Last data update: Nov 11, 2024. (Total: 48109 publications since 2009)
Records 1-22 (of 22 Records) |
Query Trace: Hatfield-Timajchy K[original query] |
---|
U.S. selected practice recommendations for contraceptive use, 2024
Curtis KM , Nguyen AT , Tepper NK , Zapata LB , Snyder EM , Hatfield-Timajchy K , Kortsmit K , Cohen MA , Whiteman MK . MMWR Recomm Rep 2024 73 (3) 1-77 The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. SPR (CDC. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR 2016;65[No. RR-4]:1-66). Notable updates include 1) updated recommendations for provision of medications for intrauterine device placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use. |
2gether: A clinic-based intervention to increase dual protection from sexually transmitted infections and pregnancy in young African American females
Kottke MJ , Sales JM , Goedken P , Brown JL , Hatfield-Timajchy K , Koumans EH , Hardin JW , Kraft JM , Kourtis AP . J Womens Health (Larchmt) 2022 32 (1) 29-38 Background: To determine whether the 2gether intervention increases use of a dual protection (DP; concurrent prevention of pregnancy and sexually transmitted infections [STIs]) strategy and decreases pregnancy and STIs among young African American females, who disproportionately experience these outcomes. Materials and Methods: We conducted a randomized clinical trial comparing the 2gether intervention to standard of care (SOC). Participants were self-identified African American females aged 14-19 years who were sexually active with a male partner in the past 6 months. Participants were followed for 12 months; 685 were included in the analytic sample. The primary biologic outcome was time to any incident biologic event (chlamydia, gonorrhea, trichomonas infections, or pregnancy). The primary behavioral outcomes were use of and adherence to a DP strategy. Results: 2gether intervention participants had a decreased hazard of chlamydia, gonorrhea, trichomonas infections, or pregnancy during follow-up, hazard ratio=0.73 (95% confidence interval [CI] 0.58-0.92), and were more likely to report use of condoms plus contraception, generally, adjusted risk ratio (aRR)=1.61 (95% CI 1.15-2.26) and condoms plus an implant or intrauterine device (IUD), specifically, aRR=2.11 (95% CI 1.35-3.29) in the prior 3 months compared with those receiving SOC. 2gether participants were also more likely to report use of condoms plus an implant or IUD at last sex and consistently over the prior 3 months. Conclusions: 2gether was efficacious in increasing use of condoms with contraception and decreasing pregnancy or selected STIs in our participants. Implementation of this intervention in clinical settings serving young people with high rates of pregnancy and STIs may be beneficial. ClinicalTrials.gov, No. NCT02291224 (https://clinicaltrials.gov/ct2/show/NCT02291224term=2gether&draw=2&rank=5). |
Emergency Department and Intensive Care Unit Overcrowding and Ventilator Shortages in US Hospitals During the COVID-19 Pandemic, 2020-2021.
Sandhu P , Shah AB , Ahmad FB , Kerr J , Demeke HB , Graeden E , Marks S , Clark H , Bombard JM , Bolduc M , Hatfield-Timajchy K , Tindall E , Neri A , Smith K , Owens C , Martin T , Strona FV . Public Health Rep 2022 137 (4) 333549221091781 OBJECTIVE: In 2020, the COVID-19 pandemic overburdened the US health care system because of extended and unprecedented patient surges and supply shortages in hospitals. We investigated the extent to which several US hospitals experienced emergency department (ED) and intensive care unit (ICU) overcrowding and ventilator shortages during the COVID-19 pandemic. METHODS: We analyzed Health Pulse data to assess the extent to which US hospitals reported alerts when experiencing ED overcrowding, ICU overcrowding, and ventilator shortages from March 7, 2020, through April 30, 2021. RESULTS: Of 625 participating hospitals in 29 states, 393 (63%) reported at least 1 hospital alert during the study period: 246 (63%) reported ED overcrowding, 239 (61%) reported ICU overcrowding, and 48 (12%) reported ventilator shortages. The number of alerts for overcrowding in EDs and ICUs increased as the number of COVID-19 cases surged. CONCLUSIONS: Timely assessment and communication about critical factors such as ED and ICU overcrowding and ventilator shortages during public health emergencies can guide public health response efforts in supporting federal, state, and local public health agencies. |
Improving access to and quality of sexual and reproductive health services for adolescents in the United States
Brittain AW , Steiner RJ , Fasula AM , Hatfield-Timajchy K , Kulkarni A , Koumans EH . J Womens Health (Larchmt) 2022 31 (1) 7-12 Equitable access to high quality adolescent sexual and reproductive health (ASRH) services can help reduce unintended pregnancies, sexually transmitted diseases, and disparities in these outcomes. The Centers for Disease Control and Prevention (CDC), Division of Reproductive Health, has a long history of working to improve access to and quality of ASRH services through applied research and public health practice. This report from CDC summarizes the evolution of these efforts from more than a decade of work-from community-based demonstration projects to an initiative to support wide-scale implementation. We describe a community-wide teen pregnancy prevention program model that includes a component addressing ASRH services (2010-2015), focused efforts related to quality improvement (QI) of and community-clinic linkages to ASRH services (2015-2020), and the development of a QI package that collates implementation strategies and tools to improve ASRH services (2020-2022). We conclude by discussing future directions. In disseminating key strategies and resources from this work, we aim to support broader public health and clinical efforts to strengthen ASRH care in the United States in ways that promote health equity. |
Information needs and experiences from pregnancies complicated by hypertensive disorders: a qualitative analysis of narrative responses
Shree R , Hatfield-Timajchy K , Brewer A , Tsigas E , Vidler M . BMC Pregnancy Childbirth 2021 21 (1) 743 BACKGROUND: Incorporation of the patient voice is urgently needed in a broad array of health care settings, but it is particularly lacking in the obstetrical literature. Systematically derived information about patients' experience with hypertensive disorders of pregnancy (HDP), most notably preeclampsia, is necessary to improve patient-provider communication and ultimately inform patient-centered care and research. We sought to examine the information needs and experiences of individuals with pregnancies complicated by hypertensive disorders. METHODS: We conducted a qualitative content analysis of narrative-responses to an open-ended question from the Preeclampsia Registry (TPR), an online registry hosted by the Preeclampsia Foundation. Individuals were invited to enroll in TPR via social media, web searches, and newsletters. We restricted our analysis to participants who self-reported a history of HDP and responded to the open-ended question, "Is there any information that you could have had at the time of this pregnancy that would have been helpful?". Available responses from July 2013 to March 2017 were included. Narrative responses were coded, reconciled, and thematically analyzed by multiple coders using an inductive approach. Our main outcome measures included participants' expressed needs and additional concerns with respect to their HDP pregnancy. RESULTS: Of 3202 enrolled participants, 1850 completed the survey and self-reported having at least one pregnancy complicated by HDP, of which 895 (48.4%) responded to the open-ended question. Participants delivered in the United States (83%) and 27 other countries. Compared to non-responders, responders reported more severe HDP phenotypes and adverse offspring outcomes. We identified three principal themes from responses: patient-identified needs, management and counseling, and potential action. Responses revealed that participants' baseline understanding of HDP, including symptoms, management, therapeutic strategies, and postpartum complications, was demonstrably lacking. Responders strongly desired improved counseling so that both they and their providers could collaboratively diagnose, appropriately manage, and robustly and continuously communicate to facilitate a partnership to address any HDP complications. CONCLUSIONS: Participants' responses regarding their HDP experience provide indispensable insight into the patient's perspectives. Our study suggests that improved education regarding possible HDP complications and transparency about the consideration of HDP and its associated outcomes during an evaluation are needed, and efforts to implement these strategies should be sought. TRIAL REGISTRATION: The Preeclampsia Registry: NCT02020174. |
Motivations to use hormonal contraceptive methods and condoms among HIV-positive and negative women randomized to a progestin contraceptive in Malawi: a qualitative study
Bula AK , Hatfield-Timajchy K , Chapola J , Chinula L , Hurst SA , Kourtis AP , Tang JH . BMC Womens Health 2021 21 (1) 114 BACKGROUND: Although many countries have been promoting hormonal contraceptives to prevent unintended pregnancy and condom use to prevent HIV transmission, little is known about how women targeted by these messages have interpreted and internalized them. We describe HIV-positive and negative women's understanding of the benefits of contraception and condoms and their motivations to use them. METHODS: This is a qualitative sub-study from a clinical trial evaluating the effects of progestin contraception on HIV-positive and negative women aged 18-45 years randomly assigned to depot medroxyprogesterone acetate (DMPA) injection or levonorgestrel (LNG) implant. We purposively recruited 41 women to participate in in-depth interviews (IDIs) and focus group discussions (FGDs) after randomization into the main study. We conducted a total of 30 IDIs and 6 FGDs comprised of 4-7 women (N = 32). All women were counselled about potential risks for HIV acquisition/transmission with progestin-only contraception, drug-drug interactions between the implant and efavirenz-based ART, and the need to use condoms with their assigned contraceptive to help prevent pregnancy and HIV acquisition and transmission. RESULTS: All women understood that HIV is transmitted through unprotected sex and that HIV transmission can be prevented through condom use but not DMPA injection or LNG implant use. Nearly all HIV-positive women knew or suspected that their partners were also HIV-positive and were most interested in using condoms to prevent infection with a drug-resistant HIV strain to keep their HIV viral load low. Almost all reported that their partners agreed to condom use, but few used them consistently. Most women believed that condoms were effective at preventing both HIV and pregnancy if used consistently. Nearly all women considered contraception and condom use as important in preventing unintended pregnancy and HIV because partner disclosure of HIV status is low. CONCLUSION: Our results showed that both HIV-positive and negative women understood modes of HIV transmission and prevention and were aware that hormonal contraceptives are only effective for preventing pregnancy and not HIV. Although both HIV-negative and positive women were motivated to use condoms to prevent both HIV acquisition and infection with other HIV strains respectively, they all faced challenges from their partners in using condoms consistently. |
Women's perspectives on relationship dynamics with their partners and their role in HIV acquisition, HIV disclosure, hormonal contraceptive uptake, and condom use
Chapola JC , Hatfield-Timajchy K , Bula AK , Hurst S , Chinula L , Kourtis AP , Tang JH . Afr J AIDS Res 2021 20 (1) 61-69 Background: Limited information exists about relationship dynamics and their role in HIV acquisition, HIV disclosure, hormonal contraceptive uptake, and condom use among women in Malawi.Methods: Ninety-seven women aged 18-45 years were randomly assigned to initiate the depot medroxyprogesterone acetate injectable or levonorgestrel implant from May 2014 to April 2015 in Lilongwe, Malawi. Women were recruited after randomisation to participate in semi-structured interviews about HIV and family planning using purposive sampling. Interviews were thematically analysed using within and between group comparisons.Results: We conducted individual interviews and/or focus group discussions with 41 women: 30 (73%) women living with HIV and 11 (27%) women not living with HIV. Most women living with HIV who participated in in-depth interviews disclosed their status to their partners, and most partners agreed to get HIV tested only after disclosure. Nearly all women said their partners agreed to use condoms, but few used them consistently. Nearly all women believed their current and former partners had outside partners. Most women living with HIV who participated in in-depth interviews believed their current or other serious partners were the source of their infection. Some women thought their partner's infidelity was due to their partner's disinterest in sex with them during menstrual/ breakthrough bleeding. Some women included their partners in contraceptive decision-making when the partner was supportive.Discussion: Relationship dynamics affected decision-making for contraceptive and condom use, as well as serodisclosure for the women living with HIV in the study. All women reported challenges with consistent condom use with their male partners, although contraceptive use was generally more acceptable. Women included their partners in their decision-making concerning contraceptive use when they were supportive. |
Telehealth Practice Among Health Centers During the COVID-19 Pandemic - United States, July 11-17, 2020.
Demeke HB , Pao LZ , Clark H , Romero L , Neri A , Shah R , McDow KB , Tindall E , Iqbal NJ , Hatfield-Timajchy K , Bolton J , Le X , Hair B , Campbell S , Bui C , Sandhu P , Nwaise I , Armstrong PA , Rose MA . MMWR Morb Mortal Wkly Rep 2020 69 (50) 1902-1905 Early in the coronavirus disease 2019 (COVID-19) pandemic, in-person ambulatory health care visits declined by 60% across the United States, while telehealth* visits increased, accounting for up to 30% of total care provided in some locations (1,2). In March 2020, the Centers for Medicare & Medicaid Services (CMS) released updated regulations and guidance changing telehealth provisions during the COVID-19 Public Health Emergency, including the elimination of geographic barriers and enhanced reimbursement for telehealth services(†) (3-6). The Health Resources and Services Administration (HRSA) administers a voluntary weekly Health Center COVID-19 Survey(§) to track health centers' COVID-19 testing capacity and the impact of COVID-19 on operations, patients, and staff. CDC and HRSA analyzed data from the weekly COVID-19 survey completed by 1,009 HRSA-funded health centers (health centers(¶)) for the week of July 11-17, 2020, to describe telehealth service use in the United States by U.S. Census region,** urbanicity,(††) staffing capacity, change in visit volume, and personal protective equipment (PPE) supply. Among the 1,009 health center respondents, 963 (95.4%) reported providing telehealth services. Health centers in urban areas were more likely to provide >30% of health care visits virtually (i.e., via telehealth) than were health centers in rural areas. Telehealth is a promising approach to promoting access to care and can facilitate public health mitigation strategies and help prevent transmission of SARS-CoV-2 and other respiratory illnesses, while supporting continuity of care. Although CMS's change of its telehealth provisions enabled health centers to expand telehealth by aligning guidance and leveraging federal resources, sustaining expanded use of telehealth services might require additional policies and resources. |
Reproductive coercion among African American female adolescents: Associations with contraception and sexually transmitted diseases
Kraft JM , Snead MC , Brown JL , Sales JM , Kottke MJ , Hatfield-Timajchy K , Goedken P . J Womens Health (Larchmt) 2020 30 (3) 429-437 Background: Among adolescents, racial disparities in reproductive health outcomes persist. The question of whether reproductive coercion (RC) influences these outcomes has received increased attention. Little is known about whether RC is independently associated with contraceptive use and having a sexually transmitted disease (STD) among African American female adolescents. Materials and Methods: Survey data for self-identified African American young women 14-19 years of age (n = 735) who accessed services at a publicly funded clinic were used to assess the extent of RC, the association between RC and other forms of intimate partner violence (IPV), and whether RC was independently associated with contraceptive use and an STD diagnosis. Results: Approximately 20% of participants had experienced RC; there was a statistically significant bivariate association between RC and other forms of IPV. In multivariate analyses, experiencing two or more forms of RC (vs. not experiencing any RC) was associated with reduced odds of contraceptive use in the past 3 months (adjusted odds ratio [aOR] = 0.46; 95% confidence interval [CI] = 0.24-0.76) and with increased odds of having an STD (aOR = 2.43; 95% CI = 2.35-4.37). Experiencing only one type of RC and experiencing other forms of IPV were not associated with the outcomes. Although ease of partner communication (aOR = 0.94; 95% CI = 0.80-0.98) was associated with having an STD, few other psychosocial variables were associated with the outcomes. Conclusions: RC is associated with reduced contraceptive use and increased STDs among African American adolescent women. Interventions to prevent and respond to RC that engage adolescent women and men are needed. |
An investigation of early syphilis among men who have sex with men: Alaska, 2018: Findings from a 2018 rapid ethnographic assessment
Loosier PS , Carry M , Fasula A , Hatfield-Timajchy K , Jones SA , Harvill J , Smith T , McLaughlin J . J Community Health 2020 46 (1) 22-30 The state of Alaska had a sharp increase in cases of primary and secondary syphilis among gay, bisexual, and other men who have sex with men (GBMSM) in 2018, centered in Anchorage. A rapid ethnographic assessment was conducted in October 2018 to examine contextual factors contributing to local increases in syphilis. The assessment team conducted qualitative interviews with 64 (N=49 interviews) key informants in Anchorage and Matanuska-Susitna Valley identified through the STD/HIV program at the Alaska Department of Health and Social Services, Division of Public Health (ADPH): ADPH staff (n = 11; 22%) Medical Providers (n = 18; 37%), Community-Based Organizations/Partners (n = 9; 18%), and GBMSM Community Members (n = 11; 22%). This project was deemed exempt from IRB review. Primary factors affecting syphilis transmission, care, and treatment among GBMSM were: (1) Low awareness about the current syphilis outbreak and ambivalence about syphilis and other STIs; (2) Aspects of sexual partnering such as travel, tourism, and the use of online sites and apps to facilitate anonymous sex and multiple (both sequential/concurrent) partnering; (3) The synergistic effects of substance use, homelessness, and transactional sex; (4) Choosing condomless sex; and (5) Challenges accessing healthcare, including the ability to find appropriate and culturally competent care. Syphilis increases may have been influenced by factors which spanned multiple sectors of the Anchorage community, including individual behavior, community-level risk and protective factors, and use of and interactions with resources offered by ADPH, community-based organizations, and medical providers. |
Examining the contraceptive decisions of young, HIV-infected women: a qualitative study
Brown JL , Haddad LB , Gause NK , Cordes S , Bess C , King CC , Hatfield-Timajchy K , Chakraborty R , Kourtis A . Women Health 2018 59 (3) 305-317 This study qualitatively examined factors that influenced contraceptive choices in a sample of young, HIV-infected women. Individual qualitative interviews were conducted among 30 vertically- and horizontally-HIV-infected women (n = 26 African American) from the ages of 14 to 24 years (Mean age = 20.9 years). We recruited sample groups with the following characteristics: (a) current contraceptive/condom use with >/=1 child (n = 11); (b) current contraceptive/condom use with no children (n = 12); and (c) no current contraceptive/condom use with no children (n = 7). A semi-structured interview guide was used to ask participants about factors influencing past and current contraceptive choices. Individual interviews were digitally recorded and transcribed verbatim; analyses to identify core themes were informed by the Grounded Theoretical approach. Young, HIV-infected women did not identify their HIV serostatus or disease-related concerns as influential in their contraceptive decisions. However, they reported that recommendations from healthcare providers and input from family and friends influenced their contraceptive choices. They also considered a particular method's advantages (e.g., menstrual cycle improvements) and disadvantages (e.g., increased pill burden) when selecting a method. Findings suggested that HIV-infected young women's contraceptive decisions were influenced by factors other than those related to their infection. |
Parenting among adolescents and young adults with human immunodeficiency virus infection in the United States: Challenges, unmet needs, and opportunities
Hatfield-Timajchy K , Brown JL , Haddad LB , Chakraborty R , Kourtis AP . AIDS Patient Care STDS 2016 30 (7) 315-23 Given the realistic expectations of HIV-infected adolescents and young adults (AYA) to have children and start families, steps must be taken to ensure that youth are prepared to deal with the challenges associated with their HIV and parenting. Literature reviews were conducted to identify published research and practice guidelines addressing parenting or becoming parents among HIV-infected AYA in the United States. Research articles or practice guidelines on this topic were not identified. Given the paucity of information available on this topic, this article provides a framework for the development of appropriate interventions and guidelines for use in clinical and community-based settings. First, the social, economic, and sexual and reproductive health challenges facing HIV-infected AYA in the United States are summarized. Next, family planning considerations, including age-appropriate disclosure of HIV status to those who are perinatally infected, and contraceptive and preconception counseling are described. The impact of early childbearing on young parents is discussed and considerations are outlined during the preconception, antenatal, and postnatal periods with regard to antiretroviral medications and clinical care guidelines. The importance of transitioning AYA from pediatric or adolescent to adult-centered medical care is highlighted. Finally, a comprehensive approach is suggested that addresses not only medical needs but also emphasizes ways to mitigate the impact of social and economic factors on the health and well-being of these young parents and their children. |
Factors associated with contraceptive use differ between younger and older African-American female adolescents
North Clarke KE , Kraft JM , Wiener JB , Hatfield-Timajchy K , Kottke M , Sales JM , Goedken P , Kourtis AP . J Pediatr Adolesc Gynecol 2016 29 (5) 448-453 STUDY OBJECTIVE: Examine differences in factors associated with contraceptive use between younger and older adolescent age groups, which has not previously been well described. DESIGN: Age-group-specific analyses were performed on cross-sectional survey data to identify factors associated with any contraceptive use at last sex among younger (14-16 year old) and older (17-19 year old) sexually-active African-American females; interaction analyses assessed whether these associations differed by age. SETTING: Adolescent reproductive health clinic in Atlanta, Georgia PARTICIPANTS: Sexually active African-American female adolescents 14-19 years of age INTERVENTIONS: No intervention tested; cross-sectional design MAIN OUTCOME MEASURE: Self-reported contraceptive use during most recent vaginal sex with a male partner. RESULTS: The prevalence of contraceptive use at last sex was identical in both groups; however, factors associated with contraceptive use differed by age. The only factor associated with contraceptive use in both age groups was involvement in decisions about sexual health in the most recent relationship. Associations between factors and contraceptive use significantly differed by age. History of sexually transmitted infection, age difference with partner, discussion of condoms with partner, and concurrent partners were important factors among younger adolescents; worry about pregnancy and discussion of birth control with partner were important among older adolescents. CONCLUSIONS: Factors associated with contraceptive use at last sex differ by adolescent age; this should be considered when designing counseling and interventions for teens, as well as research. |
Withdrawal as pregnancy prevention and associated risk factors among US high school students: findings from the 2011 National Youth Risk Behavior Survey
Liddon N , O'Malley Olsen E , Carter M , Hatfield-Timajchy K . Contraception 2015 93 (2) 126-32 PURPOSE: Withdrawal is less effective for preventing pregnancy than other contraceptive methods and offers no protection against sexually transmitted infections including HIV. Little is known from a national perspective about adolescents who primarily use withdrawal. This study describes the prevalence of withdrawalas their primary method of pregnancy prevention at last sexual intercourse among sexually active US high school students and associations with sexual risk and substance use. METHODS: Data from the 2011 national Youth Risk Behavior Survey were used to estimate sexually active students' most recent contraceptive method. Logistic regressions examined sexual behaviors and substance use, comparing students who used withdrawal to those who used no method, a condom, and a highly effective method. RESULTS: Among 4,793 currently sexually active students, 10.2% used withdrawalonly, 12.4% used no method, 53.6% used a condom, and 23.8% used a more effective method as their primary form of pregnancy prevention during last sexual intercourse. Students who used withdrawal were less likely than those who used no method to have had sexual intercourse before age 13 years (APR=.56) and currently use cocaine (APR=.36). Among females, students who used withdrawal were more likely to engage in risky behaviors than those who used a condom and those who used a highly effective method of pregnancy prevention in a number of ways (e.g. having multiple sex partners during the past three months, current alcohol use, binge drinking, current marijuana use, drank alcohol or used drugs before last sexual intercourse). CONCLUSIONS: Approximately 1 in 10 sexually active students used withdrawal only, about the same percentage as those who used no method. Health care providers and others who serve adolescents may want to discuss its pros and cons with their clients and help ensure they have information about and access to other contraceptive methods that are more effective at preventing pregnancy and sexually transmitted infections. Health care professionals should not consider young people who use withdrawal similar in risk to those that use no method. |
Identifying psychosocial and social correlates of sexually transmitted diseases among black female teenagers
Kraft JM , Whiteman MK , Carter MW , Snead MC , DiClemente RJ , Murray CC , Hatfield-Timajchy K , Kottke M . Sex Transm Dis 2015 42 (4) 192-7 BACKGROUND: Black teenagers have relatively high rates of sexually transmitted diseases (STDs), and recent research suggests the role of contextual factors, as well as risk behaviors. We explore the role of 4 categories of risk and protective factors on having a biologically confirmed STD among black, female teenagers. METHODS: Black teenage girls (14-19 years old) accessing services at a publicly funded family planning clinic provided a urine specimen for STD testing and completed an audio computer-assisted self-interview that assessed the following: risk behaviors, relationship characteristics, social factors, and psychosocial factors. We examined bivariate associations between each risk and protective factor and having gonorrhea and/or chlamydia, as well as multivariate logistic regression among 339 black female teenagers. RESULTS: More than one-fourth (26.5%) of participants had either gonorrhea and/or chlamydia. In multivariate analyses, having initiated sex before age 15 (adjusted odds ratio [aOR], 1.87) and having concurrent sex partners in the past 6 months (aOR, 1.55) were positively associated with having an STD. Living with her father (aOR, 0.44), believing that an STD is the worst thing that could happen (aOR, 0.50), and believing she would feel dirty and embarrassed about an STD (aOR, 0.44) were negatively associated with having an STD. CONCLUSIONS: Social factors and attitudes toward STDs and select risk behaviors were associated with the risk for STDs, suggesting the need for interventions that address more distal factors. Future studies should investigate how such factors influence safer sexual behaviors and the risk for STDs among black female teenagers. |
In their own words: romantic relationships and the sexual health of young African American women
Murray CC , Hatfield-Timajchy K , Kraft JM , Bergdall AR , Habel MA , Kottke M , Diclemente RJ . Public Health Rep 2013 128 Suppl 1 33-42 OBJECTIVE: We assessed young African American women's understanding of "dual protection" (DP) (i.e., strategies that simultaneously protect against unintended pregnancies and sexually transmitted diseases [STDs]) and how relationship factors influence their use of DP methods. METHODS: We conducted 10 focus groups with African American women (n=51) aged 15-24 years in Atlanta, Georgia, to identify barriers to and facilitators of their DP use. Focus group participants also completed a brief self-administered questionnaire that assessed demographics and sexual behaviors. We analyzed focus group data by theme: relationships, planning for sex, pregnancy intentions, STD worries, the trade-off between pregnancy and STDs, attitudes toward condoms and contraceptives, and understanding of DP. RESULTS: From the questionnaire, 51% of participants reported that an STD would be the "worst thing that could happen," and 26% reported that being pregnant would be "terrible." Focus group data suggested that most participants understood what DP was but thought it was not always feasible. Relationship factors (e.g., trust, intimacy, length of relationship, and centrality) affected pregnancy intentions, STD concerns, and use of DP. Social influences (e.g., parents) and pregnancy and STD history also affected attitudes about pregnancy, STDs, and relationships. CONCLUSIONS: Although participants identified risks associated with sex, a complex web of social and relationship factors influenced the extent to which they engaged in protective behavior. The extent to which relationship factors influence DP may reflect developmental tasks of adolescence and should be considered in any program promoting sexual health among young African American women. |
Condom use with serious and casual heterosexual partners: findings from a community venue-based survey of young adults
Hock-Long L , Henry-Moss D , Carter M , Hatfield-Timajchy K , Erickson PI , Cassidy A , Macauda M , Singer M , Chittams J . AIDS Behav 2013 17 (3) 900-13 Given the racial/ethnic disparities that characterize STI trends and recent increases in heterosexually transmitted HIV infection in the US, an understanding of factors underlying condom use among young adults in minority communities is vitally important. To this end, this paper presents findings from a community venue-based survey examining the influence of motivations, heuristics, and relationship factors on condom behaviors with serious and casual heterosexual partners in a sample of urban African American and Puerto Rican males and females ages 18-25 (n = 380). Condom use rates at time of last sex were considerably higher with casual partners (n = 87) than with serious (n = 313) partners, 77.9% vs. 38.7%. While dual pregnancy/STI prevention was the most frequently cited reason for use at last sex with casual partners, pregnancy prevention was the most frequently cited reason for use with serious partners. Bivariate conditional logistic regression analyses found two factors to be associated with condom use at last sex with casual partners: use at first sex with the partner and belief that neighborhood peers worried some/a lot about HIV. In contrast, such factors as condom heuristics (e.g., nonuse symbolizes trust), contraceptive status, and markers of emotional intimacy were associated with condom use with serious partners in both bivariate and multivariable analyses. |
Love and hooking up in the new millennium: communication technology and relationships among urban African American and Puerto Rican young adults
Bergdall AR , Kraft JM , Andes K , Carter M , Hatfield-Timajchy K , Hock-Long L . J Sex Res 2012 49 (6) 570-82 Communication technology is a central feature of young people's lives, but its role in romantic and sexual relationships has not been thoroughly examined. This article describes how young adults use communication technology for partnering across relationship stages (formation, maintenance, and dissolution) and types (serious/casual), and proposes implications of usage in relationships. This study analyzed qualitative data from a five-week, prospective, coital diary method with related debriefing interviews (N=70) of African American and Puerto Rican men and women aged 18 to 25 years in Hartford and Philadelphia. Cell phones, including calls, text messaging, and mobile Internet, were the most common forms of communication technology used for partnering goals. Participants reported using cell phones to pursue partnering goals across all relationship stages, including formation (meeting, screening, and getting to know new partners), maintaining existing relationships, and breaking up. Cell phone uses depended on the type of relationship (serious/casual) and the participants' intentions and desires. Results indicated that cell phones are an important element of communication among young adults in romantic and sexual relationships. Specific features of cell phone communication shape the process and context of partnering. Future research should explore emerging communication technologies and implications for psychosocial development, dating violence, and sexual behavior. |
A qualitative study of contraceptive understanding among young adults
Carter MW , Bergdall AR , Henry-Moss D , Hatfield-Timajchy K , Hock-Long L . Contraception 2012 86 (5) 543-50 BACKGROUND: This study describes contraceptive understanding, sources of information and consequences of contraceptive misunderstandings among urban, young adults. STUDY DESIGN: We used qualitative data from 16 focus groups and 53 interviews with Puerto Rican and African American men and women aged 18-25 years from Philadelphia and Hartford. We categorized and compared assertions made about all contraceptive methods' side effects, effectiveness and use using an iterative process. RESULTS: Participants considered contraceptive use worthwhile but felt that it carried risks of problematic side effects and contraceptive failure, with variation among methods. Men knew most about condoms and withdrawal and trusted both more than women. Personal or second-hand experience was the dominant source of information on contraceptive understanding. Misunderstandings about contraception affected their relationships and risk of unintended pregnancy. CONCLUSION: Contraceptive understanding is a powerful determinant of contraceptive use and limits the options perceived by young adults to prevent pregnancy. Research is needed to strengthen contraceptive counseling and outreach in ways that better leverage peer influence. |
Strategies for managing the dual risk of sexually transmitted infections and unintended pregnancy among Puerto Rican and African American young adults
Carter MW , Hock-Long L , Kraft JM , Henry-Moss D , Hatfield-Timajchy K , Singer M . Am J Public Health 2012 102 (3) 449-456 Although young adults in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy, they do not report high rates of dual-method use (condoms plus other contraception) for prevention. We used prospective qualitative data from 69 urban Puerto Rican and African American individuals aged 18 to 25 years to determine how they managed these risks in their heterosexual relationships during a 4- to 8-week period. Hormonal or long-acting contraceptive use, condoms, and withdrawal were the most common unintended pregnancy prevention strategies; condoms, STI testing, and perceived fidelity were dominant among STI prevention strategies. We need to shift the focus from dual-method use toward a broader concept of dual protection to be more responsive to young adults' concerns, perceptions, and priorities. |
STD and HIV testing behaviors among black and Puerto Rican young adults
Carter MW , Kraft JM , Hatfield-Timajchy K , Hock-Long L , Hogben M . Perspect Sex Reprod Health 2011 43 (4) 238-46 CONTEXT: Given the high rates of infection among urban young adults, STD and HIV testing promotion is a public health priority. To inform future testing efforts, lifetime and recent testing behaviors of this population within casual and serious relationships should be better understood. METHODS: Data from a 2007-2008 study conducted in select neighborhoods in Hartford and Philadelphia were used to examine self-reported STD and HIV testing behaviors and attitudes among 483 sexually active black and Puerto Rican young adults aged 18-25. Multivariate ordered logit regression analyses were conducted to assess characteristics associated with lifetime number of STD tests. RESULTS: More than eight in 10 participants reported having been tested for STDs, and a similar proportion for HIV, most of them multiple times. Nineteen percent had ever had an STD diagnosis. A majority-86%-perceived their risk of STD infection in the next year as "not at all likely." Sixty-one percent of those in serious relationships reported that both partners had been tested, compared with 25% of those in casual relationships. Characteristics associated with higher lifetime number of STD tests were being female (odds ratio, 2.2), being from Philadelphia (2.5), being black (1.5), having lived with two or more serious partners (1.7) and having ever received an STD diagnosis (2.3). DISCUSSION: Despite their risks, participants did not perceive themselves to be at risk of STDs. However, they did report testing repeatedly. Testing was highly acceptable, particularly within serious relationships. Questions about the timing of testing initiation and repeat testing merit attention for the benefits of widespread testing to be fully realized. |
Pregnancy motivations and contraceptive use: hers, his, or theirs?
Kraft JM , Harvey SM , Hatfield-Timajchy K , Beckman L , Farr SL , Jamieson DJ , Thorburn S . Womens Health Issues 2010 20 (4) 234-41 CONTEXT: Studies increasingly consider the role of pregnancy motivations on contraceptive use. Few studies include measures of men's pregnancy motivations. METHODS: We used baseline data (from a couples-intervention study) to examine the contribution of women's and men's pregnancy motivations and participation in decision making to contraceptive use by women in relatively stable relationships who were not trying to get pregnant. In addition to conducting multivariate analyses, we assessed agreement between a woman's perceptions of and her partner's reports of his pregnancy motivations. RESULTS: We observed moderate agreement between men's pregnancy motivations and their partners' perceptions of those motivations. Levels of agreement about participation in decision making were somewhat lower. In bivariate analyses, effective contraceptive use was significantly associated with two measures of pregnancy motivation for men and women. In multivariate analyses, only women not wanting a child in 2 years (adjusted odds ratio [aOR], 1.73), women's (aOR, 1.80) and men's (aOR, 0.78) participation in decision making, women believing their partners favored contraceptive use (aOR, 2.01), relationships lasting 2 or more years (aOR, 1.98), and ethnicity/race (Latina aOR, 0.27; other race aOR , 0.45) were associated with effective contraceptive use. CONCLUSION: Providers and those developing interventions must recognize that some women who are "not trying to get pregnant" have weak motivations to avoid pregnancy, and so should help women to clarify their motivations and seek support from their partners for contraceptive use. To understand the role of pregnancy motivations, future research may include both qualitative and longitudinal quantitative studies. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Nov 11, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure