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PubMed1995

Smoking, alcohol, sexual behaviour and drug use in women with cervical human papillomavirus infection.

OBJECTIVE: The aim of the study was to determine if smoking is associated with cervical human papillomavirus infection (CHPI) independent of sexual risk factors. SETTING: Two family planning clinics and one youth clinic in Sweden. SUBJECTS: Human papillomavirus (HPV) DNA was found in cervical samples of 66 (6.8%) of 972 women attending for contraceptive advice, using Southern blot tests. RESULTS: Among women with cervical human papillomavirus infection (CHPI), 33 (50%) were smokers, as compared to 307 (33.9%) among a comparison group of HPV-negative women (odds ratio = 2.0, 95% CI = 1.2-3.2). After stepwise adjustment for number of lifetime partners, number of partners last six months, age at first intercourse, alcohol use, drug abuse and history of or current sexually transmitted disease other than CHPI, the odds ratio decreased to 1.4 (95% CI = 0.8-2.4). Recent use of alcohol and ever use of narcotics were also significantly correlated to CHPI in crude analyses, but vanished in multifactorial analyses after adjustment for the mentioned sexual risk behavioral factors. CONCLUSIONS: The results of this study indicate that smoking, alcohol and drug abuse are risk markers, but not causal factors, for CHPI.

Adult↗
PubMed1995

Sexual behavior of women with repeated episodes of vulvovaginal candidiasis.

One hundred and two women with a history of a median of six episodes of vulvovaginal candidiasis (VVC) and 204 age-matched controls participated in a structured in-depth interview on sexual behavior. Mean and median ages of the two groups were 26.7 and 26 years, respectively. Sexual characteristics, associated with VVC in crude analyses, were adjusted in multifactorial analyses for coital frequency, experience of casual sex, vaginal irritation, smoking, alcohol habits, and having a steady partner. In addition, education, as a measure of socioeconomic status, was added in the multifactorial analyses. VVC was not associated with multiple sexual partners or ever-experience of causal sex. Sexual variables that remained significant or were of borderline significance after adjustment were: age at first intercourse (p = 0.001), causal sex partners the previous month (odds ratio (OR) = 3.1), sex during menstruation (OR = 1.7), regular oral sex (OR = 2.4), experience of anal intercourse ever (OR = 2.4), oral intercourse the last month (OR = 3.1), and frequency of oral intercourse (p = 0.02). Thus, the study indicates that certain sexual activities are associated with repeated episodes of VVC.

Adult↗
PubMed1995

Contraceptive use and reproductive history in women with cervical human papillomavirus infection.

The study was conducted to investigate whether cervical human papillomavirus infections (CHPI) are associated with contraceptive use and reproductive history. The contraceptive and reproductive histories in 972 women seeking contraceptive advice were noted and screening conducted for human papillomavirus infection. The interview included number of pregnancies and childbirths, legal and spontaneous abortions, and menstrual pattern. Information about current use of contraceptive methods, about casual sex, and history of combined oral contraceptive pill (OC) use was obtained. Women with a history of spontaneous abortion showed a significant correlation with CHPI, as did women who used high-dose OCs when compared with the remaining study population (odds ratio 3.0). There was no association between use of low-dose OCs and CHPI. In multifactorial analyses with adjustment for age, number of lifetime sexual partners, number of partners during the preceding six months and age at first intercourse, the significant correlation between use of high-dose OCs and CHPI remained (adjusted odds ratio 2.8). The results indicate a relationship between female steroid hormones and the occurrence of CHPI. An association with high-dose OCs could not be excluded.

Abortion, Induced↗
PubMed1987

Bacterial vaginosis: microbiological and clinical findings.

A prospective study was performed involving 101 women who consecutively attended a primary health care unit for complaints of genital malodour and/or abnormal vaginal discharge. Bacterial vaginosis was diagnosed in 34 women on the basis of four diagnostic criteria: vaginal pH greater than 4.7, homogeneous vaginal discharge, a positive amine test and clue cells. The sensitivity of these criteria was greater than 90% except for homogeneous discharge (82%). Their specificity was greater than 90% except for vaginal pH greater than 4.7 (46%); a specificity of 87% could have been achieved by using the criterion for vaginal pH greater than or equal to 5.0. There was a strong association between diagnosis of bacterial vaginosis and the concomitant occurrence of Gardnerella vaginalis, Mobiluncus spp. and Bacteroides spp. There was no difference between women with or without bacterial vaginosis as regards contraception methods (except for use of an intrauterine device), age at first intercourse, or earlier episodes of vaginal discharge. Sexual transmission of the predominant bacteria was not supported by data collected from the male consorts.

Adolescent↗
PubMed1985

Cervical dysplasia: association with sexual behavior, smoking, and oral contraceptive use?

Information on possible risk factors of cervical dysplasia, including indices of sexual behavior, smoking habits, and the use of oral contraceptives was obtained from a case-control study in Ontario in which 250 cases of histologically proved cervical dysplasia and 500 age-matched neighborhood controls were interviewed. Initial analysis showed an increased risk associated with more than one sexual partner, an early age at first intercourse, current smoking, the use and duration of use of oral contraceptives, and education. However, the increased risk of use and duration of use of oral contraceptives and education was reduced after adjustment for indices of sexual behavior and smoking. This finding does not confirm previously reported large adverse effects of pill use. The relationship between smoking and cervical dysplasia might be explained by some agent in cigarette smoke which depresses the immune mechanism, thus permitting a sexually transmitted agent to result in abnormal cellular development that leads to the onset of cervical dysplasia.

Adolescent↗
PubMed1989

Risk factors for vulvar lichen sclerosus.

To assess risk factors for vulvar lichen sclerosus data were collected in a case-control study of 75 cases and 225 age-matched control subjects. Questions concerned personal characteristics and habits, gynecologic and obstetric data, general indicators of sexual habits, and selected dietary habits. The risk of vulvar lichen sclerosus was greater in parous women than nulliparous women, but there was little tendency for the risk to increase with number of births; the finding was not significant when only married women were considered. There was no material difference between cases and control subjects in relation to major indicators of sexual habits (age at first intercourse and number of sexual partners). A smaller proportion of cases was married, but no difference was observed in the distribution of cases and controls with reference to education, smoking habits, body mass index, and previous history of diabetes. There was no association between retinoids and risk of vulvar lichen sclerosus, but intake of carotenoids was inversely and strongly associated with vulvar lichen sclerosus. This apparent protection did not materially change after adjustment for socioeconomic status and other potential confounding factors.

Adult↗
PubMed1991

Correlation between sexual abuse and somatization in women with somatic and nonsomatic chronic pelvic pain.

After a comprehensive clinical and psychological evaluation, 99 women with pelvic pain of at least 6 months' duration and normal findings at laparoscopy were divided into two groups, including 47 women with probable somatic causes of pain (group 1) and 52 women without identifiable somatic abnormality (group 2). Women without identifiable somatic abnormality (group 2) were younger, had higher mean somatization scores, and reported an earlier mean age at first intercourse, a higher number of total sexual partners, and a higher prevalence of sexual abuse before the age of 20. Within group 2 (nonsomatic pain) but not within group 1, mean somatization scores were significantly higher among women with a history of sexual abuse than among women with a negative history. When analyzed as risks for nonsomatic pelvic pain, the positive predictive value of both a history of sexual abuse and a high somatization score was 78% (relative risk compared with that of women with zero or one risk factor, 2.1; p less than 0.0001). These data suggest that the psychosocial profile of women with nonsomatic pelvic pain differs from that of women with somatic pelvic pain and that previous sexual abuse is a significant predisposing risk for somatization and non-somatic chronic pelvic pain.

Adolescent↗
PubMed1994

History of long-term use of depot-medroxyprogesterone acetate in patients with cervical dysplasia; case-control analysis nested in a cohort study. The New Zealand Contraception and Health Study Group.

Histories of use of depot-medroxyprogesterone acetate (MPA) given by women entering a previously-reported prospective study of risk of cervical dysplasia, including carcinoma, have been evaluated. Over a six-year follow-up period, 348 of the 7199 enrolled women developed cervical dysplasia diagnosed by cytology and confirmed by histology or DNA analysis. Use of MPA prior to entry into the study was reported somewhat more commonly and for somewhat longer periods by the women who developed confirmed dysplasia than by those who did not. However, this association was accounted for entirely by the fact that women who reported use of MPA, particularly at an early age, tended to carry a number of known strong risk factors for dysplasia, specifically, first intercourse at an early age, multiple sex partners and cigarette smoking. These findings indicate that the lack of relationship of MPA use to risk of cervical dysplasia, noted previously for women whose median duration of use within the formal study period was about 2 years, extended to the same women who used MPA prior to the study period--even to those whose duration of prior use was 4 years or more.

Adult↗
PubMed1996

Heterogeneous etiology of squamous carcinoma of the vulva.

OBJECTIVE: To correlate various previously identified risk factors, different histologic types, and the presence of human papillomaviruses (HPV) in squamous vulvar carcinomas and intraepithelial precursor lesions. METHODS: Cases of squamous vulvar carcinomas and intraepithelial precursor lesions from a case-control study were analyzed by histologic type, the presence of HPV, and HPV type. These findings were correlated with demographic and interview data. RESULTS: Significant differences (P < .001) in the prevalence of HPV DNA were noted between the following: 1) patients with high-grade vulvar intraepithelial neoplasia (VIN) (48 of 54 [88.9%]), 2) different types of squamous carcinomas, designated basaloid and warty carcinomas (18 of 21 [85.7%]), and 3) keratinizing squamous carcinoma (three of 48 [6.3%]). When the risk factor profiles for basaloid or warty carcinoma and keratinizing squamous carcinoma were compared, it was found that basaloid and warty carcinoma was significantly associated with the classical cervical cancer risk factors (lifetime number of sexual partners, age at first intercourse, abnormal Papanicolaou smears, venereal warts, low socioeconomic status, and cigarette smoking) whereas keratinizing squamous carcinoma was less strongly linked to these factors and in some cases not at all. The risk profile for VIN was similar to that of basaloid and warty carcinoma (with respect to sexual and reproductive history and smoking), although effects were weaker for some factors. CONCLUSION: The results of this study further support the view that vulvar carcinoma has two different etiologies, one related to HPV infection and one that is not.

Adult↗
PubMed1990

Epidemiology of adenocarcinoma of the cervix.

There is general evidence that the incidence of adenocarcinoma of the cervix has been rising, particularly among younger women. The determinants of these trends, however, remain largely unknown. We have reviewed the epidemiology of adenocarcinoma of the cervix using descriptive data from cancer registration and clinical series and two main sources of analytical data: clinical studies comparing cervical adenocarcinoma (AC) and squamous carcinoma (SC) and formal case-control and cohort epidemiological studies. In both the United States and northern Europe there is evidence of the rising frequency of AC in absolute and relative terms as compared to SC. These trends are generally restricted to younger women: under-age-35 AC incidence approximately doubled from the early 1970s to the early 1980s. Available data, although scanty, consistently show that the frequency of cervical adenocarcinoma rises with the number of partners and with decreasing age at first intercourse, suggesting a potential role for sexually transmitted (viral) factors. In clinical series, nulliparity was reported more frequently in AC than in SC cases but an inconsistent association was found in three formal epidemiological studies. Similarities with the epidemiology of endometrial cancer are also suggested from the association with overweight, while a possible relation with hypertension and diabetes is based on clinical series only and hence more difficult to interpret. Thus, adenocarcinoma of the cervix appears to share epidemiological characteristics with both adenosquamous cancer of the cervix and adenocarcinoma of the endometrium, although uncertainties in classification and registration leave several questions unanswered.

Adenocarcinoma↗
PubMed1992

The AIDS awareness and sexual behaviour of young people in the South-west of England.

A programme of surveys was undertaken in collaboration with District Health Authorities to assess the AIDS awareness and sexual behaviour of young people, in order to help the development and implementation of HIV/AIDS risk-reduction strategies. Given that the patterns of findings were strongly replicated in the different districts, the data is presented in terms of a combined data set comprising 2955 respondents aged 16-24. The surveys indicate fairly reasonable levels of knowledge about HIV/AIDS but very low personally perceived vulnerability to infection. The sexual culture is one of fairly early ages of first intercourse, moderate levels of partner change and low (one third) levels of condom use. The findings are discussed in terms of their implications for HIV/AIDS risk-reduction strategies.

Acquired Immunodeficiency Syndrome↗
PubMed1989

School-based clinic use and other factors affecting adolescent contraceptive behavior.

Adolescent risk taking, preventive behavior, and contraceptive use were investigated using a self-administered questionnaire in a sample of 260 inner-city high school students targeted by a school-based health clinic. Multivariate models consisting of individual and environmental variables significantly predicted sexual activity and contraceptive use. Older age at first intercourse, higher number of welfare benefits received by the household (including Medicaid, food stamps, and free or reduced price lunch), and use of the school-based clinic were significant positive predictors of more frequent contraceptive use by adolescents. Results of our study suggest that programs may be having some success in encouraging and enabling sexually active adolescents to use contraception and to use it more consistently. Rigorous program evaluations should help program planners and policy makers design and refine adolescent pregnancy-prevention efforts.

Adolescent↗
PubMed1989

Early sexual activity of delinquent adolescents.

Sexual experiences of 1255 adolescents admitted to a juvenile detention facility were assessed through their responses to a health history questionnaire. More than 80% reported sexual experience. Age at first intercourse acknowledged by females was early (mean 13 years) but rarely prepubertal and was similar for blacks and nonblacks. Males commonly reported beginning sexual experience before age 10 years (40% in blacks and 20% in nonblacks). Sexual activity continued in most, with 73% of the sexually experienced teens reporting intercourse in the month prior to admission. Reports of recent sexual activity increased with age in all race/gender groups. For females, 26% reported sexual misuse compared to 2% of the males. Willingness to answer questions about sexual experiences varied with the question and increased with age. Prepubertal sexual activity is a more common phenomenon than is generally acknowledged. To what extent the experiences reported in our study represent the norm for behavior among individuals of similar background requires further study.

Adolescent↗
PubMed1989

Vaginal douching in teenagers attending a family planning clinic.

This study assessed the knowledge and usage patterns of vaginal douching in sexually active teenagers attending a family planning clinic. A questionnaire was administered consecutively to 94 black, 36 Hispanic, and 12 Anglo females ranging in age from 13 to 19 years. The survey showed that vaginal douching is a common practice, with almost two thirds learning about douching from their mother. The technique is primarily used for hygienic reasons with few using it to prevent pregnancy or infection. Age of first douche correlated with age of first intercourse (p less than 0.001). Almost 23% had douched within 2 days of the clinic visit, and 56% reported douching one or more times a week.

Adolescent↗
PubMed1995

Psychosocial factors influencing teenage sexual activity, use of contraception and unplanned pregnancy.

OBJECTIVE: to compare teenagers who become unintentionally pregnant and teenagers who have never been pregnant but are using contraception on matters related to family/partner stability, and communication with a parent or stable sexual partner about sexual matters. DESIGN: survey utilising self-completed questionnaire. SETTING: a hospital antenatal clinic and community-based family planning clinic. PARTICIPANTS: 30 teenagers with an unplanned pregnancy and 31 'never-pregnant' teenagers using contraception. FINDINGS: the two groups were similar on demographic factors, mean age at which sexual intercourse was first experienced, total number of sexual partnerships, the number of teenagers having a current, regular boyfriend and mean length of the interval between when the teenagers first started going out with their boyfriend and when first sexual intercourse took place. Teenagers in the family planning clinic group were more likely to be living with both natural parents and to be still at school or in higher education. The mean length of time pregnant teenagers had been going out with their boyfriend was longer, they were more likely to be cohabiting with him and to be unemployed. Participants from the antenatal clinic group communicated more with their mothers about sexual matters than those in the family planning clinic group, who were more likely to seek this information from books. The family planning clinic participants were more likely to discuss personal rules and values with friends than those in the antenatal clinic group. IMPLICATIONS FOR PRACTICE: to develop understanding of factors predisposing to unplanned pregnancy during adolescence and to implement measures to counter them, further studies to examine the influence of teenagers' perceptions of family relationships and future life prospects on contraception use and unplanned pregnancy were identified.

Adolescent↗
PubMed1992

Behavioral risk factors for sexually transmitted diseases in American households.

The analysis of a representative survey of households (n = 968) in a San Francisco Bay Area county provides strong evidence for the role of problem drinking as a risk factor for sexually transmitted diseases independent of drinking patterns and drug use. Among women, age, race, early age at first intercourse, history of multiple partners, drinking patterns, as well as current symptoms of problem drinking were all associated with reported STD rates. Stepwise logistic regression analysis showed, however, that female problem drinkers are nearly four and a half times more likely (adjusted O.R. = 4.65, 95% C.I. = 1.30, 16.70) than other women to have had STDs independent of all these potential risk factors. Problem drinking puts women at a greater risk for STDs than a history of multiple sex partners (adjusted O.R. = 2.75, 95% C.I. = 0.98, 7.75). This finding is also observed among men, among whom STDs were associated with a history of multiple sex partners (adjusted O.R. = 4.12, 95% C.I. = 1.90, 8.94) and the lifetime prevalence of drinking problems (adjusted O.R. = 4.95, 95% C.I. = 2.13, 11.50). Frequent bar-going, drunkenness episodes, high volume drinking, feeling disinhibited while drinking and drug use increase the risk for STDs via their effects on the rate of sex partner change. Problem drinking determines STD rates independent of these factors. The implications of these findings for future research and health policy are discussed.

Adult↗
PubMed1996

Risk factors for invasive cervix cancer in young women.

The aim of the study was to evaluate risk factors for invasive cervix cancer in young British women and to look for factors which might explain its increased incidence in younger ages. A case-control study involving 121 women with invasive cervix cancer diagnosed before the age of 40 years, and 241 matched controls was undertaken. Questions were asked about demography, sexual behaviour, reproductive and contraceptive history, smoking, diet and hygiene. Age at first intercourse and lifetime number of sexual partners were found to be the most important factors, whereas parity, educational attainment and social class were not related to risk. Smoking was only weakly related to risk (P = 0.01) and this effect disappeared after adjustment for sexual behaviour variables. A weak protective effective of increased fruit consumption was observed (P = 0.03), but again this became non-significant after adjustment for sexual behaviour. Only factors related to sexual behaviour were found to be important in this study and other cofactors often associated with invasive cancer in older women were not found to be involved. It is possible that genetic factors influencing viral persistence, and specific more virulent strains of human papillomavirus may be more important in early onset cases.

Adult↗
PubMed1993

Substance use among youth seen at a community-based health clinic.

Despite recent surveys reporting a decline in adolescents' use of alcohol and other drugs in the general population, substance abuse may actually be increasing among particular subgroups of high-risk youth. This study examined the prevalence of alcohol and other drug use reported by 1121 youth, ages 12-24 years, seen for an initial medical visit at a free community-based primary health clinic. The clinic, located in the Hollywood/Wilshire area of Los Angeles, serves both homeless (62%) and non-homeless (38%) youth. Bivariate and multivariate analyses revealed that the homeless youth were significantly more likely to report use of alcohol and illicit drugs (marijuana, stimulants, hallucinogens, and narcotics) and prior involvement in injecting drug use (IDU). Variables found to be significantly associated with substance use among the homeless youth included length of time homeless, an attempted suicide, physical and sexual abuse, and involvement in survival sex/prostitution. Among the non-homeless youth, age of first intercourse, a previous suicide attempt, and a history of physical and sexual abuse were significantly associated with substance use. These findings suggest that rates of alcohol and other drug use may be higher among youth seen at community-based primary health clinics, particularly homeless youth underscoring the need for screening for these risk variables.

Adolescent↗