Index to Volume 31: August 1982–June 1983

Abstract

“Immunodeficiency in Female Sexual Partners of Men with the Acquired Immunodeficiency Syndrome,” CAROL HARRIS, et al. Because the current outbreak of acquired immunodeficiency syndrome (AIDS) among previously healthy adults may be caused by a transmissible biologic agent, and because it may be preceded by immunologic abnormalities with or without a prodromal illness, we studied seven female sexual partners of male patients with the syndrome. The male patients were all drug abusers. One of the seven women was found to have the full-blown syndrome, a second had an illness consistent with the prodrome of AIDS (generalized lymphadenopathy, lymphopenia, and a decreased ratio of helper to suppressor T cells), and four others had generalized lymphadenopathy or lymphopenia, with or without a decreased ratio of helper to suppressor T cells. Only one woman had no abnormalities. These findings suggest that AIDS may be transmitted between heterosexual men and women. (New England Journal of Medicine 1983;308:1181–4.)

“The Effect of Different Types of Intrauterine Devices on the Risk of Pelvic Inflammatory Disease,” DAVID W. KAUFMAN, et al. A case-control study of 155 women with pelvic inflammatory disease (PID) and 305 controls with other conditions was carried out. Compared with other methods of contraception, the age-adjusted relative risk estimate for use of any intrauterine device (IUD) within one month of admission was 8.6 (95% confidence limits, 5.3 and 13.8); for past use, the estimate was 1.6 (confidence limits, 0.6 and 4.0). The estimated risk was highest for users of the Dalkon Shield (11 cases and two controls), lowest for users of copper-containing devices (40 cases and 34 controls), and intermediate for users of other IUDs, principally the Lippes Loop (32 cases and 23 controls). Compared with copper-containing IUDs, the relative risk estimate for the Dalkon Shield was 6.5 (confidence limits, 1.5 and 27.5). When the Dalkon Shield and copper-containing IUDs were compared, in turn, with the Lippes Loop, the estimated risk was increased for the former and reduced for the latter, but the differences were not statistically significant. Nine of the 11 cases using the Dalkon Shield (82%) had severe PID (diagnosed at surgery or because of purulent cervical discharge), compared with 12 of 40 copper device users (30%) and nine of 32 Lippes Loop users (28%). The risk of PID did not seem to be related to duration of use of any of the three IUDs. This study confirms that IUD use increases the risk of PID. It also suggests that the Dalkon Shield is more harmful than other devices. (Journal of the American Medical Association 1983;250:759–762.)     

Sharing Health Services: Two Universities,a Seminary,and a Community

Abstract

“The Inverse Relation Between Fish Consumption and 20-Year Mortality From Coronary Heart Disease,” DAAN KROMHOUT, et al. The low death rate from coronary heart disease among the Greenland Eskimos has been ascribed to their high fish consumption. We therefore decided to investigate the relation between fish consumption and coronary heart disease in a group of men in the town of Zutphen, the Netherlands. Information about the fish consumption of 852 middle-aged men without coronary heart disease was collected in 1960 by a careful dietary history obtained from the participants and their wives. During 20 years of follow-up 78 men died from coronary heart disease. An inverse dose-response relation was observed between fish consumption in 1960 and death from coronary heart disease during 20 years of follow-up. This relation persisted after multiple logistic-regression analyses. Mortality from coronary heart disease was more than 50 per cent lower among those who consumed at least 30g of fish per day than among those who did not eat fish.

We conclude that the consumption of as little as one or two fish dishes per week may be of preventive value in relation to coronary heart disease. (New England Journal of Medicine 1985;312:1205–9.)

“Teaching Touch at Medical School,” JULES OLDER. The association between touch and healing is ancient and worldwide. Skilled hands are among the physician's most important diagnostic and therapeutic tools. Yet a survey of medical schools in the English-speaking world revealed that most offer no touch training in their curricula. Of 169 medical schools, only 12 give any formal instruction in the uses and meaning of therapeutic touch in medicine. The teaching modes of these 12 schools are discussed, and the program of the most touch-conscious school, the University of Otago, is described. (Journal of the American Medical Association 1984;252:931–3.)

“Tubal Infertility and the Intrauterine Device,” DANIEL W. CRAMER, et al. To study the association between intrauterine devices (IUDs) and pelvic inflammatory disease, we compared contraceptive histories in 4185 white women—283 nulliparous women with primary tubal infertility, 69 women with secondary tubal infertility, and 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with IUD use was calculated by means of multivariate logistic regression to control for confounding factors, including region, year of menarche, religion, education, smoking, and reported number of sexual partners. The adjusted risk of primary tubal infertility associated with any IUD use before a first live birth was 2.0 (95 per cent confidence limits, 1.5 to 2.6) relative to nonuse. Users of the Dalkon Shield had an adjusted risk of 3.3 (1.7 to 6.1), users of the Lippes Loop or Saf-T-Coil had a risk of 2.9 (1.7 to 5.2), and users of copper IUDs had a risk of 1.6 (1.1 to 2.4). Women who reported having only one sexual partner had no increased risk of primary tubal infertility associated with IUD use. The adjusted risk of secondary tubal infertility associated with use of a copper IUD after a first live birth was not statistically significant (1.5; 95 per cent confidence limits, 0.8 to 3.0), whereas the risk from similar use of noncopper devices was significant (2.8; 1.3 to 5.9). We conclude that tubal infertility is associated with IUD use, but less so with copper IUDs. (New England Journal of Medicine 1985;312:941–7.)     

Motivational Factors Affecting Patient Attrition in a Weight Reduction Program

Abstract

The study hypothesizes that the greater the satisfaction of a patient's basic motivational needs, the greater the likelihood that the patient will complete the program. Patients were given a self-report questionnaire to assess the strength of their basic motivational needs as they entered the program; and a Likert-type questionnaire concerning satisfaction of needs as they left the program. The results show that those who completed the program experienced greater satisfaction of needs than those who did not complete the program. Analysis of covariance of completion of the program and need satisfaction was significant (p < .01) thus supporting the hypothesis.

“Long-term Oral Contraceptive Use and the Risk of Breast Cancer,” THE CENTERS FOR DISEASE CONTROL CANCER AND STEROID HORMONE STUDY. Using oral contraceptives for long periods or using them when one has other risk factors has been hypothesized to increase the risk of breast cancer. To study these issues, we analyzed data from a multicenter, case-control investigation—the Centers for Disease Control's Cancer and Steroid Hormone Study. All women 20 to 54 years old with a first diagnosis of breast cancer ascertained by eight population-based cancer registries are study subjects; controls are selected at random from the general population of these eight areas. Analysis of the first 689 cases and 1,077 controls studied showed that women who had used oral contraceptives at some time in their lives had a relative risk of 0.9 compared with never-users (95% confidence interval, 0.8 to 1.2). Neither duration of oral contraceptive use nor time since first use altered a user's risk of breast cancer; women whose first use was more than 15 years ago and who used oral contraceptives for 11 years or more had a relative risk of 0.8 (0.5 to 1.4). Oral contraceptive use did not increase the risk of breast cancer among women with benign breast disease or a family history of breast cancer. Oral contraceptive use before a woman's first pregnancy did not increase her risk of breast cancer significantly more than other methods of delaying first pregnancy. This study provides no support to the hypothesis that oral contraceptive use increases a woman's risk of breast cancer. (Journal of the American Medical Association 1983;249:1591–1595.)

“Oral Contraceptive Use and the Risk of Ovarian Cancer,” THE CENTERS FOR DISEASE CONTROL CANCER AND STEROID HORMONE STUDY. Since oral contraceptives have been used by more than 40 million American women, an association between oral contraceptives and ovarian cancer could have a substantial public health impact. The Centers for Disease Control, Atlanta, is studying this relationship as part of a multicenter, case-control study—the Cancer and Steroid Hormone Study. During the first ten months of the study, we enrolled 179 women aged 20 to 54 years who had been ascertained to have newly diagnosed ovarian cancer by eight population-based cancer registries. From the general population of those eight areas, we selected as controls 1,642 women with intact ovaries. Users of oral contraceptives had an age-adjusted risk of ovarian cancer developing of 0.6 relative to those who had never used them (95% confidence interval, 0.4 to 0.9). The risk of ovarian cancer decreased with increasing duration of oral contraceptive use and remained low long after cessation of use. These results were not accounted for by parity, infertility, or other potentially confounding factors. We estimate that more than 1,700 cases of ovarian cancer are averted each year by past and current oral contraceptive use among women in the United States. (Journal of the American Medical Association 1983;249:1596–1599.)     

EDITORIAL

ABSTRACT

Data from Cycle 5 of the National Survey of Family Growth (NSFG) (1995) were analyzed to identify factors that could predict whether a woman 18-44 years of age would ever have sought to adopt a child. Of the 10,019 women in the specified age group overall, 508 (5.1 percent) had ever sought to adopt, including 5.4 percent of white women and 5.2 percent of black women. Multiple logistic regression analyses were conducted for all women and for white women and black women separately. Among women who were white, the likelihood of having ever sought to adopt increased under conditions of childlessness, a history of treatment for infertility and surgical sterility for non-contraceptive reasons, non-surgical sterility, or physical difficulty in becoming pregnant (subfecundity), and if the woman was married, older, had some amount of college education, and considered religion very important. Having received assisted reproductive technology treatment also increased the likelihood that women in this group had sought to adopt. The likelihood of having ever sought to adopt increased among black women who were childless, older, and surgically sterile for non-contraceptive reasons, non-surgically sterile, or subfe-cund. However, having been treated for infertility and the presence of “resource” variables (other than age) did not predict that black women would have sought adoption. Among women of all races, having been a foster parent to a child increased the likelihood that the woman had sought to adopt the child when the woman was also childless, had been treated for infertility, was non-surgically sterile or subfecund, and older. Having been a foster parent was a significant predictor among white women who were childless and had ever been treated for infertility. Results are discussed in terms of benefits and limitations of all analyses and in terms of their implications for practice, policy, and research.     

Predictors of HIV Sexual Risk Behavior Among Men Who Have Sex with Men,Men Who Have Sex with Men and Women,and Transgender Women

ABSTRACT

Men who have sex with men, men who have sex with men and women, and transgender women are at high risk for HIV infection. This study seeks to clarify which known HIV risk factors (partner type, sex location, serodiscordance, multiple sex partners, substance use during sex) contribute to engagement in high-risk (unprotected receptive anal) sex in each population. Data collected from June 2005 through June 2008 indicate all three populations display different HIV sexual risk profiles. The data suggest that HIV-prevention interventions should be individually tailored to address the specific needs of these three highly vulnerable and impacted populations.     

Multiple Risks,Multiple Worries,and Adolescent Coping

Summary

To describe the process that clinicians use to engage vulnerable urban adolescents in mental health counseling, the authors propose a tri-partite model of clinical engagement that takes into account: (1) consumer preference; (2) risk and worry; and (3) youth development (YD) perspectives. These conceptual lenses embody what adolescents want to talk about, their exposure to behavioral and environmental risks, and their coping and strengths. Based on responses given by urban adolescents seeking mental health services to a clinical self-assessment questionnaire (Adquest), this paper uses this tripartite model to summarize patterns of risk that service applicants experience, what they worry about, and how they cope. It explores the substructure of adolescent risk and vulnerability, through factor analysis of relevant items across a broad range of Adquest life areas, to develop a typology of adolescents by risk and worry. Patterns of coping and desire to talk across a range of life areas within this typology are described, as are the practice implications. The authors conclude that even those adolescents who most concern clinicians—because they have high environmental and behavioral risk and low worry-present many different opportunities for engagement.     

Women’s Employment Status,Coercive Control,and Intimate Partner Violence in Mexico

Findings from previous studies examining the relation between women’s employment and the risk of intimate partner violence have been mixed. Some studies find greater violence toward women who are employed, whereas others find the opposite relation or no relation at all. I propose a new framework in which a woman’s employment status and her risk of violent victimization are both influenced by the level of control exercised by her partner. Controlling men will actively prevent women from working and are also more likely to physically harm their partners. Using a statistical model in which the effect of omitted characteristics on women’s employment and their risk of violence are allowed to be correlated reverses the estimated association between employment and violence. The final results show that employment reduces women’s risk of violence. Data for the study are drawn from a sample of over 30,000 Mexican women in intimate relationships. The findings have broad implications given the increase in female labor force participation in many parts of the world.     

Frustrated Fertility: Infertility and Psychological Distress Among Women

Using a random sample of 580 Midwestern women, we test the hypothesis that women who have experienced infertility report higher psychological distress. Approximately one third of our sample reports having experienced infertility sometime in their lives, although the majority of the infertile now have biological children. Drawing hypotheses from identity and stress theories, we examine whether roles or resources condition the effects of infertility or whether its effects are limited to childless women. Infertility combined with involuntary childlessness (including biological and social) is associated with significantly greater distress. For women in this category, the risk of distress is substantial.     

Do Alcohol and Marijuana Use Decrease the Probability of Condom Use for College Women?

Alcohol and marijuana use are thought to increase sexual risk taking, but event-level studies conflict in their findings and often depend on reports from a limited number of people or on a limited number of sexual events per person. With event-level data from 1,856 sexual intercourse events provided by 297 college women (M _age = 18 years; 71% White), we used multilevel modeling to examine associations between alcohol and marijuana use and condom use as well as interactions involving sexual partner type and alcohol-sexual risk expectancies. Controlling for alternative contraception use, partner type, regular levels of substance use, impulsivity and sensation seeking, and demographics, women were no more or less likely to use condoms during events involving drinking or heavy episodic drinking than during those without drinking. However, for drinking events, there was a negative association between number of drinks consumed and condom use; in addition, women with stronger alcohol-sexual risk expectancies were marginally less likely to use condoms when drinking. Although there was no main effect of marijuana use on condom use, these data suggest marijuana use with established romantic partners may increase risk of unprotected sex. Intervention efforts should target expectancies and emphasize the dose-response relationship of drinks to condom use.     

Women in Substance Use Treatment

Abstract

The objective of this study was to examine the differences between women with children in substance use treatment who are involved in Child Protective Services (CPS+) and those who are not involved (CPS-). Using a sample of all alcohol and other drug (AOD) clients (N = 6,023) receiving substance use treatment over a three-year period (1997-99), the study found that CPS+ women were more likely to be younger, have more children, have been arrested less often, be mandated to receive treatment, to have an unsatisfactory exit status or be transferred to another treatment program at discharge. CPS+ women were also more likely to have attended outpatient or day treatment for the AOD treatment. This study points out that there may be specific risk factors in place for a subgroup of women with children in AOD treatment.     

Factors Influencing Condom Use and STD Acquisition Among African American College Women

Abstract

To identify factors that influence condom use and the risk of acquiring sexually transmitted diseases (STDs) among African American college women, the authors surveyed a sample of 123 sexually experienced undergraduate women at a state university. The college women who were older, had initiated sex earlier, or had more recent sexual partners were more likely than others in the study to report a history of an STD. The findings have implications for prevention and intervention programs for African American college women.     

Social Networks,Substance Use,and Mental Health in College Students

Abstract

Objectives: The relationship between social network risk (alcohol-using close friends), perceived peer closeness, substance use, and psychiatric symptoms was examined to identify risk and protective features of college students’ social context. Participants: Six hundred and seventy undergraduate students enrolled in a large southeastern university. Methods: An online survey was administered to consenting students. Results: Students with risky networks were at a 10-fold increase of hazardous drinking, 6-fold increase for weekly marijuana use, and 3-fold increase for weekly tobacco use. College students’ who feel very close to their peers were protected against psychiatric symptoms yet were at increased risk for marijuana use. Perceived closeness of peers was highly protective against psychiatric symptoms, adding a natural preventive effect for a population at great risk for mental illness. Conclusions: Results support targeting college students through network-oriented preventive interventions to address substance use as well as mental health.     

Married women's resource position and household food expenditures in Cebu,Philippines

This study analyzes how married women use their access to and control over economic resources to increase household spending on food. Using data from Cebu, Philippines, where child malnutrition is high, this study finds that the more income women earn and control, the more households spend on food. Women's control over their income is particularly important for increasing food expenditures in the poorest households. In richer households, women who earn little of their own income also use spouse income transfers to increase food expenditures. The findings from this study suggest that in a developing country setting, improving women's economic status so that they earn and control more household resources can increase household spending on goods that benefit children.     

Out of Cairo: forging a new population policy

The 1994 International Conference on Population and Development (ICPD) was the first where thousands of women contributed to the agenda. The previous emphasis of population policies on the simple provision of family planning (FP) services has led to abuses such as coercion to have only one child in China or financial incentives for undergoing sterilization in India. The 1994 ICPD Program of Action provides a more humane basis for population programs by emphasizing the fact that women have fewer children when they are educated and gainfully employed. Thus, improving women's reproductive health and social status has become a central issue, and widening access to contraception remains an important objective. In addition to the 500,000 women who die of pregnancy-related causes each year, half a billion suffer infections of the reproductive tract. By failing to address these problems, many FP services actually exacerbate them. In Giza, for example, although 39% of 500 women studied used contraception (45% of those married and living with their husbands), only 1 in 7 was free of gynecological problems, urinary tract infections, and syphilis (50% had at least 2 of these conditions). The women who used contraceptives were no healthier than their neighbors who did not. Once FP clinics attempt to tend to reproductive health issues, they encounter cultural and religious constraints. For example, a woman may obtain an IUD and then suffer from severe side effects rather than return to the clinic for attention. Another woman may become infected from an illegal abortion obtained at her husband's insistence. The infection may preclude an IUD for months, so the woman may obtain oral contraceptives from a pharmacy although she knows her high blood pressure should preclude their use. Full implementation of the ICPD Program of Action would improve the status of women such as these, fostering their self-esteem, their access to education and employment, and their participation in the political process; eliminating violence against them; and making them aware of their legal rights. The success of the readjustments in FP programs, government resource allocation, and family structures which will accomplish this task will depend largely on the women who helped put reproductive health on the ICPD agenda.     

Emotional Intimacy Power Predicts Different Sexual Experiences for Men and Women

Those who are more emotionally invested in relationships have less power than their partners. Furthermore, less powerful individuals may attempt to equalize power imbalances by offering rewards to their partner and using sex and condom use as exchange resources. Australian young adults reported their condom use and pressured sex experiences in both romantic (n = 708) and casual (n = 118) relationships. Results showed that greater power (lower relative emotional investment) predicted more condom use among those wanting to use condoms. In casual relationships, an interaction with gender showed that women in particular used condoms more when they had more power. Power also interacted with gender for pressured sex and, unexpectedly, men who had more power experienced more pressured sex. The possibility that condom use and pressured sex have different meanings for men and women is explored.     

Actual Versus Perceived Risk of Cervical Cancer Among College Women Smokers

Cervical cancer is a well-established smoking-related illness, but many at-risk women are unaware of this link. Objective: The authors designed this study to (1) investigate the relationship of smoking behavior with the history of abnormal Pap test results, sexual history, and perceived risk of cervical cancer and (2) determine whether self-classified smoking status (and hence perceived risk) corresponds with actual smoking behavior in a college student population. Participants and Method Summary: College women students (N = 135) completed a survey assessing smoking history, health history, sexual risk behavior, and risk awareness. Results: Relative to those who had not smoked in the past month, current smokers (n = 36, or 27% of the total sample) perceived themselves to be at higher risk for developing cervical cancer, but did not demonstrate increased awareness of specific cervical cancer risk factors, including smoking. Twenty-eight percent (10 of 36) of past-month smokers did not define themselves as current smokers. Conclusion: The authors conclude that antismoking and health-related messages targeting smokers may misfire for individuals who do not define themselves as smokers but are nonetheless at risk for smoking-related consequences and escalating use.     

Knowledge of Suicide Risk Factors,But Not Suicide Ideation Severity,Is Greater Among College Students Who Viewed 13 Reasons Why

Abstract

Objective: To test associations between viewing 13 Reasons Why, Season 1 and past week suicide ideation severity, behavior risk, stigma, and knowledge in college students. To explore whether personal exposure to suicide and depressive symptom severity moderated these associations. Participants: Eight-hundred and eighteen college students, 64% (n?=?522) of whom watched 13 Reasons Why. Methods: Students completed surveys online. Multivariate negative binomial regressions were used to test associations between watching 13 Reasons Why and suicide-related variables, and interaction terms. Results: Suicide ideation severity and suicide behavior risk were not significantly associated with viewing 13 Reasons Why; however, there was limited statistical power to detect associations. The association between watching 13 Reasons Why and greater suicide knowledge was stronger among those who did not have personal exposure to suicide. Conclusions: 13 Reasons Why may be a platform for psychoeducation on suicide, particularly among those who do not have personal exposure.     

Determinants of Vaginal Cleansing,Application, and Insertion in Tete Province,Mozambique, and Products Used

Objective: In this article, we review insertion, application, and cleansing as they include the use of products other than water and have a number of harmful effects. Method: In 2007, a household survey of 919 women carried out in Tete Province, Mozambique, examined 8 vaginal practices. Results: Overall, 10% of the sexually active women reported regularly using these 3 vaginal practices concurrently. Of the women who practiced insertion, 65% used natural substances. A wider variety of products was used for applying substances on the external genitalia and for cleansing purposes. Conclusions: These findings have important implications for future HIV prevention, including in the use of microbicides.