Association of Cannabis Use and At-Risk Alcohol Use With Intimate Partner Violence in an Urban ED Sample

IntroductionUrban ED patients have elevated rates of substance use and intimate partner violence. The purpose of this study is to describe the risk profiles for intimate partner violence among urban ED patients who report at-risk alcohol use only, cannabis use only, or both types of substance use.MethodsCross-sectional survey data were collected from study participants (N = 1037; 53% female; ages 18-50) following informed consent. We measured participants’ past-year at-risk drinking (women/men who had 4+/5+ drinks in a day), cannabis use, psychosocial and demographic characteristics, and past-year physical intimate partner violence (assessed with the Revised Conflict Tactics Scale). We used bivariate analysis to assess whether rates of intimate partner violence perpetration and victimization differed by type of substance use behavior. Multivariate logistic regression models were estimated for each intimate partner violence outcome. All analyses were stratified by gender.ResultsRates of intimate partner violence differed significantly by type of substance use behavior and were highest among those who reported both at-risk drinking and cannabis use. Multivariate analysis showed that women who reported at-risk drinking only, cannabis use only, or both types of substance use had increased odds for intimate partner violence perpetration and victimization compared with women who reported neither type of substance use. Men’s at-risk drinking and cannabis use were not associated with elevated odds of intimate partner violence perpetration or victimization.DiscussionBrief screening of patients’ at-risk drinking and cannabis use behaviors may help identify those at greater risk for intimate partner violence and those in need of referral to treatment.     

Context of sexual risk behaviour among abused ethnic minority adolescent women

CHAMPION J.D. (2011) Context of sexual risk behaviour among abused ethnic minority adolescent women. International Nursing Review 58 , 61–67 Background: Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. Purpose: This study aims to describe associations between childhood molestation and sexual risk behaviour. Method: African American and Mexican American adolescent women aged 14–18 years (n = 562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self‐report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Results: Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self‐reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported ‘getting high’ and having sex when out of control as reasons for sex with multiple partners. Conclusion: Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae.     

Psychosocial Risk Factors for Perinatal Depression among Female Adolescents: A Systematic Review

Perinatal depression is a health concern among pregnant and postpartum adolescents as it may negatively impact fetal development and result in complications such as preterm delivery, low infant birth weight, and poor maternal-infant attachment. The purpose of this systematic review is to examine psychosocial risk factors for depression among adolescents during pregnancy and postpartum. A literature search was conducted from five databases from 1995 to 2016. A total of 17 studies matched the inclusion criteria. Lack of social support, perceived stress, prior history of depression, and a history of sexual or physical violence were most frequently identified as potential risk factors for perinatal depression. Additional risk factors include the adolescent's perception of her pregnancy, family criticism, self-efficacy, self-esteem, substance use, parental stress, community violence, anxiety, and African-American ethnicity. Research and clinical implications are indicated for adolescents at risk for perinatal depression.     

Methamphetamine use among incarcerated women

Problem Women face greater vulnerability to using stimulant drugs, their rate of incarceration for methamphetamine use is increasing, and women's issues have been historically neglected in substance abuse research. This study examined demographic, social and psychological characteristics of incarcerated methamphetamine‐using women that could influence service needs and utilization during incarceration.

Method Incarcerated women completed individual interviews and questionnaires regarding drug use and other psychosocial variables. Psychosocial factors were examined according to lifetime drug use history. Comparison groups were: (1) nonstimulant drug users (n=16); (2) noninjection methamphetamine users (n=24); and (3) injection methamphetamine users (n=31). Psychosocial factors were also examined according to recent methamphetamine use. Recent use comparison groups were: (1) no recent drug use (n=18); (2) nonstimulant drug use (n=17); (3) noninjected methamphetamine (n=22); and (4) injected methamphetamine (n=20).

Findings Nearly one‐third of these incarcerated drug‐using women had never before received substance abuse treatment. Drug abuse, sexual assault and concomitant psychiatric symptoms were high across the entire sample, but greatest for methamphetamine users.

Conclusion Results revealed the complex psychosocial needs and risks that confront incarcerated methamphetamine‐using women and pose serious threats to eventual drug recovery.     

Predictors of HIV-related high-risk sexual behaviors among female substance users

This study aimed to explore predictors of human immunodeficiency virus (HIV)-related risky sexual behaviors among women with substance use. A total of 150 women were selected from harm reduction centers in Tehran, Iran, and completed the risk behavior assessment, the Beck depression inventory, the revised self-efficacy scale, and the peer group beliefs regarding HIV-related risk behaviors scale. The results showed that age (β = ?.07, P ? .01) and exchange of sex for drugs or money (β = 3.34, P ? .001) were significant predictors of whether women had multiple sex partners. Moreover, depression (β = .06, P ? .05), exchange of sex for drugs or money (β = 1.42, P ? .01), and self-efficacy (β = ?.19, P ? .001) significantly predicted unprotected sex among women with substance use. Accordingly, providing female substance users with harm reduction services and developing HIV prevention programs are likely to decrease high-risk sexual behaviors and consequent HIV infection within this vulnerable group.     

Sex and substances: Does body image play a role?

ABSTRACT

Objective: Having sex under the influence of alcohol and/or drugs places individuals at high risk for STI transmission and unplanned pregnancy. Although the relationship between body image and sexual behavior has been well established, research on the relationship between body image and sexual behavior under the influence among adolescents is scant. The purpose of this study is to investigate the relationship between body image and unprotected sex and unprotected sex while under the influence among adolescents.

Methods: We conducted logistic regression analyses using data from the Oregon Youth Substance Use Project (N = 937). Measures included body image, unprotected sex, unprotected sex while inebriated, age, sex, and BMI.

Results: Body image was not related to unprotected sex, but was significantly related to unprotected sex while inebriated in the past year and in their lifetime (OR = 2.17, 2.33).

Conclusions: Results suggest substance use may be important to the relationship between body image and sexual behavior among adolescents. Additional research is warranted to inform future interventions.     

Violence and substance use in sexual minorities: Data from the Second Brazilian National Alcohol and Drugs Survey (II BNADS)

ObjectiveTo describe the prevalence of substance use and the associations between adverse early life experiences, sexual behaviour and violence in sexual minority (SM) individuals.MethodsThe Brazilian National Alcohol and Drugs Survey is a probabilistic household survey performed in 2012, collecting data from 4067 Brazilians aged 14 years and older.Results3.4% of the sample declared themselves as sexual minorities, 53.8% female, 66.5% single, mean age of 29.5 years (standard deviation 16.0 years). A high prevalence of alcohol dependence (15.2%) and binge drinking (22.2%) was identified in the SM group. Respondents were more likely to use crack cocaine and hallucinogens, to have been involved in child prostitution, child sexual abuse and to report suicidal ideation in the previous year. Respondents were also more likely to engage in unprotected sex compared to non-sexual minorities. Nearly one-third referred to having suffered homophobic discrimination in their lives. Respondents also reported higher rates of domestic violence (18.9%) and urban violence (18%) among the SM.ConclusionThe findings reinforce that violence directed at individuals in the Brazilian SM community begins early in life and persists into adulthood when compared to non-sexual minorities. This population is also more exposed to substance use disorders.     

Calidad de vida sexual de las mujeres ribereñas: análisis de las prácticas y actitudes sexuales

ObjectiveTo analyse the sexual practices, attitudes, and sexual quality of life of Riparian woman and associated factors.MethodA cross-sectional analytical study conducted among Riparian women using the Study of Sexual Behaviour questionnaire. A bivariate analysis and binary logistic regressions were performed to identify factors associated with sexual quality of life.ResultsA total of 138 women participated in the study (n = 138). Of the women, 34.1% and 33.3% reported pain and loss of interest during or after sex, respectively. In terms of practices during sex, women reported kissing (85.5%), cuddling (89.1%), mutual masturbation (37.2%), oral sex (34.8%), and anal sex (23.9%). However, the majority reported not using condoms during sex (63.0%). In terms of sexual quality of life, 39.9% of the women rated it as good. Higher education and early sexual initiation increase the chances of a “good” sexual quality of life.ConclusionBecause Riparian women engage in some risky sexual behaviours, such as not using condoms, educational strategies on the prevention of sexually transmitted infections should be reinforced and incorporated in this population. This may help improve these women's sexual quality of life.     

A Systematic Review Exploring Racial Disparities,Social Determinants of Health,and Sexually Transmitted Infections in Black Women

ObjectiveTo explore and describe racial disparities, the role of social determinants of health, and individual risk behaviors among Black women as related to sexual health and/or sexually transmitted infections (STIs).Data SourcesElectronic resource databases used were PubMed, CINAHL, and Google Scholar. Peer-reviewed articles published during 2010 to 2020 were considered.Study SelectionThirty-two studies met the criteria and included data for a total of 18,904 Black women.Data ExtractionData were extracted from each study using the subheadings author (year), purpose, design, sample demographics and setting, key measures, key findings, and quality assessment. In addition, PRISMA-E and PROGRESS-Plus guided data extraction to illustrate health inequity.Data SynthesisBlack women who were more likely to report having an STI over the course of their lifetime engaged in behaviors associated with greater risk, the most common of which were unprotected sex, disproportionate partner power, and substance abuse. The primary social determinants of health associated with increased risk were lower income and lower levels of education. Black women were less likely to discuss or feel comfortable discussing their sexual health with health care providers. By contrast, engagement in safe sexual practices stemmed from internal, social, and relationship factors.ConclusionIdentifying Black women who are at risk of contracting an STI is essential in driving clinical decision-making. Health care providers should be cognizant of the long-standing mistrust that Black women have of health care providers and, therefore, work to establish positive respectful and trusting relationships with open communication.     

Risk Factors for Injuries From Physical Violence in African Women in the Gambia

BackgroundPhysical violence against women is a major public health problem in African countries; however, no studies have focused on factors associated with violent injuries to women in Africa.ObjectivesA matched case-control study was conducted to investigate risk factors for injuries from physical violence against African women in The Gambia.MethodsOver a 12-month study period, study participants were recruited from emergency departments of eight government-managed health care facilities. Cases were female patients aged ≥ 15 years who had been violently injured. Matched by the health facility, date of injury, sex, and age, a control patient for each case was selected from those injured due to nonviolent mechanisms.ResultsIn total, 194 case-control pairs were recruited. Results of a conditional logistic regression showed that being a Fula (odds ratio [OR] 2.45; 95% confidence interval [CI] 1.06–5.66), living in an extended family compound (OR 3.07; 95% CI 1.22–7.72), having six or more female siblings (OR 3.10; 95% CI 1.38–6.97), having been raised by grandparents (OR 3.34; 95% CI 1.06–10.51), and having been verbally (OR 3.04; 95% CI 1.56–5.96) or physically abused (OR 3.36; 95% CI 1.34–8.39) in the past 12 months were significantly associated with injury from physical violence.ConclusionMost risk factors identified for violent injury among African women are unique to the studied geography. Violence prevention programs, if designed based on these identified risk factors, may be more effective for this population.     

Intimate partner sexual assault against women and associated victim substance use, suicidality, and risk factors for femicide

In order to establish the frequency of substance use, following and attributed to sexual assault, and describe the danger for femicide and suicidality for women physically and sexually abused compared to physically-abused only women, a personal interview of 148 African-American, Hispanic, and white English and Spanish-speaking abused women was completed. Women who reported more than one sexual assault were 3.5 (95% CI, 0.9, 13.4) times more likely to report beginning or increasing substance use compared to women who reported only one sexual assault. Sexually assaulted women reported significantly (p=.002) more risk factors for femicide compared to physically- abused only women. Specific to suicide, women reporting sexual assault were 5.3 (95% CI, 1.3, 21.5) times more likely to report threatening or attempted suicide within a 90-day period compared to physically-abused only women. The health assessment and intervention of intimate partner violence must extend beyond injury to include behavior risk sequelae of substance abuse and suicidality.     

Sexual abuse and sexual risk behaviors of minority women with sexually transmitted diseases

The relationship between sexual abuse and sexually transmitted disease (STD) represents an important and underinvestigated context of domestic violence. This study examined the association between sexual abuse, sexual risk behaviors, and risk for reinfection and HIV among minority women with STD. Mexican American and African American women (n = 617) with active STD entered a randomized study of behavioral intervention to reduce STD recurrence. Each underwent questioning at entry regarding sexual abuse and sexual risk behaviors. Comparisons of these behaviors using chi-square, t tests, and logistic regression were made by history of sexual abuse. Sexually abused women were more likely to have lower incomes, earlier coitus, STD history, currently abusive partners, new sex partners, anal sex, and bleeding with sex, placing them at increased risk for STD reinfection and HIV. Due to this association with sexual risk behavior, assessment for sexual abuse is essential in programs focusing on STD/HIV prevention.     

INTIMATE PARTNER SEXUAL ASSAULT AGAINST WOMEN AND ASSOCIATED VICTIM SUBSTANCE USE,SUICIDALITY, AND RISK FACTORS FOR FEMICIDE

In order to establish the frequency of substance use, following and attributed to sexual assault, and describe the danger for femicide and suicidality for women physically and sexually abused compared to physically-abused only women, a personal interview of 148 African-American, Hispanic, and white English and Spanish-speaking abused women was completed. Women who reported more than one sexual assault were 3.5 (95% CI, 0.9, 13.4) times more likely to report beginning or increasing substance use compared to women who reported only one sexual assault. Sexually assaulted women reported significantly (p = .002) more risk factors for femicide compared to physically- abused only women. Specific to suicide, women reporting sexual assault were 5.3 (95% CI, 1.3, 21.5) times more likely to report threatening or attempted suicide within a 90-day period compared to physically-abused only women. The health assessment and intervention of intimate partner violence must extend beyond injury to include behavior risk sequelae of substance abuse and suicidality.     

Sex differences among treatment clients with cocaine-related problems

Background: In a sample of treatment clients with cocaine-related problems, the present study examined sex differences in measures across six key domains, including socio-demographics, mental health, substance use, physical health, sexual health and psychosocial health.

Methods: Data were utilized from a cross-sectional study of treatment clients in Ontario and British Columbia, Canada (N?=?417). t-Tests were used to examine sex differences in continuous measures, while Fisher’s exact tests were used for dichotomous measures. A Bonferroni correction was applied to adjust for multiple comparisons. For measures that were significant in these tests, multivariable analyses were also conducted.

Results: Females were found to be more likely than males to have lower personal and household incomes, report membership in sexual minority groups and engage in high risk sexual behaviors, including trading sex for money, trading sex for drugs and having sex when they did not want to. Males were more likely than females to report higher sexual compulsion scores and have paid for sex.

Conclusion: Overall, the health-related needs of treatment clients with cocaine-related problems appear to differ by sex, especially in relation to sexual health. As such, setting of treatment priorities by treatment providers should reflect these important differences.     

Minority adolescent women with sexually transmitted diseases and a history of sexual or physical abuse

Life history methods were used to obtain a more in-depth understanding of the configuration of psychosocial and situational factors that are associated with high-risk sexual behavior among minority adolescent women with a history of sexual or physical abuse and sexually transmitted disease (STD), to facilitate development of behavioral risk-reduction interventions. Study participants ranged in age from 14 to 18 years; 19 were Mexican American and 11 were African American. Women were recruited from clinics in a metropolitan health district. Various constitutive patterns unfolded during interview analysis including "fearing," "trusting," and "being a woman." The study revealed the perceptions of an extremely high-risk population of adolescent women regarding their STD risk, the context of their sexual relationships, sexual risk behaviors, contraception, and STD prevention, screening, and treatment practices. Intervention strategies based upon these findings are described.     

MINORITY ADOLESCENT WOMEN WITH SEXUALLY TRANSMITTED DISEASES AND A HISTORY OF SEXUAL OR PHYSICAL ABUSE

Life history methods were used to obtain a more in-depth understanding of the configuration of psychosocial and situational factors that are associated with high-risk sexual behavior among minority adolescent women with a history of sexual or physical abuse and sexually transmitted disease (STD), to facilitate development of behavioral risk-reduction interventions. Study participants ranged in age from 14 to 18 years; 19 were Mexican American and 11 were African American. Women were recruited from clinics in a metropolitan health district. Various constitutive patterns unfolded during interview analysis including “fearing,” “trusting,” and “being a woman.” The study revealed the perceptions of an extremely high-risk population of adolescent women regarding their STD risk, the context of their sexual relationships, sexual risk behaviors, contraception, and STD prevention, screening, and treatment practices. Intervention strategies based upon these findings are described.