Demographic, psychosocial, and contextual factors associated with sexual risk behaviors among young sexual minority women

Syndemic Profiles and Sexual Health Risks Among Sexually Exploited Adolescent Girls in Taiwan: A Latent Class Analysis

Sexually exploited adolescent girls are disproportionately affected by adverse psychosocial conditions, such as intra-familial child physical and sexual abuse, extra-familial violence and sexual assault, alcohol and drug use, and suicide. Syndemic theory suggests that these adverse psychosocial or syndemic conditions are concentrated and co-occurring in socially marginalized populations, including sexually exploited adolescents, and increase their sexual health risks, including pregnancy, abortion, and the acquisition of sexually transmitted diseases (STDs). To examine clusters of syndemic conditions, latent class analysis (LCA) was conducted to classify 335 sexually exploited girls in Taiwan into subgroups based on their probability of experiencing each syndemic condition. We used syndemic class membership to predict their sexual health outcomes, specifically pregnancy, abortion, and the acquisition of STDs. The results of LCA revealed three classes, which were "low-risk syndemic," "moderate-risk syndemic," and "high-risk syndemic." The risk of acquisition of STDs among sexually exploited girls in the "high-risk syndemic class" and "moderate-risk syndemic class" was 239% and 135% higher, respectively, than the risk of acquisition of STDs among sexually exploited girls in the "low-risk syndemic class." Differences between these three classes in pregnancy and abortion were not significant. Our findings support the syndemic theory that a pattern of syndemic conditions is associated with an increased risk of acquiring STDs. Interventions aimed at reducing the acquisition of STDs among sexually exploited girls in Taiwan should adopt a comprehensive approach to address co-occurring conditions.

Improving the Sexual Health of Young People (under 25) in High-Risk Populations: A Systematic Review of Behavioural and Psychosocial Interventions

Background: Ensuring young people experience good sexual health is a key public health concern, yet some vulnerable groups of young people remain at higher risk of poor sexual health. These individuals require additional support to achieve good sexual health but the best way to provide this remains needs to be better understood. Methods: We searched for randomised controlled trials of behavioural and psychosocial interventions aimed at promoting sexual health in high-risk young populations. Outcomes of interest were indicators of sexual health (e.g., condom use, attitudes to contraception, knowledge of risk). Participants were under 25 years old and in one of the following high-risk groups: alcohol and other drug use; ethnic minority; homeless; justice-involved; LGBTQI+; mental ill-health; or out-of-home care. Results: Twenty-eight papers from 26 trials met our inclusion criteria, with all but one conducted in North America. Condom use was the most frequently reported outcome measure along with knowledge and attitudes towards sexual health but considerable differences in measures used made comparisons across studies difficult. Change in knowledge and attitudes did not consistently result in long-term change in behaviours. Conclusions: There remains a dearth of research undertaken outside of North America across all high-risk groups of young people. Future interventions should address sexual health more broadly than just the absence of negative biological outcomes, with LGBTQI+, homeless and mental ill-health populations targeted for such work. An international consensus on outcome measures would support the research field going forward, making future meta-analyses possible.

Research on alcohol and other drug (AOD) use among sexual minority women: A global scoping review

Until the 1980s, the limited research on alcohol and other drug (AOD) use among sexual minority women (SMW) focused on alcohol and used samples recruited from gay bars, resulting in inflated estimates of hazardous drinking. Over the past several decades the number of AOD studies with SMW has increased dramatically. To characterize this literature, we conducted a scoping review to answer the following questions: What do we know, and what are the gaps in research about AOD use among SMW? We searched multiple electronic databases (Medline [PubMed], CINAHL, PsycInfo, and Web of Science) for peer-reviewed research articles about AOD use among adult SMW published between January 1, 2000 and May 31, 2017. After duplicates were removed the search identified 4,204 articles. We reviewed the titles and abstracts and removed articles that did not meet inclusion criteria. We used full-text review of the remaining 229 articles to make a final determination regarding inclusion and we retained 181 articles for review. Although the quantity of AOD research with SMW has grown substantially, the great majority of studies have been conducted in the United States (US) and most focus on hazardous drinking; relatively little research has focused on other drugs. In addition, although there has been marked improvement in theories and methods used in this research, many gaps and limitations remain. Examples are the lack of longitudinal research; reliance on samples that tend to over-represent white, well-educated, and relatively young women; sparse attention to mechanisms underlying the disproportionately high rates of AOD use among SMW; and the absence of intervention research. In general, more high-quality research on SMW's use of AODs is needed, but gaps and limitations are particularly large in non-western countries. Addressing these research gaps and limitations is essential for providing information that can be used to develop more effective prevention and early intervention strategies, as well as for informing policies that can help to reduce risky drinking and drug misuse among SMW.

Paths to Parenthood Among Self-Identified Bisexual Individuals in the United States

Bisexual parents have been notably absent from prior research on parenting, despite comprising the largest proportion of parents among "lesbian, gay, and bisexual" (LGB) individuals. Indeed, recent national probability data indicate that young bisexual women are more likely than their heterosexual counterparts to report having at least one child. Intentions to have children, patterns of family planning and contraception use, and related issues have important implications for health and healthcare-related decisions and priorities among bisexual parents. We conducted in-depth interviews with a sample of 33 bisexual parents from across the U.S. who reported having at least one child (genetic, adopted, step or foster child, guardian, and/or warden of the state). In cases of intentional pregnancies, participants considered relationship and financial stability, job security and their ideal family size. Unintentional pregnancies, as well as pregnancy terminations, were often reframed as positive experiences. After deciding not to have more children, participants reported using contraceptive methods, including sterilization or long-acting reversible contraceptive methods (e.g., intrauterine devices). Instances of deception, in which partners deceived participants with false beliefs regarding their contraceptive use, were recalled negatively for the relatively small number of participants who reported such experiences. Overall, our findings point to a diversity in the intentions and ways bisexual individuals become parents, similar to parents of other sexual identities. Acknowledgements of the diverse experiences and concerns faced by bisexual parents may be beneficial in improving efforts related to providing appropriate and relevant health- and healthcare-related services.

Timing of abortion among adolescent and young women presenting for post-abortion care in Kenya: a cross-sectional analysis of nationally-representative data

Background

Complications of unsafe abortion are a leading cause of maternal mortality in sub-Saharan Africa. Adolescents and young women are disproportionately represented among those at risk of these complications. Currently, we know little about the factors associated with young women’s timing of abortion. This study examined the timing of abortion as well as factors influencing it among adolescents and young women aged 12–24 years who sought post-abortion care (PAC) in health facilities in Kenya.

Methods

We draw on data from a cross-sectional study on the magnitude and incidence of induced abortion in Kenya conducted in 2012. The study surveyed women presenting with a diagnosis of incomplete, inevitable, missed, complete, or septic abortion over a one-month data collection period in 328 health facilities (levels 2–6). Survey data, specifically, from adolescents and young women were analyzed to examine their characteristics, the timing of abortion, and the factors associated with the timing of abortion.

Results

One thousand one hundred forty-five adolescents and young women presented for PAC during the data collection period. Eight percent of the women reported a previous induced abortion and 78% were not using a modern method of contraception about the time of conception. Thirty-nine percent of the index abortions occurred after 12 weeks of gestation. A greater proportion of women presenting with late abortions (more than 12 weeks gestational age) (46%) than those presenting with early abortions (33%) presented with severe complications. Controlling for socio-demographic and reproductive history, timing of abortion was significantly associated with place of residence (marginal), education, parity, clinical stage of abortion and level of severity.

Conclusions

Late-term abortions were substantial, and may have contributed substantially to the high proportion of women with post-abortion complications. Efforts to reduce the severity of abortion-related morbidities and mortality must target young women, particularly those living in rural and other remote areas. Interventions to reduce unintended pregnancies in this population are also urgently needed to improve early pregnancy detection and timely care seeking.

Socioeconomic Status As a Risk Factor for Unintended Pregnancy in the Contraceptive CHOICE Project

OBJECTIVE

To evaluate the association of low socioeconomic status as an independent risk factor for unintended pregnancy.

METHODS

We performed a secondary analysis of data from the Contraceptive CHOICE project. Between 2007 and 2011, 9,256 participants were recruited and followed for up to 3 years. The primary outcome of interest was unintended pregnancy; the primary exposure variable was low socioeconomic status, defined as self-report of either receiving public assistance or having difficulty paying for basic necessities. Four contraceptive groups were evaluated: 1) long-acting reversible contraceptive method (hormonal or copper intrauterine device or subdermal implant); 2) depot medroxyprogesterone acetate injection; 3) oral contraceptive pills, a transdermal patch, or a vaginal ring; or 4) other or no method. Confounders were adjusted for in the multivariable Cox proportional hazard model to estimate the effect of socioeconomic status on risk of unintended pregnancy.

RESULTS

Participants with low socioeconomic status experienced 515 unintended pregnancies during 14,001 women-years of follow-up (3.68/100 women-years; 95% CI 3.37-4.01) compared with 200 unintended pregnancies during 10,296 women-years (1.94/100 women-years; 95% CI 1.68-2.23) among participants without low socioeconomic status. Women with low socioeconomic status were more likely to have an unintended pregnancy (unadjusted hazard ratio [HR] 1.8, 95% CI 1.5-2.2). After adjusting for age, education level, insurance status, and history of unintended pregnancy, low socioeconomic status was associated with an increased risk of unintended pregnancy (adjusted HR 1.4, 95% CI 1.1-1.7).

CONCLUSION

Despite the removal of cost barriers, low socioeconomic status is associated with a higher incidence of unintended pregnancy.

Young sexual minority women's use of the internet and other digital technologies for sexual health information seeking

We know little about the online sexual health information seeking practices and needs specific to young sexual minority women. This is problematic as young sexual minority women report heightened negative sexual health outcomes in contrast to their heterosexual peers, which could be partially addressed through being able to access effective, relevant online sexual health information sources. This exploratory qualitative study employed a series of focus groups to understand more about what types of online resources young sexual minority women access, their motivations for using those resources, and what types of sexual health information they need. The focus group data were analyzed from a thematic analysis approach. Results indicate that participants used a wide range of online resources, such as apps, websites, blogs, and YouTube. The type of resource accessed often depended upon the information needed. Participants reported preferring online resources due to experiences or expectations of heteronormativity from their sexual health service providers, convenience and accessibility, the capacity to remain anonymous, and the lack of relevant sexual health information offline. These findings help begin to fill the gap on knowledge of young sexual minority women's sexual health information seeking practices, which can be used for the development of effective online sexual health information resources targeting young sexual minority women.

Teen Pregnancy Among Sexual Minority Women: Results From the National Longitudinal Study of Adolescent to Adult Health

PURPOSE

The purpose of this study was to explore the association between sexual orientation and teen pregnancy (before age 20 years) in a U.S. nationally representative cohort of young adult females aged 24-32 years.

METHODS

A total of 5,972 participants in Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health were included. Self-reported sexual orientation identity was categorized as heterosexual, and three sexual minority (SM) groups: mostly heterosexual, bisexual, and lesbian (combining "mostly homosexual" and "100% homosexual"). Stepwise multivariate regression models were fit to compare odds of teen pregnancy and relative risk ratios of timing of teen pregnancy, between heterosexual and SM groups, adjusting for sociodemographic characteristics, sexual victimization history, and sexual risk behaviors.

RESULTS

After adjusting for sociodemographics and sexual victimization, bisexual women had significantly higher odds than heterosexual peers of teen pregnancy (odds ratio [OR] = 1.70; 95% confidence interval [CI] = 1.05-2.75); this association was marginally significant after adjusting for sexual risk behaviors. Bisexuals were also more likely to have an early (before age 18 years) teen pregnancy (OR = 2.04; 95% CI = 1.17-3.56). In contrast, lesbian women were significantly less likely to have a teen pregnancy than heterosexual (OR = .47; 95% CI = .23-.97), mostly heterosexual (OR = .46; 95% CI = .21-.99), and bisexual (OR = .29; 95% CI = .12-.71) women in final models.

CONCLUSIONS

Expanding on extant literature, we found opposing risk patterns for teen pregnancy between bisexual and lesbian women, likely due to distinct patterns of sexual risk taking. Findings suggest that SM-inclusive teen pregnancy prevention efforts tailored to meet the unique needs of SM young women, particularly bisexuals, are needed.

A Psychometric Review of Measures Assessing Discrimination Against Sexual Minorities

Discrimination against sexual minorities is widespread and has deleterious consequences on victims' psychological and physical wellbeing. However, a review of the psychometric properties of instruments measuring lesbian, gay, and bisexual (LGB) discrimination has not been conducted. The results of this review, which involved evaluating 162 articles, reveal that most have suboptimal psychometric properties. Specifically, myriad scales possess questionable content validity as (1) items are not created in collaboration with sexual minorities; (2) measures possess a small number of items and, thus, may not sufficiently represent the domain of interest; and (3) scales are "adapted" from measures designed to examine race- and gender-based discrimination. Additional limitations include (1) summed scores are computed, often in the absence of scale score reliability metrics; (2) summed scores operate from the questionable assumption that diverse forms of discrimination are necessarily interrelated; (3) the dimensionality of instruments presumed to consist of subscales is seldom tested; (4) tests of criterion-related validity are routinely omitted; and (5) formal tests of measures' construct validity are seldom provided, necessitating that one infer validity based on the results obtained. The absence of "gold standard" measures, the attendant difficulty in formulating a coherent picture of this body of research, and suggestions for psychometric improvements are noted.

Sexual minority youth of color: A content analysis and critical review of the literature

This study analyzed the content of 125 unique reports published since 1990 that have examined the health and well-being-as well as the interpersonal and contextual experiences-of sexual minority youth of color (SMYoC). One-half of reports sampled only young men, 73% were noncomparative samples of sexual minority youth, and 68% of samples included multiple racial-ethnic groups (i.e., 32% of samples were mono-racial/ethnic). Most reports focused on health-related outcomes (i.e., sexual and mental health, substance use), while substantially fewer attended to normative developmental processes (i.e., identity development) or contextual and interpersonal relationships (i.e., family, school, community, or violence). Few reports intentionally examined how intersecting oppressions and privileges related to sexual orientation and race-ethnicity contributed to outcomes of interest. Findings suggest that research with SMYoC has been framed by a lingering deficit perspective, rather than emphasizing normative developmental processes or cultural strengths. The findings highlight areas for future research focused on minority stress, coping, and resilience of SMYoC.

Reproductive coercion, sexual risk behaviours and mental health symptoms among young low-income behaviourally bisexual women: implications for nursing practice

AIMS AND OBJECTIVES

To describe prevalence of reproductive coercion, sexual risk behaviours and mental health symptoms among women reporting lifetime sexual experiences with men and women compared to peers reporting sex exclusively with men.

BACKGROUND

Reproductive coercion, a global public health problem, is understudied among sexual minority women. Violence against women remains high among women who have sex with women and men. Rates of sexual and physical violence among this population are higher than women reporting exclusive sexual partnerships with either men or women. Nurses and other healthcare providers often do not conduct comprehensive sexual histories; assumptions related to a sex partner's gender may provide indications of broader health implications.

DESIGN

Cross-sectional survey of low-income Black women ages 18-25 recruited from six community-based sites for a parent study focused on intimate partner violence and health.

METHODS

We analysed survey data from participants who reported lifetime sexual experiences with men and women (N = 42) and compared their outcomes to those of women reporting sexual experiences with men only (N = 107).

RESULTS

A greater proportion of women who have sex with women and men reported experiencing reproductive coercion. Women who have sex with women and men also reported a greater number of lifetime intimate partner physical and sexual violence experiences, traded sex for resources, and had post-traumatic stress disorder symptoms.

CONCLUSIONS

Findings provide vital information that can inform nursing clinical practice, specifically related to history-taking, screening protocols and counselling strategies for intimate partner violence and mental health among women who have sex with women and men.

RELEVANCE TO CLINICAL PRACTICE

Strategies for addressing reproductive coercion and intimate partner violence as well as the health consequences among women who have sex with women and men in clinical and community-based settings should include a longitudinal understanding of sexual behaviour and gender of sex partners.

Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis

Background

Unsafe abortion is a leading cause of death among young women aged 10–24 years in sub-Saharan Africa. Although having multiple induced abortions may exacerbate the risk for poor health outcomes, there has been minimal research on young women in this region who have multiple induced abortions. The objective of this study was therefore to assess the prevalence and correlates of reporting a previous induced abortion among young females aged 12–24 years seeking abortion-related care in Kenya.

Methods

We used data on 1,378 young women aged 12–24 years who presented for abortion-related care in 246 health facilities in a nationwide survey conducted in 2012. Socio-demographic characteristics, reproductive and clinical histories, and physical examination assessment data were collected from women during a one-month data collection period using an abortion case capture form.

Results

Nine percent (n = 98) of young women reported a previous induced abortion prior to the index pregnancy for which they were receiving care. Statistically significant differences by previous history of induced abortion were observed for area of residence, religion and occupation at bivariate level. Urban dwellers and unemployed/other young women were more likely to report a previous induced abortion. A greater proportion of young women reporting a previous induced abortion stated that they were using a contraceptive method at the time of the index pregnancy (47 %) compared with those reporting no previous induced abortion (23 %). Not surprisingly, a greater proportion of young women reporting a previous induced abortion (82 %) reported their index pregnancy as unintended (not wanted at all or mistimed) compared with women reporting no previous induced abortion (64 %).

Conclusions

Our study results show that about one in every ten young women seeking abortion-related care in Kenya reports a previous induced abortion. Comprehensive post-abortion care services targeting young women are needed. In particular, post-abortion care service providers must ensure that young clients receive contraceptive counseling and effective pregnancy prevention methods before discharge from the health care facility to prevent unintended pregnancies that may result in subsequent induced abortions.

Contextual influence of Taiwanese adolescents' sexual attitudes and behavioral intent

This study examined parental, peer, and media influences on Taiwanese adolescents' attitudes toward premarital sex and intent to engage in sexual behavior. Participants included a convenience sample of 186 adolescents aged 13-15 recruited from two middle schools in Taiwan. Parental influence was indicated by perceived parental disapproval toward premarital sex and perceived peer sexual behavior was used to measure peer influence. Media influence was measured by the adolescents' perception of whether the media promotes premarital sex. We conducted structural equation modeling to test a hypothesized model. The findings suggested that the perceived sexual behavior of peers had the strongest effect on Taiwanese adolescents' sexual attitudes and behavioral intent, while parental disapproval and media influence also significantly contributed to adolescents' sexual attitudes and intent to engage in sex. School nurses are in an ideal position to coordinate essential resources and implement evidence-based sexually transmitted infection and HIV/AIDS prevention interventions that address issues associated with the influence of parents, peers, and media.

Evidence of Syndemics and Sexuality-Related Discrimination Among Young Sexual-Minority Women

PURPOSE

Syndemics, or the co-occurrence and interaction of health problems, have been examined extensively among young men who have sex with men, but their existence remain unexamined, to our knowledge, among sexual-minority (i.e., lesbian, gay, and bisexual) women. Thus, we investigated if syndemics were present among young sexual-minority women, and if sexual-orientation discrimination was an independent variable of syndemic production.

METHODS

A total of 467 sexual-minority women between the ages of 18 and 24 completed a cross-sectional online survey regarding their substance use, mental health, sexual behaviors, height, weight, and experiences of discrimination. We used structural equation modeling to investigate the presence of syndemics and their relationship to sexual-orientation discrimination.

RESULTS

Heavy episodic drinking, marijuana use, ecstasy use, hallucinogen use, depressive symptoms, multiple sexual partners, and history of sexually transmitted infections (STIs) comprised syndemics in this population (chi-square=24.989, P=.201; comparative fit index [CFI]=0.946; root mean square error of approximation [RMSEA]=0.023). Sexual-orientation discrimination is significantly and positively associated with the latent syndemic variable (unstandardized coefficient=0.095, P<.05), and this model fit the data well (chi-square=33.558, P=.059; CFI=0.914; RMSEA=0.029). The reverse causal model showed syndemics is not an independent variable of sexual-orientation discrimination (unstandardized coefficient=0.602, P>.05).

CONCLUSIONS

Syndemics appear to be present and associated with sexual-orientation discrimination among young sexual-minority women. Interventions aimed at reducing discrimination or increasing healthy coping may help reduce substance use, depressive symptoms, and sexual risk behaviors in this population.

FROM BIAS TO BISEXUAL HEALTH DISPARITIES: ATTITUDES TOWARD BISEXUAL MEN AND WOMEN IN THE UNITED STATES

PUROPSE

A newly emergent literature suggest that bisexual men and women face profound health disparities in comparison to both heterosexual and homosexual individuals. Additionally, bisexual individuals often experience prejudice, stigma, and discrimination from both gay/lesbian and straight communities, termed "biphobia." However, only limited research exists that empirically tests the extent and predictors of this double discrimination. The Bisexualities: Indiana Attitudes Survey (BIAS) was developed to test associations between biphobia and sexual identity.

METHODS

Using standard techniques, we developed and administered a scale to a purposive online sample of adults from a wide range of social networking websites. We conducted exploratory factor analysis to refine scales assessing attitudes toward bisexual men and bisexual women, respectively. Using generalized linear modeling, we assessed relationships between BIAS scores and sexual identity, adjusting for covariates.

RESULTS

Two separately gendered scales were developed, administered, and refined: BIAS-m (n=645), focusing on attitudes toward bisexual men; and BIAS-f (n=631), focusing on attitudes toward bisexual women. Across scales, sexual identity significantly predicted response variance. Lesbian/gay respondents had lower levels of bi-negative attitudes than their heterosexual counterparts (all p-values <.05); bisexual respondents had lower levels of bi-negative attitudes than their straight counterparts (all p-values <.001); and bisexual respondents had lower levels of bi-negative attitudes than their lesbian/gay counterparts (all p-values <.05). Within racial/ethnic minority respondents, biracial/multiracial status was associated with lower bi-negativity scores (all p-values <.05).

CONCLUSION

This study provides important quantitative support for theories related to biphobia and double discrimination. Our findings provide strong evidence for understanding how stereotypes and stigma may lead to dramatic disparities in depression, anxiety, stress, and other health outcomes among bisexual individuals in comparison to their heterosexual and homosexual counterparts. Our results yield valuable data for informing social awareness and intervention efforts that aim to decrease bi-negative attitudes within both straight and gay/lesbian communities, with the ultimate goal of alleviating health disparities among bisexual men and women.

Differences by sexual minority status in relationship abuse and sexual and reproductive health among adolescent females

PURPOSE

Little is known about adolescent relationship abuse (ARA) and related sexual and reproductive health among females who either identify as lesbian or bisexual or engage in sexual behavior with female partners (i.e., sexual minority girls [SMGs]).

METHODS

Baseline data were collected from 564 sexually active girls ages 14-19 years seeking care at eight California school-based health centers participating in a randomized controlled trial. Associations between ARA, sexual minority status and study outcomes (vaginal, oral, and anal sex, number and age of sex partners, contraceptive nonuse, reproductive coercion, sexually transmitted infection [STI] and pregnancy testing) were assessed via logistic regression models for clustered survey data.

RESULTS

SMGs comprised 23% (n = 130) of the sample. Controlling for exposure to ARA, SMGs were less likely to report recent vaginal sex (adjusted odds ratio [AOR], .51; 95% confidence interval [CI], .35-.75) and more likely to report recent oral sex (AOR, 2.01; 95% CI, 1.38-2.92) and anal sex (AOR, 1.76; 95% CI, 1.26-2.46) compared with heterosexual girls. Heterosexual girls with ARA exposure (AOR, 2.85; 95% CI, 1.07-7.59) and SMGs without ARA exposure (AOR, 3.01; 95% CI, 2.01-4.50) were more likely than nonabused heterosexual girls be seeking care for STI testing or treatment than heterosexual girls without recent victimization.

CONCLUSIONS

Findings suggest the need for attention to STI risk among all girls, but SMGs in particular. Clinicians should be trained to assess youth for sexual contacts and sexual identity and counsel all youth on healthy relationships, consensual sex, and safer sex practices relevant to their sexual experiences.