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Venue-based strategies offer effective means of targeting men who have sex with men. Few studies have sought to focus on where younger men congregate and understand risk behaviors that may occur at lower (i.e., community centers) versus higher risk venues. Data from 1,311 young men who have sex with men (YMSM) aged 12- to 24-years-old recruited from publicly accessible venues was used to examine the association between venue type (bar/club, community center, mixed [adjacent to bar/club, including parking lot/alley]) and HIV-related risk factors. YMSM recruited from community venues were more likely than those from bars/clubs to report more partners in last year, receive money in exchange for sex, and to be tested for HIV in prior 6 months, whereas YMSM from mixed-use venues were more likely to have ever received money in exchange for sex, and injected drugs. Community and mixed venues may be key access points for YMSM. [Supplemental funding was provided by the National Institute on Drug Abuse and Mental Health.]

Few studies have examined sexual partnerships and HIV risk in diverse samples of African American/Black and Hispanic/Latino adolescent and young adult men who have sex with men (YMSM), a group that have a high burden of HIV in the United States. A community-venue recruitment approach was used, which identified significant differences in HIV risk by sexual partner type among 1,215 YMSM. Those with casual partners had a higher number of sexual partners, had more sexually transmitted infections (STIs), were more likely to engage in transactional sex, and to use alcohol, marijuana, or other substances compared with those with main partners only. Among those with female sexual partners, many used condoms "every time" when engaging in vaginal sex with casual partners, but a sizable proportion "never/rarely" used condoms with their main partners. Our findings demonstrate a need for tailored HIV prevention education and counseling with necessary skills regarding consistent and correct condom use with all sexual partnerships. [The Adolescent Medicine Trials Network for HIV/AIDS Interventions contributed to the writing of this report.]

We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect to Protect (C2P) coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2,248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking, and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.

Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community.

Public health HIV prevention efforts have begun to focus on addressing social and structural factors contributing to HIV risk, such as unstable housing, unemployment, and access to health care. With a limited body of evidence-based structural interventions for HIV, communities tasked with developing structural changes need a defined process to clarify their purpose and goals. This article describes the adaptations made to a coalition development model with the purpose of improving the start-up phase for a second group of coalitions. Modifications focused on preparing coalitions to more efficiently apply structural change concepts to their strategic planning activities, create more objectives that met study goals, and enhance coalition procedures such as building distributed coalition leadership to better support the mobilization process. We report on primary modifications to the process, findings for the coalitions, and recommendations for public health practitioners who are seeking to start a similar coalition.

Adolescents and young adults (AYA) 13–24 years old make up a disproportionate 21% of new HIV diagnoses. Unfortunately, they are less likely to treat HIV effectively, with only 30% achieving viral suppression, limiting efforts to interrupt HIV transmission. Previous work with mindfulness-based stress reduction (MBSR) has shown promise for improving treatment in AYA living with HIV (AYALH). This randomized controlled trial compared MBSR with general health education (HT). Seventy-four 13–24-year-old AYALH conducted baseline data collection and were randomized to nine sessions of MBSR or HT. Data were collected at baseline, post-program (3 months), 6 and 12 months on mindfulness and HIV management [medication adherence (MA), HIV viral load (HIV VL), and CD4]. Longitudinal analyses were conducted. The MBSR arm reported higher mindfulness at baseline. Participants were average 20.5 years old, 92% non-Hispanic Black, 51% male, 46% female, and 3% transgender. Post-program, MBSR participants had greater increases than HT in MA (p = 0.001) and decreased HIV VL (p = 0.052). MBSR participants showed decreased mindfulness at follow-up. Given the significant challenges related to HIV treatment in AYALH, these findings suggest that MBSR may play a role in improving HIV MA and decreasing HIV VL. Additional research is merited to investigate MBSR further for this important population. [ABSTRACT FROM AUTHOR]

HIV-infected youth experience many stressors, including stress related to their illness, which can negatively impact their mental and physical health. Therefore, there is a significant need to identify potentially effective interventions to improve stress management, coping, and self-regulation. The object of the study was to assess the effect of a mindfulness-based stress reduction (MBSR) program compared to an active control group on psychological symptoms and HIV disease management in youth utilizing a randomized controlled trial. Seventy-two HIV-infected adolescents, ages 14-22 (mean age 18.71 years), were enrolled from two urban clinics and randomized to MBSR or an active control. Data were collected on mindfulness, stress, self-regulation, psychological symptoms, medication adherence, and cognitive flexibility at baseline, post-program, and 3-month follow-up. CD4+ T lymphocyte and HIV viral load (HIV VL) counts were also pulled from medical records. HIV-infected youth in the MBSR group reported higher levels of mindfulness (P = .03), problem-solving coping (P = .03), and life satisfaction (P = .047), and lower aggression (P = .002) than those in the control group at the 3-month follow-up. At post-program, MBSR participants had higher cognitive accuracy when faced with negative emotion stimuli (P = .02). Also, those in the MBSR study arm were more likely to have or maintain reductions in HIV VL at 3-month follow-up than those in the control group (P = .04). In our sample, MBSR instruction proved beneficial for important psychological and HIV-disease outcomes, even when compared with an active control condition. Lower HIV VL levels suggest improved HIV disease control, possibly due to higher levels of HIV medication adherence, which is of great significance in both HIV treatment and prevention. Additional research is needed to explore further the role of MBSR for improving the psychological and physical health of HIV-positive youth. [ABSTRACT FROM AUTHOR]

Purpose To maximize positive health outcomes for youth with HIV as they transition from youth to adult care, clinical staff need strategies and protocols to help youth maintain clinic engagement and medication adherence. Accordingly, this paper describe transition processes across twelve clinics within the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) to provide lessons learned and inform the development of transition protocols to improve health outcomes as youth shift from adolescent to adult HIV care. Design and Methods During a large multi-method Care Initiative program evaluation, three annual visits were completed at each site from 2010–2012 and conducted 174 semi-structured interviews with clinical and program staff (baseline n = 64, year 1 n = 56, year 2 = 54). Results The results underscore the value of adhering to recent American Academy of Pediatrics (AAP) transition recommendations, including: developing formal transition protocols, preparing youth for transition, facilitating youth's connection to the adult clinic, and identifying necessary strategies for transition evaluation. Conclusions Transitioning youth with HIV involves targeting individual-, provider-, and system-level factors. Acknowledging and addressing key barriers is essential for developing streamlined, comprehensive, and context-specific transition protocols. Practice Implications Adolescent and adult clinic involvement in transition is essential to reduce service fragmentation, provide coordinated and continuous care, and support individual and community level health. [ABSTRACT FROM AUTHOR]

Purpose The fear of negative reactions from friends and family members affects many human immunodeficiency virus (HIV)-positive adolescents' decisions regarding disclosure of their HIV status. The complex relationships and interplay among social support, fear of stigma, and disclosure of HIV status need to be better understood among youth living with HIV (YLHIV). Methods Social support from friends and family members and HIV status disclosure were examined among 402 youth, aged 12–24 years, living with HIV. Results In separate analyses, (1) HIV-positive youth who reported more than one close friend and (2) HIV-positive youth who reported that friends and family members continued to socialize with them after disclosure of their HIV diagnosis, had higher levels of perceived social support overall (both p < .05). Furthermore, perceived social support did not differ significantly between those participants for whom no family member knew their HIV status and those for whom at least one family member knew their status ( p = .13). Race/ethnicity, sexual orientation, education level, and current living situation were not associated with family's knowledge of the participants' HIV infection status ( p > .07). Conclusion This investigation adds important information concerning YLHIV, whose early disclosure experiences may influence their resilience and future coping mechanisms regarding experienced stigma, and thus influence the length of time they conceal their HIV status, their decision to disclose their status, and potentially their decisions regarding treatment. Interventions and support systems to assist YLHIV with disclosure, as well as medical care, may improve their overall quality of life. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: This research examined the association between a novel measure of perceived partner availability and discordance between ideal and actual partner characteristics as well as trajectories of ideal partner preferences and perceptions of partner availability over time. Methods: A clinic-recruited cohort of adolescent females (N = 92), aged 1619 years, were interviewed quarterly for 12 months using audio computer-assisted self-interview. Participants ranked the importance of characteristics for their ideal main sex partner and then reported on these characteristics for their current main partner. Participants reported on perceptions of availability of ideal sex partners in their neighborhood. Paired t-tests examined discordance between ideal and actual partner characteristics. Random-intercept regression models examined repeated measures. Results: Actual partner ratings were lower than ideal partner preferences for fidelity, equaled ideal preferences for emotional support and exceeded ideal preferences for social/economic status and physical attractiveness. Discordance on emotional support and social/economic status was associated with sex partner concurrency. Participants perceived low availability of ideal sex partners. Those who perceived more availability were less likely to be ideal/actual discordant on fidelity [OR = .88, 95% CI: .78, 1.0]. Neither ideal partner preferences nor perceptions of partner availability changed over 12 months. Conclusions: Current main sex partners met or exceeded ideal partner preferences in all domains except fidelity. If emotional needs are met, adolescents may tolerate partner concurrency in areas of limited partner pools. Urban adolescent females who perceive low availability may be at increased risk for sexually transmitted infection (STI) because they may be more likely to have nonmonogamous partners. [Copyright &y& Elsevier]

Objective: We aimed to explore the specific effects of mindfulness-based stress reduction (MBSR) for urban youth by comparing it with an active control program, designed to control for time, positive peer-group experience, and positive adult instructor. Methods: Patients between the ages of 13–21 years who received primary pediatric care at our urban outpatient clinic were eligible for study participation. Those who were interested were consented and randomly assigned to an eight-week program of MBSR or Healthy Topics (HT), a health education curriculum. To increase sensitivity to outcomes of interest, mixed methods were used to assess psychological symptoms, coping, and program experience. Analysis of variance and regression modeling were used; interviews were audio-taped, transcribed, and coded for key themes. Results: A total of 43 (26 MBSR, 17 HT) youths attended one or more sessions, of whom 35 [20 MBSR (77%), 15 HT (88%)] attended the majority of the sessions and were considered completers. Program completers were African American, 80% female, with average age of 15.0 years. Statistical analysis of survey data did not identify significant post-program differences between groups. Qualitative data show comparable positive experiences in both programs, but specific differences related to MBSR participants׳ use of mindfulness techniques to calm down and avoid conflicts, as well as descriptions of internal processes and self-regulation. Conclusions: Compared with an active control program, MBSR did not result in statistically significant differences in self-reported survey outcomes of interest but was associated with qualitative outcomes of increased calm, conflict avoidance, self-awareness, and self-regulation for urban youths. Importantly, based on qualitative results, the HT program functioned as an effective active control for MBSR in this sample, facilitating a more rigorous methodological approach to MBSR research in this population. We believe the promising effects elucidated in the qualitative data have the potential for positive affective and behavioral outcomes. [Copyright &y& Elsevier]

Linkage and engagement in care are critical corollaries to the health of HIV-infected adolescents. The adolescent HIV epidemic and adolescents' unique barriers to care necessitates innovation in the provision of care, including the consideration of the clinical experience. Little research has addressed how “youth friendly” clinics may influence care retention for HIV-infected youth. We conducted 124 interviews with providers, outreach workers, and case managers, at 15 Adolescent Medicine Trials Network clinics. Photographs of each clinic documented the characteristics of the physical space. Constant comparison and content and visual narrative methods were utilized for data analysis. Three elements of youth friendliness were identified for clinics serving HIV-infected youth, including: (1) role of target population (e.g., pediatric, adolescent, HIV); (2) clinics' physical environment; and (3) clinics' social environment. Working to create ‘youth friendly’ clinics through changes in physical (e.g., space, entertainment, and educational materials) and social (e.g., staff training related to development, gender, sexual orientation) environments may help reduce HIV-infected adolescents' unique barriers to care engagement. The integration of clinic design and staff training within the organization of a clinical program is helpful in meeting the specialized needs of HIV-infected youth. [ABSTRACT FROM PUBLISHER]

Linkage to care is a critical corollary to expanded HIV testing, but many adolescents are not successfully linked to care, in part due to fragmented care systems. Through a collaboration of the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and the Adolescent Trials Network (ATN), a linkage to care outreach worker was provided to ATN clinics. Factors related to linkage were explored to better understand how to improve retention rates and health outcomes for HIV-positive adolescents. We conducted 124 interviews with staff at 15 Adolescent Trials Network clinics to better understand linkage to care processes, barriers, and facilitators. Content analysis was conducted focusing on structural barriers to care and potential solutions, specifically at the macro-, meso-, and micro-levels. Macro-level barriers included navigating health insurance policies, transportation to appointments, and ease of collecting and sharing client-level contact information between testing agencies, local health departments and clinics; meso-level barriers included lack of youth friendliness within clinic space and staff, and duplication of linkage services; micro-level barriers included adolescents' readiness for care and adolescent developmental capacity. Staff initiated solutions included providing transportation for appointments and funding clinic visits and tests with a range of grants and clinic funds while waiting for insurance approval. However, such solutions were often ad hoc and partial, using micro-level solutions to address macro-level barriers. Comprehensive initiatives to improve linkage to care are needed to address barriers to HIV-care for adolescents, whose unique developmental needs make accessing care particularly challenging. Matching the level of structural solution to the level of structural barriers (i.e., macro-level with macro-level), such as creating policy to address needed youth healthcare entitlements versus covering uninsured patients with clinic funds is imperative to achieving the goal of increasing linkage to care rates for newly diagnosed adolescents. [ABSTRACT FROM AUTHOR]

The fragmentation of HIV-related diagnostic and treatment services, especially for youth, is a significant barrier for engaging in care. The authors identified key elements that affected care linkage efforts and conducted 64 interviews across 15 clinical sites. The constant comparative method was used. Primary linkages to care processes are illustrated through three geographically diverse case studies. Factors included interagency relationships, data-sharing protocols, and service duplication concerns. Program improvement strategies were discussed. A strong, citywide network is helpful in coordinating care linkage services. These partnerships will be critical in effectively realizing the goals of the National HIV/AIDS Strategy. [ABSTRACT FROM PUBLISHER]

Abstract: Using a probability-based neighborhood sample of urban African American youth and a sample of their close friends (N = 202), we conducted a one-year longitudinal study to examine key questions regarding sexual and drug using norms. The results provide validation of social norms governing sexual behavior, condom use, and substance use among friendship groups. These norms had strong to moderate homogeneity; and both normative strength and homogeneity were relatively stable over a one-year period independent of changes in group membership. The data further suggest that sex and substance using norms may operate as a normative set. Similar to studies of adults, we identified three distinct “norm-based” social strata in our sample. Together, our findings suggest that the norms investigated are valid targets for health promotion efforts, and such efforts may benefit from tailoring programs to the normative sets that make up the different social strata in a given adolescent community. [Copyright &y& Elsevier]

Abstract: Objectives: We evaluated highly active antiretroviral therapy (HAART) utilization in youth infected with HIV through risk behaviors who met treatment criteria for HAART. We assessed the impact of receiving care at an adult or pediatric HIV clinical site on initiation and discontinuation of the first HAART regimen in behaviorally infected youth (BIY). Methods: This was a retrospective analysis of treatment-naive BIY, aged 12–24 years, who enrolled in the HIV Research Network between 2002 and 2008 and who met criteria for HAART. The outcomes were time from meeting criteria to initiation of HAART and time to discontinuation of the first HAART regimen. Analyses were conducted using Cox proportional hazards regression. Results: Of 287 treatment-eligible youth, 198 (69%) received HAART; of these 198 youth, 58 (29.3%) subsequently discontinued HAART. In multivariable analyses, there was no significant difference in the time between meeting treatment criteria and initiating HAART for BIY followed at adult or pediatric HIV clinical sites. However, BIY followed at adult sites discontinued HAART sooner than BIY followed at pediatric HIV clinical sites (adjusted hazard ratio [AHR]: 3.19 [1.26–8.06]). Conclusions: Two-thirds of treatment-eligible BIY in the HIV Research Network cohort initiated HAART; however, one-third who initiated HAART discontinued it during the study period. Identifying factors associated with earlier HAART initiation and sustainability can inform interventions to enhance HAART utilization among treatment-eligible youth. The finding of earlier HAART discontinuation for youth at adult care sites deserves further study. [Copyright &y& Elsevier]

Abstract: Purpose: Epidemic levels of sexually transmitted infections (STIs) among urban youth have drawn attention to the potential role of sex partner selection in creating risk for STIs. The objectives of this study were to describe the ideal preferences and real selection of sex partners, to evaluate sex partner ideal versus real discordance using quantitative methods, and to determine the association between discordance and STI risk behaviors. Methods: Data are obtained from an urban, household sample of 429 individuals aged 15–24 years. Trait clusters were developed for participants'' ratings of their real and ideal sex partners and tested for reliability. Discordance between the ratings of real and ideal partners was measured. Logistic regression was used to assess associations between sex partner discordance and STI risk behaviors. Results: Ratings of the real sex partners were often lower than participants'' ideal sex partner ratings. A total of 33% of male adolescents and young men and 66% of female adolescents and young women were discordant on at least one trait cluster. Male adolescents and young men who were discordant on the emotional support they expected of their partner were more likely to report more than two sex partners in the past 90 days (odds ratio = 2.13, 95% confidence interval: 1.06–4.26) and perceived partner concurrency (odds ratio = 3.85, 95% confidence interval: 1.53–9.72). For female adolescents and young women, discordance on fidelity or emotional support significantly increased the odds of all risk behaviors. Conclusion: Male and female adolescents with discordant real and ideal sex partner ratings were more likely to report STI-related risk behaviors. Further steps should involve identification of factors associated with ideal versus real sex partner discordance, such as features of the social context. [Copyright &y& Elsevier]

The article discusses the benefits that community engagement offers. It notes that the benefits of community engagement can increase both effectiveness and dissemination of new strategies and might improve the participation in trials through community support and community referrals. It also notes that community engagement has two examples, including the Connect to Protect in the U.S. and the South African Studies on HIV in Adolescents project.

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Abstract: Purpose: To evaluate the impact of a quality improvement intervention for outpatient management of pelvic inflammatory disease (PID) on provider compliance with published guidelines and to explore issues affecting patient adherence to outpatient care regimens. Methods: This study utilized an interrupted time series design. The intervention included an algorithm and clinical practice guideline based on the 2002 Centers for Disease Control STD Guidelines, a complete course of medications to be given at discharge after initial doses given in the site, standardized discharge instructions, close follow-up at 24–48 hours and after two weeks of treatment by a member of the PID team, and a referral for follow-up. Results: At baseline, 38% of patients did not receive an appropriate medication regimen and only 10% of clinic outpatients returned for follow-up evaluations within 72 hours. In the postintervention group, 91% of patients received an appropriate outpatient regimen and 43% of emergency department and clinic patients returned for care. Based on the results of logistic regression models, adolescents in the postintervention group were 8.4 times more likely (adjusted odds ratio [AOR]: 8.4, confidence interval [CI]: 2.6–26.8, p <. 001) to receive an appropriate outpatient medication regimen than girls in the baseline group. Follow-up interview revealed that 61% of postintervention patients completed all doses of the medication, 67% practiced temporary abstinence, 86% notified their partner for treatment, and 96% were satisfied with their care. Conclusions: Interventions utilizing a multi-level approach to the management of outpatient PID improve provider compliance with published guidelines and quality of care delivered to adolescents in academic settings. Many adolescents, however, continue to have difficulty with adherence. Additional research is warranted to address adherence to outpatient regimens for the treatment of PID in adolescent girls. [Copyright &y& Elsevier]

Abstract: Purpose: Limited information is available about adolescents’ beliefs about fertility in women and its link to sexually transmitted disease (STD) and whether men and women differ in their beliefs. This information may be useful for developing messages intended to motivate youth to seek STD screening while they are asymptomatic. The purpose of this study was to examine gender-based differences in fertility beliefs and knowledge. Methods: Data were derived from the Adolescent Health Study, a population-based telephone survey study in which urban household adolescents from a high STD-prevalence community were queried about their sexual experience, fertility-related knowledge, beliefs related to timing of childbearing, and risk assessment of future fertility problems. χ2 and regression analyses were used to evaluate group differences. Results: The majority of adolescents reported that having children was somewhat or very important, but that the 15- to 19-year-old age group was not the optimal time for a woman to have a child. Regression analyses indicated that female adolescents were more likely than male adolescents to identify chlamydia and pelvic inflammatory disease as causes of fertility problems. Seventy-two percent of adolescent girls thought there was some chance they would have future fertility problems and 58% thought they had little or no control over developing fertility problems in the future. Conclusion: Additional health education is needed if we are to motivate adolescents to participate in asymptomatic STD screening programs. Involving male adolescents may be a more significant challenge given that fewer male adolescents understand the link between female fertility and common STD-related conditions. Given our findings, fertility preservation may be a valuable teaching tool and social marketing agent for STD prevention in adolescents. [Copyright &y& Elsevier]

Abstract: Background: The objectives of this study were as follows: (1) to determine the extent of agreement between adolescents’ perceptions of sex-partner concurrency (having a partner who has other overlapping sexual partnerships) and their partners’ self-reported concurrency, and (2) to identify the relationship-level factors associated with agreement. Methods: Adolescents ages 14 to 19 years, along with their main sex partners, were recruited from a primary care clinic and a public sexually transmitted disease clinic and interviewed separately about their own concurrency status and their perception of their partner’s concurrency status. Information from both participants and their partners were included in this analysis (N = 90 couples). Results: This sample consisted of African-American, sexually experienced heterosexual couples. For males and females who perceived their partner not to have other partners, 16% and 37% of their sex partners reported having other partners, respectively. Of males and females who perceived their partner to have other partners, 80% and 39% of their sex partners reported not having other partners, respectively. Multivariate logistic regression revealed that adolescents who had been with their partners for more than 6 months and considered themselves more emotionally close were nearly twice as likely to agree on concurrency. Conclusions: Among adolescent couples, agreement between perceptions of sex-partner concurrency and partner-reported behavior was low. To the extent that partner self-reports are accurate, individuals who presume that they are in a mutually monogamous relationship often underestimate their own sexually transmitted disease risk. To appropriately tailor risk reduction messages, prevention efforts need to consider adolescents’ perceptions of concurrent sex partners. [Copyright &y& Elsevier]

Purpose: To compare response bias associated with a telephone survey of sexually transmitted disease/human immunodeficiency virus (STD/HIV)-related risk behaviors and an in-home self-administered audio computer assisted self interview (A-CASI).Methods: We randomly assigned an urban household sample of 223 African-American adolescents to a telephone interview or an A-CASI in their home. The sample was previously recruited by telephone for an earlier study regarding STDs and sexual behavior. We queried participants about their STD/HIV-related risk behaviors. We also assessed their perceived comfort, honesty, and accuracy in answering questions in the different modes through a telephone computer-assisted self-interview (T-CASI).Results: There were no significant differences by mode in percentages of participants reporting STD/HIV-related risk behaviors, except more A-CASI participants reported having engaged in sexual intercourse in past 3 months (43.8% vs. 33.3%). There were no differences in perceived comfort, honesty, and accuracy in answering questions in the different modes. These results also did not change after we adjusted for age, household structure, and current school enrollment.Conclusions: Telephone interviews, a more economical mode, can be employed without much risk of increasing the response bias in the data assessing crude measures of risk. [Copyright &y& Elsevier]

Abstract: We explored the prevalence of gender differences in human immunodeficiency virus (HIV) testing among a household sample of sexually active African-American adolescents. Females disproportionately self-report being tested for HIV more than males. This difference was not explained by age or receipt of services for sexually transmitted infection but was partially attributable to history of pregnancy. [Copyright &y& Elsevier]

Purpose: To examine how interpersonal factors are associated with family, peer, and partner social support among urban female adolescents in sexual relationships.Design: Secondary data analysis of cross-sectional data.Setting: Two urban health clinics and community sites in Baltimore, Maryland.Participants: One hundred sixteen female adolescents (ages 16-19) with 131 heterosexual relationships from the Perceived Risk of Sexually Transmitted Diseases cohort.Measures: Interpersonal factors included parental monitoring, friend-partner connectedness, and feelings of intimacy for partner. Social support was measured using the Multidimensional Scale of Perceived Social Support with family, peer, and partner subdomains.Analysis: Multivariable linear regression models using baseline data and accounting for clustering of partners.Results: Adolescents perceived high levels of family, peer, and partner support, with the greatest coming from partners (range: 1-5; family mean: 4.0 [95% confidence interval, CI: 3.83-4.18]; peer mean: 4.2 [95% CI: 4.05-4.33]; partner mean: 4.5 [95% CI: 4.36-4.60]). Parental monitoring and friend-partner connectedness were significantly associated with greater family (b = 0.11, standard error [SE] = 0.03, P = 0.001; b = 0.15, SE = 0.06, P = .02) and peer support (b = 0.06, SE = 0.02, P = .01; b = 0.29, SE = 0.07, P < .001). Feelings of intimacy for partner was significantly associated with greater partner support (b = 0.08, SE = 0.03, P = .02).Conclusion: Feeling connected to one's social network and having a connected network is an important contribution to social support for urban female adolescents in sexual relationships. Future research targeting interpersonal factors is warranted, as it may result in increased social support and promote positive sexual health behaviors in an urban female adolescent population. [ABSTRACT FROM AUTHOR]

This study explored the relationship between the social organization of neighborhoods including informal social control and social cohesion and a current bacterial sexually transmitted infection (STI) among adolescents and young adults in one U.S. urban setting. Data for the current study were collected from April 2004 to April 2007 in a cross-sectional household study. The target population included English-speaking, sexually-active persons between the ages of 15 and 24 years who resided in 486 neighborhoods. The study sample included 599 participants from 63 neighborhoods. A current bacterial STI was defined as diagnosis of a chlamydia and/or gonorrhea infection at the time of study participation. Participants reported on informal social control (i.e. scale comprised of 9 items) and social cohesion (i.e. scale comprised of 5 items) in their neighborhood. In a series of weighted multilevel logistic regression models stratified by gender, greater informal social control was significantly associated with a decreased odds of a current bacterial STI among females (AOR 0.53, 95% CI 0.34, 0.84) after controlling for individual social support and other factors. The association, while in a similar direction, was not significant for males (AOR 0.73, 95% CI 0.48, 1.12). Social cohesion was not significantly associated with a current bacterial STI among females (OR 0.85, 95% CI 0.61, 1.19) and separately, males (OR 0.98, 95% CI 0.67, 1.44). Greater individual social support was associated with an almost seven-fold increase in the odds of a bacterial STI among males (AOR 6.85, 95% CI 1.99, 23.53), a finding which is in contrast to our hypotheses. The findings suggest that neighborhood social organizational factors such as informal social control have an independent relationship with sexual health among U.S. urban youth. The causality of the relationship remains to be determined. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of this research was to examine the effectiveness of a brief behavioral intervention, provided at the time of diagnosis of pelvic inflammatory disease, on subsequent behaviors by patients who were urban adolescents in a community in which sexually transmitted infection was prevalent. Methods: 121 adolescents aged 15 to 21 years with mild to moderate pelvic inflammatory disease were enrolled in a randomized trial. All participants received standardized care, completed baseline audio computerized self-interviews, received full courses of medication at discharge, and were interviewed after the 2-week treatment course. The intervention group also watched a 6-minute intervention video. Main Outcome Measures: Medication completion, temporary sexual abstinence during the 14-day treatment period, partner notification, partner treatment, and return for 72-hour follow-up were studied. Data were evaluated using multivariate regression analysis. Results: Of the participants, 61% were located and could participate in the 2-week interview by the disease intervention specialist. The intervention participants had higher rates of 72-hour follow-up (32% vs. 16%) and partner treatment (71% vs. 53%) in bivariate analyses at a P = 0.1 level. There were no differences in medication completion (66% vs. 66%), sexual abstinence (78% vs. 89%), or partner notification (88% vs. 92%). Only the partner-treatment finding persisted in multivariate models (AOR = 3.10; 95% CI, 1.03-9.39, P = .045). Conclusions: Adolescent girls randomized to a community-specific video intervention at diagnosis of pelvic inflammatory disease were three times more likely to have their partners treated than those in the control group. Given the value of partner treatment in secondary prevention of sexually transmitted diseases, this video may be an essential component of discharge programming in urgent care settings. Additional structural supports may be necessary to facilitate improved adherence to other key adherence behaviors. [Copyright &y& Elsevier]