- Email: [email protected]
131. Mapping the Views of Adolescent Health Stakeholders
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Poster Abstracts / 56 (2015) S36eS84
130.
131.
SEXUAL BEHAVIOR AMONG ADOLESCENT WOMEN BY WEIGHT STATUS: A LONGITUDINAL ANALYSIS Tammy Chang, MD, MPH, Matthew M. Davis, MD, Yasamin Kusonoki, PhD, Elizabeth J. Ela, MA, Kelli Stidham Hall, PhD, Jennifer S. Barber, PhD.
MAPPING THE VIEWS OF ADOLESCENT HEALTH STAKEHOLDERS Lindsay Ewan, MD 1, Daniel McLinden, EdD 2, Frank Biro, MD, FSAHM 1, Melissa DeJonckheere, MA 2, Lisa Vaughn, PhD 3. 1
University of Michigan.
Cincinnati Children’s Hospital Medical Center; 2University of Cincinnati; 3University of Cincinnati College of Medicine.
Purpose: Over one-fifth of US adolescents are obese. While nationally representative studies indicate obese adolescent women are at increased risk for health-compromising behaviorsdfrequent smoking, alcohol consumption, cannabis usedwhen compared to normal weight peers, the association between weight status and sexual practices remain poorly understood. To address this gap we measured the relationships between sexual behavior, contraception use, and weight status among adolescent women. Methods: The Relationship Dynamics and Social Life study is a population-based longitudinal investigation of 18 to 19 year-old women residing in a Michigan county at cohort inception. Baseline sociodemographic characteristics include age, race/ethnicity, history of childhood public assistance, history of a live birth, and selfreported height and weight. Weekly journal surveys measured sexual practices, including contraceptive behaviors. Outcomes included proportion of weeks with a partner, proportion of weeks with sexual intercourse, number of partners, average length of relationships, proportion of weeks with contraception use, and proportion of weeks where contraception was used consistently. We examined 26,545 journal surveys from 900 women over the first study year. Ordinary least squares regression models for each outcome examined differences by weight status, controlling for sociodemographic characteristics. Results: The mean proportion of weeks in which adolescents reported sexual intercourse was 52%; there was no difference by weight status. Among weeks in which adolescents reported sexual activity, obese adolescents had a smaller proportion of weeks where any contraception was used compared to normal-weight adolescents (84% vs 91%, p¼0.011). Among weeks in which adolescents reported sexual activity and contraceptive use, obese adolescents had a smaller proportion of weeks with consistent contraceptive use (68% vs 78%, p¼0.016) and oral contraceptive pill use (27% vs 45%, p¼0.001) compared to normal-weight adolescents. All other relationships by weight status were not statistically significant. Conclusions: In this longitudinal study, obese adolescent women were not only less likely to use contraception, they were less likely to use it consistently when compared to normal-weight peers. Findings suggest obesity may be an important indicator of adolescent women’s sexual behavior. Increased clinical awareness and targeted public health outreach could help to reduce unintended pregnancy among this adolescent population. Sources of Support: This research was supported by two grants from the National Institute of Child Health and Human Development (R01 HD050329, R01 HD050329-S1, PI Barber), a grant from the National Institute on Drug Abuse (R21 DA024186, PI Axinn), and a population center grant from the National Institute of Child Health and Human Development to the University of Michigan’s Population Studies Center (R24 HD041028).
Purpose: Research that includes youth and community stakeholders increases the contextual relevance of findings and improves the chances of identifying acceptable and successful interventions. This project sought to identify the adolescent health condition that myriad stakeholders find most important, then use a participatory research modality to characterize strategies to address this condition. Methods: Using a self-administered questionnaire, participants, including adolescents, parents, healthcare workers, and public health workers, identified 3 health problems they considered most important among local youth. Concept mapping (CM), a mixedmethod participatory research modality that invites input from community stakeholders, was then used to identify strategies to address the most commonly identified condition. CM steps are idea generation, idea sorting and rating, multivariate analysis, and interpretation. In the idea generation step, stakeholders responded to a prompt and listed ideas for addressing the target health condition. Researchers edited responses for clarity and redundancy. Adolescent participants then sorted the ideas into groups of similar items, named these groups, and rated the individual ideas for importance and feasibility using 5-point Likert scales. Multidimensional scaling and cluster analysis were applied to create a visual concept map. Results: Two hundred forty-four stakeholders responded to the initial questionnaire, providing 704 total responses. Of these, 42% were adolescents, 76% were African American, and 85% were female. STIs represented the most common response from adolescent participants and were the most common response overall, followed by mental health and obesity. These three responses were consistently among the most common across different categories of stakeholders. One hundred forty-seven stakeholders (48% adolescents, 42% African American, 77% female) responded to the prompt “In order to address sexually transmitted diseases (STDs) in teenagers and young adults, I believe we need to.” and provided 333 total responses. After editing, the responses were reduced to 67 statements. Thirty-one adolescent participants (94% female, 84% African American) performed the sorting and rating tasks. The concept map showed the 67 STI ideas organized into 7 clusters: general sex education; support and empowerment; testing and treatment; community involvement and awareness; prevention and protection; parental involvement in sex education; and media. Out of the seven clusters, general sex education was rated highest for importance (average rating 4.4) and feasibility (average rating 4.0). The concept map stress score indicated good fit of the data. Conclusions: This participatory research approach using concept mapping invites youth involvement and captures the youth voice, providing results that are contextually relevant. These results suggest that adolescents, providers, and other stakeholders identify similar health conditions as important. All groups identified STIs as important. CM allowed us to identify strategies for addressing STIs in a contextual manner for this specific adolescent population. Various types of education were identified as the most
Poster Abstracts / 56 (2015) S36eS84
important strategies. Most strategies were felt to be more important than they were feasible, except for prevention and protection. Youth and community participation can improve and inform successful implementation of STI interventions in this population. Next steps include inviting stakeholders to view and reflect upon the concept map and discuss potential interventions in collaboration with researchers. Sources of Support: CCHMC grant awardee. 132. IMPROVING DISEASE-SPECIFIC SEXUAL AND REPRODUCTIVE HEALTH KNOWLEDGE AMONG ADOLESCENTS WITH CYSTIC FIBROSIS Zachary Colin Jacobs, DO, Rebekah L. Williams, MD, Michelle S. Howenstine, MD, Matthew C. Aalsma, PhD, Kimberly L. Korn, RN.
S69
discussion with their CF or other healthcare provider. From reviewing the handout, males uniformly reported learning about infertility and assistive reproductive technologies. Females reported learning about pregnancy complications, pubertal delay, and contraception. Conclusions: Adolescents with CF, regardless of age, desire information about their disease specific SRH. Moreover, adolescents with CF had deficiencies in their reproductive health knowledge reported interest in discussing SRH issues with their healthcare providers. Provision of a brief educational handout as a standard part of adolescent CF clinical care may be an important first step to address this need, and could prompt improved conversations between CF patients and their care team across the reproductive lifespan. Sources of Support: Adolescent Medicine Section, IU School of Medicine.
Indiana University School of Medicine.
133.
Purpose: Cystic fibrosis (CF) has many known effects on sexual and reproductive health (SRH). Adolescents with CF have variable understanding of these effects. Research indicates that CF patients report suboptimal SRH discussions with their healthcare providers. The purpose of this study is to (1) assess CF specific SRH knowledge in adolescents with CF, and (2) pilot an educational brochure for use in CF clinics. Methods: A convenience sample of 20 participant’s age 12-21 years with CF was recruited during an inpatient hospitalization or outpatient CF clinic visit. We stratified our sample based on gender and age, recruiting at least 2 males and 2 females in each stage of adolescence - early (12-13yrs), middle (14-17yrs), and late (1821yrs). Participants completed baseline gender-specific CF-SRH knowledge quiz, then reviewed a “CF Sexual and Reproductive Health Information” handout. Next, a brief semi-structured interview assessed the utility of the handout. Three days later the participant retook the CF-SRH quiz to assess knowledge improvement and retention. Descriptive statistics and paired t-tests (SPSS 21) assessed baseline versus post-handout knowledge. Results: Thus far, 16 participants (mean age 16.9yrs) have completed the baseline and post-handout CF-SRH quiz. At baseline, female (N¼9) participants were more likely to give incorrect answers regarding average pubertal delay in CF (N¼5), effectiveness of hormonal contraception in CF (N¼5), and the difference between infertility and impotence (N¼6). On post-quiz, only the difference between infertility and impotence (N¼4) was commonly incorrect. At baseline, male (N¼7) participants were more likely to give incorrect answers regarding average pubertal delay in CF (N¼6), normal pubertal development (N¼7), cause of male infertility in CF (N¼5), and infertility in females with CF (N¼5). On post-quiz, only infertility in females with CF (N¼4) was commonly incorrect. Late adolescents had higher baseline SRH knowledge than early and middle adolescents. Average scores on the CF-SRH quiz improved following handout review (68.2% vs 87.3%, p<0.05). This did not change when stratified by gender (F: 75.6% vs 90.4%, p<0.05; M: 58.8% vs 83.3%, p<0.05) or adolescent stage [Middle (N¼10): 60.2% vs 83.0%, p<0.05; Late (N¼5): 86.0% vs 96.0%, p¼0.08]. Most participants reported that healthcare providers had not discussed sexually transmitted infections (STI) or pregnancy (N¼13), STI prevention (N¼14), or contraception (N¼14). During semi-structured interview, participants consistently reported a desire to learn about CF-SRH (specifically CF effects on fertility, pregnancy and puberty) via printed material and
A SOCIAL ECOLOGICAL MODEL OF SEXUAL REPERTOIRE, CHOICE OF BARRIER METHOD, AND ORGASM AMONG ADOLESCENTS, EMERGING, AND YOUNG ADULTS William Martin McConnell, MPH 1, M. Aaron Sayegh, PhD 1, Michael Reece, PhD 1, Debra Herbenick, PhD 1, J. Dennis Fortenberry, MD, FSAHM 2. 1
Indiana University School of Public Health- Bloomington; 2Indiana University School of Medicine.
Purpose: To describe the effects of state characteristics and attributes on the complexity of sexual repertoire, the choice of barrier method, and the likelihood of orgasm between adolescents, emerging, and young adults. Methods: The National Survey of Sexual Health and Behavior (NSSHB) is a population-based, cross-sectional survey of adolescents and adults in the United States. During MarcheMay 2009, a probability sample of 1383 respondents (e.g. ages 14 to17, 18 to 21, and 22 to 25 years) reported information about the most recent partnered sexual event. Demographic information includes age at interview, race/ethnicity, biologic sex, and US state of residence. Sexual event data includes sexual behaviors, type of barrier method used (i.e. condom, dental dam, plastic wrap, other barrier, product to increase sensation, or no barrier method), and achieving orgasm. Complexity of sexual repertoire is the sum of low STI risk behaviors (e.g. kissing- 1 item, 1 point; touching and masturbation-7 items, 10 points each) and medium STI risk behaviors (e.g. oral/genital/anal contact-3 items, 100 points each) that may accompany anal and/or vaginal sex (2 items, 1000 points each). Analysis relied on data from respondents with a complexity score of at least 1000, indicating coitus. Information from the US Census about state population size, rurality, median income, majority political party in addition to HIV and bacterial STI prevalence estimates from the Guttmacher Institute were analyzed with the NSSHB data in a 2-level, fixed-intercepts, hierarchical linear model using HLM 7.01. Results: Multi-level analyses showed a significant intercept for sexual repertoire complexity of 1623.1 (non-significant intercept variance), indicating that anal and/or vaginal intercourse included kissing, touching and oral sex across the three age groups. Greater sexual repertoire complexity was associated with achieving orgasm (b¼0.32, p<0.05) for females across all age groups. Being a male was associated with achieving orgasm across all age groups (b¼0.55, p<0.05). Condom and no barrier method choices had
Poster Abstracts / 56 (2015) S36eS84
130.
131.
SEXUAL BEHAVIOR AMONG ADOLESCENT WOMEN BY WEIGHT STATUS: A LONGITUDINAL ANALYSIS Tammy Chang, MD, MPH, Matthew M. Davis, MD, Yasamin Kusonoki, PhD, Elizabeth J. Ela, MA, Kelli Stidham Hall, PhD, Jennifer S. Barber, PhD.
MAPPING THE VIEWS OF ADOLESCENT HEALTH STAKEHOLDERS Lindsay Ewan, MD 1, Daniel McLinden, EdD 2, Frank Biro, MD, FSAHM 1, Melissa DeJonckheere, MA 2, Lisa Vaughn, PhD 3. 1
University of Michigan.
Cincinnati Children’s Hospital Medical Center; 2University of Cincinnati; 3University of Cincinnati College of Medicine.
Purpose: Over one-fifth of US adolescents are obese. While nationally representative studies indicate obese adolescent women are at increased risk for health-compromising behaviorsdfrequent smoking, alcohol consumption, cannabis usedwhen compared to normal weight peers, the association between weight status and sexual practices remain poorly understood. To address this gap we measured the relationships between sexual behavior, contraception use, and weight status among adolescent women. Methods: The Relationship Dynamics and Social Life study is a population-based longitudinal investigation of 18 to 19 year-old women residing in a Michigan county at cohort inception. Baseline sociodemographic characteristics include age, race/ethnicity, history of childhood public assistance, history of a live birth, and selfreported height and weight. Weekly journal surveys measured sexual practices, including contraceptive behaviors. Outcomes included proportion of weeks with a partner, proportion of weeks with sexual intercourse, number of partners, average length of relationships, proportion of weeks with contraception use, and proportion of weeks where contraception was used consistently. We examined 26,545 journal surveys from 900 women over the first study year. Ordinary least squares regression models for each outcome examined differences by weight status, controlling for sociodemographic characteristics. Results: The mean proportion of weeks in which adolescents reported sexual intercourse was 52%; there was no difference by weight status. Among weeks in which adolescents reported sexual activity, obese adolescents had a smaller proportion of weeks where any contraception was used compared to normal-weight adolescents (84% vs 91%, p¼0.011). Among weeks in which adolescents reported sexual activity and contraceptive use, obese adolescents had a smaller proportion of weeks with consistent contraceptive use (68% vs 78%, p¼0.016) and oral contraceptive pill use (27% vs 45%, p¼0.001) compared to normal-weight adolescents. All other relationships by weight status were not statistically significant. Conclusions: In this longitudinal study, obese adolescent women were not only less likely to use contraception, they were less likely to use it consistently when compared to normal-weight peers. Findings suggest obesity may be an important indicator of adolescent women’s sexual behavior. Increased clinical awareness and targeted public health outreach could help to reduce unintended pregnancy among this adolescent population. Sources of Support: This research was supported by two grants from the National Institute of Child Health and Human Development (R01 HD050329, R01 HD050329-S1, PI Barber), a grant from the National Institute on Drug Abuse (R21 DA024186, PI Axinn), and a population center grant from the National Institute of Child Health and Human Development to the University of Michigan’s Population Studies Center (R24 HD041028).
Purpose: Research that includes youth and community stakeholders increases the contextual relevance of findings and improves the chances of identifying acceptable and successful interventions. This project sought to identify the adolescent health condition that myriad stakeholders find most important, then use a participatory research modality to characterize strategies to address this condition. Methods: Using a self-administered questionnaire, participants, including adolescents, parents, healthcare workers, and public health workers, identified 3 health problems they considered most important among local youth. Concept mapping (CM), a mixedmethod participatory research modality that invites input from community stakeholders, was then used to identify strategies to address the most commonly identified condition. CM steps are idea generation, idea sorting and rating, multivariate analysis, and interpretation. In the idea generation step, stakeholders responded to a prompt and listed ideas for addressing the target health condition. Researchers edited responses for clarity and redundancy. Adolescent participants then sorted the ideas into groups of similar items, named these groups, and rated the individual ideas for importance and feasibility using 5-point Likert scales. Multidimensional scaling and cluster analysis were applied to create a visual concept map. Results: Two hundred forty-four stakeholders responded to the initial questionnaire, providing 704 total responses. Of these, 42% were adolescents, 76% were African American, and 85% were female. STIs represented the most common response from adolescent participants and were the most common response overall, followed by mental health and obesity. These three responses were consistently among the most common across different categories of stakeholders. One hundred forty-seven stakeholders (48% adolescents, 42% African American, 77% female) responded to the prompt “In order to address sexually transmitted diseases (STDs) in teenagers and young adults, I believe we need to.” and provided 333 total responses. After editing, the responses were reduced to 67 statements. Thirty-one adolescent participants (94% female, 84% African American) performed the sorting and rating tasks. The concept map showed the 67 STI ideas organized into 7 clusters: general sex education; support and empowerment; testing and treatment; community involvement and awareness; prevention and protection; parental involvement in sex education; and media. Out of the seven clusters, general sex education was rated highest for importance (average rating 4.4) and feasibility (average rating 4.0). The concept map stress score indicated good fit of the data. Conclusions: This participatory research approach using concept mapping invites youth involvement and captures the youth voice, providing results that are contextually relevant. These results suggest that adolescents, providers, and other stakeholders identify similar health conditions as important. All groups identified STIs as important. CM allowed us to identify strategies for addressing STIs in a contextual manner for this specific adolescent population. Various types of education were identified as the most
Poster Abstracts / 56 (2015) S36eS84
important strategies. Most strategies were felt to be more important than they were feasible, except for prevention and protection. Youth and community participation can improve and inform successful implementation of STI interventions in this population. Next steps include inviting stakeholders to view and reflect upon the concept map and discuss potential interventions in collaboration with researchers. Sources of Support: CCHMC grant awardee. 132. IMPROVING DISEASE-SPECIFIC SEXUAL AND REPRODUCTIVE HEALTH KNOWLEDGE AMONG ADOLESCENTS WITH CYSTIC FIBROSIS Zachary Colin Jacobs, DO, Rebekah L. Williams, MD, Michelle S. Howenstine, MD, Matthew C. Aalsma, PhD, Kimberly L. Korn, RN.
S69
discussion with their CF or other healthcare provider. From reviewing the handout, males uniformly reported learning about infertility and assistive reproductive technologies. Females reported learning about pregnancy complications, pubertal delay, and contraception. Conclusions: Adolescents with CF, regardless of age, desire information about their disease specific SRH. Moreover, adolescents with CF had deficiencies in their reproductive health knowledge reported interest in discussing SRH issues with their healthcare providers. Provision of a brief educational handout as a standard part of adolescent CF clinical care may be an important first step to address this need, and could prompt improved conversations between CF patients and their care team across the reproductive lifespan. Sources of Support: Adolescent Medicine Section, IU School of Medicine.
Indiana University School of Medicine.
133.
Purpose: Cystic fibrosis (CF) has many known effects on sexual and reproductive health (SRH). Adolescents with CF have variable understanding of these effects. Research indicates that CF patients report suboptimal SRH discussions with their healthcare providers. The purpose of this study is to (1) assess CF specific SRH knowledge in adolescents with CF, and (2) pilot an educational brochure for use in CF clinics. Methods: A convenience sample of 20 participant’s age 12-21 years with CF was recruited during an inpatient hospitalization or outpatient CF clinic visit. We stratified our sample based on gender and age, recruiting at least 2 males and 2 females in each stage of adolescence - early (12-13yrs), middle (14-17yrs), and late (1821yrs). Participants completed baseline gender-specific CF-SRH knowledge quiz, then reviewed a “CF Sexual and Reproductive Health Information” handout. Next, a brief semi-structured interview assessed the utility of the handout. Three days later the participant retook the CF-SRH quiz to assess knowledge improvement and retention. Descriptive statistics and paired t-tests (SPSS 21) assessed baseline versus post-handout knowledge. Results: Thus far, 16 participants (mean age 16.9yrs) have completed the baseline and post-handout CF-SRH quiz. At baseline, female (N¼9) participants were more likely to give incorrect answers regarding average pubertal delay in CF (N¼5), effectiveness of hormonal contraception in CF (N¼5), and the difference between infertility and impotence (N¼6). On post-quiz, only the difference between infertility and impotence (N¼4) was commonly incorrect. At baseline, male (N¼7) participants were more likely to give incorrect answers regarding average pubertal delay in CF (N¼6), normal pubertal development (N¼7), cause of male infertility in CF (N¼5), and infertility in females with CF (N¼5). On post-quiz, only infertility in females with CF (N¼4) was commonly incorrect. Late adolescents had higher baseline SRH knowledge than early and middle adolescents. Average scores on the CF-SRH quiz improved following handout review (68.2% vs 87.3%, p<0.05). This did not change when stratified by gender (F: 75.6% vs 90.4%, p<0.05; M: 58.8% vs 83.3%, p<0.05) or adolescent stage [Middle (N¼10): 60.2% vs 83.0%, p<0.05; Late (N¼5): 86.0% vs 96.0%, p¼0.08]. Most participants reported that healthcare providers had not discussed sexually transmitted infections (STI) or pregnancy (N¼13), STI prevention (N¼14), or contraception (N¼14). During semi-structured interview, participants consistently reported a desire to learn about CF-SRH (specifically CF effects on fertility, pregnancy and puberty) via printed material and
A SOCIAL ECOLOGICAL MODEL OF SEXUAL REPERTOIRE, CHOICE OF BARRIER METHOD, AND ORGASM AMONG ADOLESCENTS, EMERGING, AND YOUNG ADULTS William Martin McConnell, MPH 1, M. Aaron Sayegh, PhD 1, Michael Reece, PhD 1, Debra Herbenick, PhD 1, J. Dennis Fortenberry, MD, FSAHM 2. 1
Indiana University School of Public Health- Bloomington; 2Indiana University School of Medicine.
Purpose: To describe the effects of state characteristics and attributes on the complexity of sexual repertoire, the choice of barrier method, and the likelihood of orgasm between adolescents, emerging, and young adults. Methods: The National Survey of Sexual Health and Behavior (NSSHB) is a population-based, cross-sectional survey of adolescents and adults in the United States. During MarcheMay 2009, a probability sample of 1383 respondents (e.g. ages 14 to17, 18 to 21, and 22 to 25 years) reported information about the most recent partnered sexual event. Demographic information includes age at interview, race/ethnicity, biologic sex, and US state of residence. Sexual event data includes sexual behaviors, type of barrier method used (i.e. condom, dental dam, plastic wrap, other barrier, product to increase sensation, or no barrier method), and achieving orgasm. Complexity of sexual repertoire is the sum of low STI risk behaviors (e.g. kissing- 1 item, 1 point; touching and masturbation-7 items, 10 points each) and medium STI risk behaviors (e.g. oral/genital/anal contact-3 items, 100 points each) that may accompany anal and/or vaginal sex (2 items, 1000 points each). Analysis relied on data from respondents with a complexity score of at least 1000, indicating coitus. Information from the US Census about state population size, rurality, median income, majority political party in addition to HIV and bacterial STI prevalence estimates from the Guttmacher Institute were analyzed with the NSSHB data in a 2-level, fixed-intercepts, hierarchical linear model using HLM 7.01. Results: Multi-level analyses showed a significant intercept for sexual repertoire complexity of 1623.1 (non-significant intercept variance), indicating that anal and/or vaginal intercourse included kissing, touching and oral sex across the three age groups. Greater sexual repertoire complexity was associated with achieving orgasm (b¼0.32, p<0.05) for females across all age groups. Being a male was associated with achieving orgasm across all age groups (b¼0.55, p<0.05). Condom and no barrier method choices had