All articles are online following embargo under First Look at www.ajph.org
American Journal of Public Health Highlights
- Sexual orientation may affect health care access
- Virginity pledges may bias reports of premarital sex
- HIV infection among nation's youth shows early racial disparities
- Smoking reduces effectiveness of some HIV treatments
- Childhood abuse increases likelihood of adult HIV infection
The articles below are published online by the American Journal of Public Health under "First Look," and will appear in the June 2006 print issue of the Journal. "First Look" articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. Following the embargo, articles will appear under "First Look" at www.ajph.org/first_look.shtml. The American Journal of Public Health is published by the American Public Health Association and is available at www.ajph.org.
Sexual orientation may affect health care access
Poor health care access is a problem for many homosexual women in the United States, while gay men may actually be more likely than heterosexual men to have a usual source of health care and health insurance coverage.
A study based on data from the National Health Interview Survey of 614 individuals in same-sex relationships and 93,418 individuals in heterosexual relationships found lesbians and bisexual women were particularly vulnerable to health care access problems. Women in same-sex relationships had significantly lower odds of having health insurance coverage, having seen a medical provider in the previous 12 months and having a usual source of health care than women in opposite-sex relationships. And women in same-sex relationships were more likely to have an unmet medical need because of an inability to pay for health care.
By contrast, men in same-sex relationships had health care access that was either equal to or greater than that of men in heterosexual relationships.
The study's authors said their findings "suggest that health educators designing programs to improve access to health services should be aware of the barriers that lesbian patients may face. We encourage the development of outreach programs to the lesbian community to improve regular use of health services." [From: "Health Care Access Among Individuals in Same-Sex Relationships." Contact: Julia E. Heck, MPH, Columbia University, jeh61@columbia.edu.]
Virginity pledges may bias reports of premarital sex
Adolescents who sign a "virginity pledge" and then go on to have premarital sex are likely to retract ever having signed such a pledge, making it difficult for abstinence programs to accurately assess sexually transmitted disease risk.
A study of 13,568 adolescents who participated in the National Longitudinal Study of Adolescent Health compared respondents' reports of virginity pledges, sexual histories and whether participants recanted either a previously reported pledge or sexual experience during the second wave of the survey. They found 73 percent of those in the initial survey of virginity pledgers who subsequently initiate sexual activity denied in the follow up survey at having pledged. And pledgers who initiate sexual activity are three times as likely to report their pledge. Almost one-third of first round non-virgins who take a virginity pledge recant their sexual histories at second round of surveys, with non-virgins who take a virginity pledge almost four times as likely to report sexual experience. "The evaluation of sexual abstinence programs is vulnerable to unreliable data," the study's authors wrote. "Virginity pledgers may not correctly assess STD risks due to their pre-pledge sexual behavior." [From: "Reborn a Virgin: Adolescent Recanting of Virginity Pledges and Sexual Histories." Contact: Robin Herman, Harvard University, rherman@hsph.harvard.edu.]
HIV infection among nation's youth shows early racial disparities
HIV infection is taking a larger toll on the nation's black population than any other racial or ethnic group, and the disparity seems to appear in early adulthood.
A study of HIV infection rates among young adults ages 19-24 based on data from about 13,000 individuals found the overall infection rate was low at 1.0 per 1,000. Yet the infection rate for black men and women was 4.9 per 1,000, compared to a rate of 0.22 per 1,000 for other races.
"Our findings indicate that racial disparities in HIV in the Unite States are established early in life," the study's authors wrote. "Prevention research and resources should be focused accordingly." [From: "Prevalence of HIV Infection Among Young Adults in the U.S.: Results from the Add Health Study." Contact: Martina Morris, PhD, MA, BA, University of Washington, Seattle, morrism@u.washington.edu.]
Smoking reduces effectiveness of some HIV treatments
Cigarette smoking can greatly reduce the effectiveness of a specific type of HIV treatment in women.
A study of 924 HIV-positive women who initiated highly active antiretroviral treatment (HAART) between July 1, 1995, and Sept. 30, 2003 found those who smoked cigarettes had poorer viral response and immunologic response than nonsmokers. Smokers also faced a greater risk of so-called "virologic rebound" and more frequent immune system failure than nonsmokers. The women smokers in the study also had a higher risk of death and risk of developing AIDS than nonsmokers.
[From: "The association of cigarette smoking with HIV prognosis among women in the HAART era- a report from the Women's Interagency HIV Study (WIHS)." Contact: Joseph G. Feldman, DrPH, SUNY Downstate Medical Center, Brooklyn, N.Y., joseph.feldman@downstate.edu.]
Childhood abuse increases likelihood of adult HIV infection
HIV-positive individuals are much more likely than the general population to have suffered childhood sexual abuse, a trauma that often leads to drug use, unprotected sex and other behaviors that up the risk for HIV infection.
A study based on interviews with HIV-infected individuals in the Deep South found more than half were victims of childhood sexual abuse. For about 30 percent of them, the abuse began when they were younger than 13.
"The findings help explain why people engage in high-HIV-risk activities and can assist in designing more appropriate care and prevention messages," the study's authors wrote. [From: "Prevalence of Childhood Sexual Abuse in a Southern HIV-Positive Cohort." Contact: Kathryn Whetten, PhD, MPH, Duke University, Durham, N.C., k.whettn@duke.edu.]