- Email: [email protected]
162. Adoption as a Pregnancy Outcome Option: Assessing Attitudes and Knowledge of Adolescent Females
Poster Abstracts / 48 (2011) S18 –S120
ing, and health outcomes. Multivariate regressions were performed to determine whether gender, age, ethnicity, BMI, and ADHD diagnosis were independently related to PVP score. Results: In 2008, participants averaged 2.7 hours online and 4.7 offline play per week; 82.6% indicated 1 or more PVP symptoms (M ⫽ 5.04, SD ⫽ 3.35). In 2010, participants played 6.4 hours online and 5.8 offline weekly; 74.8% reported at least 1 symptom (M ⫽ 4.46, SD ⫽ 3.31). Total game play was related to more PVP symptoms in 2008 (r ⫽ .461, p ⬍ .001) and 2010 (r ⫽ .577, p ⬍ .001). In 2008, playing games offline was correlated with PVP (r ⫽ .586, p ⬍ .001). In 2010, both offline (r ⫽ .348, p ⬍ .001) and online (r ⫽ .579, p ⬍ .001) play were correlated with PVP. In 2010, playing certain genres, including Massive Multi-player Online Role Playing Games (Boys, r ⫽ .340, p ⬍ .001; Girls, r ⫽ .254, p ⬍ .001) and First Person Shooters (Boys, r ⫽ .151, p⬍.01; Girls r ⫽ .265, p ⬍ .001), was associated with PVP, with girls showing a stronger correlation than boys. Bivariate results indicated that higher PVP scores were associated with male gender and having a diagnosis of ADHD in both years, and with greater age in 2008 only. Multivariate regression found age, gender, and ADHD remained associated with PVP in 2008, but only gender predicted PVP in 2010. Neither sleep nor BMI was significantly associated with PVP. Conclusions: High proportions of adolescents reported PVP symptoms that interfered with 1 or more aspects of their lives. While gender was consistently related to PVP, with boys experiencing more symptoms than girls, playing certain games such as online role-playing games was associated with higher severity of PVP for both genders. Parents and clinicians should monitor for social, physical, and psychological problems that are potential outcomes of video game play and are especially apparent in boys and young people with ADHD. Sources of Support: NICHD #1R21HD054734-01A2 MCHB #T71MC00009.
POSTER SESSION II: SEXUAL BEHAVIOR AND CONTRACEPTION 161. THE UNMET HEALTH NEEDS OF YOUNG MEN WHO TRADE SEX FOR MONEY OR GOODS Laura MacKay, PhD, Elizabeth Saewyc, PhD, RN, Pam Hirakata, PhD, Derek Roelofsen, BSW, RN, John Oliffe, PhD, RN. University of British Columbia Purpose: Despite recent evidence that street-involved young men are as likely as young women to trade sex for money, drugs, food, shelter, or other goods, most studies of health issues and interventions have focused on young women involved in sex work; almost no research has explored these young men’s specific health needs and access to care. This study compared health services utilization among urban young men who have traded sex and those who have not. Methods: A total of 133 young men between the ages of 19 and 25 (mean age ⫽ 21.8 years) were recruited by teams of researchers at community locations where street-involved and at-risk young men congregate throughout Vancouver, Canada. Participants completed a computer-assisted survey on iPod
S101
Touches. The survey included measures of health needs, experiences of health and social services, unmet needs (i.e., not getting care when it was needed), and reasons for foregone care. Cross-tabulations with 2 tested differences between the two groups. Results: Overall, 15.8% of the sample reported trading sex for money or other goods. Over half of these young men were under age 19 when they first traded sex, which in Canada is considered sexual exploitation. Those who traded sex reported significantly greater health issues, including higher rates of ADHD, depression, and substance use problems (all ps ⬍ .01); 66.7% of young men who traded sex had shared needles, compared to only 15.0% of others (2 ⫽ 26.11, p ⬍ .001). There was no difference in the rates of self-reported STIs. In the past year, both groups reported relatively similar rates of accessing emergency rooms (38.1% vs. 43.6%), family doctors (52.6% vs. 40.2%), and alcohol and drug counseling (22.2 vs. 18.1%). Young men who traded sex were more likely to have accessed street nurses (50.0% vs. 13.1%), mental health services (41.2% vs. 18.4%) and sexual health services (35.5% vs. 10.9%) than their peers, but they were less likely to utilize walk-in clinics (47.6% vs. 70.3%). Despite similar utilization rates, males who had traded sex were significantly more likely than the other young men to report foregoing needed care from emergency departments (36.4% unmet need among men who trade sex vs. 8.9% of others), family doctors (62.5% vs. 26.8%), mental health services (33.3% vs. 9.0%), sexual health services (33.3 vs. 8.1%) as well as alcohol and drug services (70.0 vs. 7.3%). The reasons young men who traded sex gave for not accessing these services despite having a need included: thinking the problem would go away, feeling judged, unhelpful staff and/or services, cost, and inconvenient location. Conclusions: Greater health disparities are reported by young men who trade sex for money or goods in Vancouver, compared to other urban at-risk young men. Although young men who traded sex had similar or greater rates of health service utilization, they also reported more unmet health needs and foregone care, in part because of service responses. Health care providers may need to be sensitive to the stigma attached to young men involved in survival sex or sex work, and work to reduce potential barriers that prevent these young men from accessing critical health care services. Sources of Support: Grant # MOP-93559, Canadian Institutes for Health Research: Institute for Gender and Health (Saewyc, PI). 162. ADOPTION AS A PREGNANCY OUTCOME OPTION: ASSESSING ATTITUDES AND KNOWLEDGE OF ADOLESCENT FEMALES Kenisha Campbell, MD1, Keith King, PhD, CHES2, Kahn Jessica, MD, MPH1. 1Cincinnati Children’s Hospital Medical Center 2University of Cincinnati Purpose: Adolescents rarely choose adoption as a pregnancy outcome option, and little is known about factors that drive their decision to consider adoption. Information about knowledge and attitudes could be used to design evidence-based interventions to educate non-pregnant adolescents about adoption and to improve reproductive options counseling in
S102
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pregnant adolescents. We designed a qualitative study, involving a diverse sample of female adolescents, with the following aims: 1) to explore knowledge and attitudes, and 2) to identify determinants of knowledge and attitudes about adoption as a pregnancy outcome option. Methods: Participants were 14-22 year old females (n ⫽ 49) recruited from clinical and educational settings who completed a brief survey to assess baseline demographic data, and then participated in one of eight focus groups. Focus groups were conducted at an urban adolescent health center, a suburban high school, and a university-based sorority house. Each group interview was audio taped and transcribed. Three investigators analyzed the interview data using framework analysis. This is a method for analyzing qualitative data consisting of five sequential phases, which facilitates the development of a conceptual framework. Results: The mean age of participants was 17.5 years, 43% were black, 49% were white, and 6% had been pregnant. Most participants expressed low intention to consider adoption as a pregnancy outcome option. The conceptual framework suggested that knowledge about adoption influenced attitudes about adoption, and both knowledge and attitudes were determined by a set of personal, family, religious, and cultural beliefs. Most participants had some knowledge about adoption; specifically, regarding logistical factors, cost, and legal issues (e.g., open vs. closed) surrounding adoption. Many teens had misperceptions about adoption, namely confusing adoption with foster care. The most salient attitudes about adoption included: 1) perceived benefits (adoption may be in the best interest of the child, allows the biological mother to achieve her goals, and enables the adoptive parents to raise a child), 2) perceived barriers (negative psychological consequences for the biological mother and child, stigma and shame around adoption, and lack of education), and 3) sense of personal responsibility for the pregnancy. The primary determinants of knowledge and attitudes about adoption were: 1) personal experience with adoption, 2) personal beliefs about family and parenting, 3) influences of important others (attitudes of parents, friends and male partners and perceived parental support of the teen’s decision), 4) perceived susceptibility to pregnancy, 5) religious beliefs, 6) cultural beliefs, and 7) media exposure. Conclusions: These findings have important implications for the design of educational interventions for non-pregnant adolescents and reproductive options counseling with pregnant adolescents. Both should include accurate information about the adoption process, involve exploration of an adolescent’s personal experiences and beliefs surrounding pregnancy and adoption, and consider religious and cultural beliefs that may influence her decision. Sources of Support: None. 163. DIVERSE SEXUAL BEHAVIORS AMONG GAY AND BISEXUAL MEN Joshua G. Rosenberger, PhD(c), MPH2, Vanessa Schick, PhD2, Michael Reece, PhD, MPH2, Debby Herbenick, PhD, MPH2, David S. Novak, MSW3, J. Dennis Fortenberry, MD, MS1. 1Indiana University School of Medicine 2Indiana
University, Center for Sexual Health Promotion Online Buddies, Inc. - OLB Research Institute
3
Purpose: Growing literature has documented the extent to which college aged men frequent online forums as a venue for interacting with sexual partners. Further, recent studies have reported college aged gay and bisexual men to be more likely than their heterosexual counterparts to visit sexual networking sites for reasons including geographic isolation, limited venues for meeting sexual partners, and online social acceptance. Virtual sexual spaces have become increasingly normative, yet little research has comprehensively assessed the sexual repertoire of men who visit such sites. This study sought to document the sexual behaviors of 18-24 year old gay and bisexually identified men who utilized sexual networking websites. Methods: Data were collected via an internet-based survey from 4,266 18-24 year old gay and bisexually identified men who were members of an online sexual networking website. Measures included socio-demographics, health-related indicators, and lifetime sexual behavior history. Results: Participants’ mean age was 21.6 years, ethnicities included white (76.2%), Latino (10.5%), African American (5.0%), and Asian (3.6%), and most (80.0%) self identified as homosexual. Over half (70.7%) of participants indicated they were not in a romantic relationship with another person, although most (77.4%) were currently sexually active. The most common behavior was solo masturbation, with nearly all participants (99.1%) reporting have done so in the past month, and the majority (68.3%) indicating they did so at least daily. Lifetime male partner interactions included performing oral sex (97.3%), receiving oral sex (97.6%), and engaging in receptive (89.8%), and insertive anal intercourse (87.9%). Past month behaviors with men were similar, with receiving oral sex (72.9%) being most frequent, followed by performing oral sex (72.3%), receptive (47.1%) anal intercourse, and insertive (46.0%) anal intercourse. Among those who engaged in any past month partnered interaction, 21.9% reported exclusively non-insertive behaviors. Lifetime sexual experiences with women varied with just over a quarter (29.5%) of men having engaged in vaginal intercourse, 30.6% having received oral sex, 23.4% having performed oral sex, and 8.8% have participated in anal intercourse with a female partner. The frequency of male partnered sexual behaviors was significantly different as a result of age, with men who were 21 years of age or over being more likely to have recently engaged in partnered masturbation (p ⬍ .01), receptive anal intercourse (p ⬍ .03) and insertive anal intercourse (p ⬍ .03). Further, sexual orientation was predictive of past 30 day sexual behavior, with bisexual men being more likely to have engaged in sexual activity with women (p ⬍ .001) and gay identified men being significantly more likely to engage in all male partnered sexual behaviors (p ⬍ .001). Conclusions: These data provide one of the first large national assessments of sexual behavior among college aged gay and bisexual men who visit sexual networking websites. Findings from this study suggest men have a diverse sexual repertoire and that partnered sexual behaviors are not limited solely to acts of penile insertion. Understanding the extent and frequency in which these men engage in various sexual behaviors
ing, and health outcomes. Multivariate regressions were performed to determine whether gender, age, ethnicity, BMI, and ADHD diagnosis were independently related to PVP score. Results: In 2008, participants averaged 2.7 hours online and 4.7 offline play per week; 82.6% indicated 1 or more PVP symptoms (M ⫽ 5.04, SD ⫽ 3.35). In 2010, participants played 6.4 hours online and 5.8 offline weekly; 74.8% reported at least 1 symptom (M ⫽ 4.46, SD ⫽ 3.31). Total game play was related to more PVP symptoms in 2008 (r ⫽ .461, p ⬍ .001) and 2010 (r ⫽ .577, p ⬍ .001). In 2008, playing games offline was correlated with PVP (r ⫽ .586, p ⬍ .001). In 2010, both offline (r ⫽ .348, p ⬍ .001) and online (r ⫽ .579, p ⬍ .001) play were correlated with PVP. In 2010, playing certain genres, including Massive Multi-player Online Role Playing Games (Boys, r ⫽ .340, p ⬍ .001; Girls, r ⫽ .254, p ⬍ .001) and First Person Shooters (Boys, r ⫽ .151, p⬍.01; Girls r ⫽ .265, p ⬍ .001), was associated with PVP, with girls showing a stronger correlation than boys. Bivariate results indicated that higher PVP scores were associated with male gender and having a diagnosis of ADHD in both years, and with greater age in 2008 only. Multivariate regression found age, gender, and ADHD remained associated with PVP in 2008, but only gender predicted PVP in 2010. Neither sleep nor BMI was significantly associated with PVP. Conclusions: High proportions of adolescents reported PVP symptoms that interfered with 1 or more aspects of their lives. While gender was consistently related to PVP, with boys experiencing more symptoms than girls, playing certain games such as online role-playing games was associated with higher severity of PVP for both genders. Parents and clinicians should monitor for social, physical, and psychological problems that are potential outcomes of video game play and are especially apparent in boys and young people with ADHD. Sources of Support: NICHD #1R21HD054734-01A2 MCHB #T71MC00009.
POSTER SESSION II: SEXUAL BEHAVIOR AND CONTRACEPTION 161. THE UNMET HEALTH NEEDS OF YOUNG MEN WHO TRADE SEX FOR MONEY OR GOODS Laura MacKay, PhD, Elizabeth Saewyc, PhD, RN, Pam Hirakata, PhD, Derek Roelofsen, BSW, RN, John Oliffe, PhD, RN. University of British Columbia Purpose: Despite recent evidence that street-involved young men are as likely as young women to trade sex for money, drugs, food, shelter, or other goods, most studies of health issues and interventions have focused on young women involved in sex work; almost no research has explored these young men’s specific health needs and access to care. This study compared health services utilization among urban young men who have traded sex and those who have not. Methods: A total of 133 young men between the ages of 19 and 25 (mean age ⫽ 21.8 years) were recruited by teams of researchers at community locations where street-involved and at-risk young men congregate throughout Vancouver, Canada. Participants completed a computer-assisted survey on iPod
S101
Touches. The survey included measures of health needs, experiences of health and social services, unmet needs (i.e., not getting care when it was needed), and reasons for foregone care. Cross-tabulations with 2 tested differences between the two groups. Results: Overall, 15.8% of the sample reported trading sex for money or other goods. Over half of these young men were under age 19 when they first traded sex, which in Canada is considered sexual exploitation. Those who traded sex reported significantly greater health issues, including higher rates of ADHD, depression, and substance use problems (all ps ⬍ .01); 66.7% of young men who traded sex had shared needles, compared to only 15.0% of others (2 ⫽ 26.11, p ⬍ .001). There was no difference in the rates of self-reported STIs. In the past year, both groups reported relatively similar rates of accessing emergency rooms (38.1% vs. 43.6%), family doctors (52.6% vs. 40.2%), and alcohol and drug counseling (22.2 vs. 18.1%). Young men who traded sex were more likely to have accessed street nurses (50.0% vs. 13.1%), mental health services (41.2% vs. 18.4%) and sexual health services (35.5% vs. 10.9%) than their peers, but they were less likely to utilize walk-in clinics (47.6% vs. 70.3%). Despite similar utilization rates, males who had traded sex were significantly more likely than the other young men to report foregoing needed care from emergency departments (36.4% unmet need among men who trade sex vs. 8.9% of others), family doctors (62.5% vs. 26.8%), mental health services (33.3% vs. 9.0%), sexual health services (33.3 vs. 8.1%) as well as alcohol and drug services (70.0 vs. 7.3%). The reasons young men who traded sex gave for not accessing these services despite having a need included: thinking the problem would go away, feeling judged, unhelpful staff and/or services, cost, and inconvenient location. Conclusions: Greater health disparities are reported by young men who trade sex for money or goods in Vancouver, compared to other urban at-risk young men. Although young men who traded sex had similar or greater rates of health service utilization, they also reported more unmet health needs and foregone care, in part because of service responses. Health care providers may need to be sensitive to the stigma attached to young men involved in survival sex or sex work, and work to reduce potential barriers that prevent these young men from accessing critical health care services. Sources of Support: Grant # MOP-93559, Canadian Institutes for Health Research: Institute for Gender and Health (Saewyc, PI). 162. ADOPTION AS A PREGNANCY OUTCOME OPTION: ASSESSING ATTITUDES AND KNOWLEDGE OF ADOLESCENT FEMALES Kenisha Campbell, MD1, Keith King, PhD, CHES2, Kahn Jessica, MD, MPH1. 1Cincinnati Children’s Hospital Medical Center 2University of Cincinnati Purpose: Adolescents rarely choose adoption as a pregnancy outcome option, and little is known about factors that drive their decision to consider adoption. Information about knowledge and attitudes could be used to design evidence-based interventions to educate non-pregnant adolescents about adoption and to improve reproductive options counseling in
S102
Poster Abstracts / 48 (2011) S18 –S120
pregnant adolescents. We designed a qualitative study, involving a diverse sample of female adolescents, with the following aims: 1) to explore knowledge and attitudes, and 2) to identify determinants of knowledge and attitudes about adoption as a pregnancy outcome option. Methods: Participants were 14-22 year old females (n ⫽ 49) recruited from clinical and educational settings who completed a brief survey to assess baseline demographic data, and then participated in one of eight focus groups. Focus groups were conducted at an urban adolescent health center, a suburban high school, and a university-based sorority house. Each group interview was audio taped and transcribed. Three investigators analyzed the interview data using framework analysis. This is a method for analyzing qualitative data consisting of five sequential phases, which facilitates the development of a conceptual framework. Results: The mean age of participants was 17.5 years, 43% were black, 49% were white, and 6% had been pregnant. Most participants expressed low intention to consider adoption as a pregnancy outcome option. The conceptual framework suggested that knowledge about adoption influenced attitudes about adoption, and both knowledge and attitudes were determined by a set of personal, family, religious, and cultural beliefs. Most participants had some knowledge about adoption; specifically, regarding logistical factors, cost, and legal issues (e.g., open vs. closed) surrounding adoption. Many teens had misperceptions about adoption, namely confusing adoption with foster care. The most salient attitudes about adoption included: 1) perceived benefits (adoption may be in the best interest of the child, allows the biological mother to achieve her goals, and enables the adoptive parents to raise a child), 2) perceived barriers (negative psychological consequences for the biological mother and child, stigma and shame around adoption, and lack of education), and 3) sense of personal responsibility for the pregnancy. The primary determinants of knowledge and attitudes about adoption were: 1) personal experience with adoption, 2) personal beliefs about family and parenting, 3) influences of important others (attitudes of parents, friends and male partners and perceived parental support of the teen’s decision), 4) perceived susceptibility to pregnancy, 5) religious beliefs, 6) cultural beliefs, and 7) media exposure. Conclusions: These findings have important implications for the design of educational interventions for non-pregnant adolescents and reproductive options counseling with pregnant adolescents. Both should include accurate information about the adoption process, involve exploration of an adolescent’s personal experiences and beliefs surrounding pregnancy and adoption, and consider religious and cultural beliefs that may influence her decision. Sources of Support: None. 163. DIVERSE SEXUAL BEHAVIORS AMONG GAY AND BISEXUAL MEN Joshua G. Rosenberger, PhD(c), MPH2, Vanessa Schick, PhD2, Michael Reece, PhD, MPH2, Debby Herbenick, PhD, MPH2, David S. Novak, MSW3, J. Dennis Fortenberry, MD, MS1. 1Indiana University School of Medicine 2Indiana
University, Center for Sexual Health Promotion Online Buddies, Inc. - OLB Research Institute
3
Purpose: Growing literature has documented the extent to which college aged men frequent online forums as a venue for interacting with sexual partners. Further, recent studies have reported college aged gay and bisexual men to be more likely than their heterosexual counterparts to visit sexual networking sites for reasons including geographic isolation, limited venues for meeting sexual partners, and online social acceptance. Virtual sexual spaces have become increasingly normative, yet little research has comprehensively assessed the sexual repertoire of men who visit such sites. This study sought to document the sexual behaviors of 18-24 year old gay and bisexually identified men who utilized sexual networking websites. Methods: Data were collected via an internet-based survey from 4,266 18-24 year old gay and bisexually identified men who were members of an online sexual networking website. Measures included socio-demographics, health-related indicators, and lifetime sexual behavior history. Results: Participants’ mean age was 21.6 years, ethnicities included white (76.2%), Latino (10.5%), African American (5.0%), and Asian (3.6%), and most (80.0%) self identified as homosexual. Over half (70.7%) of participants indicated they were not in a romantic relationship with another person, although most (77.4%) were currently sexually active. The most common behavior was solo masturbation, with nearly all participants (99.1%) reporting have done so in the past month, and the majority (68.3%) indicating they did so at least daily. Lifetime male partner interactions included performing oral sex (97.3%), receiving oral sex (97.6%), and engaging in receptive (89.8%), and insertive anal intercourse (87.9%). Past month behaviors with men were similar, with receiving oral sex (72.9%) being most frequent, followed by performing oral sex (72.3%), receptive (47.1%) anal intercourse, and insertive (46.0%) anal intercourse. Among those who engaged in any past month partnered interaction, 21.9% reported exclusively non-insertive behaviors. Lifetime sexual experiences with women varied with just over a quarter (29.5%) of men having engaged in vaginal intercourse, 30.6% having received oral sex, 23.4% having performed oral sex, and 8.8% have participated in anal intercourse with a female partner. The frequency of male partnered sexual behaviors was significantly different as a result of age, with men who were 21 years of age or over being more likely to have recently engaged in partnered masturbation (p ⬍ .01), receptive anal intercourse (p ⬍ .03) and insertive anal intercourse (p ⬍ .03). Further, sexual orientation was predictive of past 30 day sexual behavior, with bisexual men being more likely to have engaged in sexual activity with women (p ⬍ .001) and gay identified men being significantly more likely to engage in all male partnered sexual behaviors (p ⬍ .001). Conclusions: These data provide one of the first large national assessments of sexual behavior among college aged gay and bisexual men who visit sexual networking websites. Findings from this study suggest men have a diverse sexual repertoire and that partnered sexual behaviors are not limited solely to acts of penile insertion. Understanding the extent and frequency in which these men engage in various sexual behaviors