Is phosphodiesterase type 5 inhibitor use associated with condom breakage?

This is an open access article - Copyright © 2009 by the BMJ Publishing Group Ltd. All rights reserved.We tested the hypothesis that phosphodiesterase type 5 inhibitor (PDE5i) use would be associated with increased likelihood of condom breakage using an event-specific analysis. A convenience sample of 440 men completed an internetbased questionnaire that assessed variables pertaining to the last time they used condoms for penile-vaginal intercourse (PVI). A bivariate (screening) analysis was performed to identify covariates for a multivariate analysis using logistic regression. Altogether, 5.9% of the men reported breakage and 9.5% reported PDE5i use during the last time a condom was used for PVI. Among men who had used PDE5i during the last condom-protected occasion of PVI, 11.9% reported breakage compared with 5.3% of those not reporting PDE5i use. Adjusting for men’s age, ethnic minority status, marital status, reported duration of PVI and alcohol use at last PVI, those using PDE5i were about four times more likely to also report condom breakage (AOR 4.02; 95% CI 1.20 to 13.48; p=0.04). Of note, duration of PVI was independently associated with breakage (AOR 1.36; CI 1.02 to 1.83; p=0.04). Findings suggest that PDE5i use may potentially be associated with increased odds of condom breakage among some men.Support for this project was provided, in part, by the Rural Center for AIDS/ STD Prevention, a joint project of Indiana University, University of Colorado and the University of Kentucky, and by The Kinsey Institute, Indiana University

Does it fit okay? Problems with condom use as a function of self-reported poor fit

This is an open access article - Copyright © 2010 by the BMJ Publishing Group Ltd. All rights reservedOBJECTIVE: To identify associations between men's self-reports of ill-fitting condoms and selected condom use problems, using an event-specific analysis. METHODS: A convenience sample of men was recruited via advertisements in newspapers (two urban and one small town) and a blog on the website of a condom sales company. Men completed a questionnaire posted on the website of The Kinsey Institute for Research in Sex, Gender, and Reproduction. Inclusion criteria were: at least 18 years old, used condoms for penile–vaginal intercourse in the past 3 months and the ability to read English. RESULTS: In controlled, event-specific, analyses of 436 men, those reporting ill-fitting condoms (44.7%) were significantly more likely to report breakage (adjusted odds ratio (AOR 2.6), slippage (AOR 2.7), difficulty reaching orgasm, both for their female partners (AOR 1.9) and for themselves (AOR 2.3). In addition, they were more likely to report irritation of the penis (AOR 5.0) and reduced sexual pleasure, both for their female partner (AOR 1.6) and for themselves (AOR 2.4). Furthermore, they were more likely to report that condoms interfered with erection (AOR 2.0), caused erection loss (AOR 2.3), or became dry during sex (AOR 1.9). Finally, they were more likely to report removing condoms before penile–vaginal sex ended (AOR 2.0). CONCLUSIONS: Men and their female sex partners may benefit from public health efforts designed to promote the improved fit of condoms.Support for this project was provided, in part, by the Rural Center for AIDS/STD Prevention, a joint project of Indiana University, University of Colorado, and the University of Kentucky and by The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University

If the condom fits, wear it: a qualitative study of young African-American men

This is an open access article - Copyright @ 2004 BMJ Publishing GroupObjective: To extend the current knowledge base pertaining to condom failure among young African-American men by assessing their experiences with male condom use. Methods: Qualitative assessments were conducted with 19 African-American men (aged 18–29 years) who had just been diagnosed with an STI and reported using condoms in the previous 3 months. Results: Five categories were identified from the data. These categories pertained to: (1) the “fit and feel” of condoms; (2) condom brand and size; (3) application problems; (4) availability of condoms and lubricants; and (5) commitment to condom use. Common themes included reasons why men believed condoms would break or slip off during sex. Comfort problems, including tightly fitting condoms and condoms drying out during intercourse, were mentioned frequently. Condom associated erection problems were often described. Many men also noted that condom use reduced the level of sexual satisfaction for their female partners. Men noted that finding the right kind of condom was not always easy and it became apparent during the interviews that men typically did not acquire lubrication to add to condoms. Despite their expressed problems with using condoms, men were, none the less, typically emphatic that condom use is an important part of their protective behaviour against STIs. Conclusion: Men were highly motivated to use condoms; however, they experienced a broad range of problems with condom use. With the exception of losing the sensation of skin to skin contact, the vast majority of these problems may be amenable to behavioural interventions.This study was funded by a grant from the National Institutes of Mental Health (1 R21 MH066682-01A1)

Two heads are better than one: The association between condom decision-making and condom use errors and problems

This is an open access article - Copyright @ 2008 BMJ Publishing GroupObjectives: This exploratory study compared the frequency of condom use errors and problems between men reporting that condom use for penile–vaginal sex was a mutual decision compared with men making the decision unilaterally. Methods: Nearly 2000 people completed a web-based questionnaire. A sub-sample of 660 men reporting that they last used a condom for penile–vaginal sex (within the past three months) was analysed. Nine condom use errors/problems were assessed. Multivariate analyses controlled for men’s age, marital status, and level of experience using condoms. Results: Men’s unilateral decision-making was associated with increased odds of removing condoms before sex ended (adjusted odds ratio (AOR) 2.51, p=0.002), breakage (AOR 3.90, p=0.037), and slippage during withdrawal (AOR 2.04, p=0.019). Men’s self-reported level of experience using condoms was significantly associated with seven out of nine errors/problems, with those indicating less experience consistently reporting more errors/problems. Conclusions: Findings suggest that female involvement in the decision to use condoms for penile–vaginal sex may be partly protective against some condom errors/problems. Men’s self-reported level of experience using condoms may be a useful indicator of the need for education designed to promote the correct use of condoms. Education programmes may benefit men by urging them to involve their female partner in condom use decisions.Funding for this project was provided by the Canada Research Chair in Social Justice and Sexual Health at the University of Windsor, and the Rural Center for AIDS/STD Prevention and The Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University

Men with broken condoms: Who and why?

This is an open access article - Copyright @ 2007 BMJ Publishing GroupObjectives: To identify (1) the prevalence of condom breakage, and demographic and sexuality-related differences among young men who have sex with women reporting and not reporting this event; (2) condom-specific behaviours associated with breakage. Methods: Young men (n=278) attending a clinic for treatment of sexually transmitted infections (STIs) responded to an anonymous questionnaire aided by a CD recording of the questions. The samples were screened to include only men who had used a condom during penile–vaginal sex at least three times in the past 3 months. Condom-specific behaviours (including breakage) were assessed using these last three acts of condom use as the recall period. Correlates achieving bivariate significance were subjected to multivariate analysis. Results: Nearly one third (31.3%) of the men reported recent breakage. The breakage rate was 15%. Three correlates significantly distinguished between men who did and did not report breakage. Men who had past STIs were more likely to report breakage (adjusted odds ratio (AOR) 2.08), as were men who also reported condom slippage (AOR 2.72). Less self-efficacy for correct condom use was also significantly associated with breakage (AOR 1.07). Further, three condom-specific behaviours were significantly associated with breakage: allowing condoms to contact sharp objects (AOR 2.6), experiencing problems with the “fit or feel” of condoms (AOR 2.3) and not squeezing air from the receptacle tip (AOR 2.0). Conclusions: Breakage may be common and may occur in a larger context of difficulties with condoms. STI clinics could potentially benefit some men by providing instructions on the correct use of condoms.Financial Support for this project was provided by the Rural Center for AIDS/STD Prevention, a joint project of Indiana University, University of Colorado and University of Kentucky, and the Office of the Associate Dean of Research, School of Health, Physical Education, and Recreation, Indiana University

Mobile health use predicts self-efficacy and self-management in adolescents with sickle cell disease

Sickle cell disease (SCD) is associated with significant health challenges that often worsen during adolescence. Living with SCD requires a substantial amount of self-management and mobile health (mHealth) holds considerable promise for assessing and changing behaviors to improve health outcomes. We integrated a mobile app as an adjunct to a group intervention (SCThrive) and hypothesized that more engagement with the mHealth app would increase self-management and self-efficacy for adolescents and young adults (AYA) with SCD. Twenty-six AYA ages 13–21 years (54% female; 46% HbSS genotype; all African-American/Black) received six weekly group sessions (three in-person, three online). Participants were provided with the mobile app (iManage for SCD) to record progress on their self-management goals and log pain and mood symptoms. The Transition Readiness Assessment Questionnaire (TRAQ-5) assessed self-management skills and the Patient Activation Measure (PAM-13) assessed self-efficacy at baseline and post-treatment. Logging on to the app more frequently was associated higher mood ratings (r = .54, CI[.18, .77], p = .006) and lower pain ratings (r = −.48, CI[−.77, −.02], p = .04). Regression analyses demonstrated that after controlling for scores at baseline, the number of logins to the app predicted self-management skills (p = .05, η2 = .17) and possibly self-efficacy (p = .08, η2 = .13). Our study findings indicate that it can be challenging to maintain engagement in mHealth for AYA with SCD, but for those who do engage, there are significant benefits related to self-management, self-efficacy, and managing pain and mood

Increasing condom use in heterosexual men: development of a theory-based interactive digital intervention

Increasing condom use to prevent sexually transmitted infections is a key public health goal. Interventions are more likely to be effective if they are theory- and evidence-based. The Behaviour Change Wheel (BCW) provides a framework for intervention development. To provide an example of how the BCW was used to develop an intervention to increase condom use in heterosexual men (the MenSS website), the steps of the BCW intervention development process were followed, incorporating evidence from the research literature and views of experts and the target population. Capability (e.g. knowledge) and motivation (e.g. beliefs about pleasure) were identified as important targets of the intervention. We devised ways to address each intervention target, including selecting interactive features and behaviour change techniques. The BCW provides a useful framework for integrating sources of evidence to inform intervention content and deciding which influences on behaviour to target

Pica and refractory iron deficiency anaemia: a case report

INTRODUCTION: Iron deficiency is the most common cause of anaemia worldwide. Pica, the ingestion of substances that are inappropriate for consumption, is associated with iron deficiency and may be under-diagnosed. CASE PRESENTATION: A 34-year-old woman presented with iron deficiency anaemia refractory to treatment for more than a decade. The clinical presentation, endoscopic findings and laboratory investigations were consistent with pica. Subsequent geophysical analysis confirmed that the ingested material was kaolin, a negatively charged silicate. CONCLUSION: Prolonged unexplained iron deficiency anaemia should prompt clinicians to remember and inquire about pica. In our patient, this would have averted numerous unnecessary investigations and prevented a decade-long suffering

Researching COVID-19: A Research Agenda for Public Policy and Administration Scholars

Coronavirus (COVID-19) is one of the defining policy challenges of an era. In this article we sketch some possible ways in which the public policy and administration (PPA) scholarly community can make an enduring contribution about how to cope with this terrible crisis. We do so by offering some elements that to delineate a tentative research agenda for PPA scholars, to be pursued with epistemic humility. We outline the contours of seven analytical themes that are central to the challenges presented by COVID-19: policy design and instruments; policy learning; public service and its publics; organisational capacity; public governance; administrative traditions; and public sector reforms in multi-level governance (MLG). The list is neither exhaustive nor exclusive to COVID-19 only. The knowledge the PPA scholarly community can generate must speak not only to the daunting challenge of COVID-19 itself but also to policymakers, and indeed humankind, trying to cope with future unexpected but high impact threats (‘black swans’), by leveraging better public policies and building administrative capacities to enable more resilient, equitable and effective public services

The impact of privatisation on union membership and density: A Western Australian case study

Falling membership numbers and declining union density are issues of concern for many Australian unions. Australian Bureau of Statistics figures show that between 2005 and 2008, trade union membership declined from 22.4% to 18.9% of the workforce. Studies and statistics consistently show that union membership and density are lowest in Western Australia, despite trend reversals elsewhere. Using the Western Australian branches of two 'blue-collar' unions - the Australian Rail, Tram and Bus Industry Union, Western Australian Branch and the Australian Manufacturing Workers' Union, covering a range of transport, metal working, printing and manufacturing trades - as examples, this article examines whether privatisation has contributed significantly to falling trade union density and membership in this state. These unions represented large public sector workforces. In order to test the hypothesis that privatisation has adversely affected union membership and density, the article examines three areas: changing policies in the Australian Labor Party, the breaking down of union culture and changes in trade training, and concludes that privatisation is a significant factor in the recent decline of these two unions