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Purpose Trust is an essential component of romantic relationships. It is not understood how youth respond to a relationship stressor, which may impact trust, such as perceiving to be at risk for a sexually transmitted infection or their partner has other sex partners. We used a system science approach to examine feedback between trust and prorelationship behaviors within adolescent relationships. Methods A prospective cohort of clinic-recruited young women (N = 122), aged 16–19 years, completed daily questionnaires on partner-specific feelings and risk perceptions for 18 months. Relationship stressor defined as either perceiving the risk of sexually transmitted infection from a partner or partner had other sex partners. Prorelationship behaviors were more time spent with partner, sex with partner, and/or gift from partner. Time-lagged generalized estimating equation models were used to examine whether a relationship stressor is associated with a decrease in trust and whether prorelationship behaviors changed following the stressor. Results Experiencing a stressor was associated with threefold increased odds of having a decrease in trust in the same week (odds ratio [OR] = 3.30, 95% confidence interval [CI]: 2.30–4.72). Trust increased significantly the week following the stressor (OR = 2.09, 95% CI: 1.54–2.85). An increase in trust relative to the week of the stressor was associated with a 65% increase in prorelationship behavior in the week following the stressor (OR = 1.65, 95% CI: 1.20–2.26). Conclusions Data uniquely show that trust is impacted following a relationship stressor and that youth increase prorelationship behaviors following a drop in trust. The findings suggest that adolescents prioritize maintaining trust, which may impact engagement in protective health behaviors.

Current pelvic inflammatory disease (PID) treatment effectively treats Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT). However, coverage may be inadequate for Mycoplasma genitalium (MG)/Trichomonas vaginalis (TV) infections. We compared the longitudinal MG and TV outcomes with NG/CT outcomes for women enrolled in a longitudinal randomized controlled trial to optimize outcomes after PID. The prevalences of CT and NG were lower at 30- and 90-day follow-up compared with the prevalence at the time of diagnosis. No significant difference was observed for MG (odds ratio, 0.95; 0.86-1.04; P = 0.265) and TV (odds ratio, 0.89; 0.75-1.04; P = 0.146) over time for both treatment groups, showing that persistence and/or reinfection with MG and TV occurs more frequently than with CT or NG after treatment of PID using current national treatment guidelines.

BackgroundYoung men who have been involved with the criminal justice system are more likely to have concurrent sexual partners, a key driver of sexually transmitted infections. The value men place on having sexual relationships to validate themselves may play an important role in understanding this

While HIV is prevalent among adolescents and young adults, testing levels remain low and little is known about gender differences in HIV testing. The objectives of this study were to describe the prevalence of past-year HIV testing and evaluate associations between HIV testing and individual- and partner-level factors by gender among heterosexually experienced youth (15-24 years) in Baltimore, Maryland (N = 352). Past-year HIV testing was prevalent (60.1%) and differed by gender (69.4% among women vs. 49.6% among men, p = 0.005). For women, African-American race (AOR 3.09) and recent older partner by ≤2 years (AOR 4.04) were significantly associated with testing. Among men, only African-American race was associated with testing (OR 4.23), with no patterns identified based on risk behavior or perceived partner risk. HIV testing among adolescent and young adults was prevalent in this highly affected urban area. Findings emphasize the value of a gender lens, and provide direction for optimizing engagement in HIV testing.

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.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.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.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.

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.

In this study we explore associations between child and adult victimization and sexual risk behavior in 118 young, HIV positive women. Prior research has demonstrated associations between victimization and engagement in sexual risk behavior. Victimization sequelae can include disrupted assertiveness and communication, as well as increased association with risky partners, both of which are also linked with engagement in sexual risk behavior. Thus, we propose a model wherein victimization is linked to sexual risk behavior through two mediating pathways, sexual communication and affiliation with risky partners. We also examine the moderating effects of the presence of an anxiety or depressive disorder on the path from child to adult victimization. Results suggested that adult victimization was associated with unprotected sex with a main partner; however, this association was mediated by less sexual communication and having a risky partner. Trends toward significance were found for depression and anxiety as a moderator of the relationship between child and adult victimization. Child victimization did not have direct effects on unprotected sex. Implications for secondary prevention of HIV and healthy intimate relationships are discussed.

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.

Objectives Mindfulness-based stress reduction (MBSR) has been shown to improve mental health and reduce stress in a variety of adult populations. Here, we explore the effects of a school-based MBSR program for young urban males. Participants and methods In fall 2009, 7th and 8th graders at a small school for low-income urban boys were randomly assigned to 12-session programs of MBSR or health education (Healthy Topics—HT). Data were collected at baseline, post-program, and three-month follow-up on psychological functioning; sleep; and salivary cortisol, a physiologic measure of stress. Results Forty-one (22 MBSR and 19 HT) of the 42 eligible boys participated, of whom 95% were African American, with a mean age of 12.5 years. Following the programs, MBSR boys had less anxiety (p = 0.01), less rumination (p = 0.02), and showed a trend for less negative coping (p = 0.06) than HT boys. Comparing baseline with post-program, cortisol levels increased during the academic terms for HT participants at a trend level (p = 0.07) but remained constant for MBSR participants (p = 0.33). Conclusions In this study, MBSR participants showed less anxiety, improved coping, and a possible attenuation of cortisol response to academic stress, when compared with HT participants. These results suggest that MBSR improves psychological functioning among urban male youth.

Stigma in HIV positive persons has been associated with numerous negative sequelae, including decreased social support, depressive symptoms, and engagement in risk behaviors. Few studies examined the interrelationships of these factors to facilitate understanding of the mechanisms by which HIV stigma influences risk behavior, thus the current study focuses on identifying pathways between HIV-related stigma and risk behavior in 147 young HIV positive women. Depression and social support were hypothesized to mediate between HIV-related stigma and risk behavior. Structural equation modeling was used to test these hypothesized pathways, results suggested that depression was a significant mediator between HIV-related stigma and risk behavior. Implications for interventions with young HIV positive women who report high levels of HIV-related stigma include a focus on depression as a method of reducing engagement in risk behavior and improving mental health and health behaviors in persons living with HIV.

Significant numbers of adolescents are initiating sexual activity at age 13 and younger. Little is known about this younger population of adolescents. This includes risk or protective factors for sexual activity and sexually transmitted infection (STI) acquisition. To safeguard all adolescents from the consequences of risky sexual behaviors, and to insure age appropriate and effective interventions, further study is critical to address risky behaviors specific to early adolescents.This study was a retrospective chart review of 155 sexually active adolescent girls enrolled in 3 inner city school-based health centers. Students were divided into those who never had a documented STI and those who had 1 or more STIs. Data were collected from a sexual history questionnaire and the Guidelines for Adolescent Preventive Services questionnaire. These data were grouped into risk or protective Guidelines for Adolescent Preventive Services domains. Domains were made up of 5 items of protective factors, 3 items of peer risks, 2 items of family risks, and 7 items of individual risks. STI outcomes were compared to these characteristics.One hundred fifty-five sexually active black adolescents were studied. A univariate and multivariate analysis of risk and protective factors for testing positive for an STI demonstrated that high levels of protective factors reduced the risk of STIs.Increased levels of protective factors were associated with a decrease in STI risk. This suggests that STI prevention programs should focus on increasing protective factors among young adolescents in addition to reducing risk factors.

The importance of gender within HIV/STI prevention has become widely recognized. However, gender ideologies associated with vulnerability to HIV/STI are often examined and addressed without sufficient attention to the larger socioeconomic context within which they arise and evolve. We conducted a cross-sectional survey with 155 female, African-American adolescents recruited from two health clinics in Baltimore, Maryland. Multivariate logistic regression was utilized to assess the relationships between HIV/STI vulnerability resulting from male partner concurrency, adherence to traditional female gender norms, using a measure of hyperfemininity, and perceived socioeconomic opportunity structures. The likelihood of reported partner concurrency increased significantly among participants reporting higher levels of hyperfemininity (OR = 2.08; 95%CI = 1.01–4.30). Hyperfeminine thinking and behavior was significantly lower in the context of higher perceived socioeconomic opportunity structures (OR = 0.87; 95%CI = 0.79–0.95). Interventions seeking to promote gender equity and reduce HIV/STI may be more effective when the socioeconomic context of gender ideologies is assessed and addressed. Programs and policies to increase educational and professional opportunity structures, particularly among marginalized communities, should be actively integrated into HIV/STI prevention planning.

Background: Although physical attributes have been shown to be associated with sexually transmitted disease (SD) rates, there is little information about the association between social attributes and STD rates. Goal: The objective of this study was to determine the association between gonorrhea prevalence and perceptions of social cohesion in impoverished, urban neighborhoods. Study Design: We conducted a street-based survey of 18- to 24year-olds residing in selected census block groups in Baltimore City, Maryland. Census block groups eligible for selection were defined as impoverished (greater than 20% in poverty) and unstable (lowest 25th percentile for stability). From the eligible census block groups, 5 from high gonorrhea rate (greater than the 75th percentile) census block groups and 5 from the lower gonorrhea rate (lowest 25th percentile to equal or greater than the 75th percentile) census block groups were randomly selected. Participants within the 10 selected census block groups were recruited using a street-intercept method. Participants were asked about perceived social cohesion and control. Results: Results showed that for young adults 18 to 24 years of age residing in high gonorrhea census block groups, the mean social cohesion index scores were 1.7 points lower than mean social cohesion index scores of the participants residing in the low gonorrhea census block groups (P

BACKGROUND It is not well understood whether characteristics of adolescent main partnerships differ categorically from one relationship to the next or whether observed differences in sexually transmitted infection (STI)-related perceptions and sexual behaviors between main partnerships results from a failure to capture variability within adolescent main partnerships. The objective of this study was to examine the extent to which female adolescents' STI-related feelings, perceptions, and sexual behavior associated with main sex partners varied over the course of their relationship. METHODS A cohort of adolescent women aged 16 to 19 years at baseline, recruited from health clinics or community venues, completed daily diaries on a Smartphone continuously for 18 months. Participants reported daily on their partner-specific feelings of closeness, trust, commitment, perceived risk for acquiring a sexually transmitted disease (PRSTD), perception of partner concurrency (PPC), and condom use for their main sexual partners. RESULTS Relationships from 49 participants were used to examine variability over time in STI-related feelings, perceptions, and behavior. Overall, relationships were characterized by high levels of trust, closeness, and commitment and low levels of PPC, PRSTD, and condom use. However, for all but PRSTD, there was more variation (>50%) within than between relationships for each of these measures, although variability of PRSTD was high (47.1%). Residual variability for all perceptions and behaviors remained significant after controlling for trends over time. CONCLUSIONS Diary data illustrate wide day-to-day fluctuations in feelings of intimacy, PPCs, PRSTDs, and condom use indicating that these are dynamic attributes of adolescent romantic relationships.

We investigated the association between parental factors (including infection with human immunodeficiency virus [HIV], acquired immunodeficiency syndrome [AIDS] diagnosis, parental medical illness, and depression) and children's behavioral and emotional problems among children of injection drug users (IDUs). IDUs were recruited through community outreach. The sample included 73 parents of 73 children, aged 4 to 12 years. Parental depression (odds ratio [OR] = 4.61) and medical illness (OR = 4.70) were found to be significantly associated with internalizing (depressive and anxiety-related symptoms), but not with externalizing (aggressive and disruptive behaviors) symptoms in the children of IDUs. The clinical implications are that children of IDUs are known to be at high risk for psychiatric symptoms and disorders; these data suggest that children of depressed and/or medically ill IDU parents may be at even higher risk of internalizing symptoms (depression and anxiety symptoms) than children of IDUs who do not suffer from these conditions.

The study sought to assess the associations of HIV status, physical health status, current drug use, and gender with depressive symptoms in former and current illicit drug users. In 1994–1995, 503 individuals (188 HIV-infected; 191 females; 279 current drug users) were interviewed. Of HIV-infected participants, 70 were women and 96 were current drug users. Physical health status was measured by physical functioning (instrumental activities of daily living), CD4 count, AIDS, and HIV-related symptoms. Depressive symptoms were measured by the CES-D. Nearly two fifths (38%) reported a high level of depressive symptoms (CES-D ≥ 16). In multivariate analysis, impaired functioning (OR = 4.09, p < .001), HIV-related symptoms (OR = 3.09, p < .001), current drug use (OR = 1.59, p < .05), and history of mental illness (OR=3.22, p < .001) were independently associated with depressive symptoms. Gender and HIV status were not statistically significant. Detection and treatment of depression in drug using populations may improve quality of life and adherence to medical regimens.

Summary To determine effectiveness of alternate venue testing (AVT), social network strategy (SNS) and provider referral (PR) for identifying previously undiagnosed HIV-infected 18–64-year-old African American men who have sex with men (AA MSM) by a health department. For AVT, staff used a mobile clinic to conduct HIV testing. For PR, staff solicited contact information from HIV-infected AA MSM, located contacts and offered HIV testing. For SNS, HIV-positive AA MSM recruited network associates for HIV testing. Two hundred and eighteen self-identified AA MSM were tested through AVT (25.2% HIV positivity) of whom 20 were newly identified HIV-positive. Fourteen HIV-positive men participated in SNS; 22 AA MSM contacts were recruited through SNS, eight (36.4%) were HIV positive and none were new positives. Two HIV-infected men participated in the PR strategy, yielding two AA MSM sex partners (one previously positive). The results suggest the need for health departments to consider using several complimentary strategies for identifying previously undiagnosed HIV infections in AA MSM in urban environments such as Baltimore.

BACKGROUND Sex partner concurrency is an important risk factor for sexually transmitted infection transmission. Understanding how adolescents conceptualize the length of their relationships when they break up and get back together is essential to the assessment of concurrency. METHODS A prospective cohort of 392 late adolescents and emerging adults, aged 14 to 19 years at baseline, were recruited from 2 clinics in Baltimore, MD and interviewed semiannually for 3 years. At each interview, participants were asked to report on all of their sexual partners in the previous 6 months, the length of relationship, and whether they thought their partner had other sex partners. For relationships that had broken up and gotten back together, reports of length of the relationship were compared before and after the breakup. Random effects logistic regression was used to examine the association between length of relationship and both breakup and partner concurrency. RESULTS For relationships that ended and subsequently got back together, participants considered the length of relationship to include the period when they were broken up. Longer relationships were at increased odds of both having broken up and gotten back together (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 1.02, 1.05) and of partner concurrency (OR = 1.03, 95% CI: 1.02, 1.04). The magnitude of the odds of concurrency was greater for relationships that had broken up and gotten back together (OR = 1.07, 95% CI: 1.02, 1.11). CONCLUSIONS Findings from this study emphasize the need for an improved understanding of the association between the temporal dynamics of late adolescent and emerging adult romantic relationships and concurrency.

Objectives To examine the effect of retaliatory attitudes on subsequent violent behavior and fight-related injuries among youth who presented to the emergency department with assault injuries. Design Assault-injured youth were interviewed at baseline, 6 months, and 18 months to assess fighting behavior, retaliatory attitudes, weapon carrying, and injury history as part of a larger randomized control trial. Setting Two emergency departments in urban areas were selected for the study. Participants A total of 129 adolescents aged 10–15 years were included in the study. Outcome measures Fighting behavior, assault injury, weapon carrying, and aggressive behavior. Results Higher retaliatory attitudes at baseline were associated with more aggression and a higher frequency of fighting over time. Conclusions Retaliatory attitudes may fuel cycles of violence among youth. Medical professionals in acute care settings have an opportunity to identify youths at risk of future assault injury by assessing retaliation, providing anticipatory guidance, and referring to intervention programs.

Identify factors associated with appointment-keeping among HIV-infected adolescents and young adults.HIV-infected adolescent and young adult females in five U.S. cities were followed for a period of 18 months to examine adherence to scheduled clinic visits with their HIV care provider. Psychosocial and behavioral factors that have been shown in other populations to influence appointment adherence were measured at baseline and follow-up visits using an audio computer-assisted self-interview questionnaire. These factors included mood disorder, depressive symptoms, social network support, healthcare satisfaction, disease acceptance, HIV stigma, alcohol use, and marijuana use. CD4 count and prescription of antiretroviral therapy medication were also monitored to understand the influence of health status on appointment- keeping.Participants included 178 youth with a mean age of 20.6 years. Forty-two percent had clinically significant depressive symptoms, 10% had a diagnosable mood disorder, 37% reported marijuana use in the last 90 days, and 47% reported alcohol use. Overall, participants attended 67.3% of their scheduled visits. Controlling for age and health status, marijuana use was the only variable that was associated with appointment-keeping behavior.Considering the importance of appointment-keeping for maintaining personal health and preventing further transmission, screening HIV-infected adolescents for marijuana use could help alert providers of this specific barrier to visit compliance.

Background: Urine-based screening for Chlamydia trachomatis using highly sensitive and specific nucleic acid amplification tests offers a unique opportunity to screen men attending school-based health centers. Methods: As part of a large multicenter chlamydia screening project in men, 1434 students were enrolled; 1090 in high schools in Baltimore and 344 middle and high-school students in Denver. Students were screened for chlamydia using urine-based nucleic acid amplification tests at well adolescent visits, acute care visits, or visits for other reasons, such as sports physicals. A self-administered survey to ascertain sexual risk behaviors was used. Data were analyzed separately for Baltimore and Denver, with univariate and multivariate logistic regression analysis. Results: The overall prevalence in asymptomatic adolescent men was 6.8% (7.5% in Baltimore and 4.7% in Denver, P = n.s.). Students in Denver were older, more racially diverse, and more likely to have had intercourse in the previous 2 months than students in Baltimore. Students in Baltimore were more likely than those in Denver to have used a condom at last intercourse with casual and main partners. Among men in Denver but not Baltimore, condom use at last intercourse with both casual (OR 0.15, 95% CI, 0.03, 0.78) and main partners (OR 0.30, 95% CI, 0.10, 0.91) was protective against infection. The only risk factor for CT infection in Baltimore students was age (OR 1.47, 95% CI, 1.23, 1.75). In multivariate analysis that included age (as a continuous variable), race, history of an STI, any sex partner in the last 2 months, > 1 sex partner in the past 12 months, a new partner in the last 2 months, and condom use with last main and last casual partner, age (adjusted odds ratio 1.34, 95% CI, 1.11, 1.62) and black race (adjusted odds ratio 2.37, 95% CI, 1.21, 4.63) were the only variables associated with testing chlamydia positive. Conclusions: School-based health centers are important venues in which to perform urine-based screening for chlamydia in sexually active, asymptomatic males, especially in high prevalence communities, and such screening provides the opportunity to identify and treat substantial numbers of chlamydia infections.

Results: Most schools (n1⁄454, 60%) had health professionals with some training in youth health (study days, on-off lectures, informal teaching); 10 schools (11%) had health professionals with postgraduate education in youth health; 9 (10%) schools had no information on the level of training of their health professionals; 6 schools (6.7%) had heath professionals with no training in youth health, and 11 schools had no health services. Nurses were more likely than doctors to report post-graduate training in youth health (p< 0.001). Students in schools where the clinicians had post-graduate training in youth health were less likely to report emotional and behaviour difficulties (b1⁄40.765, p 1⁄4 0.003), significant depression symptoms (b1⁄4-0.21, p 1⁄4 0.01), suicide risk (b1⁄4-0.053, p1⁄40.039), and binge drinking(b1⁄4 -0.29, p1⁄40.035) than students from schools where school health clinicians had not completed post-graduate papers in youth health or had no health services. There were no significant associations between cigarette, marijuana, or contraception use among students and specialised training among clinicians in their schools’ health service. Conclusions: Postgraduate training inyouth health among clinicians in school health services is associated with better health outcomes among students. These findings support specialised training in youth health for clinicians working predominantly with young people. Sources of Support: Youth’12 was funded by the Ministries of Youth Development, Social Development, Health, Education, Justice; the Department of Labour, Families Commission; and the Alcohol Advisory Council.

The relationship between neighborhood social dynamics and adolescent sexual behavior has not been well explored. We conducted a cross-sectional survey with 343 adolescents recruited from two health clinics in Baltimore. Multivariate logistic regression was utilized to assess the influence of perceived neighborhood social cohesion and collective monitoring of youth on condom use at last sex, controlling for family and individual factors. Condom use was significantly higher among participants who perceived their neighborhoods as high, 54.7%, versus low, 40.4%, in social cohesion. Neighborhood cohesion was significantly associated with condom use in multivariate analyses, as was parental communication, family structure, and gender. No association between perceived neighborhood collective monitoring of youth and condom use was found. We conclude that perceived neighborhood social cohesion is positively associated with condom use among adolescents vulnerable to HIV/STI and should be encouraged in the context of community-based prevention efforts.

The goal of this study was to examine the risk for repeat sexually transmitted infections (STIs) associated with reducing the number of sex partners who come from within the social networks of males 13 to 25 years old in Baltimore Maryland and Denver Colorado. Asymptomatic males diagnosed with chlamydia and/or gonorrhea as part of an asymptomatic chlamydia and gonorrhea male screening project were recruited and interviewed about their sexual behaviors and their perceptions of social characteristics and sexual behaviors of their sex partners. We characterized the sex partners of each participant as belonging to or not belonging to his social network. We examined whether a decrease in percentage of sex partners who were in the participants social network was associated with repeat infection. There were 47 participants in Baltimore and 92 in Denver. In both cities there was a trend toward a finding that decreasing the percentage of sex partners belonging to a participants social network was protective for repeat STI. These data suggest that interventions may need to be designed to reduce the prevalence of infection in the social networks of infected men. (authors)

Purpose: To determine the relationships among sociodemographic factors, constructs of the Information, Motivation, and Behavioral Skills (IMB) model, and sexual risk factors associated with acquisition of sexually transmitted infections (STIs) among women entering recruit training for the U.S. Marine Corps. Methods: Participants/Setting: A total of 2157 (94%) female Marine Corps recruits volunteered to participate in a cognitivebehavioral intervention to decrease STIs and unintended pregnancies. Study Design: This cross-sectional study reflects the baseline self-administered questionnaire that assessed sociodemographic factors (age, race/ethnicity, marital status, location of residence), constructs from the IMB model (e.g., knowledge, attitudes about condoms and sex under the influence of alcohol, perceptions of STI risk and selfefficacy, percent of time that a condom is used), and sexual risk factors (number of all sexual and casual partners, condom use, sex under the influence of alcohol/drugs, and knowledge of whether their partners had a history of STIs and/or had other partners). Outcome Variable: The responses to questions about sexual behavior were compiled into a composite risk index that was constructed to reflect the recruits’ overall level of risk for STIs and unintended pregnancy in the three months prior to recruit training entry. Each measure was scored on a 0-15 point scale, resulting in a 0-75 point risk index score. A two-step hierarchical logistic regression assessed correlates of scoring in the highest quartile of the risk index, with IMB constructs entered first followed by sociodemographic factors. Results: Compared to participants at lower risk, those at highest risk for STIs were significantly more likely to be younger [17-19 vs. 20, odds ratio (OR) 1.35, 95% confidence interval (CI) 1.01-1.82], single (vs. married) [OR 3.24, CI 1.63-6.43], have more knowledge about STIs [OR 1.34, CI 1.07-1.67], have less positive condom attitudes [OR 0.54, CI 0.37-0.79], have perceptions of higher STI risk [OR 11.53, CI 5.98-22.23], agree with statements that sex is more likely/enjoyable under the influence of alcohol [OR 0.40 CI 0.26-0.60], be heavy alcohol users [OR 4.45, CI 2.86-6.91], and drug users (yes vs. no) [OR 1.66, CI 1.03-2.68] prior to recruit training entry. Conclusions: Despite having high levels of knowledge and perceptions of higher STI risk, this study suggests the need for ongoing intensive behavioral interventions that emphasize the importance of using barrier methods of contraception to prevent STIs as well as the significance of alcohol

Purpose: Urban communities with high sexually transmitted infection (STI) prevalence often have disparities in unplanned pregnancies among young women. Research using single measures of pregnancy desire and/or intention has not yielded guidance on dual prevention strategies. Exploring childbearing motivation (CBM), the first step in the psychological sequence to childbearing behavior, may enable us to better understand reproductive decisions. The objective of this study is to examine the relationship between CBM and use of hormonal contraception, condoms, and dual contraception.

Conclusions: Perceived social support has been shown to be important in health care seeking and well-being. We found perceived social support to be related to STD related health care among sexually experienced adolescents. However perceived parental support and participation in outside of school activities were not significant. These findings may suggest that friends more so than parents have an impact on the seeking of confidential health care services such as care for STDs. (excerpt)