Sexual Risk Prevention Research Articles

The longitudinal impact of a family-based communication intervention on observational and self-reports of sexual communication.

Parents can play a vital role in shaping teenagers' sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent-adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent adolescent sexual communication was examined at 12-months among adolescents with mental health problems. Of the 721 parent- adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent-adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent Body-Language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11 hours of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12-months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent-adolescent sexual communication among a mental health sample.

The Effects of Men's Hostility Toward Women, Acute Alcohol Intoxication, and Women's Condom Request Style on Men's Condom Use Resistance Tactics.

To extend previous research demonstrating that intoxicated men high in hostility toward women report stronger intentions to use coercive condom use resistance (CUR) tactics to have unprotected sex by examining the role of women's condom request style. Community, non-problem drinking men, ages 21-30 (N = 296) completed standard alcohol administration procedures and read an eroticized story of a casual sexual interaction. Following the woman's request to use a condom, intentions to engage in coercive CUR tactics were assessed. Generalized linear models with gamma distributions assessed the 3-way interaction of men's hostility toward women, beverage condition (alcohol or sober), and the woman's condom request style (indirect, direct, or insistent). The 3-way interaction between hostility toward women, beverage condition, and indirect condom request (vs. direct) significantly predicted men's coercive CUR intentions. Men high in hostility toward women reported stronger CUR intentions after experiencing an indirect condom request, when sober or intoxicated, and after a direct condom request when intoxicated. Men high in hostility toward women reported the weakest CUR intentions when sober following an insistent or direct condom request. Men high in hostility toward women pose a threat to women's sexual safety, particularly when intoxicated or following an indirect condom request. Hostility toward women and alcohol consumption should be addressed in sexual risk prevention programs. Pending further replication, women should be informed of the relative effectiveness of using insistent condom requests.

Black Pastors’ Views on preaching about sex: barriers, facilitators, and opportunities for HIV prevention messaging

ABSTRACTObjectives: Despite the disproportionately high rates of heterosexually transmitted HIV infection among US Blacks and ongoing need for effective inexpensive behavioral interventions, the use of sermons as an HIV prevention tool in Black churches has received little research attention. The Black church plays an important role in Black communities and is a potential ally in development and delivery of sexual risk prevention messages. The objective of this study was to examine Black pastors’ thoughts about whether sermons should address issues related to heterosexual relationships – and the barriers and facilitators to discussing these topics in a sermon setting.Design: We conducted in-depth semi-structured, individual interviews among 39 pastors of Black churches in North Carolina and analyzed the interview data using thematic analysis strategies based on grounded theory.Results: Pastors expressed widely ranging opinions, especially about discussion of condom use, but generally agreed that sermons should discuss marriage, abstinence, monogamy, dating, and infidelity – behaviors that impact sexual networks and HIV transmission. The major barriers to incorporation of these subjects into sermons include the extent to which a concept undermines their religious beliefs and uncertainty about how to incorporate it. However, scriptural support for a prevention message and the pastor’s perception that the message is relevant to the congregation facilitate incorporation of related topics into sermons.Conclusions: These findings have implications for the potential utility of sermons as an HIV prevention tool and suggest that it is possible for public health professionals and pastors of Black churches to form partnerships to develop messages that are consonant with pastors’ religious convictions as well as public health recommendations.

Provider perceptions on HIV risk and prevention services within permanent supportive housing

ABSTRACTPermanent supportive housing (PSH) is an evidence-based solution to homelessness for persons experiencing chronic or long-term homelessness and one or more physical or behavioral health problems. Health services through PSH typically focus on physical and behavioral health. With the exception of programs specifically designed for persons living with HIV/AIDS, little attention has focused on services through PSH to prevent transmission of HIV or other sexually transmitted infections (STIs), yet sexual risk behavior continues after homeless persons move into PSH. The purpose of this study was to investigate how PSH providers approach HIV prevention and the challenges they perceive surrounding HIV prevention in PSH. Results serve as a critical first step toward addressing the acceptability and feasibility of providing HIV/STI prevention services to PSH residents. As part of a longitudinal mixed methods study examining HIV risk and prevention behavior among homeless unaccompanied adults moving into PSH in Los Angeles, we conducted eleven focus groups with a total of 60 frontline staff across 10 PSH agencies. Thirty-three percent of focus group participants were African American, 32% were Hispanic, and 55% were women. Results suggest that provider awareness and knowledge of PrEP is very limited, and provision of formal HIV prevention programing for residents is perceived as challenging. Informal, ad hoc conversations with residents about sexual risk and HIV prevention do occur when providers have rapport with clients and perceive risk. There are significant gaps in HIV prevention services through PSH but also opportunities to enhance providers’ efforts to promote the health of residents through prevention.

Developmental Patterns of Adolescent Marijuana and Alcohol Use and Their Joint Association with Sexual Risk Behavior and Outcomes in Young Adulthood.

Urban populations disproportionately experience poor sexual outcomes, including high rates of teenage pregnancy and sexually transmitted infections. However, the contribution of substance use across adolescence to poor sexual outcomes in young adulthood has not been investigated in depth, despite offering opportunities for more targeted prevention. This study aimed to estimate joint trajectories of adolescent alcohol and marijuana useto determine if they relate differently to four sexual outcomes: multiple sexual partners, sex without a condom, teenage pregnancy, and contraction of a sexually transmitted infection in young adulthood (by age 25). Data came from a longitudinal study of urban youth followed from age 6 to age 25, with annual assessments during adolescence and young adulthood (n = 608). The sample showed high levels of sexual risk, with young adults on average having sex without a condom once in the past month, 28.5% having multiple sexual partners in the past month, one quarter having contracted a sexually transmitted infection, and over 60% of the women being pregnant as a teenager and 36% of the men having gotten a partner pregnant. Applying longitudinal latent profile analysis to estimate joint trajectories of alcohol and marijuana use from grades 8-12, we identified four classes representing high dual use, moderate alcohol use, moderate alcohol use with increasing marijuana use, and non-use. Class membership differently predicted all four outcomes investigated with high dual users having the highest level of teenage pregnancy and the increasing marijuana trajectory having the highest risk of engaging with multiple sexual partners in the past month. Results suggest implications for both sexual risk and substance use prevention for urban youth.

A Review of the Effectiveness of HIV Sexual Risk Prevention Interventions in Adult Prison Inmates.

This article reviews the effectiveness of HIV sexual risk prevention programs among adult prison inmates. A database search was performed to identify studies that used HIV sexual risk prevention programs with incarcerated adults. Of the 234 articles identified, 9 met the inclusion criteria. In addition, 5 articles were found containing supporting information for the 9 studies reviewed, increasing the number of articles reviewed to 14. All studies reported a significant increase in knowledge or a decrease in high-risk behaviors among the inmates at the conclusion of the interventions. Common limitations included a lack of a theoretical framework used in developing the interventions, a lack of process evaluations to measure program fidelity, and a lack of validity and reliability reporting for the study surveys. However, programs and interventions targeting HIV and sexual risk reduction appear to improve the knowledge of HIV prevention and reduce risk in the adult prison inmate population.

Sex Differences in Virtual Network Characteristics and Sexual Risk Behavior among Emerging Adults.

Emerging adults (EAs)ages 18 to 24 account for a large proportion of all sexually transmitted infections (STIs), HIV infections, and unintended pregnancies in the United States. Given the increased influence of online media on decision-making, we examined how EA online networks were associated with sexual risk behaviors. We used egocentric network data collected from EAs aged 18 to 24 years old across the United States (N=1,687) to examine how online norms (e.g., acceptance of HIV infections, other STIs, and pregnancy) and network characteristics (i.e., network size and density; ties' closeness, race, age, and sex similarities) were associated with participants' unprotected vaginal intercourse (UVI) in the last 30 days. Findings suggested that in male EAs, there was a strong association between sexual norms, structural characteristics, and sexual risk behavior compared to females. Researchers and practitioners may wish to address online peer norms and EAs' online network composition when developing online sexual risk prevention tools.

Everything is connected: social determinants of pediatric health and disease.

Carine Tarazi, MA, is an Assistant Editor for Pediatric Research in Boston, Massachusetts, USA. Margie Skeer, ScD, MPH, MSW, served as a Guest Editor for this special issue. Dr. Skeer is Assistant Professor of Public Health and Community Medicine at Tufts University. Her research focuses on adolescent substance misuse and sexual risk prevention, both from epidemiologic and intervention-development perspectives. Kevin Fiscella, MD, MPH, served as a Guest Editor for this special issue. Dr. Fiscella is Tenured Professor of Family Medicine, Public Health Sciences and Community Health at the University of Rochester Medical Center. Dr. Fiscella's research focuses on health and health care disparities, particularly practical strategies to improve health equity. Stephanie Dean, MBA, is Managing Editor of Pediatric Research and is based out of editorial office in The Woodlands, Texas. Olaf Dammann, MD, served as a Guest Editor for this special issue. Dr. Dammann is a Professor of Public Health and Community Medicine, Pediatrics, and Ophthalmology at Tufts University School of Medicine in Boston, Massachusetts, USA, as well as Professor of Perinatal Neuroepidemiology at Hannover Medical School, Hannover, Germany. His research interests include the elucidation of risk factors for brain damage and retinopathy in preterm newborns, the theory of risk and causation in biomedical and public health research, and the development of computational chronic disease models.

Brain Derived Neurotrophic Factor: From Neurobiology to Sexual Risk Prevention

Objective: The authors’ draw on neurobiological theory to posit that sexual risks might be associated with neurological changes, specifically, those neuro-adaptive changes associated with addictions. We propose that low levels of brain-derived neurotrophic factor (BDNF), a signaling molecule involved in cognitive, emotional, and addiction behaviors, may play a key role in the expression of high-risk sexual behaviors. Methods: In a prospective cohort of 400 people living with HIV (PLWH), information was collected regarding smoking (Fagerstrom Test for Nicotine Dependence), hazardous alcohol use (men >14 and women >7 drinks/week), sexual behaviors. To assess the role of BDNF, platelet poor plasma was obtained to measure BDNF levels and participants were dichotomized into Groups 1 (BDNF ≤ 5000 pg/mL) and 2 (BDNF >5000 pg/mL). Results: Over two-thirds of the participants reported multiple risk behaviors, confirming our hypothesis that Group 1 would have a general risk-taking tendency. Individuals in Group 1 were more likely to smoke (p=0.0001) and to drink alcohol hazardously (HAU) more days per week (p=0.04), particularly hard liquor (p=0.001). In support of our hypothesis, Group 1 was also more likely to report sex under the influence of drugs/alcohol (p=0.003) and to exchange sex for money (p=0.03). Men from Group 1 had multiple partners (p=0.09), and engaged in unprotected anal sex (p=0.08) more than those in Group 2. The results from regressions showed that BDNF (p=0.05), use of antidepressants (p=0.003), hazardous alcohol use (p=0.0001) and the BDNF x gender interaction (p=0.022) were significant predictors of high-risk sexual behaviors. Further supporting our postulate, participants with low BDNF showed triple the risk of herpes (p=0.05). Conclusion: This innovative approach demonstrated for the first time that substance abuse disorders (especially alcohol abuse), high-risk sexual behaviors, and sexually transmitted diseases occur more frequently in individuals with low BDNF levels. These findings suggest the importance of using BDNF modifiers in preventive interventions concerning people living with HIV. Given the limitations of the design, new studies among the general population are needed to confirm the generalizability of the findings.

Cannabis users show increased susceptibility to false memories

Drug and Alcohol Dependence 156 (2015) e183–e245 e189 areas of sexual risk reduction, prevention and treatment for substanceabuseandmental health. Publichealthprogramsprioritizing the different populations are necessary. Financial support: Fogarty International Center; Grant 1R03TW007612; Fundo de Incentivo e Auxilio a Pesquisa (FIPE) from Hospital de Clinicas de Porto Alegre, Brazil (GPPGHCPA – No. 07-391). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.507 Crack, powdered cocaine, both or neither: A generalized logit analysis of a community-based sample Grace L. Reynolds1,2,∗, Dennis G. Fisher1, Erlyana Erlyana2 1 Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, CA, United States 2 Health Care Administration, California State University, Long Beach, Long Beach, CA, United States Aims: To understand factors associated with use of both crack cocaine and non-injected powered cocaine. Methods: The Risk Behavior Assessment (RBA; 1993) was used to elicit information on past month, past 48-hours and drugs used before/during sex drug use in a sample of out-of-treatment drug users (N=8538). Past 30 day, past 48h, and before/during sex drug use were coded into (1) use of crack (smokable cocaine) only, (2) powdered cocaine use only, (3) both drugs used during the timeframe and (4) neither drug used. Generalized logit analysis was used to develop models for each timeframe (48-hour and 30-day). For all models the reference group was using neither drug. Results: Respondents who reported use of both crack and powdered cocaine (N=306) included both men (n=207) and women (n=99). The 48-hour, 30-day, and before/during sex models were almost identical. Those who reported using both crack and cocaine were more likely to: be Black (OR=1.65, CI 1.27, 2.14); bisexual (OR=1.85, CI 1.39, 2.47); trade sex fordrugs (OR=4.88CI 3.73, 6.39); tobehomeless (OR=3.50, CI 2.66, 4.62), havehighernumberof days used alcohol in the pastmonth (OR=1.09, CI 1.08, 1.10); and to have had gonorrhea (OR=1.42, CI 1.07, 1.88). Conclusions: The general logit model highlights factors associated with use of both crack and powdered cocaine within the same timeframe, includinghomelessness, andbeingamemberof anethic or sexual minority, and sex trading. Financial support: Funding was provided in part by grant R01 DA030234 from the National Institute on Drug Abuse, P20MD003942 from the National Institute of Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse, the National Institute ofMinority Health and Health Disparities or the National Institutes of Health. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.508 Cannabis users show increased susceptibility to false memories Jordi Riba1,∗, Frederic Sampedro2, Aina Rodriguez-Pujadas2, Saul Martinez-Horta1, Jaime Kulisevsky1, Jose-Carlos Perez-de-los-Cobos1, Antoni Rodriguez-Fornells1, Marta Valle1 1 Hospital Sant Pau, Barcelona, Spain 2 University of Barcelona, Barcelona, Spain Aims: Previous studies on the neurocognitive impact of cannabis use have found working and declarative memory deficits that tend to normalize with abstinence. An unexplored aspect of cognitive function in chronic cannabis users is the ability to distinguish between veridical and illusory events; a crucial aspect of reality monitoring that relies on adequate memory function and cognitive control. Methods: Sixteen heavy cannabis users not seeking treatment for their cannabis consumptionwerematched to a group of healthy controls taking into account sex, age, years of education, verbal intelligence and fluid intelligence. All participants performed a modified version of the Deese–Roediger–McDermott paradigm in an MRI scanner. Following a study phase, subjects were presented with 75 old words, 40 semantically unrelated new words and 40 semantically related new words or lures. They were required to judge whether a word had been presented in the study phase and make an old vs. new decision by button press. Results: Cannabis users showed an increased susceptibility to false memories, failing to identify lure stimuli as events that never occurred. In addition to impaired performance, they displayed reduced activation in areas associated with memory processing within the medial temporal lobe (MTL), and in parietal and frontal brain regions involved in attention and performance monitoring. Reduced activity in the MTL was associated with greater cannabis consumption. Conclusions: These findings indicate that cannabis users have an increased susceptibility to memory distortions even when abstinent and drug-free, suggesting a long-lasting compromise of memory and cognitive control mechanisms involved in reality monitoring. Financial support: This research was supported by the “Plan Nacional Sobre Drogas” of the Spanish Government. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.509 CaMKII inhibition affects cocaine-cue memory processes to attenuate reinstatement Matthew T. Rich1,∗, Mary M. Torregrossa2 1 University of Pittsburgh, Pittsburgh, PA, United States 2 Psychiatry, University of Pittsburgh, Pittsburgh, PA,

Correlates between Brazilian club drug users men who have sex with men, psychiatric vulnerabilities and multiple sexual partners

Drug and Alcohol Dependence 156 (2015) e183–e245 e189 areas of sexual risk reduction, prevention and treatment for substanceabuseandmental health. Publichealthprogramsprioritizing the different populations are necessary. Financial support: Fogarty International Center; Grant 1R03TW007612; Fundo de Incentivo e Auxilio a Pesquisa (FIPE) from Hospital de Clinicas de Porto Alegre, Brazil (GPPGHCPA – No. 07-391). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.507 Crack, powdered cocaine, both or neither: A generalized logit analysis of a community-based sample Grace L. Reynolds1,2,∗, Dennis G. Fisher1, Erlyana Erlyana2 1 Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, CA, United States 2 Health Care Administration, California State University, Long Beach, Long Beach, CA, United States Aims: To understand factors associated with use of both crack cocaine and non-injected powered cocaine. Methods: The Risk Behavior Assessment (RBA; 1993) was used to elicit information on past month, past 48-hours and drugs used before/during sex drug use in a sample of out-of-treatment drug users (N=8538). Past 30 day, past 48h, and before/during sex drug use were coded into (1) use of crack (smokable cocaine) only, (2) powdered cocaine use only, (3) both drugs used during the timeframe and (4) neither drug used. Generalized logit analysis was used to develop models for each timeframe (48-hour and 30-day). For all models the reference group was using neither drug. Results: Respondents who reported use of both crack and powdered cocaine (N=306) included both men (n=207) and women (n=99). The 48-hour, 30-day, and before/during sex models were almost identical. Those who reported using both crack and cocaine were more likely to: be Black (OR=1.65, CI 1.27, 2.14); bisexual (OR=1.85, CI 1.39, 2.47); trade sex fordrugs (OR=4.88CI 3.73, 6.39); tobehomeless (OR=3.50, CI 2.66, 4.62), havehighernumberof days used alcohol in the pastmonth (OR=1.09, CI 1.08, 1.10); and to have had gonorrhea (OR=1.42, CI 1.07, 1.88). Conclusions: The general logit model highlights factors associated with use of both crack and powdered cocaine within the same timeframe, includinghomelessness, andbeingamemberof anethic or sexual minority, and sex trading. Financial support: Funding was provided in part by grant R01 DA030234 from the National Institute on Drug Abuse, P20MD003942 from the National Institute of Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse, the National Institute ofMinority Health and Health Disparities or the National Institutes of Health. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.508 Cannabis users show increased susceptibility to false memories Jordi Riba1,∗, Frederic Sampedro2, Aina Rodriguez-Pujadas2, Saul Martinez-Horta1, Jaime Kulisevsky1, Jose-Carlos Perez-de-los-Cobos1, Antoni Rodriguez-Fornells1, Marta Valle1 1 Hospital Sant Pau, Barcelona, Spain 2 University of Barcelona, Barcelona, Spain Aims: Previous studies on the neurocognitive impact of cannabis use have found working and declarative memory deficits that tend to normalize with abstinence. An unexplored aspect of cognitive function in chronic cannabis users is the ability to distinguish between veridical and illusory events; a crucial aspect of reality monitoring that relies on adequate memory function and cognitive control. Methods: Sixteen heavy cannabis users not seeking treatment for their cannabis consumptionwerematched to a group of healthy controls taking into account sex, age, years of education, verbal intelligence and fluid intelligence. All participants performed a modified version of the Deese–Roediger–McDermott paradigm in an MRI scanner. Following a study phase, subjects were presented with 75 old words, 40 semantically unrelated new words and 40 semantically related new words or lures. They were required to judge whether a word had been presented in the study phase and make an old vs. new decision by button press. Results: Cannabis users showed an increased susceptibility to false memories, failing to identify lure stimuli as events that never occurred. In addition to impaired performance, they displayed reduced activation in areas associated with memory processing within the medial temporal lobe (MTL), and in parietal and frontal brain regions involved in attention and performance monitoring. Reduced activity in the MTL was associated with greater cannabis consumption. Conclusions: These findings indicate that cannabis users have an increased susceptibility to memory distortions even when abstinent and drug-free, suggesting a long-lasting compromise of memory and cognitive control mechanisms involved in reality monitoring. Financial support: This research was supported by the “Plan Nacional Sobre Drogas” of the Spanish Government. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.509 CaMKII inhibition affects cocaine-cue memory processes to attenuate reinstatement Matthew T. Rich1,∗, Mary M. Torregrossa2 1 University of Pittsburgh, Pittsburgh, PA, United States 2 Psychiatry, University of Pittsburgh, Pittsburgh, PA,

Effects of syndemics on HIV viral load and medication adherence in the multicentre AIDS cohort study.

The objective of this study is to determine associations between intertwining epidemics (syndemics) and HIV medication adherence and viral load levels among HIV-positive MSM and to test whether adherence mediates the relationship between syndemics and viral load. We analysed participant data collected between 2003 and 2009 from the Multicenter AIDS Cohort Study, a prospective HIV/AIDS cohort study in four U.S. cities. We conducted longitudinal analyses (repeated measures mixed models) to assess whether differences in viral load levels, undetectable viral load and self-reported HIV medication adherence were associated with count of syndemic conditions (substance use, depression symptoms and sexual risk behaviour, range 0-3), adjusting for race/ethnicity, age and income. Mediation analyses were conducted using structural equation modelling and the SAS %mediate macro. Syndemics count was associated with higher viral loads (P < 0.0001) and lower adherence (P < 0.0001). Increased counts of concomitant syndemics were associated with viral load (P < 0.01), detectable viral load (P < 0.05) and adherence (P < 0.001). Black MSM experienced worse outcomes across domains than white MSM (P < 0.0001) and experienced higher overall rates of syndemics (P < 0.01). Adherence significantly mediated the relationship between syndemics and viral load, accounting for an estimated 32.3% of the effect (P < 0.05). Effectively lowering viral load levels among MSM has implications for both HIV/AIDS prevention and care. Our findings suggest that integrating substance use interventions, mental healthcare and sexual risk prevention into standard HIV care may be necessary to optimize treatment and Treatment as Prevention (TasP) models.

Attachment and Associated Sexual Health Behaviors of Heterosexual Mexican Housewives

Sexually transmitted infections including human immunodeficiency virus are international public health concerns. Heterosexual women who are in steady relationships have been described as a particularly vulnerable population at risk for sexually transmitted infections acquired from their male partners. In this pilot study, we describe associations identified via cross-sectional survey among demographic variables, attachment style, and condom use in Mexican heterosexual women (ages 20–44 years, n = 50) who self-reported current steady partner relationships. Descriptive, bivariate, and correlation analyses were conducted. Secure attachment and condom use were positively correlated with education level. Limited sexual risk prevention knowledge and contraception use, low risk perception within male partner relationships and misconception about proper condom use were identified as sources of elevated risk for sexually transmitted infections via male partners. Implications of findings include sexual health intervention modification to include dialogue concerning the context of steady relationship and sexual risk among Mexican heterosexual women.

Socio-demographics, sexual behaviours, and use of HIV prevention services among men who have sex with men and women in Western China.

This paper looks into the differences of sexual risk behaviours and prevention services among men who have sex with men and women and men who have sex with men only. The data from a cross-sectional survey of 159 men who have sex with men and women and 1186 men who have sex with men only in western China is analysed. It is found that men who have sex with men and women, with multiple anal sex partners, have higher rates of selling and buying sex than men who have sex with men only, but obtain less HIV-related knowledge from partners or HIV consulting and testing services. More efforts should be made to promote safer sexual behaviours and reduce the barriers for access to health services.

Association of gender norms, relationship and intrapersonal variables, and acculturation with sexual communication among young adult Latinos.

Sexual communication is an important strategy in promoting safer sex behavior, but few investigators have explored sexual communication among young adult Latinos. In this cross-sectional study, we examined the role of traditional gender norms, relationship factors (relationship characteristics and relationship power), intrapersonal factors (attitudes and subjective norms), and acculturation as statistical predictors of three different types of sexual communication (sexual health, pleasure discussions, and physical sexual communication) in Latino women and men. The sample was 220 Latinos (111 women and 109 men) ages 18-30 years who were sexually active in heterosexual relationships. In multiple regression, after controlling for relationship power, intrapersonal factors, and acculturation, traditional gender norms did not predict sexual communication for either women or men. For both women and men, pleasure-focused communication (pleasure discussions and physical sexual communication) increased with acculturation. For women, the strongest predictor of all types of sexual communication was their attitudes toward sexual communication. Greater relationship power and lower acculturation were associated with women's sexual health communication. For men, no variables explained sexual health communication or physical sexual communication, and acculturation and attitude toward pleasure discussions predicted pleasure communication. Women who believed they had power in their relationships and had positive attitudes toward pleasure discussions and a high level of acculturation reported more physical sexual communication. Findings suggest the importance of relationship power, attitudes, and acculturation in young adult Latinos' sexual communication. Sexual risk prevention strategies among young adult Latinos should include encouraging sexual communication by supporting positive attitudes toward pleasure-focused communication. © 2015 Wiley Periodicals, Inc.

Community Violence Exposure and Sexual Behaviors in a Nationally Representative Sample of Young Adults: The Effects of Race/Ethnicity and Gender

ABSTRACTThis study examined whether exposure to community violence was related to sexual risk behaviors in a nationally representative sample of young adults and if there were gender or racial/ethnic differences in these relationships. The analytic sample for this study was drawn from the National Longitudinal Study of Adolescent Health and was composed of 7,726 unmarried, heterosexual African American, Caucasian, and Hispanic/Latino young adults aged 18 to 27 years old. Approximately 12% of participants reported some community violence exposures, with men and African Americans reporting the highest rates of such exposures. Regression analyses controlling for age, gender, parental education, and family structure indicated that exposures to community violence were associated with earlier sexual debut history, a higher number of sexual partners within the previous 12 months, and a higher number of total sexual partners. Additionally, violence exposures had stronger effects for males and weaker effects for African Americans. Primary and secondary sexual risk prevention initiatives would need to consider how patterns of sexual risk behaviors may be related to exposure to community violence and how such relationships may differ based on gender and race/ethnicity. Future research should also seek to illuminate pathways connecting these 2 major public health concerns.

Cultural orientation and social capital as predictors of condom use among internal migrants in China

Background: The global literature has revealed that cultural orientation, adaptation and social capital may influence HIV-related sexual behaviours among migrants. However, whether cultural orientations influence adaptation and social capital and thereby affect sexual behaviour is not well understood. Method: This study examined whether individualistic and collectivistic orientations, adaptation and social capital have direct and indirect effects on condom use among rural-to-urban migrants in China. We collected data from 641 migrants aged 17 to 30 years, in Beijing, China. Participants completed scales on individualistic orientation, collectivistic orientation, adaptation, social capital and condom use. Structural equation modelling was used for model testing. Results: Condom use was positively associated with an individualistic orientation and social capital. An individualistic orientation had an indirect effect on condom use via social capital. Women reported higher levels of condom use than men. Conclusion: Future sexual risk prevention and intervention programmes to improve sexual health should pay more attention to building social capital and engaging with relevant cultural factors.

Adolescent Age at Time of Receipt of One or More Sexual Risk Reduction Interventions

Age of the target audience at time of intervention is thought to be a critical variable influencing the effectiveness of adolescent sexual risk reduction interventions. Despite this postulated importance, to date, studies have not been designed to enable a direct comparison of outcomes according to age at the time of intervention delivery. We examined outcomes of 598 youth who were sequentially involved in two randomized controlled trials of sexual risk prevention interventions, the first one delivered in grade 6 (Focus on Youth in the Caribbean [FOYC]) and the second one in grade 10 (Bahamian Focus on Older Youth [BFOOY]). Four groups were examined, including those who received (1) both treatment conditions, FOYC and BFOOY; (2) FOYC in grade 6 and the control condition in grade 10; (3) the control condition in grade 6 and BFOOY in grade 10; and (4) both control conditions. Intentions, perceptions, condom-use skills, and HIV-related knowledge were assessed over 60months. Data showed that those who received both interventions had the greatest increase in condom-use skills. Youth who received FOYC in grade 6 had greater scores in knowledge and intention. These results suggest that youth receive the most protection with early and repeated exposure to interventions. These findings suggest that educators should consider implementing HIV prevention and risk reduction programs as a fixed component of education curriculum beginning in the preadolescent years and if possible also during the adolescent years.

Sexting and Sexual Behavior in At-Risk Adolescents

This study aimed to examine the prevalence of sexting behaviors (sexually explicit messages and/or pictures) among an at-risk sample of early adolescents as well as the associations between sexting behaviors and sexual behaviors, risk-related cognitions, and emotional regulation skills. It also aimed to determine whether differences in risk were associated with text-based versus photo-based sexts. Seventh-grade adolescents participating in a sexual risk prevention trial for at-risk early adolescents completed a computer-based survey at baseline regarding sexting behavior (having sent sexually explicit messages and/or pictures), sexual activities, intentions to have sex, perceived approval of sexual activity, and emotional regulation skills. Twenty-two percent of the sample reported having sexted in the past 6 months; sexual messages were endorsed by 17% (n = 71), sexual messages and photos by 5% (n = 21). Pictures were endorsed significantly more often by females (χ(2)[2] = 7.33, P = .03) and Latinos (χ(2)[2] = 7.27, P = .03). Sexting of any kind was associated with higher rates of engaging in a variety of sexual behaviors, and sending photos was associated with higher rates of sexual activity than sending text messages only. This was true for a range of behaviors from touching genitals over clothes (odds ratio [OR] = 1.98, P = .03) to oral sex (OR = 2.66, P < .01) to vaginal sex (OR = 2.23, P < .01). Sexting behavior (both photo and text messages) was not uncommon among middle school youth and co-occurred with sexual behavior. These data suggest that phone behaviors, even flirtatious messages, may be an indicator of risk. Clinicians, parents, and health programs should discuss sexting with early adolescents.

Effectiveness of HIV Prevention for Women: What Is Working?

The HIV-AIDS remains a public health problem which disproportionally affects women. However, prevention strategies have rarely considered their specific efficacy for them. For this reason, this study examines the differential effectiveness of six intervention elements based on socio-cognitive theories addressing young women. A controlled between-groups design examined the change in risk profile among 167 young Spanish women (mean age 21.3 years old) involved in five sexual risk prevention interventions (informative talk, attitudinal discussion, role-play, fear induction and informative website) and one control non-intervening group (waiting list). Our findings support the differential efficacy of some HIV preventive intervention elements comparing others for women. In particular, the attitudinal discussion stands out followed by the informative talk and the role play. Contrarily, the fear induction component did not reveal relevant improvements. This study provides new evidence related to HIV prevention. Particularly, the higher efficacy of motivational components for these young Spanish women is revealed.