 4-month RR=4.6; 95% CI 3.0, 7.0; adjusted 4-month RR=4.0, 95% CI 2.6 to 6.1). CONCLUSIONS: Recent PPNM was associated with incident concurrency. Among young adults, onset of concurrency may be stimulated, relatively quickly, by the PPNM. Programmes which promote relationship communication skills and explicit monogamy expectations may help reduce concurrency.

Individual, Interpersonal, and Structural Power: Associations With Condom Use in a Sample of Young Adult Latinos.

Interviews were conducted with 480 sexually active Latino young adults from four rural counties in Oregon. We examined relationships between three levels of power (individual, interpersonal, and structural) and consistent condom use. Condom use self-efficacy and sexual decision-making, examples of individual and interpersonal measures of power, respectively, were associated with increased odds of consistent condom use among both men and women. Among men only, increasing relationship control, an interpersonal measure of power, was associated with lower odds of consistent condom use. Among women only, increasing medical mistrust, a structural measure of power, was associated with increased odds of consistent condom use.

Concurrent sexual partnerships among young heterosexual adults at increased HIV risk: types and characteristics.

BACKGROUND: The impact of concurrency on sexually transmitted infection transmission depends on coital frequency, condom use, duration of relationship overlap, and number of partners. Previous research has identified distinct concurrency types; however, little is known about their risk characteristics. METHODS: Men (n = 261) and women (n = 275) aged 18 to 30 years at increased risk for acquiring HIV were recruited from community locations in Los Angeles. Participants completed 4 in-person interviews for 12 months. Partnership data were used to characterize the prevalence of 4 types of concurrency: transitional (2 overlapping relationships in which the first relationship ended before the second), single day (a second relationship of 1 day's duration during the course of another relationship), contained (a second relationship >1 day began and ended during the course of another), and multiple (≥3 overlapping relationships). Multilevel random intercept models were used to estimate mean coital frequency, proportion of condom-protected acts, total duration of overlap, and lifetime sex partners. RESULTS: At baseline, 47% of male and 32% of female participants reported any type of concurrency in the previous 4 months, and 26% of men and 10% of women reported multiple concurrencies. Condom use ranged from 56% to 64%, with the highest use in transitional concurrency (61% for men, 68% for women) and the lowest in contained (52% for men, 54% for women). Coital frequency, total overlap, and lifetime sex partners also varied by concurrency type. CONCLUSIONS: Inconsistent condom use and repeated opportunities for exposure characterize common types of concurrency among high-risk young adults.

Medical mistrust, perceived discrimination, and satisfaction with health care among young-adult rural latinos.

PURPOSE: Little research has analyzed mistrust and discrimination influencing receipt of health care services among Latinos, particularly those living in rural areas. This study examined the associations between medical mistrust, perceived discrimination, and satisfaction with health care among young-adult rural Latinos. RESEARCH DESIGN: This cross-sectional study analyzed data from 387 young-adult Latinos (ages 18-25) living in rural Oregon. The Behavioral Model of Vulnerable Populations was utilized as the theoretical framework. Correlations were run to assess bivariate associations among variables included in the study. Ordered logistic regression models evaluated the associations between medical mistrust, perceived discrimination, and satisfaction with health care. RESULTS: On average, participants used health services 4 times in the past year. Almost half of the participants had health insurance (46%). The majority reported that they were moderately (32%) or very satisfied (41%) with health care services used in the previous year. In multivariable models, medical mistrust and perceived discrimination were significantly associated with satisfaction with health care. CONCLUSIONS: Medical mistrust and perceived discrimination were significant contributors to lower satisfaction with health care among young-adult Latinos living in rural Oregon. Health care reform implementation, currently under way, provides a unique opportunity for developing evaluation systems and interventions toward monitoring and reducing rural Latino health care disparities.

Whose intentions predict? Power over condom use within heterosexual dyads.

UNLABELLED: According to major theories of behavioral prediction, the most proximal psychological predictor of an individual's behavior is that individual's intention. With respect to interdependent behaviors such as condom use, however, relationship dynamics influence individuals' power to make decisions and to act. OBJECTIVE: The current study examines how relationship dynamics impact 3 condom use relevant outcomes: (a) the individual forming his or her own intention to use condoms, (b) the couple forming their joint intention to use condoms, and (c) actual condom use behavior. METHOD: We conducted a 2-wave longitudinal study of young heterosexual adult couples at high risk for HIV infection involving the collection of both individual- and couple-derived data. RESULTS: Results demonstrate the importance of both person (e.g., biological sex and dispositional dominance) and relational (e.g., relational power and amount of interest in the relationship, operationalized as commitment and perceived alternatives to the relationship) factors in predicting condom use intentions and behavior. Individuals who are lower in dispositional dominance are likely to incorporate their partner's intentions into their own individual intentions; the intentions of individuals who have less interest in the relationship are more highly predictive of the couple's joint intention; and the intentions of men and individuals higher in relationship power are more likely to exert a direct influence on condom use. CONCLUSIONS: These findings have implications for improving the health of high-risk individuals, including suggesting situations in which individuals are highly influenced by their partners' intentions.

One love: explicit monogamy agreements among heterosexual young adult couples at increased risk of sexually transmitted infections.

HIV prevention strategies among couples include condom use, mutual monogamy, and HIV testing. Research suggests that condom use is more likely with new or casual partners, and tends to decline as relationships become steady over time. Little is known, however, about explicit mutual monogamy agreements and HIV testing within heterosexual couples. This study used data from 434 young heterosexual couples at increased risk of HIV and sexually transmitted infections (STIs) to assess (a) couple concordance on perceptions of a monogamy agreement, sustained monogamy, and HIV testing; and (b) the associations of relationship and demographic factors with monogamy agreement, sustained monogamy, and HIV testing. Results indicated only slight to fair agreement within couples on measures of monogamy agreement and sustained monogamy. Overall, 227 couples (52%) concurred that they had an explicit agreement to be monogamous; of those, 162 (71%) had sustained the agreement. Couples with greater health protective communication and commitment were more likely to have a monogamy agreement. Couples of Latino and Hispanic ethnicity and those with children were less likely to have a monogamy agreement. Only commitment was related to sustained monogamy. Having children, greater health protective communication, and perceived vulnerability to HIV and STIs were associated with HIV testing within the couple.

Characteristics related to effective contraceptive use among a sample of nonurban Latinos.

CONTEXT: A better understanding of effective contraceptive use among Latinos is needed to reduce their high rate of unintended pregnancy. Most research has focused on urban Latinas and has overlooked the relationship context of effective contraceptive use. METHODS: Interviews were conducted among a sample of 450 Latino women and men aged 18-25 in sexual relationships, who were recruited from community sites in four rural Oregon counties in 2006. Bivariate and multinomial logistic regression analyses were used to examine the associations between effective contraceptive use and -individual, cultural and relationship characteristics. RESULTS: Half of participants reported effective contraceptive use in their primary relationships: Thirty-six percent consistently used a female method, and 15% consistently used condoms. Acculturation and confidence in one's -ability to practice contraception with a primary partner were associated with female method use rather than no effective use (risk ratios, 0.7 and 1.7, respectively). Participation in sexual decision making was positively associated with condom use rather than no effective method use (2.2) or female method use (1.9); partner involvement in birth control was positively associated with condom use rather than female method use (1.8). CONCLUSIONS: Variations in effective contraceptive use among nonurban Latinos appear related to relationship characteristics and dynamics. Contraceptive counseling and unintended pregnancy prevention programs that are tailored to reflect relationship contexts and to include male partners where appropriate could improve the quality and cultural relevance of services among nonurban Latinos.

Do depression and low self-esteem follow abortion among adolescents? Evidence from a national study.

CONTEXT: A 2008 report by the American Psychological Association found no evidence that an induced abortion causes mental health problems in adult women. No conclusions were drawn with respect to adolescents because of a scarcity of evidence. METHODS: Data from the National Longitudinal Study of Adolescent Health were used to examine whether abortion in adolescence was associated with subsequent depression and low self-esteem. In all, 289 female respondents reported at least one pregnancy between Wave 1 (1994-1995) and Wave 2 (1996) of the survey. Of these, 69 reported an induced abortion. Population-averaged lagged logistic regression models were used to assess associations between abortion and depression and low self-esteem within a year of the pregnancy and approximately five years later, at Wave 3 (2001-2002). RESULTS: Abortion was not associated with depression or low self-esteem at either time point. Socioeconomic and demographic characteristics did not substantially modify the relationships between abortion and the outcomes. CONCLUSIONS: Adolescents who have an abortion do not appear to be at elevated risk for depression or low self-esteem in the short term or up to five years after the abortion.

Prevention of unintended pregnancy and HIV/STIs among Latinos in rural communities: perspectives of health care providers.

Latino women in the United States are disproportionately at risk for unintended pregnancy, HIV, and sexually transmitted infections (STIs). We conducted nine focus groups with health care practitioners who provide reproductive health care to Latinos in rural areas of the Northwest. From the practitioner perspective, we explored barriers and facilitators to the acquisition and use of contraceptives and to the prevention of HIV/STIs among rural Latinos. Suggestions for improving reproductive health care included Spanish-language resources/materials and convenient contraceptive methods. Findings provide context to the complex issues related to unintended pregnancy and disease prevention among Latinos residing in rural communities.

Exploring diaphragm use as a potential HIV prevention strategy among women in the United States at risk.

Given the immediate need for physical cervical barrier methods like the diaphragm to protect against HIV/STIs, understanding what factors influence the acceptability of these products and how to overcome obstacles to their use is important. We explored perceptions of the diaphragm and factors that might enhance its acceptability in 25 focus groups with racially/ethnically diverse young women in the U.S. at risk for HIV/STIs (N = 140). Women believed the diaphragm has positive attributes, and most indicated they would be more likely to use the diaphragm if they were confident they could use it correctly and it protected against HIV. They also considered it messy to use and difficult to insert or remove. Findings suggest that the diaphragm could be a desirable option for pregnancy and disease prevention for some women at risk for HIV/STIs. Although disadvantages to diaphragm use were identified, many could be eliminated through changes in product design and provider intervention.