Under our new Early View feature, articles in Perspectives on Sexual and Reproductive Health are now published online as they complete the production process, which allows us to get material to you weeks before the printed journal arrives in your mailbox. Sign up at this link to receive an alert when new articles become available.
Thanks to Early View, many of you have already seen the first article in our December issue: "Do Depression and Low Self-Esteem Follow Abortion Among Adolescents? Evidence from a National Study," (click here for the news release), by Jocelyn T. Warren of Oregon State University et al.
HERE’S WHAT ELSE YOU CAN FIND IN THIS ISSUE OF PERSPECTIVES:
Providers See Importance of Screening for Intimate Partner Violence but Report Barriers to Adequate Screening
Health care staff at a large family planning organization in New York City who participated in focus group discussions and a brief survey reported positive attitudes about screening for intimate partner violence and considered it an important part of comprehensive health care. However, according to "Barriers to Screening for Intimate Partner Violence: A Mixed-Methods Study of Providers in Family Planning Clinics," by Lisa Colarossi et al., of Planned Parenthood of New York City, both licensed professionals (advanced practice clinicians and social workers) and unlicensed practitioners (health care assistants) reported lack of time, training and referral resources as barriers to providing those services. Additionally, providers expressed frustration over clients’ unwillingness to utilize referrals after disclosing violence and a sense that the assistance they are able to give is inadequate. The authors suggest that ongoing training about the relationship of violence to sexual behaviors and contraceptive use may help improve providers’ attitudes toward screening and skills for responding to disclosures with counseling or referrals.
Teen Athletes More Likely to Be Sexually Active than Nonathletes; Also More Likely to Use Condoms
Students as young as middle school age who participate in sports daily may be at elevated risk of STDs and pregnancy, compared with their peers who do not engage in sports daily, according to "Daily Participation in Sports and Students’ Sexual Activity," by Melissa A. Habel of the Centers for Disease Control and Prevention et al. The authors analyzed data on 10,487 students in 26 Los Angeles public middle and high schools, and found that student athletes were more likely than nonathletes to report ever having had intercourse or oral sex, but were also more likely to report using a condom at last sex. Habel and colleagues speculate that the higher likelihood of condom use could be due to the potential ramifications of pregnancy for teens’ athletic aspirations. Additionally, they found that the likelihood of having engaged in intercourse or in oral sex was higher among middle school athletes than among their high school counterparts. The authors suggest that teens be encouraged to be physically active and to play team sports, but that they also be given the information and skills they need to avoid the potential negative consequences of risky sexual behavior. Habel and colleagues recommend that health educators consider targeting athletes at the middle school level and work directly with athletic teams and coaches to promote sexual risk reduction.
Follow-Up Phone Calls to Adolescent Clinic Clients Fail to Improve Contraceptive Use
An intervention in which adolescent clinic clients in San Francisco received multiple follow-up telephone calls that incorporated motivational interviewing techniques failed to improve contraceptive behaviors, according to "Impact of an Intervention to Improve Contraceptive Use Through Follow-Up Phone Calls to Female Adolescent Clinic Patients," by Douglas Kirby of ETR Associates et al. The authors examined data from 805 females aged 14–18 and found that the intervention did not have an impact on levels of condom use or on use of hormonal methods of birth control. They report that reaching young women by phone after a clinic visit for contraception was challenging: Clinic counselors completed only 30% of the nine follow-up calls attempted in the year following participants’ initial visit and made 7.8 attempts for every completed call. Prior research has found that the most important reason sexually active young women become pregnant unintentionally is their failure to use contraceptives consistently and correctly. Kirby and colleagues note that the San Francisco project was a modest intervention, and they suggest that more intensive ones may be needed to markedly improve teens’ sexual and contraceptive behavior.
Women with Disabilities Are Less Likely to Receive a Pap Smear Than Women Without Disabilities
In addition to being one of the most common reproductive cancers, cervical cancer is one of the most preventable. Preventive screening is most widely done with the Pap smear, which has been credited with reducing the cervical cancer mortality rate by an estimated 70% over the past 40 years. Yet many women are not screened regularly, and women with disabilities are even less likely than women without disabilities to obtain a Pap smear, even when the test has been recommended by a doctor. "Disability and Pap Smear Receipt Among U.S. Women, 2000 and 2005," by Julia A. Rivera Drew of the University of Minnesota Population Center and Susan E. Short of Brown University, reports that 68% of women with disabilities had received a Pap smear in the previous year, compared with 75% of women without disabilities. The authors examined data from 20,907 women aged 21–64 from the 2000 and 2005 National Health Interview Surveys, and found that approximately one in five women reported living with at least one disabling condition—a mobility limitation or a sensory, mental, cognitive or social impairment. Women with disabilities were almost as likely as others to be insured, yet they were substantially more likely to cite cost or lack of insurance as their primary reason for not receiving a Pap smear. The authors recommend examining health system barriers beyond insurance to understand the underutilization of cervical cancer screening and other preventive reproductive health services for women with disabilities. They suggest that there may be a need for programs specifically targeted at reducing barriers to reproductive health care for these women.
Heterosexual Anal Sex Is Common Among Young Black and Puerto Rican Adults, Particularly in the Context of Serious Relationships
An analysis of quantitative and qualitative data collected from black and Puerto Rican 18–25-year-olds found that 34% of survey participants had engaged in heterosexual anal sex, according to "Heterosexual Anal Sex Experiences Among Puerto Rican and Black Young Adults," by Marion Carter of the Centers for Disease Control and Prevention et al. The behavior was more common with serious partners than with casual partners (22% vs. 8%). Additionally, the study found low condom use during anal sex, which may reflect the perception that serious partners are often not considered sources of STD risk. The authors report that none of the participants in the study’s qualitative component mentioned anal sex without interviewers’ first raising the issue, and when the issue was raised, negative views dominated. Some respondents viewed it as unappealing, while others expected it to be too painful. Among participants who had engaged in anal sex, most did not elaborate on why; rather, they discussed anal sex in the context of describing enjoyable sexual encounters. Heterosexual anal sex is not uncommon in the United States and is a health concern, primarily because it is associated with a greater risk of STD transmission than oral and vaginal sex. This research suggests that many young adults in heterosexual relationships are engaging in anal sex. The authors recommend that health care providers initiate discussions about this issue with their patients, and that they discuss the pros and cons of condom use during anal sex and related health concerns with clients.
Childhood Maltreatment May Be Linked to Increased STD Risk in Young Adulthood
Young women who experienced physical neglect by parents or other adult caregivers during childhood and adolescence are at increased risk of testing positive for an STD in young adulthood, according to "Childhood Abuse and Neglect and the Risk of STDs in Early Adulthood," by Abigail A. Haydon et al., of the University of North Carolina at Chapel Hill. Furthermore, those who experienced any of four types of maltreatment have an elevated likelihood of reporting that they recently had an STD. The analysis, based on data from the National Longitudinal Study of Adolescent Health, reveals a positive relationship among young women between maltreatment and both self-reported and test-identified STDs, even after adjustment for socioeconomic and demographic characteristics, but no association among young males once these characteristics are accounted for. Increased sexual risk-taking did not explain the elevated risk of current STDs among young women. Given the finding that only physical neglect is associated with test-identified STDs, the authors suggest that exclusive use of self-reported STD data—the measure most frequently used in studies—may overstate the relationship between childhood maltreatment and adult STD risk. They recommend that future research examine the factors underlying the association between childhood maltreatment and STD acquisition in adulthood, to help health professionals and program planners tailor interventions that will effectively promote sexual and reproductive health among maltreated youth.