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1. Changes in Rates of Syphilis Testing and Infection in an Urban Adolescent Clinic During a Local Syphilis Outbreak
Journal of Adolescent Health 50 (2012) S16 –S95
Abstracts of Research Poster Presentations SESSION I: STIS AND CONDOM USE 1. CHANGES IN RATES OF SYPHILIS TESTING AND INFECTION IN AN URBAN ADOLESCENT CLINIC DURING A LOCAL SYPHILIS OUTBREAK Sherine A. Patterson-Rose, MD, Lea Widdice, MD, Tanya L. Kowalczyk Mullins, MD, Corrine Lehmann, MD, Jill S. Huppert, MD, MPH. Cincinnati Children’s Hospital Medical Center Purpose: In response to local public health reports of increase syphilis rates in adolescent, in which rates were higher in males than females, we examined testing practices and disease incidence within a large urban primary care adolescent clinic to explore differences by patient gender. Methods: Retrospective electronic health information was reviewed to identify clinic visits of 13- through 22-year-old patients seen from 1/2006 to 12/2009 with a history of Chlamydia trachomatis (CT) testing at the visit, a proxy indication of sexual activity. Independent variables included: age, gender, race and year. Two outcome variables were analyzed: syphilis testing (RPR) completed and positive RPR. Descriptive analyses included frequencies of independent and outcome variables. Chi-square tests were used to determine if significant differences existed between groups. Results: Included in the analyses were 18,777 patient visits: 86% were made by females, 75% were made by patients with self-reported race of Black. Mean age at the visits was 17.2 years (SD 1.9). RPR testing was performed at 2051 (13%) of female visits and 759 (29%) of male visits (p⬍0.01). Between 2006 and 2009, there was an increase in the rate of testing for female visits (194/3883 [5%] vs. 938/4277 [21.9%], p⬍0.01) and for male visits (92/568 [16.2%] vs. 310/690 [44.9%], p⬍0.001). Over time, increases in syphilis testing were noted between 2006 vs. 2007 (females: 194/3883[5%] vs. 427/3875[(11%], p⬍0.01; males: 92/568[16.2%] vs. 166/640 [25.9%], p⬍0.01) and between 2008 vs. 2009 (females: 492/4149 [11.9%] vs. 938/4277 [21.9%], p⬍0.01; males: 191/695 [27.5%] vs.310/690 [44.9%], p⬍0.01). There was no difference in testing between 2007 vs. 2008 (females: 427/3875 [11%] vs. 492/4149 [21.9%], NS; males: 166/ 640 [25.9%] vs. 191/695[(27.5%], NS). Among those tested for syphilis, the rate of syphilis infection was 21/2051 (1%) of female visits and 4/759 (0.5%) of male visits (NS). The ratio of male to female syphilis infection was 1:2.The change in rate of syphilis infection between 2006 and 2009 for female visits (0/194 (0%) vs. 13/938 [1.4%], NS) and male visits (1/92 [1%] vs. 2/310 [0.7%], NS) were not statistically significant. Conclusions: There was an increase in the rate of syphilis testing over time, with the rate of testing higher in male visits than female visits. Although clinicians appear to have increased their screening practices over time, which may reflect changes in HIV screening recommendations and local epidemiology, there was no significant increase in rates of syphilis diagnoses. We also detected a low male to female ratio of infection. These findings contradict local public health data for adolescents and warrant further investigation. Sources Of Support: Fellowship Funds.
2. ANALYZING THE TEMPORAL RELATIONSHIP BETWEEN AFFECTIVE STATES AND CONDOM USE IN DEPRESSED ADOLESCENTS USING STRUCTURAL EQUATION MODELING Emily A. Blood, PhD, Lydia A. Shrier, MD, MPH. Children’s Hospital Boston Purpose: Depressive symptoms are associated with increased rates of sexually transmitted infections in adolescents. However, it is unknown whether on a moment-to-moment basis, affective states are related to subsequent sexual risk behavior, such as condom nonuse, and if so, whether the associations are indirect through other factors that characterize the sexual event. Further, the optimal analytic technique to address research questions related to complex momentary sampling data and potential mediation has not been established. Methods: We analyzed data from a momentary sampling study of risk behaviors in depressed adolescents recruited from medical and psychiatric clinics. Participants carried handheld computers that signaled randomly 4-6 times per day throughout waking hours for 2 weeks. Participants contributed questionnaires on positive and negative affect and timing and characteristics of sex events. Associations between affect (6-30 hours prior to sex) and condom use, as well as potential mediation were analyzed with two techniques: non-linear mixed effects modeling (NLM) and structural equation modeling (SEM). Analysis with NLM accounted for correlation of reports from the same individual, treating condom use as the binary outcome and affect and potential mediating factors as predictors. Two sets of SEMs were fit to the data. The first (SEM1) accounted for both correlation of reports from the same individual and multiple affect reports prior to the same sex event. The second (SEM2) accounted only for correlation of reports from the same individual. Both SEMs estimated and tested mediation effects of several potential mediators. All models were adjusted for age, gender, baseline severity of depressive symptoms, impulsivity, and whether sex occurred on a weekend. Results: Participants (N⫽51) contributed a total of 909 momentary reports preceding 267 sex events. Most participants (86%) were female and mean age was 18 years (range: 15-22). In both NLM and SEM2, momentary affect was not significantly associated with eventlevel condom use (positive affect, p⫽0.09 and p⫽0.24; negative affect, p⫽0.14 and p⫽0.21). Additionally, no mediating effects were found between affect and condom use when reason for sex, sex with non-main partner, who wanted sex, substance use prior to sex, and affect in the 6 hours immediately prior to sex each were tested. Increased negative affect was associated with sex with non-main partner which, in turn, was associated with condom use. However, no total effect of negative affect on condom use was seen, so mediation was not likely present. Results from NLM models were similar to those of the SEM2 models. Estimation problems were encountered in the structural equation model additionally accounting for multiple affect reports prior to the same sex event (SEM1), likely due to limited variability and sample size. Conclusions: Positive and negative affect in the hours preceding a sex event do not appear to be associated with condom use in depressed adolescents. Non-linear mixed models did not allow direct testing of mediated effects. SEM showed similar results, but allowed testing mediation effects within the context of momentary sampling 1054-139X/12/$ – see front matter 䉷 2012 All rights reserved.
Abstracts of Research Poster Presentations SESSION I: STIS AND CONDOM USE 1. CHANGES IN RATES OF SYPHILIS TESTING AND INFECTION IN AN URBAN ADOLESCENT CLINIC DURING A LOCAL SYPHILIS OUTBREAK Sherine A. Patterson-Rose, MD, Lea Widdice, MD, Tanya L. Kowalczyk Mullins, MD, Corrine Lehmann, MD, Jill S. Huppert, MD, MPH. Cincinnati Children’s Hospital Medical Center Purpose: In response to local public health reports of increase syphilis rates in adolescent, in which rates were higher in males than females, we examined testing practices and disease incidence within a large urban primary care adolescent clinic to explore differences by patient gender. Methods: Retrospective electronic health information was reviewed to identify clinic visits of 13- through 22-year-old patients seen from 1/2006 to 12/2009 with a history of Chlamydia trachomatis (CT) testing at the visit, a proxy indication of sexual activity. Independent variables included: age, gender, race and year. Two outcome variables were analyzed: syphilis testing (RPR) completed and positive RPR. Descriptive analyses included frequencies of independent and outcome variables. Chi-square tests were used to determine if significant differences existed between groups. Results: Included in the analyses were 18,777 patient visits: 86% were made by females, 75% were made by patients with self-reported race of Black. Mean age at the visits was 17.2 years (SD 1.9). RPR testing was performed at 2051 (13%) of female visits and 759 (29%) of male visits (p⬍0.01). Between 2006 and 2009, there was an increase in the rate of testing for female visits (194/3883 [5%] vs. 938/4277 [21.9%], p⬍0.01) and for male visits (92/568 [16.2%] vs. 310/690 [44.9%], p⬍0.001). Over time, increases in syphilis testing were noted between 2006 vs. 2007 (females: 194/3883[5%] vs. 427/3875[(11%], p⬍0.01; males: 92/568[16.2%] vs. 166/640 [25.9%], p⬍0.01) and between 2008 vs. 2009 (females: 492/4149 [11.9%] vs. 938/4277 [21.9%], p⬍0.01; males: 191/695 [27.5%] vs.310/690 [44.9%], p⬍0.01). There was no difference in testing between 2007 vs. 2008 (females: 427/3875 [11%] vs. 492/4149 [21.9%], NS; males: 166/ 640 [25.9%] vs. 191/695[(27.5%], NS). Among those tested for syphilis, the rate of syphilis infection was 21/2051 (1%) of female visits and 4/759 (0.5%) of male visits (NS). The ratio of male to female syphilis infection was 1:2.The change in rate of syphilis infection between 2006 and 2009 for female visits (0/194 (0%) vs. 13/938 [1.4%], NS) and male visits (1/92 [1%] vs. 2/310 [0.7%], NS) were not statistically significant. Conclusions: There was an increase in the rate of syphilis testing over time, with the rate of testing higher in male visits than female visits. Although clinicians appear to have increased their screening practices over time, which may reflect changes in HIV screening recommendations and local epidemiology, there was no significant increase in rates of syphilis diagnoses. We also detected a low male to female ratio of infection. These findings contradict local public health data for adolescents and warrant further investigation. Sources Of Support: Fellowship Funds.
2. ANALYZING THE TEMPORAL RELATIONSHIP BETWEEN AFFECTIVE STATES AND CONDOM USE IN DEPRESSED ADOLESCENTS USING STRUCTURAL EQUATION MODELING Emily A. Blood, PhD, Lydia A. Shrier, MD, MPH. Children’s Hospital Boston Purpose: Depressive symptoms are associated with increased rates of sexually transmitted infections in adolescents. However, it is unknown whether on a moment-to-moment basis, affective states are related to subsequent sexual risk behavior, such as condom nonuse, and if so, whether the associations are indirect through other factors that characterize the sexual event. Further, the optimal analytic technique to address research questions related to complex momentary sampling data and potential mediation has not been established. Methods: We analyzed data from a momentary sampling study of risk behaviors in depressed adolescents recruited from medical and psychiatric clinics. Participants carried handheld computers that signaled randomly 4-6 times per day throughout waking hours for 2 weeks. Participants contributed questionnaires on positive and negative affect and timing and characteristics of sex events. Associations between affect (6-30 hours prior to sex) and condom use, as well as potential mediation were analyzed with two techniques: non-linear mixed effects modeling (NLM) and structural equation modeling (SEM). Analysis with NLM accounted for correlation of reports from the same individual, treating condom use as the binary outcome and affect and potential mediating factors as predictors. Two sets of SEMs were fit to the data. The first (SEM1) accounted for both correlation of reports from the same individual and multiple affect reports prior to the same sex event. The second (SEM2) accounted only for correlation of reports from the same individual. Both SEMs estimated and tested mediation effects of several potential mediators. All models were adjusted for age, gender, baseline severity of depressive symptoms, impulsivity, and whether sex occurred on a weekend. Results: Participants (N⫽51) contributed a total of 909 momentary reports preceding 267 sex events. Most participants (86%) were female and mean age was 18 years (range: 15-22). In both NLM and SEM2, momentary affect was not significantly associated with eventlevel condom use (positive affect, p⫽0.09 and p⫽0.24; negative affect, p⫽0.14 and p⫽0.21). Additionally, no mediating effects were found between affect and condom use when reason for sex, sex with non-main partner, who wanted sex, substance use prior to sex, and affect in the 6 hours immediately prior to sex each were tested. Increased negative affect was associated with sex with non-main partner which, in turn, was associated with condom use. However, no total effect of negative affect on condom use was seen, so mediation was not likely present. Results from NLM models were similar to those of the SEM2 models. Estimation problems were encountered in the structural equation model additionally accounting for multiple affect reports prior to the same sex event (SEM1), likely due to limited variability and sample size. Conclusions: Positive and negative affect in the hours preceding a sex event do not appear to be associated with condom use in depressed adolescents. Non-linear mixed models did not allow direct testing of mediated effects. SEM showed similar results, but allowed testing mediation effects within the context of momentary sampling 1054-139X/12/$ – see front matter 䉷 2012 All rights reserved.