Trust, Sexual Trust, and Sexual Health: An Interrogative Review

Trust is experienced almost constantly in all forms of social and interpersonal relationships, including sexual relationships, and may contribute both directly and indirectly to sexual health. The purpose of this review is to link three aspects of trust to sexual health: (1) the role of trust in sexual relationships; (2) the role of trust in sexually transmitted infection (STI) prevention, particularly condom use; and (3) the relevance of trust in sexual relationships outside of the traditional model of monogamy. The review ends with consideration of perspectives that could guide new research toward understanding the enigmas of trust in partnered sexual relations in the context of sexual and public health

The IUPUI Center for HPV Research: Updates 2014-2015

poster abstractBackground: Human papillomavirus (HPV) is a very common infection. High risk (HR) HPV types (particularly types 16 & 18) are causally implicated in many cancers, including cervical, anal, vaginal, vulvar, penile, and head and neck cancers. In an effort to address the problems associated with HPV infection and prevention, the Center for HPV Research at IUPUI (Zimet & Fortenberry, Co-Directors) fosters collaboration among investigators from multiple disciplines and departments at IUPUI, IU Bloomington, Purdue University, and University of Notre Dame. There currently are 32 faculty and 8 pre- and post-doctoral fellows who are members of the Center. The Center for HPV Research was established in July, 2012 with funds from the IUPUI Signature Center Initiative, the Department of Pediatrics, and the IU Simon Cancer Center. Over the past year, Center members had 6 external & internal grants funded, 5 additional grants submitted, 8 peer-reviewed articles published, and gave over 20 scientific conference and invited presentations. In this abstract we highlight a study representing a collaboration among 5 center members, with Dr. Marcia Shew as the lead and including an MPH student. Objectives: Most HR HPV infections do not progress to cancer, but progression is associated with persistent infection. HPV was previously thought to "clear" or persist, but newer studies suggest that HPV may be a latent virus that can be re-detected episodically. This study examined the persistence and/or redetection of HR HPV in young women recruited 6 years after identification of a HR HPV infection during their prior involvement in a longitudinal study of adolescent women. Methods: 30 women from the prior study (the Young Women’s Project) were recruited for 2 visits, 6 weeks apart. During Visit 1 they had a Pap test, HPV DNA testing, HPV serology, and were administered a semi-structured interview. During Visit 2, Pap test results were given, a self-swab for HPV testing was obtained, and a qualitative interview was administered. Results: 15 women had normal Pap test results, 2 were ASCUS, and 3 LGSIL. 12 women had a history of colposcopy for a previous abnormal Pap results and 4 had received treatment for cervical dysplasia. 26 of the women had HPV 16 in the original YWP study. 11 had HPV 16 redetected in the present study, including in 6 women who had apparently "cleared" the infection during the original YWP study. Conclusions: High risk HPV may not always (or ever) "clear" Persistent low viral levels may not be detectible. However, some HPV infections may be episodically detected if changes in immune function lead to increases in viral copies. Questions raised by this research include: 1) who is at risk for episodic detection?; 2) what factors are predictive of episodic detection?; 3) how likely is episodically-detect HR HPV to progress to cervical disease?; 4) what is the predictive value of a negative HPV DNA test?; and 5) what do we tell women with a positive HR HPV DNA screen if they have been sexually abstinent or with a life-long partner ... or if they have a new partner

Daily mood, partner support, sexual interest, and sexual activity among adolescent women

This is a post print version of the article. The official published version can be accessed from the link below.Objective: to examine day-to-day associations of coitus, sexual interest, partner emotional support, negative mood and positive mood among adolescent women. Methods: Women (ages 14 – 17 at enrollment; N=146) enrolled from one of three adolescent primary care clinics completed up to five 84-day diaries over a 27-month period. The diaries assessed partner interactions, sexual activity, substance use and mood. Partner-specific measures assessed on each day included partner emotional support (4 items; alpha = 0.94), argument with a partner (no/yes) and coitus (no/yes). Within-day measures assessed marijuana use (no/yes), Positive Mood (3-items; alpha = 0. 86); Negative Mood (3-items; alpha = 0.82) and Sexual Interest (1-item). Lagged measures of mood and sexual activity were included in multivariate models to control for recent mood and sexual behavior effects on current day mood and coitus. Two main analyses were conducted: coitus as a predictor of positive and negative mood; and the role of positive and negative mood as predictors of coitus. Analyses were conducted by multivariate mixed effect regression and mixed effect logistic regression models. Results: Data represent 28,376 days from 146 participants. The average number of diary days was 194 days per participant. Sexual activity was reported on 8.3% of days, with condoms used for 27.0% of these coital events. Marijuana was used on 11% of days. Significant predictors of positive mood on a given day included partner support, marijuana use, and coitus. Negative mood was associated with having an argument with a partner and with prior day coitus. Predictors of coitus on a given day included age (Odds ratio = 1.22), increased coital frequency in previous week (OR = 1.49), coitus on the previous day (1.21), increased same-day sexual interest (OR = 2.8) and decreased same-day negative mood (OR = 0.92). Conclusions: The data demonstrate complex associations of sexual interest, mood, partner interactions and sexual activity

Study of sexual partner accrual patterns among adolescent women via Generalized Additive Mixed Models

poster abstractThe number of lifetime partners is a consistently identified epidemiological risk factor for sexually transmitted infections (STIs). Higher rate of partner accrual during adolescence has been associated with increased STI rates among adolescent women. To study sexual partner accrual pattern among adolescent females, we applied generalized additive mixed models (GAMM) to the data obtained from a longitudinal STI study. GAMM regression components included a bivariate function enabling separation of cohort (“age at study entry”) and longitudinal (“follow-up years”) effects on partner accrual while the correlation was accounted for by the subject-specific random components. Longitudinal effect partial derivative was used to estimate within-subject rates of partner accrual and their standard errors. The results show that slowing of partner accrual depends more on the prior sexual experience and less on the females’ chronological age. Our modeling approach combining the GAMM flexibility and the time covariates’ of interest definition enabled clear differentiation between the cohort (chronological age) and longitudinal (follow-up time) effects, thus providing the estimates of both between-subject differences and within-subject trajectories of partner accrual

The Association between Sexual Health and Physical, Mental and Social Health in Adolescent Women

Purpose Developmental models link sexual well-being to physical, mental/emotional, and social well-being, yet little empirical literature evaluates these relationships in adolescents. Better understanding of how and when sexuality complements other aspects of health may yield important points to enhance existing health education and prevention efforts. Methods Data were drawn from a 10-year longitudinal cohort study of sexual relationships and sexual behavior among adolescent women (N = 387; 14–17 years at enrollment). Sexual health data were drawn from quarterly partner-specific interviews and were linked to physical, mental/emotional, and social health information in annual questionnaires. Random intercept, mixed effects linear, ordinal logistic, or binary logistic regression were used to estimate the influence of sexual health on health and well-being outcomes (Stata, v.23, StataCorp, College Station, TX). All models controlled for participant age and race/ethnicity. Results Higher sexual health was significantly associated with less frequent nicotine and substance use, lower self-reported depression, lower thrill seeking, higher self-esteem, having fewer friends who use substances, higher religiosity, better social integration, lower frequency of delinquent behavior and crime, and more frequent community group membership. Sexual health was not associated with the number of friends who used cigarettes. Conclusions Positive sexually related experiences in romantic relationships during adolescence may complement physical, mental/emotional, and social health. Addressing specific aspects of healthy sexual development during clinical encounters could dually help primary prevention and health education address other common adolescent health issues

Center for HPV Research at IUPUI

poster abstractHuman Papillomavirus (HPV) infection is highly prevalent among women and men and is associated with a number of diseases including genital warts, cervical cancers, other anogenital cancers in both men and women, and cancers of the head and neck. HPV infections are also associated with millions of dollars in annual health care costs. Two vaccines have been developed to prevent HPV infection. Both are approved for use in females ages 9 through 26, and one vaccine is approved for use in 9 to 26 year old males as well. Both vaccines are efficacious, safe, and cost-effective. Despite the great promise of HPV vaccines, vaccination rates in the U.S. are much lower than desired, with 2011 data indicating that 53% of 13-17 year old females received one or more doses and only 37% completed the 3-dose series. The ongoing medical, psychosocial, and financial costs of HPV infection indicate the need for comprehensive, cross-disciplinary research efforts coordinated with community outreach. We have established the Center for Human Papillomavirus (HPV) Research at IUPUI; which fosters cohesion and collaboration among investigators from multiple disciplines and departments at IUPUI, IU Bloomington, and University of Notre Dame pursuing HPV-related research. This group of accomplished senior faculty and promising junior scholars represents a growing synergy between basic, clinical, and social/behavioral sciences. The Center for HPV Research will provide formal infrastructure and resources for pilot research projects, and a collaborative environment for development of proposals for external funding. By capitalizing on the unique strengths of an internationally recognized faculty and IUPUI’s remarkable culture of collaborative and interdisciplinary research, we will establish a world-class center for HPV research, research training, and research translation. The overall mission of the Center for HPV Research will be to improve understanding of HPV transmission, infection, and prevention of HPV infection and its consequences

Photo-Elicitation as an Adjunct to Structured Interviews When Assessing Ideal Romantic and Sexual Relationships

Structured interviews have been used as an assessment tool in clinical and research settings for many years. However, such interviews have limitations, especially when questions are abstract from the daily life experiences of adolescents and young adults (e.g., “What are all the qualities you desire in a romantic partner?”). Accordingly, photo-elicitation was incorporated as a tool into how young women perceive ideal romantic and sexual relationships

More like him, me, or us: the impact of trait similarity on adolescent women’s sexual risk behaviors in relationships

Ideal partner traits and how they relate to a young woman’s current partner and relationship is a knowledge gap in the literature. The objectives of this study were 1) to assess any differences in interpersonal characteristics between a young woman or her partner and relationship and 2) to examine the impact of this difference on sexual monogamy, condom use and frequency of vaginal sex. Study participants (n=387, 14–17 years at enrollment, 90% African American) were recruited from three primary care adolescent health clinics serving areas with high rates of unintended pregnancy and sexually transmitted infection (STI); data were drawn from a longitudinal cohort study of sexual relationships and behaviors among young women. Nineteen interpersonal characteristics, including physical, financial, communication and personal characteristic variables, were found to have varying influences on relationships and sexual behaviors with ‘like him’ and ‘like us’ as referents. Monogamy increased as a male partner wanted to get somewhere in life [OR 5.41, (1.25, 23.52, p<0.05)], was intelligent [OR 3.42, (1.09, 10.76, p<0.05)] and had money [OR 1.55, (0.272, 0.595, p<0.001)] in a partnership; monogamy similarly increased when a partner wanted to get somewhere in life [OR 6.77, (1.51, 30.36, p<0.01)], was intelligent [OR 4.02, (1.23, 13.23, p<0.05)], and had money [OR 2.41, (1.51, 3.84, p<0.001)] compared to the young woman. The likelihood of using a condom at last sex increased when the male partner had a nice body [OR 1.42, (1.02, 1.99, p<0.05)], was popular [OR 1.60, (1.12, 2.29, p<0.01)], cared for others [OR 3.43, (1.32, 8.98, p<0.01)], was good at sports [OR 1.35, (1.06, 1.73, p<0.05)] and expressed his feelings [OR 2.03, (1.14, 3.60, p<0.01)]. The condom use ratio increased when the male partner was able to take care of himself [OR 0.076, (0.017, 0.136, p<0.01)], was cute [OR 0.190, (0.082, 0.30, p<0.001)], and had a nice body [OR 0.044, (0.001, 0.09, p<0.05)] in a dyad; the condom use ratio also increased when a male partner could take care of himself [OR 0.091, (0.014, 0.168, p<0.05)], was cute [OR 0.194, (0.077, 0.311, p<0.001)] compared to the young woman. Coital frequency increased when the male partner was described as being able to take care of himself [OR 3.33, (0.138, 6.52, p<0.05)]. Such influences are important in discussions with young women regarding personal and partner choices in sexual health as partners, behaviors and motivations for choice frequently change

Condom use as a function of number of coital events in new relationships

STUDY OBJECTIVE: To assess condom use as a function of number of coital events in newly formed sexual relationships. METHODS: Participants who reported at least one new partner during the 12-week study interval (n = 115; ages 18-29 years; 48% women; 90% African American) completed weekly sexually transmitted infections testing and 3 times daily electronic diary collection assessing individual and partner-specific affect, daily activities, sexual behavior, and condom use. We analyzed event-level condom use percentage and participant-level behavior response effects. generalized additive mixed models were used to estimate condom use probability accounting for within-partner and within-participant correlations via random effects. RESULTS: The average condom use probability at the first coital event in new relationships was 55% for men and 36% for women. Analyses showed that smooth shapes of estimated condom use probabilities were similar for both sexes and were fitted using generalized additive mixed models. Relatively higher condom use percentage was followed by a sharp decline during the first 9 coital events decreasing to 16% for men and 8% for women. More rapid decline in condom use among women was highly associated with higher levels of relationship and sexual satisfaction. CONCLUSIONS: The likelihood of condom use declines sharply for both men and women after the early accrual experience with a partner. Relationship and sexual satisfaction also influence declines in condom use, especially among women