Increasingly, health care providers are using approaches targeting parents in an effort to improve adolescent sexual and reproductive health. Research is needed to elucidate areas in which providers ...can target adolescents and parents effectively. Parental monitoring offers one such opportunity, given consistent protective associations with adolescent sexual risk behavior. However, less is known about which components of monitoring are most effective and most suitable for provider-initiated family-based interventions.
We performed a meta-analysis to assess the magnitude of association between parental monitoring and adolescent sexual intercourse, condom use, and contraceptive use.
We conducted searches of Medline, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane, the Education Resources Information Center, Social Services Abstracts, Sociological Abstracts, Proquest, and Google Scholar.
We selected studies published from 1984 to 2014 that were written in English, included adolescents, and examined relationships between parental monitoring and sexual behavior.
We extracted effect size data to calculate pooled odds ratios (ORs) by using a mixed-effects model.
Higher overall monitoring (pooled OR, 0.74; 95% confidence interval CI, 0.69-0.80), monitoring knowledge (pooled OR, 0.81; 95% CI, 0.73-0.90), and rule enforcement (pooled OR, 0.67; 95% CI, 0.59-0.75) were associated with delayed sexual intercourse. Higher overall monitoring (pooled OR, 1.12; 95% CI, 1.01-1.24) and monitoring knowledge (pooled OR, 1.14; 95% CI, 1.01-1.31) were associated with greater condom use. Finally, higher overall monitoring was associated with increased contraceptive use (pooled OR, 1.42; 95% CI, 1.09-1.86), as was monitoring knowledge (pooled OR, 2.27; 95% CI, 1.42-3.63).
Effect sizes were not uniform across studies, and most studies were cross-sectional.
Provider-initiated family-based interventions focused on parental monitoring represent a novel mechanism for enhancing adolescent sexual and reproductive health.
Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of ...disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million 192·7 million to 231·1 million global DALYs), smoking (148·6 million 134·2 million to 163·1 million), high fasting plasma glucose (143·1 million 125·1 million to 163·5 million), high BMI (120·1 million 83·8 million to 158·4 million), childhood undernutrition (113·3 million 103·9 million to 123·4 million), ambient particulate matter (103·1 million 90·8 million to 115·1 million), high total cholesterol (88·7 million 74·6 million to 105·7 million), household air pollution (85·6 million 66·7 million to 106·1 million), alcohol use (85·0 million 77·2 million to 93·0 million), and diets high in sodium (83·0 million 49·3 million to 127·5 million). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation.
INTRODUCTION:Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic ...increase in research focused on transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for transgender populations.
METHODS:A systematic review was conducted of the medical literature published between January 1, 2012 and November 30, 2015. The data focused on HIV prevalence, determinants of risk, and syndemics among transgender populations.
RESULTS:Estimates varied dramatically by location and subpopulation. Transfeminine individuals have some of the highest concentrated HIV epidemics in the world with laboratory-confirmed prevalence up to 40%. Data were sparse among trans masculine individuals; however, they suggest potential increased risk for trans masculine men who have sex with men (MSM). No prevalence data were available for transgender people across Sub-Saharan Africa or Eastern Europe/Central Asia. Emerging data consistently support the association of syndemic conditions with HIV risk in transgender populations.
DISCUSSION:Addressing syndemic conditions and gender-specific challenges is critical to ensure engagement and retention in HIV prevention by transgender populations. Future research should prioritizefilling knowledge gaps in HIV epidemiology; elucidating how stigma shapes syndemic factors to produce HIV and other deleterious effects on transgender health; and understanding how to effectively implement HIV interventions for transgender people.
Despite significant declines over the past 2 decades, the United States continues to experience birth rates among teenagers that are significantly higher than other high-income nations. Use of ...emergency contraception (EC) within 120 hours after unprotected or underprotected intercourse can reduce the risk of pregnancy. Emergency contraceptive methods include oral medications labeled and dedicated for use as EC by the US Food and Drug Administration (ulipristal and levonorgestrel), the "off-label" use of combined oral contraceptives, and insertion of a copper intrauterine device. Indications for the use of EC include intercourse without use of contraception; condom breakage or slippage; missed or late doses of contraceptives, including the oral contraceptive pill, contraceptive patch, contraceptive ring, and injectable contraception; vomiting after use of oral contraceptives; and sexual assault. Our aim in this updated policy statement is to (1) educate pediatricians and other physicians on available emergency contraceptive methods; (2) provide current data on the safety, efficacy, and use of EC in teenagers; and (3) encourage routine counseling and advance EC prescription as 1 public health strategy to reduce teenaged pregnancy.
ABSTRACT
Aims To review and analyse in experimentally controlled studies the impact of alcohol consumption on intentions to engage in unprotected sex. To draw conclusions with respect to the ...question of whether alcohol has an independent effect on the incidence of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs).
Methods A systematic review and meta‐analysis of randomized controlled studies examined the association between blood alcohol content (BAC) and self‐perceived likelihood of using a condom during intercourse. The systematic review and meta‐analysis were conducted according to internationally standardized protocols (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses: PRISMA). The meta‐analysis included an estimate of the dose–response effect, tests for publication bias and sensitivity analyses.
Results Of the 12 studies included in the quantitative synthesis, our pooled analysis indicated that an increase in BAC of 0.1 mg/ml resulted in an increase of 5.0% (95% CI: 2.8–7.1%) in the indicated likelihood (indicated by a Likert scale) of engaging in unprotected sex. After adjusting for potential publication bias, this estimate dropped to 2.9% (95% CI: 2.0–3.9%). Thus, the larger the alcohol intake and the subsequent level of BAC, the higher the intentions to engage in unsafe sex. The main results were homogeneous, persisted in sensitivity analyses and after correction for publication bias.
Conclusions Alcohol use is an independent risk factor for intentions to engage in unprotected sex, and as risky sex intentions have been shown to be linked to actual risk behavior, the role of alcohol consumption in the transmission of HIV and other STIs may be of public health importance.
IMPORTANCE: Methamphetamine use is increasingly prevalent and associated with HIV transmission. A previous phase 2a study of mirtazapine demonstrated reductions in methamphetamine use and sexual risk ...behaviors among men who have sex with men. OBJECTIVE: To determine the efficacy of mirtazapine for treatment of methamphetamine use disorder and reduction in HIV risk behaviors. DESIGN, SETTING, AND PARTICIPANTS: This double-blind randomized clinical trial of mirtazapine vs placebo took place from August 2013 to September 2017 in an outpatient research clinic in San Francisco, California. Participants were community-recruited adults who were sexually active; cisgender men, transgender men, and transgender women who (1) had sex with men, (2) had methamphetamine use disorder, and (3) were actively using methamphetamine were eligible. Participants were randomized to receive the study drug or placebo for 24 weeks, with 12 more weeks of follow-up. Data analysis took place from February to June 2018. EXPOSURES: Mirtazapine, 30 mg, or matched placebo orally once daily for 24 weeks, with background counseling. MAIN OUTCOMES AND MEASURES: Positive urine test results for methamphetamine over 12, 24, and 36 weeks (primary outcomes) and sexual risk behaviors (secondary outcomes). Sleep, methamphetamine craving, dependence severity, and adverse events were assessed. RESULTS: Of 241 persons assessed, 120 were enrolled (5 transgender women and 115 cisgender men). The mean (SD) age was 43.3 (9.8) years; 61 (50.8%) were white, 31 (25.8%) were African American, and 15 (12.5%) were Latinx. A mean (SD) of 66% (47%) of visits were completed overall. By week 12, the rate of methamphetamine-positive urine test results significantly declined among participants randomized to mirtazapine vs placebo (risk ratio RR, 0.67 95% CI, 0.51-0.87). Mirtazapine resulted in reductions in positive urine test results at 24 weeks (RR, 0.75 95% CI, 0.56-1.00) and 36 weeks (RR, 0.73 95% CI, 0.57-0.96) vs placebo. Mean (SD) medication adherence by WisePill dispenser was 38.5% (27.0%) in the mirtazapine group vs 39.5% (26.2%) in the placebo group (P = .77) over 2 to 12 weeks and 28.1% (23.4%) vs 38.5% (27.0%) (P = .59) over 13 to 24 weeks. Changes in sexual risk behaviors were not significantly different by study arm at 12 weeks, but those assigned to receive mirtazapine had fewer sexual partners (RR, 0.52 95% CI, 0.27-0.97; P = .04), fewer episodes of condomless anal sex with partners who were serodiscordant (RR, 0.47 95% CI, 0.23-0.97; P = .04), and fewer episodes of condomless receptive anal sex with partners who were serodiscordant (RR, 0.37 95% CI, 0.14-0.93; P = .04) at week 24. Participants assigned to mirtazapine had net reductions in depressive symptoms (Center for Epidemiologic Studies Depression Scale score, 6.2 95% CI, 1.3-11.1 points lower; P = .01) and insomnia severity (Athens score, 1.4 95% CI, 0.1-2.7 points lower; P = .04) at week 24. There were no serious adverse events associated with the study drug. CONCLUSIONS AND RELEVANCE: In this expanded replication trial, adding mirtazapine to substance use counseling reduced methamphetamine use and some HIV risk behaviors among cisgender men and transgender women who have sex with men, with benefits extending after treatment despite suboptimal medication adherence. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01888835.
This paper presents data from a recent cross-sectional survey of gay, bisexual and other men who have sex with men (GBMSM) in the US, to understand changes in sexual behavior and access to HIV ...prevention options (i.e. condoms and pre-exposure prophylaxis (PrEP)) during the COVID-19 lockdown period. The
Love and Sex in the Time of COVID
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19
survey was conducted online from April to May, 2020. GBMSM were recruited through advertisements featured on social networking platforms, recruiting a sample size of 518 GBMSM. Analysis considers changes three in self-reported measures of sexual behavior: number of sex partners, number of anal sex partners and number of anal sex partners not protected by pre-exposure prophylaxis (PrEP) or condoms. Approximately two-thirds of the sample reported that they believed it was possible to contract COVID-19 through sex, with anal sex reported as the least risky sex act. Men did not generally feel it was important to reduce their number of sex partners during COVID-19, but reported a moderate willingness to have sex during COVID-19. For the period between February and April–May 20,202, participants reported a mean increase of 2.3 sex partners during COVID-19, a mean increase of 2.1 anal sex partners (range − 40 to 70), but a very small increase in the number of unprotected anal sex partners. Increases in sexual behavior during COVID-19 were associated with increases in substance use during the same period. High levels of sexual activity continue to be reported during the COVID-19 lockdown period and these high levels of sexual activity are often paralleled by increases in substance use and binge drinking. There is a clear need to continue to provide comprehensive HIV prevention and care services during COVID-19, and telehealth and other eHealth platforms provide a safe, flexible mechanism for providing services.
To understand how the emerging public health issue of chemsex relates to broader patterns of sexualised drug use (SDU) among men who have sex with men (MSM), which has been understudied.
Potential ...participants were invited to take part in an anonymous, cross-sectional online survey through Facebook advertising and community organisations' social media posts (April-June 2018). Multivariable logistic regression was used to compare MSM who engaged in recent SDU (past 12 months) with those who did not, and those who engaged in chemsex (γ-hydroxybutyrate/γ-butyrolactone, crystal methamphetamine, mephedrone, ketamine) with those who engaged in other SDU (eg, poppers, cocaine, cannabis).
Of the 1648 MSM included, 41% reported recent SDU; 15% of these (6% of total, n=99) reported chemsex. Factors associated with SDU were recent STI diagnosis (aOR=2.44, 95% CI 1.58 to 3.76), sexual health clinic attendance (aOR=2.46, 95% CI 1.90 to 3.20), image and performance-enhancing drug use (aOR=3.82, 95% CI 1.87 to 7.82), greater number of condomless anal male partners, lower satisfaction with life and greater sexual satisfaction. Predictors of chemsex compared with other SDU were not being UK-born (aOR=2.02, 95% CI 1.05 to 3.86), living in a densely populated area (aOR=2.69, 95% CI 1.26 to 5.74), low sexual self-efficacy (aOR=4.52, 95% CI 2.18 to 9.40) and greater number of condomless anal male partners. Living with HIV, taking pre-exposure prophylaxis (PrEP), and experiencing or being unsure of experiencing sexual contact without consent were significantly associated with SDU and chemsex in bivariate analyses but not in the multivariable.
Health and behavioural differences were observed between MSM engaging in chemsex, those engaging in SDU and those engaging in neither. While some MSM engaging in chemsex and SDU appeared content with these behaviours, the association with life satisfaction and sexual self-efficacy indicates psychosocial support is needed for some. The association with sexual risk and sexual consent also indicates the importance of promoting harm reduction among this population (eg, condoms, PrEP, drug knowledge).
BACKGROUND:Individual sexual risk behaviors have failed to explain the observed racial disparity in HIV acquisition. To increase understanding of potential drivers in disparities, we assessed ...differences across individual, network, and social determinants.
METHODS:Data come from RADAR (N = 1015), a longitudinal cohort study of multilevel HIV-risk factors among young men who have sex with men (YMSM) aged 16–29 years in Chicago, IL. Data collection includes biological specimens; network data, including detailed information about social, sexual, and drug-use networks; and psychosocial characteristics of YMSM.
RESULTS:Compared to white YMSM (24.8%) and Hispanic YMSM (30.0%), black YMSM (33.9%) had a higher prevalence of both HIV (32%; P < 0.001) and rectal sexually transmitted infections (26.5%; P = 0.011) with no observed differences in pre-exposure prophylaxis use. Black YMSM reported lower rates of sexual risk behaviors and more lifetime HIV tests (P < 0.001) compared with all other YMSM; however, they were also significantly less likely to achieve viral suppression (P = 0.01). Black YMSM reported the highest rate of cannabis use (P = 0.03) as well as greater levels of stigma (P < 0.001), victimization (P = 0.04), trauma (P < 0.001), and childhood sexual abuse (P < 0.001). White YMSM reported higher rates of depression (P < 0.001) and alcohol use (P < 0.001). In network analyses, significant differences existed across network characteristics with black YMSM having the lowest transitivity (P = 0.002), the highest density (P < 0.001), and the highest homophily (P < 0.001).
CONCLUSIONS:Black YMSM do not report higher rates of HIV-risk behaviors, but social and network determinants are aligned toward increased HIV risk. These results suggest that network interventions and those addressing social determinants may help reduce disparities.
Abstract Purpose To examine the relation between “sexting” (sending and sharing sexual photos online, via text messaging, and in person) with sexual risk behaviors and psychosocial challenge in ...adolescence. Methods Data were collected online between 2010 and 2011 with 3,715 randomly selected 13- to 18-year-old youth across the United States. Results Seven percent of youth reported sending or showing someone sexual pictures of themselves, in which they were nude or nearly nude, online, via text messaging, or in person, during the past year. Although females and older youth were more likely to share sexual photos than males and younger youth, the profile of psychosocial challenge and sexual behavior was similar for all youth. After adjusting for demographic characteristics, sharing sexual photos was associated with all types of sexual behaviors assessed (e.g., oral sex, vaginal sex) as well as some of the risky sexual behaviors examined—particularly having concurrent sexual partners and having more past-year sexual partners. Adolescents who shared sexual photos also were more likely to use substances and less likely to have high self-esteem than their demographically similar peers. Conclusions Although the media has portrayed sexting as a problem caused by new technology, health professionals may be more effective by approaching it as an aspect of adolescent sexual development and exploration and, in some cases, risk-taking and psychosocial challenge.
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