Comparison of dichotomized and distributional approaches in rare event clinical trial design: a fixed Bayesian design

This research was motivated by our goal to design an efficient clinical trial to compare two doses of docosahexaenoic acid supplementation for reducing the rate of earliest preterm births (ePTB) and/or preterm births (PTB). Dichotomizing continuous gestational age (GA) data using a classic binomial distribution will result in a loss of information and reduced power. A distributional approach is an improved strategy to retain statistical power from the continuous distribution. However, appropriate distributions that fit the data properly, particularly in the tails, must be chosen, especially when the data are skewed. A recent study proposed a skew-normal method. We propose a three-component normal mixture model and introduce separate treatment effects at different components of GA. We evaluate operating characteristics of mixture model, beta-binomial model, and skew-normal model through simulation. We also apply these three methods to data from two completed clinical trials from the USA and Australia. Finite mixture models are shown to have favorable properties in PTB analysis but minimal benefit for ePTB analysis. Normal models on log-transformed data have the largest bias. Therefore we recommend finite mixture model for PTB study. Either finite mixture model or beta-binomial model is acceptable for ePTB study.     

“I Feel Like More of a Man”: A Mixed Methods Study of Masculinity,Sexual Performance,and Circumcision for HIV Prevention

Ethnographic studies from numerous societies have documented the central role of male circumcision in conferring masculinity and preparing boys for adult male sexuality. Despite this link between masculinity, sexuality, and circumcision, there has been little research on these dynamics among men who have been circumcised for HIV prevention. We employed a mixed methods approach with data collected from recently circumcised men in the Dominican Republic (DR) to explore this link. We analyzed survey data collected six to 12 months post-circumcision (N = 293) as well as in-depth interviews conducted with a subsample of those men (n = 30). We found that 42% of men felt more masculine post-circumcision. In multivariate analysis, feeling more masculine was associated with greater concern about being perceived as masculine (OR = 1.70, 95% CI: 1.25–2.32), feeling more potent erections post-circumcision (OR = 2.25, 95% CI: 1.26–4.03), and reporting increased ability to satisfy their partners post-circumcision (OR = 2.30, 95% CI: 1.11–4.77). In qualitative interviews, these factors were all related to masculine norms of sexually satisfying one’s partner, and men’s experiences of circumcision were shaped by social norms of masculinity. This study highlights that circumcision is not simply a biomedical intervention and that circumcision programs need to incorporate considerations of masculine norms and male sexuality into their programming.     

Competing Priorities: Partner-Specific Relationship Characteristics and Motives for Condom Use Among At-Risk Young Adults

Condoms protect against human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) and unintended pregnancy and are essential to sexual health efforts targeting young adults, who are disproportionately affected by both outcomes. Understanding condom use motives is critical to increasing condom use. Research in this area is limited, particularly regarding the roles of partners and relationship factors. Using a longitudinal sample of 441 young adults and 684 reported partnerships we examined associations between relationship factors and condom use motives (pregnancy prevention, disease prevention, or dual protection). Simultaneous multilevel models identified variables associated with motives; level-specific models identified the levels (individual, partnership, time) variables impacted motives. Participants reported choosing condoms for pregnancy prevention, disease prevention, and dual protection in 51%, 17%, and 33% of partnerships, respectively. Partner-specific factors varied, to a differing degree, across the three levels. Seven variables (duration, condom self-efficacy, commitment, sexual decision-making, power, and vulnerability to harm [HIV/STIs] and pregnancy) distinguished condom use motives. The level of this association varied but was most pronounced at the partner and individual levels. Researchers and practitioners should consider the impact of both individual- and partner-level factors on condom use motives, in both research and sexual health programs.     

“I Had to Go to the Streets to Get Love”: Pathways From Parental Rejection to HIV Risk Among Young Gay and Bisexual Men

Young, gay, and bisexual men (YGBM) are at increased risk of family rejection, which is related to HIV infection. What remains unknown is how family rejection leads to HIV risk. In this exploratory study, qualitative interviews were conducted with 21 HIV-positive YGBM aged 18 to 24. Most participants reported family rejection, which decreased instrumental and emotional support and resulted in participants using riskier ways to support themselves, such as engaging in survival sex. Conceptualizing the findings using a family systems framework, we present a tentative conceptual model to describe the potential relationships between family rejection and HIV risk for YGBM.     

Forced Sexual Experiences and Sexual Situation Self‐Efficacy Among South African Youth

Nearly 20% of South African youth experience forced or coerced sexual intercourse. Understanding the factors associated with forced sex is important for informing prevention programs aimed at reducing sexual violence and HIV and AIDS. Multilevel regression models test the association between sexual situation self‐efficacy and forced sex among 2,893 South African adolescents. Findings suggest that youth are more likely to experience forced sex after periods of time when their levels of self‐efficacy are lower than their average levels of self‐efficacy. Furthermore, youth who are lower on their self‐efficacy compared to their peers are more likely to experience forced sex. Implications for prevention research are discussed.     

Editors’ Introduction to the Special Issue — Bion: Here,There, and In Between

ABSTRACT

We introduce this special issue of Studies in Gender and Sexuality, “Bion: Here, There, and In Between.”     

The Intergenerational Continuity of Fathers' Absence in a Socioeconomically Disadvantaged Sample

Fathers' absence is a pattern that shows intergenerational continuity, most notably within disadvantaged populations. The process whereby this pattern is repeated across generations is not well understood. Using data from the Concordia Longitudinal Risk Project, the authors investigated pathways between fathers' absence in 1 generation and the experience of fathers' absence by their children. The current sample included 386 socioeconomically at‐risk individuals across 2 waves of data collection: (a) when they were children and (b) when they were adults with their own children. Analyses based on structural equation modeling revealed that men whose fathers were absent when they were children were more likely to become absent fathers, and women whose fathers were absent when they were children were more likely to have children with absent partners. Indirect pathways between fathers' absence in 2 generations through aggression, education, and substance abuse were illustrated for women. These findings add to the literature suggesting that fathers' absence during childhood has intergenerational effects.     

Process evaluation of an environmental walking and healthy eating pilot in small rural worksites

Small Steps are Easier Together (SS) was a pilot environmental intervention in small rural worksites in Upstate New York in collaboration with Extension educators. Worksite leaders teamed with co-workers to select and implement environmental changes to increase walking steps over individual baseline and to choose healthy eating options over 10 weeks. Participants were 226 primarily white, women employees in 5 sites. A mixed methods process evaluation, conducted to identify determinants of intervention effectiveness and to explain differences in outcomes across worksites, included surveys, self-reports of walking and eating, interviews, focus groups, and an intervention log. The evaluation assessed reach, characteristics of recruited participants, dose delivered, dose received, and context and compared sites on walking and eating outcomes. Emergent elements of participant-reported dose received included: active leadership, visible environmental changes, critical mass of participants, public display of accomplishments, accountability to co-workers, and group decision making. Participants at sites with high reach and dose were significantly more likely than sites with low reach and dose to achieve intervention goals. Although this small pilot needs replication, these findings describe how these evaluation methods can be applied and analyzed in an environmental intervention and provide information on trends in the data.     

The Elephant Is Not Pink: Talking About White, Black, and Brown to Achieve Excellence in Clinical Practice

Incorporating issues of race and racism can improve clinical engagement and the therapeutic alliance. Assessing, understanding, and responding to experiences related to racial identity and racism related stress can be an important factor in a clinician??s ability to be culturally responsive. A vignette of client treatment presents common dilemmas in clinical treatment. Responses to questions about race from focus groups are presented to frame the experiences of women of color who struggle with poverty and social-emotional issues. A framework of multicultural antiracist practice highlights the skills necessary for clinicians, supervisors, and managers.