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Biomedical subjects

J M Ellen

Publications and source records attributed to J M Ellen.

At least 19 recordsLinked to original sources
PubMed2006

Evidence of heterosexual bridging among syphilis-positive men who have sex with men.

OBJECTIVE: To explore whether heterosexual bridging among syphilis-positive men who have sex with men (MSM) contributes to increased infection rates among adolescent women in Baltimore City, Maryland. METHODS: Interview data for patients with primary, secondary and early-latent syphilis from January 2001 to July 2005 were linked with their corresponding field records for named exposed contacts to assess prevalence of male bisexual activity and risk profiles of potential male bisexual bridgers and their female sex partners. RESULTS: None of the women with syphilis reported having known heterosexual relationships with a bisexual man. However, 3.9% and 11.0% of the male sex partners of adolescent females and women aged >25 years with syphilis, respectively, self-reported as MSM or named male sex partners. Likewise, 10.3% of syphilis-positive MSM named female sex partners and 3.0% of syphilis-positive men who did not self-identify as MSM named both male and female sex partners. CONCLUSIONS: Sexual network links exist between syphilis-positive MSM and heterosexual women, but the extent of bisexual behaviour among men is not detectable by self-identification and disclosure to female sex partners.

Adolescent↗
PubMed2005

Social support and sexually transmitted disease related healthcare utilisation in sexually experienced African-American adolescents.

OBJECTIVE: To determine whether adolescents' perceived social support predicts future utilisation of sexually transmitted disease (STD) related health care. METHODS: A longitudinal study of African-American adolescents ages 12-18 recruited from a random sample of households in the San Francisco Bay area in which baseline data were collected by telephone and follow up data were collected by telephone or in-home audio computer assisted self interview. At baseline, participants were asked about their sexual behaviours, STD history, and social support. At follow up 14-18 months later, participants were asked whether they, while asymptomatic, had sought STD related medical care within the past year. RESULTS: Asymptomatic sexually experienced adolescents who talked to their closest friend almost every day were more likely to have had STD related health care in the past year (odds ratio (OR) = 1.38; 95% confidence interval (CI) 1.09, 1.76). Closeness to female and male parents/guardians and participation in extracurricular activities were not associated with utilisation of STD related health care within the past year. After controlling for age and sex, sexually experienced adolescents who talked to or saw their closest friend almost every day were more likely to have had STD related health care within the past year (OR = 1.35; 95% CI = 1.08 to 1.70). CONCLUSIONS: These findings suggest that friends have an impact on the seeking of confidential healthcare services, such as care for STDs.

Adolescent↗
PubMed2004

Perceived STD risk, relationship, and health values in adolescents' delaying sexual intercourse with new partners.

OBJECTIVES: To examine the amount of time adolescents waited to have intercourse with past partners (main and casual), and intentions to delay with future partners. To determine psychosocial factors which predict delay intentions among adolescent males and females with future partners (main and casual). METHODS: Adolescent STD clinic attendees were approached before clinical appointments to participate in an interview. Data from 205 participants who had previous experience with both main and casual partners were used in the current study. RESULTS: Adolescents waited less time to have intercourse with most recent casual than with most recent main partners (chi2 = 31.97, p<0.0001). The amount of time waited with past partners was shorter than intended time to wait in future relationships (medians of 1 month v 2 months (main) (t = 3.47, p<0.0010; medians of 2 weeks v 1 month (casual) (t = 6.14, p<0.0001)). Factors influencing intentions to delay intercourse with future main partners differed by sex; males were negatively influenced by importance of sex in relationships, while females were positively influenced by importance of intimacy in relationships, perceived risk of STDs, and health values. CONCLUSIONS: Implications for designing interventions for adolescent males and females are discussed.

Adolescent↗
PubMed2002

Attitudes about sexual disclosure and perceptions of stigma and shame.

OBJECTIVES: To determine the association between stigma and shame about having a sexually transmitted disease and adolescents' past STD related care seeking; between stigma, shame, and perceptions about disclosure of sexual behaviours to a doctor or nurse; and whether the association of stigma, shame, and care seeking was moderated by perceptions about disclosure. METHODS: A household sample of 142 sexually active African-American youths, 13-19 years old, was questioned about STD related stigma (alpha = 0.89), STD related shame (alpha = 0.90), and perceptions about disclosure of sexual behaviours to a doctor or nurse (alpha = 0.81). RESULTS: Among females, stigma was associated with increased anticipation of negative reactions to disclosure of sexual behaviours to a doctor or nurse (odds ratio (OR) = 0.319; 95% confidence interval (CI) =0.12 to 0.85) while shame was not. Stigma was also independently associated with STD related care seeking in the past year (OR = 0.296; 95% CI = 0.09 to 0.94) while shame was not. There was no association between stigma and shame with perceptions about disclosure or past care seeking in males. Perceived outcomes of disclosing sexual behaviours did not moderate the association of stigma, shame, and past STD related care seeking. CONCLUSIONS: Stigma about STDs may influence how female adolescents perceive reactions to disclosure of their sexual behaviour to healthcare providers. It may also be an important factor in their decision seek to STD related care. Perceptions about disclosure of sexual behaviour to a doctor or nurse do not change the relation of stigma or shame to past STD related care seeking.

Adolescent↗
PubMed2001

Protective role of health values in adolescents' future intentions to use condoms.

PURPOSE: To examine the protective role of health values in adolescents' intentions to use condoms. METHODS: Two hundred thirty-six sexually active adolescents who were attending a municipal sexually transmitted diseases clinic were interviewed, using standardized and constructed instruments, regarding their previous condom use, health values, condom attitudes, social norms regarding condoms, self-efficacy regarding condoms, and intentions to use condoms in the future. Correlations and hierarchical multiple regression analyses were conducted to examine the direct and indirect effects of health values on intentions to use condoms. RESULTS: Health values were significantly correlated with intentions to use condoms with main and casual sexual partners, and accounted for a significant amount of variance in intentions to use condoms with casual sexual partners, after controlling for demographic variables, past condom use, and constructs from the Theory of Planned Behavior. Health values were also found to moderate the relationship between condom attitudes and intentions to use condoms with casual partners. CONCLUSIONS: Efforts to include health values as a protective factor in health behavior theory and risk-reduction interventions are warranted.

Adolescent↗
PubMed2001

The role of behavioral experience in judging risks.

This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10-30; N = 577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication.

Adolescent↗
PubMed2000

Are adolescents being screened for sexually transmitted diseases?

OBJECTIVES: To determine the proportion of sexually experienced African American adolescents who report having been screened for sexually transmitted diseases and to determine the proportion who report having been screened for these diseases among adolescents who have had a preventive primary health care visit in the past 2 years. METHODS: A telephone survey of a population-based sample of African American adolescents aged 12 to 17 years residing in a low-income neighborhood in San Francisco with a high prevalence of sexually transmitted diseases. RESULTS: Of the 302 adolescents surveyed, 118 (39.1%) reported a history of sexual intercourse. Of these, 17 (26. 2%) of 65 males and 31 (58.5%) of 53 females had been screened for a sexually transmitted disease in the previous 12 months. Twenty (30. 8%) of the males and 32 (60.4%) of the females had been screened for a sexually transmitted disease in the previous 24 months. Of the 93 participants who had a preventive primary care visit since their first episode of sexual intercourse, 14 (26.4%) of the 53 males and 24 (60.0%) of the 40 females had been screened for a sexually transmitted disease in the previous 24 months. CONCLUSIONS: Sexually experienced African American adolescents in San Francisco are being screened for sexually transmitted diseases at rates well below those recommended by current clinical guidelines. A low rate of screening was found even in adolescents who had been seen for a preventive primary care visit since they had first had sex. This suggests that the preventive primary care visit is not being used to its full potential as an opportunity to screen and treat adolescents for sexually transmitted diseases. Capitalizing on this opportunity to screen may increase the number of cases of sexually transmitted diseases diagnosed and, thus, decrease rates of these diseases in this population.

Adolescent↗
PubMed2000

Are adolescents being screened for sexually transmitted diseases? A study of low income African American adolescents in San Francisco.

OBJECTIVES: To determine the proportion of sexually experienced African American adolescents who report having been screened for sexually transmitted diseased (STDs), and to determine the proportion who report having been screened for STDs among those adolescents who have had a preventive primary healthcare visit in the past 2 years. METHODS: A telephone survey of a population based sample of African American 12-17 year old adolescents residing in a low income San Francisco neighbourhood with a high prevalence of STDs. RESULTS: Of the 302 adolescents surveyed, 118 (39%) reported a history of sexual intercourse. Of these, 26% of the males and 59% of the females had been screened for an STD in the previous 12 months. 31% of the males and 63% of the females had been screened for an STD in the previous 24 months. Of the 93 participants who had had a preventive primary care visit since their first episode of sexual intercourse, 26% of the males and 60% of the females had been screened for an STD in the previous 24 months. CONCLUSIONS: Sexually experienced African American adolescents in San Francisco are being screened for STDs at rates well below that recommended by current clinical guidelines. A low rate of screening was found even in those adolescents who had been seen for a preventive primary care visit since they first had sex. This suggests that the preventive primary care visit is not being used to its full potential as an opportunity to screen and treat adolescents for STDs. Capitalizing on this opportunity to screen may increase the number of STDs diagnosed and, thus, decrease rates of STDs in this population.

Adolescent↗
PubMed1999

Features of sexually transmitted disease services important to African American adolescents.

OBJECTIVE: To determine the relative importance of various features of health clinics when African American adolescents consider seeking care for sexually transmitted diseases (STDs). DESIGN: Confidential interviewer-administered telephone survey. SETTING: A predominantly low-income, African American neighborhood in San Francisco, Calif. PARTICIPANTS: Random sample of African American adolescents aged 12 to 17 years; 302 (76.6%) of 394 identified eligible adolescents participated. MAIN OUTCOME MEASURES: Items and scales measuring adolescents' sense of the importance of the attributes of the provider (alpha = .58), availability of services (alpha = .61), and perceived confidentiality of health services from family (alpha = . 72) when deciding where to seek care for possible STDs. RESULTS: More than 90% (90.4%) of subjects rated items relating to provider attributes as being highly important when they consider where they would seek care for an STD; between 62.5% and 82.7% rated availability items as being highly important; and between 38.6% and 60.8% rated items pertaining to confidentiality as being highly important. Greater importance was placed on provider attributes and confidentiality by female than male adolescents. The importance placed on provider attributes and confidentiality increased as adolescents aged. CONCLUSIONS: Low-income, African American adolescents place great importance on provider attributes, less importance on availability, and even less importance on confidentiality when deciding where to seek health care for a possible STD. Health care providers and organizations need to be aware of these adolescent preferences to better promote screening and treatment of STDs in this population.

Adolescent↗
PubMed1999

Cervical secretory immunoglobulin A in adolescent girls.

PURPOSE: To determine whether there are differences in levels of cervical secretory immunoglobulin A (sIgA) between adolescent girls in the secretory and proliferative phases of their menstrual cycle. METHODS: Sexually active adolescent girls (n = 117) at health maintenance organization (HMO) based adolescent medical clinic were recruited into the study. In addition to demographic and clinical data, cervical specimens were collected for sIgA measurement and gonorrhea culture, urine for chlamydia ligase chain reaction, and blood for progesterone levels. Subjects were classified as being in the proliferative phase or secretory phase of the menstrual cycle on the basis of their progesterone levels. RESULTS: The mean age of the subjects was 17.2 years old. There was no difference in the sIgA levels between those in the proliferative phase of their cycle (n = 45; mean sIgA level, 0.0055 mg/mL) and those in the secretory phase (n = 40; mean sIgA level, 0.0032 mg/mL) (p > .10). CONCLUSIONS: The secretory phase of the menstrual cycle does not appear to be associated with higher levels of sIgA in adolescent girls. These results suggest that adolescents with anovulatory cycles, i.e., those who lack a secretory phase, may not be at increased risk for genital tract infections such as chlamydia or gonorrhea.

Adolescent↗
PubMed1999

Concurrent sex partners and risk for sexually transmitted diseases among adolescents.

BACKGROUND/OBJECTIVES: A large percentage of sexually active adolescents have multiple sex partners and are at high risk of acquiring sexually transmitted diseases (STDs). Little is known about adolescents' patterns of sexual partnerships (e.g., concurrent versus serial) and how these patterns influence STD risk. GOAL OF THE STUDY: To determine the frequency with which adolescents have concurrent partners during a main relationship and the association between having concurrent partners and STD risk. STUDY DESIGN: Adolescents seeking care at a public STD clinic were recruited from March, 1996, to May, 1998. Demographic and behavioral data were obtained during an interviewer-administered questionnaire. Sexually transmitted disease testing and physical exams were performed by clinicians. RESULTS: Of those adolescents who reported having at least one main partner during the previous 6 months (n = 245), 110 (44.9%) had multiple partners, and 76 (31%) had at least one concurrent partner during a main relationship. Greater number of concurrent partners was associated with STD diagnosis/exposure after controlling for number of sex partners (OR = 1.6; 95% CI, 1.1-2.4). CONCLUSIONS: A significant percentage of adolescents have concurrent partners during a main relationship, and having concurrent partners increases STD risk.

Adolescent↗
PubMed1998

Primary care physicians' screening of adolescent patients: a survey of California physicians.

PURPOSE: To determine how often primary care physicians screen adolescents for important risk factors and to determine how rates of screening vary by physicians' specialty and practice setting, patients' age, and type of risk factor. METHODS: A stratified random sample of 343 California physicians who are Board certified in pediatrics, family practice, or internal medicine, and physicians in these specialties who specialized in adolescent medicine were surveyed about their screening practices using a mailed questionnaire. Subjects were asked the percentage of routine comprehensive physical examination during which they personally queried or screened each age group of adolescents (11-14 years old and 15-18 years old) for each of the following risk factors: high blood pressure, alcohol use, cigarette use, sexual activity, and drug use. RESULTS: The frequency with which primary care physicians reported actually screening younger and older adolescents for the various risks were approximately: 93% and 96% for high blood pressure, 70% and 84% for alcohol use, 74% and 82% for drug use, 67% and 83% for sexual activity, and 76% and 86% for smoking, respectively. For all risk factors, providers screened older adolescents more frequently than younger adolescents (p < 0.01). Finally, screening rates varied by specialty (p < 0.01) but not by practice setting. CONCLUSIONS: This study found that California physicians frequently screen adolescents for a variety of risk factors. However, the reported rates may not be consistent with published guidelines. Interventions may need to be developed which focus on improving primary care physicians' adolescent-specific screening practices.

Adolescent↗
PubMed1998

Determinants of adolescents' satisfaction with health care providers and intentions to keep follow-up appointments.

OBJECTIVE: To better understand the determinants of adolescents' satisfaction with their health care providers and to examine the relationship among satisfaction, intention to return for follow-up, and appointment-keeping behavior. METHODS: One hundred and twenty-four adolescent patients attending a university-based general adolescent medicine clinic were surveyed prior to the visit about their attitudes regarding provider behavior. After the visit, subjects completed a questionnaire on provider behavior during the visit, satisfaction with the visit, and intention to keep their follow-up appointment. RESULTS: Multivariate regression analysis revealed that pre-visit attitudes about providers' style of behavior predicted satisfaction (beta = 0.252; p < 0.01). After controlling for pre-visit attitudes, perceptions about providers' style of behavior proved to be a strong predictor of visit satisfaction (beta = 0.512; p < 0.01). Visit satisfaction was associated with intention to keep scheduled follow-up appointments (r = 0.327; p < 0.01). However, subjects with greater intention to return were not more likely to keep their follow-up appointments. CONCLUSION: Provider behavior is an important determinant of adolescents' satisfaction with their health care.

Adolescent↗
PubMed1998

Do differences in sexual behaviors account for the racial/ethnic differences in adolescents' self-reported history of a sexually transmitted disease?

BACKGROUND AND OBJECTIVES: African-American adolescents have the highest rates of sexually transmitted diseases (STDs) of any racial/ethnic group of adolescents. The objective of this study was to determine the degree to which racial/ethnic differences in sexual behaviors account for African-American adolescents' higher rates of STDs. STUDY DESIGN: A secondary analysis of data collected as part of the Youth Risk Behavior Survey supplement to the 1992 National Health Interview Survey was conducted. The sample included 5,189 nationally representative civilian noninstitutionalized sexually experienced United States adolescents 14 to 21 years of age. RESULTS: The age- and sex-adjusted odds ratio (OR) for a reported history of an STD for African-American adolescents was 3.86 (95% confidence interval [CI] = 1.57, 9.50). The STD risk for African-American youth increased with the adjustment for other sociodemographic factors (OR = 4.13; CI = 1.71, 9.99) and decreased with the adjustment for sexual behaviors (OR = 3.67; CI = 1.55,8.66). CONCLUSIONS: Differences in sexual behaviors do not fully account for African-American adolescents' increased risk for STDs. Interventions designed to reduce sexual risk taking among African-American adolescents may not ameliorate racial/ethnic differences in rates of STDs.

Adolescent↗
PubMed1997

An investigation of geographic clustering of repeat cases of gonorrhea and chlamydial infection in San Francisco, 1989-1993: evidence for core groups.

To determine whether there were core groups of transmitters of gonorrhea and chlamydial infection among 14- to 35-year-olds in San Francisco during 1989-1993, sociodemographic risk factors for repeat gonorrhea and chlamydial infection were examined. During those 5 years, 8613 cases of gonorrhea were reported among males and 3893 among females; the proportions with repeat infection were 17.0% and 19.0%, respectively. There were also 2465 reported cases of chlamydial infection among males and 6996 among females; the proportions with repeat infection were 8.6% and 15.1%, respectively. Multivariate analyses reveal that for males, city planning region 5 was an independent risk factor for both repeat gonorrhea (relative hazard [RH] = 1.22; 95% confidence interval [CI] = 1.05-1.43) and repeat chlamydial infection (RH = 1.78; 95% CI = 1.23-2.57). For females, city planning region 4 was an independent risk factor for repeat gonorrhea (RH = 1.50; 95% CI = 1.12-1.98), and there was no high-risk planning region for repeat chlamydial infection. In San Francisco, there appear to be male and female core transmitters for gonorrhea but there may not be core transmitters for chlamydial infection.

Adolescent↗
PubMed1997

Screening for adolescent smoking among primary care physicians in California.

OBJECTIVES: This study determined how often primary care physicians ask adolescents about smoking. METHODS: We surveyed a stratified random sample of community-based, board-certified California physicians, using a mailed questionnaire. RESULTS: Overall, physicians (n = 343; 77% response rate) screened younger adolescents for regular smoking during 71.4% (95% confidence interval [CI] = 67.9, 74.9) of routine physical exams and older adolescents during 84.8% (95% CI = 82.3, 87.4) of such visits. For acute-care visits, the screening rates were 24.4% (95% CI = 20.6, 28.1) for younger and 40.2% (95% CI = 36.4, 44.0) for older adolescents. Physicians asked 18.2% (95% CI = 15.2, 21.3) of younger and 35.6% (95% CI = 32.0, 39.1) of older adolescents about experimental smoking. Screening varied by specialty. CONCLUSIONS: These data imply that physicians are missing opportunities to screen adolescents for smoking.

Adolescent↗
PubMed1996

Adolescents' perceived risk for STDs and HIV infection.

PURPOSE: (1) To determine whether adolescents systematically underestimate their relative risk for STDs and HIV; and (2) to determine to what extent anxiety about STDs and HIV, past condom use, number of lifetime partners and STD/HIV-related beliefs predict perceived relative risk. METHODS: Two hundred and thirty-one sexually experienced, racially diverse, urban high school teenagers (mean age = 15.5 years; 53% male) were surveyed regarding their STD/HIV-related attitudes, beliefs, and behaviors. RESULTS: The subjects did not perceive themselves to be at lower risk compared to their perceptions of the risk of other people their age for STDs or HIV. Using hierarchical multiple linear regression analysis, perceptions of lower relative risk for STDs and for HIV were predicted by higher levels of anxiety (p < .001) but not by past condom use, number of lifetime partners or STD/HIV-related beliefs (p > .05). CONCLUSIONS: Adolescents' perceptions of risk appear to be related to anxiety about STDs and HIV and their behaviors may be related to peer influences and attitudes toward using condoms.

Adolescent↗