Charleston teenage girls seeking sexual partners

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Try out PMC Labs and tell us what you think. Learn More. Background: Latent class analysis LCA is a useful statistical tool that can be used to enhance understanding of how various patterns of combined sexual behavior risk factors may confer differential levels of HIV infection risk and to identify subtypes among African American adolescent girls.

Methods: Data for this analysis is derived from baseline assessments completed prior to randomization in an HIV prevention trial. Girls completed an audio computer-assisted self-interview, which assessed a range of variables regarding sexual history and current and past sexual behavior. : Two latent classes were identified with the probability statistics for the two groups in this model being 0. The derived model correctly classified The higher risk class also had worse scores on all hypothesized correlates e.

Conclusions: Sexual health clinics represent a unique point of access for HIV-related sexual risk behavior intervention delivery by capitalizing on contact with adolescent girls when they present for services. Four empirically supported risk factors differentiated higher versus lower HIV risk. Replication of these findings is warranted and may offer an empirical basis for parsimonious screening recommendations for girls presenting for sexual healthcare services.

Hence, targeting and implementing prevention interventions for adolescents at highest risk for HIV infection that target this HIV-related sexual risk behavior and related correlates e. Although multiple evidence-based HIV-prevention interventions have been developed and rigorously evaluated for adolescent populations, 3 limited resources cost, personnel, space, time support the utility of identifying youth at highest risk for infection. Numerous research efforts over the past several decades have uncovered a range of individual risk factors contributing to HIV infection among African American girls, including infrequent condom use, 4 multiple sexual partners, 5 substance use, 6 low self-esteem, 7 interpersonal trauma e.

Establishing risk profiles could improve identification of girls who may benefit most from such preventative services. Similarly, elucidating subtypes of HIV risk may help more efficiently utilize assessment data and hone screening efforts among healthcare providers who may already collect information regarding individual risk factors for HIV infection among their sexually active African American teen patients.

Latent class analysis LCA is a useful statistical tool to address this critical gap in the literature by enhancing our understanding of how various patterns of combined risk factors may confer differential levels of HIV infection risk and by identifying potential subtypes within a seemingly homogenous population. HIV risk behavior profiles among youth in the school setting has been explored with similar statistical procedures latent profile analysis, cluster analysis , yielding a three-profile condom users, few partners, and risk takers solution for 8th to 10th graders, 5 a four-profile condom users, one partner, two partners, and risk takers solution for 11th and 12th graders, 5 and four cluster low risk, monogamy, condom, and high risk solutions for high school students 15—18 years.

Thus, further research is warranted in this area. Sexual health clinics often serve as a medical home for young women, and provide a unique window of opportunity to assess and intervene with a population at elevated risk for HIV infection. Despite that sexual health clinics serve as the most common target population for HIV prevention intervention, 4 no studies to date have investigated specific patterns of risk behavior and classification among African American adolescent girls within this setting.

The current study will apply LCA to identify empirically derived behavior patterns that are ecologically valid for sexual healthcare seeking African American adolescent girls. Identification of latent classes e. The latent classes will be composed of behaviors that differentiate among levels of risk to equip pediatricians and other healthcare providers, who are often charged with serving a high volume of clientele, with the ability to screen efficiently for HIV risk.

The objective of the study was to identify latent classes of risk factors for HIV sexual risk behaviors among sexual healthcare-seeking African American adolescent girls and determine the degree to which these classes predict an HIV sexual risk index.

A two-group solution lower risk and higher risk subtypes was hypothesized. Although prior studies had found evidence of factor solutions greater than two under certain circumstances, less heterogeneity was expected in this all-female, sexual health service—seeking sample.

Participants were part of a larger study evaluating a sexual risk—reduction intervention for African American adolescent girls. Analyses reported in this article are based on data from the baseline assessment. From June to June , African American female adolescents 14—20 years of age were recruited from three clinics in Atlanta, Georgia, providing sexual health services to predominantly inner-city adolescents. A young African American woman recruiter approached adolescents in the clinic waiting area, described the study, solicited participation, and assessed eligibility.

Eligibility criteria included self-identifying as African American, being 14—20 years of age, and reporting vaginal intercourse at least once without a condom in the past 6 months. Adolescents who were married, currently pregnant, or attempting to become pregnant were excluded from the study. Adolescents returned to the clinic to complete informed consent procedures, baseline assessments, and be randomized to trial conditions.

Written informed consent was obtained from all adolescents with parental consent waived for those younger than 18 due to the confidential nature of clinic services. The mean SD age of the participants was Most Most reported currently living in a mother-only headed household The majority of participants Data collection consisted of a minute survey administered via audio computer-assisted, self-interviewing technology assessing for demographics and a range of other study variables as described below.

This baseline survey was developed from psychometrically sound standardized measures utilized in evaluations of HIV prevention curriculum. Of the Fourteen items modified from the African American Women's Stress Scale 17 reflected perceived stress in various interpersonal relationships.

Recent alcohol and marijuana use was assessed by asking participants to report the of days in the past 90 days that they used alcohol and the of days in the past 90 days that they used marijuana. LCA, using Mplus 5. It is assumed that the latent variable probabilistically represents distinct subgroups 20 , which are then assessed on their substantive, theoretical, and empirical merits. Multiple solutions specifying various s of groups were run, and the optimal of groups was identified using the substantive meaningfulness of the models and three model fit statistics Table 1 : the adjusted Bayesian information criterion aBIC , the Lo-Mendell-Rubin L-M-R test statistic, and class probability statistics.

The L-M-R test statistic is a comparative fit statistic; ificant values indicate how many groups should be extracted by testing the parsimony of the current model against the model with one less group. After examining fit statistics for various solutions and choosing the best fitting solution, we examined chi-square differences in the indicator variables between groups to characterize the subgroups identified in the LCA Table 2.

We then conducted a logistic regression analysis predicting latent class membership from the indicator variables to examine the independent and relative contributions of each indicator to overall risk classification Table 3. Finally, to better characterize the groups, we used analysis of variance and chi-square, respectively, to examine differences between the classes on five continuous and four dichotomous correlates that are theoretically linked to and empirically predictive of high-risk behavior e.

Solutions were identified for one, two, and three groups representing risk level. The solution remained unidentified at the three-group model, suggesting that larger models should not be examined. The lowest aBIC, which indicates the best fitting model, was found with the predicted two-group solution Table 1. The L-M-R statistic, which indicates how many groups should be extracted, remained ificant for the two-group model. We also examined the probability statistics, which summarize how well participants are classified into one group or another based on a given model.

The probability statistics for groups 1 and 2 in this model were 0. The low aBIC value, the statistically ificant L-M-R value, and the strong probability statistics for the two-group class solution suggested that this solution is robust and should be examined for its substantive utility. Table 2 presents the chi-square values and the proportion of individuals classified into each group based on the latent class variable indicators. We examined mean differences between the groups on the continuous versions of the indicator variables to glean more information about these groups.

The higher risk group had nearly 14 lifetime sexual partners on average compared to only 3 for the lower risk group. Logistic regression analyses were used to examine which indicator variables were the strongest relative predictors of membership in the higher risk group Table 3. The model correctly classified Sex while high on alcohol or drugs was the next strongest predictor, followed by ever having a positive STD result.

We also explored differences between the two groups on five continuous correlates and four dichotomous variables that have been linked with HIV risk in the empirical literature Table 4. The higher risk group had ificantly lower sex refusal self-efficacy scores, higher fear of condom negotiation scores, lower self-esteem scores, higher perceived stress scores, and higher impulsivity scores when compared with the lower risk group. The higher risk group members also were more likely to report alcohol and marijuana use in the last 90 days and they were more likely to report a history of sexual assault or physical abuse when compared to the lower risk group.

As an additional question regarding high risk sexual partners, we examined whether the participants had recently had sex with an incarcerated male. Girls in the higher risk group This is amongst the first studies to examine how empirically identified factors associated with HIV sexual risk behavior may align to confer differential risk for HIV among African American adolescent girls seeking sexual healthcare services.

Answering this question in a healthcare service—seeking population is critical, as a single healthcare visit may represent a unique and perhaps only window of opportunity to access young women at highest risk for HIV to provide targeted screening and intervention. Indeed, many teen girls engaging in risky sexual behavior do not have one particular clinician following their behavior and symptomatology over time.

Although the majority of the young women present with some level of risky behavior, it would be cost-prohibitive in these clinics, which are often understaffed and overburdened, to provide intensive screening, in-depth counseling services, and highly tailored referrals for patients.

Thus, there is value in improving HIV risk screening in public health clinics or hospital settings to screen, identify, and possibly triage those in greatest need of more intensive screening and counseling. To date, an efficient and reliable HIV prevention screening approach for such purposes has been largely absent.

The current LCA study offers a systematic, empirical approach—rather than an anecdotal or clinician-driven approach as used most typically—to inform screening content for this population, by identifying specific classes of risk and explicating which variables best classify patients into these risk groups.

yielded by LCA procedures supported the hypothesized two-class solution, suggesting that the sample fell into two : higher risk and lower risk for HIV. The strongest predictor of being classified as higher risk was of sexual partners, although the associated confidence intervals were quite large. Follow-up analyses indicated that the higher risk group reported a mean of This is not surprising, as increasing contact with new and different partners increases the odds of encountering an HIV infected partner within a social network.

The contributing mechanisms and processes by which the girls that fall in the higher risk class seek a greater of sexual partners are not well understood; however, some theories suggest that media may influence sexual behavior.

Another theory suggests that some girls seek new sexual partners as a means of reducing negative affect by achieving intimacy. For instance, if girls are engaging in sexual behavior with multiple partners in an attempt to create feelings of intimacy and connectedness with others, 26 teaching strategies for meeting intimacy needs without engagement in sexual behavior with multiple partners may be important. This may be a unique and noteworthy descriptor of this particular population, in comparison to other samples such as school-based samples of African American adolescent girls and boys, where both Beadnell et al.

The current findings suggest that assessing and addressing barriers to consistent condom use is important when providing healthcare services to African American female adolescents. The higher risk group reported problems across a of associated domains that also have assessment and psychosocial clinical intervention implications.

Specifically, findings identified a higher prevalence of sexual and physical abuse, as well as alcohol and marijuana use, stress, impulsivity, and lower self-esteem among the higher risk group. The relation between history of abuse and engagement in HIV risk behavior supported in the current study is consistent with prior research demonstrating a strong association between child abuse and engagement in sexual risk behaviors. For example, young women who have been sexually abused in childhood may engage in risky sexual behavior such as having intercourse with a partner who refuses to wear a condom due to learned behaviors of communication in sexual situations e.

Evidence-based, trauma-focused interventions that seek to break the link between unhelpful and inaccurate beliefs a victim may develop in the aftermath of child abuse and later problematic behaviors have been shown to be useful among adolescent populations. Additionally, associations between active substance misuse, stress, and impulsivity with high-risk sexual behavior have been documented in the literature, 36 particularly among child abuse victims, suggesting additional possible targets for treatment among the higher risk group.

Risk Reduction through Family Therapy 37 , 38 is another promising trauma-focused intervention that directly targets risky behaviors such as substance abuse and sexual risk taking, in addition to distress tolerance, and may be useful for patients who present at sexual health clinics with child abuse histories, and who, per the current study, are at increased risk for HIV infection. Limitations of the current study should be noted. First, the cross-sectional de prohibits information about new HIV infection in this sample overtime. Second, the sample was limited to a specific geographic region i.

Third, the assessment of some variables e. In sum, this study represents one of the first attempts to better understand patterns of HIV sexual risk behaviors among healthcare seeking African American female adolescents. While findings are informative, they are in need of replication and extension to longitudinal risk associations.

Replication of the current findings would provide future directions for parsimonious and empirically informed screening and assessment of HIV risk behavior among this population. Future research also should consider and examine the cost-effectiveness of early intervention among youth falling in the lower risk group, as recent treatment outcome research suggests specific interventions cognitive behavioral therapy can be efficacious in reducing HIV risk behaviors among adolescent populations presenting for services in other settings.

National Center for Biotechnology Information , U. Journal of Women's Health. J Womens Health Larchmt. Ruggiero , PhD, 1,, 3 Jennifer L. Brown , PhD, 4 Jessica M. Wingood , ScD, 4,, 5,, 6 and Ralph J. DiClemente , PhD 4,, 5,, 6.

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Charleston teenage girls seeking sexual partners

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