Motivations for Intravaginal Product Use among a Cohort of Women in Los Angeles

Objective

Intravaginal practices—including behaviors such as intravaginal cleansing and insertion of products—have been linked to a number of adverse reproductive health outcomes, including increased risk for bacterial vaginosis, sexually transmitted infections, and HIV. Currently, little is known about the motivations for intravaginal practices among women in the United States. The objective of this study was to identify and describe motivations for intravaginal washing and intravaginal insertion of products among women of differing ages and racial/ethnic groups.

Methods

Between 2008 and 2010, we enrolled a convenience sample of sexually active women aged 18–65 years living in Los Angeles recruited through community education and outreach activities in HIV/AIDS service organizations, women’s health clinics, community-based organizations, and HIV testing sites. At the enrollment visit, women completed a self-administered, computer-assisted questionnaire covering demographics, sexual behaviors, intravaginal practices, and motivations for intravaginal practices over the past month and past year.

Results

We enrolled 141 women; 34% of participants were Caucasian, 40% African American, and 26% Latina. Peri-sexual intravaginal washing was common in all groups, whether to clean up after sex (70%) or to prepare for sex (54%). African American women were more likely to report learning to wash intravaginally from their mothers compared to Latina or Caucasian women (70% vs. 49%, P = 0.04). Sixty-one percent of African American women reported using a douching device over the past year compared to 41% of Latina and 40% of Caucasian women (p = 0.02). Younger women were more likely to report that their male partners wanted them to wash intravaginally than older women (77% vs. 24%, P<0.01), and more likely to report the removal of odors as a motive than older women (65% vs. 40%, P = 0.04). The most commonly used intravaginal products included sexual lubricants, petroleum jelly, body lotions, oils, and wet wipes. Use of these products varied by race, and motives given included increasing lubrication, preparing for sex, smelling good, and preventing sexually transmitted infections.

Conclusion

Women’s intravaginal practices and motivations for these practices differ across race and age. Motivations for use also vary by type of intravaginal product used. Given that some intravaginal practices have been shown to be harmful, interventions, programs and counseling messages to encourage less harmful practices are needed, and should consider underlying motivations that influence women’s vaginal practices. Practitioners may use these results to better support women in achieving vaginal health.

Below:  Motivations for intravaginal insertion of products during last vaginal intercourse, by type of product used

Full article at:   http://goo.gl/kvUVBe

By:  

Joelle M. Brown, Eugenie Poirot
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America

Joelle M. Brown, Kristen L. Hess, Michele Vertucci
Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America

Stephen Brown, Michele Vertucci, Marjan Hezareh
AIDS Research Alliance of America, Los Angeles, California, United States of America

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Food Insecurity among People Who Inject Drugs in Los Angeles & San Francisco

OBJECTIVE:

We estimated the prevalence of food insecurity among people who inject drugs (PWID) in Los Angeles and San Francisco and explored correlates of food insecurity.

DESIGN:

A cross-sectional study that measured 30 d food insecurity using the US Adult Food Security Survey ten-item Module developed by the US Department of Agriculture. Food insecurity was defined as including low and very low food security.

SETTING:

Two cities in the state of California, USA.

SUBJECTS:

Male and female active PWID (n 777).

RESULTS:

Among participants, 58% reported food insecurity and 41 % reported very low food security. Food-insecure PWID were more likely to report being homeless, chest pain in the past 12 months, acquiring syringes from someone who goes to a syringe exchange program and feeling at risk for arrest for possession of drug paraphernalia.

CONCLUSIONS:

Current food insecurity was common among PWID in these two cities, yet few factors were independently associated with food insecurity. These data suggest that broad strategies to improve food access for this high-risk population are urgently needed.

Purchase full article at:  http://goo.gl/B29Ffr

By:  Schmitz J1, Kral AH2, Chu D1, Wenger LD2, Bluthenthal RN1.

• 1Department of Preventive Medicine,Keck School of Medicine,University of Southern California,Los Angeles,CA,USA.
• 2RTI International,San Francisco,CA,USA. 

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California - Trends in Property Crime and Larceny Rates

Via:   http://goo.gl/wMjFeU

Stress and Coping with Racism and Their Role in Sexual Risk for HIV among African American, Asian/Pacific Islander, and Latino Men Who Have Sex with Men

The deleterious effects of racism on a wide range of health outcomes, including HIV risk, are well documented among racial/ethnic minority groups in the United States. However, little is known about how men of color who have sex with men (MSM) cope with stress from racism and whether the coping strategies they employ buffer against the impact of racism on sexual risk for HIV transmission. 

We examined associations of stress and coping with racism with unprotected anal intercourse (UAI) in a sample of African American (N = 403), Asian/Pacific Islander (N = 393), and Latino (N = 400) MSM recruited in Los Angeles County, CA during 2008-2009. Almost two-thirds (65 %) of the sample reported being stressed as a consequence of racism experienced within the gay community. 

Overall, 51 % of the sample reported having UAI in the prior 6 months. After controlling for race/ethnicity, age, nativity, marital status, sexual orientation, education, HIV serostatus, and lifetime history of incarceration, the multivariate analysis found statistically significant main effects of stress from racism and avoidance coping on UAI; no statistically significant main effects of dismissal, education/confrontation, and social-support seeking were observed. None of the interactions of stress with the four coping measures were statistically significant. Although stress from racism within the gay community increased the likelihood of engaging in UAI among MSM of color, we found little evidence that coping responses to racism buffered stress from racism. Instead, avoidance coping appears to suggest an increase in UAI. 

Below:  Stress from Racism Experienced in the Gay Community, by Race/Ethnicity (%)

Below:  Coping Strategies Employed to Deal with Racism, by Race/Ethnicity: Mean Scale Scores¹

1. Range: 1 = “strongly disagree” to 4 = “strongly agree”

Full article at:   http://goo.gl/78mRbc

By:   Han CS1, Ayala G, Paul JP, Boylan R, Gregorich SE, Choi KH.

• 1Department of Sociology and Anthropology, Middlebury College (http://www.middlebury.edu/academics/soan), Middlebury, VT, 05753, USA, chongsukhan@gmail.com.
• Arch Sex Behav. 2015 Feb;44(2):411-20. doi: 10.1007/s10508-014-0331-1. Epub 2014 Jul 25. 

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Assessing Risk-Based Policies for Pretrial Release and Split Sentencing in Los Angeles County Jails

Court-mandated downsizing of the CA prison system has led to a redistribution of detainees from prisons to CA county jails, and subsequent jail overcrowding. 

Using data that is representative of the LA County jail system, we build a mathematical model that tracks the flow of individuals during arraignment, pretrial release or detention, case disposition, jail sentence, and possible recidivism during pretrial release, after a failure to appear in court, during non-felony probation and during felony supervision. 

We assess 64 joint pretrial release and split-sentencing (where low-level felon sentences are split between jail time and mandatory supervision) policies that are based on the type of charge (felony or non-felony) and the risk category as determined by the CA Static Risk Assessment tool, and compare their performance to that of the policy LA County used in early 2014, before split sentencing was in use. 

In our model, policies that offer split sentences to all low-level felons optimize the key tradeoff between public safety and jail congestion by, e.g., simultaneously reducing the rearrest rate by 7% and the mean jail population by 20% relative to the policy LA County used in 2014. 

The effectiveness of split sentencing is due to two facts: 

1. convicted felony offenders comprised ≈ 45% of LA County’s jail population in 2014, and 
2. compared to pretrial release, split sentencing exposes offenders to much less time under recidivism risk per saved jail day.

Below:  For each of the four options for split sentencing in the right column of Table 1, the optimal (i.e., optimizing over the remaining 16 options in Table 1) tradeoff curves of the annual rearrest rate vs. (a) the mean jail population and (b) mean jail overcrowding. The circle denotes the status quo policy for LA County in early 2014.

Full article at:   http://goo.gl/06yV9h

By:   

Mericcan Usta

Management Science & Engineering Department, Stanford University, Stanford, CA, United States of America

Lawrence M. Wein

Graduate School of Business, Stanford University, Stanford, CA, United States of America

  

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Adaptation of the HIV Care Continuum as a Method for Evaluating Syphilis and Gonorrhea Disease Control Activities in Los Angeles County

Treatment verification and contact elicitation are core approaches used to control the spread of sexually transmitted diseases (STDs). Methodology adapted from the HIV care continuum is presented as an evaluation and communication tool for STD control activities.

Sexually transmitted disease surveillance and program data for Los Angeles County in 2013 were used to construct a 2-part continuum to examine syphilis (all stages) and gonorrhea outcomes among index patients and elicited contacts. The Index Case Continuum (Part 1) assesses the proportion of patients who were treated, assigned for interview, interviewed, and provided name and locating information for at least 1 contact. The Elicited Contact Continuum (Part 2) assesses the proportion of contacts who were located, interviewed, and treated.

Among 3668 patients with syphilis, 97% (n = 3556) were treated, 72% (n = 2633) were interviewed, and 25% (n = 920) provided name and locating information for at least 1 contact. The corresponding numbers for 12,541 gonorrhea cases were 95% (n = 11,936), 45% (n = 5633), and 16% (1944), respectively. Among the 1392 contacts elicited from syphilis cases, 53% (n = 735) were either interviewed or determined to not need an interview and 43% (n = 595) were treated. The corresponding numbers for the 2323 contacts elicited from gonorrhea cases were 53% (n = 1221) and 46% (n = 1075), respectively.

Adaptation of the HIV continuum is a useful tool for evaluating treatment verification and contact elicitation activities. In Los Angeles County, this approach revealed significant drop-offs in the proportion of index cases naming contacts and in the proportion of contacts who are interviewed and treated.

Purchase full article at:  http://goo.gl/Ph9qVT

By:  Murphy RD1, Wohl AR, Ma Y, Kobeissi L, Oduyemi O, Pérez MJ.

• 1From the Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles CA. 

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Examining Racial/Ethnic Disparities in the Association between Adolescent Sleep and Alcohol or Marijuana Use

The current study examines the association between self-reported measures of trouble sleeping, total sleep time (TST), and bedtimes and odds of past month alcohol and marijuana (AM) use in a racially/ethnically diverse sample of adolescents.

Web-based cross-sectional survey in Los Angeles (LA) County, California.

The sample is comprised of 2539 youth representing four distinct racial/ethnic categories (Non-Hispanic White, Hispanic, Asian, and “Other”; mean age= 15.54; 54.23% female) from Los Angeles.

The survey assessed TST and bedtimes (weekdays and weekends), trouble sleeping, and past month AM use, as well as relevant covariates (sociodemographics and mental health symptoms).

Although there were significant racial/ethnic differences in the prevalence of sleep problems and AM use, the associations between sleep problems and AM use were consistent across racial/ethnic groups. Specifically, shorter TST, later bedtimes, and trouble sleeping, were each associated with significantly higher odds of past month alcohol use, whereas later bedtimes and shorter TST were also associated with increased odds of past month marijuana use, even after adjusting for other known risk factors.

Sleep problems are associated with increased AM use in teens, even after controlling for sociodemographics and mental health symptoms. Further longitudinal research on sleep and AM use is critical to identify novel prevention and intervention efforts to reduce disparities in the relationship between sleep and AM use.

Results of Logistic Regression Predicting Marijuana Use in the Past Month both overall and stratified by Race/Ethnicity.

	Overall Sample (n=2539)a		Non-Hispanic White (n=533)b		Hispanic (n=1115)b		Asian (n=532)b		Other (n=359)b
	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Weekday Bedtime
10 minutes	1.04	1.02 – 1.06***	1.05	1.02 – 1.09**	1.04	1.01 – 1.06*	0.99	0.93 – 1.04	1.05	1.01 – 1.09*
Weekend Bedtime
10 minutes	1.06	1.05 – 1.08***	1.07	1.03 – 1.10***	1.07	1.05 – 1.09***	1.01	0.97 – 1.06	1.08	1.05 – 1.12***
Total Sleep Time Hours
Weekend	0.87	0.80 – 0.94***	0.91	0.78 – 1.06	0.89	0.79 – 1.00	0.98	0.79 – 1.21	0.71	0.59 – 0.85***
Weekday	0.89	0.81 – 0.99*	0.85	0.71 – 1.03	0.97	0.82 – 1.15	1.01	0.72 – 1.41	0.78	0.62 – 0.99*
Bothered by Trouble Sleeping
Bothered a Little	1.17	0.87 – 1.57	0.89	0.52 – 1.51	1.26	0.80 – 1.98	1.53	0.62 – 3.77	1.32	0.62 – 2.81
Bothered a Lot	1.40	0.98 – 2.01	1.37	0.70 – 2.70	1.39	0.81 – 2.38	1.01	0.25 – 4.11	1.60	0.67 – 3.82
Not Bothered (reference)

*p<.05,

**p<.01,

***p<.001

aThe overall model controls for age, gender, race/ethnicity (White, Hispanic, Asian, Other), mother's highest education (<HS, HS, >HS), family structure (two-parent versus single-parent household), mental health symptoms (MHI-5 score), and an indicator for whether or not the respondent attended an intervention school; n's for each model differ slightly due to item missingness.

bAll stratified models control for the same covariates as in total sample, with the exception of race/ethnicity; n's for each model differ slightly due to item missingness.

Note: In the models including the sleep by race/ethnicity interactions, the omnibus interaction term was non-significant in all models.

Full article at: http://goo.gl/BXCSA9

By: Wendy M. Troxel, Brett Ewing, and Elizabeth J. D’Amico

RAND Corporation, 1776 Main St, Santa Monica, CA 90407, USA

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Drinking Patterns and HIV Risk Behaviors among Black and Latino Men Who Have Sex with Men within Los Angeles County

Alcohol, the most widely used substance among men who have sex with men (85%), remains an important factor in HIV research among this high-risk population. However, research on alcohol use among Black and Latino men who have sex with men (BLMSM), a population disproportionately affected by HIV in the United States, is limited and inconclusive. 

This study explored sociodemographic and HIV risk with daily heavy and low-risk drinking patterns among BLMSM. BLMSM (N = 188) aged 18 to 40 years were recruited through social media, local colleges, heteronormative clubs, private men's groups, gay establishments, and organized events in Los Angeles County. Participants completed self-administered questionnaires. 

Fisher's exact tests revealed significant relationships between drinking patterns and condomless insertive anal intercourse, race, age, and perception of alcohol-related HIV risk. The Fisher's exact tests findings for age held true in the multiple regression model. 

Findings suggest that BLMSM who engage in higher risk drinking also engage in alcohol-related HIV risk. Culturally competent interventions should consider including a combined focus to explore the synergy between risky drinking patterns and HIV risk among BLMSM.

Via:  http://ht.ly/SMb2c Full article at: http://goo.gl/4dRwqU

By: Washington TA1, Patel SN2, Meyer-Adams N1.

• 1 California State University, Long Beach, CA, USA.
• 2 California State University, Long Beach, CA, USA
• 
  
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Do Sexually Oriented Massage Parlors Cluster in Specific Neighborhoods? A Spatial Analysis of Indoor Sex Work in Los Angeles and Orange Counties, California

Social determinants of health may be substantially affected by spatial factors, which together may explain the persistence of health inequities. Clustering of possible sources of negative health and social outcomes points to a spatial focus for future interventions. We analyzed the spatial clustering of sex work businesses in Southern California to examine where and why they cluster. We explored economic and legal factors as possible explanations of clustering.

A total of 889 venues were identified. Clusters of tracts having higher-than-expected numbers of sexually oriented massage parlors ("hot spots") were located outside downtowns. These hot spots were characterized by a higher proportion of adult males, a higher proportion of households below the federal poverty level, and a smaller average household size.

Sexually oriented massage parlors in Los Angeles and Orange counties cluster in particular neighborhoods. More research is needed to ascertain the causal factors of such clusters and how interventions can be designed to leverage these spatial factors.

Via: http://ht.ly/S1gfF

By: Chin JJ1, Kim AJ2, Takahashi L3, Wiebe DJ4.

• 1Hunter College, City University of New York, Urban Affairs and Planning, New York, NY.
• 2Georgia Institute of Technology, City and Regional Planning, Atlanta, GA.
• 3University of California, Los Angeles, Urban Planning, Los Angeles, CA.
• 4University of Pennsylvania, Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, PA.