Patterns of Intimate Partner Violence Victimization from Adolescence to Young Adulthood in a Nationally Representative Sample

We examine sexual violence and reproductive health outcomes among sexually experienced youth in Port-au-Prince, Haiti, using the Priorities for Local AIDS Control methodology to identify participants in locations where sexual partnerships are formed. Our findings indicated that sexual violence is common and is significantly associated with condom use, pregnancy experience, and recent sexually transmitted infection symptoms.     

The neglected health care needs of street youth.

Juveniles who live on the street are often the victims of physical and sexual abuse and family chaos. They have a multitude of health problems such as malnutrition, respiratory infections, sexually transmitted diseases, including human immunodeficiency virus, mental illness, and substance abuse. Health care, if available, is generally fragmented and often not relevant to their needs. Their high-risk existence leads to individual morbidity and has a negative effect on the health of the community. Presently, there is limited research on the health status and health care needs of street youth who are difficult to track and quantify. The findings of a project undertaken by Region IX of the Public Health Service in 1989 to provide technical assistance to three primary care clinics serving street youth in San Francisco are reviewed. Data were collected on demographics, overall health status, sex-related medical problems, mental health, and substance abuse and compared with another group of adolescents in the general population. Street youth were found to have a greater number of problems--both physical and psychological--than the general adolescent population. High-risk behaviors, such as drug abuse and failure to use condoms during sex, make this population especially vulnerable to sexually transmitted diseases, including human immunodeficiency virus. The potential impact on public health is enormous. Adequate access to health services needs to be addressed legislatively.     

Use of Media Technologies by Native American Teens and Young Adults in the Pacific Northwest: Exploring Their Utility for Designing Culturally Appropriate Technology-Based Health Interventions

American Indian and Alaska Native (AI/AN) youth are disproportionally burdened by many common adolescent health issues, including drug and alcohol use, injury and violence, sexually transmitted infections, and teen pregnancy. Media technologies, including the Internet, cell phones, and video games, offer new avenues for reaching adolescents on a wide range of sensitive health topics. While several studies have informed the development of technology-based interventions targeting mainstream youth, no such data have been reported for AI/AN youth. To fill this gap, this study quantified media technology use among 405 AI/AN youth (13-21?years old) living in tribes and urban communities in the Pacific Northwest, and identified patterns in their health information-seeking practices and preferences. Overall, technology use was exceptionally common among survey respondents, mirroring or exceeding national rates. High rates of online health information seeking were also reported: Over 75% of AI/AN youth reported searching online for health information. These data are now being used by the Northwest Portland Area Indian Health Board and NW tribes to design culturally-appropriate, technology-based health interventions targeting AI/AN youth.     

Richmond Latino Needs Assessment: A Community-University Partnership to Identify Health Concerns and Service Needs for Latino Youth

The presence of Latinos in Virginia is a new phenomenon and as a result, less is known about the health needs of these newest community members. We formed a community-university partnership to identify health concerns and service needs as they relate to Latino youth living in Richmond, Virginia and the surrounding area. Using a mixed-method approach, survey data was obtained from 212 Latino adults, qualitative interviews were conducted with 15 community leaders and focus groups with 23 Latino parents (16 mothers, 7 fathers) and 6 Latino boys. Participants expressed concern about sexually transmitted infections/pregnancy among youth (76%), youth behavior problems at home/school (75%), and mental health problems (75%). Participants also expressed worry that youth would lose their connection to their Latin culture (83%). Qualitative data provided more information regarding these concerns by linking them with inter-ethnic tensions, and immigration and acculturation-related stressors. Survey participants also indicated a need for bilingual mental health services (88%) and after-school programs for youth (94%). This study provided the local community with information on the health concerns and service needs of a new group of community youth—Latino youth. Findings were presented to local community and City organizations that used the information to respond to the identified needs and/or concerns. The process in which the data was obtained may prove useful to other individuals interested in obtaining local level health information in emerging communities.     

Trends in Vaccine-induced Immunity to Hepatitis B among Canadian Street-involved Youth

In Canada, universal and publicly funded hepatitis B immunization programs have been available since 1998 in all provinces and territories. This present study estimates the proportion of having vaccine-induced immunity to hepatitis B virus (HBV) infection and its associated determinants among street-involved youth aged at 15–24 years old in Canada using the data collected by the Enhanced Surveillance of Canadian Street Youth. Vaccine-induced immunity was identified by blood test results of anti-HBc negative and anti-HBs positive. Of the 4,035 participants included in this study, the overall proportion of those with vaccine-induced immunity to HBV was 51.7% during the study period compared to over 90% among the general adolescent population. The proportion of street-involved youth immunized with HBV vaccine increased from 34.7% in 1999 to 64.4% in 2005. Immunity was higher among females (aOR = 1.43, 1.17–1.75) and among those with a reported history of sexually transmitted infection (aOR = 1.30, 1.03–1.63). The proportion of youth with the immunity decreased as age increased (aOR = 0.78, 0.76–0.81, per year increase). Despite an overall increase in the proportion of Canadian street-involved youth with vaccine-induced immunity to HBV, the proportion was still significantly lower than that observed in the general adolescent population. This highlights the need to improve the access to basic health care and the immunization programs to HBV for street-involved youth through creative outreach programs and other multi-faceted approaches.     

The impact of violence against women on reproductive health and child mortality in Timor‐Leste

Objectives: To determine differences in reproductive health and infant and child mortality and health between abused and non‐abused ever‐married women in Timor‐Leste. Methods: Secondary data analysis of Timor‐Leste Demographic Health Survey (1,959 ever‐married women aged 15–49 years). Associations with violence estimated using multinomial logistic regression adjusted for sociodemographic variables and age of first intercourse. Results: Overall, 45% of ever‐married women experienced violence: 34% reported physical only and 11% reported combined physical, sexual and/or emotional violence. Compared to non‐abused women, women reporting physical violence only were more likely to use traditional contraception (AdjOR 2.35, 95%CI 1.05–5.26) or report: a sexually transmitted infection (AdjOR 4.46, 95%CI 3.27–6.08); a pregnancy termination (AdjOR 1.42, 95%CI 1.03–1.96); a child who had died (AdjOR 1.30, 95%CI 1.05–1.60), a low birth weight infant (AdjOR 2.08, 95%CI 1.64–2.64); and partially vaccinated children (AdjOR 1.35, 95%CI 1.05–1.74). Women who reported combined abuse were more likely to report: a sexually transmitted infection (AdjOR 3.51, 95%CI 2.26–5.44); a pregnancy termination (AdjOR 1.95, 95%CI 1.27–3.01); few antenatal visits (AdjOR 1.76 95%CI 1.21–2.55); and a child who had died (AdjOR 1.45, 95%CI 1.06–2.00). Conclusions: Violence exposes women to poor reproductive health, infant and child mortality and poor infant and child health. Implications: Preventing and reducing violence against women should improve women and children's health outcomes in Timor‐Leste.     

The challenge of providing health care to adolescents

This article discusses the common health problems of adolescents with an emphasis on the differences between those affecting girls and boys. Statistics are given for mortality, hospitalization, and out-patient health visits from several different sources. Accidents and violence are the leading causes of death in adolescents but they affect boys much more often than girls. Teenaged girls are frequently hospitalized for health problems related to sexual behavior, mainly pregnancy and delivery related care and sexually transmitted diseases. Emotional and psychosomatic disorders are very common among adolescents of both sexes. Three general considerations important for the provision of health care to adolescents are discussed in detail. These include privacy and confidentiality, prevention of adverse health consequences of risk-taking behaviors, and the utilization of professionals from several different health care disciplines.     

An examination of the path between recent sexual violence and sexually transmitted infections

PurposeSexually transmitted infections (STIs) are among the most common infections in the United States and are particularly prevalent in survivors of sexual violence. The purpose of this study is to examine co-occurring risk factors for sexual violence and STIs including mental health, alcohol use, drug use, and multiple partners as intersecting pathways to STIs for women who experienced sexual abuse in the past year.MethodsSecondary analyses were conducted on cross-sectional data from women originally recruited as respondents for an epidemiologic survey funded by the Centers for Disease Control and Prevention (CDC): Project CHOICES. The survey was administered to 2,672 women in six settings: A large, urban jail and residential alcohol and drug treatment facilities (Texas); a gynecology clinic (Virginia); two primary care clinics (Virginia and Florida); and media solicitation (Florida). Women were included in the current study if they were fertile, sexually active, and not pregnant or trying to get pregnant (n = 1,183). Structural equation modeling (SEM) was used to test the conceptual path model between sexual violence and STI occurrence.ResultsIn the SEM, there were no significant paths from mental health, alcohol severity, or drug use to STI occurrence contrary to the results of the initial bivariate analyses. Multiple sexual partners significantly mediated the relationship between sexual violence and STIs and between mental health and drug use and STIs.ConclusionThis study highlights the importance of providing effective treatment to survivors of sexual violence, which includes addressing risky sexual behaviors to reduce STI occurrence.     

Family structure and adolescent sexual behavior in a poor area of S?o Paulo, Brazil

PURPOSE: In Brazil, as elsewhere, behavior during adolescence can place young people at risk for serious medical and social problems, including sexually transmitted infections, unintended pregnancy, drugs, crime, and violence. Few studies internationally have examined the influence of family structure on risk behavior among low-income youths. METHODS: This cross-sectional study included 296 young people in one of the poorest areas of S?o Paulo who were recruited through a vocational school and completed an anonymous, self-administered questionnaire. We examined associations between family structure and various risk behaviors. RESULTS: Ages ranged from 13-24 years (82%, 15-18); 67% were of Afro-Brazilian ancestry, and 56% were female. Median family monthly income was about US$200. Less than half lived with both parents, and 14% lived with neither parent. Rates of many risk behaviors, including involvement in crime and violence, drug and alcohol use, and sexual risk, were lowest among those living with both parents, higher among those living with one parent, and highest among those living with neither parent. For example, 26% of females living with both parents, 37% with one parent, and 71% with neither parent were sexually active (p = .003). Family structure and a personal or parental history of drug or alcohol problems were significant independent predictors of sexual activity. CONCLUSIONS: The presence of both parents is an important protective factor for Brazilian youth vulnerable to multiple risks. Prevention programs should explore ways to support parents to be present and involved in the lives of their adolescent children.     

Safe Sext: Adolescents' Use of Technology to Communicate About Sexual Health With Dating Partners

PurposeThis study examined adolescents' technology-based sexual communication with dating partners, and evaluated associations between technology-based communication and condom use.MethodsParticipants were 176 high school students who indicated their use of technology to communicate with partners about condoms, birth control, sexually transmitted infections (STIs), HIV/AIDS, pregnancy, and sexual limits. Sexually active youth also reported their frequency of condom use.ResultsMany adolescents (49%) used technology to discuss sexual health with partners, with rates varying by topic. Girls were more likely than boys to discuss HIV, pregnancy, and sexual limits. Ethnic minorities were more likely than whites to discuss condoms, STIs, HIV, pregnancy, and birth control. Importantly, rates of consistent condom use were three times higher among youth using technology to discuss condoms and birth control.ConclusionsResults provide novel preliminary evidence regarding adolescents' use of technology to discuss sexual health and demonstrate links between technology-based communication and condom use among sexually active youth.     

The Youth Risk Behavior Surveillance System: updating policy and program applications

To monitor behaviors that place adolescents at increased risk for premature morbidity and mortality, the Centers for Disease Control and Prevention developed the Youth Risk Behavior Surveillance System (YRBSS). This system measures six categories of behaviors, including behaviors that contribute to violence and unintentional injuries; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection; unhealthy dietary behaviors; and inadequate physical activity. This article summarizes how some education and health agencies and nongovernmental organizations, in collaboration with community agencies, school boards, parents, and youth, use YRBSS data to describe risk behaviors, create awareness, supplement staff development, set and monitor program goals, develop health education programs, support health-related legislation, and seek funding. Ways in which YRBSS data are distributed electronically also are summarized.     

Self-reported health and prior health behaviors of newly admitted correctional inmates

OBJECTIVES: This study obtained comprehensive health information from newly admitted correctional inmates. METHODS: Interviews were conducted with 1198 inmates on day 3 of their incarceration. RESULTS: Interviewers found a high prevalence of chronic medical and mental health issues, limited access to health care, high rates of infections and sexually transmitted diseases, substantial substance abuse, other unhealthy behaviors and violence, and a strong desire for help with health-related problems. CONCLUSIONS: The data document the need to apply the public health approach to correctional health care, including detection and early treatment of disease, education and prevention to facilitate health and behavior change, and continuity of care into the community.     

Unsafe sex,substance abuse,and domestic violence: how do recently trained obstetricians-gynecologists fare at lifestyle risk assessment and counseling on STD prevention?

BACKGROUND: Unsafe sexual practices, substance abuse, and domestic violence impact women's health. This study examined whether lifestyle risk assessment during a general medical examination and counseling about sexually transmitted disease during consultations for adolescent contraception and treatment of a sexually transmitted disease were more frequently done by recently trained obstetricians-gynecologists compared to those of obstetrician-gynecologists licensed before 1990. It also documented obstetrician-gynecologists' evaluations of their medical training in that area. METHODS: A pretested anonymous mail survey was conducted in 1995 with all 241 obstetrician-gynecologists practicing in Quebec, Canada; 66% responded (N = 158). RESULTS: Compared to less recently trained obstetrician-gynecologists, recently trained obstetrician-gynecologists reported routinely assessing tobacco use (77 vs 51%, P = 0.01), alcohol use (50 vs 23%, P = 0.004), and illicit drug use (33 vs 17%, P = 0.05) more frequently during a patient's general medical evaluation. However, they did not assess condom use (50%), number of sexual partners, sexual partners' sexually transmitted disease risk (30%), or experiences of sexual abuse or domestic violence (3%) more frequently than less recently trained obstetrician-gynecologists. They were also not more likely to counsel teenagers about sexually transmitted disease prevention during a contraceptive consultation (30-60%) or to discuss human immunodeficiency virus infection (29%) and hepatitis B immunization (13%) during a sexually transmitted disease consultation. CONCLUSION: Although evaluation of substance use was better among recently trained OB-Gyn physicians, little or no improvement has been noted regarding STD prevention or the evaluation of sexual abuse or domestic violence, all important lifestyle risks that directly affect women's health and well-being.     

The contextual determinants of sexually transmissible infections among street‐involved youth in North America

Young people living on the urban street are at a significantly increased risk of HIV and other sexually transmitted infections (STIs). Much research examining the epidemiological basis for their heightened susceptibility has concentrated on the individual behaviours and characteristics associated with acquiring these infections. However, contextual factors, including the social, structural and environmental forces that influence sexual risk behaviour, are increasingly found to play an important role in shaping the transmission dynamics of HIV and STIs within these marginalised populations. This paper reviews research describing the individual and contextual factors that have been shown to influence street youth sexual behaviour and provides an analysis of the potential impact of such factors on HIV and STI transmission. In order to implement effective sexual health programmes for street‐involved young people, innovative programmes are required that take into account the unique social and structural context of youth homelessness. Interventions to reduce the elevated prevalence and incidence of HIV and STIs among this population must explicitly target multi‐level factors influencing the transmission dynamics of these diseases.     

Health and access to care: perspectives of homeless youth in Baltimore City, U.S.A

Homeless youth suffer from high rates of health problems, yet little is known about their perceptions of or context for their own health issues. In this study, a combination of qualitative techniques from participatory rural appraisal and rapid assessment procedures was used to investigate the perceptions of health needs of shelter-based youth in Baltimore, MD in the U.S.A. The most common youth-identified health problems included STDs, HIV/AIDS, pregnancy, depression, drug use and injuries. These correlate well with more objective health status data for the same youth. The youth spoke of environmental safety threats of violence and victimization by adults, as well as racism and sexism in their lives. Youth reported that trusted adult figures such as grandmothers are important sources of health advice. Many homeless youth from less than ideal family situations remain in contact with and continue to seek advice from parents and other family members. Health interventions with urban street youth need to acknowledge the primacy of the social context for these youth, as well as the reality of violence as a daily health threat.     

Sexually transmitted infections among Black young people in south-east London: Results of a rapid ethnographic assessment

Epidemiological research has found a ten-fold ethnic disparity in rates of sexually transmitted infections among young people in south-east London. A rapid ethnographic assessment was conducted as part of a first phase of work to reduce the risk of bacterial sexually transmitted infections among heterosexual youth of Black Caribbean and African extraction. Methods included secondary data-collection, semi-structured street and group observations, interviews with key informants and group discussions with young people. Key informants attributed high rates of sexually transmitted infections to young people's 'natural' risk-taking, reluctance to use condoms, gender issues in intimate relationships, poverty and statutory services' shortcomings in addressing the needs of Black and young people. The rapid ethnographic assessment acquainted people with the project, highlighted aspects of the local context that may affect the development of potential interventions, and helped in focus group recruitment and the development of survey questionnaires.     

Mortality From Sexually Transmitted Diseases in Reproductive-Aged Women: United States, 1999–2010

Objectives. I estimated the sexually transmitted disease–related mortality among US reproductive-aged women from 1999 to 2010.Methods. I estimated mortality from National Center for Health Statistics’ Multiple Cause of Death data. I defined reproductive age as 15 to 44 years. For diseases partially caused by sexual transmission, I estimated the proportion attributable to sexual transmission from the literature. To calculate mortality rates, I estimated number of deaths from each disease and Census Bureau population for reproductive-aged women for 1999 to 2010.Results. From 1999 to 2010, the cumulative sexually transmitted disease–related mortality rate decreased by 49%, from 5.3 to 2.7 deaths per 100 000. The primary contributors were HIV and human papilloma virus infections. Mortality from sexually transmitted HIV infection decreased by 62%, from 3.4 to 1.3 deaths per 100 000. Mortality from human papilloma virus–associated gynecologic cancers decreased by 19%, from 1.6 deaths per 100 000 in 1999 to 1.3 deaths per 100 000 in 2010.Conclusions. Screening and treatment for sexually transmitted diseases may reduce mortality. Research is needed to determine whether sexually transmitted disease–related morbidity among reproductive-aged women has decreased over the past decade.Deaths from sexually transmitted diseases (STDs) often occur long after acute infection, making their incidence difficult to estimate.1–3 Some infections, such as syphilis, may directly result in death. By contrast, human papilloma virus (HPV), HIV, and hepatitis more commonly cause death because of secondary sequelae. Genital herpes, gonorrheal infection, and chlamydial infection may cause death from primary infection (e.g., disseminated herpes simplex virus or pelvic inflammatory disease [PID]) or secondary sequelae (e.g., ectopic pregnancy). Because death certificates usually list only the prevalent conditions, STDs are often not recorded on death certificates. In addition, some causes of death, such as liver cancer, may or may not be STD related. STD-related deaths cannot always be counted directly; therefore, direct and indirect methods of estimation must be used.The methodology for estimating STD-related mortality in women in the United States has evolved. Early estimates used measures of reproductive health mortality.1 Subsequently, a more comprehensive approach used direct and indirect measures of deaths from all STD-related diseases.2 Most recently, disability-adjusted life-years lost because of sexual behaviors were found to be threefold higher in the United States than in other developed countries. Women carry a disproportionately high proportion of the health burden.3Between 1955 and 1975, STDs such as syphilis and PID were responsible for 20% to 30% of reproductive mortality among women aged 15 to 44 years.1 Since then, mortality from syphilis and PID has decreased. Cervical carcinoma, HIV, and viral hepatitis infection were the top 3 contributors to STD-related mortality among all women older than 15 years as of 1992.2 I have updated the estimated annual STD-related mortality among reproductive-aged women in the United States for 1999 to 2010.     

The contextual determinants of sexually transmissible infections among street-involved youth in North America

Young people living on the urban street are at a significantly increased risk of HIV and other sexually transmitted infections (STIs). Much research examining the epidemiological basis for their heightened susceptibility has concentrated on the individual behaviours and characteristics associated with acquiring these infections. However, contextual factors, including the social, structural and environmental forces that influence sexual risk behaviour, are increasingly found to play an important role in shaping the transmission dynamics of HIV and STIs within these marginalised populations. This paper reviews research describing the individual and contextual factors that have been shown to influence street youth sexual behaviour and provides an analysis of the potential impact of such factors on HIV and STI transmission. In order to implement effective sexual health programmes for street-involved young people, innovative programmes are required that take into account the unique social and structural context of youth homelessness. Interventions to reduce the elevated prevalence and incidence of HIV and STIs among this population must explicitly target multi-level factors influencing the transmission dynamics of these diseases.     

Spousal Abuse Against Women and Its Consequences on Reproductive Health: A Study in the Urban Slums in Bangladesh

Objectives: Spousal violence is common and results in costly problems both for society and for the reproductive health of women. Despite the recognition that violence may be associated with serious consequences for women's reproductive health, our understanding of the relationship between the two remains limited. In this study, we assessed the association between spousal violence and women's reproductive health. Methods: Data from an interviewer-administered questionnaire assessing socioeconomic, demographic, behavioral profiles, and spousal violence-related information was collected from 496 women. Subjects were chosen from eight randomly selected urban slums from four metropolitan cities. Results: Spousal violence was significantly higher amongst the group of less educated women who had been in several marriages; indicating that the social and behavioral traits of women act as catalysts for spousal violence. Abusive husbands also had been married several times and were more likely to be addicted to alcohol or drugs. This demonstrates that the behavioral traits of husbands were also responsible for spousal violence. Spousal violence injuries adversely affect the health and well-being of women. More than three-quarters of physically violated women suffered injuries as a result of this violence. About 50% of these injuries were minor and about 10% serious. Sexual violence adversely affected women's health; more than 80% of sexually violated women complained of pelvic pain, more than 50% reported reproductive tract infections, and more than 50% reported symptoms of irritable bowel syndrome. Abused women suffered from gynecological problems at the time of pregnancy significantly more than non-abused women (p<0.05) and abused women suffered from reproductive tract infections significantly more than non-abused women (p<0.01). Abusive husbands suffered from sexually transmitted diseases (STD) significantly more than non-abusive husbands (p<0.05). Abused women used contraception significantly less than non-abused women (p<0.01). Logistic regression analysis suggested that spousal violence was the most important contributing factor for reproductive health problems in women. Conclusions: The findings of this study may enhance our understanding of the impact of spousal violence against women and their reproductive health and therefore highlight the importance of spousal violence prevention measures. Increasing the awareness and understanding of the relationship between violence against women and reproductive health could be achieved if lawyers, researchers, clinicians, practitioners, and government workers from multiple disciplines and agencies worked together.     

Seroprevalence and risk factors for hepatitis A among Montreal street youth

OBJECTIVE: To estimate the prevalence of hepatitis A virus (HAV) antibodies among Montreal street youth. METHOD: Anti-HAV antibody testing was performed on blood samples from a hepatitis B and C study conducted among street youth in 1995-96. RESULTS: Among the 427 youth aged 14 to 25 years, prevalence of HAV antibodies was 4.7% (95% confidence interval [CI]: 2.9%-7.2%). A multivariate logistic regression analysis showed that birth in a country with a high anti-HAV prevalence (Adjusted odds ratio [AOR]: 200.7; 95% CI: 38.1-1058.4), having had sexual partner(s) with history of unspecified hepatitis (AOR: 13.8; 95% CI: 4.2-45.2), and insertive anal penetration (AOR: 5.1; 95% CI: 1.6-16.7) were independently associated with infection. CONCLUSION: Based on the relatively low HAV prevalence, the high prevalence of risk factors for infection, and the substantial hepatitis B and C prevalence, vaccination against hepatitis A is now actively promoted among Montreal street youth.