Abstract
Cannabis and Sexual Health: Identifying Unknowns through Quantitative and Qualitative Inquiry
Regina Nelson, Ph.D., Jon Ross, Ph.D. and Christopher Smith, Ph.D.
Integral Education and Consulting LLC, Boulder, CO
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
The internet is rampant with claims tying cannabis use to sexual enhancement, but its longtime status as a controlled substance has inhibited serious scholarly investigation of the physiological connection between cannabis and sexual health. Among those few scientific studies performed, study methodologies – participant pools limited by stigma associated with an illegal drug; the lack of studies examining biphasic effects (those that vary widely) reported by cannabis users; overreliance on studying only heterosexuals, to the exclusion of LGBTQ individuals; and, perhaps most notably, studies that measure only or predominantly smoked cannabis products – have led to findings that are limited in their scope and relevance, as well as unsupportable claims of health benefits. Now, as cannabis use evolves into mainstream and widespread medical and commercial use, the health benefits/risks of cannabis products and their relation to sexual health are particularly important to public health officials and consumers alike. The presenter, a [co-]principal investigator in a mixed methods study investigating how cannabis products designed for sexual enhancement and health for all (specifically those ingested through means other than traditional smoking: lubes, oils, etc.) affect sexual behaviors and performance will provide a broad overview of this new research and methodological approach, including the study’s design, research questions, and initial data. This presentation will include how this study proposes to explore sexuality using explorative questions in addition to quantitative data collection, allowing participant narratives to expand to broader contexts than past studies have allowed.
Basic medical science applied in public health Public health or related education Social and behavioral sciences
Abstract
Drugs and sex: How risky behaviors propagate among gender non-conforming and cis-gender LGBTQ youth
Ankur Srivastava, MPhil, MSW, Joshua Rusow, MSW, Monique Holguin, LCSW and Jeremy Goldbach, Ph.D.., LMSW
University of Southern California, Los Angeles, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Introduction: Among sexual minority youth, gender minority youth report disparate rates of alcohol and drug use than their cis-gender peers. Additionally, substance use is associated with risky sex. How these behaviors are associated with intention for future behavior is understudied among LGBTQ youth. Methods: This study examined rates of engaging in sexual behavior, sex under influence (alcohol/drugs), and likelihood of engaging in future sex by gender identity; and the association between sex under influence and intention to engage in future sex for cis-gendered and gender non-conforming (GNC) youth who contacted LGBTQ crisis services. Results: 49% of youth identified with GNC identities. Compared to cisgender youth, GNC youth reported higher rates of engagement in sexual intercourse (51% vs 28%), oral sex (55.3% vs 46.3%) and anal sex (28.2% vs 22%). Almost of half of the participants who had engaged in sexual behavior, reported doing so under the influence. GNC youth reported higher odds of engaging in sexual intercourse (OR=2.5) after accounting for age, race and sexual orientation. Those who reported having sex after using alcohol/drugs had higher odds of intending to engaging in sex in next three months (OR=4.8), adjusting for other variables. Conclusions: Youth who report sex under the influence further report intent to engage in future sex, providing an avenue for prevention services. Crisis service organizations and public health professionals working with LGBTQ youth may want to include alcohol and substance use questions in their screening for strengthen interventions to promote positive health outcomes.
Conduct evaluation related to programs, research, and other areas of practice Public health or related education Social and behavioral sciences
Abstract
Relationship between sexual intercourse before the age of 13 and alcohol, tobacco, and other drug use among high school students
Michael S. Dunn, PhD and John Yannessa, PhD
Coastal Carolina University, Conway, SC
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Adolescent use of alcohol, tobacco, and other drugs (ATOD) is a common experience in the United States. Additionally, sexual intercourse typically begin in adolescence with first experiences beginning at approximately 16 years of age. What impact sexual intercourse before the age of 13 (SIBA13) has on risk factors such as ATOD is not well documented. The purpose of this study was to assess the relationships between SIBA13 and ATOD use among high school students. Data was derived from the 2015 Youth Risk Behavior Survey (n=15,624). This study is conducted every odd year, and is a representative sample of high school students in the United States. Results found that 897 students reported SIBA13. Logistic regression was conducted to determine the relationship between SIBA13 and ATOD use. Students who engaged in SIBA13 were significantly more likely to have initiated cigarette, alcohol, or marijuana use. Additionally, SIBA13 was a significant predictor of current cigarette use (OR=1.30) and current marijuana use (OR=1.21). Lastly, those student who had SIBA13 were significantly more likely to have used alcohol (OR=1.98) and marijuana (OR=3.13) before the age of 13. Since the results of this study show the relationships between SIBA13 and ATOD use, it is necessary to develop comprehensive sex education programs with effective strategies to reduce health risk behaviors. While it may seem early to discuss sexual health issues in elementary school, these results indicate that continued education is needed in the pre-teen years to prevent early sexual intercourse and the risks that the behavior brings.
Public health or related education Public health or related research Social and behavioral sciences
Abstract
Preconception Pregnancy Intention and Contraception Use Among Pregnant Women with Opioid Use Disorder
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Over 86% of pregnancies among women with opioid use disorder (OUD) are unintended, compared to 46% in the general population, suggesting discrepancies in contraceptive use and access. However, little is known about the relationship between pregnancy intention and contraceptive-related behaviors among pregnant women with OUD. Two hundred pregnant women with OUD participated in an observational clinical trial on effectiveness of postpartum Nexplanon placement (97 participants) compared to routine postpartum contraceptive care (103 participants) in preventing rapid repeat pregnancy. All participants completed questionnaires and a subset of 40 participants completed semi-structured interviews regarding sexual behavior and contraceptive history. Descriptive statistics were computed in STATA to assess contraceptive use prevalence. Interviews were coded by two researchers independently in Atlas.ti for emerging themes. Most participants were aged 20-29 (111/200; 55%), non-Hispanic (192/200; 96%), white (182/200; 91%), never married (158/200; 79%), unemployed (133/200; 66%), on medical assistance (176/200; 88%), and graduated high school (77/200; 38%). Most participants (129/200; 64%) did not use any contraceptives the year before pregnancy, however; only 12% (25/200) reported not using contraceptives in order to become pregnant. In-depth interview themes included lack of knowledge regarding contraceptive options at time of first sexual experience, lack of contraceptive decisionmaking control due to parent or partner interference, barriers to use, such as side effects and inaccessibility, and facilitators, including social support and ease of use. Most pregnancies among women with OUD were unplanned, suggesting future research should address disparities regarding unplanned pregnancies and contraceptive use among pregnant women with OUD.
Other professions or practice related to public health Public health or related research
Abstract
Coercive experiences and sexual/reproductive health outcomes among women with opioid use disorders
Lindsay Cannon, MPH, MSW1, Yasamin Kusunoki, PhD, MPH2, Vanessa Dalton, MD, MPH1, Roxanne Harfmann, BA1, Carol Boyd, PhD, RN, FAAN1 and Lauren MacAfee, MD3
(1)University of Michigan, Ann Arbor, MI, (2)University of Michigan School of Nursing, Ann Arbor, MI, (3)University of Vermont, Burlington, VT
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Women with opioid use disorders experience worse sexual/reproductive health outcomes, including higher rates of unintended pregnancy, abortion, and sexually transmitted infections (STIs), compared with women without substance use disorders. Further, women who experience coercion, including intimate partner violence, reproductive coercion (i.e., pregnancy coercion or contraceptive sabotage), and exchanging sex for drugs or money, also experience negative health outcomes, including higher rates of unintended pregnancy and STIs. The purpose of this study is to explore 1) the prevalence of coercive experiences and 2) the associations between coercive experiences and sexual/reproductive health outcomes in women with opioid use disorders.
Methods: English-speaking women with an opioid use disorder aged 18-50 were recruited from substance use treatment centers in Michigan. Participants (N=271) completed an anonymous computer-assisted survey about sexual/reproductive health outcomes and coercive experiences. Descriptive statistics and logistic regressions were computed in Stata®, with p-values set at <.05.
Results: Coercive experiences were common, with 79% reporting emotional/physical violence, 23% reporting forced sex, 53% reporting ever having sex for drugs or money, and 55% reporting reproductive coercion. Emotional/physical violence was associated with higher rates of unwanted pregnancy, and reproductive coercion was associated with higher rates of STIs. Ever having sex for drugs or money was associated with higher rates of unwanted pregnancy, abortion, and STIs.
Conclusions: Women with opioid use disorders have a high prevalence of coercive experiences, which are associated with negative sexual/reproductive health outcomes. Care for women with substance use disorders should be trauma-informed and address sexual/reproductive health.
Public health or related research
Abstract
What Does a Theory of Syndemic Production Look Like for Black Bisexual and Gay Men?
Typhanye Dyer, PhD, MPH1, Ron Stall, PhD2, Maria R. Khan, PhD, MPH3, Deanna Ware, MPH4, LaRon Nelson, PhD, RN, NP5, Matthew Mimiaga, ScD, MPH6, Mackey Reuel Friedman, PhD, MPH7, Michael Plankey, PhD4, Robert L. Cook, MD, MPH8, Conall O'Cleirigh, PhD9 and Kenneth Mayer, MD10
(1)University of Maryland, College Park, MD, (2)University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, (3)NYU School of Medicine, New York, NY, (4)Georgetown University, Washington, DC, (5)University of Rochester School of Nursing, Rochester, NY, (6)Brown University School of Public Health, Providence, RI, (7)University of Pittsburgh, Pittsburgh, PA, (8)University of Florida, Gainesville, FL, (9)Massachusetts General Hospital, Boston, MA, (10)The Fenway Institute, Fenway Health and Harvard Medical School, Boston, MA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Aim: We used data from The HIV Prevention Trials Network Study (HPTN061) to describe baseline prevalence of syndemics and identify factors most likely to converge in Black Bisexual Men (BBM) compared to Black Gay Men (BGM).
Methods: We included participants born cis-men and not reporting transwomen partners (N=1440). Men were categorized by sexual partner type. BGM = having only male partners, whereas BBM = having at least one female partner. A syndemic was defined as having three or more HIV vulnerability factors: victimization, trauma, depression, stimulant drug use, heavy alcohol use, racism, and incarceration. We generated descriptives on sociodemographics stratified by sexual behavior (BGM vs BBM). Stratified univariate logistic models by sexual behavior tested the correlation between each HIV vulnerability factor. Subsequently, adjusted associations between syndemics and 6 month HIV-sexual risks were estimated.
Results: Compared to BGM, BBM had a higher prevalence of syndemics (53.2% vs 50.5%; p< 0.0001); reported less racism (59.4% vs 65.9%; p <0.0001), had elevated rates incarceration (72.3% vs 49.0%; p <0.0001), depression (47.6% vs 39.8%; p <0.0001), stimulant drug use (48.2% vs 35.1%; p <0.0001) and heavy alcohol use (22.6% vs 12.2%; p <0.0001). Among BGM, incarceration, victimization, depression, trauma, stimulant use and heavy alcohol use were intercorrelated, whereas among BBM, incarceration, victimization, stimulant drug use and heavy alcohol use were intercorrelated.
Conclusions: Syndemics are important for priority populations who experience differing levels of reinforcing psychosocial and structural vulnerabilities. Understanding how vulnerability factors converge differently should be understood to tailor prevention and treatment efforts successfully.
Epidemiology Public health or related research Social and behavioral sciences
Abstract
Association Between Number of Sexual Partners and Depression in Early Adults
Paulina Menichiello, MPH, Wenhui Zeng, PhD Candidate, Maggie Rossano, MPH (anticipated '18) and Lauren Arnold, PhD, MPH
Saint Louis University, St. Louis, MO
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Current literature suggests that the association between sexual activity and depression varies by age group and relationship status. While physically-intimate sexual relationships are associated with lower depression in older age, “non-romantic” sexual activity has been linked to depressive symptoms and diagnosis in adolescents.
Methods: Using the NHANES 2013-14 data, this study investigated the relationship between number of lifetime sexual partners and self-reported symptoms of depression and anxiety in adults ages 20-39 (n=1,954) in the past two weeks. The weighted, multivariable binary logistic regression models adjusted for the presence of sexually transmitted infections, substance abuse, marital status, and various demographic factors.
Results: Approximately 69.0% of the population showed some type of depressive symptoms. After adjusting for covariates, preliminary results indicate that people who have one lifetime sex partner were 30.0% [aOR 0.704 95% CI 0.484, 1.025] less likely to experience depression compared with people who did not have any sex partners. People who have more than one sex partner were 8.7% more likely to experience depressive symptoms [aOR 1.087 95% CI 0.636, 1.856] than those without any partners. Females were almost twice likely to be depressed as men, as were marijuana users compared to non-users.
Conclusion: The relationship between sexual activity and depression in adults ages 20-39 is similar to adolescents. Adults who have one or more lifetime sexual partners will experience higher rates of depressive symptoms. Results will inform practice by contributing to the development of comprehensive mental health interventions for sexually-active early adults.
Clinical medicine applied in public health Diversity and culture Epidemiology Public health or related research Social and behavioral sciences
Abstract
"Please describe what you know about the 'morning after pill'": A salient belief elicitation of emergency contraceptive knowledge
Tiffany Marcantonio, MA, Mary Hunt, MS and Kristen Jozkowski, PhD
University of Arkansas, Fayetteville, AR
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
background: Research exploring participants' knowledge of emergency contraceptives (EC) is limited. The purpose of our study was to elicit an open-ended response about EC knowledge to examine what information is salient and important to participants about the contraceptive method.
methods: Data were collected online from a large convenience sample (N = 1660). Participants were majority female (65%) and young (Mage = 24; SD = 6.8). Participants were asked to explain what they know about EC. Using an inductive approach, a codebook was created, and responses were coded. Chi-square analyses were conducted to compare the types of responses by participant demographic characteristics. We also examined accuracy of participants' knowledge regarding EC.
results: Seven different themes emerged representing accurate and inaccurate information about EC such as, function, time, and accessibility. Significant differences emerged for two demographic variables: age χ2 (21, N = 1,889) = 34.78, p < .03, Φ = .14 and education χ2 (14, N = 1,889) = 46.32, p < .001, Φ =.16; younger individuals (18-24) and those with a Bachelor's degree were more likely to list more aspects of EC. Participants had accurate and inaccurate responses across all themes.
conclusion: Young adults with at least some college education were more likely to have knowledge about aspects of EC; young adults are more likely to use EC, thus it is not surprising that they are more aware. However, the information they provided was not always accurate. Implications for education and contraceptive message sources will be discussed.
Advocacy for health and health education Public health or related research Social and behavioral sciences
Abstract
Obstetrician-gynecologists' willingness to prescribe hormone therapy for transgender men and women
Deirdre Shires, PhD, MPH, MSW1, Daphna Stroumsa, MD, MPH2, Lucas Prieto, MSW1, Kim Jaffee, PhD, MSW3 and Michael Woodford, PhD4
(1)Michigan State University, East Lansing, MI, (2)University of Michigan, Ann Arbor, MI, (3)Wayne State University, Detroit, MI, (4)Wifrid Laurier University, Faculty of Social Work, Kitchener, ON, Canada
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Gender-affirming hormone therapy (HT) use among transgender individuals is associated with improved mental health and quality of life. However, finding a provider willing to prescribe HT can be challenging. We examined obstetrician-gynecologists' (Ob-Gyn) willingness to both initiate and continue HT prescriptions. Eligible participants were Ob-Gyn providers in a large health system. Sixty attending physicians, residents, and advanced practitioners completed an online survey (response rate = 74%). Most participants were female (68.3%) and white (73.3%). Over half (60.3%) were willing to continue HT for transgender patients, but only 29.3% and 30.5% were willing to initiate HT for transgender women and men, respectively. Willingness to continue HT was associated with having met a transgender person (p=.032) and lower transphobia (p=.035) as well as not endorsing barriers related to lack of transgender health training (p=.007), lack of transgender health knowledge (p=.012), or lack of familiarity with transition guidelines (p=.016). Willingness to initiate HT for transgender men was associated with younger age (p<.001), being a resident (p=.003), and not endorsing barriers related to lack of familiarity with transition guidelines (p=.030) or lack of transgender health training (p=.012). Willingness to initiate HT for transgender women was associated with younger age (p=.002), liberal/moderate political views (p=.046), and being a resident (p=.002). Willingness to prescribe HT may be influenced by both personal and clinical/professional factors. Willingness to initiate HT for transgender women and men, respectively, was consistently low, but may be influenced by different factors. Transgender health training should be included in Ob-Gyn provider education.
Diversity and culture Provision of health care to the public